Get the VBAC You Want
BY Nicole Taylor
A successful VBAC (vaginal birth after cesarean) is within your grasp even if you have been told that you are “not a good candidate” by a practitioner in your past, as I was. While there are circumstances where repeat cesareans are necessary, those circumstances are not as prevalent as our current birth climate would suggest.
Most women who have had cesarean sections do have a high chance of success with a VBAC. In fact, ACOG (the American College of Gynecologists) estimates that between 60–80% of women who attempt can successfully achieve one (American College of Gynecologists, 2010).
Many midwives and obstetricians have even better success rates than that! The best candidates for VBAC are those who have a low transverse incision, have an adequate pelvis (and if you have been told that you do not, you may want to get another opinion on that, sometimes practitioners disagree on what constitutes “adequate”) and have had only one cesarean section, but there are those who do not meet those qualifications who can still be successful.
The key to achieving the VBAC is not what your body can or cannot do (statistically, your body can do it), but is having adequate support. Here are some tips to help you achieve the birth you want for you and your family.
1. Build your personal support team.
Talk to your birth partner and others about your desire to have a successful VBAC. Explain to them some of the research you have been doing and why a VBAC is important for both you and your baby. It was long thought that a repeat cesarean was always safer than an attempted VBAC, so you may need to explain that recent research reveals the opposite (American College of Gynecologists, 2010). Also consider hiring a doula. Studies have repeatedly shown that women who have continuous support throughout their labor (like the support a doula provides) have much better, and more natural birth experiences (Hodnett ED, 2012). Doulas can often be found through community support groups like ICAN (International Cesarean Awareness Network) or local birthing support groups or partnerships. Many can be found through social media or online.
2. Choose a birthing location where you feel safe and respected.
Many women choose the closest hospital for their first birth, but for your VBAC, an alternative location may be preferable. This can mean a homebirth, a freestanding birth center birth, or even a birth at a different hospital. Research has revealed that homebirth can be as safe as a hospital birth for those who are low risk seeking a VBAC (Haas, 2008), but only you can determine if that option is for you. Consider the VBAC success rates of all your options in the area and your own comfort level. A practice that is very supportive of your choice to have a VBAC may work in a birthing environment with rigid rules (such as protocols for how long a labor is “allowed” to continue after your water breaks) that may not support your VBAC as fully as you want it to. For me, I chose a VBAC in a hospital setting based on insurance limitations and my birth partner’s comfort level which I knew would affect me profoundly in labor. This meant a hospital almost an hour and a half away because that hospital and their midwives had much better success rates for VBACs and more flexible guidelines for what constituted “normal birth.” For you, there may be other factors, but the most important factor is a place in which you feel like your VBAC and your decisions will be adequately respected and supported.
3. Screen your practitioner and his/her practice closely.
After deciding where you want to have your VBAC, look for your practitioner. Make sure to ask very specific questions about how VBACs are approached from that practice whether you are interviewing a home birth midwife or a hospital based OBGYN and anyone in between. Ask them about both their own, personal success rates with patients seeking VBACs but also those of the entire practice they work within (if it is their practice to have whoever is on call attend births). It’s also important to ask the success rate of the hospital where they practice if that is applicable. You may find that while a specific midwife or doctor is very knowledgeable and open to VBACs and has a very high success rate with patients who attempt them under his/her care, others who have an equally good chance of attending your birth may not. Ask about the specific circumstances that led up to your first cesarean to see what this provider would do if faced with the same circumstances. You want to make this decision knowing exactly where your proposed provider’s comfort level with VBACs rests. I knew I had chosen the right midwife when I realized every meeting with her left me feeling more calm and sure of myself than when I walked into her office.
4. Make a birth plan for both a successful VBAC and a successful repeat cesarean.
While I wholeheartedly believe in planning for VBAC success in all cases and creating a birth plan that will create success, I felt it was very therapeutic for me to outline what I wanted in case of cesarean as well. This led me to understand myself as completely in charge of the decisions in my birth no matter what may occur. In my first birth, I had not let the idea of a cesarean enter my mind or my plans and afterward I was left feeling overwhelmed and heartbroken over the change in plans. This time, I faced the slight possibility that I might require a repeat cesarean and I talked about the perimeters I wanted for that possibility right in my birth plan. This is not the same as “hoping for a VBAC” while planning a cesarean. This is facing the possibility of a repeat cesarean and making plans for that experience so that you can more clearly focus on your VBAC goal as the time approaches.
5. Plan as “natural” a birth as possible and know the risks of different kinds of interventions.
Most interventions, from the decision to induce to comfort measures such as epidurals, often carry with them a slightly increased risk of a uterine rupture which is the extremely rare complication that differentiates a vaginal birth after a cesarean from ordinary vaginal birth. Know the risks and the benefits of choices that you made in your last delivery and think about what you might want to do with this one now that you want a VBAC.
6. Work through any residual emotion you have regarding your cesarean.
You may or may not still feel residual emotional pain or stress from how your last labor went. It might be a good idea to find ways of working through those emotions before you are in labor again. Talk about your birth experience. If you haven’t yet, write that birth story down and really experience what feelings emerge. Birthing hypnotherapy can be a great help for replacing scary or painful birthing memories with positive intentions and hope. One of the greatest suggestions my doula made for me was to create my own hypnobirthing script and record it in my own voice and listen to it every night for the last ten weeks of my pregnancy. Only I knew what it is that I needed to hear when I was in labor and hearing those words in my voice over and over and envisioning my successful VBAC was very comforting and helpful for me. Pam England and Rob Horowitz’s affirming book Birthing From Within is also a great tool to help you work through any lasting emotions and stress you might still have from your previous experience(s).
7. Develop an understanding of the full range of normal birth.
Collect as many true birth stories as you can. Let yourself be inspired by them and all the differences that can be found in them. Read VBAC stories and imagine yourself exhibiting the strength and beauty you read about. Read about births in other countries and cultures. Talk to other mothers about their birth experiences particularly the mothers who have had VBACs or attempted them as they give you insight on what your experience may be like. If you already know the stories of those around you, listen to birth story podcasts or watch videos online. Learn that birth doesn’t always look like what we expect it to look like and that VBACs do not have to progress any specific way to be successful. The more you read, the less you will be surprised by how your labor develops.
8. Love yourself.
If you feel you made mistakes in your last birth, forgive yourself for them. If you suffered from post partum depression, forgive yourself for that. If you have fears, recognize them, do what you can about them, and then let them go. Above all else, be proud of yourself for being courageous enough to become a mother once more and to plan for your successful VBAC. Best of luck to you and may your VBAC be blessed and successful.
Works Cited and Recommended Reading
American College of Gynecologists. (2010, August). New VBAC guidelines: What they mean to you and your patients. ACOG Today, 54(4), 6–7.
Boston Women’s Health Book Collective. (2008). Our Bodies, Ourselves: Pregnancy and birth. New York: Touchstone.
Cushman-Dowdee, H. (2010). Simply Give Birth. Raleigh: lulu.com.
England, P. and R. Horowitz. (1998). Birthing From Within. Albuquerque: Partera Press.
Gaskin, I.M. (2003). Ina May’s Guide to Childbirth. New York: Bantam Books.
Haas, A.V. (2008, Summer 1). Homebirth After Cesarean: The Myth and the Reality. Retrieved 2014, from Midwifery Today.
Hodnett ED, G.S. (2012, August 1). Childbirth Connection. Retrieved from Cochrane Database of Systematic Reviews Issue 10: