Planning for a vaginal birth after having a cesarean? Here's how to set yourself up for success.
Think just because you've delivered via cesarean in the past you're out of choices for subsequent childbirths? Think again. Vaginal birth after cesarean, or VBAC, is a safe option for most women, and statistically speaking, a fairly successful one, too. According to the National Institutes of Health, 60 to 80 percent of women—or roughly 3 to 4 out of 5—who attempt a VBAC are able to deliver vaginally.
- Related: Is a VBAC Right for You?
While a vaginal birth isn't guaranteed—sometimes a C-section is necessary for the health and safety of the mom and baby—there are a few things that could improve your chances, including a labor that begins naturally, having previously delivered vaginally, and having only one prior low transverse incision (the most common type). There are also some steps you can take during your pregnancy to help boost your odds of having the VBAC you want. Here are six strategies to consider.
1. Educate yourself. Uterine rupture is often touted as a major reason why women should steer clear of a VBAC, yet statistics show the chances of it happening are less than 1 percent. And that's just one of the many points of confusion surrounding VBACs. So it pays to educate yourself about the potential risks and rewards of this method of delivery. Luckily, there are plenty of places for expectant moms to turn, such as prenatal VBAC classes, health care providers, and even VBAC moms.
Getting all the facts early on was helpful for Jessica Whittington. The Baltimore, Maryland, mom of two knew she didn't want to have to make a decision about the method of delivery in the throes of labor with her second child, so she boned up on VBACs before finalizing her birth plan. "I was very educated in all the possible scenarios that I could find myself in during my birth," she says. "I knew that what was on my birth plan was there for a purpose, and nothing was written on that page lightly."
2. Find a supportive health care provider. Finding a provider who is supportive of VBACs and has a proven success rate is of the utmost importance, explains Larry Leeman, M.D., professor of family medicine/obstetrics and gynecology and co-medical director of The University of New Mexico Hospital's Mother Baby Unit. "It's important to know if your doctor or midwife is likely to be attending your planned VBAC and to be sure that his or her partner or covering physicians are also supportive of VBAC," he says.
When interviewing prospective doctors and midwives, be sure to ask what Dr. Leeman calls "revealing" questions. For example, if you go past your due date or have a medical need for labor induction, will your physician and hospital support the choice of induction, or does that mean a VBAC is no longer an option? What is the successful VBAC rate in his or her practice as well as the hospital you plan to birth in?
Certified professional midwife Deanna Kopf agrees: "The most important thing is having a supportive and patient provider. Someone who won't starting planting seeds of doubt at 36 weeks that your baby is getting too big to fit through your pelvis. Someone who won't be afraid to let the baby come when he or she is ready."
3. Make sure your hospital is VBAC-friendly. Even if your health care provider supports your wish for a VBAC, the hospital where you plan to deliver may not. In the summer of 2014, Hudson Hospital in Hudson, Wisconsin, made headlines when it announced it was banning VBACs, forcing women to change their birth plans and, in some cases, even their hospital. Yet Hudson Hospital is hardly the only facility that does not accommodate VBACs. According to a 2009 report from the International Cesarean Awareness Network, more than 40 percent of U.S. hospitals do not allow moms to deliver vaginally after a cesarean.
Arguing against hospital policy while in labor is a job no woman should have to do, so make sure you have a clear understanding of your hospital's birth practices ahead of time, including whether it allows VBACs and what the routine procedure looks like for this type of birth. Dr. Leeman says one important consideration is whether you'll be able to move freely during labor, instead of being restricted by a fetal monitor. Continuous fetal monitoring in active labor is required by hospitals for women planning a vaginal birth after cesarean, but many hospitals now have wireless monitoring called telemetry that allows freedom of movement.
4. Consider all your options. Many VBAC moms prefer to give birth in a hospital, but if you feel comfortable with other options, you should explore those as well. Talk to your local birth centers about their VBAC practices or consider alternate birthing options, like a home birth.
In fact, these at-home and birth center deliveries are a reasonable option for women to consider, says Alexa Richardson, a certified professional midwife and chair of the Direct-Entry Midwifery Advisory Committee in Maryland. Out-of-hospital births supported by certified midwives have extraordinarily high VBAC success rates. A recent national study conducted by the Midwives Alliance of North America found that 87 percent of women who planned a VBAC at home birthed vaginally. Plus, Richardson says, the risk of complications from a VBAC is roughly 0.5 percent, "about the same low risk level as other rare birth complications that all women may face in childbirth."
Stuart Fischbein, M.D., a Los Angeles-based ob-gyn who specializes in breech, twin, and VBAC home births, says the risks associated with VBACs "are blown way out of proportion." Further, he believes the choice to deliver at home should be available to all women, and points to the birth practices in England as a potential model. "They're starting to get it right in terms of encouraging home birth and making sure women have midwifery care," Dr. Fischbein explains. "They are finding that those things are really quite reasonable, and it's something that should be offered to women attempting a VBAC."
Bottom line: If you're considering delivering outside of a hospital, spend time researching your options, then discuss them with your partner and your health care provider to help figure out what's right for you.
5. Hire a doula. Enlisting the help of a designated nonmedical labor support person is not only great for pain management but can also drastically reduce the rates of cesareans that are not medically necessary. A 2014 report published in The American Journal of Managed Care discovered that having the continuous support of a doula throughout the birthing process reduced a woman's chances of a non-indicated C-section by as much as 80 percent.
Whittington credits much of her VBAC success to the trusting relationship she had with her doula. "[My doula] was in my ear during labor at the hospital, and while I labored at home," she says. "She was a calm voice, helping me through each contraction, reminding me that I could do this, that I was 'doing this,' as she so often said. She was a source of strength for me at that time."
6. Believe in your birth plan. Though it's important to mentally prepare for the possibility of another C-section—after all, even the best-laid birth plans can unravel in the delivery room—it's just as essential to believe you can give birth vaginally. Exhaustive research helped Whittington gain much-needed confidence, but so did trusting her gut. "Often, women need to regain that trust with their bodies, or even find it for the first time," she explains. "It's amazing what you can do when you believe."