Most Frequently Asked VBAC Questions: Answered

This post needs very little introduction because I know you’re eager to get right to the good stuff. Here you’ll find a list of the questions we get asked the most often in our community, in our DMs, to our inbox and basically when we meet anyone who knows we eat, sleep and breathe all things VBAC! 🥰

Scroll along and get answers to the things YOU want to know most. And whatever you don’t find here, search our main Blog page or shoot us an email at info@thevbaclink.com. We love hearing from you!

Let’s get started!

What is safer – VBAC, RCS or CBAC?

This is a big question with lots of different variables. When looking at VBAC or RCS, the statistics are pretty similar – the numbers tell us that VBAC is slightly safer than choosing a repeat c-section, but there isn’t a big enough difference to outright say you should definitely choose VBAC.

In terms of general safety, the safest is VBAC, the second safest is a scheduled c-section and the last is a VBAC attempt that ends in a repeat c-section (CBAC). CBAC carries greater risk for postpartum hemorrhage and need for blood transfusions because it’s more difficult to operate on a uterus that is contracting. Other risks include possibly needing to use a special incision, using general anesthesia or increased risk of postpartum infection 

Most importantly, there are many factors at play such as how many children you want to have (the more c-sections you have, the higher your chances of having severe complications), your current health status, your personal desires, your intuition and more. It really comes down to you weighing the risks and deciding which risks you’re more comfortable taking. What is an acceptable risk for one person is not for another. 

For more on “safety and risks associated with VBAC,” listen to podcast episode 259 and read “VBAC vs RCS: Which is right for you?” 

How long should I wait after my c-section to get pregnant again?

This is truly a matter of personal preference. Most providers will suggest you have 18-24 months between your c-section and your next birth, as there is some evidence showing that longer intervals between pregnancies could decrease the risk of uterine rupture. However, an “ideal” spacing is yet to be determined since the research is subpar. In general, we believe you should consider multiple factors like your personal preferences, your health, desired family size and more. 

For more on “length between pregnancies,” listen to podcast episode 269 and read “Getting Pregnant After C-Section.”

What is the best way to prep for a VBAC?

No one’s VBAC journey is the same. However, there are some things we truly believe can help increase your chances of having your VBAC, including…

1. Find a supportive provider who believes VBAC is possible and wants it for you as much as you do, a provider who will not pull a bait-and-switch and, in the end, use non-evidence based information and fear tactics to persuade you to have a c-section. Interview providers before you settle on one by being honest about what you want and asking open-ended questions. Read more about finding a good provider here.

2. Educate yourself. Researching, taking a VBAC course, listening to VBAC birth stories, engaging in VBAC-related communities – all of these things give you the confidence to make informed decisions and have well-thought out conversations with your provider, partner and others in your circle. The more educated you are, the more confidence your provider will have in you as well.

3. Build a supportive birth team. Yes, a provider is important, but it’s also so important to have people by your side who truly care about the kind of birth you want and want to help you get it. Have genuine conversations with your partner, family & friends and hire a doula, especially one who is trained in all things VBAC. Check out our Certified VBAC doula directory.

4. Take care of yourself. Nourish yourself with lots of protein, fruits & vegetables, healthy fats and whole grains. And unfortunately, because our bodies just don’t get everything we need to grow a healthy human, make sure you are taking a good supplement like Needed (use code VBAC20 for 20% off your order). Stay hydrated every day. Exercise regularly, and try to walk at least 30 minutes every day. Obviously, make sure that everything you are doing and ingesting is in line with your personal situation. If we are truly fueling and taking care of our bodies, we’ll improve our pregnancy and improve our chances for a better birth.

For more on “prepping for your VBAC,” listen to podcast episode 269 and read a few of our favorite articles here. 

Can I go past 41 weeks?

