Birth Planning and VBAC

When creating a birth plan, it's important for expectant moms to know the many choices available during labor, birth, and postpartum. Part of this is understanding how, when, and how often (unique to each care provider and place of birth) different medical interventions are used. (Taking a quality childbirth class will provide this information and more!) For women planning VBAC (vaginal birth after cesarean), where the ultimate goal (after, of course, healthy mom and baby) is to have a vaginal birth, understanding how and when interventions should be used -- or not -- could make the difference between a vaginal birth and repeat cesarean. Consider the following scenarios:


vbac.jpgGoing past your due date: If you pass up 40 weeks and are staring down the barrel of 42 weeks (The American Congress of Obstetricians and Gynecologists, ACOG, recommends induction be considered in most cases only after a full 41 weeks), talking about induction -- and non-cesarean alternatives to induction -- with your care provider could help you avoid having a repeat cesarean. Discuss your options for induction and how they could be used. Some care providers tell women they cannot be induced when having a VBAC, but the evidence and guidelines state otherwise.


A very long labor: Labor can be long. Sometimes very long. And generally, that's ok. If your labor is slow, but progressing, there typically is no need to intervene. Sometimes, however, the reason for an unusually long labor is due to your baby's position. A baby who is "OP" or occiput posterior (where the back of his head is against your tailbone), can cause an erratic and long labor. If your labor is extraordinarily long, you've tried lots of different position changes and other strategies to get it going, and a) you are not progressing (dilation of cervix, descent of baby) or b) you are utterly exhausted and depleted of energy, it may be time to consider an intervention in order to avoid repeat cesarean. Perhaps that would be an internal uterine pressure monitor (IUPC) to measure the strength of your contractions to see if they're being effective. Perhaps that would be an epidural to give you the rest you need to keep going. Perhaps that would mean Pitocin to pick up your labor. Think -- and discuss with your care provider -- what alternatives you could seek to increase your chance of a vaginal birth. 


Pushing for more than 3 hours: Similar to labor, pushing also can take a long time. Consider well in advance of your birth whether, if it is presented as an option, you would choose an assisted birth with the use of vacuum or forceps in place of a repeat cesaran. Of course, keep in mind too that actions like changing positions during pushing, pushing in a more upright position, and waiting to "labor down" before pushing all can help make your pushing more effective and shorten the time that you spend pushing. 


Birth is a natural process that our bodies were beautifully built to perform. And, there are many, many different non-medical interventive (aka "natural") ways to find comfort and keep labor and birth progressing. There also is a time and place for the use of medical interventions. First and foremost, when it comes to preserving the health of mother and baby, and second, when it comes to achieving goals and desires in birth. It's important to determine for yourself, well in advance of labor, where you might draw a line in the sand when it comes to accepting an intervention as a means to helping you achieve vaginal birth. Doing so does not mean it will necessarily happen, but preparing mentally in advance will help you make a more informed decision if it is needed. 

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