The Most Important Things To Know about VBAC

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

YouTube Videos:
How to Get Baby in the Best Position for Childbirth – No Back Labor!
Question CPD
My Journey to VBA2C (VBAC)! My Birth
My Twin Homebirth VBAC (HBAC)

(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

Birth Centers in Maine
The Birth House in Bridgton
Clear Light Birth Suite in Old Town

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!

Under Construction

Birth a Miracle Services is a woman-centered business offering several services useful to expecting families. For nearly five years, this blog has served to support the business and provide additional resources to my clients and pregnant women all over the world.

The time has come however, where this blog is no longer aligned with the needs of the business, and it’s becoming more difficult to keep up with its maintainence.

Over the course of the next few weeks I will slowely be making changes to the site to make sure it remains useful to both clients and non clients. In the end it will look much different, but it will still offer substantial resources and information to pregnant women and their families.

Until the site is made new there will be no new posts. Please be patient with me as I make changes, and be sure to subscribe to receive an update once the new site is complete!

I look forward to seeing you all back here!

Prenatal counseling in Central and Western Maine

Since I began offering certified birth doula care in 2002, I also made it practice to offer families the option of prenatal counseling without labor support. If you are planning a pregnancy and want to be proactive in making it a healthy one, if you are concerned about specific heealth conditions as they relate to pregnancy and birth, or you are wondering how you should decide what birthing options are best for you, you should consider meeting a professional prenatal counselor.

Why prenatal counseling? As I offer it, counseling gives numerous benefits to women and their families. For important medical decisions it is essential that you discuss your options and decisions with your primary care provider. I do not tell my clients what they should do because that is not my role. Instead, I spend an hour or mroe with each one, listening to her story, offering information, resources, and appropriate referrals for her situation so she and her family feel more confident planning a healthy and joyful pregnancy and birth that fit their needs and desires.

What do I not do? I do not share my personal opinion unless it is asked of me. I believe there is no perfect birth applying to all women, so my counseling is individualized for every woman’s needs and desires.

If you contact me about a prenatal counseling visit, you will be under no obligation to hire me as a doula. Think of these visits as a resource of information and encouragement to reinforce your own decision-making, completely unbiased and having no interest other than you being able to pursue the best pregnancy and birth for you.

Any personal information you choose to share with me will of course be held in confidence and only used to provide you with the best prenatal counseling possible.

Why prenatal counseling? When you are only given ten minutes a month with your doctor, you will not have time to discuss all of yoru concerns, questions, background, or preferences. Instead of hoping that ten minutes will be enough, I can give you an opportunity to meet as many of those needs as possible in a safe environmnet with fewer time restrictions, so you can be more relaxed and confident when speaking to your doctor at prenatal visits.

At our prenatal counseling visits, you come first!

And, because I know you are wondering, pricing is very reasonable. I offer counseling at just $20 for a one hour visit in office. For those living outside of my area, I am interested in offering prenatal counseling by phone or email. Contact me for more info!

For more information and scheduling, email Naomi at

Jacobs Chiropractic and Acupuncture

I have long vouched for the benefits of chiropractic care and specifically, the Webster Technique, to help align the baby for an easier birth. So when I received a postcard in the mail from a local chiropractor who recently became Webster Technique certified I knew I had to share his information with you. If you live in the Portland, Maine area, you should check it out!

Here’s what his postcard says:

Dr. Lou Jacobs a Portland chiropractor who has been treating children and expecting mothers for the past 10 years is now certified in the Webster Technique. The Webster Technique is a system of analysis and specific chiropractic adjustments that facilitate the normalization of position of joints, bones and specific soft tissues in the pelvic, sacral and low back region. This facilitation of balance has been known to free up space in the womb for the baby to move into a more comfortable, more normal position. This repositioning often allows for a baby to move into proper birthing position as well.

Because pregnant moms should minimize taking medication during pregnancy, chiropractic is a safe, gentle alternative to dealing with discomfort as well as promoting a healthy body environment for the easiest pregnancy and delivery possible.

Dr. Jacobs is a member of the ICPA (International Chiropractic Pediatric Association) and may be reached for more information at 207-774-6251 or by emailing For more information on the ICPA visit or follow Dr. Jacobs on twitter @drloujacobs.

You can also find him on his website at

Greeting 2012

A big thank you to all of my readers for coming back again and again and sharing your own thoughts! You are the ones who keep me writing, sharing about birthing options and all things baby-related.

It’s been a wild year for my family, and Birth a Miracle Services at the same time. I met my goal for this year of attending six births, bringing my total to 25. That might not seem like much, but with three kids ages five and under and another on the way, six births (and 25!) is a big accomplishment for me!