Going past 41 weeks in general is something that has become more and more controversial, especially after the ARRIVE trial (read more here), a study which looked at the correlation between 39-week inductions and complications for first-time moms. In general, you should know this… going past 40 weeks and even 41 weeks is common. When you get to your “due date,” it’s normal for your provider to suggest some extra evaluations like a non-stress test and / or a biophysical profile, which can help identify if there are any concerns with you or baby.

According to ACOG’s guidelines, “For women who desire TOLAC and who have not had a prior vaginal delivery, awaiting spontaneous labor as opposed to undergoing labor induction most likely avoids further additional increased risk of uterine rupture. Thus, TOLAC remains an option for women with postterm pregnancies who have not had a prior vaginal delivery, but these women should be counseled regarding these unusual risks** such as failure of TOLAC and uterine rupture.” Additionally, they summarize by stating that looking at all of the evidence, it’s safe to go to 42 weeks of pregnancy before recommending a routine induction of labor due to post-term pregnancies.

As far as VBAC-related risks go, there is no significant increase in the risk of uterine rupture going past 40 weeks, but there could be some concern about hypertension or other things at play just depending on your circumstance. However, these should be dealt with on a case-by-case basis if / when you run into them rather than a provider automatically telling you that you cannot go past 41 weeks simply because you are planning a VBAC.

For more on going past your due date, listen to podcast episode 269 and read “VBAC After 40 Weeks.”

If I was considered “failure to progress” with my c-section birth, is my body capable of having a vaginal birth?

So, so many moms end up with a c-section because their provider diagnoses them as “failure to progress,” essentially meaning that dilation, station or labor in general stalled and / or stopped progressing. Now, to preface this, you should know that it’s very likely that you didn’t progress in your first labor because of the environment, rushed labor, artificial rupture of membranes causing malposition of baby, lack of mobility or other issues like that. 

It’s very, very rare that someone’s body can’t or doesn’t know how to dilate to 10cm and push a baby out. And even if your body didn’t progress in one labor, that doesn’t mean your body won’t progress in your next labor. 

Know that if your provider is putting doubt in your mind about your ability to have a VBAC because your body didn’t do it before, you may not be with the right provider or you may have to fight hard. And don’t forget the importance of educating yourself and building the right birth team, including a supportive partner and doula.

For more on “failure to progress,” listen to podcast episode 269 and episode 194 and read “Why Failure to Progress in Labor is Usually Failure to Wait.”

If my body never went into labor on its own last time, what is the likelihood of that happening again?

Just because you didn’t go into labor once does not mean you are never going to go into labor with your next birth. We hear from so many people in our community who just never got the opportunity to go into labor (i.e. were induced between 39-41 weeks). We believe that nearly everyone will go into labor eventually. What you really need to consider is will your body go into spontaneous labor before your provider wants you to go into labor – those are often two different expectations. If your provider expects you to go into labor by a certain date, you may have to fight a little harder, be more patient and trust your body. 

For more on “failure to progress,” listen to podcast episode 269 and episode 194 and read “Why Failure to Progress in Labor is Usually Failure to Wait.”

My provider diagnosed me with CPD. Can I still have a VBAC?

If we are being super honest, one of the most frustrating things in the VBAC world is hearing people being told their pelvis is too small, which can just cause a ton of self-doubt. CPD is cephalopelvic disproportion, essentially a diagnosis that your pelvis is too small to birth a baby vaginally. We hear so, so many stories of women who want to have VBACs but have been told they can’t because they have CPD. 

What we know about CPD is that it is actually incredibly rare. In most cases, CPD is a side effect of growing up malnourished or having a traumatic pelvic injury. CPD can only truly be diagnosed with a pelvic imagery exam, not an x-ray. Additionally, we have to remember that during labor, your pelvis expands and your baby’s head overlaps. Even if you have a “small pelvis,” there is no way to know how much it will expand during labor to allow baby’s head to navigate.

For more on “CPD,” listen to podcast episode 259 and read “Your Pelvis is NOT Too Small – Overuse of the CPD Diagnosis.”

