On my first, I wanted to do it without pain relief, but I didn’t prepared, and when I was induced, I felt like my body had failed me. When I asked for pethidine and then the epidural I continued to feel like I had failed somehow. Although I escaped without episiotomy or section, I didn’t feel like I had any control – it was something that was happening to me, not something I was actively taking part in. So I wanted to do things differently this time around. Continue reading
Given that my little man is now eight months I think it’s about time I finally get his birth story down on paper! I had a fantastically easy pregnancy and pretty much sailed through the nine months. I did the Gentlebirth home study programme and listened to the tracks daily, did pregnancy yoga every week and had regular acupuncture. I also did lots of research into birth in Ireland, interventions, hospital protocols, natural pain relief and so on. The Gentlebirth Facebook group was my go-to for any questions. I drank raspberry leaf tea from 34 weeks, used evening primrose oil from 38 weeks and bounced on my birthing ball for hours. So by the time my due date arrived I was fully prepared and ready to go! Continue reading
My first baby was a Caesarean for breech. It was quick, easy, and stress free – a generally positive experience. Regardless, I knew that if I got pregnant again, I would like to have a normal birth, not another Caesarean.
Fast-forward a year later, I’m pregnant!! This time, from early on, my baby was head down. I discussed the option of VBAC with everyone I could. Doctors. Midwives. Friends. Family. Online resources. I could not get enough information in me. I was healthy, fit, and everyone agreed, a fantastic candidate for a normal birth. Continue reading
It was my wedding anniversary and we’d been spending the past few weeks mad busy doing a lot of painting in our new house. We had 2 weeks to go til my due date so we were both fairly relaxed as we’d heard first babies are usually overdue. So that day we took off and had a lovely big meal with his family and then more pasta later on…I had a big appetite all of a sudden. Just as well really as my waters broke at around 10pm that night. I rang the Rotunda who said just to head in as a precaution to see if waters clear and check me. I was letting out so much waters my tracksuit was soaked so I don’t think there was any doubt about the fact that it was really my waters breaking! Continue reading
Electronic Foetal Monitoring
Electronic foetal monitoring is a commonly used practice in Irish maternity units.
Electronic foetal monitoring (EFM or CTG) measures your baby’s heartbeat in frequency and strength and measures your contractions. Continue reading
What is a VBAC?
A VBAC is when a woman gives birth vaginally after a previous Caesarean Section. Sometimes, you will see a number following VBAC – this indicates that a woman has had more than one previous Caesarean Section. For example VBAC2 means a vaginal birth following two previous Caesarean Section.
With supportive and appropriate care, at least 70% of women who choose VBAC, will give birth without complications vaginally. Your maternity unit and individual health care providers should reflect this in their VBAC rates.
Why Choose VBAC?
There are many reasons why a woman may decide to choose a VBAC.
Some of these include:
* difficult or long recovery from surgery
* extended hospital stay
* complications with scar
* worry about recovery from surgery with small children
* disappointment following Caesarean Section
* desire to have control
* not wanting to be separated from your baby immediately following birth
* health concerns for your or your baby
Is vaginal birth following a Caesarean safe?
Uterine rupture is the main concern given to women choosing vaginal birth following a previous Caesarean Section. A uterine rupture is a tear in the wall of the uterus. Uterine rupture is usually associated with women with a previous Caesarean Section, however, this is not always the case. Sometimes, uterine rupture can occur with women with no previous Caesarean history. Vaginal birth, particularly when interventions are used to manage your labour or birth, can also increase your likelihood of other complications such as vaginal pain from stitches or episiotomy, assisted delivery, incontinence.
You are more likely to have a uterine rupture if your previous Caesarean was done with a vertical incision, rather than a low transverse incision.
The rate of uterine rupture in Ireland is low. The rate is 2 per 1000 women overall, or 1 per 1000 for women in spontaneous labour who did not receive oxytocin augmentation (Turner et al, 2006).
VBAC2 – Evidence for VBAC2 has shown that women choosing VBAC vs VBAC2 have similar rates of uncomplicated vaginal birth. The rate of major complications is slightly higher if you have had more than one previous Caesarean Section. However, while the risk of major complications is higher for women with 2 previous Caesarean Sections, when compared to the risks for elective Caesarean Section, the absolute risks of major complications are quite low. (AJOG)
VBAC3+ – There is very little evidence on vaginal birth following 3 or more Caesarean Sections. For women considering VBAC3 or more, your medical professionals need to provide you with information to make an informed decision on VBAC vs repeat Caesarean. This evidence must prove that VBAC3+ is unsafe – more unsafe than a repeat Caesarean.
Repeat Caesareans – Repeat Caesareans have many benefits but are not risk free. In fact, evidence shows us that risks to mothers and babies increase with each Caesarean Section. These risks can affect your current or subsequent pregnancies.
* increased risk of ectopic pregnancy in future pregnancies
* increased risk of placenta previa (when the placenta covers the cervix)
* increased risk of placental abruption (when the placenta comes away from the uterus before the baby is born)
* increased risk of placenta accrete (the placenta grows into or through the wall of the uterus)
* increases likelihood of problems for women – haemorrhage, blood clots, infection, scar pain
* increases time of hospital stay and the instances of re-admission
* longer recovery period
* increases the likelihood of problems for babies – admission to NICU, breathing problems, cuts from incision
What are VBAC guidelines in Ireland?
