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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.

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

  • Great post!!

    I concur completely about hospital vbac and a doula. A doula is essential.

  • Jamie C

    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.

  • Nicole

    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

  • Carolina

    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.

  • Leah

    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

  • Daniela

    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

  • Daniela

    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.

  • Jax

    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.

    • S.Davis

      Where do you live??? I need information as soon as possible…I need your help.

      • Jen from vbacfacts.com

        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

  • Lisa

    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?

    • Charlotte

      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?, * 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. [...]

  • Ineasha

    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

  • Jeri

    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.

  • 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.

    • Jen from vbacfacts.com

      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.

  • Jessica

    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!!

    • Jen from vbacfacts.com

      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!

  • Becka Lynn

    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.

  • Morgan

    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.

  • Zsuzsanna Anderson

    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.

  • Christina Cox

    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.

  • Brooke

    I love, Love, LOVE that one of your final comments is comparing the statistic of miscarriage following amniocentesis vs. uterine rupture during a VBAC. That’s the statistic I always cite when I come across naysayers and one of the reasons I felt COMPLETELY comfortable (another reason being my Hypnobabies education ;) ) having a homebirth VBAC with my 5th baby in 2008 after having a c-section with my 4th. Now I’m in a different state and get to start looking all over again for a homebirth midwife for my baby due March 2011.
    Thank you for encouraging others with the TRUTH!

  • YELENA

    HELP ME! I HAD 2 C-CESTION MY YOUNGEST DAUGHTER IS 3.5 AND IM PREGNANT WITH 3RD BABY, I REALLY REALLY WANT TO FELL LIKE TO HAVING A BABY VAGINAL. I WENT TO SEE A DOCTOR SHE WONT SUPPORT ME WITH MY DECISION. I DON’T KNOW WHAT TO DO NOW IT BRING ME TO TEARS. SOMEONE HELP ME FINDING A VERY GOOD DOCTOR OR MIDWIFE IN ROSEVILLE, CA I WANT TO HAVE VBAC IN SUTTER ROSEVILLE HOSPITAL.THANX

  • [...] Want more information on planning a VBAC?  Go here. [...]

  • Alicia

    I am pregnant with my 3rd child. My oldest is 4, my youngest is 20 months, and I am due in August of 2011. I had c-section with my oldest cuz my doc wanted me to deliver before my body was ready, and so I thought a repeat c-section was best for me and my youngest. I am really sorry I jipped myself, do I have a chance for a VBAC now? I see the doc in 2 weeks. I live in Richland, WA. I plan to deliver at Kadlec Regional Medical Center in Richland.

    • Jen Kamel

      Hi Alicia!

      Whether you have a chance at a VBA2C (vaginal birth after two cesareans) really depends on your doctor. If your current doctor is not supportive, interview others. You can read more on finding a supportive practitioner here.

      The National Institutes of Health and the American College of Obstetricians and Gynecologists have both recently stated that VBAC is a “safe and appropriate choice for most women” with one prior cesarean and for “some women” with two prior cesareans. You can read more here.

      While some hospitals have not change their VBAC practices as a result of these recommendations, some have. So it really pays to check out multiple doctors and, if possible in your area, multiple hospitals.

      You can also read more on the research on VBA2C here.

      Warmly,

      Jen

  • Melanie

    Hi;

    I am considering haveing a VBAC after two cesareans. Call me crazy, but I think it may be a option for me.

    My first was a VBAC after multiple failed interventions, and it was very clear that the baby was in a bad position to be born even had she been small. With my second, I planned a VBAC(no other option to me), and my OB/GYN was very supportive of my choice right to the end. However, when I got to the hospital The OB on duty pretty much told me that it was “EASIER if I just agreed to the c-section”(and I wasn’t even ther 20 min, labour was past 5cm and going well)… Fortunaly, I had my Doula(or rather Back-up whom I had just met). My labour and Delivery nurse was neutral on the issue and didn’t push one way or the other… But after a couple hours of CONSTANT negative pressure, even with no medical reason(I was even told that my the OB- his reason was there MIGHT be and it was easier – for whom?) I agreed to the epidural, quickly followed by the c-section(still ne medical reson – ERRR)… Anyway, I did have a large baby 10lbs 9oz, so it might have been a difficult birth(however my mom is not quite 5 feet tall and had an 11 pounder slide out easily).

