Why plan a VBAC/EBAC?
Planning a vaginal/empowered birth after a previous Caesarean (VBAC) has many benefits. A vaginal birth will result in 86% of planned VBACs. Some studies like the ICEA review show the stats to be more like 90% vaginal births.
A vaginal birth avoids the risks of surgery and anaesthesia and improves the health outcomes for the woman and her baby. It is well documented that babies benefit from the stimulation of labour and birth, particularly with regard to breathing and alertness at birth.
Women who want to VBAC need to achieve two prerequisites. Firstly, they must have had a low-transverse incision on their bikini line and secondly, the head must be down ready for birth and not breech. Having said that, these days any woman would be hard pressed to find anyone willing and qualified to birth a breech baby, whether a first birth or VBAC, although it does happen as I have highlighted in Chapter Eighteen of A Labour of Love II.
Many women wish to give birth without intervention and given a choice many would opt for a more natural alternative. If the Caesarean experience was particularly distressing it may be very important to avoid a repetition. Bearing this in mind and looking at how women who employ a doula cope so well in labour, it makes great sense for women who are planning to VBAC to seriously consider having a doula present. Research suggests that having a doula present at a birth can and does affect the outcome of the birth experience providing there is no overriding medical problem or condition in the mother or baby.
A woman who vaginally births is much less likely to be separated from her newborn, her partner, support person and other children that maybe present for the birth. During a Caesarean, only one support person can be present if the woman has regional anaesthesia (epidural). In the event a woman needs a general anaesthesia no support people, partner included are allowed in the operating theatre. As routine policy with Caesareans in many hospitals around Australia currently, only one person is allowed into the operating theatre, therefore all support people must wait outside (doulas as well). This can be extremely hard for a doula when you have been with a woman for so long throughout a labour and then be told you cannot see the baby coming out. When I find myself in this situation I always feel a sense of absence like something is missing and I feel I never have closure with these clients as I was unable to be a part of the final moment and seeing the baby actually come out of the woman’s body and into the world.
With a vaginal birth, a woman is more likely to feel in control and as if she and her baby are the most important people present. This can be very empowering for a woman to experience and assists in creating a sense of achievement. A vaginal birth can be a healing process for a woman who has had a previous Caesarean. The greatest risks associated with having a VBAC or EBAC is uterine rupture, however this is rare. In fact, to put the risks into perspective, research suggests: The risk of perinatal death following uterine rupture in a scarred uterus is 10 in 10,000 and in an unscarred uterus is 2 in 10,000 Induction of labour doubles the risk of uterine rupture in a VBAC. For all methods of induction in a scarred uterus, the absolute risk of uterine rupture is between 82 to 101 per 10,000, basically 1%. In an unscarred uterus is 6 per 10,000 Among women attempting VBAC, the risk of uterine rupture in those with non-augmented labour is 36 per 10,000 (about the same as women experiencing uterine rupture in an unscarred uterus overall and in those having augmented is 87 per 10,000)
Royal College of Obstetricians and Gynaecologists, Evidence-based Guidelines for Delivery after Previous Caesarean Birth compiled by Professor G C S Smith MRCOG, Dr R Varma MRCOG, and Dr J K Gupta FRCOG
The fact is that most women can birth vaginally after having a Caesarean (the latest statistics suggest 70–80% of women) if they are not pressured into going into labour by a certain date and are allowed to labour naturally without the threat of another Caesarean. As a doula, it is imperative that VBAC women have the support of a doula that can massage them and assist a woman to stay off the bed, as in many hospitals they are monitored continuously which inhibits a labouring woman from being able to move about in her labour room.
This is what my client Kimberley Potter wanted to share with us via e-mail this week on the 14th June 2016, as her amazing news of achieving a successful VBAC. I would like to add that the odds were initially stacked against her as she was with a private Obstetric who basically told her there was no way she could birth her baby vaginally after having a previous caesarean. Incidentally he was her Ob the last time around which led her to her previous Caesarean for no apparent medical reason. After many a conversation she decided to leave his care and move to another hospital to increase her chances of having a successful VBAC. This paid off tremendously.
I cannot tell you how proud I am of Kim and her husband Ferg for getting educated, ‘skilled up’ and empowered for a natural birth and different labour journey this time around.
At 6:40am Saturday 11th of June 2016 we welcomed Mr Richie Nathan Robert Potter earth side at Armadale Kelmscott Memorial Hospital in our extremely healing, drug free VBAC.
The birth story is a novel and a half but my birth plan was honoured to the letter. I had my membranes spontaneously rupture, delayed cord clamping, physiological 3rd stage and I never once found out my dilation (birth plan was mostly Gaby’s NBAC plan).
I had the amazing experience of my membranes spontaneously rupturing, not an obstetrician putting his hand up there to do it. I only asked for the gas once, but I was already pushing and the midwife said “we take it off ladies now anyway, she goes what do you want the gas for anyhow?” to which I said “I don’t know” haha.
At the start of the labour we headed straight to the hospital because I had mec stained liquor but I was 6cm and 100% effaced (asked after the birth). The moment in my labour I’ll never forget was probably when my midwife wrapped her arms around me and said “girl you have already made it SO much further than you did last time you should be so proud”. The first person whose eyes my baby looked into was MINE and he heard my voice first and it has truly healed every part of my being.
I guess the point of this email is to say I really truly could not have done it without Gaby, from our weekly pregnancy aqua-fitness chats, to our childbirth education workshop/class, to your amazing books. Gaby your books made me excited about the coming birth, although I still went in a little scared I never once felt like the pain was too much or I couldn’t cope.
Gabrielle, you are a GIFT to pregnant women, your A Labour of Love centre can and will revolutionize birth as we know it. I owe you so much. I don’t think I could ever thank you enough. You weren’t my doula but the emotional support you and your team at ALOL provided during my pregnancy truly changed the outcome of my birth.
I had a birth photographer present who filmed and photographed the whole thing so I am thinking maybe a photo of Richie crowning with fuck you written on the back might be an appropriate birth announcement for my OB?
I hope to pop in soon but until then huge love and hugs!