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If you’ve had a cesarean birth before, you may be curious about your options for your next birth.

Many people have the choice of scheduling a repeat C-section birth or attempting vaginal birth after cesarean — or VBAC. Some people choose a VBAC because it allows them to potentially avoid the risks associated with multiple abdominal births and experience a faster recovery time compared with surgery.

When planning for either type of birth, the first step is to talk with your provider, says Laura Salvatierra, RN, BSN, and team coordinator for perinatal education and support at Sentara Martha Jefferson Hospital.

If your provider gives you the green light to attempt a VBAC, having a birth plan and discussing any concerns with your team will go a long way in making sure your birth is a positive experience, no matter what happens.

Here are some of our favorite tips to help you plan for a successful VBAC:

1. Learn about VBAC.

If having a vaginal birth after a cesarean birth is what you want, it’s essential to do your research. The more you know and understand about VBACs, the better prepared you will be. This can include:

• Reviewing studies and articles online
• Watching informational videos
• Reading books
• Talking with your doctor

“How birth happens matters,” says Salvatierra. “It’s an experience you’ll never forget. So how it happens is something we want to prepare for to the best of our ability.”

Salvatierra’s favorite VBAC resources include:

This website and online community prioritize providing current education and research in a digestible form for families and practitioners.

Spinning Babies is a physiological approach to preparing for birth. “They’re all about creating the best opportunity for your baby to be in the optimal position for a vaginal birth,” explains Salvatierra.

2. Talk to people who have experienced VBAC.

Salvatierra recommends having honest conversations with those who attempted VBAC birth, and not just the ones who were able to have a successful VBAC.

“It’s important to talk to people who attempted a VBAC and needed a second cesarean birth for a more realistic look at the different birth experiences,” Salvatierra explains. “Based on my personal experience and work in support groups, I think we need to be better at not sugarcoating birth and recovery experiences. It’s important to hold space for both celebrating when things go well and practicing how to respond when things go unexpectedly.”

3. Find your VBAC-supportive providers, loved ones and birth location.

Having people in your life who believe in what you're doing is an important factor in your VBAC attempt. This includes support from your provider, family and friends, loved ones and in-person support groups.

Finding the right practitioner for you is one of the most important things you can do when attempting a VBAC. Your provider should have a strong record of VBAC success. You’ll also want to find a provider who is clear and upfront about supporting people who’d like to try a VBAC.

Discuss all the risks and benefits with your provider before deciding on VBAC. Not all people are candidates for VBAC, and some providers (doctors and midwives) may not recommend it. A physician or midwife will take into consideration several factors before supporting a VBAC, including assessing the type of incision a person had for their previous C-section, as well as the cause for it.

If you have the option of giving birth at a few different hospitals, take the time to tour them all and ask questions about their labor and delivery models of care. Not all hospitals can accommodate VBAC.

4. Be willing to let go of control.

“Parenthood is an opportunity for us — if we choose to see it that way — of practicing how we can let go of control,” explains Salvatierra. “Practicing letting go of control is a great way of preparing for parenthood in the long term, too.”

She advises parents to work on lowering their desire to control things when approaching the birthing experience, and that goes for VBAC births as well. A key component of this approach is your own mental and physical preparation. Salvatierra recommends finding coping strategies to practice when you’re feeling anxious or uncomfortable.

Preparation for a VBAC is helpful, but Salvatierra wants expectant parents to realize that a successful birth may look different than what was planned. Like any birth plan, the outcome of a VBAC can be hard to predict. While 60% to 80% of VBAC attempts are successful there’s a chance you may still need a C-section.

Having a “Plan B” and thinking about your preferences if things don’t go according to plan can make even an unsuccessful VBAC feel like a win. Talk to your provider about what type of medication you’d prefer if surgery is necessary, whether it’s an epidural, spinal block or a combination of the two. Consider your previous birth story. What went well and what didn’t? What is important to you about this birth? This knowledge can help inform your VBAC birth plan.

5. Think about both mental and physical health during birth.

Mental health is a bigger slice of the birth experience than is often given credit.

“Physiologically, if we are in a fight or flight fearful state during labor, oxytocin is not released from the brain the same way it is if we feel safe and supported,” Salvatierra explains.

She recommends finding ways to allow labor to continue uninhibited for as long as possible. For some birth experiences, this may mean laboring in your natural environment for as long as possible if your provider allows it.

A more grounded mindset during birth helps reduce muscle tension and helps your body naturally work through contractions more efficiently. And as anyone who has experienced significant stress understands, tensing up and feeling anxious leads to quicker emotional and physical fatigue. Lowering anxiety and tension can help conserve your energy and help labor progress more smoothly.

Don’t forget to process the experience.

After the baby is born, Salvatierra encourages new moms to work through their birth experience, whether the birth followed their desired outcomes or was difficult.

“I want new moms to take time to process their feelings,” she says. “It may be weeks or even months after the birth because when you’re a new mom, it’s hard to think about yourself. But you also need attention and healing, and you shouldn’t go through this alone.”

For those whose birth experiences didn’t go according to their wishes, she encourages moms to grieve the birth experience they hoped for, which allows them to heal. If the birth trauma persists, new moms should request a screening at their postnatal exam for postpartum depression, perinatal mood or anxiety disorders.

 

Sentara Maternity Services offers online and in-person maternity tours, classes and support groups for expectant parents. We also provide a number of postpartum support groups.