#63 | Planning Your Successful VBAC

What does it take to have a successful VBAC (Vaginal Birth After Cesarean)?  In this episode, we hear from several women about their successful VBAC stories followed by a discussion between Cynthia and Trisha on what it takes to get there. If 60-80% of VBAC attempts are successful and only 13% of candidates are having them, what is holding them back or standing in their way?  Tune in to hear our thoughts on planning the VBAC you desire.

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Transcript

I remember thinking almost immediately after my C section that it was not something that I ever wanted to do again, I actually think right away something told me that, you know, maybe I got pregnant this time around just to do this whole thing over again and maybe have a chance at having a natural birth. I knew I wanted a VBAC. And I remember just starting to research right away, what do I do to make it work? You know, it's very intimidating.

He said, You know, if you were my wife, I would not recommend that you do it, you know, it, there is a risk of, of uterine rupture,

I sort of I think I felt very emotionally protective of myself.

And then I went for my six week postpartum visit. And I remember having the doctor look at my C section scar, and there was something that she just kind of quite didn't like about it. And so she said, you know, don't worry about it. We'll fix that with your neck c section. And he looked at her and I said, Oh, no, that's not something I'm planning to do again. And she said, Well, that's what we recommend. That's kind of, you know, the route that women usually go. And I said, Oh, no, no, that's not the route that I'm gonna go. And she looked at me with a little smirk. And I thought to myself, I'm out of here,

I think I was afraid of maybe being in labor for too long. And then having a C section. I've always felt like that would be like a worst case scenario to labor for 20 hours, and then end up with a C section. So I think that was a bit terrifying. I also wanted to be at a birthing center.

And I also had the midwives really backing me and supporting me, they never once gave me any indication that having a VBAC was something that I couldn't do.

I was lucky enough to have nothing but support when I decided to have my be back. I think that people saw what I went through with my susteren, and probably knew me as a person, I was not going to intentionally put myself through that process. Again, I got a lot of support from my friends. And I had an aunt that had had a C section 25 years prior, and then had two successful vbacs following that birth. And she really would sit with me for quite some time, and just go over her story.

Like, let me ask all the questions I could. And that instilled a lot of confidence in me that she could do it. And I could do it too.

You know, I think everybody was just so shocked. You know, we have family from Europe. And, you know, actually, at that time, when I was pregnant, the second time around, we were visiting some of the husband's family and everybody was just kind of like, Oh my gosh, that's not allowed, you know, nowhere else in the world. Would they ever allow you to have a VBAC? And I'm like, Yeah, but you know, they told me I was actually a pretty good candidate for VBAC. So anyway, I think it was very difficult to get anybody to be excited for you, I guess. So we're, like, give you some reassurance. There was none of that.

I think, you know, everybody was just kind of questioning and surprised. And my midwife really was so great about checking with me multiple times, to to really reassure me that she knew I really wanted to have a VBAC. She really was so great about making sure we were on the same page. Once I spoke to my midwife at the first appointment, and she told me that, you know, it's almost like your second pregnancy is totally different than the first time around. This is like a brand new pregnancy. And, you know, as long as the baby's not breech, you will have a vaginal birth. And, you know, I think it helped to know that their statistics were, you know, quite good. They had really high success rate of vbacs of the practice. So that certainly reassured me and, you know, supported me throughout the entire pregnancy Never did I doubt that I couldn't do it, or it was impossible, or it was dangerous in any way. Every birth is different. You know, just because your first one went one way, the second one will be completely different. And I have you to thank for that, Cynthia, because that's something that you told us. My midwives was very clear that you know, it's a different pregnancy and you know, if not more likely to have a breech baby just because my first one was a breech. So again, all of that support from midwife and doula was awesome.

When my baby's head emerged, I was shocked. I mean, it didn't make any sense. I had been in labor for over 24 hours and I was exhausted and but I guess, consciously, you know, even though I've been pushing and they're saying that, you know, she was coming. She was Coming. I guess subconsciously I just didn't believe that I was actually going to be able to do it. I thought that I would end up in a Syrian just like with my first, I had worked so hard to get myself physically and mentally prepared for that VBAC. And when it was successful, and I had all of these women standing around me kind of congratulating me, I thought that I was to sound really cliche on top of the world. Since then, anytime I'm feeling low, or I'm doubting myself or I need a boost of confidence. I actually go back and I replay the memory of my VBAC. So when she was born, I just, I really was shocked. And I was just full of gratitude and full of joy, that I was able to experience her birth this way. I felt amazing. I felt I could do anything. I truly thought it was something that I meant to experience when I got pregnant the second time, you know, I couldn't believe that.

I hope that for the rest of my life, I never forget the moment I had my second son, and how empowered I felt. I really hope I don't ever forget the feeling that I had of accomplishment and empowerment. For myself. It was the single most empowering moment of my entire life.

I just kept thinking to myself, wow, I did it. Wow, I did it. So like I couldn't believe it. I actually did it.

If I knew how beautiful and easy the delivery with.

I would I wish I could tell myself like just believe in myself more. But it's so hard to believe in yourself in the face of people telling you it's probably not going to happen. What ended up happening after my susteren was I put myself in a position of feeling like a failure. And I thought that having a VBAC would undo that feeling that I would feel successful, and no longer a failure that it would almost like replace those memories. But in actuality what having a VBAC did was it gave me an appreciation for both scenarios. Without the first event, I couldn't have had the second event and I wouldn't trade either one. At this point for anything. I think I've learned a great deal from both. And I am really glad that I never forgot. And, and I didn't replace that memory of kind of what I went through with my sister Marian, I draw from both experiences a great deal of strength, I will always be very grateful for both of their births for what they taught me respectively. And I am so thankful that I had an opportunity to have my second birth that gently.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Trsha, what struck you as you listen to those?

It has to be how every single woman in every single story you could just hear how empowered they felt by their successful the back story.

Yeah, and I think what I've seen over the years is that you know, VBAC usually does seem to work successfully. It certainly has in the community that I've I've been in all these years. But I think what matters so much is that women be given a true trial of labor that they really feel they had the support that could have brought them there. Because even when it doesn't result in that beautiful inspired VBAC, the women can still feel at peace that they truly had the space and freedom and information to experience one if it was in the cards for them. I've worked with dozens of women maybe between 70 and 90 at this point, who've had successful vbacs and I've certainly formed my own observations around this. And Trisha, what's the VBAC rate in our country right now?

So currently, it's right around 13% that's all that's all it is. That's all but but what's really important to point out is that of those 13% of women who do trial of labor 60 to 80% of them will have a successful VBAC. So if we have this really high success rate, it's that's a pretty good success rate. Those are decent odds for sure our our numbers are still very low.

So this is no joke when I tell you I've been I've been teaching since 2007. I have not had one single year in my work where I've taught, let's say around 100 to 125 couples a year, most of the years that I've been teaching, I haven't had a single year where the VBAC rate was under 95%. Almost every year I've been teaching the VBAC rate was 100% of the women who came into this community, some of whom had two c sections. Why do you think that is?

I think it's because they found the right providers.

I really do. And they got educated, and they got educated. But I'm going to tell you that, yes, of course, that's important. And you're going to cover that some of that important education in this episode. But I will tell you, one of those women only birthed with an obstetrician. And there was one year, the year that I had the most the greatest number of vbacs. In my business, I think it was, I think it was 16 women, half of them birth at home. And these were women who never dreamed of birthing at home initially. In fact, to birth at home after you've had one or two c sections is really daunting. And that year, I had two clients who had had two c sections, and both of them ended up birthing at home, not because they wanted to initially, because they literally couldn't find support anywhere else. They couldn't find a single obstetrician who supported them and having a vaginal birth after c section after two c sections. So I really think that almost all roads lead to Yes, being informed, but having support from the provider because it doesn't take much to scare the heck out of us away from wanting to have a VBAC. I think what you could hear in those women's stories is just support support support. And sometimes we say rule number one if you want a VBAC is do not go for your VBAC with the obstetrician who gave you a C section. Even if you had a C section. for good reasons, like one of those stories I know involved a woman who had plus full placenta previa, that's a good reason for ss arion section another was a breech baby. Another very legitimate reason for a C section. But sometimes we just want to wipe the slate clean form a new relationship and really embedded into our minds and our bodies that this is a new experience with none of the triggers of the initial birth.

