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.