It used to be recommended that once you have a C-section delivery, your succeeding deliveries should also be done the same way to prevent the risk of a uterine rupture. However, a major study on the matter revealed that VBAC (Vaginal Birth After Cesarean Delivery) success rates both for term and preterm were 74% and 82% respectively. The decreasing trend in uterine ruptures is a good reason to re-educate women, and it is also good news for those who wish to avoid having another C-section.
It has also been widely held in Singapore that once a C-section mom, always a C-section mom. This explains why there remains to be an increasing rate of C-sections in the country, with an estimated 40-45% births in 2015 from 10-15% in the early 90’s. However, as practices improve in the care for mothers who undergo VBAC, expectant moms who previously had a cesarean delivery now have another option.
If you prefer a VBAC for your next delivery, here’s what you can do.
Space your pregnancies
Spacing your pregnancies allows your scar to heal and your uterus to be stronger which improves your chances of avoiding another C-section. Know that a C-section is a major surgical procedure, therefore, it is important that your uterus is in great shape for the pressure expected in a vaginal delivery. This could mean an 18-month wait, at the least, for a couple.
Closely spaced pregnancies might not also give enough time for a mommy to bounce back. For example, pregnancy and breastfeeding alone can already deplete your stores of nutrients. When you monkey-bar your way to the next pregnancy, before you even replenish your nutritional stores, it will not only affect your health but that of your baby, too.
Do your research
If you aim to deliver your next baby vaginally, you need to be fully aware of the process. You can get a good amount of information through books, other literature, or on the web where you can even join discussions or forums to reach out to other moms who have done it.
You might come across a whole lot of fear-mongering on some websites or personal accounts, but it is always safe to see the good, the bad, and the ugly so that you can make an informed decision. Educating yourself about natural birth and VBAC, equips you with sound knowledge to stand as your own advocate. Furthermore, if you understood the root cause of your previous C-section, proper knowledge can help you eliminate it as a factor in your next delivery.
Talk to other moms
A personal account is always a good way to gauge the experience. You can join a mother’s support group in your area or an online support. Finding other women who have experienced it, or those with the same goal, can really help especially as you form a plan for your next delivery. Having been there and succeeded, they may even offer your some coping methods for birth.
Some members of your family or circle of friends may not fully agree with your decision, but it is important to have key people who you can talk to and cheer you on. Check if there is a local ICAN (International Cesarean Awareness Network) in your area. This is where you can find the support you need on your stance on VBAC because it is their mission “to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean.”
Hire a supportive care provider
If you are decided on delivering your next baby vaginally, having a professional care provider who truly believes in the process is a major advantage for VBAC success. There are OB-GYNs in Singapore who are staunch VBAC advocates and having them on your team will help you become more prepared. A provider who might say that they support VBAC but jumps off the boat when push comes to shove, or at the slightest red flag, then you could expect to go off-course.
Go for someone with a history of successful VBACs and is willing to do everything in their power to make your vaginal delivery a success. Don’t be afraid to ask about a practitioner’s VBAC philosophy and be willing to switch providers if you see that you are not on the same page.
Choose a supportive hospital
It is fortunate for us in Singapore that there are healthcare facilities that are supportive of VBAC. There are hospitals with rules that are in black and white, while some are more inviting and flexible. Take the time to tour around and ask questions. Be familiar with their protocols, and with your provider’s help, see if they suit your needs and goals.
Write a Birth Plan
If there is anything that should keep you prepared it is a well thought-out birth plan. This is the perfect instrument where you can make your desires for your next delivery become known. This should come after you have done your thorough research so that you come up with one that is not only extensive, but realistic as well.
Avoid non-emergent inductions
The main reason why people are wary of a VBAC is potential uterine rupture. When the need for labor induction with Pitocen is reduced, the risk of rupture also lowers while improving your chances for a successful vaginal delivery. Women with the best outcomes are the one who went into labor naturally and were able to control the pushing. Meanwhile, induced labor increases the risk for rupture because it forces unnatural and intense contractions.
Now that you have taken the step to educate yourself by reading this piece, drive yourself to learn more, and get professional advice from a practitioner whose heart and practice is dedicated to the process. Dr. Pamela Tan is an obstetrics and gynaecology specialist in Singapore who is a believer in natural birthing and is certified in VBAC deliveries.
Book your appointment with Dr. Tan today for an individualized approach in care as you prepare for your next milestone.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.