There are many reasons why mothers want to deliver vaginally after having a cesarean section with their first child. Maybe they feel a desire to deliver naturally; maybe they don’t want to go through the recovery process of major surgery again. Whatever the motivation, if you’ve decided to try for a VBAC—a vaginal birth after caesarean—a little due diligence along with a well-strategized VBAC birth plan will help everything go a little more smoothly.
Creating a VBAC Birth Plan
Of course, some elements required for having a successful VBAC are out of your control, and you must meet some basic criteria before your practitioner will allow you to try for one: Your uterine incision from your c-section has to be low transverse or low vertical, your surgery must be well documented and include a clear note on why you needed a c-section, and you and baby should meet a general set of characteristics that make you less likely to run into complications during a VBAC.
If you meet all the criteria, then it’s time to think through the whole VBAC process before the big day. Discussing any concerns and needs with your partner and practitioner and putting together a VBAC birth plan—a clear picture of what your ideal birth experience should look like—will go a long way in making sure you have a positive experience, no matter what happens. Here, some top tips to help you prepare for a successful VBAC.
1. Find a VBAC-supportive practitioner
The most important thing you can do when trying for a successful VBAC is find the right practitioner, says Mari Melby, a childbirth educator and doula in Minneapolis. Look for a provider with a strong record of VBAC success, she says. That doctor should be very clear up front that she supports mothers who’d like a VBAC and that she’ll try everything possible to make it happen.
Be aware, though, that many doctors and midwives aren’t as likely to recommend VBACs today as they are repeat c-sections because of concerns about medical liability and the ability in an emergency to offer immediate qualified help—like access to an anesthesiologist and an operating room staff, says Yvonne Butler Tobah, MD, an ob-gyn at the Mayo Clinic in Rochester, Minnesota.
Reach out to labor-and-delivery nurses, childbirth educators and doulas in your community (if you don’t know any, ask friends and other health care providers who do). These birth professionals tend to have insider knowledge on which providers are VBAC supportive (and which ones might cut short a trial of labor before it’s necessary). Checking cesareanrates.com to find hospitals in your area with a higher percentage of VBAC rates may also lead you to a VBAC-supportive provider.
2. Take your time in signing the VBAC consent form
If you’re about to sign a consent form, then you’ve presumably already done the research needed to get this far in the VBAC birth plan process. (If you feel you should get up to speed, check out What You Need to Know About VBAC.) Many practitioners hand you a VBAC consent form early on in your pregnancy that lays out the risks and asks you to acknowledge them after you’ve discussed them together. “I always say [to patients] that I’m not going to have you sign this today because we don’t have the end of the story,” says Lynne Gibeau, MD, an ob-gyn and staff physician at the Mother Baby Center/Abbott Northwestern Hospital in Minneapolis. This leaves room to talk about health complications or other worries that arise during your pregnancy as you get closer to your due date, she says.
“When a patient arrives at the hospital in labor and has had a prior c-section … I say, ‘Okay, these are the risks and this is how it looks right now, are you good with this?’ And then I have them sign the form; only then do I feel like we have had much more of the story,” she says.
If you find yourself wavering between trying for a vaginal delivery and going for a c-section, then securing a spot on the calendar for the surgery should be part of your VBAC birth plan—just in case. “A hospital schedule shouldn’t dictate how your baby is born,” Gibeau says, “but we also live in this world [in which] we need some semblance of order. If you feel you’re on the fence, pick a time where you think, if it gets to this point, then I’m okay with a c-section—that’s usually 41 weeks.”
3. Have a VBAC Plan B
Like any birthing process, the outcome of a VBAC attempt is hard to predict. Sixty to 80 percent of VBAC attempts succeed—which means, unfortunately, there’s still a considerable chance that you might end up having an unplanned c-section after a trial of labor anyway.
How your labor proceeds will dictate a lot of what happens, but putting into place what you can will help make even an unsuccessful VBAC attempt feel like a triumph.
• Talk with your practitioner about what type of medications you would prefer if it comes to surgery, whether it’s an epidural, a spinal block or a combination of the two. “I prefer an epidural or a spinal epidural over just a spinal block,” says William Schweizer, MD, an ob-gyn with NYU Langone Health in New York City. “I like the idea that [an epidural allows us to] give the patient added medication postoperatively.” He also says that an epidural is less likely to make a patient feel nauseated than other types of anesthesia.
• Think about your last cesarean: What went well and what didn’t? Use that knowledge to inform your VBAC birth plan. Then talk with your provider about what you’d like to happen the second time around, should it be necessary. Did certain medications make you horribly queasy the first time? Ask your provider about making any adjustments. Did you like that you were able to nuzzle your newborn cheek-to-cheek before being cleaned up? Plan with your provider to make sure that happens again should you need a second c-section.
• Ask if the physician provides a “gentler” version of a c-section—a c-section that allows the mother to be more involved with the birth. When Melby looked for a provider, she made sure this was an option, in case her VBAC didn’t work out. (Fortunately, it did.)
One of the biggest upshots to a VBAC is the shorter recovery time versus a c-section. A VBAC recovery is comparative to a regular vaginal birth: If all goes well, your time spent in the hospital should be one to three days shorter than what you’ll have after a cesarean (in most cases, you’ll have to stay two days, tops). You also won’t have the anesthesia hangover that often comes with c-sections, which means you’ll be less nauseated and you’ll feel more engaged with your new baby.
You get to walk almost immediately after a VBAC—or when your legs are no longer numb if you had an epidural—which means a shower as soon as you want.
With a VBAC recovery, you won’t have a sore stomach and a painful incision to avoid as you’re trying to breastfeed. Just keep in mind that sitting down after delivering vaginally is no picnic, especially if you’ve had an episiotomy or if you popped a hemorrhoid or two. And be prepared for the postpartum blood leakage—called lochia—which will have you wearing teenage-size maxi pads (and those crazy netted underwear!) for at least a week.
What else you can expect from a VBAC? Experiencing the confidence that goes along with any second or subsequent birth: You’re already a pro when it comes to handling a newborn and knowing how to respond to your baby’s needs.
Published October 2017