(Pictures throughout are from Christine’s beautiful homebirth VBAC journey.)
You have in your arms a beautiful child already, maybe more than one. You are all happy and healthy, but something about your previous birth haunts you. Something says, “I want to do it different next time.”
Take charge of your pregnancy and birth. You CAN have a VBAC. Having worked with several couples striving for this goal, I have created a “To-Do List” for couples to complete on their beautiful journey to healing and (hopefully natural) vaginal birth.
Join the ICAN network (link)
Reevaluate Previous Birth(s): Take a pen and paper and write down your entire birth experience(s) as you remember it. Try to include your emotions, physical experiences, and mental hurtles in as much detail as you can. Once you have written it all, read it. Reread it. Then talk about the birth with your partner. From there, you can decide what exactly you would like to go differently this time. Were you induced, labor failed to progress, or baby was “too big?” This is time to learn the truth and figure out what you, your partner, and the birth team could have or should have done different.
Deal with Your Fears and Emotions: If feelings of guilt, sadness, or fear arise while reliving your birth, that is ok. You need these feelings to surface so that you can process them and make peace with yourself. Seek counseling, talk openly; say positive affirmations daily, anything you need to truly process the feelings.
Find a VBAC Friendly Birth Team/Birthing Center : This is KEY. Seek a midwife, if possible, who performs VBACs. A VBAC friendly birthing center is also ideal. If you feel comfortable, choose a homebirth. Eliminating the medical interventions is what will prevent the domino effect from beginning. If using an OB, make sure that he or she is understanding of your wants and is willing to work with you throughout the pregnancy to meet your goals.
What is your c-section rate? Ask Questions/Get Answers: Do not be afraid to “shop around” for the perfect birth team. When speaking with your provider, a few questions to ask: ( source)
- What are your philosophies on VBACs? (This should be very telling.)
- Do you work with VBAC mothers often? What is their success rate for vaginal deliveries?
- Under what circumstances do you advise a mom to have a repeat cesarean instead of a VBAC?
- During labor what would cause you to suggest another cesarean?
- What do you feel the risks are for a VBAC? How often do you see serious complications?
- How often do you see uterine ruptures? What were the circumstances and outcomes?
- oThe generally-accepted uterine rupture rate based on numerous studies is 0.48% for moms with no prior vaginal deliveries, and even lower for someone who has delivered vaginally before. ACOG says 0.4%--0.9% based on mom’s personal situation. If the doctor says rupture rates are higher than one percent, be concerned!
- What is your protocol when working with a VBAC mom?
- How long will you let me go overdue before scheduling a c-section?
- Do you have any other ways of encouraging labor or do we just go into a c-section?
- What can I do to improve my odds towards VBACing?
- What general recommendations do you have for me?
Take a Natural Childbirth Class: Yes, I will preach this every chance I can get. TAKE A CLASS. A series of classes.
Read, Learn, and Know: Throughout your classes you will learn a lot about pregnancy, labor and birth, but don’t stop there. Pick up a book or six. Read blogs and articles. Learn everything about every stage of labor and techniques to handle them, all of the best 2nd stage pushing positions, ideas for changing positions, techniques to speed up labor, and every way to practice relaxation. Understand what your body went through during your c-section and what will be different with a natural birth. Know your birth team and trust them. Learn about their ways and talk to them about yours. Allow yourself to soak it all in and enjoy the journey.Whether you want an unmedicated birth or a vaginal medicated birth, take the classes. You will build your confidence, lower your fears, and understand that you are capable.
Write a Birth Plan (I’ll cover creating a birth plan in it’s own blog): You may do this during your birthing class, with the help of a midwife or doula, or on your own. Do not hold back with this, but try to keep it in an easy-to-read format. Research peaceful VBAC birthing and decide what you want during your labor. From there, consider everything that took place during your c-section delivery and include the steps in which it may have been prevented. Also include everything from your desires of movement, monitoring, positions, episiotomy wishes, circumcision choice, breastfeeding plans, and postpartum care. Createa small section on what you would like if a c-section is necessary. If your first was not a family-centered c-section, then I highly suggest you aim for that this time.
Visit a Chiropractor: A family chiropractor certified in the webster technique (spinning breech babies or those in non-ideal positions), will come in handy throughout pregnancy. Not only does getting adjusted relieve pregnancy ailments, but it helps baby align himself for birth, which will increase your successful VBAC chances!
SpinningBabies: (link) This site is a wonderful tool to belly map your baby. Knowing his position will help ensure your confidence in VBAC’ing.
Hire a Doula: Having an experienced VBAC’ing doula present is worth every single dime spent on her. She has guided so many women before you, allow her to help you and your partner through this beautiful journey!
