B Y D R. V I J A Y A K R I S H N A N
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1 VAGINAL BIRTH AFTER CESAREAN B Y D R. V I J A Y A K R I S H N A N
2 M Y T H F A C T Once a Cesarean, Always a Cesarean V A G I N A L B I R T H A F T E R C E S A R E A N ( V B A C ) With one previous low transverse C-section, your chance of having a normal delivery in your next pregnancy (VBAC) is as high as 80% In the Sanctum experience, the chances of a woman having a successful VBAC is as high as 96%
3 How do you determine if you stand a good chance of having a VBAC? 1. I f y o u a r e o t h e r w i s e a l o w - r i s k M o m, w i t h n o o t h e r m e d i c a l c o m p l i c a t i o n s i n t h e c u r r e n t p r e g n a n c y. 2. I f y o u h a v e a s i n g l e t o n p r e g n a n c y, w i t h a h e a d d o w n b a b y a t t e r m. 3. I f y o u h a v e h a d a p r e v i o u s v a g i n a l b i r t h, t h a t m a k e s y o u r V B A C c h a n c e s e v e n h i g h e r. 4. I f y o u r r e a s o n f o r t h e p r e v i o u s C - s e c t i o n i s a n o n - r e p e t i t i v e e v e n t s u c h a s a b r e e c h b a b y, o r f o e t a l d i s t r e s s i n t h e p r e v i o u s p r e g n a n c y, o r a n y o t h e r f a c t o r t h a t y o u w e r e t o l d, s u c h a s c o r d a r o u n d n e c k o r l o w A F I w h i c h a r e i n t h e m s e l v e s, n o t g o o d r e a s o n s f o r a n e l e c t i v e C - s e c t i o n i n t h e f i r s t p l a c e. 5. M o s t i m p o r t a n t l y, i f y o u c h o o s e a c a r e p r o v i d e r w i t h k n o w n % V B A C s u c c e s s r a t e s - C h o o s i n g s u c h a c a r e p r o v i d e r i s n o w b e i n g r e c o m m e n d e d a s a l m o s t a g o l d s t a n d a r d t o d e t e r m i n e / i n c r e a s e y o u r c h a n c e s o f h a v i n g a s u c c e s s f u l V B A C! I t s e e m s p r a c t i c e m a k e s t h e D o c t o r / M i d w i f e p e r f e c t! W e l l, w h o k n e w?
4 VBAC Benefits to the Mother A s k a n y w o m a n w h o h a s h a d a V B A C, a n d s h e w i l l t e l l y o u t h a t t h e d i f f e r e n c e i s d r a m a t i c! 1. I t i s b e t t e r t o d e l i v e r v a g i n a l l y, a s w i t h a n y m a j o r s u r g e r y, t h e r i s k s a r e n o n - t r i v i a l. I n f e c t i o n s, p o o r h e a l i n g, b l o o d l o s s, u s e o f p l e n t y o f a n t i b i o t i c s a n d p a i n k i l l e r s a l l t h e s e i n c r e a s e s d r a m a t i c a l l y. 2. T h e m o r e s u r g e r i e s t h a t a w o m a n h a s, t h e m o r e t h e r i s k s i n c r e a s e i n c r e a s e d r i s k o f s c a r a d h e s i o n s, p l a c e n t a l a b n o r m a l i t i e s i n f u t u r e p r e g n a n c i e s, r i s k s o f m i s c a r r i a g e / e c t o p i c p r e g n a n c y, a l l i n c r e a s e. 3. M o s t i m p o r t a n t l y, y o u r p h y s i c a l r e c o v e r y i s a m a z i n g l y f a s t. F o r m o s t w o m e n, w i t h h a v i n g a v a g i n a l b i r t h, t h e y a r e a b l e t o w a l k a n d m o v e a r o u n d w i t h i n a c o u p l e o f h o u r s. T h i s i s a l l t h e m o r e i m p o r t a n t w h e n y o u h a v e a n o l d e r c h i l d t o t a k e c a r e o f! 4. E m o t i o n a l l y t o o, y o u a s t h e m o t h e r f e e l s t r o n g, a n d y o u r c o n f i d e n c e l e v e l s o a r s a s t h e f e e l - g o o d h o r m o n e s o f a c c o m p l i s h m e n t & I d i d i t, m a k e y o u r b o n d i n g w i t h t h e b a b y s t a r t o f f o n a m u c h b e t t e r n o t e. B r e a s t f e e d i n g i s e a s i e r t o o w h e n y o u r b o d y d o e s n o t f e e l p a i n a n d d r u g g e d! D i d y o u k n o w t h a t C - s e c t i o n i s t h e m o s t c o m m o n l y p e r f o r m e d s u r g e r y t o d a y? S u r p r i s e d? I t i s.
