As a mum who prepared and then achieved my VBAC I wanted to share my advice for how to develop your VBAC plans and really how to make a VBAC as possible as possible – coz that’s what we are really looking for!
Advice is like a buffet, you may take a bit of everything on your plate, grab a morsel or go straight to the deserts (chocolate cake)! This is just my personal advice that as a non-medical VBAC mother I have gathered from my own birth preparations, books, searches on the net, my work as a Wise Hippo Birthing Programme Instructor, conversations with midwifes and experiences of other VBAC and hopeful VBAC mothers. Please take or leave this advice to suit your appetite or country’s system (I’m in the UK).
1. If you need to, take some time to heal your previous birth.
Behind every VBAC is a first birth story. This maybe like mine not wholly great but mainly positive, it may have been traumatic for you, or fall somewhere inbetween. Whether you are thinking about getting pregnant or are already pregnant, as early as you can, take some time to deal with your previous birth. In the Wise Hippo programme we do some fear release which maybe enough for you. You may want to review the notes from your previous birth yourself. You may also like to have a de-brief with a midwife. If you didn’t have one after your birth a de-brief is where you sit down with a midwife and go through the notes from your previous birth and talk about what happened and perhaps discuss prevention for your next birth. You should be able to set this up at the hospital where you had your previous caesarean. As well as a de-brief you may feel a few sessions with a hypnotherapist would help you clear and clarify your mind. I say this is good before or early on in pregnancy, so you can focus on your up and coming birth. However it is never too late to heal and be ready physiologically for birth again. If you have suffered from birth trauma and haven’t yet healed The Birth Trauma Association is a great place to start.
2. Join a Facebook group or forum.
This is great to do when you initially start your VBAC journey. There are many Facebook groups (I set up Calm & Relaxed VBAC Group to be a place for hypnobirthing VBAC mums to connect) or a forum (I like babycentre community) and these are great for reading other women’s birth stories, to ask particular questions or to just share your story with a fellow VBAC mothers. However please note: You may want to leave after a time or only look at your own posts as I personally found that hearing the negative stores of births and unhelpful medical persons to bring me down. So pick a group that is a positive place or get out before it makes you cynical.
If you are new to the VBAC forums this may help:-
There are more but if you’re unfamiliar with forums this will get you started.
3. Bond with baby.
This point is so easy it seems obvious right? But this is something I had to do mindfully at first. If you’re a VBACer you probably have a child already so it can be extra hard to have any private moments at all and you have your own previous birth experience which can suddenly become fresh again. If you do have any anxiety about birth, not to mention the extra appointments swirling around your mind you need to take time to stop. It is important to mindfully take your thoughts inward and breath in the appreciation for the life within you. You can join a class (The Wise Hippo now do Bond with Baby classes, YAY) or build a little time into your routine to take a moment of relaxation. If you are doing The Wise Hippo Birthing Programme, pregnancy yoga, hypnobirthing or any form of relaxation then this maybe a perfect opportunity to breathe and reflect on the miracle of pregnancy.
4. Research, research, research.
Read everything you can when doing your initial investigation into a VBAC. Find websites that help answer the questions you have. Ask for links on your fb group or forums to articles to do with your own personal circumstances and worries. Eg. Look into the likelihood of uterine rupture and continuous electronic fetal monitoring if you’re worried about being unable to move around during labour. Here are some great sites to start you off:
5. Write your VBAC birth plan.
A birth plan is so important. This is not a list of stuff that must happen this is just a list of preferences. Your care providers are not mind readers. It helps them to know if you want an epidural immediately or do not want to be offered drugs. Make this part of your research. If you know you want to be as active as possible and only want intermittent monitoring after your research, put it down, you’ll have a birth plan before you know it.
6. Write a caesarean birth plan.
Research and discuss family friendly caesarean with your doctor and midwife and write a caesarean birth plan (there are some great videos on YouTube of family friendly caesareans). Family friendly caesareans usually consist of skin to skin straight after birth, lowering of the drape to witness the birth, playing of relaxing music, photos or videos being taken of the birth, and skin to skin with the birth partner whilst mother is being moved into recovery room – just to mention a few. It is my personal view that all women who are having a caesarean should automatically be offered skin to skin (unless this is medically unsafe). It can be a comfort to have a plan B and to know that if you need a caesarean you still have options and choices.
