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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

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. When I did this exercise, I was surprised how uneasy I was about going to the hospital. Specifically, how fearful I was to lose all control, privacy, and peace.  I was worried about having to debate or fight or even having to explain myself.

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.  Let me say that again: Hire a doula.  Labor requires concentration.  Dealing with medical professionals who 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.  Oh, and hire a doula.

Now, that isn’t to say that a VBAC hospital birth is always horrible.  It really depends on your care provider and the climate of the hospital.  To show you the other side, 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.  I didn’t have a doula at my homebirth and it was really lovely to share that time with my husband.  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.  (I experienced this when in labor before my CS.  Extremely annoying to be obviously in mid-contraction and the nurse just starts talking to you.)

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.)  I am a full supporter of non-nurse midwives, but please do your homework.  If you have an inexperienced midwife with limited informal or formal education, you are taking on additional risk that is really unnecessary.

As someone who experienced a post-partum hemorrhage, I am very happy, to say the least, that my midwife had the experience to quickly diagnose the problem as well as the drugs – Pitocin and Methergin – to quickly stop my bleeding.

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.

We are very fortunate to live in California where there are many VBAC supportive homebirth midwives.  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.

If you find it hard to justify the money an out-of-hospital birth costs, please read Going to the hospital for financial reasons.

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.  So many women have fallen for the ‘bait & switch’ at 36 weeks because their provider told them everything they wanted 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.  Here is a List of midwives and birth centers in Southern California.  Note that not all of these midwives attend VBAC.  Also, you might find these interesting to read: Two Doctors Respond to the Hastings Indian Medical Center VBAC Ban and Encourage Native American Women to VBAC! and A VBAC Supportive OB’s Response to the AMA’s Statement on Homebirth.

4. Childbirth Education. I took a Bradley class during my first pregnancy, which ended in a cesarean for footling breech.  I think Bradley classes are great because you learn a ton.  There are even some Bradley classes that are for homebirthers while others focus on hospital birth.  I took the Hypnobabies Home Study course with my HBAC baby and I thought it was good, but it had a completely different emphasis.  I would also encourage you to find a VBAC Class 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 HBAC 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.  For more on Hypnobabies, read my birth story.

Labor is intense, and yes, towards the end my labor hurt like hell and it was very painful, BUT it was still manageable.  I didn’t die from the pain.  I didn’t pass out.  And knowing what I know now, I would still have that birth at home.  My son’s head was tilted and he had his hand by his head which made my labor more painful, which it why, again, I was glad I was home because I don’t think I could have moved, and screamed, and ran from the shower to the bed, to my hands and knees, to the tub and back to the shower, all the while being naked, in a hospital.

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 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.

If anyone gives you a hard time about VBAC, tell them that a baby is more likely to die via miscarriage after an amniocentesis than be injured or die from a VBAC.  Read Comparing Fetal Death and Injury: VBAC vs. Amniocentesis/CVS for more information.  Or you can tell them that the risk of a baby dying during a trial of labor after cesarean is similar to the risk of a baby dying during a woman’s first labor (Smith, 2002) … and no one suggests that first-time moms plan elective primary cesareans or make them feel like pursuing a vaginal birth is to dangerous.  Or you can tell them that ACOG (2010) and the NIH (2010) say that VBAC is a reasonable choice for most women with one prior cesarean.

Take good care of yourself.  Sleep.  Eat.  Exercise.  Rest.  You can do this.

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

  • Sarah

    Hi! I am planning on ttc in just a couple of months but But I want to be 100% firm in my decision to VBAC before I get pregnant, because I do not want that added stress and I do not want my emotions to get the best of me and talk me out of it. I asked my doctor at my first post c-section follow up appointment if I could vbac with my next child and he said yes, I see no reason why we can’t. But I have a lot of friends and family who have heard the same thing and ended up having c-sections without even being able to try. So I want to get an idea of how many people actually have successful vbacs in my area. Tanner Medical Center in Carrollton, Georgia is where I would give birth and I’m curious to know their vbac rate. Do you know where or how I can get that??

  • Danita

    Hi! We just found out that we are pregnant with our second baby, and are so excited! Unfortunately, we’ve already had a damper put on our excitement by some frustrating news.

    Our first daughter was born via C-section at our local hospital for a stated reason of failure to progress/suboptimal positioning. (She was face-forward.) However, my impression, my husband’s impression, and the feeling of many people we’ve talked to since then (including midwives and LC’s) has been that it had more to do with the fact that it was 4:30 pm on a Friday, as I’d only been in labor for 10 hours, daughter’s heart rate was perfect the entire time, and I was fully dilated/effaced.

    I contacted a local midwife today after getting a positive pregnancy test, and was told that because I will not be 18 month’s post-Cesarean when this baby is due, the midwives in our state cannot legally attend VBAC’s, and that my chances with the local hospital are almost zero because of current attitudes in our location. (The hospital where I had my first has an astronomical C-section rate – it used to be 60% and they’re very proud of the fact that it’s now ‘only’ about 40%.) I was given contact information for a doctor in a city about 2 hours away that specializes in vaginal deliveries most other doctors won’t touch (breech, twins, etc.), but was warned not to get my hopes up. I was then told that I may want to consider contacting Farm Midwives in TN, which is a few thousand miles away from us.

    I really, really, REALLY want to have a VBAC if it’s remotely possible. It took me months to even start to recover from what I felt was a betrayal of the system after my first daughter’s birth, and I’m still struggling with it. My question is mostly that, if it turns out I have to go far out of state to even have the possibility of a VBAC, what would you recommend? Is there anywhere closer than TN (I live in Montana) that you might recommend talking to? What should I do?

    Thanks so much!

    -Danita

  • Sabah

    Does being overweight have anything to do with not being able to have a VBAC?

  • Hi i recently found out I was pregnant again with my 3rd child. With my first i had vaginal birth on 7-14-2011 because she was a stillborn baby so I was induced into labor with her and then I had a emergency via c-section because my daughter was failure to progress/suboptimal positioning (head tilted backwards.) And Im 18 and I really wanna have a VBAC and my husband wants me to also, we didnt plan this pregnancy at all and I want to give natural birth to this baby. But I also have a blood clot disorder called “Thrombophilias” will that mean I cant have a VBAC since I have this. And i dont know where to go to find a doctor who will give me a VBAC. I live in San Antonio Texas.

    • Jen Kamel

      Hi Michelle!

      Sounds like you need the advice of a VBAC supportive medical professional. I have posted your question here in the hopes of finding you a referral.

      Best,

      Jen

  • Jessica

    Hi, I am pregnant with my second child. I had a c-section in October 2012 because my son was breech. I am 29 weeks now and have been planning a HBAC, but as of right now, baby is breech again. I am doi g everything I can to help Baby flip, but since I wasn’t successful the first time, I am prepared for the same outcome. My problem is, my midwives won’t attend a vaginal breech birth. I’m wondering if this is an option? How can I find a care provider in CT or MA that will let me attempt a breech VBAC in the event my baby doesn’t turn?

    • Jen Kamel

      Hi Jessica,

      I think it’s important to have a doctor or midwife who is skilled in breech vaginal delivery and, unfortunately, this is a skill set that is dwindling away.

      I’ve posted your question here to see if others can provide referrals.

      Best,

      Jen

  • 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.
    Thanks,

    • Jen Kamel

      Flavia,

      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.

      Best,

      Jen

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