VBACs - making a come back

This month, the National Institutes of Health (NIH) held a conference to review new findings on Vaginal Birth after Cesareans (VBACs). An important conclusion from this conference was that - given the available evidence, Trial of Labor (TOL) is a reasonable option for many pregnant women with a prior low transverse uterine incision. This shift in medical thinking is a promising start to return to more evidence-based practices that can help women understand their options for birth.

Data on births in the US show that in the mid-nineties, there was a steady increase in women having access to VBACs. In 1996 VBAC rates peeked at 28.3% while the cesarean rates were at 20.7%. Most recent data from 2005 show that VBAC rates have dropped to 7.9% while cesarean rates have soared to over 30%. Today, one in three women in the US is giving birth via c-sections with fewer options to attempt a vaginal birth for future births. Unfortunately, reasons cited for VBAC plummeting by the late 1990s have more to do with the American College of Obstetricians and Gynecologists (ACOG) restrictive recommendations and guidelines on VBACs and increased malpractice insurance fees, than with evidence-based assessment of each woman’s unique birth experience and circumstance.

Consumer advocate groups like the International Cesarean Awareness Network (ICAN) and Coalition for Improving Maternal Services (CIMS) provide strong voices to educate parents to make informed decisions on birth choices and preparing for subsequent births after a Cesarean. Similar to many aspects of childbirth, we moms must continue to do our research and be our own best advocates. Good starting points include educating ourselves, finding community and support, and exploring options with our healthcare provider early in our pregnancy. Below are a few suggestions for getting started:

Educate ourselves:

Blossom Birth now offers a new VBAC Refresher class, an opportunity to explore the reasons for and feelings about your previous birth so that you can more easily move towards a successful trial of labor and VBAC. This class provides a comprehensive birth refresher class, including reminders of stages of labor, physical and emotional comfort techniques, questions to ask your care provider and helpful tips for partners.  

Find community:

ICAN San Jose Chapter holds free monthly meetings on the second Tuesday evening of every month at Blossom Birth. ICAN’s website also provides an online community and other educational resources.

Explore your options with your healthcare provider:

CIMS has recently published an updated factsheet on “The Risks of Cesarean Section” and “A Checklist for Expectant Mothers” to help expectant parents explore options with their healthcare provider. 


-Mora