Melbourne Doula

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A Midwife's Recommendations for a Successful VBAC

Midwives specialize in keeping birth normal. Many independent midwives support women planning VBAC at home. Homebirth midwives have a high rate of successful VBACs compared to hospital-based VBACs. In Victoria, since birth centres are not permitted to accept women desiring VBAC, women who do not want to return to the system that led to their primary caesarean, who want to try gentle birth/midwifery-model care, have no choice but to birth at home.

These are the recommendations of one such midwife, who has supported many women for their home VBACs.


1. Own Choice of Primary Caregiver – one who believes that you’re capable. Care should be centered around vaginal birth and the caregiver should have a high normal birth rate. Avoid careproviders who practice “Just In Case Obstetrics”.

2. Own Choice of Birth Place

3. A Belief that Your Body is Capable of Vaginal Birth

4. 100% Commitment to VBAC

5. Partner Supportive of VBAC - He may not be on the same page as you, or exactly where you are at, but he needs to be supportive of your choice, and of your right to assert your choice, even if he has his own reservations at this stage in his journey of discovery.

6. Extra Birth Support – a friend or relative who believes in birth, VBAC and YOU and will not be spooked by the effort and process of birth. A trained Doula (birth attendant) can be more objective, is paid by you to be in your corner and to be at your service no matter what. A doula is able to remind you of your choices, your birth plan preferences and any alternatives there may be.

7. Practice Optimal Foetal Positioning – daily from 30 weeks, to encourage baby to lie in an anterior (front-lying) position. Hands & knees or elbows and knees, for 20–30 minutes twice daily. As soon as you wake up and just before sleeping is a good time to do it. And while watching TV. Avoid reclining backwards (like we normally do when sitting on a sofa).

8. Increase Level of Physical Fitness – if your lifestyle is normally quite sedentary. Regular exercise helps your body to work efficiently. Walk for half an hour per day absolute minimum. Better yet, regular exercise (walking & swimming are ideal) for an hour per day.

9. Prepare for Birth - have an understanding of what is involved in birth:
- if it is night when labour starts, stay in bed, sleep or doze between contractions
- Strategies for Pre-Labour: - keep eating & drinking – avoid dehydration – eat complex carbs like athletes do – keep moving – don’t pay too much attention to early contractions
- Labour is a muscular activity
- Practice relaxation & breathing
- Calmbirthing
- Childbirth Education classes
- Visualisations and affirmations – combat doubts & fears in your mind, speak out the positive
- pelvic adjustment with Chiropractor who understands the Webster Technique
- Deal with emotional / social / psychological issues, emotional stuff from the past,trauma, relationship issues.
- Be prepared for ‘wild card’ crises of confidence

10. Spontaneous Onset of Labour

11. No Interventions to Physiological Process. Avoid vaginal exams, which undermine your confidence.

12. No Restrictions – on your physicality, time, food & fluids. No IV, able to walk around.

13. No Continuous CTG (foetal heart monitor) - Say no to CEFM. (Continuous Electrical Foetal Monitoring). Have a document in your notes stating that you decline CEFM. Use strong language: “I do not give my permission for CEFM and I take responsibility for this.”
CEFM leads to caesarian.

14. Have your doula come to your home, and stay at home until the last possible minute.

The hospital is a fear-based system. Surround yourself with positivity. Do not let your options be pushed aside.

Many women make the same choices and get the same outcome. If you want a different outcome, make different choices.

You have to want it, believe that you can. De-brief fully from the first experience. This will take time, and counseling may help.

Reasons for the Primary Caesarian – this is a pattern we commonly see:
- overdue
- induced
- a long posterior labour
- membranes ruptured first (common in overdue pregnancy with baby in posterior position)
- going to hospital too soon
- still only in pre-labour – but NOT sent home by the hospital
- waters broken and augmentation (syntocinon) given
- cascade of interventions
- if you are induced, you are 60% more likely to have a c/s
- if you have an epidural it increases the likelihood that you will have a c/s (Check Cochrane and PubMed for research).

Of women in Australia who had a primary c/s, only 28% are given an opportunity to try for a VBAC. 72% have repeat c/s. Of the 28% who try for VBAC, 58% succeed in the hospital system.

Independent midwives have nearly a 90% success rate for VBAC at home.

Homebirths Australia-wide have an 8% c/s rate compared to a nearly 40% c/s rate nationally.

The homebirth transfer rate nationally is 19%. This is a lower transfer rate than most birth centres, who due to stringent policies laid down by obstetricians, have a transfer rate of around 40%.

