At DTI we believe in the primary importance of honoring all births: from medicated to unmedicated, from surgical to unassisted. During this Cesarean Awareness Month, today’s focus is on the option of VBAC (vaginal birth after Cesarean). Although VBAC may not be the right choice for some, it’s important to remain aware of the safety and potential benefits that exist for many families choosing this option. One aspect of Cesarean awareness is VBAC awareness.
If you are pregnant after having given birth by Cesarean, you may be faced with decisions during this pregnancy which weren’t a part of the planning period the first time around. Some parents may have been presented with a repeat Cesarean as the only option and may not know that vaginal birth may also be a safe and achievable option. Others will be presented with both options or will already know they’d like to pursue a VBAC. For some parents, opting for a repeat Cesarean birth—either prior to labor or during labor—is truly the best choice.
This article is geared towards families who have decided they would like to pursue a VBAC. What steps can you take to find the support you need to pursue this goal and how can you prepare yourself mentally and emotionally? As a VBAC mother myself, a birth doula, a childbirth educator who has created a workshop for families birthing after Cesarean, and the leader of my local ICAN (International Cesarean Awareness Network) chapter, I’m sharing what I find to be the most important and helpful things you can do as you approach your birth.
Get the facts
It’s important to know that for many parents, VBAC is a reasonable and safe option. Access to VBAC is expanding in the United States, but depending on the region, it’s not always easy for families to locate supportive facilities or providers. Misconceptions about VBAC are common and it’s helpful to understand the actual evidence to be able to facilitate an open dialogue with your provider or concerned family members and friends. 13 Myths About VBAC by Jennifer Kamel of VBAC Facts is an excellent short read to give you an overview of some common VBAC myths.
Learn about your local options and find a supportive provider
For any pregnant parent, VBAC or not, choosing a provider who is supportive of your goals and preferences is one of the most important decisions you will make during your pregnancy. If you haven’t chosen a provider yet, I’ll share some ideas for finding supportive providers in your area. If you have chosen a provider, don’t skip this section because you’ll learn what truly supportive care looks like. It’s never too late to switch providers if you begin to think that your current provider is not supportive of your wishes. And remember that you don’t need to stick with the provider who attended your birth with your previous baby if it doesn’t feel like a good fit.
The first step is to survey the options. Try to find out if there are any OBs, hospital midwives, and/or homebirth midwives who are known to attend and support VBACs. You can ask in local online groups, call local doulas, ask at La Leche League meetings, ICAN meetings and/or other meetups of new mothers. You can also call health care practices, hospitals, homebirth midwives, and birth centers in your area and ask if they support VBACs.
If you can’t find anybody in your immediate vicinity, you may need to expand your search. If you do get some leads, your work isn’t done yet. This next step is crucial. Set up interviews with the providers that are recommended to you. When you call their offices, be very clear that you would just like a consultation and not a medical appointment. Some offices also call this a “meet and greet.” This is not a norm for all practices, so you may need to be persistent and explain that you want to meet with a provider to determine if the practice is a good fit for you. Prepare for your interviews by formulating questions you will ask based on your goals and wishes. This ICAN paper has a great list of things to ask that are geared specifically towards parents pursuing VBAC.
Once you have interviewed providers, spend some time reflecting on how you felt about each of them. You can use this resource to try and determine which providers seemed truly VBAC supportive and which might be tolerant of a VBAC, but not necessarily excited and/or truly dedicated to supporting your wishes.
Process your previous birth experience
This is something that you may or may not have already done. And my suggestion to process your experience is not a suggestion or implication that you need to fully heal from it and move on. I have found, however, that helping and supporting parents to talk about, think about, ask questions about, and reflect on their previous birth experience(s) is crucial when preparing for a subsequent birth. Your experience matters and it will inform this next experience. Here are some ideas for processing and working towards healing:
- Share your story with others who will listen to you without trying to fix anything. Find others who can empathize and validate your experience. If your community has a local ICAN chapter, this is an excellent place to do that. You can search for a local chapter here. If you can’t find one, your community might have a birth circle/story sharing gathering or you might talk with your doula or other parents who have been through a similar experience.
