Vaginal Birth After Cesarean – VBAC what can you do?
Vaginal Birth After Cesareans – What Can You Do?
In 1995 the American College of Obstetricians and Gynecologists (ACOG) published updated guidelines for a vaginal birth after a cesarean. In the guides physicians are strongly encouraged to counsel and encourage women to plan labor rather than schedule a repeat surgery. Based on current evidence almost all women with prior cesareans can plan a VBAC.
- Get moving. Labor is the hardest work you’ll ever do, but it’s worth it! Focus on good nutrition and exercise. Make a daily checklist to ensure you are getting essential nutrients. check our foodlist Exercise daily: swim, walk, yoga, prenatal fitness class — whatever feels good.
- Childbirth Education Classes. Be sure to register early for VBAC, refresher or any other quality prenatal program. Even though you may have taken classes in a previous pregnancy, an evening out together with your partner will help to prepare you both, promote discussion; give you ideas on coping with labor and focusing on this baby and its birth.
- Find a supportive practitioner. Find someone who believes in VBACs, has a VBAC success rate over 75% and a cesarean rate that is lower than community average. If you are unsure about anything, get a second opinion.
- Hire a midwife/Doula/support person. Consider hiring a support person; it is worthy every penny to be reassured during labor by someone who believes birth is a natural function. Stay home as long as you can under the observation of this person. This support person will be your advocate in the hospital to help you have the birth you want. You can call your doula as many times as you want, she will be happy to share all the information she has as your doula, and will support you emotionally through out.
- Write a Birth Plan . Make sure your tone is gentle and loving, many healthcare providers do not like to be told what they should do; remember you are entering their territory, their home and their licenses and their livelihood is on the line. They will listen to your wishes. Make a list in a gentle, tone of voice. Don’t make it too long. I tell my clients to use 4×6 card, one for the labor room, one for the delivery room, and one for the baby’s nurse. Include what is important to you and that which you have discussed with your care provider. Know your hospital’s VBAC policies and negotiate well before the birth for anything different. Here are some ideas to consider when writing your birth plan: Ask to be allowed to try a variety of positions. Standing or walking instead of lying down facilitates labor and squatting to push can be most effective. Try sitting on the toilet.
- Continue calorie and fluid intake. Labor is hard work and takes a lot of energy. Far from eliminating the risk of aspiration with general anesthesia, total fasting (NPO) may increase the risk by raising the acidity of the stomach contents. Fasting may also make it harder for the uterus to work. Ask for a heplock (that is when they place a needle in you hand or arm in case you need to be hooked up to an IV in an emergency.)
Practice, throughout pregnancy, relaxation and visualization with exercises, CDs, massage, affirmation and touch. During labor, warm water (bath, shower, hot compresses) helps you relax and open up.
Avoid medical intervention whenever possible. Continuous electronic fetal monitoring may restrict your movement and artificial induction such as rupture of the membranes can usually be avoided. There are pros and cons about fetal monitoring. Ask if you can be monitored every hour for fifteen minutes at the time, and change position or walk around the rest of the time. Ask for more time to try non-medical methods to stimulate labor if your doctor thinks labor is not progressing. These include: change of position, walking, nipple stimulation, warm water, relaxation. Time limits are unrealistic as every labor is different. Unless you dilated 5-6 cm during a previous labor, consider this one your first labor. Discuss this with your doctor before going into the hospital.
Discuss the length of time you care provider will allow you to wait after your due date. Discuss alternatives to induction drugs; nipple stimulation, acupressure, chiropractic care, acupuncture.
- Believe in yourself, your body, and the process of birth. Affirmations and visualizations are powerful.
Here are some ideas:
“I know everything I need to know to give birth to my baby. All I have to do is remember!”
“I let go of the need to control the outcome of this birth, my body will lead me through the right path!”
“Each contraction is embracing my baby”
“At each contraction my cervix is opening up like a flower at dawn”
“The waves of contraction are bringing me closer to holding my baby in my arms”
“My baby and I are working hard to come together in joy and peace”
- Your feelings are welcome! Work through leftover negative feelings (guilt, disappointment, anger) from previous cesarean birth(s). Feeling you fears before hand and delving into it can help you let go and let this baby out.
Accept the fact that labor pressure is a sign of how strong and well your body is.
Learn to trust, cooperate with and listen to your body it knows what you need and what to do. TRUST in the divine order and the natural flow of things. You body was built for giving birth it is written in your DNA.
Feel good about yourself and your relationship as a couple and keep a positive outlook.
- About family and friends. Remember that according to medical studies VBAC is usually safer for both you and your baby than a repeat cesarean. Ask people to support you, and turn off worriers.
- VBAC group support. Get on the web and join a chat group. Read stories of others who’ve “been there” and are willing to share their VBAC experiences.
Use of Pitocin
The use of pitocin or prostaglandins for induction or augmentation of labor in women with a previous cesarean section has remained controversial, because of speculation that there might be an increased risk of uterine rupture or dehiscence. This view is not universally held nor is it strongly supported by the available data. A number of series have been reported in which pitocin or prostaglandins were used for the usual indications with no suggestion of increased hazard. Review of the reported case series show that an increased risk of uterine rupture with the use of pitocin or prostaglandins is likely to be extremely small. When dehiscenses occur in women they are more likely to occur in women who have received more than one pitocin agent, rather than a single agent used in an appropriate manner.
Such comparisons, of course, are rendered invalid by the fact that the cohorts of women who received, or did not receive pitocin, may have differed in many other respects in addition to the use of pitocin agents. Nevertheless, the high vaginal birth rates and low dehiscence rates noted in these women suggest that pitocin can be used for induction or augmentation of labor in women who have had a previous cesarean section, with the same precautions that should always attend the use of pitocin agents.
Read about uterine rupture
Read about Scar Tissue Massage
For more information go to www.vbac.com