I want to have a VBAC but can’t find a care provider in my area who will attend one. What should I do?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

One of my past doula clients — we’ll call her Jamie — interviewed fifteen care providers in her search for one who supported VBACs. After two months of searching, she discovered there wasn’t a doctor in a fifty-mile radius of her home willing to attend a VBAC. During that time she was shamed by almost every care provider she interviewed, being told she cared more about her ego than her baby’s life, was uneducated and irresponsible, and would likely fail at having a VBAC. “I’m totally disgusted and disheartened,” she told me after one of the worst encounters. “All these doctors care about is not being sued.”

She then decided she wanted the VBAC enough to drive two hours to the nearest city to be cared for by a group of pro-VBAC midwives at a university hospital. The midwives and doctors she met with at this hospital, after confirming she was an excellent candidate for a VBAC, shared with her the latest information about how much safer VBACs were than repeat C-sections for women in Jamie’s position. Almost all the data they provided contradicted what she had been told by the “fear-based gang,” as she called the local doctors she’d met.

Jamie’s labor came on strong and fast. She made it to the hospital thirty minutes before she was fully dilated. To lower her high blood pressure, she was given a walking epidural and quickly slipped into a state of serenity — she couldn’t stop smiling and telling everyone how empowered and excited she felt. Jamie then started to push. And push. And push. After four hours of pushing the baby hadn’t come out, but Jamie and the baby were in good health. I overheard a nurse say to the midwife, “If we were at the last hospital I worked, they would have forced a C-section on her hours ago.” But that didn’t happen. They kept gently supporting Jamie, ensuring her the baby was coming, albeit slowly. And then the baby arrived, healthy and screaming.

When I talked with Jamie a few weeks after her birth, she said, “I’m really happy I had the VBAC, but I think I would still be happy if I had to have a C-section. I felt so supported, heard, and respected by everyone at that hospital that I know they would’ve recommended a C-section only if it was really needed. I felt like I could trust them, and that made me okay with the idea of a C-section.”

This is the essence of what many women are looking for when seeking a care provider for their VBAC. They’re usually not looking for someone who will go to any length to get them a VBAC. They of course want someone who understands the value of a VBAC and is willing to support it when a woman is in a safe position to have one, but above all, they want someone they trust — someone who supports them in their choices and is one of their staunchest advocates. Being cared for by someone like that often allows women to loosen their grip on the desire for birth to unfold in the exact way they’d envisioned, and instead trust that it will play out in the way it’s supposed to.

What to do

Begin the process of finding quality VBAC support by reaching out to friends in your area who’ve had a VBAC and asking for their care provider’s information. You can also go to the ICAN website (ican-online.org /education) to find the nearest chapter, which can provide quality information on VBAC policies and pro-VBAC care providers in your area.

If you live in a smaller town that doesn’t have pro-VBAC care providers, research doctors and midwives in the nearest city. You’ll probably have the best luck with those who deliver at hospitals affiliated with universities, as they often have the most up-to-date information about VBACs, the risks of repeat C-sections, and how they can best support a woman through a VBAC. Finally, create a list of care providers you would like to interview. Before you meet with each candidate, call ahead to confirm they’ll attend a VBAC, as you don’t want to waste your time.

To conduct illuminating interviews, ask the questions below. They’re intended not just to elicit information but also to provide you with the opportunity to read the care provider’s body language, tone of voice, and overall vibe as they answer your queries. These nonverbal signs might be more telling evidence of whether they’re a good fit for you than what they actually say.

  • Do you feel comfortable with VBACs? The most honest component 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 say they “might be willing” to support you in a VBAC “if all goes well,” be wary of their 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 VBACs but most ended in C-sections, take this as a potential sign that they’re actually most comfortable with repeat C-sections.
  • 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 the hospital you’ll be delivering in to be supportive of VBACs and to have a low C-section rate.
  • Am I a good candidate for a VBAC? I placed this question after the previous ones because it’s important to gain a sense of the care provider’s philosophy on VBACs before having them assess whether you would be a good candidate. If it seems clear they don’t fully support VBACs, this may skew their assessment of your candidacy. Legitimate reasons a woman would not be a good candidate for a VBAC are a twin pregnancy, a breech baby, placenta previa, and fetal distress. Take comfort in knowing that according to the American Pregnancy Association, 90 percent 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’s no way for a care provider to guarantee you’ll have a VBAC, your experience will be more positive if they express confidence in your body’s ability to move through a VBAC and in their ability to ensure your safety.

By asking these questions you’re being a strong advocate for yourself and baby, while also ensuring your care provider is one of your greatest advocates.

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