The best things you can do for your chances of having a successful VBAC are finding a VBAC friendly doctor or midwife, and giving birth in a VBAC friendly hospital, birth center, or at home with a VBAC midwife.
According to the APA, 90% of parents with a prior Cesarean are good candidates for VBAC, yet only 10% will be given the option to try.
Even ACOG supports VBAC and VBA2C as a safe and reasonable option.
It becomes a problem when you have a doctor who claims to support VBAC, but might be less supportive than they let on — or worse, changes their tune when you are in labor.
So, how do you know if you have a VBAC supportive doctor, and how do you know they will continue to remain supportive? 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.
In this article, we’ll talk about the types of care providers that can support you if you want to have a VBAC. You’ll learn how to find a VBAC supportive provider and determine VBAC rates by hospital.
Most importantly, you’ll learn how to know if your provider is truly supportive of your birth plans. This article provides a big list of questions for VBAC friendly doctors to get into the details of how supportive they really are.
As a bonus, we will give you some tips on finding a provider to support you!
Originally published in 2019, this article was updated and republished on March 8, 2021.
VBAC Friendly Care Provider Options
There are many options for providers to help you on your VBAC journey, including a maternal-fetal medicine doctor, an OBGYN, a family practitioner, a CNM (Certified Nurse Midwife) based in a hospital, or an out-of-hospital midwife for VBAC at home or a birth center.
Maternal-Fetal Medicine Doctor
Maternal-fetal medicine (MFM) providers work with high-risk women from preconception through to prenatal, birth, and postpartum care. They work in a hospital and typically have a high rate of interventions due to most of their patients’ high-risk nature.
MFM providers do not typically work with VBAC women unless they have something going on medically, making them high risk.
If your pregnancy is high-risk, seeing an MFM doctor will be the way to go. It is important to note that having a prior Cesarean does not automatically put you into a high-risk category, despite the higher risk for uterine rupture.
OBGYNs are the most common VBAC doctor. They complete care for all periods of women’s health and are experts in preconception health, pregnancy, common birth complications, and surgery.
They work in a hospital and may commonly recommend typical interventions, including epidurals, induction, and C-sections.
They do work with VBAC parents and may or may not be VBAC friendly doctors.
If you are birthing in a hospital, you will most likely work with an OBGYN, unless you choose a Certified Nurse Midwife (CNM) for your care.
You might choose an OBGYN for your pregnancy if you feel safer in a hospital environment and want a provider who will stay with you during a Cesarean if it becomes necessary during labor.
Your typical family doctor provides care for all of your family members; however, 25% perform pregnancy, birth, and postpartum care with low-risk women. They work in a hospital and may recommend common interventions, including epidurals, induction, and Cesarean.
Family doctors may work with VBAC parents, depending on hospital policy.
Staying with a family doctor for your pregnancy and delivery might be the right choice for you if you like the familiarity of an established relationship with your provider heading into pregnancy.
Midwives can deliver at a hospital, at a birth center, or at home. In-hospital midwives must be CNMs, although some CNMs do out-of-hospital birth. However, typically, a hospital midwife cannot provide birth center or home birth care, and a home birth midwife cannot work in or deliver at a hospital.
Midwives provide preconception, prenatal, birth, and postpartum care for low-risk pregnancies. They know and have access to all of the same things OBGYNs do concerning labor and delivery, except for the surgical part.
If a Cesarean becomes necessary or your pregnancy turns high-risk, you will need to transfer care to either an OBGYN or an MFM doctor.
Midwives in a hospital work with an OBGYN and transfer care when needed. Out of hospital midwives also transfer care when needed during pregnancy and are experts in emergency hospital transfers when complications arise during delivery.
Midwives have lower rates of intervention, lower Cesarean rates, and higher VBAC rates. They are most likely to be VBAC friendly of the provider types.
You might choose a VBAC midwife if you desire an unmedicated birth (although in-hospital midwives can hook you up with an epidural). You might want someone more familiar with the natural birth process and less likely to intervene and push things along unless medically necessary.
How to Find a VBAC Friendly Care Provider
The goal 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 with whom you can form a great relationship before delivery.
Most notably in your search is to make sure to ask open-ended questions. Any provider can agree to any VBAC birth plan you put before them at first. But knowing how they 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 during pregnancy and delivery.
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.
If you do not know of any providers that support VBAC in your area, we have some great options for you to connect with others and start exploring the options in your area. Recommendations from people who know your local birth scene will be valuable to you in your search.
- Find a VBAC-trained or certified doula near you. These doulas know your birth community well, know what providers will genuinely support you on your journey, and know what providers you might want to avoid. These are the VBAC experts in your area.
- Connect with your local ICAN chapter. Parents here have gone through Cesarean births and VBAC and will likely have great recommendations for you.
- If there are Facebook groups local to you that are birth or VBAC-specific, join them and ask for recommendations.
- Join our VBAC Community on Facebook. We have members from all over the world that might have an excellent recommendation for you in your area.
Questions for interviewing VBAC doctors and care providers
Here are some examples of questions you can use to determine how VBAC supportive your doctor is. Please note that not all of the questions will be relevant, depending on your provider and birth location choice.
