The topic of Vaginal Birth After Caesarean (VBAC) is an emotional one, with many believing that it is a risky attempt for both mother and baby. Danielle Sweetman shares the lowdown of VBAC and how you can attain it.
Uterine rupture, labour complications and unsubstantiated concerns are often the reasons why women relent to another Caesarean surgery for their subsequent births. Yet there are many mothers out there who are curious over whether it is possible for them to achieve VBAC. Some may even have a strong intuition that they can have one.
More often than not, women who have undergone a C-sec feel as though they have not achieved what they bodies are designed to do, which is to birth vaginally.
They may have felt as though they weren’t given the chance by their care provider to have a vaginal birth, or disliked the interventions or limitations of the previous birth. Some may have found the recovery of their previous C-sec uncomfortable and lengthy, or found that it hampered their ability to breastfeed their child. Importantly, women who want to have a VBAC will also look at the risks of C-sec to both mother and baby, and come to realise that they are greater than those of VBACs.
VBACs are achievable, and in fact, can be quite easy. There are several things to consider while preparing for a VBAC.
Understanding VBAC and its risks
The major risk concern in VBACs is that of uterine rupture. However, it is vital to understand that the risk is extremely small. According to studies conducted through the National Institutes of Health, Maternal Fetal Medicine Unit Network by Dr. Mark Landon in U.S., the risk ranges from ~0.4% for women with one prior C-sec and can rise to ~0.9% for women who underwent more than one. By comparison, the risk of uterine rupture in first time labour is ~0.2%.
Another risk in VBAC is that of Dehiscence, which is the separation of the uterine scar. In a number of studies, this risk has been recorded as lesser than uterine rupture. It can occur without breaking of the amniotic sac, and as such vaginal births have happened even with the dehiscence of the scar.
Uterine rupture and dehiscence have been seen to occur most often in labours which were induced through means of breaking of the water sac, or drugs were used to induce and augment the labour. These induction procedures tend to produce particularly strong uterine contractions, which can pose a threat to the stability of the uterus and scar. In particular, use of the prostaglandin Cytotec to ripen the cervix during labour has had a high consequence of uterine rupture, and has been banned from use in the United States. If induction of labour in a VBAC does occur, it is best to do so slowly and gradually. As long as you are gentle to your body during your VBAC (through no rushing of your labour or minimal induction, finding comfortable labouring and birthing positions), these risks should be minimised.
What may happen in a VBAC?
VBAC mothers may find that they have a long labouring period, called Prodromal Labour, with gentle and bearable contractions. It is suggested that this occurs to get the uterus accustomed slowly to pushing the baby out, putting less stress on the uterus and C-sec scar.
If your labour is long, rest frequently, eat as often as you can and rehydrate often. Do something fun and positive – I know of one mother who baked brownies during her labour! Utilise the support of family and friends to make the labour bearable and positive.
Making VBAC A Reality
Understanding natural birth
It is highly recommended to learn all about birthing naturally and ways to manage pain without medication such as walking, having showers or baths and using a TENS machine. Attending an independent ante-natal class helps too. Besides learning about your body and birthing, hypnobirthing classes also focus on managing the fear-tension-pain pattern, hypnotic relaxation and visualisations, as well as releasing negative emotions. Being able to provide your doctor with evidence on matters such as freedom to walk, labouring and birthing in different positions may help to make your VBAC more comfortable and attainable. The more you know about how your body works in pregnancy, in labour and birth, the more confident you can be that you can achieve a VBAC.
Finding a supportive doctor
The American College of Obstetricians and Gynaecologists (ACOG) now states that a VBAC is a “safe and appropriate choice” for most women with a birthing history of one Cesarean, and for some with two. Additionally, it states that concerns over the size of the baby, the presence of twins or the type of C-sec scar should not hinder the mother’s attempt at a VBAC.
It is essential to find an obstetrician who is truly supportive of and has had a number of clients under his care with successful VBACs. If your doctor is not, share the guidelines from ACOG or get a second opinion, and change doctors until you are satisfied. Speak to other women and do your research on this.
When meeting with the doctor, be honest and ask what process he would follow to manage your VBAC. Among some of the questions you could ask could be: What drugs would he utilise should he find the need? Would you be given the freedom to walk around during labour, to have intermittent fetal monitoring during labour and to birth in a position which is comfortable for you?
Getting a doula
The professional support of a doula – a woman who is trained and certified to help parents during pregnancy and birth – can make a big difference to your VBAC experience. She can provide you with physical and emotional support such as massage while your husband takes a rest and help you with showers, baths, the TENS machine and labour positions – both at home and the hospital. Your doula will also offer encouragement and help you to focus on managing contractions.
Connecting with network groups
In your journey to a VBAC, it is essential to have the support of family and friends. But it’s also great to be in touch with other women seeking natural births and those who can offer advice and moral support to mothers in this position.
The Gentle Birthing Group Malaysia runs a support group for this purpose and offers many free talks and chats on different topics relating to birthing and parenting. A doula, midwife or childbirth educator attends these events and offers excellent insight. They also have an online page in Facebook where women can post their queries and find answers.
On the Facebook pages of both local and official International Caesarean Awareness Network (ICAN), you can access some excellent resources on VBACs and C-secs. In the near future, ICAN Malaysia will be holding regular talks and support groups on the subjects too.
Your body, your choice!
Ultimately, it’s important to be educated as well as feel supported when you are going for a VBAC. It is necessary to research about VBAC, find a supportive doctor, understand the natural birthing process and to enlist the help of family, friends and peers and other birth professionals.
The outcome of informed choice is the lessening of fear and the creation of confidence and trust in your body, which is the greatest tool you can have in your quest for a VBAC. Trust yourself, know what your body can do and enjoy the process. Happy birthing!
Danielle Sweetman is a Communications Coordinator with the Gentle Birthing Group. She can be contacted at mygentlebirth@gmail.com
