Like many women, I never wanted to have a C-Section, but ended up with one anyway with my first pregnancy. I had breech twins so my babies were born through my abdomen instead of my vagina. When I became pregnant again, I knew I wanted to avoid another C-section; I wanted to have a successful VBAC or Vaginal Birth After Cesarean.
Due to this strong desire I went about educating myself about C-section vs VBAC, labor, childbirth, VBAC risks, VBAC success stories, hospital’s VBAC policies, and other VBAC facts. When it comes to pregnancy and childbirth, education is fundamental.
I am passionate about helping other women have successful VBACs for themselves (as long as it is their desire), so if you want to know how I’ve managed to have two successful hospital VBAC births, read on.
8 Tips for Having a Successful VBAC Birth
1.) Choose the Right Medical Team
This one is hard because of insurance, location, and availability. We aren’t always able to pick the best doctor due to various constraints. But, when you are doctor shopping, you need to know how your doctor feels about VBACs, what his VBAC success rate is, how many of his deliveries are C-sections, when your VBAC cutoff date will be, and so on. If your doctor sounds hesitant at all about VBACs, or says something like “we’ll see when the time comes” – RUN. This is not the doctor for you.
You want a doctor who says “I love VBACs! I do them all the time. I definitely recommend them over a repeat C-section, assuming you’re a good candidate for one.”
In Indianapolis I found an awesome Midwife who said exactly those words. She was very supportive, as was the OBGYN I worked with at the practice as well. They were so supportive they let me go 13 days past my due date in order for me to have a successful VBAC. They never pushed me into a C-section, at all. That’s the type of medical team you want. You don’t want a doctor who appears worried or concerned about your abilities to give birth vaginally.
I have always loved the breakdown of different practitioners and various types of practices found in the What to Expect® When You’re Expecting book, which is now in a brand new 5th edition with fresh perspective, up-to-date information and advice, and the same reassuring voice that you’ve got this! I really like that the new addition has brought Dad into the book throughout, and that it pretty much answers every imaginable question expecting parents could ask during their pregnancy and postpartum period (for better or worse sometimes!).
2.) Choose the Right Hospital to Deliver At
It’s ridiculous and idiotic that some hospital have a blanket no-VBAC policy, so before your TOLAC (trial of labor after cesarean) in a hospital do your research on the hospital itself and it’s relative high or low C-section and VBAC rates. This is important because you may end up having a different doctor or midwife delivering your baby at the hospital than your chosen one, because your he or she is not on-call the day of your delivery, or because of the way your medical practice works.
You also need to understand the hospital policies for VBAC mothers. Some are more loose with monitoring restrictions, allowing you use of intermittent monitoring. Some hospitals will let you take a shower or maybe even get into a birthing tub (many may not). Some will highly recommend an epidural “just in case.” Know what your delivering hospital’s beliefs and views on VBACs are ahead of time so you aren’t surprised and can stand up for yourself and the labor you desire.
3.) Know the VBAC facts
Here is a fact – a vaginal delivery is safer than a C-section. Period. It is recommended by the American College Of Gynecologists (ACOG) and heaps of research, yet because of malpractice and insurance, many hospitals don’t allow it. The biggest risk factor in delivering vaginally after a C-section birth is uterine rupture.
Uterine rupture is serious business as it can cause internal bleeding, an emergency hysterectomy, or even death for yourself and cause neurological complications and even death for your baby. Yikes! However, only about 5 in 1000 women (or 0.2 to 1.5% chance) have their uterus rupture (and P.S. your uterus can rupture during a repeat C-section and even in women who have never had a C-section) and thanks to constant monitoring and hospital staff and services, it doesn’t end up being very severe for most who experience it.
The other risks involved with having a VBAC are the same risks involved with all normal vaginal deliveries. The risks associated with C-sections are more serious than a regular vaginal delivery and the recovery period is much longer.
But here are some other awesome statistics about VBAC:
- The VBAC success rate is about 60-80% of women (or the same as any woman delivering a baby in the US)
- More than 90% of women who’ve had a successful vaginal delivery before their C-section have a successful VBAC
- 2 out of 3 women who previously had “Failure to Progress” have a successful VBAC
- Even with more than one previous cesarean, your odds of a successful VBAC are still 60-79%
4.) Be Patient and Trust Your Body and Your Baby
The waiting game is the worst. Ask me how I know! My son came 13 days after his due date. It was agonizing! But, if you who want to have a TOLAC, then you need to wait on your body and wait for baby to come when she is good and ready to come.
