What to Know About VBAC & Cesarean Birth
Thursday night’s All About Birth workshop brought together some of New York’s most respected and experienced providers of VBAC (vaginal birth after cesarean) and family-centered cesarean birth. The night also featured three inspiring stories of birth by moms and their partners. Representatives of ICAN of Manhattan were present, promoting this phenomenal support group. Mary Esther Malloy of Mindful Birth NY facilitated the event.
The workshop centered around three distinct birth stories and outcomes. Damaris had a VBAC in a hospital with the same OB practice that she had her first baby, but made some very different choices, including hiring a doula. She appreciated knowing the rules and risks of VBAC, laid out for her from the beginning by her doctor. When she went into labor at 41 weeks, labor came fast and hard. Her doula looked in her eyes and said “I know you can do this”. It was an utterly distinct experience and looking back, she says, “I will never ever have a baby without a doula.”
Michelle and Morris sought the care of home birth midwives with her second pregnancy. She also attended a Choices in Childbirth VBAC workshop, and took a comprehensive childbirth education class that she wished she had taken during her first pregnancy. On the day of her labor, things moved very quickly. Before she knew it, her daughter was in her arms and her toddler came to greet his baby sister with the words, “Mama…. Animal.”
Suzanne felt very disconnected from the process of birth after her first cesarean section, 16 weeks after her due date and after a planned home birth. “It was not the way I imagined giving birth to my baby. My baby came to me in a blanket and hat, not all goopy and alive.” Suzanne attended a Choices in Childbirth VBAC workshop as well and felt much more empowered. She again selected a home birth midwife but when labor stopped progressing, she was encouraged to transfer to hospital. Her desires for a different type of cesarean were made explicit: she was not tied down, she wanted a double layer of sutures, she wanted to see her baby before she was transferred to the warming table, and she wanted skin to skin time. This made for a truly empowering cesarean experience for Suzanne.
Joan Bryson, CNM, a retired home birth midwife who has delivered many VBAC clients, shared how important it is that women find people who support their choices, including the provider, so that no matter what happens a woman will not have to doubt or regret anything. As a midwife who delivered many VBAC births in homes, she discussed the individuality of the initial interview process.
On the topic of exams, Joan said that they can take away the validity of experiences happening inside your body. They’re very external ways of assessing something very internal. Dr. Jaqueline Worth of Village Obstetrics concurred that exams are not the best way of gauging labor. Sarah Pancake, a DONA-certified doula with extensive experience supporting VBACs, spoke about her role and scope as a doula in hospitals, birthing centers and home settings. She stressed the importance of adhering to any and all instructions from the primary care provider, especially in the case of births after cesarean.
Dr. Worth listed her requirements for VBAC clients: the pregnant mother MUST have a doula if she wants a VBAC; she must pay close attention to nutrition and exercise; she must have freedom of movement whenever possible. Dr. Worth also uses electronic fetal monitoring as a critical tool for safety.
Dr. Worth’s recommendations for VBAC:
- Have a doula!
- Have a provider you trust
- Have a 55cm to 66cm ball
- Stay out of bed as long as possible to get the extra 2cm in the mid pelvis (a doula can hold a monitor in place with mom sitting on a ball)
- Efforts that may maximize your chance of vaginal delivery may conflict with optimal safety for mom and baby, so your job as a parent is to walk the fine line that enhances both.
- Remember to take steps to keep a category 1 fetal heart rate tracing, so avoid rupture of membranes and epidural for as long as possible.
- Fetal monitoring is your friend. It lets you know when danger lurks.
- Recognize that if you see repetitive fetal heart rate decelerations in labor, it is time to move to the operating room for a repeat cesarean section regardless of the reasons for decelerations.
- Be assured that with fetal monitoring, a trial of labor is safe for mom and baby.