Do I have to get an epidural if I want a VBAC / Can I have an epidural if I want a VBAC?

No. Many providers will suggest (or even “require”) that you have an epidural placed if you want a VBAC, telling you that it’s “just in case” you would need a c-section. However, even if you have an epidural placed and would decide or need a c-section, it still takes 20-30 minutes to dose the epidural.

Along the same lines, it is ok to choose an epidural if you are planning a VBAC. Going unmedicated is not for everyone. Even if you plan to go unmedicated and then you change your mind, that is absolutely ok.

For more on “VBAC and epidurals,” listen to podcast episode 269 and read a few of our favorite articles here. 

Should I get a membrane sweep with a VBAC?

A membrane sweep, scrape or strip is when your provider inserts a gloved finger into the cervix and separates the membranes of the amniotic sac from the cervix, which releases hormones like prostaglandins. This is often performed in the office around your due date as a more gentle, non-medical form of induction. 

According to research done by Evidence Based Birth (we love them!!), starting regular membrane sweeps at 37 weeks or pregnancy and doing them twice a week until delivery can shorten your pregnancy by one to two days. This equates to a lot of membrane sweeps for some people. Although you may have heard stories about it, having one membrane sweep at 40 weeks hasn’t been statistically proven to shorten pregnancy or induce labor. And while there are some risks like premature rupture of membranes, irritation or cramping, even the onset of prodromal labor, there isn’t a lot of significant evidence there either. 

For more on “membrane sweeps,” listen to podcast episode 259 and episode 194 and read “Membrane Sweeps for VBAC: Details Explained.” 

Can I be induced and still have a VBAC?

The short answer: YES, you can be induced with a VBAC. There are various ways to do it that are very reasonable. Our number one suggestion for a VBAC induction is to go low and slow, which regardless of what other moms or providers may say, is also very possible and reasonable. 

Now, to explain – when we talk about low and slow, we’re typically referring to a Pitocin induction. Many providers will suggest starting at 4mL and increasing by 4mL every 30 minutes. This can be overwhelming for your body, especially if it doesn’t respond right away and has to kind of catch up (you’ve likely heard about the intensity of Pitocin contractions for some moms). Low and slow, however, would be starting at 1 or 2mL and then increasing by smaller increments and / or spacing out the timing even more. Also remember, you can always turn the Pitocin off. If it’s too intense, you’ve started progressing at a rate you’re comfortable with or it’s just not feeling right, you can have it turned off. 

You should note that this low and slow method is likely something you’ll need to be educated and adamant about, possibly even fight for. Trust your intuition and decide what’s best for you. 

It’s also very important to note that Cytotec, also called Misoprostol, is not considered a safe method for VBAC induction, due to an increased risk of uterine rupture.

For more on induction for VBAC, listen to podcast episode 269 and read “The Best VBAC Induction Methods.”

What is a foley catheter, and is it safe for VBAC?

A Foley catheter is a non-medical form of induction where a small balloon is inserted through your cervix, periodically pumped with saline, thus putting pressure on your cervix and mechanically changing dilation and effacement. When the Foley is placed, your provider will tug on it, or suggest you do, every 20-30 minutes. You typically have to be dilated a little to get the catheter placed, and then it will usually fall out when you progress to 4-6cm. 

A Cook catheter is similar, the only difference being it has two balloons, like a barbell shape. According to our research, the Cook has a greater result of actually ripening the cervix, but the Foley has a greater success rate overall from start to finish. 

One thing to note is that sometimes when the Foley comes out, your dilation might relax a little bit. Not necessarily going backward, but your body has to catch back up again. Using a very small dose of Pitocin in conjunction with or immediately following a Foley can be useful to help keep progress going. 

Although some providers refuse to use these catheters as a form of induction for VBAC, we think they can be safer and more effective than other inductions, like cervical ripeners. According to an ACOG study, “Foley catheter did not increase the risk of uterine rupture in TOLAC,” and that “The data shows the Foley catheter is a safe tool for mechanical dilation in women undergoing a trial of labor after a Cesarean.” If your provider says that you’re not a candidate or it’s a contraindication for VBAC, we highly suggest you have an open discussion with them and ask for their reasoning and research. 

