Every month I get a call from at least one or two families telling me that they want a VBAC (vaginal birth after a cesarean). They share their previous birth story with me, how and why it ended up in a c-section, and that they really want to have a VBAC but aren’t sure what to do to improve their chances. They ask if there are any secrets or tips that I can give them to help, and you know what… There are things that you can do that are in your control to increase your chances of having the VBAC that you want.
Many people may think that it’s all about the health of you and your baby to have a successful VBAC. While obviously health is important, many other factors can determine the outcome of your delivery. For example, who you choose as your care provider, where you choose to give birth, what tests and procedures you have during your pregnancy and labor, and many more. All of these choices make a difference. By being an active participant and making informed decisions, you lower your chances of having a repeat cesarean.
Now before I get a bunch of people saying that I’m “shaming c-section births,” I have to say that I’m not! There is absolutely nothing wrong with having a c-section (they are needed and at times necessary). However, some people look at the benefits of having a vaginal birth after a c-section and want to try having a VBAC. Because of those people, I want to help! If you are one of those people, this article is for you. Here are some important issues to consider to help you have a successful VBAC.
Disclaimer: There is no way to 100% guarantee a VBAC because, unfortunately, there are no guarantees when it comes to labor and childbirth.
1. Choose a Supportive Care Provider
The number one thing that you can do to improve your chances when planning for a VBAC is to choose a care provider that fully supports and believes in VBACs. When you’re interviewing different care providers, an OB might say that they are supportive of VBACs, but it could be a different story on your big day. This is why you need to choose someone with a history of successful VBACs and someone prepared to do everything they can to make your VBAC a success. (Be sure to ask what their cesarean percentages are as well as their VBAC percentages and be willing to change providers if you don’t have confidence in them.)
There is also another option available that many women in the United States don’t consider… midwives. Evidence proves that for healthy low-risk pregnant women, care provided by professional midwives reduces the risk for cesarean sections when compared to care provided by physicians. I highly recommend that if you are low-risk (your only high-risk condition being a VBAC), you should consider meeting with a midwife or two to ask her some questions. Your chances for a VBAC will be much higher choosing a midwife, and you will be surprised to discover how much experience and training they have, especially helping women who want to have VBACs. So I encourage you to do your research and find access to midwifery care and accredited birth centers in your community that accepts VBAC clients.
2. Choose a Supportive Place to Give Birth
Something important to know is that there are hospitals and birth centers out there that absolutely do not accept VBAC patients and will not allow women to attempt/have a VBAC. This surprises some people that their care provider may approve, but the birth location may not. This is why you need to make sure that your care provider has privileges at a location that does allow VBACs and is also going to be supportive of you during your labor.
3. Ask Questions
A question that you should ask your care provider is, “how long will you allow me to go past my due date?” You need to ask this question because since you previously had a cesarean section, scheduling an induction (more than likely) is not an option for you. If you do not go into labor spontaneously around your due date, your leading choice is to schedule a c-section. 🙁 This is why you want to ask, so you know how much time you have before they are ready to schedule you for a c-section.
If you are wondering why inductions usually are off the table for VBAC mamas, the reason is the drug that they use to induce women (Pitocin) increases your chances for uterine rupture. Uterine rupture is a serious matter that every care provider takes extremely seriously. For more information on potential gentle inductions for VBACs, read this.
4. Join A Mother’s Support Group
Whether that’s an ICAN group in your area or even a Facebook group/ online support group, finding other women to talk to about what you are going through and hear their success stories of how they have been able to do it can really help.
5. Do Your Research
If a VBAC is what you want, you need to be aware of the facts behind it and do your research. This includes reviewing studies and articles on the internet, watching videos (DVDs and YouTube clips), joining/visiting online. In-person support groups (a point made above), reading books, talking to medical professionals, as well as meeting with other hopeful VBAC mamas (to know what steps they are taking) and successful VBAC moms (to understand what they did).
