10 years ago today, the 17th October 2014, I achieved a VBAC (vaginal birth after caesarean section). Last week, I supported a mother in a VBA2C (vaginal birth after two caesarean sections), my second VBAC in my short career as a doula. My next two doula clients are planned VBACS, making it three in a row! I seem to be living in a VBAC bubble at the moment and I’ve been doing a lot of reflecting on them.
Why do I say “achieving” a VBAC?
Because above everything else it is an absolutely massive achievement. The high after my VBAC is one of the most indescribable moments in my entire life. It is by far one of the hardest things I’ve done in my life, and I’m not actually talking so much about the actual labour and birth- even though that was an absolutely wild ride and the hardest physical task I’ve completed in my life! It’s more the preparation for a VBAC that makes achieving one feel like such a high.
Why is preparing for a VBAC so difficult?
Because you have to prove yourself to be a “Good Candidate”
Women often feel like they have to beg for the opportunity to try to give birth in a way their body is designed to do. It starts out with a meeting with medical professionals and being granted the chance to be “allowed” to “try” for a vaginal birth. I still remember those words “you are a good candidate for a vaginal birth after your section”. Ten years ago I didn’t realise how ridiculous that terminology is. I basked in the affirmation that I was a “good candidate”. Of course I was! I am a woman who’s every cell knows how to give birth vaginally, I was just massively let down by the medical system the first time round.
Because you are often made to feel like you are taking a massive risk for “selfish” reasons
Women can be made to feel like they are playing with fire with their baby’s life by having plans to birth vaginally. Of course there are risks to having a VBAC, I’m not going to suggest otherwise. The main risk is uterine rupture because of the old surgical wound. According to the Royal College of Obstetricians and Gynecologists:
“Women should be informed that planned VBAC is associated with an approximately 1 in 200 (0.5%) risk of uterine rupture”. However it is important to note that they also state:
“Women should be informed that the absolute risk of birth-related perinatal death associated with VBAC is extremely low and comparable to the risk for nulliparous women in labour”
RCOG (2015)
So all in all, it is a low risk venture.
Advocacy can be harder in VBAC preparation
Women have to advocate for themselves SO much more than in “normal” birth preparation. Often women planning a vbac are told they are “not allowed” to birth at home, or in an alongside midwifery unit, or have a water birth, or give birth after a certain gestation, or that they must consent to continual monitoring during labour. It’s important to remember there is no such thing as being “not allowed”. For some women these are a calculated risk in order to support physiological birth.
Trust
Learning to trust your body can be extremely hard after a previous section and it’s a huge part of the preparation for birth to bring this trust back. Of course, it depends on the circumstances of the previous birth but there is more often than not a lot of work to be done in learning to trust your body to do what it was designed to do. A reminder of the basic needs of a woman in labour to support physiological birth:
Safety
Security
Warmth
Darkness
As little observers as possible
Turning your neocortex off- this is easier said than done when you are planning a VBAC- but it can be done! When I work with my VBAC doula clients this is the largest part of our preparations.
What if a VBAC isn’t for me?
I also want to make a very big point that It’s ok if a VBAC isn't for you and women should always have the right to choose which method of birth is best for them
Sometimes women are left with no choice to have a section with subsequent babies (I had placenta previa with my third baby, hence my elective section);
Sometimes the trauma of their first birth is too much to try again;
Sometimes they were let down so badly with support during their first vaginal labour that ended in section they can’t see any other option;
Sometimes the risk factors and the effort of advocacy for yourself are too much to handle and too detrimental to mental health;
For some women their first birth means “one and done”
There are many many reasons women do not want a VBAC, believe me, I see you if this is you.
However, for some women the craving for vaginal delivery is too much and they see no other option but to attempt a VBAC.
My last doula client said this when we were preparing for her 4th baby's birth, and I can’t think of a better way to put it:
“I said to the consultant today, it’s weird, I know I’ve had babies in all different modes but c section just feels like you didn’t finish the job, it’s an actual feeling inside of you physically and mentally especially when it was unnecessary.
It’s like you are stuck or something.
Like you didn’t release something that needed out”
I asked her today would you still go through 36 hours of labour again to achieve a VBAC/
“Yes. Any day.” she replied.
Some women simply cannot shake the craving for vaginal birth.
They are not selfish to want to experience it.
They see it as essential for their mental health.
They see it as the best option for their physical health.
They see it as essential to their healing process of previous birth trauma.
They see it as important to their unborn babies.
And this should always be supported, because women are important too.
RCOG (2015) Birth After PreviousCaesarean Birth https://www.rcog.org.uk/media/kpkjwd5h/gtg_45.pdf
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