Mother planning a VBAC: “Am I making the right choice?”
I am pregnant and plan on having a VBAC. As my due date gets closer, I get more nervous about it. I hope I am making the right choice in having the VBAC.
Hi Isha!
I too wondered if it was unreasonable to plan a VBAC when I had my cesarean. And that is when I started researching.
My obstetrician said I was a great candidate for VBAC. In fact, it’s one of the first things I remember him telling me after my cesarean. But when I talked to my friends and family they were confused… and concerned.
Navigating misinformation
All they had heard was how dangerous VBAC was and how convenient, easy, and safe cesareans were. So why would my OB tell me that I was a good candidate? Doesn’t everyone have repeat cesareans? What about “once a cesarean, always a cesarean?”
The discrepancy between what my doctor said and what my friends and family said was enough to propel me on my journey to the facts and then creating VBAC Facts so other people could easily access the evidence too.
Not wishing thinking. Not fear mongering. There’s enough of that out there. But the actual, straight facts directly from the medical literature.
How I boosted my VBAC odds
Here’s how my brain works: What makes me scared is the unknown, so I found that learning about the risks and benefits of VBAC versus repeat cesarean gave me a lot of peace.
I like having all the statistics in my brain. It enabled me to quickly identify misinformation, from providers and advocates alike.
It gave me a solid foundation from which to make a truly educated decision. It gave me confidence and peace.
And it also made it clear what I needed to do to boost my VBAC odds which accepting what was outside of my control.
It enabled me to be kind to myself. So many cesarean parents feel broken. Like their body failed them or their body just doesn’t work.
I wanted to create space for the truth: There are a lot of things we can control. But there are some things we can’t.
Finding peace about repeat cesareans
Learning what I could control, and making the best choices for me, set myself up for success.
But I also learned that even if I made all the “right” decisions, I could still have a repeat cesarean.
That truth was not a reflection on me, my body, my value, or my worth. Sometimes repeat cesareans are needed. That’s all it meant.
Given that I felt like I had done everything in my power to boost my VBAC odds, I felt like I could relax into that possibility. Knowing that I controlled everything I could while releasing everything I couldn’t control.
The best piece of advice I received
After I learned the facts, one of the best pieces of advice I received was to “try on” the two different choices.
For a few days, decide to plan a VBAC. Give your heart and mind an opportunity to sink into that decision.
Then check in with yourself: How do you feel? What emotions are coming up for you? Do you feel settled or uneasy?
Then do the same with a repeat cesarean. Try that decision on for a few days and note how it makes you feel.
The best way to learn the facts
Now I spent years learning how to evaluate medical research and then compiling it and distilling it for my own use. So, I don’t recommend starting from scratch and culling through all the literature yourself because it will take forever… believe me, I know.
If I could have attended a class like my “The Truth About VBAC™ for Families” and just had all the information given to me, I would have jumped at the chance.
Because it’s not just all the things that are floating around in your mind right now. The specific questions you know to ask.
It’s also all the questions you don’t even know to ask. All the things you don’t know you don’t know.
What I learned during my journey is how much I didn’t know. How much my friends and family didn’t know. And frankly, the massive gap between what most physicians say and the conclusions of medical research.
80% risk of uterine rupture after two cesareans?
A reader told me how her obstetrician claimed to be quoting “ACOG’s uterine rupture statistics” when they said the risk of uterine rupture was 80% after two prior cesareans.
To be clear, ACOG says the risk is 0.9 – 3.7%. Nowhere near 80%.
But unless people know what ACOG says, physicians can say whatever they want – and some do. This deprives birthing people from the right to make their own medical decisions based on the evidence.
80% is frightening. I’m sure that physician has many clients who “choose” a repeat cesarean after a VBAC consult with them. But is it a real choice at that point? No.
Some obstetricians knowingly mislead because while they claim they are supportive of VBAC, they really prefer their clients to schedule repeat cesareans. Others don’t know any better or just haven’t made the time to review ACOG’s guidelines and the research.
There is a lot of information available here, but if you want to get up to speed quick, if you want the complete picture, check out my training because it’s the most comprehensive course out there for families planning or considering VBAC.
It weaves together the most relevant medical facts – like everything you want to know about VBAC and repeat cesarean outcomes, risks, and benefits. We also cover home and community VBAC, the truth about VBAC bans, as well as the questions I get asked the most by people just like you.
After completing the course, you will be clear on what is right for you. That might be a VBAC. Or it might be a repeat cesarean. There’s no judgement here. Just what is right for you.
You will also be able to talk to anyone at anytime about VBAC and repeat cesareans and feel completely confident in that discussion because you will have the facts at the ready to dispel any misinformation flying your way.
I wish you well on your journey and best of luck!
