4 Secrets Of VBAC

Do you know the secrets of VBAC?

newborn picture, vbac, secrets of vbac, advice for vbac, tips for vbac, having a vbac, uterine rupture, baby in hat, newborn in hatMother’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
American Pregnancy
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.leaning forward in labor, mom in labor, breathing through contractions, breathing in labor, vbac labor, secrets of vbac

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!

More resources:
Childbirth Connection – VBAC or repeat Cesarean


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13 Responses to 4 Secrets Of VBAC

  1. Jennifer says:

    This is a GREAT post!! I am going to share it with a couple of friends who are attempting VBACs soon… My friend just had a successful VBAC at Memorial last week with Dr. McGee. As you know, I also had a very amazing, natural, successful VBAC with TWINS! I wrote about it here: http://www.multiplerealitiesblog.com/2012/08/the-natural-vbac-twin-birth.html Leah, I’m going to post a link to this (your) VBAC post in the comments, too! Really great info and pep talk you gave! xo.

    • Leah DeCesare says:

      Thank you, Jen! Your twin VBAC story is an inspiration! I’m so happy you’re out there sharing it! Women need to know that the old – but still believed – adage “once a cesarean, always a cesarean” is not true!!

  2. […] wasn’t due for two more weeks, I didn’t know about the changes in the hospital VBAC policies only a day before my water broke. When you hear about someone’s “water […]

  3. Valerie says:

    What a great post! I am researching certain aspects of cesarean and VBAC for articles I am writing, and your four Secrets are very clear and helpful! Thanks.
    P.S. I found you on TMB. 🙂

    • Leah DeCesare says:

      Thanks, Valerie! Glad you came by and found helpful info! Also – thanks for pointing out about my about page – I keep fixing it and I’m not sure why it keeps going back to the error … Thanks! Feel free to link to my VBAC/ Cesarean posts as reference in your articles.

  4. Top 5 Reads | Blue Matriarch says:

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  5. Jessica says:

    If My cesearian baby is only 6 mo and I am now pregnant again, do you think vbac is possible?

    • ldecesare says:

      This is a question appropriate for your midwife or doctor, I would encourage you to talk with your provider.

      Here is some information from Baby Center:

      “There isn’t enough research in this area, but one analysis suggests that women who waited more than 18 months after their caesarean before conceiving had a higher chance of a successful VBAC (86 per cent) than those who conceived earlier than 18 months (79 per cent). The difference was very small though, and at the moment we don’t know whether waiting longer between pregnancies will make a difference to the success of a VBAC.

      However, there is a very low risk of your caesarean scar tearing with VBAC. This is called uterine rupture. Even though the risk is low, it may increase if there is a short gap between your pregnancies. The risk appears to be highest with a short gap (6 months or less) between your caesarean and becoming pregnant again.”


  6. Cheryl Guilford says:

    Unfortunately I was one of the .07% of women who had a VBAC and suffered a uterus rupture. My rupture happened on a previous c-section scar. Luckily It happened in the hospital and the fast acting nurses and doctors performed surgery and it all turned out well. Because of the blood loss I had to stay in the hospital for awhile and my healing time was very long. This all happened pre-internet and google so I had to rely on the doctor for info when I made my decision for a VBAC. To be honest with you I don’t know if I would have done it if I had all the info then. I had a wonderful doctor but he did not do a good job of informing me of the risks. Looking back, I realize that I was pretty naive but I was so excited. Even after all that happened, I am still happy that I got to experience a vaginal delivery.The good news is that I have had several friends that have had successful VBACs without any problems or ruptures! My advice to moms-to-be is to do your homework and understand the risks. Thank you for you post.

    • ldecesare says:

      How very scary! I have an friend who is an obstetrician who, too, has seen the small percentage chance of a uterine rupture and it stays with her. While it is a tiny number, there are those few cases for whom it is all too real. I’m happy you were in the hospital, fast-action is vital in a rupture. My own midwife, for my VBAC, shared her experience with a rupture – but it had happened on an unscarred uterus, meaning no prior c-section, also unusual and rare.

      You seem to have a great perspective and I’m glad you are able to look back and have a silver lining in your gratitude for the experience of a vaginal birth despite your long recovery and frightening rupture.

      Incidentally, I had a C-section with my son (read Michael’s Birth Story) and it was pre-internet so we had to research breech babies in the library. That birth then became the reason for my subsequent VBAC. I’m all about informed decision making and – you’re right – we can’t make informed choices when we’re not given the full picture. We need balanced information on both sides of the equation – pros and cons, risks and benefits, and real numbers not scare-tactics which I hear all too often.

      Thank you for sharing your experience with me and Mother’s Circle readers!

  7. Sandra says:

    am already in first stages of labour .can I have a succeful vbac

  8. Naila siddiqui says:

    Hi, I am planning for my second pregnancy n I want it to be a successful vbac .it’s been 4 years I had c-section and now I am little worried. M I the safe candidate for it ,my c-section was due to heavyweight of my baby.plz help me out , I am not yet pregnant.

    • ldecesare says:

      Knowing if you’re a good candidate is something you need to discuss with your caregiver. Learn as much as you can, ask questions, and choose a provider you’re really comfortable with and you’ll be prepared to make the best decision for you and your circumstances. All my best!

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