There’s more to being a VBAC (Vaginal Birth After Caesarean) friendly care provider than just saying “Yes, we allow VBAC”. There’s a big difference between talking the talk and walking the walk but many times care providers don’t show their true colours until later in pregnancy, or women are so happy to have found someone that doesn’t say “NO VBAC!” that they don’t ask enough questions to be certain There are two main factors that influence the success of VBAC, and you might be surprised by what they are.
Unfortunately women need to be incredibly savvy when it comes to birth, and especially VBAC. What we see time and time again is that health rarely determines VBAC success. More often than not the more crucial factors are WHO you hire to attend your birth and the VENUE you choose to give birth in.
Courtesy of Wikimedia Commons
Before you attend any interviews with potential care providers do lots of research on current evidence based practice to ensure that it is what they are offering. Whatever you do don’t simply trust a care provider. Having a university degree doesn’t make someone competent to provide the service you want. There’s a very delicate balance between knowledge and bedside manner.
Show them your birth plan early on, probably at the first interview before they set their hands on you. If they are dismissive of birth plans then they aren’t a good care provider. If you get any whiff of power imbalance run for the hills, YOU are the person in charge of your birth. The job of your care provider is to present you with options, support their recommendations with evidence, then stand back and await your decision.
Ask lots of questions. If you don’t feel like you can ask questions then this care provider isn’t right for you. Ask how many births a month they attend, what they will recommend if you go post dates (post dates is more than 42w) ask how they will detect problems in your labour and how they will manage them, ask why they will recommend a repeat caesarean, ask how many repeat caesareans vs VBACs they have attended in the last year.
Ask how many drug free births they have attended in the last year and how many women give birth upright and / or in water under their care. Ask their views on big babies, ask how many ultrasounds they like to recommend in a normal pregnancy and if they use them in the third trimester when they give the most inaccurate results. If they give you generalised answers, brush you off with “only when it’s really necessary” then ask what constitutes necessary in their mind.
Throughout pregnancy you should always be on the lookout for subtle red flags and have a care provider as back up in the event that your first preference starts to back out on you. Never hire a provider who doesn’t treat you like their boss, be assertive throughout pregnancy and address niggling doubts immediately so you have the ability to relax and let your support team (partner and doula, not care provider) take over, supporting you during birth.
If we are honest with ourselves, the odds of VBAC success in a hospital are statistically slim. It pays to look into homebirth thoroughly. Speak to midwives, ask all the same questions mentioned above. Be a fully informed consumer, not one who trusts everything the “experts” say. After all we haven’t come to have a 1 in 3 caesarean rate because providers are giving sage advice at every step of the way. Remember it’s not your fault if things don’t go to plan, if your care provider totally bombs out on the day, it’s never ever your fault, but make sure you do plenty of homework in the lead up, it does increase your odds.