Q & A - preparing for a VBAC

Last week in my pre-natal classes I discussed two words - determination and doubt. And I posed the question: "do you doubt that you can birth your baby naturally?"

The three students who admitted out loud, without any hesitation, that they were doubtful, are all preparing for a Vaginal Birth After Caesarean (VBAC).

Please note than I always use the term 'caesarean birth' instead of 'caesarean section' or 'c-section'. I think it's really important to acknowledge that it is a birth and not just a medical procedure.

There are two types of women who actively prepare for a VBAC.

1. A woman who had a scheduled caesarean birth and never experienced labour. This may be due to, for example, a breech baby, pre-eclampsia, high-blood pressure, placenta previa or the health of the baby etc
2. A woman who laboured, possibly as far as full dilation, but for a range of possible reasons ( foetal distress, failure to progress, de-flexed head etc) couldn't birth her baby vaginally.

Wrapped up in the doubt of those that had a scheduled caesarean birth is a fear of labour...fear of the unknown, something so common to first-time mums. For those who have laboured and are attempting a VBAC there's a looming hurdle awaiting them. For most women in this situation, that hurdle is daunting. They know, deep within, that in order to achieve a VBAC they need to move past that moment in their first labour where, for one reason or another, it was decided that a caesarean birth was necessary. 

And so, like I say to my students each and every week, it is the mental preparation that is essential. Because the mental challenge of labour is often far greater than the physical challenge.

Here is my advice, in simple dot form:

• 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 an ante-natal 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
• talk to your support people about your fears. Talk to them about your determination to have a VBAC. Tell them what words you want to hear in labour. (If you are a support person and you notice that doubt is creeping in, quietly tell the labouring woman: "you CAN and you ARE doing it)
• do your research. Find a midwife or obstetrician who wholly supports your journey towards a VBAC. 
• create a sankalpa (positive affirmation). Yogis believe that a sankalpa that is repeated daily and never shared will always be realised. Use simple language and repeat it to yourself in moments of fear or doubt, or when you are feeling most connected with your baby. An example of a sankalpa could be: "I will carry my baby to full term and birth calmly and confidently."
• acknowledge your fears and doubts
• commence a regular yoga practice. The best preparation you can do is regular preparation. I find for those who already have children it's really important to go to a yoga studio for that space - where you can connect and be with your unborn baby without the need to look after your other child(ren). Recognise that it's your time
• why is prenatal yoga so powerful? Well, within weeks of starting a practice you will notice that you understand your body a bit more. When you become more aware of your body you have more faith in its ability to birth.
• remind yourself that your body, your breath and your baby are one. 
• your unborn baby is comforted by your heartbeat, vitalised by your breath
• as you breathe, mentally repeat 'let' as you inhale and 'go' as you exhale
• when you begin to doubt, remind yourself that you are determined
• when you become fearful, remind yourself that you have faith
• remember all those women that have birthed before you. So much wisdom.
• remember that you are nature - and nature never ever adheres to a clock
• labour cannot be controlled, only experienced. You cannot 'do' labour, you just have to 'be' in it
• don't write a birth plan - nothing in life ever goes according to plan. Instead, create a birth intention
• know that the very essence of birth is surrender - surrender to where your body and your baby takes you
• *next week I'll write about sound in birth. Sound, I believe, is the most powerful technique you can use in labour.

If I have learnt one thing after close to five years of teaching prenatal yoga it is this: you just never know where your birth journey will take you. And so, I say to each pregnant woman that crosses my path - surrender and accept. 

So what is it like to experience a VBAC? I'll let Sarah, one of my students, tell you....

Q: Why did you have a caesarean birth with your first child?
A: Finn was posterior facing (spine on spine) with a deflexed presentation (his head was tilted backwards instead of having his chin tucked in). My obstetrician suspected that he would be born via caesarean birth but I was insistent that I go into labour. I was induced (my membranes were ruptured at 41+3 weeks) and I laboured for nine hours with little or no progress. We agreed to go ahead with the caesarean birth.