The Irish Guidelines “Delivery after previous caesarean section” (issued Oct 2011) are available on the HSE website.
You can read them in full here – #5: http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/obsgyneguide.html
AIMS Ireland is in regular contact with women who choose VBAC2+ in Ireland who are not supported by care providers, even before individual assessment is considered. These guidelines are national guidelines for obstetric practice in Ireland. These guidelines are meant to provide guidance to the local policy of units in Ireland. VBAC2 is included into these guidelines as a care option in Ireland; though in a very restricted capacity.
Recommendations in The National Guideline provides a starting point for women choosing VBAC(2+) to open communication with care providers to aide informed decision making. Recommendations are not compulsory. Your care provider can advice you on any of the practices listed below, but its your decision on the day.
Main Points of recommendations include:
* incision site is low transverse and not vertical
* electronic fetal monitoring during labour
* where loss of contact with abdominal belt during monitoring, foetal scalp monitoring is recommended
* if electronic foetal monitoring shows abnormal results, foetal blood sampling is recommended
* oxytocin may be used if your labour is not progressing as required
* induction of labour is possible following 1 previous caesarean, however should only be based on medical need to mother or baby
VBAC2+ to be supported where:
* head is engaged
* cervix is favourable
* history of prior vaginal birth
* spontaneous labour
Continuous Monitoring in VBAC in Ireland
Continuous electronic foetal monitoring features heavily in the VBAC guidelines for Ireland.
Continuous foetal monitoring measures your baby’s heartbeat in frequency and strength and measures your contractions. Continuous monitoring can be either A) external – by a belt (CTG) which goes around your tummy or B) internal – a monitor which is attached to your baby through the top layer of your baby’s scalp.
The reason for continuous monitoring is that it will show if your baby’s oxygen levels are low or your baby is not tolerating labour well and to prevent cerebral palsy, brain damage, newborn seizures, or death or may prevent a uterine rupture.
However, the evidence shows us:
* CTG has been shown to be less accurate than internal foetal scalp monitoring.
* CTG has been shown to increase your chances of interventions, including Caesarean Section and assisted delivery
* there is no difference between intermittent monitoring and continuous monitoring for “perinatal mortality, cerebral palsy, Apgar scores, cord blood gasses, admission to the neonatal intensive care unit, or low-oxygen brain damage” Cochrane Review 2006
* there was less instance of newborn seizures when continuous monitoring was used
* intermittent monitoring has more benefits with no additional risks in low and high risk women
What women tell us:
* Electronic monitoring makes it difficult to move in labour.
* CTG very uncomfortable
* CTG makes contractions more difficult
* CTG makes women feel tied to the bed
June 2012, the HSE launched a guideline “Intrapartum Fetal Heart Rate Monitoring (issued June 2012)” – recommending no admissions trace and intermittent monitoring in labour for low risk mothers.
Read more on the evidence for intermittent vs continuous monitoring for low and high risk women here:
Evidence Based Birth http://evidencebasedbirth.com/evidence-based-fetal-monitoring/
For more information or to access AIMS Ireland support services please contact us at firstname.lastname@example.org or email@example.com
“I had a very emotional pregnancy and was quite anxious coming up to my baby’s birth. I had transferred my care to Dublin, rather than our local unit. It was the winter of very wintery weather, and the snow added to the worries and stresses as I was booked into a unit over an hour away. On the morning of Dec 20th, my labour started and we quickly knew we would not make Dublin. I was quite upset over this. We made our way in the snow and ice to the hospital. I was admitted at 9cm dilated and in transition. I was finding it quite tough due to an injury in the coccyx and the midwife I had was not sympathetic to this nor my needs. She wanted me on the bed, with CTG on continuously, and to push despite not having an urge. My contractions started to space out and I had a thick anterior lip on the cervix that wasn’t coming away. The midwife wanted to use oxytocin. I felt like everything was spiraling out of control and no one was listening to me – I wanted to stand, get off the bed, no CTG. (there was no reason for CTG, just midwife more comfortable with it as I was a transfer). I become more and more upset and the contractions got more and more spaced…… following a tense conversation (refusing oxytocin and my partner & I getting quite upset).
A new midwife took over named Emer. She was immediately a relief. She was calm and understanding and supportive. She recognised how anxious I was being there. She listened to my preferences. I was still 9cm dilated and with every contraction had a gush of waters. I had no urge to push. Emer told me I had a thick anterior lip on the cervix and that had to come away before I could have my baby. I remained standing by the bed. Emer brought in a birth ball, massage tools for my back, and a cd player so I could listen to music. She occasionally would take the baby’s heartrate intermittently as I stood and swayed. She would assure me all was well and let me get on with it. She was a quiet and calm force in the background, never imposing. Just what I needed.
After about a 1/2 hr of standing, my contractions started picking back up again. The waters kept gushing. At this stage I was in transition about 2 hrs! Suddenly, I had a few strong contractions, felt another little gush and felt the baby slip down. Emer asked me if I wanted to stay standing for the birth – I did. She got down on her knees and her gentle voice reminded me to open my legs for my baby. I started bearing down and after a few pushes my baby girl was born as I stood by the bed. I had no tears or need for stitches.
My entire labour was 3hrs – I was 2hrs in the hospital. When I think that oxytocin was prescribed…. Emer, was amazing. Her support was so vital. She believed in me, gave me time, and supported my choices. I would have had a very different experience had she not been my midwife and I am so thankful for her.”