pregnancy

Can you have a vaginal birth after a caesarean? The answer is complicated.

According to statistics, 36 per cent of pregnant women in Australia give birth via caesarean. A significant proportion of these women will elect to have a caesarean for subsequent births but increasingly, more women are choosing to prepare for a vaginal birth after caesarean (VBAC). 

Many Australian hospitals, both private and public, support and encourage women to achieve a VBAC.

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If you’ve had a caesarean and you’re considering a VBAC for your next birth, I want you to know that it’s definitely possible but there are two things you can do to improve your chances of of achieving one: 

1. Find a supportive care provider.

Whether you choose private obstetric or public midwifery care, make sure that your care provider is willing to support and encourage you to achieve a VBAC. Continuity of care is definitely recommended (this is when you have the same midwife or obstetrician throughout your pregnancy and they’ll support you during labour and birth, too) but it’s not always easy to access. 

My advice? Book in early (as soon as you’ve peed on the pregnancy test). And if you’re not yet pregnant but thinking of a VBAC for a future pregnancy, it’s never too early to start preparing. 

Be proactive and look into your local care options and join local VBAC Facebook groups to gauge advice and recommendations from other women. Some larger public hospitals have midwifery groups dedicated to supporting women attempting a VBAC but they are very popular so getting in early is essential.

2. Embrace birth preparation. 

It’s never too early to start preparing for your birth.

Birth skills are absolutely essential for any birth but particularly a VBAC when it’s quite normal to carry grief, fear and trauma from your previous birth. The best thing you can do is actively let go of your past birth and remind yourself that you’re preparing for an entirely new birth experience. 

And then? 

Learn about the physiology of birth (what actually happens in your body during labour), understand how breath and sound can support you through contractions, learn to see labour pain as good, healthy pain that’s bringing your baby to you and foster trust in your body’s natural ability to birth. 

Ask your care provider questions.

When you meet your obstetrician or midwife for the first time, it’s a really good idea to gauge their support of VBACs by simply asking them questions. You may ask: 

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  • What is your success rate with VBACS?

  • How many VBACs have you supported in the last 12 months?

  • What are your thoughts on VBACs?

  • What is the hospital’s policy regarding VBACs? 

  • Can you provide me with consistent evidence-based information regarding this?

  • Is there a time restraint on my labour and the second stage (pushing stage)?

  • Is there an anaesthetist on call 24/7?

You may also want to discuss inductions. Generally speaking, you won’t be able to have a medical induction (syntocinon via IV drip) because it places significant pressure on the uterine walls and can increase the risk of a uterine rupture. 

However, some hospitals have strict policies surrounding induction, especially if you’re in a high-risk category and you go past your estimated due date (you have gestational diabetes, high blood pressure or you’re of advanced maternal age). Openly discussing your care provider’s understanding of induction in relation to VBAC is a really proactive step you can take to ensure you’re gaining a thorough understanding of your level of support and your birth options. 

If you and your baby are well and induction has been recommended, you can always request daily monitoring in the hospital (they’ll typically monitor your baby’s heart rate, movements and the level of amniotic fluid via CTG monitor and ultrasound) before you give consent for an induction. 

There are many stages of induction so starting with a cervical gel or balloon catheter is recommended so you can continue with your preparation of a VBAC. Inductions and VBACs can work together but it really is dependent on your hospital’s policies. 

VBAC risks.

Uterine rupture is the main concern with a VBAC. Scar tissue from your past caesarean takes time to heal and is, therefore, weaker and more likely to tear from the pressure of contractions. 

Between one and two in 200 women who attempt a VBAC will suffer a ruptured scar. It is a severely painful experience that can also be life-threatening so it definitely is a concern. However, the chances of it occurring are small. In many cases, your hospital will want to monitor you closely throughout labour and may have time limits on both first and second (pushing) stage of labour. 

Birth preparation.

Many women preparing for a VBAC will admit that they feel significant pressure to get past the point when a planned or emergency caesarean was called in their first birth. 

It’s for this reason that many midwives will encourage women who are preparing for a VBAC to prioritise their birth preparation, particularly in regards to mental preparation:   

  • Remind yourself that this is a new baby and a new birth experience.

  • If you are feeling angry, disappointed or traumatised about your first birth experience you may want to consider seeking help from a perinatal counsellor. Your GP or midwife will be able to refer you. Ultimately, you can only prepare for a second birth once you have made peace with the first.

  • If you feel guilty, forgive yourself. Forgive yourself. Forgive yourself.

  • Think about who you want at your birth. Choose people who you wholeheartedly trust. Remember, you will be at your most vulnerable and transparent, you want support from those who have the utmost faith in you and your ability to birth.

  • Stay active! Even if you’re required to be monitored throughout your labour, you will still be able to move around, use the shower and use gravity to encourage your baby down (when your baby’s head places pressure on the cervix, it dilates, hence you want to stay upright or on all-fours for as long as possible). 

  • Remind yourself daily that you trust in your ability to birth your baby.

  • During labour you may like to ask your partner to repeat this phrase, particularly in times of fear or doubt: You CAN and you ARE doing it! 

  • Learn breathing techniques, understand the connection between your jaw and pelvic floor, embrace positive affirmations, use sounds to ride the intensity of contractions, and welcome the pain of labour

  • Understand your options when it comes to pain relief - both non-pharmacological and pharmacological. For instance, an epidural can be a positive step in your labour but it also carries a higher risk of instrumental birth or emergency caesarean. If you can labour without an epidural, you’ll have a better chance of achieving a VBAC. 

Sophie Walker has a Masters in Public Health, is a mum to three boys and is the founder and host of the Australian Birth Stories podcast that has over 8 million downloads and is endorsed by the Australian College of Midwives. She also has a range of education resources available, including her online birth preparation course,  The Birth Class. Every week on the podcast she shares an interview with a woman who steps into her most vulnerable space to detail all the precious details of her pregnancy, birth and postpartum experience. Each story is unique hence the podcast is an amazing educational resource for pregnant women, their birth support partners and professionals working in perinatal health. 

Feature Image: Canva.

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