There are many reasons you may have heard of a VBAC (vaginal birth after cesarean) or considered preparing for VBAC. Your desires might be related to having a more natural experience, desires to avoid another surgical procedure (due to risks of multiple surgeries), a positive previous vaginal birth, or the desire to experience the benefits of a vaginal birth. Whatever your reasons might be you are no longer doomed to the saying “once a cesarean, always a cesarean.” Preparing for a VBAC can lead to a successful and positive vaginal birth experience.
Is a VBAC Safer Than Routine Cesarean?
Having a cesarean will always come with more risks than a vaginal delivery. However, you have to balance those risks with your particular situation. For some individuals that are high risk in other ways a cesarean may be the safest option. It is important to have open and honest discussions with your own medical provider based on your particular health history and the history of your current pregnancy.
Overall the VBAC success rate is around 60-80%. So there is a very good chance if you would like to attempt a VBAC, you could have a positive outcome if you prepare properly. There are many factors that go into making a strong VBAC candidate.
- Low risk pregnancy
- Low-transverse incision from prior cesarean
- Single delivery (no multiples aka twins)
- 2 cesarean deliveries or less prior
- 2 years or more between deliveries
- Spontaneous labor versus induction
- Familiarity of medical team with VBAC deliveries
- Placenta previa
- High risk pregnancy
- Vertical incision from prior cesarean
- Birth of multiples
- Breech position
- Fetal distress
- Medical team with limited knowledge or experience with VBAC
- Gestation greater than 40 weeks
*These are general guidelines not the rule. Your situation is unique alway make decisions with the guidance of a trusted medical team.
Choosing Your Provider and Location
One of the most important aspects of preparing for VBAC is making the right choice when it comes to a medical provider and a delivery location. In some cases you may have limitations based on your health history. If your recovery has been difficult or you are higher risk you may not have the option of birthing in a birth center or having a home birth.
Find a VBAC Supporter
You will want to find a provider that doesn’t just say “I will let you” try to delivery vaginally, but someone who is really on your team. You will want someone that understands your desires, the research, and can partner with you to give you a safe delivery that is closest to what you desire.
Pick the Right Birth Location
Once you have a provider that can be on your side you need to find a delivery location that is not only supports VBACs but but doesn’t have policies that go against your plan. It is best to look into this well in advance so you don’t get pressured into scheduling a routine cesarean if that is not your goal.
Avoid Medical Induction
Having a medically induced birth can increase a your risks when attempting a vbac. It is best to try to allow your labor to happen naturally. It is possible to medically induce and have a successful vaginal birth. Discuss the risks and benefits thoroughly with your provider and ensure you feel informed of all your options prior to making a decision.
Preparing Yourself Physically
Your physical health when preparing for VBAC is very important to your success. A study done in China of over 200 pregnant women attempting a VBAC found that physical activity of 150 mins/week (~20min/day) improved VBAC success by 95%. It doesn’t have to be strenuous activity but should include some cardio and strength resistance. It is impossible to target your uterus muscles but your overall physical fitness including strengthening abdominal muscle and pelvic floor contributes to your uterine health. Consistency is key and you should start incorporating regular physical exercise as soon as possible.
A healthy diet is essential when preparing for VBAC as it leads to a healthy uterus. The following foods are great for improving uterine health by decreasing risk of developing fibroids that can complicate your pregnancy. Try to incorporate many of these foods into your diet:
Nuts & Seeds: almonds, cashews, walnuts, sesame seeds, pumpkin seeds, and flaxseeds.
Dark Green Leafy Vegetables: spinach, kale, bok choy, and swiss chard
Fresh Fruits & Lemons: avocados, berries, apples, pears, pomegranates, bananas, strawberries, and lemons
Whole Grains: barley, brown rice buckwheat, millet, oatmeal, and whole wheat bread
Red Raspberry Leaf Tea: This is a uterine tonic that strengthens the uterus, improves labor outcomes, and prevents excessive bleeding postpartum. (Pink Stork Labor Prep Tea)
It is best to avoid foods that are high in sugar, highly processed, caffeine, alcohol, red meats, and high fat dairy products.
Pelvic Floor & Stretching
Having a strong pelvic floor is important when preparing for VBAC, and there are many exercises that you can do to strengthen those muscles. It is however, just as important to be able to relax and stretch those muscles as it is to strengthen them. Reach out to a pelvic floor physical therapist to help you determine a plan that is best for your and your situation. It’s not just as simple as doing a bunch of kegels.
Preparing Yourself Mentally
Your mental state is a huge factor in the success when preparing for VBAC. Fear can actually slow and stop labor progression. It’s important to feel educated and confident as you go into your delivery.
- Educate yourself– read quality literature to educate yourself so you can be your best advocate, understand what to expect, and have tools to use as situations unfold. It’s also a good idea to join a VBAC support group and hear other positive VBAC experiences.
- Have an Advocate – Get your partner involved so they can reassure you when you start to have doubts. You can also choose to hire a doula with VBAC experience to guide you through this process and be your advocate through your birth.
- Connect with your body – through meditation, breathwork, yoga, hypnotherapy, and other techniques to strengthen your mental toughness and feel one with your body.
- Create a Birth Plan – having a birth plan that you can share with your medical team helps you determine what is really important and communicate those desires clearly to them.
Frequently Asked Questions
Preparing for VBAC is going to increase your likelihood of success. However, things don’t always go as planned. The best thing you can do is prepare and educate yourself to make good decisions regardless of the outcome. If at the end of the day you have to have a cesarean delivery, know that you did not fail. You did amazing things for yourself and your baby, and your efforts were not in vain. Those benefits will improve your immediate postpartum experience and the health of your baby in the long term.
Jess is a registered nurse with over 6+ years of critical care experience for patients young and old and is the mother of two small children. After having her own children she felt inspired to provide mothers with real actionable guidance and education to make informed decisions throughout their pregnancy and postpartum experience.