With most series reporting that the likelihood of a vaginal delivery after Caesarean is somewhere between 60-80%*, VBAC is a choice well worth considering.
The following is advice from previous CARES members who have planned VBACs. The choice to plan a VBAC is a very personal one – if you decide this path is the right one for you, we hope the following resources and information help you during your journey.
The following information can be downloaded as a PDF here:
Helpful Hints from Women Who have
Planned a VBAC
Reflect on the birth you are hoping to have.
What qualities would you like your birth setting to have? Speak to range of women and gather as much information as you can about different birth experiences in a variety of settings and models of care. Read birth stories, watch birth videos and use your own experiences to help you form a clear idea of the birth you are hoping to have. This does not guarantee you will achieve the birth you envisage for yourself and your baby, but it does allow you to form a clearer idea of the qualities you desire your birth to have.
Start asking questions and then research, research, research.
Be very clear about why you are making the choice to plan a VBAC. Research the risks of a repeat Caesarean to you, your baby and your future pregnancies and, conversely, find out what the potential benefits of VBAC are. To strengthen your resolve, do the reverse – research the potential benefits of an elective repeat Caesarean, and any risks of VBAC in your individual case. Think about which benefits outweigh which risks for you, remembering that no decision will be risk-free – you need to know which set of risks and benefits you are prepared to accept, and which ones you are not. (The Childbirth Connection website has a page dedicated to the question of ‘VBAC or Repeat C-Section?‘)
Know the importance of planning an active birth – how does this increase your chances at a successful VBAC? CARES members can share with you their own experiences of active labour at coffee mornings and on the facebook page.
Make sure you do ample research about uterine rupture and the use of routine continuous monitoring during VBAC labour; these are two very VBAC-specific topics about which you must be fully informed if you are planning an active birth. CARES members can share with you their own experiences of active labour at coffee mornings and on the facebook page.
Don’t contain your knowledge about birth to the information your care provider offers, or even to the information contained within the pages of our website. Seek information from a variety of sources, both online and in person – our external links page could be a place to start.
Know your full range of options for birth settings and care providers.
There are many birth settings and models of care available to women birthing in South Australia. You might choose to seek care through only one of these models, or you might prefer to ‘mix and match’ services to better suit your needs.
Birth settings include (but are not limited to):
- Public and private hospitals;
- Birth centres;
- The ‘Midwifery Group Practice’ (at the Women’s and Children’s Hospital);
Models of care include (but are not limited to):
- Obstetric care, both publicly and privately funded;
- Midwifery-led care, through a public hospital, birth centre, the MGP or with a privately hired independent midwife;
- GP shared care.
Birth workers and doulas can also be hired for antenatal, labour, birth and postnatal support.
For more information about current birth choices in South Australia, please email us.
Write a birth plan.
Writing your birth plan helps you to reconcile your desires for your impending birth. Use the process to initiate discussion with your partner and care provider. Once your birth plan is written, you may choose not to use it or you might change your mind about certain things – your birth plan is as much about active decision making, and working out how you will manage the system in which you are birthing (and what your role within it will be!), as it is about ‘planning’ your actual birth.
A sample VBAC birth plan and cover sheet can be downloaded below (scroll down) and on our downloads page here; many more can be easily found online.
Choose your care provider wisely.
Interview a range of prospective care providers – remember that you hire your care provider to meet your individual needs. It is important to go to your appointments with a range of questions to ask. Know that interviewing a care provider is not a commitment to their care if what he/she offers is not what you need – it might help to think of yourself as a consumer, not a patient. Lastly, you may also decide to change care providers at any point of your birth journey, and you are always advised to seek second and third opinions if you are ever in any doubt about the care you receive.
Some sample care provider interview questions can be found in our ‘Resources’ section here.
Learn about fear and how it affects you.
