Našla sam par zanimljivih stvari o VBAC na netu pa stavljam tu:

How should I move forward after deciding to plan either a VBAC or a repeat c-section?
Planned repeat cesarean may be the safest choice in a small number of situations, but for most mother-baby pairs, the overall risks of surgical delivery outweigh VBAC ("vee-back" or vaginal birth after cesarean) risks. If you do not have a clear and compelling need for a repeat cesarean, planning VBAC is far safer for you and any future pregnancies and babies. Thinking just of your baby in the current pregnancy, some rare but serious risks of VBAC need to be weighed against a number of more common risks of c-section. Planned VBAC is also likely to be the most emotional satisfying option for you.


If your birth plan is for VBAC, there are no guarantees that you will avoid another cesarean. However, you can take steps to increase your chances for having a safe and satisfying vaginal birth. Most of these steps are strongly supported by good research. Advance preparation in pregnancy can make all the difference. Careful choice of a doctor or midwife and birth setting that support and encourage VBAC and a trained or experienced companion who will be available to provide continuous labor support may be the most important things you can do. The Q&As that follow give detailed guidance about these and other tips to include in your pregnancy and birth plans.



While overall risks favor vaginal birth, you may have a repeat cesarean delivery for various reasons. There may be special considerations in your individual case, or some risks may be especially important to you and override others. Or your options may be limited by what is available in your community or through your health plan. Finally, no one can know what labor may bring. For these reasons, this section concludes with tips for having a safer and more satisfying cesarean birth.



WHEN PLANNING VBAC, what are some tips that can help avoid problems with the scar in my uterus in labor?
Try to:
Wait at least 9 months before trying to conceive again: While the difference is small (1 more woman in every 100), research suggests that you are less likely to have a problem with the scar opening in labor with a birth-to-birth interval of 18 months or more compared with a shorter time period.
Avoid induction of labor, whenever possible: Experts disagree about some common reasons given for induction (for example, the pregnancy has gone beyond 41 weeks), and others are not supported by research (for example, induction for suspected big baby). Some inductions may be recommended for non-medical reasons, such as your convenience or that of your caregivers. Because induction agents may increase risk of scar rupture and do increase the likelihood that the labor will end with a c-section, it is best to limit induction to situations where there is a clear, compelling, and well-supported reason. Should the question of induction arise, discuss the trade-offs with your caregiver of awaiting labor, having the induction, or scheduling a c-section. In many cases, awaiting labor is the safest option. (See making informed decisions for tips on how to discuss your options with your caregivers.)
If you are having labor induction, avoid cervical ripening agents: Available research on the role of cervical ripening agents is hard to interpret but suggests caution. Dinoprostone, also called prostaglandin E2, the agent found in Prepidil and Cervidil, may increase the likelihood of scar rupture, especially in combination with synthetic oxytocin (Pitocin or "Pit"). Misoprostol, also called prostaglandin E1, the agent found in Cytotec, may increase the chance of scar rupture. Please note: although a recent independent review concluded that evidence about impact of labor induction on VBAC labors is unclear at this time, the manufacturer of Cytotec includes a warning on the official Food and Drug Administration (FDA) "label" that use of this product for induction increases risk for uterine rupture, which is higher for women with a previous cesarean (see references for Searle and Guise, McDonagh and colleagues).
Avoid use of synthetic oxytocin (Pitocin or "Pit") early in labor: Available research suggests caution about synthetic oxytocin in early labor. However, synthetic oxytocin given once labor is well underway doesn't seem to cause a problem. This may be because more forceful contractions over a longer period are needed to get labor going than to help it along once it is in progress.


Are there some practices used in VBAC labors that I might want to avoid?
There appears to be no research showing benefits for using the following practices in VBAC labor, and all either reduce the chances of vaginal birth or increase discomfort. Should they be recommended in your case, you may wish to discuss the trade-offs with your caregivers. (See making informed decisions for tips on discussing options with caregivers.):


