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.


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

National Health Service, UK

Choices In Childbirth


Birth Professionals Are Eager to Increase Awareness About VBAC

21 Sep

Maternity care professionals have many suggestions for increasing awareness about the safety of VBAC and supporting mothers who want to labor after a prior cesarean. They only need an opportunity to make that happen. Intro.key

On Saturday, September 19, I had the honor of speaking about VBAC and the VBAC Education Project to a room full of dedicated maternity care professionals at the Lamaze/ICEA Joint Conference in Las Vegas, Nevada. I spoke about the need to educate parents and professionals about bringing back the choice to labor for a VBAC which was widely available till the late nineties when nearly 1 in three U.S. mothers with a prior cesarean had a vaginal birth. I asked the audience if they could think of one strategy they could use to increase awareness of the safety of VBAC in their community or one change they could make in their hospital policies and procedures to help mothers who wanted to labor after a prior cesarean. I was inspired by the suggestions they made.


Update On The Safety of Home Birth After a Cesarean (HBAC)

17 Sep

A recently published study on planned home VBAC in the United States, the largest to date, may shed a little more light on the safety of home birth after a cesarean for parents who may be considering that option. The study is the second one on planned home births based on the MANA Stats 2.0 data set.

More and more women in the U.S. are faced with the denial of hospital-based maternity care for VBAC. According to a report by the Centers for Disease Control and Prevention, planned home VBACs have been increasing at the same time that hospital VBACs have been decreasing. Some women are choosing a home VBAC rather than having an unnecessary repeat cesarean or repeating a previously traumatic surgical birth. Mothers need as much information as possible to make an informed decision about where and with whom they want to give birth.        20111225_Jess_6743_2000

Researchers compared outcomes for 1,052 women with a prior cesarean who planned a home birth with 12,092 women without a prior cesarean. All women were cared for by midwives. Here is what the study found: