It really is up to each mother, and the circumstances surrounding her pregnancy, as to which way she may want to give birth. There are two options for giving birth: a vaginal birth after Caesarean section (VBAC) or an elective repeat Caesarean section.
Most women can have successful VBACs without any complications. However, one of the risks that you will hear a lot about is uterine rupture. This is when the scar along the uterus from a previous C-Section opens during a vaginal delivery. It is very rare and affects less than 1 percent of pregnant women, but it is important that you know this risk.
Your caregivers will know that you previously gave birth via C-Section and will watch out for any signs of uterine rupture during your labour. During your labour you will be checked more closely and more often when you have opted for a VBAC. During your labour you'll be offered continuous electronic fetal monitoring. This will measure your baby's heart rate and your contractions. Your baby's heart rate can give caregivers an early sign that your uterine may have ruptured. Should this happen they will act quickly and offer you alternative care for your labour.
Because it is a riskier procedure, your doctor may recommend that you give birth in a labour unit. This may sound alarming, but they are mitigating the possibility of things taking a turn and there being a delay in your care. Of course, ultimately it is your decision where you prefer to give birth.
It is important for you to know that if you go into labour prematurely (before 37 weeks), VBAC is still an option.
Can I have pain relief during a VBAC?
Yes. You should be able to have the same pain relief options during your VBAC that you would have been offered during a vaginal birth. However, be aware that if you had an epidural, this form of pain relief would block out the abdominal pains in between contractions or sudden feelings of tenderness of your scar. Being numbed means that you may not be aware that you have symptoms of a uterine rupture.
You should be able to use a birth pool for relaxation – your caregivers can let you know if this is not possible in your case.
Many units have waterproof continuous monitoring systems (telemetry), to make it possible to monitor your baby whilst you are in the pool.
What’s the alternative to a VBAC?
If you’re unsure whether you want to have a VBAC, you could opt for planned repeat caesarean. This is usually booked close to your due date, unless your doctor can clinically justify your baby being born sooner.
If you have experienced any of the following, it may be advisable not to go through with a VBAC
It is recommended to speak to your caregivers and ask them specifically about you and your baby. If they present evidence, does that tie in with your medical situation? Don’t be afraid to ask questions.
If both VBAC or planned C-Sections are options available to you, you'll have plenty of time to consider the risks and benefits of each. Talk to your obstetrician about your previous birth(s). Find groups to speak with women who have been in your position, such as VBAC Empowerment & Support Group. Get varied opinions and experiences to ensure that you are comfortable with your decision.
What are the advantages of a VBAC?
A successful VBAC carries the lowest risk of complications. If you have a VBAC, you’ll avoid the risks associated with repeat caesareans and have a quicker recovery time. Looking after your child and your new baby following a vaginal birth will be easier on you.
Planned C-Section babies born before 39 weeks are more likely to have trouble breathing after it’s born, compared with a baby born at the same time vaginally. However, if you do have a repeat caesarean before 39 weeks, your doctor is likely to offer you steroids beforehand to help prepare your baby's lungs and reduce their risk of breathing problems. Again it’s up to you to decide if you want to take the steroids.
With a successful VBAC, you'll have a shorter stay in hospital and you should experience less pain and discomfort in the weeks and months after the birth.
If you‘re planning more pregnancies, then trying for a VBAC may help you to avoid future complications that are more likely after repeat caesareans, including placenta praevia, placenta accreta and hysterectomy.
Once you've had one successful VBAC, you're more likely to have another one in the future.
Are there disadvantages to having a VBAC?
There a no disadvantages to a VBAC, in as much as, there are things that can happen to a woman who gives birth vaginally. These can include:
Pregnancy itself can weaken your pelvic floor, so having a C-Section doesn’t mean that you won’t have pelvic floor issues in later life. It's important to do pelvic floor exercises, whichever way you give birth.
How do I decide whether to plan for a VBAC?
Take time to explore your feelings about the birth. Have you had the chance to talk about your previous birth(s). What is your body instinctively telling you to go for? Never ignore your intuition and gut feeling. Talking it over with your caregivers and your loved ones, may help. You may want to look online for groups that support women planning a VBAC, such as the VBAC Empowerment & Support Group on Facebook.
