There’s more to being a VBAC (Vaginal Birth After Caesarean) friendly care provider than just saying “Yes, we allow VBAC”. There’s a big difference between talking the talk and walking the walk but many times care providers don’t show their true colours until later in pregnancy, when it’s too late to swap. Other times women are so happy to have found someone that doesn’t say “NO VBAC!” that they don’t ask enough questions to establish whether their provider is really VBAC friendly, or whether they just want the business.
Unfortunately women need to be incredibly savvy and well informed when it comes to birth, and especially VBAC. There are two main factors that influence the success of VBAC, and you might be surprised by what they are. More often than not the most critical factors are WHO you hire to attend your birth and the VENUE you choose to give birth in. That’s right, your care provider will have more impact on VBAC success than your health, statistically speaking.
Before you schedule any interviews with potential care providers, do lots of research on current evidence based practice, to ensure that it is what they are offering. Whatever you do, don’t simply hire the first care provider in the phone directory. Having a university degree doesn’t make someone competent to provide the service you want. There’s a very delicate balance between knowledge and bedside manner, and a care provider may be a lovely person, but that doesn’t make them VBAC friendly.
Show them your birth plan early on, probably at the first interview before they set their hands on you. If they are dismissive of birth plans then they aren’t a good care provider. If you get any whiff of power imbalance run for the hills, YOU are the person in charge of your birth, not a child awaiting instruction. The job of your care provider is to present you with options, support their recommendations with evidence, then stand back and await your decision.
Ask lots of questions. If you don’t feel like you can ask questions then this care provider isn’t right for you. Ask how many births a month they attend, what they will recommend if you go post dates (post dates is more than 42w) ask how they will detect problems in your labour and how they will manage them, ask why they will recommend a repeat caesarean, ask how many repeat caesareans vs VBACs they have attended in the last year.
Ask how many drug free births they have attended in the last year and how many women give birth upright and or in water under their care. How many of the births they attend are on a bed? How many are elsewhere? Ask their views on big babies, ask how many ultrasounds they like to recommend in a normal pregnancy and if they use them in the third trimester when they give the most inaccurate results. If they give you generalised answers, brush you off with “only when it’s really necessary” then ask what constitutes necessary in their mind.
Throughout pregnancy you should always be on the lookout for subtle red flags and have a care provider as back up in the event that your first preference starts to back out on you. Never hire a provider who doesn’t treat you like their boss, be assertive throughout pregnancy and address niggling doubts immediately so you have the ability to relax and let your support team (partner and doula, not care provider) take over, supporting you during birth. It can be really hard to be open and upfront with doctors or midwives, so be mindful of this: if you can’t be assertive in pregnancy, being assertive in labour is going to be all but impossible.
If we are honest with ourselves, the odds of VBAC success in a hospital are statistically slim. It pays to interview as many different care providers (midwives as well as doctors) and different venues for birth as you possibly can. Be a fully informed consumer, not one who trusts everything the “experts” say. After all we haven’t come to have a 1 in 3 caesarean rate because providers are giving sage advice at every step of the way. Remember it’s not your fault if things don’t go to plan, if your care provider totally bombs out on the day, it’s never ever your fault, but make sure you do plenty of homework in the lead up, because it does increase your odds.
You Can Not Fail At VBAC