Expert Interview: VBAC

When I had my twins a C-section was my only option, my son was breech and my daughter was transverse. Having major abdominal surgery was not exactly something I was looking forward to and even though it was a fairly pleasant experience, it’s not something I’m looking forward to repeating. My husband and I plan on having more children and I have contemplated a VBAC, vaginal birth after cesarean. To get a better grasp on what all this entails I interviewed Dr. Lauren Feder and Dawn Berryman of MarketMommy.com.

Dr. Feder is a nationally recognized, Los Angeles based physician who specializes in both standard medicine, as well as holistic. She has written a variety of books and articles, and has been seen on various health-oriented television and radio shows, including most recently, Oprah and Friends, interview by Dr. Oz. Dawn Berryman resides with her husband, Craig, and their two pre-school aged children in rural Ohio. She works as a marketing specialist for a non-profit, is an active volunteer in her community and also operates www.marketmommy.com and www.announcementsgalore.com. Dawn also had a VBAC 16 months after the birth of her first child and can offer her perspective on the experience.

This post is going to be broken into two separate interviews, the first is with Dr. Feder and the second will be with Dawn on her experience.

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Can you explain what a VBAC is?

Vaginal birth after cesarean section, this means having a vaginal birth following a previous birth that was by cesarean section.

What are some of the benefits for mom and baby with having a vaginal birth?

The ability to give birth vaginally is coveted by many women, as it is the way in which nature intended. Delivery in the birth canal has many advantages:

1. Important for breathing in newborns. This may be due to compression a baby experiences during contractions while going thru the birth canal. Studies show an increased incidence of respiratory distress syndrome in babies born by cesarean section.

2. Exposure to vaginal flora in the birth canal helps colonize a baby’s intestines and promotes healthy growth of intestinal bacteria which is important for a newborn’s immune system.

Many women have a common fear of having their uterus rupture, how common is this?

I believe a woman’s fear of uterine rupture comes from the physicians. The good news is that according to ACOG (American College Obstetricians And Gynecologists) a VBAC is considered to be safer than undergoing a repeat cesarean delivery. A rupture is considered rare and for a woman who has had a previous cesarean (with a low transverse incision) the risk is .2 to 1.5% or 1 in 500 (this is considered a low rate). Induction of labor with such medications as Pitocin is considered a risk factor for uterine rupture.

How do you decide if someone is a candidate for a VBAC?

Most physicians believe that if a woman had a cesarean delivery with a vertical cut, there can be increased risk for a uterine rupture considering this to be a contraindication to VBAC, Another contraindication would be if a woman has had a previous uterine rupture.

How should an expectant mother prepare for a VBAC?

It is important to find a healthcare provider who is in favor of VBAC, this can include options that are beyond a hospital such as birth center or home birth. As with any pregnancy, I advocate a healthy diet, regular prenatal visits, exercise, and positive outlook. I believe it is important to take a birth class and/or refresher course.

Are there any resources you would recommend?

The International Cesarean Awareness Network (ICAN) offers wonderful support groups and community services.

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What made you choose to have a VBAC?

There were several things that made me want a vbac. I didn’t feel like I was in control at all with my c-section and felt like I had let myself down. I knew I needed to become more educated and take responsibility for my health and the health of my children. I was not satisfied with my first birth experience and immediate knew it could be so much better. A large reason I wanted to vbac was that multiple c-sections can effect fertility and future pregnancies. I knew I wanted more children and didn’t want to be having surgery each time I wanted to have a baby. I also knew that I would have a 16 month old at home to take care of as well and didn’t want to be recovering from major abdominal surgery.

Did you meet any resistance from your ob/gyn?

Yes! Shortly after my first trimester I switched doctors to a more supportive one. My original OB was very condescending and negative toward vbac. He said surgery was a much easier option. I didn’t agree.

What fears did you have about a VBAC, if any at all?

I was slightly afraid of uterine rupture. But, I felt confident in my doula, my body and my OB so that really wasn’t a worry for me. Most of all I was afraid I would fail and end up in surgery again.

