Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 NCT info sheet in production below is a draft - will let you know when you can get the real one Belinda Vaginal birth after a caesarean (VBAC) This leaflet gives information for women who have had their last baby by caesarean section and who are pregnant again. Often women in this situation would like to have their next baby normally (i.e. a vaginal birth). The care of a woman in labour after a previous lower segment caesarean should be similar to that of any women in labour. A vaginal birth after a caesarean is usually shortened to VBAC – pronounced ‘vee back’. Some midwives and doctors may also use the terms " trial of labour " or " trial of scar " . Here are some of the questions which women frequently ask about VBAC. How safe is VBAC? There is now quite a lot of good research on the safety of VBAC and it is very reassuring. The three common concerns women have about VBAC are · am I more at risk · is my baby’s life more at risk · am I more likely to lose my uterus The evidence shows that the risks of a mother dying (which are very small indeed) or losing her uterus are lower with a VBAC than with a repeat caesarean section. VBAC is safer for the mother than repeat caesarean because caesarean itself carries extra risks ie more chance of infection, injury from the operation, pain after the birth, problems getting pregnant again, feeling low and staying in hospital longer. There is also, especially with repeat caesareans, a greater risk of needing a hysterectomy (removal of the uterus), Although very rare, the chances of the mother dying from a repeat caesarean section are about 4 times higher than with a normal vaginal birth (2 per 10,000 as against 0.5 per 10,000). Women also suffer more serious illnesses after surgery than after a vaginal birth. Providing your baby is well positioned and there is no particular medical reason not to have a vaginal birth VBAC is also as safe for your baby. The exception to this is if your previous caesarean was done through a high, vertical cut in the uterus. If this is the case you will need more detailed information to make a decision I have had two (or more!) previous caesareans – is it still possible for me to go for a VBAC? Yes, it is. The research on this is encouraging. The likelihood of women successfully having a vaginal delivery after more than one previous caesarean section is about the same as that in women who have had only one previous section. Why are midwives and doctors worried about women having a vaginal birth after a caesarean? When a woman has had a caesarean section her uterus has a scar on it. 'The concern is that the scar may not be as tough as the surrounding muscle. The stretching of the muscle during pregnancy or the strong contractions of labour could cause the scar to become thin or begin to separate. In practice this happens in only 0.5-2.0% of women . This is known as ‘scar dehiscence’ and it doesn’t usually cause any problem – providing there is no bleeding. Doctors’ main concern is the extremely rare situation (0.3% of VBAC labours) where the scar opens causing bleeding and other complications. This is called ‘uterine rupture’ and is a serious risk to both mother and baby. If a uterine rupture happens during labour, the woman needs to have a caesarean section very quickly. However careful monitoring of the baby’s heartbeat and watching for significant bleeding or pain that lasts between contractions will give early warning of serious problems. Will my midwife and doctor support me in having a VBAC? They should, but it does vary in different parts of the country and between different consultants and midwives. If you want a vaginal birth this time, discuss it with those caring for you. Find out whether, in their opinion, the reason for having a caesarean section last time is likely to apply to you again this time – usually it doesn’t. Women who have been thought to have a small pelvis have gone on to have a safe and straightforward vaginal birth, often with a baby larger than the caesarean-born baby! If your midwives and doctors are not supportive, and advise you to have a caesarean section without going into labour (an ‘elective’ section), you can do one of three things: i) ask your midwife or GP to refer you to a different consultant ii) go along with what your midwives and doctors advise, if you feel this is best for you iii) stay with your current caregivers but decline their advice and choose a vaginal birth. They should support your right to make an informed decision. If you find your carers reluctant to respect your preferences, you can get support from the NCT VBAC supporters (contact details below). What are the chances of my having a vaginal delivery this time? Most women