After an unexpected Cesarean with my firstborn, my heart was set on one thing as I considered a second pregnancy: a vaginal birth after Cesarean (VBAC). Was it the right choice for me? Could I successfully and safely give birth to my second child this way?
The data is promising: VBAC rates continue to be on the rise, and studies have shown a 60%-80% success rate for women who attempt a VBAC. For most women with a previous C-section, the American College of Obstetricians and Gynecologists recommends VBAC as a safe choice, despite the popular belief of “once a Cesarean, always a Cesarean.”
For many women - myself included - the appeal is clear: women who deliver vaginally after a previous Cesarean are less likely to experience the birth-related complications that may come with a repeated Cesarean. Recovery after labor and delivery tends to be much easier as well.
It’s important to note that a VBAC may not be for every mom. Some moms may prefer another Cesarean, while others might have a care team that has advised against a VBAC for a number of valid health reasons for mom and/or baby. Every mom should feel supported no matter what route she chooses.
My VBAC, which I achieved with my daughter’s birth last September, was a memorable, healing experience that I am so grateful for. I recognize that my story is not every mom’s story, but I hope other moms considering a VBAC can feel empowered to do their research and discuss the options with their providers.
Here are five ways to prepare for a VBAC:
1. IDENTIFY THE RIGHT CARE TEAM.
Access to supportive care is non-negotiable when attempting a VBAC; not every doctor or hospital is equipped to handle VBACs (and many choose not to do them). For many women, finding a doctor to support their VBAC goals can be difficult.
If your doctor doesn’t support VBACs but you still desire one, ask yourself if you are prepared to switch doctors. How far would you be willing to travel and still manage a safe labor and delivery? Are you comfortable with Home Birth After Cesarean (HBAC) or midwife options?
Many women leverage internet resources and VBAC networks, from Facebook groups to online forums, to find care providers who are willing to discuss their VBAC plans. As with any choice in care, utmost consideration for mom and baby’s health should stay top of mind.
Uterine rupture - a potentially life-threatening event - is a common concern with a VBAC. But according to studies, this incident occurs 0.1%-0.2% of the time. Your care provider should be someone who can openly discuss this and other scenarios with you, and with knowledge of your previous birth experience(s), can assist you in making key decisions about your delivery.
2. SURROUND YOURSELF WITH EMPOWERMENT.
One of the first things I did when I realized my heart was set on a VBAC was to join a handful of Facebook groups where other women shared their experiences. It was so empowering to read stories of women who, like me, had an emergency Cesarean but went on to achieve successful VBAC outcomes.
Empowerment might look different for every woman. Whether you choose to read stories of VBAC successes, watch VBAC birth videos, or - yes - join a Facebook group, finding community through your VBAC research can be a great way to set yourself up for success.
It can also expose you to a variety of scenarios that may come up during your birth and open up the chance to have a dialogue with your birth partner or birthing team in advance of your labor and delivery.
3. DO YOUR OWN RESEARCH AND ASK QUESTIONS.
Induction? Epidural? Interventions? These decisions can shape your VBAC experience and are perhaps even more important to discuss with your prenatal care team this time around.
With my first delivery, nothing went according to plan. I found that with my second, I didn’t want a true “birth plan” but instead focused on learning about why a certain choice might be made and how to weigh the various options if that choice came up during labor and delivery.
For example, I read about induction - the pros and cons of inducing with a VBAC. At my doctor’s recommendation, I chose to wait for labor to start on its own, but I was armed with knowledge on the subject of induction if it came up (it hadn’t with my first).
When my labor stalled out around 5cm of dilation, despite my water breaking, we shifted paths. Induction it was. Instead of feeling scared and unsure, though, I felt confident that we were making the best choice based on the circumstances.
During my second pregnancy, I also blocked out time in the evenings to read articles about VBAC and brought a list of questions to almost every one of my third-trimester doctor appointments. It was a good way for me to feel certain my doctor was fully on board with my VBAC and a chance for me to align with her on my ideal birth experience.
I encourage every mom to do their research. It’s also likely that someone in your family or mom friend circles has concerns about VBAC, but in educating yourself on both risks and benefits, you’re prepared to put them at ease!
4. MAKE TIME FOR MOVEMENT.
Though there’s been little research, some studies suggest that increased physical activity can lead to greater odds of VBAC success.
Research aside, why not build in a daily walk or prenatal yoga sequence to your pregnancy routine? With the go-ahead from your doctor, physical activity is generally viewed as a benefit for both mom and baby during pregnancy.
I grew to love my neighborhood walks, even as they got more uncomfortable in the third trimester. I tried to make it a part of my routine to put on running shoes in the morning as I was getting dressed (because I found it was more likely that I’d actually go for a walk if my shoes were already on – third-trimester moms, you understand).
Physical activity is great for keeping your mental health in check, too - especially if you (like me!) start experiencing jitters and nerves as your due date approaches.
5. CLEAR YOUR MIND.
I hired a doula (virtually, due to COVID) for my VBAC experience, and she made it a point to check in with me regularly as I neared my due date. It turned out to be invaluable.
How was I feeling? What exactly was I nervous about? Did I have the right tools in my tool kit - meditation, affirmations, etc. - to mentally prepare for my VBAC? Did I feel optimistic about it? Was I feeling connected to baby? Was I shutting out negative thoughts, remaining focused on my goal?
In the weeks leading up, I took advantage of the quiet moments where I could unwind with a bath or some music and focus on the outcome I knew I wanted. While another Cesarean may not be completely off the table for any mom trying for a VBAC, choose to embrace a mindset of positivity: “I can do this. I can have a VBAC. I’ll process a Cesarean in my own way, only if it turns out that way.”
I spoke and willed what I wanted into existence - and while I recognize this alone doesn’t lead to a VBAC, it certainly helped my mental preparation.
And then it happened: the VBAC I dreamt about ever since my last pregnancy had ended dramatically with a rushed emergency Cesarean.
When my daughter entered the world - after days of on-and-off labor, the induction to help speed things along, and an hour and a half of pushing - all of the anxiety leading up to her birth was gone. I was truly on “cloud nine.”
That feeling stuck around for weeks - realizing I had achieved the outcome I so desired with my firstborn. My recovery was a lot easier, and it allowed me to be all-hands-on-deck for my energetic toddler.
Do I recommend VBAC? One hundred percent, yes. If it’s what you desire and your care team gives the go-ahead, know that it is so very possible. If you’ve made it this far and are considering a VBAC of your own: I hope you get it, too.
And while you’re here, I’ll say one more thing. Because it’s just worth saying. Because sometimes things DON’T go according to plan. I’ll be the first to admit that I learned this with my firstborn.
No matter how your baby comes into the world, your experience is valid. Repeat Cesarean or VBAC, your birth story literally makes a mom out of you. The right mom for your baby. What could be more beautiful than that?