There is pretty awesome news for VBAC mothers and positive birthers alike. The Royal College of Obstetricians and Gynaecologists in their revised Guidelines Birth After Previous Caesarean Birth have said:
'successful VBAC have the fewest complications.'
But can I be honest? I feel like that person. You know, the scientist at mission control after the rocket has launched and is successfully in orbit? Everyone else is dancing around, cracking out the Whiskey. The camera pans back to me. I'm still chewing my finger nails looking at the screen on my desk making rapid calculations on a yellow pad. Not only are we off course but, holy cow, has anyone noticed that comet?
Surprisingly, the name of this comet is not uterine rupture (seen as the risk for VBAC mothers) but VBAC preparation. No provision for the mental and emotional side of a VBAC has even been alluded to in these guidelines. When you are planning to give birth as a 'low risk' first time mother, you do not have to talk much about the mortality rates of mum and baby when opting for a vaginal birth. But when I was planning my VBAC, I had this conversation many times and gave it even more hours of thought. VBAC mothers understand the medical miracle (after all we have our baby thanks to the miracle of caesarean) and we want to understand the risks to make informed decisions, to give informed consent, and to stay in control as the birth mother. However, this, without any other preparation, can be the monster under the bed for the VBAC mother; the hand lurking in wait threatening to grab at the ankles bringing fear and anxiety to the birth but also to the pregnancy - to the detriment of both. I know as a VBAC mother, and by providing The Wise Hippo Birthing Programme for VBAC Mothers, that preparation is needed to balance the conversation about risks of birth, with the knowledge of the natural birthing process. Furthermore, tools to help actively relax during pregnancy and birth, and techniques to deal with all the fears and anxieties that a VBAC can produce are both vital. Without these tools, you are telling a women to consider the likelihood of her own or her baby's death without the knowledge to balance this picture with the, more likely, positive birth outcome. To recommend and provide this sort of VBAC preparation is not only important for the maternal state of mind but for the eventual birth outcome.
Whilst there has been development into who will be recommended a VBAC (including mothers who have had more than one caesarean) it is very much limited to who will be advised to VBAC and doesn't affect the legacy of VBAC management. Making no differentials between mothers with a high VBAC success rate and a low uterine rupture risk, such as mothers wanting a second VBAC. The RCOG Guidelines for the management of VBAC includes: continuous electronic foetal monitoring - from when regular contractions begin, having an IV, and regular (less than 4 hourly) vaginal examinations.
How might those points feel to the mother during birth? You have come into the hospital as soon as contractions are regular but before you felt you really needed to. When you arrive you feel the clock is ticking. You want to move around but you are told that when you do the monitor is not able to work. You try to lay on your back but this makes things hurt in a way they didn't when you were upright and able to move your hips. You can move even less once the IV is in your hand, every time it tugs you are reminded of the possibility of caesarean. You get into your zone but the vaginal examinations make you worry 'are dilating to schedule'?
What seems oxymoronic to me is the fact that the RCOG state:
'[W]omen should be made aware that the greatest risk of adverse outcome occurs in a trial of VBAC resulting in emergency caesarean delivery.'
Yet these guidelines for the management of labour seem to be making it very difficult for the female body to perform the birth function. The fear, tension, pain cycle being pushed into a full turn.
The step from medically managed to low intervention birth has happened for 'low risk' mothers. We are now taking the leap as birthing programmes, water births, and active birthing are the new normal. I hope that this is the first of the small steps we need to take, so that 'high risk' VBAC mothers are not only encouraged to have a VBAC but are given the support to actually birth. So I can have that celebratory Whisky and you can have your calm and relaxed VBAC.