The options re birth options have never been more flexible. Women come to their 1st pregnancy from many and varied journeys. For a whole host of reasons the prospect of a vaginal birth is confronting for many. My aim is to explore your individual story and wishes, make sure you have all the possible options explained and understood and then try and achieve the birth you want.

Modern surgical and anaesthetic techniques mean that the risks and recovery from Caesarean Section has improved greatly. There is very little difference in risk to the mother and it’s very safe for the baby. If you come and see with the thoughts of wanting an elective Caesarean for your 1st birth we will discuss it. I will make sure you are informed, sometimes there may be alternative options that you are not yet aware of that may better suit you. If the Caesar is you choice at the end of the day, it will be booked and you will be supported all the way. The mood in theatre when you have your `1st baby will be exciting, maybe laced with a bit of anxiety, but I will strive to make sure you look back on this day, with the wonderful photos obtained, as perhaps the best of your life.

The short answer is – Yes!! Vaginal birth after Caesarean (VBAC) is an option I believe should be open to most women who have has a Caesar, (C-Section, Caesarean) with their 1st birth. It’s a safe method of having a baby and a wonderful journey for many women who haven’t been able to experience that with their 1st birth. There are rules to follow where there is a scar from a previous pregnancy, but most VBACs end with a vaginal delivery. You need to speak to an obstetrician who is both experienced and enthusiastic to help women have a successful VBAC.

While that group has shrunk over time people like myself (Dr David O’Callaghan), at hospitals like St Vincents Private, still provide this option with a team experienced and committed to successful outcomes. St Vincents Private in Melbourne is the leading hospital in Australia for women who want a VBAC.

While there are many medications that are safe to take in pregnancy it is vital to be sure the medications you are taking fall into that category. While it is impossible to provide absolute proof of safety we have a catagorisation system, A, B1, B2, B3, C, D to rate different medications. Common over the counter medications like paracetamol, antacids, most antihistamines, many cough and cold medications are very safe others like aspirin and the anti inflammatories should be avoided unless specific medical advice has been received

Prescription medication should be reviewed pre pregnancy and forms part of any pre pregnancy visit I do. Some medications will not be compatible so will need to be ceased or changed to a pregnancy friendly alternative. This will involve weighing up the pros and cons of the treatment on the condition being treated and any potential effect on the baby. It needs to be individualised at you pre pregnancy visit. I work with your treating doctor to ensure the best options are picked and a plan is in place.

This is a very important consideration and ideally something that is discussed , understood and optimised prior to trying for a pregnancy. A pre pregnancy visit to an obstetrician is highly recommended. There are some medical conditions that don’t have any effect on pregnancy and vice versa but in others there are significant management issues involved to maximise care of the disease and safety of the pregnancy. Examples of some of the pmain diseases are discussed below

Diabetes. Optimisation of diabetes pre pregnancy is vital as poorly controlled diabetes substantially increases miscarriage risk. Later in pregnancy diabetes can increase risk of growth issues, both overly large babies and growth restriction and increase risk of pre eclampsia. Pregnancy itself is a condition of insulin resistance so treatment requirements, especially insulin needs, will increase progressively.

Thyroid disease. Another disease that can effect miscarriage risk if not well controlled and requirements for thyroxine doses rise through pregnancy. A pre pregnancy visit is very important

Depression/Anxiety. All mental health issues can be effected by pregnancy. Pregnancy and the post partum months are the most vulnerable time in a womans life to experience mood disorders. If you have a history prior to pregnancy seeing your treating doctor and an obstetrician is wise to decide on what medications will be continued or modified and develop a plan for the pregnancy.

Autoimmune disorders. In the main this group has sometimes but not always a link to increased pregnancy problems. The ideal is see you treating doctor and an obstetrician to see what risks your condition has and do that pregnancy planning.

Hypertension/Kidney disorders. These conditions can deteriorate in pregnanct and also have major effects on the pregnancy itself, especially the risk od pre eclampsia and growth of the baby. A pre pregnancy visit is vital to optimise medications, change them where necessary and make that plan

Multiple pregnancy, the vast majority of whom are twins, always raise that extra mix of excitement and anxiety in the woman herself and great excitement for all those around her.

Twins can be divided into fratenal or dizygotic, two eggs fertilised by two different sperm, and identical or monozygotic twins, a single egg fertilised by a single sperm creating an embryo, which then divides into two early in its development to create two genetically identical children. They are also likely share their placentas to varying degrees. In contrast fraternal twins are genetically the same as any siblings but are sharing the uterus to grow in but not sharing placentas at all. Two individual pregnancies in one uterus.

Fraternal twins run in families , monozygotic twins don’t. In all twin pregnancies the pregnant woman can consider herself more pregnant in effect. Virtually all the common ailments and disorders, reflux, pelvis pain, gestational diabetes, pre eclampsia etc etc are more common so the pregnancy is watch more constantly. The two biggest issues to watch are growth of the twins and early arrival, prematurity. Regualarultrasounds track growth in the 3rd trimester and women wilt a multiple pregnancy will need more rest and help through the antenatal time.

