VBAC info/support

[chuck]

Okay so there are more and more ladies coming here who are hoping to VBAC/HBAC so being someone who recently achieved a VBAC (planned HBAC but transferred for blood loss concerns and still got a VBAC with GnA only and survived with no stitches!) I thought I would gather together all the links and resources etc in one place for reference.

For now I will keep it to VBAC info rather than specifically HBAC but will add right now that there is no reason you cannot VBAC at home so DO NOT BE TOLD YOU CANNOT!

Chuck EDD May 13th 2011 - planned HBAC turned VBAC on May 13th 2011

tannembaumEDD Dec 22nd 2011 - Planned VBAC - ELCS on Dec 30th 2011

Celesse EDD Dec 25th 2011 - planned VBAC achieved 20th December 2011

Melissa_M EDD Jan 6th 2012 - planned VBAC, CBAC after trial of labour 9th January 2012

Irishmammy EDD Jan 11th 2012 - planned VBAC achieved Jan 27th

NickyNack EDD Jun 22nd 2012 - planned VBA3C

IcedQueen EDD Jun 26th 2012 Planned VBAC

heavyheart EDD Jul 17th 2012 Planned VBA2C

momofone08 EDD Aug 21st 2012 Planned VBAC

​

Looking at the emotional side of things and support groups...

Spoiler

International CS awareness Network
https://www.childbirth.org/section/ICAN.html

International VBAC Support
https://vbacsupport.com/

Birth trauma association
https://www.birthtraumaassociation.org.uk/

Yahoo email group
https://health.groups.yahoo.com/group/ukvbachbac/

CS and courage
https://avital.blogspot.com/2011/01/cesarean-courage.html#axzz1NhQ9wdKr

A wonderful post about our feeling post CS
https://www.plus-size-pregnancy.org/CSANDVBAC/shouldbegrateful.htm

Birth Matters - a lovely blog post about how birth really matters not just a healthy baby
https://andnobodytoldme.com/2011/09/that-the-birth-matters-and-so-do-i/

NICE Guidelines...

Spoiler

Inrapartum Care
https://guidance.nice.org.uk/CG55

CS
https://guidance.nice.org.uk/CG13

General Info and Stats...

Spoiler

https://vbacfacts.com/

Brilliant comparison table of VBAC vs Repeat CS in this blog post
https://victorybirth.blogspot.co.uk/2012/03/im-pretty-excited-about-my-guest-post.html


Cochrane Review of CFM
https://www2.cochrane.org/reviews/en/ab006066.html

Summary of 20 articles re: uterine rupture
https://birthwithoutfearblog.com/?p=2131

Womens guide to VBAC
https://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/


Making decision about birth after CS
https://www.healthtalkonline.org/pregnancy_children_/making_decisions_about_birth_after_caesarean

Systematic review of CS birth compared to Vaginal Birth
https://childbirthconnection.org/article.asp?ck=10166#systematic

Swedish study od risk factors for UR
https://www.ncbi.nlm.nih.gov/pubmed/17877673

CS myths and mis-quoted stats
https://www.caesarean.org.uk/articles/Myths.html

VBAC info (taken from Homebirth.org) not all about HBAC though.
https://www.homebirth.org.uk/vbchances.htm
https://www.homebirth.org.uk/vbacsigns.htm

A 3 part article looking at VBAC from a Lamaze research blog (V.V good site it references everything)
https://www.scienceandsensibility.org/?p=2887

Another fab Lamaze post about VBAC - great links in here I have posted a few of the good ones
https://www.scienceandsensibility.org/?p=3512

US Birth statistics 1989-2006 showing, CS and VBAC rates
https://www.childbirthconnection.org/article.asp?ck=10554&ClickedLink=274&area=27


MW blog running through risks and statistics
https://midwifethinking.com/2011/02/2...of-a-molehill/

Continuous fetal monitoring
https://www2.cochrane.org/reviews/en/ab006066.html
cochrane review of continuous monitoring and its outcomes shows that there is no difference with maternal or neonatal death rates but increased rates of instrumental deliveries and c sections when CTG is used!
https://www.nct.org.uk/info-centre/decisions/view-40
"continuous fetal heart rate monitoring", lancet, 12 Dec 1987, 1375-7
2 - RCOG recommendations from a study of 35k women showed that there wasn't any beneficial outcome to baby from CFM. C-sections and use of forceps were increased by 33%. Due to any signs of distress is acted upon more frequently, but this study also showed the babies chances of survival were not improved by operative deliveries. Also it found that often the baby wasn't found to have a lower APGAR score after operational delivery, which would have been expected in cases of fetal distress.

