VBAC Support: 5 Ways to Tell if Your Provider is VBAC Progressive

Looking for VBAC Support? Learn how to tell if you have a supportive provider.

Are you planning a VBAC (Vaginal Birth After Cesarean)? Are you looking for VBAC support? Currently, the overall VBAC rate is about 13.8%. However, the success rate for those who seek a vaginal birth after a cesarean is between 60-80%. Another way to think about this is that the C-section rate for a VBAC isn’t much different than any other birthing person who hasn’t had a cesarean. The cesarean rate in the United States is around 30-40%.

If you desire a VBAC, there is a very good chance that you will be successful if you have a supportive provider. In this blog post, I’m going to share 5 ways to tell if your provider is VBAC progressive. VBAC progressive is another way to say that a doctor or a midwife provides evidence-based VBAC support.

 

5 Signs of a VBAC Progressive Provider

They don’t place a timeline on when labor should begin.

This is critical. Firstly, we know that there is a wide variation of normal in terms of when labor starts. It could be totally normal for one parent to birth at 42 weeks. Yet, another parent could birth at 38 weeks. Sometimes, providers place restrictions such as not allowing a pregnancy to go beyond 40 weeks. They may recommend a cesarean if labor does not begin on its own between 39-40 weeks. This can lead to many unnecessary cesarean births.

A VBAC progressive provider allows labor to begin on its own in the absence of medical necessity. There is no evidence-based cut-off where a planned cesarean should be scheduled if you’re planning a VBAC.

 

They are open to the use of evidence-based induction methods if it becomes medically necessary.

Sometimes, providers may have a blanket no-induction policy for VBAC. It is often believed that induction methods raise the risk of uterine hyperstimulation. It is believed that this can increase the risk of uterine rupture. According to ACOG, in parents with a low transverse c-section scar, only the use of Misoprostol (Cytotec) is contraindicated for this reason. One case-control study showed that the use of Misoprostal for induction increased the rate of uterine rupture to 5.6%. The risk was .2% in the control group.

Other induction methods found to be safe include a Foley balloon, Pitocin, or artificial rupture of the membranes (breaking the water).

 

They have a high VBAC rate and they are in a practice where all providers are VBAC progressive.

This is so important. Sometimes, hospital VBAC rates are used by families to choose a provider and birth place. But this doesn’t tell the whole story. Individual doctors and midwives can have wildly different VBAC rates. The hospital statistics are only an average. It doesn’t tell you if your provider or practice is specifically VBAC progressive.

Also, it’s important to find out if all the providers in a particular practice are supportive of VBAC. Are they aligned in their beliefs and protocols? If you are seeing a rotation of providers, then you can express your plan for a VBAC with each provider you meet.

Also, it may be beneficial to seek out others in your community who have had a VBAC. Ask them what doctor or midwife they used. Listen to their story and see if it aligns with what you want for your birth.

 

They are able to discuss the risks and benefits of VBAC vs Elective Repeat Cesarean without bias.

Firstly, your provider should be able to discuss the risks and benefits of both options and remain neutral. Are they centering your needs and desires in the conversation? Are they truly discussing all the risks and benefits and offering you the full range of choices?

Sometimes, clients tell me that they got a *feeling* that their provider didn’t support their choice of VBAC. This can come in the form of language such as “allowing” or “trying.” It can also come from negative talk about your body and your past birth. They might even simply seem skeptical, negative, or disparaging about that choice.

If you decide to plan a VBAC, then your provider should support your decision to do so. Alternatively, if you choose a repeat cesarean, then they should support you as well.

 

They don’t recommend a repeat cesarean simply because of a baby’s estimated size.

Everyone is afraid of big babies. And there are very legitimate reasons why people may feel this is concerning. However, a suspected “large baby” is not an evidence-based reason to recommend a repeat cesarean. People birth large babies all the time, and recommending a cesarean for a large baby is not evidence-based practice.

Also, a baby’s weight as estimated by ultrasound can be +- two pounds in either direction. We know that estimated fetal weight via ultrasound is notoriously inaccurate. For example, my last baby was estimated to be in the 30th percentile via ultrasound. He was 10lbs at birth. A suspected “large baby” also creates provider bias and is shown to change the way a birthing parent is cared for in their experience.


 

Mindful Mama’s VBAC PLANNER

Are you looking for VBAC support? Check out this fantastic free VBAC planner! As a VBAC specialist, I created this planner for parents just like you. I walk you step-by-step through the process of discovering your vision for your birth, choosing the right care provider, how to recognize warning signs and red flags, and more!

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