When preparing for a VBAC, making a long must-do list is easy. We may think we had a cesarean birth because we failed to do “something” during our previous pregnancy. Maybe we felt that we didn’t exercise enough, or we must have eaten wrong, which caused us to develop that complication.
But, no matter how we prepare or how much we do or don’t do, we cannot guarantee a birth outcome or specific experience. We can, however, set up the parameters for being treated with respect by our team and given the best opportunity to have a vaginal birth (if that is your desire) or knowing when a repeat cesarean may be more optimal.
1. Find a VBAC Supportive Provider
This is possibly the most important aspect when preparing for a vaginal birth after a cesarean. If you have a provider that truly supports your birth desire to have a VBAC, you will likely find that you feel much more relaxed and have a lot more trust in your provider. You’ll also be given a chance to try!
In my births, because I completely trusted my provider (although I have not had a c-section), I knew I needed it if she recommended an intervention.
I had a client preparing for a VBA2C (vaginal birth after two c-sections), and we drove over 2 hours to find a supportive provider. When I asked her if she trusted that if this new provider recommended a c-section that it was one she needed, she said absolutely. She had a VBA2C.
If my client had a VBAC tolerant provider or a provider that sets a lot of “rules” on their labor and birth, they usually find that in the final weeks of their pregnancy, they are met with a lot of frustration due to sudden scheduled c-sections or inductions, or pressure from their provider to perform.
They may be told, “Oh, your cervix is still 1cm, so you’ll never go into labor. We should just schedule the repeat c-section.” But, cervical dilation is not a predictor of the onset of labor.
Or they may say, “Oh, well, your last birth, you didn’t have a vaginal birth, so it’s unlikely you’ll have one this time. Your VBAC calculation is about 40%.” This usually does not consider WHY you had a c-section and how that reason may or may not affect your upcoming birth.
I had a client whose baby had gone into fetal distress as the reason for her emergency c-section and was told that her chances of having a VBAC were small because her baby was too big. But her baby’s size was not a factor in her previous c-section, so it was odd that this was even a concern. She had a VBAC.
Choosing a supportive provider is what I would consider the most important thing to do in preparing for a VBAC.
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How to find a supportive provider
But, how can you even go about finding that supportive provider? Maybe there are limited providers in your area, and you have already found some resistance to their VBAC support. You may need to travel to find a provider, especially if you have had multiple cesareans. Usually, bigger cities will have more providers supporting VBAC, but small towns may also have some!
You also are not necessarily limited to a hospital setting; in some states, VBAC is supported in birth centers or home birth! If your state has restrictions on what type of providers can support VBAC, you may still have options! It is worth exploring options with local doulas.
My tips for finding a supportive provider are to:
- Ask local doulas (ask a few because they may have differing experiences)
- Ask in local parenting groups
- There are even VBAC-specific groups, such as the VBAC Link Facebook group, where you can ask other folks who have had a c-section and VBAC!
If you find that you do not feel supported by your current provider, or they are placing rules on your birth (such as you must go into labor by X date), you can switch providers!! I had a client switch providers on her due date!
2. Prepare the Body
After preparing the support environment for your birth, we can focus on the physical environment for your baby! There is a lot of mental preparation involved with preparing for birth in general, but this blog will be focused on the physical!
C-Section Scar Mobilization
After surgery, scar mobilization is typically provided under the care of a physical therapist. Unfortunately, not many who have had a c-section are referred to physical therapy.
Scar mobilization supports how the tissue is healing under the incision site, and can support more optimal function.
When you have a c-section, the incision is through 7 layers:
- Skin
- Subcutaneous Tissue
- Fascia
- Rectus Abdominal Muscles
- Peritoneum
- Uterus
- Amniotic Sac (Does not remain after birth)
When healing from a cesarean birth and in preparation for a VBAC, we want to ensure these layers glide smoothly over one another. If there are adhesions, or sticky points (which may feel like pulling or tugging), it could interfere with your baby’s path during birth. It may also affect your comfort throughout your pregnancy (and life in general).
We can still do scar mobilization throughout pregnancy! You may not be able to go as deep as if you were not pregnant, but we can still work on our scars.
Working with an in-person physical therapist can be a great starting point to address your scar, but if there are limited options, our in-house physical therapists can do virtual consults to support your scar healing.
We also offer a c-section scar mobilization course and live webinar with Casey Backus, a physical therapist and 2x c-section mom, to provide general education on approaching scar mobilization!
Pelvic Floor Preparation
The pelvic floor plays a huge role in birth! The pelvic floor influences your baby’s head position, which may present smaller or larger. Baby’s head position plays a large role in birth, so supporting a chin tucked position is beneficial!
Working on an even tone or tension throughout the pelvic floor can benefit labor preparation!
One of my favorite ways to work on pelvic floor movement and address uneven tension is to do breathing drills! See the video below.
If you feel that you have any pelvic floor issues, working with a pelvic floor PT during pregnancy is a great option! There are so many PTs that now offer in-person and virtual support so you have a lot of options!
Pelvic Mobility
The next component of your baby’s path through the pelvis for birth is the actual physical structure of the pelvis!
We want to ensure that we can open each pelvic level without compensation. Typically, it is the lower midpelvis that we may have more issues opening due to common prenatal postural tendencies. Focusing on emphasizing internal rotation at the hip asymmetrically can support pelvic mobility!
Watch the two videos below for more of a breakdown, plus an exercise to incorporate into your prenatal routine!
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Prepare for YOUR Birth
Preparing for a VBAC can be daunting. You may feel that you failed in some way which is why you had a c-section; or you may feel that your team failed you in some way; or you may feel that your c-section was totally necessary! There is no right way to feel about your birth!
You may be browsing all the forums to find a list of things to do to ensure you have a VBAC, but there is no list of things that will guarantee a specific birth experience. So, we can focus on creating a supportive environment by choosing a truly VBAC supportive provider, and ensuring the environment that baby is navigating is ready for them to descend and rotate through for birth!