You have a right to make informed choices about your healthcare. There are risks also associated with VBAC. The main safety concern of a VBAC is fear of the Cesarean Scar giving way, less than 1% incidence. A uterine rupture is a tear through the entire thickness of uterine wall. This is a potentially life-threatening condition and requires an emergency cesarean section. If you have a low transverse uterine scar (the bikini line incision), uterine rupture occurs in 1% of VBACs. The National Institutes for Health states that the risks of laboring for a VBAC are the same as for any pregnant body giving birth the first time.
Vaginal birth after cesarean is a safe and reasonable option to a routine repeat cesarean. There are many risks associated with cesarean birth. Cesarean birth is not always been used as much as it is today. According to the CDC, the rate of cesarean birth increased by 71% between 1996 and 2007. In 1997 vaginal birth was 80% of all birth. By 2006, it was only 68%. Compared with vaginal birth, those who have a cesarean are likely to experience postoperative complications, rehospitalization, and a high probability of future repeat cesarean. There is also greater difficulty with nursing and attachment.
The top 3 risks for VBAC with prevalence in 1000 laboring situations:
Uterine rupture, symptomatic separation of uterine scar 7-8
Placental Abruption, placenta separates from the uterus before the baby is born 11-13
Umbilical Cord Prolapse, umbilical cord precedes the baby’s head through the cervix 14-62
Doula care during VBAC can reduce your odds for a Cesarean. Numerous clinical studies have found that the continuous support during labor shortens labor, reduces complications, and results in fewer Cesareans. Families who have a doula need less pitocin, less need for pain relief drugs and procedures, such as, an epidural, forceps, and vacuum extraction. Doula care also increases the families’ satisfaction with labor.
A Doula is a valuable addition to your VBAC birthing team. I focus on helping your partner feel less anxious, take fewer breaks away from the labor room, stay closer use more touch for comfort. Partners also say that they feel more relaxed with a trained doula present at the birth of their children. They are often surprised at the beautiful intensity of birth.
In Colorado, you can VBAC with a midwife at home (CPM or CNM) or you can birth in a birth in a hospital. Denver Health Medical Center has the highest VBAC rate in the Denver Metropolitan area. Local Hospital Statistics (they are about a year old right now but new ones have not come out yet)
Before labor starts, How can I increase the odds of having a VBAC?
Families have a better chance of VBAC when they feel supported and encouraged by their caregiver, have minimum medical intervention, use non-drug methods of pain relief, process fears and anxieties about VBAC, staying home until active labor when the bag of waters stays intact. think about your VBAC s any other normal labor and remember the majority of families who plan a VBAC give birth naturally. If you have never labored before or had your cesarean before active labor, your labor will be much like laboring for the first time and you may require more time to labor. Talk to your medical provider, your partner, and your doula. Make sure that everyone on your team is ready to actively support and encourage you during labor.
I will work with you on optimal fetal positioning, nutritional support, processing of past births, and massage. We will spend lots of time getting to know each other, building trust, and planning for your birth. We can talk about different locations for birth and how each may influence your outcomes, if you feel that would be beneficial to your situation. I will help you write a birth plan that both gives you the best odds for VBAC and also provides provisions for you in the event of a repeat cesarean (23%).
I do suggest that if you are dealing with trauma from your previous Cesarean to attend regular sessions with a therapist. I have some great resources in our community for therapists that focus on therapy in the perinatal time (pregnancy, childbirth, and 1 year postpartum) and and birth trauma. Trauma from previous births is not uncommon and is more common than you may think. You are not alone. Let us support you in this transition!
During labor, How can I increase the odds of having a VBAC?
Stay as relaxed as possible, especially during contractions. Drink lots of clear liquids and easy to digest carbohydrates and proteins during early labor. Keep moving, walking, sitting, kneeling, on all fours, bouncing on a birth ball, according to your comfort and allow gravity to help your labor progress. Use non-drug pain relief methods such as massage, acupressure, essential oils, visualization, deep breathing, meditation, hypnotherapy, sitting in warm water, showering, hot socks or your birthing ball before taking drugs.
Try delaying pain relief medications as long as possible, until your cervix has dilated to 5 cm. Take your contractions one at a time, try to think of the intensity of sensation as a normal and healthy sign that your labor is progressing. Ask your caregivers to avoid interventions unless its medically necessary. Only push when you feel like you need to. Listen and trust your body to tell you what to do. If you have an epidural, try and let it wear off so that your can both feel the urge to push and have greater control of your body. Use positions that use gravity to help bring baby down.
Squatting for birth helps to widen your pelvis by 20-30%, swaying side to side on a birth ball will help to relieve back pain and help labor progress. Also, stay upright and walk during labor.