Is Your Provider VBAC-Friendly?

Woman talking to her doctor

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If you have previously delivered via cesarean section (C-section), you might be interested in trying for a vaginal birth after cesarean (VBAC). This is an option for many women, but it is important to find a VBAC-friendly prenatal care provider. Choosing a provider who is supportive of your plan can make it more likely that you are able to have a successful VBAC.

Taking time early in your pregnancy to discuss your birth can help put you and your provider on the same page. It will 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.

ACOG (American College of Obstetricians and Gynecologists) notes that a trial of labor is a safe and reasonable choice for most mothers with a prior cesarean birth, but that the hospital must be prepared to manage any emergency complications.

Talk to Your Practitioner About VBAC

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. A VBAC has a number of potential benefits, including a lower risk of surgical complications and a shorter recovery time following birth. 

There are risks, however, and your provider should explain them. You should ask your doctor what kind of incision you had in your previous C-section and how that affects your VBAC options. Also ask what factors might change your delivery plan.

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 2019 ACOG Guidelines on VBAC would also be an indicator that your practitioner is using evidence-based information.

Red Flags to Watch For

  • Your doctor uses older practice guidelines to discuss VBAC with you.
  • Your doctor tries to scare you.
  • Your doctor only gives you personal stories of unsuccessful VBACs.

Ask About VBAC Rates

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. 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.

Studies suggest that women who attempt a trial of labor after one previous cesarean delivery (TOLAC) have a 60 to 80% likelihood of having a VBAC.

Factors that can increase a woman's chances of having a VBAC include having had a previous vaginal birth and going into spontaneous labor. Factors that may decrease the probability of success include going past 40 weeks of gestation and increased maternal age, though these don't necessarily rule out VBAC.

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.

Ask About Requirements and Restrictions

Learn your practitioner’s guidelines on length of pregnancy and induction options, should you need one. Some doctors and midwives only allow a 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 an automatic elective repeat cesarean.

Also, ask about other restrictions that might prevent you from having a VBAC. These include such things as:

  • Advanced maternal age
  • Gestational diabetes
  • Going past 40 weeks
  • Maternal obesity
  • Maternal weight gain
  • The predicted size of the baby

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 practices.

Know Their Birth Practices

Find out about birth practices. Providers may have specific practices in place when performing a VBAC. Knowing about these practices can help you better plan for the birth.

Things to Consider

Some questions that you should ask include:

  • Does your doctor encourage moving around the labor room?
  • If you choose a trial of labor after cesarean, where will you have to give birth (i.e., in a regular labor and delivery room or an operating room)?
  • What kind of monitoring does your practitioner require?
  • What comfort techniques does your practitioner support?

Ask Other Mothers About Experiences

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. 

Trust Your Instincts

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. Interviewing other care providers can help give you confidence in your decision to leave or stay with your practitioner.

A Word From Verywell

While many women are able to have a VBAC, there are situations where it may not happen. Once you find a VBAC-friendly provider, talk to them about the possibility of having a "gentle cesarean" in the event that a planned VBAC doesn't work out. This is aimed at being more family-centered and focused on facilitating skin-to-skin and early contact between the baby and parents.

Remember, a VBAC is a viable birth option for the majority of women who have previously had a cesarean. Do your research early on to find a provider who supports your decision in order to ensure you and your baby get the care that you want and deserve.

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Article Sources
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  1. American College of Obstetricians and Gynecologists. ACOG Practice bulletin No. 205: Vaginal birth after cesarean deliveryObstet Gynecol. 2019;133(2):e110–e127. 10.1097/AOG.0000000000003078

  2. Metz TD. UpToDate. Choosing the route of delivery after cesarean birth. Updated June 12, 2020.