If you read my Questions To Ask Your VBAC Doctor blog, you know that a supportive provider can make the difference between achieving your VBAC (Vaginal birth after cesarean) and having a CBAC (cesarean birth after cesarean). But what are some red-flag policies that would clue you in to knowing you either need a different provider or need to be a stronger self advocate?
This post will explore 5 common VBAC Doctor Red Flags that might stop you from achieving your VBAC.
You MUST go into labor, on your own, before 40 weeks (or earlier) and we should schedule your repeat c-section for 40+1.
This policy is not backed up by science, ACOG (American College of Obstetricians and Gynecologists) VBAC guidelines, or even logical. In fact, policies like this only throw you into a fear cycle that can inhibit your labor process. ACOG VBAC Guidelines are very clear that mothers should not be forced to give birth before 40 weeks, and that all of their guidelines are merely recommendations, and that ethical care demands supporting the mother's individual decision.
Reality is most women will not go into spontaneous labor before or on their due date. Especially if they've never labored before. There are many studies that show 40 week due dates are not an exact science, so creating a deadline for spontaneous labor can be very problematic.
These providers often also follow the next red-flag policy as well...
VBACs can not be induced.
While it is true that most studies show inducing VBACs can increase risk of uterine rupture, there are a lot of nuances to this, and ACOG does support induction of labor as an option for TOLAC (trial of labor after cesarean) when medically indicated. If your healthcare provider does not allow this option, they are not practicing ethical medicine.
You can only VBAC if you're not giving birth to a big baby.
I'm just going to go ahead and direct you to my blog-series on Big Babies and remind you that I VBACd a 9lb 4oz baby and two 10lb 4oz babies... past 40 weeks...
You can only attempt VBAC if you've had one previous cesarean. VBAC after multiple cesareans (VBAMC) is too dangerous.
Oh man. This one drives me wild. As a doula, I've witnessed a beautiful unmedicated VBA2C in the hospital, and I will say this mama had to be a strong self-advocate... but she did it! Her baby was "big" too! Here's the thing. We have a limited amount of data on VBA2C because so many providers refuse to support them. The data we do have, is alllll over the place, and scientifically... flawed. But the bottom line is ACOG does support women choosing VBA2C especially if they plan to continue having children. While we don't have a clear scientific picture of the risks of vaginal birth after multiple cesareans, what we do know is the increasing risk of multiple cesareans. Knowing that risk, it is absolutely unethical to force any mother into RCS over TOLAC.
TOLAC patients need an epidural in case of repeat cesarean.
This is another policy that makes me want to bang my head against the wall. Thankfully it's becoming less and less common to hear this one. The thinking is that if you need an emergency cesarean, you'll already have a line placed to get into surgery quicker. For some moms this is a benefit because they reduce their risk of needing general anesthesia. However, for some mothers, they feel strongly about the benefits of being upright, active, and do not want to opt for risks associated with epidurals. Again, gatekeeping options from mothers is unethical care, and you should run away fast from any provider advocating this policy.
If you are planning a Vaginal Birth After Cesarean and want to be well-informed so you can be a strong self advocate, check out this Free VBAC class now! or enroll in the VBAC With Confidence Complete Birth Prep Program.
Jaimie Zaki is a mother of 4, doula, IBCLC, VBAC mama, and birth photographer. Jaimie helps women birth and breastfeed with confidence by offering prenatal support, labor support, and postpartum support both in person in Wichita Falls, Texas and virtually. If you would like to connect with Jaimie, email jaimiezaki@littlebearlactation.com.
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