I would absolutely agree with you on that. And I mean, unfortunately, we're digging ourselves out of a kind of a hole with VBAC. VBAC rates really, really dropped off in recent history, and now we're sort of climbing back up to being more VBAC supportive. Unfortunately, a kaag and acnm are both coming around. Yes, yeah. I mean, especially a CAG. acnm has always been supportive. But a cog is really stepping up their support a VBAC. So we're just sort of like climbing out of this VBAC hole, I feel like we're in where the rates were very low. We're climbing out of an age of misinformation. Because in the 70s, women were told, and before the 70s, women were told once a C section, always a C section. But even now, you still have women who go to that first prenatal with their next pregnancy, and they hear the term uterine rupture, which I think is such a great injustice. Because first time pregnant moms never hear the term uterine rupture, and they also are at risk of uterine rupture. And it is only a little bit higher. For women who've had prior says Aaron sections. It's not nearly as high as women believe.

It's less than 1%. Yeah, it is. And the interesting thing, just to put it in perspective, because sometimes for mothers, it's hard to understand we need we need to understand relative risk, it's hard to just kind of comprehend the numbers. What does that mean? The risk of uterine rupture is very, it's actually lower than the risk of other things like placental abruption or cord prolapse or even a shoulder dystocia. So, all of those things can happen in any labor. And we get so hung up on this idea that if we're going to be backward, we're putting ourselves in our baby at risk because of uterine rupture. It's not that you can wipe that risk off the table. Some people are extreme in that direction and say that, you know, uterine rupture is so rare, I'm just going to have a VBAC no matter what, I'm going to plow through it no matter what. We have to make smart choices. We have to educate and inform ourselves so that we make the safest smartest choice for ourselves and our baby. And it's all too common, though, that the that the that the myth is that uterine rupture, the risk of uterine rupture is so high in some cases, providers will say it's one in four chance of uterine rupture, that's 25%.

It's nowhere near that.

So we're gonna hear that, but that but women are told that and that will scare any woman away from so can I tell you something? I don't think I've ever told you this. And it's just so it's so unethical. I had one client a couple of years ago who went back to her obstetrician, the one who gave her the C section at the first place and it was For a failure to progress, which as we know is not really a meta, it's not a medical indication, and it is not a good reason for the C section, but it is the number one reason for C section and I don't recall any other factors around that birth other than the duration of her labor. At that prenatal with her second baby. When she asked about the back, Tricia, her obstetrician showed her a video of a woman in labor experiencing uterine rupture.

What? What? Wow.

Talk about the fear factor right there and you believe someone did that? No, I can't believe somebody did that. But the other thing that can really scare women away from it is their provider might say something like, you know, if your uterus ruptures, your baby's gonna die. Yeah, right. Or you're gonna die. And that is not true, right? It's not true. uterine rupture is risky. Sure. But it's not it's not a death sentence for a baby or mother not even close. Right? It's something that sometimes just happens in birth. And this is something we can see signs of if a woman is having a trial of labor and a VBAC, right. I mean, don't isn't part of the whole approach to manage that risk anyway.

Part of the whole approach is to manage that risk, but unfortunately, there is no solid formula for doing that. Nor is there any really consistent indication of uterine rupture, it can go it can be missed, and that's part of why it's problematic. There are signs sure, but there's no guarantee that if you're if you're experiencing a uterine rupture that you're going to know about it. So first, let's just talk about who's a good VBAC candidate because I think this is a question on every woman's mind who is considering it in? Is it right for me? And I think it's important for mothers to know that almost everyone is a good VBAC candidate, there are a few absolute contraindications or contraindication means absolute No, no VBAC for you, that is based on the type of uterine scar you have. So if you have a very old fashion type of uterine scar, VBAC is not recommended.

