The old adage, still often believed, is "once a C-section, always a C-section." And for many years, because of the techniques used to perform the surgery, that belief was, indeed, best practice. But times and techniques change. Now the American College of Obstetricians and Gynecologists (ACOG) encourages physicians to offer the option of a vaginal delivery after cesarean (VBAC). While your care provider will work with you to decide whether you're a good candidate (statistically you probably are), there are VBAC questions you should ask if you're considering this particular birth method. Everyone, and every birth, is different, but asking a few very specific questions can help you decide if a VBAC is right for you and, if it is, how you can increase your chances of success.
Some people want a VBAC delivery because they found a C-section to be traumatic. Some people feel they were "cheated" out of the vaginal birth they'd prepared for. Others are less sentimental and more practical: they don't want to recover from surgery while caring for two kids. There are risks associated with VBAC delivery, but the benefits are clear, too. According to the ACOG, avoiding surgery, and thus decreasing the risk of hemorrhage and infection, as well as future risks associated with multiple cesarean deliveries, is, for most people, a win.
I'm a naturally curious person, so after having a C-section with my first and getting pregnant with my second I wanted to know what squeezing a baby out of my bits felt like (spoilers: not pleasant, as it turns out, but still pretty cool). So for me, a VBAC just felt like the way to go, and now, five years later, I'm still really glad I did it. But that's not to say the birth itself, or the months leading up to it, weren't trying. But really processing things in real time, I think, helped tremendously. And so did asking the following questions:
"Do I Want A VBAC?"
Like I said, a lot of people don't know a VBAC is even an option, and not only should they know that it is, but they should consider whether it's a good option for them without the meddling interference of people who think they know better. On the other hand, I have known a lot of people who, when presented with the idea of a VBAC, simply shrug and say, "Nah, not for me." And you know what I think about those people? Good for them for knowing themselves so well and having a clear idea of what they want and don't want when it comes to their own birth experiences.
There are a ton of very valid reasons to want to try for a VBAC, medical and personal. There are also a ton of reasons to never seriously consider it, including (but not limited to): enjoying a C-section, sticking to a kind of birth you are already familiar with, the idea of a VBAC making you nervous, or just, you know, not wanting to.
As long as you know you have a choice I feel like my work is done (not that I'm not happy to help a friend in subsequent steps in whatever way I can).
"Do My Care Provider & Hospital Support VBAC Deliveries?"
A lot of doctors won't do a VBAC, and a lot of hospitals do not actively support them. This is not actually based on the riskiness of VBACs — per ACOG guidelines, trial of labor after C-section should be offered as an option — but rather outdated guidelines. Other doctors nominally support VBAC delivery, but ultimately prove overly cautious and wind up with a lower than typical VBAC success rate. Childbirth and postpartum educator Robin Elise Weiss, writing for VeryWellFamily, suggests talking to your doctor about their VBAC policies, paying particular attention to whether they're speaking in anecdotes or using cited data.
"Am I A Good Candidate For A VBAC?"
While most pregnant folks who've had a C-section are considered a good candidate for a VBAC, individual medical history is crucially important in deciding whether a vaginal delivery after a C-section is advisable. Incision type, number of previous births and C-sections, existing medical conditions, and other factors can all play a part in helping providers determine whether the benefits of a vaginal delivery would outweigh the risks.
"What Are The Risks?"
There are risks associated with VBACs, which should not be brushed aside, chief among them uterine rupture, which is exactly what it sounds like. Because previous surgery has weakened your uterine wall, the chances of your uterus rupturing as a result of labor are significantly higher than they would be if otherwise. However, "significantly higher," per the Mayo Clinic, is still less than 1 percent under typical circumstances. Still, being aware of the risks, and how your unique medical history may affect those risks, is important to discus with your provider and consider on your own.
"Why Do I Want A VBAC?"
This is different than "Do I want a VBAC?" and prompts an expectant parent to dig a little deeper. Because, OK, cool! There are lots of valid reasons to go for a VBAC, including "I just want to give it a whirl and I'm a good candidate for it." But other times, despite the fact that VBACs are sometimes hard to come by, there's a lot of pressure to try one, even when you'd really rather go for another C-section.
So, do you want a VBAC because you actually want one for yourself? Or do you want a VBAC because your crunchy cousin Deirdre won't stop low-key shaming you for your C-section and keeps talking about how amazing hypnobirths are?
"What Are My Fears?
I was so determined to be the logical, not "hysterical" pregnant lady that I didn't acknowledge the fact that, actually, any experience you haven't had before can be stressful and scary and birth is certainly no exception. So even though my brain was reassuring me that everything would be fine (because it would be), by not confronting my "irrational" fears, my body didn't get the memo and went into panic mode and I'm convinced to this day that this made my birth harder.
So there's no official guideline to support this step, but consider it a personal tip from me to you: voice your fears, but then don't get bogged down in them. Learn about how reasonable they are, talk to your provider, and then go have your baby.
"How Can I Help Ensure An Empowered Birth Regardless Of Outcome?"
A big part of the mental prep of planning a VBAC is making peace with the idea that, in spite of a lot of effort and hope, you still may not get it. Writing for Utah Southwestern Medical Center, Dr. Patricia Santiago-Munoz cites a 60 to 80 percent success rate among women who attempt a VBAC delivery, which is encouraging! That said, this means there's a 20 to 40 percent chance that someone will not get the birth they hoped for.
For a lot of people, a VBAC is about having an empowered birth after a birth they felt they didn't have much control over. (Not always, but often.) But the truth is that lots of different kinds of birth can be empowered if you have a plan and feel respected through the process. Talk to your care provider about the different possible outcomes and how you'd like to handle each.
"What Resources Are Available To Me?"
Obviously your care provider is going to be your VBAC MVP, so they're not only your best resource but your best resource for other resources. Do they have book recommendations? Websites? Articles? Do you want a doula? Do they know a good one? Are they in touch with people in the birth community who work with VBAC moms? Do you know anyone who's had a VBAC? Or attempted one? Hearing or even just reading other people's stories is going to really help you in this process.
"Am I Being Supported By My Loved Ones?"
That's not to say no one can express questions or concerns ever, but if people are undermining you or ignoring your needs call them the f*ck out, honey. You're making the decision to try to push a fully-formed human out of your vagina. You need support.
"Did You Know I'm A Badass?"
OK, this isn't a serious question the way the others are, but getting in this mindset is helpful because, honestly, no matter how it happens, giving birth is supremely badass and you should know your power and demand everyone respect it.