I’m pregnant and want a VBAC, what do I do?

I recently received this comment.

Hi…thank you so much for your site! Very informative. I live in Glendale and I had a c-section last year with my first daughter. I went in to be induced even though I wasn’t looking forward to it. No contractions. No mucus plug. No water broken. I guess I just wasn’t ready for labor yet. They hooked me up to an epidural because they said I was going to feel immense pain so I went with it. 26 hours went by and I never dilated so they gave me a c-section at citrus valley medical center. I saw them on your list for high c-section rate. Now, I am pregnant again (a year and a month later) I really want to have a VBAC! Any suggestions? I can see that you have touched many women…any information to spare would be awesome- Rose


There are so many women who have experienced your exact story.  They trust their OB because, hey, they didn’t go to medical school, right?  So, here is your body, so obviously not ready to birth and yet we feel like if we force your body to birth by giving you drugs, somehow this will result in a normal labor.  Did your OB discuss the risks of induction?  How it increases the likelihood that you will need a cesarean either by the induction “not working” or your labor starting and then stopping or by the induction stressing the baby resulting in a “fetal distress” diagnosis?  I’m guessing no.  Let me make one suggestion.  If you want a VBAC, don’t go back to that OB and certainly don’t go back to Citrus Valley.  With a 28.7% primary cesarean rate, a 43.3% total cesarean rate, and a sad 1.5% VBAC rate, your chances of VBACing there are zero.  Put it another way: in 2006, there were 2105 cesareans and 17 VBACs there.  And I bet that if we knew your OB’s cesarean rate, it would probably be about the same as Citrus’ total cesarean rate.  So, you need a new care provider and a new location for your birth!  YOU CAN DO THIS!

So, first things, first.  Congratulations on your pregnancy! This is such an exciting time of your life!  But know that if you want a VBAC, this is not something that is just going to fall into your lap.  Especially if you want a hospital birth, you need to become informed, empowered, and ready for (a likely) battle.  If you pick a homebirth, you can relax a bit.  But more on that later.

Here are your marching orders!

1. Read. Rikki Lake’s My Best Birth is an excellent overview of birth.  Once you read that, if you are ready for more I recommend Ina May Gaskin’s Ina May’s Guide to Childbirth, Dr. Marsden Wagner’s Born in the USA, Henci’s Goer’s The Thinking Woman’s Guide, Jennifer Block’s Pushed, Tina Cassidy’s Birth in that order.  (While I want to give you all the great books I love, I also know that a lot of women only have time to read one or two.)

Please don’t waste your money or time on The Girlfriend’s Guide or What to Expect When You Are Expecting.  I’ve read them both and was so surprised that these are some of the top selling pregnancy books in the US.  They are dumb.  And lame.  And dumb.

Let me give you a recap of What to Expect: Can I take baths?  Can I exercise?  Can I have sex while pregnant?  Yes (not to hot), yes (not to strenuous), and yes (provided you have a normal pregnancy without a history of preterm labor.)

And The Girlfriend’s Guide?  Basically tells you to go to the hospital and get your epidural.  Oh, and your body is going to hell after a baby.  After I read that book, I was truly terrified of what my post-baby body would look like.

Seriously, skip them both.  There are so many great books to read, don’t waste your time on that dribble.  And yes, your boobs and butt will sag after having a baby, but at the end of your days, I don’t think you, or your children, will care one bit about your flabby boobs.

2. Home vs hospital. I had a homebirth, I had a good outcome and it was amazing.  You can read my birth story here: My HBAC Birth story.   But homebirth comes with real risks and even though the risk of uterine rupture is low, it does and will happen.  And in about 6% of uterine ruptures, the baby will die (Guise, 2010).  Chances are, you will be fine, but those statistics represent real moms and real babies.  With what we gain in homebirth (privacy, control, peace, limited pressure, etc), the primary thing that we lose is immediate access to surgical intervention.  You can read my extended thoughts on homebirth here: Why Homebirth.

So, read, think, reflect and decide what feels best. Of course, this also depends on your health and if you would qualify for a homebirth.

Someone suggested this to me when I was early pregnant with my VBAC son and I learned a lot: Imagine for a week that you are having a hospital birth. How do you feel? Are you nervous or at peace?  Are you excited or anxious?  Now do the same with  homebirth.

Other articles you might find interesting: Homebirth vs hospital birth for the number cruncher, OB lists reasons for rising cesarean rate, and Neonatal nurse has a homebirth VBAC.

