Childbirth, Pregnancy

Essential Questions to Ask Care Providers When Considering a VBAC

If your last baby was birthed via a cesarean section it means your chances of a vaginal birth are dashed forever, right? Wrong.

There is a prevalent misconception that a cesarean birth should beget another cesarean birth. But, what if a vaginal birth after a cesarean birth (a VBAC) was actually safer for many women? An American College of Obstetricians and Gynecologists (ACOG) bulletin says, “A VBAC avoids major abdominal surgery, lowers a woman’s risk of hemorrhage and infection, and shortens postpartum recovery.”

Despite this statement by a trusted organization, many care providers are hesitant to support a VBAC because of their fear of the mother experiencing a uterine rupture, but according to ACOG, if you had a previous cesarean with a low transverse incision, your risk of uterine rupture in a vaginal delivery is .2 to 1.5% – aka it’s a very low risk.

So, if you have dreams of a VBAC know that that can be a very real and safe possibility for you, as long as you have a care provider who fully supports your desire.

To begin the process of finding such a care provider, reach out to friends in your area who have had a VBAC and ask for their care provider’s information. If referrals are not an option, do some online research, or ask your current care provider if they have any recommendations (if they are not willing to support a VBAC.) Then, create a list of a few care providers you would like to interview.

Before you sit down with a care provider, call ahead to confirm they’ll agree to attend a VBAC – don’t waste your time with a NO care provider. You want a YES man, or woman.

When you’re meeting with the candidates, make sure to ask them the questions below – these questions are not just intended to elicit information, they provide you with the opportunity to read the body language, tone of voice and overall vibe of the care provider as they answer your queries – these signs might just be more telling of whether they are a good fit for you, than what they’re actually saying.

As you move through these questions, keep in mind that you’re looking for a care provider that openly expresses their authentic enthusiasm for not only VBACs, but enthusiasm for supporting your unique body and baby through a VBAC.

You also want to be sure the care provider is willing to work with you on the emotional aspects of a VBAC, or at the very least embrace the presence of a birth doula who will support you in this way.

Do you feel comfortable with VBACs? The most authentic piece of the care provider’s answer to this question will likely live in their initial reaction. If they immediately seem enthusiastic, that’s a good sign. If they seem ambivalent, but then say they would be willing to support you in a VBAC, be wary of their initial timidity.

How many VBACs have you attended? What were the outcomes? You want the care provider to have attended many successful VBACs. If they’ve attended multiple VBACs, but most ended in cesarean, take this as a potential sign that this care provider supports VBACs at face value, but really feels most comfortable with a repeat cesarean birth.

What is your cesarean birth rate? You want this number to be low.

What is the general VBAC philosophy of the hospital I would deliver in? If for whatever reason your VBAC-supportive care provider isn’t able to attend your birth, you want to be certain that the hospital you’ll be delivering in is supportive of VBACs, and has a low cesarean birth rate.

Am I a good candidate for a VBAC? I placed this question after the fore-mentioned ones because it’s important to gain a sense of the care provider’s philosophy on VBACs before having them assess if you would be a good candidate. If it seems clear that they do not fully support VBACs, this may skew their assessment of your candidacy. If it’s clear that they’re in favor of VBACs, you’ll likely receive a more unbiased evaluation.

Common reasons a woman won’t be a good candidate for a VBAC are the presence of twins, a breech baby, placenta previa and fetal distress.

Take comfort in knowing that, according to the American Pregnancy Association, 90% of women who have had a cesarean birth are candidates for a VBAC.

How confident are you that I’ll have a successful VBAC? While there is no way for a care provider to guarantee that you will have a VBAC, your experience will be more positive if they express confidence in your body’s ability to move through a VBAC, and their ability to ensure you stay safe.

By asking these questions you are being a strong advocate for yourself and your baby, and increasing the chances that you will move into your VBAC with a care provider who is also one of your greatest advocates- this is not a privilege, it is your right. You want to feel as though you’re in a partnership with your care provider.

Claiming your right to have a supportive care provider will ensure you experience the birth you’re meant to have. You got this.

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