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5 Provider Red Flags to Watch For: VBAC Edition

Updated: Apr 22, 2023

Who you choose to be present at your birth matters!!! Often times, when we discuss providers, it's easy to assume we mean doctors. Maybe this is because only 1% of women in the United States birth their babies at home, but it's important to distinguish that "providers" include all healthcare staff that will be attending you during your pregnancy, birth and postpartum. This can include doctors, but can also include nurses and midwives - in the hospital, birth center, or at home!

I trust women to know what feels right to them, and to use that information to make decisions that they think are best for themselves and their babies. When we are talking about birthing vaginally after a cesarean section (VBAC), it's extra important to hone in on your intuition - especially when you're working with healthcare providers who may not be familiar and/or comfortable with your birth priorities.

That said, mothers share plenty of stories about how their providers influence their births. The ways of which range from wavering confidence into submission - and straight up medical hijacking of an otherwise healthy, uncomplicated birth. I've compiled the most common red flags from the stories I've witnessed, so that you can be proactive about working with a provider that can truly serve you the way you're looking to be be helped, and that you have the power of information to guide your own further research.

As a side note, I can not emphasize enough how important it is that you and your provider both understand that the final decision making in every step of your prenatal, birth, and postpartum care lies within YOUR scope of responsibility, not the providers. Working with a provider to build a trusting relationship and mutual understanding is important, and when this feels one sided, thats a sign to move onto a better patient-provider relationship.

Let's Get Started:

Your provider wants to induce labor.

Why it's a red flag: The risk of uterine rupture in a VBAC birth, by itself, percentage-wise is low. Induction increases the strength, frequency, and duration of uterine contractions, which increases the risk of uterine rupture, and significantly increases the risk of hemorrhage, poor fetal oxygenation, and emergency cesarean and/or hysterectomy. Artificial oxytocin, known as Pitocin or Syntocinon is per haps the best known method of induction, but induction can include any pharmaceutical or manual mean of kick-starting labor before your body initiates it on it's own. This includes foley dilation, membrane sweeps, artificially rupturing your bag of waters (amniotic membrane), and use of of prostoglandin suppositories to soften the cervix. Cytotec is another drug commonly used, though not approved, to induce or augment (speed up) labor, and that poses much higher risks for emergent adverse effects in VBAC births.

Proactively, you can bring this conversation up with your provider during pregnancy, and talk to your provider and/or your OB nurses in early labor about preserving the integrity of your birth without induction methods . . . and of course, use this experience to gauge whether or not you are welcoming the right people into your birth space.

Your provider INSISTS you need to birth in the operating room.

Why it's a red flag: Statistically, VBAC in an otherwise uncomplicated birth is no more dangerous than any other regular vaginal birth. Bringing a healthy birth process into the operating room immediately affects that process mentally and physically for the mother.

Moving into a cool, sterile foreign room without the comforts of mobility and common accessory tools inhibits the mother's use of her primal brain, bodily comfort, and intuitive positioning. Birthing in the OR decreases the liklihood that "extra people," such as a partner, doula or other suppport person will be allowed to support the birthing mother - an inhumane circumstance to force someone into. In the OR, the mother will likely be told she needs to wear a hair bonnet and face mask, as well as have IV fluids hooked up, if not running. This can affect her comfort, but also increase the risk of other interventions that can quickly escalate into an iatrogenic surgical birth.

As with every birth, consider your personal comfort levels with your birth place as it applies to your unique circumstance - and make decisions that feel most aligned with your needs.

Your provider condensendingly refers to your upcoming VBAC as "trial of labor" or "VBAC attempt."

Why it's a red flag: Any provider that consistently refers to birth as a "trial" is in the wrong business. Yes, it is true that sometimes VBAC-intended births end surgically, for various reasons. . . AND it's important to note that VBAC rates are directly influenced by the birth attendant's beliefs about birth and their correlated actions, as well as the mindset of the mother. In fact, many, or maybe most, obstetric providers refer to all VBAC births as a TOLAC (trial of labor after cesarean) until a vaginal birth is completed.

A birthing mother who's provider knows how to witness without intervening, and who knows how to wait is much more likely to successfully VBAC than if her provider fed her distrusting beliefs about her intuition and body. If your provider feels the needs to be hands on, or otherwise discourages your capability to birth your baby until an urgency or emergency occurs, you need a new provider STAT.

Your provider adamently pushes for an epidural despite your wishes, "just in case" or "to get it out of the way"

Why it's a red flag: Epidurals can be great tools for any birthing mom to help her relax enough to rest and allow her pelvic muscles to gently open. Epidurals, like every other birth intervention comes with risk factors and influences the delicate hormonal blueprint of the birth process.

More importantly in this specific scenerio - a provider should NEVER adamently push for any birthing woman to have an epidural or any other drug that has sedative or immobilizing effects (and it feels awful that this needs to be said).

Any provider that insists that such interventions will occur in a matter of time anyway is not expecting a vaginal birth, and is not going to be supportive of your wishes - they're too busy anticipating the transfer to the surgical unit.

Your provider tells you they don't allow doulas in the birth room, or that they do not like to work with doulas.

Why it's a red flag: Providers who do not "allow" women to be supported emotionally and informationally are a walking red flag. Doulas who take the time to build strong relationships with their clients, understand their priorities, share information that many OBs do not, and continue to advocate for that client in a system that profits on mysogyny are an incredible asset to women who are inevitably going to birth within that system.

VBAC mothers definately can benefit from this extra layer of support, and can prompt the proper questions and buffers to common care that the mother does not wish to engage with. If your provider is in disagreement with you having this type of support, there is something other than you that they are trying to protect. Take your doula and run to a better provider (She probably knows one!)



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