Getting ready for birth
Getting ready for birth
Getting ready for birth
Vaginal birth after caesarean (VBAC)
Vaginal birth after caesarean (VBAC)
What is VBAC?
VBAC stands for ‘vaginal birth after caesarean’. This term is used when women give birth or plan to give birth vaginally after previous caesarean birth. Vaginal birth includes normal delivery and delivery assisted by forceps or vacuum cup (ventouse).What choices do you have in managing your pregnancy pathway?
Women who have had a caesarean birth before will have a consultation during the course of pregnancy with either a consultant obstetrician or consultant midwife or designated deputy to discuss individual risks and options. Women can choose either VBAC or planned elective caesarean, an operation to deliver the baby after 39 weeks of pregnancy. The plan will be reviewed with you throughout pregnancy. You can change your mind and you should discuss any questions with your midwife or obstetrician. In case of any emergency please call your local maternity unit.Are all women suitable for VBAC?
Not all women are recommended for VBAC. In your first/subsequent pregnancy after an LSCS you may have been given a letter which explains your options. At the consultation the obstetric doctor or specialist midwife will discuss your options with you, and review your previous notes, if available. An individualised plan will be agreed with you that will be reviewed throughout your pregnancy.VBAC facts
More than one in five women in the UK may have experienced birth by LSCS. Around half of these are planned and the other half as an emergency. VBAC is generally only offered to women with a singleton pregnancy with the baby in the head down position, who have had a lower segment caesarean section (LSCS). Chances of success are approximately 72-75%. A number of factors affect the success rate of VBAC. These include maternal weight, your health, and whether your labour starts spontaneously. Women who have an interval of less than a year from a previous LSCS are not at greater risk of scar rupture, but are more at risk of having a preterm birth. It is generally advised that there should be at least a year between births. Women who have had two or more caesarean births can be offered the opportunity for VBAC after counselling. Success rates are similar (62-75%). If you have had a successful VBAC previously you have an 85-90% chance of successful VBAC the next time.What are the risks associated with VBAC?
There is a 1:200 (0.5%) chance of scar rupture, this increases significantly if you are induced. Induction with amniotomy (artificial rupture of the membranes) or balloon catheter is associated with a lower risk of scar rupture compared to using prostaglandins (medical method). Approximately 25% of women in labour will need an LSCS. An emergency LSCS has more risk than a planned LSCS, and you may have a higher chance of haemorrhage, leading to the need for a blood transfusion in this situation. Your chance of experiencing bladder or bowel injury during an emergency procedure is higher than in a planned procedure. Complications for baby are similar to a woman birthing a baby for the first time. You may require an assisted birth, or experience perineal trauma involving the back passage (anus). Estimated birth weight may be a factor in the risk affecting perineal trauma.What are the advantages of a successful VBAC?
If you have a successful VBAC it is associated with fewer complications than a planned LSCS. Your recovery is likely to be quicker and you should be able to return to normal activities sooner. Your hospital stay is likely to be shorter. Your baby is likely to have less chance of breathing difficulties.When is VBAC not advisable?
Planned VBAC is not recommended if you have experienced a previous uterine rupture or have classical caesarean scar (a vertical scar on the tummy) or if there are other pregnancy or medical/health complications, or previous uterine surgery.What happens during labour for women experiencing VBAC?
You will normally be advised to labour in the hospital’s labour ward. You are advised to call the hospital when you have regular contractions or your waters have broken. Continuous monitoring of the baby’s heart rate is recommended. There are a range of pain relief options, and you will be advised about having an intravenous needle inserted in your hand for fluid management. If you choose not to give birth in hospital then you are normally seen by a specialist midwife or consultant midwife who will create an individualised plan with you.What happens when labour does not start spontaneously?
If you are not in spontaneous labour by 40 weeks you will normally be seen in the antenatal clinic and assessed. You will be given options that include induction (IOL) with prostaglandins (medical method), induction with amniotomy (artificial rupture of the membranes) or balloon catheter, or to wait another week. Delivery by LSCS will be discussed with you on an individualised basis. Any decision relating to induction of labour or LSCS will take into consideration any risks for you and your baby.Giving birth to your breech baby: Frequently asked questions
Giving birth to your breech baby: Frequently asked questions
How is the diagnosis made?
It may be suspected that your baby is lying feet or bottom first in the womb, when a midwife or obstetrician feels your abdomen at or after 36 weeks of pregnancy. This is then usually confirmed by an ultrasound scan. If you are in labour when this is suspected, the baby’s position may be confirmed by internal examination.What will the medical team recommend?
When a baby is in a breech position after 36 weeks of pregnancy there are three options that might be possible: 1. An external cephalic version (ECV) – using pressure on your abdomen to turn the baby head first 2. A planned vaginal breech birth 3. A planned caesarean birth If the breech position is first noted during labour an ECV may not be possible, and a woman will need to choose between a vaginal breech birth and a caesarean birth.What tests will/may be considered? How often may they be needed?
An ultrasound to check on the growth of your baby may be arranged if the breech position is detected before labour. This can help to guide your decision making about your preferred mode of birth.What symptoms and signs should I be looking out for?
You should contact your maternity unit if you think your waters have broken or you are in labour with a baby known to be in the breech position.What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If your waters break and your baby is lying feet or bottom first, there is an increased chance of the umbilical cord being below the baby – this is called an umbilical cord prolapse. If this happens you should promptly attend the hospital for review. If a loop of cord is seen outside the vagina, then you should call 999 immediately.How may this impact my birth choices?
Your midwife and doctor will discuss your choices with you. Your choices will depend on whether the breech presentation is diagnosed during late pregnancy or in labour.What will this mean for future pregnancies? How can I reduce my risk of this happening again?
