Many women who delivered their first child through C-section assume that a vaginal birth after C-section—VBAC, for short—is impossible for their second child. In truth, the answer is a bit more complicated than that. So, for those interested in their options, we tracked down three people who have experience with the matter: an OBGYN, a doula and a real mom who went through it. Here, their advice on VBACs.
VBAC Tips from an OBGYN
Obstetrics and gynecology physician Charlsie Celestine, M.D., had a lot to say on the matter—in fact, she hosts an entire podcast, For Vaginas Only, dedicated to common and not-so-common topics that have to do with women’s health and pregnancy. Here’s what she told us.
Education is key
Celestine encourages women to know what they’re in for. “Many women out there believe that after one C-section they are locked into C-sections for life, and that may not be the case,” she says. “Not everyone with a prior cesarean is a great candidate for a VBAC, but that doesn’t mean it’s not an option. Having this discussion with your doctor is important to fully understand if you have a good chance of a successful VBAC.” She notes there are lots of great and trustworthy resources on the subject, like Celestine’s own podcast or the American College of Obstetricians and Gynecologists (ACOG).
Know the risks
In terms of risks, Celestine warns about uterine rupture, which can be traumatic for both mom and baby. (However, that risk is less than one percent for those who have had only one cesarean.) Celestine elaborates, “The risks involved with having to undergo a cesarean section after attempting to have a vaginal delivery are higher than the risks with electing to have a repeat C-section instead of a VBAC, but lower than the risks involved with a successful VBAC.” OK, so what does this mean? Well, generally speaking, a successful VBAC is the least risky in terms of outcomes for both mom and baby, however a failed VBAC has more risk than deciding you want to skip the VBAC and have a repeat C-section instead. Still, Celestine says, “I definitely do not say that to discourage anyone. But, when making a decision for yourself, your baby and your family, it is important to know not only the great benefits of VBAC but the risks as well.”
Choose the right doctor and hospital
“Some doctors and hospitals,” Celestine has noticed, “do not perform VBACs, or they may have special policies in place specifically for how they handle VBACs. Make sure you find the right physician and hospital that will support your desire to have a VBAC.”
Be OK with the fact that a C-section may still happen
As a physician who performs VBACs, Celestine makes sure her patients know she is on their side, but sometimes, a repeat C-section is inevitable. “As their doctor,” Celestine explains, “I am prepared for that possible outcome, and it is important that my expecting mom is aware of that possibility as well.”
VBAC Tips from a Doula
As a doula with 12 years of experience, founder of Expecting NYC Kristy Zadrozny has helped many expecting parents form a birth plan they feel comfortable with. Here’s her take on VBAC.
Set yourself up to succeed
Zadrozny told us that the key to having a successful VBAC is having the support of your care provider. “Make sure your doctor or midwife are not only supportive of a VBAC but are also well practiced in delivering babies that way. Find out about your individual provider's VBAC rate.” And while no provider can promise you an outcome, Zadrozny says “Feeling like you have a participatory relationship with your OB is key, so start talking with your provider early in your pregnancy. Ask what the VBAC plan might be, how would this look, how can you set yourself up for success.” While our culture often focuses solely on the outcome, Zadrozny’s viewpoint is that “childbirth is more of a process. And feeling satisfied with one’s birth is the goal here, regardless of the VBAC outcome.”
Avoid “waiting to see”
Procrastinate much? Zadrozny highly encourages you don’t wind up in this scenario: “36 weeks pregnant and you just found out your provider isn't comfortable with you going past your due date, so they schedule a surgical birth.” In other words, Zadrozny explains, “Obstetrical practices have different comfort levels around VBACs, which reflects the way they care for their patients and so you want to align yourself with a practice that resonates with you.”
Stay active and nourish yourself during pregnancy
According to Zadrozny, “Staying active during your pregnancy, eating nourishing foods and keeping your oxytocin levels high” all aid in labor. She continues, “Do the things that bring you joy and surround yourself with a solid support team including dear friends and family, your doula and allied health professionals like massage therapists, acupuncturists and fitness trainers.”
VBAC Tips from a Real Mom Who Did It
And finally, the ever-practical advice from a real woman who had a VBAC.
Don’t assume that just because you’ve had one kid, you understand how birth works
“My first child came out via planned C-section (due to breech). But still, I thought that because I had been pregnant before and had done all the reading and birth classes back then, I’d be totally prepared for a vaginal delivery the second time around. Well, cut to the part where I show up to the hospital, convinced I’m in labor (remember, I’d never felt a contraction before!), get sent home, and then wait too long to go back to the hospital and essentially deliver in triage. Oh, and I also had zero techniques for breathing, pushing, etc. because, again, I was too cocky to do one iota of research. (Although, in my defense I also had a toddler to contend with.)” – Jillian, Brooklyn, New York
Moral of the story: As goes with any birth plan, be as prepared as you possibly can. Talk to your doctors, your birth support team and your partner to make sure you all are on the same page regarding your VBAC. Things may not go as planned—and they probably won't—but familiarizing yourself with the potential outcomes will give you a little peace of mind.