2a. Hospital birth. If you chose to birth in a hospital, find the hospital with the highest VBAC rate.  Since you are in California, you can easily do this by going here: VBAC & Cesarean Rates of California Hospitals, 2007 and be sure to read Why if your hospital “allows” VBAC isn’t enough.

I think that if you want a hospital VBAC, your best bet is Kaiser.  Just looking at their 2006 California statistics, they had a 20.8% VBAC rate, a 15% primary cesarean rate and a 22.4% total cesarean rate.  Some Kaiser locations even permit CNMs (certified nurse midwives) to manage VBAC labors.  The national VBAC rate is 10% and in California it’s 9%, so 20% is excellent.

If you have a hospital birth and good insurance, you will likely save money in comparison to a homebirth (unless you have a PPO which may pay for some of your homebirth costs or you live in a state like Florida), but take that money you save and invest it in a doula.  I strongly recommend you have a doula if you have a hospital birth.  Labor requires concentration.  Dealing with medical professionals who may think you are a bit odd for wanting a VBAC requires concentration.  Your typical laboring woman does not have enough concentration and energy to deal with both things.  Read VBACing Against the Odds and Hospital VBAC turned CS due to constant scare tactics.

Hospitals vary greatly. Here is a wonderful birth story of a woman who VBACed at a Southern California Kaiser: The Birth Story of James Liam.

2b. Home birth. If you are at home, I think a doula is something you can get if you want, but skip if you don’t feel the need.  But this is really a personal preference.  At home, you have the freedom that you just don’t have at the hospital and you need not worry about hospital personnel trying to talk to you mid-contraction.

However, with homebirth you have other issues to attend to.  The most important thing when interviewing midwives is experience.  You need to know how many births she has attended and of those, how many was she the primary midwife (the responsible person at the birth as opposed to assisting a senior midwife.)  If you have an inexperienced midwife with limited informal or formal education, you are taking on additional risk that is really unnecessary.

Additionally, you want a midwife who has enough experience to know when to go to the hospital as well as the professionalism to interface, and even take crap from, hospital employees.  You and your baby’s well being should come well before her possible discomfort.  In states where it is illegal for a midwife to attend a OOH (out-of-hospital) VBAC, your midwife is not likely to present herself as your midwife if you transfer and this is understandable.

You also want to be aware of the birth myths that are sometimes propagated amongst midwives.  It is a massive red flag if your midwife repeats any of these myths to you.

I personally think that hiring a midwife who has experience and knowledge is more important than hiring one that you “click” with.  That really should come secondary to the ability to make quick decisions regarding your health as well as the health of your baby.

3. Find a provider. After you read The Three Types of Care Providers Amongst OBs and Midwives, Questions to Ask a Provider, Scare tactics vs. informed consent aka why I started this website, you can go to Finding a VBAC Supportive OB or Midwife and start using the resources listed there to find referrals for OBs or midwives.  I think the best way to find a care provider is through word of mouth.  I have heard many ‘bait & switch’ stories at 36 weeks. A provider says everything the mom wants to hear in the interview and then did a 180 once the woman was to far along in her pregnancy to expend the effort of finding another care provider.  It’s best to hear from multiple women, if possible, how a provider is during birth. 

4. Childbirth Education.  I think Bradley classes are great because you learn a ton.  The tone of a particular class can vary greatly depending on who is teaching it. I took the Hypnobabies Home Study course with my VBAC baby and I thought it was good, but it had a completely different emphasis.  I would also encourage you to find a “Truth About VBAC” workshop in your area.

Bradley had far more information about interventions, pros, cons, physiology and anatomy.  Hypnobabies was more about relaxation, visualization, positive thinking, calm, and peace.  My VBAC labor was very manageable until the last hour or so and I attribute that to maintaining a calm and peaceful state of mind, being in the peace of my own home, and, since I was drug-free and at home, having the freedom to move into the most comfortable position at the moment however and whenever I wanted.

There are many things that I enjoyed about Hypnobabies and if it’s possible, I would suggest doing both.  Hypnobabies is very clear that they don’t want you to take any other course and that they don’t want you to be exposed to the idea that childbirth is painful.  They even discuss pain like it’s a four letter word.  Pain doesn’t have to be negative though.

