4 questions for your VBAC doctor
One of the most important decisions you’ll make during your pregnancy is choosing your care provider. This single decision will have a huge influence on your birth experience, especially when choosing Vaginal Birth After Cesarean (VBAC). When you get pregnant choosing your care provider will be one of the first decisions you make. Most women will just call their regular well-woman care provider and start there. The problem with this approach is that a provider who may be amazing when you aren’t pregnant might not vibe with your goals and values during pregnancy.
This is especially true for women planning a VBAC. With my first born’s pregnancy, I was seeing an OB/GYN practice that was steeped very strongly in the medical model. They were extremely skilled providers who were well known for helping women with complex gynecological issues and even saving lives during complicated births. However, half way through my pregnancy I realized I didn’t vibe with them and we were not a good fit. In the third trimester I decided to switch to the other practice in town. Now it was a small town so there were only two pregnancy care practices. When I ended up with a cesarean anyway I was devastated, but there was a DISTINCT difference between these two practices…
The original practice was anti-VBAC. They did not support VBAC at all and would not “allow” their clients to choose TOLAC (trial of labor after cesarean).
However, the new practice I was at, that had a huge midwifery model influence, was the absolute opposite. My OB, who was a VBAC Mama herself, started talking about VBAC options before ever even cutting me open. I knew that when the time came, I’d be returning to that practice, and I did. At that time the VBAC rate in South Carolina was around 8%, which tells you how difficult it was for women state-wide to find VBAC supportive care.
Your provider and their approach toward VBAC will be one of the most influential factors of achieving your goals. Without the unwavering support of your care team, your VBAC can become much more difficult to achieve. There are a lot of questions that are important to ask your healthcare provider when planning a VBAC, but these are 4 questions that are a great place to start, in my opinion.
What is your primary cesarean rate? Why do you think that is?
The World Health Organization estimates that cesarean rates should be around 10-15% on a population level, but in the United States the primary (first time) cesarean rate is around 25% with the overall cesarean rate around 30%. Understanding your doctor’s approach to cesareans and understanding/respect for physiological birth is crucial.
Their cesarea rate alone, however, is not necessarily indicative of their birth philosophy. Doctors who work with a higher risk population would reasonably have higher cesarean rates. Understanding why their cesarean rates are high or low is even more important than the rate itself.
What is your VBAC philosophy?
Does your provider truly support VBAC, or do they only support it in very specific circumstances? Having a lot of “buts” or “only ifs” around their VBAC policies can be a huge red flag.
What is your policy on inducing TOLAC birth?
Ask your provider what options they have for inducing VBACs early on, even if you have no desire to be induced. This question is crucial because the answer will tell you how up to date your provider is on modern guidelines. The truth is, a blanket ban on VBAC induction is not evidence based or supported by ACOG (American College of Obstetrician and Gynecologists). Blanket policies that gate keep options and don’t individualize care limit your capacity for true informed consent and are usually a red flag.
How will you feel if I disagree with your recommendations or make a decision opposite of your preference?
This question is not super technical, but your provider’s response will tell you a lot about how much they respect you and how they feel about true informed consent. The answer to this question should be able to tell you if your provider views you as an equal teammate or a subordinate.
Walking into birth confidently is such an important part of having a positive birth experience, especially when you're planning a VBAC. You must strengthen your Three Pillars of Confidence, to improve your birth experience, even creating a healing birth.
The second Pillar of Confidnece in Birth is Self Advocacy. This includes communicating with your provider to make sure they are truly supportive of your birth goals. This list of questions is just a starting point for learning more about how well your provider will be able to support your VBAC goals. VBAC With Confidence, my in-depth VBAC course for pregnant mothers, goes even deeper into what to look for in a provider when planning your VBAC.
Get instant access to this Free VBAC Class now to take the first steps toward a better VBAC experience.
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.
Keywords: Vaginal Birth After Cesarean, VBAC, TOLAC, trial of labor after cesarean, how to choose a Vbac provider, Vbac supportive obgyn, Vbac doctor, how to have a Vbac, tips for getting my Vbac
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