VBAC Medical Risk?
We have been asked this question many times over the past 45 years: ‘Can I have a VBAC if I or my baby have medical high risks?’ That’s certainly a very important question. Our goal is to make certain YOU … not statistics … can determine whether YOU and your BABY will actually be at risk if you strive for a vaginal birth after a cesarean.
Here’s an important distinction BETWEEN wanting a VBAC or even writing a Birth Plan for a VBAC when you have high medical risks THAN trying to reduce or prevent the risks you have from becoming problems. If you want a VBAC with medical high risks then you must be driven to reduce or prevent the potential from those risks becoming problems which either risks you and your baby or prevents you from achieving a VBAC
Birthing Better families know-how to actually reduce and prevent many of the medical high risks from becoming a ‘problem’ during birth! That’s right but we do it in a different way than you imagine. You probably think we’re claiming to ‘cure’ your risks. NOPE, we’re telling you to become skilled so that you can labor and deliver your baby effectively without putting undue stress on your risk factors. But there’s more so read below.
This will be a long post! You matter and Birthing Better families want to share with you how they achieved what you want and even more.
So how do we best answer your question? We have to start someplace.
You and your baby are and aren’t a statistic
Professor Marjorie Tew (UK) did heaps of research around ‘risk’ and safe birth many, many years ago. I heard her speak in 1984 at the first International Home Birth Conference. 1984 was 12 years into the development of Birthing Better skills. The original hundreds of Birthing Better families who developed these skills in the early 1970s through 1984 were almost all very high risk as well as strongly faith-based.
I have no medical training nor am I faith-based so it was always interesting to work with such families. We didn’t share much in common except one thing … our human body.
1984 was about the time the ‘evidence based maternity system’ that existed post World War 2 through the 1950s and into the 1970s was beginning to change. At that Time women had NO choices. We followed our doctor’s orders. There were standards of care for all sorts of medical assessments, monitoring and procedures you are not exposed to today. And the cesarean surgery was very major, leaving a woman with an internal uterine and external belly scar from belly button to pubic bone. Once a cesarean always a cesarean was the ‘evidence based practice’ of that Time.
Statistics are funny things. If your high risks impact your VBAC then you fall into those statistics … if not, you don’t. You are now left with really two choices. Either accept Life as Fate without your ability to influence experience or outcome OR do something to improve your probabilities. Human use skills to improve and ‘do’ things.
In other words, we KNOW Birthing Better skills work because a very large percent of Birthing Better families achieve a VBAC with multiple high risks while other still have an empowered and positive birth because they used their skills throughout their baby’s birth.
Statistics today and way back then
If you have an interest in childbirth back in previous generations just google. Somewhere there will be a list of all the assessments, monitoring and procedures that were the ‘guidelines to practice’ after WW2 through the late 1970s. If you get really interested go back to the earlier ‘evidence based practice’ from World War 1 to World War 2. Almost every generation or so there is a change in maternity care and definitely the childbirth trend women follow. If you go back to the 1800 what happens to and around women is much different than today. Then look around the world to all the diverse cultures throughout the past Eons … childbirth today is different. Yet, our human body remains the same as does our shared pregnancy and giving birth to our babies.
Times change, care changes, women’s approach to birth changes. You live in a very consumer positive childbirth trend and a maternity system trying hard to work with your ‘choices’. Given the complex history of childbirth, Birthing Better skills weren’t sugar coated but actually were effective for pregnant women with high risks to birth safely.
We’ve come a long way baby but we lost the plot
A long way from there to now
‘Follow your doctor’s orders’ was the childbirth trend of the childbirth trend that went up to the 1970s. Since the mid1980s, childbirth is basically run by YOU … the consumer, ordered by your Birth Plan. The ‘evidence based’ maternity system of today is so fundamentally changed in the past 2 generations. Goodness. So much of what families wanted you now have! You might not be aware of how lucky you are! Yet, over all statistics reflect a rise in medical birth due to the ‘choices being made by pregnant women everywhere. There are more elective cesareans then ever before. More requested use of epidural than ever before. You have ‘choice’!
We lost the plot
From the 1950s until the 1970s in at least the United States and New Zealand, Lamaze, The Bradley Method and Grantly Dick-Reed’s breathing and relaxation skills were taught. This means families used some skills in a maternity system that gave them no ‘choices’ and in a very medicalised maternity system. Coupling skilled families to a rigid maternity system led to the most amazing positive changes!
