VBAC Tip #2 – Support Support Support!

Choose your caregivers wisely. It will really make a difference. If you are serious about achieving a VBAC then it will be worth while seeking out some sort of VBAC support. This is was the biggest factor for me.

This was the reason i failed at my VBAC attempt first time around with Amaya, because of my caregiver i did not even attempt a VBAC. Warning bells were going on towards the end of my pregnancy with Amaya as we started to discuss my upcoming VBAC – he wasn’t really interested in talking about things before then and to be honest i felt a little intimidated but that was my issue not his. I was not confident enough in myself and what i wanted.

His “requirements” for a VBAC were that I had to go into natural labour by 39 weeks! (UMMMM HELLO!? i went over with Ethan – over 41 weeks!) – i argued and he unwilling agreed to “let me” go to my due date although he was obviously not really happy with this. His reasons being my previous large baby (over 4kgs) and usually subsequent babies are larger.

I should have changed care-givers right then and there because he was obviously not supportive but being so close to the end it was all too much for me. Then he sent me for the sizing scan – even though again i didn’t want to but felt a little intimidated (again my issues), so i went along.

So i have first hand experience at the hands of unsupportive caregivers with regards to VBAC’s. It also seemed the be the recurring issue at the VBAC support group i was invited to talk at last week – that the right support was paramount (whether it was the hospital, doctor, hired midwife or doula) in a successful VBAC.

For all those women out there who may be pregnant now with your first OR thinking/planning on getting pregnant in the near future – please choose your caregivers wisely. Don’t just think that you are going to rock up to your birth in labour and not prepared. We plan so much for AFTER, when the baby is here but i think we fail to plan for the momentous occasion of birth! I honestly thought that things going “wrong” would never happen to me – i thought i would go into labour, rock up to the hospital and after a few hours push my baby out into this world and everything would be just like in the movies.

Considering a VBAC? Look into a supportive Doctor – look at questioning their VBAC rates/Cesarean rates. Ask the following questions to see how supportive they are:

1.How long will you support the pregnancy post dates? My doctor was happy for me to go to 42 weeks and then it was open for discussion – you want a doctor who is at least realistic about going into natural labour post dates.

2.Continual Fetal Monitoring – this is where they want to monitor the babies heart-rate throughout labour as baby distress can be an indicator for uterine rupture this seems to be a requirement for alot of hospitals/doctors these days – see if your Doctor is will to negotiate this atleast for the active labour stage – if your hospital is not equipped with the latest telemetry (wireless) monitoring it means you are confined to wherever your wire is hooked up to the machine – so no water and alot less movement for active labour. Discuss options such as 20 minutes on/off or 20 minutes out of every hour? My Doctor was happy with intermittent monitoring (they just came and checked bub every hour and once i started to push i was permanently hooked up wireless, the reading was sketchy towards the end so a midwife held the monitor on for most of my pushing stage while i was allowed to fully remain in active labour, she worked with whatever position i was in not once asking me to move/change to get a better reading!!)

3.Induction – most doctors/hospitals will not do inductions for VBAC’s and you don’t want one – as evidence/research shows a higher rate of uterine rupture with induced VBAC births.

4.Cannula insertion upon admittance to labor ward. This is a routine “just in case” – and for some women this can be psychologically discouraging as it really is in place just in case of emergency cesarean, for me personally i didn’t mind and in the end i needed to have it as i had to have antibiotics administered intravenously due to my waters leaking more than 48hours and testing positive to Group B strep – it was pretty annoying at the start it hurt  a little in certain positions but i did forget about it once labour established.

Kelly Winder from Belly Belly writes an awesome article when considering doctor’s for VBAC.

At the end of this post i will put my birth preference list.

You may also want to look at hiring extra support for labour such as an independent midwife or doula – there are more successful outcomes for women and babies…

Benefits of hiring a doula

• 60% less need for an epidural and 30% less need for an injection or pain killers
• Reduction in the need for syntocinon drip
• Length of labour reduced by 25%
• Less need of forceps or vacuum deliveries
• The need for cesarean section reduced by 50%
• Fewer sick babies
• Fewer sick mothers
• Mothers have less bleeding after the birth
• More normal births
• Mothers have a better birth experience
• Mothers have less anxiety during labour
• Mothers bond better with their babies
• Mothers are more confident with their babies
• Mothers have less depression following birth

With those kind of statistics who wouldn’t want a DOULA!? can’t afford the extra cost of hiring professional support then look into hiring a student midwife or student doula. Search places such as the major online mother’s forums for students posting looking for clients to complete their studies (Essential Baby, Bubhub, BellyBelly). I hired a student doula for my attempted VBAC with Amaya.

Maybe you are thinking about a homebirth? If i could have my time again first time around after all that i know now about birth etc – i would totally go for a homebirth! There are plenty of women out there who homebirth and its not just for the barefoot hippies of Byron Bay. My midwife informed me that often alot of her clients are professionals (doctors, lawyers etc etc), as it becomes more and more accepted by society as normal birth and not freaky hippy-ish! Check out the homebirth network of your state – midwife Betty Vella has all her details on the Homebirth Access Sydney website found here. There are plenty of highly experienced midwives out there willing to support VBAC births… There is much speculation of late as to what the government will change the choices of birth for womens (a total invasion of right of choice!) – in the not too distant future homebirths may only be available as a choice for a small percentage of women that meet their very strict criteria!

If homebirth isn’t your thing…then you can always hire a midwife for you care and use her in hospital as support (this is exactly what i did!)

If you have had a not so great birth experience in the past, don’t be discouraged but press on! Some wise words my midwife told me “sometimes we are just not in the space to achieve what we want to achieve” we will get there eventually! Surround yourself with people who fully support what you want, because when you doubt yourself they are the ones who keep you positive that you really can do it. Don’t regret your journey thus far – just look forward to your future!

I am forever grateful for all of Betty’s and Dr Bisits support and belief in me – not once did they ever doubt that i would acheive my VBA2C so if i had them beleiving in me why would i doubt myself? I believe that their true support for the birth that i wanted allowed me to achieve my natural birth after 2 cesareans.

Following is a copy of my Birth Preference List that my Doctor signed off on (to give you some idea of points you want to think about and talk with your doctor:

Labour:

• I would like to have an Active Labour – free to move around etc
• I would like the lights to remain low and people to talk in quiet voices
• I would like intermittent CTG Telemetry monitoring – If there is a problem with babies heart rate I am happy for continuous monitoring via telemetry wireless monitoring. I understand that I will be fully monitored during 2^nd stage.
• Happy for the routine Cannula to be inserted – however if it is hindering my labour in any way I will remove it
• Please do not offer me any medicated pain relief – I am fully aware of my options and will ask if I need it.
• I would like full access to the birthing pool during my labour
• I would like minimal amount of Vaginal Exams (as few as possible)
• I do not want my waters artificially ruptured unless there is a concern for the baby
• I would like to eat (light foods) and drink as needed to help with my energy and focus during the labour
• I would like staff to liaise with my support team (Betty Vella – private midwife, Jake Kearns – Husband) as they are fully aware of my wishes – and would like this done out of earshot to not break my concentration and disturb me unless need be

Birth:

• I would like to chose my own position for birth – preferably an upright position
• I would like no episiotomy – rather let my perineum stretch naturally
• I would like my husband Jake to be offered to receive the baby if everything is fine (he may accept/decline as he wishes at the time)
• I would like the baby to be placed on me immediately unless medically unstable
• I would like the Cord to remain attached until its stops pulsating and would prefer a natural 3^rd stage (no drugs or pulling) – unless drugs are needed to stop blood flow.