I’ve Got Your BAC

VBAC: vaginal birth after cesarean. TOLAC: trial of labor after cesarean. LAC: labor after cesarean. CBAC: cesarean birth after cesarean. ACOG: American colligate of obstetricians and gynecologists.

When you planned everything for your first birth you possibly went in with the idea that everyone on your care team had the same plan of you having a vaginal birth. Or perhaps you already knew, statistically speaking, more than 1/3 of births in the US end in surgery, but if you set your standards high and were very specific with your ideas and ideals you would have the birth you dreamt of.

Now you’ve been awakened to the reality that cesareans happen. And it happened to you and your baby. Now you may be struggling with the labels and statistics that have been placed upon you. That dream birth didn’t happen, and now that you’re (thinking about becoming or already are) pregnant, you have to look at your options going forward. These are your choices to make, and doing so with all the facts in play is so important to your own confidence in your ability to birth your way.

According to ACOG, the cesarean birth rates should be at or below 23%, whereas it’s sitting at 33-35%, nationally, and some hospitals the percentage is upward of 54%. ACOG goes on to state that 90% of those who have had a cesarean birth qualify to LAC, and 80% of those will go on to have a VBAC. Ultimately, the decision going forward is yours to make. What factors will you consider when making the decision on how to birth your baby?

Perhaps it was traumatic for you to go through the labor process and to wind up with a cesarean and you want to avoid going through that trauma again at all costs. No amount of inner work, talking it out, nudging or cajoling from your provider, partner, doula, family or friends will change your mind. Choosing a CBAC could be the perfect plan for you. Going in with the knowledge of what risks and benefits there are to having a CBAC, having a doula or birth worker that can guide you in having all your choices laid out so that birth space looks and feels the way you wish, having the people around you that you desire to feel safe and secure, and the provider team that supports your decision will go a long way in making your birth look and feel the way you want it to.

Maybe your self-confidence is dependent on you at least giving it a go, so having at least the experience of LAC is what you need as your choice for birth. Knowing that you had that TOLAC and your body indicated her capabilities loud and clear could be your ideal way to go. Finding a provider that truly believes in the importance of the labor process and knows the successful outcomes in the postpartum period from allowing labor hormones to happen can make a huge difference in your view of your body, your birth experience, in how your body recuperates, and in your lactation journey with your baby. Having a doula or trained birth support person can help you in decision making, in feeling empowered by knowing that this person believes in you and your baby, and knows the indications of inductions, epidurals, interventions and augmentations. Having a doula present also increases the chances of your TOLAC becoming a VBAC.

Planning for a VBAC or LAC means knowing what your birth team feels about these decisions. What language do they use when talking about your choices? How supportive are they? What are your statistics for complications? What information are they sharing? What information are they not telling you? Do they use terms like, “We’ll see if…,” or “Hospital policy says…”? Or do they use terms like, “This sounds great! I support your decision for…”? Do they share statistics that coincide with your beliefs? Do they also share the ones that contradict your decision? Do they have an agenda on their personal beliefs? If you doubt how they feel, ask them! You want to know these things early on so you can find a provider and support team that fits you and your birth choices.

The complications that can possibly come with deciding to birth again are going to be there no matter which birth style you choose to have. No matter what your preference is, it’s your decision to make, and finding the right support people is key to having a successful birth in your own mind. What’s important is knowing that you went into this decision with the facts in hand, that you made this call based on your own intuition and beliefs, and that you are supported and trusted in these things.

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