who choose a VBAC do succeed in having a vaginal delivery. The rate varies a lot between different studies and different areas, but everywhere more than half of the women who choose a VBAC go on to have one, and several studies record VBAC rates of over 90%. Having a VBAC also seems to improve your chances of a another vaginal delivery for any future baby. There are a number of things you can do to maximise your chances of having a vaginal birth – these are exactly the same as for any woman giving birth; · Start labour naturally, avoiding prostaglandins (especially repeat doses) · Let the waters break on their own · Choose to have the baby’s heartbeat listened to with a stethoscope or a hand-held Sonicaid (a ‘doppler’) rather than being strapped to an electronic fetal heart rate monitor · Avoid having an oxytocin drip to ‘speed up’ labour · As long as your labour is progressing don’t be tied to strict time limits on how long the first or second stage of labour should be · Keep moving around, changing position, being upright If you get one-to-one support from a midwife throughout your labour, this will also reduce the chance of your having a caesarean. Another option is to have a birth supporter who can also support your partner. This could be a female friend or relative who is relaxed about vaginal birth What happens during a VBAC labour’? Although research evidence shows that the care of women in labour after a previous caesarean section should be basically the same as for any woman in labour, most hospitals do have policies about how such labours are managed. These vary from hospital to hospital. Ask for a copy. There may be little evidence for some of the procedures they require. Do make your own views and preferences known and find out in advance how much flexibility there is. Keep in mind that you have the right to decide whether you wish to accept any treatments or interventions, regardless of hospital policies. You may like to make a birth plan to go in your notes, which should be discussed with your consultant and midwife. Can I choose a home birth? Yes home birth is an option.. If you are considering home birth you might like to talk to the NCT VBAC supporters or the NCT home birth co-ordinator. If you are considering a home birth, discuss with your midwife how she will monitor you to spot any problems before they become serious. Also consider how long it would take for you to be transferred to hospital in the event of a problem developing during labour. Currently recommended practice for women with a uterine scar is that they need to be in a setting where the baby can be delivered within 30 minutes if an emergency arises. Further information If you would like more information, a further book list or caesarean birth/VBAC support, please contact one of the NCT volunteer co-ordinators: Debbie – tel: 01252 690627 or – tel: 01256 704871 (both after 4.30pm evenings and weekends). In addition, your local NCT branch may be able to put you in touch with a mother who has had a VBAC call the UK office on 0 for details The NCT specialist worker on home birth is Horn,: angela@... One of the personal websites dedicated to homebirth is: www.homebirth.org.uk For the research evidence on VBAC read chapter 38 in: Enkin M and others (eds.) (2000) Guide to Effective Care in Pregnancy and Childbirth, 3rd edition. Oxford: Oxford University Press. Further reading Crawford K, Walters JC. (1996) Natural Childbirth After Cesarean – a practical guide. Blackwell Science. (American, and as such ‘natural’ tends to mean ‘vaginal’, but good with much guidance on how to prepare yourself for a VBAC) Clement S. The Caesarean Experience (1995) 2nd edition. Pandora. ( Clement is a psychologist and deals well with feelings on having a caesarean as well as other aspects). NCT Caesarean Birth – your questions answered £4.00 from NCT Maternity Sales: HYPERLINK " http://www.nctms.co.uk " www.nctms.co.uk tel: 0141 636 0600. UK VBAC organisation See http://www.hants.gov.uk/cousin/cousinweb/vbac.html The National Childbirth Trust is a charity and we would be grateful if you would make a donation towards the cost of providing this information. We suggest £3.00. Thank you. Add NCT address enquiry and bf line number and fax no and charity no and purpose statement and all 3 websites Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2001 Report Share Posted May 25, 2001 Gosh, I should learn to read a whole thread before I reply to the first message, shouldn't I?! Thanks for this, Belinda - made my day, and I shall be off to the bookshop. I'll put an extra £3 in the pot at the next coffee morning! Vicki Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2001 Report Share Posted May 25, 2001 Could we lose the word " normally " ? it