For more on “foley induction,” listen to podcast episode 259 and read a few of our induction-related articles here. 

Does induction increase the rates of uterine rupture?

A usual follow-up to the induction question is about uterine rupture. We are unaware of any research showing increased rates of uterine rupture with induction methods (except for the use of Cytotec). We often hear providers throwing out seemingly random statistics like “you have a 60% chance of rupturing,” but we urge everyone to challenge that information. Ask questions about where they are finding the statistics and request to see it so that you can make the best, most informed decision for yourself.

For more on uterine rupture, listen to podcast episode 269 and read “How to Really Understand the Risk for Uterine Rupture.”

How do I avoid a uterine rupture?

Unfortunately, we don’t always know why uterine rupture happens; t’s hard to say exactly what causes it. It’s also important to note that, although the chances are extremely small, uterine rupture happens and can even happen in people who have not had a previous c-section. 

Things we can do to to lower our risk include

• Avoid unnecessary induction
• If you do decide to induce, be educated about your options
• Never use Cytotec
• Avoid aggressive augmentation
• See a pelvic floor physical therapist
• Ensure baby is in an optimal position by doing Spinning Babies and The Miles Circuit
• Educate yourself by listening to birth stories, attending our Q&A sessions, taking a course

For more on uterine rupture, listen to podcast episode 269 and read “How to Really Understand the Risk for Uterine Rupture,” “The Risks of Uterine Rupture During VBAC or HBAC and How to Reduce Them,” and “Signs of Uterine Rupture: What you need to know as a VBAC mom.”

Can I still VBAC with hypertension?

Absolutely, you can VBAC with hypertension. Some providers may assume or suggest that TOLAC increases blood pressure, but we are unaware of any studies making that correlation. Even if your hypertension progresses to preeclampsia, there are things you can do to navigate and reduce the effects, and research shows that TOLAC can still be a safe option. 

For more on hypertension / preeclampsia, listen to podcast episode 269 and read “VBAC with Preeclampsia.”

Can I have a VBAC with gestational diabetes?

Yes, you can still have a VBAC with gestational diabetes. Providers often suggest induction at 38 or 39 weeks depending on how the GD has been managed, but it is not always necessary to have an induction.

Our best tip here is to educate yourself. Food, exercise and other personal health practices can oftentimes impact GD and help you manage it. We also highly recommend Real Food for Gestational Diabetes by Lily Nichols. And, of course, talk with your provider, understand what they’re looking for and what their plan is to help you manage your diagnosis so that you can still have the birth you desire.

For more on gestational diabetes, listen to podcast episode 269 and read “VBAC with Gestational Diabetes.”

Is it safe to VBAC with twins?

Yes, you can VBAC with twins. Yes, it is safe. Sometimes providers will set some stipulations on what position each baby needs to be in (i.e. one head down and one breech or both head down), but it is still safe in most cases. It’s also common for a provider to have you give birth in the operating room, but yes, research shows that a vaginal birth for twins is generally safer than a c-section. 

For more on “VBAC with twins,” listen to podcast episode 269 and read “Can You Have a VBAC with Twins?” Also, check out the podcast Birthing Instincts with Dr. Stuart Fischbein and Midwife Blyss.

Is home birth safe for a VBAC?

Yes, you can have a home birth for your VBAC, often referred to as an HBAC. We hear tons and tons of HBAC stories in our community and on our podcast. Home birth is a reasonable option for VBAC. That being said, HBAC is not usually recommend by providers or ACOG (even though we use and appreciate ACOG’s research very much). It’s important to keep in mind, however, that it is still an option that many people choose and experience successfully. Like everything else related to VBAC, do your research, find a supportive team and move forward with the choice that feels the best to you. 