Good Blogs...

Spoiler

Blog of a VBA3C mama
https://victorybirth.blogspot.com/

Blog looking at unnecessary CS
https://www.theunnecesarean.com/

Blog post about distorted risks of VBA2C
https://wellroundedmama.blogspot.com/2010/12/vbac-after-2-cesareans-distorted-risk.html

VBAC/HBAC Birth stories.

Spoiler

Whole ton of story links here
https://www.vbac.co.uk/stories/

HBA2C baby born in the caul
https://birthwithoutfearblog.com/20...fter-2-cesareans-hba2c-baby-born-in-the-caul/

Unassisted birth after CS
https://mamabirth.blogspot.com/2011/07/unassisted-birth-after-cesarean-caution.html

unassisted birth after 2 CS!
https://mamabirth.blogspot.com/2010/04/guest-birth-story-unassisted-home-birth.html

VBAC after 4 CS...YES 4 CS!!
https://birthwithoutfearblog.com/2011/08/21/hba4c-homebirth-after-four-cesareans/

Post dates HBAC of 10lb 12oz baby!
https://mamabirth.blogspot.co.uk/2012/04/10lb12oz-42-weeks-3-days-hbac.html

VBAC after ELCS for Breech baby
https://mamabirth.blogspot.com/2010/06/birth-story-proud-vbac-mama.html

Awesome VBAC
https://mamabirth.blogspot.co.uk/2012/06/incredible-vbac.html
Transfer from HB and a VBAC
https://mamabirth.blogspot.com/2010/06/birth-story-proud-vbac-mama.html

VBAC of a 10lb baby!
https://mamabirth.blogspot.com/2010/10/birth-story-vbac.html

6 week early VBAC
https://www.babycentre.co.uk/pregnancy/labourandbirth/birthstories/hugh/

HBA2C video
https://vimeo.com/5648654

post dates HBAC - NSFW piccies so careful where you read this, the pics are glorious though!
https://birthwithoutfearblog.com/20...ing-a-post-dates-home-birth-after-a-cesarean/

Accidental Unassisted VBAC
https://birthwithoutfearblog.com/2011/05/19/an-accidental-unassisted-vbac/

11lb 12oz HBAC
https://mamabirth.blogspot.com/2012/01/11-lb-12-oz-hbac-home-birth-equals.html

Long hospital VBAC (but worth it!)
https://birthwithoutfearblog.com/2011/09/02/a-long-hospital-vbac-a-learning-experience/

HBAC in water
https://birthwithoutfearblog.com/2011/08/24/a-home-water-birth-of-a-vbac-with-beautiful-pictures/

HOSPITAL WBAC
https://birthwithoutfearblog.com/2011/11/01/vbac-hospital-water-birth-announcement-with-pictures/

5 foot 1 mama VBACing a 10lb baby!
https://mamabirth.blogspot.com/2012/01/10-pound-vbac-5-1-mama-not-possible.html

VBA7C!!!!!!!!
https://www.plus-size-pregnancy.org/CSANDVBAC/VBA2Cstories.htm

Accidental unassisted VBAC after a non-typical incision - T-shaped scar
https://birthwithoutfearblog.com/2012/05/28/accidental-unassisted-vbac-after-an-inverted-t-incision/

VBA3C - very awesome very hard work forceps birth with no pain releif
https://birthwithoutfearblog.com/20...-needed-interventions-and-pure-determination/

Facebook pages of interest

Spoiler

the unnecesarean
https://www.facebook.com/theunnecesarean

special scars ~ special women (for those with unusual CS scars)
https://www.facebook.com/pages/Special-Scars-Special-Women/267106676661425?sk=info

normal birth is not high risk
https://www.facebook.com/vbacsrock

CS smiles
https://www.facebook.com/CesareanSmiles

vbac
https://www.facebook.com/vbacfan

Add a blinkie in your siggy!!

https://www.kstardesign.com/blinkies/blinkie_VBACdelivery.gifhttps://www.kstardesign.com/blinkies/blinkie_VBACdelivery.gif

https://www.kstardesign.com/blinkies/blinkie_hopingVBACdelivery.gifhttps://www.kstardesign.com/blinkies/blinkie_hopingVBACdelivery.gif

 

[chuck]

So there are the links but lets cut to the chase.

