Preparing for a successful VBAC Birth

VBAC birth stands for “vaginal birth after cesarean.” VBAC statistics say, about 1 in 3 birthing people (31%) will give birth by cesarean in the United States with some hospitals reporting their cesarean rate to be as high as 60%. This is significantly higher than the World Health Organization’s recommended 10%-15% cesarean rate. Maybe you have heard “once a cesarean, always a cesarean,” however, evidence shows us that VBAC is a safe, sometimes safer, option than a repeat cesarean and should be given as an option, especially considering the fact that risks go up the more cesareans are performed. This article will tell you how to best prepare for a successful VBAC.

With that said, please know that cesarean births are valid and necessary. They’re not “the easy way out.” Nobody goes into a major abdominal surgery lightly. Choosing whether to attempt a VBAC or have an elective surgery is a personal decision, and neither is ‘bad.’ The most important thing is that the birthing person has a voice and is able to choose from a place of knowledge and support, not from a place of fear. And right now, we see  a lot more fear being thrown towards VBAC than the evidence suggests is necessary.

Too often, pregnant people are scared into a decision or choose a particular path because they do not realize that there are other options. And far too often, pregnant people do not realize that VBAC is a safe and valid option. Or they’re scared into believing that a repeat cesarean is the only way. 

This article aims to educate on the facts. So birthing people can decide for themselves which way is right for them. We also aim to educate on how to best stack the cards in your favor to achieve your VBAC birth, if you decide that’s the way you’d like to go!

Natural Birth after Cesarean (VBAC) Statistics

Most individuals who have previously had a cesarean, choose to have a repeat elective cesarean. Currently, there is an 89% repeat cesarean rate and an 11% VBAC statistic rate in the United States. Of the 11% who have a trial of labor after cesarean (TOLAC for short), approximately 60-80% will have a vaginal birth. While a VBAC is not right for everyone, it is a safe and valid option. 

Vaginal Birth After Cesarean (VBAC) rate in the United States is 12.4%

Those who have had a VBAC often describe the experience as empowering and often note that the recovery is easier than their recovery from a cesarean, which is a major abdominal surgery. While not all who attempt to birth vaginally after cesarean (TOLAC- – trial of labor after cesarean) will have a vaginal birth, there is some evidence to support the idea that laboring, even without being birthed vaginally, is actually good for the baby. 

What are the risks and statistics of VBAC?

Maternal morbidity, by method of delivery and previous cesarean history

Bar graph showing maternal morbidity by method of delivery

Successful VBAC Birth

Are VBACs usually successful?

According to studies, 60-80% of folks who attempted a VBAC are successful. That is roughly 3-4 out of 5 birthing people! And we believe this stat could go even higher with the right preparation and support.

Is VBAC riskier or safer than a repeat cesarean?

According to the research, if there is no medically indicated reason for a cesarean, VBAC is likely to be safer. Additionally, the risks associated with cesarean increase the more they’re performed. So someone who is planning more pregnancies may want to consider VBAC as a safe and valid option. Multiple cesareans increase the risk of complications such as placenta accreta, placenta previa, and placental abruption. Interestingly, the risk of uterine rupture (which is 0.87% of those planning their first VBAC) actually decreases with each subsequent vaginal birth. The risk of uterine rupture is actually about the same as the risk of other birth complications that can occur, even amongst those who have never had a cesarean, such as shoulder dystocia and hemorrhaging.

While this can sounds scary, it is rare and not more risky than complications that can occur during  a cesarean section. With that said, it is important- no matter whether you are planning a VBAC or a Cesarean that you have a provider that you trust that, in the event of a rare complication, knows how to appropriately intervene. It is also important to not only look at the research, but to listen to your gut. Only you get to decide and your choice, no matter what it is, is a valid one.

I was told that my pelvis was just too small for VBAC

The pelvis is not a fixed entity. It has joints and is mobile! Moreover, it’s impossible to know for sure what it will do during the process of labor and birth. The pelvis is held together by muscles and ligaments, and these muscles and ligaments are not fixed. Meaning, the pelvis shape can change,  both during the birthing process and based on how we move it throughout our lives. This is one of our WHYs behind the OSM program𑁋we know that how you move throughout your day matters, so we give you moves you can easily incorporate into your day along with workouts that are designed to create the most space in the pelvis for the baby. 

Here are some VBAC success stories from our own OSM users:

“It is because of the program I was able to have a vbac with no pain meds due to all the breathing and classes you provided!”

Kathleen Zimmerman, OSM user

 

“…my second vbac, my water broke as I pushed her out (I swear I pushed less than 10 times) and I was left without a tear…” 

Jessica Thomson, OSM user


Cephalopelvic disproportion (CPD) is a real thing, but it happens much more rarely than it is diagnosed as the cause for cesarean. Often CPD is associated with pelvic anomalies.

Image of the inlet pelvis with a baby's head coming through
Interior Pelvis

In the past, when nutrition wasn’t as readily available, CPD was observed in those who were malnourished as children while the pelvis was growing. Another occurrence that is commonly overlooked when the CPD diagnosis is slapped on, is the position of the baby. A baby whose chin is not tucked, whose head is tipped to the side, or who is in the posterior position has a greater surface area that needs to make its way through the pelvis. It’s rather common that I see individuals who were told they were simply “too small” to birth their babies go on to birth babies that are 1-2 pounds larger vaginally with no issue. With this said, there will be a small segment of individuals who truly have CPD. And for those individuals, a cesarean will be needed.

Line graph, showing risks for a uterine rupture decrease with each additional planned VBAC
Risk for Uterine Rupture

VBAC uterine rupture stories

Less than 1% (.87% to be exact) of those laboring for their first VBAC will have a uterine rupture.

