You’ve had a cesarean and you’re looking ahead to your next birth. “Once a cesarean, always a cesarean” is no longer the rule, and for reasons that are uniquely yours, you want to have a vaginal birth this time. Good for you! You are about to join the growing number of women who have planned for a vaginal birth after a cesarean (VBAC ). If you have a birth plan, then talk with your doctor early to find out if you will be allowed to go through a trial labor. Include a class on VBAC as part of your birth plan.
Why have a VBAC?
Many women want to have a VBAC because of the feeling that they missed out on an important life experience when they had a cesarean. They want to feel a baby move through and out of their bodies and into their arms. Other women and medical professionals know that labor is important for the newborn’s adjustment to life outside mother. They also know that vaginal births are safer for mothers and infants than planned cesareans. Still others want a faster recovery from birth and to go home sooner than when they had a cesarean. They want to mother and nurture their infants (and other children) without the restrictions that accompany surgical delivery. They want to avoid surgery and its risks and complications.
You may share these reasons or have different ones, but it’s important to remember that any reason to want a VBAC is a good reason.
What do I need to know about my previous cesarean?
It’s helpful to know why you had your pervious cesarean(s). Most reasons for a cesarean don’t repeat themselves. These include:
~ Fetal distress – baby in trouble
~ Cephalopelvic disproportion (CPD) – “too-big baby for too-small pelvis”
~ Failure to progress – labor lasts too long
~ Breech position – baby comes bottom or feet first
~ Transverse – baby lies sideways
~ Abrupted placenta or a placenta previa – location or separation of the placenta causing bleeding and problems with the baby’s supply of oxygen
~ Prolonged rupture of the membranes – the bag of waters breaks, and either labor does not begin or the baby is not born within a specified amount of time
~ Previous birth(s) by cesarean – including planned, repeat cesareans
Despite cesareans for the above or other reasons, many women have successfully and safely had later babies vaginally.
What about my scar?
It is important to know the type of incision that was used on your uterus. The two most common incisions are the horizontal (low transverse), which is considered the safest, and vertical (classical or low vertical). You should check with your doctor or hospital records to see if your abdominal scar (outside, on your skin) is different from you uterine (inside) scar. It is encouraging to know that some women who did not know their type of uterine incision have been permitted to labor and gave birth vaginally without any problems.
In the past the most common reason for planned, repeat cesareans was a belief that the uterine scar would rupture (or separate) during a vaginal birth. Recent medical findings, however, show that this is rare, particularly in the case of the more common low transverse incision.
How can I guarantee that I will have a VBAC?
No one can guarantee that you will have a VBAC, although current medical information makes it clear that most cesarean mothers can later give birth naturally. There are some things that VBAC women have found helpful to increase the chances for a vaginal birth.
What can I do before I get pregnant or in early pregnancy?
~ Inform yourself and take personal responsibility for your birth experience. Learn as much as you can before you get pregnant and during your There are many excellent books, films, tapes and written materials on VBAC and birth in general. Such information can help you make informed choices and accept the responsibility for your birth.
~ Join a support group.
Don’t overlook the value of cesarean or birth support groups that may exist in your area. The information and caring atmosphere in such groups can help promote healing of any past unhappy birth experiences and offer encouragement for upcoming births.
~ Take childbirth classes.
Consumer-oriented childbirth classes or special VBAC classes offer a wealth of information and skills. They also give you and your partner an opportunity to consider this new pregnancy and birth as a separate experience from your cesarean(s). Learn and practice the skills you are taught to cope with the reality of labor.
~ Get in touch with yourself.
Techniques such as visualization, meditation and affirmation can help you heal and accept feelings inadequacy, grief and failure from past births. Recognizing these feelings, even if they are not totally resolved, will help clear the way for more positive thoughts and more confidence in yourself and the birth process.
My partner is nervous about a VBAC. What can I do?
Talking to each other about past birth(s) will help clarify ways in which you can work together toward VBAC. Involve your partner as you read and research. Reassure your partner that vaginal birth is safe and the best choice for you and your baby – and important to you! Another labor support person can assist both of you during labor. You might also ask your partner to read this booklet.
What about additional companions?
Some women have found it helpful to have one or more additional people with them as they labor and give birth. Such companions, professional or not, should be available to the woman throughout her labor and should know exactly what the pregnant woman wants from her birth.
If you choose to have others at your birth, let them know your desires before labor begins. For example, do you want an unmedicated birth or are you willing to accept medicine under certain circumstances? When are you planning to go to the hospital? And so on…
My friends think I’m crazy to want to labor.
VBAC is a very personal decision, and sometimes a lonely one. If you find that family and friends are not supportive of your goals, it’s probably best to keep your feelings and plans to yourself, or to share them only with those friends who understand your feelings. A local support group can be especially helpful at a time like this and give you any additional information you may need.
Being pregnant and planning a VBAC are not everyday occurrences. You deserve a supportive environment. You probably don’t agree with your friends and family about everything, anyway. What you want for you, your baby, and your family is your responsibility.
What if I end up with another cesarean?
This is a difficult question. Certainly, if you have planned and worked for a VBAC, having another cesarean can be, at the least, a disappointing or sad experience. You will have physical and emotional reactions common to cesarean mothers — some of which may be familiar to you. However, you will not be a failure, because you have worked at having the best possible birth experience for you and your baby. Sadness and grief over any loss (including the loss of a vaginal birth) is a part of living. As time passes, you will find that you have grown and learned from this experience, too. Women who have repeat cesareans, after planning vaginal births, often say how glad they were to have tried. Many are delighted that labor began on its own and their babies were naturally ready to be born.
To learn more see our Pregnancy Guide