VBACs! Let's talk about them.
Because we’re obsessed with learning from some of the best in the birth world, we talked with Mina’s own Heather Christine Struwe about this topic.
What You Need to Know about Cesarean Births and VBAC Births
First, let's address that Cesarean births are a necessity for some babies to come into the world safely. And we’re grateful for the option when it’s medically necessary to save the life of a birthing person or a baby. On the other hand we can't argue that since the medicalization of birth, surgical births have skyrocketed. And there is a lot of research and investigative journalism that shows the conditions in which we need surgical birth maybe be actually caused medicine. Take for instance "failure to progress" and how hospitals put you on a time schedule. Once you're in the hospital, the interventions start and often begin the cascade of interventions.
But just because you’ve had a Cesarean birth in the past -- whether it was caused by interventions or if you had a one-time medical reason like placenta previa -- doesn’t take away the option for a vaginal birth after a surgical one. In fact, the American College of Obstetricians and Gynecologists (ACOG) states that a Trial of Labor after Cesarean Birth (TOLAC) to achieve a Vaginal Birth after Cesarean Birth (VBAC) is safe for most birthing people. And the CDC data shows evidence that a VBAC is usually safer than multiple surgical births (reference image at the end of this post).
But instead of just dive into the data, we wanted to hear from a professional who works with VBAC birthing people and has also experienced a VBAC. So we sat down with Heather Christine.
Heather is a licensed Physical Therapist in Minnesota (and has loads of experience in leading PT programs in large hospital and clinical settings that spans from inpatient orthopedic/neuro to outpatient aquatic therapy and in-home care), she’s also trained in group fitness and yoga. Heather came to an “epiphany about becoming a doula” after supporting births in non-professional settings. She fell in love with birth work and became DONA certified eight years ago. She’s been supporting birth ever since in birth centers, homes and hospitals. She’s also a CLEC (Certified Lactation Educator Counselor), MUTU Pro®️ and “uses therapeutic exercise for prevention and treatment of core and pelvic floor” (PT is probably handy there). She’s also an Evidence Based Birth®️ instructor.
Wow. That’s an impressive list of knowledge and experience. But Heather also has a unique perspective on TOLAC and VBAC because she’s experienced those things firsthand. At the time, she didn’t know all of the ins and outs of the birth world since she wasn’t a doula back then but felt lucky in finding an amazing provider group from the start of her second pregnancy. They gave her the support and confidence about going forward with a TOLAC to achieve a VBAC.
She needed their continued support, because family members expressed their concern about her choice and tried to persuade her away from a VBAC by sending research articles about “catastrophic outcomes” in a small percentage of birthing people that go through an unsuccessful Trial of Labor After a Cesarean. Her family feared for her health and safety. It’s a mindset that can be hard to shake from our culture. Medical recommendations used to be, “once a Cesarean birth, always a Cesarean birth.”
That’s not the case, or what evidence supports. But Heather pointed out that it often takes about 10-15 years for evidence to become practice. Because of lack of evidence-based practice, limited knowledge and fear-based decisions, there are providers and hospitals, even today, that on paper say they’re supportive of VBACs but will try to dissuade pregnant parents by using language and sway tactics that aren’t in favor of TOLAC. Heather describes it as VBAC tolerant rather than VBAC supportive. It comes from a time when the evidence wasn’t there (or recognized) to prove that TOLAC is a safe option for birthing parents.
There are some complications in a small percentage of birthing people that can come from trying for a vaginal birth after a Cesarean birth. It depends on some factors such as what type and the location of the incision during the surgical birth, the amount of Cesarean births prior to a TOLAC, maternal age, multiple babies, and other health-related issues like preeclampsia and placenta accreta. A Cesarean birth may also need to occur in subsequent births if the same medical condition is still present that caused the first surgical birth. But there’s a ton of research from multiple sources, as well as a private panel commissioned from NIH that recommends TOALC and VBACs and states they’re safe and a great option for most parents.
In fact, not only are they safe, but they help to eliminate some of the complications that come from surgical birth in general and multiple Cesarean births. The chances of “hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as placenta previa and placenta accreta,” are less with a VBAC when compared to multiple surgical births.
Heather feels blessed with her TOLAC outcome but doesn’t always share with her clients that she’s experienced a Cesarean birth or VBAC, because she wants the focus to be on her clients, their birth, and their decisions but if it helps support them in their wishes to go forward with a TOLAC, she will.
She also understands that a VBAC is like any other birth; it’s just a variation of normal. But because she’s been there, she also knows that technically that’s true but there can be baseline fears from society that come into play for some people. Emotions from the previous birth experience can also happen. She personally understands that mindset and gives continuous support in pulling that person back into the present state of the current birth. She also wants parents to be fully aware that if a birthing person needs to move to a surgical birth, that there are no expectations, and no one is disappointed.
To those thinking about a TOLAC there are ways to distinguish between VBAC tolerant and VBAC friendly. Heather expressed one of the biggest factors, “Where you birth matters, and the expectations are different for VBAC at each birthplace. It is important to ask your provider questions about any differences in care specifically for VBAC that could include requiring a saline lock/IV access and continuous monitoring.” She also stated, “I highly recommend having a doula, even though in full disclosure I didn’t have one… we thought about it but ultimately, I let others make that decision for me. Even though I feel so blessed about my outcome, I do wonder about how certain aspects would have been different with a doula.”
Doulas have their hand on the pulse of the birth world and can direct those seeking a successful TOLAC to providers and birth places that will provide the best support needed. Heather also tells her clients to ask their providers or birth places what type of restrictions they have on when to induce or what methods are used with induction because not all kinds can be used for a VBAC. She expressed, “It’s important to ask your provider open ended questions so that you don’t lead them to the answer you are hoping for. Open ended questions like, ‘What are your standard interventions for VBAC that are not standard for non-VBAC?.’”
In the end, because of her own experiences in birth and observations as a doula, Heather encourages all of us to “choose your medical team well and then find the people that truly support your decision,” and also reminds us to, “not second guess yourself because you make the best decision in the moment, with the information and support that you have at that time.”
We’re so thankful for birth workers, like Heather, to be an advocate that works to support parents both physically and emotionally with vast amounts of knowledge, intuition, kindness, and evidence-based care.
Are you looking for support or have a TOLAC or VBAC story to share? We’d love to hear from you.