Not all women who have had cesareans have VBAC fears when they're pregnant again, but many do. Maybe that describes you. Once you recognize your own VBAC worries, you'll need some strategies to help you cope with your concerns so that you remain positive and focused on your goal of a successful birth experience. Here are five suggestions that have worked for thousands of women who have had VBACs, some even after multiple cesareans.

• Appreciate that you did your best, if you tried for a vaginal birth and ended up with a cesarean. You may find yourself going over all the "what ifs" -- What if I hadn't had Pitocin (or what if I had)? What if I had waited to have an epidural? Would my body have relaxed if I'd had an epidural sooner? Or that all time favorite: What if I had breathed better? Join the crowd. You've got lots of company. It's natural for women to ruminate on their birth experiences, whether joyful or disappointing. We need to go over them in our minds and in conversations with other women in great detail.

  "I have been doing VBAC/cesarean prevention work for 25 years. Every one of the women I have been contacted by, or have met as I traveled and spoke, have made the very best decisions that they could make at the time, given who they are, and the information that they had available to them -- or the pressure they felt -- at the time. It is important to note that "choices" made out of fear are not free choices, and to distinguish between fear and intuition. Every one of the women and their families were transformed by the outcomes of their decisions, sometimes positively and sometimes not so positively. People should not have to be defensive if things go well, nor should they have to defend the decisions they made if something goes awry. We do our best to predict outcomes, knowing that our powers to do so are limited, at best. Birth is a miracle and also a mystery. We cannot necessarily know what will happen when we begin the journey, although we can certainly trust that, in most instances, things will go remarkably well. Accepting that and at the same time eliminating our fear -- not our awe and respect -- around it, is perhaps one of our most important challenges." ~ Nancy Wainer Cohen, co-author of Silent Knife

• Get to know women who have had VBACs, as well as other people who will support your goal. Although every year more women in the United States have VBACs, it's still not the standard. In our Western culture, most women who give birth after a cesarean have another cesarean. So it's no surprise, therefore, that most friends, family members, and even health-care providers have negative programming where VBACs are concerned. It doesn't matter if they know anything about them or not. Try to avoid the worries and concerns of uninformed naysayers.

  "I was so emotionally distraught after my third birth I did not know what to do. I had been disappointed about all my births, but I truly believed in my heart I was going to do it this time, the third time, and when it didn't happen, I just did not know how to handle it. I wasn't sure what was wrong with me. All I would do is cry and felt this tremendous amount of guilt. I finally remembered this VBAC group I had heard about and decided to call. The group really knew what I was feeling. They let me cry and let out all of my feelings where other people kept telling me I should just let it go because I had a healthy baby. I kept going to that group, not even knowing if I would have another child. The VBAC group helped me to become more educated about birth than I had ever been before. They showed me I had options and choices in just about every aspect of my labor and birth. So when I got pregnant for the fourth time, I knew attempting another VBAC was the only way for me, even though everyone other than the doctor, my husband and the VBAC group was telling me I was crazy for trying it again -- and hadn't I suffered enough in my three last labors and c-sections? I had my VBAC with a supportive doctor, my husband and two doulas." Dina C, Illinois

• It's normal to feel that you will fail in your VBAC attempt, even though many women have succeeded. The trauma of having an unexpected cesarean, and then perhaps failing once at VBAC, can imprint itself deeply in your mind, leaving you believing that a vaginal birth is just impossible for you. But many women in this situation have succeeded at VBAC. A positive attitude and advance preparation don't guarantee success, but they have made a profound difference for some women who have had VBACs.

  "It's worth it to try. A big concern is that we know that we can labor and still end up with a cesarean -- we've been there, done that. I had two cesareans before I had my VBAC. So why bother going through all that again? Women need to know that there is a physiological benefit to both them and their babies to go into labor. That even if they have another cesarean, most, many women -- all the women I've worked with as a doula -- don't regret trying. They have a good chance -- as good as any other woman -- of having a vaginal birth." ~ Kathleen F, Ohio

• Read and reread VBAC stories, and gain from their strength. Many women who've had VBACs say that reading other women's stories made a big difference. It kept them going, knowing that women like themselves, or even women who had more cesareans or more pregnancy problems, had given birth vaginally. Some women suggest that viewing birth videos can be helpful as well.

  "A story has emotional power: it brings meaning, hope and vision together; it connects body and soul. It can be as simple as a saying or as complex as a biography; it can come from a conversation, a newspaper clipping, a movie or a myth. A story can bring the power of imagination into a situation. If we identify with the story, it becomes incorporated into us, and every cell and molecule in our body responds. When a person is in a crisis and uncertain, the right words can be life-sustaining. There is an 'Aha!' response when the soul makes a link between a story and my story, a sense of recognition that something feels intuitively, deeply right; a match between inner inclination and outer configuration. When a patient learns that other patients with this same illness, or the same stage of the illness, recover, it contributes to recovery: if she could or he could do it, then I can, too!" ~ Jean Shinoda Bolen, Close to the Bone: Life-Threatening Illness and the Search for Meaning (New York: Scribner Books, 1996)

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• Practice visualization and positive affirmations to help your body and your mind know the past is not necessarily your future. By "visualization," I mean seeing your desired goal in your mind's eye, as if it's already happened. Top athletes often use this technique. Different types of visualization have produced good results in many areas of health care. Affirmations are positive statements you repeat every day, especially when you're deeply relaxed, to send your body the messages you want it to have.

  Here's a simple way to get into a relaxed state. Sit or lie down in a comfortable position. Close your eyes. Relax your muscles. You can start by letting your shoulders go limp. Breathe slowly and naturally. As you breathe out, feel yourself beginning to relax. Feel the tension leave your body. You might want to imagine that you're doing this in a calm and relaxing place--say, at the beach or in the mountains. Don't worry about well you're doing. Continue for 10 to 20 minutes. Do this once or twice a day. Your concentration will improve over time, with practice.

  While you're in your favorite place, visualize your baby's impending birth exactly as you wish it to be. Be quite specific. Think of your VBAC fears and turn them around into positive images and words. (Examples: See your uterine scar getting stronger and stronger. Watch your baby move smoothly through the birth canal. Feel the power of the contractions and know that you can work with them.) Write down your statements and post them around the house or carry them with you in your pocket as daily reminders. Here are some affirmations to get you started:

  • I believe in myself and my body.
    
  • My body is always strong and capable.
    
  • I will give birth vaginally with effort, but also with joy.
    
  • I see myself easily getting past where I was stuck in my last labor.
    
  • I enjoy watching my baby start down the birth canal into my waiting arms.

Copyright 1997 by The Harvard Common Press. Reprinted with permission of the author.

Diana Korte is an award winning journalist and author of The VBAC Companion (Harvard Common Press, 1997) and Every Woman's Body (Ballantine, 1994), as well as the co-author of the much acclaimed A Good Birth, A Safe Birth: Choosing and Having the Childbirth Experience You Want (Harvard Common Press, 1992). She has been a La Leche League leader and is the mother of four children and three grandchildren. She's also served on local, state, and international health related boards of directors.