VBACs are such a huge topic in the birth world. It’s a topic that Deb, one of our owners and doulas, feels passionately about. You’ll often see Deb say that VBACs are her jam, and that’s because Deb spent three years (while studying midwifery under a CPM that was very VBAC supportive) supporting mothers that wanted a vaginal birth after a cesarean. Deb saw firsthand the unfair bias that care providers had when discussing VBACs and deciding whether or not women “would be allowed” to try to VBAC. She has supported over 85 clients during their TOLACs, and the very large majority of them were able to birth vaginally.
- Know the facts. It’s important to know that ACOG says that a trial of labor after a cesarean birth is a reasonable option for most women. Here is a great resource that lays out what ACOG does and does not support in an easy to read and understand format. You also need to know that placenta accreta is a higher risk than uterine rupture. Read the actual statistics. Don’t be afraid to voice that you’ve read the data and ACOG’s guidelines, and you’re comfortable with the risk associated with a trial of labor. Request your records from your previous cesarean, read read read, and seek out information from people in the know: midwives, OB/GYNs, doulas, childbirth educators, etc.
- Hire a VBAC supportive provider. Have you heard the terms VBAC friendly/VBAC tolerant? It’s incredibly important to have a truly supportive care provider when planning for your VBAC. My suggestion is to ask other women and doulas in your community for their referrals for a provider that has a reputation for supporting vaginal birth after a cesarean. A “VBAC tolerant” provider will insist on things such as: must go into labor before X weeks, baby needs to be under X pounds, refuses to induce or augment labor under an circumstances, uses a VBAC calculator, insists on double layer sutures, wants an epidural placed “just in case”, and requires internal fetal monitoring be used. Run away from providers like this. (Credit for terms “VBAC tolerant/VBAC friendly” belongs to Melek Speros, Midwife)
- Utilize the B.R.A.I.N acronym. What are the Benefits of this procedure? What are the Risks? Are there any Alternatives? What does my Intuition tell me? Can we Negotiate- what happens if we wait a while longer, can we try X first?
- Build a support system. We know that continuous labor support from a doula reduces the risk of interventions and improves birth outcomes. Hiring a doula is always a great first step, and obviously, it’s one I encourage you take, but there’s more. You need to join your local ICAN chapter, attend support groups, take a birth class and meet other mothers hoping to VBAC, reach out to online communities and ask if anyone has pursued a vaginal birth after a cesarean. These women know what you’re going through, they feel the same things you’ve been feeling, and it’s great to have people on your side.
- Honor your body. A story that will always stick with me is one about a midwife that requires her VBAC planning moms to walk 5 miles, 5 days a week- but she also has a 98% VBAC success rate, so maybe she’s onto something? We know that staying active during your pregnancy helps facilitate a smooth labor and delivery, so why wouldn’t this apply to VBAC moms, too? 25 miles a week might be excessive, but do something. A 45 minute walk in the evenings, swimming, dancing around your house while you clean, squats, whatever floats your boat. Move your body, eat food that makes you feel good, drink lots of water, see a chiropractor, process your mental and emotional baggage, and remember to breathe.
You are a woman that wants a vaginal birth. Scarred uterus or not, this is not an unreasonable desire.
Did you have a VBAC? What tips would you give others planning a VBAC? Do you have a VBAC friendly provider recommendation in the Nashville or Clarksville, TN area? Drop them in the comments!