There’s a lot of fear and misinformation being spread about uterine rupture, so let’s just lay out the stats. Less than 1% of those laboring for their first VBAC will have a uterine rupture. This is roughly equal to, if not slightly lower, than the % of complications that can occur across all those giving birth, not just those planning for VBAC.  Shoulder dystocia and hemorrhaging, though risk of hemorrhage is higher during cesarean birth, are some complications that can arise during birth.

This isn’t to say that uterine rupture isn’t a valid concern, it is. But we must also look at it from a statistical standpoint. It is indeed a rare occurrence. Additionally, after each vaginal birth, the risk of uterine rupture goes down. But with each cesarean performed, the risk associated with the surgery actually goes up.

How to avoid a second c-section and have a successful VBAC Birth

Preparing for VBAC

Woman preparing for birth, leaning forward on her knees

1. Find VBAC friendly doctors

The #1 way to stack the cards in your favor for a VBAC is having a provider who is truly supportive of VBAC. There are too many stories of “bait and switch”, where providers seem to be on board with plans to VBAC until the last minute, suddenly changing their tune. This is not only stressful, but also makes VBAC much more difficult. 

 

The best way to figure out if you have a supportive provider is to first, reach out to your local ICAN (International Cesarean Awareness Network) chapter and your local birth community (doulas, childbirth educators, etc). Ask them which providers they see as the most supportive of VBAC. The next step is to look at the following chart and ask your provider questions to learn if they are VBAC Supportive or just VBAC Tolerant. VBAC tolerant providers attend them sometimes, but everything has to line up a certain way.

2. Prepare your body

Lindsay McCoy (left) helping a woman (right) squat correctly and safely
Squats One Strong Mama

Preparing the body for birth is an important but often overlooked step of preparing for a VBAC birth. Our body responds to the input placed upon it. Meaning, when planning for birth, it’s important we input it with movement that allows for a mobile, balanced pelvis. Having a pelvis that MOVES well is hugely important. At OSM, we have a multi-pillared approach to preparing the body for birth. Two critical pieces of the puzzle that I would like to discuss are sacral mobility and pelvic floor yield. Please see our full program options and prepare your body for a more comfortable birth.

Pelvic Outlet

The sacrum is part of the pelvis that is designed to MOVE via the sacroiliac (SI) joints. There are certain movements, such as sitting on the sacrum all day, that can create immobility and lack of balance in the sacrum. For this reason, it is incredibly helpful to learn workouts, alignment, and nourishing movements that allow for sacral movement, so that it can move more freely during childbirth.  

Sacral Mobility:

Sacral mobility + pelvic floor yield

Pelvic Floor Yield:

Superior and inferior view of the pelvis
Inferior-Superior Pelvis

Sometimes, if the pelvic floor is hypertonic or “too tight,” it can make it more difficult for it to yield to allow for a baby to come through. We ideally want a pelvic floor that’s strong enough to hold up our organs (and our pee when we sneeze!), but is also able to yield. A muscle that’s too tight isn’t a stronger muscle, it’s just tighter. And tighter often equals less functional and can also be associated with a lot of pain. Learn how to keep the pelvic floor strong AND yielding throughout pregnancy (and life!). Hint: 100 kegels a day is not the ticket and can actually create issues for many.

3. Prepare your mind

Just as we should prepare our body for birth, we also should prepare our mind. Many times, when someone has had a previous Cesarean (and even many who haven’t!), there is birth trauma. It’s so important to be able to release that trauma and fear prior to going into the next birth experience. There are many ways to do so, including speaking to a therapist who is trained and experienced in birth trauma, mind-body modalities, and one of my favorites are Hypnobabies or other hypnosis for childbirth programs. I am partial to Hypnobabies as I used it for 3 of my births and attend many Hypnobabies births, including VBACs. 

I explain it this way: If you go into a marathon, even if your body is ready, and the entire race your inner dialogue says “I suck, my legs hurt, I’m tired, I can’t do this, this is hard”, how far do you think you’ll go?  Similarly with birth, we need to prepare our minds, ahead of time. There is so much going on beneath the surface that is better to address prior to birth. If not addressed, it may be much more difficult to let go in the way birth necessitates.

Pregnant woman seeking advice on laptop

4. Hire a doula

Lindsay McCoy helping a client give birth

Hire a Doula

Doulas improve birth outcomes…

Research has shown that doulas improve birth outcomes. They lower the risk of cesarean by anywhere from 28%-56%, depending on the study. They can help you know your options, support you while you consider the pros and cons of interventions, support the emotional journey of TOLAC, cesarean or VBAC both prenatally, during the entire birthing process, and postnatally. Many are trained to help with baby positioning and creative birth positions to make the birth process go smoother. We train birth professionals to understand how to encourage a smoother labor and delivery 𑁋 check out our directory of trained pros.

The Evidence for Doulas

As a doula myself, I attend many TOLAC/VBACs, and everyone needs support a little differently. Some need a lot of emotional support prenatally, others need more use of creative birth positions, and others maybe need more postpartum support in processing the birth experience. Support will look differently each birth and with each family, but what doesn’t change is that continuity of care. A doula is with you through your pregnancy, entire birth experience including time you labor at home, and is there to check on you after the birth. Interview a few doulas to find the right fit for you. Look for someone who is experienced with VBAC and understands baby and body positioning (if they are Body Ready MethodR  trained, even better).

Evidence for doulas

Whatever you decide for your birth, decide it because it is what YOU want, not because of fear or what other people think you should do. Truly, there is no one right way to give birth.

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