Preparing for a successful VBAC Birth
VBAC birth stands for “vaginal birth after cesarean.” Currently, 33% or 1 in 3 birthing people will give birth by cesarean in the United States. This is significantly higher than the World Health Organization’s recommended 10-15% cesarean rate. This article will tell you how to best prepare for a VBAC.
With that said, cesarean births are valid and necessary. They are not “the easy way out.” No mother goes into a major abdominal surgery lightly. Choosing whether to attempt a VBAC or have an elective is a personal decision and neither is ‘bad.’ The most important thing is that the birthing person has a voice and is able to choose from a place of education and support and not from a place of fear. Too often, pregnant people are scared into a decision or choose a particular path because they do not realize that there are other options. Too often, pregnant people do not realize that VBAC is a safe and valid option. Or they are scared into believing that a repeat cesarean is the only way. This article aims to educate on the facts. So that the birthing person can decide for themselves which way is right for them. We also aim to educate on how to best “stack the cards in your favor” to achieve your VBAC, if you decide that this is the way you would like to go!
Vaginal Birth after Cesarean (VBAC) Stats
Most individuals who have previously had a cesarean, choose to have a repeat elective cesarean. Currently, there is an 89% repeat cesarean rate and an 11% VBAC rate in the United States. Of the 11% who have a trial of labor after cesarean (TOLAC for short), approximately 60-80% will have a vaginal birth. While a VBAC is not right for everyone, it is a safe and valid option. Those who have had a VBAC often describe the experience as empowering and often note that the recovery is easier than their recovery from a cesarean, which is a major abdominal surgery. While not all who attempt to birth vaginally after cesarean (TOLAC- – trial of labor after cesarean) will have a vaginal birth, there is some evidence to support the idea that laboring, even without being birthed vaginally, is actually good for the baby.
What does the research say?
According to the research, VBAC is likely to be safer, if there is no medically indicated reason for a cesarean. Additionally, the risks associated with cesarean increase with more of them performed. So someone who is planning more pregnancies may want to consider vbac as a safe and valid option. Multiple cesareans increase the risk of complications such as placenta accreta, placenta previa, and placental abruption. Interestingly, the risk of uterine rupture (which is .87% of those planning their first vbac) actually decreases with each subsequent vaginal birth. The risk of uterine rupture is actually about the same as the risk of other birth complications that can occur, even amongst those who have never had a cesarean such a shoulder dystocia and hemorrhage.
While this can sounds scary, it is rare and not more risky than complications that can occur during a cesarean section. With that said, it is important- no matter whether you are planning a VBAC or a Cesarean that you have a provider that you trust that, in the event of a rare complication, knows how to appropriately intervene. It is also important to not only look at the research, but to listen to your gut. Only you get to decide and your choice, no matter what it is, is a valid one.
I was told that my pelvis was just too small for VBAC
Here’s the thing. The pelvis is not a fixed entity. It is impossible to know for sure what it will do during the process of labor and birth. The pelvis is held together by muscles and ligaments and these muscles and ligaments are also not fixed. Meaning- the pelvis shape can change- both during the birthing process and based on how we move it throughout our lives. CPD (Cephalopelvic disproportion) is a real thing, but it happens much more rarely than it is diagnosed as the cause for cesarean. Often CPD is associated with pelvic anomalies. In the past, when nutrition was not so readily available, CPD was observed in those who were malnourished as children while the pelvis was growing. Another occurrence that is commonly overlooked when the CPD diagnosis is slapped on is the position of the baby. A baby whose chin is not tucked, whose head is tipped to the side, or who is in the posterior position has a greater surface area that needs to make its way through the pelvis. It is rather common that I see individuals who were told they were simply “too small” to birth their babies go on to birth babies that are 1-2 pounds larger vaginally with no issue. With this said, there will be a small segment of individuals who truly have CPD.
What everybody wants to talk about- uterine rupture.
There is a lot of fear and misinformation being spread about uterine rupture. So let’s just lay out the stats. Less than 1% (.87% to be exact) of those laboring for their first VBAC will have a uterine rupture. This is roughly equal, if not slightly lower, than the % of complications that can occur across all those giving birth (not just those planning to VBAC) such as shoulder dystocia and hemorrhage (though risk of hemorrhage is higher during cesarean birth). This is not to say that uterine rupture is not a valid concern, it is. But we must also look at it from a statistical standpoint. It is indeed a rare occurrence. Additionally, after each vaginal birth, the risk of uterine rupture goes down. But with each cesarean performed, the risk associated with the surgery actually goes up.
