Wednesday, December 4, 2013

Factors for VBAC success, Part 1/2

In this post, I will discuss why each of the following factors are important in VBAC success:

*reasons for previous c-sections
*arriving at the hospital as late into labor as possible
*not having continuous fetal monitoring
*epidural as late as possible into the labor, if at all
*no induction or acceleration
*previous vaginal birth

*Reasons for previous cesareans
If previous cesareans happened because of something unlikely to reoccur, like the baby being breech (which is a whole other topic, and I will be featuring both facts on breech babies and a couple of guest post on the topic next month), you have a pretty good chance of a successful VBAC. Something like CPD (a medical condition where one's pelvis is actually too small to allow a baby to pass) can make a VBAC more difficult, but it is still not impossible. According to The VBAC Handbook, as many as 2/3 of women with CPD that attempt VBACs are successful!

*Arriving at the hospital as late into labor as possible
The reason for this is simple. The longer you labor at home, the less opportunity the hospital/doctors/nurses have to "help" you with a cascade of interventions that could just lead to a RCS.

*Not having continuous fetal monitoring
Continuous monitoring restricts your mobility, which is a huge problem because being able to move around in labor is a necessity to help labor progress. You might also experience more pain/discomfort constantly laying on your back because you're stuck in bed, hooked up to a monitor. 15 minutes an hour is more than sufficient to give care providers an idea of how baby is doing, and then momma can focus the other 45 minutes of the hour on LABORING how she's most comfortable. Another reason to avoid monitoring if you can help it is that results are often misread, which leads to more cesareans unnecessarily.

*Epidural as late as possible into the labor, if at all
Epidurals usually require continuous fetal monitoring so that the laboring moms lowered blood pressure (a side effect of the epidural) can be checked regularly, along with it's effect on the baby. Because you don't want CFM (see above), you should wait as late as you can to get the epidural, if you get one at all. Epidurals have also been shown to stall labor.

*No induction or acceleration
Any sort of induction or acceleration of labor, including artificial rupture of membranes (AROM, or having your water broken) can raise the risk of the previous cesarean scar "unzipping". Some doctors might want to administer pitocin once a labor really gets going to speed things up, but be aware of the risks before you consent to ANY sort of augmentation!!!

*Previous vaginal birth
If you have had a vaginal birth before your cesarean, you are likelier to have a successful VBAC. You are also likelier to have a successful VBAC if you've already had a VBAC! Crazy, huh? ;) Not much help for mommas like me, that had an unnecesarean right out of the gate, but perhaps good news for other mommas out there!

The next post will finish up the list of factors and the reasons behind them. I'd love to hear your thoughts on the list so far!

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