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 battle. If you pick a homebirth, you can relax a bit. But more on that later.
Here are your marching orders!
1. Read. Henci’s Goer’s The Thinking Woman’s Guide, Dr. Marsden Wagner’s Born in the USA, Jennifer Block’s Pushed, Tina Cassidy’s Birth, Ina May Gaskin’s Ina May’s Guide to Childbirth and The Childbirth Connection’s VBAC vs. Repeat Cesarean are all excellent resources of information and inspiration.
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 and I wouldn’t go to the hospital unless there was a reason to, but that is me. I know a lot of women can’t imagine giving birth at home. 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 a 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.
You can read more about my “road to homebirth” at: Why Homebirth and My HBAC Birth story. 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, so you know some of the games OBs play. Oh, and hire a doula.
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 midwives tend to be more respectful of the whole “you are having a contraction, maybe they can wait until it’s over to talk to you” thing. (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.
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 want to go through 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. 90% of women in the US have a repeat cesarean. 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 supported their decision to VBAC, and that person was me.
You will find support, you just need to know where to look, so 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.
Take good care of yourself. Sleep. Eat. Exercise. Rest. You can do this.
Great post!!
I concur completely about hospital vbac and a doula. A doula is essential.
Great post. I’m going to share with some moms.
Absolutely wonderful post! Well done!!
An OB told my friend that she wasn’t allowed to try for a VBAC unless it had been at least 5-7 years since her last c-section. And since she was already pregnant only 18 months after her first, she would have to have a repeat c-section. I can’t believe the LIES!!
She had her elected c-section like a good little girl and never even questioned the validity of what he said. Like you said… who would ever question a Dr- they are the ones that went to medical school, right? Its just sad.
I love this post!!! As a matter of fact I´m also pregnant with my third child. My first two were cesareans, but I am determined to have this third baby the natural way I am just having a very hard time making it happen. I live in South America because I´m married to an Ecuadorian and my two sons have been born in Ecuador. But this time since I want to give birth naturally I´m looking at options in the U.S. It´s my only chance. I´ve considered Houston because my brother lives there and I want to be as comfortable as possible, but I´ve found two doctors that are VBAC supporters, but I´ve already called one and she´s not taking anymore patients and I´m trying to contact the other but it´s very frustrating to see yours options so limited. Is tehre any advice you can give me about the Houston area, it´s hospitals and doctors? I was specifically looking for Dr. Jane Reed or Dr. Hector Del Castillo. I´m in my third month and if I can get appointments I´ll travel in April or May to meet these doctors.HELP!!!
Hello
I am in need of some help. I am a Navy wife in San Diego and I have to go to Balboa Naval hospital. My daughter was emergency csection and my son was a csection at Celebration Hospital in Florida. I would love more than anything to have a VBAC but I need to know what I can do to achieve those goals. This is really stressing me out.
Thank you
Jennifer Nguyen
I had a home vbac on March 4, 2009. Originally the birth had been planned to be at the birth center but because recent changes in florida law I was informed at 37 weeks that my only options were to go to a hospital or labor at home. I knew my chances of a vbac were horrible at any local hospital in south florida and I did not want any unnecessary medical interventions. I chose to do this at home and I am so glad I did. laboring in a hospital is completely different from laboring in a hospital and by doing it at home you avoid the interventions that probably led to your csection in the first place. I had a supportive husband, a few supportive friends, and an awesome group of midwives. If you are planning a vbac don’t be afraid to do it at home if you must.
Hello, I have had 4 c-section first one was because baby was breech they tried to turn didn’t work. My Dr. said pelvic is small so baby wont fit unless he was small no more then 6.5 lbs. So my other ones were done because I din’t think babies would fit plus hospital don’t do vbacs don’t have them staff. So I want to have another baby wondering if I should look in to a vbac or not? I live in MN so not so where I can go. Have always wanted a home birth, can I do that safely? Thanks so much for your help. Leah
Hello from Croatia! Your site is a godsend, and your birth story inspiring! Could you expand upon the part where your midwife recommended that you eat certain foods to strengthen your scar in the last trimester? I haven’t been able to find any information on this online.
Thanks
Daniela, I did not eat a special diet to strengthen my scar. I did exercise throughout my entire pregnancy, as I did pre-pregnancy, and eat as good of a diet as I could. Best, Jen
This is what I meant, are they exclusively supplements or the actual food? anything outside of these three on the list?
We were talking the whole time and I felt alert, strong… not scared. L attributed how well I handled the hemorrhage to the “green” supplements (alfalfa, spirulina, or chlorophyll) she recommends during the third trimester.
I’m due 25 August 2009. Planning a VBAC. Got great OB he specialise in VBAC. There are great dr out there. I suggest get a midwife and ask her to recommend a OB. They will know who’s pro VBAC or not.
Where do you live??? I need information as soon as possible…I need your help.
S,
I just emailed you, but the email address you provided is invalid.
What specific information are you looking for? If I don’t have the answer, I might be able to point you in the direction of someone who does.
