Many women who want to have a vaginal birth after cesarean (or VBAC, pronounced “vee-back”) in the United States have faced some sort of opposition from their care providers when they have expressed their desire to VBAC.
Sometimes this opposition is blatant (e.g. “I don’t do VBACs. Why would you ever want to risk your baby’s life like that?”). (More on why this is an outrageous statement in a bit.)
Sometimes this opposition becomes obvious only at the end of the third trimester (e.g. “Oh, it looks like your cervix isn’t dilating, so you probably won’t go into labor on your own. Let’s schedule you for a c-section.”) (Many VBAC-ing moms refer to this tactic as a “bait-and-switch” since it involves a supposedly VBAC-supportive care provider rescinding this support once the actual VBAC is imminent.)
Sometimes even a care provider’s “support” of VBAC is instead a conditional, half-hearted, or perhaps sneakily-disguised opposition to VBAC (e.g. “You can only have a VBAC if you deliver before 39 weeks/are dilating and effacing well before your due date/didn’t have a cesarean for failure to progress/etc.”).
These “scare tactics” (as many VBAC-ing moms have come to call them) are often misleading, exaggerated efforts by care providers–and yes, either OB/GYNs or midwives–to discourage women from VBAC and to encourage them to “choose” a repeat cesarean. (Of course, it’s not really a choice if your provider won’t even “let” you VBAC, is it?)
If you find yourself up against a barrage of scare tactics–as I once did–it can be exceedingly difficult to stake your claim and present your case to a care provider who may or may not have your and your baby’s health prioritized higher than medico-legal concerns and who may or may not be insinuating that VBACs are synonymous with driving your child in a car without a car seat. (Yep, some women hear this very analogy.)
If you do find yourself facing such scare tactics, and if you do want to have a VBAC, there are some questions that your care provider should be able to answer when s/he hurls those scary and/or outrageous comments and standards your way. And if s/he refuses to or even cannot answer these questions, then you might want to consider finding an alternative care provider–one who is making medical decisions based on research, evidence, and even respect for your patient autonomy and not on fear, willful ignorance, or even convenience.
Note: these pieces are only as up-to-date as their publication dates OR the dates listed in the editor’s notes. While the questions themselves might be timeless, the research is not. You can search PubMed for the most current research on VBAC, cesarean section, and related topics.
VBAC scare tactics (1): VBAC = uterine rupture = catastrophic outcome
VBAC scare tactics (2): When bad outcomes in the past affect patient options in the future
VBAC scare tactics (3): An early eviction date
VBAC scare tactics (4): No pre-labor dilatation = no VBAC
VBAC scare tactics (5): VBACs aren’t as safe as we thought they were
VBAC scare tactics (6): CPD or FTP = no VBAC
VBAC scare tactics (7): Playing the epidural card
VBAC scare tactics (8): The MD trump card
VBAC scare tactics (9): You have *how many* scars on your uterus?
VBAC scare tactics (10): Big baby, big problems
VBAC scare tactics (11): Your uterus is too thin to attempt a VBAC
I don’t know if I’ve ever thanked you enough for writing these! I swear that my CNM’s supervising OB has told me EVERY SINGLE ONE OF THESE THINGS to try to get me to schedule a c/s.
I’m so, so glad they’ve helped you, Bethany! As sad as it makes me that there is even a REASON to write them, I’m just thrilled to know that they have made a difference for women out there like you.
Thank you for your awesome post. I’ve bookmarked this for my upcoming prenatal appointments – I’m currently 33 weeks, seeking a VBAC.
One of the scare tactics I’ve gotten the most is the “big baby” tactic, like I’m going to “grow” a baby I can’t push out.
Can you speak to that tactic too?
Thank you! And congratulations!
You know, I’ve had a “big baby scare tactic” draft in my queue for a while. You’ve given me the impetus to get working on it in the next week or so!
