A Doula's Guide to VBAC
We've had a surprising amount of VBAC inquiries lately, and as a doula and a VBAC mom, I could not be more thrilled. This means VBAC as a concept is becoming better known in our society and I cannot wait to work with more clients who are educating themselves on their options.
So, what does VBAC stand for?
VBAC is an acronym that means Vaginal Birth After Cesarean.
To most, this can be perceived as a risky option - as the phrase "once a Cesarean, always a Cesarean," has been ingrained in so many of our minds. However, Cesarean, while occasionally medically necessary - is major abdominal surgery and has the associated risks that come with such a procedure. For most women who have healthy, low risk pregnancies, a TOLAC (Trial of Labor after Cesarean) is a perfectly safe option. Statistically speaking, 80% of women who TOLAC have successful VBACs (American Pregnancy Association, 2015).
Why would you want to TOLAC/Have a VBAC?
- Recovery from a vaginal delivery is a much gentler process than recovering from major abdominal surgery.
- The anesthesia used during a Cesarean can have an impact on initial bonding with your newborn.
- There is a lower risk of infection for birthing parent.
- There is a lower risk of major blood loss for birthing parent.
- Vaginal birth provides baby with exposure to the vaginal microbiome (healthy bacteria) that can help baby develop a healthy immune system.
What are the risks of VBAC?
Apart from the usual risks associated with vaginal birth, one serious risk is uterine rupture. However uterine rupture is extremely rare, and only occurs in 0.4% of women who TOLAC, or one in 250.
It's also worth noting, that although it is extremely rare, uterine rupture CAN occur in women with no prior Cesarean at a rate of 0.07%, or one in 1,146 pregnancies (Nahum, 2018).
What is uterine rupture?
Uterine rupture is when the uterine scar completely opens along the scar going through every single layer of the tissue. Uterine dehiscence and uterine window are both often classified as a uterine rupture, although they are slightly different and can usually only be identified when a repeat Cesarean occurs. A uterine dehiscence is when a very small amount of the scar begins to separate but doesn’t separate the entire length of the scar. A uterine window is when the scar is so thin it can be seen through, but does not tear open. After a Cesarean, our bodies heal and create scar tissue along the incision. Although the scar tissue still has the ability to stretch, it is not as stretchy as our original tissue, thus the increased risk of uterine rupture that is associated with TOLAC (The VBAC Link, 2015).
How do we mitigate this risk?
- Avoid induction and augmentation of labor unless medically necessary.
- Stay mobile during labor - walk, change position and posture frequently.
- Rest or sleep when your body allows for it.
- Encourage optimal positioning for baby BEFORE labor begins through chiropractic work, massage, exercise and proper nutrition.
- Avoid artificial rupturing of membranes if baby isn't in optimal position.
- Have attentive labor support at all times (Hire a DOULA!).
- Stay in tune with your body and your mind. If something doesn't feel right, alert your support and your medical provider immediately (The VBAC Link, 2015).
What are the risks of a repeat Cesarean?
- Increased rate of infection.
- Increased risk of hemorrhage.
- Injury to organs occurs to 1 in 50 women.
- Adhesions (scar tissues that can cause pain and future pregnancy complications).
- Higher risks of additional surgeries (i.e. future Cesareans or Hysterectomy).
- Potential injury to baby.
- Higher maternal mortality rates (Jukelevics & Wilf, 2009).
Is TOLAC/VBAC right for everyone?
To put it simply, no, there is no one size fits all answer for everyone. Each birthing parent should make this decision on an individual basis in conjunction with their medical care provider. That said, if you feel you may be a good candidate and your medical team is not on the same page - a second opinion from another medical professional is never a bad idea.
Why am I excited about more VBAC clients?
Clients who express interest in TOLAC/VBAC are clearly taking time to research their options and discus them with their providers. And in a nutshell, my favorite clients - are informed clients! In my experience, education is the single best preparation for pregnancy, birth and the postpartum period and I am delighted to assist clients on this journey.
**The information on this site is not intended or implied to be a substitute for professional medical advice diagnosis or treatment. Please make seek the advice of your health care provider to make decisions regarding your care.**
American Pregnancy Association. (2015). VBAC: Vaginal Birth After Cesarean. Retrieved from http://americanpregnancy.org/labor-and-birth/vbac/
Jukelevics, N., & Wilf, R. (2009). Breastfeeding is Priceless. Retrieved from http://www.motherfriendly.org/downloads
Nahum, G. G. (2018). Uterine Rupture inPregnancy. Retrieved from https://reference.medscape.com/article/275854-overview
The VBAC Link. Francom, J., & Heaton, M. (2019) VBAC: The Doula Guide. Retrieved from
The VBAC Link
ICAN - International Cesarean Awareness Network