Did your doctor tell you that you have to wait 18-24 months to have a vaginal birth after cesarean? Were you told that if you get pregnant too soon after your cesarean VBAC is off the table and you have to have a repeat cesarean? Are you wondering if it's safe to have a VBAC less than 18 months, or even 12 months after your cesarean?
Today on theVBACpodcast we're going to talk about the common recommendations for spacing pregnancies to increase your chances of a VBAC, what ACOG says about pregnancy intervals for VBAC, and what the data says about spacing your pregnancy after cesarean.
**As a reminder, this podcast is for informational and educational purposes only. This podcast is not intended to serve as individual or personal medical advice. Please use this information as a conversation starter with your OBGYN or Midwife if you have more questions about pregnancy intervals and VBAC** FREE VBAC CLASS: www.littlebearlactation.com/links
VBAC With Confidence Complete Birth Preparation Program: https://www.littlebearlactation.com/vbacwithconfidence247
Connect with Jaimie: https://www.littlebearlactation.com/contact
Instagram: www.instagram.com/thevbacpodcast
Jaimie Zaki is an LPN, Doula, IBCLC, hostess of the VBAC Podcast and Author of Baby's First Year for New Parents. Jaimie is an Air Force Wife, Homeschooling Mom of Four, c-section mommy and three time VBAC mama! Jaimie's mission is to inspire women to birth and breastfeed with confidence. Jaimie offers private virtual consulting to women across America and in-person support to families in Wichita Falls, TX
<<Transcript>>
Hey mama bear was your last birth A C.
Section and you have been dreaming of a vaginal birth ever since maybe you're newly pregnant and planning of back but struggling to get straight answers and support if you're dreaming of a healing positive and peaceful vaginal birth after cesarean.
You're in the right place.
Welcome to the VBAC podcast.
I'm your host Jamie Zaki and I am a licensed practical nurse,
international Board certified lactation consultant and birth doula.
I'm also a mama to four little bears and a three time VBAC mama.
My mission is to help you cultivate confidence for a positive and peaceful VBAC
This is a disclaimer that any of the information experiences opinions and stories told on this podcast are with the intention of inspiring educating and informing parents.
This information is not intended to treat or diagnose any medical conditions.
If you have questions you must consult your provider.
Jamie's Zaki does not accept liability for any decisions that you make after listening to this podcast.
Hello there mama bear.
I am so excited to be back with you this week.
So lately in some facebook groups and instagram and you know all over social media,
I've been seeing this question pop up and it's one that I see quite a bit but I just I feel like I've been seeing it a lot more.
So I wanted to talk to you guys about it because I'm going to guess that some of you probably have the same question.
So that question if you have read the title,
which I'm assuming you have is about spacing pregnancies for the best chance of having a VBAC.
If you are here right now listening odds are you are in one of two groups,
you're either pregnant and planning of back or you are postpartum and planning to VBAC with your next baby.
So this question of whether or not you can have a VBAC if your pregnancies are not spaced the proper way is probably in the back of your mind somewhere.
So I wanted to talk about this today and clear up some misconceptions and I apologize ahead of time if I sound like I'm reading from a script because I typically do not script myself but there's a lot of data in this.
So I am going to be sharing a lot of numbers with you guys today and I want to keep them straight so I don't want to um get too messed up.
So I'm going to be reading a little bit so you might know that it's really common for providers to recommend spacing births 18 to 24 months Now,
even that recommendation in itself seems to be a topic of hot debate.
People will be debating whether or not that's 18 to 24 months between pregnancies.
So from the time the baby was born until the time you conceive or if that's 18 to 24 months between deliveries.
My providers have always made it very clear that it was 18 to 24 months between deliveries between births.
Other providers say different things.
Um But today,
I'm going to tell you that it doesn't really matter,
and I'm going to explain why it doesn't really matter because that is a waste of time to debate that,
because none of it actually matters,
and I'll tell you why.
So the thing is,
providers are consistently telling moms that if they had a C section,
they need to wait 18 to 24 months to give birth again.
Um But ACOG does say that shorter birth interval intervals should not risk moms out of the option for a vaginal birth after cesarean.
But the reality is many of you have been told that you cannot have a VBAC if your babies are too close together.
So the big question we're gonna ask today is whether or not this limit makes sense,
and how much time should you put between your pregnancies.
So there was a dutch study done between 2000 and 2009 and it looked at 36,000 moms who had one full term singleton birth.
That was a cesarean and has had no prior vaginal deliveries.
And these women opted for what they called a trial of labor in their subsequent term singleton pregnancy.
So what that means is they've had one C section no vaginal births and they did not have their C section for reasons like preterm complications or because of twins and their second pregnancy also was not impacted by preterm complications requiring delivery or twin pregnancy.
And what they did in this study was they divided moms into five different groups based off how much time was between there C.