If your baby is born by caesarean birth, this may impact on future pregnancies.Where can I find out more information about this condition?
Giving birth to your breech baby
Giving birth to your breech baby
About one in 25 babies are in a breech position (bottom first or feet first) after 36 weeks of pregnancy. If your baby remains breech, you should be offered the choice of attempting to turn your baby, planning a caesarean birth or planning a vaginal birth. The most likely outcome, no matter what you choose, is that you and your baby will be well. But it’s important for you to consider the benefits and risks of each option for you.
Turning the baby head-down gives you the greatest chance of a vaginal birth, about 80%. The procedure of attempting to turn a breech baby is known as External Cephalic Version (ECV). If baby remains breech, only about 60% of these babies will be born vaginally. Some will require a pre-labour caesarean birth, and some will require a caesarean delivery in labour.
All women with a baby who remains breech are offered the option of a planned caesarean birth at 39 weeks. That is because we can identify a difference in short-term outcomes for breech babies. Following a caesarean birth, the perinatal mortality (death) rate is reduced, at 0.5 in 1,000, compared to 1 in 1,000 following a head-first birth, and 2 in 1,000 following a breech birth. In the short-term, there is also an increased chance your baby could need special care following a vaginal birth. However, by two years of age, the same studies show no difference between planning a caesarean birth and planning a vaginal birth for a breech baby.
The benefits of planning a vaginal birth include a quicker recovery and avoidance of the risks associated with caesarean surgery. These include things like heavy bleeding and infection. A caesarean scar also introduces some additional risks, for mother and baby, in all future pregnancies. The perineal outcomes (remaining intact) are similar or better following vaginal breech births, compared to head-first births, and there are fewer instrumental deliveries. You should have the same choice of pain relief, and freedom to choose your birthing position, as you would in any birth. But some of this may depend on the experience of your team, so you should discuss it with them.
Your doctor or specialist midwife will be able to provide you with more information about some specific clinical situations that make breech births safe or less safe, and whether these apply to you. The most important factor that influences the safety of vaginal breech birth is the training, skill and experience of the professionals attending the birth. If your hospital is unable to provide you with a skilled attendant, and you would like to consider planning a vaginal breech birth, you should be offered a referral to a hospital that can.
Options for place of birth
Options for place of birth
Place of birth choices
You can discover where you can give birth according to your preferences and needs – in a labour ward, in a birth centre or at home.
Watch the video to learn about the different options. Your midwife at your chosen maternity unit or your doctor can help advise you on the best choice for you.
Video credit: NHS North West London maternity services. Preparing for birth
Preparing for birth
Towards the end of pregnancy, you may feel a variety of different emotions as the birth becomes closer. You may feel excited, anxious or even scared – this is all normal. There are things that you can do to help you prepare for birth.
Information for partners (preparing for birth)
Information for partners (preparing for birth)
Before labour and birth
It is important to discuss with your partner your role as birth partner and how you feel about being present at the birth. You can write a birth plan together and support her if it needs to change for any reason. You can also:- make sure you can always be contacted in the final weeks
- arrange how you’ll go to the maternity unit, if you are planning on having the baby there
- ensure the car always has fuel and ensure you have tested fitting the car seat. You can keep the car seat in the car
- do a trial run to test your route to the maternity unit, and ensure you have small change for parking meters
- help pack the maternity unit bag and make sure you pack the things you need
- think about preparing/freezing some meals for after the birth so you don’t have to worry about cooking when first at home
- learn about what to expect so you can be as prepared as possible to care for your partner and baby read the sections on:
Preparing for after the birth
The birth can often feel like such a huge event that not much time or attention is given to fatherhood and parenting. Having a baby changes relationships, carries responsibility and has significant financial impact, whilst also being a time of intense joy and pride. Up to 10% of new dads can suffer from postnatal depression, so if you start to feel changes in your mood, talk to your family, friends and GP (and see here).Portal: Information for partners
For your baby
For your baby
❏ 1 x pack of nappies
❏ Clothes; sleepsuits and vests (3-4 of each)
❏ Several cotton hats and a woolly hat
❏ Clothes for going home
❏ Socks/mittens (x2 pairs)
❏ Cotton wool/water wipes
❏ Muslin square/bibs
❏ Car seat to take baby home – learn how to use beforehand!
❏ Baby blanket/shawl
If you are planning to formula feed your baby; check with your midwife what you need to take to the maternity unit. For you
For you
❏ maternity notes and personal care plan
❏ any medications that you take regularly
❏ comfy clothes to wear in labour
❏ slippers and/or flip-flops
❏ dressing gown and pyjamas/nightdress (2) that open at the front (for ease of feeding)
❏ comfy clothes to wear home
❏ crop top/bikini top if using water/birthing pool
❏ comfortable bra/feeding bra
❏ knickers for after the birth – large size, cotton and comfortable and/or disposable knickers
❏ adult size towel (2 if using birthing pool)
❏ toiletries, including toothbrush and toothpaste, hairbrush, hair ties and lip balm
❏ 2 packs of maternity sanitary pads (thick and ultra-absorbent)
❏ breast pads
❏ massage oils for use in labour
❏ glasses/contact lenses
❏ portable speakers/earphones to play music
❏ drinks, snacks and drinking straws
❏ water spray/fan
❏ extra pillow(s)
❏ TENS machine (if you plan to use one)
❏ books/magazines
❏ phone and charger For your birth partner
For your birth partner
❏ coins for car park/car park payment details
❏ drinks and snacks
❏ phone and charger
❏ camera
❏ books magazine
❏ comfy clothes/shoes/shorts
❏ overnight stay clothes/toiletries etc. if planning/able to stay 