Practice Yoga, Relaxation, or Other Form of Inner-Healing: While pregnant, work on finding an inner-peace and connecting with this baby. Talk to him about the birth journey that you wish for him. Cut down on daily stressors and focus your energy inward.
When is a repeat c-section truly needed? Cesareans are advised in cases of transverse presentation of the baby, complete placenta previa, and a few other circumstances that may become apparent during labor such as cord prolapse.
When is a Repeat C-Section NOT Needed? Reasons such as an estimated “big” baby, going past 40 weeks gestation, breech presentation, twins, water broken more than 24 hours, etc should not automatically rule out a VBAC. There are factors that vary per pregnancy, but none of these should prevent a VBAC. DO NOT LET A DOCTOR SCARE YOU INTO A REPEAT C-SECTION.
Take the time to read others’ stories. A great place to start is “The VBAC Project,” where you can add your story and photos to help inspire others.
My first pregnancy was the result of work with an endocrinologist, though without the use of fertility meds, and happened before we had resolved all of the contributing factors to my infertility. I had been so fixated on getting pregnant; I hadn't really given thought to what I would do once I got there. I got a referral to an OB that was recommended by a friend and started seeing her at 14 weeks. I felt like I was just a number. There was no relationship, which I felt was important during this experience. I left that practice and went to a birth center with midwives. I was 26 weeks when I came into the care of the birth center. While I did their prenatal classes, there was a lot I was still unprepared for. I was advised that I didn't need a doula, I knew nothing about optimal fetal positioning, I thought it was virtually impossible to end up transferred to the hospital if we were healthy. I had not allowed myself to picture anything but a peaceful, uncomplicated water birth. In reality, I ended up with a malpositioned baby and ruptured waters before labor at 39 weeks. Even though I was fine and my baby was fine, no fever or signs of infection, I was kept up all night with herbs and enemas trying to induce labor. When I hadn't dilated by the next morning, I was sent to the hospital. I was hysterical and feeling betrayed, by my body and by this experience. I went through a medical induction, and 9 hours later I was pushing. I still had a malpositioned baby and was flat of my back, so after 3 hours of pushing and not being able to move her under the pelvic bone, I was told I was headed for a cesarean section. I laid in bed for an hour trying not to push with my daughter's head in my pelvis (we could see her hair) sobbing and waiting for the surgeon. My daughter was born at 1:26AM without issue. The OB didn't lift her up for me to see her, I didn't get to touch her. I didn't even know she had been born healthy until I heard her cry across the room. She was cleaned and weighed and handled by all the nurses before being handed off to my husband in a bundle of swaddling blankets. I was able to touch her face with one finger while I quietly sobbed. I was shaking too hard from the drugs to hold her once I got to recovery, but my husband held her to my chest and let her latch on for the first time. I was encouraged by the nurses to keep her on my chest the rest of the night, which helped me get back to normal quickly. She stayed in my arms, rotating between breastfeeding and sleeping, the whole night. It took hours of staring at her face to start to feel that immense, fierce, oxytocin bond of maternal love. I was exhausted and raw and pushed my own feelings aside to care for this perfect little baby. After about 3 months I finally had enough time to reflect on my own experience, and begin to mourn it. I learned that I can love my baby and not love my birth, and the two are not mutually exclusive. When my daughter turned 1 I decided I needed to turn my trauma into something positive, productive. I found Improving Birth and got involved as a rally coordinator. I stood on Labor Day with thousands of women around the world to call attention to the need for respectful, evidence based maternity care. I was the coordinator for 3 years until I passed the torch to two other fantastic women and stepped into the roll of Media Spokesperson this year. In December of that first year I attended my first birth as a doula. I went on to do training through DONA, and to develop an independent childbirth education course. I knew that the next pregnancy, I would do things very differently, and I did. I conceived my second child 21 months after my daughter's birth. I knew that I would be pursuing a vaginal birth after cesarean, because the evidence said it was not only safe, but healthier for both of us. I also knew I wanted a totally different experience. I wanted to be honored and respected. I wanted to be in the decision making role. I wanted support and to know that any intervention that might happen would truly be needed. I wanted to feel like this birth was something I did, not something that happened to me. I planned a home birth with a midwife. I was disciplined and took absolute responsibility for the health of my pregnancy. I kept my body fit and my diet clean so that I would stay low risk. I hired a doula and took an awesome Birthing From Within childbirth class with my husband. I knew that no one would be able to tranfer me away from my home without my permission. I knew that I would have an emotionally and physically safe birth space. I felt great! I passed my due date with my surprise gender baby. I went 5 days over, and at midnight going into