VBAC, by Gloria Lemay

The Day of the Birth

The female uterus is a very strong organ that maintains its integrity and resiliency through the birth process AS LONG AS IT HAS NEVER BEEN CUT. One obstetrician explained it to me, thus: ” The nulliparous (first time birther) uterus is as strong as a rugby ball. You could kick it all over a field and it would never break. However, if you cut a rugby ball and repair it, it will still be quite strong and may work all right in most games but one day someone will land a kick on it that breaks it open again because the integrity is never quite perfect again with a repair.” This is the source of the obstetrical concern about VBAC births. Most women attempting a VBAC will do absolutely fine and the scar where they were cut will hold strong.

It is 1 woman in 200 VBACs who will have a rupture of the scar. It is essential that VBAC births are not induced or augmented IN ANY WAY. If the physician/midwife were to give a VBAC woman misoprostol (Cytotec), oxytocin, castor oil, strip the membranes or use any other form of induction then that would triple her chance of having a uterine rupture. I believe that VBAC women have longer, gentler births because nature is compensating for the scar. There must be no hurrying. Many midwives would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally.

What are the signs of rupture? Stabbing pain, unusual bleeding, decelerations of the baby’s heart, or a peculiar shape of the abdomen. In most cases, the mother is the first to know that “something’s wrong”, “something’s tearing”. IF she is unmedicated. For this reason, the VBAC woman must be having her birth with all her senses active (no epidural). Very rarely, it is possible to have a uterine rupture without the mother feeling it.

Third stage

The doctor/midwife must be especially careful with the birth of the placenta in a VBAC because there is a slightly increased chance that the placenta might be adhered to the scar, and cord traction (pulling on the cord) could cause the uterus to prolapse. A physiologic third stage (no routine oxytocin and no pulling) is something that should be included in the birth plan.

After the birth

After the birth, VBAC women need to be told that they can walk upright. They can’t believe that they can straighten at the waist right after giving birth. Then, they can’t believe they can do sit-ups and leg raises on day one. Usually by day three, you’ll find the VBAC woman working out at the gym! With VBAC women, the complaints are very few in the postpartum period because they are comparing to post-surgery pain and any minor scrapes and bruises seem like nothing.

A VBAC is an amazing experience for everyone involved. Very Beautiful And Courageous (VBAC).