Here are some books that I recommend reading:
- The Thinking Woman’s Guide To A Better Birth by Henci Goer
- Ina May’s Guide to Childbirth by Ina May Gaskin
- Spiritual Midwifery by Ina May Gaskin
- Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean by Nancy Cohen
- The Birth Partner by Penny Simkin
All in all, the more you understand and know about VBACs, the better prepared you will be. Just remember that you can do this! 60 – 80% of women who attempt VBACs are successful, and the American Congress of Obstetrics and Gynecology (ACOG) supports attempting a VBAC.
If you’re nervous about being your own advocate during labor, my next point will help tremendously…
6. Hire a Doula
If you’re in the hospital, it can be challenging to speak your mind when you are going through contractions and trying to rest in-between each. The hospital staff can and do (sometimes) make medical decisions for you, even when they may not be necessary. (And yes, I have seen this happen.) This is why a doula can be a vital component for a successful VBAC. Most partners (if you have a partner or family member or friend) do not know what to expect during labor and delivery and won’t know how to advocate for you if things are going in the wrong direction. A doula does just that; she is trained to help you labor, make informed decisions, and advocate for you if necessary. Also, women who birth with a doula are significantly less likely to have a c-section and have more satisfying birth experiences. The knowledge and support a doula offers could be the difference between a successful VBAC and a repeat c-section.
If you’ve chosen a midwife as your care provider, a doula might not be necessary, but she can still be extremely helpful. (The more people that are around you that have experience helping women have VBACs, the better.) Start interviewing some doulas in your area. They book up quickly!
7. Go to a Childbirth Class Outside the Hospital
Taking a childbirth class (whether that be a one-day course or a 12-week course) is a great option! I recommend taking your class outside of the hospital so that your educators aren’t withholding any information from the class. Outside of the hospital, those educators can also give you some valuable information about what to expect from each hospital or birth center. Unfortunately, in-hospital classes, doctors can and will tell the educators that they cannot talk about specific topics or cover certain options since they don’t want their patients to know things that they don’t feel comfortable with. It shouldn’t be about what’s easiest and most convenient for the doctor; it should be what’s best for the laboring woman.
8. Stay Healthy
9. Speak Up
You must communicate with your care provider and support person(s) about the experience that you want. Start these conversations from the very beginning so that everyone is on the same page. The more that you make your desires known, the better. It’s also a great idea to write a birth plan. Your doula can help you with this if you have questions. Your birth plan will then give your entire birthing team (doctor, nurses, etc.) a better understanding of what your goals are when you get admitted into L&D.
10. Avoid Screening for a Big Baby
Once you start approaching your due date, your doctor may recommend measuring the size of your baby. Based on the measurements, your care provider then determines whether or not your baby is “too big” to be born vaginally. I want you to know that these measurements are usually inaccurate since this isn’t the most reliable way to determine the baby’s weight and size.
I always tell my clients that an ultrasound screening has an error margin of 10% to 20%. Sometimes it’s accurate, but a lot of times it’s not. Some women have been told that they are going to have a big baby and their baby came out weighing only 7 pounds. I’ve also seen very petite women deliver 10+ pound babies vaginally with no issues, so when people say your baby is too big to be born vaginally, I think of those women. It’s not true! So avoid having this screening done because they may just want to convince you that your baby is “too big” and want you to schedule a c-section when you may be able to have the VBAC you want.
11. Give Yourself Grace
As I stated at the beginning of this post, nothing is guaranteed when it comes to labor and birth. And after all of the preparation and research that you’ve done, even if it doesn’t happen exactly the way you wanted, don’t beat yourself up. It’s okay. Even if you have another c-section, that’s okay too. Whatever happens, you did all you could, and at the end of the day, you just brought your new daughter or son into the world. You carried, labored, and birthed life. That is a miracle. Always give yourself grace, mama, because you are amazing.
Have you attempted a VBAC? What advice would you add?
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