VBAC - Do you Doula Differently?

[Apple Blossom]

I have my 1st VBAC client coming up ('due' Jan 25th). I also doula'd for her 2 years ago during her first labour which ended in a c-section (basically failed induction).

My question to you all is this:

Do you doula differently for a VBAC client? If so, how? Are there any 'extra' things I should be doing while supporting her?

She's a special client to me - 1st client ever, then 1st repeat client ever and 1st VBAC!

[happydoula]

Encouragement will be the biggest part. Also, remind her that her last failed induction is not in indication that her body failed her - just that her body wasn't ready last time.

[Brie+3]

I find I need to be much more emotionally present for the client; often prenatally I find that I have to rebuild their confidence in their body. Reassurance in labor is a big thing; for my VBAC clients I have found that they rely more on me than their partners for support, even if they plan otherwise. I think this is because they see me as some sort of 'expert' with the know how to do things different than last time, honestly, this is more of a guess, I really don't know why, but it's obvious they feel a stronger bond to me than my other clients because I have had a VBAC of my own.

It's not really different, just more emotionally intense.

In a hospital be prepared for a longer period of EFM, at least thats my experience here. Some require continuos monitoring, but for the more VBAC friendly OB's they just want longer than the 10 minutes of every hour intermittent monitoring. So I prepare to support more from bed and coach to that in the prenatals. It's important she has open communication with her OB during pregnancy and she finds out what his policies are and what to expect in labor; shes got so much else going on she doesn't need the disappointment of no getting her way in labor.

Often times VBAC's have a story to tell and most haven't really processed their past birth, so be prepared with resources if thats the case and be prepared to listen. A VBAC client from early 2009 hadn't processed at all, so the vaginal birth brought up a tremendous amount of emotions and she's currently on anti-depressants and seeing a psychiatrist to deal with it now. My prenatal's with her went on and on and on and on.... 3+ hours both times, she really needed someone to talk too.

[novadoula]

I agree with the pps and would add that often during transition mom may need more reassurance that what is happening is normal. Sometimes the fear of a ruptured uterus is planted deeply and comes up during the intense contractions of transition.

also some moms are afraid when they get to the point in their labor that the c-section happened the time before and may stall for emotional reasons. It can be a very big confidence booster to reach that point and sail on toward a vaginal birth.

[momof ten]

I agree with everything mentioned....all good advice. Also, be prepared that you might have a nazi anesthesologist who INSISTS on putting in a "dry epidural" (needle in but no meds) that you will have to fight. One of the anesthesologists here pressured my client all night long to put the epi in (he was a real jerk). He said it was "outrageous" to attempt a vbac without a epi in place. I really hope this guy has fallen into a deep pit somewhere. Just letting you know so you can inform parents if they run across something like this.

[Comfy]

All good advice.
Starting with prenatal appointments, a lot of doctors say they are VBAC friendly, but when the client gets to about 38 weeks, the pressure starts to have a repeat c-section. She will look to you to give her the strength and determination that she needs to be strong and not cave. Keep reminding her that she can do it, and that even the words" failed induction" do not mean that SHE was the failure.

Once in labour, there could be pressure and suggestions from staff to have a repeat c-section. It takes a very strong and brave women to stick to her guns when a doctor plays the "dead baby card"...... about uterine rupture.

Also, when she reaches the point in her labour where it "failed" to progress, she will have apprehension and fear at this time.

My client agreed to a heplock (IV) in place.

Those are the only things that might be different. I know couples who have not hired wonderful doulas because they had no vbac experience. If they only knew that they passed over fantastic doulas.

So to answer your question , there is not a lot I would do diffferently. I encourage and support all my Moms, in the way they need support the most.