For what ever reason you had your CS whether it was planned or emergency under Epi or General deciding if you want to VBAC or not is one of the most difficult decisions you will have to make.

It is easy to underestimate the effect the previous CS had on you physically and emotionally until it comes to making decisions about another childbirth, so we have to make sure we make the right decisions based on the right info - well as best as we can anyway!

I struggled for a long time after my DS1 EMCS I hated every second of it and it led me to carry out A LOT of research and while I cannot claim to be a font of all knowledge I can give a few condensed facts that are as far as I know correct concerning VBAC.

So here goes.

* There are more risks to Mother and baby with any CS birth compared to a normal vaginal delivery.

* Physical recovery from Vaginal Birth is quicker and easier that that from a CS

* Vaginal Birth is associated with fewer BF'ing problems and better bonding with baby - even with a planned CS

* The chances of achieving a VBAC are the same as the achieving a Vaginal birth for a 1st time Mother (around 75/80% depending on your hospital), but again this is variable depending on your circumstances i.e. was the CS your 1st baby/did you labour last time/do you have any other complications?

* The increased risk of VBAC over a normal vaginal birth is that of uterine rupture but this risk is around 0.5% TINY! (I'll put this into perspective later)

* Recommendations for VBAC mothers to have a cannula and constant fetal monitoring have not been proven to improve outcomes

* USe of synthetic hormones to augment/induce labour increase the risks of uterine rupture

 

[Bournefree]

Brilliant Chuck!! This is so needed to have a central place where women can share their experiences and get support and information. You're a star!

Some of this might be repeated, but I have cut and pasted from another post. Could you help organise on the first page Chuck? - Thank you

Section Risks
https://www.childbirth.org/section/risks.html
https://www.childbirthconnection.org/article.asp?ck=10166
As with any surgery, there is some risk associated with the anaesthesia used during caesarean births. If you happen to be sensitive to the anaesthetic used, you may experience a drop in blood pressure of respiratory complications. Infection is also of concern. Organs close to your uterus, like the kidney and bladder, may be infected during the c-section. If you have a c-section you may also notice increased blood loss. You will lose about twice as much blood as with a vaginal birth.
Your baby can also experience some problems associated with a caesarean delivery. Babies born through caesarean section tend to have a greater chance of having respiratory problems

Risk of needing a c-section
'the risk of having an emergency caesarean section for risk of serious
acute condition in labour (such as for fetal distress, post partum haemorrhage,
or cord prolapse) is 2.7%, or up to 30 times more likely than for a uterine
rupture with a planned vaginal birth after caesarean section.' (p96 Midwife's
labour and birth handbook, 2003)

VBAC/HBAC Info:
www.homebirth.net.au/2009/09/home-birth-vbac-after-3-sections-one.html
https://health.groups.yahoo.com/group/ukvbachbac/ Yahoo group
https://www.caesarean.org.uk/articles/Myths.html
The often quoted rupture rate of 2.2% for classical incisions is based on studies carried out more than 30 years ago. It is not known whether advances in surgical technology over recent decades will have affected this figure.
https://www.choicesforbirth.org/faqsarticle.php?id=44.. Explains the differences between risk of UR in a classic and LSCS (Lower Segment Caesarean Section)
https://www.homebirth.org.uk/vbchances.htm
https://www.theunnecesarean.com/
https://www.plus-size-pregnancy.org/C...begrateful.htm
https://www.childbirth.org/section/ICAN.html
https://www.homebirth.org.uk/vbacsigns.htm
https://www.childbirth.org/section/ICAN.html
https://wellroundedmama.blogspot.com/...rted-risk.html

