Well Rounded Birth Prep

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Sunday, September 16, 2012

Weighing VBAC vs. repeat c-section

I frequently get emails from mommas who are considering VBAC (Vaginal Birth After Cesarean) vs. ERCS (Elective Repeat Cesarean Section). Are you interested in the possibility of VBAC and wondering what your options are? Here are a few places to start your research.

This post is not intended to try to talk moms who want a repeat cesarean birth, into having a VBAC, or vice versa. There isn't one right answer for everyone. For some, repeat cesarean is best. For others, VBAC is best. It depends on your situation. My goal is to give a springboard for research for those who might want VBAC, but aren't sure where to start with looking into it.

Even if you are still just in the planning stages of your next pregnancy, talk to your care provider about your options now. If you are interested in the possibility of VBAC but your OB doesn't attend VBACs, your best option for having a VBAC will be switching to a care provider who DOES attend VBAC. (You can always change your mind later, if you decide you do want ERCS.) Current research supports the safety of VBAC for the majority of VBAC candidates and some VBAMC (Vaginal Birth After Multiple Cesarean) candidates. Some of the factors to consider are personal health history, reason for prior cesarean(s), how many prior cesareans, type of incision (low transverse incision is lowest risk, but other incisions don't necessarily mean that VBAC isn't a possibility), length of time between pregnancies, whether there were any post-op infections, how recovery/healing went, and more.

Another good step is to request your full medical records of your cesarean(s), including notes from anyone who attended the birth (doctors, nurses, etc.) so you can get the fullest picture possible of what led to the cesarean and all the circumstances surrounding it. You can also ask to have your medical records forwarded to another care provider (OB or midwife) who does attend VBAC and can give you a second opinion about your options.

Some OBs will not attend VBACs regardless of evidence of the safety of VBAC, simply because of their liability. Depending on their malpractice insurance, some OBs are forbidden to attend VBACs or their insurance company will drop their coverage. Some OBs aren't aware of the research and evidence supporting the safety of VBAC and VBAMC. For some, it's a matter of their personal perception of risk (regardless of the research) or anecdotal experience. For others, it's just their personal preference because cesareans are quicker and easier for OBs. Some hospitals have policies outright forbidding (intentional) VBACs, regardless of physician preference. Regardless of your OB's reason, he or she is highly unlikely to change his/her policy and begin attending VBACs or VBAMCs if he or she doesn't do so already. If you want to plan for a VBAC (or even just leave your options open to the possibility of VBAC), your best odds may be to change providers and/or birth location to a VBAC-friendly one.

The number one factor that with whether or not a mother will have a vaginal birth (whether VBAC, VBAMC, or even a mom's first birth) is choice of hospital and choice of care provider. Know your hospital's cesarean rate, and make sure that both your hospital's policies and your OB's or midwife's standards of practice are evidence based and support normal, physiologic birth.

Here is a link with WV hospital cesarean rates:

In our region, the 4 major hospitals are Thomas (54.5% cesareans), CAMC (43.0%), Cabell (40.6%), and St. Mary's (24.3%), as of 2009 stats (the latest statistics available as of Sept. 2012).

You can find cesarean rates for other states and regions here:


About 50% of US hospitals either have an outright or de facto ban on VBACs. De facto ban means there is no outright ban on VBAC at that hospital, but there are no care providers who attend births there who are willing and able to attend VBAC, for whatever reason (personal or legal). Some moms find that they have to travel a little or a lot to find a hospital that will support their desire to VBAC. The hospital closest to your house might not necessarily be the best hospital for your needs. Check out Joy Szabo's story. She traveled 6 hours away to a hospital that would support her wish to VBAC her 4th child when she discovered that her prior hospital had banned VBACs after her previous successful VBAC with her 3rd child. 

This article helps moms make sense of the National Institutes of Health recommendations for VBAC and VBAMC (most current research & recommendations). It looks at various factors and helps you know what questions to ask when you talk to your care provider.

Additionally, we are blessed to have the first ICAN in WV here in Charleston. ICAN is International Cesarean Awareness Network, the world's premiere organization for cesarean recovery, healing, support, prevention, and VBAC info.

Their website has a lot of great info for research on VBAC vs. ERCS.

Our local ICAN's website:

and their Facebook page where you can get local meeting info:

An excellent free podcast on preparing for VBAC by Desirre Andrews, the former president of ICAN:

ChildbirthConnection.org is one of my favorite sites for evidence-based birth info. Here are a few of their resources.

For moms who have a cesarean scar other than the traditional low transverse incision (including other uterine surgeries such as myomectomy), the group Special Scars ~ Special Women provides support and info on options.

The medical term for "attempting a VBAC" is TOLAC (Trial of Labor After Cesarean), just so that you're not alarmed by that. That term can sometimes be a little bit unnerving or less-than-confidence-inducing for some moms, but nothing negative is meant or implied. It's just the terminology used.

If you are still in the planning stages of your next pregnancy, now is the time to work toward improving your health and resolving any current health concerns, such as working toward a healthy weight for your build, getting diabetes under control, seeing a specialist if there are any endocrine issues (thyroid, PCOS, etc.) that can be treated now, reducing or eliminating environmental toxins and cleaning chemicals, and researching the pregnancy diet and supplements that are recommended for your needs. An early pregnancy class might benefit you, to let you know what preventative measures can be taken for best health for you and baby prenatally, and another comprehensive birth class later in the pregnancy if you have not already attended one.

VBACfacts.com is a great source for statistics on VBAC vs. ERCS. Its owner periodically offers online classes for parents who are preparing for VBAC.

Moms who choose a repeat cesarean may choose options for a family centered cesarean, but that's another blog post.

I hope this gives you a place to start your research! Please let me know if I can serve you with preparing info for a private (in person or via Skype) or group class for you, whether it's info on TTC, for a healthy low-risk pregnancy to increase your odds of vaginal birth, and/or birth class for later pregnancy. I specialize in informed options.

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