If you thinking about or planning a VBAC (vaginal birth after caesarean) there is good news – the NICE guidelines have been updated and care for women in labour is no longer very restrictive. It has been a long time coming but this is brilliant and it means that women who have previously had a caesarean will be able to labour with more options.
I am all about options and these new guidelines will hopefully provide women with more power to do what they need to do to work with their contractions and to manage their pain and their energy. I say hopefully because this guidance is not fixed, they are just recommendations but the more women know about their increased options, the more likely they are to ask for what they need.
The NICE VBAC guidance includes…
Do not routinely insert an intravenous cannula for women in labour who have had a previous caesarean section.
A cannula can be routinely used as part of the what-if management of a VBAC, so this is a great change because this could prevent vbac being treated as a trial of labour. Cannulas are uncomfortable and, when it is not needed, it can make a women feel like labour might not work so she could feel defeated before labour has properly got going.
When discussing oxytocin for delay in the first or second stage of labour, explain to women who have had a previous caesarean section that this:
- increases the chance of uterine rupture
- reduces the chance of another caesarean section
- increases the chance of an instrumental birth
An oxytocin drip could put more pressure on the uterus, which is why it can increase the chance of a uterine rupture. But I am all for options and a discussion about what is available and how a woman feels about the next step.
Offer continuous CTG to women with a previous caesarean section if using oxytocin for delay in the first or second stage of labour.
So, no continuous monitoring unless oxytocin is used and unless it is needed because there is an indication of an issue with baby’s heartrate. This will make such a difference because the impact of continuous CTG can be about being less mobile and feeling less relaxed because you may be waiting for a problem to arrive.
Support informed choice of a full range of options for pain relief for women who have had a previous caesarean section, including labour and birth in water.
Water has always been ruled out before, narrowing the options for some women. This change provides more options for women to manage their pain and their energy.
Explain to women in labour who have had a previous caesarean section that there is little evidence of a difference in outcomes for the baby between a vaginal birth or another caesarean section.
I read this to mean that one is not safer than the other – another caesarean can often be considered the safer option but NICE now highlights there is little difference between the two options. This is more brilliant news because it means that women having a vbac are being treated the same as any labouring woman, dealing with any issues if they arise and not assuming that labour will be more complicated.
For women who have had a previous caesarean section, be aware of the particular importance of following the recommendations from the NICE guideline on intrapartum care for healthy women and babies on:
- food and drink in labour: Inform the woman that she may drink during established labour and that isotonic drinks may be more beneficial than water…Inform the woman that she may eat a light diet in established labour unless she has received opioids or she develops risk factors that make a general anaesthetic more likely
- position in labour, including the latent first stage, and birth: Encourage and help the woman to move and adopt whatever positions she finds most comfortable throughout labour.
These recommendations mean that women having a vbac can now move and be off the bed, use water, eat & drink in labour and be treated as a ‘normal’ labouring woman. It really is great news – it will be interesting to see how these are put into practice within maternity units but I am all about expectant parents having more knowledge and more of a say – these new guidelines will contribute to that, with more discussions and women wanting more of a say in their care.
Please do share this post so it reaches more women and just send me a message if I can help you prepare for the birth of your baby.
Janine | Birth, Baby & Family
A specialist in pregnancy, birth and early parenting