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10 Tips For Your VBAC
- thesmartdoula
- 2 days ago
- 8 min read
Once a cesarean, always a cesarean?
Didn't it use to be once a cesarean, always a cesarean? Yes, and unfortunately for some, this mindset persists for some today!
At the time of this saying, rickets, malnutrition, and pelvic deformity were common, and the surgical procedure was much less refined. It was accepted that once it had been performed, most women would not give birth vaginally again.
Today, the Royal College of Obstetrics and Gynecology (RCOG) states:
‘Planned VBAC is appropriate for and may be offered to the majority of women with a singleton pregnancy of cephalic presentation at 37+0 weeks or beyond who have had a single previous lower segment caesarean delivery, with or without a history of previous vaginal birth.’
The full guideline can be found here: https://www.rcog.org.uk/media/kpkjwd5h/gtg_45.pdf.
If you are considering a vaginal birth before cesarean, I would bookmark this to refer to!
Whilst the above paragraph mentions one previous caesarean, they also go on to mention that it is possible with two or more previous caesareans:
Women who have had two or more prior lower-segment caesarean deliveries may be offered VBAC after counselling by a senior obstetrician. This should include the risk of uterine rupture and maternal morbidity, and the individual's likelihood of successful VBAC.
You don't HAVE to attempt a vaginal birth; if you feel more aligned to an elective cesarean birth, this is entirely your choice and should be respected.
Below are the 10 top tips I would always talk about with any Virtual Doula client who is considering a VBAC. Grab a cup of coffee (or decaf) and read on!
I am not going to cover the risks of VBAC in this blog, but some of the resources I suggest do - please do your own research into this before making your own informed choice.
Tip Number One - Do Your Research
Below is a list of my recommended reading and listening; they are all evidence-based. something that I think is important to prepare you to have these discussions with your care team.
This is an American-based podcast with an obstetrician and a midwife; it is an honest discussion of the risks and benefits of choosing a VBAC over an elective cesarean.
This is an Australian podcast (my favourite!), Dr Melanie Jackson is a midwife with a PHD, in this episode she meets with Dr Hazel Keedle to discuss the risks and benefits of a VBAC and strategies for planning one.
Another Great Birth Rebellion podcast, where Melanie gives her top tips.
This is Dr Hazel Keedle's book; it's a great read!
Tip Number Two - Choose Your Place of Birth Carefully
When you speak to your midwife or obstetrician, you will probably be told the following figures:
'3 out of 4 women who have had one caesarean section and then have a straightforward pregnancy and go into labour naturally give birth vaginally'
'9 out of 10 women will have a successful VBAC if they have ever given birth vaginally. Successful VBAC has the fewest complications'
Whilst this is true from research, these figures do not reflect the state of the NHS today.
Early on in pregnancy, or even better, before you get pregnant, you need to understand what you are up against.
You can use the Maternity Dashboard to determine what the VBAC numbers in your Trust look like, for example, my local hospital, Leeds Teaching Hospitals, has a VBAC rate of 11.9%, the national average is 13.1%, although this doesn't tell us how many women attempted a VBAC, it does tell us that the number of women having a VBAC in the hospital is low.
You can use the maternity dashboard to look at hospitals around your area to find out if one has more experience in VBACS than another.
You will automatically be assigned physician-led care or potentially shared care, due to the 'high-risk' label you have been given because of your previous cesarean birth.
The evidence shows, however, that midwife-led care is associated with a higher number of vaginal births after cesarean.
One review showed that women who planned a VBAC (vaginal birth after a previous cesarean) in a midwifery-led setting were more likely to have a straightforward vaginal birth and less likely to need an emergency cesarean or instruments like forceps or vacuum compared with those planning VBAC in a standard hospital obstetric setting.
Specifically, planned VBAC in midwifery-led care was associated with:
About 42% more unassisted vaginal births
About 54% fewer emergency cesareans
About 67% fewer instrumental births.
Importantly, there was no increase in serious risks such as uterine rupture, babies needing special care, or low Apgar scores. Overall, midwifery-led settings supported safer and more successful vaginal births without adding risk to mothers or babies.
In reality, this could have been choosing a birth centre or a homebirth (HBAC), which would entail putting together an out-of-guidance plan.
Tip Three - Choose Your Team
This follows on nicely from choosing your place of birth. If you have decided to give birth in a midwife-led centre, you will have chosen to be supported by midwives, BUT...you actually have more options!
Did you know that you could choose to use Independent Midwives? Paying privately would mean guaranteed attendance and continuity of care (something that cannot be guaranteed with NHS homebirth teams). Many Independent Midwives offer flexible payment plans and packages.
Another wise addition to your team is a Virtual Doula or a Doula!
American Journal of Obstetrics & Gynecology found that among users with a history of cesarean birth, those who had one or more virtual doula appointments experienced a 63% to 65% reduction in the odds of having a repeat cesarean birth.
Another study showed that for every 100 patients who received doula care, there were 15 to 34 more vaginal births after cesarean.
You must also make sure your chosen birth partner does ALL the research and preparation that you do!