- 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 women in TOLAC different from those for women without a prior Cesarean?
- What is your hospital or birth center policy surrounding VBAC?
- What do you and your hospital or 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 or birth center birth?
- At what point, when I am laboring at home, 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 that you have all these discussion points, what do you do with them? You can generally divide providers into three categories when it comes to supporting VBAC:
- Non-supportive: Clearly encourages repeat Cesarean over VBAC.
- Tolerant: Allows VBAC, but expresses many conditions or has a high Cesarean rate.
- Supportive: Fully supports VBAC and works with you to achieve your desired birth as long as medically safe.
Remember, most providers do not fall into a category of 100% VBAC supportive or 100% VBAC tolerant. Think of it more like a sliding scale from 1-10, with one being the least supportive and ten being the most supportive.
Each provider will have some aspects of VBAC that they are more particular about, and that is not necessarily a red flag. The key is to find a provider as close to being a ten as possible with few, if any, things they are particular about.
Here are some suggestions on what to consider when evaluating your provider interview, to determine how supportive they will be of your VBAC.
VBAC tolerant or non-supportive providers
- Require spontaneous labor before 39 or 40 weeks or have some other arbitrary deadline.
- Will not induce for VBAC at all. If an earlier delivery is necessary, they will jump right to a Cesarean instead of inducing.
- Talk a lot about your “chances of success” based on the VBAC calculator.
- Suggest your baby may be too large early on or require a third-trimester ultrasound to determine the baby’s size.
- Comments on your small hips, pelvis, or stature.
- Require epidural placement, “just in case” an emergency Cesarean is necessary.
- Do not go over repeat C-section risks or downplay those risks over VBAC risks.
- Work in a group with a shared on-call schedule that includes unsupportive providers.
VBAC supportive doctors
- Have no time limits for labor to start.
- Will induce gently, and only if medically necessary.
- Consider your unique birth history, pregnancy, and preferences.
- Know that even bigger babies can be born vaginally to petite women.
- Encourage movement and being upright, especially in early and active labor.
- Go over the risks of VBAC and repeat Cesarean equally.
- May work in a group with an on-call schedule, but the other providers in the practice support VBAC equally, or your provider may even come to deliver your baby when they are not on call.
Ask VBAC Providers About Their Personal History with VBAC
The higher their VBAC success rates and lower their Cesarean rates, the better! You can start by getting a good idea of your hospital’s Cesarean rates by visiting one of my favorite sites, cesareanrates.org. This site breaks Cesarean rates down by state and hospital.
If you have a VBAC doctor at a hospital with a high Cesarean rate, that might indicate that the birth environment isn’t conducive to VBAC.
Ask your provider for actual numbers for their Cesarean and VBAC rates. Most providers are unwilling to share that information or might not even know it. If they are reluctant to share actual statistics, answers like, “I only intervene, perform a C-section, or transfer when absolutely necessary” might be a red flag.
“Absolutely necessary” is a pretty subjective response, and more importantly, the path before a Cesarean becomes necessary is essential to consider as well.
Asking for their personal belief and philosophy surrounding VBAC will get care providers talking more freely about VBAC. This conversation will give you a good feel on whether they are more supportive or tolerant.
Don’t let anyone tell you they will let you TRY.
What Are Their Requirements for VBAC?
Many providers have stipulations for allowing you to TOLAC. Some of these requirements involve induction methods, giving birth by a certain gestational age, the reason for previous Cesareans, 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 policies a provider or birthplace has for VBAC, the less likely they are to be supportive.
If they insist your pelvis is too small or your baby too big, check around and find a provider who practices evidence-based care. Women whose providers suspect they have a big baby are 30% more likely to have a Cesarean due to the suspicion of a larger baby.
A VBAC should be treated as any other type of birth, personal and unique, and not be given blanket requirements based on what might 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 there is one VBAC friendly doctor in the practice, that does not mean the entire practice is supportive.
Find out if the provider you see will be the one at your birth, if they have any time off scheduled around your due date, and the policies and standards of care for the other providers they work with.
Knowing what the standard of care is for the entire group may make you want other providers if it is not in line with your provider.
Get the VBAC Support You Need
If you ever find yourself in a position where you are faced with a birth space or birth provider who is unsupportive, you ALWAYS have the right to seek new care, even in the middle of your labor!
Beyond all of this, you should consider hiring a doula to support you if things get tricky (and for many other benefits of having a doula, too!). Dr. John Kennell, who co-authored one of the first studies on continuous labor support, said about continued 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.
Check out the VBAC journey of Taylor on episode 45 of our podcast, who ended up choosing the perfect provider for her birth.
Or, if you’re looking for a doula, check out our “Doulas Near Me” directory to find someone in your area to help you through the birthing process.
I would like to ask you what does ot mean “APA”
The American Pregnancy Association
Hi I’m having the exact same issue. This is my second pregnancy and did a MRI to check if it could have been a reason for failed induced labour At first. So now the doc is saying that my pelvic is narrow and baby is big but measure 3.4kg at 38wks. At first I believe but now I’m having a second thought. What shud I do?