Lately, I have had an increasing number of clients looking for support with a vaginal birth after Caesarean (VBAC). I love working with clients in this situation! Here are some things to consider when deciding how you want to give birth following a Caesarean, and how to prepare for the experience.

Ok, first of all, I apologize for the cheesy pun in the title. Sometimes my goofiness gets the better of me. I might wake up one night and decide to remove that parenthetical V from the title. Let me know in the comments if you think that’s a good idea or not!

Now, on to the important subject of this post: vaginal birth after Caesarean, or VBAC. If you have had a Caesarean birth before, and you are either contemplating another pregnancy or find yourself pregnant again, you may have spent a lot of time wondering about what any future births might be like for you. Depending on the circumstances surrounding your Caesarean birth, you will likely have an important decision to make: whether to aim for a vaginal birth or to schedule another Caesarean birth. I will write about supporting Caesarean births in another blog post. Today, I want to share some tips about the VBAC option. These tips are based on my observations supporting clients having VBACs, my own two VBAC births, and my training as a ProDoula-certified VBAC Specialist.

For some reason, I have had a lot of recent clients seeking support for VBACs. According to the CDC, the rates of first-time Caesarean birth are going up, while the rates of subsequent birth by Caesarean are going down, so it makes sense that more people are having VBACs now. I had a theory about how COVID-19 might have played into all this, but couldn’t actually find any evidence to suggest that the pandemic changed the Caesarean rate significantly in the United States. Regardless of those statistics, it is clear that parents who had their first baby during the early days of the pandemic faced a lot of challenges. Add to that recovery from a major abdominal surgery while caring for a newborn, and it makes sense that a few years later, some of those parents are now anticipating another baby and are considering how their experience might be different this time.

If you have had a Caesarean birth in the past, there are two aspects that need to be considered when preparing for your next birth: your medical history, and your emotions surrounding birth. Your medical provider will be most concerned with your medical history, understanding the reasons why your older baby was born by Caesarean and any additional risk factors. It is important to choose a provider whose philosophy aligns with your own as much as possible. A doula can help you learn about the provider options available in your area and how to make sure that you feel heard and get your questions answered.

As a doula, I’m especially concerned with your emotions surrounding birth after a Caesarean. There can be a lot of complicated emotions. It is not uncommon to feel like you were not supported or listened to the way you wanted to be in your last birth, and to question whether the Caesarean outcome was necessary. Even if you feel that everything was done as it should have been, you may have some strong feelings or fears about the circumstances that led to your Caesarean. It is important to acknowledge and discuss those feelings, because they are likely to resurface during pregnancy or labor. If your partner was also present at the previous birth, they may also have a lot of feelings about it. Talking to a doula can help you voice what you are feeling. Sometimes through these conversations you may even recognize that you have some trauma about your previous birth experience; in these cases, you may also find it beneficial or necessary to seek out a trauma-informed counselor.

In many ways, preparing for a VBAC is not so different from any other person anticipating labor and a vaginal birth. You probably have a lot of feelings, ranging from excitement to fear, and you may not really know what to expect. If you experienced some labor before your Caesarean, there may be a particular significance in your mind to the point at which the decision was made to pivot to a surgical birth. Clients reflecting on their previous labor experience will frequently focus on how many centimeters dilation they “got to” or what they understood about the baby’s position. There may be a strong desire and sense of relief associated with “getting past” that point in the subsequent labor.

One thing that we can always say about labor is that it is unpredictable, so it is helpful to go into it with an attitude of flexibility and with someone who will be able to support you whatever circumstances arise. Birth preparations that help you practice your ability to exist in the moment, whatever may be happening in and around you, are helpful for anybody approaching labor, and may be especially helpful as you prepare for a VBAC. Two simple but profound practices that I especially recommend are: practicing slow, deep breathing, and choosing a simple prayer or phrase that is meaningful to you that you can repeat slowly and intentionally.

To practice this kind of breathing, sit comfortably and take a deep breath through your nose, using your diaphragm in your abdomen to inhale as deeply as you can. Hold it for a second and then release the air slowly. Try this a few times and then use a stopwatch or phone timer to see how many of these slow breaths you can complete in one minute. This is helpful because one minute is about the length of an average contraction. When you are in labor, you can start this breathing when a contraction starts, and you may find it helpful to count (or have your partner or doula count) the breaths. Knowing about how many breaths your contraction will probably last for can help reassure you that the contraction is going to come to an end. Here is a short video from Penny Simkin about the technique.

As you approach the birth of a child, this can be a wonderful time to tune into your own spirituality and reflect on the meaning of your life and of this event. Spirituality can also provide a profound source of strength for you to calmly handle whatever feelings and events may arise. If you already have a spiritual practice or religious tradition, think about what practices you already know that help to ground you in your spirituality. One practice from my own faith that I find very beautiful and helpful is known as the “Jesus prayer.” This involves the slow, steady repetition, often accompanied by fingering the knots on a prayer rope, of the phrase, “Lord Jesus Christ, Son of God, have mercy on me.” Other clients I have worked with have used Muslim prayer beads, Gospel music, and mindfulness meditations in a similar way. If you have a partner or doula who shares your spiritual practice, they may be able to softly say the words for you, helping you to focus. Or you may prepare a playlist on your phone. These practices are wonderful to help you get “out of your head” and draw strength to ride through the pains and fears you may have about labor.

I will write another post addressing some of the common questions that VBAC clients ask about labor and birth. To learn more about choosing and preparing for a VBAC, two excellent sites are VBAC Facts and the International Cesarean Awareness Network (ICAN). For now, the concluding advice that I want to leave you with are to examine and voice your emotions around birth, practice breathing and grounding techniques that you can draw on in labor, especially practices that will draw on and enhance your spiritual connectedness, and build a team of supportive people to accompany you in birth, ideally including a VBAC-supportive medical provider, a doula with whom you have a good rapport, and a loving partner.