Planning a VBAC Birth: A Midwife's Preparation Guide

Tips & Strategies for Planning a VBAC

Have you had a caesarean section for your most recent birth and been wondering how to increase your chances of a successful vaginal birth after a caesarean (VBAC)? Then look no further, this blog will go through what a VBAC is and how to maximise your chance of having a successful VBAC.

What is a VBAC?

VBAC stands for Vaginal Birth After Caesarean and refers to a woman who has had at least one caesarean and is wanting to try and achieve a vaginal birth for her next birth. It may also be termed NBAC, which stands for next birth after caesarean. Having a VBAC can be a safe and successful birth option for many women, with the current success rate in Australia sitting around 60-80%. The main risk associated with a VBAC is the risk of the uterine scar opening up, this is called a uterine scar rupture, which increases the risk of intrapartum or neonatal death. It is important to balance the risks of a VBAC against the benefits and this will look different for each individual person. 

Why would I want to have a VBAC?

The more caesarean sections that a woman has the greater the risk of serious complications arising. Having a vaginal birth after a caesarean can reduce the risk of increased complications associated with Elective Repeat Caesarean Sections (ERCS). Furthermore, having a vaginal birth means that you can have an easier recovery, easier mobilisation after birth and earlier discharge from hospital. This means that it may be easier to look after your older children as well as your new baby. Women who desire to have a vaginal birth, may also have increased satisfaction with their birth if they achieve a VBAC. 

Can I have a VBAC?

The suitability for a VBAC depends on your individual health, the reason why a caesarean was needed previous pregnancy and the specific circumstances of your current pregnancy. For women who had an uncomplicated lower segment caesarean section, a VBAC can be a great option for future pregnancies.

You should always discuss your specific circumstances, potential risks and benefits with your healthcare provider.

 

Factors that increase the chance of a successful VBAC

There are several factors that increase the chance of having a successful VBAC. These include:

• Having a previous vaginal birth (before or after the caesarean)
• Going into labour spontaneously
• Uncomplicated pregnancy
• Your previous caesarean being due to fetal distress or fetal position rather than the cervix not dilating effectively.

 

Factors that reduce the chance of having a successful VBAC:

• Having a previous caesarean section due to your labour not progressing
• Having a macrosomic baby (greater than 4.5kg)
• Having a BMI greater than 30Kg/M2
• Advanced maternal age
• Short stature
• Concerns for the baby, mother or placenta
• More than one previous caesarean section

 

How to prepare for a VBAC

• The first thing to do when you are preparing for your VBAC is to understand why you had a caesarean section in your previous pregnancy. Understanding exactly why you had a caesarean and how that operation was performed can help you to understand your individual chances of having a successful VBAC.
• Next, it is essential to educate yourself on everything birth!! Educate yourself in whatever way works for you, whether that is attending One Mama Midwife Birth Classes, doing reading online, listening to podcasts or talking to your health provider. Educating yourself will help you to understand the process of birth and the best ways to maximise your hormones in labour and birth.
• Create a calming birth space where you will feel calm, loved, respected and safe.
• Utilise complimentary pain relief options as much as you can. Complimentary pain relief such as the Birth Comb, TENS Machine and water mean that you are able to continue utilising mobilisation as well as gravity during your labour and birth.
• Be active during your pregnancy, this will help to increase your blood flow to your uterus, support your muscles and ligaments and thus increase your chance of having a successful VBAC.
• Do perineal massage from 36 weeks to help prepare your body for labour and reduce your risk of tearing. Your BodyICE Woman perineum strip can be warmed up and used on your perineum prior to starting the massage to help warm up the muscles.
• Have a supportive birth team and healthcare provider. This will ensure that you are completely supported and having trust in your healthcare provider can help to increase your VBAC success rates.
• Believe in yourself – labour and birth are just as much of a mental game as it is a physical one. Believing in yourself and your body comes with education, but it is a really important factor in increasing your VBAC success.

 

Remember, every birth experience is different and there is no right or wrong decision there is only the decision that is best for you and your family. These tips can help you to feel prepared and increase your chances of having a safe and successful VBAC, however they are no guarantee. It is important that if you have any concerns during your pregnancy, that you talk to your healthcare provider.

 

Written by Lauren Brenton

Endorsed Midwife, Clinical Midwifery Specialist and founder of One Mama Midwife Pty Ltd