What is an old fashioned scar gonna mean? I mean, no one who's had 100 year old scar is gonna go for a VBAC. So how old fashioned? Are we talking here?

Okay. I don't know the scars from the 60s or whatever the classical or the inverted t shaped scar.

What did they stop doing? Didn't they, for C sections? Yes. But women can sometimes still have that kind of uterine incision, if they've had a fibroid removed, I say, or other type of uterine surgery. Okay, so if you have that kind of scar, it's a no, no, if you've had a prior rupture in labor, it's not a good idea. If you have a transverse lie, I mean, some of these things, or you have a placenta accreta or previous and some of these things are just things that are contraindications for vaginal, right for any birth, same thing? Yeah.

Yeah, exactly. But outside of that, most women are good candidates for for VBAC.

But Trisha, what if she got pregnant eight months after her c section? Because isn't there normally a rule of about 18 months is that that's by evidence or what do you say about that?

There is a recommendation that to optimize your chances of a successful VBAC you wait 24 months between pregnancies 24 months, two years, a lot of my clients have been told 18 in the past few years, so I wonder, I just wonder what the evidence shows. So like I say, so much of this is just cultural and like the the word of the day.

And it's constantly I mean, aycock is updating their guidelines very frequently as they do as we're learning more. So that's not to say that if you are under the 24 month mark, that you can't find a provider who will support you if you are a good candidate on all other levels. Other things that help to have a successful VBAC are to allow spontaneous labor. So we we know that inducing or even augmenting, augmenting meaning to having pitocin to speed up speed up your labor. Those are two things that definitely decrease the chances of a successful VBAC.

That is true for a first time birthing woman as well, for sure. Right. In fact, pitocin hasn't been FDA approved for that purpose of just beating up labor, right? Even though it's very frequently widespread. Yep.

Having had a vaginal birth prior to your trial of labor. So if you had a vaginal birth, then you had a C section and now you're going for a VBAC. That is a definitely a plus.

So a lot of the challenge is just to combat the misinformation because what so many women encounter is a scared partner who's been through the trauma of a C section in the past or scared family members. And that is a lot for a woman to overcome as well. So yeah, back to what Trisha said, having information is the starting point. And then that helps to make getting the support easier, but sometimes When you really can't get the support you need, sometimes you have to draw the line and have the resolve within yourself to plan your own birth. Like just to take true responsibility for your birth when you know you're sufficiently informed. It's hard. It's hard for women when their sisters Betsy sections when their mothers are afraid when their partners are afraid. I've had one I think only one. But I've had one father in class once over these years who, who started to cry and talk about the trauma he experienced, when his wife went had a C section the first time around, it was really overwhelming for him and really intimidating to him. So we carry a real emotional burden into this process.

I think it's really, really hard to, for women to do something that they think is putting their baby or their themselves at risk, especially their baby. And like you said, getting the right information is very powerful. Because if we look at the actual risks to mother and baby have a C section or VPC section, they're significant.

That's right. And no one ever talks about those risks. And that this is my argument with everything. It's like when women are convinced to be induced without a medical indication. It's like, well, let's not take any chances. Let's just reduce you and no one ever talks about the risks of that induction. The same thing exists here when we're talking about vbacs.

So we overemphasize the risks of VBAC, and we under emphasize the risks of C section. And then we also downplay the benefits of having a vaginal birth. We don't think about the earlier skin to skin contact, we don't think about the higher rates of exclusive breastfeeding or breastfeeding initiation. We don't think about the hot the shorter hospital stay for the mother or the D, increased risk of infection, we don't think about the lower rates of postpartum depression, right? Or the easier recovery in a vaginal birth most of the time,

but it isn't fair. When women hear comments like what do you have to prove you don't have to be a hero. As if she's as if that's all this boils down to win. This can be an intensely satisfying and gratifying experience as we just heard out of women's mouths, at the in the beginning part of this episode, you do want to be your hero, more power to you, you know,

I would I texted these women and said, Hey, just send me a voice memo and just answer this question. You know, how what made you decide to have a VBAC? And how did you feel afterwards? And I did not expect them all to come in with the same answer, empowered, empowered, empowered.

But well, that's all. That's That's all I heard in those stories. Everything that I was feeling, listening to those stories was the feeling of empowerment they were experiencing.

I think what's worth discussing in another episode, though, is that we sometimes think, if the C section was traumatic, and that was not the case for half of the women, at least, who contributed to this episode. That's not the case for everyone. We sometimes think the VBAC will heal the trauma from the first birth. And that is not necessarily true. And I I only learned that from running Syrian support groups for so many years. I remember one of my clients had two c sections. And then she had a really quick, lovely easy home birth for her third. And I remember, I was so much less experienced back then this was like 10 years ago. And I remember just thinking, Oh, thank goodness, I'm so happy for her. Ah, like what good news for all of them. And then I remember seeing her and talking to her in that support group setting now that she was on the other side of her successful VBAC. And I remember how much She hesitated and said, What I didn't expect was that I would still have to continue processing my first two births. And that was real growth for me, because that thought had never crossed my mind before.

Yeah, that's a really good point. I mean, I would, I would think, like you that replacing a negative experience with a positive experience would help negate the negative experience. But that doesn't mean that you can just, you know, jump over the fire and forget the negative experience. And it doesn't work like that you still have to process the grief of the traumatic experience, you still have to process whatever emotions you experienced.

Yeah, there was another woman in that group once who I respected so much for being willing to share this because this would not be an easy thing for any woman to share. But her second birth was so wonderful and empowering and gratifying. And she said she had moments where she was home with her two boys, the one who was born by C section and the one who was born vaginally, and she said she had moments where she had to say to herself, wait a minute, I don't love them differently, do I? I don't love the second one more, do I? And she would say No, okay, we're good, we're good. But sometimes women are afraid to pursue a VBAC because they are a little bit afraid of the guilt that may come with knowing one child is having More potentially more satisfying birth experience and potentially less traumatic birth experience than their older sibling. And that takes a lot of love and courage for a woman to be willing to do as well. That's an uncomfortable thought that one of your children went through a harder labor than the other. But these women are willing to, to have their best birth each time around. Despite that potential guilt that they know they may experience. I think it says a lot. It sure does. It's very powerful. That's what that is. Yeah. So I think it's just such an injustice when we dismiss these women, like, you don't have to prove anything. And don't be a hero. It's like you have no idea how complex this is for women, you have no idea what they go through to come to these decisions. And we can presume to, it's a very personal decision. And if it feels right to you, then the next step is education and support. And you will continue to make the right decisions for yourself no matter what birth you pursue.

That's absolutely right.

We want to thank the women again who contributed to this episode today. I know for each of you, a VBAC would not have been possible had you not heard at least one inspiring, successful the back story yourself. And by sharing your stories today, you've now provided that to many other women. This is how we touch each other's lives just by sharing our story. So just once again want to thank those women who shared theirs today.

And this conversation is something that we want to continue. This is not the end of the VBAC compensation there's so much to say there's so much to share.

And if you have any comments about this episode, if you feel there's any point that we may have missed any emotion that we didn't touch upon on just message us through Instagram at down to earth show or through our website at down to earth show calm, we'll tell you how to contact us and contribute your own comments for us to plan a future episode.

Think you know Zu accused me of having to dry a sense of humor that people won't be able to relate to you stumped me with it all the time.

I still get stumped by you. Zu was like you really are dry. I don't think people are gonna get it. And I said, I don't know what choice I have. You can't change who you are. But I texted with one of these women who contributed the VBAC. And I said, that Zoo said, I'm too dry. She's like, I always understand your humor. And I was like, thank you. At least someone she said, I love the outtakes. I love the mistakes. I love hearing everything in the back scenes, but she's like, I don't think your dry humor is lost on me. So with that one listener, and thank you, Jen, because I know you're listening. And I know you listen to the outtakes.