Q : “I had a cesarean with my first birth, which I didn’t think was really necessary. The doctor didn’t want to wait. I’m having my second child and I would really like a normal birth this time. I have a midwife who is very encouraging of VBAC. I’m wondering if I should write a birth plan so that I don’t end up with an unnecessary c-section again.”
A : A birth plan is not always necessary, although it is useful as a communication tool and also the process of thinking about and clarifying what you want can be invaluable. You can’t just copy someone else’s birth plan because every woman is different in what they find important to them. Some women are totally happy with sections are some are disappointed.
It’s awesome that you know what you want and are committed enough to seek out a midwife. Good for you! The most important factor in helping you have a VBAC is choosing a caregiver, whether it is a doctor or a midwife, who has lots of experience successfully supporting VBACs.
Another very important factor is feeling clear yourself about what you want and why, and educating yourself on the evidence to support your preferences. For example, many doctors are not comfortable with VBAC’s because of the small risk of uterine rupture. If you understand the evidence based research, you can dispel your fears because overwhelmingly the evidence states that VBAC is safer than another section. There are far more risks associated with sections than VBACs. Uterine rupture occurs in less than 1% of vbacs, and of those, they tend to mainly occur only when pitocin (artificial oxytocin) or cervadil (prostaglandin) is administered because they can cause unnaturally strong contractions.
The third factor to increase your chances of having a VBAC is to hire a Doula. At my first birth, I made the mistake of thinking I didn’t need a doula because I had a midwife, but what I found was that the role of a doula and a midwife, although overlapping, are quite different.
Research shows that having a doula can reduce cesarean rates by 50%, as well as reduce the need for epidurals, instrumental deliveries, inductions etc. A doula provides continuous support, while a midwife may have other clients to attend to. Doulas provide emotional, physical and informational support. The doula goes to your home before you go to the hospital. This in itself helps moms stay home longer so they don’t show up at the hospital too early. The reality is that when you get to the hospital, you are on the clock. We don’t live in utopia. Doctors have other patients, hospital beds may be full etc. If a mom is in labor too long, there may be a lot of pressure to speed things up, whether or not there is a medical reason for it. And some women are glad to speed things up, but some are not. This is where knowing yourself is important and communicating with your caregiver about what’s important to you. There are many grey areas in labor where there is room for negotiation.
If you do decide to hire a doula, find one who connects with you and listens to your needs. Besides having three kids, I am also a doula and prenatal teacher in Surrey, BC, Canada. I also do birth plan consultations to help moms create plans that are individualized. You can contact me or find another doula who is local to you.
Have a great day, and have a wonderful birth!