Some mornings, you wake up and the dream is right there. Clear and vivid. You might still feel the emotion in your chest, and it can take a few minutes to remember where you are and what was real.

Other mornings, you open your eyes and there is nothing. Just a quiet sense of having slept.

You might know people who think they do not dream. However, the reality is we all do. Sometimes we have many in one night.

What varies is whether people remember their dreams and how often they remember them.

Dream recall myth vs reality

During the night, we cycle through periods of light sleep, deep sleep and rapid-eye-movement (REM) sleep. A full cycle takes about 90 minutes.

People generally spend more time in deep sleep in the first half of the night and more time in REM sleep in the second half.

The main function of deep sleep is restorative: to replenish energy, repair our bodies and help store memories.

REM sleep is important for memory consolidation and emotional processing. Later in the night, REM sleep becomes longer. This is the stage most closely linked to vivid, emotional dreaming.

If you wake up during or just after REM sleep, you are much more likely to remember a dream. If you wake from deep sleep, you probably will not, even though you were dreaming earlier. It isn’t a sign something is wrong; it’s simply how the sleeping brain works.

Another myth is dreams only happen in REM sleep. While REM dreams tend to be more intense and story-like, dreaming can happen in other stages, too; they are just often quieter and harder to recall.

So if you wake up some mornings with a clear recollection of your dream, and other mornings with nothing at all, that is completely normal. It doesn’t mean you didn’t dream. It just means you woke up at a different point in your sleep cycle.

Why do some people remember their dreams more often?

Several factors affect whether you recall dreams.

As you get older, your capacity to recall dreams decreases. Some studies suggest women are more likely to remember dreams than men. Some medications, such as antidepressants and sedatives, can affect your dream recall.

Timing plays a big role. We spend more time in REM sleep later in the night, so dreams that happen closer to morning are easier to remember. Waking up briefly during the night offers a chance to remember dreams before they fade. That’s why parents of young children and light sleepers, who are more likely to wake up from REM sleep, often report remembering more dreams.

How you wake up also matters. If someone jolts you awake, the dream can vanish in an instant. But if you are woken gently, someone softly calling your name, there is a better chance the dream lingers long enough for you to remember.

Some people are naturally “high recallers” and are just better at capturing their dreams before they fade. And therefore, they consistently remember dreams.

Why do some dreams feel intense?

Dreams can sometimes feel highly emotional, dramatic or unusually vivid. This is largely because REM sleep, the stage most associated with dreaming, involves increased activation of regions of the brain that control our emotions, such as the amygdala and limbic system.

This occurs alongside relatively reduced activity in parts of the prefrontal cortex that regulate logic and emotional control.

Stress, life changes or heightened emotions can make dreams feel more intense. Dreams often reflect elements of real-life experiences as the brain tries to process events from the day and consolidate them into long-term memory.

In most cases, having intense dreams is entirely normal and part of healthy emotional processing.

So is dreaming a reflection of good sleep?

Remembering your dreams does not automatically mean you had poor sleep, and forgetting them does not mean your sleep was perfect.

Rather than using dream recall as an indicator of sleep quality, it is more helpful to focus on how you feel during the day. Indicators such as feeling rested on waking and daytime energy provide a more meaningful indicator of your sleep health.

For most people, differences in dream recall and dream intensity are normal and shouldn’t cause concern. Dream frequency varies widely among people and across lifespans.

However, it may be helpful to seek advice from a health professional if:

• you experience persistent daytime exhaustion despite adequate time in bed
• nightmares are frequent, highly distressing or interfere with your mood and functioning
• sleep is regularly disrupted by awakenings, panic or prolonged difficulty returning to sleep.

If you feel rested, functional and emotionally stable during the day, occasional vivid dreams or changes in recall are completely fine and simply part of how healthy sleep unfolds.

Yaqoot Fatima, Professor of Sleep Health, University of the Sunshine Coast; Danielle Wilson, Research Fellow and Sleep Scientist at the Thompson Institute, University of the Sunshine Coast, and Nisreen Aouira, Research Program Manager, Let’s Yarn About Sleep, Thompson Institute, University of the Sunshine Coast

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A vaginal birth after caesarean (known as a VBAC) is when a woman who has had a caesarean has a vaginal birth down the track.

