Birth Doula Blog
Sometimes the amount of info out there regarding VBAC can be overwhelming, confusing, and at times plain false! It can be tricky navigating through all that noise, so I've narrowed it down for you. Read on to learn how YOU can stay informed and in control of your care.
Your provider is a key person in the success of your VBAC and it's very important to find someone who is supportive, not just tolerant. Remember that yes, no one can legally force you to have a C-section nor deny you care even if the hospital has a VBAC ban, but it's also important to know ahead of time if your hospital has the tools and staff to support a true C-section emergency. You really can't force a hospital to treat you if they don't have the means. And if your provider is suggesting a repeat C-section, don't dismiss the advice so quickly. Really talk to them about their concerns to find solutions and compromises. Sometimes having a repeat C-section is truly medically necessary and your best option.
Next time you see your provider ask:
•How long will you allow me to remain pregnant? Why do you prefer that date?
•Will we attempt an induction? Which methods will be used?
•How will I be monitored during labor?
•How do you feel about me laboring as long as possible as long baby and I are doing well?
•At what point during labor will a C-section be needed?
Also, ask yourself:
•How do you know this will be a successful birth, no matter the outcome?
•What are you doing to ensure a VBAC?
•What did you learn from the previous C-section that will help you birth vaginally?
Signs your provider may be tolerant, but not supportive:
•They say yes, you can absolutely TRY and VBAC.
•You can VBAC, IF you go into labor by a certain date on your own.
•You can VBAC, but they will NOT induce labor for VBAC.
•If they require extra growth ultrasounds. This may indicate that your provider is concerned about the baby’s size. A big baby should not be a reason for scheduling a cesarean.
•If they only talk about the risks of VBAC and not the risks of repeat cesareans.
•They tell you that you must have a “just in case” epidural.
•They require you to come to the hospital as soon as labor begins.
•They sound supportive, but practice with an unsupportive team that may attend your birth.
Many of the above mentioned signs are NOT evidence based practices and I am happy to give you more info on the procedures and practices.
The Real Risks of VBAC and Repeat Caesarean
Generally speaking, the benefits of a VBAC outweigh those of repeat Cesareans. And the chances of it being successful are 60-80%. If your intuition tells you something is not quite right about either choice, listen to that. Figure out what is making you uncomfortable and make appropriate plans that make you feel safe. If a provider insists you have your baby by your due date or they will schedule a C-section, that policy is not evidence-based. It is perfectly safe for birthing parents to go past their due dates and to be induced for a VBAC. The American College of Obstetricians and Gynecologists (ACOG) also states that the decision to not allow the patient to attempt a trial of labor after Cesarean (TOLAC) due to hospital bans is coercion and disrespects the patient's autonomy. Ultimately, such bans are unacceptable and the decision is still the patient's as long as the hospital can handle an emergency C-section.
The greatest fear with a VBAC is uterine rupture. The risk of uterine rupture for people who are having a trial of labor after cesarean is about 0.47%. And for those who get a second C-section, the risk of uterine rupture is about 0.026% and the chances of placenta accreta (which carries a risk of significant blood loss and hysterectomy) is nearly 0.6%. The rupture risk is about 1.1% if you have Pitocin, about 2% if you have prostaglandins, and 6% if you’re given misoprostol to induce labor. There’s also a link between having your labor augmented with Pitocin and uterine rupture. Given this information, ACOG recommends you avoid prostaglandins such as Cervidil and Prepidil, Cytotec (misoprostol) and encourages other methods of induction/augmentation such as membrane stripping, Foley or Cook catheter, and Pitocin. Also important to note that continuous monitoring take place in order to identify any fetal distress due to uterine rupture. You have a decreased probability of success if you are overweight, have a vertical incision on your uterus, are greater than 40 weeks, or baby is proven to be big. Your success improves if you've ever had a vaginal birth or if you go into spontaneous labor.
In the end, neither planning a VBAC versus planning a C-section are easy decisions. And If you truly want a VBAC, it's imperative your provider supports it, not just tolerates it or lets you "try."
Remember B.R.A.I.N. For Any Intervention or Procedure
B what are the Benefits?
R what are the Risks?
A what are the Alternatives and options?
I what do my Intuition and gut tell me?
N what happens if we do Nothing?
My Favorite VBAC Resources
If you'd like an amazing resource for VBAC facts and support, go to The VBAC Link. And for studies and evidence on all things labor, I highly recommend Evidence Based Birth. Lastly, check out ACOG's latest guidelines.
More Tips on Successful Birthing
•Watch videos and read stories about the birth you want. Make those experiences normal and see yourself in the success stories.
•Ask yourself why you want that experience. What are the risks and benefits?
•Resolve any prior trauma or fears.
•Think of the procedures you want or don't and look into the opposing views. Are you still firm in your choice?
•Get spun up on patient's rights and advocacy. You will need to speak up for what you want! I always tell my clients there is no labor police, even if it feels like it. There is SO much you can deny and request.
•Don't be afraid to question your provider and hospital staff! Trust your gut if something feels off.
With the right support, education, and intentional work, you can definitely increase your chances of a VBAC! As a good doula, I have to add that opening yourself to the possibility of a repeat C-section is imperative to having a successful birth experience...no matter the outcome. I so wish that just wanting a beautiful birth were enough, but sometimes different plans have been laid out for us. I never want my clients to feel like they've failed, so my best advice is to never make decisions from a place of fear or coercion. That's why education is key in giving you an outcome you can feel proud of.