day 5 I was telling a friend I might be the first woman to stay pregnant forever. I was in no hurry though. Quite the contrary. I loved being pregnant, and I was willing to wait as long as it might take for this baby to be ready. I got off the phone with my friend around 12:30AM and dozed off. At 1:24AM I was awoken with a contraction. Thinking it was Braxton Hicks, I dozed back off. I was awoken again, and this time I was starting to wonder if this was more. I got up to take a bath and things picked up. I never made it into the bath, and woke my husband to help. In less than an hour, I was having him call in the birth team and my parents. I hit transition almost immediately. It wasn't long before I realized I was bearing down at the end of a contraction. The intensity and speed of my labor was overwhelming. I made it to my bed, and felt my baby's head descending in my pelvis. As soon as I saw my birth team enter, relief washed over me and I started to cooperate with my body's efforts. I was on my hands and knees, and my midwife could see my baby's head. No one but my husband touched me, I had no vaginal exams and no interventions. We listened to baby's heart tones on the doppler, and knew we were both doing well. Around 5:30AM my mother woke my daughter and brought her in the room. She cheered me on as she watched her brother being born, at 5:53AM after a little over 4 hours of labor. As soon as he emerged, he was placed on my abdomen. I will never forget the image of him feebly lifting his head and looking up at my face. I held him and talked to him and he latched right away. I felt so grateful, so whole. Knowing that I was able to have an uncomplicated vaginal birth was life changing. I was humbled by my body's strength. It was such an involuntary experience, my body took over and I just had to surrender to the ride. My HBAC was wonderful, and I do feel very different about my body afterwards. I have made peace with my cesarean and found gratitude in that it motivated me to become the woman I am today, with a passion for birth and serving women. I think back to that moment right after birth with my son, though....that moment of locking eyes and holding his tiny warm body against mine... and I am even more sad about what my daughter and I missed. I think I will always feel that remorse that she missed out on the start she deserved in her mother's arms. I will always wonder if the experience traumatized her too. If I ever require another cesarean, I will plan a gentle family centered cesarean, and I will demand those practices. But I will also work diligently to have healthy future pregnancies, and I will always plan to birth in my own home, if possible. I hope to have a big family and welcome each new child the way we welcomed my son - with the help of his/her siblings, surrounded by love, joy and peace.
Carrie's VBAC: read the story here
After my first pregnancy ended in an emergency c section due to preeclampsia and HELLP syndrome at 34 weeks I was being monitored very closely with my second pregnancy. I was determined to take my next pregnancy all the way to full term and I wanted to discuss with my doctor the option of having a vbac this time around. My doctor told me that it could be an option - She said that my blood pressure had to stay normal throughout my entire pregnancy and that I had to go into labor on my own( no inducing allowed and She would not let me go past 40 weeks) - My doctor had also told me that in the 10 yrs she has been with the practice she has only seen 5 successful vbacs- she told me I needed to make sure I read up on vbacs and read the risks involved as well.
Everything with my second pregnancy was great- no blood pressure problems- I hit my 38 week mark and I was thrilled I had made it full term ! At my 38 week appt my doctor had me pick a c section date as a plan B for a just in case I did not go into labor on my own. That evening I was having contractions and at 10pm I called my dr and told her contractions were about 5 min apart -she told me to go to the hospital since I am attempting a vbac to get hooked up and monitored. My doctor came to see me and she said If I wanted an epidural I needed to hold out as long as I could before getting one - I was having contractions all night and through the afternoon the next day- At 3pm I was still laboring and my contractions were intense now but I was only 4cm dilated- My doctor came in to see me again and she decided to break my water and told me that if there was no progress by 8pm she was going to call it and do a c section - not something I wanted to hear but if my body was not doing what it was supposed to do I could not get down on myself. After she broke my water the contractions were about every minute! I got an epidural around 4pm and I was actually able to sleep after that! It must have been a great nap because when I woke up at 7pm to be checked I was 10cm dilated! I could not believe it was actually going to have a vbac!. I pushed for 30 minutes and delivered a 7lb baby girl- what an amazing experience! I was filled with emotions - I had a full term baby-my baby was placed on my chest and I was able to hold and touch her and my baby was going to be able to go home from the hospital with me.!
Healing was 10x easier than after a c section- I was actually able to move and I felt really good! The day we were able to go home with our baby was amazing! -I felt like after my 1st pregnancy I missed out on all of that because we had a 14 day nicu stay - When I think back on being able to have vbac and experience a vaginal birth it was one of the greatest moments of my life and I am so glad I was given the chance to do it!