10 considerations for a restorative VBAC
Vicki Hobbs – a respected Perth-based Doula, Childbirth Educator, and Hypnobirthing Practitioner (and much more!) – has kindly provided a guest blog that is packed with valuable content for mums who are considering a VBAC (vaginal birth after caesarean). This is the sort of information that needs to be shared, that women need to know, and I would recommend that anyone wanting to know more attends one of Vicki’s VBAC workshops for more information.
Planning a VBAC?
There are so many things to consider when you are planning your vaginal birth after caesarean (VBAC) and these are just the ones I wanted to put together quickly to get you started, but you have to do your own mind-mapping to work out where you need more information, where you feel strong and confident and where you have mixed feelings and need to explore more.
1. Positive Mind
When you prepare your mind in a positive way, this can help to build a strong platform for labour and birth. Using positive affirmations on a regular basis during your pregnancy is a great way to prepare your mind. Having positive affirmations there during your labour is a great way to keep you motivated and reinforces the power you have within you, because you are a woman, designed for birth.
In my childbirth classes I recommend my clients create a vision board with words and images to help you focus on what a positive, calm birth means to you along with power words such as breathe, release and let go and surrender. Say those words over and over like a mantra.
The main thing about being pregnant again and planning a VBAC is to really enjoy your pregnancy and positively anticipate your next birth. Think about the miracle that has been created within you. You are growing and nurturing another human being that initially was only visible through a microscope.
How incredible is that?
Trust and believe in your body and your baby.
2. Strong, relaxed body
Do whatever you can to help your body be comfortable during pregnancy, effective during labour and achieve a fast recovery after birth.
As a natural therapist, I perform or recommend many complementary therapies that help to prepare your body. Therapies such as pregnancy massage, chiropractic care, physiotherapy, acupuncture, naturopathy, reiki or energy healing, hypnosis and meditation, regular walks in the sunshine, stretching, good nutrition, swimming and meeting up regularly with friends who make you feel happy and laugh to release endorphins.
As a certified Spinning Babies practitioner, I also encourage my clients to do the Three Sisters Spinning Babies techniques every day from the start of the third trimester to help loosen the round ligaments, broad ligaments, diaphragm and pelvic floor for optimal foetal positioning.
Click on the Spinning Babies logo to find out more.
3. Balanced Emotions
When you are fearful, anxious, stressed or angry, you release adrenaline (your stress hormones) for that fight-flight-freeze-appease response.
Producing adrenaline can inhibit the labour hormones, preventing you from going into spontaneous labour. Likewise, releasing adrenaline in early labour when it is not needed may also prevent a woman from going into active labour, so the muscles that create the contractions are not working efficiently or strongly enough to pull up and dilate the cervix and push baby down into the birth canal. This is commonly known as failure to progress and can lead to repeat caesarean.
Your mind, body and emotions should all be in balance and aligned, which creates a beautiful synergy of positive energy that surrounds you so you feel calm, strong and confident about your birth.
Allow yourself to be excited and enjoy it. Enjoy every part of your pregnancy because before you know it you will meet your baby and that is something to get excited about. The more you laugh and feel excited the more you are releasing stress and tension through the body and the mind. Surrender to all the sensations you are feeling, and work on any discomfort in your body by using techniques that help you to feel at ease and more comfortable.
When I talk about “surrendering” I mean that on all levels. Surrendering and letting go of all fear, stress, tension, doubt, fear – anything that might inhibit your birth.
4. You can only do what you are prepared to do!
Only you know what you feel comfortable doing for you and your baby.
Are you prepared to interview your health care providers and do background checks before you sign them up – just like you would for a new employee? Are you prepared to change health care providers when you identify that they are not really VBAC supportive – the well-known bait and switch technique? Are you prepared to forfeit the Obstetrician management fee if you do change? Are you prepared to ask questions and find out the reasons why you are being told you can’t do something? Are you prepared to dig deeper to get evidence-based information or debunk what you have been told? Are you prepared to fight for your rights? Are you prepared to take what you have learned and put it into practice?
We all know that we have rights and choices – but with rights and choices comes responsibility. Are you prepared for the consequences of your choices, if the outcomes are not positive?
5. Independent Childbirth Classes – knowledge is power.
A ground-breaking Australian study on effective childbirth education was released in 2016 by Dr Kate Levett and Professor Hannah Dahlen.
This study highlighted how important it was to not only participate in independent childbirth education classes but to also find a program that included complementary therapies to support normal labour and birth. The research showed that this basically halved the intervention rates for births!
Antenatal classes held at the maternity hospitals are primarily focused on the policies and procedures of the hospital, and what could go wrong and the drugs and interventions that are available, rather than encouraging women and demonstrating how they can birth as naturally as possible and offering alternatives to the medical model. However, I never discourage my clients from attending the hospital classes, because knowledge is power.
For those who can’t attend face-to-face classes, there are plenty of online courses that you can do and this has also been a huge mission of mine; to provide a comprehensive online course, that incorporates live webinars so that I can interact with those who do the course, and you still feel like you have that dedicated person supporting you.
6. Ask questions and make informed choices on what is right for you and your circumstances – not someone elses!
We are all unique – every woman, every pregnancy and every birth experience is unique.
We are so lucky that we can gain so much information from the internet, but sometimes the information is not accurate or is biased. Statistics and information can be manipulated by the person who may want you to make decisions based on their own beliefs or recommendations. Make sure you are reading studies correctly – don’t just skip down to the bottom and read the conclusion – what are the numbers really saying? A small study is not going to provide the big picture and can be misleading.