internal monitoring of contraction pressures (as opposed to internal monitoring of the baby's heart rate): The theory is that should the scar give way, internal contraction monitoring will pick up a drop in contraction pressure, but studies have not found this to be the case. Meanwhile, internal monitoring increases the risk of uterine infection and limits mobility.
prohibition of eating and drinking in labor: The fear is that in the event of general anesthesia, the woman may risk serious infection by vomiting and inhaling the vomit into her lungs. But cesareans are rarely performed under general anesthesia. When general anesthesia is used, a tube is inserted to protect the airway. If hospital staff are unwilling to permit solid food, a compromise is frequent sips of clear fluids, which are rapidly absorbed into the bloodstream.
routine intravenous (IV) drip: If the hospital will not agree to forgo an IV line, a good compromise is a heparin or saline lock. The IV needle is inserted with a short piece of attached tubing, and heparin or saline keep the needle from clogging. In an emergency, an IV bag can be connected immediately.
routine internal examination of the uterine scar after vaginal birth: This is extremely painful for a woman who doesn't have an epidural, it could introduce infection, and it could convert a small, harmless gap in the scar into a problem.
http://www.childbirthconnection.org/...e.asp?ck=10214
Ovdje imaju i vrlo dobru usporedbu rizika VBAC i ponovnog Carskog reza
http://www.childbirthconnection.org/...e.asp?ck=10210


Feelings after a caesarean...
article by Birthtalk

Some women who have met their babies through a caesarean operation share similar emotions and thoughts about the experience. They also can share similar ways of behaving and coping afterwards.

This not often talked about by many obstetricians and midwives to women after they have had a caesarean. Not because they don’t care…but because they don’t know.
Does any of this sound like you?

feelings of emptiness...a feeling that there was something missing from the birth.

a lack of confidence with mothering and difficulty accessing your mothering instincts

hypervigilance in your care of your baby...(a natural expression of feeling powerless during childbirth

feelings of failure, that you failed to be a “real woman”, which can impact upon your general confidence in life

anger with your partner if you felt he should have rescued you (whether or not he really could).

feeling so constricted by the trauma of the birth that you cannot fully express your love for your baby.

Having a caesarean can be a challenging start to motherhood
Parenting a newborn is hard enough anyway, but often, after a caesarean, women are “behind the eight ball” before they’ve even left the hospital

It is really tough going into parenthood with any of the above feelings colouring your postnatal life.

Plus there are the physical challenges & restrictions facing a woman recovering from major abdominal surgery. You can’t pick up your baby, breastfeeding can be difficult when lying down post-surgery, often you can’t even walk to the bathroom let alone stand to bath your child. It can be physically difficult to tend to your baby’s needs.

This combination of valid emotional vulnerability post-birth, and physical struggles in recovery can result in a very negative experience, and a rough start to life as a family.

Why does a caesarean often produce these results?
There are many reasons – and none of them are commonly talked about. But not because they don’t exist…but because most people just don’t know.

Some reasons are below…

Caesarean women don’t get the “good” hormones of birth
Even if you have a labour before your caesarean, once you have an epidural or Syntocinon, your body alters its production of hormones. This is due to a feedback mechanism in the brain that leads to a marked reduction in the production of a specific cocktail of hormones. Their job includes aiding bonding after the birth, and encouraging a good start to breastfeeding. Basically, the hormones switch on our natural mothering instinct, created by nature to ensure our babies’ survival by making us fall in love with them and aid breastfeeding and making us want to just sit and stare at them.

One way that these hormones are produced is by holding a naked, slippery, gooey baby to our breast after the birth, who smells of birth and feels of birth. That rarely happens with a caesarean – usually women get a clean, wiped baby wrapped up to the neck in a blanket, and are usually allowed only a quick touch before the baby is whisked away.

So if you feel a bit empty after the birth, or numbed emotionally, or struggle with feeding, it does not at all mean that you are not maternal, and it certainly does not mean that you must not love your baby.

What it does mean is that you might need a bit of help to kickstart those hormones that are waiting there for you. (A simple way is baths with your baby where you are both wet and slippery together- your baby to your chest- contact us for more ideas)

The indignities: having to buzz when you want to hold your baby and being unable to care for your baby postbirth

We imagine that, after our baby is born, we will hold, caress, and care for our babies. We will change their nappies and comfort their cries. We will envelope them in all the warmth and nurturing they received in utero.

This is not the reality for many women after a caesarean. Instead, we have to buzz the midwife when our baby is crying in the cot – lying so close to us, but out of reach. The post-operative pain forces us to lie back and wait, helpless, while our baby cries. This indignity can strike deeply in the heart of a new mother. And the feeling of helplessness that may have begun during the birth, is amplified by yet again feeling unable to be a “real woman” and comfort her child.