5 VBAC Benefits to Baby 1. C e r t a i n l y, t h e p r o c e s s o f b e i n g b o r n v a g i n a l l y s e e m s t o b e t h e f i r s t v a c c i n a t i o n f o r t h e b a b y. O n g o i n g r e s e a r c h s h o w s t h a t e v e n a s M o m p u s h e s t h e p H o f t h e b i r t h c a n a l c h a n g e s t o o n l y a l l o w f o r b e n e f i c i a l b a c t e r i a t o b e p r e s e n t. T h i s i s t h e n i n g e s t e d b y t h e b a b y, w h i c h f o r m s t h e f i r s t c o l o n y o f g o o d b a c t e r i a i n t h e b a b y s g u t s o t h a t t h e b a b y h a s g o o d g u t f u n c t i o n a n d l e s s d i g e s t i v e d i s o r d e r s a n d a l l e r g i e s l a t e r o n i n l i f e. 2. M u c h i s b e i n g f o u n d a b o u t t h e i m p o r t a n c e o f t h e M i c r o b i o m e a n d t h e i m m u n e s y s t e m s o f t h e b a b y t o o. W h e n t h e b a b y i s b o r n n a t u r a l l y a n d i s r e c e i v e d b y t h e m o t h e r, o n h e r b e l l y, o n l y t h e b e n e f i c i a l m a t e r n a l b a c t e r i a a r e i n c o n t a c t w i t h t h e b a b y, t h u s m i n i m i s i n g i n f e c t i o n r i s k s. 3. T h e p r o c e s s o f b e i n g b o r n v a g i n a l l y s e e m s t o i m p r o v e t h e b a b y s l u n g f u n c t i o n a s w e l l.
6 4. B e i n g a b l e t o b e s k i n - t o - s k i n w i t h M o m, a l l o w s f o r b e t t e r t e m p e r a t u r e c o n t r o l, r e g u l a t i n g b a b y s h e a r t b e a t a n d r e s p i r a t i o n s, a n d a i d i n g t h e e a s i e r t r a n s i t i o n t o t h e o u t s i d e w o r l d. T h i s a l s o t r a n s l a t e s i n t o b e t t e r h o r m o n a l r e g u l a t i o n f o r b o t h M o t h e r a n d h e r b a b y a n d a l l o w s f o r a g o o d s t a r t t o b r e a s t f e e d i n g. 5. D e l a y e d c o r d c l a m p i n g a l l o w s f o r t r a n s f e r o f m o r e t h a n 1 / 3 r d o t h e b a b y s b l o o d w h i c h i s s t i l l i n t h e p l a c e n t a a t b i r t h. W i t h t h i s c o m e s t h e b e n e f i t t o t r a n s f e r o f s t e m c e l l s, W B C a n d R B C s. T h i s t r a n s l a t e s t o b e t t e r h a e m o g l o b i n s t o r e s f o r 4-6 m o n t h s, d e c r e a s e d r i s k s o f c h i l d h o o d a n a e m i a, a n d b e t t e r b r a i n d e v e l o p m e n t! y e a r s o f r e s e a r c h o n m o r e t h a n 1 m i l l i o n D a n i s h c h i l d r e n, i s a l s o t e l l i n g u s t h a t b a b i e s b o r n b y e l e c t i v e C - s e c t i o n s a r e a t a h i g h e r r i s k f o r b r o n c h i t i s, a s t h m a, o t h e r r e s p i r a t o r y d i s o r d e r s, i n c l u d i n g h i g h e r r i s k s o f n e w b o r n r e s p i r a t o r y d i s t r e s s, o b e s i t y, a l l e r g i e s, a n d a u t o i m m u n e d i s o r d e r s. 7. F i n a l l y, t h e s t r e s s o f b e i n g b o r n s e e m s t o b e a s t r e s s t h a t i s m u c h n e e d e d f o r t h e b a b y t o s u r v i v e i n t h e s t r e s s f u l e n v i r o n m e n t o f t h e o u t s i d e w o r l d!
