When patients come into L&D with the plan to VBAC with their current pregnancy I will usually advise certain things to see that they can have the birth experience they are wanting. Not all of the things on this list are indicators that if someone does them they will definitely have a VBAC, but could increase the chance that it happens.
1. Supportive provider
Interview providers during early pregnancy to hear their stance on VBACs and whether or not they support VBACs. Some providers will allow you to labor BUT only if you go into labor on your own before 39/40 weeks. Some will induce you but will only allow the Pitocin to go up to a certain amount and require the internal monitor to be in place. (Even though there is no research to support a certain level of Pitocin and/or an internal monitor limits uterine rupture from occurring)
Cervical ripening – does your provider do foley bulbs in VBACs if induction is necessary. Since Cytotec/cervidil is contraindicated in VBACs due to the increased risk of uterine rupture when those are used, some providers will use a foley bulb for induction (especially for PROM).
Some states allow VBACs at home or in birth centers
2. Spontaneous labor
Going into labor on your own vs being induced has a higher “success” rate of VBAC. This is where a supportive provider will be so important! Having a deadline on when you need to go into labor can make it more challenging to go into spontaneous labor. One, you may feel stressed out which may inhibit the onset of labor. And two, you may not go into labor before your due date or deadline just normally.
3. Movement through labor
The more you move throughout labor the higher the chance of vaginal delivery, for both VBACs and non-VBACs.
Wireless or portable monitors could help promote this. Most VBACs will be required to have continuous monitoring during labor. Learn what type of monitoring options are available for you with your birthing location on either a labor tour or asking your provider at a prenatal appointment.
Waiting till active labor for an epidural in both induction and spontaneous labor because it allows you to listen to your body cues to avoid the baby getting into a malposition BUT if getting it earlier ensuring you are being repositioned every 30mins!
4. Limit vaginal checks
This is more mental, labor can take a long time and if someone is checking your cervix every 2 hours this can mentally break you down if you aren’t making a ton of change every time they check you. Also, this will decrease the chance of developing an infection (especially if your water is broken) which increases your chance of a VBAC.
5. Knowing what your ultimate goal for the birth is and how will those guide your decisions during labor - not just vaginal delivery vs c-section but things like:
have a baby not go to NICU/Nursery or have nonroutine testing– may guide you to get certain interventions to limit the stress on the baby, for example, if you develop an infection baby may need to go to the NICU for testing or getting an IV
breastfeed within the first hour of life – may not be able to if you have any complications with delivery
if have to have a c-section do you want to be awake or put to sleep
6. Having a birth plan for if an unplanning C-section does have to occur
If you do end up with a c-section, what birth options do you want? Having this decided prior to will help ease the transition to the OR. Does the hospital have a clear drape? Window in the drape to drop so you can see the birth? Will they drop the drape at birth or hold the baby over the drape? Learn more about preparing for a c-section birth in our complete childbirth education course and VBAC prep bundle, where we will discuss possible options available and conversational prompts to have with your provider.