Section and conception of the next baby.
So they split them into six month group,
a 6 to 11 month group,
a 12 to 23 month group,
24 to 35 month group,
and 36 to 59 month group and 60 month plus group.
So that is +123456.
That's six groups.
I'm sorry.
So basically,
if you're like me and you don't like calculating months,
that is six months between birth and conception,
six months to a year between birth and conception,
1 to 2 years between birth and conception,
2 to 3 years between birth and conception,
3 to 5 years between birth and conception and then over five years.
So in these groups,
what they saw was a 70.4% VBAC rate in the group,
the six month group,
71.9% success rate in the six month to one year group,
72.2% success rate in the 12 to 23 month group,
70.1% success rate in the 34 to 35 month group,
67% success rate.
In the 36 to,
59 month group and 62.4%.
In the five year or 60 month plus group.
They also noted that across the board,
across all the groups,
there was no significant difference in maternal and neonatal complications.
So what do all these numbers mean?
If you could look at these like a chart,
you would see like if we did a bar chart,
you would see what we call a bell curve,
right?
It would look like a bell and basically it's like lower success,
higher success,
best success peaks around 12 to 23 months post birth for conception.
Which would line up with about 18 to 24 months between births,
right?
Actually a little more than that.
Really.
More like 24 to 36 months between births.
If my math is right.
But we're talking birth to conception,
remember.
So and if we look at these numbers,
we also see that 70 71 72% really isn't that big of a difference.
The really notable numbers that are a little further away are the 36 to 59 month group which was 67% and the 60 month plus group which was 62.4% success rate.
So now we kind of want to understand what all this means.
Right,
Okay.
So just to make this really,
really easy,
since I'm saying a lot of numbers and I know some of you probably hate that what this data actually shows us is that if you conceive between six months and three years post cesarean,
there is an over 70% likelihood of achieving your back and if you conceive over three years,
that likelihood drops down to about 67% and over five years it drops down to about 62%.
We also need to keep in mind that this 60 to 70% back success rate does not mean that the 30 to 40% see back cesarean birth after cesarean or repeat c sections was due to major complications like uterine rupture.
It does not mean that they were due to uterine rupture.
People have a tendency to think oh they didn't get their VBAC.
They must have ruptured because realistically we kind of think that should be the only reason for a repeat C section.
But the truth is it's not.
So what we see is that there is 60 to 70% back success rate.
Which is pretty good.
I mean remember this was between 2000 and 2009.
So between 2000 and 2009 that was pretty good.
Studies now are showing that women should have an 80 to 90% success rate if they have low risk factors.
So with low risk factors having a 60 to 70% back success rate in 2000 and 2009 sounds about on par.
So now we just need to keep in mind that there are a lot of reasons for these numbers.
So first of all it's reasonable to assume that if there are more than five years between births,
the women in that group might have been slightly older.
So they may have had a higher set of risk factors due to their age that created a higher risk of complications.
There could also be other factors at play,
such as the providers biases.
Again,
2000 to 2009,
the vbac scene was definitely looking different than it is today.
Um,
believe it or not,
VBAC rates are a little bit better today than back then.
And it's really important to understand that studies have shown time and time and time again that the provider,
how the provider practices and their personal biases will have a very big impact on success rates.
So most studies show that around 80% even up to 90% of women who plan a VBAC could and should have a successful VBAC.
We talked about that,
right?
So let's talk about what this study does not mean.
It does not mean that you only have a 60% or 70% chance of achieving your VBAC.
It definitely doesn't mean that short pregnancy intervals risks you out of having a VBAC.
And it also does not mean that pregnancy intervals of 3 to 5 years or more are more dangerous.
What is interesting,
however,
is doctors continue to tell mothers that they cannot have a VBAC because they're having irish twins,
but they also don't say a word to the mother with 3 to 5 years between her pregnancies about having a quote higher risk of repeat cesarean.
So like we talked about before,
if you're listening to this,
you're probably in one of two places you're either pregnant and planning a VBAC or youre postpartum and planning to VBAC.
If you are pregnant and planning a VBAC,
I want you to know that no matter how space,
how far apart or how close together your pregnancies are.
You can achieve a VBAC and it is perfectly reasonable and responsible of you to continue continue pursuing a V.
VBAC.
You are not selfish for trying to have a VBAC.
You are not stupid.
You are not taking a huge crazy risk.
If your baby will be born less than 18 months after your cesarean,
you can have a VBAC.
If your baby will be born less than 12 months after your cesarean,
you can have a V.
VBAC.
If you are postpartum and trying to decide how far to space your pregnancies,
you'll have some decisions to make because it is clear that no matter how much or how little time you choose with the right provider,
you'll have great odds of a successful VBAC but you might still want to space these pregnancies out to give your body a chance to recuperate before and during pregnancy again to get back to a good sleep cycle just to kind of get yourself back before going back into that newborn pregnancy feeling.
