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For Fathers, Providing Support for a VBAC Can Be Challenging

6 Feb

A cesarean can be emotionally difficult or traumatic for fathers/partners. After a long and difficult birth that ended with a cesarean, partners may feel that a repeat cesarean would be safer than planning a VBAC. Some partners may not be sure they can meet the challenge of another possibly long birth.

Father holding newborn baby over black background

Each partner is different and needs to prepare in his or her own way for the coming birth. Partners should take the time to talk about the prior cesarean and define for themselves how they can best support their partners for a VBAC.

  • What advantages do you see for your partner, yourself, and your family if you plan a VBAC?
  • What are the disadvantages?
  • What issues do both of you agree and disagree on?
  • Can you think of ways of working through these issues?
  • Have you thought about accompanying your partner to a prenatal appointment?
  • Would you consider going with her to a VBAC support group?
  • Supporting a woman in childbirth is hard work. Are you worried you won’t be able to give her what she needs?
  • How do you feel about advocating for your partner during labor?
  • Have you thought about having a doula that can guide and support you both during labor and birth?
  • What information or resources do you need to make you feel comfortable about planning a VBAC?
  • You feel strongly that a scheduled repeat cesarean is the safest and easiest way to have this baby. Can you understand why your partner feels strongly about planning a VBAC?

An unexpected cesarean can be emotionally difficult for both mothers and fathers. Providing support for a mother who is planning a VBAC can be challenging. As couples think about their next birth,  fathers/partners should take the time to share their feelings, their concerns, and their differences so that they can provide the best support they can in pregnancy and birth.

For additional resources on planning a VBAC, download, Deciding if VBAC Is Right For You: A Parents Guide from the VBAC Education Project  VBAC Handouts For Parents

 

 

 

A Game-Changer: Tool Kit To Support Vaginal Birth and Reduce Cesarean Delivery, Coming in Spring 2016

9 Jan

Unlike previous U.S. guidelines, consensus statements, position papers, and tool kits developed to reduce the high rate of cesareans, the Toolkit to Support Vaginal Birth and Reduce Primary Cesarean Delivery was developed by a multidisciplinary task force of over fifty expert writers and advisers representing physicians, midwives, nurses, lactation experts, childbirth educators, doulas, patient advocates, public health experts, policymakers, and health care purchasers. It is a comprehensive, evidence-based, how-to guide to support vaginal birth and reduce the first cesarean in low-risk mothers.

Developed by the California Maternal Quality Care Collaborative (CMQCC) of the Stanford School of Medicine, the Tool Kit includes strategies to lower the odds for a cesarean during labor. The strategies can be implemented by women and clinicians as early as the first trimester. The Task Force acknowledged that most women do not have evidence-based information about labor and birth or about the potential risks of frequently used interventions that increase the risk for a cesarean. So it is critical that communications between providers and pregnant women be frank and comprehensive during prenatal care to help women make informed decisions about how they want to give birth.  365087516311

“ By identifying the major decision points that most impact the risk for cesarean delivery, “ the Task Force found that, “providers can markedly improve patient decision making and improve knowledge deficit.”

The underlying principles of the recommendations include respect for childbearing women’s values, choices, and cultural background. The Tool Kit strongly recommends that women should be treated with dignity, respect, and cultural sensitivity throughout pregnancy, labor and birth, and postpartum.

The Task Force has included guidelines and recommendations for all stakeholders in maternity care from hospital administrations to healthcare insurance payers. The strategies that focus on hospital-based care encourage nursing skills which focus on promoting freedom of movement, fetal positioning, intermittent auscultation instead of continuous fetal monitoring, labor support techniques, and non-medical options of pain relief. Doulas are recommended as part of the collaborative healthcare team’s support for vaginal birth and reducing cesareans.

Although the main focus of the CMQCC Toolkit is on low-risk first births, nulliparous, at term, with a single fetus in a vertex position (NTSV), the philosophical principles and specific recommended strategies can be applied to all women giving birth.

While the Tool Kit is meant to guide individual hospitals and provider level change in California it also includes guidance for state, county, and hospital system-level change. Hopefully, this game-changer Tool Kit will eventually be adopted by maternity care stakeholders across the U.S.

 

 

For Doulas Who Support VBAC Clients: A Personal Perspective

9 Dec

By Jess Larsen Jukelevics, MA, CD(DONA)

VBAC families commonly come to birth with hopes or determination for a different experience, fear of repeating some part of their first birth, and sometimes unresolved feelings about giving birth again. In short, it can often feel (for every one) that the stakes are high.

We know that labor support is associated with better outcomes (Childbirth Connection, 2013), and a doula can go a long way to alleviate the fear and anxiety a VBAC mom may experience. But it’s also critical for doulas to be capable of supporting the emotional realities of VBAC women regardless of the clinical outcome of the VBAC attempt. VBAC For Educators

So how can a doula:

  1. Offer help that best supports a family’s chances of a successful VBAC?
  2. Hold the space for a family no matter the outcome in a productive and healthy way?

In prenatal work together with the family:

Depending on how the family is approaching this birth, it may be helpful to plan for more time prenatally than you might with other families. Before now, they may not have had an opportunity to digest what happened last time, their feelings about it, or to get clear on what they want this time (particularly if their first child is still young). Their time with you may be the most productive and helpful time they’ve had to do that. If they need more help than you can offer, refer them to a Birth Story Medicine® session[1] or local birth trauma workshop. These can be very healing experiences for parents.

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Coping with the Pain of Labor

6 Nov

Many mothers considering a VBAC, especially if their prior cesarean was scheduled, are concerned about how they will cope with the pain of labor. Some fear that having an epidural will complicate labor and lead to additional interventions that will lower their odds for having a vaginal birth. The VBAC Education Project

Non-drug methods of pain relief including continuous emotional support from a doula are beneficial for mothers and babies and do not cause harm.

  • What options for pain relief are you considering?
  • Try to use non-drug methods of pain relief and comfort measures before using drugs for pain relief.
  • You may want to use music, aromatherapy, visualisation, rhythmic breathing and relaxation, yoga or hypnobirthing techniques.
  • Find out about touch therapy, massage, a water birth, acupressure or acupuncture, water injections, and TENS (electrical stimulation).

If you want an epidural:

  • Try to wait until your cervix is dilated to 4-5 centimeters before it is given to you.
  • To help the baby move through your pelvis and rotate for birth, try changing positions slowly while in bed every 20 to 30 minutes during labor. You may need some help.
  • When you are fully dilated, you may need to wait an hour or more before you feel you’re ready for active pushing.
  • You may want to rest or sleep until you feel rectal pressure strong enough to push on your own.
  • You may want to wait until the numbness of the epidural wears off before pushing. With an epidural you may need up to three hours to push your baby out.

Find out more about coping with the pain of labor from Module 7 of  Deciding if VBAC Is Right for You: A Parent’s Guide.

Additional Resources

BirthTOOLS.org

National Health Service, UK

Choices In Childbirth