really offends me and I'm sure some others. Vaginally would do or even non-surgically. Lesley, Antenatal teacher, trainee breasteeding counsellor. Demented mother of 3. Worthing. " We are born naked, wet and hungry. Then things get worse " . vbac NCT info sheet in production below is a draft - will let you know when you can get the real one Belinda Vaginal birth after a caesarean (VBAC) This leaflet gives information for women who have had their last baby by caesarean section and who are pregnant again. Often women in this situation would like to have their next baby normally (i.e. a vaginal birth). The care of a woman in labour after a previous lower segment caesarean should be similar to that of any women in labour. A vaginal birth after a caesarean is usually shortened to VBAC - pronounced 'vee back'. Some midwives and doctors may also use the terms " trial of labour " or " trial of scar " . Here are some of the questions which women frequently ask about VBAC. How safe is VBAC? There is now quite a lot of good research on the safety of VBAC and it is very reassuring. The three common concerns women have about VBAC are · am I more at risk · is my baby's life more at risk · am I more likely to lose my uterus The evidence shows that the risks of a mother dying (which are very small indeed) or losing her uterus are lower with a VBAC than with a repeat caesarean section. VBAC is safer for the mother than repeat caesarean because caesarean itself carries extra risks ie more chance of infection, injury from the operation, pain after the birth, problems getting pregnant again, feeling low and staying in hospital longer. There is also, especially with repeat caesareans, a greater risk of needing a hysterectomy (removal of the uterus), Although very rare, the chances of the mother dying from a repeat caesarean section are about 4 times higher than with a normal vaginal birth (2 per 10,000 as against 0.5 per 10,000). Women also suffer more serious illnesses after surgery than after a vaginal birth. Providing your baby is well positioned and there is no particular medical reason not to have a vaginal birth VBAC is also as safe for your baby. The exception to this is if your previous caesarean was done through a high, vertical cut in the uterus. If this is the case you will need more detailed information to make a decision I have had two (or more!) previous caesareans - is it still possible for me to go for a VBAC? Yes, it is. The research on this is encouraging. The likelihood of women successfully having a vaginal delivery after more than one previous caesarean section is about the same as that in women who have had only one previous section. Why are midwives and doctors worried about women having a vaginal birth after a caesarean? When a woman has had a caesarean section her uterus has a scar on it. 'The concern is that the scar may not be as tough as the surrounding muscle. The stretching of the muscle during pregnancy or the strong contractions of labour could cause the scar to become thin or begin to separate. In practice this happens in only 0.5-2.0% of women . This is known as 'scar dehiscence' and it doesn't usually cause any problem - providing there is no bleeding. Doctors' main concern is the extremely rare situation (0.3% of VBAC labours) where the scar opens causing bleeding and other complications. This is called 'uterine rupture' and is a serious risk to both mother and baby. If a uterine rupture happens during labour, the woman needs to have a caesarean section very quickly. However careful monitoring of the baby's heartbeat and watching for significant bleeding or pain that lasts between contractions will give early warning of serious problems. Will my midwife and doctor support me in having a VBAC? They should, but it does vary in different parts of the country and between different consultants and midwives. If you want a vaginal birth this time, discuss it with those caring for you. Find out whether, in their opinion, the reason for having a caesarean section last time is likely to apply to you again this time - usually it doesn't. Women who have been thought to have a small pelvis have gone on to have a safe and straightforward vaginal birth, often with a baby larger than the caesarean-born baby! If your midwives and doctors are not supportive, and advise you to have a caesarean section without going into labour (an 'elective' section), you can do one of three things: i) ask your midwife or GP to refer you to a different consultant ii) go along with what your midwives and doctors advise, if you feel this is best for you iii) stay with your current caregivers but decline their advice and choose a vaginal birth. They should support your right to make an informed decision. If you find your