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Vaginal birth after cesarean (VBAC): providing access and education for women.

"No one ever told me ..."

In our first conversation on the phone, her soft voice said "this is my third pregnancy. I have had two cesarean sections and now I am going to have a vaginal birth after cesarean (VBAC). I get my prenatal care with a midwife who is in practice with an obstetrician. My delivery will be in a hospital and I want a doula." We set up a meeting place for the next day at Hardees and she tells me the story of her previous birth experiences.

Her first cesarean section was done for Cephalopelvic Disproportion (CPD). Her second cesarean birth was scheduled. "No one ever told me I could have a vaginal birth after a previous cesarean surgery. Now I know that I can. In recently read material and in talking with other mothers, I have learned that I could have a normal vaginal delivery." She found a health care provider and a hospital that supports VBAC's. From this point forward, I became her Childbirth Educator and Doula.

She delivered her third child vaginally. Empowered by the experience, she said, "I can do anything now."

"Whenever and however you intend to give birth, your experience will impact your emotions, your mind, your body, your spirit, for the rest of your life." (Guide to Childbirth Ina May Gaskin)

According to the Nicette Jukelevics website In the U.S. one out of three women gives birth by cesarean and more than 90% of women with a prior cesarean have a routine repeat operation. The cesarean rate runs contrary to the US Healthy People 2010 and 2020 goals. US National objectives to improve maternal, infant, and child health outcomes is to lower the cesarean rate for first time mothers to 15%, and increase the VBAC rate to 63% by the year 2020.

Many cesareans are scheduled for non-medical reasons, often before term. The March of Dimes, hospital associations and State Health Departments are working hard to reduce scheduled cesareans before term because of the health complications and long-term effects on the baby.

Know that 90% of women who have undergone cesarean deliveries are candidates for VBAC. In most published studies, 60-80%--roughly 3 to 4 out of 5--women who have previously undergone cesarean births can successfully give birth vaginally (American Pregnancy Association, VBAC).

This writing is not intended to give substantial statistical information on VBAC's. The childbirth educator can familiarize herself with this information by reviewing American Congress of Obstetricians and Gynecologists (ACOG) recommendations and visiting the International Caesarian Awareness Network (ICAN) and

In 2010, the ACOG released updated practice guidelines for vaginal birth after cesarean section. Those guidelines state VBAC's are a safe and reasonable option for most women. Note that this includes some women with multiple cesareans and twins. ACOG also states that an institution not offering a trial of labor after cesarean (TOLAC) cannot force or deny care to women. is a privately funded website that has been providing information on VBAC and reducing the odds of a cesarean section since 1998. This website provides child bearing women and maternity care professional's access to evidence based resources, educational materials, and support for VBAC and cesarean prevention. This website is written by Nicette Jukelevics M.A. ICCE. Nicette is a childbirth educator, researcher, and author of Understanding the Dangers of Cesarean Birth: Making Informed Decisions.

International Cesarean Awareness Network (ICAN) is an organization whose mission is to improve maternal child health by preventing unnecessary cesarean sections through education, providing support for cesarean recovery, and promoting vaginal birth after cesarean. While ICAN supports and believes that when a cesarean is necessary, it can be a lifesaving technique for mother and baby and worth the risks involved.

Women must be allowed to express their birth related feelings in a safe environment. Women must be given all options for childbirth so they can make a decision. Information is not accurate if it's focus is on myths and elicits fear. How a woman will make her decision to have a VBAC, or cesarean birth will include medical risks/benefits/information and her psychological and social factors.

For a woman who chooses VBAC, what the childbirth educators, medical professionals, and doulas need to know in order to give support during her pregnancy, labor and delivery is:


A. Know the mothers' feelings about prior cesarean sections and why they matter

B. Know how women make decisions about VBAC's

C. Know why fathers' experiences of cesarean births matter

ICEA will be offering a VBAC teaching guide as a resource for childbirth educators, doulas and healthcare providers.

Nancy Lantz, RN BSN ICCE ICD
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Title Annotation:Across the President's Desk
Author:Lantz, Nancy
Publication:International Journal of Childbirth Education
Date:Apr 1, 2014
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