7. Speak to your midwife or the supervisor of midwifes about your birth plan.
This links into the next point as it does make a difference where you giving birth. But she (or he) may have some great insight or solution to an issue you hadn’t thought of. My Midwife suggested I was in the Consultant Led Unit but only under midwife care. So I would not see a doctor unless I needed one. This solution was perfect for me and I would not have found this on my own. Also your midwife will get you both to sign the birth plan and then it is put in your notes. Some doctors take this more seriously than one you have compiled yourself (this is unfortunate but true in some but not all cases).
8. Consider your birth place options.
All units – be it consultant led, midwife led or a birth centre have different criteria for the women they accept. Don’t assume you will not be allowed to birth there. You maybe able to negotiate and find a solution which works for you. Don’t be afraid to look into other hospitals, do a tour and talk about their policies to choose the right birth place for you and your baby. A lot of women wanting a VBAC are drawn to homebirths due to the level of control they feel that have at home, especially if their previous experience in hospital wasn’t so good. Homebirth.org have some useful information to consider. You have lots of time to consider your options and do not need to make a decision immediately and can change your mind at anytime. Get set up for a home birth but then choose to go to hospital or vice versa. Research is key as is following your instincts to do what is best for you in your circumstance. Which have a good website for comparing facilities.
9. Prepare for your birth – yourself and with your birth partner.
When preparing for a VBAC I say do a class if you can as opposed to an at home hypnobirthing study. I studied at home and it really did inform me and I’m sure my birth wouldn’t have been as amazing without it. However I feel my opinion of birth and therefore my experience could have been enhanced by having someone to talk to and support me in my VBAC journey. However, the main reason I feel that a course is preferable over at home study is because of the birth partner. They may have witnessed the previous birth and may have their own views and negativity about birth. You really need your birth partner on board and to get what you’re doing so he or she can help you with your relaxation and also take their place of protector in the birth process when talking to medical professionals. Also a course will give you lots of feedback, interaction and information so you’re in the best position knowledge wise and in your head space to give birth. There are a few different providers of birth preparation and hypnobirthing. I teach The Wise Hippo Birthing Programme as it focuses on ‘the right birth on the day’ which is perfectly in tune with women who are preparing for VBAC as we want a positive birth, whether we birth vaginally or by caesarean. You can get a great feel for your instructor from their sites, look around and you will find a course and Instructor that is right for you.
If you’d like to find out more about me in my capacity as a Birthing Programme Instruction in person or by Skype see here.
To find out more about The Wise Hippo here’s a link: www.thewisehippo.com
10. Hire a Doula
If you can afford it hiring a doula is infinitely worth it. Your doula will be your advocate, your protection for yourself, your partner and the whole birth process. If you pick an experienced Doula she may have attended VBACs so you and your birth partner (and it does take the pressure off your partner too) know that there’s someone who is looking after your choices and personal wellbeing. The Doula Directory can help you with advice and finding the right doula for you.
11. Stay well-nourished and as active as you can in your pregnancy.
If you are physically well you are more likely to be able to have a vaginal birth, you will be more able to be active during your birth, and be less likely to tire as easily. Yoga is amazing, low impact and strengthens the muscles you’ll use during your active birth positions. But walking, swimming or staying active in your own way is good too. And it’s never too late. Even a short walk every day in late pregnancy is fab and may even help the baby get into a birth position too. In fairness this is great no matter how you end up birthing.
12. Write your ideal birth.
With your previous birth still ringing in your ears and with all the uncertain will I /will I not have a caesarean it can be hard to keep a positive idea of birth in your mind. So to write down how your ideal birth would look and feel is perfect for helping you create this positive picture. (This is not to be confused with your birth plan.) Here is an example:
It’s a beautiful fresh clear day and I start to feel twinges in the low of my bump. My little boy goes off for a day at nanny’s. My partner has some time together to talk and eat. The window is open and I can feel the clean air on my face cooling me down. I walk into hospital with my partners arms around my waist supporting me. The midwife is nice, the room is cozy, I move around freely and I birth upright. I’m the first to hold my baby girl and look into her eyes. She doesn’t cry much just looks up at me as I cuddle her skin to skin.
Make this as emotive as possible. Give it meaning to you personally. Notice that I do not add much detail – this is not a preference list (that is your birth plan). This is about the feelings you will get that help you imagine the day. This is also not a destination; this is a dream which could turn into reality. It really doesn’t matter if you imagine giving birth in the day and you end up giving birth at night. What is important is that you can write, read, then re-read anytime you start to imagine the birth you don’t want. The more you imagine and practice seeing your ideal birth the easier it will be to replace those negative images. The weird by-product is that by getting rid of the negative you are more likely to have a positive experience.
