VBAC, or vaginal birth after cesarean, is again experiencing an upswing. If ever the metaphor of the swinging pendulum applied in the birth world, it is here. VBACs were almost unheard of before the ’80s, and the phrase “once a cesarean, always a cesarean” was the conventional wisdom. Starting in the ’80s, the VBAC movement gained momentum through the ’90s, but it became so difficult to find a doctor or hospital willing to do one in this century, that it was rare to hear someone talk about their upcoming VBAC in the hospital. Anecdotally, I see more willingness on the part of docs and hospitals now–though that may very well be location-related since it largely coincides with my return to Denver. (There were two docs I knew who would do VBACs in Pueblo, but it was a challenge for them since they had to stay at the hospital for the entire labor.)
In Colorado, homebirth midwives can offer VBACs to women under certain circumstances. They can only have had one c-section without an intervening vaginal birth, there must be 18 months between deliveries, they must live near the hospital, etc. While I have heard many cautionary words about VBACing at home, there is no doubt to me that the restrictive hospital policies and “bait-and-switch” tactics of the past decade have pushed women to find caregivers who truly believe in their abilities to birth their babies vaginally.
The risks of VBAC are small, but significant. Though the risk is uterine rupture is about 1:500, the consequences can be severe, including severe hemorrhage, hysterectomy, or fetal demise. However, these risks are increased when labor is induced or augmented, which, of course, we do not do at home. Other than monitoring vigilantly for signs of uterine rupture, and possibly doing a bit more emotional preparation for the birth, VBAC labors are very much the same as any other.
Over the past couple of months, Midwives of the Rockies has had five sequential mamas planning VBACs, which is quite unusual (three of their previous babies were born in 2010, which further supports my theory that that year was whacky beyond all belief). Again there is little that is technically different, but that sense of accomplishment and triumph in the room when that baby makes his or her way to his mama’s chest is really something to behold. And once she has had one VBAC, her risk in future births is cut by half. Alternatively, each subsequent c-section introduces more risk to the the woman. So, this is something that we must continue to fight vigilantly for.
If you would like to plan a VBAC, arm yourself with knowledge and support. Find caregivers who truly support VBAC (language like, “well we’ll see,” may be a yellow flag unless there were mitigating circumstances from your c-section). For this, I strongly believe that midwives are going to have a philosophical perspective that supports your goals. Find mother to mother support through ICAN. Do everything you can to have a healthy pregnancy–eat well, exercise, receive regular chiropractic care, etc. But above all, believe in yourself and your body. Everyone knows that cesarean is warranted some of the time. But we also know it’s over-utilized, and your chances of birthing your next baby vaginally are very good.