From the 1960s through late 1970s, US obstetricians and staff saw millions upon millions upon millions of women using some level of skill and fathers (who were just permitted to come in about 1970) were doing great birth-coaching. Seeing more women cope with labor pains was inspirational. Women no longer looked out of control which was the reason maternity care not only developed care for ‘the problems’ but also pain relief for the ‘suffering’.
There were two FATAL FLAWS with the early skills techniques The three above mentioned obstetricians developed methods to specifically promote natural birth, pain-free labor and less medical care. This meant by the end of the 1970s (a generation of kind-of skilled families), not enough women had achieved these three goals. Therefore birth advocates and the midwifery profession who had pinned great hopes that these methods would lead to these stated goals got discouraged and turned their attention to advocating for ‘choices’ via a Birth Plan.
Fatal Flaw Number One … these methods targeted only one a type of birth:
The focus of these early methods was directly related to the mentioned goals. This left out all the women not able to seek those goals for multiple reasons or those who ‘failed’ to achieve them after supreme effort.
While the above three goals proved elusive, many skilled women and birth-coaching dads felt better about their births even if they didn’t have a natural or pain-free birth or even less medical care. No one paid attention to this BIG detail!
- Hindsight and future solution: Direct skills to all pregnant women, expectant fathers in every type of birth because every single birth matters. Skills can hugely improve the family’s experience. That should have been the original goal and must be the future goal … every family becomes skilled.
Had these methods been advocated for ALL pregnant women and every type of birth childbirth would be different today.
Fatal Flaw Number Two … skills were dropped and replaced by choice
Birth advocates from the 1950s-70s who put all their hopes at skills would increase natural, pain free birth with no medical care shifted to putting their hopes into women’s ‘choices’. Sadly they dismissed skills as not working (‘Cats/cows aren’t taught to birth, women don’t need to be taught’ or ‘You breathe all the time, you’ll breathe in birth’ or ‘You’ll know what to do on the day’. ). Collectively birth advocates ignored the millions of families who birthed better because of their skills even with every type of medical need and care.
- Hindsight and future solution: Both Skills and Choices should have been and should be now encouraged. Choices are notoriously unreliable and fickle. Skills are your bedrock of what you can ‘do’ for yourself no matter the circumstances.
To understand how your specific risks can or might impact your successful VBAC is happening in the present ‘choice-based’ childbirth trend that has left behind the skills you need! You’ve need to know this history!
Let’s dig deeper.
There is NO generic ‘problem’
While pregnancy and childbirth are ‘normal’ Life events the word ‘normal’ absolutely includes all of the health issues any woman and/or baby has. However, YOU only have the issues that you and/or your baby has. If you’re not expecting twins then you don’t have that ‘problem’. If you have had a previous Cesarean then you’re faced with having had that ‘problem’. If you aren’t RhNegative, you don’t have this ‘problem’. If your labor progresses you don’t have a ‘delayed labor problem’.
Never accept anyone saying to you: ‘What if you have a problem?’ There are no generic problems. You need to know exactly which of your issues might become a ‘problem’ in your VBAC goal. For example, many Birthing Better mothers had/have severe heart problems yet were successful in achieving a vaginal birth after a cesarean. They prepare their body to give birth as well as use skills to cope with labor pain means that women can birth effectively and not put stress on such issues.
How did anyone with problems have success? They learned skills that could reduce and prevent what could blow a risk into a full blown problem. For those with heart problems, you want to labor effectively and as quickly as possible. Then you want 2nd stage to move along quickly (in less than an hour) without stressful pushing. With skills these things are realistic to achieve!
Understanding that there are no ‘generic problems’ is very important to understand. None or some of your health issues or those of your baby may have NOTHING to do with whether you can hope for, plan and achieve a VBAC. Your health issues may not interfere in any way with your ability to labor and have a vaginal birth. You need to do the research and ask. And talk to us!
Normal = Normal = Natural = Natural
The words: normal, natural or low risk have been used in a confusing way. Counter to what we are told, when there is no medical care anything that happens is normal and natural even if tragic. Even when there is lots of medical care, normal and natural means heaps of things. Normal and natural birth should not be assumed to mean: safe, easy and good outcome. Being ‘low risk’ does not mean you won’t develop ‘problems’. Nor does ‘low risk’ mean you will naturally know how-to cope with the naturally occurring and normal pain associated with labor contractions.
