I’m wanting to do a VBAC for my next baby. Any recommendations on how to prep my body for this to help it go smoothly?
—Audry
I want to pause before answering, because I think the framing of this question inadvertently gets to some broad issues in how we approach birth. “How to prep my body” carries with it the idea that if a vaginal birth after cesarean (VBAC) didn’t happen, it would be because in some way you didn’t prepare enough. I recognize this isn’t really what you mean, but I wanted to call it out to make sure you give yourself grace. Much of this isn’t in your control.
There are two main risks to a VBAC (or rather, to a trial of labor after cesarean — TOLAC — which could lead to a VBAC). One is a risk of uterine rupture, which could be very serious but is extremely rare. The more significant risk is that the trial will not be successful, and you’ll have a cesarean anyway. If you knew you’d have a cesarean anyway, it would be better to have planned it from the outset, in terms of recovery.
On average, a TOLAC leads to a vaginal birth an estimated 70% of the time after one cesarean and about 50% of the time after two. These odds vary with individual characteristics. That variation is important to understand for at least two reasons. First, to answer your question about whether there is anything that could change. But, second, even if all we can do is predict, this is useful. The decision to trial labor is probably affected by how likely it is to be successful.
There is a calculator. The inputs are simple. Age, obesity, and chronic hypertension reduce the chance of a successful VBAC. Having had a previous successful VBAC increases your chance of success. The other important input is the reason for the prior cesarean: if it occurred because of issues that arose during labor, the chance of success later is smaller (since these issues may arise again).
For the most part, getting back to my first point, there is little or nothing you can do to affect these characteristics. Don’t put it on yourself! The good news, though, is that a very large share of labor trials do end in a successful VBAC, and this will be more true with a supportive provider. In the end, finding that kind of provider is probably the best prep you can do.
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