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Vaginal Birth After Cesarean (VBAC): What to Expect


VAGINAL BIRTH AFTER CESAREAN (VBAC0: WHAT TO EXPECT WHEN PLANNING YOUR VBAC



If you have had a c-section, you might be wondering if the old adage of "Once a Cesarean, Always a Cesarean" is true. You might have heard that Vaginal Birth After Cesarean (VBAC) is an option, but you may have many questions about the VBAC option.


In this article, we will explore what to expect when considering VBAC for your next birth.




What is a VBAC?


Before we can talk about what to expect when planning a VBAC, we should probably talk about what a VBAC even is... VBAC is the acronym for Vaginal Birth After Cesarean. Sometimes when a woman is planning a VBAC, the OBGYN may refer to it as "TOLAC" which stands for Trial of Labor After Cesarean. VBAC used to be considered a dangerous option, but is becoming more common in recent years. Continue reading to learn why more women are choosing VBAC, the benefits of VBAC, the risks of VBAC, who is a candidate for VBAC, and how you can increase your chances of a successful VBAC.


Why some women choose VBAC?


Women choose to plan a VBAC for many reasons. Some women simply want the experience of Vaginal Birth, whereas others feel strongly that Vaginal Birth is associated with better birth outcomes for both mom and baby. Others simply do not want to experience serious abdominal surgery again, as recovering from a cesarean can be extra difficult with both a newborn and a toddler. Some women hope to have a large family and know that multiple cesareans can increase risks to both mom and baby, therefore, they choose to pursue VBAC for healthier pregnancies in the future.


What are the benefits of VBAC?


TOLACs that end in VBAC are associated with lower risks and complications than a planned or emergency repeat cesarean. Some of the benefits include, but are not limited to:

  • Decreased Hemmorhage Risk

  • Decreased Risk of Infection

  • Decreased Risk of placental problems in future pregnancies

  • Decreased risk of abdominal adhesions due to scar tissue

  • Stronger Gut Microbiome for baby due to colonization from birth canal

  • Less breastfeeding challenges

  • Less risk of baby/mother separation

Despite these well known benefits of a VBAC, many people still have a lot of hesitation to plan a VBAC. Sometimes, even when a mother is dedicated to her VBAC, her support partner, OBGYN, and others may be more suspicious of planning a VBAC. This is because there are some unique risks to planning a VBAC.


What are the risks of planning a VBAC?


While VBAC is generally considered a safe option, VBAC is associated with an increased risk of uterine rupture due to the scarred uterus. This risk is why so many people are afraid of VBAC. Uterine Rupture is very rare, but can be very serious when it does occur. Therefore, it is critical to learn the signs and symptoms of uterine rupture, understand how it is handled, and know how to reduce the chances of experiencing uterine rupture.


While the risk of uterine rupture is low, this is the reason many people are hesitant to plan or support VBAC. There is sometimes a perception that a cesarean feels more controllable, therefore some believe it is safer. While sometimes cesarean may be the safest option, most women can have a safe and healthy VBAC birth.


Are you a good candidate for VBAC?


While most women can safely choose to plan a vaginal birth after cesarean, you might be wondering what makes VBAC safe for some women and not others. There are a few things to consider.


The biggest factor in whether or not you can safely choose to plan a cesarean is the type of uterine incision you received during your first cesarean. If you had classical incision during your cesarean, it will be harder to find a provider to support VBAC because this kind of vertical incision is associated with a higher risk of uterine rupture.


You might also have a hard time finding a supportive doctor for your VBAC if you have had more than one cesarean. However, VBAmC (Vaginal Birth After Multiple Cesareans) is considered a safe option according to the most recent American College of Obstetricians and Gynecologists (ACOG) VBAC Guidelines.


Traditionally, the most ideal candidate for a VBAC is considered someone who has given birth vaginally in the past, has had only one cesarean, and has a lower transverse uterine incision.


However, that does not mean you are not a good candidate for VBAC if you don't meet that exact criteria. You should consider learning more about who is considered a good candidate for VBAC to decide if VBAC is a good idea for you.


