♥ The Facts on Having a VBAC ♥
In honor of VBAC Awareness Day, I want to share with you some statistics on VBAC. I’m also including tips for planning a VBAC.
What is a VBAC?
VBAC stands for having a Vaginal Birth After Cesarean. It means to give birth vaginally after having had a cesarean, also known as a c-section.
C-section has become one of the most frequently performed major operations in the United States. Over 30% of births in the US (higher in some other countries) are c-sections. The World Health Organization recommends a rate closer to 10%. Some hospitals have begun to try to bring their rates down, but sadly, many continue to increase their rates steadily. In Brazil, 80-90% of births in private hospitals are c-sections. With numbers like this, it’s likely that many people will plan to have a VBAC one day.
Why Would Anyone Want to Have One?
Reasons differ from person to person. Some choose VBAC because they want to have the experience of vaginal birth. Others choose it because they know that vaginal birth is the best method for optimal seeding of the infant microbiome. Another reason is to avoid the risks that come with having another major surgery. Some choose it because they simply see no reason for another c-section. It is a very personal choice, in any case.
Each surgery performed causes more scar tissue, and impacts not only fertility, but the stability and safety of future pregnancies. Some providers simply refuse to attend a vaginal birth after more than two previous c-sections. For someone who wants to have multiple children, avoiding c-sections is essential to ensure the health and safety of future pregnancies. Not to mention the general lifelong health and wellbeing of the person undergoing them.
Why is it so Hard to Have One?
Many providers still have the outdated thought pattern of “once a c-section, always a c-section.” At one time, it was believed that a vaginal birth was never safe after having a c-section. We now know that one of the primary reasons for this belief, the increased risk of uterine rupture, is actually much smaller than once believed. It can also be reduced by simply not inducing, and allowing the body to go into labor on its own.
Other reasons, such as increased risk of stillbirth, have also come from low-quality studies in which there were poorly thought out selection processes. One example is including trials of labor, or TOL, in which a classical or T-inverted scar was present from a prior c-section, but excluding them from the elective c-section group because it was “an indication for repeat surgery”.
Now that these studies have been scrutinized and the results questioned, we know that the reasons for denying VBACs by many providers and insitutions are invalid. But policy change takes time, as well as pressure from the community. Both from those who are having babies, and those who are delivering them. Unfortunately, many providers don’t want to question the status quo and potentially face repercussions from their place of practice or insurance for “making waves”. And fighting for policy change takes a lot of time and effort that most just can not muster during pregnancy, especially while taking care of their other children.
Who is a candidate?
According to ACOG, most people with one previous c-section with a low-transverse icut are candidates, and should be given the option to choose a VBAC. There are times when a VBAC would be contraindicated, however the majority of them are also situations where someone who has never had a c-section would also be recommended for a c-section. Even after two or more previous c-sections, as long as there are no other contraindications, VBAC is still a reasonable option.
Can You Have a VBAC at Home?
In some states, you may find restrictions imposed upon midwives and their patients regarding insurance coverage and requirements for consulting an OB/GYN for VBAC. And some midwives just don’t want the hassle of the extra paperwork. But having a previous cesarean is not a reason you can’t have a homebirth.
I have met many women who have had amazingly peaceful and powerful homebirths after having a cesarean (or three). I, myself, had my youngest at home after having my first via c-section.
There are considerations, and in some situations, it may involve more risk, but only you can make the choice of how much risk you’re comfortable with, or whether it outweighs the risks associated with a hospital birth.
If a VBAC at home is what you want, be sure to research your options for providers in your area. In some places, there may be no legal options for an attended homebirth after c-section. In these cases, any provider that chooses to attend your birth may be putting themselves at risk for considerable legal repercussions. However, an unassisted home birth after c-section is not subject to these regulations. If you choose this route, like I did, ensure that you have done adequate research and be prepared with a good back-up plan. Unassisted birth is a viable option for many people, but it requires a lot of planning and education. It is definitely not for everyone. Nor is it for the faint of heart.
How Can You Have One?
The most important factor in planning a VBAC is having a supportive provider. Many providers are starting to recognize the many benefits of having a vaginal birth, and changing their policies to reflect that. Sadly, there are still many providers that do not support it, or they pretend to, but pull a bait-and-switch. Make sure you ask around for feedback from people in your local area that have had a VBAC. Find out how they were treated and talked to by their providers. Get stories from those who wanted a VBAC but did not have one, as well. You will often be able to identify many red flags to watch out for from specific providers after listening to the stories of others. And you will learn which ones to avoid completely.
The second most important factor when you are planning a VBAC is the actual planning of it. You need to prepare yourself for birth, and consider what you might need to do differently. Working to break up adhesions from scar tissue is something I highly recommend. The softer and more flexible the scar, the safer and easier your VBAC will be. Massage, acupuncture, and certain herbs can help with this. In addition, ensuring your baby is in an optimal position helps to give you the best chance at a smooth birth. Educating yourself on the risks and benefits of – as well as ways to prepare your body and your mind for – VBAC is the best thing that you can do for yourself when you are planning for to have one.
If you want to have a VBAC, get informed. Do your research, ask around, and talk with potential providers about their opinions. Make sure you choose a provider that is supportive and has experience with VBAC. Remember that not all providers are equal. And they are all human, therefore subject to their own biases.
Where Can You Learn More?
To learn more, please explore the site vbacfacts.com. It is run by the incredibly passionate Jen Kamel. She has spent decades, tirelessly working to bring awareness and education to birth professionals and parents. Her goal is to ensure everyone has access to and quality information about VBAC. Her website is full of amazing and insightful information, from the current ACOG guidelines, to common myths about VBAC, and much more. I highly recommend giving it a read!
1. Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol. 1990 Nov;76(5 Pt 1):750-4. doi: 10.1097/00006250-199011000-00004. PMID: 2216218. https://pubmed.ncbi.nlm.nih.gov/2216218/
2. Bujold E, Gauthier RJ, Hamilton E. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. J Midwifery Womens Health. 2005 Sep-Oct;50(5):363-4. doi: 10.1016/j.jmwh.2005.06.001. PMID: 16154061.