carers reluctant to respect your preferences, you can get support from the NCT VBAC supporters (contact details below). What are the chances of my having a vaginal delivery this time? Most women who choose a VBAC do succeed in having a vaginal delivery. The rate varies a lot between different studies and different areas, but everywhere more than half of the women who choose a VBAC go on to have one, and several studies record VBAC rates of over 90%. Having a VBAC also seems to improve your chances of a another vaginal delivery for any future baby. There are a number of things you can do to maximise your chances of having a vaginal birth - these are exactly the same as for any woman giving birth; · Start labour naturally, avoiding prostaglandins (especially repeat doses) · Let the waters break on their own · Choose to have the baby's heartbeat listened to with a stethoscope or a hand-held Sonicaid (a 'doppler') rather than being strapped to an electronic fetal heart rate monitor · Avoid having an oxytocin drip to 'speed up' labour · As long as your labour is progressing don't be tied to strict time limits on how long the first or second stage of labour should be · Keep moving around, changing position, being upright If you get one-to-one support from a midwife throughout your labour, this will also reduce the chance of your having a caesarean. Another option is to have a birth supporter who can also support your partner. This could be a female friend or relative who is relaxed about vaginal birth What happens during a VBAC labour'? Although research evidence shows that the care of women in labour after a previous caesarean section should be basically the same as for any woman in labour, most hospitals do have policies about how such labours are managed. These vary from hospital to hospital. Ask for a copy. There may be little evidence for some of the procedures they require. Do make your own views and preferences known and find out in advance how much flexibility there is. Keep in mind that you have the right to decide whether you wish to accept any treatments or interventions, regardless of hospital policies. You may like to make a birth plan to go in your notes, which should be discussed with your consultant and midwife. Can I choose a home birth? Yes home birth is an option.. If you are considering home birth you might like to talk to the NCT VBAC supporters or the NCT home birth co-ordinator. If you are considering a home birth, discuss with your midwife how she will monitor you to spot any problems before they become serious. Also consider how long it would take for you to be transferred to hospital in the event of a problem developing during labour. Currently recommended practice for women with a uterine scar is that they need to be in a setting where the baby can be delivered within 30 minutes if an emergency arises. Further information If you would like more information, a further book list or caesarean birth/VBAC support, please contact one of the NCT volunteer co-ordinators: Debbie - tel: 01252 690627 or - tel: 01256 704871 (both after 4.30pm evenings and weekends). In addition, your local NCT branch may be able to put you in touch with a mother who has had a VBAC call the UK office on 0 for details The NCT specialist worker on home birth is Horn,: angela@... One of the personal websites dedicated to homebirth is: www.homebirth.org.uk For the research evidence on VBAC read chapter 38 in: Enkin M and others (eds.) (2000) Guide to Effective Care in Pregnancy and Childbirth, 3rd edition. Oxford: Oxford University Press. Further reading Crawford K, Walters JC. (1996) Natural Childbirth After Cesarean - a practical guide. Blackwell Science. (American, and as such 'natural' tends to mean 'vaginal', but good with much guidance on how to prepare yourself for a VBAC) Clement S. The Caesarean Experience (1995) 2nd edition. Pandora. ( Clement is a psychologist and deals well with feelings on having a caesarean as well as other aspects). NCT Caesarean Birth - your questions answered £4.00 from NCT Maternity Sales: HYPERLINK " http://www.nctms.co.uk " www.nctms.co.uk tel: 0141 636 0600. UK VBAC organisation See http://www.hants.gov.uk/cousin/cousinweb/vbac.html The National Childbirth Trust is a charity and we would be grateful if you would make a donation towards the cost of providing this information. We suggest £3.00. Thank you. Add NCT address enquiry and bf line number and fax no and charity no and purpose statement and all 3 websites *** NCT enquiry line - 0 *** Live chat http://www.yahoogroups.com/chat/nct-coffee Have you found out about all the other groups for the NCT online? Quote Link to comment Share on other sites More sharing options...
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