Videos:
https://www.youtube.com/watch?v=21eW6vNch08
The woman on the video is the US as well so it's great for those who think they can't do it because the laws are so much different than in the UK"

Continuous fetal monitoring
https://www2.cochrane.org/reviews/en/ab006066.html
cochrane review of continuous monitoring and its outcomes shows that there is no difference with maternal or neonatal death rates but increased rates of instrumental deliveries and c sections when CTG is used!
https://www.nct.org.uk/info-centre/decisions/view-40
"continuous fetal heart rate monitoring", lancet, 12 Dec 1987, 1375-7
2 - RCOG recommendations from a study of 35k women showed that there wasn't any beneficial outcome to baby from CFM. C-sections and use of forceps were increased by 33%. Due to any signs of distress is acted upon more frequently, but this study also showed the babies chances of survival were not improved by operative deliveries. Also it found that often the baby wasn't found to have a lower APGAR score after operational delivery, which would have been expected in cases of fetal distress.

 

[chuck]

UTERINE RUPTURE (insert intense scary music here!)

UR is the reason cited to you by OB's as to why a VBAC is 'dangerous' and particularly the reason why you are not allowed a water birth/homebirth etc and why you need to labour in hospital the minute you feel a niggle and have a cannula and monitor strapped to you.

<facepalm>

Risk of UR for a VBA1C is around 0.5%, so a 1 in 200 chance of it happening or thereabouts.

This is a really small risk 1 in 200 sounds quite big given how many women have babies every day but look at it this way, there are always risks with a vaginal birth and plenty of those risks can have just as poor outcome if you are unlucky enough to suffer them and many of those risks have a higher chance of occurring than UR.

Risk of cord prolapse in a normal vaginal delivery is the same 0.5% (ranging up to 20% for a transverse baby and in between for various breech presentations). Now an overt cord prolapse is an emergency which can lead to fetal brain damage or death.

Scary stuff eh?

...and this can happen in ANY vaginal birth not just my dangerous VBAC? YES it can, yet why isn't every mother forced to have constant monitoring and a cannula 'just in case'?

Because UR is an additional risk on top of that yes I understand that but still with all risks it can be monitored and managed. One of the best indicators of UR is funnily enough the Mother feeling something is wrong and pain between contractions...how is the Mother supposed to be able to pay attention to her body properly if she is worried about the cannula in her arm or very uncomfortable because she cannot move how she wants because of the monitor? Not to mention on edge because she is being offered interventions she may not want in a cold hard clinical setting?

I digress...but yes UR is a an additional risk but a very small one, one that can be most effectively managed if the Mother is allowed to labour how she wants which will in turn increase the likelihood of a normal vaginal Birth which is better all around for everyone involved.

Read through some of the links above there is some good info about UR - just dont be scaremongered but awful unsupportive OB's.

Here is a Swedish study of UR risk factors (Thanks to Celesse for this one)
https://www.ncbi.nlm.nih.gov/pubmed/17877673

Summarized here
RESULTS:

Compared with women who delivered vaginally in their first birth, women who underwent a caesarean delivery were, during their second delivery, at increased risk of uterine rupture (adjusted OR 41.79; 95% CI 29.73-57.00). Induction of labour, high (> or = 4000 g) birthweight, postterm (> or = 42 weeks) births, high (> or = 35 years) maternal age, and short (< or = 164 cm) maternal stature were also associated with increased risk of uterine rupture. Uterine rupture was associated with a substantially increased risk in neonatal mortality (adjusted OR 65.62; 95% CI 32.60-132.08)

So in list form things that can increase UR chance:

* Induction of labour
* high (> or = 4000 g) birthweight
* postterm (> or = 42 weeks) births
* high (> or = 35 years) maternal age
* short (< or = 164 cm) maternal stature

 

[chuck]

LOL Bourne I had to do it some time before you told me off for not doing it LOL!

 

[chuck]

Reet thats it started please post any links etc you think would be useful...hopefully we'll get some good discussion too.

I'm away for the weekend now - getting some rest as MIL will take the boys and me and hubby are off for the night to a wedding and staying in a BnB so rest much needed rest...and maybe a drink or 3 LOL!

