Emotional Aspects of A Vaginal Birth After Caesarean (VBAC)
Often, as soon as you talk about having a Vaginal Birth After Caesarean (VBAC), you are given all the negative thoughts on it, such as 1 in 200 will have a Uterine Rupture, or your baby will die, or even worse – you will die. Please don’t allow these negative and unhelpful opinions make your decision as to whether you go ahead with a VBAC or not. Obviously all the information and medical advice available should be considered, because yes these are risk factors, but they are very rare.
If you choose to have a VBAC you will be closely monitored and if there are any suspicions of uterine rupture or fetal distress you will be taken for an Emergency Caesarean Section straight away. So it’s important to do your research first before jumping straight into another caesarean section.
Many women planning a VBAC will have unique emotional issues to deal with. Sometimes the emotions within themselves are enough to impede their chances of achieving a vaginal birth. Take time to consider how you are feeling before the birth, and try to work through your emotions before they confront you in labour. The following are some common concerns that have been expressed by women planning a VBAC.
Fear of Disappointment
Many women worry that they will have to endure a long and / or difficult labour, and this can be one of the main reasons to opt for a repeated caesarean.
Try and have realistic expectations. Plan as much for a vaginal birth as another caesarean, so you cover all your bases. Be aware that despite the best possible preparation, some women will still ultimately experience another caesarean.
Sometimes the experience of labour reinforces the need for another caesarean, or makes you feel at least you gave vaginal birth a chance. Not planning a VBAC may mean you will never know if a vaginal birth would have ever been possible.
Surround yourself with people who are willing to support you no matter what the outcome. Balancing your plans for a VBAC and the prospect of another caesarean will not be easy, and being able to share your feelings and thoughts in a safe and supportive environment is important.
The Fear of Losing Control
For many women, their Caesarean made them feel their birth experience was totally out of their control. Discussing this with your midwife/doctor and writing a birth plan that outlines your desired expectations for a vaginal birth as well as a caesarean birth, may help you to have a positive experience next time around.
The Fear of the Unknown
A repeat caesarean section can be an attractive option because it is a familiar experience, even if it was unpleasant or meant complications the first time round. Trying something new, not knowing what may lie ahead is always hard, as it would have been before your first birth. Take it one step at a time. Even women who have had a vaginal birth first time around have fears. There are no guarantees about what anyone’s second birth will bring.
Fear of the Pain
If your last labour was painful or you have not experienced labour, then fear of the pain can be something you need to come to terms with. Balancing this fear with not wanting to jeopardize your chances of a vaginal birth can be difficult.If possible, plan to delay having pain relief until the pain is no longer tolerable, rather than not wanting to experience any pain at all. When you get to that point in the labour, choose pain-relieving options that you feel the most comfortable with.
Fear of Complications
Many women feel positive about planning a VBAC, but hold concerns about the possibility of complications. Fears around the scar splitting during the labour and birth are commonly voiced. These fears can be dwelt on frequently during the pregnancy and will often surface during the labour. Some women will acknowledge these fears but continue on to have their VBAC. Others will lose confidence and feel more comfortable with opting for a repeat caesarean section.
Your fears can be compounded when others use scare tactics about complications to persuade you to do otherwise. Your chances of a major complication are virtually equal to any healthy woman having a baby. Choosing to have a VBAC is actually decreasing your health risks when compared to a caesarean section.Talk with your partner or a friend, share your feelings, try and make the decision that is right for you, and avoid others who are not supportive.
Feeling Very Alone
It can sometimes feel like you are on a lone crusade when you plan a VBAC. Caesareans tend to be a much more accepted part of our modern society. Prepare yourself for negative comments from friends and relatives, even possibly your partner. Look into contacting other mothers who have planned a VBAC. There are many local groups throughout Australia that offer empathy, support and up to date information.
Pre-labour and Early First Stage
The labour starting can bring up a lot of mixed emotions. You could feel excited that the labour has started on its own as well as a little anxious that your ‘moment of truth’ has arrived. Try and stay calm, keep your breathing slow, take each contraction as it comes, treat it as pre-labour until the pains are too strong to feel otherwise. Be aware that many women have ‘opted’ for a caesarean in early labour because of their concerns of what may lay ahead. If you have had a previous caesarean, this is more likely to be granted on request, but may defeat the purpose of all your preparation.
The “Been there, done that” Thoughts
Feelings of’Déjà vu’ in a subsequent labour can bring up past unpleasant experiences or feelings. Your partner may experience the same feelings. Talk about this, try and separate this labour from your previous one. They are different and you don’t want to set yourselves up for a similar ending, if this does not necessarily need to be the case.
Before you go into labour, try journaling your first birth experience in an effort to minimize this reaction. Record what happened and how you felt at the time. Writing is one way of trying to separate and integrate your first birth. If you feel unresolved about certain aspects of the previous birth, then talking with your caregiver or a counselor may help you obtain some clarity and resolve any issues you may be feeling.
Reaching the point where you had the Caesarean last time can be an emotional, as well as a physical hurdle for many women. You could feel anxious and pessimistic until you reach the stage that you got to last time. Once this has passed though, you will often feel more relaxed and optimistic.
Ultimately the decisions you make have to be yours with no other person influencing your decisions. Spend time doing your own research, work out the results you are trying to obtain from this birth, and then go for it!
The most common response from every woman that has had both a vaginal delivery and a caesarean section is “why do people choose a caesarean section”. Imagine the immensely positive feeling you would have to look back and know you too have successfully achieved a VBAC, both emotionally and medically!
I hope this has helped a few women who are planning a VBAC in the near future. The emotional aspects are just as important to address as the medical aspects of care, so surround yourself with those who will support and uplift you through this experience, and arm yourself with all the information you require to make this one of your most treasured memories in life.
(This article contains general information only and is not intended to replace advice from a qualified health professional. All information is written from the experience and knowledge of the person writing the post).