How To Have A Successful Vaginal Birth After Cesarean (VBAC)
Think you’re destined to have another C-section because you had one in the past? Not so. Vaginal birth after cesarean (VBAC) is a safe and recommended option for many mamas.
After a traumatic first birth that ended in an emergency C-section due to fetal distress and the culmination of spending eight hours in the ICU due to a bad reaction to the anesthetic, Louise was convinced she’d have another C-section with her second child. “My husband and I wanted to feel in control of the situation and avoid anything like the surprises we’d experienced during my first labor,” she explains.
But halfway through her pregnancy, Louise changed her mind. “I started to think about how empowered I might feel by having a VBAC [vaginal birth after cesarean] and how it might help me heal from the trauma of my first birth experience,” she says. So, with the support of her husband and some hypnobirthing classes, Louise welcomed her second son into the world via VBAC.
“I feel lucky and so grateful that it went well,” says Louise. “My experience was more healing and empowering than I ever could have hoped it to be. The moment I lifted my boy onto my chest for our first embrace and skin-to-skin experience, feeling his gorgeous tiny warm body against mine, helped me in ways I couldn’t have imagined. I think it did for my husband too, though he did get a bit stumbly right after and needed the midwife to source him a solid chair to sit on! It’s a moment I’ll never forget and continue to crave – I guess that’s the magic of mother nature.”
Amelia, a mother of three, couldn’t agree more. After an emergency cesarean that left her feeling robbed of the natural birth experience, she’d been dreaming of with her first child, she insisted on a vaginal birth the second time around – and she’s so glad that she did.
“The second Zachary was born, we bonded immediately,” she says. “He started feeding right away and I can’t even begin to describe the elation I felt. What a different experience to the first time. My mom was outside with our daughter and brought her right in to meet her little brother. I jumped out of bed and gave her the biggest hug. It was all perfect. I was back home three hours after giving birth and I was on cloud nine.”
10 tips for a successful VBAC
The American College of Obstetricians and Gynecologists (ACOG) recommends that VBACs be attempted at maternal-care facilities that can perform emergency deliveries. The benefits cited by the organization include a shorter recovery period, a reduced risk of complications such as hemorrhage and infection associated with major abdominal surgery, and a lower risk of maternal mortality during delivery due to repeated C-sections.
If you’d like to have a VBAC, you should start planning for it as early as possible. Here are 10 tips to help you achieve your goal:
Get the facts
According to the National Institutes of Health, 60 to 80 percent of women who attempt a VBAC are successful, but unfounded fears based on outdated statistics often prevent them from trying.
The most common concern associated with VBAC is uterine rupture – a potentially life-threatening event that occurs when the scar from a previous C-section tears – but according to two 2012 studies, the incidence of uterine rupture in women planning a VBAC is only 0.2 percent. And the longer the interval between C-section and VBAC, the less likely it is to occur. Educating yourself about VBAC by conducting research online and talking to your healthcare provider will help you plan and prepare adequately.
Seek out a supportive and experienced healthcare provider
“Find an obstetrician who actively does VBAC deliveries and has an idea of how to support women seeking this option,” says Dr. Mary Mirto, a private practice obstetrician at OBGYN North in Austin, Texas. “This means that their hospital supports them with VBAC policies and 24-hour anesthesia availability for emergencies, and that their call partners also support women who want to have a trial of labor after cesarean [TOLAC] so that your opportunity won’t be limited to when your doctor is available. They should also know their VBAC success rate and be willing to share it with you.”
Decide where you want to give birth
Dr. Mirto cautions against attempting a VBAC in a birthing center or at home. “Women should be aware that the need for emergency delivery can occur even during early labor, so they shouldn’t plan to labor at home or to have a home birth,” she says. But if you have your heart set on giving birth outside of a hospital, talk to your healthcare provider about your options.
Discuss the risks
“Have a discussion with your obstetrician about the risks involved in a trial of labor after cesarean,” says Dr. Mirto. “A patient who’s had previous successful vaginal deliveries or who’s had a previous caesarean for breech presentation would be expected to have a better chance of success [than someone who had a C-section because of issues with the labor process].”
Other factors that can increase your chances of having a successful VBAC include being under 35 and having a low-transverse (horizontal) uterine incision rather than a vertical or T-shaped one.
Manage your weight and health
Researchers at the University of Washington found that overweight women who lost at least one body mass index (BMI) unit increased their chances of VBAC success by 12 percent, while obese women who lost one or more BMI units boosted their success rates by 24 percent. Eating a healthy diet and exercising regularly can not only keep your weight down, but also reduce your risk of other health issues such as hypertension that might require a C-section.
A doula can give you all the physical and mental tools you need to have a successful VBAC, as well as provide much-needed emotional support during your pregnancy, labor and delivery. A study published in The American Journal of Managed Care found that the odds of a non-indicated C-section were 80 to 90 percent lower in doula-supported births. See more in our article on Having a doula.
Take a VBAC childbirth class
Avoid being induced (if possible)
The risk of uterine rupture increases with the use of induction drugs such as oxytocin or prostaglandins, so ideally labor should start naturally. If your healthcare provider suggests induction, make sure to discuss the risks with them.
Build a strong support system
Join an online VBAC support group, attend a meeting at your local International Cesarean Awareness Network chapter, and talk to as many VBAC moms as possible to get the advice and support you need.
Commit to your birth plan, but have a plan B
One of the most important steps in having a successful VBAC is learning to trust your body again and believing in its ability to birth naturally. Your healthcare provider, doula, childbirth class and support systems will all help to build back your confidence.
You should also prepare your mind for the possibility of another C-section in case it becomes necessary. “Remember that the goal of pregnancy is a safe delivery and a healthy mother and baby,” says Dr. Mirto. “Needing or choosing to deliver by repeat cesarean section is not a failure.”