What makes a VBAC “successful”? Part 3
Welcome to our third and final post for VBAC Success. It’s been a great few weeks as we sorted through information that is helpful for successful VBAC experience in addition to things to avoid!
In this post, we will play a few rounds of myth busters as we review common phrases we often hear about VBACs.
“Once a cesarean birth, always a cesarean birth”
Myth. Each pregnancy is unique and different and each baby is as well. What happened in one pregnancy or birth does not mean it will replicate in the next or subsequent ones. There are a variety of reasons that people have had a C-section, and they may not lead to a repeat surgery for the next birth. This is a very good discussion to have with your provider, since c-cections are generally specific to a particular labor - not indicative of an ongoing problem for future pregnancies. Some of our favorite resources for VBAC support, in addition to your VBAC-experienced doula is: VBACfacts and The VBAC Link.
“You can’t be induced if you’ve had a prior cesarean”
Myth. Risk vs benefit is something that should be considered for each person and birth- VBAC or other wise. There isn’t just one type of induction, and they are carried out in different ways. The well-known drug Pitocin, which is the synthetic version of the hormone oxytocin, can actually be a safe and effective way to induce someone who is preparing for their VBAC. As mentioned here in a NIH paper: “....spontaneous entry into labor is preferred as spontaneous labor carries a higher risk of successful vaginal delivery and a lower risk of uterine rupture. Induction of labor remains an option when indicated however use of prostaglandins for cervical ripening as several studies have demonstrated increased risks of uterine rupture when prostaglandins (such as misoprostol or dinoprostone) are used for cervical ripening.” It goes on to say “.... use of low-dose oxytocin and/or mechanical dilation with intracervical balloons (a Foley Bulb) is used to facilitate induction in patients undergoing TOLAC with an unripe cervix.” This is evidence and recommendation that it is not the ‘induction piece” that is of concern for a VBAC patient, but more of the “HOW” the induction might take place for each individual patient and their unique needs. As a VBAC client of MBS, we take care to discuss all of these risks, benefits, needs, and concerns with our clients so they have a clear understanding of what might be available to them, and to discuss with their provider.
“If I’m having a VBAC I can’t have an epidural.” or “An epidural will stall my labor and make me need another C-section”
I honestly hear this once or twice a week from clients. This is a myth and not rooted in much truth at all. Epidurals can be extremely useful tools and absolutely can be used in any labor if the patient wishes, VBACs included. Now, the other side of this is epidurals will make mobility difficult as you will need to remain in bed for the duration of labor. Sometimes that can slow labor down a bit, but there are many tips, tricks and resources for our clients who CHOOSE a VBAC and who also CHOOSE an epidural. The word “CHOOSE” is big here on purpose, because we want you to know that these are YOUR choices. These options are available to you and you are encouraged to find the best option for you and your baby. Some of those tips, tricks and resources include: using a peanut ball to help open and relax the pelvis. We use your body position and the various positions of the hospital bed to support helpful postures and poses known to open the pelvis, soften the ligaments around the belly, and help baby lower into the birth canal. Our clients at MBS receive all of our helpful resources for birth and VBAC’s, and we keep in close contact with you to bring these goals to reality.
“My provider used a VBAC Prediction Calculator with me and my score was low, so it means that I won’t have a successful VBAC”
Myth. A VBAC prediction calculator was devised by researchers to assess whether someone seeking a VBAC would have a low risk of problems, or alternatively, an emergency resulting in a CBAC (Cesarean Birth after Cesarean). While calculators can have their place in medical guidance, it should be used as a tool to promote open dialogue between patient and provider. It should also be a choice for the patient to use, not mandated. As stated in Evidenced Based Birth’s “The Evidence on VBAC” episode, Rebecca Dekker explains that the risk ratings from these calculators can be inaccurate because they don’t take into account the patient’s values, personal goals, the resources available to them by their providers and birth facility. Using these calculators have not been proven to reduce complications in VBACs. The encouragement to our clients and those reading this blog is to seek a provider that is truly informed of your goals, and then together you can decide to use or not use a calculator or “prediction” chart.
“There are strategies that you can do to increase the success of a VBAC”
Fact! There are physical and emotional strategies that you can implement both in the pre-pregnancy period and in pregnancy to increase the probability of having a vaginal birth. Eating a healthy, nutritious diet; staying active; and keeping walking/exercise in your daily routine are important to maintain - particularly once you have decided to get pregnant. Consider your mental and emotional support needs and if anything could be added or taken away to benefit your mental health. Consider seeing a Webster Certified Chiropractor during your pregnancy. The Webster Certification is very good for pregnancy to increase balance and motion to the pelvis. Other community resources that are helpful are: pregnancy yoga, acupuncture and pregnancy massages. These all have a positive effect on your soft tissue, pelvis, and spine; encouraging optimum positioning for baby and your labor.
We‘ve enjoyed diving deeper into VBAC information with you. The most recent numbers we have to show the percentage of VBAC’s in the United States was in 2018, and found to be 13.3%. Total- only 13.3% of pregnancies resulting in a vaginal delivery after having had a cesarean in a prior pregnancy.
Research and evidence shows us time and again that VBACs can be a very healthy option for most families seeking a vaginal delivery after a prior cesarean. We’d love to talk with you further to support you in your pregnancy and birth - please send us a note on our contact page.
Be well!