As a doula I have had the honor to support clients going for a VBAC (Vaginal Birth after Cesarean), and the experience I had with these strong women has inspired me to share what I have learned from these births with the hope of helping other mothers who are considering a VBAC.
Tip #1: Be prepared & Inform yourself about your options
I would recommend all pregnant women/couples to prepare for their birth on time, but for VBAC mothers it is important to begin preparing early on in the pregnancy as it requires time to gather the information you might need to make an informed choice and to get physically and psychologically ready for your upcoming birth.
With a history of Cesarean birth, you might find your options limited. You will likely be advised to give birth in a hospital. Depending on what you feel comfortable yourself, all options are open for you in terms of the birth you want. You are not obliged to a planned Cesarean. With an experienced midwife, it is even possible to have a home birth if that is what you desire.
There are some myths about giving birth after a previous C-section and the risks of VBAC might be smaller than you think, compared to the risks of having a repeat Cesarean.
It is important to address your questions and doubts to your care giver, and usually the more you are informed about the topic yourself, the more detailed information the care giver is inclined to provide. When you’re more informed yourself, the communication becomes two-way, instead of ‘the doctor telling you’.
Tip #2: Choose your care providers & birth partners wisely
Wherever you choose to go for a VBAC birth, it is important to have care providers and birth partners who support your decision. A supportive birth team raises the chances of fulfilling your birth wishes and minimizes your chances of having a traumatic birth experience.
If you feel safer giving birth at the hospital, the question might be one of finding a hospital team that believes in VBAC. In case you opt for Cesarean after trying for VBAC, you might want to know if the hospital of your choice is offering gentle Cesarean.
Alternatively, you can search for a midwife who is willing to support you in a non-medical or medical setting. Evidence shows that women who are under midwife care have fewer Cesareans and more VBACs: http://www.vbac.com/with-midwives-women-have-fewer-cesareans-and-more-vbacs/
Opting for doula support can also raise your chances of VBAC: http://www.vbac.com/a-doula-can-reduce-your-odds-for-a-cesarean/. A doula can both assist you during your pregnancy and birth by offering you personal support tailored to your needs. Having a doula during a hospital birth assures continuity in your birth team as the hospital team might be shifting throughout a long labor.
Besides professional support, it is helpful to have a supportive partner (whether it is your significant other, mother, sister, or friend) who is willing to stand on your side whatever turns the labor takes. It is important to talk with your partner beforehand about what kind of choices you might make in different birth scenarios, so that you do not need to make important decision at the heat of the moment.
Births rarely occur according to birth plans, but having a birth plan increases the chances that your wishes will be respected by your care givers. Writing up a birth plan also gives you the opportunity to think about all the aspects of the birthing process. Since you have already experienced birth before, you may now have a clearer idea as to how you would like to do it this time around. It helps to put your wishes on paper, it makes it easier to communicate them to your care givers, especially while you are in the process of birthing.
Tip #3: Start early with your mental preparation
It takes time and effort to change our mindset and emotions, especially when it comes to issues linked to traumatic event. As a counselor, I have worked with several women with birth traumas and what I have observed is that the fear and stress that is linked to the trauma tends to resurface as the birthing day approaches or during birth. If your experience with C-section has been traumatic, it might be useful to seek professional help to process your previous trauma so that you can enjoy your current pregnancy and go into your next labor with a fresh mindset.
It might be that you have a feeling that you have failed the last time around. It is actually not your first birth, but if you have not experienced vaginal birth before, you might still feel insecure about it, especially if the C-section was performed early on in labor because of ‘failure of progress’. If your care giver has told you after the C-section that your baby was too large, for example, you may have doubts as to whether you are fit for a vaginal birth. As a result, it might be difficult not to think back to your previous birth experience.
In any case, please remember: every birth is different, just like every child is different. You are also a different woman now, so trust that this birth WILL BE a new birth because you now have a new birth team with your new baby! Working with such positive thoughts throughout the pregnancy can motivate you for your VBAC and give you strength during birth.
Tip #4: Be gentle to your body & avoid interventions to speed up labor
To reduce stress on your uterus scar, it is best to be gentle to it and to let nature run its course. Interventions to speed up the labor process may exert extra pressure on the uterus. Inducing or augmenting labor, for example, can lead to painful contractions and thus may raise the need for pain medication, whereas it is important for a VBAC mother to feel her body. Furthermore, some babies do not react well to induced contractions as they may be stronger and closer to each other. If your baby reacts by a drop in the heartbeat, you might be risking further interventions, such as vacuum extraction or C-section.
Breaking the membranes may in practice lead to the same result if contractions do not begin afterwards. In a hospital setting, the risk for infections raises with broken membranes, which raises the tendency to induce or augment labor. Keep in mind that any intervention changes the course of labor, so every choice you make may influence the next step and make VBAC more difficult as one medical intervention might lead to another.
Tip #5: Be patient & take your time
The pressure to induce labor arises especially if your care giver is not willing to postpone labor after 41 or 42 weeks of pregnancy. Try to stay calm despite the days passing by and get mentally ready for going into labor. The further you are in the pregnancy, the riper your body is for labor. Inducing labor before your baby and you are ready for birth is likely to lead to more interventions and raise the chances of a repeat Cesarean.
A VBAC mother needs a lot of patience as labor may progress slower than usual during different phases of labor. This may be partly to the scar tissue and partly to the psychological barriers due to previous birth trauma. Give yourself and your body the time it needs to progress in labor. Take your time and stay focused on the labor. Relaxing and not panicking might especially be difficult at the hospital setting with frequent supervision and the luring chance of a repeat Cesarean. If you feel comfortable with the idea, try to stay at home during the pre-labor phase and head on to the hospital during the active labor phase in order to give your VBAC the maximum chance.
Be patient and don’t despair if labor stalls during the active or transition phase. Remember that you have come so far and that your baby is doing their best, too. Don’t give up!
Tip #6: Believe in You: You are strong & You can do it!
Stay strong during your pregnancy and labor! You can do it! With a healthy dose of motivation, perseverance combined with the right kind of support provided by your birth team, you can reach your VBAC wish.
And rest assured: If for whatever reason you may end up having to opt for a repeat C-section, you are still one strong mama! You did your best, and you can handle the operation and its aftermath much better this time as you are both experienced and prepared now.