VBAC - Vaginal Birth After Cesarean



VBAC - Vaginal Birth After Cesarean - is my heart. I have had one very unnecessary cesarean, and one necessary cesarean (as a direct result of the unnecessary one) with a home birth VBAC in between the two. VBAC is an area of interest as a mom and a Midwife that I have researched thoroughly. With our Cesarean rates increasing, and VBAC rates decreasing...something needs to be done.

Did you know that the main risk associated with a VBAC (though is not isolated to women with a scar on their uterus!) is a uterine rupture, where the uterus opens (with varying degrees - some as minor as a "window", or dehiscience that is asymptomatic). Intervention increases the risk of uterine rupture, particularly induction of labor.

So what is the risk of uterine rupture?

0.3 - 0.7%...which means that you have a 99.3-99.7% chance of NOT rupturing. And the risk of baby dying, what is known as a catastrophic rupture, is a fraction of that 0.3-0.7%.

Did you know that when you have had a successful VBAC, that your risk of uterine rupture is actually *decreased* with future pregnancies?

Vaginal Birth After Cesarean is even possible, and still low statistical risk, if you've had more than one cesarean. The links provided include research for Vaginal Birth After Multiple Cesarean.

The difficulty with "achieving" a VBAC is in finding a care provider who not only knows the research, but who will completely support it and do everything that they can do to help you give birth. Often women find a "VBAC Friendly" care provider, who turns out to only be paying lip service. I am one of those women. When I was looking for a VBAC care provider in 2005, I went through 6 different Obstetricians at varying facilities, spanning multiple different cities. I was given a list of what would "qualify" me as a "good candidate". Some phone calls ended immediately after finding out my history - large babies, pregnant just under a year after my cesarean, and closed with a single layer instead of double. I was told "no" without further prodding. When I did find some who were willing to entertain my wishes, I was told that I had to have baby by 40 weeks, I would be on a restricted diet so that baby would not grow "too big" (which isn't evidence based at all), had to have an IV, be on continuous monitoring, and some even required an epidural ...

All pointing to the idea that I would end up with a cesarean no matter what I did.

This is not rare. Many OBs (and even Midwives) who will "allow" you to "attempt" a VBAC will have a list of guidelines and criteria that you must meet. This is NOT VBAC supportive. This is a system set up for failure. In the new Business of Being Born documentary about VBACs, Dr. Moritz puts it beautifully - "In order to achieve a VBAC you must have a 'Cinderella' labor and birth - meaning that EVERYTHING goes perfectly smooth, without ANY bumps at all". This is not a realistic rule, as rarely do all births go perfectly smoothly...which is why we have variations of normal.

Women need care providers who are not basing their care decisions on malpractice insurance, lawsuits, or scare-based information. Women need to be fully informed themselves, and not allow themselves to buy into the boat load of misinformation that abounds surrounding vaginal birth after cesarean.