VBAC ‘Vaginal Birth After Caesarean’

VBAC refers to the birth of a baby through the vagina during subsequent labour after Caesarean birth. With careful selection of patients and good obstetric care, VBAC can be successful and safe.

Benefits of VBAC

• Quicker recovery and shorter hospital stay
• Avoidance of complications related to surgery, e.g. Clots in the legs
• Lower risk of complications, such as bleeding and infection, when compared to repeat caesarean section
• If successful, it facilitates vaginal birth for subsequent babies

Risks of VBAC

• Small risk (1 in 200 VBAC attempts) of uterine rupture related to the force of the contractions during labour and the pressure on the scar. In those women who have a uterine rupture:
• It may be life-threatening to the mother and baby, and an emergency caesarean section will be necessary.
• 1 in 10 risks of requiring a Hysterectomy (following uncontrollable bleeding)
• 1 in 20 risks of still birth
• Need for emergency caesarean section due to failure to progress, uterine rupture or foetal concerns

Unsuitable conditions for VBAC

• A ‘Classical’ scar or inverted-T uterine scar
• The position of the uterine scar is unknown
• The position of the uterine scar is unknown
• Following some types of previous uterine surgery
• Previous rupture of the uterus
• Unusual shape of the pelvis
• A baby in transverse position
• The baby appears too big to pass through the birth canal
• Presence of a medical condition that may complicate labour
• Any other contraindications to labour

Women who are attempting vaginal birth after caesarean section are monitored throughout the labour to ensure both the wellbeing of the mother and of the baby. This is done by continuous CTG monitoring of the baby’s heartbeat and monitoring contractions, any bleeding or any pain between contractions.

Success rates for suitable women are high and, as mentioned will result in a shorter hospital stay and recovery.

Early Pregnancy Complications

Losing a pregnancy is a deeply personal experience that affects everyone differently. Unfortunately, pregnancy loss is not uncommon. Following a woman’s first missed period, the rate of miscarriage may be as high as one in five pregnancies. Most Miscarriages are a ‘once-off’ sporadic event and there is a good chance of having a successful pregnancy in the future.

The cause of miscarriages is still not well known. A couple often worries that it is something they have done wrong that has caused the miscarriage but often this is not the case. Most commonly, the cause of early pregnancy loss is a mismatch in the chromosomes. Chromosomes are required to ensure the growth of the baby and if there are too many or too few chromosomes this may result in a miscarriage.

Following a miscarriage, some women have passed all the products and nothing more needs to be done. Bleeding, like a light period, may continue for several days until the lining of the uterus is completely shed. Other women may pass no products or only some products of the pregnancy. In most cases, the products will pass with time but occasionally assistance may be required to empty the uterus.

Option 1: Wait and See

Following a miscarriage, if you have not passed all products you may choose to wait for your body to pass the products naturally. This option is not suitable for all forms of miscarriage.

• Benefits: You can avoid surgery and an anaesthetic
• Risks: You may notice ongoing bleeding, that may become heavier and may be associated with pain as you pass the products left behind. There is a small risk of infection and it may take up to three weeks for you to completely miscarriage.

Option 2: Surgery

The surgical option for miscarriage is called ‘Dilatation and Curettage’ and refers to the opening of the cervix and removal of the products from the uterus. It requires an anaesthetic to perform and is a short procedure.

• Benefits: No delay in completion of the miscarriage.
• Risks: There is a small risk of infection and injury to the uterus, as well as, a small risk associated to the anaesthetic.

Following a miscarriage, it is common to have continued bleeding for 10 – 14 days while your uterus is returning to its normal size.

All miscarriages may be complicated by infection. If you have any concerns with ongoing or increasing bleeding, increasing pain, malodorous discharge or fevers, please make sure you seek medical advice. There is no time frame to wait to try again. The best time to try again is when you and your partner are physically and emotionally ready.

Postnatal Care

Following the birth of your baby, you will be monitored to ensure everything is progressing smoothly before you are taken back to your postnatal room. A paediatrician will check your baby after birth and prior to discharge.

The length of time you stay in hospital after the birth of your baby depends on a number of factors, such as, the type of birth you have had, how the baby behaves and feeds and so on. It is usually between 2-6 days, but this time is entirely negotiable. You will usually be seen daily in the postnatal ward.

An appointment will also be made to see DR Shweta Wazir 6 weeks after your delivery in the practice rooms.

Through the 9 months of pregnancy your body has gone through significant changes and these changes will continue in the following months. It is important to take care of yourself through this time. This will ensure you are able to care for yourself and your baby.

Postnatal Depression and ‘the Blues’

As well as the physical changes, it is not uncommon to feel down in the postnatal period. Up to 75% of new mothers feel a little sad or depressed after giving birth. These feelings may range from very mild to severe, but there is help.

It is important to be aware of your feelings and talk to your family, friends and doctors. Sometimes the feelings go away without requiring any assistance but occasionally medication and or counselling may be required. Both can make you feel better and allow you to enjoy your newborn.

Breastfeeding

Breastfeeding should be recommended as routine but some mothers are unable to breastfeed or choose to bottle feed for a number of different reasons and should not feel ostracised for their decision.

Breastfeeding has many benefits.

• Provides the nutrients required for the growth of your newborn
• Cheaper
• Sterile food
• Prevents infection in the newborn through the passage of antibodies from the mother
• Causes uterine contractions and reduces blood loss
• Maternal – Infant bonding

a joint WHO/UNICEF statement)

• Be aware that some drugs in labour can affect the baby with sucking e.g. pethidine.
• Correct positioning and attachment at the breast will ensure nipples will not be damaged, and also stimulates production and emptying of the breast.
• Skin-to-skin soon with mothers immediately following birth for at least an hour will aid with bonding and helps mothers to recognise when their babies are ready to breastfeed. This maintains the baby’s temperature and allows the baby to sniff and smell around the breast.
• Give newborn infant no other food or drink other than breast milk unless medically indicated.
• Practice rooming-in, mothers and infants should stay together 24 hours a day if possible.
• Breastfeeding on demand: the baby will demonstrate cues for feeding. Allow babies to breastfeed when they demand. This will also stimulate breast milk production and prevent engorgement and jaundice in the baby.
• Give unrestricted time at the breast. Babies know when they have had enough and this will ensure that the breast is softened and prevents engorgement.
• Try to avoid artificial teats and pacifiers.
• Attend antenatal and parenting classes.
• Try to exclusively breastfeed until 6+ months of age.

When breastfeeding is not recommended.

• Galactosaemia in the baby
• Severe cleft palate
• Neurological problems in the baby e.g. severe prematurity
• Anatomical problems e.g. pyloric stenosis
• HIV positive mother
• With certain medications taken by the mother
• Chemotherapy

Motherhood is highly supportive of breast feeding. Lactation Consultants and staff nurses with expertise in Breast Feeding are available to assist if you have any concerns at any time. Dr Shweta Wazir will be able to give you further details if you require.