How to Counsel Your Members to Find a Provider for a Vaginal Birth After Cesarean (VBAC)

Molly Beinfeld, MPH, Solution Strategist

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In the U.S., about a third of all births are by cesarean. And 90% of women who have a cesarean have another, even though more than two-thirds of those who aim for a VBAC succeed. It’s important to provide your members with information and resources they might need to make an informed decision about their birth options, including VBAC. For your members interested in a VBAC, the most important thing to ensure their success is to pick a provider and a setting for the birth that supports their individual decision. Here are some tips and resources to help you support your members.

Finding a health care provider supportive of VBAC

When your members meet with a provider, encourage them to think about how responsive the provider is to questions. Does the provider take the time to dive into the issues? If so, this is a sign that he or she is very willing to have an open dialogue about childbirth options. If the provider says: “Trust me” or “This is how we typically do things here” and shuts down the conversation, it is not a good sign. Have your member look for clues that the provider is uncomfortable with the conversation. Look at the provider’s body language and tone, for example.

Here are some specific questions your members can ask a potential provider:

  1. How many VBACs have you done this year? What percentage of VBACs in your practice are successful?
    The more VBACs they do, the better. Look for a success rate over 50%.
  2. How often do you counsel women to have a VBAC vs. a repeat cesarean?
    There are circumstances under which VBACs are not appropriate, but most women have options.
  3. What would make you tell me that I need to have a repeat cesarean? What circumstances would require it, in your opinion?
    If the provider gives answers not supported by evidence, like “Because you’ve gone past your due date” or “Because you need an induction,” he or she might not be supportive.

Finding a hospital supportive of VBAC

The first thing your member should ask for, or research, is the hospital’s VBAC rate. Hospitals with a greater than 10% VBAC rate are suggested.

Talking to women who have had successful VBACs, especially at the center being considered, can be a valuable resource for your members. Local mom boards are a great resource for doing this.

Local childbirth educators and doulas know the hospitals well and have seen it all. So suggest to your members that they ask those people for suggestions or recommendations. Numerous studies have also shown that having a doula present at the birth can reduce the risk of a cesarean. You can help your members find a doula in their area here: http://www.dona.org/.

Here are some things for your members to consider when they pick a hospital:

  1. Does the hospital have high-quality patient education materials about VBAC? (This is a good sign that they value informed decision making and patient autonomy.)
  2. Do they have the resources to provide immediate surgery in the case of an emergency?
  3. If you don’t have access to a hospital that is open to VBAC, is traveling to another city/urban area possible?