How did you prepare for your VBAC?

I read a lot. I joined online support groups. I read studies and books and websites, anything related to vbac that I could get my hands on. I talked with other vbac moms. I switched OBs. I hired a doula. I used EPO (evening primrose oil) I read books on natural childbirth and I labored at home until I was 8 cm dilated.

What would you tell someone who is debating whether to have a VBAC or opt for another c-section?

After experiencing both I would simply say there is no comparison between the two. If it is at all possible to have a vbac I wouldn’t hesitate. The difference in recovery is amazing! My 16 month old was bouncing on my lap hours after giving birth. I was up and in the shower hours afterward as well. I felt 100 percent better after my vbac than I did after my section. I would never voluntarily agree to a c-section unless there was a major medical reason to do so. Women have a right to experience the type of birth that they want to and should feel empowered to advocate for themselves and their health.

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Have any of you had a VBAC? What was your experience like? Would you recommend it to others?

If you’re on the fence about a VBAC, did this article sway you either way?

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6 comments

  1. Awesome article!

    When I had my twins in 2006 my situation was exactly the same… twin A was breach and twin B was transverse. They stayed that way from 28 weeks until they were born at 37 weeks. My doc, who has delivered all of my children, would not turn them either. It said the success rate in twins just was not high enough. He could turn baby A and then still be forced to deliver twin B via c-section.

    C-sections make you feel so vulnerable. I hated it! No control. Recovery was not ideal especially after a breezy vaginal delivery and recovery 6 years before.

    When I was pregnant with my last baby (delivered 2009) from the beginning I was upfront about my VBAC desires. I did NOT want another c-section. My doctor was supportive as long as there were no issues. I went until my due date and I was not effaced or dilated. He was forced to perform a c-section for fear of my uterus rupturing if he induced or let me go too far past 40 weeks. I was so update.

    Praise God I trusted him. The membranes of my uterus were exposed when he went in to perform my c-section. Had the baby pushed that area of my uterus it would have been ugly.

    I still wish I had been able to have a VBAC, but I am so glad I listened to my husband and trusted that the doctor in this particular situation.

    My tubes are tied now as given the condition of my uterus another pregnancy would not have been possible. But I completely understand the desire to have a VBAC.

  2. I was able to have a VBAC! Read about it here:

    http://tripletcrown.blogspot.com/2010/02/birth-story.html

    best thing I ever did!

  3. This article didn't sway me either way. I think it might have been more helpful had the interviews been with a doctor who has personally performed VBACs on women who had multiples (especially HOMs) and if the woman had been one of your own MoMs who had a VBAC.

    That being said, I go back and forth on what I'll want. My C-section wasn't all that bad with the boys. I can't even see my scar, the doctor did such an awesome job! On the other hand, the supposed faster recovery with a VBAC sounds appealing.

  4. heather@it'stwinsanity

    So refreshing to see an article in support of VBAC! Cesareans have come to be "the norm" and it should not be that way.

    I had a VBAC (HBAC, a homebirth after cesarean) with my first set of twins and it was amazing. (Story here: http://www.itstwinsanity.com/2008/04/two-years-ago-today.html) Sometimes cesareans really are necessary (I had one with my second set of twins) by vaginal birth is usually possible with a supportive care provider.

    It's really important to do your own research.
    ICAN (www.ican-online.org)
    "Having Twins" by Elizabeth Noble
    Natural birth videos (http://www.youtube.com/watch?v=7E-wULAaD50)

  5. great post!! It is so wonderful to know that you can do that!!!

  6. I had a VBAC 20 months after delivering my twins! The recovery was so much better. I was able to care for my three other children almost immediately after returning home from the hospital. I labored for 26 hours before having my C-Section at 39 weeks with twins. While in the end C-Section was the only way they would have come out because Baby A was stuck and had no room to move. I had no problems with my VBAC and would do it again if we have any more.

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