I'm not creating and running but give me time in the week and I can organize anything left link wise into the first post.

 

[Bournefree]

LOL Bourne I had to do it some time before you told me off for not doing it LOL!

me? I wouldn't do such a thing! ;-)
Have a great weekend Mrs. I always smile at your posts - you give it good and straight!
Xx

 

[chuck]

I will endeavour to get good birth stories and good CS stories too.

ELCS can be awesome if you know your rights, EMCS will always be a little scary but with knowledge they can be good I'm sure so I'll try to get a little from the other side of the coin too.

You never k ow this may make it over to the new labour and birth section!

 

[tristansmum]

thank you. my next pregnancy is a way off yet but vbac is what i hope to do. good to have some info.

 

[indigo_fairy]

Great source of info all in one place

Loved that vid when I found it a while back, really empowering and no matter how many times I've seen it always need tissues!

 

[Lina]

The blog entitled "You should be grateful---after all, you've got a healthy baby."
has brought tears to my eyes. Every single word and emotion resonates with me.
I cannot thank you enough Chuck for starting this thread. I too had an emcs for reasons I believe were
'The woman has been here for 24 hours and we are really busy and in need of beds.'
It is an experience which I will likely never recover from.

 

[Nikki_d72]

UTERINE RUPTURE (insert intense scary music here!)

UR is the reason cited to you by OB's as to why a VBAC is 'dangerous' and particularly the reason why you are not allowed a water birth/homebirth etc and why you need to labour in hospital the minute you feel a niggle and have a cannula and monitor strapped to you.

<facepalm>

Risk of UR for a VBA1C is around 0.5%, so a 1 in 200 chance of it happening or thereabouts.

This is a really small risk 1 in 200 sounds quite big given how many women have babies every day but look at it this way, there are always risks with a vaginal birth and plenty of those risks can have just as poor outcome if you are unlucky enough to suffer them and many of those risks have a higher chance of occurring than UR.

Risk of cord prolapse in a normal vaginal delivery is the same 0.5% (ranging up to 20% for a transverse baby and in between for various breech presentations). Now an overt cord prolapse is an emergency which can lead to fetal brain damage or death.

Scary stuff eh?

...and this can happen in ANY vaginal birth not just my dangerous VBAC? YES it can, yet why isn't every mother forced to have constant monitoring and a cannula 'just in case'?

Because UR is an additional risk on top of that yes I understand that but still with all risks it can be monitored and managed. One of the best indicators of UR is funnily enough the Mother feeling something is wrong and pain between contractions...how is the Mother supposed to be able to pay attention to her body properly if she is worried about the cannula in her arm or very uncomfortable because she cannot move how she wants because of the monitor? Not to mention on edge because she is being offered interventions she may not want in a cold hard clinical setting?

I digress...but yes UR is a an additional risk but a very small one, one that can be most effectively managed if the Mother is allowed to labour how she wants which will in turn increase the likelihood of a normal vaginal Birth which is better all around for everyone involved.

Read through some of the links above there is some good info about UR - just dont be scaremongered but awful unsupportive OB's.

Thanks for bringing this all together, Chuck! (there goes another couple of days to the net, then, hehe)

What the stats don't tell us either is that only a tiny percentage (of the already tiny percentage) of UR's are catastrophic full ruptures, most are only slight separations of scar, causing no major problems and repaired afterwards. The other thing is the stats also don't differentiate between those who had Pitocin or Syntocinon to induce or augment labour and the effects that had. They also don't tell you that as many UR's occur prior to labour as in labour (so doing away with any logic in limiting time spent in labour, as they do) and in women with no scarring nearly as commonly as those with (mainly thought to be caused by synthetic oxytocin administration, although never proven and never admitted as no comprehensive study into the full effects of these drugs has been undertaken, despite their wide usage). Brilliant, eh?

 

[indigo_fairy]

UTERINE RUPTURE (insert intense scary music here!)

UR is the reason cited to you by OB's as to why a VBAC is 'dangerous' and particularly the reason why you are not allowed a water birth/homebirth etc and why you need to labour in hospital the minute you feel a niggle and have a cannula and monitor strapped to you.