This is a fantastic series of posts! I am going to send the link to the listserv I just joined for my local ICAN group.
Hello, first I want to say how all of the information you’ve provided here has helped me in my decision to VBAC with this baby. I would love to share my story with you but it is a touch lengthy and I’m not sure you want it here. However, I have a question that I fully trust you will have an accurate answer to. According to the surgical report for my c-section, I was closed with a single-layer suture. Yes, the single-layer vs double-layer debate. I have already surmised from prior research that there really is no difference in the sutures when it comes to my ability to VBAC. However, and this is the irritating part, the OB I thought was proVBAC has thrown out such things as I must deliver by 38wks and absolutely NO single layer sutures or else no VBAC. (I’m currently searching for a new doctor!) I did my research and figured out the truth. Unfortunately, my husband (who is still apprehensive about my choice to VBAC) works in the same medical office as a computer tech. Today, they tried another tactic to scare us away from VBACing by saying that it was strange that my previous doc did a single layer suture on me but that it could be because my uterus was “too thin” and therefor VBAC would be too dangerous for me to risk. It really ticks me off that they targeted him with this “info” because it has only freaked him out more so. I swear I saw research opposing that info but heck if I can remember where. So, I thought I’d ask YOU because I trust that I’ll get an accurate answer. Thanks in advance, sorry if that was long-winded and thank you again for providing all of this fantastic info for us VBAC hopefuls.
I did respond to Kaite via email, but if anyone else would like to take a look at it, ICAN has a fabulous and well-researched article on the single-layer and double-layer suture issue. Check it out if you’re interested! (www.ican-online.org/vbac/the-suture-debate)
Oddly enough, I never got that email. It probably ended up in the junk file, unfortunately. But after reading the ICAN’s article on single vs. double layer sutures twice, I’ve decided to continue with my plan to VBAC. I’m sure your email was great and I wish I would have gotten it. I would suggest you add the single vs. double layer issue to your list of scare tactics though, as it seems to be something ALL of the doctors at USF (and probably many others) like to go on and on about. I’ve had some really nasty things said to me because of this one issue. Thanks again for all this great info, it has really helped a lot of women, including myself.
Thanks for the post recommendation! I agree that (sadly) this has become an increasingly frequent VBAC scare tactic.
I’m so sorry that you never received the email! Let me look through my sent file and see if I can find it…
Love it. Excellent. Will be spreading around, thank you!
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Love this!!! I will be printing this list off to keep on hand for my next pregnancy. I know for 100% they are going to pull the baby is too big card on me. My first was 9lb 14oz…so yeah..I see it happening.
I’m so glad you’ve found this helpful! Sadly, I think it’s a rarity for a woman planning a VBAC not to encounter a scare tactic (or two…or ten…). But sometimes knowing the right questions and having the right sort of information can help us to avoid these scare tactics…or at least to know when to change care providers!
I’m so glad you posted this! I have had 2 successful VBAC’s and I am so thankful that I had the support of both a great doula and CNM. Prior to picking my midwife I interviewed several ob’s and midwifes. I have heard everyone of those scare tactics during the interviewing process. I’m a petite woman and I was told by many ob’s and yes, even a couple of midwifes that my body was too small to birth a baby naturally. I ended up going into labor on my own two weeks past my due date and I gave birth to a very healthy 8lbs 4oz baby boy. My second VBAC was just as successful and enjoyable.
Thank you for posting this! I hope that more woman feel empowered by this and choose to take control of their pregnancy and health care.
Great post! I got so very lucky with my VBAC. My Cesarean was due to breach presentation, I was in labor at 6 cm progressing fine, until they realized my son was not head down. So my doc was extremely supportive. Although she did frown a bit on the fact I didn’t want an epidural to even be offered, she let me go through with it! I had a super successful VBAC. If it weren’t for my doctors full support I probably would have opted to deliver at home, because I searched for other pro-VBAC doctors closer to home, and there weren’t many!
