Wednesday, 4 September 2013

The formation of our birth plan?!

Yesterday we had our long-awaited appointment with our consultant.

Cue an hour of waiting in the most ridiculously busy waiting room at St Helier - thank God we didn't have to get Scarlett from school because it was 4pm before we actually went in to our 3pm appointment!

We met one of the Consultant's Registrars.  Excuse my ignorance, is a Registrar below a Consultant?!

Let me retrace my steps slightly, I had spent the morning writing a birth plan and doing research.  Chatting to a few people on Twitter, people I really respect (and wow, the power of an open Twitter account...!) I felt quite empowered to have a VBAC, I even bookmarked a Doula who I thought about contacting to help us through it.

Then I stumbled across two RCOG (Royal College of Obstetricians and Gynaecologists) pieces of guidance.

The first, my word, clearly not written for the general public, the language used was kind of shocking.  It was their guidance on the Management of Women with Obesity in Pregnancy.  To clarify, my booking BMI was 49, it has since come down to around 46.5  It all left me feeling a bit like, why should I bloody even bother trying for a VBAC when they're going to do the 2 things I really don't want them to do; constant monitoring and a pre-sited IV.  More on the former later...

The second bit of guidance I read was RCOG's Birth After Previous Caesarean Birth.  Figures leapt out at me like, for women with a BMI greater than 30, a successful VBAC is only achieved in 40% of cases.  Compared with a 72-76% success rate for a planned VBAC after a single Caesarean.  So that's kinda half.

All of this lead to me deciding by 1pm that I was having a Caesarean and that was going to be safest option because it seemed likely I'd end up having an Emergency Caesarean if I even attempted a VBAC and from hearing other people's stories, a planned is very different to an emergency!

So, back to the hospital.  We were finally called in to see a lady with a name I didn't quite catch!  (We're back again to see the Anaesthetist this afternoon so I might ask!)

I had planned that I would go in and lie and say I'd given it no thought (despite the fact Andy had printed my birth plan and was hiding it in my handbag!).  Don't know why I bothered because as soon as she started talking I interrupted her and just blurted out, "I want a Caesarean, it's going to be safest as you're going to hook me up to so many wires I won't be able to move, will just have a slow labour and end up having a Caesarean anyway.  You're going to remove my control so I'd rather know that I'm having a Caesarean which I can control!"

She was stunned but then continued with her reasons for suggesting a VBAC.  I gave her the 40% figure but she just gave me a look and dismissed it.  "But the RCOG said it!" I retorted.  Bless her, she continued anyway.

Eventually I shut up long enough to tell her my worries: that I didn't want to be hooked straight up to a monitor so that I couldn't move, couldn't use a birthing ball, couldn't change position, couldn't walk.  I told her I've read and seen enough (on telly, to which she rolled her eyes again, hahah!) to know that being on your back, being monitored is basically a fast track to an EMCS (Emergency Caesarean Section).  And that I didn't want to be induced and that I didn't want a pre-sited IV - again she sort of pulled a face at that last one but I just said, "Look, you need to get one into me in a hurry, someone will manage it!"  To which she smiled.

She explained that I would certainly be able to move off the bed, use a birthing ball and crouch to help ease the pain.  I explained I was happy with that outcome as I wanted to try and avoid an Epidural and was keen to try hypnobirthing and breathing techniques alongside a little bit of gas and air.  She seemed happy with all these suggestions.  The only bit which might hold me back is the birth position, I had hoped to give birth on all fours or kneeling over the back of the bed but she said all fours might certainly be difficult with the monitor.  She suggested they could use a clip on the baby's head but again, from hearing other's experiences, sod that!!

She also explained that once I'm 4cm they class it as active labour.  She suggested that I stay at home for as long as I feel comfortable and generally speaking, active labour is when you're having 3-4 contractions in a 10 minute time frame.  I said to Andy on the way home that we'd buy a paddling pool so I could at least spend my early labour in water!  So we have our benchmark on that.  (I did say in the evening whilst watching The Midwives on BBC2 - which was quite useful lastnight as they showed a VBAC in a slightly bigger girl, she did well! - what would he do if I had an accidental homebirth in a kid's paddling pool?  He didn't seem amused!)

The Registrar went on to explain that they like to see progress of 2cms every 4 hours.  So, generally speaking, if I go in at 4cms, get strapped up, I should in theory only be strapped up for 12 hours at most.  She said that they will usually allow a mother attempting VBAC to push for an hour before either intervening with forceps or ventouse depending on how far the baby has descended or if the baby is still way up, they'll refer for an EMCS.  This in a strange way made me feel better, that the most I would be allowed to struggle on would be 13 hours.  That seemed somehow achievable and made me again feel determined (that, coupled with the resolve to labour at home for as long as possible.)

I also stated quite firmly that I wanted my consent to be explicitly sought before anything was carried out (basically because I really don't want a cannula in my hand, it was the worst bit, genuinely, about having Scarlett, it was so restrictive!)  This is also the reason that I don't particularly want an Epidural, the cannula and the lack of movement (I did say I would probably be climbing the walls begging for pain relief and she said that was fine too!)

So we agreed the following:
1: Not keen on Induction of Labour
2: Not keen on augmentation of labour if slow progress
3: Happy to be monitored once in active labour (oh go on, if you HAVE to!)
4: ELCS (Elective Caesarean Section) at 41 weeks if no spontaneous labour
5: ELCS if no progress after 4 hours of active labour

Overall I felt quite pleased with the outcome.  Andy said he was proud that despite going in all guns blazing, I had pulled back and calmed down enough to shut up and let her speak!  We both felt reassured knowing that if nothing has happened by New Year's Eve we'd have a clear deadline (albeit a Caesarean which I still go back and forth in my feelings about!)

Ordered the VBAC hypnobirthing set last night and will look into a birthing ball.  Have also decided to try and start maternity leave at 37 weeks so that I can ramp up efforts to get baby out before Christmas.  I'm also going to gauge how work feel about allowing me time off on a Tuesday morning to do aquanatal classes - not sure it's going to go down well!

1 comment:

  1. Sounds like you definitely used your meeting to ensure you got a plan in place which is really positive. You can definitely borrow my ball and yes a registrar is under a consultant, then it's SHO and then HO. Hope your anaesthetist appointment goes well.


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