<facepalm>

Risk of UR for a VBA1C is around 0.5%, so a 1 in 200 chance of it happening or thereabouts.

This is a really small risk 1 in 200 sounds quite big given how many women have babies every day but look at it this way, there are always risks with a vaginal birth and plenty of those risks can have just as poor outcome if you are unlucky enough to suffer them and many of those risks have a higher chance of occurring than UR.

Risk of cord prolapse in a normal vaginal delivery is the same 0.5% (ranging up to 20% for a transverse baby and in between for various breech presentations). Now an overt cord prolapse is an emergency which can lead to fetal brain damage or death.

Scary stuff eh?

...and this can happen in ANY vaginal birth not just my dangerous VBAC? YES it can, yet why isn't every mother forced to have constant monitoring and a cannula 'just in case'?

Because UR is an additional risk on top of that yes I understand that but still with all risks it can be monitored and managed. One of the best indicators of UR is funnily enough the Mother feeling something is wrong and pain between contractions...how is the Mother supposed to be able to pay attention to her body properly if she is worried about the cannula in her arm or very uncomfortable because she cannot move how she wants because of the monitor? Not to mention on edge because she is being offered interventions she may not want in a cold hard clinical setting?

I digress...but yes UR is a an additional risk but a very small one, one that can be most effectively managed if the Mother is allowed to labour how she wants which will in turn increase the likelihood of a normal vaginal Birth which is better all around for everyone involved.

Read through some of the links above there is some good info about UR - just dont be scaremongered but awful unsupportive OB's.

Thanks for bringing this all together, Chuck! (there goes another couple of days to the net, then, hehe)

What the stats don't tell us either is that only a tiny percentage (of the already tiny percentage) of UR's are catastrophic full ruptures, most are only slight separations of scar, causing no major problems and repaired afterwards. The other thing is the stats also don't differentiate between those who had Pitocin or Syntocinon to induce or augment labour and the effects that had. They also don't tell you that as many UR's occur prior to labour as in labour (so doing away with any logic in limiting time spent in labour, as they do) and in women with no scarring nearly as commonly as those with (mainly thought to be caused by synthetic oxytocin administration, although never proven and never admitted as no comprehensive study into the full effects of these drugs has been undertaken, despite their wide usage). Brilliant, eh?

Exactly, they don't go into details do they! And if I'd remember all that lot when seeing my consultant I would have loved to hear his response... oh no hang on.. he wouldn't have had one - selective hearing would have kicked in no doubt.

 

[chuck]

The fact that UR can and does occur in unscarred uterus's (or is that uterii? LOL)

It's touted as such a scary fatal thing and I'm sure it can be catastrophic for some but there's no need for such fear when birth is a risky business anyway.

Like another poster has already mentioned we're more likely to end up in theatre because of time/bed constraints.

I'd rather avoid theatre all together and thankfully did this time but I'd rather be there for a good reason - a real need for surgery.

 

[Samantha675]

I read this on my midwife's partnering MW's blog the other day.

It is an article written by an OB, which was meant to sound really supportive, but comes off condescending. It is the follow up reply which made me clap my hands while sitting at the computer. It is written by an OB who left the hospital setting TO ONLY ATTEND HOMEBIRTHS!!! He was so disgusted by the system in the US, he left it. AMAZING!!!!

https://www.motherbloommidwifery.com/2011/05/very-interesting-article-and-response.html

 

[chuck]

I think all OB's should be made to attend homebirths and waterbirths and good ol fashioned normal births at least 1 week a month.

 

[SmokyJoe78]

Thanks Chuck for starting this thread - brilliant

 

[Samantha675]

I think all OB's should be made to attend homebirths and waterburyhs and good ok fashioned normal births at least 1 week a month.

But how would they control the birth? What about being home in time fir dinner?

 

[RyliesMummy]

Thanks for this, great info

 

[chuck]

But how would they control the birth? What about being home in time fir dinner?

LOL maybe they might need a gag and chains a strict no bloody messing it up policy!

IN all honestly though I'm sure there are amazing OB's out there and yes they will and do save lives but from what I read and speak with women and MW's about there sure seem to be plenty of OB's who have no idea why birth is important any more or how it can and mostly happens without following the textbook or policy.