The following information was included on a handout I gave to attendees of a class on VBAC I taught a few years ago. These simple, yet important facts have been gleaned from a large number of VBAC resources, studies, books, and websites. Additional resources are listed at the bottom of this post. If you are planning a vaginal birth after cesarean, I strongly encourage you to learn about all your options for birth place and birth team, and foster your own inner resources for birth – learn how you can find the strength to stand up and give birth. No one else can do it for you, no matter how excellent your doctor, midwife, nurse, or doula!
The general consensus is that a planned cesarean is safer than an emergency or unexpected cesarean, but a VBAC is much safer than a planned cesarean.
You are a great candidate for a VBAC if:
- You had a vaginal birth either before or after your cesarean
- You have had no more than two cesareans, your cesarean was for non-recurring reasons like fetal distress or breech position
- Your uterine incision is low-transverse or low vertical, and some would say, stitched with a double closure technique
- Because most incisions are low-transverse, ACOG now says if you have no way of accessing your files it is still safe to do a VBAC with an unknown scar type
- You are pregnant with one or two babies
- If your baby is breech and you had a low transverse incision you are eligible for ECV after 37 weeks, although other methods of turning a baby are preferred
- You are less than 42 weeks pregnant
- Your baby is average sized or estimated to be larger than 8lbs 13oz.
- Preferably, you have had at least two years between your cesarean pregnancy and your current pregnancy
Keep in mind that although women who have had a cesarean birth for “failure to progress” or “cephalopelvic disproportion” are less likely to have a VBAC, women who have had VBACs after being diagnosed with CPD often give birth vaginally to much larger babies without trouble. The key is to determine why labor stalled or the baby didn’t move down, and then take steps to prevent it from happening again.
Also keep in mind that if you don’t meet the criteria for a “good VBAC candidate”, that doesn’t mean you shouldn’t plan one. Many women fall outside those guidelines and have wonderfully empowering births.
Before you plan to have a VBAC, you must first address your cesarean birth. Don’t repress your feelings, express them. Find support and resources and use them.
Understand that your fears are normal but they do not determine your future.
The overall risk for perinatal mortality and morbidity with a trial of labor following a cesarean is comparable to that of any first time mom.
During your pregnancy and labor focus on alignment – big babies are usually born easily if aligned well in the pelvis. Use upright positions, keep moving, and use specific positions to turn baby if not aligned well.
Don’t pay attention to the media’s representation of birth; understand that money and views determine how birth is shown on TV, in movies, and in magazines.
Spend your pregnancy loving your pregnancy, your belly, and your baby. Celebrate life, think positive energy, avoid criticism.
Unlike the top portion of the uterus, the bottom (where most cesarean incisions are made) is made of fibroelastic tissue which heals very well and becomes once again, flexible and elastic when stretched.
The risk of rupture during spontaneous labor is comparable to any woman’s risk of serious abruption, damaging fetal distress, and cord prolapse.
The good news: You can decrease your chance of having a uterine rupture by: avoiding prostaglandin cervical ripening, cytotec/misoprostol ripening, pitocin augmentation, induction of labor by any means, forceps, vacuum extraction, and epidurals.
Watch out for professionals who make claims about VBAC that are not backed up. This happens even in places you would least expect, including the American Congress of Obstetricians and Gynecologists.
Hire a doula. Research shows they help women to reduce their chances of interventionist births, including cesareans, and to have more satisfying birth experiences.
Choose your environment and birth team with extreme caution – make sure they have a cesarean rate below 30%, a VBAC rate above 70%, and that they are positive and supportive. Do not be afraid to switch care providers, even late in pregnancy or in labor. Look for a care provider who offers what you want instead of trying to fit what you want into what they do.
Keep in mind that hospitals are not designed for VBAC success although it is possible to have one there. Consider home birth or a birth center.
When choosing an environment and care provider remember the sphincter law – the cervix is a sphincter; that just like the urethra and anus it will not open on command. Privacy, respect, and a state of safety and relaxation will encourage them to open. If you combine this with ideal fetal positioning you are unlikely to have any problems with your birth.