This indignity and helplessness must not be underestimated. And we must stress that the situation is not made worse because a woman “set her expectations too high”. The time post-birth is designed by nature to be the penultimate hours of bonding. It was designed to ensure our baby’s survival. If we miss out on this, it undoubtedly can have repercussions for our postnatal life.

Not being considered in the decision-making, not being acknowledged, and feeling like a “piece of meat”

These are not “little things” that don’t really matter. Being involved in decision-making is one of the most significant factors women who have had a positive birth have in common. That is, a good birth is one where you are involved in deciding “what happens”.

Sure, you’re having major surgery, and you are trusting the surgeon’s skills. But being involved in decision-making does not mean knowing as much as the head obstetrician.
It means being included in the deal. Being acknowledged as an important stake-holder in how things go. After all – it is you, not the medical staff, who will leave hospital with this child and have to deal with the repercussions of the birth.

Simple things such as being talked to, not over. Or everyone involved remembering that this is a birth, not just an operation. This is a peak moment for you and your partner, and it is very hard if you are seemingly viewed as just another uterus.

To be involved in the decision-making before and during a caesarean takes a great deal of confidence and previous knowledge. It is not knowledge that is freely available in our community. So not many people know it.

Having birth “done to” you, instead of you “doing” birth
In an active, drug-free birth, a woman can move around freely, changing positions, working through contractions, using her body and her mind to meet the challenge of birth…she is “doing” birth.

In a caesarean, you are prone on a surgical table – literally at the mercy of the medical staff, which can be a frightening, and again, helpless feeling. Many women describe their caesarean birth as being “done to” them, and that they didn’t really give birth.

But why should this matter for us?
Birth was designed to have us “doing it” as a means of showing us how powerful and strong we can be – power and strength are important attributes for a newborn’s mother to have. If we don’t have the chance to meet that challenge, and feel those hormones created to help us with the job of meeting the pain of labour and nurturing a newborn, we have to work much harder to do what is supposed to “come naturally” postnatally.

Plus, a lot of women grieve for this lost chance…without even fully understanding what they are grieving for. It is ok and normal to feel a sense of loss if you missed the chance to face the final challenge before motherhood. It makes sense to be sad about that : from a physiological point of view,(because you’ve missed out on vital hormones meant for you) and from an emotional position (you’ve missed out on gathering mental strength meant for you).

So what can I do now? I can’t change the fact that I had a caesarean. How can I feel better?
We can’t alter our path to birth once it has happened. But we most certainly can change how we feel about it, and the intensity we feel about it. It is definitely possible to make peace with the experience. And to gather some of those lost hormones. And to feel much, much better.

Some initial ideas include:
receiving validation for how you feel. This is tricky as most family members don’t understand. A great resource is an IRL support group. Birthtalk has a Brisbane group called “Moving On From a Negative Birth” to support women even years after their birth. Also see www.canaustralia.net/support for other Australian caesarean support groups in your area. And check out specialist caesarean support forums such as that at the International Caesarean Awareness Network.

Read about other women who have moved on after a challenging caesarean on our BirthStories page.

write your birth story from the point of view of “how I felt” rather than “what happened”.
It may give you insights into what aspects you need to heal and explore.

Read more about the emotional effects of a caesarean: Birthing from within by Pam England, Silent knife and Open season by Nancy Wainer Cohen are all great places to start

Get on the Caesarean Awareness Network Australia website,they have a heaps of articles and further resources, plus a National Support Phone Line, where a midwife is available to answer any questions and hear your concerns.

Just keep reading, researching, asking questions…getting the right knowledge is power!
http://www.birthtalk.org/Art4FeelingsCS.html
If my goal is VBAC, how can I increase the likelihood of giving birth vaginally?
(For additional ideas, see tips for lowering your chances of having an avoidable cesarean within Tips & Tools: C-Section.)


Choose a doctor or midwife who favors VBAC: Unfortunately, with changing cultural views of c-section, VBAC and vaginal birth, and fears of legal claims and lawsuits, caregivers who offer you the option of VBAC are becoming more difficult to find. Discuss your goals and preferences with potential caregivers, and find out how they will work with you to meet your objectives. If their response does not satisfy you, and you have other options, seek a better match.

