To VBAC or Not to VBAC

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    Great article Borrowed from the UK Vbac yahoo group.

    To VBAC or not to VBAC

    For women who have previously had one or more caesarean sections, many have clear preferences for future births. Some women prefer to choose a repeat caesarean and other women have strong instincts towards a vaginal birth. The risks and benefits of both are relatively well known and the purpose of this article is not to take another look at them. Anyone wishing to know more about each would be well advised to have a look at for a starting point and further reading suggestions.

    This article seeks to give ideas on how mothers can maximise their chances of achieving a vbac (vaginal birth after caesarean) if that is what they wish to do. Of course, every woman and labour is different and these are just ideas to get started with and see how they feel!

    Place of birth

    Sometimes mothers with previous caesareans are given the impression that hospitals with immediate facilities for a repeat section are the only place suitable for a “trial of labour.” Of course, many women will find the hospital environment with such things nearby reassuring and could not imagine choosing another birth place. There will also be mothers who found the hospital environment inconducive to labouring with their previous birth and who then wish to avoid lack of privacy, time constraints and numerous changes of carers for a subsequent birth. It is not so much the environment as the mother’s feelings about the environment that will assist or hinder her labour there, sometimes to dramatic effect. Women need to feel safe in their chosen place of birth.

    In the UK Mothers with previous caesareans have the same choices as any other pregnant woman in our country and can book for a home delivery like anyone else (sadly not the case in Ireland anymore). This can be one way of keeping the birth on your own terms and maximising your right to privacy, peace and quiet and so on. Michel Odent writes eloquently on the effects these factors have on the hormones of a labouring woman.

    Labour companions

    Women attempting vbac need to feel confident in their ability to give birth. A clear factor in maintaining this confidence is whether those who are also present at the birth also believe the woman will give birth vaginally. As Sheila Kitzinger says in her book Homebirth and other alternatives to hospital:

    “Anxiety is contaminating. Anyone who is apprehensive around a woman in labour communicates his or her own fear, and can have a negative effect on the labour.”

    For this reason, it is well worth spending time talking with your husband or partner and anyone else who may be supporting you at the birth, about your plans and how you feel about the upcoming event! It is worth noting as well that the National Institute for Clinical Excellence (NICE) Caesarean Section Guidelines state that having continuous support from a female decreases a woman’s chances of a casearean section ( If you don’t have a friend/mother/sister etc you’d like to ask, you might like to look into a birthing doula.

    With woman?

    More difficult to arrange is the medical professionals who will attend your birth and how committed they will be to your vbac plans. Women having a hospital vbac will almost certainly be seen by a consultant obstetrician in Ireland. Be wary of anyone who refers to your vbac as “trial of scar” and talks about what you will be “allowed” to do. This is actually the birth of one of your children from your body, and care that works from this perspective will consider your wishes more seriously. It is you who does the allowing.

    It is no secret that obstetricians are experts in abnormal birth and midwives the opposite. If you are planning to have a normal birth and do not have other medical problems you wish to consult an expert about, there is no reason to involve an obstetrician in your care unless you wish to. There is still the burning question of your midwife – who will you get on the day? Some vbac-ing women feel they need real continuity of care to get the birth they want and this can be difficult to achieve in Ireland. In the unlikely eventthat you are really unhappy with the person you get on the day, ask your birth partner to request a new midwife. Never be afraid of offending – this is your opportunity to get the birth you want and you won’t get a second chance at it!


    Many vbac candidates are continuously tethered to the electronic fetal monitoring (EFM) in the expectation that this machine will indicate if the uterine scar is rupturing. This carries its own risks in terms of limited mobility, which in turn leads to slower progress and ultimately a vbac which is clock-watched can end in a repeat caesarean for “failure to progress.” EFM is also to have a high false positive rate, showing potential signs of fetal distress in a baby which may be fine. The over riding question is whether taking on these extra risks results in a safer vbac attempt for mother and baby, but this question remains unanswered. Scar rupture is so rare that few health professionals have witnessed it and so opinion on symptoms of it vary. Many midwives and obstetricians believe that the first (and sometimes only) indication of a problem would be a rise in the maternal pulse, and that the last symptom to show itself would be the effect on the baby as shown on the EFM. Have a look at Mary Cronk’s guidelines at for more thoughts on this.

    Monitoring is an intervention that women can accept or reject like any other care offered and you are well within your rights to ask for intermittent monitoring by a midwife with a Doppler or Pinard (ear trumpet). The added plus for this is that you will then have 1:1 care which evidence again shows increases a mother’s chance of a straightforward birth! The monitoring you choose to accept can have a huge influence on the outcome of your birth and is well worth researching further.

    Induction and other interventions

    Evidence suggests that induction increases the small risk of scar rupture, although every mother facing possible induction would need to weigh this up against the different risks that repeat caesarean poses. Of all the induction methods, prostaglandins are the most “risky” increasing the risk of rupture to 240 per 10,000 for prostaglandin inductions ( uk/cg013) . Women who are past their E.D.D and are offered induction would want to make informed choices about what to do. A post-dates pregnancy (according to the World Health Organisation) is from 42 weeks and is not necessarily a reason to induce: extra monitoring can be requested instead and there is always the option to do nothing and await events. Check out … uction.htm
    for futher information from a midwife on this topic.

    So much to think about, so little time?

    It can sometimes feel like you need to read hundred of books and websites to have a chance at achieving the birth you want! I’ve heard vbac women say they forget they are having a baby they are so absorbed in organising the birth!  While it’s a good idea to make informed decisions and give plenty of thought to what you need, remember that birth when treated respectfully is an instinctive and natural process. If you are planning a vbac, surround yourself with people who are positive about your ability to do this.
    • Connect with women who have had vbacs or tried for vbacs in the area and find out what worked for them. Build up a network of support.
    • If you feel like you might have unresolved issues about your past experiences, you could try asking an Independent Midwife to review your notes (many will do this for a small fee whether you are booking independently or not) or phone Sheila Kitzinger’s Birth Crisis hotline (see for the number).
    • Writing your birth story or stories can also be cathartic.

    Often understanding what happened last time is the best way to work out what you need this time for things to be different. Find someone who can listen without judgement as you work out what this means for you.

    Further reading and websites – First and last stop for cs/vbac info! & – Association for Improvements in Maternity Services – Lovely birth stories – This is an unrivalled resource for women planning vbacs. Whatever your dilemma, someone on this forum will have some advice for you and the evidence to back it up! – Evidence based site including vbac information, useful even if you aren’t planning for homebirth.


    Tried for VBAC but it didnt work out for me, Rabbie was very very happy to hear I wanted to try for a VBAC


    I had a previous section and was keen to try for VBAC second time round, have to say Dr. Harkin was very supportive of this and she explained how I still had a risk of a section (due to gestational diabetes..), but that we would monitor everything nearer the end to see how things were, she didn’t try to persuade me not to try but was realistic with me.. I had a VBAC this time, which was a big shock to me, as I believed that I would have a section again!

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