Making an informed choice
If you’re pregnant for the first time, consider the long-term potential repercussions of having a medically unnecessary C-section (see “Advice for First-Time Moms,”). If you’re not a first-timer, would like to try for a VBAC and are a good candidate, start researching your options early in pregnancy. If your doctor or hospital doesn’t allow VBACs, consider other providers. For example, a major medical center with a level-3 NICU (neonatal intensive-care unit) and round-the-clock staffing by anesthesiologists is more likely to offer the option than a small community hospital is.
Support and information can come from childbirth educators, doulas, midwives and women online and in other communities who have had a VBAC. “Making a choice that is not considered mainstream, even when research supports its safety, can be very difficult,” Romano says. “So the more support a woman has, the better.”
More support might have helped Jamie Smith, 36, of Port Orange, Fla., who delivered her first child vaginally and her second by C-section because the baby was large and breech. When she was pregnant with her third child, she asked her doctor to consider VBAC, but he cautioned against it, even though there were no safety issues this time around. Reluctantly, Smith gave in and
delivered her daughter by C-section, but it was a decision she regrets because she wanted very badly to give birth without any
interventions. “I should have been much more adamant about my desire for a VBAC,” she says.
Are you low risk?
VBAC tends to be safest for women who:
>Have had at least one vaginal delivery
>Have had only one previous C-section
>Had a low-transverse incision (a horizontal cut low in the uterus) during their previous C-section
>Have a history of low-risk pregnancies
>Are delivering only one baby who is a reasonable size and well-positioned
>Do not have certain health conditions, including high blood pressure, diabetes (pre-existing or gestational) or active genital herpes
>Have no history of uterine surgery or other uterine problems
Advice for first-time moms
If you think the VBAC debate doesn’t affect you because you’re pregnant for the first time, think again. As the number of medically unnecessary C-sections rises, so do your chances of going under the knife for delivery No. 1 and having to deal with the VBAC
question for delivery No. 2.
The best advice? If at all possible, avoid that first C-section. Certified nurse-midwife Amy Romano, C.N.M., says some women decide to be “conservative” during their first pregnancy and agree to interventions that may not be necessary, including C-sections. “Then in their next pregnancy, those women face risks they would not have faced if their first baby had been born vaginally,” she says.
Find out more about new medical guidelines from the American College of Obstetricians and Gynecologists (ACOG).