7 Who is not a good candidate for trying for a VBAC? 1. I f y o u h a v e a p r i o r v e r t i c a l i n c i s i o n / s c a r o n y o u r u t e r u s f r o m a p r e v i o u s s u r g e r y o r C - s e c t i o n. 2. I f y o u r b a b y i s n o t h e a d d o w n ( V B A C b r e e c h b i r t h i s p o s s i b l e, b u t t h e r i s k s a r e m u c h h i g h e r ), o r l y i n g o n y o u r b e l l y, o r y o u r p l a c e n t a i s a t t a c h e d t o o c l o s e t o t h e c e r v i x ( t h e o p e n i n g o f t h e m o u t h o f t h e u t e r u s ) l o w l y i n g p l a c e n t a, o r P l a c e n t a P r e v i a. 3. I f y o u h a v e h a d o t h e r m a j o r u t e r i n e s u r g e r i e s. 4. I f y o u h a v e a n y o t h e r m a j o r m e d i c a l c o m p l i c a t i o n s. What are the risks to a VBAC? S o, t h e r e a s o n n o t e v e r y w o m a n c a n h a v e a V B A C, i s t h a t t h e r e i s a v e r y s m a l l r i s k t h a t d u r i n g t h e p r o c e s s o f l a b o u r, y o u s c a r m i g h t s e p a r a t e. T h i s i s c a l l e d U t e r i n e R u p t u r e, w h i c h m e a n s t h a t t h e u t e r u s m i g h t o p e n u p a l o n g t h e l i n e o f t h e i n c i s i o n t h a t w a s m a d e d u r i n g y o u r p r e v i o u s C - s e c t i o n. I f t h i s h a p p e n s d u r i n g l a b o u r, t h a t w o u l d l e a d t o a n e m e r g e n c y, w h e r e y o u r b a b y w o u l d n e e d t o b e d e l i v e r e d v e r y q u i c k l y.
8 T h e r e s e a r c h a n d l i t e r a t u r e c u r r e n t l y p u t t h i s r i s k a s 3 o u t o f A n d, m o s t o f t h e t i m e s t h e b o d y d o e s g i v e i n d i c a t i o n o f s o m e t h i n g b e i n g o f f. M o r e i m p o r t a n t l y, i t d o e s n o t g i v e w a y c o m p l e t e l y a t o n c e. T h e r e i s w h a t i s c a l l e d a s c a r d e h i s c e n c e o r t h i n n i n g t h a t h a p p e n s. Y o u r b o d y d o e s n o t g o f r o m b e i n g p e r f e c t l y h e a l t h y, t o b e c o m i n g p e r f e c t l y u n h e a l t h y, i n t h e b l i n k o f a n e y e! I f t h e r e i s a c a r e p r o v i d e r w h o i s e x p e r i e n c e d i n V B A C, a n d o n e w h o i s s u p p o r t i n g a n d i n t e r m i t t e n t l y m o n i t o r i n g y o u, h e / s h e w i l l p i c k u p t h e s i g n s o f e i t h e r a p a i n t h a t s e e m s o u t o f t h e r a n g e o f n o r m a l, o r o f r a d i a t i o n o f t h a t p a i n i n t o a r e a s t h a t a r e r e m o t e, o r o f t h e u t e r i n e c o n t r a c t i o n s g e t t i n g i n e f f e c t i v e, o r o f t h e b a b y n o t m o v i n g d o w n w i t h t h e c o n t r a c t i o n, o r o f a b l e e d t h a t s e e m s o u t o f p r o p o r t i o n t o t h e d i l a t i o n o f t h e c e r v i x, o r o f m o t h e r s v i t a l s n o t b e i n g i n t h e n o r m a l r a n g e, o r o f b a b y s t a r t i n g t o s h o w s i g n s o f d i s t r e s s. I n e a c h o f t h e s e c a s e s, a v a i l a b i l i t y o f a s e t t i n g w h e r e t h e r e i s i m m e d i a t e a c c e s s t o s u r g i c a l i n f r a s t r u c t u r e a n d A n a e s t h e s i o l o g i s t, O B G y n a n d P a e d i a t r i c i a n, a c c u s t o m e d t o p e r f o r m i n g a n E m e r g e n c y C - s e c t i o n i s h i g h l y r e c o m m e n d e d.
