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Author
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Topic: Successful VBAC
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<Kelly>
unregistered
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posted 10 November 2004 11:54 AM
I'm going to be attempting a VBAC, I'm due Mid April with my second child. My first labour ended in an emergency C/S after I had SROM with no natural contractions, so I was augmented, still no progress, so I was given a epidural so the oxytocin could be increased (they told be it would be very painful and constant). I still did not progress and eventually there was fetal distress. My baby was Posterior, and a little crooked. What I'd like to know is: 1.good positions for labour 2.what interventions to avoid? 3.What to ask my midwife 4.What are my chances given previous birth 5.What will be different between normal vaginal birth & VBAC? Thanks for your time,
Kelly
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Mary
Moderator
Member # 461
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posted 10 December 2004 02:56 PM
Hi Kelly
It’s often the case that when a baby is in the posterior position, the membranes rupture before the commencement of labour. So, one aim should be to get the baby in the best possible position before labour begins.
1. Good Positions – start with good positions in pregnancy to encourage the baby into a head down, back facing out position (anterior). Read “Optimal Fetal Positioning’ by J Sutton and P Scott. Watch your posture, ie don’t slouch in chairs or spend too much time in a semi-recumbant position as these encourage the baby in to a posterior position. Swimming freestyle is good, practising yoga, walking up stairs, forward lying into a beanbag, or sitting astride a chair leaning into a pillow. Practise squatting when you know the baby is in a good position as this will encourage him/her into the pelvis, ready for labour.
2. Positions in Labour – be as active as possible within reason ie don’t wear yourself out!! Listen to your body – it knows what to do to get the baby down and out. Hip rocking/gyrating/circular movements are great. Be as upright as possible to increase the pressure of the baby’s head on the cervix. Squatting, walking, sitting on a birth ball and bouncing gently up and down or doing circular movements, water immersion/shower etc. The main point is to keep moving. Don’t get stuck in one position the entire labour as this may slow things down a bit. Practise a whole range of positions and movements so that you’re comfortable with them in labour (I’d recommend going along to an Active Birth Workshop in your local area).
3. Interventions to avoid –
induction – not recommended in women who have had a previous c/s as the risk of uterine rupture is slightly higher
augmentation by rupturing membranes – having some amniotic fluid in front of the head, between it and the cervix, acts as a lubricating fluid to enable easier movement of the head into the position it needs to assume to be born. ie in a posterior presentation it allows the head to rotate more easily into the anterior position. When the membranes are ruptured, the contractions become more intense and painful. The research shows that AROM (artificial rupture of membranes) only reduces the total length of labour by about an hour.
Try and avoid an Epidural – it interferes with the natural hormonal responses in labour ie endorphins, oxytocin. Epidurals MAY mask the pain of uterine rupture. Interferes with the ability to know where the baby is, sense it’s descent and to push the baby out to be born.
continuous fetal monitoring – the research shows that intermittant fetal ascultation is just as effective as continuous fetal monitoring and, in fact, CFM has been shown to increase the use of c/s. CFM can certainly inhibit a woman’s movements.
numerous vaginal examinations – they’re invasive, an interruption, increase the likelihood of introducing infection to the mother and baby, painful and can interfere with the whole process of labour ie the hormones, the ambience/environment etc
4. Ask your midwife whatever you’d like to know. Discuss with her your birthplan. It is a good idea to have continuous support, so find out what the hospital policy/procedures are in relation to this. You may need to hire a private midwife or a doula to have the continuity of support and care.
5. Chances of a VBAC – the research shows that 70-80% women will go on to have a normal vaginal birth after a previous caesarean section.
6. The only way that VBAC differs from other labours is the small increased risk of uterine rupture - about 0.4% (one in 250). The risk of uterine rupture prior to elective repeat caesarean section is 0.2%. I suppose the other issue is a woman’s fears. A woman labouring after a previous caesarean experience has ‘baggage’ and so it would be a good idea to work through all those issues before labour commences ie counselling, talking to other women about your experiences, visualisation, hypnotherapy, meditation, writing your birth story etc.
Hope that helps
Midwife Mary
Posts: 22 | Registered: Dec 2004
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