Prepping for VBAC

VBAC

There are great reasons why many mothers opt to try for a VBAC with their second child.  Benefits of a VBAC can include a generally quicker postpartum recovery and less trauma/scarring to your abdominal wall.  These positive outcomes are due to the lack of surgical intervention. Our friend @mommylabornurse did a blog post offering great information regarding the medical decision-making behind VBACs (link).  One of our biggest takeaways from her information was that 90% of women who have had a c-section in the past are safe to have a VBAC!  In summary, if a VBAC is something you want, usually it is medically safe to pursue it! The following information is intended to help prepare your body to increase the probability that you will reach your goal of a successful vaginal childbirth.     

PREPARING YOUR BODY FOR VAGINAL BIRTH AFTER A C-SECTION: HEALING CORRECTLY

You have one chance to heal correctly. After a c-section we want to decrease the inflammation, get the abdominal scar moving and take pressure off of the internal organs (the front side of the uterus). This blog post has tips on how to move intentionally after a c-section.  The postpartum guide is incredibly helpful as it is all laid out for you week by week.  The guide is safe for c-section mamas and will give you explicit directions in how to best optimize your healing. Below are important steps if your desire is a VBAC.

• Scar Tissue Mobilization

• Diaphragmatic Breathing

• Seeing a visceral therapist: see IPA or Barral for a local provider

  • Get the scar tissue moving and the organs that live below it

• Opening the hips up/Optimizing hip mobiltiy

  • Seeing a PT for dry needling and targeted strengthening to address your specific issues

• Pelvic floor release

• Proper strengthening and relaxing of the pelvic floor

DURING PREGNANCY

• Fix your posture: It is important to try to minimize the time spent in “poor” pregnancy posture.  Less than optimal posture during pregnancy is typically the result of increasing in weight of your belly.  What happens for a lot of women is that as the weight in front of your body increases, so does the arch in your lower back.  This increased arching in your lower back (what we medically call a “lumbar lordosis”) actually puts more pressure on the front side of the uterus.  These postural changes often also affect your hips, which often get tighter and start rotating outward. Increased lumbar lordosis and tight, externally rotated hips force the uterus into a more forward position in the abdominal wall.  This ultimately forces the uterus into areas affected by the abdominal scar from your previous c-section.  

• Increase your strength: (Expecting and Empower Pregnancy Guide) helps to decrease this pressure. Pregnancy is a time of instability. The body has to carry more load and the hormones make your body less stable.

• Find out what caused your c-section: What was the cause of your c-section? A clinical observation is that very modifiable factors such as tightness in the hips and pelvic floor can be a HUGE contributing factor.  If you feel this may be true in your body you will set yourself up for success by addressing these orthopedic issues. Severe hip and pelvic floor tightness tends to be particularly true of athletes (runners, gymnastics, tennis players). This population can really benefit from Expecting and Empowered workouts and/or yoga.  There are often great benefits seen from reducing the amount and frequency of high-impact exercise. For many women, this means the cessation of running (typically by 20-ish weeks gestation) in favor of using an elliptical, walking, or cycling.

• Start perineum prepping of the tissue at 32 weeks.

LABOR AND DELIVERY —SEE TIPS FOR VBAC VIDEO

The amount of direction women recieve for the process labor and delivery is incredibly minimal. It truly is one of the biggest mental and physical experiences that you will ever go through, and so it is important to educate yourself. These are some of our best directions for labor and delivery:

• During contractions, know how to worth WITH your body

  • Blowing out as you push (trying to decrease the pressure) - with small pursed lips blow as if you are blowing out birthday candles.  Holding your breath can cause your pelvic floor to actually contract at the time where you need it to be the most open and relaxed!

• Positioning Considerations:

  • Upright labor with rest when it is appropriate. Try to keep moving. When you are in a more upright (standing) position, gravity is a helper!  Use gravity to your advantage as it will assist the baby drop into the pelvis toward the pelvic floor. It is not really possible to do this once you have an epidural, so one thought is that delaying the epidural and thus improving your ability to be mobile can be quite helpful

  • Hip opener exercises

    • Quadruped with your ankles rotated outward

    • Rocking your pelvis on a stability ball

    • Staggered stance

    • Pelvic squeeze

  • Positions ideally for less pressure on the uterus

    • Unmedicated: quadruped with ankles out to the sides

    • Epidural: laying in the bed on your side with one knee pulled up toward your chest

We wish you the best of luck and sincerely hope this information will be helpful!

Uploaded by Expecting and Empowered Kiefer/Howald on 2020-02-11.