How To Prepare For A VBAC (Vaginal Birth After Cesarean)
I’ve been there, mama. I am you. VBAC is close to my heart because I am a VBAC mama too!
If you’ve landed here because you’re hoping for a VBAC (vaginal birth after cesarean), I would love to share with you what I did and tips to prepare for a successful VBAC.
Know your why.
There are so many reasons for choosing to pursue a VBAC. The decision to do so is very personal, and the birthing person should be the one who makes the final call. For me, I chose to pursue it for a few reasons.
I am absolutely terrified of anesthesia due to complications with my first cesarean.
I had a hard recovery requiring physical therapy for over a year.
I wanted to keep the option open of having more kids in the future.
I personally felt that if I never tried, I would forever regret the “what if.”
I wanted to be able to hold my older kiddos and be able to take care of them also!
Your reasons may be totally different, and that’s okay! But your why will be something you may have to keep coming back to when you face challenges or protests.
Here are some possible reasons that women decide on VBAC:
Previous traumatic or emergency cesarean
They feel their previous birth was “hijacked” and they didn’t have a say.
They don’t feel confident their cesarean was necessary.
“Planned” first cesarean - breech delivery, multiples, “big baby,” etc.
“Cascade of interventions”
Hard recovery, older kids at home, etc.
Not much “support” at home, partner has to return to work quickly, etc.
Want to lessen risks of multiple cesareans.
OR everything went “perfectly” in their previous cesarean - they just simply want to try for a vaginal delivery.
For me, it was never about thinking a vaginal delivery was the “superior” choice, it just felt like the right choice for my family and I.
Choose a supportive care team.
IN-HOSPITAL OR OUT-OF-HOSPITAL
Having a supportive team is my #1 tip for VBAC success.
Depending on where you live, there’s options for even VBAC mamas. Hospital, birth centers, or even home birth. Ob-gyns, family doctors, CNM (Certified Nurse Midwife) or CPM (Certified Professional Midwife).
It’s important to note that some providers or hospitals may not be supportive due to hospital policy or procedure. Some may not have the resources to support VBAC.
Whoever you choose, make sure you vet them! Ask the hard questions. Fact-check that they are giving you evidence-based answers and don’t practice in a way that sets you up for failure. Your provider should be experienced and 100% supportive of VBAC’s.
PROVIDER RED-FLAGS:
Supportive only if you go into labor by ___ weeks.
Uses the VBAC Calculator to “assess” risk and considers a barrier. See here.
Tells you your baby must be under ___ lbs. in order to TOLAC.
Tells you that they are supportive, but their “on call” or “backups” are not.
Tells you that VBACs cannot ever be induced.
A lot of providers seem to be supportive but are only “tolerant.” Something to note also is that you can like your provider, and they still might not be the best fit. Sometimes we have to separate the “nice, and agreeable” doctor with the one you need for your VBAC. I REALLY liked the doctor for my first pregnancy, and I had such a hard time debating to switch because she was just really such a nice person. However, when I asked at my 38-week appointment about preventing a cesarean, her immediate response was that “we don’t need to worry about that! Cesareans are not bad, and it’s totally fine if you end up needing one.” Looking back, I felt dismissed and like it was a red flag, but I didn’t say anything because I liked her. So, this is not to say that providers are bad, they just might not be the right fit for a VBAC! Many aren’t up to date on evidence-based practices.
I personally did not have a good experience in-hospital with my first two births, so I chose to birth at a birth center with experienced midwives. I had complete faith in them with the care of my baby and I, and I trusted that if I had to transfer to the hospital, it was for a good reason and absolutely necessary. There is a lot less “red tape” with birth centers which allows for letting birth happen as it’s “supposed” to. I 100% believe they are the reason for my successful VBAC. It was important to me to let my body go into labor spontaneously, not have the epidural available, and just trust my body and baby to work together. I struggled with speaking up for myself and my birth preferences at the hospital, and I didn’t want to use up my energy defending myself like I had had to with my previous births.
Of course, many people have great experiences in-hospital as there’s SO many variables unique to your personal situation.
Here are my best tips for choosing your support team:
Up-to-date on evidence-based VBAC knowledge
Uses INFORMED CONSENT! Provides risks of VBAC as well as risks of repeat cesarean.
Out-of-hospital provider should be confident that they know when to transfer you if necessary.
A provider should never be upset that you have a doula!
Know who will attend the birth; and is everyone supportive of VBAC?
Sometimes because of insurance reasons or reasons outside of our control, we have to choose a less-than-ideal provider. I highly recommend a doula in this circumstance if you can make it work! They can do the leg-work for you if needed and help decipher what is going on during labor and delivery, as well as advocate for you!
Lastly, who are you going to let in your circle?
I firmly believe it is up to the birthing mother on delivery preferences. Family/friends, including dad, can give opinions but the mother is the one who labors, delivers, recovers, etc. This decision can affect your physical and/or mental health for the rest of your life and it is crucial that mom is the one who chooses.
That being said, having my husband on board was crucial for me. He was my biggest cheerleader and having his unwavering support was key for me. We talked about the topic a lot and he researched for himself. He also talked thoroughly with the midwives about any worries or fears he had.
