In short, no, a VBAC (vaginal birth after cesarean) isn’t nearly as dangerous as some would have you believe. If you’re having a healthy pregnancy, at least eighteen months have passed since your last C-section, you’ve never had a uterine rupture, and your baby is head down (vertex position), a VBAC is likely a safer option than a repeat cesarean.
According to a report published in the journal Obstetrics & Gynecology, a VBAC often decreases the risk of maternal mortality, the need for a hysterectomy, and complications in future pregnancies by helping women avoid major abdominal surgery, which also lowers the risk of hemorrhage and infection and shortens postpartum recovery. The American College of Obstetricians and Gynecologists also affirms that a VBAC is a safe option for many women. Despite this data, some care providers are still hesitant to support a VBAC because of concern that the mother will experience a uterine rupture. But according to the Obstetrics & Gynecology report, if you had a previous cesarean with a low transverse incision (very common), your risk of uterine rupture in a vaginal delivery is less than 1 percent. They also found that 60 to 80 percent of women who plan a VBAC do deliver their baby vaginally.
Even with solid information backing the safety of VBACs for women who are good candidates, a number of care providers and hospitals won’t support VBACs because they think the liability risk is too high. They prefer repeat C-sections because a C-section is the most invasive option and gives them the highest degree of control, and if anything goes wrong, they can say, “We did everything we could.” A survey done by the American College of Obstetricians and Gynecologists found that 30 percent of obstetricians stopped offering VBACs because of concern about liability claims or litigation. The good news is there are still plenty of care providers willing to support a VBAC, and there are plenty of ways to increase your chances of having one.
Note: Medical professionals use the term trial of labor after cesarean (TOLAC) to refer to planned VBAC labor while it’s happening. In other words, TOLAC is the labor, and VBAC is the delivery.
What to do
Before you decide to walk the VBAC path, consider whether it’s what you really want. While research supports the safety of VBAC for many women, you still need to make sure you feel comfortable having one. If you wholeheartedly want a repeat C-section, and you know that’s what would make you most comfortable, there’s nothing wrong with going that route. But if you’re even a little bit on the fence, I recommend exploring the following suggestions, as they’ll shed light on whether a VBAC is right for your unique situation:
Find a care provider who is an advocate of VBACs. Some care providers say they’ll let you “try” for a VBAC, but they’re usually more comfortable with you having another C-section. If you really want a VBAC, you don’t want that type of care provider. You want someone who has not only attended numerous successful VBACs but also wholeheartedly believes in them being the safest option for women who are good candidates. If that’s you, you want the care provider you select to be 100 percent behind your decision. You want them to be your champion and do everything possible to help you get that VBAC, while of course, keeping your safety as the number one priority.
Get a copy of the surgical reports from your C-section. These reports tell you the type of incision and repair used on your uterus, why you received a C-section, and if there were any complications. This informs your care provider if you’re a good candidate for a VBAC.
Equip yourself with knowledge. Because many people don’t have an accurate understanding of the safety of VBACs, you might encounter naysayers when you share this birth preference. First of all, you don’t have to talk about this plan with anyone but your partner and care provider. But if you do want to discuss it with others, arm yourself with the following fun facts that will help you educate the uninformed:
- For a healthy woman having a healthy pregnancy, a VBAC is usually safer than a repeat C-section, as it decreases the risk of maternal mortality, the need for a hysterectomy, and complications in future pregnancies. It also lowers the risk of hemorrhage and infection, and shortens postpartum recovery.
- Their risk of uterine rupture during a VBAC is less than 1 percent.
- Sixty to 80 percent of women who plan a VBAC do end up delivering their baby vaginally.
Utilize the International Cesarean Awareness Network (ICAN). This is a nonprofit aimed at reducing preventable C-sections through education and advocacy for VBACs. Their local chapters connect you with women in your community who have had or are hoping to have VBACs, and they can help you understand the VBAC policies of hospitals in your area and share information about the care providers that support them.
In addition, if you feel you’re being forced into a cesarean, you can call the ICAN hotline at 1-800-686-4226. As they go through the menu, you’ll hear the prompt, “If you feel you are being forced into a cesarean, press 3.” When you press 3, you’ll then be asked to press 2 if you’re currently in labor. If you press 2 you’ll be transferred to an ICAN representative, who very likely has legal or medical training; they can walk you through how to advocate for yourself and prevent an unneeded repeat cesarean.
Utilize VBAC affirmations. If other people’s fears of VBACs start get- ting to you, reinforce your resolve by filling your mind with these positive messages:
- My C-section scar heals more and more every day.
- My C-section scar is incredibly strong and will not rupture.
- My body will do exactly what it needs to do to have a safe vaginal birth.
- I will have a healthy and happy VBAC.
- I trust my decision to have a VBAC. I am doing the best thing for my baby and myself.
- I will be lovingly supported through my VBAC.
Listen to this guided meditation. Visualize yourself moving through a positive VBAC experience by listening to the meditation at this link: yourserenelife.wordpress.com/vbac/.