I just got off the phone with yet another patient that is in utter panic.  She has had a cesarean section in a previous pregnancy, and is just finding out at the end of her current pregnancy that she can’t have the vaginal birth that her doctor originally supported.  Also known as a “VBAC”.

 

This bait and switch modus operandi is something I simply can’t tolerate any longer!

 

Unfortunately, all providers aren’t forthcoming with you at your initial visit. Many practices will tell you that they routinely support vaginal birth after cesarean section, and 30 some odd weeks later they’re scheduling you for major abdominal surgery! Let me help you flesh out this situation before it happens.

 

Print these questions out, and take them to your next appointment.

 

Let’s get started…

 

#5 What are my risks associated with VBAC?

 

Now… I know you know the risks.  You’re asking this question to show your doctor that you want to be educated about all the possibilities particular to you. Asking this will make you look thoughtful and well meaning.  

 

It will also let you know if you have an increased risk for complications with VBAC, including but not limited to the following:

 

a) multiple cesarean sections,

b) an unresolved reason for your previous cesarean

c) a cesarean section less than 18 months ago, or even

d) a previous cesarean incision that is not compatible with VBAC

 

There are multiple valid reasons for a repeat cesarean section in certain women.

 

 So please—even though you have already done your research via Google, Facebook, or your doula—ask anyway.

 

#4 If necessary, what induction methods will you use?

 

Many providers will not induce a patient with a previous cesarean section.  If you don’t have a natural start to your labor, they will just schedule you for your repeat.  So listen closely when your doctor answers this one. 

 

They should be able to tell you in detail about their plan. 

 

Do what you can to have a natural start to your labor—sorry, I’m reserving those tricks for a later post. Stay tuned!

 

#3 Will I be allowed to move about the room and walk during labor, and can I have intermittent monitoring?

 

This question will let you know just how committed your doctor is to your success!  Anyone that knows anything about birthing babies, knows you can’t confine a woman to a bed and expect her to have an easy labor!

 

 Walking, freedom of movement and getting out of that bed, will expedite your labor. 

 

You can make it work with continuous monitoring, but your movement is limited to however far the monitor cables will stretch.

 

If your doctor says, the hospital has a cordless monitoring system – you are in luck!  You can move around the room and everyone will be happy!

 

 

#2 What are the stats for your practice on successful VBAC?

 

Girl – now watch ‘em sweat! Don’t for even one minute let them tell you they aren’t sure. 

 

Run like hell, if they don’t know their stats. 

 

These people know their stats on number of vaginal births for the year, number of cesarean sections for the year and number of VBACs for the year.  They live and breathe stats. 

 

Ideally, the number should be around 60-80%. 

 

If the practice has a low number, or they don’t know the answer, it is because they are not committed to VBAC. More than likely, the only women that were successful were the ones that labored at home before they got to the hospital and spit out a baby before anesthesia could consent them for a cesarean section. 

 

 

If the numbers sound pretty good but you are still unsure, call labor and delivery and ask one of the nurses.  “Does Dr. Such and Such do a lot of VBACs here”.  Those nurses will rat them out for sure!

 

And finally the most important question about your VBAC is…{drum roll please}…

 

 

#1 What are the hospital policies for VBAC?

 

Huh?  Hospital policies?  What does that have to do with anything?  A lot. 

 

One of the biggest deterrents to doctors doing VBACs is a little known hospital policy that requires your doctor to be on-site from the moment you arrive in labor (or within 30 minutes of being notified), until you deliver. 

 

So for your labor that goes throughout the night, through the little league double header, through the dance recital, through the anniversary or birthday dinner—your doctor will be with you instead of with his/her family. 

 

I know what you are thinking, “My doctor chose this profession, so I don’t want to hear any of that”!  But think about it.  If your child’s 6th birthday party had been planned, how would you feel if you couldn’t attend?  Or what about the day’s clinic schedule? 

 

VBAC’s require a lot of commitment from everyone.

 

 If there is no commitment, then it is so much easier to schedule you and be done with it.  There’s less time spent with you, less liability, and more financial gain.

At the end of the day, you have a cute wrinkly little baby, and your doctor gets what any normal human should have—a life. 

 

So, if you want to avoid this nasty little hospital rule, deliver in a larger hospital. 

 

There should be an “on-call” doctor present 24-7.  That way, your doctor can keep a clinic running on time, or make it to the soccer championship, without resenting you for demanding a VBAC.

 

I wish you great success in your birthing endeavors!  Please know that I am not saying everyone is a candidate for a vaginal birth after cesarean section—but most should be. I value honesty, and I hate to see women being misled. The majority of women have no frame of reference outside of what their physician tells them.

 

So keep pushing.  Keep demanding.  Get the best birth you can have.  YOU DESERVE IT!



Hi, my name is Traci Santangelo! I am a Certified Nurse Midwife, a self-proclaimed birth geek and a momma to two of the cutest kids on the block! I am fiercely loyal to those that I love or consider as friends, and I’m lucky enough to be married to a man that “gets me completely”.  My family continues to be highly annoyed with my true crime TV addiction, but I can’t get enough of it!  If you want to see me annoyed, tell me about a provider that didn't treat you right or lied to you. Although I consider myself a darn good nurse midwife, I really think I should have been a travel writer – after all, “vacation” is my favorite word.

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