Jen
Hope this doesn’t go outside of what this post is speaking of… I am not yet pregnant with my second child but am already doing research on having a VBAC. I was wondering if I could ask a similar question. My first baby, a little girl, was born at 36 weeks. I went into early labor. Had contractions and water broke at home. We rushed to the hospital and I was 3 1/2 cent. dialated, but they saw the baby was frank breech so they did an emergancy c-section. She ended up having breathing problems when she was delivered and had to stay in the NICU for 10 days. I would LOVE to have a VBAC and am contemplating a homebirth since the nearest hospital which does a VBAC is, I believe, 2-3 hours from our home. I still worry about the health of the baby if we do homebirth since my daughter had breathing issues, but I very much would love to have a natural birth. Any suggestions?
Breathing problems are much more common after a cesarean, so your daughter having breathing problems is no indication of a future vaginally born baby having problems. Also, home birth midwives usually carry equipment to help a baby that is having breathing problems.
[...] I’m pregnant and want a VBAC, what do I do?, [...]
[...] * I’m pregnant and want a VBAC, what do I do?, * The Three Types of Care Providers Amongst OBs and Midwives, * Homebirth vs hospital birth for the number cruncher, # VBACing against the odds, and # Comparing fetal death and injury: VBAC vs. amniocentesis/CVS. [...]
I’m expecting my third baby, due date is OCT 15th. First 2 were c sections and the doctor insists on another. I live in the Houston area, are there any doctors that anyone could suggest. contact at muchmexlove@yahoo.com
I want to plan for a VBAC I am not pregnant as of yet but will be ttc in 2 months. I am from La Crosse WI area and they have two hospitals Gunderson Lutheran and Franciscan Skemp..when I called them to get there statistics about VBACs they told me they didn’t have any. So how should I choose which hospital to go to for the better chance of succeeding with my VBAC. I also do not have any doulas in the area is it necessary to have a doula for a successful VBAC? Any thoughts or suggestions would be great. Thank you.
Hi Jeri!
I did some research for you, which you can find here: Finding VBAC statistics for your hospital and state.
Warmly,
Jen
Hey Jen! I had my first VBA2C (Inv T) with my last pregnancy. I’m pregnant again and guess what – my placenta is low! lol Can you believe it?? I was just happy it was posterior, rather than anterior like last time. So, I need info to argue with my OB about staying off my back about it. When I saw her at 16 wks she said she was ok with me VBACing since I already did once even though I had an Inv T and everyone else on the planet is still terrified of that scar. lol She did tell me that she wants biwkly NSTs and for me to deliver by 42 wks. I warned her that I probably would go to exactly 42 wks. Anyways, back to my current placenta. When they looked at 12 wks it was “a little low” but they didn’t put me on pelvis rest or anything, haven’t had any symptoms of a low placenta. Do you know what is a happy distance for the placenta to be away from the cervix? I’m a little concerned that they are going to try to scare me with some bull shit and I want to be ready for it.
Hi Jessica!
Low lying placentas frequently rectify themselves during the course of pregnancy. As your uterus grows, your placenta will naturally move up.
I did a quick search and found this from eMedicine’s August 10, 2009 article entitled Placenta Previa, “A recent study concluded that more than two thirds of women with a distance of more than 10 mm from the placental edge to cervical os have vaginal delivery without an increased risk of hemorrhage.” Vergani P, Ornaghi S, Pozzi I, Beretta P, Russo FM, Follesa I, et al. Placenta previa: distance to internal os and mode of delivery. Am J Obstet Gynecol. Jul 23 2009.
I’m hoping that placenta moves to a safe distance!
Warmly,
Jen
I forgot to update you – they checked it again at 20 wks and it’s now 2.5 cm away from my cervix and far enough away that they won’t worry about it anymore.
Thank you for your info though, I’m going to file that away in case someone else needs it.
Im honestly not sure as to where I should post, so forgive me for using this one… This is my first time venturing on here, at the recommendation of a midwife.
I am about 5 minutes pregnant, so there isnt a major rush to get to the point of delivery, however there is a pretty decent rush to seek some sort of care. A bit of history, super short and not so sweet…
Our son was born @ 24 weeks via classical c section due to an incompetent cervix. I started my search for a midwife before we became pregnant this go around, had one lined up who has backed out on me now that I have those 10+ positive pregnancy tests. I cannot find anyone through any common source on the internet that is willing to take us on as clients due to one issue or another. I do flat out refuse to voluntarily walk in to the hospital to have another preemie by repeat c section, as 36 weeks is the cut off for me thought all local OBs. I have a back up plan of laboring at a near by hotel until its time to push then just run to the ER on the off chance that I would rupture, but this just doesnt seem ideal. There must be another way to do this that Im not considering… We are near Pittsburgh PA and are willing to travel a fairly good distance, nothing over 200 miles. Thank you, in advance, for any help at all!!
Jessica,
I’m so sorry about your son’s birth. Having a 24 week preemie must have been so scary.
I suggest getting a copy of your medical records and surgical report so that you may review it with your next care provider.
