When the going gets tough, you're going to want more than ice chips. You're going to want a damn good doula. Dr. Mussalli tells me that the women who succeed in his care have excellent doulas who really help them through the tough areas -- doulas that are of course, well worth the money.
The biggest risk ladies often take is that of a uterine rupture. Although the chances are slim, it's a documented risk that can mean fatal outcomes for both mommy and baby. Should something go awry, Dr. Mussalli tells Mommyish that blood flow to the baby is immediately restricted which means doctors have to perform a c-section quickly.
"In those situations you have to get the baby out in five or six minutes. It's not really the kind of labor they should be doing at home. Women have to get a baby out in five minutes and they can't even get out of the house in five minutes, " he says.
He recommends scheduling a VBAC in a hospital where all emergency resources are nearby.
Dr. Worth says that knowing the size of the baby is crucial to a successful VBAC, so much so that growth sonograms should be conducted every month starting at 20 weeks. Fetal assessment should be top priority all through pregnancy. Your baby's size should also be determined again right before going into labor. Fetal monitoring should be performed all during childbirth too.
Knowing that you're committed to a VBAC means committing to that risk factor. In his practice, Dr. Mussalli says that he always counsels couples on the possible dangers before pushing ahead.
Ladies who have three c-sections are too high risk, Dr. Mussalli says, for a VBAC. Any other uterine surgeries, such as having fibroids removed, also make a lady not a good candidate for a VBAC because incisions to the uterus have already been made. This makes the risks for rupture that much higher.
When shopping around for doctors to oversee your VBAC, ask their VBAC success rate along with how many VBACs they have seen. A VBAC success rate under 80% is something to be "cautious" of, says Dr. Mussalli, and you want a doctor who has handled more than a few.
"Experience counts," he says.
Mothers who have a classical, or vertical, c-section scar are also "not allowed" to have VBACS, according to Dr. Worth.
Although it's good to seek out a high risk OB to help with your VBAC, your general OB GYN probably has more experience with delivery, says Dr. Mussalli. Although a high risk OB is pretty familiar with pregnancy and abnormalities with the baby, high risk doctors usually don't deliver babies. So don't put all your proverbial eggs in that basket.
If you're looking to have quite a few kids, despite what the fertility-shamers say, VBACs are definitely more advantageous, says Dr. Mussalli. The risk of repeated c-section is not exactly wonderful for those looking to have three or more children -- so plan accordingly.