9 1 0 T I P S T O A S U C C E S S F U L V A G I N A L B I R T H A F T E R C E S A R E A N ( V B A C )
10 1. Find a Care Provider who has greater than 80% VBAC success rates. Ask questions How many VBACs do you do in a month/in a year? How many are successful? 2. Ask what are their must haves or what restrictions do they place in order for them to help you deliver vaginally. If they say, baby should not be bigger than 3 kgs, or baby should be born before 39 weeks, or if they say we will see at that time - that is not a good answer. Talk with your feet walk out, and find someone else whom you can trust.
11 3. Find a hospital with overall low C- section rates. Chances are that they already practice good birthing practices, so that you will have a better chance for a natural birth with them. 4. Ensure that your labour partner is fully supportive. Whether it is Dad or Grandma or a Doula, everyone in that room should be supportive and encouraging of your intent to have a VBAC. Negativity, even non-verbal stalls labour! 5. Make a Birth Plan. It does not have to be very long; it can be even a small visual birth plan. Share it with your care provider. That way, they will know what your wishes for your birth are.
12 6. Deal with your fears. Fear closes, Love opens. This is the hallmark of good Midwifery practices. There is a lot of listening that goes on during each antenatal check-up, and that allows you to talk about your fears, concerns, wishes aspirations, so that when labour starts your body is ready to do the work and surrender to the process of labour! Meditate daily. Mental health is as much important as physical health. 7. Become physically active Current recommendations are that you should do some form of physical activity in pregnancy! Walk, walk, walk. Climb a flight of stairs daily. Do some prenatal yoga It opens up your body and soul. Join a Prenatal Aerobics class, it is fun and you will be amazed as to how much both you and your baby enjoy it! Labour is called labour, because it is hard work. Prepare yourself to push through it in the best possible way!
13 8. Take a Lamaze childbirth preparation class. No one that we know has ever come out of the classes saying that it was not beneficial. In fact, most parents say that the Lamaze classes were the game changer and that it empowered them with good information to have a positive birth experience. Read books, watch good birth related videos too. You would not go into an exam without preparation, would you? Mental preparation and knowledge of what to expect can help you to navigate the uncertainties of labour, just that much better! You can also consider joining one of the many VBAC/Natural Birth Support groups that are available on social media.
14 9. Practice relaxation and visualise giving birth daily. Make your own positive affirmations, find a music or a song that relaxes your resonates with your pregnancy. Labour is stressful on many levels, and these are wonderful coping tools to have, to help you have a successful VBAC! 10. Finally Be open to whatever birth brings! Sometimes, despite everything, it may become necessary to have a repeat C -section. Being in a space that supports and celebrates you, and gives you the continuity of care that is so important for good postpartum recovery, will allow you to feel empowered and satisfied with your birth experience. If you have access to a Midwife/ Birth Centre in your city, go check it out. Their focus towards normal birth and least interventions might give you the best chances of a safe, successful VBAC!
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