Teaching Tips for VBAC Classes

20 Jul

Maternity care professional organizations are finally beginning to acknowledge the health risks of avoidable cesarean sections and the benefits of supporting women who want a normal vaginal birth after a prior cesarean (VBAC). Medical guidelines currently state that any hospital that cares for birthing mothers can support women who choose to labor for a VBAC.  This is an opportunity to introduce and develop a VBAC awareness, education, and support program for mothers considering that option.

Depending on how much time you have, and the physical space you are teaching in, these suggestions may be helpful to you. You can find many of the resources you need to teach a class from the VBAC Education Project. Select the slides in any of the fourteen Modules that best meet parents’ needs in your community. A companion chapter for each of the Modules can be found in VBAC for Educators: A Teaching Guide. The VBAC Education Project

Teaching Tips

The educational offering can be a monthly presentation to a large group or a series of weekly classes. Depending on how much time you have, and the physical space you are teaching in, these suggestions may be helpful to you.

  1. If you have the names of the parents who will be attending your class, you might want to give them a call before class begins. This will give mothers the opportunity to clarify some of their personal concerns and give you specific information that you may want to add for discussion in your class.
  2. Use a room set-up that encourages participation and interaction, circle or U-shaped set-up instead of classroom style. Given the opportunity, VBAC students learn a lot from each other.
  3. Make your role clear. Present the information in a neutral manner without trying to influence parents to choose one option over another. For many mothers, how to give birth after a cesarean is a complicated and emotional process. They need to arrive at their own conclusions. Refer mothers to their caregivers for individual medical issues, but help them to feel comfortable asking questions to get the answers they need. 
  4. Parents need to feel safe. They need to get to know each other and feel comfortable sharing personal issues. Establish some ground rules. Ask your students what those ground rules might be (e.g. not criticizing each other, respecting each mother’s choice).
  5. Allow time for each mother to share her cesarean experience. Let everyone listen without commenting until she has finished her story. Allow time for fathers/partners to do the same. Often, this is the first time that a partner may have heard how the cesarean affected her and the first time a mother  heard how her cesarean birth impacted her partner. This also gives parents the opportunity to begin processing the cesarean birth in a safe environment.
  6. Invite parents who have planned a VBAC to share their experience with the class, whether their birth was a VBAC or an unexpected repeat cesarean.
  7. Let parents who are planning a hospital VBAC know that providers’ care practices vary widely on issues like when to arrive at the hospital, fetal monitoring, IVs, Heparin locks (capped IVs), and how long a woman can labor before “failure to progress” is determined. Help your students discuss these issues within a physiologic birth framework.
  8. Let parents know that hospital cesarean and VBAC rates matter. Guide them on how to compare VBAC services available in their community.
  9. Avoid substituting opinion for facts and help your students assess the accuracy of what they may have heard or found on the Internet. Refer your students to the Resources for VBAC and Physiologic Birth for evidence-based information.
  10. If a care provider is not supportive of VBAC, refer mothers to another health professional, hospital, or birth center you may know so they can get a second opinion.
  11. Encourage mothers to discover their strengths. Emphasize that the overwhelming majority of births are normal and that VBAC labors tend to have very safe outcomes.
  12. Become aware of the variety of cultural approaches to helping women through childbirth, and remember that each can enrich class content. Ask parents to share their own customs of birth and describe how their culture supports women in labor.
  13. For students who have strong religious beliefs—validate that faith and being part of a religious community can be a powerful source of support for them.
  14. Many women have been told by their caregiver that their “pelvis is not shaped properly,” they are “too small,” or they’ll “never be able to birth their baby without a cesarean.” These comments have a strong impact on a woman’s confidence to give birth. Emphasize how a woman’s body changes during pregnancy to facilitate the process of labor. For example, how softening of connective tissues make the pelvis, cervix, and vagina flexible and freedom of movement in labor facilitates the process of birth.   
  15. Help students to consider other challenges and painful experiences that they may have faced in life. Help them to identify the inner resources they used to cope with those challenges and experiences.
  16. Inform mothers of their legal rights. Their right to be involved in all medical decisions that affect them and their baby, their right to informed consent and refusal, their right to respectful maternity care, and their right to make the final decision about how they want to give birth.
  17. Refer mothers to a cesarean/VBAC support group in your community or online. For many women who have had a cesarean, support groups are an opportunity to meet their emotional needs which may have been ignored by their caregivers, family, and friends. A support group can help women process a prior traumatic birth and restore their confidence in their ability to give birth without surgery.
  18. Keep up-to-date with developing research and other relevant information by signing on to receive updates from the websites in the Resources for VBAC and Physiologic Birth: A Parent’s Guide.

Multiple repeat cesareans put women at significant risk for serious complications and death. Providing evidence-based VBAC information and resources to mothers with a prior cesarean may encourage women to avoid a routine repeat cesarean.

 

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