• Keep a positive mindset.
• Prepare your mind for birth – to achieve a safe baby and safe you and a positive birth experience.
• Environment in labour- bring into your birthing room whatever makes you feel relaxed to create a “romantic scene,” increasing endorphins and oxytocin. e.g. dim lighting, birth ball, mats, rocking chair, birth pool, birth stool and aromatherapy.
• Birth stool very useful in 2nd stage for pushing phase – (not birth as it may increase tears to vagina and perineum) particularly if have an epidural as it increases the chance of natural vaginal birth.(Ref photo on our web)
• Visualizations (refer to Swirls on web page) think of each contraction reaching its deep peak and then unravelling another one gone and closer to meeting your baby
• Rituals- repeat movements in labour e.g. hold wall during contraction with one leg further back and rock gently-compare calf muscle to uterus. Labour dancing with your partner, figure of 8 s on birth ball – all are distracting and useful in progressing labour.
• Snuggly bits –bring in a scarf (soft to hold on to) or a beanbag to grip, warm cosy socks.
• Speak to your baby asking him/her to open the passageways of cervix, birth canal.
• Hypnobirth, mantra’s and CD’s to listen to whilst pregnant so that you are very familiar with them, to drift into, closing eyes
• Breathing- think of a shower over your head and relax you body all the way down as the water drips over you, relax your jaw, shoulders, and breathe in gently and exhale deeply as if your breathe was from the bottom of your tummy.
• Mobility- Ask to be as mobile as possible request to use telemetry (mobile cardiotocograph monitoring (CTG) (see photo on web page) if unavailable walk the length of the wires of a normal CTG machine.
• Waterbirth- it is possible to use a birth pool in labour and also to have an underwater birth with the use of telemetry but you will need a midwife in constant attendance (not always possible on very busy labour wards) if not, do not worry the other points will help you through.

PRACTICAL POINTS

• Discuss with your obstetrician you plan for a VBAC discussing your previous labour and reasons for your emergency caesarean section or elective (planned) caesarean. VBAC has a 70-75% success rate for vaginal birth.
• Risks are small 1 in 200 risk of small uterine rupture, 3 in 1,000 risk of large uterine rupture. Risk of your baby dying is the same as a first baby 0.2% (2 in 1,000), or 0.1% if elective caesarean (1 in 1,000)
• Benefits to you much faster recovery, 90% chance of another vaginal birth in the future.
• Reduces risks from repeat caesarean section in the future eg placenta accreta (where placenta attaches deeply to uterine muscle),haemorrhage and risk of hysterectomy( removal of uterus)
• Attend midwifery VBAC clinic in the hospital (if available) and ask to attend a VBAC antenatal class (for all women with one previous caesarean section) to have an open discussion with other mothers, facilitated by midwife.
• In labour you will be considered “high risk” as you have a scar in your uterus and will be recommended to have your baby on the labour ward in hospital, rather than in the birth centre or at home. (If you do decide to have your baby at home a midwife will look after you, but you do need to be aware of the small risks of scar rupture, and risks to both yourself and baby and need to transfer to hospital in an emergency)
• In labour continuous fetal heart rate monitoring (to detect baby heart rate abnormalities) and a venflon (plastic tube in arm to give intravenous fluid) are recommended incase a emergency caesarean becomes necessary in labour.

References
1. http://www.rcog.org.uk/files/rcog-corp/CTG4511022011.pdf
2. http://www.rcog.org.uk/files/rcog-corp/uploaded-files/P1VaginalBirthAfterCaesarean2008.pdf
3. Your Body, Your Baby, Your Birth Jenny Smith Rodale

Please send us your VBAC stories to share on our website we so look forward to hearing from you and plan to do a VBAC film soon.
Meanwhile if your baby decides that his/her journey is not possible ask for as many elements of the “natural caesarean” as are considered safe, even in an emergency caesarean.