VBAC: What You Need to Know
Updated: Aug 18, 2021
"I think it's time we consider moving forward with a c-section." I couldn't believe it. This is not at all what I had prepared for.
When I found out I was pregnant with my first, I envisioned this perfect, (pain-free), vaginal birth. I had no reason to believe I would experience anything different. Up until that moment, everything looked like it was supposed to.
I put my faith in my doctor and trusted that she knew what was best. I went forward with the unnecessary and elective induction without asking the risks. I got the epidural after having 2 contractions because she told me she could make me more comfortable. I consented to her recommendation of breaking my water at 3 cm.
My faith in her was met with devastation as I was rolled into the OR 12 hours after the start of Pitocin to birth my beautiful baby girl via c-section.
A few years later, after finding out I was pregnant with my youngest, I knew I wanted a different birth; a FULLY INFORMED birth. So, I did just that! It was incredible! I had to do a few things differently in order to ensure that I would have a chance at a vaginal delivery. After my experience, I wanted to shout my story from the roof tops! I wanted EVERYONE who had a previous c-section to know that they too could have a VBAC, if that's something they genuinely desired (even though I initially pushed my own desires on to everyone else.... oops.... don't do what I did).
But, I know there are pregnant women out there who don't know what they don't know. I was one of them.
Many people have been told that "once a c-section, always a c-section" (which is based on super outdated advice from 1916). They blindly follow their provider's advice because, well, they are doctors... really smart doctors... who went to medical school, and like, practice medicine. We are told to trust them even if it goes against our better judgement. I think there is a better way. My goal is to provide the small masses of people I reach the information they might be missing. You can have a different birth BUT you have to work for it, you have to do your research and know which questions to ask.
Here we go! Let's dig in to the in's and out's of VBACs and what steps you should take to have one!. Or maybe this will help you decide you want to move forward with a repeat c-section... WHO KNOWS?!.
I do want to lead with a super obvious statement, I am not a medical provider. The information and advice I am giving should be something you should always review with your provider and research on your own.
1. What is a VBAC?
A VBAC is a Vaginal Birth After a C-section. You might see some say they want a VBA2C or VBA3C, this means they are wanting a VBAC following 2 or 3 c-sections (yes, it's possible!). Some might have a HBAC which is a Home Birth After a C-section. Easy, right? Hang in there, we'll get into a lot more detail.
2. What are the benefits and risks of a VBAC?
Here is just a few of the major points that many providers will give to their patients (or might leave out).
No abdominal surgery -
Shorter recovery period - No surgery = less recovery
Lower risk of infection
Less blood loss -
Avoid health risks associated with multiple c-sections (bowel or bladder injury, hysterectomy, problems with the placenta in future pregnancies- placenta previa and/or accreta) (1)
Benefits associated with vaginal birth (baby's exposure to vaginal microflora) (2)
Avoiding risks associated with c-section birth (neonatal depression due to general anesthesia, fetal injury during hysterectomy and/or delivery, increased likelihood of respiratory distress even at term, and breastfeeding complications) (2)
As with any vaginal delivery, VBAC or not, there are still risks. A few of these seem to counter the benefits of a VBAC because these risks are also present with any vaginal delivery.
Uterine rupture (1) which is rare, but let's talk about it*
Hysterectomy as a result of a uterine rupture
*Uterine rupture is a rare but potentially serious complication that occurs when the uterus tears spontaneously along the site of the previous c-section incision. The risk of a uterine rupture with a low, transverse (most common) incision is less than 1% with the perinatal loss rate being about .006% (3). Abnormal fetal heart tones (variable decelerations, or bradycardia) have been consistently associated with uterine rupture which is one of the reasons The American College of Obstetricians and Gynecologists (ACOG) recommends those attempting a VBAC utilize electronic fetal monitoring (4)
According to the Mayo Clinic ,a successful VBAC results in fewer complications than an elective c-section BUT a "failed trial of labor" following an attempted VBAC is associated with more complications (5).
Whew, lot's of info! Let's keep going.
3. Who would be considered a "good candidate" for a VBAC?
"VBACS are a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans" according to guidelines by The ACOG
Ultimately, anyone who wants a VBAC can go for a VBAC, even if your provider isn't in support of it. Women have rights in childbirth, including the right to say no to an elective c-section. It is important to weigh the benefits vs. risks. The more c-sections a person has, the greater their chances of complications are. Different scars also increase their chances of complications but don't necessarily mean they can't go for it.
