Whether or not you will have a VBAC is dependent on many things other than your health or the health of your baby. Who you choose as your careprovider, where you choose to give birth, and what tests of procedures you may have during pregnancy make a difference. By making informed choices you lower your odds for having a cesarean delivery. Here are the important issues you want to think about.
Explore Your Options for Care Providers and Place of Birth
Evidence shows that for healthy low-risk pregnant women, care provided by professional midwives reduces the risk for cesarean section when compared to care provided by physicians for a similar group of women. Family physicians also have a lower rate of cesareans compared to obstetrician/gynecologist. You may want to find out more about access to midwifery care and accredited birth centers in your community and coverage for midwifery services by your health care insurance provider.
Childbirth Connection, Choosing A Caregiver
CIMS, The Birth Survey
Giving Birth With Confidence Blog, Finding Mother-Friendly Care – Some Questions to Ask
Have an Early Ultrasound to Determine Your “Real” Due Date
Many women have their labor induced because they have been told that their pregnancy has gone past their due date. Induction of labor for healthy women increases the risk for a cesarean. About 4% to 14% of women do not go into labor on their own by the end of the 42nd week. Calculating the due date by going back to the first day of the last menstrual period, as it is often done may be an inaccurate form of measure. This method is based on a 28 day menstrual cycle. If a woman’s cycle is other than 28 days or if she became pregnant while she was on oral contraceptives or soon after their use the date may be off by three days. Often women are induced because they don’t go into spontaneous labor by their due date increasing their risk for cesarean section. Evidence shows that calculating the due date based on an early ultrasound scan is a more accurate method of estimating the due date and would avoid induction for an otherwise post due pregnancy.
Avoid a Routine Ultrasound in Late Pregnancy (after 24 weeks gestation).
Some care providers recommend a late pregnancy ultrasound routinely, even for women with no medical risk factors. Research shows that routine late pregnancy screening does not improve health outcomes for mothers or babies when compared with women who do not have the screening. However, routine late pregnancy ultrasound screening can potentially increase the use of major interventions including a cesarean section.
Avoid Screening for a Big Baby (Macrosomia)
Sometimes a care provider recommends that a woman be screened (by X-ray, ultrasound, computerized tomography scanning or magnetic resonance imaging (MRI) to determine the weight of her baby at birth. Based on these measurements the care provider decides whether or not the baby is “too big” to be born vaginally. This is called pelvimetry. Pelvimetry is an inaccurate method of predicting the size of the baby and cannot predict whether or not the baby will move down through the mother’s pelvis. An ultrasound screening has an error margin of 10% to 20%. Women who have pelvimetry are more likely to have a cesarean, but there is no evidence that the health outcomes of babies are improved. Medical experts state that pelvimetry should not be used to make decisions about a vaginal or a cesarean birth.
Avoid an induction of labor
An induction of labor is a complex and painful process that often requires additional medical interventions to keep the mother and baby safe from subsequent potential complications. Confining the laboring mother to bed, the use of continuous fetal monitoring, an epidural for pain, and the use of an IV, are standard with an induction. Induction of labor is a risk factor for several complications for both mother and baby including a higher risk for a cesarean section. Inducing labor with pitocin when the cervix is unripe (long and closed) sometimes causes the mother to labor for long hours with little progress. Cesarean section after a failed induction with pitocin is not uncommon.
Elective induction also impacts newborns. All induction agents increase the risk for stronger than normal contractions (uterine hyperstimulation), affect the baby’s oxygen supply and consequently its heart rate (fetal distress). Newborns are more likely to experience shoulder dystocia (a life-threatening complication of secondstage) with labor is induced. At birth they are more likely to need neonatal phototherapy to treat jaundice, to need resuscitation, and to need treatment in an intensive care unit.Elective inductions are also a risk factor for preterm birth.
Childbirth Connection, What You Need to Know about Induction of Labor
Mother’s Advocate, Let Labor Begin On Its Own, video
March of Dimes, Induction By Request
Consider hiring a doula. (see Doulas Can Increase Your Odds for a VBAC on this website)
Mother’s Advocate, Have Continuous Support, video
Contact A Mother’s Support Group. (See Support Groups on this website.)
During Labor and Birth
Avoid routine hospital practices known as “the cascade of interventions.”
Mother’s Advocate, Avoid Unnecessary Interventions , video
Childbirth Connection, Cascade of Intervention in Childbirth
Move around and stay upright as long as you can during labor.
You have a better chance of easing your labor with a big baby when you are free to move and change positions in labor and birth. Find out more about helping labor progress and discuss your options with your care provider. This will help you make an informed decision about the best way for you to have your baby.
Mother’s Advocate, Walk, Move, and Change Positions, video
Penny Simkin, Comfort In Labor
Paula Perez, Pros and Cons of 11 Labor Positions
When it’s time to push the baby out, don’t push while lying on your back.
Lamaze International, Avoid Giving Birth On Your Back
Mother’s Advocate, Follow Your Body’s Urges To Push,video