With my first pregnancy, I needed to have a c-section, so with the next one I really want a VBAC. Is there anything I can do to increase my chances of being able to have a VBAC?
It’s great to hear from women who want to have a VBAC (Vaginal Birth After Caesarean). The good news is that there is a lot of really great information and resources out there for you now. The bad news is that it can be very challenging to find a doctor – or hospital – that will be strongly supportive of your desire for a VBAC. Often hospitals (and obstetricians) will tell you they strongly support VBAC, but the reality is their VBAC rate is shockingly low. Don’t be shy about asking for cold, hard statistics from them and find out what their successful VBAC rate actually is. You are absolutely entitled to be told this information.
According to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) approximately 60-80% of women should be able to successfully have a vaginal delivery following a trial of labour (TOL).
The reason behind doctors’ and hospitals’ reticence when it comes to permitting VBAC is the fear of uterine rupture (and of course this boils down to one thing: the fear of litigation). The truth is however, that the actual risk of uterine rupture is exceptionally low; about 1/3 of 1 percent (or 325 in 100,000). Even with this small risk of rupture, vaginal birth still carries fewer overall risks than surgical birth.
So, in saying all this, how do you improve your chances of having a successful VBAC?
- Choose a caregiver who proves his or her support of VBAC by having a high VBAC attempt rate; and a success rate of 70 percent or higher. You may have to meet several doctors before finding the right one for you.
- Consider hiring a doula (a professional birth support attendant) who has either had a VBAC herself, or supported other women through one.
- Take a childbirth education course refresher, or find a childbirth educator who offers a VBAC course.
- If your Caesarean birth was traumatic, or you feel anger, mistrust or fear about your next birth, talk with a birth counsellor, childbirth educator, or doula to help you deal with these feelings. You might also want to contact Caesarean Awareness Network Australia (CANA) http://www.canaustralia.net/.They’re a good source of information and emotional support.
- Avoid induction with Syntocinon or prostaglandins which studies have shown increase the risk of uterine rupture. If induction is absolutely (medically) necessary, then non-drug method of induction such as rupture of membranes or balloon catheter may be safer for VBAC.
- Try to minimise medications for pain relief (such as epidural).
By following these suggestions, you’ll have done all you can to ensure a vaginal birth. But always remember that there’s no guarantee a Caesarean won’t become a wise option if serious problems arise during labour. Consider writing a VBAC birth plan as well as a “best possible Caesarean” plan to use if a repeat caesarean becomes the safest option.
Tanya Strusberg is a Lamaze Certified Childbirth Educator (LCCE) and teaches prenatal education to pregnant women and their partners in Melbourne.
She and her husband Doron have two beautiful children, Liev and Amalia.
To learn more visit www.birthwellbirthright.com
Disclaimer: The information contained in this column is of a general nature only and does not constitute formal medical advice. Any specific medical problem should be referred directly to a qualified health professional.