VBAC’S
Vaginal Births After C-Section and how to prepare for one
First we need to ask ourselves…..
Why did we have the C-section in the first place.
This is going to determine what the potential issue was with the last birth and how we can try to mitigate this for the next one.
Some reasons for C-sections are problems that we can do absolutely NOTHING about and there is no point stressing about this happening again as it is simply out of our control.
However there are many C-sections that take place UNNECESSARILY!
This may be due to maternal exhaustion unable to push on (we will discuss how to mitigate this in future)
This may be due to the cervix not opening after hours and hours
This may be due to baby not moving down
This may be due to contractions not being effective and strong
So in this blog post I am going to break down the most common reasons C-sections happen, and how to prepare for a VBAC in the future.
Lets start with the easiest:
Placenta Previa
This is when the placenta forms and grows over the cervix. You absolutely cannot birth vaginally with placenta previa.
There is nothing you can do to encourage or discourage placenta previa.
If your first babe was born via C-section due to placenta previa, with your new pregnancy, if you don’t have placenta previa you should prepare yourself for birth as a first time mamas would! No need to do anything different than this
Prepare your body, mind and partner for a natural birth experience!
Below is the the NBC method to a natural birth.
Breech
Okay so your first C-section was for a breech babe- Fair call- I want you to reflect.
Sometimes our bodies can naturally encourage baby into a breech and there is nothing you can do about it, however, quite often your baby can be in a Breech position due to imbalance of the ligaments.
When the ligaments surrounding the uterus are tight they literally decrease the space in the uterus for baby to move. When the uterosacral ligaments specifically are tight they decrease the space at the bottom of the uterus/top (inlet) of the pelvis- if these are a little tight they don’t allow the baby’s head to engage in the pelvis however to float above the pelvis (will go deeper into this in the next sections), if they are so tight that the head doesn’t have space to float above the pelvis the baby is in a breech position (as a newborns booty is smaller than it’s head hehe).
So I invite you to reflect, do you recall your baby rotating positions until later in pregnancy? Was baby able to engage in the pelvis before labour started even though it was just the booty?
This may be a sign that you were BALANCED and baby was simply just physiologically meant to be in a breech position.
Or was your babe pretty well locked into one position from 30(ish) weeks?
Did you feel pains/stretching in your ligaments/muscles surrounding the uterus and pelvis?
Were you active and stretching with your first pregnancy?
Where you rounding into your spine during pregnancy?
If this is the case then it may be due to tight ligaments and decreased space in the uterus that your baby was Breech.
Now I DEFINITELY don’t want this to be a blame game or an opportunity to beat yourself up for this ABSOLUTELY NOT.
You only know what you know and you obviously didn’t know at the time, and it’s now past with nothing we can do about it.
If anything it is a great thing because it means that there are things we can do about it for this birth!
If this is you this will include plenty of physical preparation for balance in the ligaments, to create space in the uterus for your baby to be in the optimal position for birth, and descend efficiently through the pelvis during labour allowing labour to progress effectively.
Check out our the ultimate ONLINE physical preparation for birth workshop- Pregnancy Body Balance Workshop HERE
Did your labour never start…. Leading to induction….. Leading to a cascade of intervention (including the epidural)
This is sometimes avoidable and sometimes not.
As a profession of Obstetrics and Midwifery, we do not know how or what starts labour unfortunately. So when your due dates comes and goes, we do our best however this method of induction is not very conducive towards and pleasurable natural experience.
One of the potential CONTROLLABLE reasons labour may not start can be:
The Utero Sacral Ligaments being so tight —---> Bubs head can not engage in the pelvis —---> this makes the body not put itself into labour knowing its not ready.
How this can be mitigated is through Body Balancing to create space at the bottom of the uterus/ inlet of the pelvis for baby to effectively engage in the pelvis well before labour even starts.
What can also help with C-section history:
Having deep understand and education about the risk of Induction vs. Waiting for labour to naturally start. Could we maybe wait longer this time using our value based decision making to determine when we actually want labour to start.
Having a deep understanding and education about induction, and how to encourage it to the natural path.
Having a supportive partner that can advocate for you during your induction to not allow the interventions to cascade but each intervention is an informed and value based decision that can be declined, partly accepted, or fully accepted.
