There are many reasons why a woman would consider having a vaginal birth after a previous c/section including quicker recovery time, shorter hospital stay and being able to resume your normal activities sooner. Some women prefer the idea of being more involved/an active part of their birth experience, some may feel of loss from not previously having birthed vaginally. Each woman has their own unique reason for wanting to attempt a vaginal birth and all the evidence published over the past few years indicates that a woman under the right circumstances should be afforded the opportunity to attempt a vaginal birth after c/section (VBAC).
There is a huge worldwide drive for preventing the primary caeserian section i.e only doing a c/section when it is truly indicated and medically safer for either mom or baby and not for social or feeble reasons that are not truly evidence based.
The private sector in South Africa has a very high Caesarian section rate. Sadly it is too often only afterwards that one realises you may not have had the birth experience you really wanted and you may even feel angry. For this reason there is a very high demand for vaginal births after Caesarsean Section. (VBAC’s).
It can be devastating to have a c/section when you were planning on a vaginal birth and it’s understandable that some may feel cheated or want another chance to have the birth their wanted.
Dealing with the above it an essential part of your recovery process as well as your future birth experience. It is so important that you come to terms with the outcome of your birth experience, the choices you made, decisions that were made and the actual physical experience of your birth as you go forward to parenthood and also to subsequent birth experiences that may well be affected by your history if not dealt with. Sometimes just by chatting to your previous caregiver about your c/section you may find healing and understanding which results in peace.
VBAC is most certainly not only about having a vaginal birth but so very much more.
On average 20% of our monthly clients are planning VBAC’s. Of these VBAC clients around 60% of them will proceed to have a natural birth with their midwife, which is in line with international statistics. This also means that some of our VBAC clients will have repeat Caesarean Sections too though.
Given this we work hard with your throughout the pregnancy to ensure that regardless of the type of birth you will be able to make peace with your experience and find a positive outcome ultimately knowing you have tried your best, done everything you could to give yourself the best chance for a VBAC, had the best opportunity, choices and chose your team that really respected your wishes and gave you the best chances.
In our practice we feel strongly about transparency and believe we walk alongside you not pushing or pulling your through any experience. We want you to be fully on board and have full understanding of both risks and realities of attempting a VBAC. We support our VBAC couples but want them to make fully informed decisions.
After a previous Caesarean section there is a slightly increased risk of uterine rupture during labour and birth which when not diagnosed or treated promptly may lead to severe and even fatal outcomes for your baby and yourself. Because of this there are strict criteria when determining whether a woman is a suitable candidate for a VBAC as well as clear guidelines as to where one should attempt to VBAC. Though the risk of complications is small, it is still important to make an informed decision when choosing a VBAC.
A book that will assist you with this is ‘Vaginal Birth After Caesarean – The VBAC Handbook’, written by Helen Churchill and Wendy Savage. The publishers are Pinter and Martin, but it is distributed in South Africa by Juta and Company.
Other good links for good information and guidelines that are easy to read and very well balanced:
We have set our own standpoint for when we deal with our VBAC clients which is as follows:
- Clients need to be in good health and live a healthy lifestyle, including following a healthy diet, exercising regularly and maintaining a healthy weight
- Stress should be addressed and effort made to manage it and a way found to balance the challenges of everyday life. If fear was what led you to your previous c/section this in itself can lead to incredible stress so deal with it accordingly.
- Receive good regular antenatal care with your chosen team who not only supports your wishes but will not compromise on safety.
- The pregnancy should be uncomplicated and healthy.
- See one of our back up obstetricians who supports VBAC births.
- Attend a VBAC prep workshop / childbirth prep workshop to ensure you are fully prepared for the journey. A workshop is offered one a one on one basic specifically suited to our VBAC couples based on emotional preparation and letting go of previous negative experiences.
- Have had no more than 1 Caesarean section previously
- Have a singleton pregnancy (only one baby, not twins)
- Go into labour spontaneously before 41 weeks +3 days (if all evidence points to it still being safe) – an induction of labour is not done after a previous Caesar. Be patient!
- Give birth in a hospital. We don’t do homebirths or births at the free standing birth centre on woman who’ve had previous Caesarean sections as the time delay in receiving emergency care is too long. We can offer to assist you with your VBAC birth at one of the hospitals we have birthing rights at. Both hospitals are very well equipped and come highly recommended + our back up doctors work here.
- Your labour needs to progress at a reasonable rate when in active labour. You need to agree that if we feel the risk is outweighting the benefits you will trust us i.e. not fight us on this.
*Active labour: consistant contractions every 3-4 minutes lasting 40 seconds or longer / cervix dilated to 5cm at least
We always request a full and detailed written account/story from our clients, explaining what they understand about a VBAC and the risks associated, why they want a VBAC, what they’re planning on doing to ensure they have the best possible chance of a successful VBAC and why they had a c/section the first time around. This debriefing letter is in actual fact a very good starting point for your VBAC and can lead us to help you more uniquely once we understand your motives a little better. It also serves as informed consent for us.
Note about back up/referral:
Because we provide care to low-risk, healthy women, we make use of a back-up system. Thus, should any complications arise during pregnancy or birth, we may need to refer to an obstetrician or hospital. If you have the funds or have a medical aid you can use one of the private obstetricians whom we work with and are willing to provide back-up support (you’ll need to see the back-up gynaecologist 1 – 2 times during your pregnancy). If you don’t have the funds for a Caesarean section or further care at a private hospital, you would be referred to the Steve Biko Academic Hospital for further management. We highly recommend you join a basic hospital plan that will cover the baby from the moment of birth.
Afer the birth of your baby:
After birth we do post-birth visits to you and your baby, either in hospital or at your home. We do on average 3-5 visits after the birth to check that you are healing, assist you with breastfeeding, check for jaundice, provide support and education on caring for your baby, debrief after your birth, etc. This is to ensure you and your baby’s well-being and we feel an essential part of what we do.
We follow a well rounded approach to ensure that you and your baby really receive all the care you need throughout pregnancy, birth and the postnatal period. Other services we offer at Midwives Exclusive include:
- Antenatal classes and natural birth workshops (VBAC prep workshops)
- Breastfeeding support groups and consultations
- Well baby check-ups and full 6 week mom and baby check-ups after birth
- Pregnancy yoga as well as mom and baby yoga
- Various post birth workshops for mom’s and babies.
If you are considering a VBAC with us we always suggest we start the journey with a one on one VBAC assessment where we get to know one another, looks at your risk profile and motivation as well as get a chance to explain how it all works practically speaking.
It also gives you a good opportunity to meet us, see if we suite your expectations and you feel we’re the right match for your VBAC support person as well as address your specific questions and concerns.
It is strongly recommend you read through the VBAC info links we provide above as well as do your own further research avoiding social media but rather focussing on proper evidence and research. The purpose of this is not to put you off or scare you but rather so we can all be on the same page with the same commitment to your successful, safe pregnancy and birth.
If we cannot meet your requirements there are other midwives and facilities, both in Pretoria and in Johannesburg, which may be able to assist and may be more suited to you.