Monozygotic twins have some extra risks which need to be closely monitored and relate to potential complications that arise from the sharing of the placenta. Twin twin transfusion syndrome is one. These women will be followed with 2 weekly ultrasounds from 16 weeks in the pregnancy

Birthing for twins is exciting. The management of twin births for many obstetricians is elective Caesarean. However people like David, who are skilled , experienced and confident with vaginal twin delivery offer that option. Vaginal twin birth is safe and a great way to birth once all options are explored and the pregnancy is considered suitable. Especially if you have had a vaginal birth previously the twin birth usually becomes quite straightforward.

One of the great joys in David’s career is helping women achieve that twin birth and that woman will be up and being with her two new babies very quickly

It’s very important to check any medications, prescribed or over the counter, prior to taking them in pregnancy. That said there are many medications that have been used extensively in pregnancy and are considered very safe. We have a classification system for medications, A, B1, B2, B3, C and D depending on what evidence is available as to safety. A and B1 especially are very well proven. While no one can ever give 100% evidence the evidence for these groups is so strong we use them very confidently. Examples would be paracetamol, many common antibiotics, reflux medications etc.

Its also a consideration as to what effect the disease being treated could have on the pregnancy. As an example, with asthma we know uncontrolled asthma leaving a risk of a severe respiratory event that may have implications for the baby and we know that almost all the common asthma treatments are very safe so women with asthma are reassured about the medications and encouraged to be compliant with taking them. Occasionally asthma flares ups are at their worst in pregnancy so keeping up with medications is vital

Alternatively with some forms of epilepsy we know that some of the medications used carry some risk so pre pregnancy counselling would be suggested and consideration given to making sure that woman is on the safest medication/s that give control. Occasionally a tril off medications may be used pre pregnancy to see if that is safe. However sometimes, because the risk of uncontrolled disease for the baby is greater than the medication risk a woman will continue those medications on the balance of that’s the least risk.

Daibetes treatment is very important to optimise prior to pregnancy and poor control increases risk of fetal anomalies and miscarriage. Thyroid medications need to be reviewed and modified pre and through a pregnancy as requirements may rise.

What these examples show is its important to have any medical conditions and medications reviewed pre pregnancy and a plan be made. Once a plan is made its important the woman feels comfortable and supported taking medications as required. Final thing to say is don’t scrimp on doses. Simplest example would be headache or migraine, common in pregnancy. Don’t take 1 tablet only as it’s an inadequate dose. Take 2 500mg tabs per dose up to 4 x per day. Once a medication is deemed fine sub therapeutic doses are not needed.

While there are many medications that are safe to take in pregnancy it is vital to be sure the medications you are taking fall into that category. While it is impossible to provide absolute proof of safety we have a catagorisation system, A, B1, B2, B3, C, D to rate different medications. Common over the counter medications like paracetamol, antacids, most antihistamines, many cough and cold medications are very safe others like aspirin and the anti inflammatories should be avoided unless specific medical advice has been received

Prescription medication should be reviewed pre pregnancyand forms part of any pre pregnancy visit I do. Some medications will not be compatible so will need to be ceased or changed to a pregnancy friendly alternative. This will involve weighing up the pros and cons of the treatment on the condition being treated and any potential effect on the baby. It needs to be individualised at you pre pregnancy visit. I work with your treating doctor to ensure the best options are picked and a plan is in place

VBAC, attempting a vaginal birth after a caesarean section in a previous pregnancy is a choice that should be open to most women who have had a Caesar with their 1st birth.

For lots of reasons Caesareans have become more common in recent decades but most women in this group are suitable for a try at a vaginal birth next time, if that is a choice they want.

If someone has had a vaginal birth in the past as well as a Caesarean then they will almost always suitable and have a very high success rate

David encourages women who have had a Caesar to consider VBAC and can go through all the pros and cons with you.

Most Caesareans are done for reasons that don’t recur in the next pregnancy so a VBAC is an option.

E.g If the Caesarean was done for a breech, bottom first baby, its likely the 2ndpregnancy will have a head 1st baby, the reason for the initial Caesar is no longer present so VBAC is suitable.

There are some rules and precautions that apply to VBACs because of the surgical scar on the uterus but VBAC is a wonderful way to birth and very rewarding for the woman who is keen to try this. David will guide and encourage you on this path.

While there are many good and beneficial things with breast feeding it’s not always a successful option and for some women, for a multitude of reasons, something they don’t want to attempt in their 1st pregnancy or don’t want to try again because of difficulties they had with previous attempts.

David will support your choices. It will be important to discuss the issue and make sure you are aware of all the options around breast feeding but once done and your choice made David will support you all the way. If you decide to suppress lactation immediately you will be given a medication to help prevent lactation developing. This is less effective if lactation is already established so here a slower weaning process will be started with no medication.

Its also important for the woman to be reassured by the thought that there has never been a better time to formula feed a baby. Modern formulas have developed a long way and much more approximate breast milk itself. There are also multiple high quality formulas that add option to find the one that best suits your baby. While for many women breast feeding is best we do forget there has been throughout history women who found it difficult to feed or produce enough milk for their baby.

Today there is little difference in the two methods of feeding and there is no doubt a healthy formula fed baby who thrives is better off compared the the breast fed baby where problems with supply leads the baby not to keep up. The beauty of modern feeding is that baby can be fed with an option very close to breast milk itself but without the problems of production. This can take either the role of supplementing the breast milk or supressing and moving fully to formula. David, Emma and Katie, the midwives in his rooms, as well as those in the hospital will support you through a time that can be very challenging.