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.
This is a great resource for women pursuing VBAC. They have a wealth of information on VBAC friendly doctors and hospitals and also provide support for women who have had c-sections. Local chapters hold meetings, where you can meet women in your area who are attempting VBAC. This may seem strange, but these meetings are amazing because you can meet real women who are going through the same thing you are. These women can recommend doctors that have helped them in the past or who are helping them now.
2. Remember that just because your doctor claims to be “VBAC friendly” doesn’t necessarily mean she is.
Ask questions like, “How many successful VBACs have you attended this year?” That’s always a good place to start.
3. If your doctor says you are not a candidate for VBAC, ask WHY.
This may seem basic, but I think we are so used to following a doctor’s advice we may not always dig deeper. You have every reason to know the motivations behind her recommendation. If the only answer you get is “because there is an increased risk of a uterine wall tear” you may want to search for another doctor.
4. Make sure the hospital where you plan to deliver allows VBACs.
As I mentioned above, some don’t. Do your research. If your doctor only has privileges at one of these – you’re screwed.
5. Look up the VBAC and caesarean rates at the hospital where you plan to deliver.
You can see which hospitals perform successful VBACs at increasing rates and choose to deliver there or make sure you choose a doctor who delivers there.
6. Visit message boards and find women in your area that have had a successful VBAC.
Pretty much every pregnancy site out there has a VBAC support group. Find women in your area who have had successful VBACs and ask them about their experience and which doctors they used.
I am not giving you this advice to in any way imply that doctors are not competent – they are. I’m just recommending that you find the best fit for your motivations. You have every right to take control of your health, ask questions, and find the right doctor for you.
For the record, I did not get my VBAC. Even after all my research and questions, my baby still decided she would not be exiting my womb at my pace. At 42 weeks I had to give up on my VBAC dreams and admit myself to a hospital for my second c-section. Guess what? A planned c-section isn’t nearly as terrifying as an emergency one. She was born healthy. I didn’t get my VBAC, and I was fine. I was also content knowing that I put myself in a situation where I trusted my doctor’s advice – and when she advised that it was time for the c-section, I could follow her advice without doubt or fear.