In Australia, about 12% of women have a vaginal birth for a subsequent baby after a caesarean. A VBAC is much more common in some other countries, including in several Scandinavian ones, where 45-55% of women have one.

So what’s involved? What are the risks? And who’s most likely to give birth vaginally the next time round?

What happens? What are the risks?

When a woman chooses a VBAC she is cared for much like she would during a planned vaginal birth.

However, an induction of labour is avoided as much as possible, due to the slightly increased risk of the caesarean scar opening up (known as uterine rupture). This is because the medication used in inductions can stimulate strong contractions that put a greater strain on the scar.

In fact, one of the main reasons women may be recommended to have a repeat caesarean over a vaginal birth is due to an increased chance of her caesarean scar rupturing.

This is when layers of the uterus (womb) separate and an emergency caesarean is needed to deliver the baby and repair the uterus.

Uterine rupture is rare. It occurs in about 0.2-0.7% of women with a history of a previous caesarean. A uterine rupture can also happen without a previous caesarean, but this is even rarer.

However, uterine rupture is a medical emergency. A large European study found 13% of babies died after a uterine rupture and 10% of women needed to have their uterus removed.

The risk of uterine rupture increases if women have what’s known as complicated or classical caesarean scars, and for women who have had more than two previous caesareans.

Most care providers recommend you avoid getting pregnant again for around 12 months after a caesarean, to allow full healing of the scar and to reduce the risk of the scar rupturing.

National guidelines recommend women attempt a VBAC in hospital in case emergency care is needed after uterine rupture.

During a VBAC, recommendations are for closer monitoring of the baby’s heart rate and vigilance for abnormal pain that could indicate a rupture is happening.

If labour is not progressing, a caesarean would then usually be advised.

Why avoid multiple caesareans?

There are also risks with repeat caesareans. These include slower recovery, increased risks of the placenta growing abnormally in subsequent pregnancies (placenta accreta), or low in front of the cervix (placenta praevia), and being readmitted to hospital for infection.

Women reported birth trauma and post-traumatic stress more commonly after a caesarean than a vaginal birth, especially if the caesarean was not planned.

Women who had a traumatic caesarean or disrespectful care in their previous birth may choose a VBAC to prevent re-traumatisation and to try to regain control over their birth.

We looked at what happened to women

The most common reason for a caesarean section in Australia is a repeat caesarean. Our new research looked at what this means for VBAC.

We analysed data about 172,000 low-risk women who gave birth for the first time in New South Wales between 2001 and 2016.

We found women who had an initial spontaneous vaginal birth had a 91.3% chance of having subsequent vaginal births. However, if they had a caesarean, their probability of having a VBAC was 4.6% after an elective caesarean and 9% after an emergency one.

We also confirmed what national data and previous studies have shown – there are lower VBAC rates (meaning higher rates of repeat caesareans) in private hospitals compared to public hospitals.

We found the probability of subsequent elective caesarean births was higher in private hospitals (84.9%) compared to public hospitals (76.9%).

Our study did not specifically address why this might be the case. However, we know that in private hospitals women access private obstetric care and experience higher caesarean rates overall.

What increases the chance of success?

When women plan a VBAC there is a 60-80% chance of having a vaginal birth in the next birth.

The success rates are higher for women who are younger, have a lower body mass index, have had a previous vaginal birth, give birth in a home-like environment or with midwife-led care.

For instance, an Australian study found women who accessed continuity of care with a midwife were more likely to have a successful VBAC compared to having no continuity of care and seeing different care providers each time.

An Australian national survey we conducted found having continuity of care with a midwife when planning a VBAC can increase women’s sense of control and confidence, increase their chance to be upright and active in labour and result in a better relationship with their health-care provider.

Why is this important?

With the rise of caesareans globally, including in Australia, it is more important than ever to value vaginal birth and support women to have a VBAC if this is what they choose.

Our research is also a reminder that how a woman gives birth the first time greatly influences how she gives birth after that. For too many women, this can lead to multiple caesareans, not all of them needed.

Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University; Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University, and Lilian Peters, Adjunct Research Fellow, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.