We all have different reasons for wanting a VBAC and while we are hopeful that those in our lives will be nothing but supportive, that is not always the case. I have had the opportunity of working with many women preparing for a VBAC at my chiropractic office while preparing for my own. During my pregnancy, I was surprised to come across as many people as I did who thought “once a cesarean, always a cesarean”.
The Facts
There are benefits to a VBAC: no abdominal surgery, shorter recovery period, less blood loss, and lower risk of infection. There are risks to a VBAC and many women preparing for a VBAC don’t totally ignore this risk, but they also know the statistics and facts. One rare, but serious risk with a VBAC is uterine rupture.
With one cesarean, the chance of uterine rupture is 1 in 240. Only 6% of uterine ruptures are catastrophic, meaning the chance of infant mortality due to rupture is 1 in 769. Uterine rupture can occur in women without a uterine scar (1 in 1,146 pregnancies).
What is a uterine rupture?
A uterine rupture is a tear through all three layers of the uterine lining. The scar completely opens along the scar. A uterine dehiscence can often be mistaken and classified as a uterine rupture.
What is a uterine window and uterine dehiscence?
A uterine dehiscence is when a part of the scar begins to separate but the entire scar does not separate. A cesarean would need to be preformed in order for your provider to identify the uterine dehiscence. Often times, when providers talk about uterine rupture, they do not differentiate between a complete rupture and a uterine dehiscence.
A uterine window is when the scar is very thin and you can see through it. The scar does not tear. Evidence has not been able to show (so far) if a uterine window will lead to a rupture or not. Your provider will only be able to tell you how thin the scar looks during a cesarean.
How can I reduce the risk of uterine rupture?
· Avoid an induction or augmentation of labor (usually this means Pitocin)
· Avoid Cytotec (Cytotec increases risk of uterine rupture to 5.6% with previous cesarean)
· Find a supportive provider
· Build your dream birth team (doula, chiropractor, acupuncturist, fitness instructor, etc.!)
· Try to make sure your baby is in an optimal position before labor begins
· Stay mobile during labor
· Know the signs of uterine rupture
· Follow your intuition. Trust what your body and your baby are telling you.
80% of women who attempt a VBAC will be successful.
My Experience
There were a lot of emotions surrounding me as I prepared for my VBAC. When preparing for my first birth, which resulted in cesarean, I felt like I did “everything” to prepare for a homebirth and avoid a cesarean. You can listen to my oldest sons birth story here. So when we got pregnant again, I knew I wanted nothing but a vaginal birth, but I wasn’t ready to prepare for the birth.
I started off doing what I had been doing when we were TTC: I moved my body, nourished my body with whole foods, attended ICAN meetings, got adjusted, and received acupuncture treatments. Since those were things a part of my daily life, I didn’t really consider them as part of my birth preparation, but they were. It wasn’t until about 30 weeks that I started feeling that I “wasn’t prepared” for a VBAC. I started reading more (I found Ina May’s Guide to Childbirth most beneficial [along with Cut, Stapled, and Mended which I read earlier on in my pregnancy]) and incorporating Spinning Babies and Miles Circuit into my weekly routine. I started listening to The VBAC Link, walking more, and slowing down at work. At 36 weeks I started eating 70g of dates a day and drank Chinese herbs (with direction of my Traditional Chinese Medicine practitioner). As I approached 39 weeks, a talk with my midwife lead me to realize that didn’t need to “do more” (read more, prepare more, etc.) for this birth. I needed to surrender and trust birth and my body again. She reminded me that there are other cultures and populations that just have babies because they know that’s what they are supposed to do. I stopped finding more things to do and started letting go.
Thank you! Download your freebie here!
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Some of My Favorite VBAC Resources
ICAN (find your local chapter!)
Northeast Ohio VBAC Support Group
Are you preparing for a VBAC? Why is it important to you?
Resources:
Guise J-M, Eden K, Emeis C, Denman MA, Marshall N, Fu R, Janik R, Nygren P, Walker M, McDonagh M. Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E001. Rockville, MD: Agency for Healthcare Research and Quality. March 2010.