As a doula I have worked with hundreds of women planning VBACs (vaginal birth after a Cesarean) and I am often asked how to best achieve the goal of having a VBAC. This is a complicated question (and sometimes the best birth *is* in fact a Cesarean delivery), however based on my experience there is one thing that best predicts a woman’s odds of having a successful VBAC. It is NOT how big a baby is, or the age or size of the expecting woman. It is not even her prior medical history or if she has been told she has a small pelvis….most of these women VBAC just fine. The biggest factor that will determine if a women has a successful VBAC is if she is using an experienced and skilled VBAC care provider.
So why do women stay with a non-VBAC skilled or experienced providers? Here are a few common reasons I hear: |
“I love my OB” – It is good to love your care provider! However a woman may love her General Practitioner too, but she will certainly choose to go elsewhere if she develops a heart issue requiring a cardiologist. Choosing a VBAC provider is no different; a woman needs a specialist. I tell women who want a VBAC to find a care provider that specializes in VBACs, then enjoy well woman exams for the rest of her life with their GYN if they want.
“I am uncomfortable with a male OB” – I totally get this one. Women have babies and it involves some degree of nakedness and our intimate areas. However, if the best VBAC option in the area is a male, priorities must be decided. Would you rather have unnecessary surgery from a person who is female or have a VBAC with someone who is not? (I do work with families of various faith backgrounds where a male OB is not an option. Usually there are some female options that strike a balance between religious convictions and the desire to have a VBAC. )
“It is too far to drive” – I also get this one. Driving is boring, gas is expensive, traffic stinks. Once again, each couple will have to work through this question. Is it worth the hassle, time and money to drive an extra 10, 20, 30, (or more) minutes approximately 15 times during the course of pregnancy to increase the odds of avoiding major surgery?
“My OB just really cares about me and my baby’s health” – Uterine rupture is real, but it is rare. Risks to mom, baby (and future babies) from abdominal surgery are also real. Choosing how to deliver is not a zero sum game where one choice is completely safe and the other is not. However, ACOG states that VBAC is “safe and appropriate” for most women with one or two previous Cesareans. An OB that does not believe that statement, or does not give his patients that info, may not be keeping up well with the research in his field or he may be putting his liability or scheduling concerns ahead of you and your baby’s health.
There are many other reasons why people don’t switch to a supportive care provider, but perhaps the most common reason is because they don’t think outcomes vary much from provider to provider and that one provider is basically the same as another. This is very far from the truth. Even the best provider cannot guarantee that every women will have a successful VBAC, sometimes the best birth is a baby born via C-section. However, choosing a care provider that knows how to support a woman planning a VBAC and has experience doing so will exponentially increase you odds of having a successful VBAC.
Want to know more about how to actually choose a VBAC supportive provider? Read more here.
DFW has great VBAC resources! Ready for more local support and info? Join the DFW VBAC/Cesarean Support Facebook group for peer to peer support. 
Maria Pokluda has been a doula serving expecting families in Dallas and Ft. Worth since 2007 and has helped hundreds of 
families have happy birth days. Maria was voted “Best Doula” by DFW Child the past three years and has a special passion for helping couples achieve VBACs. In 2011, Maria co-created the Birth Boot Camp DOULA certification program. You can find information about Maria’s services or read her blog at greatexpectationsbirth.com