What are my chances of a successful VBAC?
If you needed a caesarean to give birth previously because of a uterine abnormality, then you may need to have a repeat caesarean. Each woman needs to be assessed individually. However, if you had a C-section because of something unique to your last pregnancy, such as a breech baby, pre-eclampsia or a low-lying placenta, you stand a good chance of having a successful VBAC. Having a supportive team comprising of both medical caregivers and family members, can hugely impact your chances.
VBAC success rates are lower if you:
Can I have a VBAC at home?
Yes if you want to. You caregivers will advise you as to why they may not recommend this.
Having a VBAC in hospital means that if your scar tears you can be treated straight away. A c-section should be done as soon as possible. If you’re planning to try for a VBAC at home, it may help to find out what the transfer time to hospital would be.
If your heart is set on a home birth, it's worth contacting a local supervisor of midwives or midwifery advocate by phoning your maternity unit. A senior midwife can take you through all your options and help you to plan the safest care for you and your baby.
Another option is to employ an independent midwife, but you’ll have to pay for her services. Use the Independent Midwives Association’s Find a Midwife service for a list of midwives in your area.
Case study, Joanne gave birth in Harold Wood Hospital in Essex
We asked a mum of three about her two VBAC experiences.
How did you decide to opt for a VBAC?
I decided for VBAC because I wanted to experience a natural birth and felt I had missed out!
When did you decide this?
I had wanted to do a VBAC even before I fell pregnant.
How were the antenatal midwives when you said you wanted to do this?
The antenatal midwives were very supportive, but they were always reminding me of the risk of my womb rupturing from the previous c section. I was advised that when I went into labour that I was to go to hospital straight away, so they could keep an eye on me because of the risks, especially uterine rupture.
How were the labour staff about you wanting to do a VBAC?
The midwives did not try and sway me, they were very supportive.
Were they spontaneous or induced labours?
The first VBAC in 1997 was induced at 41 weeks. I was induced repeatedly with a pessary, then eventually with the Synthetic Oxytocin drip.
I was very well-monitored during this labour. This labour lasted around 24 hours. I remember having the first pessary the day before. I was having contractions but then they would stop, that’s why I went on to have the drip. There was so much intervening because of being induced, this made it feel like it went on forever.
This birth was extremely painful! I was prescribed pethidine which made me very sick. I ended up having an epidural, then I went off to sleep. The birth when it eventually happened was a very good experience, I had no pain, the pushing was an unusual experience as I couldn’t feel very much, due to the epidural. I gave birth on the bed, in the normal laying on your back position with my husband next to me, he cut the cord. I was advised not to give birth in a pool because it was too risky.
I had trouble with the epidural afterwards. I bruised my coccyx bone and I was in terrible pain. The pain lasted for about a week.
My second VBAC in 2004 was spontaneous at 37 weeks. My waters broke when I was sleeping in bed, I felt a pop and then, a trickle of water, this was just before 6 in the morning, I remember changing the bed before going off to the hospital. On arrival at the hospital I was monitored but I’m assuming that because this was my second VBAC the midwives felt quite relaxed with me. I spent most of the day walking the grounds of the hospital trying to increase the intensity of my contractions. This really did help and I went on to have him at 1 o’clock in the morning.
I was left to fend for myself for this birth. I was assigned to a designated group of midwives, who were attached to my doctor’s surgery. When I went into full labour they were called and came to the hospital to deliver my baby (I’m not sure if they still do it that way anymore). I felt that they thought that because it was third time that I knew what I was doing. The midwives were more concerned for the first-time mothers, which was terribly unfair. When they realised I was dilating rather quickly they panicked, which was very bad because they should have been watching me more closely because of uterine rupture. However, when the midwife did turn up it was a very good experience. The birth was a wonderful experience, maybe because I knew what to expect, I gave birth with just gas and air, which made the whole experience very real! I could feel every pain and movement in my body, an absolutely unforgettable experience. I wasn’t afraid this time, I knew what was about to happen. I thoroughly enjoyed the whole experience.
