In order to have the best chances of VBAC success, one of the most important things is having a VBAC friendly birth place and a VBAC friendly provider.
Knowing what questions to ask potential VBAC providers can be pretty frustrating, especially when you aren’t sure if they are being honest or, just telling you what you want to hear.
Below, we will suggest some topics of discussion and then show you how to interpret their answers. Most importantly, if they seem to answer all the questions “right” if you still feel like something just isn’t sitting right with you, then it might be time to look around some more.
VBAC Friendly Provider Options
Most importantly in your search is to make sure to ask open ended questions. Any provider can agree to any birth plan you put before them, at first but, knowing how they personally feel about VBAC and knowing what requirements they might have can let you know a lot about whether they are VBAC friendly or, will just “allow” it if everything goes perfectly.
The ideal is to find a provider who views vaginal birth after cesarean as a normal process, who is not afraid to support you, will only jump in with interventions when there is a TRUE medical indication, and one who you can form a great relationship with beforehand.
We suggest first discussing VBAC and TOLAC in their office across the desk from one another rather than in an exam room in a gown. This puts a lot of power back in your court! If you are interviewing birth center or home birth midwives, your consultation will likely be in a comfortable location at their birth center or office.
Here are some great questions to start off with:
Please note, not all of the questions below will be relevant depending on your choice of provider and/or birth location.
- How do you feel about supporting TOLAC/VBAC and how many of your clients who attempt VBAC are successful?
- What are the potential long term and short term risks of having a repeat Cesarean for myself and my baby?
- If I have a repeat Cesarean, how will this impact future pregnancies and births?
- Due to what complications or at what point would you recommend a repeat Cesarean?
- Have you had any clients with a uterine rupture? What did you do and what was the outcome?
- What requirements do you have to support a women in TOLAC?
- What is your hospital/birth center policy surrounding VBAC?
- What do you and your hospital/birth center do to avoid patients having an unnecessary repeat Cesarean?
- Are there others in your group that might be at my birth if you are not available? How do they feel about TOLAC/VBAC?
Questions for interviewing home birth or birth center providers:
- What possible complications would risk me out of home/birth center birth?
- At what point, during labor, would you want to transfer me to a hospital if it becomes necessary?
- What hospitals near me do you prefer to transfer to?
- Do you have existing relationships with any OBGYNs if I need to transfer care?
- What is your emergency transfer plan?
- What are your hospital transfer rates for both parents and babies?
Is your provider VBAC friendly or VBAC tolerant?
Now you have all these discussion points, what do you do with them? We have divided things into three categories with suggestions on what to consider when evaluating your provider interview.
Ask VBAC Providers About Their Personal History
The higher their VBAC success rates and lower their cesarean rates, the better! You can start by getting a good idea what those are by visiting one of mine and Meagan’s favorite sites cesareanrates.org.
This allows you to break down rates by state, and hospital. Knowing what the baseline is for your area is a great way to start off in determining where your provider ranks.
Ask for actual numbers here. Answers like “I only intervene, perform a C-section, or transfer when absolutely necessary” might be a red flag if they are reluctant to share actual statistics.
Asking what their personal belief and philosophy is surrounding VBAC will give you a great idea, and don’t let anyone tell you the will let you TRY. Like Yoda says, “Do or do not, there is no try” (my husband would be so proud!).
Many providers have stipulations for allowing you to TOLAC. Some of these requirements involved induction methods or even induction at all, giving birth by a certain gestational age, the reason for previous cesarean, and if you have ever had a vaginal birth.
A provider that insists a VBAC client go into labor before 40 weeks or automatically goes to a C-section is probably not VBAC friendly, for example. The more requirements or even policies a provider or birth place has for VBAC the less likely they are to be supportive.
A VBAC should be treated as any other type of birth, personal and unique, and not be given blanket requirements based on what may or may not increase or decrease chances of success.
What Do the Others in Their Practice or Group Think?
A lot of providers work in a practice or group with an on-call schedule. Just because one doctor in the practice is VBAC supportive does not mean that all of them will be.
Find out if the provider you see will be the one at your birth, if they have any time off scheduled for around your due date, and what the policies and the standard or care for the other providers they work with are. Knowing what the standard of care is for the entire group may make you want to seek other providers if it is not in line with what YOUR provider does.
Lastly, If you even find yourself in a position where you are faced with a birth space or birth provider who is clearly unsupportive, you ALWAYS have the right to seek new care, even in the middle of your labor!
Beyond all of this, you should definitely consider hiring a doula to support you if things get tricky (and for lots of other reasons, too!). Dr. John Kennell, who co-authored one of the first studies on continuous labor support said in reference to continuous doula support:
“If anyone said that a new drug or electronic device could reduce problems associated with fetal distress and labor progress to a third, or even that it would shorten labor by half and facilitate mother-baby interaction after the birth, there would be a stampede to make sure this new drug or equipment was available in every maternity unit in the country, whatever the cost involved.”
Have other suggestions on what to look for in a provider? Comment below or contact us here.
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