Written by: Doulas of Shanghai
You may have heard the old adage, “Once a cesarean, always a cesarean.”
And while this was common practice for decades, studies and care providers are now finding that many women CAN and DO safely birth their babies vaginally after a previous cesarean.
A vaginal birth after cesarean, or VBAC, is decided on by the birthing person for a variety of reasons. Maybe your first cesarean birth was unplanned, and you want to achieve the vaginal birth you originally planned for with your first.
You may be thinking about going for a VBAC for a number of reasons.
Maybe your doctor is telling you that it is the best choice for you and your future family plans.
Or perhaps you just want to see what all the fuss is about regarding vaginal delivery.
But type “VBAC” into a search engine, and you may get a lot of conflicting or confusing information about the safety and availability of VBAC birth. If you’re having your baby here in China, you may get even more confusing information.
A trial of labor after cesarean, or TOLAC, is another term you will come across when planning your VBAC. This is when a birthing person labors before deciding with their medical providers to repeat a cesarean birth.
Let’s break down what seeking out a VBAC in Shanghai or China can look like, as well as offer some practical information to help along your way.
What are the benefits of a VBAC?
Your reasons around choosing a VBAC for your upcoming birth are often personal to you. People choose VBACs for different reasons, and whatever your reason, it is valid.
We also know that there are many benefits to VBAC, both for the mother and baby. Benefits include:
Avoiding major abdominal surgery. Cesarean birth is common, but shouldn’t be considered the “easy way out” for those who give birth this way. Recovery takes time, patience with yourself, and pain medications.
Shorter recovery and hospital stay. Compared to a cesarean birth, you will be up and moving around sooner and more comfortably if you birth your baby vaginally.
Lower risk of infection, blood loss, and blood clots. These risks are common with any major surgery.
Reduced risk of bladder or bowel injury. These injuries can happen during any major abdominal surgery.
Lower risk of maternal mortality. Studies show that for most healthy pregnancies, giving birth vaginally shows statistically significant reduction in the material mortality rate.
And last but not least, YOU HAVE A GOOD CHANCE OF SUCCESS! Observational data suggests that those who try for a VBAC succeed 60-80% of the time. A successful VBAC is no longer the unicorn of birth, and is now being embraced by more and more care providers as a safe and viable choice for birthing your baby.
What are the risks of a VBAC?
Every birth carries with it benefits and risks, whether that’s an induction, planned cesarean, or unmedicated vaginal birth.
We also know that every person and pregnancy is different, so it’s important to talk to your doctor about any risks that may be specific to you and your pregnancy.
Risks for VBAC include:
Infection. As with any major surgery, there is always a risk of infection. Your doctor will help you to know the signs of infection and when to call your provider. Risk may increase with a trial of labor ending in a cesarean.
Uterine Rupture. This is the big, bad wolf of VBACs, the one of the key reasons a provider may want to schedule a repeat cesarean. The rate of uterine rupture is low, occurring in about 1 in 5000 births, and your doctor will carefully monitor you for signs of rupture.
Possibility of vaginal tearing or episiotomy. This is a risk associated with any vaginal birth, but one that you may be able to minimize. Talk to your doctor or doula to learn more about what you can do to prepare for vaginal delivery.
Now that we’ve gotten the risks and benefits out of the way, let’s talk about how you go about getting your VBAC in China.
1. Know your “why”
Setting out to get your VBAC may come with challenges or opposition from some friends, family, or even some medical providers. Knowing why you want your VBAC and surrounding yourself with supportive people, like a VBAC doula, can help you feel more confident in your decision.
2. Find a provider who supports your decision
This can be a more challenging task in China than some other countries. Most Chinese hospitals have high cesarean rates and some medical providers may be more comfortable with a repeat cesarean than VBAC. You may want to talk to several medical providers to find one who will support your VBAC.
When choosing your provider, you can ask the following questions:
- What is your professional opinion regarding VBAC?
- Do your on-call partners share a similar philosophy?
- What is your hospital policy regarding VBAC beyond 40 weeks’ pregnancy?
- What methods of induction would you use if labor does not begin on its own?
- What is your policy regarding augmentation of labor during a TOLAC?
- How about walking and fetal monitoring during a TOLAC?
- What is your policy about rupture of membranes?
Answers to these questions will be helpful when making a decision about your provider and birth facility.
3. Take a childbirth education course
Learning more about what to expect during a vaginal delivery and comfort measures available to you will improve your chance for a successful vaginal delivery.
Your local and international hospital may offer childbirth education courses in English and Chinese.
If you’re looking for a childbirth education course outside of a hospital, Doulas of Shanghai offers small group childbirth education courses that are independent of any hospital, and will even create a custom private course to fit you and your needs. You can schedule your private childbirth education course today, and can be done in the privacy and comfort of your home.
4. Hire a doula
Study after study show that having a doula present at your birth will increase your chance for a vaginal delivery. The American College of Obstetricians and Gynecologists (ACOG) state, “one of the most effective tools to improve labor and delivery outcomes in the continuous presence of support personnel, such as a doula.”
Women who have a doula attending tend to have births that are shorter, easier, request less pain medication, and more. Babies born to moms with doula attending tend to be healthier and breastfeed more easily.
According to Evidence-Based Birth, births attended by doulas have up to a 39% decrease in cesarean birth.
Your doula will also help your partner to feel more involved and safer during your labor.
VBACs can bring with them an array of feelings, including fear and emotional baggage from previous experiences. She is here to help you feel safer, calmer, and improve communication with your medical providers. She will help you know the questions to ask and may even be able to help with translation.
Doulas of Shanghai has doulas that have taken advanced training to be certified as a VBAC Specialists. Our doulas are trained in evidence-based support, and are non-biased in their philosophy towards birth. Meaning, we will support you and all of your choices, no ifs, and, or buts. Contact us to learn more about how we can support you.
Preparing for your VBAC is exciting, but also brings with it fears and anxieties that are unique to this type of birth. Contact Doulas of Shanghai to learn more about more resources in your community, and how we can help you to relieve anxiety, talk about your fears, and help you prepare for a more confident birth.
Doulas of Shanghai is an independent doula agency serving families in the Shanghai area, and offers virtual services to the greater China area. Contact us to learn more about and schedule your childbirth education class, infant feeding consultation, labor, and postpartum support.