cute babyThinking about VBAC? If you had a caesarean last time round and are pregnant again, you’re probably wondering what to expect this time. In almost all cases, attempting VBAC, rather than an elective repeat caesarean is recommended as the safest option for mothers. Even if things don’t go to plan and you require a repeat caesarean in labour, there are benefits to labouring prior to having a caesarean birth.

Research has found that babies whose mothers go into labour and subsequently give birth by c-section are less likely to have breathing problems after birth than babies born by elective caesarean. If you’re planning on breastfeeding, going into labour helps your body to naturally produce the necessary hormones for lactation. This may make breastfeeding easier as your milk may come in sooner. Mother and baby get other benefits from these hormones, in particular oxytocin which promotes bonding and reduces the risk of post partum depression.

One huge benefit of avoiding an elective caesarean is that your baby is less likely to be born prematurely. Many elective c-sections are performed at 39 weeks of pregnancy; however this doesn’t allow for possible inaccuracy of due dates (see more here) and one study found that of almost 13,500 repeat caesarean births, around 36% of babies were actually less than 39 weeks gestation. Babies born early are more at risk of breathing problems, low blood sugar, and other problems and may need to spend some time in special care or the NICU (neonatal intensive care unit).

So how do you stack the odds in your favour of having a successful VBAC?

1. Carefully choose your care provider and place of birth.

Choosing private versus public care may seem like a good idea, but research has found that birth interventions including induction, epidural, caesarean, instrumental birth and episiotomy are more likely if you have private care. On the flip side, if you have private care, you may have more opportunity to choose the consultant you feel you ‘click with’ best and who you feel will give you the best chance of VBAC.

When choosing your care provider, be sure to have a list of questions you can ask at your initial consultation.

Some women planning a VBAC choose to have their baby at home to avoid the interventions associated with hospital based care. Unfortunately, we don’t have statistics on the safety of VBAC at home although we do know that vaginal birth is more likely for a low risk mother choosing to birth at home. If you’re in Ireland and thinking about taking this route for your VBAC, you may not be accepted on a HSE homebirth scheme. Achieving your home birth after Caesarean section or HBAC may depend on hiring a private midwife and finding a supportive GP.

2. Hire a doula.

A doula is a professional who is trained to give continuous support to a woman in labour and is usually in addition to a woman’s partner. Research has shown that the support of a doula reduces the use of synthetic oxytocin (used to start or strengthen labour contractions) by 31%, the risk of c-section by 28% and increases the chance of spontaneous vaginal birth by 12%. Women who have continuous support in labour are also less likely to require an epidural, which restricts movement and can sometimes cause labour to slow down. In fact, well known paediatrician and researcher John H. Kennell is quoted as saying “if doula was a drug, it would be unethical not to use it.” You can find a doula in your area through the Doula Association of Ireland (DAI).

3. Get Support

Speak to a friend (or friends) who have already had a VBAC or join an online or local support group. Connecting with people who have had a VBAC makes it seem more achievable and these mums may have valuable advice to share with you. The Gentlebirth VBAC in Ireland group is an excellent source of information for mums in Ireland planning a VBAC.

4. Take an independent childbirth class.

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An independent antenatal class can provide you with unbiased information so that you can make informed decisions with regard to your pregnancy and birth. Hospital classes can be excellent and can help you to find out what the local policies are in your chosen place of birth, but you may find that these policies are not always evidence based and in line with current research.

Independent classes are unbiased and not based on based on any particular policies, but rather on the latest available research. You may also be able to find a dedicated VBAC class, tailored especially to help ensure families planning a VBAC are fully informed so that they can assess and weigh up the benefits, risks and alternatives of interventions that may be offered during pregnancy and birth and how they may or may not affect the chances of having a successful VBAC.

 

5. Build a labour toolkit.

What's In Your Toolbox Red Metal Tool Box Skills ExperienceHaving plenty of ideas and tools to keep you comfortable and focused during your labour and promote labour progress gives you the best chance of having a successful VBAC.

6. Write birth preferences.

These won’t be a ‘shopping list’ of ‘demands’, rather a document to help your caregivers identify the issues that are most important for you andĀ help you to have a clear role in the decision-making process. Some tips for writing birth preferences:

  • Keep it short. Nobody is going to read a two page essay when you arrive to the hospital in labour in the middle of the night! Five or six numbered or bulleted points are much more likely to be read and remembered by your midwife or other healthcare provider.

  • Be flexible and keep all your options on the table. You may not be planning on having an epidural but if you’ve been in labour for 12 hours and are feeling exhausted, the epidural can be a gift from heaven. Include preferences for a repeat caesarean section, so that if it does happen you can still feel positive, in control and ready to meet your baby. Some hospitals will facilitate a ‘gentle caesarean’ on request.

  • Make sure you discuss your birth preferences with your consultant and/or midwife prior to the birth. This minimises the chance of possible misunderstandings or conflict on the day your labour starts.

7. Consider labouring at home for as long as you can.

imageArriving to the labour ward in active labour means you’ll be more likely to avoid interventions that might end in an emergency caesarean. Of course, you should remain at home only for as long as you feel comfortable and safe and head to the hospital when you feel you need to.

8. Mentally Prepare

I had my VBAC in 2008, and looking back, I can honestly say I hadn’t a clue! But what I did have going in my favour was that my mum had had an emergency caesarean on her first baby (me!) and went on to have 4 VBACs afterwards, so having a VBAC in my mind was completely normal and achievable. And just in case I was in any doubt, the only reaction from my consultant on hearing that I’d had a caesarean last tine round was simply to say ‘You’ll have a vaginal birth this time.’

So although I was pretty clueless, the scene was set for a fear free experience from the beginning. I wasn’t afraid. I was lucky to have had these experiences to draw on. If you don’t, it’s time to start removing any doubts from your mind, tuning out the ‘Negative Nellies’, writing your affirmations and visualising a calm, positive fear free birth, whatever path that birth takes. Consider taking a Gentlebirth workshop to help with this and to give you and your partner tools to keep you calm, confident and in control.

Remember, no matter how well prepared you are, labour is impossible to predict and sometimes a repeat caesarean may be necessary. If it happens before you go into labour, you and your baby will have the benefit of time to prepare for a really good experience and if it happens in labour, you’ll both have the benefit of all those labour hormones working their magic to help in the first hours and days of parenting.

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