Is Your Provider VBAC-Friendly?

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6 Tips to See if Your Doctor or Midwife Supports VBAC

Woman talking to her doctor
Photo © Dougal Waters/Getty Images

If you have a prior cesarean, you may be asking yourself if your provider is comfortable with VBAC (vaginal birth after cesarean). Taking time early in your pregnancy to discuss your birth can help put you and provider on the same page and also alert you if you need to change doctors or midwives. Making a decision early means that you are not locked into decisions with your due date around the corner. Remember that ACOG (American Congress of Obstetrics and Gynecology) notes that a trial of labor is a safe and reasonable choice for most mothers with a prior cesarean birth.

First things first: ask your practitioner how they feel about VBAC. Things that you want to hear are discussions of the risks, benefits and alternatives of vaginal birth after cesarean. Your doctor or midwife also needs to discuss the risks, benefits and the alternatives of repeat cesarean section. They may include their personal philosophy or why they feel the way they do. A nod to the 2010 ACOG Guidelines on Vaginal Birth After One or Multiple Cesareans would also be an indicator that your practitioner is using evidence-based information. Red flags would be: your doctor uses older practice guidelines to discuss VBAC with you, your doctor tries to scare you or only gives you personal stories of VBACs with you.

Next, ask your practitioner their VBAC rate. You want to know how many women in the last year have attempted a trial of labor after cesarean in their practice. Research tells us that of women who attempt a vaginal birth after cesarean, 70% will be successful. If you find out that only a few women in your doctor’s care have tried, it could be because your practitioner has talked them out of it at the end of their pregnancies. Out of those attempted VBACs, how many VBACs has your doctor personally attended in the last year? It’s easy for a practitioner to talk the talk, but the numbers really tell you if your doctor walks the walk.

Learn your practitioner’s guidelines on length of pregnancy and induction options, should you need one. Some doctors and midwives only allow trial of labor after cesarean if labor starts naturally by 38 (or 39, 40 or 41 weeks.) These policies are likely unsupportive of your goal. According to ACOG, pregnancy lasting longer than 40 weeks is not a reason for automatic elective repeat cesarean. Although avoiding elective induction is the healthiest choice for you and your baby, in case a medical need for induction arises during your pregnancy, you’ll want to know your doctor’s policies. Even though the ACOG practice bulletin notes that induction and augmentation remains an option for those undergoing a trial of labor, many physicians refuse to include these in their personal practice guidelines.

Find out about birth practices. If you choose a trial of labor after cesarean, where will you have to give birth? Does your practitioner attend VBACs in a regular labor and delivery room or are VBACs required to give birth in the operating room? What kind of monitoring does your practitioner require? Does your doctor encourage moving around the labor room? What comfort techniques does your practitioner support?

Ask other mothers for their experiences with your practitioner. The International Cesarean Awareness Network (ICAN) is a wonderful resource for expecting mothers. Attending a meeting or joining an online community in your area can help you hear real stories from real mothers. Everything in the exam room is theoretical. What your practitioner tells you gives you some information about their practice style. What other mothers experienced can be invaluable information. (See also VBAC Birth Stories.)

Listen to your intuition. Has your practitioner provided you clues that they aren’t going to support you in your decision to VBAC? Do you feel that they think this is a risky decision despite evidence that supports your choice? Your intuition is there for a reason. If red flags are popping up for you, interview other doctors and midwives. The only thing that interviewing other care providers can do is give you support for your decision to leave or stay with your practitioner.

Source:

Vaginal birth after previous cesarean delivery. Practice Bulletin No. 115. American College of Obstetricians and Gynecologists. Obstet Gynecol 2010;116:450–63.

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