A pro-VBAC caregiver:
believes that women should labor unless there is a new reason for cesarean or a compelling reason not to labor. Even in these cases, the caregiver respects a woman's right to make the ultimate decision.
does not have policies that discourage VBAC but are not supported by sound research. Examples of unnecessary barriers would be caregivers who refuse VBAC for women thought to be having a big baby, for women with "gestational diabetes," or when the pregnancy goes past 40 weeks. (To learn more about what such policies might be, see Options: VBAC or Repeat C-Section.)
has a VBAC rate (proportion having a vaginal birth among those who plan VBAC) of 70% or more. Dozens of studies involving tens of thousands of women have shown that a VBAC rate this high or higher is an achievable goal.
Hire a doula (trained labor support specialist): Because your prior labor ended in a cesarean (or if you haven't experienced labor), and there is growing bias against VBAC, you and your partner may feel heightened anxiety and doubts during a VBAC labor. The continuous presence of a trained, experienced woman can help you deal with this. She will know ways to help you relax, ease pain, and promote progress.
Work with your caregivers to delay hospital admission until your cervix is beginning to open: Women who are admitted to the hospital before their uterine contractions are well-established are less likely to have VBAC.
Avoid labor induction procedures, when possible: when caregivers use drugs or other techniques to try to start labor artificially, a woman's risk for c-section goes up
Commit yourself to vaginal birth: If you ask for a cesarean in a weak moment, your request is likely to be granted.
Avoid epidural and spinal analgesia: Although these generally provide excellent pain relief, they have many drawbacks. One in particular is important to VBAC labors: a common side effect is slowing of the baby's heart rate. As a drop in the fetal heart rate is also the most reliable symptom that the uterine scar has given way and is causing problems, this side effect could lead your caregivers to push for an urgent c-section. If you wish to avoid this "regional" analgesia, be sure to learn about the wide variety of comfort measures and other strategies, including continuous labor support, that can help you cope effectively with labor pain. (See Options: Labor Pain for more information on epidurals and other methods of coping with labor pain.)

One factor that need not enter into the epidural decision is the concern that having an epidural could mask the pain of the scar giving way. Pain has not been shown to be a reliable symptom. Experts agree that women should not be denied an epidural for this reason.


What are some tips I can use to reduce my risk of having an unnecessary repeat cesarean?
You can:
If a c-section is proposed and you're not in an emergency situation: Ask about (1) why it's being recommended, (2) the benefits and risks of surgery, (3) other possible solutions to the problem, including just waiting longer, and (4) the benefits and risks of those. If you aren't in labor at the time the issue arises, you should have time to do your own research and talk things over with your partner and caregivers before making a decision. (See making informed decisions for more information on this topic and Options: VBAC or Repeat C-Section for information on reasons that may given for a c-section.)
If your baby is in a buttocks- or feet-first position (breech): Very few caregivers will agree to vaginal birth with a breech baby. Ask your caregiver about having an external cephalic version (a doctor turns the baby to a head-first position by manipulating your belly) if your baby is still breech when you reach "term" (about the 37th week of pregnancy). You may need to search to find a caregiver who has skills and experience with this technique. We do not have much research on external version in women with prior cesareans, but what little we have has not found extra problems. See more on breech position and external version on the Cesarean Section page in Resources A-Z.


What if I have unresolved emotional issues?
Some women who have had an extremely difficult or frightening prior birth experience or other traumatic experiences such as sexual abuse find that thinking about labor brings up such strong emotions that it interferes with their ability to make decisions. Unresolved issues can interfere with the smooth progress of labor as well. If you feel that you have unresolved emotional issues, you will want to work through them so that they don't get in your way when planning for or experiencing your next birth. Keeping a journal, talking through the troubling events and your concerns with a friend or relative who is a good listener, or getting peer support from other women with similar experiences may help with this. Getting professional counseling from a competent mental health professional who is well-informed about maternity issues proves very helpful in resolving extremely deep fear and anxiety for many women.


Consider, too, what you will need during this birth to feel safe and well-cared for. If you were dissatisfied with your previous care, you will want to pinpoint the sources of your dissatisfaction and plan to do things differently this time.



What if I can't find a hospital and caregiver who will support my wish for VBAC?
If you feel strongly about having a VBAC and do not have access to VBAC care in your community, you may wish to consider relocating at the end of your pregnancy to stay with a friend or relative in a community where such care is available.


It may be possible in some communities to find a practitioner willing to take on a VBAC client who wishes to give birth outside of the hospital at home or in a birth center. You should know, however, that while many birth center and home birth practitioners have had good success with helping women who plan VBAC achieve vaginal birth, a national study of VBAC in birth centers concluded that risks of laboring with a scarred uterus warrant hospital care.