    Anyway, I am considering a VBAC after 2 C-sections! Midwives wan’t take me(no space, and they would have to transfer care). So my options are to find a family DR that delivers(very rare here), or go with the OB that the hospital selects for me and hope for the best… I want to stay home as long as possible, but we are 20min+ to the hospital(depernding on time of day), and I don’t want to put me or the baby in danger. I have no control over who the OB on duty will be(hospital policy – no other large hospitals/birthing centers les than 2 1/2 -4 hours away).

    I am hiring a Doula again… The Doula’s that I have had were both wonderful. I have to give Sue credit for being so supportave after just meeting me that morning! She helped me to stay positive even in the OR…

    Anyone have suggestions!

    I am considering talking to a nautropathic dr to see waht options are avaliable to lessen the chances of a large baby, and to start/augment labour naturally. And if there might be anything I can do to increase the chances of a VBAC… I am hopefull that since they are into “alternatives” they may be able to help or at least be supportive… Unfortunatly it isn’t covered by OHIP and may be partly covered by my private insurance… I am also considering a massage therepist and a curopractor…can’t do any harm anyway…

    Unfortunatly I know as soon as I get to the hospital I will be forced to lay still on a bed and not be allowed to move, except maybe to go to the bathroom(if I beg enough)… That is horrible, I don’t like laying still and that was torture(probably partly why I gave in…) I am hoping to negotiate a birthing ball(I’ll bring my own if nesicary… LOL).

    Any advice? I am in ontario.

    • Jen Kamel

      Melanie,

      Some women who plan hospital births, but want to stay home as long as possible, hire a montrice. A montrice is someone who has the medical training (sometimes they are nurses or midwives) to check heart tones, perform vaginal exams, and maintain a medical chart. They would come to your home when labor began and be there until you decide it’s time to go to the hospital or a complication occurs that necessitates transfer. Once at the hospital, your montrice becomes your doula. Since they have medical training, they are familiar with the fetal monitors and other medical equipment and terminology. There are a few ways to find a montrice in your area.

      I would recommend interviewing your local Family Practice doctor. I would also recommend calling the Labor & Delivery unit and asking for the head nurse. Tell her that you are planning a VBAC and ask who are the most VBAC friendly OBs. You could set up interviews with them (so you are more of a person rather than another patient they deliver five minutes after meeting them.) You could also just keep their names in the back of your head so when you do go into labor and arrive at the hospital, you will know if you have a supportive OB or not on call that night.

      When interviewing doctors, bring a copy of your operative reports from both cesareans and a copy of this article that summarizes the recommendations from the latest ACOG VBAC Practice Bulletin which state that it is “safe and appropriate” for “some women” with two prior cesareans to plan a VBAC. You might even want to print out a copy of the VBAC Statement produced by the National Institutes of Health to leave with each doctor.

      You do have an uphill battle ahead of you. I wish you the best of luck.

      Warmly,

      Jen

  • Rachael

    I am so alone! My doctor led me to believe that he was capable and willing to do a VBAC throughout my entire pregnancy, albeit through a great deal of dead baby dead mommy scenarios thrown in our face at every visit. Now he is refusing to cancel our repeat C by way of manipulation, “the OR is booked next week and if we wait too long it’s really bad for the baby”. I can’t believe he did this to us. I was adamant the entire pregnancy about wanting to at least try and he is going to take that away from us. What has the medical profession become? Why didn’t he just say he isn’t comfortable doing this and let us go? The more I read, the more I see there are women out there just like me struggling with the exact same thing. Keep trying girls; hopefully you’ll have better success than we did.

    • Jen Kamel

      Rachael,

      I’m so sorry you feel so alone. Rest assured, you are not. There are many women who go through your exact experience: their OB says throughout their pregnancy that VBAC is an option only to slowly apply pressure for a repeat cesarean as the pregnancy progresses. I hope some miracle occurs and your labor begins before your surgery date.

      Hugs,

      Jen

  • Emily

    Jen,
    Thanks so much for this site — I’ve been trawling the web looking for trustworthy information on VBACs and have found very little that is actually useful, until I stumbled onto your site. I’m on bed rest (had preterm labor symptoms) so I’ve spent hours reading the posts and comments on this site. Have I come any closer to making a decision about whether to VBAC or RCS? No… For many, it’s not so simple to change OBs….