Warmly,
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Jen Kamel
Jen Kamel is the CEO and Founder of VBAC Facts® whose mission is to increase access to vaginal birth after cesarean (VBAC). VBAC Facts® works to achieve this mission through their educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. As an internationally recognized consumer advocate, Jen speaks at conferences across the world, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. VBAC Facts® envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support so they can plan the birth of their choosing in the setting they desire.
Jen Kamel
Jen Kamel is the CEO and Founder of VBAC Facts® whose mission is to increase access to vaginal birth after cesarean (VBAC). VBAC Facts® works to achieve this mission through their educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. As an internationally recognized consumer advocate, Jen speaks at conferences across the world, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. VBAC Facts® envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support so they can plan the birth of their choosing in the setting they desire.
I want to urge any woman who is considering a VBAC to go for it! I successfully VBAC’d on 9/15/11 – a 7lb baby girl. My first child was posterior and almost 9lbs, resulting in an emergency c-section. It didn’t help that I had gained almost 75lbs through my pregnancy. I am 5’4″ and got pregnant when I was already overweight (165lbs). The docs said I had “a small pelvis.” Ladies, that is balony. Do not listen to them if they tell you that. There is no way they can tell how big your pelvis will get in labor.
A few words of advice:
1) Be as active as possible throughout your pregnancy. This keeps your weight down and also your baby’s weight (which helps to make sure the baby can fit through the birth canal). I walked several miles a day up until I delivered. Take the steps instead of the elevator, etc. You will thank yourself. Trust me. Plus it really speeds recovery. I was only in the hospital for 36 hours from the time I set foot in L&D. I was able to leave the hospital a full day early. As a bonus, my daughter is 5 months old today and I am 11 lbs lighter than I was when I got pregnant!
2) Go to http://www.spinningbabies.com and follow the advice to make sure your baby is in the optimal position prior to labor. Just say NO to a posterior baby! 🙂
3) Stick to your guns. They wanted to schedule me for a C because I was a week overdue. My OB said ok to VBAC with the stipulation that I didn’t get induced with Pitocin. If you are under Pit, the risks of uterine tear greatly increase (and so do the chances you will sue your doctor, which is why they don’t want to let you go VBAC in the first place). I put the C off and did lots of nipple stimulation, sex & pelvic exercises to get the labor hormones going so I would go into spontaneous labor. It worked. My water broke on its own.
My water broke around 7pm. I ate a big bowl of cereal for strength and waited a bit longer. Went to the hospital around 8:00pm and by 2:00am I was pushing. At 4:30, Natalie was born. I pushed for a long time, but that was because she was turning and trying to find her way out. Once she got into optimal position, she was out 10 minutes later.
I can’t stress enough how physical activity will help you successfully VBAC. It will also give you the strength & stamina you will need to push if your baby is not in optimal position.
Good luck to you all! And trust in yourself & your body. Women were made to have babies and anyone who tells you a C is necessary because of a small pelvis should only say that if you have had Polio. Otherwise, I guarantee you are big enough to vaginally deliver. Even if you are only 4ft tall!
I am looking for the risks to fetus if a uterine rupture occurs, i have found data that suggests the risk of rupture if the first csection is less than 18 months jumps to almost 5%
But even if that occurs what are the risks to the baby? My ob said baby could suffocate, is that true, how long do you have etc? I can’t find info on fetal survival after rupture and what would be the cause of death or injury to baby if it does occur?
Hi Colleen,
I’m sorry it has taken me so long to reply to your comment. It is frankly really hard to keep on top of all the comments I receive!
The studies on uterine rupture by birth interval are small and don’t control for important factors like induction and augmentation which we know increases the rate of rupture. So in studies like this that have reported high rates of rupture, we don’t know if that rate is due to short birth intervals or induction/augmentation or simply due to the wonky numbers that small population samples occasionally yield. Read more here.
As a result of this inconclusive evidence, some OBs require 18 -24 months from cesarean to subsequent delivery whereas others don’t. So, if you have a small birth interval, it might be worth your while to interview other care providers in your area.
As your OB said, uterine rupture impacts baby by interrupting the blood flow to and through the placenta, and thus oxygen supply. The evidence strength on rupture-related perinatal mortality (infant death within 28 days of birth) is low and you can read more about this here. The evidence on the rate of rupture-related oxygen deprivation and brain damage is even more inconclusive as reported by the 2010 National Institutes of Health VBAC Conference. You can review all the documents and presentations related to that conference here.
I do cover this topic and so much more in the 6 hour class I teach which is offer via an on-line webinar and in a city near you.
Hope this helps!
Best,
Jen
Hello Ladies! I am a Certified Professional Midwife in southern Calif. My birth center, AquaNatal, specializes in assisting women to have safe VBACs in our deep warm built-in tubs from Waterbirth International. If you are in the area I hope you will stop by.
