VBAC Success- DC and NOVA Area Stories
This past October, I had the joy and honor to work with 3 amazing families seeking empowering, gentle births. Two of those families were working for a VBAC- (vaginal birth after a cesarean) and travelled (very far in some cases) to a DC hospital, to make it happen. I will be sharing some lessons to be learned from their successful (aH!) VBAC journeys below. Read on for some key elements that you can incorporate in your VBAC journey.
The Most Important VBAC Tip- Choosing the Right Provider-
The right provider/doctor/midwife makes ALL the difference in a successful VBAC journey. Here in the DC and NOVA area, there is a really limited number of in-hospital providers who I (and most doulas in the area) can recommend for a truly positive VBAC birth experience. When I had my first Meet and Greet with one of these dear clients, we had a conversation about their current provider (ie. who they go to for their pregnancy checks/prenatal care- OB or midwife practice). I shared with them what makes a great VBAC provider and shared with them the names of a couple of local DC area providers who are known for their VBAC positive-ness.
My clients decided to trust their doula (thank you!) and take that big jump to switch their DC area VBAC provider. This came with an added-on driving distance (they would be commuting 45 minutes minimum to get to their DC area midwives + hospital for their VBAC) but it was 100% well worth it in the end. Read on below to find out why it was especially relevant for this fam!
The second VBAC family I worked with this past month travelled literally thousands of miles to DC because they already knew how important their provider would be for a successful VBAC. They did not quite have their insurance set up to cover this provider in the beginning, but they were willing to invest the money, time and effort in being with the right provider because they knew how much it meant to them to put in 100% of what was in their control in seeking this VBAC. Because they were familiar with this DC area’s VBAC positive provider, and because the DC area was originally their hometown, they made that big move.
Positive VBAC Provider- No 41 Week Cut Off-
Many DC area VBAC providers are open to working with families seeking a VBAC, but they have policies that can very much cut off an attempt at a successful VBAC. One of those VBAC policies that many local DC area providers have is that if you do not go into labor on your own, by 40 or 41 weeks pregnancy, you are automatically signed up for a cesarean birth. Many families seeking a VBAC might assume that they will go into labor by 41 weeks pregnancy, but I always tell my clients, don’t assume anything when it comes to birth. It is much more relaxing to have a pregnancy care provider with very fluid policies that don’t box you in. Trust me.
I have seen many pregnant friends and community friends who did not go into labor by 41 weeks, find themselves scheduled for an automatic cesarean, with no trial of labor, no chance for some sort of induction to help things along. This is a whole ‘nother topic in itself, but the research out there shows that inductions for VBACs are an option that can be put on the table, and going past 41 weeks can be an option for families- just share with them the benefits and risks and let them make their choice. VBAC, here we come!
Positive VBAC Provider- Options for Induction/Augmentation as Needed
Another really useful element for our positive DC area VBAC providers is that they do work with inductions for their VBAC clients if needed. This can happen in different circumstances- for some families, their water might break, and contractions might not start for many hours after. With a provider who isn’t really positive, they will automatically go to a cesarean birth if your contractions have not started within a number of hours after your water breaks. They will not try to induce or augment contractions in this situation.
Likewise, a VBAC positive provider will open up the door to an induction if their clients reach 41/42 weeks pregnancy and have not yet gone into labor. This always comes with a discussion, some forms of induction are not recommended, and other forms are available, and space for families to make a choice on what they feel best proceeding with.
For the two DC area VBAC clients that I worked with this past October, the option for an induction and for remaining pregnant beyond 41 weeks proved beyond useful.
VBAC Positive Provider- Positive Talk
The VBAC positive aspects of this journey and these providers wasn’t just about their policies, it was also in large part about their attitude towards VBACs. Without a doubt, VBACs come with risks- and so do repeat cesareans. Most providers don’t share the risks on both sides, and many providers don’t share that these risks associated with a VBAC are less than 1%. In the end of the day, the way you talk to your clients about the birth they want, definitely affects their emotions and feelings. A doctor who tells you that your baby is getting too big, and you are so small- is not encouraging. A provider who tells you we believe in you and your desire for a VBAC- is encouraging. Surround yourself with positive vibes and words Try your best to stay far, far away from anyone who clouds your mental space and doesn’t give you a full, balanced picture.
VBAC Story #1-
Family #1 had switched providers around 26-28 weeks pregnancy after our first conversation together. They did a lot of amazing prep alongside switching providers; they hired a doula, started their mental mindfulness prep with GentleBirth, visited a chiropractor for pregnancy regularly and got into a good head space. Their due date rolled around and they were still happily (:)) pregnant. Then, 41 weeks pregnancy (!) rolled around and they were still pregnant.
If they had remained with their previous providers, they would have been automatically signed up for a cesarean birth at this date. (You always have an option to decline an induction and/or a cesarean, but without a doubt, the words and doubts and fears that are spoken to you by your provider, will largely influence you, and many families decide to move forward with the scheduled cesarean.)
Around this time, my client started to have prodromal labor. For the next 4-5 days, she was going through birth sensations that seemed to last all day, but were mild enough where she was able to sleep and rest through them (key points!).
At her 41+4 week appointment, her midwife signed them up for an induction (with their permission) at 41+6 days. A night before her scheduled induction, her birth waves picked up and she entered active labor. She gave birth hours later to a beautiful baby boy. She pushed him out in less than an hour, in a squatting position on her hospital bed, with the squat bar for support, and epidural given at 8 cm dilation. Her VBAC was gentle, it was non-confrontational, it was peaceful and healthy. Without a doubt, we were all grateful for this beautiful experience.
VBAC Story #2-
Family #2– This client traveled across the globe, from Kenya, for her VBAC with the GW Midwives. She started having prodromal labor around 41+1 days, and continued with these contractions on and off for a number of days. Her midwife scheduled them for an induction at 42 weeks pregnancy, and she woke up on the morning of 42 weeks pregnant and ready for it. Her induction started with a foley balloon for a number of hours and then with pitocin. After 30+ hours of laboring, she pushed her baby out in a moment of pure emotions. She had really worked hard for her VBAC and was blessed with it.
Had she stayed with a provider that did not give an option for an induction for VBAC, or a provider who scheduled automatic cesareans at 40/41/42 weeks pregnancy, she would have gone straight into a cesarean birth without a chance at laboring and VBAC-ing.
Gratefulness
As a doula, I’m beyond grateful to witness my clients make intentional choices in their VBAC journeys and beyond honored to support them during this time. I’m especially touched when DC area VBAC families trust me as their doula in their VBAC journey- and trust that this biggest tip of choosing a positive provider is key to a VBAC journey where they feel heard and respected. I 100% believe that in the end of the day, everything lies in God’s hands, and it might be that something outside of your control dictates that a repeat cesarean birth is needed. I also know that some families prefer to have a repeat cesarean without going the VBAC route, and I do believe everyone should be supported in the way they truly desire.