Among those births, two took place at a new hospital for me, and I am very excited to be attending births there. I never imagined myself saying this about a hospital, but if you are in the area, Mercy Hospital in Portland, Maine is an excellent place to give birth! It’s a bit of a travel for me, but I absolutely love the staff; they have been very supportive of my clients, including preferences that are hardly ever supported by hospitals, like skin-to-skin bonding with baby during a cesarean birth. I do hope to be back at Mercy this coming year!

Now that I have finished my unpaid advertising, I’ll also mention that 2011 has been an important year for me because I finally published my book, Inspired Birth through Please support this blog by purchasing your copy here. Thank you!

Two sad things that happened this year were my realization that my midwifery studies needed to be put on hold when I discovered my fourth pregnancy (due in March 2012!) and Haley Grant leaving BAMS. If you remember, Haley Grant was the childbirth educator-in-training who joined me at Birth a Miracle Services, but due to health restrictions, we decided that it wasn’t the right timing for her to be committing herself to teaching classes. I hope that in time she will return because her values and experiences are really what I’m looking for in a team here.

Stats for 2002 through 2011 are now as follows:

  • Total births attended: 25
  • Vaginal: 16, Cesarean: 9
  • Planned VBACs: 4, 2 successful
  • Home births: 9, Hospital: 16
  • Unmedicated: 13, Medicated: 12
  • Water births: 3
  • HypnoBabies: 2

I have received zero negative reviews, instead I usually hear something like, “thank you! thank you! thank you!” when I leave a new family after their birth. The moms do all the laboring of course, but a doula is such a tremendous blessing to a new family.

So what does 2012 look like for Birth a Miracle Services, keeping in mind I’m expecting my fourth baby? I hope to attend 2-4 births, but I’m going to have to figure something else out for on-call babysitting for my four kids! I also have hopes to host a booth at a local fair and develop my photography skills to offer as an additional service to my clients.

Now, I need your help! I do not anticipate being able to blog on a regular basis around and during my babymoon in March and April, so I am looking for moms and dads willing to write a guest post featuring one or more of their birth stories to be scheduled for publishing at that time. Would you consider sharing your story? Written posts, videos, and pictures are all welcome. If interested, please email me at Thank you!

Happy New Year everyone!

Making Connections

This past weekend I attended the second annual Women’s Health and Happiness fair in South Paris, Maine. The fair grew this year with more venders and more visitors.

I hosted an all-day viewing of The Business of Being Born, and taught a two-part class on The Top Ten Ways to Have An Easier Birth.

For Birth a Miracle Services, this fair is all about making connections; connections with local residents, and connections with local businesses. Over time I have seen an increased awareness of the role of a professional birth doula, and I am excited to be a part of that process – to show families in my community that birth doulas are a good option for them.

I expect that each year the fair will continue to grow, and I look forward to being there in 2012 as I return back to work after my 4th babymoon!

The Women’s Health and Happiness Fair comes to OHCHS!

Last year, Birth a Miracle Services held a booth at the Women’s Health and Happiness Fair hosted by Richard Bader Physical Therapy. This year it is expanding and will be held at the Oxford Hills Comprehensive High School in South Paris, Maine!

At the all-day event you will find all sorts of opportunities for women of all ages. Meet local care providers such as midwives, dentists, chiropractors, and massage therapists. You can also buy handmade jewlery, stylish handbags, receive all sorts of freebies, coupons, gift certificates, participate in the door prize, and so much more!

Free classes will also be offered by various care providers on issues relating to women of all ages, including a class by yours truly on the Top Ten Ways You Can Have an Easier Birth.

Will you please come and visit? The Women’s Health and Happiness Fair will be at the high school on Saturday October 15, 2011 from 10am to 3pm.

For more information about the booths, classes, or vender opportunities, please email Carley Packard at Richard Bader Physical Therapy who is directing the fair.

Mark you calendars, I look forward to meeting you!

BAMS on YouTube

Birth a Miracle Services has a new video on YouTube, enjoy!

FYI – I’ll be taking a week off from posting here to work on development of the Birth a Miracle Services blog, as well as the family blog, American Family Now. (I’m having trouble making links, if you want to visit my family blog see the “about Naomi” page at the top.)

In the meantime, my first pregnancy update for my 4th pregnancy is now up on AFN, click here to read it! If you are looking for a particular topic, check out our categories and search box. Comments will still be responded to, so feel free to share your questions and thoughts!

I’ll see you back here on the 9th of September!

Having your baby at St. Mary’s or CMMC?

My family and I are settling in to our new home near Central Maine, and I am now putting more emphasis in offering my doula service to women planning births at St. Mary’s Regional Medical Center and Central Maine Medical Center in Lewiston, Maine.

Birth a Miracle Services has been offering professional labor support and independent childbirth preparation classes since 2002 at affordable prices, with great review!