    I’m a state employee stuck with an in-plan insurance company that has a cautious viewpoint of VBAC that is shared by all of the OBs within the plan. Switching from to another OB in the plan would be pointless — they all follow the party line of the plan. It would also be pointless because the day of delivery, I could end up with any one of the OBs in the plan.

    I’ve gotten some mixed messages from my OB. She went as far as to say that she believes that much of the anti-VBAC rhetoric is driven by lawyers and people around a conference table — not doctors that deal with actual patients. She has mentioned VBAC as an option several times over the course of my visits with her. I have been told I am a good candidate for VBAC (1st CS was low transverse for breech presentation). **But** my OB also says “we’ll try it and see how it goes,” which seems to suggest failure — and of course I was handed the obligatory consent form, which I still haven’t shown my husband. She also said “Uterine rupture is rare, but it’s not nice at all if you’re the one it happens to.” Sounds like one of the scare tactics you mentioned.

    I feel like the mixed messages I’m receiving have to do with my OB having her own ideas but being pushed in one direction or the other by the insurance plan. I sense ambivalence maybe because she’s ambivalent.

    And of course there are the other factors and stipulations that make a first time labor seem impossible. I was told that I could VBAC only if I go into labor before my due date — the plan will not allow me to go past it. Couple that with the high C-section rate for my hospital and a dismally low VBAC rate (47 VBACs out of 3027 births in 2009) and oh yeah that I would likely have never met the OB who delivers the baby, and I feel like my chances of success are compromised. I also worry about the increased risk should I have to have a CBAC.

    I agree with you that it’s important to find an OB and a hospital that is truly supportive of VBAC, but I think it’s very hard for women who don’t have much choice to go forward with VBAC in settings that offer VBAC but don’t necessarily encourage it.

    Again, still don’t know what I will decide — I have two more months to research and think. Thanks again for this amazing resource.

    • Jen Kamel

      Emily,

      Thank you so much for your kind words. As you may of read, I too grappled with the post-cesarean birth choice and it can be very difficult to decide. I want you to know that you are not alone. There are many women who have their options drastically limited either by their insurance plan or their geography. I am very fortunate to live in Southern California where we have a handful of VBAC supportive providers. My heart goes out to women who do not have these resources available to them.

      Have you had a chance to read the National Institutes of Health 2010 VBAC Statement as well as ACOG’s latest VBAC Practice Bulletin? I highly recommend it and you might even want to bring them in with you at your next doctor’s appointment. I am shocked how many doctors are not aware, or simply choose to ignore, these very important recommendations. Also, I encourage you to read VBAC Ban Rationale is Irrational. That might also be a good piece to share with your doctors.

      Best of luck in your decision making process. Would you please keep me posted on your birth?

      Warmly,

      Jen

  • sonya

    this is a wonderful source of information!! i had a c-section with my first because she was breech. my doc told me her head was down, and that if she didn’t start dropping or if i didn’t start dilating (she told me this 2 WEEKS BEFORE my due date!!) that we would talk about inducing. if i had known she was breech, i could have tried to turn her, and avoided a c-section altogether! and on top of that, i had no idea you could even try to deliver a breech baby vaginally! i was so looking forwards to having a natural drug-free labor. but my dreams were shattered due to lack of info/misinformation. i thought i was gonna be stuck with another c-section, but your website has opened my eyes to the fact that i can still have my natural delivery!! the 3 things i have been dead-set against since the beginning of my 1st pregnancy are a) induction/augmentation, b) c-section, and c) epidural. not necessarily in that order. this time i plan to avoid all 3!! thank you so much for this website!!

  • Anthony

    Make sure they have a surgical team ready to go 24-7 If you are attempting VBAC’S.

    They have about 15 min’s to get the child out, without serious damage after complete uterine rupture. It won’t be a Bikini cut either.

    • Jen Kamel

      Anthony,

      I had the opportunity to attend the March 2010 National Institutes of Health VBAC Conference where the ability of rural hospitals to safely attend VBACs was extensively discussed. One doctor spoke during the public comment period and stated that her rural hospital had a VBAC rate of over 30%! It turns out, if a hospital is supportive of VBAC and motivated, they can absolutely offer VBAC safely. (I also welcome you to read the commentary of two obstetricians and one certified nurse midwife who argued against the VBAC ban instated at their local rural hospital.) Read more about the policies that this hospital impleted: VBAC Ban Rationale is Irrational.