I was wondering if you have any statistics on VBAC risks with 2 prior c-sections. I had a c-section the first time because of concerns related to high blood pressure and gestational diabetes. My dr told me that my incision was low and transverse, and that a vbac would be an option for the next delivery, but I moved out of state and the dr I had last time would not allow it and actually told me that there wasn’t one in the region that would. (I did not have HBP or GD) That was a little over 3 years ago. My dr did tell me after the c-section that she was able to make the incision along my previous scar so that I would still only have one scar.
This time, I was able to find a dr (in the same city) that will let me try a VBAC as long as everything continues to go well. Apparently even the clinic I used last time has started allowing some VBACs as well. My current dr said that he would not induce labor under any circumstances and doesn’t want me to go past 41 weeks. I think that’s wise and am agreeable to that. No HBP or GD this time either!! But I did hit the magic age of 35 at the end of April which immediately bumped my pregnancy into a high risk category. I’m currently 36 weeks (due July 9) and feel like a VBAC is the right option for me. But I have some family and friends that are concerned and I know I would benefit from their support. So if you have some information that could help me help them feel better about it, I’d appreciate it.
Cheryl,
Please check out KMom’s website on vbac after multiple cesareans. She has a lot of great information.
Jen
I am strongly considering a VBAC. Everyone else is saying once a cesarean always a cesarean but I want to challenge my gynae next week when I see him for my appointment. My son did not engage at 39 weeks that was the reason for the first cesarean. I will be giving birth in October 2011. I am doing all the research that I can possibly do and I want to thank everyone for the wonderful support that you are giving us mothers who are considering a VBAC.
My mom is a midwife and she says as long as this baby engage she does not see any reason why I wont be able to deliver vaginally.
Thank you again and I will let you know how it went.
Alverna
I really learnt a lot from your research. i had my first daughter vaginally, it was a long labour lasting 48 hours,i was induced ,she weighed 8.3lbs.
my second daughters labour was different, her water broke, and i went to the hospital early, after 11 hours i was only 4 cm and the nurse said my baby had turned to a breech position. i had to have an emergency Caesarean .
My third baby, had no problems, but the hospital wont let me have a VBAC, even though i changed hospitals. They all said the same thing, i eventually had to have an over medicated elective Caesarean, my son suffered a lot in the hospital. he was placed on i.v and was given so many injections that i knew nothing of. i eventually left the hospital after i realized they had read a false blood level on a faulty machine, and caused my little boy a lot of distress.
Now am pregnant for my fourth child, i live in Nigeria, i do not know what kind of care i can recieve. we do not have an active midwifery organisation, and most hospitals would not allow a VBAC. Am secretly planning an home birth, your research gave me plenty comfort.
Hi,
What is your definition of spontaneous labor? For example, my water broke, but I didn’t go into active labor right away and was given patocin, which allowed me to get to 9.5cm dilation with in hours. Would this still be considered spontaneous?
My little man was face up and wouldn’t turn, at the end of the day we did c-section. At the time my doctor said I should be able to go natural in future births, but receiving all of the facts now, it doesn’t seem that way.
Thanks for all your information. I feel so much more informed and able to discuss it better w/ my doctor and husband going forward.
Thanks,
Kari
Hi Kari!
I’m not a medical professional, but my understanding is that when your water breaks it can take several hours for contractions to start. How long a medical provider waits until they use pitocin, if at all, varies from practice to practice.
When a labor starts spontaneously (without being induced), but then something like pitocin is administered, that is called augmenting a labor.
Warmly,
Jen
I was wondering about the statistic you mentioned at the top of your reply. “There is about a 0.4% risk of having a uterine rupture with one prior low transverse cesarean in a spontaneous labor (meaning you weren’t induced or given pitocin or other similar drugs during your labor) (Landon, 2004).”
With my first delivery, I was determined to have a natural, no drugs birth but it ended up being the complete opposite. After 20 hrs of labor I was only 2 cm dilated, the baby hadn’t dropped and also about 10 hrs before delivery my water broke and there was meconium. I still wanted a natural birth so we waited as much as possible and I was even put on a drip to strengthen contractions. I remained at the same dilation and we had to have a cesarean. The baby was getting stressed and the heart rate was rising.
So we did, I did ask my doc whether I could have a VBAC and he said if no complications in next birth yes.
In your quote you say that the risk of rupture is 0.4% if there was no other intervention (so I guess if it was immediate emergency to get the baby out or selective Cesarean). Which means in my case the risk would be higher. Is that right?
Hi Vanja,
The 0.4% statistic is based on your VBAC labor starting spontaneously.
Warmly,
Jen
Isha-
Interestingly enough, I am due only a couple days ahead of you. I am due on January 28th, 2011. I too am concerned about VBAC – but after reading Jen’s response, I quickly realized that in order for me to feel more confident, I just need to do more research. I am also going to attend one of the ICAN support groups in my area. I hope that you continue to take the steps you need to feel comfortable with your decision.
Take care-
Zsuzsi