It is great to ask questions in social media groups so you can find out about what someone did in similar circumstances, however remember the information that you receive is based on that person’s experience. For a woman to make a true informed decision on whether to have a planned VBAC or repeat caesarean, she needs to be provided with accurate evidence on risks and benefits around her own set of circumstances.
We also must acknowledge that two people can review the same risks and benefits and make completely different decisions for what feels right for them.
That doesn’t mean that one or the other is right or wrong.
7. Have a great support team
Your chances of a VBAC increase when you have an Independent Midwife and / or a Doula because they provide continuity of care. Your Independent Midwife or Doula is familiar to you and they have developed rapport with you. They are dedicated to supporting you, encouraging you and focusing on you – nobody else.
They are trained to deal with fears and doubts as they arise, to suggest alternative options, tools and techniques to get you through the intensity of labour and birth. They are your birth coach, that person who pushes you to the edge and then a little bit more. That bond from another woman who is there to protect your space and provide ongoing nurturing, support and a female understanding and connection in birth is one of the most powerful reasons for having an Independent Midwife or Doula.
However, sometimes it is not viable to have an Independent Midwife or Doula, and that is the reason it is crucial that you attend independent childbirth classes with your partner, so that they can be educated on how to be the best support person they can be – don’t settle for anything less.
8. Eating and drinking during labour
Recent studies have now shown that it is important for women to eat and drink regularly during labour to ensure that they maintain their blood sugar levels and energy.
A recent Cochrane review concluded the following:
“Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women. Conflicting evidence on carbohydrate solutions means further studies are needed and it is critical in any future studies to assess women’s views.”
9. As the end of your pregnancy draws near – BE PATIENT
Once you get close to that magical “due date” that you have circled on the calendar, this is where you need all the patience you can muster. For some women it can be frustrating, uncomfortable and stressful, so do things to nurture yourself and enjoy the final days and weeks of your pregnancy rather than focusing on the dates.
You’ve spent all that time waiting, and so many women get impatient at that 38-week mark, they’ve just had enough, and start thinking about induction, probably because they are being pressured into being induced or hassled by well-meaning family members or friends, but the last few weeks even days are crucial for baby’s development and preparing their lungs to work efficiently outside the womb.
Many birth workers use the marathon runner as an example of a woman getting to the finish line during labour and birth. I share this analogy too, but adapt it for the end of pregnancy as well.
Start focusing on your baby needing that little bit of extra time – we know that it is your baby that triggers spontaneous labour by releasing a protein to the placenta when their lungs are ready. You are the marathon runner, almost at the end. You can see that finish line about 800m ahead … flags waving, people excitedly cheering, and in your head you are thinking it is just so close yet so far, you are so tired, so uncomfortable and you just want it to be the end but it seems so far out of reach, and then you start to doubt yourself and your body….
Then you hear your coach on the sideline shouting to you to “keep going, keep it steady, breathe, nurture baby, keep baby safe, you’ve got this, you can do it, I believe in you” and you change your mindset – YOU HAVE GOT THIS …you’re not going to let time beat you… not after all you’ve done to nurture your baby over the whole time of your pregnancy… no way!
And you say:
I’ve got this…
I can do it….
I can get to the next stage when my baby is ready….
I will pace myself …
I will enjoy and savour those cheers on the sideline….
I’ve got this…
I can do it ….
I trust my body and my baby”
Relax all the muscles in your body.
Have a massage then a warm relaxing bath.
Listen to some guided relaxation hypnosis or meditation.
Take long slow breaths all the way down to your baby.
Say I am ready baby when you are ready
10. Breathe – release and let go
Needless to say, that with everything I have covered so far, one of the most important things to learn and practice is your breathing.
Breathing from the diaphragm increases the oxygen flow down to the muscles of the uterus and to your baby and also helps you to conserve energy. A marathon runner needs to ensure that they are getting oxygen to their muscles so that they don’t get cramp and seize up or become tense creating pain and fear – the fear of failure.
This is the same necessity for a labouring woman! You are running a marathon too – a birth marathon – and so you need to ensure that you are breathing efficiently. In my experience as a doula and childbirth educator, I have found that nasal breathing is most effective during labour as it connects with the parasympathetic system of the body and the central nervous system.
However, don’t get stressed about breathing. Just find the best and most comfortable way to breathe for you. Let me focus on one breathing technique to help you during your contractions. Just have a practice – start off by closing your eyes, and then take a long, slow breath in through your nose as far as you can go and then a long slow deep breath out through your nose as far as you can go.
Some women find it difficult to breathe out through the nose, so again, just do what feels right for you. If you have a blocked nose, then it makes sense to breathe in and out through your mouth. Again, long slow deep breaths in and out. Don’t get stuck on trying to nasal breathe when it is too difficult.
When you practice and master the breathing technique it will really help you in any stressful situation not just labour and birth, as it is a universally recognised method of releasing stress and anxiety.
It is like trying to meditate for the first time. Some find it easy and others notice that chatter in their mind, they can’t switch it off, but the more they practice the easier it becomes until they can do it anywhere at any time. I teach my meditation students to focus on the flame of a candle, and breathe. You too can practice this way, quietening the mind, relaxing the body and balancing the emotions.
Do what feels right for you and just breathe.
That is the key!
Vicki Hobbs is a Childbirth Educator (Back to Basics Birthing), Hypnobirthing Australia Practitioner, VBAC Educator, Remedial Massage Therapist specialising in Pregnancy Massage, Birth & Postpartum Doula, Certified Placenta Encapsulator, Hypnotherapist, Aromatherapist, Reiki Practitioner and Life Coach. She is based in the northern suburbs of Perth and can be contacted by email email@example.com or phone (08) 9303 9111. You can view Vicki’s website here