More than a third of all babies born in Northern Virginia and Metro DC (35-40% depending on the hospital) are delivered surgically. Every C-section leaves parents with a decision to make if they become pregnant again: repeat Cesarean section or vaginal birth after Cesarean (commonly referred to as VBAC)?

Talk to your doctor or midwife about your options. Based on your medical history, they can make recommendations to help you achieve the birth experience you desire. Your choices may include:

• Scheduled Cesarean birth
• Gentle or family-centered Cesarean birth
• Laboring to achieve a vaginal birth
• Hospital or home birth (depending on your primary care provider)

 

If you feel that vaginal birth is suitable for you and your primary care provider disagrees, get a second opinion from another maternity care provider. Some doctors and midwives are more comfortable and experienced with VBAC than others. Your local ICAN support group is an excellent resource for discovering if your doctor is VBAC friendly.

Think a VBAC might be right for you? Let’s talk VBAC facts!

 

VBAC (Vaginal Birth After Cesarean) has real benefits for you and your baby.

Your desire to experience a vaginal birth is valid all on its own. Still, successful vaginal birth after a Cesarean section has significant benefits compared to a repeat Cesarean birth. 

According to The Mayo Clinic, possible Cesarean side effects include:

• Infection of the incision site
• Postpartum hemorrhage
• Reactions to anesthesia
• Blood clots
• Infection of the uterus
• Risks associated with multiple C-sections, such as placenta accreta and previa, where the placenta becomes embedded in the scar tissue of the uterus and cannot be easily removed.
• Surgical injury to the mother, including organ damage and (very rarely) death
• Breathing problems for the baby
• Surgical injury to the baby
• Increased likelihood if NICU admission
• Multiple other long-term medical problems.

 

By having a vaginal birth rather repeat cesarean section, your risks of the above side effects are either greatly reduced or completely avoided.

 

 

Are there are risks associated with VBAC?

When you are laboring to achieve a VBAC, it is called TOLAC (Trial of Labor After Cesarean). A successful VBAC has similar risks to any other vaginal birth. Some people choose not to attempt a VBAC because there is an *small* but still possible risk of uterine rupture. This risk increases depending on the type of incision you received during your previous C-section.  A uterine rupture can harm both you and your baby.

 

Uterine rupture may occur in 0.5% of all TOLACs (meaning 99.5% of all women successfully have a VBAC without incident). When it happens, the uterus tears, usually along the line of the previous C-section scar. Uterine rupture requires immediate surgery, and in up to 5% of uterine ruptures there are further complications. Your risk factor is increased (but still very low) if your:

• most recent birth was less than 18 months ago
• labor is induced or augmented

 

The above risk factors do not mean that planning a VBAC is unsafe. Uterine rupture is rare. Your doctor or midwife and your doula can help you weigh the risks and benefits based on your goals for birth.

 

A VBAC Certified Doula can help you meet your goals for a vaginal birth.

Choosing a VBAC can feel overwhelming. A Certified VBAC Doula can help you navigate the uncertainty and increase confidence to have a vaginal birth after a prior Cesarean. Our VBAC Doula Package includes bonuses like:

 

• Birth Reflection prenatal session to help process your last birth.
• 1 week VBAC Prep Method program to help you prepare.
• Comfort Measures and Labor Techniques session workshop.
• VBAC hypno-birthing MP3 file
• VBAC Essentials Guidebook
• Exclusive VBAC Resources Page

 

There is such thing as VBA2C and VBA3C!

You may still be able to plan for a vaginal birth if you have had more than one Cesarean section. Although the chances are very low, there is a slight increase in rates of uterine rupture for VBA2C, with a rate of approximately 1.4%. ACOG suggests that VBA2C is still a very reasonable option and not a contraindication.

Many providers discourage their patients from trying for a VBA2C, when in fact, the chances of having a successful vaginal birth after two C-sections is pretty high. Research shows that people who decide to have a VBA2C will have a 71.1% success rate. 

One of the biggest hurdles for people who want to go forward with delivering vaginally after two C-sections is that it can be hard to find a provider who is up to date with the VBA2C facts and statistics and will truly support them. 

 In Northern Virginia and Metro DC, some medical care providers support vaginal birth after two and even three Cesarean deliveries.

 

Homebirth may be an option.

The American College of Obstetricians and Gynecologists recommends that TOLAC occur only in the hospital. However, no significant research shows that VBAC is less safe when attempted in a supported home or birth center environment. At least one analysis suggests that parents birthing at home experience less medical intervention and fewer Cesarean births.  Most midwives in the Northern Virginia and DC area support HBAC (Home Birth After Cesarean) and can help you decide if this option is right for you.  

 

You have pain relief options when attempting a vaginal birth.

Attempting a vaginal birth doesn’t mean you have to birth without medication or pain relief!

The same pain relief options available to those who have not had a previous surgical birth are generally available to you when attempting a vaginal birth after a prior C-section. You may choose non-pharmacological pain relief such as:

• hydrotherapy
• massage
• counter pressure
• Rebozo
• acupressure
• essential oils
• visualization
• hypnotherapy

 

Medical options available to you include:

• epidural
• IV pain medicine
• nitrous oxide

 

Discuss the many, many options you have for laboring comfortably with a VBAC certified doula.  

No matter how you choose to give birth after having a previous Cesarean section, you have options. Talking to your doctor, midwife, childbirth educator, and your VBAC certified doula will help you prepare for the birth that is right for you and your family.