You can start preparing for your birth in the early stages of pregnancy, thinking about classes and finding out what is available locally to suit you is important.
If you’ve had a previous caesarean, you might be feeling unsure about your birth options. There’s lots of myths and misinformation around vaginal birth after caesarean (also known as VBAC).
You might be sure that you want a VBAC this time, or anxious about the idea of it. You might feel that you don’t want to try a VBAC at all. If you’ve had a traumatic birth experience previously, it’s understandable that you might be feeling scared and anxious.
Whether a VBAC will be recommended will depend on lots of factors. Women have caesareans for all sorts of reasons – some of these are unlikely to recur in future pregnancies, while in others the team may think it’s safest for you to have another caesarean. The obstetric team will help you to understand the circumstances around your caesarean, why it was necessary, and whether your caesarean and any other issues will affect your birth options.
For example, if you had a caesarean because your baby was breech, it’s unlikely that you will need another caesarean. Women who’ve had one previous caesarean and are having a straightforward pregnancy have a 75% chance of a successful vaginal birth. If you had a vaginal birth before your caesarean, you have an even higher chance of success – about 80-90% of women in this situation are able to have a vaginal birth.
Hypnobirthing uses breathing, relaxation and visualisation tools to help you relax and feel confident in birthing your baby. This helps you prepare for your birth by replacing your worries with a positive mind-set. The evidence shows that hypnobirthing improves women’s experience of comfort in labour and confidence in their ability to give birth. These tools can help you keep calm regardless of what is happening around you. Hypnobirthing is soundly based on established medical knowledge.
Most Hypnobirthing courses will:
Whether you are birthing at home or in a hospital, are having your first or fifth baby, the tools you learn will prepare you to feel confident to make your own decisions during your birth and beyond. It aims to give you the tools to have an empowering birth on the day. Hypnobirthing is for all types of birth, including caesarean birth.
Massage of the perineum (the area between the anus and the vagina) has been shown to reduce the risk of tearing, needing an episiotomy or stitches during a vaginal birth. You can start practicing perineal massage when you’re 34 weeks pregnant – research shows that it is most effective when performed at least twice a week. You can do it yourself or ask your partner to do it for you, as it can be a little difficult to reach if you have a big bump!
To perform the massage, you should:
Moxibustion is a traditional Chinese medicine technique, used to turn babies into the head-down (cephalic) position.
It is a Chinese medicine treatment allied to acupuncture but uses no needles. A dried herb called moxa (mugwort) is tightly rolled into the shape of a cigar. This roll is lit and held above the skin, next to an acupuncture point on the foot called Bladder 67, on the outside of the little toe nail. When lit, the herb smoulders slowly, allowing the heat to permeate into the body. This is believed to affect the flow of qi (energy) and blood flow in the area (British Acupuncture Council 2010).
Research suggests that this technique might be helpful for some women whose babies are not head down. It’s not painful or harmful, and some women may wish to try it before having an external cephalic version (ECV). There’s also some evidence that it might reduce the need for oxytocin and, if combined with acupuncture, may reduce the likelihood of needing a caesarean.
Although this is generally a safe and gentle procedure, it may not be suitable for you if:
If moxibustion does not help your baby to turn to the head down position, you may be offered an ECV.
External cephalic version (ECV) is a method of turning babies who are breech or transverse into the head-down (cephalic) position. A doctor or specialist midwife will apply pressure to your abdomen with their hands.
Some women find this uncomfortable. This method works for around 50% of women and is generally safe. A small number of babies (approximately 1 in 200) will need to be delivered by emergency caesarean after an ECV, but your baby will be monitored throughout the procedure to ensure they are coping well.
If your baby needs help to turn into the right position, your midwife will refer you to the ECV clinic at University Hospitals Dorset, or to have the procedure in the day assessment unit at Dorset County Hospital.
Most mothers start producing colostrum about halfway through pregnancy, and some leak small amounts of colostrum while they are still pregnant.
Some women decide they would like to hand express and freeze colostrum during pregnancy. This is not usually necessary, but it might be recommended if you are diabetic or taking medication for high-blood pressure, or if your baby is likely to be premature.
If you do wish to try hand expressing colostrum, speak to your midwife so that they can advise you. You should wait until you are at least 36 weeks pregnant. If you are leaking before this, you can try to collect some of the colostrum with sterile syringes.
Please don’t worry if you aren’t leaking during pregnancy, or if nothing happens when you try to hand express. This does not mean you will be unable to breastfeed or that you aren’t going to produce colostrum or milk once your baby is born.
Some women are specifically advised not to attempt to express during pregnancy, including:
This is because of a slight risk of triggering labour in women who are already at risk of preterm labour.
If you experience any contractions while hand expressing during pregnancy, you should stop immediately.
Find out more about antenatal hand expression
It’s a good idea to think in advance about how you want to feed your baby, and to include this in your birth plan. You can discuss your thoughts with your midwife. There’s lots of evidence that breastfeeding has many health benefits for you and your baby, but it is up to you how you would like to feed your baby, and the team will support you whatever you choose.
Read more about feeding your baby.
During your pregnancy, you should think about where your baby is going to sleep. It’s a good idea to set up a safe sleep environment for your baby during late pregnancy, in case your baby is born early. Your health visitor can help advise you with this at your home antenatal visit from them.
There are lots of options for sleeping and it can feel a bit overwhelming. It’s really important to do your research and consider what will be both practical for you and safe for your baby.
The following resources will help you to decide what’s best for you and your family: