Lately, I’ve been hearing a lot more about VBAC. For those who don’t know, this stands for Vaginal Birth After Cesarean. Fair warning…..This is a hot button topic for me.
There is a long-standing myth that seems to be firmly entrenched in our collective consciousness, that one cesarean means all subsequent babies must be born by cesarean. I can’t find much evidence to say that this is true. There are some cases that make this true, but those are relatively rare. For example, if the issue that made the first cesarean necessary still exists, maybe she should opt for cesarean births. If there was some abnormal damage or scarring of the uterus from the first surgery, there may be a need for another cesarean. In these cases and maybe a few other special cases, a repeat cesarean would be favorable. Of course, the typical unexpected reasons for needing cesareans such as preeclampsia, placenta previa, fetal distress, etc., could come up and make a cesarean necessary, but most of the time a repeat cesarean does not need to be planned. If your previous cesarean was needed due to a post-dates baby, a large baby, a breech presentation, failure to progress in labor, etc., and you had a low transverse incision, then there’s no reason to expect there to be a repeat, and you’re likely a great candidate for a VBAC. Talk this over with your care provider in detail, and get a second opinion if the conversation seems one-sided or cut short.
The professional organization for 0bstetricians in the U.S. has made several statements in support of VBAC since 2010. VBAC rates were climbing from 1985 to 1996, but then started to take a dive as the rates of cesarean increased drastically after that period. So why aren’t they being recommended as a standard of care in so many practices now? It’s misunderstanding and fear of medical liability, not evidence. I might also suggest, and this is just a guess, that some care providers recommend repeat cesareans out of inertia and convenience. This is just what they’ve always done, it’s been working for them just fine, and it’s convenient.
Why attempt a VBAC? The benefits of a VBAC include a shorter and less complicated recovery period, reduced risk for infection, hemorrhage and blood clots. There is a reduced risk of maternal morbidity in future pregnancies that could be caused by repeat cesareans. On top of these reasons stated officially, I can add a few that I find really important.
Delivering a baby under a woman’s own direction and power is an amazingly empowering and healing experience. It can make the difference between a strong and easy bond between mother and baby and a more difficult postpartum time. It can make the transition into motherhood more effortless and full of an indescribable energy that can carry her so far forward in her mothering journey. The psychological effects are so far-reaching that I can’t even begin to list the benefits or even understand the snowball effect a positive birth experience can have on a woman for the rest of her life.
If a VBAC is what a woman needs to find this psychological, spiritual, emotional healing and wisdom, AND evidence shows that it is a safe option for her physically, why wouldn’t this be the GOLD standard of care? It worries me that the psychological effects of birth are so often understated or completely neglected by our care providers. I think we can all agree that a positive outlook and emotions affect our physical picture too. Is something “safe” if it causes mental anguish or emotional distress? There is a surplus of clinical proof that stress has an extremely negative impact on our physical health. Why is it that our medical system hasn’t included this in the map for our births?
I love that we are beginning to take this back for ourselves. Obstetrics has been a male dominated field since its inception, and I can see that it would be difficult for a man to understand that birth is not just a medical event for a woman, it is a Rite of Passage. Even now, so many women have lost that understanding and give over this celebration of her body to the care of medical professionals. We do this because we’ve been told since our own births that they are looking out for the safety of our bodies and our babies. While this might be true, and I’m not suggesting that our medical care providers are intending to harm, it is also not the whole picture. Our births are an emotional growth journey that we need to fully integrate into our life experiences in order to flourish as a mother and human being. When the power inherent in this process is taken from us, it makes that integration so much more complicated and difficult. Sadly, for many women without support, this is an impossible task, and they never fully realize their potential.
I’m happy to see that VBAC seems to be making a comeback and is receiving more vocal support from all types of birth attendants. The more we ask questions and share our concerns, the further these conversations can go.
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Thank you!