Here are a few comments my clients have shared after I supported them through birth:

  • “Thank you thank you thank you a million times over!”
  • “I didn’t realize how much I would appreciate having someone there.”
  • “Naomi was such a calm voice in the midst of chaos. We chose to have a hospital birth for our second child, and it was very comforting to know that we had an advocate who was for natural birth. Naomi made our hospital birthing experience as close to home birthing as possible – a difficult task, indeed. And she made sure that I, as the husband, kept as involved as possible. We would certainly hire her again (if my wife will concede to having another baby :0).”

And one nurse had this to say after seeing me in action:

  • “You are the best doula I have seen in my twenty years of nursing!”

To see more reviews, click here. As a student midwife, birth doula, and childbirth educator, I place high value on holistic childbearing care that places emphasis on empowering mothers and fathers on their journey to parenthood, and my clients have voiced their appreciation for the respect and information support I have given them as they made decisions regarding their care.

Over 20 families have now hired me to support them through birth, and since I began I have birthed three of my own children, including two home births. My professional experience includes home and hospital births, working with doctors and midwives, unmedicated births, water births, epidural-assisted births, and cesarean births. However you plan to give birth to our baby, I can help you have a safe and satisfying experience you will never want to forget.

Families who hire me receive unlimited phone and email support pre and postpartum, 2-4 prenatal visits in-office, my continuous presence during labor and birth, guidance and support for the woman’s partner, emotional support, assistance with comfort techniques, help with communicating their wishes to hospital staff, initial breastfeeding assistance, and 1-2 postpartum visits in-office. All this for just $250! Gift certificates are available – a great baby shower gift!

I still have openings from September 2011 onward! Do you know anyone having their baby in Lewiston this fall? Please encourage them to interview me! I offer free, no-obligation consultations before parents decide whether or not to hire me.

To learn more, or have other doula-related questions answered, feel free to email me at

March Favorites

Already the 20th, and I haven’t gotten to my favorite reads this month! Sorry about that, but I do have some good ones to share with you now.

Navelgazing Midwife offers her thoughts on the show One Born Every Minute. I haven’t seen it myself, but it’s nice to know what’s out there.

The Midwife Next Door offers 3 reasons midwives do not offer more superior care than obstetricians.

Stumbled across a study published in the CMAJ in 2003 showing a strong link between prenatal ultrasound and delayed speech in children.

One mom shares her story on becoming a birth doula.

Former Blossom star Mayim Bialik, shares her home birth story.

A good reminder: Doulas aren’t just for hippie home births

Dads in Australia now banned from filming their wives’ births. Good grief!

Of course CNN had to spin the drama, but I enjoyed this dad’s story of catching his baby boy. In his words, the experience “reinforces, in a powerful way, what just about all dads want our kids to have — the feeling, the knowledge, that we will take care of them, protect them, provide for them.”

Do you have a prominent sacral promontory? Don’t schedule that c-section yet! Consider hiring a chiropractor.

The FDA has long advised against the use of terbutaline to prevent premature births, but it must still be in use because they reissued an advisory against the drug for pregnant women.

A Johns Hopkins University group has designed a magic marker that will recognize dangerous levels of protein in pregnant women’s urine. This means that clinics in third world countries will be able to treat for preeclampsia faster than usual, hopefully saving many lives.

Another mom’s home birth story. The baby inhaled fluid during the birth and contracted pneumonia, but knowing that could have happened anywhere, she defended her midwife, who helped her have a safe birth.

Enjoy Birth features an article on rupture of membranes that we published. She has a great blog, go check her out!

Interesting studies on placentas.

Prenatal surgery may increase health of babies with spina bifida.

A Certified Professional Midwife, who has practiced for over 30 years and convicted of NO wrong doing, was arrested and charged for “unauthorized practice of midwifery”. Imagine, a midwife practicing midwifery! The audacity! (I hope you are hearing the sarcasm)

Approved by the U.S. Food and Drug Administration, Makena — hydroxyprogesterone caproate injection, or 17P — is a synthetic version of progesterone, is showing promise for preventing premature birth.
Obstetrics and Gynecology’s latest issue includes a commentary by Dr. David Grimes, entitled Electronic Fetal Monitoring as a Public Health Screening Program: The Arithmetic of Failure.  He says, “electronic fetal monitoring has failed as a public health screening program. Nevertheless, most of the four million low-risk women giving birth in the United States each year continue to undergo this screening. The failure of this program should have been anticipated and thus avoided had the accepted principles of screening been considered before its introduction.” 
Man-Nurse Diaries shows compelling evidence that breastfeeding reduces the incidence of SIDS.
The Times reports that too many hospitals are scheduling elective inductions before 39 weeks – a recipe for trouble when it comes to baby’s health.
A student midwife, local to my area! shares her story of an unexpected birth outcome.
It will be interesting to see how this works out. A mom from my state may be planning an unassisted birth because she can’t find a VBAC friendly hospital, and her insurance won’t cover CPM. It’s sad to see women being forced into an unassisted birth for lack of good care, but I hope that courageous women like her will send a message that we need more freedom for VBAC in hospitals. I’m rootin’ for ya Leah!