A vaginal birth after cesarean is a VBAC. A VBAC is an option for mothers who birthed via a Cesarean before their current pregnancy. A vaginal birth after cesarean was not considered a safe option for moms before. Yet the most recent research shows that a VBAC is a great option if the patient is an appropriate candidate.
Why consider a VBAC?
Why choose a VBAC over a repeat cesarean? There are MANY reasons one might choose a VBAC over repeat cesarean. Some of the more common reasons include:
- An individual’s first (or most recent delivery) was an unplanned cesarean. A VBAC is an opportunity to experience a vaginal delivery and have a different birth story this time.
- Not wanting to schedule a repeat c-section. Cesarean births need major abdominal surgery.
- Cesareans need an epidural and some women may not tolerate anesthesia well.
- Cesarean births are 4x more likely to cause blood clots than a vaginal delivery. This risk increases to 24.5% for a second cesarean and 46.1% for a third cesarean.
- Repeat cesareans come with a risk of increased scarring along the incision. This can cause difficulty with: bowel and bladder function, low back pain, pain with intercourse and infertility.
The largest complication with a VBAC
Studies show uterine rupture as the largest potential complication of attempting a VBAC. The risk of uterine rupture is 0.2% – 0.4% in women who have a bikini cut incision and have at least 2 years between deliveries. There is a 60 – 80% success rate with attempted VBAC according to the Mayo Clinic.
VBAC is not a one-size-fits-all approach
What criteria make a patient a good candidate for VBAC? Those criteria are not limited to, but include the following.
- Low risk pregnancy
- Low-transverse (bikini cut) incision from prior cesarean
- Single delivery ( i.e. not twins)
- 2 cesarean deliveries or less before attempted VBAC
- 2 years or more between deliveries
- Spontaneous labor versus induction
- Familiarity of medical team with VBAC deliveries
Some criteria that might make a patient a non-ideal candidate for VBAC are:
- Placenta Previa
- High risk pregnancy
- A birth of multiples or twins
- Breech position of the baby
- Fetal distress
- Medical care team with limited knowledge or experience with VBAC
- Gestation longer than 40 weeks
No one component alone will make a patient an ideal or non-ideal candidate for VBAC. Your history, desired experience, and presentation at time of delivery will determine this.
So, you’ve decided to give VBAC a try… Now what?
Believe it or not, there are things you can do to prepare your body for a vaginal birth after cesarean. One of the first things I would recommend is having a lengthy discussion with your OB/GYN or midwife. Here are a few things to cover in conversation:
- Discuss their comfort level in attempting a VBAC. Discuss their recommendations for what you can do for VBAC preparation.
- Ask if they have experience with vaginal delivery after cesarean. Make sure the facility where you plan to give birth has experience with VBAC deliveries.
- Ask your healthcare provider about the risks associated with VBAC. Ask how those risks apply to you.
- Discuss the reasons for your previous c-section. Ask if that will impact your ability to attempt a VBAC for a successful vaginal delivery.
Bottom line: make sure you and your healthcare provider are on the same page. If you are hiring a doula, I would recommend including them in the care plan as well so they can advocate for you if need be. You should feel confident in the care plan you and your birth team have established. Then you can start working on the physical preparation for the VBAC attempt.
Pelvic Floor Physical Therapy for the win!
Pelvic PT can be beneficial in helping prepare your body for a VBAC. They can help assess the muscles of your pelvic floor. We can also confirm there are no issues that may hinder pushing during delivery. Pelvic PTs can assess and treat residual scar tissue along your cesarean scar. This includes the surrounding tissues of your abdomen. Ultimately, this can help improve pelvic floor function and motor control. How? The pelvic floor muscles impact the function of the transverse abdominis (deep abdominals)!
Pelvic PT for VBAC prep
Pelvic PT for VBAC preparation includes:
- Guidance on how to push without excessive strain on your pelvic floor
- Education on the phases of labor
- Proper timing for an epidural
- Positioning to assist with cervical dilation and engaging of the baby
- An internal exam to improve the effectiveness of your pushing without placing unwanted strain on the muscles of your pelvic floor and perineum
Tips for an empowered VBAC
Knowing more about the labor and delivery process can also help empower you during a VBAC. Here are a few key tips to try and keep in mind in the moment:
How pelvic floor strengthening is helpful for a VBAC
Pelvic floor exercises are helpful if you are considering a VBAC. Pelvic floor strengthening helps prepare the pelvic floor muscles for labor and gives you better control over the muscles in that region. This will make it easier for them to relax during labor and delivery. It can also reduce the chances of vaginal tearing or other complications. Pelvic floor strengthening exercises are generally safe during pregnancy, too!
How to strengthen uterus for VBAC
While you can’t strengthen your uterus for a VBAC, you can strengthen your pelvic floor. And your pelvic floor supports your uterus. Strengthening your pelvic floor muscles strengthens the ligaments and tissues of the uterus. This can help reduce the risk of uterine rupture during labor. All of this helps improve core strength, which makes it easier for the body to move and adjust during labor. Strengthening your pelvic floor will ultimately increase your chances of a successful VBAC.
Remember during delivery that your pelvic floor does not push your baby out… your uterus does. That’s right, your uterus is doing most of the work during delivery and your pelvic floor is there to assist. So all that breath holding, straining, and excessive pushing you see in the movies… yeah, that’s not right.
Breathe and release
We also focus on releasing any pressure that has built up in your abdomen as this is happening. That means NO breath holding. To prevent this, you should exhale as you push. This will reduce the pressure in your abdomen. It will also limit excessive strain on the pelvic floor muscles and perineum.
The magic of motion
Allowing yourself to move can help progress labor. This will limit the need for excessive intervention. Try not to induce labor with medical intervention. Movement helps baby engage into the birth canal and helps progress cervical dilation. Thus, it is often best to wait until you are between 5 and 6 cm dilated before you receive the epidural. This will ensure you are in the active phase of labor. Waiting until then will most likely continue to progress without added intervention.
Whichever way baby arrives
You want to choose the birth plan that brings you the most comfort and helps you stay the most relaxed. If that happens to be a VBAC, great. If that happens to be a scheduled repeat c-section, also great! There are cases in which the anatomy does not allow for the baby to drop down into the birth canal, no matter what you try. In those cases, the baby has to come out of the sunroof (aka tummy), and that’s okay.
Many hospitals offer a family-centered Cesarean. This offers a clear shield to allow mom to view the baby’s arrival along. Mom can also get immediate skin-to-skin with the baby, which can be beneficial for both momma and baby.
Remember, pelvic floor physical therapists help you recover from ALL types of birth. So, whether you have a VBAC or repeat cesarean, be sure to find a pelvic PT in your area to help with your recovery. Be sure to check out our product list for all the postpartum recovery goodies! Happy birthing to all!
Are you currently pregnant or planning to conceive? Download my FREE resource — How to Prepare Your Pelvic Floor & Core for Childbirth + 8 Must-Dos for C-Section and Vaginal Deliveries.
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