What Are the Odds of Having a VBAC? A Guide for Birth Educators

12 Sep

These guidelines are based on the content of the VBAC Education Project. 

Planning a VBAC presents different challenges for different women. Some are ready to face labor head on without any drugs for pain relief choosing instead a variety of comfort measures, doula care for emotional and physical support, and a midwife as their primary care provider. Others, who may have had a long, difficult, and painful labor before having a cesarean may feel they can only go through another labor if they have dependable pain relief (an epidural), the safety of electronic fetal monitoring, and the reassurance of an “immediately available” physician and operating room staff in case of complications. Every mother’s choice should be respected. There are many ways to support women who labor for a VBAC within their self-selected birth choices.

ACOG’s guidelines for VBAC suggest there are factors that are likely to increase women’s odds for completing a VBAC:

  • A prior vaginal birth;
  • A healthy pregnancy weight;
  • The prior cesarean was for malpresentation (baby in a non-vertex position);
  • Going into labor at or near term;
  • Labor that is not induced or augmented;
  • The bag of waters having ruptured on its own or the cervix having started to dilate before admission to the hospital labor and delivery unit;
  • No complications in the current pregnancy such as preeclampsia.

However, there are other important factors that can make a difference in whether or not a mother will complete a VBAC.

Evidence is mounting and validating what many maternity care professionals have always known, that health outcomes are better when the process of labor is allowed to unfold on its own (physiologic birth) without routine medical interventions and when mothers are full participants in their care. Women are more likely to get the support they need and the care that is best for them when care providers collaborate to bring about healthy outcomes for mothers and babies (Goer & Romano, 2012).

Simkin and Ancheta (2011) have demonstrated that women can have an easier and safer birth when they feel safe and respected by their caregivers and when their values and preferences are taken into consideration. When they have freedom of movement and can stay in upright positions as long as they feel comfortable.

Routine Interventions and Electronic Fetal Monitoring

žAvoiding routine interventions helps labor progress, but with a VBAC, monitoring the baby’s heart rate is important. žThe baby’s heart rate pattern frequently changes when the uterine scar separates.ž Up to 70% of the time electronic fetal monitoring (EFM) has detected an abnormal heart rate pattern, suggesting a separation of the uterine scar (ACOG, 2010).

žSome care providers recommend continuous EFM in active labor. Even with continuous monitoring for a hospital VBAC it’s possible to change positions, rock in a chair, stand and move side to side, lean over the back of the bed or a birth ball and use an upright position for birth. A telemetry unit (portable fetal monitor), or a waterproof hand-held Doppler allows mothers to walk, change positions or use the birth tub while monitoring the baby (Simkin & Ancheta, 2011).

Implications for Educators 

The concept of physiologic birth, allowing birth to proceed without interventions unless medically necessary, moving around in labor, and avoiding an epidural in the early stage of labor will probably be new for most of your students. In U.S. hospitals the majority of women experience multiple interventions, two out of three women have an epidural for pain relief in labor, only four out of ten have freedom of movement once labor begins and more than six out of ten are on their back for the second stage of labor (Declercq, Sakala, Corry, et al., 2013) . 

To help women clarify what options are available to them and how they prefer to give birth use the list of suggested questions in the Educational Handouts For Parents for Module 4 to begin the conversation so that they have the time and opportunity during pregnancy to get the answers they need.

The questions are designed to encourage parents to feel comfortable asking questions of their caregivers and to find out more about their provider’s approach and philosophy of birth. The discussion will also help partners themselves to find out if their views about having a “safe” VBAC are similar or different. Partners may decide they can both benefit from the expertise and support of a doula.

Mothers have their own unique preferences for how they want to give birth and what they need to labor safely for a VBAC. Educators have the tools and knowledge to support them and give them the confidence they need.


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