- Many women bring into pregnancy health issues or develop them during pregnancy and/or in birth.
- A small percent of babies have health issues and some issues develop between the mother and baby (low amniotic fluid, unusual position and others).
- A number of babies develop issues during birth associated with long labors and delay in 2nd stage.
Normal and natural has to do with health issues and outcomes such as:
- Diabetes is natural and normal and can be part of pregnancy and birth even for healthy women!
- A woman’s uterus can have an unusual shape due to a tissue septum inside.
- A baby can have congenital problems
- A woman can be in a car accident late in pregnancy
- Make a list. There are heaps of health issues that impact pregnancy/birth that are all natural and normal.
Normal and natural also has to do with how women cope:
- Labor contractions are normally and naturally painful and can be very, very painful
- A woman’s ability to cope with the natural occurring pain does not come naturally for most of us.
Low Risk can lead to high risk and high risk may not impact birth
- Healthy, low risk women can have a long and delayed labor or 2nd stage
- Low risk women can have a high risk baby/ies
- Low risk women can be totally blown out and overwhelmed with the natural occurring pain of labor contractions.
There is ZERO correlation between ‘low risk’ and having an effective birth or being able to cope with the natural occurring pain.
Going back to Marjorie’s research, she clearly shows that the number of risk factors has no particular correlation to ‘safety’ or ‘outcome’. She actually looked at women with up to 12 risk factors. There was still no correlation between safety or the baby’s ability to be born relatively easily. This has been our experience as Birthing Better families.
IMPORTANT, IMPORTANT, IMPORTANT
- The number of multiple high risk factors had absolutely nothing to do with how easily a baby could get out of their mother’s body during birth.
- The number of multiple high risk factors has zero correlation to how a woman copes with the natural occurring pain of labor contractions.
********* YOUR risks may have absolutely nothing to do with how easily your baby comes down, through and out of your body or how well you cope *********
- You NEED to know how-to know whether your health risks can cause problems to your self. You also don’t want to risk your baby’s health and wellbeing. In fact you will lay your life down for your baby even if that means you sacrifice something of who you are and what you want.
- You NEED to know how to cope and manage so you get through the labor part in order to get to the vaginal part of the VBAC.
1. How do I know if my health issues could risk me or my baby?
There are two factors to help you know whether your medical issues during pregnancy or birth actually will risk you or your baby’s health and well being:
- Results of the assessments, monitoring and procedures (AMPs) that indicate whether issues are becoming a problem. If everything appears fine then those ‘issues’ are not ‘problems’. This does not mean on further or later AMPs this won’t change. Also an other issues might develop. However, if everything is fine right now then keep doing what you’re doing right now. In other words, if you want a VBAC and your ‘issues’ are not yet problems then go for your VBAC. If you go into labor and none of your issues are becoming problems then keep laboring. If you’re in 2nd stage and some issue becomes a problem then deal with it then.
- A woman’s sense of herself and baby not connected to her ideological belief. This means that ideological beliefs can hinder a woman from paying attention to herself and baby. She can either assume problems that don’t actually exist or she may ignore signs within herself because she beliefs the AMPs are actually imposed ‘interventions’ that are ‘unnecessary’ and ‘imposed’. In other words, if you want a VBAC at all costs then you won’t pay attention and reach out for help. On the other hand, if you’re afraid that an issue is a problem but it’s not actually happening then you are more likely to want another cesarean. this is particularly true when women don’t cope with the natural occurring pain of contractions. They think the ‘pain’ is a ‘problem’.
Ideology = success and failure:
Consider your beliefs about VBAC and having medical risks. If you want a VBAC and have medical issues and have strong anti-medical beliefs either never go to hospital or obstetrician because you will have medical assessments, monitoring and procedures (AMPs) or what you may call ‘interventions’. Once you go to an obstetrician or hospital you will absolutely have to work with and around all forms of medical interventions or what we call AMPs.
Your determination to get through labor and vaginal birth will not be diminished by becoming skilled. You will be more relaxed because your skills grow your confidence.
Can I reduce or prevent issues from becoming ‘problems’?
YES! This was the question the original Birthing Better families were asking about their own pregnancy and birth and the skills they developed that worked.
Click here for the list of all the skills in Specific Skills for VBAC
Birthing Better Childbirth online courses are housed in Common Knowledge Trust