By Jen Kamel, Founder/Director VBAC Facts
Vaginal birth after cesarean (VBAC) rates have been slowly rising in America the last few years as more and more women become familiar with the option. (1; 2) However, our latest statistics reflect still that only 11% of women with a prior cesarean birth had a VBAC in 2014. (2) This is despite the fact that national medical organizations describe VBAC as a safe, reasonable and appropriate option for most women. (3; 4) Some women hire doulas to increase their odds. Here are six specific ways doulas can support these families as they traverse the sometimes challenging terrain of VBAC.
1. Be aware of what she is up against.
It’s huge. Almost 90% of women have repeat cesarean births in America. (2) Many members of the public still believe “once a cesarean, always a cesarean.” One third of hospitals mandate repeat cesareans and don’t “allow” VBAC – called VBAC bans – and one half of all obstetricians don’t attend VBAC. (5; 6; 7; 8) The logistics of planning a VBAC in this climate can be complicated, difficult and emotionally exhausting. Your clients will look to you for support, reassurance and resources.
2. Get educated.
The best way to provide reassurance is to learn as much as you can about VBAC. Despite the fact that many remain uneducated about the subject, everyone from the crossing guard at school to the cashier at Target has an opinion. It can be difficult for pregnant people to navigate the sea of conflicting viewpoints, and they may come to you seeking clarity. By understanding the basic medical facts and political barriers, you can help your clients by debunking misinformation. Be sure to assemble resources for your clients so you can quickly direct them to solid evidence. I find that achieving clarity on the facts helps women eliminate their confusion, conquer their fears and joyfully plan their VBACs.
3. Realize that finding a VBAC supportive provider can be really tough.
Some doctors tell parents that planning a VBAC is just as reckless as running across a busy freeway. And when parents hear this, they are scared. Make it a point to learn about the various providers in your area who attend VBACs, and what their policies are so you can help your clients find the best provider for them. Rack up bonus points by reaching out to those providers and creating a personal rapport with them.
4. Be honest with your clients.
If they have hired a provider you know isn’t supportive of VBAC, you need to tell them. This can be very difficult and even awkward. However women unanimously report that if their doula knew their provider wasn’t supportive of VBAC, they would want to be told. If you withhold this information, it can erode the trust between you and your client.
5. Keep an open in mind.
Not all women carry emotional trauma from their cesarean birth. Some women celebrate their cesareans, and other women mourn them. Some women feel that their body is broken; others don’t. There are a lot of factors that go into how a parent processes their cesarean birth. Listen to your clients, ask about their story, and be ready to refer them to your local ICAN chapter or mental health professional if they need more support or assistance.
6. Know how to support your client through another cesarean.
If client of yours has a repeat cesarean, there are a few key things that they need to hear. Let her know that it’s ok to be disappointed if she is. Assure her that having a cesarean birth doesn’t make her less of a woman or mother. Remind her that her body is not broken. And let her know that some women are candidates for VBAC after two cesareans even if the hospitals in your area have VBAC bans or very restrictive VBAC policies.
Through your work, you have the opportunity to increase VBAC access and improve maternity care in your community. Through learning about VBAC and creating alliances with VBAC supportive providers, you can create change one pregnancy at a time.
About the Author
Jen Kamel has been a consumer advocate and national speaker since she founded VBAC Facts nearly a decade ago. The mission of VBAC Facts is to increase access to vaginal birth after cesarean (VBAC) through educational programs, legislative action, and amplifying the consumer voice. Through her work, she has traveled the country as a California Board of Registered Nursing Continuing Education Provider presenting her program “The Truth About VBAC” to hundreds of professionals, providers, and highly motivated parents. She has spoken at national conferences including the American Association of Birth Centers, DONA, Lamaze, ICAN, and Human Rights in Childbirth and has been a featured guest on several radio shows and podcasts. She has testified multiple times in front of the California Medical Board on the importance of VBAC access, is a board member for the California Association of Midwives, and has served as an expert witness in a legal proceeding.
- American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. (2014). Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No 1. Obster Gynecol, 123, 693-711.
- National Center for Health Statistics. (2015, Dec 23). User guide to the 2014 natality public use file.
- American College of Obstetricians and Gynecologists. (2010, August). Vaginal birth after previous cesarean delivery. Practice Bulletin No. 115. Obstet Gynecol, 116(2), 450-463.
- National Institutes of Health. (2010, June). Final Statement. Retrieved from NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights.
- National Institutes of Health Development Conference Panel. (2010). National Institutes of Health Consensus Development conference statement: Vaginal birth after cesarean: New Insights. March 8-10, 2010. Obstet Gynecol, 115<(6), 1279-1295.
- Leeman, L., Beagle, M., & Espey, E. (2013). Diminishing availability of trial of labor after cesarean delivery in New Mexico hospitals. Obstet Gynecol, 122(2 Pt 1), 242-247.
- Barger, M. K., Dunn, T. J., Bearman, S., DeLain, M., & Gates, E. (2013). A survey of access to trial of labor in California hospitals in 2012. BMC Pregnancy and Childbirth.
- Guise, J.-M., Eden, K., Emeis, C., Denman, M., Marshall, N., Fu, R., . . . McDonagh, M. (2010). Vaginal Birth After Cesarean: New Insights. Rockville (MD): Agency for Healthcare Research and Quality (US).