      VBACs can absolutely be offered safely without 24/7 anesthesia present. All it takes is a motivated staff that acknowledges that while the risk of infant death or oxygen deprivation in VBACs is 0.05%, the maternal mortality in repeat cesareans is 0.04% (Landon, 2004). Whose lives do we save? And in fact Henci Goer’s analysis shares with us that the 0.05% rate is inaccurately elevated. In the Landon (2004) study, women whose babies had died before labor were encouraged to VBAC. Those infant deaths were included in the 0.05% figure even though their deaths could not be attributed to a labor after cesarean. (For more information, please Henci’s analysis.)

      There was an entire lecture at the NIH VBAC Conference about uterine rupture, oxygen deprivation and blood gases. You can find a summary in the Program and Abstracts.

      Warmly,

      Jen

  • Taryn

    Hi,
    I’m at 19 weeks with my second pregnancy and was told from week 3 that I would have to have a repeat C-Section. I’m not very assertive and didn’t argue at the time, and haven’t since. This issue is very important to me because of the struggles I had after my first child was delivered via emergency c-section. I plan on talking to my doctor about this at our next appointment, but I’m wondering if it’s too late for me to change doctors if she is not supportive or does not allow VBAC. Is half way, 19-20 weeks, too far along for me to find the help and support I need to attempt a VBAC?
    Thanks! Great information overall, I’ve learned a lot and gained confidence is voicing my needs and wishes.
    -Taryn, Portland, Oregon

    • Jen Kamel

      Taryn,

      Your current OB has made it clear: if you continue under her care, you will have another cesarean. If you do not want another cesarean, you still have time to find another care provider. If you can get names of three different care providers and meet with each of them, you can get a feel for the different styles of care that are available to you. Hopefully you will be able to find someone with whom you have similar birth philosophies and resulting in an argue-free pregnancy and labor. I don’t like to argue either, especially during labor! :)

      Best of luck!

      Jen

  • Jodi

    Thank you for all of your information on VBAC’s. I am 28 wks pregnant with my second baby and have found a doctor and hospital who will do a VBAC. I am ready to do it but have a lot of concerns. For my first baby I was in labor at a birthing center for 3 1/2 days and finally went to the hospital because my son was stuck. He had his hands up by his head and never dropped and I only got to 5 centimeters. My back up doctor (who happens to be amazing and now going to do my VBAC) went in to move his head and when he did a ton of water came out along with the cord. So I was rushed into an emergency c-section and was completely knocked out for the birth of my son who is perfectly healthy.
    My worst fear is to be knocked out again for my second birth. I don’t want an epideral and I know the chances of a cord prolapse hapening again are slim to none but if any emergency happens such as my uterus rupturing then they will have to. So do I try to do a no pain med VBAC or do I go ahead with the epideral in case an emergency situation does happen? In order to do the VBAC my doctor says I have to come in as soon as I go into labor to be monitored and he will stick around the hospital until I’m ready to deliver. So what happens if Im in labor as long as my first? And how do you labor for so long in a hospital. It does not sound like fun but I will do anything to have a natural drug free labor.

    • Jen Kamel

      Jodi,

      I’m so sorry about your first birth. That must have been so scary! Now you are pregnant again! Congratulations!

      I personally would try to go without drugs for as long as I could. Going without drugs gives the birthing mom more options in turns of movement and eliminates the risks they can bring.

      Second labors tend to go more quickly than the first. Be upright and move in a way that feels good to you. For some women, they like to sit on a birth ball, others like to lend over a bed or cabinet. Read a lot of drug-free hospital and homebirth stories to get ideas on the different way women cope. You can then put these ideas on index cards so you can refer to them during birth.

      Bradley Childbirth Classes are generally geared toward women who want to go drug-free. This might be a good additional resource for more ideas and strategies.

      Happy pushing!

