Giving Birth After Cesarean Surgery
When I was pregnant with my third daughter, someone said “oh, you are having a VBAC?” and I replied, “No, I’m just having a baby.” – Shannon Mitchell
What is a VBAC?
Vaginal birth after cesarean (VBAC) is not a procedure. It’s the act of giving birth vaginally after having had a previous cesarean section. You, the mother, plan your VBAC – your care provider does NOT give you permission to have one. Wouldn’t you find it ridiculous to walk into the post office and say “My doctor gave me permission to use my vagina!” and yet, that’s how we frequently treat our doctor’s opinion. It’s important for moms to recognize that their body is theirs. Finding an honest care provider who will discuss risks with you and their relative importance to your pregnancy may not be EASY — in fact, sometimes it can be downright impossible — but that doesn’t mean you have to agree to a surgery you don’t feel you need or that your medical circumstances warrant. Be your own best advocate.
So if VBAC is vaginal birth, what are all those other terms?
VBAmC is a vaginal birth after multiple cesareans. Many women have VBACs after more than one cesarean. Considering that every VBAC decreases the overall risk of complications traced to the cesareans a woman has already had, women who plan larger families (in other words, more than two children!) should seriously consider planning a trial of labor and a vaginal birth in order to help bring down her risks for future pregnancies and babies.
Other issues in VBAC:
- fear of the unknown or of uterine rupture
- ignorance of options
- physician control of hospital birthing environments
- lack of options, access or informed consent
Many OB’s state they are not doing VBAmC because of malpractice insurers, though it’s also frequently claimed that the risks are too high after multiple cesareans. Here are some pros and cons for you to consider before you agree to an elective cesarean because of past cesareans:
US Government Resources:
71. Vaginal Birth After Cesarean (VBAC) : New Insights
Professional Guidelines about VBAC
In order to understand how care providers are (or are NOT) acting as their guiding organization leads and in order to understand the way those organizations see women’s choices in their births, it is important to understand the guidelines they present. These are not binding by law but are often presented as if they are. Women should understand that these are simply statements by professional organizations seeking to protect their practitioners.
The American Association of Family Practitioners (AAFP) has released a statement in support of VBAC:
The American College of Nurse-Midwives (ACNM) revised their statement in 2000: www.midwife.org/siteFiles/position/VBAC_05.pdf
The American Congress (formerly College) of Obstetricians and Gynecologists (ACOG) has numerous statements defining their views on VBAC:
Midwives Alliance North America (MANA) has no official statement regarding VBAC but does have a strongly-worded President’s Letter that involves women’s access to VBAC: http://mana.org/pdfs/MANAPresidentResponseAMA.pdf
While not an American organization, ACOG’s Canadian counterparts, the Society of Obstetricians and Gynaecologists (SOGC) have a more lenient outlook on clinical practice guidelines for VBAC: http://www.sogc.org/guidelines/public/155E-CPG-February2005.pdf