Tip Four - Consider Fetal Monitoring During Labour Carefully
One of the main reasons for birth on a labour ward is that you can be continuously monitored by a device called CTG.
CTG is a whole other topic, which is something you MUST do your own research into, but the highlights are:
CTG doesn't improve outcomes for mothers or babies when compared to intermittent monitoring, apart from in induction, where it reduces the number of neonatal seizures, but this isnt associated with long-term differences.
CTG use is associated with an increased risk of cesarean
To do more research, you could start here and then move to The Great Birth Rebellion podcasts on the topic.
When it comes to CTG use in VBAC, the theory is that the CTG can detect uterine rupture by changes in the readings, before it would be picked up with intermittent monitoring.
The best blog post discussing the evidence behind this is here. It is by Dr Kirsten Small, who is an OB with a special interest in fetal monitoring.
Tip Five - Debrief Your Last Birth
Request your medical notes and work through your previous birth.
Birth reflections or debrief sessions are available free on the NHS. They may be helpful for fact-finding, but you may not find deeper answers there —just which guidelines or policies led to your cesarean.
In my 'get to know you' sessions with my Virtual Doula clients, I offer the opportunity to debrief your previous birth through the lens of physiology and biomechanics.
From this, you can learn about the things that happened in your previous birth that MAY have led to the cesarean, and the things you can put in place to avoid a repeat.
This is not about assigning blame or giving certain answers; more of a holistic look at your whole birth story.
If you are not working with me as a Virtual Doula client you can book a BirthBOOST session with me to debrief your previous birth. More info can be found below:
Tip 6 - Fear Release
Using positive affirmations, work with your partner to identify your fears for this birth, and write positive affirmations to help you release them.
You can find out more about this process in my Positive Affirmations Blog below:
Tip 7 - Invest In Body Work
Pregnancy is the best reason to invest in yourself.
It is thought that tightness in your pelvic ligaments and fascia can prevent the baby from getting into an optimal position before and during labour.
Physical and emotional trauma can be stored in the body and have an impact on pregnancy and birth.
It is evidence-based that bodywork, such as chiropractic care or osteopathy, can help with back pain in pregnancy.
Body work could also include Mizan therapy and scar release.
Tip 8 - Do A Birth Biomechanics Course
Birth Biomechanics will give you an in-depth look into how your baby moves through your pelvis, how you can support physiology, and gentle ways to troubleshoot.
Should your labour pause, should you feel significant unexpected pain, or should the fetal heart rate show signs of distress, you and your partner will have tools to attempt to address this without significant medical intervention - potentially avoiding a transfer to the labour ward.
You can see the evidence about using birth biomechanics (such as spinning babies techniques) here.
One study showed that Spinning Babies® reduced Cesarean Rates by up to 48%.
Birth Biomechanics knowledge will help you to understand that the best way to help your baby move through your body is by moving instinctively, and avoiding lying back on a bed.
For my Virtual Doula families, I offer a Birth Biomechanics Essentials call as an add-on or as one of their calls included in their package.
Tip 9 - Go Back To Basics With Birth Education
This is a big one; it may involve throwing what you learnt at your antenatal course out of the window.
When you start to learn about the physiology of birth and how to support it, you may begin to understand that the hospital system actually may have contributed to your previous cesarean.
Learn about the variations of normal (the stages of labour are not a one-size-fits-all) and the common interventions (think vaginal checks) that are not evidence-based.
Look into the 'phase' of labour that isnt often mentioned (Rest and be thankful) and how to support your hormones (those tea lights are doing more than looking good in the photos).
Search out evidence-based podcasts, books, and blogs.
My Virtual Doula families get a list of recommended resources to help them do just this.
Tip Ten - Avoid Induction
Induction with hormones increases the risk of uterine rupture.
But more than that, Induction will change your chosen place of birth, monitoring choices, and potentially have downstream impacts, which include strong pain relief or an epidural.
These things may impact your mobility, making it harder for your baby to move through your pelvis.
Real-world data show that induction increases your risk of cesarean.
If you feel as though an induction is medically necessary, do all you can to support physiology and instinctual movement.
Final thoughts
I hope this blog has helped you to feel more confident about planning a VBAC.
I try to stay away from language such as success or failure when it comes to birth and particularly VBAC, as long as you feel informed and in control, the path your birth takes will hopefully feel the right one for you.
It is absolutely ok to have an emotional investment in one outcome over the other; it's only human!
As for any person planning their birth, I would urge you to put together a cesarean birth plan, irrespective of a previous cesarean the UK's cesarean rate is around 42%.
Knowing that you will feel in control should you choose to have another cesarean will do a lot to take away the fear it holds.
Should you choose to move to a cesarean at any point, my recovery blog, written with other mums, will help you with your recovery
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Who am I?
I am Charlotte, a Virtual Doula, providing bespoke evidence-based pregnancy support to families who want an empowering birth.
With 10 years + of clinical research experience, a biomedical science degree, and two hospital births under my belt, I use my knowledge to provide pregnancy support to help you make informed decisions about your pregnancy, birth, and postpartum.
I provide pregnancy support for all types of births, including hospital births, helping you to navigate NHS guidelines and have an empowering, positive birth.
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