Vaginal Birth After Cesarean (VBAC): Finding Support for a Successful Journey

Choosing to pursue a vaginal birth after cesarean (VBAC) is a significant decision for many parents. While cesarean deliveries are sometimes necessary and lifesaving, many individuals with prior C-sections can safely deliver vaginally in subsequent pregnancies, despite what many people say.

However, one factor stands out as particularly crucial for VBAC success: provider support. Many providers will suggest if you’ve had a C-Section before, the safest way to give birth is to have a cesarean again. However, evidence suggests that those who have multiple cesareans may have a higher chance of high-risk complications, such as blood transfusion, ruptured uterus, unplanned hysterectomy, and admission to the Intensive Care Unit.

While a VBAC is not right for every person giving birth after a cesarean, it may be a great option for you in your birth journey.

The Critical Importance of Provider Support

The difference in VBAC success rates between supportive and unsupportive providers is stark. With a truly supportive healthcare provider, VBAC success rates can reach up to 80%. In contrast, those with providers who aren't genuinely supportive in VBAC see success rates plummet to around 9%. This dramatic difference highlights how essential it is to have a provider who believes in your body's capabilities and the VBAC process. It can also lend some clarity into why some providers continue to believe that VBAC isn’t as successful as it could be.

How to Determine if Your Provider is Truly VBAC-Supportive

Finding a provider who genuinely supports your VBAC goals requires asking the right questions. Here are some key questions to help you assess your provider's level of support and get you started on your VBAC journey:

Questions to Ask Your Healthcare Provider

1. What is your personal VBAC success rate? A supportive provider should know their numbers and be proud to share them.

2. How many VBACs have you attended in the past year? Experience matters, and a provider who regularly attends VBACs is likely more comfortable with the process.

3. What are your specific criteria for recommending against a VBAC? Listen for evidence-based responses rather than vague concerns.

4. How do you manage labor for VBAC patients differently than other patients? A truly supportive provider shouldn't treat your labor significantly differently unless medically indicated.

5. At what point would you recommend a repeat cesarean during labor? Look for specific medical indications rather than time limits.

6. What is your cesarean rate for first-time mothers? This can indicate their overall approach to birth interventions.

7. How do you feel about intermittent monitoring versus continuous monitoring during VBAC labor? Supportive providers often allow for movement and different monitoring options.

8. Would you support my VBAC if I go past 40 weeks? Some less-supportive providers use post-dates as a reason to schedule a repeat cesarean.

9. What resources do you recommend for VBAC preparation? A supportive provider should have suggestions ready.

10. How do you feel about doula support for VBAC? Truly supportive providers welcome additional support persons.

Beyond Provider Support: Other VBAC Success Factors

While provider support is crucial, other factors can influence VBAC success:

- Birth preparation: Taking VBAC-specific childbirth education classes to help you navigate any challenges that may arise during birth

- Continuous labor support: Having a doula has been shown to increase VBAC success rates

- Movement during labor: Upright positions and movement can help labor progress, especially during a VBAC

- Mental preparation: Addressing previous birth trauma and building confidence around your VBAC when the time comes

- Physical preparation: Maintaining good physical health during pregnancy is essential to a successful VBAC

Risks and Benefits of VBAC

A balanced approach to VBAC includes understanding both potential benefits and risks:

Benefits:

- Shorter recovery time: cesareans can take up to 16 weeks or more to fully recover from

- Lower risk of surgical complications: although cesareans are certainly safe and performed all the time by qualified medical professionals, whenever a surgery takes place there is always a risk for complications

- Reduced risk of placental complications in future pregnancies

- Opportunity for immediate bonding with baby

- Potential for more positive birth experience: this is especially true if your previous cesarean was especially difficult, had complications, or took a lot of time and energy to heal from

Risks:

- Small risk of uterine rupture (approximately 0.5-1% with one prior low transverse incision)

- Possibility of emergency cesarean if complications arise (this is true of any birth, however, and should not be a deterrent for planning for a VBAC)

Making an Informed Decision

Ultimately, the decision to pursue a VBAC should be made with complete information and genuine support. If your current provider doesn't offer the support you need, consider seeking a second opinion or switching providers. Many parents find success with midwives, family physicians, or obstetricians who specialize in VBAC support, as well as making sure the support you get along the way (partners, doula, birthing classes, etc.) are aware and informed about VBAC.

Remember that your birth choices are personal, and finding a healthcare team that respects your informed decisions is an essential step toward a positive birth experience, regardless of delivery method.