There are many resources for finding a supportive care provider listed here: Finding a VBAC supportive OB or midwife. You can also consider a traveling midwife if you can’t find a local provider.
Warmly,
Jen
Having had an Inverted T, I got that from a lot of doctors too before my VBAC. FWIW the rupture rate after a Classical, Inverted T or J incision was only found to be 1.9% in the Landon study which lumped them all together. They only had a little over 200 women that attempted a VBAC after one of those incisions, but that’s the most recent study that has included them.
I wish you much luck and second the idea of traveling midwives or home birth midwives.
If you are interested I have a Yahoo Group called Life_After_InvT for women who’ve had a classical, Inv T or J incision. Feel free to join us!
I live in Maryland..
I had a c-section 6 and a half years ago with my daughter because her head was large, and she ended up getting stuck on my pelvic bone. I was in labor for 3 days before the doc decided to do an emergency c-section. I am now 29 weeks pregnant and I want to have a VBAC, but was just told that I can’t get a midwife because I am insulin dependant diabetic. I really don’t want to have another c-section, because I have to take care of my daughter, who is now Autistic right after I give birth. I am a single mom, and have nobody to help me. I don’t know what to do. If anyone has any suggestions, please let me know.
Very encouraging post. I wish I had known about it before having babies, and certainly, before my second child was born. With my firstborn, my ob insisted on inducing at 40 weeks and 5 days, telling me that it wasn’t doing the baby any good staying inside of me. My body was showing no signs of preparing for delivery. A day and a half of failed attempts at inducing me at the hospital resulted in an emergency C-section and a full term baby in the NICU for the 1st eight days of her life (in her own room, partially sedated, hooked up to two ventilators; and they told me I wasn’t to touch her) – broke my heart. Got pregnant when my firstborn was 11 months old and switched obs. Was living in South Texas at the time and finding a doctor who was willing to VBACs was next to impossible. My first ob didn’t even know what a doula is and none of the docs were willing to entertain the possibility of having midwives deliver. Welcome to a blast to the past. Anyhow, my second pregnancy was filled with anxiety, never knowing what was going to happen and whether I’d be able to deliver vaginally. Based on my records, I was a good candidate for a VBAC. However, the placenta started out low, my new ob wasn’t comfortable letting me go past 41 weeks, and things were challenging. I was 40 weeks and 5 days pregnant, and my doctor was off over the weekend (and not on call); and she wasn’t comfortable going past 41 weeks. I started going into labor after midnight Friday, at home. Went to the doc’s office to get checked later that morning. Barely made the ride from the ob’s office to the hospital and delivered the baby (all natural) within 30 minutes of arriving at the hospital. Praise the Lord for that chance. And, thankfully, she waited for my body to deliver the placenta instead of going in to get it. Waited some 40 minutes for the placenta to come on its own. Sorry for the long-winded response.
THANK YOU THANK YOU THANK YOU!!! you have given me so much hope that with my second I can HAVE MY BIRTH the way I imagined it to be. I live in Germany and had a great older wise German OB/GYN and actually let me go 42 weeks, I however never had Braxton hicks or any contractions ever. He did however (I of course over due, over tired, and over it) say that your hips are to narrow and you will NEVER be able to birth your baby and that her head wasn’t yet engaged, long story short, it was in my heart I knew it. I later found out that he had told the same story to three of my friends and they were fine with it (Me I was MAD and felt jipped) anyways thank you for giving me hope that I can get what I deserve and that is to birth my next child (whenever I get pregnant again) and that I am more at ease of having a home birth (biggest desire). so again I applaud you! and thank you.
Living in AZ, your chances of having a hospital VBAC are close to zero. Remember, we are the state with the infamous Joy Szabo case, who had to move in order to be close to the one doctor who would allow her a trial of labor. Almost all hospitals and doctors do not allow VBACs.
Home birth is a wonderful and safe option. The last four of my five babies were born at home (first was a “natural” hospital birth), and there are tons of great midwives in the PHX area. Unfortunately, the state does not allow them to attend VBACs. Of course, many do, but as a first time client you may have a harder time finding a midwife willing to take you on because they are often afraid of either being framed by the government, or later being turned in by the client if things turn sour. My midwife is Marinah Farrell and I highly recommend her, but there are probably others closer to you.
Good luck with your pregnancy. Remember, this is YOUR baby, and YOUR pregnancy. NOBODY can force you to give birth the way they want. It is completely your choice.
I wanted to add UCLA Ronald Reagan Medical Center to this list of hospitals in LA where you can try for a VBAC. I am with the UCLA Midwives right now BUT BUT BUT if you choose to go for a VBAC, they will make you get a hep-lock, wear a fetal monitor the entire time and NO shower (they don’t even have baths) so that has made me pursue an HBAC now and I am in the middle of switching care. However, I still wanted to put that out there b/c the midwives at UCLA told me they have a 78% VBAC success rate. They told me, however, that I had about a 60% success rate chance b/c of the baby not moving stations last time. Ok. Not to ramble. UCLA is a VBAC option if you want to go the hospital route.