VBAC is a safe, empowering, healing experience for women/couples who have had a previous cesarean section. In 2010, ACOG revised its stance on VBAC, stating that "Most women with one previous cesarean delivery with a low transverse incision
are candidates for and should be counseled about vaginal birth after cesarean
delivery (VBAC) and offered a trial of labor after previous cesarean delivery
(TOLAC)." Also, "Women with two previous low transverse cesarean deliveries may be considered candidates for TOLAC. Women with one previous cesarean delivery with a low transverse incision, who are otherwise appropriate candidates for twin vaginal delivery, may be considered candidates for TOLAC. External cephalic version for breech presentation is not contraindicated in women with a prior low transverse uterine incision who are at low risk for adverse maternal or neonatal outcomes from external cephalic version and TOLAC." (source: ACOG Guidelines Practice Bulletin #115)
One of the key factors in having a vaginal birth after cesarean is wisely choosing your care provider. While many physicians and midwives may philosophically support VBAC, their practices and policies (and insurance companies) may limit your chance of a vaginal birth.
I encourage you to shop around for your care provider just as you would a new car, or a wedding venue. Attend a local ICAN Chapter meeting and ask for recommendations, read testimonials from other VBAC women, and most importantly, request a consultation, and ask smart questions. When you interview your potential care provider, take note of the information given, and also be aware of how you feel in this person's presence. Here are some questions to get you started. Remember, you are the customer. Ask proudly and choose wisely!
1. What is your overall cesarean rate? How does that break down into primary c/s and repeat c/setions?
2. What is your VBAC success rate?
3. About how many VBACs do you attend each year?
4. Do you use intermittent electronic fetal monitoring? If not, will telemetry or wireless monitors be available to me?
5. Do you recommend routine use of IV fluids?
6. How far past my "due date" are you comfortable with my pregnancy progressing before recommending an induction?
7. Under what, if any, conditions do you use pitocin to augment labor?
8. Will you use a foley bulb/foley balloon if labor needs help progressing?
9. Which positions do you feel are best for the second stage of labor?
10. Can I labor in a tub? Can I birth my baby in a tub?
11. Are you comfortable with me laboring at home and coming to the hospital after active labor is well established?
12. If my water breaks early in labor, how much time are you comfortable letting the labor go before considering augmentation or cesarean section?
13. Should I require a cesarean birth, could I have a "family centered cesarean" with immediate skin-to-skin contact and non-separation from my baby?
You deserve to fall in love with your care provider. Remember, the person you choose may be the first touch your baby feels as she or he emerges into this world. You, not your doctor or midwife is the authority int he room, and the center of your birth. Birth is sacred, and choosing the right person to care for you is an important part of creating a healing, soul-nourishing experience.