      Jen

  • Suzanne

    Hi. I’m new to your site and just trying to get some more info on VBAC. My daughter was a normal vaginal delivery. My second pregnancy(a surrogate pregnancy) was also a normal vaginal delivery. My third (also a surrogate pregnancy) was twins. I had planned to attempt a vaginal delivery with the twins with the support of my OB as long as Baby A was head down. Unfortunately she was breech and I ended up with a c-section at 36 1/2 weeks. My OB said if I want to attempt a VBAC for my next pregnancy I need to wait at least 2 years between the c-section and getting pregnant again. Is she just being cautious? Or is it really necessary to wait 2 years?

  • Sabrina

    I had my son 6 months ago via C-section. I chose to do this because I had horrible hypertension and negative progression during 4 days of labor. I never thought of even considering a VBAC for my next child.
    Now I may be pregnant again with my second. My incision was low and modern with no complications. Am I a good candidate for a VBAC? Both my midwife and hospital support it, but frankly, I’m a little frightened because of my recent ‘section.

  • Dr. Mark Response:
    Very observant of you, with great questions. One study in 2008 found a 300% difference in c-section rate between hospitals. Another study in 2010 found that induction of labor is associated with an increased risk (double!) of c-section. Women should check with their obstetrician as to why they are being induced – there are medical indications (something not going right with the pregnancy) as well as social ones (tired of being pregnant, timing of delivery for convenience). You have a better chance of vaginal delivery with induction of labor if the cervix is ready (“ripe”) or if you have a favorable Bishop Score, which involved rating of: dilation of cervix, position of cervix, effacement (thinning) of cervix, station (position relative to pelvis), cervical consistency.
    Bottom line – You may prefer to find an obstetrician and hospital that support your goals for VBAC (also called TOLAC – trial of labor after cesarean). Make sure the hospital you go to deliver at has the 24×7 dedicated support services in case you need an emergency c-section.

    Disclaimer: All information is for Educational purposes only and is not a replacement for professional medical advice, diagnosis or treatment. Current medical recommendations are constantly changing. Always consult a doctor or other qualified health provider regarding any medical condition and before beginning any diet or exercise regimen and before taking any dietary supplements or other medications.

  • Rae

    Hello,

    I’m wondering what the likelihood of having a VBAC after 2 c-sections. My daughter was born in July of 2008 and I was forced to have her via c-section. She was breech and my amniotic fluid was extremely low, so the doctor felt she would be putting her in distress to try and turn her. When my son came in March 2010, I had another c-section because I did not dilate and went to almost 41 weeks, so my doctor felt it was in my best interest to go ahead with a RCS. I am due with my third in April 2012 and I really do not want to have another RCS. This is my last child and I would really like to attempt a VBAC and have a vaginal birth experience. My doctor said that if I had delivered one child vaginally, it would be a possibility, but since I have had 2 sections and no vaginal birth it is not possible. I like this doctor (she is new to me) but I am going to exhaust all possible options of having a VBAC before I have another RCS. Any advice or help would be great!

    Thanks!

    • Jen Kamel

      Hi Rae!

      There are women who have a VBAC after two or more cesareans. I think the hardest part is finding a care provider to attend you. There are rare OBs, like Dr. Tate in Florida, who have attended VBA4C (yes, after FOUR cesareans) in a hospital. Please read here for more info on how to plan a VBAC.

      It sounds like your OB is not familiar with the latest ACOG VBAC recommendations where they state:

      Attempting a VBAC is a safe and appropriate choice for most women who have had a prior cesarean delivery including for some women who have had two previous cesareans.

      You can see other information and birth stories on vbacfacts by going here.

      Plus Size Pregnancy also has an extensive review of the research as well as birth stories.

      For what it’s worth, women who have cesareans for breech have some of the highest success rates with VBAC.

      Warmly,

      Jen

  • athi

    Oh, this is fab! I am from Malaysia and I had my first czer in march 2011. now i am 3 months pregnant .. and really looking forward for VBAC. When I read the case above, it was absolutely similar to mine. I wasn’t showing any signs for labor, yet my OB send me for induced and then i was poorly progress so I was put into emergency czer..
    thanks for sharing this post. I feel it is very beneficial. tq

  • Samara Ferguson

    As a mother and birth Doula doing research for my first HBAC, I almost found this helpful. It’s too bad that you wrote very personal points of view as it turned what could have been a very positive resource into a “girlfriends guide to VBAC”

    “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.”

