Once a caesarean, not always a caesarean: tips for planning VBAC

So, you have previously had a caesarean and are now planning your next birth. 

Congratulations!

There is much to weigh up when considering your birth options after having a caesarean. Anyone who finds themselves in this situation will likely be looking for the best and safest option for themselves and for their baby, and will be considering whether to have a repeat caesarean or to attempt a vaginal birth after (their earlier) caesarean - commonly referred to as VBAC.
 
Looking at all your options can help you plan a positive birth experience. Many mums choose to have a repeat caesarean, while many other mums plan a VBAC. 

So how do you make these decisions to help you plan a positive birth - whatever your chosen path is? 

These decisions really come down to individual situations. With a toddler and/or other children at home to look after, it’s important to assess how your birth choices will impact on your post partum recovery at home. 

Being an operation, a caesarean usually requires a longer stay in hospital and a
longer physical recovery than a normal vaginal birth. It’s not recommended to
lift anything heavier than your new baby - or to drive - for six weeks after a  
caesarean. In contrast, vaginal births without complications tend to have a much quicker recovery.)

As there are lots of great tips that are easily accessible online on how to have a positive caesarean, I will focus on the VBAC option.

If you are hoping to have a VBAC, first it can be helpful to look at the reason/s that you had the caesarean last time. 

Was it for reasons that may happen again? Or not? If you are not sure, you could ask your midwife, GP or obstetrician to go through your medical records to help clarify this for you. 

Certainly, some mothers may be in a situation where it is considered a safer option to have a repeat caesarean. However, just the fact that you have had a previous caesarean does not necessarily mean that you must have another one. 

If there’s no medical compulsion to have another caesar and you decide to have a VBAC, the next step is finding the right caregiver for you. Look at your options - is there a program in your local hospital designed to support VBACs? Do you have access to a midwifery group practice that will allow you to receive continuity of care? Have you found an obstetrician that feels right to you? Is an independant midwife an option for you? 

One of the most significant factors in planning for a VBAC is choosing the best place to birth, and the best care provider for you. It might be helpful to find out the VBAC rates at a particular hospital, as this is important to be aware of if you are not wanting to have a caesarean.

Finding a care provider who is supportive of your plan to VBAC, and who you absolutely trust, is imperative. Fear interrupts the physiology of birth, so going into labour feeling confident with the place of birth and the people around you can actually be one of the factors which contribute to how your labour progresses.

Continuity of care has been associated with lower rates of caesarean and more satisfying birth experiences, so it makes sense that being cared for by a familiar midwife or obstetrician - one you have built a trusting relationship with, and who knows your fears/ dreams/ birth intentions - will help put you at ease. 

As well as your care provider, carefully consider the team you want to be supporting you on the day. 

Who is your ultimate team? Your partner/sister/friend/mother? Doula? Who is going to be able to rub your back, hold the shower head on that particular spot on your belly, offer sips of water and keep the environment calm? 

Who is going to believe in you? And love and cherish you? And make you feel safe? 
And if things don’t go to plan, and it becomes necessary to take a different path, who is going to love and support you?

You can make good decisions when you get all the information and know all your options. Hospital policies around VBAC may vary, so ask questions of any hospitals such as:

  • How long can I go past my due date? Going into labour naturally - without being induced - reduces the risks and improves the outcomes for both mother and baby. Some hospitals encourage inductions at a selected time after your due date; these durations may vary from hospital to hospital and from obstetrician to obstetrician. 
  • What is your policy around continuous foetal monitoring? Being attached to a monitor may restrict your free movement, and prevent you from using baths and showers for comfort. Unrestricted movement, helping you stay more comfortable through your labour, enables you to manage your contractions more easily. (Some birthing facilities may have waterproof wireless monitors - be sure to ask if is this is an option for you.)
  • What is your policy around time restrictions for first and second stage labour? Time restrictions can put unnecessary pressure on a mother in labour, creating stress that can interrupt the physiology of birth.

So, if you are planning a VBAC, educate yourself, ask questions and read books. (Ina May Gaskin’s Guide to Childbirth and Sarah Buckleys Gentle Birth Gentle Mothering are high on my recommended reading list.) 

Join a VBAC support group - and if you don’t have a local one look for one online. 

Do some good independant childbirth classes, such as calmbirth. Even if you already took a class last time, refresh your skills - and maybe even learn some new ones!
 
If you are planning a VBAC, the process of working of out what your options are - and making the choices that feel right to you - can be very empowering. Many mothers are now finding that that while it used to be said that “once a caesarean, always a caesarean”, this does not always have to be the case. 

Whether you choose to have another caesarean or a VBAC, the important point to know is that your birth plan need not be restricted to just one option.

Helpful Resources:

http://www.caresinc.org.au CARES Incorporated is a South Australian, not-for-profit organisation which aims to help women make informed and empowering choices about birth by Caesarean and ‘Vaginal Birth After Caesarean’ (VBAC).

http://www.caesarean.org.uk Caesarean Birth and VBAC Information  is a UK website offering research-based information and support on all aspects of caesareans and vaginal birth following caesarean section.

http://www.vbac.com VBAC.com is a USA website which provides access to information and aims to help women make informed decisions about how they will give birth.