1 - How can I naturally increase my chances of a vaginal birth after caesarean (VBAC)?
You are more likely to need a caesarean section (CS), if you have had one previously, but there are ways to increase your chances of a VBAC:

  • Choose a supportive doctor that not only support VBACs but truly believes in them.
  • Understand the root cause behind your CS, and talk with your doctor to assess your chances.
  • Learn the facts about VBACs - 60–80% of women who attempt VBACs are successful. The American Congress of Obstetrics and Gynaecology (ACOG) and Royal College of Obstetricians and Gynaecologists (RCOG) support attempting a VBAC. Inform yourself via VBAC support groups for mothers and information from RCOG and ACOG.
  • Eat nutrient-dense real foods, exercise and stay active and maintain a healthy weight This goes for any pregnancy: the more healthy you are, the greater your chances are of having a natural, healthy labour and delivery.
  • Attend your appointments, so that your baby’s and your wellbeing can be optimised. If you have medical conditions in pregnancy e.g. raised blood pressure, diabetes, thyroid disease - keep them well controlled.
  • Whether this is a written birth plan, a thorough conversation with your provider or a birth partner who expressly knows your desires, or all of the above, be confident that you have communicated your wishes and that they have been understood. Some may want to hire a professional labour assistant (PLA) or a doula to support them in labour and this may increase your VBAC rate. Doulas are welcome to city hospital as either the primary or additional birth support. Doulas are required to provide a negative PCR test within a validity of 7 days.
  • A labour that starts naturally is less likely to need medical intervention. Avoid induction of labour unless there is evidence to suggest you or your baby are at risk from prolonging your pregnancy.
  • Try different labour positions, e.g. on your sides
  • It’s important to be patient and release expectations. The calmer you are, the less likely you will have a long labour and the more likely you will achieve a VBAC.

But if it isn’t a perfect experience, and very few births are, that’s okay. If you have another C-section, that’s okay. Whatever happens you have brought a baby into the world and that is amazing.

2 - Is a Doula able to accompany me in my labour to help support me, and can you refer anyone?

  • Support in labour is extremely important and we believe that doulas can provide an excellent resource, alongside your husband, to provide you with the emotional and physical support you may require to achieve your birth goals.
  • Doulas may accompany you in your labour as either the primary support person if your husband cannot be there, or as a secondary support with your husband also by your side.
  • A few requirements must be met for your support people such as providing a negative PCR test taken within the preceding seven days, and on arrival pass a Covid health questionnaire and temperature checks.
  • Doulas will also be required to sign a partnership agreement with the hospital prior to your due date, and have consent from your obstetrician to attend the birth.
  • Although we can’t refer any doulas, we do only accept certified Doulas who have gained their accreditation with internationally renowned bodies such as DONA, Childbirth International or find choose the right fit for you, your family and your goals. Some information that can help you chose a  doula can be her personal ethos, her qualifications and experience, the number of clients she takes per month, and what her services include.

3 - Does nausea occasionally return in the third trimester and what would trigger it?

As you enter the third trimester of pregnancy, you may experience occasional bouts of nausea. The cause can range from something simple like overeating or gastric collection to a more serious one, which should be checked as soon as possible.

  • The hormone in your body during pregnancy, called progesterone, causes the muscles in your stomach and your digestive tract to relax. As a result, your digestion is slowed and food can travel back up into your oesophagus, also called acid reflux. It can cause a burning sensation in your chest and throat. This is one of the most common causes of third trimester nausea.
  • In the last trimester of your pregnancy, your baby is almost fully grown and their size can cause your stomach to move, which can make you both uncomfortable and nauseous from the disruption. As your body prepares for the future delivery of your baby, your uterus expands which can cause discomfort as it presses against your stomach.
  • Pre-eclampsia is a condition that can occur during pregnancy. It involves the tightening of the blood vessels and also causes high blood pressure. Blood vessel restriction can lead to blood clots, which constricts the blood flow to the placenta. Preeclampsia can be very dangerous to the mother and baby, so it is important to seek medical attention if your nausea is accompanied by blurred vision, swelling or extreme pain in your abdomen.
  • If you are going through constant bouts of vomiting, you should get in touch with your doctor as you can get dehydrated, which is detrimental for the baby.
  • If you have vomiting accompanied with pain, this may be due to a medical/ surgical emergency.
  • Third trimester nausea can be a sign of labour. However, don’t immediately assume that is the case unless your nausea is accompanied by contractions that are less than 10 minutes apart, pressure in the pelvic area, and cramps and sometimes a show/vaginal discharge.

