Melbourne Doula

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Gloria Lemay on VBAC (the Very Beautiful and Courageous Birth)

I want to share something that has been running through my mind all day about how you can be successful with your VBAC births. Many births begin in the night…. the woman will get up to pee, feel her membranes release and then an hour later begin having sensations fifteen minutes apart. Because we think of birth as a family/couple experience, most women will wake up their husbands to tell them something’s starting and then, probably because we all hope we’ll be
the 1 in 10,000 women who don’t experience much pain, we start getting the birth supplies organized, fill up the water tub, etc.

I have seen so many births that take days and days of prodromal (under 3 cms. dilation) sensations and they usually begin this way. The couple distracts themselves in that early critical time when the pituitary gland is beginning to put out oxytocin to dilate the cervix. Turning on the light, causes inhibition of the oxytocin release. Many couples don’t call their midwives until they’ve got sensations coming 5 minutes apart at 7:00 a.m. but they’ve been up since midnight timing every one of the early sensations. If they had called their midwife at midnight she would have said “Turn off the light and let your husband sleep as much as possible through the night. You, stay dark and quiet. Take a bath with a candle if it helps and call me back when you think
I should come over.”

That first night can make all the difference and yet so many couples act like it’s a party and don’t realize they are sabotaging their births right at the beginning. Staying up all night in the early part does two things–it throws off the body clock that controls sleep and waking and confuses the brain AND it inhibits the release of the very hormone you need to dilate effectively.

When you begin to have sensations, I urge you to ignore it as long as you possibly can. Don’t tell anyone. Have a “secret sensation time” with your unborn baby and get in as dark a space as you can. Minimize what is happening with your husband, family and the birth attendants. What would you rather have–a big, long dramatic birth story to tell everyone
or a really smooth birth? You do have a say over your hormone activity. Help your pituitary gland secrete oxytocin to open your cervix by being in a dark, quiet room with your eyes closed. - Gloria Lemay, Vancouver

Pam wrote:

"This describes what went wrong at my first birth (stayed up all night timing contractions…stupid, stupid, stupid, and was totally wiped out by morning), and could have been improved at the second, when I lacked a place to stay, dark and quiet. I printed it out for my dh to read, and am putting it in my file of important things to remember when labor starts, within the next
couple weeks."

The Day of the Birth

The female uterus is a very strong organ that maintains its integrity and resiliency through the birth process AS LONG AS IT HAS NEVER BEEN CUT. One obstetrician explained it to me, thus: ” The nulliparous (first time birther) uterus is as strong as a rugby ball. You could kick it all over a field and it would never break. However, if you cut a rugby ball and repair it, it will still be quite strong and may work all right in most games but one day someone will land a kick on it that breaks it open again because the integrity is never quite perfect again with a repair.” This is the source of the obstetrical concern about VBAC births. Most women attempting a VBAC will
do absolutely fine and the scar where they were cut will hold strong. It is 1 woman in 200 VBACs who will have a rupture of the scar. It is essential that VBAC births are not induced or augmented IN ANY WAY.

If the physician/midwife were to give a VBAC woman misoprostol (Cytotec), syntocinon, castor oil, strip the membranes or use any other form of induction then that would triple her chance of having a uterine rupture.

I believe that VBAC women have longer, gentler births because Nature is compensating for the scar. There must be no hurrying. Many midwives would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally.

What are the signs of rupture?
- stabbing pain,
- unusual bleeding,
- decelerations of the baby’s heart,
- or a peculiar shape of the abdomen.

In most cases, the mother is the first to know that “something’s wrong”, “something’s tearing”. IF she is unmedicated. For this reason, the VBAC woman must be having her birth with all her senses active (no epidural). Very rarely, it is possible to have a uterine rupture without the mother feeling it.

Third stage

The doctor/midwife must be especially careful with the birth of the placenta in a VBAC because there is a slightly increased chance that the placenta might be adhered to the scar, and cord traction (pulling on the cord) could cause the uterus to prolapse. A physiologic third stage (no routine oxytocin and no pulling) is something that should be included in the birth plan.

After the birth
After the birth, VBAC women need to be told that they can walk upright. They can’t believe that they can straighten at the waist right after giving birth. Then, they can’t believe they can do sit-ups and leg raises on day one. Usually by day three, you’ll find the VBAC woman working out at the gym! With VBAC women, the complaints are very few in the postpartum period because they are comparing to post-surgery pain and any minor scrapes and bruises seem like nothing. In the years following the birth, these women will send you more clients than anyone else, and many of them will train to be doulas.

A VBAC is an amazing experience for everyone involved. Very Beautiful And Courageous.

Read more from Gloria Lemay here

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