12 Steps to Prepare for a Successful VBAC

My first child was born via cesarean and my second child was born vaginally. Despite the odds we had a vaginal birth after a cesarean, aka VBAC! I gave birth in the comfort of my home with my husband, a licensed midwife (CPM) and my birth doula present. The journey from c-section to VBAC was full of ups and downs and challenges. 

My cesarean was unexpected and traumatic. I was taken in an ambulance to the hospital and the OB who performed the surgery was frightened and stressed by our circumstances. The good news is that we all turned out okay and healthy in the end. You can read more about that here: Shane’s Birth Story

After that experience, I was determined to have a better birth the next time. I researched, learned, investigated, planned, prepared, healed and made my way to a happy VBAC! 

From personal experience and supporting many other women, here are my 12 steps to preparing for a successful VBAC:

1. Heal your pain. 

If you had an unwanted cesarean, it is totally normal and necessary to grieve the loss of the birth experience that you wanted. Grieving is part of the healing process. Talk about it. Share your story. Tell it. Feel the emotions and let them go. Spend as much time as you need doing this. This may be an ongoing process that you continue to work on. You may want to talk to a family member, friend, a doula, a counselor or a therapist. Consider a support group like ICAN (International Cesarean Awareness Network) or a supportive Mom’s group.

Some local resources include:

• Evelyn Ojeda – Birth Trauma Healing 
• ICAN Facebook Group
• Community Roots Events
• Postpartum Support International

2. Get your questions answered. 

Learn everything you can about what happened in your cesarean and why. If the c-section was very straightforward and simple this will be an easy step to complete. But, don’t assume you know it all.

You might consider requesting your operating report from the hospital where your birth took place. Find out what kind of incision was used in your surgery, and how it was closed. This can be very revelatory and provide details about your surgery that you didn’t know. If you still have questions, schedule a time to meet with the doctors that performed your cesarean to get your questions answered. Bring the operating report and a list of prepared questions. 

Even though it was a few years after the fact, I met with the OB who did my surgery. The meeting helped me gain a better understanding of what happened on that day from her perspective, which was, of course, different from mine. Even though I felt some strong emotions about this provider, I went in with an open mind and listened to what she had to say. We didn’t see eye to eye on everything, but I was able to walk away with more information and clarity. 

Ask questions, don’t assume, clarify. It’s your birth. 

3. Educate yourself. 

Perhaps the most important step is to get educated about VBAC. Don’t believe what you hear on the street. Most people have no clue what the truth is about vaginal birth after cesarean. Read as much as you can. Check out this article: To VBAC or not To VBAC? Go to VBACfacts and invest in your own education. 

I took an in-person workshop with Jen Kamel of VBACfacts, despite having to drive two hours to get there and back in the same day. I read everything I could get my hands on, books, studies and evidence based information. The entire subject of birth was my priority. I joined online forums and talked to midwives, doulas and other mothers about their experiences. I became a certified labor doula and childbirth educator. All of this was part of my own journey to achieving a VBAC. The education provided me the tools needed to help myself and others accomplish our birth goals. 

Now, you don’t have to become a doula or a childbirth educator to have a successful VBAC. But, my point is, realize there are things you don’t know and you can learn. Knowledge is literally power in this situation.

4. Address your partner’s needs. 

Your partner may have their own level of grief and trauma related to the cesarean birth. If so, it is a good idea for your partner to also go through steps 1- 3 above. They need to take time to heal, understand and get educated on VBAC. With education comes clarity and hope for a better birth experience the next time. Work with your partner so you are on the same page and have the same goals. 

5. Know that you can do this. Take charge.  

Much of the world still erroneously believes “once a cesarean, always a cesarean.” This is wholly untrue. Do your research and figure out what is right for you. Once you have made up your mind, do not be swayed. When you are swimming against the tide, you must stand firmly in your decision regardless of how anybody else feels about it. The naysayers will show up. What is important to you is what matters. You don’t need approval from others. This is your birth and your baby. Sit in the seat of power and strength that is inside you and own it. 