The fear of childbirth is a very real challenge for most birthing women, but it can be especially difficult to overcome if you are planning a VBAC. You may need to face not only your own fears, but also those of your care provider/s, family and friends, depending on their own experiences. Read about the effects of fear on childbirth (Ina May’s ‘Sphincter Law’ is a great introduction to the concept), and start to observe how fear also affects your decision making. Set yourself the goal of learning to make conscious decisions which are not fear-based, and find a way to feel as safe as possible during your labour and birth.
Think about when you made a good decision in the past.
You will be making lots of decisions, both big and small, during your birth journey. Know that being an active participant in your birth means taking responsibility for your decisions, and this can feel overwhelming. Know what it feels like for you when you make choices which you feel good about – there is less room for any later regrets if you make conscious and informed decisions, knowing they are the best ones for you to make at the time.
Know that giving birth is a physical, emotional and spiritual experience.
Ensure you are fit physically, mentally and emotionally. Pay attention to any issues you may have been avoiding for some time – these may not even be birth-related, but pregnancy, labour and birth might bring these issues to the fore. Unpacking previous birth experiences, in particular, is very important as your next birth might bring old memories back at a time when you are most vulnerable and least likely to be able to deal with them. Because the journey to VBAC can be quite emotionally complex, make sure you are suitably supported before, during and after your birth.
For more information about health professionals who might assist you in this journey, please see our ‘Directory’.
Surround yourself with truly supportive and positive people.
Being adequately supported is an integral part of a VBAC journey – while there are many respects in which a VBAC should be simply viewed as ‘just another birth’, this isn’t the way current systems will respond.
Your decision to VBAC may be met with resistance, worry or concern by care provider/s, family and friends depending on their own birth experiences, preferences and/or level of exposure to the evidence supporting the choice to VBAC. Fear can be a common, almost expected element of birth experiences in our current culture, so remember that these reactions are not always VBAC-related. The catch phrase ‘once a Caesarean, always a Caesarean’ also still appears to exist in the general community – this is an out-dated throwback to earlier recommendations from doctors. The SA Perinatal Practice Guidelines acknowledge that “compared with repeat Caesarean section, women who give birth vaginally after a previous Caesarean section have a lower morbidity and fewer post-partum complications (Flamm et al. 1994)”.
It is very important to have people around you who know the evidence to support your planned VBAC (especially your care provider/s!) and/or fully believe in your ability make wise and informed decisions (in the case of family and friends). Many CARES members find hiring a birth worker or doula can be an excellent way to get this support and ensure that someone is there to advocate your wishes and desires during childbirth when you may not be able to do this for yourself.
CARES coffee mornings are a great place to build a support base, too – it’s a chance to meet other women who have planned or are planning VBACs and to hear their stories and ideas. It is always reassuring to know that you are not alone in the VBAC journey and that other women ‘get it’.
Obtain your medical notes.
Reading through your medical notes can help you make more informed decisions about your next birth, and can offer a sense of closure if you are still healing from previous birth experiences.
Consider having a Blessingway.
This is an alternative to the typical baby shower and might be one way for you to maintain a positive head space and to feel supported as you get ready to birth. There are many beautiful activities one can share with close family and friends during a Blessingway, including making a ‘birthing necklace’ and writing affirmations on a banner or in a book for you to read as you prepare for labour and birth.
Information about Blessingways is often shared at CARES coffee mornings, but there are also many ideas online.
Remember that your birth journey does not end with the birth.
Once the baby arrives, you still have the third stage of labour and the postnatal period ahead. Please see our sample VBAC birth plan (link below) for some things to consider about the third stage of labour and early new-born care. You might also consider hiring a post-natal doula for the ‘fourth trimester’ – those (often overlooked) early days and weeks with your new baby when an extra source of help and support can make the difference to your ‘babymoon’.
The downloadable birth plan and accompanying cover sheet available below are intended only as a starting point for you as you plan a hospital VBAC birth – these documents should be altered to suit your individual circumstances, needs and desires.
*Turner MJ, Agnew G, Langan H. Uterine rupture and labour after a previous low transverse caesarean section. BJOG 2006 Jun; 113 (6): 729-32.