I think it’s very important to discuss the particulars of your OB/midwife’s standard protocols and birth philosophy way before you hit your 3rd trimester, preferably when you are interviewing providers. No sense wasting time with a provider who isn’t really pro-VBAC. And if your OB/midwife sounds really great at the beginning and then starts talking induction/CS as your due date looms, this is a huge red flag.

There are truly pro-VBAC professionals out there, but there are far more who will string you along until you are to tired to go through the motions of finding another provider. However, it is never to late to at least seek out a provider.  Keep in mind that you will have better luck getting names when speaking to someone face to face.  Often, people don’t want to give out names to someone they don’t know over the internet.

Here is a list of questions that are relevant to all birthing women, VBAC or not. What I’ve added is my commentary on how I think their answer reflects how supportive they really are of VBAC.

1. How many VBACs have they attended? (Word spreads fast on pro-VBAC OBs.)
2. Of the last 10 women seeking VBAC from them, how many had a VBAC? (If it’s less than 7 or 8, I would ask what happened in those 2-3 labors that ended in CS. This would give you a great idea of how they operate… so to speak!)
3. Do they have any standard VBAC protocols that differ from a non-VBAC mom? (If so, this could be a red flag, because if they start viewing you as a uterus waiting to explode, rather than a laboring mom, they may not really support VBAC.)
4. Under what circumstances would they induce a VBAC? (Inducing a VBAC mom increases the risk of uterine rupture which should be weighted against the reason for the induction.  "Big baby" and "over due" are not legitimate, medical reasons. At 42 weeks, I would request a biophysical profile to check on baby and as long as baby and mom are fine, I would wait for labor to start instead of inducing/CS.)
5. If so, what methods do they use? (If they use Cytotec, find another provided FAST. According to Dr. Wagner’s Born in the USA, uterine rupture rates in VBACing women are 28 times higher when Cytotec is used.)
6. What is their philosophy on going past 40 weeks? (If they want to schedule a CS at 40 weeks, run fast. They should be fine going to 42 weeks as long as you and baby are fine.)
7. What is their philosophy on "big babies?" (ACOG Practice Bulletin No. 22 which appeared in the November 2000 issue of Obstetrics and Gynecology found no value in inducing for "big baby" since it simply doubles the CS rate and does not prevent shoulder dystocia or reduce newborn morbidity. Nor do they support cesarean section for "big babies: "While the risk of birth trauma with vaginal delivery is higher with increased birth weight, cesarean delivery reduces, but does not eliminate, this risk. In addition, randomized clinical trial results have not shown the clinical effectiveness of prophylactic cesarean delivery when any specific estimated fetal weight is unknown. Results from large cohort and case-control studies reveal that it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g. Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that cesarean delivery in these situations should be considered.")
8. Do they attend vaginal breech births? (Wouldn’t it be such a bummer to believe you are having a VBAC only to be one of the 3% of women who have breech babies at term? Find out now if this provider will support a vaginal breech birth or if they will point the way to the OR.)
9. How many uterine ruptures have they witnessed? (This can be an indicator of their induction rates.)
10. What kind of monitoring do they require? (For me, if it’s continuous fetal monitoring, that’s enough reason to find another provider because I’m not down for staying in bed the whole labor. I want to move! In addition, continuous fetal monitoring has greatly contributed to our rising c-section rate while not improving infant outcomes or reducing rates of cerebral palsy. I personally think that 15 minutes of monitoring per hour is reasonable.)
11. What is their CS rate? (If it’s greater than the World Health Organization’s recommendation of 10-15%, this is a huge red flag. How can they support VBAC if they are performing unnecessary primary CSs?)
12. Do they perform an automatic CS if waters have been broken for more than 24 hours, even if there is no evidence of infection and mom and baby are fine? (If they say yes, huge red flag. Find another provider.)
13. Do they have a time-limit on how long your labor can be before they c-section you? (There should be no limit as long as baby and you are fine.)
14. Do they require epidurals for VBAC? (One reason that some OBs require epidurals is because if they deem a CS necessary, you are already numb. Again, this is the attitude that you are a problem waiting to happen. The question is, is this how you wish to be perceived?)
15. Do they require an IV or heplock? (IV restricts your movement, heplock means they put the part in your arm, but it isn’t connected to a bag. Heplock can be annoying and get you into the "patient" rather than "healthy, birthing mom" mindset.)
16. Are you permitted to move and deliver in whatever position you want? (Laying on your back or the "on the edge of the bed with your knees by your ears" are great for their viewing, but may not be where you want to be. In addition, especially if you have a big baby, you might want to deliver on your hands and knees or on a birthing stool)

You might have to interview several providers until you find one who is truly supportive of VBAC. If you do find such a provider, refer all your friends, VBAC or not, to this provider so that they can reap the benefit of someone who supports non-interventive birth! I really think that true change won’t occur in the medical community in terms of supporting natural non-interventive birth and VBAC until the OBs and hospitals see their revenue decrease. For this reason, we all need to support OBs, midwives, and hospitals that support VBAC.