This is a very common question to be asked by a patient in advance pregnancy.
Usually when a patient asks me this question she is asking if her baby is in an occipito-anterior position.
Occipito-anterior is when the back of baby’s head (the occiput) is toward the pregnant woman’s front (or anterior).
This contrast to this occipito-posterior position is when the back of baby’s head is towards the pregnant woman’s back and the baby’s front is towards her front.
A pregnant woman asks the question ‘Is my baby in the right position?’ usually because she has heard that an occipito-posterior position of her baby in labour and delivery is associated with a greater likelihood of a more difficult labour and delivery.
Throughout the pregnancy, which way a baby is turned is not relevant as baby can move. This is particularly so if it is not the first ongoing pregnancy as the uterus is not as tight around the baby.
This article is for my patients who have had a Caesarean section and are considering attempting a VBAC delivery this time. It's purpose is to give you comprehensive information to help you to make your decision whether or not to attempt a VBAC. The contents of this article are to be used as background information only on this topic and are to be used in conjunction with consultation with me.
What’s the biggest risk of an attempting a VBAC?
Having a Caesarean section does have implications for the next delivery. The biggest concern of an attempt at a vaginal birth after a Caesarean section (VBAC) is rupture (tearing / splitting) of the uterus in labour.
Historically attempting a VBAC has been called a ‘trial of scar’ labour. This trial of scar terminology more accurately describes the concern of a labour after a Caesarean section delivery. The labour is a ‘trial’ to see if the scar remains intact and doesn’t tear.
Why is there an increased risk of uterine rupture with an attempt at a VBAC?
Healing of the previous Caesarean section uterine cut will result in scar tissue forming along the line of the uterine cut. This is unavoidable and is
Posted by January 9, 2014 -
Will I need a Caesarean section?
A Caesarean section is an abdominal operation to deliver your baby. It is either an emergency or elective operation.
An emergency Caesarean section is done when there is an urgent complication in pregnancy or labour which significantly compromises your or your baby's wellbeing (or both). This implies that continuing the pregnancy or labour for a significant time will be very dangerous. How quickly the Caesarean section needs to be done will vary from extremely urgent (viz immediately) to within the next few hours.
An elective Caesarean section is a pregnancy planned event. The reason could be previous pregnancy or labour problems, maternal health issues, complications in this pregnancy and sometimes personal patient request. Some women prefer to have a Caesarean section rather than a vaginal birth.
An elective Caesarean section is booked on a date close to your expected date of confinement (EDC) at about 39 weeks pregnancy. In these situations it is
Posted by October 5, 2013 -
The goal with a vaginal delivery is an intact perineum. This does not always happen. There can be tearing, the commonest area of tearing being the perineum. Hopefully it is only minor tearing.
Sometimes an episiotomy is needed. This could be to avoid a nasty perineal tear or if there is a forceps delivery. Sometimes the episiotomy extends so there is both an episiotomy and tear.
The diagram adjacent shows the stretched perineum with the baby's head delivering and the usual direction of a tear.
Sometimes the anal sphincter muscle is traumatised and sometimes the tear goes completely from the vagina through to tearing the rectum skin (mucosa).
Classification of perineum tears
- First degree tear: tearing limited to the posterior entrance of the vagina (fourchette) and superficial perineal skin or vaginal mucosa (skin).
- Second degree tear: tearing also involves perineal muscles, but not the anal sphincter
Posted by July 27, 2013 -
Some of my friends have said I need a birth plan. Is this necessary?
No - this is not necessary.
The birth plan concept is more relevant for pregnant women going through the public system to have their baby where there is no personalised care and the staff looking after them in labour are strangers.
I focus on personalised individual pregnancy care and during the course of the pregnancy I endeavour to get to know you, your expectations, your fears and your requests. I suggest you tell me of requests, concerns, fears, expectations, etc. at the antenatal visits and we can work through them before you are in labour.
This means when you are admitted to hospital I will have your objectives in mind. Key points will have been written onto your antenatal card that you bring in to the hospital and show to the midwife. The
Posted by July 7, 2013 -
Vacuum and Forceps - Operative vaginal deliveries
Will I need an operative vaginal delivery?
Hopefully not. Only about 12% of my patients need operative vaginal deliveries.
The usual indications for an operative vaginal delivery are:
- Lack of progress in second stage labour with achieving a vaginal delivery despite maternal effort (pushing).
- Maternal exhaustion with pushing in second stage.
- Foetal distress in second stage.
When is it safe to do an operative vaginal delivery?
- I believe you must be in second stage labour (cervix fully dilated). Some doctors do operative vaginal deliveries before then (while still in first stage labour), but this increases the risk considerably.
- Your baby’s head must be engaged in your pelvis. Some doctors do operative vaginal deliveries before then (when the baby’s head is not engaged), but this increases the risk considerably. I prefer the baby’s head not only to be engaged but to be as low as possible in your pelvis when doing an operative vaginal delivery. The lower it is the less traumatic an operative vaginal delivery is likely to be for your baby and you.
Posted by July 4, 2013 -
I think my waters have gone!
Rupture of membranes (ROM) or "waters have gone" refers to the leaking of amniotic fluid ('liquor') from the amniotic sac around your baby because of a hole that develops in the amniotic membrane.
It is a normal phenomenon during labour. In about 10% of cases will happen before the onset of labour. Sometimes it happens much earlier in the pregnancy which creates a situation of considerable risk for the baby.
If it is a forewater leak (a hole in the membrane just inside the cervix) then the amount of liquor released is considerable. It often happens in labour. If it happens before labour, it is likely labour will soon start even if the pregnancy is not that advanced. There is risk of infection ascending from the vagina into the amniotic sac where your baby is. As a consequence if there is prolonged ROM then you will be checked for infection
Posted by July 3, 2013 -
What is induction of labour?
Induction of labour is a procedure done to end a pregnancy after 20 completed weeks with the goal being a normal vaginal delivery.
When is induction of labour considered?
Induction is considered when there are complications of pregnancy which means there is risk to the mother or baby's wellbeing in continuing the pregnancy. The most common indications include high blood pressure (including preeclampsia), PUPPPS, diabetes, cholestatic jaundice of pregnancy, postdates pregnancy, intrauterine foetal growth retardation, unstable foetal lie, twins, a history of a previous very rapid labour, planned VBAC going overdue and to avoid a baby getting too big for an uncomplicated vaginal birth, foetal demise. Sometimes induction is done because of maternal request such as family commitments, husband/partner work commitments, to time arrival of relatives from overseas, excessive pregnancy
Posted by July 2, 2013 -
What is labour?
- First stage labour is defined as regular coordinated contractions that cause your cervix to dilate. The onset of labour is when your contractions cause this to happen. There may be increased uterine activity in the days or even weeks before true labour starts. This can cause confusion in knowing the time of the onset of actual labour.
- Second stage labour starts when your cervix is fully dilated (10cm). This is the time you are encouraged to push and deliver your baby.
- Third stage labour starts after your baby is delivered and ends when your placenta is delivered.
When does labour happen?
Labour usually happens at term gestation, which between 37 and 42 weeks pregnancy. If its onset is before 37 weeks it is called pre-term labour. After 42 weeks you are post-term.
How do I know I am in labour?
- You will become aware of regular contractions of increasing frequency and severity. For most women you should call the Labour Ward / Birth Unit midwife when aware and she will usually advise you to come to the hospital when the contractions are five to 10 minutes apart. Also contact your husband / partner to come home and start
Posted by July 1, 2013 -