Do you know the secrets of VBAC?
Mother’s Circle readers know that I’m a big believer in educating yourself, owning your birth and doing the work so you can make truly informed choices in not only your birth but also in your parenting and your life. Empowerment derives from being an active participant instead of feeling like things have been done to you.
Cesarean section is one of the only surgeries in which a Mom who’s had a prior c-section can go to any doctor and ask for another operation, yet many women who want a vaginal birth are limited in their choices or are not permitted to have a vaginal birth at certain hospitals.
If you want a VBAC, stack the deck in your favor. Use these tips to avoid a cesarean to begin preparing. Surround yourself with people who believe in VBAC and who believe in you.
In full disclosure, I’m a VBAC Mom. My second baby, Michael, was breech and in those pre-Google days, we found ourselves at the library trying to find ways to turn him, unsuccessfully. So he was my C-section baby. When I got pregnant again, I sought out providers who were truly supportive of VBAC. I had to hunt but found a special group of midwives.
I felt a level of frustration during that time at the realization that I could’ve easily walked in anywhere and asked for surgery while instead, I had to really fight for the vaginal birth I wanted. I had to have a real commitment and desire to have a VBAC. I had to do the work and research, interview and seek out the right people and places to support my choice in a culture where fear messages prevail.
It’s hard to believe that every day, Moms are essentially being told, “You cannot birth the way your body was made to birth at this facility.” Every single day women’s freedom to birth how she wants to birth is compromised.
Just before I went into labor, the small hospital I was to deliver at changed their policy prohibiting VBAC. Could they force me to have a surgery I didn’t want? Somehow, since the “i’s” weren’t dotted and the “t’s” weren’t yet crossed on the new rules, I became the last VBAC at that hospital.
But what about the next mother? She’d have to find another hospital, other providers, she’d have to drive further, work harder, jump through more hoops to have a baby through her vagina. It didn’t make sense to me. It doesn’t make sense.
While each of my births gave me joy and my sweet loves, while each birth was very different and taught me something new; I hold my VBAC dear as my best birth. It was healing, invigorating, empowering and the recovery was the fastest and smoothest of all three births.
As a doula, I love supporting VBAC Moms and being beside them as they experience those profound, curative feelings or pride and strength. Moms have said, “That was the best thing I’ve ever done!” “I did it!” “It was the most incredible and wonderful experience of my life.” “I know I can do anything now!”
For a woman who wants the experience of a vaginal birth, a VBAC is a gift.
4 Secrets of VBAC
1. The Risk of Uterine Rupture is Very Small
In my experience, one of the biggest fears and deterrents in the VBAC decision is uterine rupture. So let’s get that out of the way first. Uterine rupture is when the uterus tears. It can tear along a prior cesarean scar, or it can happen in an un-scarred (read: no prior cesarean) uterus.
The studies put the incidence of uterine rupture at .07% of all births (which includes Moms with no scar on their uterus and VBAC Moms) Only looking at VBAC Moms, the rate is higher at a still low .3%-.7% depending upon the study. A 2009 systemic review with meta-analysis of success rate and adverse outcomes of VBAC after two cesareans (VBAC2) vs. VBAC after one cesarean showed a uterine rupture rate in VBAC2 of 1.36% (and a success rate of 71.1% for VBAC2).
Putting uterine rupture into perspective is helpful to parents facing this decision. There is a piece called Another Perspective on Uterine Rupture by Eileen Sullivan (and her husband Patrick). Here it is in two places on line: Relative Risks of Uterine Rupture or The Baby Center: Odds of Uterine Rupture
Eileen puts uterine rupture into perspective in a playful and understandable way, for example, you are more likely to be in a bicycle accident, to be murdered, to die of heart disease, to have a cord prolapse or to have twins. You must read her ironic final comparison!
Studies and stats on uterine rupture:
Birth Without Fear – 20 Peer Reviewed Publications on Uterine Rupture
Medscape Reference – Uterine rupture rates
VBAC.com – What is Uterine Rupture and How often does it occur
2. It’s A Normal Labor
Do all the things you would do to prepare for a normal labor. Two keys are to choose your provider and place of birth carefully. The culture of the hospital and the clinical judgement calls of your doctor can make all the difference so be sure you feel comfortable with your doctor or midwife. What is your gut telling you when you leave your appointments? Trust that instinct and change providers if you do not feel right where you are.
Take childbirth education classes and know your options, learn relaxation tools and comfort measures. If you’re able to labor in the comfort of your home until you’re in active labor and if you’re able to delay some interventions, you can increase your chances for a successful VBAC.
3. If Your Doctor Schedules a C-Section She’s Not Supportive of Your VBAC
It’s amazing to me how many women share with me how they love their doctor who is so supportive of their VBAC, “He told me I could do whatever I want,” just before they tell me the date of their scheduled cesarean. Your doctor is NOT supportive if he’s scheduled a C-section “just in case” at a certain (rather arbitrary) week of gestation.
There is no “Just in Case.” If you’re a good candidate for a VBAC (most women are) then see secret #2, this is a normal labor and should be treated as such. No one schedules an OR for a normal birth. If you happen to be in the 10-20% of Moms whose TOLAC (trial of labor after cesarean) results in a repeat cesarean, they will find you a space.
If in your prior labor(s) you dilated, your body holds that memory which will help you in a VBAC labor, if not, simply consider this labor like a first birth. Allow your body to go into labor spontaneously.
It makes sense to record your wishes and talk with your provider about your options and desires in a repeat cesarean. Consider them, discuss them and then set them aside and visualize the vaginal birth you want. This is a normal labor.
4. You Can Do It!
Studies show that 75-90% of women who attempt a VBAC successfully have a vaginal birth. Sadly, one of the secrets of VBAC is that, for numerous reasons, only about 8% of women try. Is it because of the fear of uterine rupture (see secret #1)? Is it because she isn’t fully informed about VBAC benefits and risks as well as the contrasting benefits and risks of repeat cesarean? Lack of understanding produces tension and fear; never a good decision-making space.
My belief is that women do not get the full picture in order to best weigh their options. This article is a must read for Moms and families thinking of VBAC: Making a Mountain Out of a Molehill
To quote the mother of all midwives, Ina May Gaskin, “Your body is not a lemon!” It works! Find your footing, believe in your body’s ability to birth. You may have received messages from your prior birth that made you doubt birth or feel like you failed somehow. You did not fail. Do whatever work it takes prenatally to help you rediscover – or discover for the first time – the power and strength you have within you to birth.
You really can do it!