I was recently hired by clients for a VBAC. It will be my first! I am excited and of course want to do an excellent job for them. It is also a planned HBAC. I feel confident in my doula skills generally (while I am a relatively "new" doula), but I just want to make sure I am covering my all my bases, and I'm wondering how "different" of a birth this will be. I know each and every birth is so very different in general, and I've been involved in births where transfers took place and I have attended cesarean births, so I am fully comfortable with those turn of events, but again I'm just wondering if there is anything in particular I need to do to prepare for this birth, and of course how I can most effectively help this mother prior to labor and during the birth. The cesarean was performed about 4 years ago and the mother told me it took place after 2 hours of pushing. I also know that the mother and father feel this was an un-necessary cesarean. Anyway, if anyone has any specific advice to share with me or resources (i.e. sections of particular books or articles or links) I would be very appreciative! I am part of the local ICAN list-serve in my area so I have been educating myself that way, but I don't feel it is an appropriate place for me to ask these questions. Thanks!
Congrats, sounds like fun.
I don't imagine that it will be significantly different than other births. The fact that this mama made it all the way to pushing last time means that labour progress should be good, she knows her body knows how to dilate, etc.
It is often said that women may experience fear or blockage as they reach the same point in their labour where they got stopped last time. I would certainly be on the watch for that, but I haven't actually seen it happen.
From the small amount of detail you've given, it seems to me that the main issue last time has been dealt with by the mother by changing her caregiver and birth place. If she had pain medications last time you may need to help her cope with the full sensations of labour this time - but that doesn't have anything to do with VBAC. In fact the pain can be helpful. If she has any fears of rupture, it may help to understand that her pain can be her guide to how she's doing. Again, if there's fear of rupture she may want her midwife there early to listen to the baby and reassure her. Perhaps the midwife would be willing to come in and check on her and then leave if it's still early?
(For you, be prepared physically and emotionally for a sudden transfer. Rupture is rare, but it's enough of a worry that a lot of midwives here won't do home VBACs [ours all have admitting privileges, so they can do VBACs in the hospital]. If there's a problem you need a solution very, very quickly, and I would guess that some midwives would make the decision to transfer more readily with a VBAC mama than one without that history.)
Good luck. So far, all of my VBAC clients have had wonderful, unmedicated vaginal births. They tend to be pretty determined women!
And I would concentrate more on comfort measures (if she wants them, some women don't like to be touched) especially during later labor. Helping the mom tune in to her body, rather than relying on someone else to guide her, so to speak. I would also prepare her for a possible shorter labor than last time, since 1) she's at home and more comfortable and 2) this is her second baby...
I am sure you will do fine! Keep us posted! We do VBACs quite often. The midwife checks the fetal heart tones pretty regularly, and especially closer to and during pushing...
The only thing I would say is really making sure you're in line with what mom wants. I've only had one VBAC client, and she wanted a VBAC... but when it came down to it, I don't think she emotionally was ready. She did almost no prep work, and in the end it ended up seeming like a lot of the responsibility for a vaginal birth was 'on me'. In some ways I feel like she thought hiring a doula would 'ensure' she had a vbac. It was very emotionally draining for me, trying to find the happy place where I was supporting her and encouraging her, without pushing her into something she wasn't ready for. I would definately recommend lots of talking to the parents about what they want to do to prepare, what their ideal birth is, and also too what would make them go for a repeat C. In the end, my clients made it through all of labor, then they told her to push, she pushed a few times, and then was checked again and they told her she wasn't actually 10 yet, so she needed to wait a bit more... or they could just do a c-section now and she wouldn't have to wait. She jumped on it. I felt like crying.
I feel like VBAC is so emotionally charged sometimes, it's hard not to take it personally. Make sure you've got a doula friend (or here) where you can go to talk and get new ideas when you're feeling all out of them.
Two of my VBAC's come to mind. And I think the BFW is a big plus with VBAC's.
One of my VBAC's while she did not take my BFW class was very much into the book and did a bunch of birth art and a ton of exploring with herself that she shared with me. She was very adamant about a VBAC and very in tune with this being an emotional and spiritual journey as well as a physical one. As she took her journey through pregnancy she did come from a place where she thought she might have an epidural to a place where she was adamant about not having one to increase the odds of a successful VBAC. She went on to have a gorgeous labor and vaginal birth - was a birthing warrior!!
Another one of my VBAC's seemed a little like PP mentioned. She did want a VBAC but did not really seem to want to do a lot of prep work with me prenatally. She was a fast talker and tended to have that attitude of "been there done that" since she had made it to pushing in the first labor. I wasn't sure whether to sense that she was just very confident or that there was something in there that needed to be explored. And now that I look back I wish I'd pushed for more exploration. We didn't do much BFW. She walked into the hospital with me (from home where we had been laboring great) at 8 cm with bloody show like you can't believe moving at a great pace. And then suddenly decided on an epidural (which she didn't even have the first time!). And her care provider was so gung-ho because she admitted she wanted to slow the labor so she could get the meds in for the GBS. Can you believe it? Awful midwife!! Anyway Mom took epi and within minutes both her and baby crashed suddenly and she was wheeled away to c/s. Right before pushing. Dad said it was like Deja vu - same way the time before....... and afterwards she was chipper and happy and seemed to me that is what she had mentally prepared for which affected the process.
SOooooooo - what would I say a VBAC needs? Well depending on the person maybe a lot of personal exploration into what their true feelings/fears/expectations are about the upcoming birth. Maybe some time to let go old expectations and move on to new ones.
Thanks all for the great responses! There is much for me to think about here.
At our initial meeting I could tell that I already wanted to go deeper with this couple, but they are not interested in classes and did not express an interest in meeting more than our two prenatal appointments together. This could change, but I know there isn't that much time either until their due date. I really felt pulled to try to work with them more, especially in regards to processing their first birth and I even tried to come out and say that, but the dad just said that he didn't have anything to work on and it was a mistake the first time, bad doctor, etc. Anyway, I am certainly going to try to ask them more about what they are doing to prepare. We did have this conversation the first time we met too but I'm going to bring it up again. With that said, I'm trying to remain open to the possibilities and just do my best!
What I am banking on now is that this mom seems to have a tough and determined side to her and hopefully it will be fast birth too.