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VBAC Cubby - vaginal birth after cesarean

Repeat Cesarean or VBAC?
by Donna Harvel Balo ARNP, CNM, MS
Donna BaloQ. I'm expecting my second child this December. I had to have a cesarean with my first because she was in the footling breech position. How safe is a VBAC? I've heard lots of conflicting information, and I've had a bit of anxiety over what to do. Also, is it true that I may be "prone" to having breech babies due to the shape of my uterus?

A. Yes, there is a lot of conflicting info about VBACs right now. To start out with, 98% of the time, babies turn to head down by the time labor begins. Often women are encouraged to just set a time and date for the cesarean, without giving the baby a chance to turn. That is too bad, because there are many ways to encourage a baby to turn.

It is doubtful that your pelvis is shaped in such a way that it is the preferred position for babies, because there are many factors believed to encourage the babies to get head down in the first place. One is the shape of the uterus near term.

Is VBAC an option for you? Discuss this with your provider. Sadly, a lot of providers are not allowing VBACs, or the hospital says the OB has to be in the hospital the whole labor, which they are not willing to do. If one provider will not allow a VBAC, and it is what you want, find a provider that will allow it.

For a successful VBAC, spontaneous labor (no induction or augmentation) has the best outcome. The data cited against VBACs don't include the fact induced labors have the most risk.

The reason for the prior cesarean is also important. Your first was a breech and lends itself to success, because it wasn't anything necessarily wrong with how your labor went.

I remember when women were fighting to have VBACs and am saddened that we seem to be going backwards now and not allowing them. Statistically, there are more risks for surgery than are often expressed.

Do lots of research, consider hiring a doula to help with labor and to help inform you of your options. Most importantly find a provider who is comfortable with VBACs if that is your choice.

Good luck!

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