    Maybe do a little research and help your readers to come to their own decision:

    http://www.vbac.com/a-doula-can-reduce-your-odds-for-a-cesarean/

    Instead of your link, I’ll be sending that one to my clients.

  • Andrea

    Hi, I had my daughter ten months ago and I’m now two months pregnant, which means I’ll be having my babies 17 months apart. I know they say to wait at least 18 to 24 months apart, do you think 17 months is cutting it too close? Also I had a c section with my daughter because I was having contractions but wasn’t dilating, my doctor told me her head was too big and my pelvis was too small. Is that likely to be a problem again? Also I’m a bit overweight and have an average resting blood pressure of 140/91, which is high. Should I try to have a VBAC? The thought of having another c section makes me want to throw up, it wasn’t a horrible experience but I don’t want to go through it again. I live in Southern California so I’m hoping I can try to make this happen! Any advice would be greatly appreciated!

  • Kashmir

    Hi there, I am 3 months pregnant with our 2nd child, #1 is 13 months old. #1 unfortunatly ended in emergency csec after failed vontose, forcepts, epsiotomy, cytotion and 3 hours of pushing. #1 i had an anterior placenta and he was OP, he also didnt engage untill labour started. Making it to stage +1, i also was fully dialated then being born with his arm up by his head and cord around his body over 24hrs after labour began. I have just learned that again I have an anterior placenta but would much like to have a VBAC. Any advice would be great

  • Chrissy

    Hello there. Thank you for your interest and your question. All I can say is that every pregnancy is different, and every labor/birth may be as well. My first cesarean was due to breech, so I cannot say I understand what you went through or your fears/concerns, but I personally know people with a very difficult first labor that ended in a cesarean who went on to have VBACs later. Do your research, keep your faith, and good luck to you!

  • Heather

    Hi, I’m 7 weeks pregnant with my 3rd child after 2 csecs and am really wanting a vbac. My issue is finding a dr who will take the risk and my insurance in the area. I want this more than anything.

  • Katia

    Hi everyone, I have a 6 month old son who I delivered by a em section because he was breech and we didn’t know. I didn’t have any complications with him and went into labor at 37 1/2 weeks. I’m really hoping to have a VBAC for my second because I wanted an all natural labour with no medical interventions. I guess what I’m wondering is; How can I make sure ill get what I want?

  • Katia

    Oh and The reason why I got an em section is because the doctor never told me I could try to deliver him naturally even though he was breech, she just told me that the chances that he could die are very high and obviously when you hear that your child can die you opt for what the doctor is saying…

  • Ashley Ferguson

    Hello,

    I love reading empowering stories about VBAC since most people that I speak with think I’m insane for wanting to have one. I’m not pregnant again yet, but my first birth was an absolute nightmare. My water broke at 7:30 am and my contractions were great, not feeling great, but they were happening as they should have been. I was dilating about a cm every 45 minutes, no pitosin (sp?) and I was absolutely against getting it (unless my baby was in extreme danger). When I got to 6.5 cm’s my contractions were fierce so I elected for an epidural. I knew I didn’t want one and fought with myself over and over, especially because I watched the “business of being born”. Once I had my epidural my body essentially stopped moving my baby down, I started swelling from the constant checking and developed a fever. There were 5 other women in labor at the same time and 4 of the 5 women had C-sections. My Dr. wasn’t there so I had his stand-in doctor who was extremely rude and in a rush. She suggested the c-section, to which I said no. I didn’t consent I didn’t want one and I was only in labor for 6 hours. She was saying that there was no way that I would push my daughter out, basically making me feel like my body wasn’t able to do what it needed and that my daughter was going to die. After 30 minutes, I was rushed to the operating room. I cried the entire time I was laying there, I was so mad, upset, frustrated, confused, angry, and all of the other emotions that could be felt all at once. I remember them pulling her out of me, and told me to be happy because she was out. All I could do was cry, I wasn’t happy. The after effects of a c-section are horrendous too, I couldn’t move, I was so drugged up that I couldn’t hold my daughter, I didn’t get the chance to do the skin to skin contact, essentially I missed everything I was imagining I would do, for the first time. Now, 9 months later I am still dealing w/ my experience. My Husband and I want to get pregnant again by May this year but I am adamant about having a vbac. My Husband thinks it is crazy, he thinks I’m being selfish and none of my family members understand why I would want to have a natural child birth. I’m looking for more information in my city, Las Vegas or possibly information for the state of Missouri as far as VBAC doctors are concerned, home birth is an option but that scares me too. Any information or links would be amazing! I appreciate your help and look forward to reading more! :)