How to increase your chances of a successful VBAC


Planning a VBAC can be challenging emotionally and logistically. While studies show that most women who attempt VBAC should be successful, the fears and misconceptions surrounding VBAC can cause challenges for women.


Some common challenges women face when planning a VBAC are finding a hospital that supports VBAC, finding an OBGYN or Midwife that supports VBAC, having a supportive birth team (supportive partner and a VBAC doula), and overcoming the fear of a repeat cesarean or uterine rupture.


Sometimes providers are supportive of VBAC only to a point, then begin placing arbitrary or non-evidence based limits on their support due to their fears about VBAC and uterine rupture. Learning how to navigate these situations is critical to increasing the likelihood of having a successful VBAC. There are a lot of myths to correct, fears to unlearn, and nuances that need to be understood.


While planning a VBAC can sometimes feel isolating or scary, the truth is, you are more likely to have a positive VBAC if you:

  • Learn how to be a strong self advocate

  • Learn to write a VBAC birth plan

  • Find a supportive VBAC provider

  • Have a supportive partner

  • Hire a doula for your VBAC

You may be reading this thinking you have no idea where to start learning the truth about how to have a successful VBAC. Luckily, you're in the right place. If planning a Vaginal Birth After Cesarean is important to you the following resources are available to help you learn what to expect when planning a VBAC:


  • Combating Fear During VBAC Free Workshop

This free 30 minute workshop will introduce you to the concepts of the Three Pillars of Confidence to help you shut down fear as you prepare for your VBAC.

  • theVBACpodcast

This podcast available on Apple Podcasts, Spotify, and other major podcast platforms shares the truth on VBAC, addresses common fears about VBACs, and straightens out the myths surrounding VBAC

  • VBAC With Confidence Complete Birth Preparation Program

This self-paced online birth preparation course is perfect for couples who need to prepare for VBAC. The course includes a comprehensive birth preparation course that teaches what to expect during labor and how to make decisions you feel confident in. The course also teaches parents the truth about Vaginal Birth After Cesarean, provides questions to ask your OBGYN or midwife, and so much more. Parents who complete this course can also save 15% on a private VBAC consult with the internet's best VBAC doula!



top left woman labors in tub during homebirth after cesarean HBAC, top right black and white image of woman laboring on knees beside bed during HBAC homebirth after cesarean, bottom left black and white image of midwife supporting woman during TOLAC in hospital, bottom right image of woman in OR during cesarean birth, text says What to expect VBAC vaginal birth after cesarean navy blue and olive green color scheme
Vaginal Birth After Cesarean (VBAC): What to Expect. Top Left: Jaimie's first Homebirth After Cesarean Laboring in bathtub, Top Left: Jaimie during transition during HBAC labor at home, Bottom Left: Jaimie's midwife offering support during Hospital TOLAC, Bottom Right: Jaimie in the OR during First Born's Cesarean


 

Best Online VBAC Doula with her children and husband in Oklahoma
Jaimie Zaki, named best online VBAC Doula by VeryWell Family, poses with her 4 children and husband

Jaimie Zaki is a Doula, IBCLC, Author, Hostess of the VBAC podcast, and mother of Four Little Bears. Jaimie provides Virtual Birth Preparation for women planning a Vaginal Birth After Cesarean. Jaimie also provides Telehealth lactation support both prenatally and postpartum. If you’re ready to stop letting fear and doubt control you, Jaimie will help you reframe your fear and reclaim power so you can have a positive birth and breastfeeding experience.


Jaimie has had a cesarean, a hospital VBAC with an epidural after 36 hours of labor, and two home births after cesarean. Jaimie has supported countless women virtually and in-person as they prepare to overcome their fears of childbirth and cultivate a truly empowering and positive birth experience.


If you would like to work with Jaimie Zaki to prepare for your birth or breastfeeding experience, Jaimie offers virtual and local support services. Click here to learn more about how Jaimie can help you prepare for your new Little Bear.

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