With that being said, The ACOG laid out what they would consider "an ideal candidate" for a VBAC (6) based on the following criteria:
1. Only one previous c-section
2. Low-transverse incision (which you would be able to figure out based on your surgical records)
3. No prior uterine rupture
4. No extensive transfundal uterine surgery
This sounds a lot like "you have to have very specific circumstances in order to qualify for an attempt at a VBAC" which can be really discouraging (and really, most people fit in the ACOGs guidelines). They do follow up with "However, individual circumstances must be considered in all cases. For example, if a patient who may not otherwise be a candidate for TOLAC presents in advanced labor, the patient and her obstetrician or other obstetric care provider may judge it best to proceed with TOLAC (trial of labor after c-section)". (6)
There are also situations in which a VBAC would not be a good option.
1. Transverse presentation
2. Placenta previa and/or extensive accreta
3. Active herpes lesions
4. You just really want a c-section (yes, there are many out there who have no desire for a vaginal birth AND THAT IS SO OKAY!)
The ACOG does respect the choices of women in labor and suggests that there is no hard and defined space as to where we draw the line on who can and can't go for a VBAC.
"After counseling, the ultimate decision to undergo TOLAC or a repeat cesarean delivery should be made by the patient in consultation with her obstetrician or other obstetric care provider.” (4)
4. "Okay, I've weighed my benefits and risks and want to go for a VBAC. What do I do now?"
Find a supportive provider
Finding a supportive provider might mean you need to leave your current provider during your pregnancy, which can be hard if you've established a good relationship with them. You can always go back to them for your yearly visits.
Ask for recommendations within the VBAC community in your area. If you've hired a doula, they can also connect you to a VBAC friendly provider. ASK ALL THE QUESTIONS to make sure they are truly supportive.
Find a supportive place of birth
The current c-section rate in the US is 31.9% (7). This means if a birthing person walks into a hospital, they have a 1 in 3 chance of having surgery. Look at your hospitals VBAC and C-section rates when making a decision on choosing your provider, even if you're not a VBAC momma. Having a supportive hospital staff is equally, if not MORE, important than having a supportive provider.
Compare hospitals c-section rates HERE:
You also have the option to birth at a birth center or at home with a midwife! Most midwives that I've worked with in the DFW area take VBAC mommas. The ACOG does state that a hospital is the best place for a VBAC momma to give birth, buuuut.... again, it's a benefits vs. risks thing. Weigh your options, research, talk with a provider, then decide what is best for you and your family. I know PLENTY of VBAC mommas who have birthed outside of a hospital setting and had incredible experiences!
Hire a doula
Listen... I know I'm biased. However, it's not because I am a doula, it's because I had a
doula for my VBAC and she was essential to my team. Doulas can help you ask the right questions, process the information, and support you in labor so interventions aren't as necessary. We also equip you with the knowledge to help you prepare your body for birth (chiropractic care, exercises, movements, comfort techniques, etc.). You can read my previous post, What is a Doula to find out more about a doula's role in birth.
Take a Childbirth Education Course (CBE)
It's important to learn what's normal in birth, what interventions you might run into along the way, and the different rights you have as a birthing person. A childbirth education class will help lay out all of your options so you know what choices you have. Like I've said, you don't know what you don't know but a CBE can help you fill in any gaps.
There are many different options when it comes to childbirth education :
Methods based courses (Hypnobabies, Bradley, etc.) -focused on one general outcome (natural/non-medicated)
Non-methods based courses (Preparing For Birth) -focuses on different outcomes (natural, intervention, c-section, etc.)
Hospital Courses- USUALLY focus primarily on hospital interventions and what to expect. Some hospitals might offer a "natural" childbirth class. Be sure to ask!
One type of class is not necessarily better than the other. It just depends on your desires and goals for birth!
Extend yourself some grace
We put a lot of pressure on ourselves when pregnant and in labor. This can actually interfere with the labor process. If you are a VBAC momma, you tend to feel a lot more pressure because you are slightly limited in some of your choices (induction methods mostly). Trust that your body and your baby know exactly what they are doing. Seriously, remember that if you hit 41 weeks + 2 days and feel like you're never going to give birth.
I'm all about normalizing where you're at, because chances are... you're incredibly normal.
One last important reminder...
Birth is birth, no matter how it happens. There is no success or failure in birth.
Even if you're birth doesn't go how you originally planned, you birthed your baby and that is amazing!
But, it's okay to mourn the loss of the birth you imagined. It's okay to be disappointed when the world tells you "well at least you have a healthy baby". I get it. I've been there. It took me a really long time to find peace with how my first birth went. Take the time you need. Get the help you need. Do what you have to do to find healing.
It's also normal to be very content with how your c-section went, so much that you just want to move forward with a repeat, elective c-section for your next pregnancy. YOU. DO. YOU, GIRL!
All birth is beautiful when moms feel informed and supported.