The way their birth unfolds will stay with your client forever. It will be a memory imprinted on their hearts and minds always, and it can influence and impact them emotionally and physically in large and small ways.
For many of our clients, a cesarean birth is good and necessary and they are at peace with having subsequent births in the same manner. However, many people experience a sense of loss when giving birth via cesarean, especially when they had envisioned and worked to prepare for a vaginal birth. When this happens many of them eagerly work toward preparing for a vaginal birth after cesarean (VBAC) for their next birth(s). As doulas we can be an integral part in helping our clients be prepared and empowered.
Depending on the circumstances of their first cesarean, the way your client should prepare for labor for a VBAC can vary. As with any pregnancy and birth, there are so many factors that contribute to the experience: client relationship with their partner and family, client’s self-esteem, client’s relationship with their provider, physical health factors, mental health factors, and more. These coupled with how their first birth progressed and ultimately finished should all be taken into account when approaching and preparing for VBAC.
Planned for vaginal, labored for hours, ended in unplanned cesarean. In this situation, your client may be extremely versed in what to expect with a vaginal birth. They may have done lots of prenatal education and worked with you (or on their own) to practice coping strategies which they then used during labor. Due to unforeseen circumstances, after all that laboring, a cesarean was the way they gave birth. For this type of client, reviewing how they labored before and tweaking what worked and what wasn’t as helpful is a great starting point. Assessing the circumstances surrounding the need for a Cesarean and encouraging your client to talk with their provider about this is vital. As always, your emotional and practical support will be key as well.
Planned for vaginal, labored for hours, ended in emergency cesarean. This can be difficult. With a legitimate emergency situation, your client may have lingering fears and anxiety because of what they experienced. Not everyone does so don’t assume this, but be prepared to discuss this with your client and help them work through it as best as you are able to (recognizing that deep emotional issues require more than what our scope as doulas encompass). To prepare for a VBAC, your client must have a high level of trust with the provider, and needs to have open conversations regarding the reasons the emergency cesarean was necessary and what they can do together to avoid repeating that situation. Sometimes there are things that can be controlled (for example, diet and medication) and sometimes there are things that happen during labor that no one can change. Reviewing these areas with your client is important.
Planned for and had a cesarean birth. Generally, people who give birth via planned cesarean usually plan for the same for subsequent babies. However you could encounter a client who wants a VBAC due to complications from the cesarean, a difficult recovery, or other reasons. In this case, extensive prenatal education and birth preparation is a good idea, especially if your client didn’t do much of this in the earlier pregnancy. For someone who has never labored before, you’ll want to make sure to explain the general progression of labor, coping methods, and how you will support them throughout.
Clients who have had cesareans may feel a wide variety of emotions. They may feel upset, regretful, angry, sad, or even grieved that they didn’t give birth in the way they wanted. They may feel resigned, understanding, and have a level of acceptance for the way their baby was born. They may feel thankful that in their emergency situation, a cesarean saved their baby or themselves or both. It is important not to project one’s own views of cesarean onto our clients. We can impact their thinking and unwittingly discourage them if our opinions are very different from their experiences. We can best support our clients when we remember that we are there to encourage and educate them in their present circumstances, while keeping the past in mind but not dwelling on it.