Resources for Vaginal Birth After Cesarean (VBAC)

Resources for Vaginal Birth After Cesarean (VBAC)

Krystina Friedlander
Childbirth

In my experiences as a doula and midwife attending VBACs and cesareans, and being in community with some amazing women educating and supporting people after a surgical birth or those planning to VBAC, I wanted to offer what I've learned.

Though overall VBAC rates are low in this country (the most recent number I saw was 9.2% in 2010), it's important to remember that most people (75% according to one study I saw) who attempt a VBAC will indeed have a vaginal birth.

Process

The emotional toll of undesired birth experiences, including those we would categorize as traumatic, is very real. This is especially so when people are treated as if they have no choice or say in the decisions around their bodies, births and babies. In birth, parents are especially sensitive and vulnerable to care provider messages, and many mothers and parents walk away from the experience believing that their bodies are broken.

Prepare

Some possibilities here include:

  • A VBAC-positive childbirth class and especially one that addresses specific fears (HypnoBirthing is a good option)

  • Chiropractic care for pelvic balancing and encouraging the baby to enter the pelvis in an optimal position

  • Prenatal yoga, and anything that connects mind and body

  • Strengthen your uterine scar tissue by taking 1,000 mg of vitamin C

  • Treat external scar with vitamin E oil

Hire a Supportive Provider

Your provider works for you, and not the other way around. You hire an OB team, a midwifery team, or an individual midwife. Step into their office knowing that, and know that, at anytime, if they're not working for you, you can choose a practice that does support you.

It is critical to find a provider in a practice with a low c-section rate and a high VBAC rate. That way, you know that they walk the walk of a real commitment to VBAC. Respect, information, clarity, and informed decision making are critical, regardless of the outcome, so work with someone who prioritizes those elements of care. Talk with local childbirth educators, VBAC parents, ICAN groups, or other resources to find out names of providers with the best reputation for VBAC.

Birth in a Supportive Environment

Not all hospitals allow VBAC, and of those that do, some hospitals have a higher c-section rate than others (see above). I tell any birthing parents to investigate the options available to them in the birthing room. What are the policies in that space? Are you able to move, eat, shower, use a birth ball, have supportive people present, etc? Consider birth centers and homebirth as alternatives. If you're curious about homebirth but unsure, you can always interview one or more local midwives to learn more without making a commitment to an out-of-hospital birth. Unfortunately, NJ state regulations prohibit licensed NJ midwives from attending VBAC at home. Neighboring PA does not.

Review Your Records

Request the records from your previous birth and review them with your new care provider. In the case of a truly unnecessary cesarean, it can shatter the idea that one's body failed or didn't work and sometimes, we realize that we weren't even allowed to try. A sensitive record review can help shed light on where different steps could have been taken to avoid a cesarean, or can highlight how and why a cesarean was necessary. Both outcomes can help people process their initial experience/s and release feelings of shame or grief around their body.

Positivity

Surround yourself with positive affirmations, positive people (ICAN members and Facebook groups, for example) and positive VBAC stories. Connect with others, be vulnerable about your fears, receive love and support, and build positive expectation around VBAC.

Hire a Doula

Studies show that doulas significantly reduce the risk of an initial cesarean and increase the likelihood of a successful VBAC. They help to create and maintain a supportive environment for birth, help parents stay focused on their goals, provide information and space for conversations with care providers during birth, and give so much of the emotional encouragement that people need during VBAC.

Avoid induction 

Induction, especially when using combined prostaglandins (cervical ripening agents such as Cervidil) and Pitocin, increase the risk of uterine rupture and overall have a three-fold increased risk for a subsequent c-section. It's unlikely that as a VBAC parent you would be offered an induction, but sometimes it happens in irresponsible ways. However, in some cases, an induction can take place in an appropriate facility and can enable a vaginal birth.

Process, Prepare, Surrender

My take on a repeat cesarean is this: we question information that is provided to us as authoritative, based not on antagonism towards our providers but because we must advocate for ourselves and our families first with skepticism. From skepticism, we gain information and knowledge. We take steps to prepare ourselves for the best birth outcomes--including emotional processing, physical preparation, and building a fantastic birth team--and we do our best.

At the end of the day, birth is not about being in control. It's about relinquishing control, surrendering to the force of our bodies, to the force of birth, and framed by whatever our belief systems teach us. This never means giving our power to a system that sometimes chews and spits women out; it means acknowledging that we do our best as mothers, we make the best decisions we can for ourselves and our families in the moment, and we must honor all of that.

Let's say you did require another cesarean; how might it be different? Include in your birth preferences a list of c-section preferences. Thinking through a subsequent cesarean is not about chipping away at positive expectations for VBAC, it's about contingency planning and empowering yourself with information. For example, you can request to have the curtain lowered in order to see your baby being birthed (without seeing the incision site), you can request delayed cord clamping (60 seconds), immediate skin-to-skin, music, and quiet conversation. Do some research on "compassionate cesarean" and see what might be possible.

For Families in New Jersey and Pennsylvania

As a homebirth midwife, state regulations prevent me from attending VBACs in New Jersey. If you’re planning a hospital VBAC, Midwifery Care Associates is a good option for Central NJ.

  • The most recent data comes from the LeapFrog Group, which allows you to compare hospital cesarean rates. When there is no data available, consider that a bad sign. A hospital that is proud of its low cesarean rate will report it. Whether this is your first birth or your fifth, you want a practice with a low cesarean rate.

  • The CDC reports an overall cesarean rate of 35.9% in New Jersey, higher than the national average of 32% (2017).

  • ICAN of Bergen County

  • ICAN of Southeastern Pennsylvania meets in Philadelphia

New Jersey therapists specializing in birth trauma include:

Childbirth Educators who offer VBAC classes:

Other reading

Photo Credit: popularpatty, Flickr CC: http://bit.ly/29nT1ej

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