Learning ‘How to Cope with Pain in Labour’ (click to view the workshop HERE ) to avoid the epidural if a natural birth is what you desire
We teach all of this including the value based decision making in our Appetence Birth Workshop. (view this workshop HERE )
Did labour start and was going fine and within 10(ish) hrs ‘something’ happened to make you go for an emergency c-section
This ‘something’ could be a:
Bleed
Babies heart rate suddenly dropped and didn’t recover well
Both rare circumstance!
Unfortunately most of this time this is just dumb luck and there isn’t alot we can do to control this and mitigate the risk. This is the perfect time to surrender control and trust/believe in the process of birth (even though given your history this can be really hard!).
In birth we always discuss here at NBC the delicate and beautiful balance between holding on tight to what we do have control over, not giving away our power of decision around what we CAN control- And the ultimate surrender and acceptance to what is out of our control (including the past).
I am always here to talk out this balance with you and how you can incorporate into your birth story/plan.
NOTE
The reason is say ‘10 hrs isn’t based on anything specific but essentially what I am trying to get at is that there is no sign of an ‘obstructed labour’ being the cause of the ‘something’ happening.
Labour was 24hrs + leading to a c-section due to baby not moving down (obstructed labour) cervix not opening (Failure to Progress)- This may or may not include babies head being in an awkward position in the pelvis (tilted to the side up looking up (de-flexed))
This is unfortunately what we see MOST being the reasons to a C-section.
We label 33% of births here in Australia as an obstructed labour however the World Health Organisation (WHO) states that a ‘normal’ physiological amount of obstructed labours is 3%.
So why are we having all these obstructed labours?
I believe this is due to 2 things:
1- Imbalance in the ligaments and muscles that surround the uterus and pelvis previous and during birth.
2- The lack of support during labour helping you be ‘Intentionally active’ during your labour experience to create space in the pelvis in the right planes, and reading the signs from your body and your baby to tell if baby is a little stuck or tight and creating space where that is.
Okay lets break each of these down.
Ligaments and muscles that surround the uterus and pelvis have 2 roles. To encourage your babe into the optimal position individual for your pelvis during pregnancy and 2 guide bubs like a road map to flex and rotate its heads helping babes navigate it’s way through the boney pelvis.
If the ligaments are imbalanced they guid baby into a suboptimal position for birth and act as a little road block within the pelvis, preventing babe from moving down.
Everyone has a different shaped internal pelvis and we have no idea what shape yours is before birth. If you tend to have a pelvis on the smaller side (keeping in mind your body would NOT make a baby is couldn’t birth) then you will need to be very intentional with your positions and movements throughout labour to be CREATING SPACE in the plane of the pelvis your baby is in.
With a combination of birthing in an environment and company that doesn’t help you get into your intuitive state of mind, a fear based approach to birth, no one in your birth team who understand the inner workings of the pelvis, active labour, or sign that baby is stuck/labour not progressing- this is a recipe for a C-section unfortunately.
This is why we teach our birth partner in our Appetence Active Birth workshop (view this workshop HERE ) literally all of the above!
How to create an environment conducive to birth helping you get in the zone
How to know where babe is in the pelvis and how to guide you with positions to create space in the pelvis
How to support you emotionally during labour helping you get into the intuitive zone further
How to advocate for you and communicate with the midwife for you so you feel comfortable and protected through your labour (SUPER conductive to all the delicious labour hormones)
SOMETHING TO NOTE
VBAC’s are very much a mental game as well as a physical one. Alot of trust in the body and the process of birth has been lost whether the initial C-section was in your control or not.
I find when mamas can logically diagnose WHY the initial C-section happened- this can really help them deal with and mitigate this problem to move on to the next current birth. In addition you need to put in the mental work. Meditate on your birth. Rewrite the neural pathways to cultivate trust in your body and the natural process of birth. Learn to surrender to what we cannot control and hold on tight being intention, aware and empowered in what we CAN control.
Do none of these quite answer your VBAC questions?
Do you want to discuss your VBAC birth desires and how you can individually prepare?
Reach out to Amy to discuss or to book in with any of our services xx
Click here to watch the video or here for the podcast!
