Hey there guys!
Been a while since I’ve been up on the blog! Life has been crazy! Some awesome births, fertility treatments, and a new kitten named Bugatti have all been keeping me away from the blog! Time to throw some new stuff at you today!
Let’s talk VBAC! Don’t know what it is? A VBAC is a Vaginal Birth After Cesarean Section.
VBAC delivery is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level. (American College of Obstetricians and Gynecologists November 2017)
Ever heard the phrase “Once a Cesarean, Always a Cesarean?” I am here to tell you that my friends is a fallacy! Many women successfully VBAC every day, even after multiple sections!
Cesarean mama? Pregnant again? Trying to avoid the longer recovery and major surgery this time? This post is for you!
Prepping for a VBAC
Finding a VBAC-Friendly Provider
If you are looking for a VBAC, the first step is finding a truly VBAC friendly provider. Keep in mind, there is a difference between a VBAC TOLERANT provider and a VBAC FRIENDLY provider.
Where to start looking? Well, of course as a doula I am going to recommend that you ASK YOUR DOULA! (If you haven’t hired one- start looking for her first!) But there are other ways to help you find a VBAC Friendly Provider if a doula isn’t in the budget. These include: Attending a local ICAN Chapter Meeting http://www.ican-online.org/find-a-chapter/ and/or chat with doulas, childbirth educators, and nurses who work in your community. They have the unique experience of observing providers over long periods of time, so they can give you the inside scoop. I also think it’s worth your time to call your local hospital and talk to the L&D nurse manager. Ask them who attends VBAC.
Also very important is to do your best to get a copy of your surgical/operative notes from your cesarean section. Call the doctor’s office or hospital where the surgery was performed and get a copy of these notes. Any doctor or midwife performing a VBAC will likely need them going forward. (keep in mind there may be a small fee for copying your records).
If you are a good candidate for VBAC, the single most important decision you can make that will have the greatest impact on your chances of VBAC success is who you hire to attend your birth. This is why it’s important to interview several care providers and ask specific questions.
Questions You Should Ask
The key to all of these questions is that they are open ended. The trick is to ask the question and then sit back and really listen.
What is your philosophy on planned VBACs?
What is your philosophy on planned VBACs going past 40 weeks?
What is your philosophy on suspected “big babies” (macrosomia) among planned VBACs?
How many VBACs have you attended?
Of the last 10 planned VBACs you attended, how many had a VBAC?
What is your philosophy on inducing VBACs?
What is your philosophy on monitoring planned VBACs?
Does your hospital have telemetry (wireless monitoring)? How often is it used?
What is your philosophy on waters being broken for more than 24 hours?
How long do you think it’s safe for VBACs to labor?
What is your philosophy on epidurals in planned VBACs?
What are your standing orders for planned VBACs and do they differ from your standing orders for first time parents?
How does your on-call schedule work?
What is your cesarean rate?
What are your thoughts on movement during labor and delivery positions?
What is your philosophy on IV or saline lock?
Do you offer family-friendly cesareans?
In the event that the baby isn’t head down, do you manually turn babies? (This is called an external cephalic version or ECV.)
Do you attend vaginal breech births? If not, can you refer me to a provider who does?
Do you attend vaginal twin VBACs?
Do you attend VBAC after 2 cesareans?
Do you attend VBACs with a classical (high vertical), T, or J scar?
Do you attend VBACs with a low vertical or unknown scar?
Answers to these questions and more can be found at www.vbacfacts.com/courses/
**This is a very comprehensive list of questions from VBACfacts.com and the questions are meant to be open ended and many will not apply to you. You will want to ask these questions during a consultation- NOT during an exam where you are wearing a paper gown if at all possible.**
So What Are The Risks?
Are there risks? Potentially, but according to ACOG, “Most maternal morbidity related to TOLAC (Trial of Labor After Cesarean) occurs when repeat cesarean delivery becomes necessary.” Meaning, the greatest risks are associated with a REPEAT CESAREAN in most cases. Because of this, VBAC is associated with fewer complications.
Uterine rupture associated with TOLAC is considered the most significant risk when we are talking VBAC. Despite fear mongering tactics amongst many providers, the actual numbers are relatively low. A recent study (less than a year old!) by ACOG shows that the risk in a repeat cesarean is only 0.02%, whereas a TOLAC is 0.71%. Yes, a VBAC attempt is higher, but the odds in either case remain UNDER 1%, making this a rare complication.
The biggest factor influencing the chances of uterine rupture would be the location of the prior cesarean incision on the uterus. Several large studies of women who had received a vertical, T, or J type incision have experienced higher rates of uterine rupture. This is why it is SO IMPORTANT to get a hold of your prior surgical notes to determine what kind of incision was used in your prior delivery or deliveries! Keep in mind that the incision you see on your lower abdomen does not always match the incision that was performed on your uterus- so these notes truly are CRITICAL in determining whether or not a TOLAC/VBAC is a safe option for you.
If you are looking to have a VBAC, you are in luck! VBACs are relatively safe and a reasonable option for most pregnant women. Get a copy of your records, hire a doula, and find a VBAC Friendly Provider. I have attended many successful VBACs as a doula, and am always happy to assist a mama in getting more information and finding a provider that is a great fit for them! If you are a mama in Mississippi or North Florida, reach out to me! I have worked with plenty of providers in both locations and would love to recommend one for you! Living elsewhere? I will gladly help you get in touch with someone in your area to help guide you on your journey!
Check out my website at www.doulainmississippi.com or email me at firstname.lastname@example.org for help starting your VBAC journey!
PS: BONUS MATERIAL!
CHECK OUT ICAN’S VBAC CHECKLIST! http://www.ican-online.org/wp-content/uploads/2014/06/VBAC-Checklist.pdf
2015 VBAC RATE’S BY STATE FROM EBB: https://evidencebasedbirth.com/2015-vbac-rates-by-state/