There’s no doubt that anticipating birth in the midst of a pandemic can be fraught. This may be exacerbated when you may have additional risks, or complicating factors. If you have had a previous surgical birth and are pregnant again, know that you still have choices for this birth during this time.
The choice of a Vaginal Birth after Cesarean Birth (VBAC) or a Cesarean Birth after Cesarean Birth (CBAC), is one that each birthing person who has experienced surgical birth must make for themselves — based on evidence and intuition.
If you are choosing a TOLAC (Trial of Labor after Cesarean Birth), it’s important that both your provider and your place of birth is truly supportive of this path. And while the American College of Obstetricians and Gynecologists says that a VBAC is a safe and appropriate option for many birthing people, hospital or provider policies do not always reflect the evidence. If you are planning a VBAC, here are three tips that can help support your intention.
1. Finding a provider that is truly VBAC friendly is key
Our friends at ICAN have a great description of what that means. Consider talking to different types of providers to see what feels best for you. Obstetricians, Family Practice Doctors and Midwives (who can provide care at a hospital, a free-standing birth center or your home), can all provide full prenatal care plus support your birth. Practices and policies vary widely. Is your provider VBAC tolerant or VBAC supportive/friendly?
There is a difference between the two, and this can affect your outcome. Some signs your provider may be merely VBAC tolerant:
- They discuss risks for a VBAC, but not risks for repeat Cesarean births.
- They use language about what they will “allow” you to do or not do in pregnancy or labor, including specific rules about inductions, required use of an epidural, types of monitoring or time limits in labor.
- They use a VBAC calculator as a prediction tool, instead of listening to your unique birth story and circumstances.
- They discuss your stature, pelvis size or the size of your baby as reasons you may not be able to have a vaginal birth.
- They share a call schedule with providers who are not VBAC supportive and can’t guarantee they will be present at your birth.
2. Research about the provider, hospital, and how to prepare arms you with evidence based data
We’re pretty research obsessed at Mina. Some of our favorite resources for VBAC research are:
3. Hiring a doula decreases your chance for a surgical birth by 39%
What can doulas do? They can help you find evidence-based information, clarify your birth preferences, and amplify your voice as you advocate for your needs. They can help with comfort measures and positioning that can support you during birth. And multiple studies have shown that having continuous labor support has a host of benefits – including lessening your chances for a surgical birth – up to a 39% decrease.
It’s true that hospital policies are changing rapidly right now, in terms of the number of people can be present at your birth. However, doulas can provide prenatal and postpartum support, be with you in early labor at home, and be present virtually. Depending on your birth place, they may be able to offer in-person support as well.
This is your birth. Here’s the thing — beautiful births are ones where the birthing family feels safe, empowered, informed and supported. Whether that’s an operating suite, your living room, or somewhere in between, that is for you to decide.
Whatever you choose, we want you to have the information and the support to feel confident in your decisions. You’ve got this. We believe in you.