Wednesday, 2 May 2012

VBAC at Home?

Having read a post by Villagemidwife found on Twitter (yes, I do know how to tweet) I have been thinking about VBACs. That is, Vaginal Birth After Caesarian. Villagemidwife puts forward a very strong argument for allowing women wanting a VBAC to give birth at home. Within the medical contraints of hospital care offered in the UK a home birth would be strongly contraindicated and not encouraged.
If you think about it for a moment, a home birth seems the perfect place for a VBAC. In my experience, most caesarian sections are performed when a woman fails to make enough progress in labour and the baby is seen to be distressed by the long labour on the CTG monitor.

Going into hospital can be a stressful event, adrenalin will be secreted when a person in under physical or mental stress. In an earlier post I explained how adrenalin attaches itself to the uterine cervix and prevents it from opening normally. So, when stress is a factor within a labour, expected progress will not be made due to the actions of adrenalin. The contractions will have to become stronger in order to pull up on a resisting cervix. How will this help someone having a VBAC? It will make a uterine rupture much more likely.

At home however, a woman is much more likely to remain calm and in control. If she follows the advice on relaxation techniques outlined in earlier posts then she will not secrete adrenalin and the cervix will be free to dilate. The contractions will not have to become stronger as the cervix will not be resisting and so they will remain at normal contraction levels. The first stage of labour, if conducted under the methods taught in this blog, will be pain free.

When in hospital, a woman having a VBAC has to be continuously monitored to detect any early signs of uterine rupture. She will most likely be confined to a bed with only brief breaks to visit the loo. Staying upright during labour helps the uterus work with gravity so that the contractions do not have to become strong. Lying down on a CTG monitor will make the contractions become stronger and so cause pain. The fact that she is not mobile will also impact on descent of the rotating baby into the complicated anatomy of the birth canal.

At home, a woman is free to move around and relax as her body dictates. She can eat and drink anything she chooses according to her body's needs. She can remain upright and have the power of gravity helping her to labour instead of hindering. The contractions will remain normal as her environment and mental state will be in harmony with her labour, not putting obstacles in the path of normal progress.

Spot on Villagemidwife, you have put forward a brilliant argument for a VBAC at home. With the element of a pain free first stage of labour, a home birth can become a real option with all the benefits working toward encouraging normal progress. The only element that will prevent women from seeking out a pain free labour is FEAR. The fear of litigation. The fear that women are irresponsible little tykes that are all too willing to put their babies at risk. Hospitals will not support home births for VBAC. But. They may support birthing in a birth centre where pool deliveries are the norm. Water births are so nice and gentle that no extra stress will be put on the scared uterus causing it to rupture, the contractions can remain normal.
  • Lying down on a CTG machine will cause the contractions to become painful as they work against gravity.
  • Pain will cause stress that will hold the cervix closed that will make the contractions become stronger.
  • Not moving about in labour will slow the normal rotation of the baby.
  • Not eating in labour will prevent enough carbs being available to fuel a contracting uterus, labour may slow down or stop.
  • If it slows down or stops a drip may be started that will put extra stress on the scared uterus.
Everything we do in hospital seems to be against helping women to achieve a VBAC. Lets start a campaign today to allow women VBACs within a birthing centre setting. Let me know what you think?