The greatest challenges women face in achieving a VBAC are the emotional legacy of the previous birth and an absence of support and options for a safe, mother-baby centred VBAC. And it seems as though the closer women get to their baby’s birth month, the less support there is, almost as though previously supportive doctors, midwives and people are pulling the rug out from underneath them out of fear. Women are told they may have a trial of labour to VBAC, but only if they can jump through all the hoops. In The VBAC Dilemma DVD (Part 4 of More Business of Being Born), they call VBAC a ‘cindarella birth’ – finish the birth before the magic runs out at midnight!
A woman who wishes to have a VBAC has to become a researcher, an advocate, a communicator and negotiator. She needs to become comfortable with the safety of a VBAC and educated about the potential risks. And she often has to dig deeper and work harder than the first time mother to prepare emotionally and mentally for a vaginal birth, because now she has the legacy of her caesarean birth to come to terms with. While these challenges are enormous, they also are an invitation and opportunity to be transformed and empowered through the journey of birth after caesarean.
- Understand the reasons for your caesarean birth and evaluate whether these are likely to be repeated and whether any factors are within your sphere of influence. If they are, then address each of these in your birth preparation. Include your chosen doctor or midwife in this discussion.
- Choose doctors and midwives who support your choice to have a VBAC and who make you feel safe, respected and strong. If you find that your VBAC-friendly doctor is putting pressure on you or undermining your confidence, you have the right to change doctors, and it may be worth while doing so.
- Choose a place of birth where you feel safe and will be safe. 11% of Australian women choosing a VBAC will choose to have a homebirth and a high percentage of these women will have a successful vaginal birth at home. Some of these women are choosing homebirth because they felt they had no other option. They were unable to negotiate the care and environment they needed for a successful VBAC in hospital or a birth centre and have accepted the risks of VBAC at home.
- If you are having a hospital birth, find out what the policies are for VBAC and decide how these will impact on your ability to birth vaginally. Don’t ‘go with the flow’ in maternity care decisions without knowing that the flow is going to carry you towards the vaginal birth you are seeking. Think about conditions such as an IV on arrival in case you need surgery, a 12 hour time limit for labour, fluids only and no food in labour and continuous external foetal monitoring. These conditions are there to protect you from an undetected uterine rupture and to make emergency caesarean surgery quicker. They also come from a place of fear – fear of complications and fear of legal consequences.
- On the other hand, women and researchers are in agreement that many of these conditions actually make it harder for women to birth vaginally and may end up contributing to a repeat caesarean. It may be helpful and important for you to meet with hospital staff and negotiate the care you want. Avoid, if possible, anything that increases the likelihood of a caesarean or a failure to progress.
- Surround yourself with supportive people – a doula, an independent midwife, birth educators, a community of women online or in real life.
Your chances of having a vaginal birth are higher than those of a first time mother! The greatest threat to your VBAC is the impact of fear and being labelled ‘high risk’.
VBAC Journey – an opportunity to learn, grow and heal
We can reach a new perception of birth and feel confident, empowered and excited if we are open and willing to consider different possibilities. A crucial first step is knowing that your feelings about your past birth and future births are valid, no matter what they are.
Seek and read positive stories that speak to you and your experiences. Your feelings about birth may begin to change and then you will begin to consider how you can have a positive birth. If you decide that a repeat caesarean is the best path for you and your baby, you are in a far more powerful position to plan your baby’s positive and welcoming caesarean birth.
Consider the perspective that your previous caesarean birth gives you an opportunity to learn, grow, heal and transform yourself. Women who have had one or more births of any kind now have a wonderful source of information about themselves. The way they feel about birth and what they need for their next birth is held within their own birth story. Reflect, debrief, cry, rage, rant, talk, write and seek healing and lessons in your births. This self-knowledge will go a long way in empowering you for your next birth and for motherhood too.
“My VBAC was the most amazing, fabulous and triumphant thing I’ve ever done! I loved it! And I would do it all again.” Jo’s VBAC story in Birth Journeys