Actual Useful Tips For Finding A VBAC-Friendly Doctor

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After going through an emergency c-section with my first child, I was determined to have a successful VBAC (vaginal birth after caesarean) with my second. The experience I had with my first birth was a little terrifying. I wanted to do whatever I could to put myself in a position to be able to attempt having a non-surgical birth the second time around. Finding a “VBAC-friendly” doctor was not easy.

I moved to Florida when I was six months pregnant and quickly realized pursuing a VBAC wasn’t going to be as easy as I had hoped. My midwives in New York were supportive, but moving somewhere where you have to find a doctor who will support your desire to try for a VBAC is hard. VBAC’s are considered more dangerous than repeat c-sections -an idea that is not supported by facts – and are more of an insurance liability. For this reason, doctors and hospitals are cautious when deciding whether they will allow one or not.

45% of American women are interested in the option of VBAC (14), yet 92% have a RCS (15). Some women chose their RCS or it was medically necessary. Others felt like they didn’t have much of a choice for numerous reasons including hospital VBAC bans (16); immense social pressure; or the misrepresentation of VBAC risks (17).

 

In 1999, the ACOG made a recommendation that a doctor be “immediately available” to perform a cesarean, which means in some states (like Florida) in order to be assured of a trial of labor after cesarean, you have to find a physician willing to attend your entire labor. The doctor couldn’t just waltz in the last half hour like many OB’s are known to do. This is why it is increasingly more difficult to find a physician who is willing to be supportive. They may reference things like uterine rupture, but catastrophic uterine rupture – which is what doctors are usually referencing when they talk about how “dangerous” VBACs are, happen in less than one percent of women who VBAC. Basically, insurance companies have made it very hard for women in a lot of states to have successful VBACs if they do not find the right doctor/hospital fit.

So how do you find that fit? A lot of questions. I am going to go over some of the ones that I asked when I pursued my VBAC. I fundamentally believe in a woman’s right to choose what happens with her body, which also applies to how she decides to approach labor. I’m listing these questions as a guide – I am not a doctor. Nor do I believe that if your doctor gives you compelling evidence as to why you should not try for a VBAC should you ignore her. I hate to be one of those annoying people who says A healthy baby and mother is the most important outcome! But hey – a healthy baby and mother is the most important outcome. That being said, here are some tips to help you in your search for a VBAC-friendly doctor.

You can reach this post's author, Maria Guido, on twitter.
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    • Kendra

      I love this! I am definitely going to be requesting a VBAC for the next time around. I think I have a good midwife for it now, but I’m going to look up the rates and be sure to ask better questions this time.

      • Maria Guido

        Good luck!

    • Valerie

      This is great, Maria. I too tried for a VBAC that didn’t end up panning out but I felt confident that my doctor was doing what was best for me and made peace with it pretty quickly.

      • Maria Guido

        Yeah – I think had I had unsupportive doctors I would have felt much different about the whole situation.

    • geckomommy

      I also had an emergency c-section after working very hard to have a natural labor and birth, and it’s really scary. I hope to try a VBAC if/when I have another child, but you’re right, it’s hard to find a doctor who will support you, and who you trust. While I love by OB/GYN, and I think she’s a wonderfully skilled surgeon who I’m glad was on call when things went off-course under my midwife’s care, when I asked her how many VBACs she had attended she said NONE since she started at this practice, which has been at least a few years. While she says she would support me, I don’t know if she’s necessarily the best doctor for me when baby #2 comes around. And while I’m thrilled that my daughter and I are both happy and healthy, I would also love to not have the recovery time that comes with major surgery next time, if there’s any way to avoid it.

      • keetakat

        If it is what you want to do and you can find the right people to help you it can be very smooth and just wonderful, speaking from experience. My very best wishes for you!!!

      • Maria Guido

        I hope you get what you want – maybe you should look into another doctor. Also – just to let you know, the recovery from my second c-section was waaaay easier than from the emergency. 1000000x easier.

      • geckomommy

        Well, that’s a relief! Makes it sound a lot less daunting.

    • momma425

      Yikes, more power to you brave vbac mommies! Personally, I very much look forward to my repeat c-section whenever my husband and I forget how awful I behaved the first time I had a baby. I’m a control freak, and not having control scared me more than surgery.