So these are the thoughts of one of our independent midwives, working here in Victoria, with extensive experience supporting women birthing at home following a previous caesarean.

6 comments:

Anonymous said...

This makes me want to cry! For so many reasons! At 19 I was rushed off for an "Emergency" C-Section
It was THE WORST experince of my life! I've paid for it for years now. Im currently pregnant with my third child and have this voice in me thats screaming for a natural birth! NONE of this information was available to me.... I get so sad thinking of the 'young me' and how horrible it all was. This time around I'm researching like I've never researched before. I will travel ANYWHERE in Australia to find the right place to give my body the chanve to deliver naturally...

treebytheriver said...

Anonymous, I feel for you and agree it is awful that this information is not freely given to women - but instead women are often herded unsuspectingly into money-making systems. I hope you read this, and please give me a call: 03 5966 5980 - because whereever you are, I would love to hook you up with some VBAC-friendly doulas and midwives. There are birthwise women who would love to support you.

Cheyne Butler said...

I had a emergency c-section when I was 18 with my son he was posterior position and got stuck after 26 hours in labour (6th October 2009).
I recently had my second child my little girl (April 20th 2012). I had her by elective c-section, My doctor gave me the chance to VBAC but she was in transverse position and I didn't have very much information. I really wished I could have at least tried. I have got the go ahead by my doctor to try and conceive another baby as we want two close together, but am I able to try VBA2C? with a 13/16 month age gap? My heart is yearning to have a natural vaginal birth. I am very down that my children had to be ripped from my body so unnaturally. I am so happy and in love with my children yet so sad about how they had to came into this world. I have started to research and plan my next pregnancy and birth before I even conceive so I no I can get the best chance of a successful VBA2C. Any information would be much appreciated! I would be so broken hearted if I had to have another c-section...

Cheyne Butler said...

I was 18 when I had my first child on 6th October 2009 I had to have an emergency c-section due to my son being in posterior position and getting stuck after a 26 hour labour.
So when I decided to have another baby I was very determined to have a VBAC. My doctor gave me the go ahead and when it came closer to my due date a problem came up my daughter was transverse position! I was devastated. She was slowly making her way down. I was very uneducated on VBACs and I really wished I had of given it a go. I am so heart broken that my two beautiful children had to come into this world in such an unnatural unfair way. Ripped from my body! Well my husband and I both are wanting to try and conceive another baby and have the go ahead by my doctor as we want our kids close in age. But he has informed me I will need to have another c-section. I really do not want to be cut open again and have my baby like that and I have been looking and researching as much as I can about VBA2C and I was wondering if you can give me any advice and is it possible to have a VBA2C 13/16 months after c-section?
What is my best options and best chance? All I want is for a good chance!
Thank-you

Jennifer said...

I did every one of your 14 things for my amazing, wonderful home birth VBAC last year. It went perfectly, quickly, absolutely textbook. Or, as much as we could tell since my midwives, doula and family left me, my vagina and my baby to do what came completely naturally. I hope other women are able to achieve the birth they want with this advice.

Agata Panfil said...

Hi, I'm form Poland. I'm grateful for your blog!!
I'm expecting my 3rd baby (sep '16). I had c/s at first time since my baby boy was big (4660g 63cm), he wasn't going down, and at the end od our 18h birth journey they gave me oxitocine (despite I declined) what caused heart rates went down. The labour was not supported and I was not prepared enough, so wasn't my housband. The fear, the circumstances, big amount of stuff, students etc. The lack of support in providing the labour. Thats how I see the reasons of my first c/s.

The second c/s was rational, as my housband said. Macrosomy again (4290g, 57cm), I had no support despite I wanted vbac. The doctor and my huby old that it is better to have c/s now in the evening rather than some emergency at night. There was NO reason to do this at that time. I felt pressured and I chickened. I regret it weeeery much!! And still feel sad thinking of it. The second baby boy is now 2yo. So again there will be 2,5 years from birth to birth.

Now I'm determined more and preparing correctly. I didn't do my homework last time. But this time will be harder, my doctor only scares me telling tragic stories about vba2c's. I want to vba2c in a hospital since it will give me a sence of safety (if sth happens). But it also gives a lack of feeling safe since many of the stuff will be against. I'm planning to have doula or midwife attendance rather than husband, who doesn't belive in vbac (yet, I' want to have hope it will change).

Are there some more recomendations for me to prepare for vba2c?

Greetings from Poznan :)