As published on the Essential Baby website Author: Melissa Maimann www.essentialbirthconsulting.com.au
February 9, 2009
Are you planning or considering a vaginal birth after a caesarean (VBAC)? With the Australian caesar rate up to 31% more and more women are reconsidering a subsequent caesar. Read Essential Baby’s tips to help you put your plan into action.
Most women choose to have VBACs because they believe it to be safer for them and their baby. Many women want to attempt to have a different birthing experience for myriad reasons. Either decision will be hotly argued by differing camps, so it’s important you read up and make the best decision that you feel comfortable with.
For the majority of women, VBAC is a safe decision, for some women, an elective repeat caesarean section may be safer. This might be for reasons such as placenta praevia, previous classical incision, or a previous uterine rupture. Please discuss with your care provider and conduct your own independent research when deciding between elective repeat caesarean and having a VBAC.
The risk of VBAC is a uterine rupture, which affects between 0.2% and 0.7% women. The risks associated with elective repeat caesarean section (ERCS) include:
• Hysterectomy • Injury to bladder or bowel • Reduced fertility • Severe bleeding, perhaps requiring blood transfusion • Increased risk of infection • Increased pain after birth • Blood clots in the lungs, legs, or elsewhere • More difficulty establishing breast feeding • Increased risk of breathing problems for your baby • Possibility of separation of mother and baby, if baby is admitted to the nursery • Delayed bonding
Australia-wide, the proportion of women having caesarean sections increased from 20% in 1997 to 31% in 2006. In 2006, the most common reason for a caesarean was a previous caesarean having been performed. As more caesareans are performed, we are beginning to see more complications from this surgery. In 2006, Australia-wide, only 16% of women had a VBAC. ERCS occurred for 84% of women.
So, you might be thinking, “Wow, I’d really like to have a VBAC, but it seems an uncommon outcome. How can I increase the chances of my VBAC being successful?” Well, the good news is, there’s plenty you can do to have a successful VBAC.
1. Choose your place of birth carefully. Hospital birth, as you can see above, leads to an average VBAC rate of 16%. Homebirth, on the contrary, has a VBAC success rate of at least 70% - 80%. This is most likely due to the very low caesarean rates that primary midwifery care entails (home birth results in a caesarean rate of less than 5%).
2. Choose your care provider carefully. Obstetricians are specialists in providing care to women with complications in pregnancy and birth. Midwives are specialists in normal birth, so midwifery care is far more likely to result in a successful VBAC. If you choose an obstetrician, choose one who has a high VBAC success rate.
3. Choose your birth support people. If you decide to birth in hospital, consider hiring a private midwife or a doula to provide support and advocacy. A private midwife can provide support, advice and clinical care outside of hospital, whereas a doula can provide support only. Sometimes VBAC women need extra support – you have more hurdles to overcome and sometimes friends and family don't often know how to support you well. Resist the urge to discuss your plan to VBAC with people who don't support you. Just surround yourself with supportive people who believe in you. The right kind of support is most important!
4. Educate yourself! Read widely, ask questions of your care provider, get second opinions from different care providers, take independent childbirth education classes and research on the net. Learn about normal physiological birth. When we understand how labour and birth work, it’s easier to see why our bodies work with us and against us during labour.
5. Value birth preparation Birth preparation such as Calmbirth and Hyponobirthing can make the difference between natural birth and medicated birth for some women. Affirmations and visualisations act like a rehearsal for your mind and body. Trusting your body and believing you can do it – the mindset – is critical.
6. Avoid interventions in labour Typical interventions such as continuous monitoring and epidurals can really work against a successful VBAC. Instead, get up off the bed, move, get in the bath, do whatever feels comfortable. Plan to stay at home as long as possible, or even birth at home with a midwife.
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