Many of my scheduled appointments each week are what we call in our office a “preconception consult.” This is a visit where a patient is planning a pregnancy and wants to get to know our practice, make sure they are healthy before getting pregnant, and receive information or help with conceiving. There are also a certain percentage of these visits that are what I call “the VBAC interview.” These are patients who had a previous cesarean and are trying to find someone who will “let” them have a vaginal delivery in a future pregnancy. They will often dance around the questions they really want to ask, trying to figure me out and whether I am really VBAC (Vaginal Birth After Cesarean) friendly. I try to quickly relieve them of this anxiety and cut to the chase: “I see you had a previous cesarean, where you hoping for a vaginal delivery with this upcoming pregnancy?”
Unfortunately, more and more women are finding themselves in the position of having to explore their options after a previous cesarean. According to the CDC, 21.8% of women, 1 in 5 women, who have never had a cesarean before, will deliver via cesarean. If these women go on to have another child and desire a vaginal delivery, their chances of actually delivering that way are small. Only 12.4% of women with a previous cesarean will have a VBAC in a future delivery, despite the fact that a VBAC can be successful over 80% of the time it is actually attempted. While there are certainly patients who make an independent decision to have a repeat cesarean, there are many more who want a VBAC who are not being given the chance.
As an obstetrician with a large percentage of patients who choose me specifically for a VBAC, I have an insiders take on what it really means to be a VBAC-supportive provider and how women can identify whether or not they have one. Here are the four most important questions women who desire a VBAC should be asking:
There are certainly many other questions that can signal incomplete VBAC support, but these questions get to the heart of VBAC support and can quickly help a woman decide if her current care provider will really help her reach her goal of a vaginal delivery. For help in finding a VBAC-friendly practice, reach out to your local ICAN chapter
Dr. Michelle Aristizabal is a board-certified General Obstetrician and Gynecologist in Montclair, NJ. She is the author of Natural Labor and Birth: An evidenced-based review of the natural birth plan and runs a busy, private practice, with a special focus on supporting women who desire low-intervention, un-medicated births.