Another thing to note is that it’s OK if outside family and friends are not supportive. It is not up to them. Most people do not know that VBAC can be a perfectly safe, reasonable option! The term “once a cesarean, always a cesarean” is prevalent especially in older generations. People are usually projecting their fears onto you because they love and care about you! I highly suggest your in-labor support people be 100% on board with your decision.
If you find it best to keep your plans to yourself, that is 100% okay. You can set boundaries around this topic with those who have strong opinions.
Knowledge is power. Know the evidence and risks.
Deciding on pursuing a VBAC is not a decision that is made lightly by many. While it is a great option, some may decide it’s not for them, which is totally okay! The key to preparing for a VBAC is knowledge. When you’re armed with evidence-based facts, you can decide on the best choice for you and your family. Unfortunately, many providers are not up-to-date or let their own experience (or lack of) blur their vision There are a lot of fear-based myths floating around on VBACs in general, and it can be hard to decipher fact vs. fiction.
Here’s what we know:
-The biggest concern with VBAC is uterine rupture. Uterine rupture statistically happens in 0-4%-1% of TOLAC, equaling about 1/240 women. Even with this LOW figure, it doesn’t mean catastrophic consequences.
-The chance of a successful VBAC is 63.3%. (ICAN)
TRUSTED RESEARCH RESOURCES:
ACOG (American College of Ob-Gyns)
The VBAC Link
Learn about physiological birth.
Many times, we are told and treated as if pregnancy is a medical condition. The reality is that it is a natural process that “most” of the time, results in a healthy baby. Most of the time, our body knows what to do!
My best tips for learning:
Read books. Save this link for my favorites.
Take a quality childbirth class and include your support person! My local birth center offered an INCREDIBLE class for both patients and non-patients.
Create general birth preferences.
Birth plans aren’t my favorite, because things don’t always go to “plan.” I prefer birth preferences!
Know your hard-no’s. If you’re adament you do not want an epidural, make it known that you do not want to be asked or offered one.
Things to include in birth preferences for a VBAC:
Spontaneous labor/Induction preferences (most induction methods are considered safe for VBAC, however going into labor spontaneously gives you your best chance!) My WI birth center never had a limit to “risking” out of care, but some states do. Something to consider is how far along you are comfortable with going before being induced.
VBAC is safe to labor/deliver in water, but some providers will not allow this.
Eating/drinking during labor
How you want your birthing atmosphere
Dim lights? Peaceful music? Loud music? Smells?
Directed pushing?
Epidural/pain management preferences
Delay cord clamping
Avoid pitocin if desired
Who will cut the cord?
Visitors
Golden hour
Breastfeeding or formula
Newborn care: no nursery, pacifiers, baby in room, etc.
Create a Cesarean Back-Up Plan.
This is extremely important for VBAC mamas.
When I was pregnant with my first, a cesarean barely crossed my mind. My mom and sister had both had smooth vaginal deliveries and I never really considered that a cesarean would even happen. So when I had to have one, I was devastated. I bawled all the way to the OR. I had absolutely NO idea what they were like or what was about to happen to me. Obviously, if you’re planning a VBAC you have already experienced a cesarean. My first cesarean was under general anesthesia so I still had no clue while planning my VBAC!
Having a cesarean back-up plan means acknowledging that your TOLAC may result in another cesarean, and making peace with it! You can advocate for a “gentle” cesarean or have specific preferences like waiting to cut the cord, clear drape, etc. You can even request they don’t talk during your surgery, or that they play a certain playlist!
Just make sure you talk to your provider so there’s no surprises regarding what they do or do not allow.
Things to include in cesarean birth preferences:
Medication to relax before cesarean.
Preferred pain relief for surgery (epidural, spinal, general)
Music
Clear drapes
Free arms
Photography?
Cutting the cord options
Delayed cord clamping
Don’t feel guilty for choosing this for yourself.
The term “a healthy baby is what matters the most” can be toxic. Your birth is YOURS too. It is your passage into motherhood and can follow you into your postpartum journey. I really strugged with my mental health due to my first birth, and it saddens me that my memory of my firstborns’ newborn days was tainted by that.
A healthy mother is a happy mother.
As hard as we can try, sometimes it’s impossible to “focus on the positive.” That is 100% okay. We need to process trauma to move forward and trying to just push those feelings down can result in an explosion later.
A traumatic event does not have to be a specific thing. Nobody can tell you something wasn’t “traumatic.” If the person experiencing the event deemed it traumatic, then it is. Your body and nervous system will hold on to that!
At the end of the day, if there is a little inkling that this is what you want, then I suggest speaking with your provider! If in your heart of hearts, you desire this for yourself and your family, pursuing a VBAC can be very positive journey.
LAST NOTE
Birth in itself is inherently risky. Your risk will never be 0, no matter how you choose to birth! There are risks associated with both vaginal and cesarean deliveries. Either way is not “wrong.”
If you decide a repeat cesarean is right for you and your family, that is 100% okay! The most important thing is that you are a part of the decision-making process.
Please reach out if there is anything I can help you with! I am passionate in supporting mamas no matter what they decide to do.
