In last week's blog post I talked about some ways to prepare for vaginal birth, including choosing a provider with a low cesarean rate, hiring a doula, and avoiding or delaying epidurals and inductions. There's so much to say on this subject that I had to split it into two weeks. Here are more suggestions.

Take Care of Yourself During Pregnancy
Taking care of yourself prenatally will help to ensure that your baby is born vaginally. Focus on exercising regularly, staying hydrated (dehydration can lead to preterm labor), and looking for ways to reduce your stress levels, such as getting outdoors, sleeping enough, practicing meditation or yoga, warm baths, and treating yourself to a prenatal massage.

Nutrition
Excellent nutrition is so important. Today you are growing your baby’s brain, heart, liver. While reading labels is important, the best food has no labels: a glass of milk, homemade chili, a bunch of grapes. Shop the perimeter of the grocery store, through produce, dairy, meat, and the bakery, and try to avoid the middle aisles where the heavily processed foods are. Eat whole grain, protein, and a fruit or vegetable at each meal. Simple changes like whole wheat bread instead of white on your sandwich, or a fruit yogurt midmorning instead of a fruit Danish, make a difference.

Childbirth Class
Take an in-depth childbirth class. When possible, learn from an independent instructor, not one who teaches for a hospital or doctor’s practice. She’ll be able to provide you with an unbiased view of practices and policies, and because she works for you, she will only be responsible for you. Practicing contraction rituals and support techniques in class and at home, including massage, positions, hot/cold therapy, and use of the birth ball and rebozo, will give you lots of tools to use in labor. Learning informed consent and decision-making skills will help you to make decisions in labor that will create a satisfying birth experience. The Listening to Mothers Survey has shown that understanding interventions and truly consenting to them is essential for postpartum birth satisfaction. If possible, tour more than one hospital to learn about different options in your community.

If your baby is breech after thirty-two to thirty-four weeks, consider alternative options to encourage him or her to turn. Hypnotherapy, acupuncture, and chiropractic adjustment have all been shown to be effective. Turning your baby, when possible, is important because few American women have the option of vaginal breech births. Discuss manual version with your provider.

Many pregnant women who have had cesareans want to give birth vaginally (VBAC) to their subsequent babies, in part because while the risk increases with each cesarean, it decreases with each VBAC. The non-profit International Cesarean Awareness Network (ICAN)is a volunteer-run organization which supports moms by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting VBAC. They provide free meetings where women can discuss pregnancy, labor, and birth, postpartum, share birth stories, and hear guest speakers. I spoke with Kira Kim, the leader of the Eastern Massachusetts ICAN chapter about ICAN, and she told me “as a mother that had cesareans with my first two, and a natural birth with my third, the group and its mission are close to my heart. ICAN is a great way to learn about VBAC both through education and access to local resources.”

I asked Liz Libby, mother of three, why a VBAC was important to her. She told me,”I have always felt that birth is a tremendous formative experience in a woman's life, and I felt I was robbed of it the first time around. With my twins, I had a high-risk pregnancy and was highly managed by physicians who seemed not at all concerned with my experience of birth. I wanted something different the second time: a safe, peaceful, normal birth with care providers who were knowledgeable, caring, and concerned with my experience. Having the right care provider, for me it was midwives in a homebirth setting, made all the difference. I cannot stress enough how important it is to find a care provider who is 100% on board with your VBAC plan. This goes for any mom looking to have a vaginal birth as well. I know my VBAC would not have happened with a different care provider. “

Jennifer Heller, another VBAC mom I spoke with echoes this. “When I was pregnant with my third child, I was confident that a vaginal birth was the best thing for myself and my baby. There was never any doubt in me that I could have a vaginal birth again, but I didn't want to have to argue about it with providers. Having a provider who supported me and a husband who also had confidence in the birth process helped me worry less. I found a doula who was lovely. I just needed folks around me who shared my confidence.”