Cesarean sections (c-sections) have become fairly common, accounting for nearly 30% of all births (NPR). If you’ve had a c-section and are pregnant again, you may be considering your options for this birth.
For a variety of reasons, many women choose c-sections for any subsequent births. For some, a c-section is the only option, medically. Others, such as my friend Sarah, are able to try for a vaginal birth after c-section (VBAC).
We’ll begin Sarah’s story with a clarification of terms that she pointed out to me: Until the baby is actually delivered, the procedure is called a TOLAC (Trial Of Labor After Cesarean) by the medical community. The term VBAC is technically only in reference to a successful vaginal birth. You may see the terms used interchangably online and elsewhere. In this post I’ll use VBAC, as it’s more commonly used, at least in my experience.
1. What are the issues that women and their doctors consider, in determining whether a VBAC is an option?
The primary issue that your doctor or midwife will consider with you is the reason for your c-section. They will discuss the risks associated with a VBAC as well as the statistics on successful VBACs for your specific case. There are different success rates depending on the reason for the c-section and how many c-sections you have had (many places will not attempt a VBAC if you have had more than one c-section).
Each doctor is very different; some are more conservative than others when it comes to VBACs. If you are really hoping to do a VBAC and your doctor says no, seek out a second or third opinion before making a decision. The doctor who delivered my son via c-section recommended that I have another c-section, but everyone else I consulted felt that I was a good candidate. So don’t be discouraged if one doctor says, “No”, because it’s not written in stone. Unfortunately I lived with a year of disappointment before I found this out.
Another great source of information is of course the internet (just don’t trust this alone). It is an OB’s job to make sure you know all the risks associated with a VBAC and they can scare you a bit. But there are risks with any birth and risks with any c-section. The OBs will most likely focus on the risks of the VBAC, so do your own research on other risk factors and then talk over any questions you have with your doctor to make the best decision for you. In all my research I found that a successful VBAC is safer than a c-section, but a c-section following a trial of labor is more risky than just a straight c-section.
2. When did you make the decision to try for a VBAC?
Pretty much immediately upon finding out that I could! I was very determined. Even if I had not been successful, I think I would have regretted not at least trying.
3. What were your main concerns in approaching a VBAC?
My main concerns were the risks. I was worried that I might be putting my desires above the health of my baby. I use a midwife group for my prenatal care so I had to consult with an OB twice during my pregnancy. After both consults I was worried; this was due to the OB needing to make sure I was aware of the risks. After calming down from these appointments I was able to assess the risks more rationally, realizing how low the chances of the risks are (like rupturing your uterus – the chance is less than 1%). It seems really scary when you talk about it, but in reality I would never let that low of a chance deter me from something I really wanted.
4. Were others (friends/family, medical professionals) supportive or discouraging of your decision to try for a VBAC?
Everyone was supportive (except the initial doctor who I never saw again). My midwives were especially supportive, as was my husband. I have since learned that my husband had some concerns, but he wanted to support my decision despite them.
5. Did you do anything to prepare for a VBAC?
Nothing physically. Psychologically, I tried to prepare myself to be okay if I was not successful. But otherwise I approached it just like I did my first labor.
6. How did the recovery from your VBAC compare to that from your c-section?
It was night and day different – and so much easier. I actually had to remind myself to slow down because I felt so good compared to my c-section. With the c-section I was walking bent over for more than a week. This time I was up and walking normally (although a little slowly) that afternoon. Not having to worry about a surgical incision was a dream and not being on heavy pain medication was also wonderful. I felt much more present and aware during the first week after the baby was born.
7. Is there anything else you’d like to share with someone considering a VBAC?
For me, this was a dream come true. After seeing and hearing many birth stories and seeing babies placed right on mom after delivery, my c-section was an incredible disappointment. I wasn’t able to hold my son right away (it was over an hour before I was able to hold him) or even see him for the first 5 minutes. I was so drugged up that I honestly don’t even remember holding him for the first time. My daughter’s birth was so different (in many ways), but I especially felt that I got to experience something I had missed with my son. I remember her being placed on me and holding her immediately. While I obviously love my son and bonded with him despite his traumatic entrance into the world, there was something really sweet about my daughter’s birth that was lacking with my son’s.
Thank you, Sarah, for sharing your story, and welcome to baby Addison!
Obviously, this is one person’s experience, and seeking peronal medical advice is essential for each individual case. If you are considering a TOLAC/VBAC, here are some online resources:
After working at MagnetStreet for 7 years, I'm now a stay-at-home mom to my son Tate. I love my new life, but as a firstborn raising my firstborn, I tend to over-analyze most things. Join me as I try to figure it all out! 
