As a doula who trained more than ten years ago, I often recieve emails from women who are seeking support to achieve a VBAC (vaginal birth after c-section), under the care of someone who they claim to be a VBAC friendly doctor.
I only need to read a few lines into their email and it quickly becomes very clear that the obstetrician or hospital they have chosen is actually very VBAC UN-friendly, because restrictions have been put into place that can greatly sabotage any mother’s VBAC hopes and dreams.
While there are some genuinely pro-VBAC doctors and hospitals out there (who we adore and dearly thank them for their belief in women’s capable bodies), they really are few and far between.
It's very important for you trust who you’ve chosen to birth with. But if you feel like they don't have your best interests at heart, then you need to find a new carer – pronto.
As a woman who wants a VBAC, I'm sure you also want to do as much as you can to help make it a success. This article has been written so you can understand common reasons why VBAC attempts often fail before they even begin.
Here are 9 major causes of VBAC sabotage:
VBAC Sabotage #1: Restricting Pregnancy Duration
Bearing in mind that pregnancy is oficially classed as full term up to 42 weeks, doctors tend to have a ‘cut-off’ time, by which they prefer pregnant women to go into labour by. When you reach that cut-off time, they will likely want to schedule you in for an induction of labour. Often, the deadline for VBAC women is even shorter than a non-VBAC woman.
I’ve heard a wide range of VBAC and non-VBAC cut-off dates from many different obstetricians, starting as early as a week or two before the baby’s estimated due date (or guess date, I prefer to call it). Some doctors will want to induce VBAC women on or before the estimated due date, some a few days later, some a week post-dates… so there is no defined or known time-frame a VBAC mother MUST give birth by. It’s all based on your doctor's opinion.
Babies tend to defy their guess dates and deadlines and for good reason – they’re still putting the finishing touches on their development, making sure that when they’re born, they’re good and ready and have the best chance at survival. Read about what makes labor begin – it's truly fascinating.
If you broke your arm, would you take off your plaster cast a week or two earlier than your doctors appointment, because you think it’ll surely be fine by now? What's a few days anyway? Besides, it’s really frustrating not being able to do what you need to, you have a life, you know? Also, you really want to know what the heck is going on in there – how are you supposed to know if you can’t see?
Of course you wouldn’t do it, because you trust that your body is healing itself in it's own time. If you did take it off, you'd have to be super careful, because your arm would be vulnerable. You could easily end up with added complications. But your arm is safer and protected with the cast on, until it's healed fully.
Another reason a restriction on pregnancy duration could cause problems is because your guess date could be off by a week or two, resulting in baby being born prematurely. Miscalculation is very common, mainly because the method of calculating an estimated due date is based on a textbook average menstrual cycle of 28 days, ovulating on day 14. Not everyone fits that ‘average’ – only 3-5% of babies are born on their estimated guess date. If your dates are not accurate and you have a reduced time to get into labour, chances are it's not going to happen.
Ironically, ACOG have this to say about due dates:
“Waiting for the birth of a child is an exciting and anxious time. Most women give birth between 38 and 42 weeks of pregnancy. But very few babies are born on their due dates. It is normal to give birth as much as 3 weeks before or 2 weeks after your due date.”
So, if a woman hasn’t gone into labour by the time her doctor wants her to, then he may either suggest a repeat c-section or an induction of labour to get things going. Which leads to my next point…
VBAC Sabotage #2: Induction of Labour
I’m sure the risk of uterine rupture has been drummed into you already. However, the actual risk of a rupture (not fatality from a rupture) is less than 1%.
You may be surprised to know that inductions with synthetic oxytocin (Syntocinon or Pitocin) have a risk of uterine rupture, no matter if you’ve had a previous c-section or not. So if you're induced, you'll be adding a risk factor for uterine rupture.
A woman wanting a VBAC should ideally not be given anything that will increase the strength of normal, natural contractions, let alone an induction of labour.