That’s wonderful, Sondra! Care provider support is so essential when it comes to VBAC–and when it comes to any birth, for that matter!
I forgot to add, my doctor also allowed me to go over-due, would have let me go the full 42 weeks if necessary, my daughter was born 5 days late!
I had a wonderfully encouraging and supportive OB…but I knew that going into it, that’s why I chose him. I finally got my VBA3C in June, all natural, with quite a few complications…I had everything going against me but because I had such a fantastic OB, he wanted it for me, I did it!
I just got home yesterday from a very discouraging Dr. visit with a new doctor, hoping that I could do a VBAC with them. A friend sent me a link to this page (she had no idea that I had just gone to a new doctor!). . . and I was so encouraged! I had heard about 5 of the 11 tactics listed, and it was reassuring to read after my meeting with the doctor. Needless to say, I am going to keep looking for a more supportive doctor or midwife! Thanks for your encouragement.
Carrie, I absolutely love getting messages like yours! Good luck in your search for a more supportive care provider–it’s so, so worth it when it comes to preparing and planning for a VBAC!
Hi
I have not had a c-section but seem to be treated as if I have had due to some surgery I had 1 year before my son was conceived to remove fibroids. The type of surgery was a myomectomy and as I understand it from my research, it is common in the US to treat expectant women who have had this surgery with a routine C-section.
With my son I had a natural labour in a hospital and it was great. Now we’re expecting our second child and we’d like to homebirth, partly because it would be more relaxing etc and partly because it would be easier for our son. We’re advised not to home birth, however, due to this surgery, performed in March ’06. I am told by pro-HBAC-ers that I am at less risk than a regular HBAC because the surgeon did not cut all the way through to the uterine cavity. But I am told by the consultant OB (my primary care provider is a midwife) that a myomectomy carries more risk as the cut was wherever the fibroid was and therefore could be in a more dangerous position, making it more prone to rupture.
I am not concerned about this myself. Scans have shown that the uterine wall, at its thinnest, is a healthy thickness and my midwife is happy for us to birth at home. However, I am confused by these differences of opinion and statistics and research is hard to come by. Most data that I could find was based around VBAC stats not VBAMyomectomy data.
I can’t imagine that I am the only one frustrated by this and wonder if this could be an area you would like to research/write about. Your piece above is excellent, clearly you enjoy the research part of writing your articles!
I look forward to hearing what you think.
All the best,
Tami
Tami, I have not done any research on this specific topic, but I would be more than happy to look and see what there is on the topic. You’re right–I’m sure that you are not the only woman who has these very questions and concerns! I’ll let you know via email if I do publish a piece on this. In the meantime, I do wonder if anyone at ICAN (the International Cesarean Awareness Network, http://www.ican-online.org) has any information on this topic. It’s definitely worth contacting them!
thank you for this article. I had to have a c-section with my 1st (he has a medical condition that made a c-section much safer), 4 years later when I was pregnant with #2 I had my heart set on a VBAC, and most of the midwives said that It shouldn't be an issue, the warned me of possible complications, but said I was a great VBAC candidate. Then around 36 weeks I saw a midwife that gave me all these scary "statistics" I was so afraid that I scheduled a s c-section. My recovery went extraordinarily well, and I had a healthy happy baby. But part of my still feels like I was wronged. Thank you for encouraging women to do their own research and don't be afraid to get a second opinion.
I had to have a c-section with my first as he was breached. I got pregnant again and my doctor had no issues with me having a VBAC. I had no problem carrying my second and I had no problems when it came to giving birth. I was 29 yrs old when I had my second and my first and second are only 10 months apart. Don't let anyone tell you that it can't be done. It was great to have experienced both.
[...] Birthing Beautiful Ideas; VBAC Scare Tactics – Kristen Oganowski has a great series on scare tactics that women hoping to VBAC might face. Good balance of heart and science. [...]