Friday, March 26, 2010

The choice is yours


‘Once a caesar, always a caesar’ is no longer the norm, as more women are successfully achieving natural birth after having a caesarean
Just over a month ago a friend of mine gave birth to a beautiful baby girl.
Sure, heaps of women have beautiful baby girls, but this was her second child, and she is among a group of mothers who chose to have a vaginal birth after a previous caesarean (commonly called VBAC).
Her successful outcome was a result of months of preparation, research and support, and she is a perfect example of how VBACs can be achieved.
She undertook a hypnobirthing course aimed to help her relax during labour, employed a doula (birth attendant) for support, swam and took pilates classes (to help get her baby into a good position), and found an obstetrician willing to support her birth choices.
And now she has a happy and thriving baby, and none of the complications or side effects associated with surgery.
If you’ve had a caesarean and would like to open up your birth choices for future children, here are some facts and tips to get you on the path to a successful birth.

The caesar rate in Australia is up to 31 per cent, with more women considering a subsequent caesar for their next child, but the risks associated with VBAC are minimal.
The main concern is the risk of uterine rupture, but this affects only 0.2 and 0.7 per cent of women. 
The risks associated with elective repeat caesarean include hysterectomy, injury to bladder or bowel, reduced fertility, severe bleeding (sometimes requiring blood transfusion), risk of infection, pain after birth, blood clots in the lungs, legs or elsewhere, more difficulty in establishing breastfeeding, increased risk of breathing problems for your baby, delayed bonding, and possibility of separation of mother and baby.
One of the biggest problems in having a VBAC in Australia is the attitude of some care providers and the policies of hospitals. 
With the risks of caesarean outlined above, it’s surprising that women choosing a VBAC are not given more encouragement.
Instead they are restricted with the use of continuous fetal monitoring and strict time frames of progression that even a first time mother would have trouble meeting.
This can create a lot of stress and lead the women back down the path to another caesarean.
Australia-wide, the proportion of women having caesarean sections increased from 20 per cent in 1997 to 31 per cent in 2006. The most common reason for a caesarean was because a previous caesarean had been performed.
But as more caesareans are performed, we are seeing more complications from this surgery. 
In 2006, only 16 per cent of women had a VBAC, yet having a VBAC has many positives.
Firstly, you avoid the risk of surgery (and therefore any associated complications), you get to hold your baby before anyone else allowing skin to skin contact straight away, you have more control over who attends your labour, your contractions stimulate the baby and get them ready for birth (passing through the birth canal gets the baby’s lungs ready to take their first breath, and the compression of the skull fires off neurons in the brain increasing its development), and along with the feelings of empowerment and accomplishment, it can be a healing process for a woman who has had a previous caesarean and doesn’t feel good about the experience.
When choosing to have a VBAC, make sure you understand your care providers policies, negotiate fetal monitoring or ask for a midwife with a doppler, do your research and surround yourself with support.
Of course, some women will still choose to have repeat caesareans because of reasons such as placenta praevia, previous classical incision or a previous uterine rupture.
So in consultation with your care provider, you need to work out what the risks are for you and your baby.
If you are told that you can’t have a VBAC because of twins, breech, big baby, history of two or more caesars, history of slow labour, history of placenta praevia or overdue, then you should consider getting a second opinion from a care provider who has a good VBAC success rate.
In her book Birth Right, Susan Ross says it is fear that drives many women to choose an elective caesarean, but if you talk honestly with them and discuss all their issues, then it is often not what they really want.
Women who achieve a VBAC feel a huge sense of victory and relief, and for some it brings with it a deep sense of healing.
After a VBAC, one mother said: “I was euphoric, and this feeling stayed with me for a very long time. I was just so happy to be in control of my birth experience. I felt all my research and preparation had paid off. My recovery after the VBAC was so much easier than after having a caesarean.”
For more information visit www.birthrites.org or www.vbac.com

Top tips for a VBAC:
  • Choose your care provider and place of birth carefully.
  • Choose your birth support people.
  • Educate yourself.
  • Value birth preparation (eg. Calmbirth or Hypnobirthing can make a big difference between a natural birth and medicated birth – trusting your body and believing you can do it).
  • Avoid interventions in labour (such as continual monitoring and epidurals).


1 comments:

Shannon said...

I only just found out that my friend who had the VBAC (mentioned in the story above) actually had a classical incision with the first caesarean. She had quite a time finding an obstetrician to support her plans, and even when she was giving birth, she had midwives saying she was a "challenge" as they had never done a VBAC with classical incision before. In the end, there were no midwives attending her birth as they were busy with other mothers in the labour ward and didn't think she was ready to push yet! Her birth story is truly inspiring and shows that with courage, strength in body and mind, and support from her husband and doula, it can be achieved.

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