And I want you to know that that's okay too.
I don't want you to feel like you have to hurry up and have another baby sooner than you're ready just for a slightly better chance of having your VBAC.
So now the big question comes up,
what if you want to have a VBAC,
Your pregnancies are close together and your doctor tells you that you can't have a VBAC because your pregnancies are close together.
Well now you're armed with information.
You know that ACOG says that short pregnancy intervals does not risk you out of having a VBAC.
You know that the data actually says just the opposite that too much time is a little riskier.
And we also know that there's no way to apply these numbers to your specific and individual pregnancy because we literally cannot predict birth.
So what do you do if your provider continues to tell you that you are making an unsafe decision by planning VABC?
Well,
you know that I'm always going to say run,
run,
run to another doctor who gets it or go to a midwife who gets it.
Like I've said before,
that's not always an option.
So then what what do you do?
Well then you need to have a conversation,
you need to have a conversation with your provider and you need to ask them why they are so afraid of your pregnancies being spaced together or space so close together.
You need to ask them why they're ignoring ACOG in risking you out.
When ACOG says you shouldn't be risked out,
you need to ask them why they're gatekeeping options from you.
You need to ask them why why they are ignoring the data.
It doesn't have to be confrontational.
It feels like it sometimes and they might be very reactive but if you stay very calm and you're just like I just I really want to understand this.
This is important to me.
Having a vaginal birth is important to me.
You can share your reasons why you don't have to,
you tell them this is important to me and I really want to figure out how I can get you to be supportive because we see this data,
we know this data and I feel like maybe you are making these decisions based off a bad experience that you had or I feel like you're making this decision based off what's convenient for you or whatever reason that you feel they're making that decision to tell.
You know,
they won't support your VBAC and you can tell them,
you know,
hey doc,
I'm I'm really concerned with the fact that you're so focused on the fear of uterine rupture when we know that risk is really low and I plan to have more Children.
So I don't want to accept the risks of another C section.
I would like to have a vaginal delivery so that I can continue to grow my family without continuing to increase my risks with each pregnancy.
If that is something that you feel,
it's just an example and open that door for conversation,
ask them.
I really really would love to understand why you're choosing fear,
why you're choosing fear over just supporting my option.
You know,
I'm trusting you to watch out for any complications.
But I'm not asking you to predict complications that haven't occurred yet.
I'm asking you to watch out for them and manage them if they do occur.
But right now while we're healthy and there's no sign of complication,
I'm asking you to support my choices and see what they say.
I mean I can't promise that that conversation is going to go over smooth and easy but it might it might help them to see and realize that they need to start consulting the data.
They need to stop cherry picking when they do and don't listen to acog.
And I say that as somebody who I cite acog a lot because I find their VBAC guidelines very interesting.
I do not agree with everything that ACOG recommends all the time.
However,
I also am using ACOG guidelines to support freedom of medical decisions versus to limit medical decisions.
The problem is that too many doctors are using ACOG guidelines to limit medical decisions and then ignoring the guidelines.
If they mentioned freedom and informed consent and autonomy.
So that is the difference there.
Um Anyway I'm getting off topic because you guys know I love the tangent,
I just start transmitting a mama.
If you are planning a VBAC,
do not get too caught up in how spaced your pregnancies are or how close together your pregnancies are.
Because it doesn't really mean anything at the end of the day it doesn't mean you cannot have a VBAC if you are ready to start trusting in your body,
trusting in yourself and preparing for your VBAC with somebody who is going to inspire you and connect you to better information and help you learn how to advocate for yourself and learn how to strengthen those three pillars of confidence,
learn how to connect with your womanly wisdom and listen to that intuition,
your inner voice and honor.
Help you become a strong and fierce self advocate and help you understand how to find freedom and surrender.
Then I'm your girl,
I'm your girl.
You know I'm your girl and I would love it.
If you go ahead and email me or reach out to me.
Um There should be like contact information in the show notes.
You can contact me on instagram.
You can email me go through the contact page on my website and let me know what questions you have.
Let me know how I can help you have the birth you're dreaming of.
I want to help you,
I want to support you and I want you to feel confident going into your birth and stop being controlled by fear.
If you're ready to stop letting control fear you,
if you're ready to stop letting fear control you start controlling fear.
Let's chat.
Mhm Thank you for joining me on today's episode of the podcast.
I hope you feel seen supported and inspired.
If you haven't already,
make sure to check out the free I said free combatting fear during VBAC class at little Bear lactation dot com slash links.
That's Little Bear lactation dot com slash L I N K s and real quick if you could take a moment to leave a review of the podcast,
I would so appreciate it,
reviewing the podcast.
Can let more VBAC mamas to be know that I can help them the same way I'm helping you.
Can't wait to hang out with you again soon.
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