Even if you're induced without drugs, e.g. having your waters broken – if it doesn’t trigger labour and you end up with a failed induction (which can happen no matter what form of induction you have) then the only choice is to keep ramping it up with other drugs or procedures, or have an emergency c-section. Once you begin the induction process, you can’t stop or get off. You're committed to getting the baby out, one way or the other.
Your VBAC dream can quickly fly out the window with this one, because induction of labour increases the risk of c-section.
VBAC Sabotage #3: Restricting Time Allowed to Labour (First Stage)
Many VBAC women are told they can only be in labour for a certain amount of time. Considering a ‘textbook’ labour is on average 12 hours of active labour, I often hear that VBAC women are given even less than this to have their baby.
Again, this is another unfounded scare tactic with the rupture card thrown in. A doctor may say a prolonged labour may place stress or strain on your scar, which may result in rupture. Yet there is no research supporting this.
Also, because the length of time the doctor or hospital ‘allows' a VBAC woman to labour for varies greatly, this is further demonstrates that restricting time in labour is being based on individual opinions.
If your baby and body is labouring normally, there is no reason to to have a deadline, and there is no evidence to back up a reason for doing so. Interventions should only be used when there is real evidence of a problem.
VBAC Sabotage #4: No Doulas Allowed
A VBAC friendly doctor or hospital should know that many studies have consistently shown that a doula significantly reduces a woman’s chance of a c-section. A doula’s support has also been found more effective than hospital staff or the mother’s friends and family, based on a review of 21 doula studies around the world. You can read about it in the BellyBelly Forums here.
If your doctor has told you that he or she does not want you to have a doula, this is another clear indication that they don’t have your needs at heart or do not understand the benefits of a doula. If your doctor or hospital is open to receiving information and studies from you, great! There are plenty you can provide. But if they are dead against a doula, this is another reason to consider changing caregivers – especially when your doctor wont be by your side during labour, encouraging and supporting you to reach your goal – and a doula will be.
VBAC Sabotage #5: Continuous Fetal Monitoring
The evidence is clear: continuous electronic fetal monitoring has been proven to significantly increase the rate of c-section without saving lives or improving outcomes. You can read the Cochrane Database study review (which analyses all available studies and makes an independent, non-biased conclusion) here. Here’s a snippet:
“Overall, there was no difference in the number of babies who died during or shortly after labour (about one in 300). Fits (neonatal seizures) in babies were rare (about one in 500 births), but they occurred significantly less often when continuous CTG was used to monitor the fetal heart rate. There was no difference in the incidence of cerebral palsy, however, other possible long-term effects have not been fully assessed and need further study. Continuous monitoring was associated with a significant increase in caesarean section and instrumental vaginal births. Both procedures are known to carry the risks for mothers although the specific adverse outcomes were not assessed in the included studies.”
VBAC Sabotage #6: Restricting Time Allowed to Push (Second Stage)
I’ve attended births, VBAC or not, where women have been told they have 10-20 minutes to push. If mother and baby are fine, there is absolutely NO reason for such unrealistic time restraints – some women need an hour or longer and the labour can remain normal and healthy. Pushing can take longer and/or be more painful if you are on your back or reclining, which will be the case if you’ve had an epidural or other pain relief. It’s likely that you’re pushing for the first time too, so its a new experience. All these things can prolong labour but it doesn’t make it reason to intervene further.
Also, for women who do end up giving birth vaginally, sadly it's common for those women to have assisted births with forceps or vacuum. There is such a rush to get the baby out when a different approach can make all the difference.
On average, women who have doulas at their birth have labours that are 90 minutes shorter and result in 40% reduced use of forceps. Doulas not only help with comfort measures but can actively help you find effective positions to push to work with gravity and your body, not against it. So it just goes to show that support and environment play a huge part in the birth – not rushing it just because.
VBAC Sabotage #7: Suggesting an Epidural, ‘Just In Case’
An epidural, just in case? Is that ‘just in case' your other earlier attempts to de-rail my VBAC doesn’t work? Then I end up stuck in the bed, flat on my back and unable to move around during labour?