Q: How did you feel about Finn's birth?
A: I was absolutely devastated. I had put such a lot of effort into preparing for the birth with a Calm Birth course and yoga classes, that when my experience differed so much from my carefully written birthing plan, I was at a complete loss. After the birth I was euphoric, of course. A son! My beautiful baby boy! But later, I found it too hard to even tell people that I hadn't managed the perfect, natural birth that I had wanted. It took me a long time to start appreciating my happy, healthy baby as the end result of my pregnancy, rather that what I saw as a 'failure' to do the one thing that we, as women, are designed to do. 

Q: Did you always want to attempt a VBAC with your second child?
A: Yes! My research started when Finn was only a few weeks old. I spent hours on the internet finding out if such a thing was possible. I had never heard the term VBAC before, but was soon quoting success stories and statistics to anyone who would listen.

Q: What did you do to prepare yourself for a VBAC?
A: My preparation was largely emotional rather than physical. I needed to accept that Finn's birth was just that, a birth, not a disaster. I spent my time thinking in a constructive way about every possible outcome, and decided to face each eventuality with acceptance. I learnt and practiced skills to help cope with the challenges of labour and delivery but I didn't plan. I wrote nothing down. I just decided to let it happen. I thought about what it would mean to me if I needed to have another caesarean birth - I was determined to be happy with my new baby, regardless of how she arrived.

Q: What were your fears and how did you overcome them?
A: My main fear was that my OB would insist I have a caesarean or claim that I wasn't a suitable candidate for VBAC. I spent hours leaning forwards (or on all fours) to avoid a posterior facing bubba! I prepared myself before each meeting with my OB so I could calmly decline his offer to schedule a date for my baby's birth. I booked a course of acupuncture to help labour begin spontaneously and I listen to my friends' VBAC success stories. I was happy for them and hopeful for myself.

Q: How were you feeling when you went into labour?
A: Amazed! I spent a couple of hours being not-quite-awake, then a little while wondering why I was awake, then I realised! Spontaneous labour! Success! Half the battle already won! I kept it to myself for a time, then woke up my husband and told him we were on our way. That was when the feeling of disbelief started.

Q: You had a really supportive midwife with you - how did you affect your experience?
A: My midwife was amazing. She was so calm and welcoming, and completely unconcerned by the fact that I was an "attempted VBAC" - as it said on my admission papers (very encouraging!). She asked us if we had a birthing plan and was beautifully accepting of our straight forward "No!". She was of the view that a woman's body knows how to deliver a baby, so was happy just to observe and support. She could tell I was ready to push before I could, and was happy to let me be without any interference. She didn't mind that I was on all fours on the floor and encouraged me to accept what felt right when it came time to delivering my daughter, even though I had chosen an 'unconventional' position. (My OB was most displeased when he arrived. But hey - he wasn't doing the hard yards!).

Q: How did it feel, to birth Meg in the way you had intended?
A: I was stunned when the moment came to deliver her. I had been expecting the orderly to arrive at any minute and wheel me off to theatre. I can clearly remember the midwife putting on her gown and gloves and my husband asking her what she was doing. "There's going to be a baby born in here in a minute, I'm just getting ready." We looked at each other in disbelief, it was such a surprise! The feeling, when my baby girl was passed to me, was out of this world! (...and hilarious - the cord wasn't long enough so I couldn't hang on to her and had to give her back to the midwife - all very slapstick!). I still couldn't believe what had happened and it felt so good when other midwives came in to congratulate me on a successful VBAC.

Q: What is your advice for women who are planning a VBAC?
A: Don't plan it. Prepare for the fact that it might happen, but prepare equally for the fact that it might not. But do try. Be strong when you are talking to your OB. Listen to advice but decide for yourself. And enjoy your new baby, regardless of how he/she is born. 

I would love for the comments section to become a bit of a discussion board. If you have any specific questions for me, I'm more than happy to answer them. If you have had a VBAC, or are hoping to experience one, I'd love to hear your story. I do ask, however, that all comments are respectful and, if possible, kind.

I have been asked if I'm going to write about preparing for a caesarean birth - yes, most definitely. 

Now is also a good time to remind you that I am not a midwife, medical practitioner or birth educator. I'm a yoga teacher, mother and journalist. My stories are informed by my own experience, research and the blessing that has been the meeting, teaching and learning from my pre-natal students. 

Q & A - Making Peace With Birth