Ask A DTI Doula: How Can I Pursue A Vaginal Birth After Cesarean?

What does it look like to become a doula? What are some of the birth world’s most pressing issues? In our new series, Ask A DTI Doula, DTI educators and trained doulas will answer some of our community’s questions.

For the fifth piece in the series, we are proud to share an interview with DTI Doula Educator Taylor Davis on how to approach a vaginal birth after cesarean (VBAC)—and the different things expecting parents should look for in VBAC-supportive providers.

Who: Taylor Davis (she/her)

I am a mother, doula, childbirth educator, birth activist, and doula trainer. My first child was born via cesarean section, my second birth was a hospital VBAC (Vaginal Birth After Cesarean), and my third child was born at home. My 3 wildly different birth experiences place me in a unique position to support a varied range of birth experiences with deep understanding. Through these personal birth experiences, my work in the community, and my work with families, I have come to the firm belief that prenatal care, birth, and postpartum care should be family-centered and I support families to make autonomous, evidence-based decisions throughout pregnancy, childbirth, and the postpartum period.

1.) Taylor, tell us a little about yourself and your doula practice.

I have a busy and thriving practice! I work primarily as a birth doula and attend two to three births a month, with one or two-month-long breaks during the year. I work as a solo doula, but collaborate actively with other local doulas to back one another up. I work with all types of families, and especially love working with people who are birthing again after a challenging first birth experience.

2.) What is a VBAC?

VBAC stands for Vaginal Birth After Cesarean. If you have had one or more cesarean sections (C-sections) and are pregnant again, you have a few options—do you want another C-section (repeat C-section) or a vaginal birth after cesarean section (VBAC)?

According to the American Pregnancy Association, the national cesarean birth rate has been at its highest, with more than a quarter of all deliveries being C-sections. And statistically, 60-80%–roughly 3 to 4 out of 5–people who have previously undergone cesarean birth can successfully give birth vaginally.

3.) How can I start pursuing a VBAC as my birth option?

The No. 1 thing I want families pursuing VBAC to know, is that they should take the time to carefully choose a VBAC supportive provider. While I realize this might not exist in every region, it’s absolutely worth it to explore all of the available options and choose a provider who is going to be fully supportive of VBAC. This can feel overwhelming, but if taken one step at a time, it’s very manageable. I’ve often seen it be incredibly empowering as well for families to step into their power and interview providers and hire the one who is the best fit.

4.) What should I look for in a VBAC-supportive provider?

Typically, searching for a provider begins with doing some research in your community to see if there are providers who others have had good VBAC experiences with. You can then call each of those offices and schedule a meet and greet or an interview. You DO NOT have to schedule a medical appointment before interviewing providers. Here are some questions to ask when you interview providers:

What is your cesarean rate?
How many VBACs have you attended?
What is your VBAC rate?
What is your approach to fetal monitoring during a VBAC?
What will you suggest if my pregnancy goes beyond 40 weeks? 41 weeks?
What are my options for pain management during my labor?
How long are you comfortable with me laboring if myself and my baby appear healthy?
How will you support me during the pushing stage?
What’s your philosophy on using pitocin to induce or augment a VBAC labor?
How does your practice work in terms of the providers who are on call?
If you’re not on call, will I get the same level of support?
Based on my childbirth history, what do you think my chances are of having a VBAC?
What are the VBAC policies of the hospital/birth center where you practice?

Notice that these are mostly open-ended questions. Asking a VBAC provider open-ended questions, instead of questions that can be answered with a simple “yes” or “no,” allows you to get more information about their approach. Better yet, it requires them to share their philosophy in more depth and detail.

After you walk out of this interview, it’s time to evaluate the answers you received. A list of questions doesn’t help very much if you don’t understand the implications of the answers. Here are some red flags to look for when listening to a provider’s responses:

The provider’s cesarean rate is high (the national average is around 32% and that’s pretty high already).
The provider hasn’t attended many VBACs or can’t give you an estimate of how many they’ve attended.
If the provider’s VBAC rate is less than 60%, this may indicate a less than supportive provider.
The provider has a hard stop at 40 weeks and states that they either require induction or a repeat cesarean at that point.
The provider will not, under any circumstances, use pitocin for a VBAC labor (see my article on VBAC and induction for more information about this).
The provider uses the “VBAC calculator” to assess your chances of having a VBAC and states that your chances are low.
The provider answers some of your questions with, “We’ll just have to see what happens when the time comes. We’ll take it one step at a time. We’ll discuss that later in your pregnancy.” This is a major red flag and an indicator of a provider very likely to pull a bait and switch on you. Providers like this appear supportive throughout most of pregnancy and then begin to change their tune at the end.

Finally, it’s critical to pay attention to how that provider and their responses make you feel when you are interviewing them.

Do they take your questions seriously?
Do they actively listen to you?
Do they spend adequate time with you?
Are they respectful?
Is it clear that they view you as the autonomous decision-maker when it comes to your labor and birth?
Do you walk out of that VBAC provider’s office feeling motivated, excited, and positive about your VBAC? Or do you walk out feeling anxious and worried?

5.) Where can I learn more?

I created a guide to help families find supportive VBAC providers. It will walk you through the exact process, step by step. You can grab it here. There’s a lot of preparation, both logistical and emotional, that goes into planning for a VBAC. I’ve recorded a few episodes on my podcast, “Your Birth, Your Worth” all about VBACs and know that VBAC folks will find them really helpful. This episode is all about how to rock your VBAC. In this episode, I interviewed Jen Kamel, VBAC expert and creator of VBAC Facts. And in this one, I walk listeners through the a 5-step process of confronting their fears as they plan for a VBAC.

Want to become a doula?

You can reach out to DTI at hello@wearedti.com with any questions and you can also browse our training calendar to learn more! Curious about DTI’s programs? Click here to learn more about becoming a doula through the different programs we offer.

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