If you’ve decided that VBAC vs repeat C-section is the best option for you and your family, finding a VBAC midwife or a VBAC-friendly doctor is the next step on your journey.
Over the years, C-section rates have climbed. In 2019, 31.7% of births in the U.S. were Cesarean. With more people having C-sections, a lot of people consider a VBAC for their next birth — but can a midwife support VBAC?
Midwives have been around since the 17th century, creating a safe and comfortable place for women giving birth. Modern midwifery care includes Certified Nurse-Midwives who can attend hospital births, as well as midwives who deliver at birth centers and can support VBAC home birth.
There are many options to choose from in prenatal care and birth, including an OB-GYN, GYN, your family provider, and a midwife. Ultimately, finding the provider you feel most comfortable with and trust is most important.
Sometimes it can be hard to choose between a midwife and a doctor. As VBAC moms, we have both personally been in this very spot. We understand just how challenging finding the right provider can be, especially when having a successful VBAC is your goal.
Today, let’s talk about what you need to know if you are considering a midwife for your VBAC.
How a midwife can help if you are planning a VBAC
An OB-GYN is a highly-trained medical practitioner, skilled in performing life-saving interventions and supporting high-risk pregnancy and birth. We are grateful to have them help our babies arrive safely when things don’t go as planned.
If you have a high-risk pregnancy or you want an elective C-section, a midwife may not be the best option for you.
However, most births are not considered high risk, including VBAC. The facts about VBAC are that most women can have a successful vaginal birth. And if you have a midwife, you are more likely to have a vaginal birth.
While an OB-GYN is a wonderful option to choose as a provider, and we are very grateful for them, today we will be talking about midwifery care. Here are some of the many benefits to having a midwife on your team for your VBAC.
1. Having a midwife for VBAC lowers chances of C-section
Many people will choose midwifery care over a traditional OB-GYN because midwives have a different approach or view on birth. The American College of Nurse-Midwives includes the following values in their Philosophy of Care:
We honor the normalcy of women’s lifecycle events. We believe in:
Watchful waiting and non-intervention in normal processes
Appropriate use of interventions and technology for current or potential health problems
Consultation, collaboration and referral with other members of the health care team as needed to provide optimal health care
American College of Nurse-Midwives Philosophy of Care
Studies have shown that those who are under midwifery care have a 30% less chance of C-section when giving birth for the first time and 40% less for women who have delivered before.
A few ways midwives may reduce the chances of a C-section may be subtle, but very impactful. Midwives are less likely to bring in medical interventions during labor. They focus on the patient’s desires and helping labor to progress in a more natural way.
While one provider may suggest Pitocin, a synthetic hormone that mimics oxytocin, a midwife may suggest using breast stimulation or a breast pump to help get labor going with a natural hormone release.
They also have a large focus on the position of the baby and how it can impact labor. Having a less ideal position is one of the four main reasons for C-section. They may suggest using a rebozo for ideal fetal positioning, encouraging easier and faster labor.
Midwives are trained and experienced to handle births where people would like to go medicated with an epidural, unmedicated, first-time parents, and parents with multiple kids.
They are also skilled in managing the risks of VBAC. It’s their job to ensure you get medical attention when it’s needed. While a midwife can’t perform a C-section, they know when a doctor is needed and will transfer care.
2. Midwives use fewer interventions
Although midwives work in the medical world, they tend to encourage the natural birth process as much as possible. If you are planning a VBAC, interventions like induction are factors you should discuss with your provider.
Midwives will typically allow birthing parents to go past 40 weeks pregnancy for VBAC before discussing any type of induction. On the other hand, an OB-GYN may suggest a 39-week induction based on the ARRIVE trial, which did not include VBAC parents.
When we wait and allow our bodies to go into labor spontaneously, our chances of medical interventions are lower. Midwives will typically try to avoid intervening with the body’s natural journey through labor but are educated and qualified to use medical interventions when needed.
