About VBAC

Not so very long ago, we used to say ''once a c-section, always a c-section''. This isn't true anymore. Having a VBAC, or a Vaginal Birth after Cesarean is an entirely possible option for women who have had a previous cesarean section and who wish to give birth naturally.

When a woman decides to have a VBAC, some things will be checked in order to evaluate if she is a good candidate. They will look at the reason for the prior cesarean, the length of time that has passed between the pregnancies (ideally at least 18 months), the type of incision that was made, the state of the uterine scar, the woman's motivation to give birth naturally, etc. All these notions will be taken into account and explained to the pregnant woman in order to help her make an informed choice. Having had a prior cesarean section does not count to classify a woman as a high risk pregnancy, which means that in Quebec, VBAC candidates have access to the services of a midwife.

Of course, there will always be talk of risks. The most talked about risk for VBAC, and which incidentally is a very much used argument to scare women, is uterine rupture, which happens in 0.2 to 0.6% of cases (about one to three women out of 500). Uterine rupture means the opening of the uterus during labor, usually on the site of the scar, that can happen to various degrees. But if we put things in perspective, this percentage of risk is comparable to the risk of losing the baby during an amniocentesis, a procedure that health professionals do not hesitate to recommend to women to screen for genetical problems in the baby. It is also interesting to know that the perinatal death rate for babies in VBAC is the same as for women giving birth for the same time.

We also often forget to mention all the risks associated with undergoing a repeat caesarean section. It is important to remember that a c-section is a major abdominal surgery that not only poses risks to mother and baby, but that especially implies a much longer and harder recovery time than with natural childbirth. Actually, one of the most often heard remarks from women who had VBACs is their astonishment at their speed of recovery with a vaginal birth compared with their surgical experience.

There is another medical attitude towards VBAC that I don't like. It is that in medical terms, when a woman wants a VBAC,  they won't say she's going for a VBAC, they'll say she's going for a TOLAC (Trial of labor after cesarean). If she succeeds, then they'll say she had a successful VBAC. It's like saying "We don't really believe you can do it, but we'll let you try and they we'll see".

I could carry on talking about the pros and cons of VBAC, the interventions to avoid, and the choices that are available to women. But there are already numerous books which do that very well. As a matter of fact, I highly recommend to you the book: Birthing Normally After a Cesarean or Two- A Guide for Pregnant Women, by Hélène Vadeboncoeur.
I would actually like to look at the side of VBAC that I consider the most important: the psychological side. Having a VBAC starts in your head. Do not let others discourage you with their fears. Once you have made your choice, believe in it. Also do the exercice of dealing with the trauma of your cesarean experience, and trying to make peace with it. There are many many different approaches, from traditional to spiritual to help you through that journey.

When we listen to women who have had a VBAC they all radiate this wonderful feeling of empowerment. This makes me think of one of them in particular whom I saw recently. She had her VBAC a few weeks ago. This usually shy young woman had a completely different vibe about her. You could feel how proud of herself she was, how healing that birth was for her. She was glowing. I thought she was so beautiful, just sitting there holding her baby, and completely in love. And this proud, empowering moment where she welcomed that baby into the world, this beautiful episode of deep healing of her previous birth experience, she, like so many other women , will be able to revisit it in times of doubt or hardship. What a wonderful gift from life!

So, here is some advice to put all the chances on your side for your VBAC (This advice is also good for any birth, come to think of it):
- Believe in yourself
- Hire a doula
- Go for a follow-up with a midwife, of carefully choose your hospital to make sure they are pro-VBAC
- Read and listen to positive stories of women who had a VBAC
- Make sure you know all your options
- Keep in mind that no one can force a woman to undergo a cesarean section without a medical reason.

Sometimes, life can also be unpredictable. So if, even following all the advice and being as ready as you can, another cesarean is required for reasons out of anyone's control, you will have the feeling to have tried everything and will hopefully be more in peace with the situation.

I also highly suggest you watch this new documentary called Trial of Labor. It just came out and follows the journey of a couple of women going for a VBAC. They all have different stories and different outcomes, but it is a really beautiful movie to watch, and very well filmed too!

There is also ICAN, the International Cesarean Awareness Network. It has a lot of information on cesareans, VBACs and anything related to that subject.

Have a nice day!

BUCKLEY, Sarah J., Gentle Birth, Gentle Mothering, Celestial Arts, USA, 2009, 348 p. 
GASKIN, Ina May, Ina May's Guide to Childbirth, Bantam Books, USA, 2003, 348 p. 
VADEBONCOEUR, Hélène, Une autre césarienne ou un AVAC?: S'informer pour mieux décider, Éditions FIDES, Québec, 2012, 380 p.