5. Finding support. 92% of women in the US have a repeat cesarean (Martin, 2009).  I personally believe this is due to misinformation, unsupportive medical professionals, a lack of social support, and hospital VBAC bans.  If you plan to VBAC, you are likely to come across many women who were lead to believe by their OBs that VBACs are to dangerous, illegal, or that “no one does them.” I know women in real life who knew one person who didn’t think they were complete whack-a-dos for planning a VBAC, and that person was me.

It can be hard and it can be isolating, but you can find support, you just need to know where to look.   Go back to the Finding a VBAC Supportive OB or Midwife list of resources and go to a couple La Leche League, ICAN, or Holistic Moms meetings.

And rest assured that even if you don’t know anyone in real life who supports your decision, you can find loads of support on-line.  Please don’t feel alone.  It can be so hard when you are so excited about your upcoming VBAC and the rest of the world is looking at you like you are crazy.  But you are not.

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90 thoughts on “I’m pregnant and want a VBAC, what do I do?

  1. Pingback: FAKTA tentang Induksi, C-Section, & VBAC | Bidan Kita

  2. Kas

    I am currently 23 wks with baby #4. I had my first section after going into labor on my own on my due date and dilating to 9.5cm (despite very stressful emotional/family conflicts happening in the labor room). Since I couldn’t “push” past the lip and they wouldn’t give me more time since it was 11pm.

    Baby #2 I thought I found a vbac supportive OB, but at 40+3 she announced she was going out of town for a week and her colleagues wouldn’t support my vbac so we either section or induce right now. Go straight to hospital. Do not pass go. Of course that induction failed as my body and baby weren’t ready and I was tied on my side with 50 monitors. And I can’t believe she used pit on my vbac!

    Baby #3, I couldn’t find a vba2c provider at the time so we repeated section.

    I’m determined to have this vba3c! I’m otherwise healthy with perfect pregnancies and in my early 20s. I’m not ready to limit our family size because of sections. Unfortunately, I’m having NO luck finding a hospital that will allow vba3c in my state (LA).

  3. Marie

    I had 4 vaginal births, then, because the presenting twin was breech had a c-section. I am pregnant with next baby 13 months later. I am 32, healthy, and have completely boring pregnancies (besides that one of them was twins.:) ). I have found a hospitol that does VBACs. I have been told I am a good candidate for vbac and that the only thing to factor is the condition of the scar which they will monitor in the last month of pregnancy to see if “it is safe to try.” I have been told that it will depend on the doctor that reviews the ultrasound. Are there things I can do to improve my scar? Are there facts that I can defend my case with (is that even possible or are the doctors set in stone on their opinions.). I want to do whatever I can to make a vbac possible! Not sure about home birth, but would do that if it came to it. Any tips, advice??

  4. Flávia

    Hi i have one son who is now 2 years old. I wanted to have a vaginal birth, but did not work it out that way and end. up by been a c-section. I was 41 weeks and 3 days when I was induced, and I tried for 19 hours,and I dilated to 9 cent. But when I got to 9 cent. It stop… So the dr. Did a c-section.
    My son was born with 10 pounds and 6 ounces and 50 cm. I have a Heath pregnancy, no diabetes … No thing…. I’m pregnant now 🙂 I want a v-back, but how can I decide if that is the right decision ? I don’t want to risk me or the baby.

    1. Jen Kamel Post author


      I hear you. Odds are in your favor if you have a VBAC. However, no one has a crystal ball and there are a small number of women who do experience complications and have a bad outcome. This quote from the Guise 2010 Evidence Report, which was the basis for the 2010 National Institutes of Health VBAC Conference, is a good overview:

      While rare for both TOL [trial of labor] and ERCD [elective repeat cesarean delivery], maternal mortality was significantly increased for ERCD at 13.4 per 100,000 versus 3.8 per 100,000 for TOL. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between TOL and ERCD. The rate of uterine rupture for all women with prior cesarean is 3 per 1,000 and the risk was significantly increased with TOL (4.7 1,000 versus 0.3 1,000 ERCD). Six percent of uterine ruptures were associated with perinatal death. Perinatal mortality was significantly increased for TOL at 1.3 per 1,000 versus 0.5 per 1,000 for ERCD… VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans… The majority of women who have TOL will have a VBAC, and they and their infants will be healthy. However, there is a minority of women who will suffer serious adverse consequences of both TOL and ERCD.

      The only person who can make this decision is you after reviewing the risks and benefits of your options. Check out the handouts I link to here. Have you joined the VBAC Facts Community? That’s a great resource to explore your options.



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