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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Giving Birth After A Cesarean: It’s Your Decision

10 Jun

Many mothers, pregnant after a prior cesarean birth, feel pressured to schedule a routine repeat cesarean when they prefer to labor for a VBAC.

Care providers have an obligation to share information with you about your care. To present the risks and benefits of planning a VBAC or choosing a routine repeat cesarean. When you have received all the information you need to feel confident to make a decision, the choice is yours.  No provider should frighten or coerce you into having a routine repeat cesarean.The decision to have a repeat cesarean or labor for a VBAC is yours.

Prenatal visits give you the opportunity to have a frank discussion with your caregiver about your concerns and how you will be cared for. It is your right to participate in all decisions regarding your health and the health of your baby.

  • During your pregnancy you should have several discussions about the benefits and risks of VBAC and repeat cesarean.
  • Ask your caregiver about his/her VBAC rate, repeat cesarean rate, and VBAC success rate.
  • Discuss your personal medical condition with regard to VBAC and repeat cesarean. You may need to review your operative record (documentation of the surgery.)
  • Ask what safety measures are in place to respond to an obstetric emergency including a uterine rupture.
  • Try to get the hospital informed consent forms for procedures that you may need (for induction, an epidural, pain medications) during your pregnancy so that you have the time to read and understand them.
  • Make a list of the advantages and disadvantages of planning a VBAC or scheduling a repeat cesarean and discuss them with your partner.
  • Consider having a doula at your birth, a midwife as your primary caregiver, or giving birth in a birth center.

Giving birth is a transformative experience. Your caregivers should make you feel cared for, respected, and supported in your wishes and needs.

For more information about your rights in childbirth see the slides in Module 12 of the VBAC Education Project.

 

Nurses Play A Significant Role in Supporting VBAC Mothers

11 May

May 6-12, 2017 is National Nurses Week, a time to recognize, appreciate, and celebrate the important work that nurses do. In particular, maternity care nurses play a significant role in helping mothers who want to labor for a VBAC.

Women laboring for a VBAC may have some anxiety about their prior cesarean and may need additional support. They are grateful for the encouragement, validation, and labor progress suggestions that nurses can provide. Many times mothers have said, “My nurse was wonderful. Just when I wanted to quit and ask for another cesarean, she told me things were going just as they should be. I couldn’t have done it without her.”

Nurses, midwives, childbirth educators, and doulas who have  experience working with mothers who want a VBAC have learned that a mother with a prior cesarean may need additional support, time, and encouragement to have a rewarding and satisfying birth.  She needs to feel self-confident and strong. Here are some valuable suggestions that they have shared:

  • When meeting a mother for the first time, try to find out how she experienced her cesarean? Can you suggest how she can do things differently this time? Ask her how she wants to labor. What is important to her? Help her to create the birth environment she prefers so she can feel safe and supported.
  • Ask her partner or family how they feel about a VBAC? What concerns do they have?
  • Remind parents that 3 out of 4 women who labor for a VBAC have a safe birth.
  • Some mothers may have anxious moments and flashbacks of their prior birth. Disturbing memories of fetal distress or of laboring “for ever” and not getting anywhere. Help mothers to overcome these difficult moments and remind them that this is a different labor for a different baby and that they are strong enough to move through it.
  • Mothers who may have experienced a prior birth as traumatic  will especially need understanding, encouragement, and the freedom to give birth as she wishes.
  • Some mothers know when they have  gone as far as they can and that they will probably need to adjust to the idea of having a cesarean birth. Give a mother time, if circumstances allow it, to think about what she would like for this cesarean birth. Does she want her doula to be at her birth? Does she want her baby skin-to-skin after birth? Does she want her family to visit her in recovery? Does your hospital support a “gentle cesarean?” Let her know that your team wants her to have a good experience and will do their best to welcome her baby.

For additional information on how maternity care professionals can support mothers who want to labor for a VBACs see VBAC for Educators: A Teaching Guide. 

Maternity care professionals who are interested in establishing “skin-to-skin after a cesarean” clinical guidelines or developing mother-centered VBAC education guides can freely use the hospital-developed forms included in Hospital Policies that Support VBAC, Family-Centered Cesarean, and Informed Choice, both are part of the VBAC Education Project.

A nurse’s support, guidance, compassion, and respect for a mother’s individual birth preferences will give both, mother and baby their best start together.

 

 

 

 

Maternity Care Professionals Agree on How Best to Care for Women in Labor

5 Apr

Failure to progress, abnormal fetal heart rate, malposition, and “big” baby are the four main reasons for the first cesarean. These complications can often be avoided by the kind of care that women receive prenatally and during labor and birth.

The American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives (ACNM), and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) agree, “Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor…Rather than label a woman as low-risk or high-risk, the goal is…to ensure that the obstetrician-gynecologist or other obstetric care provider carefully selects and tailors labor interventions to the requirements and the preferences of the woman in labor.”                                            

The following evidence-based, recommendations from Approaches to Limit Interventions During Labor and Birth ACOG’s Committee Opinion (Number 687, February 2017) will help to facilitate physiologic birth (normal progress of labor), avoid unnecessary interventions that can complicate labor, and respect women’s own preferences for how they want to give birth.

  • During pregnancy, learn all you can about labor and birth and write down your preferences for how you would like to be cared for in labor and birth.
  • Consider having one-to-one labor support such as a doula.
  • Consider taking a childbirth class where you can learn about how to spend you time at home in early labor, different comfort measures, and positions to make you more comfortable for active labor birth.
  • Stay home until you are in active labor (about 6cm dilation).
  • Ask about being monitored intermittently with a hand-held device such as a doppler instead of an electronic fetal monitor.
  • Drink clear liquids to keep up your energy rather than using an IV.
  • Consider using non-drug methods of pain relief. There are many options for you.
  • Stay upright and use different positions for labor such as walking, kneeling on hands and knees, lying on your side, and resting on a birth ball.
  • Avoid an amniotomy (artificially breaking the bag of waters).
  • When you reach full dilation (10 cm) you many not feel the urge to push. Your baby will move down as you are resting, so wait for the urge to bear down.
  • Push using an upright position or on your hands and knees, whatever makes you comfortable at the time.
  • Ask to have your baby skin-to-skin after birth it will help you to begin breastfeeding, and ask your caregivers about delaying the cutting of your baby’s umbilical cord.
  • Let your caregivers know what you need and how they can help you to have a safe and satisfying birth.

Although these midwifery-led recommendations have been known to many caregivers and women prefer them to routine interventions, it will now be much easier to get the support you need form all maternity care providers.

Resources

To find out more about these recommendations and why they are important for a safe birth link to Childbirth Connection’s Fact Sheet on limiting interventions in labor and birth.

To find out more about avoiding labor complications that can lead to a cesarean,  non-drug options for pain relief, and different positions for labor and birth download Modules 4, 5, and 6 of the VBAC Education Project.