Tips to improve your chances of a successful VBAC
If you have previously had a caesarean section, you might be hoping to give birth vaginally during your next birth. In this post I am going to discuss some steps you can take to improve your chances of having a successful VBAC (vaginal birth after caesarean).
Before that though, it’s important to understand pre-existing factors which will add to the chance of success. These include:
- Having at least 18 months between the C-section and next birth
- You have had a vaginal birth before your C-section (you can still have a VBAC if you haven’t)
- You don’t have any special circumstances in the pregnancy such as placenta previa, fibroids, breech baby at full term or twins on board
- Having a BMI of 18-30
Studies have shown a 60-80% success rate for VBAC which is a positive sign for women hoping to give birth vaginally during their next birth.
So what can you do to help increase the chances of a successful VBAC?
Choose a supportive care provider
Whilst many obstetricians and midwives are supportive of trying for a VBAC, there are some that aren’t. In the past, women who had a C-section, were automatically scheduled for a repeat on second time around. Lots of research has gone into the safety of VBAC and although there is a slight increased risk of the scar rupturing on the uterus (approx 1 in 200), when weighed up against the general risks during a c-section coupled with the mothers desire for a vaginal birth, VBAC is deemed to be the way forward for most women. Bear in mind that the 1 in 200 risk of uterine rupture with VBAC is still lower than the risk of a placental abruption, an umbilical prolapse, or shoulder dystocia that can occur for any woman in normal labour.
Some health care providers may be opposed to VBAC and recommend a repeat c-section so it’s important to find one that is supportive of what you are hoping for so that they can help you achieve it. During your pregnancy, speak to your care provider about the VBAC guidelines/policies at the hospital. It’s good to know in advance for example whether their guidelines offer induction of labour or not at full term. Some obstetricians will offer an induction if you haven’t gone into labour by your due date and some wont – they will just recommend a repeat C-section. Keep in mind though that inductions using a prostaglandin hormone are not recommended as they can increase the incidence of uterine rupture. If you go for an induction, it will only be done if your cervix is dilated enough to break your waters and then oxytocin drip ( or in my case breaking my waters was enough to start the labour). Some hospitals have obstetricians who use a balloon to ripen and dilate the cervix but not many do and it can be quite uncomfortable.
Keep as healthy as possible
Eating well and taking gentle exercise in pregnancy reduces your risk of developing problems such as gestational diabetes and high blood pressure, making your already high risk pregnancy higher risk. A recent study published on the RCOG website suggested that eating a diet rich in vegetables and fish can reduce your risk of developing pregnancy induced hypertension and pre-eclampsia. An older study carried out in Spain found that women who took regular light exercise of 20 minutes per day were likely to have shorter and less complicated births.
Practice breathing and relaxation techniques
I am an advocate of hypnobirthing which is basically a teaching programme which helps you to remain calm, confident and able to cope better during labour. Hypnobirthing uses certain techniques including visualisations and breathing methods to help your body remains in a state of calm. You also learn about the natural physiology of birth in relation to the autonomic nervous system which decides whether you are in a fearful state (sympathetic- flight or fright) or a calm one (parasympathetic).
Help get baby into an optimal position for birth
Many C-sections are performed because the baby’s head isn’t in an optimal position for birth and the labour is prolonged. That’s not to say that the baby wouldn’t eventually get into a better position during labour but a lot of the time the term ‘failure to progress’ is marked as an indicator for a c-section when it isn’t always necessary.
Labour is likely to be easier and quicker when the baby is head down, chin tucked down (flexed), with their back facing their mothers abdomen and slightly tilted to the left or right.
There are some positions you can try at home during your pregnancy (see below) that if done daily in the last 6 weeks or so, may help get baby into the optimal position:
Write a birth plan
Birth plans are a great way for an expected mother to document her wishes for her labour, birth and first moments after birth. If you are keen on having a VBAC then everyone involved in your labour & birth care should also know, so including this in your birth plan is an ideal way to share what you would like. There is no set rules for birth plan writing but you can include things such as:
- Who your birth partner (s) will be
- Whether you have practised hypnobirthing
- Your thoughts on pain relief. Don’t feel that you HAVE to have an epidural if you are not keen on one.
- If you do end up having an emergency c-section, your wishes for the birth ie who will be going into the operating room with you.
- Mobilisation in labour. Keeping mobile and upright will help the labour to progress. Continuous fetal monitoring is recommended for women trying for a VBAC. You do not have to lay on a bed to be monitored, you can be sitting in a chair, standing or bouncing on a birthing ball. Some hospital units will have a telemetry fetal monitoring system which is wireless
- Cutting of the cord and delayed cord clamping – do you want your birth partner to cut the cord or your care provider?
Various studies have been conducted on eating dates late in pregnancy and the subsequent birth outcomes. Most conclude that consuming 4-6 dates per day from 36 weeks onwards can help to ripen the cervix and subsequently have an easier, shorter birth. The dates have to be fresh mind! I personally don’t like dates but perhaps I’m just unusual!
Most of all have faith in yourself and your body. Having a c-section does not mean that all future births have to be the same, unless of course that’s what you prefer.