What were the differences between the experiences?
The difference about the two experiences were to me, the unknown and then of course the experience of the knowing.
What would you recommend to mums to be thinking about opting for a VBAC?
I would definitely recommend a VBAC. Having a natural birth is an experience that is magical and it’s so much easier to get over. A C-section is a major operation!
If you are planning a VBAC, you can find more information on the AIMS website and their post on VBAC – On whose terms?
I'd like to think that there are lots of women out there having good birth experiences. Here are some tips on how to make your baby's birth special to you.
There is so much to learn when it comes to pregnancy, labour and birth. Sadly our stretched NHS midwives are unable to fully inform women of the choices in pregnancy labour and birth in antenatal appointments alone. In many Trusts there are limits on the number of people who can attend antenatal classes. Therefore more and more women are seeking out independent antenatal classes, such as hypnobirthing. A hypnobirthing course offers comprehensive antenatal education that gives parents the time to think about their birth preferences.
Place of birth
Decide where you would most like to give birth. The choices are:
Some people quickly make assumptions on each of these settings. When you look at them in a pragmatic way, the differences are minor. However, the outcomes on the birth experiences can be significant. Make yourself a chart and list out what you want/don't want from birth. Decide which of these settings provides the best place for you to achieve the birth that you want.
Make sure you find out what labour and birth involves. It's good to find out the most common scenarios and learning what the risks and benefits are. I recommend, that you research natural births, induced births and c-section births. Read up on how labour evolves in each of those scenarios. After this exercise you will have a firmer idea about which birth you prefer?
There are many ways a woman can be supported during birth.
Natural forms of support include:
Medicalised relief includes:
Find out the risks and benefits of the medicalised pain relief options and the impact they have on both the mum and the baby. Decide from there what you are comfortable with taking. Also list those that you may prefer not to use unless needed on the day.
Learn how to relax
Once you are in control of your experience. You are more likely to be comfortable and calm. This is key to helping you relax. Simple breathing techniques; calming visualisations; positive birth statements or affirmations, are easy ways to help you feel calm and relaxed.
Learning what may happen will give you the confidence to deal with any situation that arises. If you are well informed and know your choices you are in a strong position to take control. When you make your own decisions, you will feel empowered and comfortable. These are huge steps that lead towards a positive experience of labour and birth.
Would like help learning techniques to remain, relaxed, focused and in control? Do you want to find a comprehensive antenatal class that informs you of all the common scenarios? Then hypnobirthing classes, for you and your birth partner, will help you to achieve that.
Magical Baby Moments' hypnobirthing classes not only teach you relaxation techniques, but they also covers many aspects of labour and birth. We cover topics such as:
Read more in the classes section.
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The Microbiome Effect by Toni Harman and Alex Wakeford is a fascinating book of emerging research that indicates how vital bacteria are for human health. A baby's exposure to them during labour, birth and beyond helps kick-start their developing immune system. This book reveals the impact of babies born via Caesarean Section (C-Section) and how this potentially alters the course of their immune development and makes them more susceptible to non-communicable diseases.
Here is my synopsis, of what I believe is a must-read for all birth educators and expectant parents, to understand the intricacies of a vaginal birth and the vital components that help your baby thrive in the outside world.
Human bodies are comprised of trillions of human cells and microbes (bacteria, viruses, archaea, fungi etc). These cells and microbes live on and inside us. The bacteria inside our body help keep us functioning properly and give us the ability to fight off diseases. However, modern ways of living, such as diet, antibiotics and C-sections - to name a few - are adjusting the diversity of microbiomes in the human body. Current research indicates that this alteration in the way we live is giving rise to many common non-communicable diseases such as allergies, asthma, auto-immune disorders, diabetes, obesity and more.
For a long time, antenatal educators have explained to its parents-to-be the benefits of a vaginal birth vs a C-section birth, in regards to babies breathing abilities. In a vaginal birth, the birth canal compresses the lungs to expel the liquid that has been in them during pregnancy; so that once earth-side, the lungs are fairly clear of liquid and breathing unassisted comes more easily.
The research conducted, which is discussed in this book, digs deeper. It looks into many other vital stages that a baby encounters during a vaginal birth, which can impact his/her long-term health positively. Other scientific tests are indicating that there is a link with an imbalance in the human microbiome (often caused via Caesarean section deliveries) and with chronic non-transmissible diseases.
It is believed that during pregnancy a baby lives in a near sterile environment and exposure to microbiomes is minimal. It is during a vaginal birth, once the amniotic sac had ruptured, that a baby begins to be exposed to bacteria. This is when it comes into contact with vaginal, faecal and skin microbes. These enter the baby's eyes, ears, nose, as well as being swallowed through the mouth. This prenatal exposure is one of the main seeding events for the baby's gut. Once the baby is born it will come into contact with more bacteria - from the air in the place of birth, from the skin of its caregivers and parents etc. All of these encounters help to colonise the baby's gut.
Babies born via a Caesarean section (C-section) potentially miss out on this exposure, if the amniotic sac hasn’t ruptured, because they won’t come into contact with the mother’s vaginal or intestinal microbes. As a result the baby’s gut microbiome composition will be different.
Latest research favours infants that are born via C-section to have skin-to-skin contact and breastfeeding where possible, because the second major influx of microbes is during these two events (babies born vaginally are also recommended to do this too).
During skin-to-skin contact, and when a baby is looking for milk, it will open its mouth and suckle or lick the mother’s skin. A mother’s breastmilk is incredibly rich. It provides essential nutrients for the baby's growth and development, including key immune components and sugars. The sugars not only provide energy for the baby, but it also feeds the bacteria in the gut, quickly colonising it and preventing other harmful bacteria from taking hold. These events and opportunities to come into contact with the right bacteria kick-starts the continued development of the infant immune system. The bacteria teach the immune system to recognise friendly and harmful bacteria, and know what to attack, or not.
In contrast, a baby that is fed formula milk will only receive the nutritional benefits. This milk is missing prebiotics to feed the gut microbes. It also lacks the right bacterial species and immune components that the developing baby needs. These missing components could impact the training of the infant immune system, which could mean health implications later in life.
All the way through pregnancy, labour, birth and infancy things are supposed to happen at certain times. When the birth process is interrupted with medical intervention, the evolution of the immune system is disturbed, which could result in it malfunctioning later in life.
Research has also shown that the microbial profile of a baby born vaginally resembles that of its mother, and continues to do so with each generation that is born vaginally. However when this pattern is interrupted by a C-section delivery, the child may not match the mother’s microbial profile and the child may fail to inherit critical “keystone” species of bacteria to ensure good health. C-sections could be contributing to key microbe species being lost, making us more susceptible to pandemics.
Other evidence suggests a correlation in C-section babies having a higher risk of developing asthma, type one diabetes or coeliac disease, and of becoming overweight or obese. This is not to say that all babies born this way will go one to develop any of these, they are simply more susceptible. What we don’t know yet is the ongoing repercussions of this.
So what can we do about it?
As an antenatal educator, I feel it is my duty to inform my parents of the potential health implications of babies born via a C-section. Parents need to better understand the importance of vaginal births, as a way to ensure that their baby receives the necessary exposure to bacteria, which will help colonise its gut in the right way - to ensure a fully functioning immune system.
There will always be world in which some babies are needed to be delivered via C-section, therefore what steps can the caregivers take to help the baby receive optimal seeding and feeding? Mothers can be tested to see if they are suitable for “swab-seeding” (this is currently under a strict protocol). However for the feeding aspect, there is now no reason why babies cannot be passed to mothers straight away in all elective C-sections (and some in emergency C-sections); so that the baby can have skin-to-skin contact and have the opportunity to begin breastfeeding. This will allow the baby to be exposed to essential bacteria and microbes and helping to kick-start an immune system that could keep them healthy throughout their life.
This article only scratches the surface and highlights the key points of the book. I strongly recommend mothers to read it and learn more about it. Ask your midwife and/or obstetrician how much they know about this subject. If they don’t know too much about this subject, politely ask them to do their research. Your baby’s life is in their hands.
The Microbiome Effect is published by Pinter and Martin.