Knowledge, Advocacy Key to VBAC Success
Cesarean deliveries can be necessary for any number of medical reasons during pregnancy or childbirth. But one C-Section scar does not mean a mother is stuck with no other options.
VBAC, or Vaginal Birth After Cesarean, is a popular topic, as more women are weighing the risks and benefits VBAC for a future pregnancy.
A major risk of VBAC is that a C-Section scar could open during labor. The risk is low, but the more C-Section scars a woman has, the greater the chance of complications with all future pregnancies.
Benefits include shorter recovery time, lower risk of infection and avoiding the scar left on the uterus during Cesarean birth. Rebecca Dekker, author of the blog Evidence-Based Birth, said women should ask themselves several questions when considering VBAC:
What is my intended family size? “If you want a large family (more than 2 children), then the risks of surgery go up with each C-section that you have. In that case, VBAC may the safer option for you and your future children. However, keep in mind that half of all pregnancies in the U.S. are unplanned, and you may end up having more children than you plan on.”
Do I know all the facts about VBAC and repeat Cesarean so that I can make an informed decision? “Remember there are a lot of myths out there about VBACs and repeat Cesareans. It’s important to educate yourself and find out the facts, so that you can make a decision based on all the potential benefits and harms of VBAC or repeat Cesarean.”
Do I have a plan in place in case I end up with an unplanned C-section? How would I deal with that emotionally? “Some women who are planning VBACs say that it may be helpful to have a back-up plan in case they end up with another Cesarean.”
Is my care provider supportive of VBAC? “The care provider and birth setting you choose are extremely important if you decide to have a VBAC. If your care provider is only talking about the risks of VBAC, and talks very little about the risks of repeat C-section, then you may want to get a second opinion so that you can get fact-based information before you make up your mind.”
Women may find resistance from their care provider about VBAC. Providers may hesitate, or refuse, because they fear lawsuits, restrictions from insurance companies, they prefer scheduled deliveries, or many other possible reasons.
Dekker recommends asking three particular questions when discussing VBAC with your care provider:
Do you have any restrictions on when a woman is allowed to VBAC?
“Not allowing someone to go past 39, 40, or 41 weeks is a red flag and indicates non-evidence based medicine. Not allowing a VBAC because of a suspected “big baby” is also a red flag. If your care provider does not mention due dates or big babies, I would specifically ask, ‘What is your philosophy on big babies? What is your philosophy on going past your due date?’”
What if I end up with a medical complication that requires induction?
“Although induction increases the risk of uterine rupture from 0.4% to 1%, the American Congress of Obstetricians and Gynecologists recommends that “induction of labor for maternal or fetal indications remains an option in women undergoing trial of labor after Cesarean.” If your doctor or hospital does not induce with VBACs and you end up with a medical complication that requires delivery, then you will be forced to undergo a repeat C-section or scramble to find another care provider at the very end of pregnancy.”
How many VBACs have you attended? Out of the last 10 women who attempted a VBAC with you, how many were successful? “Their success rate should be at least 70-80%.”
If a mother feels her care provider is not supportive, it is never too late to find another. Dekker warns parents about the “bait and switch’ tactic. A care provider initially acts supportive of VBAC, but as the due date nears they push for a repeat C-section.
“It’s important to remember that as a pregnant person, you still have legal rights,” Dekker said. “You cannot be forced into surgery against your will, and you always have the right to seek a second opinion or switch care providers or hospitals—even at the very end of pregnancy.”
The most important factor in a successful VBAC is having a completely supportive care provider. Dekker said mothers also need to confirm that the hospital or birth setting is also supportive. Mothers should research any VBAC-restriction policies to see whether they are evidence-based.
“Many women find a supportive care provider, only to arrive at a hospital in labor and find out that the hospital has non-evidence based restrictions on who is ‘allowed’ to VBAC,” she said. “In other words, even when a hospital permits VBAC, they may have strict policies that make it very difficult for a woman to actually achieve a VBAC.
Women can educate themselves further by taking a childbirth education course that is not associated with their hospital, and by hiring a doula, which is proven to decrease the risk of C-Section.
Jarah Jones, mother to 4 year-old Pax and 1-year-old Isabel, had an emergency C-section for her first pregnancy. She was on bed rest due to preeclampsia, and her doctors discovered her son had a brain bleed and she needed to deliver as soon as possible.
For her second pregnancy, she sought out a new care provider, feeling she lacked information during her first pregnancy.
“It seemed my OB-GYN’s words were rehearsed and repeated to every single pregnant mother who walked into his office,” Jones said. “It felt very flat and factory-like. I learned from this experience that I had to be my and my unborn child’s biggest advocate.”
Because of her first pregnancy and labor experience, Jones knew most doctors would want to schedule another C-section. She found that her new provider at WomanKind Midwives in Lexington thought she was a perfect candidate for VBAC.
“I felt she was on my side and my special advocate and cheerleader for how I wanted my child to enter into this world,” Jones aid. “I felt instantly that she would keep us both safe and informed on any problems that were arising and if VBAC had any chance of not being a good option.”
While Jones knows her doctors did what they saw as necessary for her first baby, she knew it was not something she wished to repeat.
“I was scared, angry and unsure of why and what was happening,” she said. “I remember being completely baffled that I was having an emergency Cesarean and the doctors were discussing their weekend plans.”
She was still given certain medical restrictions for her VBAC, such as continuous monitoring and delivering within a certain time frame. But overall, Jones was elated to have the chance to deliver her baby the way she wanted.
“These were small prices to pay to not have to go through another Cesarean,” she said. “My 8.13 pound baby was born after being induced, an epidural, 12 hours of labor and to the sweet sounds of Patty Griffins’ song, Heavenly Day, playing in the background. I was fortunate to be able to hold her for two hours after birth, with Kangaroo Care, and thankful that I found a team of advocates who brought her peacefully into this world.”
Resources for information about VBAC:
http://www.childbirthconnection.org
There is also a closed VBAC Facts support group on Facebook for women who are interested in VBAC- visit https://www.facebook.com/groups/vbacfactscommunity/ and submit a request to join.