Natural Birth (Vaginal Birth – VBAC)

There are those who wonder why with the advent of epidural anesthesia a woman would “martyr” herself by not having pain relieving medications in labor. There are others who aren’t sure what they want and go in and try to have an unmedicated birth. And then there are women who know exactly what they don’t want – pain relief in labor. Here are just a handful of the reasons a woman might choose to avoid pain medications in labor:

• VBAC is usually safer for mom and baby.
• VBAC reduces the risks of infection to the mother.
• Labor is good for babies in most cases.
• Not having surgery makes mom’s recovery easier.
• VBAC reduces the risks of respiratory problems in babies.
• VBAC involves a shorter hospital stay.
• More than 80% of women will be able to have a vaginal birth after a previous cesarean.
• Breastfeeding is easier after a vaginal birth. Usually for a variety of reasons, including faster and more direct access to your baby and less postpartum pain for mom.
• VBAC can help prevent injury to your internal organs, like your bladder, intestines, or even the need for an emergency hysterectomy.
• VBAC is less expensive.

C-section: Medical reasons

Cesarean birth is the birth of a baby by surgery. The doctor makes an incision (cut) in the belly and uterus (womb) and then removes the baby. The surgery is called a cesarean section or c-section. If you or your baby have certain problems before or during labor, c-section may be safer than vaginal birth.

You and your health care provider may plan your cesarean in advance. Or you may need an emergency (unplanned) c-section because of a complication that arises for you or your baby during pregnancy or labor. Your health care provider may suggest that you have a c-section for one or more of these reasons:

• You’ve already had a c-section in another pregnancy or other surgeries on your uterus.
• Your baby is too big to pass safely through the vagina.
• The baby’s buttocks or feet enter the birth canal first, instead of the head. This is called a breech position.
• The baby’s shoulder enters the birth canal first, instead of the head. This is called a transverse position.
• There are problems with the placenta. This is the organ that nourishes your baby in the womb. Placental problems can cause dangerous bleeding during vaginal birth.
• Labor is too slow or stops.
• The baby’s umbilical cord slips into the vagina, where it could be squeezed or flattened during vaginal delivery. This is called umbilical cord prolapse.
• You have an infection like HIV or genital herpes.
• You’re having twins, triplets or more.
• The baby has problems during labour that show it is under stress, such as a slow heart rate. This is sometimes called “fetal distress.”
• You have a serious medical condition that requires intensive or emergency treatment (such as diabetes or high blood pressure).
• The baby has a certain type of birth defect.

I am 34 weeks pregnant now and been advised by my doctor that I should go for c-section as my child is already weight almost 2.8kg now.

How accurate would you think on the ultrasound result as my weight has only increased 10kg since pregnant. What would you recommend?

Try for vaginal delivery first or opt for c-section. This is my first pregnancy.

Thank You.

Regards,
LYF

Hi Reeny

There are several reasons why a doctor would recommend a caesarean section.
1. The baby is too big to go through the mother’s pelvis
2. The mother has a medical problem such as high blood pressure whereby it is safer to deliver the baby by CS
3. The mother has an obstetric problem such as a low lying placenta which makes it impossible for a vaginal delivery.
4. The baby is lying in a wrong position such as breech
5. The placenta is not functioning well therefore it is safer for the baby to be delivered by CS

Usually, the ultrasound results are quite accurate and your doctor may predict that your baby may become too big for a vaginal delivery. Did your doctor tell you the reason for wanting to do a CS? If you have any of the reasons mentioned above than it is best to follow your doctor’s advice.

Cecilia

When you want to have a VBAC after several c-sections, discuss your individual circumstances with your doctor. It’s also a good idea to look at the hospital notes from your last section. Was your scar healthy or had it started to open? Are there any anticipated problems related to your previous c-sections? Find out as much information as possible to help you make the right decision for you and your baby.

Your risk of uterine rupture increases if you have a vertical scar, but it’s much more usual to have a horizontal scar nowadays. And also if you are given prostaglandin to induce labor.

Your chances of having a successful VBAC are higher if you have delivered at least one baby vaginally in the past and also if your last c-section was for a breech baby

VBAC rates are lower if you previously had a c-section because of a small pelvis, or if you have already had more than one c-section.

However hard it seems, do try to move. About 6 hours after delivery you can attempt to. The earlier you can, the better for your circulation and general recovery. As well as moving around out of bed, you’ll be encouraged to do ankle exercises while you’re in bed, to improve circulation to your legs and help prevent clots.

Physically
Everyone knows a c-section is major surgery, but you may still be surprised by how much it hurts afterwards. You may feel you can’t do anything on your own. Trapped wind is another problem, especially by about day three. Tightening the abdominal muscles on an outward breath helps expel the gas. Peppermint water or tea also helps. It will hurt to cough or laugh, but less if you support your wound (with your hands or by holding a pillow over your stomach) as you do so. Wearing boxershorts that are a size bigger than you really need may make the wound feel more comfortable, and you’ll need to use sanitary pads because the lochia, or bleeding from the uterus, is the same as after a vaginal birth.

Going home
You’ll probably have to stay in hospital for about 3 days. It may take your body up to 6 months to recover fully after a section and many women say they don’t feel completely themselves for up to a year. You’ll probably be warned not to drive for 5 weeks, as turning and twisting may cause pain and having to do an emergency stop would be very painful. You shouldn’t lift anything heavy either. You will be encouraged to start gentle postnatal exercises the day after your operation. This will help speed your physical recovery. You should not start a more strenuous exercise program until 6 to 8 weeks after delivery.

The scar
The majority of c-sections these days are lower segment section, which means your scar runs horizontally along your bikini line. At first it will look very red, but as the weeks and months go by it will gradually fade to pink. By 2 years after your operation the scar will probably have faded to a silvery line, and it may eventually be almost invisible.

• Be in optimal condition when labor starts. Stay healthy during pregnancy; eat well, exercise and get plenty of rest.
• Maintaining an upright position as long as you can during labor. Walking and standing can hasten the process by making contractions stronger, longer, and more effective. Even sitting, rather than lying down, can cut the length of labor.
• Drinking plenty of fluids during labor to prevent dehydration. Some experts also suggest eating little bits but often during labor to keep your energy levels up.

Your husband or partner can be with you during the preparation and for the birth. Only when your c-section is a real emergency, or if you need a general anesthetic, will your partner be asked to leave. This is not often the case.

A c-section is done with an epidural or spinal block so you can be awake and see your baby immediately after the birth. You will have a catheter inserted to drain your bladder, and a drip in your arm or hand to give extra fluids or pain relief if needed. You may also have a heart monitor on.

A screen will be put up while the procedure is taking place. Some partners like to peek over the screen but others prefer not to see what is happening. You may like your doctor to tell you what he is doing, so that you know the minute your baby is born.

When the epidural is doing its work, the doctor makes a small horizontal incision in your skin above your pubic bone, and then makes a cut in the lower section of your uterus. Then your baby is lifted out, this only takes a few minutes. Your baby will be quickly checked and then shown to you.
If your baby is very small or unwell he or she may need to go straight to the special care unit. Otherwise your partner can hold him while the placenta is delivered and you are stitched up. This all can take as little as half an hour.