With a midwife, you will have help in making informed decisions about birth and when to use interventions. They will help you understand the B.R.A.I.N: Benefits, Risks, Alternatives, encouraging you to follow your Intuition, and what happens if you do Nothing.
By breaking these options down, midwives can help parents feel more in control and have an empowering birth experience.
3. Midwifery care can reduce fear of childbirth
If you are scared to give birth after a previous C-section, a midwife may be able to help ease your fears and build confidence in your body’s abilities.
Due to the more natural approach of midwifery care, they are known to work with patients through pregnancy with education and building confidence in the woman’s body.
This confidence and education will allow people to enter their birthing space with more ease and comfort.
4. A Midwife spends more time in prenatal visits
Midwives tend to spend more time with you during your prenatal visits. Depending on your birthing location and midwife, they may spend up to 30 or 60 minutes in these visits.
They take more time getting to know you, asking about your birthing desires, addressing concerns, giving references to help you find a VBAC doula, chiropractic care, prenatal massage therapist, education courses like hypnobirthing, and more.
Having a deeper connection with your provider will help you feel more supported when it comes time to giving birth.
5. Midwives are more present during VBAC
Midwives will not only spend more time prenatally with their patients but also during labor and birth. Feeling alone and unsupported can be a big contributor to birth trauma, and having a midwife for VBAC means you will have expert support for more of your labor.
A supportive presence can help you feel calmer, easing anxieties, and encouraging your body to progress through labor.
I have attended births in my work as a doula where the birthing partner, the midwife, and I were all applying counter pressure and helping the mother change positions for hours.
What’s the difference between a doula and a midwife?
One of the most common questions we get as doulas is about the differences between a doula and a midwife. Doulas and midwives have very different roles, although they both want the same things for their clients and patients.
A doula is there to love, support, and educate you during pregnancy and labor, but does not provide any medical procedures or offer medical advice. Together a doula and a midwife make a wonderful team helping couples feel loved and supported during birth.
A midwife acts as the primary health care provider to handle the medical side of birth and prenatal care. They will love, support, and educate you as well as perform labs, cervical exams, check the baby’s measurements, perform ultrasounds, deliver the baby and placenta, as well as follow up with you postnatally.
FAQ about VBAC Midwifery Care
Can midwives perform C-sections?
Midwives do not perform C-sections. They do, however, assist them. If you need a C-section while under the care of a midwife, they will have an OB-GYN come in to perform the C-section while they may assist. A midwife is 100% qualified in helping our babies arrive safely, however, they are not surgeons.
Can a midwife do a VBAC?
YES! A midwife is skilled and qualified to support VBAC. However, some states have regulations that can prohibit midwives from offering VBAC care. Be sure to ask the midwife that you are birthing with if they are allowed to support you through the birth of your baby. Midwives lower the chances of C-section and other interventions, and lead to more vaginal births.
Can a midwife give an epidural at home?
Neither a midwife nor an OB-GYN can administer an epidural at home. If you desire an epidural, a hospital location will be the best fit for your birth. Midwives can also deliver in hospitals, and their patients can receive epidurals in the hospital but not at home. Midwives are known to help people with water birth. Nicknamed “nature’s epidural,” water can help ease labor discomfort. Some hospitals also offer water birth as an option.
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As a midwife, I found your assertion that “midwives have been around since the 17th century” quite perplexing. Midwives, contrary to popular belief, are in fact the oldest profession. If a midwife is considered to be someone skilled not only in supporting a mother throughout her pregnancy, birth and postpartum time, then midwives have existed since humans began birthing. The profession may not have been known with that specific title, but the work was surely being done before that specific title was created.
Great article. Having a midwife and/or a doula will definitely increase your chances for a successful VBAC! Through guidance, pain control, support, positiveness, comfort measures, and positioning techniques, doulas can help you through labor even at the hospital while you are monitored and the OBGYN is ready to intervene if your/hyour baby health is at risk at any point.