

Preparing for a VBAC

Considering or committed to having a hospital VBAC birth?

If so, you might be wondering how to prepare, both logistically and emotionally, to give yourself the best odds of having the outcome you want.  The VBAC rate has fallen dramatically in recent years, making preparation and planning very important.

So we assembled this list of steps you can take in preparing for a VBAC.  Consider it a starting point, and feel free to add to it in the comments!

oose providers carefully, and don’t be afraid to shop around.  Probably the most important decision you’ll need to make is your choice of provider.  Obstetrical and midwifery practices can have widely varying VBAC success rates, so it’s important to shop around.  This might lead you to change providers, which you can do even in the final weeks of pregnancy.  You may feel uncomfortable switching practices or shopping around, but a provider’s VBAC history is the factor most likely to determine a birth outcome.  Concerned about having to drive a little longer to get to the hospital?  One mom we know puts it this way:  Would you drive an extra 15 minutes to get to a good hairdresser?  (And in a true emergency you’ll end up at the closest hospital anyway).

How should you judge the best place for a trial of labor?  Look at the practices’ VBAC rates, including the number of women who have had a trial of labor and the percentage of those labors which ended in VBACs.  If this isn’t available online, call and ask the practice for their rates in the last year or two.  If they are unwilling to share this, consider that important information.  Also check the hospital’s rates, which are more likely available online, but understand that most hospitals host several practices, so this number is a combination of the practices’ rates.  When interviewing providers, try to learn as much as possible about practices’ VBAC policies:  How long can you go “post dates” and still try for a VBAC?  What kind of monitoring do they do?  Can you labor in water?  If you end up with a CBAC, can your doula be present in the operating room?  What do they think makes someone a “good candidate” for a trial of labor?  In your search, remember that, while there are many wonderful obstetricians, certified nurse midwives in general have lower cesarean rates.

An important tool in researching your options is the International Cesarean Awareness Network (ICAN) website’s VBAC policy database.  ICAN members contacted every maternity hospital in the U.S. to determine which had bans on VBAC - both outright and “de facto” (those without an official policy but in which no practice would attend a VBAC) - and found that roughly half of all hospitals do not allow a trial of labor.  So you may want to begin here in your research.

Hire a doula.  Labors with the trained support of a doula are less likely to send in cesarean births, so be sure to have a doula or other trained labor support person present.  When looking for a doula, try to find one who has experience with VBAC labors and who is knowledgeable about providers’ VBAC practices and policies.  If you can’t afford one, see our post on ways of finding good labor support when a doula isn’t in the budget.

Get peer support from other mothers who are in your position.  Even when mothers get great support from their providers and partners, it can be isolating to try for a VBAC and it’s often very powerful to have peer support from people who understand how you feel.  ICAN is one such organization, and you can find a group here.    If there isn’t a group near you, you can find support in their closed Facebook page, and the forums of a number of other websites.  You may also want to read VBAC birth stories, and there are many on the ICAN website.

Learn non-medication based methods of reducing discomfort in labor.  As with birth generally, the longer you can relieve pain without using medication during a trial of labor, the better your chances of having a vaginal birth.  That’s because medication-based means of pain relief often trigger a “cascade of interventions” which leads to a cesarean.  So learn about ways of relieving pain, such as movement, deep relaxation, partner massage, visualization, breathing, water, and others.  Of course, it’s definitely possible to have a VBAC with medication, so if your labor ends up going in that direction all is not lost!

Learn about fetal positioning.  If your cesarean birth was due at least in part to fetal positioning (having a posterior or “sunnyside up” baby), learn more about that topic and choose providers (including doulas) who are skilled at helping babies settle into optimal position for vaginal birth, including during labor.  The Spinning Babies website and chiropractic care from someone trained in Webster’s Technique can be helpful.  Be sure to listen to our podcast on posterior babies and what can be done to change their positions, including the “belly lift” and “sifting” with a rebozo.

Prepare for the possibility of another cesarean birth.  Even moms who are completely focused on having a VBAC need to have a back-up plan they’re comfortable with.  Explore the possibility of family-centered cesarean, which may include options such as doing skin-to-skin and/or breastfeeding in the operating room, having your arms free to touch the baby, a slower birth through the incision, lowering the drape so you can see the baby being born (if you want), and other less frequently used practices.  Meet with the obstetrician who would be performing the cesarean to work out your backup plan.  And you may want to listen to our podcast on family-centered cesarean.

Work on processing past experience.  If the prior cesarean was traumatic and strong feelings are affecting emotional preparation for your next birth, do the hard work of processing it.  EMDR and other therapies can be very useful for this.  Discuss your prior experience with your providers and briefly explain it in your birth plan.  Other emotional preparation, such as visualizing a repeat cesarean or peering into the OR, may be useful.  You may also want to read our post on getting help for traumatic birth experiences or listen to our podcast on traumatic birth.

Stay active.  Exercising reduces your risk of gestational diabetes and having a large baby, both of which can affect your chances of having a VBAC.  You’ll also be in better shape for the workout that is labor and birth.

Finally, you may want to listen to Motherlove’s podcast on VBAC - an interview with he president of ICAN.