I am a total proponent of birth choices. Mothers and families have the right to make the best choices for them and their children when it comes to decisions around childbirth. Unfortunately, for those of us who feel as if we are enmeshed in the mainstream medical system, we may feel dis-empowered to question our care provider, or to remain steadfast in our beliefs. We may fear that we will not receive the best care if we challenge our care provider’s advice, or that we don’t have the right to a second, third or fourth opinion for that matter from another medical professional. Well the reality is, we have to take control of our bodies and our birth. We have that right. At the end of the day, we have to live with the repercussions of the medical choices that are made by us, or for us.
So when it comes to the VBAC dilemma, what am I talking about? First, let’s define VBAC. VBAC stands for Vaginal Birth After Ceserean. Women who have had previous reproductive surgeries, cesareans or c-sections may consider attempting a VBAC, or TOLAC. TOLAC stands for Trial of Labor After Cesarean. The choice often begins with a consultation with an obstetrician. They will review your medical records from a prior surgery or c-section, and determine, based on the nature and intricacies of that surgery(s), if you are an ideal candidate for a VBAC.
The major reason for push back on VBACs is that there is a potential risk of uterine rupture during delivery. Many doctors, choose to be conservative in their recommendations, and encourage most patients to opt for a c-section, hoping to reduce the risk. The medical research confirms that the risk of uterine rupture is on average at about 1%; with catastrophic uterine ruptures (that can increase the risk of fetal or maternal injury or death) ranging from 0.3 – 0.7 %. Many doctors and pregnant mothers choose not to take the risk, albeit it small, and they move forward with a scheduled-cesarean section delivery at no earlier than 39 weeks of pregnancy.
Another challenge to mothers obtaining a VBAC are institutional. Some hospitals are discouraged by their insurance carriers from allowing physicians the option of performing VBACs due to a perceived risk of potential malpractice litigation, in the event of a negative birth outcome. This can obviously make it more difficult to find a doctor who will perform a VBAC.
Now the good news is, that many women who have been identified as good candidates for VBAC have an average of a 75% success rate of vaginal delivery. However, going into this endeavor, a pregnant mom must be mindful that there is a typical VBAC/TOLAC labor & delivery protocol that many physicians follow, which may improve their birth outcomes.
Some things to mindful of in approaching the decision to pursue a VBAC:
- Labor & delivery interventions that include the medical inducement of labor, and the use of epidurals for pain, and the drug pitocin, which will artificially induce labor contractions are not ideal to use during a VBAC. This can actually put you on a fast track to a c-section if you labor is not progressing in the manner that your doctor would prefer. With a VBAC, you typically have to labor naturally, with minimal, to no intervention(s).
- Your medical provider (likely an OB doctor) will be vigilantly monitoring you and your unborn child for any signs of potential distress during labor. This level of high alert can make laboring naturally a little stressful, so be sure that you have advocates around you – your spouse/partner, Midwife, Birth Doula, and any other support persons or family.
- Remember to be flexible. You obviously want to see this through and have a vaginal birth, however, the safety of both you and your child are what is most important. So communicate your desires in a birth plan, yet remain flexible if you are counseled to pursue other measures (like a c-section) to ensure the safe delivery of your child.
As well, if you prefer, you may have the option to receive prenatal care from a Midwife up until your actual delivery date, even if your obstetrician recommends that you have a c-section delivery.
Lastly, there are some great resources available to learn more about your birth options. A documentary film entitled “More Business of Being Born” describes challenges and triumphs around mothers and families pursuing a natural birth experience, which includes a section specifically on VBAC. As well, the International Cesarean Awareness Network is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean. They can offer an abundance of information and resources in this area.
I am on the journey to discover if natural childbirth can be a reality for my family and I this time around, so I know what some of you may be going through in making this decision. I am hopeful that this information can empower you in making an informed choice for yourself and your family.
Stay Healthy and Wise,
Ericka L. Abrams, Public Health Practitioner
We want to hear from you!
Have you considered a VBAC delivery, or have you successfully labored without surgical intervention?
Please respond with a comment.
Disclaimer: This information is purely educational, and is not a substitute for the care and consult of a licensed health care provider.
