pelvic health, physical therapy, postpartum, pregnancy, women's health

Planning a VBAC

Through a series of random, fortunate events, I have met a wonderful fellow pelvic health advocate, childbirth educator and occupational therapist who also happens to be from my hometown which neither of us currently live in (it’s a small world after all)! I am so grateful she took the time to write this superb post on VBACs. You will find her website and information at the post conclusion. ENJOY! — Lacey


 

It was once thought that if a woman had one cesarean delivery, all of her babies should be born that way. Today, we know that many women can undergo a trial of labor after a cesarean delivery (TOLAC), and 60-80% will successfully achieve a vaginal birth after cesarean (VBAC)

The American Congress of Obstetricians and Gynecologists (ACOG) deems vaginal birth after cesarean (VBAC) safe and an appropriate choice for most women who have had a prior cesarean, including some women who have had 2 previous cesareans according to guidelines published in 2010.

A successful VBAC has fewer complications than an elective repeat cesarean. However, a failed trial of labor after a cesarean (TOLAC) has more complications than an elective repeat cesarean. The most injuries occur when a repeat cesarean becomes necessary after a TOLAC fails.

 Let’s discuss some of the benefits, risks, and ways of preparing for a successful VBAC.

Benefits:

  • Avoids another major abdominal surgery.
  • Lowers a woman’s risk of hemorrhage and infection.
  • Shorter postpartum recovery and hospital stay.
  • May prevent women from possible future risks of multiple C-sections such as hysterectomy, bowel and bladder injury, transfusion and abnormal placenta conditions.
  • Option to have a non-medicated birth.

Risks:

  • Uterine rupture
  • Higher risk of urinary stress incontinence with woman who have had both a cesarean and a vaginal delivery

The biggest concern is uterine rupture. According to ACOG the risk of uterine rupture during a TOLAC is low, between 0.5- 0.9% but if it occurs it is an emergency situation. Although the rate is very low the fear of medical liability has caused many hospitals to refuse VBACs all together. As I will discuss further, finding the right provider and having a good plan for your VBAC is crucial.

There is higher risk of urinary stress incontinence with people who have had both a C-section and a vaginal birth, however, this is something that can be resolved or improved without surgery. This is also something that commonly happens no matter what type of birth you have and even to women who have never given birth. Working to improve the function of your core and pelvic floor prior to and after birth is very beneficial.

Tips for Planning your VBAC

1. Picking your Birth Provider 

This is probably the most important aspect that will determine if you have a VBAC or not. Having a trusted and supportive care provider can make all the difference. Whether you choose to birth at a hospital or have an out- of – hospital birth with a midwife, you need to interview your potential provider about their experience and policies regarding VBACs. Talk with people in your community like doulas, childbirth educators, and L&D nurses who can usually give recommendations on VBAC friendly providers.

The International Cesarean Awareness Network (ICAN) is a non-profit organization whose mission is to improve maternal-child health by reducing preventable cesareans through education, supporting cesarean recovery, and advocating for vaginal birth after cesarean (VBAC). ICAN has compiled a directory of U.S. hospitals that do and do not provide medical care for VBAC. Women can access ICAN’s Hospital VBAC Data Base at http://ican-online.org/vbac-ban-info .You can also check their website for cesarean rates.

2. Healing from your Previous Cesarean

Addressing unresolved issues from previous birth(s) is important. Many women report pain in their scar area years after C-section.  If your scar seems to be stuck and does not glide like the rest of your skin then it is adhered. Scar adhesions are strands of collagen that form in the body after surgery or trauma. These powerful strands can wrap around structures and can restrict blood flow or reduce the function of internal organs. When you have multiple cesareans you are getting cut multiple times in same area which will cause more adhesions and scar tissue to form.

Do you feel disconnect to your tummy and pelvic floor since your C-section?  Your muscles may shut down around a surgical site to allow for healing. This means your abdominals and pelvic floor muscles may go on a vacation after a C-section causing weakness which can lead to incontinence. Your pelvic floor can also tense up due to the pain of a C-section. A pelvic floor can stay tense which results in dysfunction. It is important to be able to let go and fully relax your pelvic floor muscles for a vaginal birth.

What can you do if you have these problems? Work with a women’s health physical or occupational therapist that is knowledgeable in scar management techniques, and core and pelvic floor function.

If you are holding on to negative emotions associated with a previous birth it can be helpful to seek out help from a professional or trusted person. You can also check your area for postpartum support groups. An added benefit of a VBAC is that it may help a mother heal emotionally from her previous cesarean. Non-medicated births and exclusive breastfeeding help to keep hormones working properly and make you less likely to experience postpartum depression. Postpartum support for both moms and dads can be found at www.postpartum.net

3. Nutrition and Fitness

As with any pregnancy you want to keep yourself as low risk as possible. Being healthy through food and exercise will not only help you in the delivery room, but your will feel better during pregnancy and recover more quickly postpartum

Birth Boot Camp has designed a program specifically for the childbearing year. The Food and Fitness program will help you build a great physical foundation for your pregnancy, birth, and baby.

4. Education

Take a birth class that is right for you. Many people think birth classes are just for first time moms. But if you did not previously have the birth experience you desired a childbirth prep class can be a great way to prepare for your next birth. Make sure your birth class curriculum includes plenty of information on VBAC so that you can make good informed decisions.

5. Chiropractic Care

Many birth professionals feel that chiropractic care increases VBAC success rates. The Webster Technique has become a familiar term in the pregnancy and birth conversation. More and more families are seeking out chiropractors who are proficient in this technique as a way to support an easier birth. To find a Chiropractor who has completed advanced training in caring for pregnant women go to https://icpa4kids.com/

6. Build your Support Tribe

In addition to finding a supportive birth provider it is helpful to surround yourself with positivity and supportive people. Here are some ways you can do that.

  • Hire a doula! This can make a huge difference and is SO worth it.
  • Seek out others who have had a VBAC and hear their experiences.
  • Join online VBAC groups.
  • Attend local ICAN meetings.
  • Read or listen to birth and VBAC affirmations.
  • Practice relaxation and stress reduction techniques.

You CAN have an AMAZING VBAC!

Nikki Goodale, OTR, CLT, BBCI

http://www.easttexasbirthclass.com/


References

(2010) Ob Gyns Issue Less Restrictive VBAC Guidelines. Retrieved from https://www.acog.org/

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