[FLLucinda]

Mona brings up a very good point about providers being "VBAC friendly" in the office but get in the hospital they are pushing a repeat cesarean. I received a call from a possible client the other day who wants to attempt a VBAC. (baby number 4 - VBAC number 1) I asked her what her OB had to say.... He told her that "I strongly advise you to have a repeat cesarean." Unfortunately there is her answer and what I can say with 99.9% certainty will happen. She wanted me to "fight the staff" for her. Her words not mine. I had to explain a lot more about what a doula does and does not do. She also felt that if she attemped a VBAC and did not succeed she should not have to pay me for my services.
That made me think that she has not processed her first cesarean from 3 years ago. Here in FL very few doctors will do a VBAC. Oh, they talk a good talk to their patients and then WHAM! They catch mama at a vulnerable point and offf to the OR they go.
I gave her a lot of food for thought that I hope will help her. She's talking more to her husband about doula services. We'll see if I hear back from her. But no, I would not treat her any different than any other client.....every woman's birth is different and I tailor my role to that woman and her needs.

[turtlewomyndoula]

My first VBAC client is due toward the end of February. I have had a c-section (but have not had the opportunity to VBAC) so I have already done a lot of the research and have the information handy on risks of UR, etc. I am planning to do an extra prenatal with her and her husband to discuss fears, hear her birthstory from her first birth again, etc. I also got some feedback from a doula friend who recently had a VBAC herself, and asked her how her doula worked with her. It was a lot of dealing with the emotional preparation of having a VBAC.
I am excited because my client has chosen a CNM that I have heard really great things about from other friends who have had VBACs with her.

[Bl0ss0mB3lly]

this was a very helpful thread for me! i am a fairly new doula (working towards cert) and have my first vbac client coming due soon. i'm very excited as i have had a natural vbac myself. so thanks for this question, and all your replies. are there any labor/birth positions that are best avoided for vbac?

[vagabondmom]

Quote:

Originally Posted by BlossomBelly this was a very helpful thread for me! i am a fairly new doula (working towards cert) and have my first vbac client coming due soon. i'm very excited as i have had a natural vbac myself. so thanks for this question, and all your replies. are there any labor/birth positions that are best avoided for vbac?

I recently attended a VBAC, with a mom who is a family practice doctor. It was a great experience for both of us--we each learned a lot from each other. She told me that there is recent research that indicates a slightly higher risk of uterine rupture with the standing & squatting pushing position.

Ironically, she birthed in almost that position-- she was on her knees, leaning over the back of the bed, then squatting back to push.

[peacefulbabydoula]

I would have to agree with most of the women on here,encouragement is the most important thing.Honestly,I advise my client that their BEST way to achieve their vbac(especially here in florida where there are vbac bans) is to stay at home (homebirth) or make sure I get her to the hospital ready to push.Here in Florida,the birthing community is so political(especially vbacs) and if a mom gets to a hospital with a vbac ban,they transport automatically..they dont even check to see if she is dilated..its more of a "get her the hella out of here" thing.Really sad.There is one hospital here(winnie palmer) that actively allows vbacs..but it is very hostile and they still are very limited in what they "allow".Either way,reassurance that her body can still do it,and lots and lots of information on informed consent could be her best option to a happy successful vbac.

[Nicole E]

I haven't doula'd at a VBAC yet but I really hope to.

I can say what I wish my doula had done at my VBAC attempt. I wish we had discussed my plans for birth more and what a VBAC at my hospital is like (or at least encouraged me to ask my doctor, because I did not ask the right questions) I wish I was more prepared to fight interventions when the on-call doctor I had in the hospital was ordering things I didn't want. I was not prepared for being told one thing before labour by my doctor, only to be changed after. After the decision was made to have a cesarean was when she said that the continuous monitoring I was required to have (one thing I tried to fight in the moment but gave in) didn't mean I needed to be in bed, I could have been on the ball near the bed (wish she had said that earlier)

Things that she did great was reassure me that when the OB took away my icechips, did not mean that I was doomed to another cesarean (even though that was the case), and she truly was the only other person in the room who wanted a VBAC for me as much as I did and a VBAC mom really needs that.

My husband did want a VBAC for me too, but once the doctors (well only after the second one did, neither of us liked or trusted the first) said a cesarean was needed, he believed it was for the best. So dads need more prep too, to be ready for the coercion to have a repeat cesarean that can happen.