      • MLSKC

        This. Control is the same reason I had a repeat.

    • journalgal2

      Thank you for the balance in this article, stating that it’s crucial to be your own advocate and do your research, but knowing that in the end, a healthy mama and baby is the best outcome, no matter how you get there.

    • TheGiantPeach

      My doctor told me that VBAC may be safer for ther mother, but it’s quite a bit more risky for the baby than a repeat c-section. Also, if a hospital tells me that they don’t do a certain procedure because they are worried about liability, that tells me that the risks of that procedure are too high for my own comfort.

    • Harriet Meadow

      When my OB finally suggested a C-section, she assured me that I would be able to try VBAC with the next one. Then she got in there and said, “Nope. Your pelvis is way too small. I highly suggest you never try a vaginal birth.” I’m ok with that (now I am, at least. At first I was a little disappointed.

    • Diane Harrison

      I’ve had three csections. I wanted a vbac with both the second and third, but not one single doctor or hospital within several hours of me would do them. The hospitals were an absolute no and the docs (I went to many) said they wouldn’t touch me with a 10 foot stick. So repeats it was.

    • CrushLily

      I had a successful VBAC with #2 after my first was an emergency c-section. When I first suggested it early in the pregnancy my doc said it would be fine and there was no reason, based on my first experience, that I couldn’t ‘have a push’ (his words). His only concern was if I needed to be induced or was quite overdue, he would then suggest an elective caesarean, but we could see what happened. As it happened I went into labour naturally 10 days early and apart from having to go into the hospital earlier and having the baby monitored more closely, I believe there was really no difference from a standard natural birth.

      I only realised that it was a ‘big deal’ when every midwife I saw through the succession of midwife shift changes said how great it was my doctor was allowing this to go ahead. The labour lasted about 15 hours, my baby was delivered without problems, epidurals are truly awesome and everything was just fine. My doctor did say that the early delivery did help his decision to allow me to proceed.

      My initial reasoning for VBAC was because I wanted a faster recovery time as I have a toddler and no family support beyond my partner. But in hindsight, the biggest benefit was the positive experience for my partner. He confessed to me after the birth that when #1 was born, it was very traumatic because he could see things were not going the way they should, the doctor was stressed and obviously worried and he was scared because he thought I was going to die. It sounds melodramatic now, but since I was in the middle of it and everyone else in the room was focused on me and the baby, it seems reassurance for him was forgotten about. And that he’s been watching too much Downton Abbey. So for him, seeing the doctor smiling and joking throughout made a huge difference to his experience too.

      • CrushLily

        Sorry, I should say that I’m in east coast Australia, so I can’t help with US doctor referrals.

    • koolchicken

      VBAC issues are a big part of why my son will be an only. I’m not willing to risk another c section. I was 36 weeks, hadn’t gone into labor, and my son was sick not me. So while it’s almost impossible any future kids will have the problem he did, I’m not willing to have surgery again for no reason. I’m still in horrible pain from the first one a year and a half later. Why would I want to risk having that get worse?

      There are no guarantees with pregnancy. So for that reason I just won’t get pregnant again. You’re doctor can tell you a VBAC is fine with them, but that get’s you nowhere when they suddenly announce you’re having another section. And unless you’re fully committed to walking out of the hospital at that moment, you’re screwed.

    • Elizabeth Watson

      Awesome, awesome article. Thank you so much for writing this. I had a VBAC this past August, and I agree wholeheartedly with each of your tips. My c-section was not an emergency, luckily, but was due to persistent breech position. In order to even have a trail of labor the second time, I had to change doctors and hospitals for the reasons you went over (not an outright ban, but discomfort with the insurance liability). Things went well for us, and I even had an unmedicated birth. But, if circumstances had changed, I knew my new doctor wouldn’t tell me it was time for surgery unless it was the most appropriate response. This is just so important. Thanks again.

    • http://www.3under3andaphd.blogspot.com/ 3under3andaphd

      I feel really lucky. My doctor actually encouraged me fully to attempt a VBAC for my upcoming 4th (which is a relief to me after the hell that was an emergency c-section and recovery with a newborn and two young toddlers last year.) Granted, that is as long as all goes well, but she actually discussed that a VBAC for me is still less risky than a C-section. I didn’t realize how lucky I was until reading many of your comments.

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