If you’re female and older than 20, you’ve surely heard the saying “Once a cesarean, always a cesarean.” VBAC (vaginal birth after cesarean) used to be a myth...an urban legend. Doctors were (and still are, to some degree) taught that it is safer to undergo repeat cesareans rather than attempt a vaginal birth and risk uterine rupture. But most women don’t want to be resigned to future cesareans, risking infection and lengthening the time of recovery. Most women would like to birth vaginally for the health of themselves and their baby.
The good news is that VBAC is slowly becoming more widely accepted in medical maternity care. And you have the ability and right to find a care provider and birth setting that are supportive of your desires to birth vaginally after a cesarean.
If you’ve had a cesarean and you’re wanting to increase your chances of having a successful vaginal birth in the future, then read on.
Here are my six steps to preparing for a successful VBAC.
1. Time your VBAC wisely.
If possible, give your body time to fully heal after surgery before becoming pregnant again. Most professionals agree that at least 18 months in between your cesarean birth and subsequent pregnancy is ample time to recover. By allowing time to pass, you not only give your bodily tissues time to properly heal, but also a chance for your mind to heal. Take the time to process your thoughts and emotions involved with your cesarean and come to peace with your birth story. Talk to a loved one or counselor if you feel it would be helpful for your healing.
2. Do your homework.
Read as much as you can about VBACs. There are many books out there, so I would suggest looking for recent publication dates and scientific data (as opposed to anecdotal stories). To get started, take a look at Birthing From Within by Pam England CNM, MA and Birthing Normally After A Cesarean Or Two by Helene Vadeboncoeur. Find studies about VBAC research and educate yourself on what your care provider should be aware of. The National Institutes of Health combed through many VBAC studies and released a summary of their findings in 2010 that is considered the most current data we have. Be prepared to share what you learn with your midwife or doctor.
3. Learn about your cesarean.
Unless your cesarean was an emergency, you most likely have the optimal lower, transverse (or “bikini cut”) scar. This is favorable as it puts you at a lower risk of uterine rupture during future births. Instead of getting into the details of uterine rupture, I would highly recommend you use Jen Kamel’s site VBACfacts to educate yourself. Another fact you should know about your cesarean is the type of suturing your uterus had, whether single or double layered. You can ask your cesarean doctor or contact the hospital and request your birth report. If your uterus was sealed using a single-layered suturing, you may not be able to birth with a midwife or outside of a hospital. But again, ask the providers in your area, as this is always changing.
4. Take care of yourself.
Treat your body with great tenderness throughout your first year after surgery. Use skin-safe oils to massage your scar and reduce scar tissue. Take vitamins and herbs that are shown to strengthen your uterus, such as evening primrose oil and red raspberry leaf. Drink plenty of water and exercise regularly to gain mental and physical stamina. Get outdoors often.
5. Avoid medical induction.
When at the end of your pregnancy, try your best to go into labor naturally. Medical inductions can increase your likelihood of a failed attempt at a VBAC, as they can put too much strain on your uterus.
6. Be prepared for any outcome.
Know that even with all your preparation, you cannot control the outcome of your birth. If you must have a repeat cesarean, know that you were informed and prepared to the best of your ability. Try not to view this as a failure. Your body is not a lemon. Give yourself grace and understanding. Know that you are an amazing woman who cares deeply for her child.
Hiring a doula to support you in your journey to a VBAC is highly suggested. A doula can help you navigate the medical system and give you the valuable tools you need to prepare your body, mind, and heart for a VBAC. Know that you can do this! This is your birth and you have the right and responsibility to want the best for yourself and your baby. Good luck!