Want a VBAC? Consider a midwife!
As a midwife, there is nothing more fulfilling to me than helping a woman who has had a cesarean in the past go on to have a successful vaginal birth after cesarean (VBAC). While attempting VBAC is not the right choice for every woman, many if not most women who have had a c-section in the past are good candidates to try for a vaginal birth. After taking the time to make sure a woman understands the risks and benefits of BOTH choices (repeat cesarean and labor after cesarean), the most important thing is that a woman can freely make her own choice based on her risk factors, values, and priorities. Many certified nurse-midwives (CNMs) can attend VBACs in the hospital with 24-hour anesthesia and obstetric back-up available in case of an emergency.
Unfortunately, many women who want VBAC in the United States face significant barriers. Some are not offered VBAC by their providers and are simply told they will have a c-section. Others face difficulty finding a hospital in their area that will agree to attend a VBAC. Despite these barriers, women need to understand that they are the decision-makers when it comes to their health, and not be coerced into making a decision that is uncomfortable for them. Women are not being unreasonable when wanting to avoid major abdominal surgery.
We encourage women who want VBAC to look around the community for support. Find women who have pursued this option and ask them about their experiences. Figure out which doctors and midwives in the community are supportive. Be willing to travel to a hospital further away that might be a safer place to attempt VBAC. Some women who feel frustrated with the medical system consider home birth VBAC, but this is not usually recommended. While the risk of uterine rupture is low, around 1%, when this does happen, emergency cesarean is necessary to save the lives of both mother and baby, and it can be catastrophic if this help is not immediately available. Delivering with a CNM in a hospital may be a good compromise, as midwifery care is associated with greater VBAC success.
As midwives, we want our patients to feel empowered to make the decision that is right for them. There is no “wrong” or “right” choice when it comes to repeat cesarean versus VBAC, and there are factors both inside and outside of a woman’s control when it comes to pregnancy and childbirth. At the end of the day, if a patient feels like she has been informed of her choices and supported in her decision, she will be more satisfied with the outcome, no matter how she gives birth.
by Ann Ledbetter, CNM
For more information on Vaginal Birth after Caesarian Sections check out this Position Statement on VBAC from the ACNM or watch the video below: