Is a VBAC a good idea?
DEAR GENTLE DOULA,
IS A VBAC A GOOD IDEA? I HAD MY FIRST BABY BY CESAREAN BUT I WAS WONDERING ABOUT TRYING TO BIRTH MY NEXT BABY VAGINALLY. PART OF ME IS EXCITED, AND I THINK I WOULD LIKE TO TRY, BUT I ALSO WORRY ABOUT ALL THE THINGS THAT COULD GO WRONG. DO YOU HAVE ANY THOUGHTS ON WHAT IS BEST? I WOULD LOVE TO KNOW MORE!
SCARED OF THE SCAR
Dear Scared,
I’m so glad you’re thinking about having a VBAC and I completely understand worrying about what could go wrong! While it’s a good idea to consider the risks, there are also many benefits (for you and for your baby) in having a VBAC, so here are some things to think about while you make your decision.
Before I share some thoughts on VBACs, I think it’s also worth mentioning that even though we often only talk about (or even think about) the risk of having a VBAC, repeat cesarean and VBAC both have risks. And in fact, a VBAC is often the lower risk option for most birthers. But that doesn’t mean that it still can’t be a difficult – even scary – decision.
The Pros
What are some benefits of having a VBAC? Two of the most common reasons I see with my clients for choosing to have a vaginal birth after they’ve had a cesarean are:
The redemption of birthing vaginally – or at least the amazing feeling of accomplishment – especially when the cesarean birth was because of a ‘failure to progress’ or another medical reason
The many benefits for their baby with a vaginal birth. Some of these are:
Passing through the birth canal (this has so many benefits!)
An opportunity to come skin to skin with them immediately
Avoiding antibiotics during labour (for most birthers)
The Cons
There are also some specific risks to consider with a VBAC (but remember, there are also risks with a repeat cesarean!) Two common ones are:
Most studies show a higher risk of uterine rupture with a VBAC than for someone who has not had a cesarean before (more on that below)
Emotionally, it can be hard to think of attempting a VBAC (your care provider might call this a ‘trial of labour after cesarean’ or TOLAC) and then having it not succeed, but needing a repeat cesarean instead
The good news is that there are many ways to reduce the risk of uterine rupture and also to increase the chances of a successful VBAC. Here are just a few factors that are worth thinking about, and perhaps researching further. I hope that finding out more will help you make your decision – and possibly also help you feel less scared about the idea of a VBAC.
How to reduce the risk (and feel more confident)
Understand the statistics.
1 in 200. That’s the statistic on ‘uterine rupture’ when a birther is labouring after having had a previous cesarean. That means just 1 person out of 200 will have a uterine rupture during a trial of labour after cesarean. And that number goes down even more when you reduce some of the risks for a VBAC (keep reading for some ways to do that!)
1 in 25. That’s the likelihood of needing a repeat cesarean when attempting a VBAC. (Did you know that the average cesarean rate across much of North America is over 30 percent? So actually, a 25 percent chance is lower than the average!)*
Get ready to wait! While 9 months can seem long, and the last few weeks can seem even longer, VBAC success goes up dramatically when you wait for your body to go into labour on its own. That may mean learning more about pregnancy after 40 weeks, and advocating for this choice with your provider.
Learn from others. One well-known source of information is The VBAC Link. They have blogs, podcasts, and many testimonials from others who have been in your shoes. Connecting with a support group, social media, or other resources that offer positive advice and information can help help you feel more confident in choosing a VBAC – or help you understand that you want to make a different choice.
Find out about your incision. Your care provider will be able to tell you if you had a low transverse incision – the indicator that it is usually safe to try a VBAC.
Ask yourself: How much do I want a VBAC? Knowing that this is something you really want, and why, and then taking responsibility for your choice and putting in the work to make it more likely to succeed, can make a big difference for how you feel about the birth afterward – regardless of the outcome.
Surround yourself with positivity. Whether they’re your neighbours, coworkers, family members or friends – or even a health care provider – if the people around you keep telling you scary or negative stories about birth or VBAC then it might be time to find other people to spend time with until your baby arrives. The messages you hear and the support you have can make a difference – in any birth.
When you know what you want, take some positive steps to support that goal, and have the support of those around you, your chances of a successful VBAC are higher. Sometimes you will need to advocate for the choices you make, but that’s not unusual in any birth!
Remember, it’s so important – whatever choice you make – to be comfortable with it. And to you know you’re doing what you feel is best for you – and for your baby. I wish you all the best!
*Are you curious about how those statistics work? I would love to chat. Two easy ways to connect further are through registering for private childbirth classes, or reaching out for a free initial meeting to find out more about my doula services and how they can support VBAC success.