MoorMums spoke to Leigh East, local mum and author of ‘Caesarean Birth: A Positive Approach to Preparation and Recovery‘ about what to consider if you have previously had a c-section and are now expecting another baby.
‘Once a caesarean, always a caesarean’. This outdated phrase is one we have been hearing for decades. At one time there was quite a lot of truth to it. However, an increase in the number of horizontal uterine scars and improvements in technology ensuring problems can be identified earlier means women are increasingly being offered the option of a vaginal birth following a previous caesarean (VBAC).
Do your research
Decision-making following a caesarean is naturally coloured by previous experience, but if possible the key thing to focus on when making your decision for your next birth is a balanced assessment of risk in your specific circumstances, this time round. It should not simply be a question of ‘This is nature, I am made to do it this way’ or ‘This is my right’. It is the specific circumstances of your previous births, your current condition and the progress of your pregnancy this time that should carry most weight.
It is important therefore to:
- get hold of maternity notes from the previous caesarean,
- ask lots and lots of questions,
- and, where possible, attend classes which specifically include VBAC support.
Medical notes describe the reasons for your previous caesarean and the type of uterine incision. The answers will have a direct bearing on whether a VBAC is advisable. E.g. a low lying placenta obstructing the baby’s exit last time may not happen this time and therefore should not preclude a VBAC. A vertical uterine incision however, while still rare, carries a higher rupture risk and means you may have difficulty gaining agreement in many hospitals.
Your practitioners will no doubt express an opinion. Inadvertently terms like: ‘complication’ may be used and feel very scary without clarification. Ask whether the recommendation is a ‘suggestion’ or a ‘necessity’. Then clarify exactly what it is about your specific case that leads to this conclusion. You can always request a second opinion if you are not in agreement (this is your entitlement under the NICE guidelines). Many grey areas exist and what is labelled a ‘complication’ in one hospital is not necessarily the case in the birthing unit down the road.
Ultimately there are risks associated with both modes of birth but it is your ‘informed’ assessment of those risks which should carry the most weight. As an example, knowing that horizontal scar rupture rates are actually incredibly low (0.35%) helps you debate your case more accurately.
Emotional impact of a Caesarean
It is unfortunately the case that quite a few women unprepared for their first caesarean experience depression, breastfeeding problems and bonding issues afterwards. While this is typically a feature of the emotional trauma experienced rather than physical complications arising from the procedure itself, the caesarean is often blamed colouring the risk assessment crucial when planning your next birth.
Antenatal classes offering VBAC support
Lazy Daisy are a relatively new organisation presenting a very positive approach to VBAC. Much of the training focuses on “helping mum eliminate worry or fear before the birth…encouraging her to look forward to her birthing day, however the journey pans out”. Their classes enable women to experience active birthing and pregnancy movements in practical sessions, while also learning key facts about birthing. They focus on helping women become emotionally strong so that stress levels are low and fears are under control. Lazy Daisy report mums find birthing, however it concludes, a very positive, rewarding and special experience. As one mum said “We practised relaxation techniques a lot and once in labour I went into ‘auto mode’. I could hear Kris’s voice [Lazy Daisy teacher] and I felt so incredibly calm throughout, it was a wonderful experience.”
For more information about relaxed-active birthing and how it can help in a VBAC situation, see our special feature.
Prepare positively for possible outcomes
Whatever your previous experience it is important to spend time coming to terms with the possibility of another caesarean and prepare for it positively and face your birth with an open mind. 75% of attempts result in a vaginal birth, a fantastic success rate, but that does also mean that a quarter will require another caesarean. Preparing a birth plan covering both eventualities means you can express opinions about both experiences and significantly increase your potential for achieving a very positive outcome.
For more information about preparing positively for birth, read Leigh East’s new book – ‘Caesarean Birth: A Positive Approach to Preparation and Recovery‘.
Thank you to Leigh East for taking the time to prepare this feature for MoorMums. This is an issue that is very close to our hearts and we will continue to try and help other local mums through these decisions.
If you would like to contact Leigh for more information or if you would like to comment on this article and share your experiences, please contact us.