Medical professionals will most likely not induce a woman hoping for a VBAC with labor-inducing drugs like Pitocin as it increases your risk of uterine rupture (that scary thing you really want to avoid, as do your doctors). Neither of the practices I went to for my VBACs would do it (in two different states). However, both of my doctors stripped my membranes in the office (which finally got my labor started with my son) and I did a lot of walking and other things that are supposed to help induce contractions.
Your doctor can induce you in the hospital by breaking your water though, as my doctor did my last pregnancy with my daughter, as she had low amniotic fluid so it was time to deliver her as she was over 40 weeks. Thankfully, I was already having some contractions and dilation. A doctor can administer Pitocin or other labor-inducing drugs once you are already in labor, at low doses, and under medical supervision, should the need arise. I had some Pitocin administered during my daughter’s labor.
So, if you usually have long pregnancies, like me, and want a VBAC, you will need to learn patience and endurance. Otherwise you’ll be opting for the knife instead.
And even when you are laboring for a very long time (I was in labor with my son for like 36 hours), and just want to give up, remember that the recovery will be better with a vaginal delivery! Be patient even during labor. Make the doctor be patient with you and the baby too, and don’t let them force you into a C-section too soon. If baby isn’t in true distress, don’t fret! Give him some more time.
5.) Know if you are a good candidate
Take a VBAC calculator for a spin, or understand that, basically, you’re a good candidate for a VBAC if you meet the following:
- Your C-Section was a regular, low-lying cut that wasn’t extended and was a two-layer suture.
- Baby’s placenta isn’t low-lying or covering any of the C-section scar or your cervix.
- Baby is head down (vertex).
- You’ve never had a uterine rupture.
- You haven’t had extensive uterine surgery like myomectomy or have large fibroids
Other helpful factors for a successful VBAC delivery are:
- You start pregnancy at a healthy weight and keep your weight gain on target
- You have smaller babies (less than 8lbs 13oz – although both of mine were over 9lbs so don’t fret!)
- You go into labor on your own just fine
- You don’t have high blood pressure
- You don’t have gestational diabetes
- Your pelvis is normal to large in size.
- You deliver before 40 weeks
- You’re younger
- You got pregnant more than 18 months after your C-section
6.) Consider your birthing options
While many practitioners will recommend a hospital for your VBAC delivery, in case of any complications, but know it is not an absolute must! Many women have very successful, non-scary, home-birth VBACs. You will have to do your own research, prayers, and decisions on what you feel the most comfortable with for yourself and your baby.
If the hospital in your area refuses to do VBAC, a home-birth or birthing center might be your only option if you’d like to have a successful vaginal birth after cesarean.
7.) Take the Labor Birthing Classes and/or Hire a Doula
I have yet to take a real birthing class. Every pregnancy I tell myself I will, and then time and money prohibit me from actually doing it, but I believe being confident in your body and your birthing abilities, and having a real game plan for when contractions strike will make a huge difference in your success of having a VBAC.
I have though taken my friend’s online prenatal class! She’s been a registered labor and delivery nurse for 15 years, has three kids of her own, and knows her stuff. Plus, she’s funny and down to earth.
If you plan to labor naturally seriously consider hiring a Douala, because as awesome as our husbands are, they aren’t professional birth coaches. Once again – power is knowledge – so learn all you can from professionals and get the support you need so you can have the birth you desire.
8.) Wait as Long as You Can for the Epidural
If you are worried about labor stopping, slowing, or stalling or have other epidural-related concerns, wait to get one until you are well on your way to delivering. Of course, this is optional. You don’t have to get an epidural at all, and many women deliver just fine after getting an epidural while only dilated at 3 or 4 centimeters. Receiving an epidural will not cause your attempted VBAC to fail. It will not automatically mean a C-section.
I’ve had two epidural VBAC deliveries and of large babies. So have many others.
There are mixed reviews about epidurals and lots of conflicting studies and findings about what they do or do not cause. Do your own research, starting by checking out all the information about them in What to Expect® When You’re Expecting and asking your doctor other questions you may have about them.
I cannot guarantee that your TOLAC will turn into a successful VBAC, but following and considering these eight tips will help you reach that goal.
Be educated. Know your options. Know your body. And pray for success!
For more VBAC birth tips see this Parents’ article: “6 Tips for Getting the VBAC You Want.”
I was selected for this opportunity as a member of Clever Girls and the content and opinions expressed here are all my own.