13. You and your birth partner can use your BRAINS
This is great for any appointments whilst pregnant, and during birth where you need to discuss interventions and gain information from medical professionals in a digestible way. This is perfect for your birth partner and yourself to have during birth to discuss anything – induction, breaking water, monitoring, use of the water pool etc.
B – What are the benefits?
R – What are the risks?
A – What are the alternatives?
I – What are your (you the birth mother) instincts telling you?
N – What if we do nothing? (This is do nothing now, for 5 minutes, half an hour, a day. It doesn’t have to be an indefinite nothing).
S – Smile. We are all working towards the same goal – healthy mum and baby. So these questions should be framed with a smile.
By appropriate questioning you can stay in control of your birth. So even if you do end up choosing an intervention it is just that, your choice. Which really makes a world of difference.
14. You are the one who allows.
There is no such thing as your doctor or midwife allowing you to do something. It may not be their policy to do this or that but that is a different issue. You have the ultimate right to consent, as this is your body and your baby. This applies to everything a VE (vaginal examination), ARM (artificial rupture of membranes), or any other intervention. If you do not want a procedure you can say no. If you and your birth partner together use your BRAINS (above) you can work with your team to come up with a solution which suits you.
15. During birth try to stay as active as you can.
Staying active in birth is generally encourage in all hospitals and birth centres. Using gravity to work for you, walk around, kneel, squat, use the positions your body wants whilst keeping upright and forward. Your baby will find it harder to descend if you are lying down or semi-reclining, if you are upright and forward you have more room, will dilate quicker, and will have a safer birth.. Move often and when you feel you need to or if the process is slowing down. For more information on the whys behind staying upright see New Active Birth by Janet Balaskas.
If you are hungry eat. If you are thirsty drink. Not having energy can cause your body to slow. But do follow your instincts and don’t feel you have to eat if you don’t want to either. Just have it in mind that you can and should eat and drink as you require.
17. Stay at home as long as you can.
Of course within safety. And most hospitals advise this anyway. The longer you can birth without intervention in the comfort of your own home the better. However that is if it is safe for you. Call your midwife and they’ll speak to you over the phone and advice to what is best. Follow your instincts you’ll know when you want to go in.
18. Consider induction carefully.
You can have an induction with a VBAC but a lot of doctors and midwifes only offer a pessary and artificial ruptures of waters as the syntocinon drips can lead to the over stimulation of the uterus which is not recommended for those with a caesarean scar. You do not have to opt for induction at all and could go for daily monitoring on a day to day basis when you get to 42 weeks. This is a personal decision and the AIMS website has some useful information: http://www.aims.org.uk/
Also you can try some natural nudges which you will have hear of. Sex being the best, especially ‘good’ sex as the clitoral and nipple stimulations will help. Even more mundane things like completing your to do you list can help. I would have a bath every night, listen to my mp3 and visualise my baby in the right position for birth, visualise the birth and tell my baby that I was ready (in my mind as I did never get used to talking aloud to my bump – but feel free if this works for you).
19. You don’t need to save everyone.
When you are in an appointment feel free to let the little things slide and concentrate on the parts that matter to you. My consultant told me I would not be ‘allowed’ to try for a VBAC again if I had another caesarean (but I know that the risk is the same for VBAC as for VBA2C) but I did not correct her as it was unimportant. You don’t have to stick up for every woman. This is unless you want to of course and you can always send a letter after if you feel you would like to.
20. Know that you’re not silly for wanting a VBAC.
You may get a mix of responses when you tell your friends and family that you want a vaginal or ‘natural’ birth (totally using quotation marks there as I hate the term natural birth as it makes the assumptions that everything else is somehow un-natural). But some people will not understand why you care so much about your VBAC and may even tell you to go for an easy option of caesarean, like that’s easy right! They may end up telling you their horrendous birth in a why do you want that sort of way. They maybe totally understanding and supportive, or a mixture of both. If you’re getting negativity it’s better to step away smile and nod or stop them saying you’d prefer not to hear difficult stories at the moment. You do not have to explain or defend yourself to anyone. A woman’s desire to birth is such a strong instinct. I felt it myself. That I wanted to experience birth. I for one can tell you that you are awesome for listening to your instincts and doing what is right for you.
So there they are all the ways that you can prepare for your VBAC. I hope you’ve found my advice useful on your VBAC journey.
I just want to reiterate that this is no way is intended to replace or serve as medical advice. This is just the information I have gathered as a mum preparing you’re her own VBAC and as my role as a Wise Hippo Birthing Programme Instructor. I encourage you to discuss any of the points which you maybe unclear about or what to know if are right for you with your midwifes.
Love Michelle xoxo