If your hospital has a ban on VBAC, ideally you should look elsewhere for a care provider because even if you force your rights you will not get the support you need from a hospital that has a “ban” on VBAC. However, if you have no other choices, which in Maine is probably not the case, you can learn your legal rights to refuse a cesarean. No hospital can force you to have a cesarean, you must agree to it first.
Be flexible, but within reason. Take responsibility for what happens to you. Make your own decisions, do your own research, ask questions.
In case you find yourself needing another cesarean, consider what you would want to do the same or differently. It’s not planning on failure, it’s relieving your fears so you can plan on a good birth.
Only 5-10% of pregnancies fall in the category of needing an induction for an appropriate reason: gestation past 42 weeks, evidence of placental malfunction, a very small baby, preeclampsia, ruptured bag of waters beyond 2-4 days, and fetal hypoxia in labor.
It is also important to recognize what are valid and invalid reasons given for accepting a repeat cesarean. Every care giver has a different opinion about what is acceptable risk and what is not, so you must do your own research and ask lots of questions, especially during your prenatal care visits.
After accounting for situations when cesarean sections are life-saving, Dr. Marsden Wagner determined that cesareans are necessary to save moms and babies in about 5-10% of births. These situations include: bradycardia or tachycardia in the unborn baby, complete previa at term, placental abruption, prolapsed cord, tansverse lie at term, hyper stimulated uterus, uterine rupture, uncontrolled preeclampsia, active herpes lesion, and HIV.
Additional resources for planning a VBAC in Maine
Reading material and websites:
Ina May’s Guide to Childbirth by Ina May Gaskin
Creating Your Birth Plan by Marsden Wagner
The VBAC Companian by Diana Korte
Vaginal Birth After Cesarean by Helen Churchill and Wendy Savage
Birth After Cesarean: The Medical Facts by Bruce Flamm
Cesarean Recovery by Chrissie Gallagher-Mundy
Expectant Parent’s Guide to Preventing a Cesarean Section by Carl Jones
The Cesarean Myth by Rosen and Thomas
Birthing From Within by Pam England
Simply Give Birth by Heather Cushman-Dowdee
(so many more excellent VBAC stories are available on YouTube!)
What to do if your hospital has a ban on VBAC:
Certified Professional Midwives offering home birth services for VBAC moms in Maine
Susi Delaney in New Gloucester
Heidi Filmore-Patrick in Bridgton
Ann Marie Rian Wanzech in Harrison
Robin Doolittle-Illian in Bridgton and Portland
Deirdre Sulka-Meister in Portland
Holly Arrends in Penobscot
Sarah Ackerly in Topsham
Josie in Topsham
Donna Broderick in Belfast
Linsday Bushnell in Hiram
Maureen Smith in Hiram
Breanda Surabian in Limington
Jill Breen-de Behune
Nancy Duncan in Old Town
Andrea Mietkiewicz in Old Town
Pam Dyer Stewart
Hospitals in Maine permitting VBACs, VBAC success rates listed may have changed
- Mercy Hospital in Portland – Only OB’s have attending rights and there may not be any who would agree to VBAC right now. The RN I spoke to says their VBAC success rate is 70% because patients are “very carefully screened”.
- Mount Desert Island in Bar Harbor – Both OB’s and CNM’s have attending rights. The medical assistant I spoke with did not know the VBAC success rate.
- Central Maine Medical Center in Lewiston – Only OB’s have attending rights. VBAC rate is 64%.
- Eastern Maine Medical Center in Bangor – Only OB’s have attending rights. There are few OB’s who will agree and they have very strict guidelines (OB & anesthesiologist must be in-house, no VBAC for previous FTP, etc.)
- Franklin Memorial in Farmington – OB’s and the one CNM have attending rights. Only allow VBAC if you’ve already had a VBAC. Very few women have had one here.
- Maine Coast Memorial in Ellsworth – OB’s and CNM’s have attending rights. VBAC only allowed if you’ve had only 1 cesarean with a low-transverse incision. VBAC success rate is 80%.
- Maine General in Waterville – OB’s have attending rights, CNM’s can only do prenatal care. VBAC success rate is said to be between 80-90%.
- Maine Medical Center in Portland – OB’s, and possibly CNM’s are given given attending rights. I was told to ask the individual doctors about their VBAC success rate.
If you have additional resources you would like to share, please comment below!