How to best prepare for a VBAC Birth
1. Find a supportive provider
The number 1 way to stack the cards in your favor for a VBAC is to have a provider who is truly supportive of vbac. There are too many stories of “bait and switch” where providers seem to be on board with plans to VBAC until the last minute, when they suddenly change their tune. This is not only stressful, but also makes VBAC much more difficult. The best way to figure out if you have a supportive provider is to first, reach out to your local ICAN (international cesarean awareness network) chapter and your local birth community (doulas, childbirth educators, etc) and ask them which providers they see as the most supportive of VBAC. The next step, is to look at the following chart and start to ask your provider questions to learn if they are VBAC Supportive or just VBAC Tolerant. VBAC tolerant providers attend them sometimes, but everything has to line up a certain way.
2. Prepare your body
Preparing the body for birth is an important and often overlooked step of preparing for a VBAC. Our body responds to the input place upon it. Meaning, when planning for birth, it is important to we input it with movement that allows for a mobile, balanced pelvis. Have a pelvis that MOVES well is hugely important. At OSM, we have a multi pillared approach to preparing the body for birth. Two critical pieces of the puzzle that I would like to discuss are sacral mobility and pelvic floor yield. Please see our full program HERE for all the pillars and a full prepare your body for birth program.
The sacrum is part of the pelvis that is designed to MOVE via the sacroiliac (SI) joints. There are certain movements, such as sitting on the sacrum all day, that can create immobility and lack of balance in the sacrum. For this reason, it is incredibly helpful to learn exercise, alignment, and nourishing movements that allow for sacral movement, so that it can move more freely during childbirth.
Pelvic Floor Yield:
Sometimes, if the pelvic floor is hypertonic or “too tight,” it can make it more difficult for it to yield to allow for a baby to come through. We ideally want a pelvic floor that is strong enough to hold up our organs (and our pee when we sneeze!), but also is able to yield. A too tight muscle is not a stronger muscle, it is just tighter. And tighter often equals less functional and can also be associated with a lot of pain. Learn how to keep the pelvic floor strong AND yielding throughout pregnancy (and life!). Hint: 100 kegels a day is not the ticket and can actually create issues for many.
3. Prepare your mind
Just as important as preparing the body for birth, is preparing the mind. Many times, when someone has had a previous Cesarean (and even many who haven’t!), there is birth trauma. It is so important to be able to release that trauma and fear prior to going into the next birth experience. There are many ways to do so including speaking to a therapist who is training and experienced in birth trauma, mind-body modalities, and one of my favorites is Hypnobabies or other hypnosis for childbirth programs (I am partial to Hypnobabies as I used it for 3 of my births and attend many Hypnobabies births, including VBACs). I explain it this way: if you go into a marathon, even if your body is ready, and the entire race your inner dialogue says “I suck, my legs hurt, I am tired, I can’t do this this is hard…..” how far do you think you’ll go? Same too with birth, we need to prepare our minds, ahead of time. There is so much going on beneath the surface that it is better to address prior to birth. If not addressed, it may be much more difficult to let go in the way birth necessitates we do. need to prepare our minds, ahead of time. There is so much going on beneath the surface that it is better to address prior to birth. If not addressed, it may be much more difficult to let go in the way birth necessitates we do.
4. Hire a doula
Research has shown that doulas improve birth outcomes. They lower the risk of cesarean by anywhere from 28%-56% depending on the study. They can help you know your options, support you while you consider the pros and cons of interventions, support the emotional journey of TOLAC, cesarean or VBAC both prenatally, during the entire birthing process, and postnatally, and many are trained to help with baby positioning and creative birth positions to make the process of birth go smoother.
As a doula myself, I attend many TOLAC/VBACs and everyone needs support a little differently. Some need a lot of emotional support prenatally, others need more use of creative birth positions, and others maybe need more postpartum support in processing the birth experience. Support will look differently each birth and with each family, but the thing that does not change is that continuity of care. A doula is with you through your pregnancy, entire birth experience including time you labor at home, and is there to check on you after the birth. Interview a few doulas to find the right fit for you. Look for someone who is experience with VBAC, understands baby and body positioning (even better if they are Body Ready Method aware, our upcoming program for birth professionals).
Whatever you decide for your birth, decide it because it is what YOU want, not because of fear or what other people think you should do. Truly, there is no one right way to give birth.