Although constant nausea can be frustrating and limiting on your daily life, there are many ways that you can treat and prevent the sickness. Changing your diet and ensuring you are properly hydrated can help alleviate the symptoms of nausea in the third trimester of pregnancy. As mentioned before, your gastrointestinal muscles have relaxed and you may digest the food in smaller amounts, thus avoiding acid reflux. Eating smaller meals also allows for steady energy and blood-sugar levels throughout the day. Drink enough water, avoid oily, spicy and sugary foods, and caffeine. Take vitamins, do not eat right before bed, and undertake regular exercise. You can also get relief from nausea symptoms with ginger, peppermint, yoga, antacids, and anti-nausea medications.

4 - Do I need to sleep if I'm feeling sleepy or can I have a coffee and continue to work?
It is common to feel tired during pregnancy, especially in the first 12 weeks. Hormonal changes in pregnancy can make you feel tired, nauseous, and emotional.

  • You don’t have to sleep if you are feeling sleepy, however if you are not sleeping well at night, you can have a nap to rest. Being tired and not getting enough sleep, can make you feel low. Thus try to rest as much as possible.
  • Make time to sit with your feet up during the day, and accept offers of help from colleagues and family.
  • Try to look after your physical health and ensure that you eat a healthy diet, and get plenty of rest and sleep.

Later in pregnancy, you may feel tired because of the extra weight that you are carrying. Make sure you get plenty of rest. As your pregnancy grows, it can be difficult to get a good night’s sleep. You might find that lying down is uncomfortable.

  • Feeling tired will not harm you or your baby, but it can make life feel more difficult, especially in the early days before you've told people about your pregnancy.
  • Avoid tea, coffee or cola drinks in the evening, as the caffeine can make it harder to go to sleep.
  • Try to relax before bedtime, so that you’re not wide awake. Relaxation techniques may also help. You could join an antenatal yoga or Pilates class. Make sure the instructor knows you're pregnant. Exercise can help you feel less tired, so try to do some activity, such as a walk at lunchtime or going swimming, even if you feel tired during the day. If lack of sleep is bothering you, talk to your partner, friend, midwife or doctor.

5 - What is Mediclinic's procedure/policy on skin-to-skin with baby after a C-section?
Being a baby friendly hospital means all our deliveries, regardless of normal delivery or C-section, are supported and encouraged with direct skin-to-skin contact immediately after birth. Contact remains uninterrupted for as long as possible and is only broken of the mother is moving (from operating room bed to normal bed) or if mother or baby are unwell. If skin-to-skin is interrupted for any reason, mother and baby are placed together again as soon as possible.
Skin-to-skin has tremendous benefits for mother and baby and we hold this golden hour after birth as sacred. All women, if they choose, will be supported with skin-to-skin contact after their delivery. Partners are also encouraged to perform skin-to-skin, if the mother cannot.

6 - Will circumcision of our baby be done by our Mediclinic paediatrician? Does it happen before I leave the hospital or do I have to come back?
Circumcision for newborn males is available at Mediclinic City Hospital at parents’ request. After the baby has been examined by the paediatrician (after 24 hours of birth), we will inform the paediatric surgeon of your request. He will visit you in your room and give you an explanation regarding the procedure, and obtain signed consent from you. The procedure is performed by our paediatric surgeon in a designated procedure room on the 6th floor. We aim to provide the service prior to discharge, but if, due to unforeseen circumstances, the paediatric surgeon is not available, you will be given an appointment with the following two weeks to have it done as an outpatient