Choices in Birth Care Providers for VBAC Mothers
A mother who has had a prior cesarean does not always have an easy time finding someone to attend her birth, either in the professional care provider role or even for as something as simple as support. Many times, mothers find avenues closed to them when they say they want a vaginal birth after cesarean (VBAC). Since choices are often limited, BirthAction wants to outline what choices a mother does have when giving birth after cesarean and looking for care.
Obstetrician (OB) –
Obviously, the most mainstream and common of choices, some OBs do still attend VBAC births in hospitals around the country. This usually takes a fair amount of research to find one locally and they may have qualifying protocols which a mother needs to be careful to ask questions about and use her best judgment. There are also concerns about whether or not an OB truly supports VBAC mothers or is simply giving lip service until the mom gets so far along in her pregnancy. There are some OBs that give all the rest a fantastic name and not only support VBAC but also do VBAC with twins and breeches or VBAmC (vaginal birth after multiple cesareans) based on a mother’s individual risks, knowledge and care.
Certified Nurse Midwife (CNM) –
Second to the OB in the number of VBACs done, CNMs are also a more common choice, often practicing within an OB practice or birth center. While CNMs typically have some obvious drawbacks in being more medically-minded or using protocols that are required by law to be approved by OBs, CNMs are still a choice that many women make in trying to compromise between having a less-interventive but still vaginal birth and an elective cesarean.
Other Midwives (DEM, LM, CPM, “lay”) –
While often thought to be the same thing, different types of midwives also have different types of training while having one thing in common in helping women to have homebirths. VBACs are frequently done at home in many states in the US, often due both to the decline in availability in hospital providers of VBAC but also in concerns for the safety of the mother and baby and prevention of a repeat surgery due to interventions from the care providers that practice in-hospital. Women should be careful to do research about their midwife, her training and her philosophies about births, including handling an emergency situation. While concerns are often raised about the immediate available of cesarean in case of uterine rupture, homebirth has not been shown to dramatically increase the rate of rupture or of catastrophic outcomes. There is some question of the legality of midwifery in some states but many women choose to birth at home with a midwifery attendant anyway due to the same concerns of safety and realistic support of VBAC. “Traveling midwives” would fall under this category as well.
Some mothers also choose to have an unassisted or unattended birth. This does not usually mean the mother is birthing alone, without a support person, but it does usually mean that she does so without a medically-trained provider. The reasons for this are numerous, from religious and privacy concerns to an inability to find a supportive provider. Unassisted mothers are typically very educated women who research and trust in the birthing process being normal.