These 5 strategies can help you increase your chances of a successful VBAC
Ask any woman who has had more than one baby, she’ll tell you each pregnancy and the circumstances for each birth was different. What happened for your first birth won’t necessarily happen again. Planning your next birth after a caesarean may feel daunting, but there are plenty of ways you can increase your chances of having a successful VBAC.
1. Debrief what happened in your previous birth
The first step in preparing for your next birth is to debrief your previous birth with your Health Care Provider so you have a thorough understanding of WHY you had the Caesarean Section in the first place. For some women this is simple – if baby was breech or your placenta was low, it was probably a straightforward decision.
However if your caesarean happened after labour started then there will be more to understand about what happened and why it was necessary. If you weren’t able to sit with you Health Care Providers after the last birth and have everything explained, we recommend you do that first. You will be able to get a copy of your records, such as operation reports or labour notes. These will need some explanation, so even if it is a new Health Care Provider, they should be able to help you access the records and sit down and explain them to you.
It is really important that you and the people that are caring for you have a thorough understanding of what happened last time in order for you to best prepare for the next birth.
2. You meet some of these criteria
Research across the globe has shown that the following criteria can increase the likelihood of achieving a vaginal birth after a caesarean section:
- If you have previously had a vaginal birth
- You’ve had a relatively healthy and straightforward pregnancy
- You go into labour spontaneously this time
- You have a Body Mass Index (BMI) less than 30
- More than 18 months between this baby and your last caesar so the scar has had time to heal well
- Your previous caesarean section was for reasons such as placenta previa, fetal distress or a breech baby. This is because they indicate that the caesarean section happened for reasons that aren’t related to your body’s intrinsic ability to birth. Remember a debrief of your previous birth, will help you understand if you had your caesar for one of these reasons.
Whilst these increase the chances of success, they are a guide rather than an absolute. It is still possible to be successful even if you don’t meet these criteria. Your Health Care Provider is the best person to advise you regarding these criteria.
3. Understand these four elements of labour
Lots of women believe they had a cesarean because of one thing. Such as ‘my cervix didn’t dilate’ or ‘my baby didn’t budge’. The reality is that labour/birth is a complex event which is influenced by four key elements, often referred to as the “4 P’s”. They work together in synchronicity like players in a band, if one is out of tune or out of time, then the whole song is affected.
The 4 P’s are:
- Passageway – the pelvis
- Passenger – the baby
- Powers – contractions
- Psyche – your emotional state
The following table briefly outlines how these elements influence labour.
On any given day these 4 elements can change. You can influence all of them leading up to and even on the day of the birth. More about that later.
4. You have to want to try
This may seem absurdly obvious, but the reality is that lots of women have their first caesarean section and then find it all too hard to navigate their way through the health system. In the cold hard light of day, when you have competing demands from family, work, partners and other children; when another caesarean can be scheduled in so easily; when you are unsure of whether it is really worth the effort and uncertainty, it takes some resolve to see it through.
…and that’s ok. However, if it is really important to you – and we agree it is a worthwhile pursuit with lots of benefits for you and your baby – then it is entirely possible to plan for a VBAC and see it through, whatever the end result.
Once you have made your decision and are planning for a VBAC these tips will help you persevere.
- Mentally prepare for the fact that weeks 36-40 of the pregnancy will be the toughest. You will be heavy, uncomfortable and tired, ready for that baby to come out. The prospect of a booked caesar will be more attractive to you.
- Remember what your reasons for wanting a VBAC were. Write yourself a list and stick it on the fridge or somewhere prominent to remind yourself and your family of why this was important to you in the first place.
- Logistics can be tricky when you have all these competing demands. Have a plan ready to help you prepare. Include things like:
- who is going to look after your other child when you’re in labour
- how is your partner going to manage work around the time of labour and birth and your stay in hospital
- prepare a few meals in advance or ask family to help so that when it is time to drop everything and go, it won’t feel so hard.
- Avoid listening to family and friends that aren’t supportive of your decision, even if they mean well, but are likely to start sentences with “wouldn’t it be easier if you just…”
5. Be Prepared
It is really important that if you are planning to have a vaginal birth after a caesarean section that you understand
- how your labour will be different
- what will happen to you in labour
- what your options are
- what choices you would like to make
Because you now have a scar and you have a risk factor (that the scar might come apart in labour), you will be cared for differently. You’ll have extra monitoring, extra observations and possibly more direction from your medical team. This requires a different kind of preparation in order for your experience in labour to be calm and free of surprises.
We have developed an online antenatal program for women planning a VBAC that covers in detail all the above, and more. It is based on the premise that effective communication with your Health Care Provider is key to success, as is a clear understanding of how your individual circumstances will affect labour and birth.
It also has lots of great information about how to get those 4P’s we talked about earlier working in your favour on the day.
In order to be prepared for labour, your Health Care Providers need to know what is important to you and you need to know what they’ve got planned for you. Our program is designed to bring these two elements together so that you understand each other and you feel safe and ready for the birth of your beautiful newborn.
You can find out more about our program here.
As always we wish you all the best!
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