This can then be followed by baby getting stuck in a bad position, and mama not being able to push very well, because she can’t feel a thing. And hey, if baby needs to be rescued, thank goodness the epidural was already in, just in case!
Not only is an epidural totally unnecessary and adding an intervention (remember, when you need one, you need more, starting with a urinary catheter as you wont be able to feel your bladder), but it’s not a very good energy to have hanging over your head, knowing that your doctor put something in place for anticipated failure. If you or your doctor thinks it's hard to trust your body now… well it’s much harder to trust your body to work like it should under the effect of an epidural.
Epidurals result in more assisted births, including forceps and vacuum, which may even turn into c-sections. This is because the woman is no longer able to be active and working with her body, moving her pelvis to help bring baby down for birth.
VBAC Sabotage #8: Suggesting a Bung (for an IV line), ‘Just In Case’
See above. It's not demonstrating trust in the process.
VBAC Sabotage #9: Telling Women to Come Into Hospital As Soon As Labour Starts
Tick, tock, tick, tock…. can you hear that? That’s the clock your doctor just placed above your head the moment you walked through the labour ward doors. And if you don’t hurry up and get that baby out in the time he or she sees fit – while you bolt (or should that be waddle, because pregnant women aren’t designed to bolt) barefoot across the minefield of booby traps listed above – then I am sure by now you know where this is headed…
Usually, the longer you stay at home, the better your labour will progress. You may consciously or unconsciously assume that the sooner you’re in hospital, the sooner you’ll have your baby, but unless you’re planning on a caesarean section or induction, this isn’t always the case. In an environment of familiar sights, smells, safety, relaxation, comfort and privacy, your labour will establish quicker and easier than an environment of timers, lights, pressure, pokes, prods, noise, sterile smells and anxiety triggers. Unless you feel frightened or unsafe at home, its the best place to be in early labour.
An investment of time at home before going in will pay off – going in too early can slow down or stall your labour and you will be put on the clock. You’ll know when you really need to go in.
What Can You Do?
If your baby and your body are well and happy, then you can rightfully refuse any medical procedure being offered to you. It is important to educate yourself about VBAC so you feel confident making your own choices and decisions, and most importantly having the confidence saying NO, which many women and men struggle with when speaking to doctors.
If your doctor or hospital has one or more of the above restrictions in place, then they are NOT VBAC friendly. They might agree to give your labour a go (which they may call a ‘trial of labour’), and ironically many women feel grateful and appreciative of being given a chance to prove that their body works. Well, it does. However when being given a ‘trial of labour’ your carer is not trusting your body – until it proves itself capable. You need a carer who trusts your body, even at some point if it shows that it needs help – not put it on ‘trial’. Some labour is so much better for your baby than no labour.
Each and every one of the above restrictions piles on the likelihood that you wont get your VBAC.
Things you can do to take control over your experience and increase chances of a VBAC include any of the following:
- Choose a new obstetrician if you are in private care
- Choose public care – some public hospitals have higher VBAC rates than some obstetricians
- Hire a doula – there are so very many benefits to having a doula no matter what sort of birth you are having.
- Hire an independent/homebirth midwife – you can privately hire your own independent midwife who will support you as a doula would, but with more extensive training. I believe independent midwives are the gold standard in maternity care for low risk women. At less than 1%, I think you’re low risk for uterine rupture. Thats more than 99% that says you will be perfectly fine.
- Consider a HBAC (home birth after caesarean)
It’s up to us as women, together with our partners, to put our feet down, research and make our choices very wisely, based on whats best for our babies. You’d research what big screen television you’d like to buy – so make sure you research for what will be a life long memory at your next birth.
Recommended Reading For VBAC’ers
- Birthing Normally After a Cesarean or Two
- Silent Knife: Cesarean Prevention and Vaginal Birth after Cesarean
- The Thinking Woman’s Guide To A Better Birth by Henci Goer
VBAC Support Groups
It’s important to be involved with some form of VBAC ‘cheersquad’ – online is great but offline is even better.
Here are some links of offline support groups, which I will add to as I find more.