How to Have a Successful VBAC

If you’ve had a previous cesarean, we probably don’t have to tell you that childbirth doesn’t always go as planned. But the good news is it’s also possible to rewrite these stories and have a vaginal birth after cesarean (aka VBAC). How to have a successful VBAC, on the other hand? Keep reading!

While VBACs may not have always been considered an option, new research shows that for most, a VBAC is actually safer(1) than a repeat C-section.

We know it can feel intimidating, but with the right preparation and support it’s totally possible to have a VBAC.

Why consider a VBAC (vs. scheduling a repeat cesarean)?

Many good — and even life-saving — reasons exist for a cesarean, such as if your baby is in distress during labor or is breech. 

But it’s important to remember that a C-section is a major abdominal surgery. It comes with several risks that are worth considering, including:

• 4x higher risk of blood clots than vaginal delivery³ 
• Scarring complications, which can cause bowel and bladder dysfunction, low back pain, pain with intercourse, and infertility.
• Organ injury, blood loss, and infection⁴
• Anesthesia-related issues

VBACs, on the other hand, can offer a faster recovery and lower risks for future pregnancies. Plus, many people find the experience empowering and healing after a previous c section.

VBACs come with all the usual risks of having a vaginal birth, plus the additional risk of a uterine rupture. This can happen for 1 in 300 people who attempt a trial of labor after cesarean (TOLAC).(5)

What things can make a VBAC more successful?

Several factors can impact your chances of a successful VBAC:

1. You want a vaginal delivery
2. You’ve had a successful vaginal birth before, especially if it was a VBAC

On the other hand, these things can make it less likely that’ll you’ll have a successful VBAC:¹

1. You tried for a VBAC before (TOLAC) but it was unsuccessful 
2. You have a BMI > 30
3. You’re older than 40
4. The time between your pregnancies was less than 19 months
5. You’re more than 40 weeks pregnant
6. Your baby is predicted to be larger than 8 lbs 13 oz
7. You have a pre-existing medical condition
8. Unfavorable reasons for your last cesarean (like stalled of labor)
9. Your pregnancy is considered high risk (like you’re having multiples or have placenta previa which is when your placenta covers your cervix)

But don’t worry — with the right preparation for a low-risk pregnancy, the rate of a successful VBAC is 60-80%.(6) That’s pretty darn good odds!

5 tips to increase your chances of a successful VBAC

#1 Find a supportive provider

Having your doctor advocate for you is crucial. Look for a provider with a track record of successful birth stories who’s genuinely excited about your plan. Don’t settle for someone who just “allows” VBACs — you want a cheerleader in your corner!

#2 Get your body ready

For anyone attempting a VBAC (or any vaginal birth), a healthy, strong body can make a world of difference. Focus on the below to physically prepare.

• Staying active with pregnancy-safe exercises
• Practicing pelvic floor exercises (including learning to push and perineal massage)
• Considering prenatal massage or acupuncture

#3 Educate yourself

Knowledge is power, mama! Take VBAC-specific classes, read evidence-based books and resources to learn about risks and benefits, and join VBAC support groups. Lack of resources and education is one of the biggest barriers to having a VBAC.(7)

#4 Build a support system

Surround yourself with positive influences and consider hiring a VBAC-experienced doula — they can be game-changers. For low-risk births, hiring a doula can lower your chances of needing medical interventions — like a C-section.(8)

#5 Choose the right birth setting

Hospitals are usually the safest place for you to have a VBAC, but not all hospitals are created equal.(9) Opt for a VBAC-friendly hospital with high success rates and supportive policies. They’ll have the ability and equipment needed to support you through all possible birthing outcomes. They will also prepare for how to handle an emergency if needed.

Pelvic floor physical therapy for how to have a successful VBAC

A pelvic floor physical therapist can be an important part of your care team when preparing for a successful VBAC. Here are some things you can expect in PT:

• Education on pelvic floor birth prep
• Strengthening exercises for pelvic floor muscle control
• Guidance on pushing techniques
• Proper timing for an epidural
• Labor positioning to help with cervical dilation and baby engagement

Can you strengthen uterus for VBAC?

While you can’t directly strengthen your uterus for a VBAC, you can optimize your body’s natural processes during labor and delivery. The uterus does most of the work to push your baby out, but instead of focusing on “strengthening” your uterus, focus on:

• Proper pushing technique to support uterine contractions with abdominal muscle pushing
• Pelvic Floor Relaxation to allow for easier passage of your baby during birth
• Overall physical fitness, stress reduction, and education about the birthing process

3 exercises to prepare for a VBAC

1. Diaphragmatic breathing

Diaphragmatic breathing is essential for reducing abdominal pressure and minimizing strain on the pelvic floor muscles and perineum. 

• Sit or lie down in a comfortable position.
• Place one hand on your chest and the other on your abdomen.
• Inhale deeply through your nose, filling your abdomen with air as your pelvic floor lengthens and releases.
• Exhale slowly through your mouth.

2. Deep squat

Open your pelvis, encourage flexibility, and promote optimal positioning of your baby for birth with this stretch:

• Stand with your feet shoulder-width apart.
• Lower your hips into a deep squat, keeping your heels on the ground. 
• Use towel roll under heels if your lower legs are tight, or sit on a block if your hips are tight.
• Support yourself on a chair or wall if needed.
• Hold 30 to 60 seconds to a minute while breathing deeply.

3. Cat/cow stretch

Keep your spine flexible and ease tension in your back, abdomen, and pelvic floor with cat/cow. This exercise can also help position your baby correctly!

• Start on all fours with hands under shoulders, knees under hips.
• Inhale as you arch your back, lifting head and tailbone.
• Exhale as you round your back, tucking your chin and drawing your belly in.
• Repeat several times with smooth, controlled movements.

Whatever your birth journey looks like, trust your body, advocate for yourself, and know you’ve got this! 

Remember: Every birth is unique, and there’s no guarantee. But by preparing your body, mind, and support system, you’re giving yourself the best possible shot at a sucks VBAC.

Happy VBACing!

Try the V-Hive for more support today.

Remember, pelvic floor physical therapists help you recover from ALL types of birth. So, whether you have a VBAC or repeat cesarean, the V-Hive at home workouts can help – with programs dedicated to childbirth preparation AND childbirth recovery. Happy birthing to all!

References:

1. Grobman, W., et al. (2017). Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology.
2. Sung, S., et al. (2023). Cesarean section. StatPearls.
3. Blondon, M., et al. (2016). Risks of venous thromboembolism after cesarean sections: A meta-analysis. Chest. 
4. The American College of Obstetricians and Gynecologists. (2023). Cesarean Birth FAQs.
5. Cleveland Clinic. (2022). Uterine rupture.
6. Habak, P., et al. (2022). Vaginal birth after cesarean. StatPearls.
7. Ibrahim, B., et al. (2022). Women’s perceptions of barriers and facilitators to vaginal birth after cesarean in the United States: An Integrative review. J Midwifery Womens Health.
8. Fortier, J., et al. (2015). Doula support compared with standard care. Can Fam Physician.
9. The American College of Obstetricians and Gynecologists. (2023). Vaginal birth after cesareans FAQs.