In the United States, about 30% of births are primary cesarean sections, and of the women who have had previous cesareans, only about 13% of them go on to have a subsequent vaginal birth. If we listen to what women innately know about birth and their bodies, and pair that with the evidence shared by medically-acclaimed organizations like the World Health Organization (WHO) and the American College of Obstetrics of Gynecology (ACOG), it's easy to see that the rate of VBAC can and should be much higher.
Many mothers dream of having a vaginal birth after cesarean (VBAC). These women vary from those who are looking for a redemptive birth experience that validates or restores their trust in their bodies - to those who simply understand the vast benefits that VBAC has to offer them and their babies. Despite the statistical favor of VBAC, many women are faced with providers, institutions, and even systemic laws proclaiming "VBAC Bans": bans on their birth desires and capability to bring their babies forth physiologically while having a history of surgical births.
Well, I have good news for you: NOBODY CAN BAN BIRTH!
It's not fair or right to have to navigate a system built on opressing women, let alone needing to search for VBAC solutions when you deserve to be fully supported by any person you invite into your birth space. But I promise, there ARE solutions and there are women all over the globe, in your state, and in your town that support you in advocating for the birth you want . . . even if energetically through the thread of life that connects us all. Women know that better birth care exists, and that the option for utilizing women-centered birth care models is something that ALL women deserve access to.
So, lets explore your options.
1. You want a hospital birth, or maybe need one for any number of reasons, and there is a anti-VBAC hospital policy.
In this case, your options might feel narrower, but there is always an element of control that can give you a leg-up. It feels imperitive to say that while birthing within a hospital system, expect that the hospital will always operate within it's own system. Hospitals offer many emergency-related safety comforts, like rapid access to an operating room, but the birthcare options you are hoping for may not be offered to you, or at the capacity that feels good to you. Of course, understanding, compasssionate birth teams do exist within hospital structures, and you might be pleasantly surprised!
Within this structure, you have the power to hire a doula and/or keep your best support people at your side that know your rights and wishes. If your hospital or provider does not warmly welcome such support, that's a huge red flag to reevaluate the care you're willing to settle for and search for a new provider. You also retain the right to refuse any and all tests, screenings, and procedures regardless of the reason or potential consequence - this includes cesarean sections. If you are being presented with consent forms at a time that you have the headspace to read and process them, you can make notes or edits to the consent forms. Remember that there are exceptions to consent that can influence your providers actions (like if they deem an emergency that you cannot consent to, they can provide care to stabilize you). If you have the power to stay home before your baby's emergence, staying home as long as possible can help you avoid the cascade of interventions and avid clock watching that can encourage the high rate of ceseareans. It's important to keep in mind that providers often operate under liability pressure, and may not prioritize your right to refuse, or right to informed consent.
There's unfortunately a lot of gray area when talking about refusing cesareans in a "no-VBAC" hospital, so if you can, I'd highly recommend looking for a provider that is VBAC supportive and advocative - someone who lights up at the idea of VBAC and seems enthusiastic about supporting you every step of the way. I also recommend familiarizing yourself with the VBAC-related policies at various hospitals within driving distance, and keeping an open mind to interviewing midwives in non-hospital birth settings.
2. You want to birth in a birth center with a midwife.
Birth centers can be amazing options for your VBAC experience! Many families describe their decision to utilize birth centers as compromising between home and hospital based settings. Birth centers can be hospital-based or freestanding (not hospital-affiliated), and while they can offer a home-like environment, they still have medical equipment on-site and are often located fairly close to the hospital for emergency transfers. The type of experience you can expect at a birth center depends heavily on if it is regulated by the hospital, state regulations, your relationship with your midwife and their comfort and experience supporting women through VBAC births.
Some of these regulating bodies may place contraints on the spectrum of care that the midwife can offer. This does not mean having a VBAC here isn't possible or pleasant. Having an honest and thorough conversation with a midwife you trust, and getting crystal clear on what she is comfortable providing for you is the best way to gauge if you need to continue searching for other options, or if you're ready to settle in. Be sure to include discussions about overshadowing hospital policies, accomodations for non-medical birth support, and your homebirth options with this team of midwives.
3. You want a homebirth with a midwife attendant
Home is where the heart is, and there's a reason that birth unfolds at home so much differently than in a medical setting. When you choose to birth at home, your body can relax, opening up in a familiar environment, surrounded by your favorite comforts. Homebirth can happen with or without a midwife attendant, and you have the power to choose when you will call the midwife to be present with you.
Some midwives may be restricted by their licensing boards or insurance in regards to the "types" of homebirths they attend (like VBACs or multiples), but rest assured that some midwives are cool with living on the edge because they are committed to tending the needs of birthing women. Many midwives may be resistent to overstep their regulations, but even if you cannot find a licensed midwife to assist you, you still have options. For example, you might find a midwife that would be happy to help you with postpartum paperwork, or that there is a traditional, unlicensed midwife who would be honored to support your homebirth after cesarean (HBAC)!
4. You want a freebirth.
Yes, having a freebirth after a cesarean section (FBAC) is totally possible!! Many, or maybe most, women want to have the intimate support of a fellow wise woman at their birth. . . and it can also be liberating to birth in the primal environment of your own place, free of any observance. If you decide to FBAC, my biggest recommendation would be to communicate with your designated support people - about your priorities, your fears, and any potential plans of transfer that might occur leading up to birth. This way, you can find solace in knowing your support team is on the same page as you and that you can focus more on surrendering to the process of your birth.
Other considerations: Think creatively!
Even with so many options available, finding the perfect fit can feel a little tricky. I invite you to step outside of your comfort zone and think of creative solutions that bring more fluidity to your decision-making process.
If the hospitals or midwives in your state are imposed by regulatory bodies, are you able to travel out of state? Can you interview midwives in your neighboring state, asking if they can travel to you?
If you're finding that you feel utterly indecisive, take a moment to pause and reflect. What fears or priorities are driving your decisions? What information would help you feel more peace and stability?
Apart from a medical provider (nurse, doctor, midwife), do you have anyone who understands birth and can help you organize your thoughts and feelings for your VBAC?
A doula or birthkeeper is an excellent option, and can be local or consulted virtually.
Who do you visualize being part of your birth team? What are their roles, and how do they make you feel? Consider family, friends, and hired support - BONUS POINTS IF THEY HAVE VBAC EXPERIENCE!!
Whatever you choose for your birth, and however your birth unfolds, may you be enveloped in love from every person, every step along the way, and may you never forget your power.
DO YOU WANT MORE SUPPORT?
Then, be sure to stream our collection of VBAC stories on The Healing Birth Podcast!!
We also offer a private membership community in Mighty Networks, where you can connect more intimately to us & former podcast guests on all things birth & mothering. You can check it out here.