  • Stephanie Rose

    Hi there,

    I had my daughter eight months ago via c-section because she was breech. I tried the ECV, which was painful and unsuccessful. I tried to talk the practice into letting me deliver her vaginally even though she was breech. She was butt first, not foot first, and in my research back then I had read that it was not impossible because the butt would dilate the cervix in much the same way that the head would. In any case, no one went for that, so I had the surgery. It wasn’t as terrible as I imagined it would be. I healed up fine and had no issues with infection, which was my greatest fear. I am very passionate about having a vaginal delivery for any future children though. In some reading I was doing today I discovered that my hospital has a de facto ban on VBAC, so my first task is to find a new OB who works at a hospital that does permit them. I feel like I may encounter additional push back because I now have a history of having a breech baby. Do you have any information about what I might encounter if my next baby is also breech?

    • Jen Kamel

      Stephanie,

      Women who have their cesareans for breech have some of the highest VBAC success rates, over 83%. So, the odds are overwhelmingly in your favor if you choose to plan a VBAC. Unless you have a uterine anomaly that increases the odds that you will have another breech baby, the fact that your prior baby was breech is not a “bad mark” in your medical history.

      What area of the country are you in? I list some resources here on how to find a provider, but you can also come find me on Facebook here, here, or here and post that you are looking for a VBAC supportive provider in your area.

      The thing with breech is that most providers don’t attend them because they don’t have the skills. I am not a medical professional, but it is my understanding that most vaginal breech deliveries don’t have any problems. The issue is, if you do have a complication, it’s good for your health care provider to know how to address it. Since most OBs/MWs in the US don’t have the skills, most breech presentations result in a cesarean.

      If you are willing to travel to deliver your baby, that opens up your options immensely.

      Best,

      Jen

  • Leyla F

    i’m wondering about info on VBA2C….I had pre-eclampsia with #1 and #2 my pressures started to go wonky again at 39 weeks. i just want to know the facts about TOLAC after 2.

    • Jen Kamel

      Leyla,

      Factors to consider:
      1. What kind of scars do you have?
      2. Reasons for your CSs?
      3. What is your current health, in general and specific to this PG?

      Resources:
      1. ACOG says VBA2C is reasonable in “some women.” Having two prior low transverse cesareans is ideal as those scars are associated with the lowest level of rupture: http://vbacfacts.com/2010/07/21/acog-issues-less-restrictive-vbac-guidelines/

      2. If you plan on more children, a VBAC is mostly likely the safest choice in the long term: http://vbacfacts.com/2012/12/09/why-cesareans-are-a-big-deal-to-you-your-wife-and-your-daughter/

      3. Evidence strength on VBA2C is low because the studies conducted have included relatively few women (around a 1,000 or less) and don’t control for augmentation and induction. An excellent, though growing outdated, review of the literature can be found here: http://www.plus-size-pregnancy.org/CSANDVBAC/vbac_after_2_cs.htm

      4. I believe the 2010 NIH VBAC Conference discussed VBA2C: http://vbacfacts.com/2012/04/11/best-compilation-of-vbac-research-to-date/

      5. Ways women have responded to VBAC bans: http://vbacfacts.com/2012/01/23/mom-encounters-vbac-ban-request-advice/

      6. My class is 6 hours and reviews all this and much more: http://vbacfacts.com/classes. I offer a online webinar in addition to a video.

      I haven’t read the full text of this study: Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections.

      AuthorsTahseen S, et al. Show all Journal
      BJOG. 2010 Jan;117(1):5-19. doi: 10.1111/j.1471-0528.2009.02351.x.

      Affiliation
      Leeds University Hospitals NHS Trust, Leeds, UK. stjavaid@yahoo.co.uk

      Comment in
      BJOG. 2010 Oct;117(11):1426-7; author reply 1427-8.
      MAIN RESULTS: VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel-Haenszel).

      Hope this helps!

      Best,

      Jen

  • Jeri Thurber

    Do you think there will be a need for extra, careful consideration for a mom having a VBAC after 40 (probably 42 years old)? If mom is in good health (but overweight)?