How to Tell if You Have a VBAC Oppressive Provider
The cesarean rate in the United States is around 30-35%. Locally (in Western New York), our cesarean rate is around 35-40%. The pandemic of the past year has surely increased the cesarean rate for 2020-2021. No data is available yet, but when it is, I feel confident that it will confirm what birth professionals are reporting. If you’re seeking a VBAC (Vaginal Birth After Cesarean), one of the most important things you can do is to find a VBAC supportive provider.
Have you had a cesarean birth? Are you planning to have a VBAC? In this article, I’m going to offer you some potential red flags you may encounter with your provider. Learn how to tell if your provider is VBAC oppressive.
What is a VBAC?
VBAC is an abbreviation that stands for vaginal birth after cesarean. This is important to know because many providers are not VBAC supportive. Evidence shows that a VBAC is safer than a repeat cesarean for low-risk birthing people. However, there are many other factors that are involved in a family’s decision-making process aside from evidence alone.
The national VBAC rate was 13.8% in 2019. The success rate for those who plan a VBAC is anywhere between 60-80% across a variety of studies. The success rate for those who have had a previous vaginal birth is 83%. If you have had a previous VBAC, the success rate is even higher at 94%.
The risk of uterine rupture (1 in 500 individuals) and liability concerns (insurance) are the most cited issues that cause some providers to have VBAC oppressive policies. VBAC oppressive means that the provider’s policies, procedures, and protocols are not supportive of vaginal birth after cesarean.
If you’re planning a VBAC, then one of the most important things you can do is find a VBAC supportive provider. What does that look like?
Is your provider VBAC oppressive?
Here are 7 red flags you need to know that may mean your provider is VBAC oppressive.
Your provider does not follow evidence-based practices surrounding VBAC.
There are many great resources available to learn about evidence-based practices surrounding VBAC. The VBAC Link is a great resource to further your learning and can help you create great questions to ask your provider.
Your provider uses a VBAC calculator.
The VBAC calculators use factors such as height, weight, age, previous births, and race to determine a person’s chance of a successful VBAC. This absolutely perpetuates health care inequities. Facts about your body such as your weight or age have no basis in predicting your ability to have a successful VBAC. Each birthing person is holistic in their desire for a VBAC. You cannot be reduced to simple elements on a calculator. This also creates provider bias. This can potentially counsel people out of having a VBAC who could easily be able to have one.
They impose limitations on when labor must begin.
For example, limitations might include stating that labor must begin by 40 weeks. There is no evidence that this relates to VBAC success or negative outcomes.
Your doctor is not open to induction of labor in any form.
Certain medications used to ripen the cervix in an induction generate a prostaglandin response. This can potentially overstimulate the uterus and pose a risk of rupture in a VBAC. However, most of the research on this topic was done before the effect of these medications was fully understood in relation to VBAC.
For example, a birthing person who develops preeclampsia could have an induction of labor with a favorable cervix leading to a VBAC. We know a lot more about how these medications work, and there are other options available such as foley induction that are non-chemical. Someone with a favorable cervix may not even need any cervical ripening in the induction process. It is a complex decision-making process that does not universally pose a risk.
They comment on aspects of your body that they feel will make VBAC a challenge.
Firstly, this might sound like, “you’re too short to be able to birth your baby vaginally.” Secondly, this could sound like, “your BMI is too high for a vaginal birth.” Sometimes comments might be made about height, weight, hip size, etc. and none of this is based on any evidence whatsoever about VBAC.
Your provider suggests that your baby may be too large to be born vaginally.
We know that the science of predicting birth weight is highly questionable. A baby’s birth weight predicted via ultrasound can be off by several pounds in either direction. Also, large babies are born vaginally all the time. A baby’s estimated weight is not a contraindication for a VBAC.
They impose restrictions on labor.
Firstly, this might look like a restriction on the length of labor. They might say, “we won’t let you labor longer than X hours.” Secondly, this might look like a restriction on the time allowed in the second stage (pushing). It is also possible that they may require you to have an epidural in place “just in case.” Also, they may try to restrict you from laboring in water or moving around your birth space.
If you’re reading this and you have found that your provider has some VBAC oppressive policies, then you definitely want to consider your options for care. As a doula and certified VBAC specialist, I can help you work through your dreams and desires for birth and support you in the process of finding a supportive care provider. You can schedule a complimentary one-hour consultation at this link to learn more about how doula support can help you achieve a successful VBAC.