10 Must-Ask Questions When Choosing a Supportive VBAC Provider
Now that you are considering vaginal birth after cesarean (VBAC), choosing a supportive VBAC provider is likely at the top of your list. You need to do your research and make a list of questions to find a provider that is right for you.
To start, remember that you are in control and have the authority to pass on a provider. They work for YOU. When you are interviewing providers, do your research, write down your questions, and make a list of needs that you are unwilling to compromise on and a list of requirements in the nice to have column. If the provider that you’ve been seeing since you were 18 is throwing out red flags, here is your permission to make a switch.
Ready to make your list? Let's get started.
10 Questions you should be asking when choosing a supportive VBAC provider.
What is your Cesarean and VBAC rate?
If an OB’s Cesarean rate is higher than the VBAC rate, consider this a red flag. One reason you are choosing a supportive VBAC provider is to try to avoid another surgery. And, it’s important that your provider has a track record of trying to avoid unnecessary surgery as well. VBAC prevents surgical complications, reduces hospital stays and allows for a quicker return to regular daily activities. You are also considering future pregnancies. VBAC can reduce the risks of multiple cesarean deliveries, such as placental problems.
It’s important to note here that only Obstetricians can perform surgery such as Cesareans. If you’re also interviewing midwives (my personal favorite), this question might be framed a bit differently. For example: What is your hospital transfer rate?
2. What are your intervention rates?
A labor intervention is anything done to your body before and during the labor process. This includes medical induction, routine use of IV, and continuous fetal monitoring. Interventions might also include the use of forceps, vacuums and episiotomies in a vaginal birth. Be sure to read up on the cascade of interventions, so that you can decide what you’re comfortable with as you plan your birth.
While interventions aren’t inherently ‘bad,’ it’s important to know how you feel regarding routine interventions, and open up the conversation with potential providers up front. Bonus: hiring a doula who can advocate for your preferences during labor can be very beneficial.
3. Do you support non-drug methods of pain relief? What if I delayed getting an epidural?
Delaying or foregoing pain management medications during birth can allow your body to progress as much as possible and possibly reduce some of the side effects of pain medications. If you’re considering an unmedicated birth, it’s important that your provider is completely on board. When you’re asking this question, listen to their answers beyond the words. What does their body language say about unmedicated birth? Side note: midwives generally tend to be more supportive of unmedicated birth.
4. Does your facility have specific VBAC guidelines or protocols? What are they?
Some birth locations have a general liability concern connected with VBAC, and may favor a repeat cesarean birth rather than support a trial of labor. Find out the location’s protocols for VBAC, if things don't go as planned, or if there is a time limit for birth or labor before switching to emergency C-section?
Many birth locations won't offer VBAC if you have a couple of determining factors. It is essential to know what they are and if they apply to you. These are a few points to keep in mind when choosing a VBAC provider:
You've had more than two prior cesareans.
You've never had a vaginal delivery.
If you are pregnant with twins, triplets or higher multiples.
5. What VBAC preferences are left up to the doctor or midwife?
I have found that in an OB or midwife practice, the individual opinions vary among the group. In a group care model, you might rotate appointments with different providers, so that you’re somewhat familiar with the group when you go into labor. For this reason, I recommend asking the practice in general, which preferences are left up to each doctor or midwife? And then I’d also ask each of them the questions that are most important to you. For example: What is their protocol if you reach 39, 40, or 41 weeks when planning a VBAC? Do they ever recommend induction at that point? If so, under what conditions? And looking at your history and current pregnancy as a whole, what is their recommendation for you?
6. How do you respond to a potential non-VBAC emergency such as placental abruption (placenta separates from the uterine wall before the baby is born), fetal distress, shoulder dystocia or an umbilical cord prolapse?
Knowing what to expect can help to reduce the fear behind these types of emergencies. Discuss this with your birth team so that you can have a plan in place.
7. Can you refer me to another hospital that does support VBAC?
Sure, your local birth location or hospital is conveniently located, but it might not have the supports in place to accommodate your VBAC. Don't be afraid or embarrassed to ask if they can recommend a facility that is better suited to your needs. Remember, we aren’t in the business of people-pleasing. The goal here is for YOU to feel completely supported.
8. Can I have support people with me?
Whether you prefer a quiet laboring space with your partner only, or a couple of additional support people, find out how many people are permitted in the room. With restrictions remaining in many parts of the world, it’s also important to find out if your doula is counted as a support person.
9. Can I have my baby with me, skin-to-skin after birth?
This one might not be specifically VBAC related, but is important nonetheless. Skin-to-skin contact immediately following birth brings feelings of warmth and security, mimics the baby's experience in the womb, and is comforting to both you and the baby. It has a variety of benefits, including:
Improves heart and lung function
Stabilizes body temperature
Initiates breastfeeding
Reduces crying
10. Is there a lactation specialist to help me with breastfeeding?
Again, this one isn’t VBAC specific, but super important. Not all facilities have a specialist available. If there isn't one on staff, adding that to your list of needs when looking for a doula can solve that problem and provide great support, especially if you didn’t have the initial breastfeeding experience with your last baby due to a C-section.
Remember, it is your right to have your preferences and wishes honored. Choosing the right provider for you is paramount to having the birth experience that you desire, even when things don’t always go as planned. Taking back your power, making decisions for yourself and for your family along the way, is what this is all about. Before you go, be sure to download a copy of the birth plan template in my free pregnancy library.
For further support, be sure to checkout my VBAC Prep Birth Course for expectant couples considering Vaginal Birth After Cesarean (VBAC). We will cover everything from VBAC risks and perspectives to expectations during labor, what to expect during pushing and more to prepare you for delivery.