I often have asked my self why I like to specialize in clients desiring to have vaginal births after caesareans. 4 years ago, my answer was very different. When I was a newer doula, I was interested in gathering extra information about VBAC so I could be better prepared to support these clients. I was told by mentors that it really wasn't very different as supporting other births, but something about it made me feel I needed to dig deeper to serve these clients best. I had never had a c section, or a vbac myself, so I couldn't draw on that personal knowledge. In true Liz fashion, when I don't know enough about a subject I feel I need to know, I leap down the rabbit hole and arm myself with as much information as possible. When I took a continuing education course to become a VBAC doula, I learned that my instincts were confirmed. A VBAC parent should be treated like any other person preparing for a vaginal birth, but sadly this isn't the case for many people. A slight relative risk increase in the instance of uterine rupture (0.4%) and a rich history of obstertric mismanagement of this type of birth has led VBAC to be widely regarded as very risky. This is not true.
I do feel that people wanting a vaginal birth after c section need a special level of care and skill set from their doula.
For one, in our work we will very likely be unpacking a birth experience that didn't go to plan. And sometimes we are unpacking some serious birth trauma. This situation on its own can be fraught with challenges as a person steps into a new pregnancy journey. And having a doula by your side that has special knowledge in it can be a game changer. Many c-cections performed could have been prevented, and gaining this knowledge as you comb through your previous birth experience can be devestating. Learning what you need to be empowered for your next birth will require processing what happened in your last birth. A doula can help you do this with great care, using the tools they have developed in their trainings and experience.
Related to that, many c sections occur due to positional difficulties with the baby. This can be babies who are breech at term, certain other malpostions and fetal presentations that impede progress in labor, cause much more pain than anticipated or longer labor, prolonged pushing, and other interventions that led to the surgical birth. Because of this, my experience has taught me that when clients can be prepared with deeper knowledge of their own birth anatomy and ways to help crate space for the baby in that anatomy, we can have a smoother, more progressive labor the second (or third or fourth!) time around. That is another reason I added to my knowledge base by becoming a Spinning Babies parent educator, so I can bring this information to parents and help them change their story.
Thirdly, not all vaginal births are idyllic and not all c sections are traumatic. Birth is tough!(But so are you) Most people (up to 80%) who are good candidates for VBAC will be able to have one, and vaginal birth is generally regarded as safer than surgical ones. However, no birth outcome is guaranteed and both types of birth need recovery and support. A doula with special understanding of not only YOU, but of the birth outcomes with attempts at VBAC can be so essential in unpacking the journey and supporting post partum. Additionally, I'm equipped to help clients make birth plans that include their desires for gentle, family-centered c sections should the need arise. With this support, I have seen clients have healing second c sections after preparing for a VBAC and this can be quite powerful.
Penultimately, there are many myths surrounding VBAC that persist even today, and there are so many people who still think "once a c section, always a c section". This saddens me because this isn't at all based in evidence. The history behind VBAC is actually pretty fascinating. Did you know that physicians and hospitals didn't recommend VBACs in the 80s and 90s not because they are unsafe, but because of litigation and financial reasons? Selling them as unsafe was just that, a sales tactic. Every client has their own personal risk factors which may not make them a suitable candidate for a VBAC but your risk assessment will change from doctor to doctor. Basically, if they whip out the "VBAC calculator" at your OB appointment, run.
Lastly, it is imperative for clients desiring a vaginal birth after cesarean to gather information for the best place to give birth and the best provider to hire for this. I pride myself on getting the most current pulse on the internal situations at our area hospitals because I am seeing births regularly from behind the curtains and I have detailed knowledge of every changing hospital policy and provider dynamic. Did you know that some OBGYN practices simply just "don't do VBACs" as a policy ? So everyone in their practice who has had at least one c section, regardless of their individual risk factors, automatically is scheduled for a repeat c section. No one can force you to have surgery, but many people in these practices just don't feel they have any options, mainly because they're not presented with any! I also pride myslef on getting to know my clients and build trust enough to know which birth place and providers to recommend. Not everyone wants and unmedicated water birth with twinkle lights! Some clients feel best with the highest level of monitoring and NICU avaiable and have no probem with intervention and thats ok! I will help you find the best provider for YOU, whatever that looks like as long as you will have informed consent with that provider. And we can still have twinkle lights anywhere!
There are also facilities that aren't equipped with the 24/7 anesthesia team needed to support a patient who is laboring after caesarean. Some hospitals in the area make you get approved by a panel for you to even attempt a vaginal birth. And many providers aren't exactly "VBAC friendly", they are merely VBAC tolerant, meaning you may have to fit strict criteria as a patient for them to "let you" try labor and they may have strict parameters set for you, for example requiring you go into spontaneous labor by 39 weeks, requiring you to have an epidural placed or not "allowing" you to labor in water. Unfortunately, being a patient at these practices can seriously hinder your ability to VBAC, but many people don't know that until it's too late. Notice I put let and allow in quotes, because you are the ultimate decision maker in your birth and nobody "lets" you do anything. That goes for everyone giving birth!! Informed consent and evidence based practice are essential. On a personal note, I was born in 1982, a time when doctors had really frowned upon VBAC and routinely scheduled repeat cesareans. I knew my mom had desired a VBAC with me and fought for it. She went into labor on her own and tried her best at self advocacy, but in the end she was coerced in to having another surgery for me. I was head down, 7lbs, and perfectly healthy, as was my mom. There was zero reason I couldn't have been born vaginally. I know she had a lot of past unprocessed trauma from this experience (70 something's don't tend to use the word "trauma" but let's be real), which was evident when she recently told me my birth story for the first time. Our births...... We carry those experiences our whole lives. Stepping into parenthood without fear and trauma is so vital. I guess my own birth story is subconsciously why I was drawn to VBAC parents. It's literally in my blood!
To sum it up, any person who has experienced a birth that didn't go to plan and are dealing with residual feelings from that, and even if they don't describe the experience as traumatic, can benefit from the guidance and support of a VBAC and trauma informed doula. Through my five years as a doula, I have grown to really enjoy working with these clients to help them prepare for their subsequent births, to meet them where they're at, to listen and hold space for them, and to empower them with education so they can step in their new family with confidence and joy.
Reach out to book a consult today! I have limited Spring 2024 availability left and September -December 1st 2024 availability for doula services. My VBAC package includes a Spinning Babies workshop and a Reiki session for birth healing.
I also teach the spinning Babies birth prep workshop every month at Empowered Midwifery Care in Delmar and at the Albany Family Life Center every other month.
Additionally, I will be providing a 2 hour VBAC workshop in 2024. This workshop is intended for people in the first or second trimester who are preparing for a vbac or not sure and want more info. It's the perfect jumping off point for the journey!
Email me at Liz.email@example.com to learn more about any of these offerings.