- Write a letter to somebody involved in your first birth experience (doctor, midwife, nurse, doula, relative, anesthesiologist, etc,) and tell them what the experience was like for you. Tell them what you wish they had done differently. You can choose if you’d like to send it or not.
- Call your hospital and provider to request copies of your medical records. Reviewing them may help you gain clarity and/or a degree of closure. Seek support from a doula, friend, or relative to read through them.
- Talk to your child about your birth experience with them in an age-appropriate way. You can share the hard parts and the positive parts. Some parents have reported talking to their sleeping child about this and finding some peace this way.
Build a stellar support team
In addition to choosing an ideal provider, you’ll want to think carefully about who else you might ask to support you during your birth experience. The people who surround you during labor and birth, and even the people you choose to engage with during pregnancy, will have a significant impact on your experience. Consider hiring a doula who is comfortable supporting VBAC families and consider carefully the idea of having other additional relatives in your sacred birthing space. Work to communicate clearly with your chosen team, especially your doctor or midwife, as the birth approaches so that they know your wishes and how they can best support you. You can read more about this in my article, Build Your Stellar Support Team.
Learn about informed consent and critical decision-making
It’s important to know what informed consent looks like so you can be aware of it during your prenatal appointments. If your provider does not seem to be practicing informed consent during prenatals, that’s a possible sign that he/she will not do do when you’re in labor either. Human Rights in Childbirth explains informed consent this way: “When a doctor or other healthcare provider recommends an intervention or treatment, they have a legal obligation to inform the patient of the risks and benefits of the full range of options available to that patient. The patient is entitled to evidence-based, individualized recommendations, and to be supported in the exercise of genuine consent – that is, the choice to accept the recommendation or decline it – on the basis of the patient’s personal needs and values.” You can read more about informed consent in my article, Informed Consent: What Every Pregnant Woman Should Understand. There are also many strategies you and your support team can use during your labor and birth to create an environment in which effective communication is happening, your questions are being answered, and your decisions are being respected. The very best way you can ensure that this happens is to hire a doula who will educate you about this ahead of time and facilitate the process during the birth.
Finally, surround yourself with positivity, inspiration, and trust
You’ve done all you can at this point and your birth is approaching. Now is the time to shut out naysayers and scary or negative birth stories. Invite support and positivity. Reading positive birth stories is an excellent way to put yourself in a safe and healthy mental and emotional space. A few of my favorite resources for encouragement in the months, weeks, and days before a VBAC birth are (not all are VBAC specific):
Cut, Stapled, & Mended, by Roanna Rosewood
The VBAC Companion, by Diana Korte
Ina May’s Guide to Childbirth, by Ina May Gaskin
Journey Into Motherhood, by Sheri L. Menelli
Birthing from Within, by Pam England and Rob Horowitz
Invite loved ones to surround you with support by sending you positive thoughts and affirmations for birth. Make your own affirmations and hang them around your home as daily reminders of your strength. Visualize yourself having the healthy birth that you hope for. And, if you can, try to let go of the desire to control the outcome. Know that birth will unfold as it’s meant to and work hard to trust the process, trust yourself and your body, and trust your baby. Standing together with all birthing people, we are united as we honor all births. Cesarean awareness is VBAC awareness.
Taylor Davis is DTI certified doula and educator. She is also the leader of her local ICAN (International Cesarean Awareness Network) chapter in New Hampshire where she lives with her husband and two young boys. She is the co-founder of New Mama Project, an online community offering support for postpartum mothers and space for real talk about the transition into motherhood. The site offers a social supports guide and self-care quiz for new mamas that can be found here: New Mama Project
Taylor will be teaching the next DTI2 Seacoast, New Hampshire training on October 6-9, 2016. Register here.