6. Find a VBAC supportive care provider. 

The way your doctor or midwife practices will have a major impact on your birth outcome. A truly supportive care provider will practice shared decision making. They will review evidenced-based information, risks, benefits and options with you. Taking into account your health and circumstances, values and preferences, together you will make a decision that is best for you. Your provider should support your informed decision once it is made. If you do not feel supported in this way, you need to find a new health care provider.

Look for doctors and midwives that have a history and reputation for supporting VBAC. Ask your doula for recommendations, and check in local mom’s groups for recommendations.

I found a homebirth midwife that had a lot of experience supporting VBAC hopefuls. She believed in me and never doubted we were going to have a beautiful home birth. And we did. 

7. Choose a supportive birth location.

Your biggest c-section risk factor may be the hospital you choose. You can find the c-section rates and VBAC rates for most hospitals online. Choose a hospital with a low c-section rate. Choose a hospital that has a reputation for supporting women’s choices in labor and VBAC.

Experts explain more in this article from Consumer Reports: 

“THE BIGGEST RISK FACTOR is “the hospital a mother walks into to deliver her baby, and how busy it is,” says Neel Shah, M.D., an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, who has studied c-section rates in the U.S. and around the world…. “While many medical institutions across the U.S. are now taking steps to prevent unnecessary c-sections, women themselves can take steps to reduce their own risk of having one, including through their choice of hospital.“

8. Build your support team.  

Surround yourself with people who believe in you. Seek out people who know the facts and support your right to make your own medical decisions. Hire a birth doula to be in your corner, empowering you and validating your goals and preferences. Consider attending an ICAN meeting where you can connect with other families that have had a VBAC or who are planning to have one. 

9. Be proactive. 

Knowing what you now know, take action during this pregnancy to prepare yourself for a successful VBAC. For example, maybe you had an induction last time. Perhaps you feel the induction contributed to the cascade of interventions and eventual c-section. Therefore, in this next pregnancy, decide to advocate for yourself. Let your provider know, you would like to avoid an induction unless it is 100% medically necessary. Get your health care team on board with this plan.

My son was unexpectedly in a breech position, which we only discovered during labor. This is what resulted in my c-section. For my next pregnancy I saw a chiropractor regularly to  help with optimal fetal positioning and pelvic alignment. I learned about and practiced spinning babies exercises to help avoid a 2nd breech baby. 

10. Live a healthy lifestyle. 

Pregnancy takes a toll on your body, and for that reason it is essential that you give your body the TLC it needs during this strenuous time. Ensure you are properly nourished and well hydrated. Get sufficient sleep at night and rest during the day when needed. Schedule some light exercise throughout your week. Take your prenatal vitamins and make your personal health a priority! Doing so may help to prevent any further complications getting in the way of your VBAC plans.

11. Gestate in peace. 

It is a known fact that stress can cause health problems and the same applies during pregnancy. Take stock of the people, places and things in your life that may be causing you unwanted stress. Reduce time spent in these areas, or remove them from your life altogether if possible. Surround yourself with loving and supportive friends, family and colleagues. Do the things that make you happy and relaxed. Walk on the beach, read a book, go to a yoga class, meditate, and listen to your favorite music. Protect your mental health and your personal space. Save your mental energy for the VBAC journey. Now is not the time to slay the dragons, they will be there for you to conquer later. 

12. Have a back-up plan and accept that you cannot control everything. 

There are so many factors that impact how your birth plays out which you have no control over. Do not blame yourself. Sometimes life just happens and we are unlucky despite doing everything “right.” Understand this and make peace with the possibility of a repeat cesarean. It can be a positive experience when you choose it on your own terms. 

In the event that you need a repeat c-section, consider the things that are most important to you about that experience. Would you like to have clear drapes to see your baby being born? Skin to skin time immediately with your baby, if possible? Some other ideas are included in this article: What is a Gentle Cesarean?

Our team of birth doulas are highly experienced with helping to prepare and support families through c-sections and VBACs. We are here for you and would love to help you have a healing and rewarding birth experience. Reach out to us for support. We believe in you!