April is Cesarean Awareness Month. For more information on birth choices, visit the International Cesarean Awareness Network and VBAC.com.
Making the choice to go down the VBAC route isn’t always an easy one for second time mums-to-be. For me it was a no-brainer. I badly wanted a natural birth with my first child and spent a considerable amount of emotional energy beating myself up for “failing” the first time around. Despite the difficulties that I thought contributed to the CS outcome, I was determined to go down the VBAC route with baby #2, so when the midwife asked during the booking in appointment whether I had considered birth options and would I want another C-section I said no, and that was that.
Talking about my first birth was difficult even two year’s later. I hadn’t realised quite how badly it had affected me until my second pregnancy, when I found myself in tears whenever DD’s birth came up for discussion, which it inevitably did while discussing options for baby #2. This meant that James and I talked about it – a lot. He was very concerned (with his ex-therapist head on) that the strong emotions that were still present would derail my VBAC unless they were dealt with. We had some issues ourselves around that as he was convinced there was some deeper emotional trauma that also needed to be dealt with whereas I was adamant that it was the birth experience itself that had caused the trauma. We also talked about what happened the first time around in terms of the support we received, how we worked together during labour (or not), etc. and how we would try to ensure those things didn’t happen again.
All this meant that we did a lot of soul searching and mental preparation – which I would say anyone going into a VBAC owes it to themselves to do.
Based on my experience, here are six steps I recommend to anyone preparing for a VBAC.
Step 1: Understand what “went wrong” with your earlier experience.
This is the starting point for dealing with your emotional response to your earlier C section. Did you feel out of control during the birth? How did you relate to your care providers? Were there steps that could have been taken (in hindsight) that you think were overlooked at the time which may have meant a C-section could have been avoided. What, if you could do it all again, would you do differently?
I would advise anyone planning a VBAC to use their 40 weeks of pregnancy to figure all these things out so that you can go back into labour feeling empowered and ready for anything!
Here’s a list of the issues we identified:
- Loss of control leading to stress. All my birth plan went out of the window before I’d even left triage, due to high blood pressure (which hadn’t been a problem until I was in labour!) From the minute they led me down to the delivery suite I felt like a prisoner and still maintain that I didn’t ever consent to that or have the rationale for it explained to me, giving me the opportunity to ask questions. My memory of events is being told it was hospital policy, then being led down to a room on the delivery suite and hooked up to the monitor. As I’d been focussed entirely on a natural birth this threw me an emotional curve ball that I didn’t recover from.
- Lack of support. For better or worse we hired a doula. Looking back we decided that having her there meant that the midwives backed off and didn’t offer support throughout the birth. It also created some distance between myself and James, as he relied on the doula, thinking she knew what she was doing.
- Problems with continuous monitoring. I really wanted to be mobile so they put me on the mobile monitor but it kept falling off! My main memory of the birth is James and the doula following me round holding the damned thing on. Everything became about the monitoring and me, the labouring woman, went virtually unnoticed durig the whole thing.
- Naivety! Oh, natural birth mafia, what had you done? A friend had recommended Ina May’s book to me. I read it. I only knew people who’d have transformative home births or straightforward hospital births. Talk of epidurals, C-sections, continuous monitoring were all just scare mongering. I didn’t need to consider any of these things because I was going to use the power of positive thinking to ensure I had a natural birth in the pool as the sun came up over the hills in the distance. La, la, la, I can’t hear you. I think my birth plan said something like: “I know all about the drugs and will ask for them, if I need them.” I never thought for a moment that I would enter a twilight zone where I completely forget there were drugs I could take but that, on the basis of the birth plan, not one of my birth partners or the supporting midwives would suggest pain relief.
So that’s my list. Make yours, talk about it non-stop until you’ve gone over every aspect of your first birth with a fine toothed comb and have left no emotional stone unturned.
Step 2: Identify the issues you can control/change
When you’ve completed Step 1, you’ll be in a position identify the issues you can control/change the second time around. For me we identified:
- Control – so my birth plan specified that I wanted people to talk to me and ensure they received verbal consent to any recommendations, for monitoring, positioning, examinations – anything.
- Stress – I felt that the stress I felt greatly contributed to the slow progress of my labour, so emphasised in my new birth plan that we needed to work together to minimise stress and that James, my birth partner, would check in with me. I also bought some hypnobirthing CDs and listened to them every night.
- Support – I wanted to ensure that the midwives and I worked together to make the VBAC happen. I needed to trust them and, for that to happen, I needed them to communicate with me. To this end we had a meeting with the Supervisor of Midwives to discuss a formal care plan, which included specifying that I had the support of a senior midwife.
Armed with this information you’re really making progress towards a successful VBAC and you’re ready to go on to the next steps!
Step 3: Work with the hospital to address your issues.
I’m sure that many women going in for a VBAC have had similar experiences to some degree and the issues may well be the same for you as for me, but unless you are open with you care provider about them they will not know that you need their support to deal with them. Here are some ways you can build a relationship of trust with your care provider so that you go into your VBAC feeling supported.
- Approach the hospital where you had your CS and ask for a meeting to discuss your birth experience. Most hospitals (in the UK) offer couples (women and their birth partners) and opportunity to debrief.
- Arrange a meeting with the Supervisor of Midwives. This will give you the opportunity to discuss any concerns you may have and agree a care plan. It may be that you just need the option to do something, or maybe you have a very specific need that you feel must be met.
- Ask for VBAC counselling. This might be one-to-one, with a consultant or senior midwife, or in a group setting.
- Talk to your midwife or obstetrician. Ask for a different midwife or obstetrician if you feel they do not support you!
Half the battle is feeling safe during labour, so these will all make for very positive steps. But now for the hard part…
Step 4: Work on yourself to address the issues.
For me I had to work on letting go of control (while also retaining control!) and being more open to anything, so having a more flexible Plans A through Z birth plan meant I had thought through many possible outcomes. This included a plan for when I was stressed (I’ll take the Remifentanil, thank you very much!), if labour stalled and they recommended a drip (epidural, please), if my blood pressure went up again, and if the mobile monitoring straps didn’t work again (intermittent monitoring).
I listened to hynobirthing CDs, massaged myself with some calming aromatherapy oils (that worked wonders during labour), and even “did my homework” by watching One Born Every Minute, in an effort to normalise birth in my mind.
Also, be prepared to admit that you need help to resolve any feelings and strong emotions arising from your previous birth. On James’s advice I tried to arrange some counselling with a qualified birth trauma therapist but, despite contacting a few people, that didn’t pan out. As it turned out, I didn’t need it, but you might so it’s something worth thinking about. If you’re in the UK, there’s a good list of therapists on the Birth Trauma Association website.
Step 5: Remember, this is a new baby and an entirely new birth experience.
So relax. If you’ve done all the preparation in steps 1 to 4 above you’ve done pretty much all you can. The rest is down to providence on the day. For whatever reason, you may not get your VBAC – sometimes things go “wrong” and a C-section may end up being the most sensible or the only option for you and/or your baby – or the VBAC might not work out to be as healing as you hoped (you’ve heard of fourth degree tears, right?), but if you’ve done all the things listed above you can come out of other side knowing you made informed choices and owned your birth experience.
Thanks for reading. If you’ve had a VBAC, I’d love to hear your experience. Did you do anything differently re the preparation? Did everything go according to plan? How did you feel about it afterwards? Let me know!