My first child was born via C-section. When talking with the doctors about future children I expressed my wish of having vaginal births if possible, they did give me an incision that would allow this. Thirteen months after Ignacio was born we became pregnant again, and after I found out that everything looked great to give birth vaginally I started to get ready. A friend of mine wanted to know what and how I made it, since she is getting ready for a VBAC too, and I thought I’d share with you all what I told her.
Know your possibilities and limitations.
Having a VBAC implies a bit more risk than a vaginal birth without a previous C-section. There is a 0.5-0.7% risk of uterine rupture along the C-section scar, which can lead to excess bleeding, posing a risk for the mother and the baby, and it would require an emergency C-section to get the baby out as soon as possible before there is brain damage, plus mom might need a transfusion and surgery to repair the uterus. This is why some hospitals would not allow a water birth for a VBAC. Some hospitals may even refuse to do a VBAC because they are not ready for the emergency C-section that it might require. Know what the rules are in your area before attempting a VBAC in the wrong place.
Know too that this risk is lower if your labor is not induced or augmented with pitocin, and that you do have after all, 99.5 chances of not having a uterine rupture. The probability of a successful VBAC will also depend on your age, if you had previous vaginal births, and your attitude, but these are not about uterine rupture but about the same factors that would count for a woman with no prior C-sections.
Going for a repeat C-section implies higher risks than a VBAC, such as higher chance of perinatal death for the mother and child (it is a low number, but much higher than with natural birth), respiratory complications for the baby, etc. You can read about this in any medical website.
I cannot emphasize enough how important it is to prepare both mentally and physically for birth, especially for a VBAC.
Read, educate yourself about birth. No matter what you choose, drugs, no drugs, epidural, water birth, home birth, etc. make sure you know how labor works. I did a lot of reading during both pregnancies, I tried to put aside the strong opinions from both doctors and midwives, and keep the facts of birthing. The best way of not being afraid is to know as much as you can, do not let other people decide for you because you did not learn enough, you have nine months to get ready, use them well.
Do talk to your doctor about what you want, he is there to help you birth a healthy baby but also to help you achieve what you want.
As soon as I knew a VBAC was possible I started a long conversation with my OB, I told him I wanted to have a drug-free birth, I asked lots of questions, he expressed concern about me not wanting an epidural or IV and we basically talked about this for five months. Having an epidural in place during labor would make things easier if a repeat C-section was needed, but I wanted to have the freedom to move around and change positions if needed, besides there was no way I wanted to have a needle stuck in my spine again! Each time we had a visit and a talk I would go home, think about the conversation and write down more questions. After a while it was clear that if there was a uterine rupture they would put me under total anesthesia to take the baby out as soon as possible, so for me there was no point in having an epidural in place.
Be ready to compromise. If your doctor will be too nervous about what you want to do it is not a good situation. Ask where you can find a solution? I wanted no IV, but I compromised to have a port in my arm in case an IV was needed.
Do hire a doula!
If there is one thing that I think was crucial for my successful VBAC was the presence of a doula. A doula is a labor assistant, basically she has more experience than you in births, she is knowledgeable about the stages of birth and what to expect at each moment, and she can be a great support for your partner too. Bonus points if your doula has experience in VBACs. We hired a great doula: Marissa Evarts, if you are in the Pittsburgh area I cannot think of anybody better to coach you.
Keep a positive attitude.
One thing I had a hard time with during the intense reading I did was dealing with the negativity in many books and websites. I am of the idea (maybe naïve?) that most people are doing their best, nobody is out there to get you, so reading books and blogs with strong opinions against doctors or midwives was exasperating. I mentioned this to Marissa and she helped me to find very positive videos of mothers giving birth beautifully, this was great for me because it helped me to keep centered and focused on the good things and not in the negative.
There are a bunch of videos on youtube that you can watch.
I also read a lot of VBAC birth stories and focused on positive affirmations. One of the most significant ones I read was “your contractions cannot be more powerful than you, because they are coming from you” which was a real eye opener, our bodies are made to do this, it cannot be beyond us women to do it.
Be active during pregnancy.
If your doctor allows exercise do your body a favor and exercise, the more you move the better chances you have that your baby will go head down and that labor will go smoothly. Plus you will need strength and flexibility for the endurance test you h ave ahead of you! Do listen to your body and don’t do anything that does not feel right, though. Walking and prenatal yoga are two things I can recommend a lot. I blame climbing up and down three flights of stairs daily for my baby being positioned right and low from the 30th week.
Learn breathing and meditation techniques.
You will realize how much it helps you to keep calm during labor. When you feel you might lose it, breath and come back to your center, you will be ready to ride the next contraction. You might want to learn different techniques as Hypnobabies or Hypnobirthing, these are not so much hypnosis, as the name suggests, but tools to learn to relax. Yoga can help achieve a good relaxed state too.
Do give yourself a pep talk!
You are a strong woman, there are a lot of things you’ve been through successfully. I know that for sure, after all you did go through a C-section: you were cut open, stitched closed, and were taking care of a newborn before you could recover. This is just one more challenging thing to go through.
My husband, if at any moment I started thinking I could not go through with it, was in charge of reminding me of a bunch of things I tackled that were very hard and I didn’t know if I could go through them. One of my motivations was that I did run a 5K having gotten shin splints a few days before the event. Running the whole thing was excruciating, but I made it and I did enjoy the beautiful landscape. Labor was not as bad
Attend a local ICAN meeting.
I did not get to, my schedule did not allow, but it is a good idea. You will meet like minded people and learn from their experiences.
Acknowledge your fears.
Do not let fear take over you, but acknowledge what you feel, talk about it with your partner, doula, doctor or a good friend, keeping things inside will only make it worse. Many times we just need to say things out loud.
I was of the idea that I could deal with the contractions just fine, but I was terrified of pushing and passing a baby through my vagina. After all, I’ve cried during pap smears in the past. Talking about it made me realize that by the time the baby would be about to come out there is no way any doctor would accept to give me an epidural. The epidural would take longer to catch than the baby to come out, so knowing that I was doomed made me feel at ease that I was not going to cave out.
And remember, labor and delivery will be a few hours of your life. You are in for a much more challenging experience, which is mothering two (or more) children for years to come…. labor is a piece of cake compared to that!