The number of caesarian births has doubled over the last years for various obvious reasons.
The fact that most first (primary) births are too erratic for western medicine is only one of them. Not to say that caesarian births are not helpful, thanks to the opportunity that many women and children have been saved and safely delivered in emergency cases.
However, the statistics that about 23% of women in sophisticated regions like Australia and USA undergo caesarian called for another awareness program. Primary caesarian (for the first child) is often the reason women opt for the knife on their subsequent births. Calls for “Trial of labor after caesarian (TOLAC)” has reaped benefits and more women can now consider “Vaginal birth after caesarian (VBAC)”.
There are many successful cases of such births, although various preparations are required to ensure safe delivery. Here are some insights for preparing for a VBAC Birth.
1. Take sufficient time to learn about VBAC
This may sound like a time-consuming and tedious activity. However, it is very important and will help you with all other preparations. It may be something simple as browsing childbirth websites and self-learning. You can also take a childbirth class on VBAC. Take a loved one or your spouse along, if needed. While learning about VBAC, discuss your expectations and concerns with your physician who have all your medical history about the caesarian and uterine procedures you have had in the past. There is no preparation without facts, therefore, taking time to learn the basics, benefits, risks and management of post-caesarian births are the key step in preparing for a VBAC birth.
2. Find a well-equipped facility you will deliver in
Delivery is the most intense part of the whole process of childbirth and many things can go wrong calling for urgency and use of advanced medical equipment. After-caesarian births, it may expose you to scar opening or need for a second caesarian in failed TOLAC’s. You must therefore find a fully-equipped facility where you plan to deliver your baby through natural labour. This will not only be important when things get urgent, but also helps to reduce the anxiety and fears during the time of your pregnancy. The facility should be equipped for VBAC births and urgent C-section.
3. Wait at least 9 months before getting pregnant
If you have had a C-section within the last 9 months, there is a chance that the scar may open up. Trying vaginal birth within the short duration can also expose you to various complications. Statistically, those who wait for up to 18 months or more before getting pregnant again (after C-section) have more success rates in TOLAC births. It is also considered the safe birth-to-birth interval for normal births since it ensures full recovery from the strains of pregnancy and childbirth.
4. Avoid induced labour unless ultimately necessary
Women may have to induce labour for various reasons and while some are supported for a good cause, others are unacceptable and should be avoided as often as possible. Cases where pregnancies have stayed longer than 41 weeks may call for induced labour for the health of both. In other cases, induction is performed for suspected big child although this is not supported. Even worse, some induce labour for their own convenience or that of the care providers. It is important to always limit labour induction to clear compelling reasons and cases for the procedure. Most drugs used for induction will intensify your contractions and this increases the risk of uterine rapture especially if the cervix is still closed.
Avoid agents that ripen the cervix, particularly if you must use labour induction. Research shows that there are some agents found in various drugs that increase the chances of scar rupture and re-opening. Since induced labour will cause stronger contractions, it is important to avoid such ripening agents as a way of eluding uterine rapture. “Prostaglandin E2 (Dinoprostone)” found in Cervidil and Prepidil is an agent known to increase the chances of scar rupture. The risk is even higher when used in combination with drugs like Pitocin (Pit) which are synthetic oxytocin. “Prostaglandin E1 (Misoprostol)” commonly present in Cytotec is another agent that is the riskiest option. In fact, it is already considered as contraindication and many experts have concluded that it is not safe although further research is needed.
5. Never use synthetic oxytocin in early labour
The use of synthetic oxytocin early in labour appears to cause various complications and increases the risk of uterine rapture of the cervix and re-opening of C-section scars. However, using them when labour is underway does not amount to any risks since the cervix has already opened. An example of common synthetic oxytocin used in induced labour is Pitocin or just Pit.
6. At the back of your mind, be prepared for a C-section
Not all cases of VBAC births go safe. Complications with the placenta and umbilical cord may arise despite the best preparation. Such complications call for a second caesarian birth and are often quite urgent. It is therefore only wise to be ready for a C-section when emergency hits.
Other necessary observations
There are several other observations necessary when preparing for a VBAC birth. The use of internal contraction monitoring equipment is not recommended since it limits mobility and increases the chance of infection. The machines may also register a drop in contraction when the scar gives way, although this is reportedly never the case. Drinking and eating during labour is prohibited for the fear of vomit infection (in the case of general anaesthesia).
Preparing for a VBAC birth is a long-term determination and you must remain focused on VBAC until your child is delivered. Some opt to hire labour specialists and midwives during the entire time of the pregnancy and work with caregivers to delay hospital admission until they are in active labour. Doctors will usually grant wishes for caesarian in weak moments. You must therefore be determined to have a safe VBAC and work for it from the start (as soon as you make the decision).