Planning a positive home VBAC/HBAC

I’ve blogged previously about my reasons for planning a home VBAC (vaginal birth after caesarean).  Today I want to write about the steps you can take to ensure that it goes smoothly, and is a positive experience.  I don’t want to talk in terms of ‘success’ because I don’t think that birth is an achievement, and if things don’t go according to plan it is not a ‘failure’.  But I don’t think there’s any harm in being clear about what you want and doing everything you can to give yourself the best chance of getting what you want.  Many of these points also apply for a hospital VBAC.

Do your research

You need to be 100% confident in your decision.  It’s good to have a clear understanding of exactly what the risks and benefits are of having a home birth.  There may be people along the way who will question your choices, whether out of ignorance or curiosity, and it’s good to be prepared and be able to answer them.  I’ve included a list of the reading I’ve done in my previous post Planning a HBAC – Why?.

Talk to your partner

Support is so important.  Share your research with your partner.  Make sure they are on your side from the beginning, so that you can stand united.

Think about your birth preferences

I think most women who are planning a VBAC really just want to have a birth where they feel in control of what is going on.  So it’s a good idea to be clear in your mind about what you really want.  This applies if you are having a hospital VBAC or a repeat ceasarean as well.  I prefer to call this birth ‘preferences’ rather than a birth ‘plan’ because it feels more flexible.  If you’re having a home birth this is less of an issue, but it’s still worth considering.  It’s also important to talk your preferences through with your midwife in advance, so that they are aware of what you want and there are no surprises on the day.  Some issues you might want to think about are:

• Do you want routine VEs?  If so, do you want to know what the result is or just be told that you are progressing or not.
• What pain relief would you like to use?
• Would you like to use water – a birth pool, bath or shower?
• Cord clamping/cutting and placenta – would you like a managed (by injection) or physiological third stage?

Release any fears

If you had a difficult experience first time around then you may have some unresolved fears or anxieties.  It is best to deal with them as soon as possible so that you can relax and enjoy your pregnancy.  Fear can also hold back labour, so even though it is hard, it is important to face it head on.  You can do this in whatever way feels most comfortable to you.  You might like to talk to a sympathetic friend or family member or try formal counselling (CBT is particularly good if you have anxiety or any post traumatic stress).  Writing or journalling can help you to explore your feelings more privately (there are some excellent activities in the book Birthing from Within that can help with this).  You can write a letter to anyone who you feel may have let you down in your previous birth and then burn it.  Hypnobirthing courses include a emotional release session, which allows you to let go of any lingering fears in a very safe way, without even having to consciously think about them, and the natal hypnotherapy VBAC CD has a fear release session on one of the discs.

Support for the birth

Do your best to ensure you have plenty of support for the birth itself.  If your birth partner is going to be your partner, mum, sister or someone else make sure they are clued up about VBAC and talk to them about your birth preferences so they can advocate for you while you are in labour.  You might like to consider hiring a doula, preferably one with experience of attending VBACs at home, as they will be able to reassure you and speak up for you, as well as encouraging your partner to support you.  You can also find support online, for example on Facebook there are home birth and VBAC groups where women share birth stories, ask questions and get advice from each other.

Independent midwives

Most NHS midwives have never attended a HBAC, and as they are trained to view VBACs as high risk, and used to managing them under strict hospital protocols, they may be nervous or find it difficult to support you at the birth.  In some areas home births are attended by whoever is on call, so you may not even have met the midwives who attend your birth.   An independent midwife is one that is self-employed and operates independently from the NHS, and can offer you continuity of care throughout pregnancy, birth and postnatally.  They mostly attend home births and are experienced at working with women who are considered ‘high risk’ by the NHS, including VBACs.  They are expensive but you may feel that it is money well spent to have someone who is experienced at attending HBACs, and who can give you one-to-one care throughout your pregnancy, during labour and afterwards.

Positive brainwashing

Surround yourself with positive images and thoughts about birth.  Our culture and media is full of messages that birth is painful and scary, when in fact it does not have to be.  Avoid watching programmes like OBEM as those shows tend to focus on the dramatic, with things going wrong.  There are lots of lovely home birth videos on YouTube.  Read positive birth stories.  One book that has really helped me is Ina May’s Guide to Childbirth, which has lots of positive birth stories which really make birth seem like no big deal, and also explains about the physiological processes of birth.  Hypnobirthing is also fantastic for this as you listen to positive birth affirmations daily, which helps you to think positively about your body and labour and birth.

Although there are obviously no guarantees when it comes to childbirth, I think it is worth approaching labour and birth as positively and proactively as you can.  My hypnobirthing teacher suggested planning it in the same way as you plan your wedding day – instead of thinking about all the things that could go wrong, plan for it to be a happy occasion, and work hard to prepare yourself, don’t just leave it to chance.  At the very least I feel that using this approach has helped me to relax and enjoy my pregnancy so much more this time around, and I’m hoping that no matter what happens, my birth experience will be a calm and positive one.

Have you had/are you planning a home birth after caesarean?  What are you doing to prepare yourself?  What do you feel helped you to have a positive experience?