For more on “HBAC,” listen to podcast episode 269 and read a few of our favorite articles here. 

What is a cervical lip, and how do I navigate that?

A cervical lip is when your cervix is almost fully dilated (behind baby’s head) but there is a small part of it, like a crescent moon shape, that is still covering the baby’s head. This can happen anteriorly, on the side, in the back, etc. Cervical lips can be caused by baby’s position, a long labor, having a LEEP procedure or for no specific reason at all.

Suggestions for resolving a cervical lip include…

• Position changes like toilet sitting, squatting or using the peanut ball 
• Massaging or advancing (provider will hold the lip during a contraction and push it back) It can be very painful, especially without an epidural. Again, this is a time where a tiny bit of pitocin could be helpful because it can cause some stronger contractions, and that in conjunction with a little pressure, can help dilation progress, the lip to resolve and the Pitocin to be turned back off. 
• Using Arnica gel or Benadryl to reduce swelling and inflammation
• Pushing during a contraction
• Doing nothing / resting

It’s important to note that trying too many things – pushing too hard, adding too much pressure – can cause the lip to be aggravated and swell. And, truly, there isn’t always a right answer, but there are options. Sometimes they work and sometimes they don’t, but you always have choices.

For more on “cervical lips,” listen to podcast episode 259.

Why do so many providers not support VBAC after two C-sections? What does the evidence say?

Evidence says that vaginal birth after two c-sections (VBA2C) is reasonable. Studies say that women requesting a trial of labor (VBAC) should absolutely be counseled and absolutely be offered an opportunity. The success rate is about 71% or higher, and according to ACOG, the uterine rupture rate is the same or not much higher than with a VBAC. Additionally, rates of maternal morbidity with a VBA2C is comparable to those of a repeat Cesarean.

In general, it is overall safe and reasonable to have a VBA2C, and we hear tons and tons of stories on the podcast and in our community. 

When it comes to vaginal birth after multiple Cesareans, it’s pretty difficult to find evidence, and there are few providers who will support it. However, that doesn’t mean that you’re not a candidate or that it’s a major risk. Like we talk about often, you have to weigh the risks for your personal situation and decide what feels best for you. 

For more on “VBA2C,” listen to podcast episode 259 and read “VBA2C: The Facts and Statistics” and “7 Surprising Studies on VBAMC.” 

How do you cope with not getting your VBAC?

Processing a cesarean birth after cesarean (CBAC) will be different for everyone. First, we hope you understand that it’s normal to be mad or sad, and we hope that you have the time and space to welcome, feel and process those feelings. It may also be helpful to read your chart and / or op report to better understand what was said and done during your labor that you may or may not have realized. 

Also, we really believe in accepting that sometimes we just won’t know the answer or reason, which can be very tricky. It’s normal to get hung up on the fact that we don’t have a definite answer or understand why our situation happened the way it did. Taking the time to work through and practice a radical acceptance, believing that there won’t always be a “why,” can be extremely powerful. 

For more on “processing your birth / cbac,” listen to podcast episode 269 and read “How to Cope When You Don’t Get Your VBAC.” 

What role does diastasis recti play when it comes to a successful VBAC?

Diastasis recti is the separation of the abdominal muscles that happens during pregnancy. Many moms are left with a separation after their babies are born which can cause some issues postpartum and for years to come if not healed properly. As far as your VBAC journey goes, there shouldn’t be any major issues if you have DR. It’s possible that you have some issues with pelvic pain, discomfort or alignment, but there is not reason you aren’t still a good candidate for a VBAC. We definitely recommend seeing a pelvic floor physical therapist to help you heal your DR regardless of if you’re planning to have more children or not.

For more on “diastasis recti,” listen to podcast episode 194 and read “Your VBAC Guide to Pelvic Floor Physical Therapy.”

What happens to c-section scar tissue after you’ve had a VBAC?

We don’t know the scientific answer behind this, but you will always have scar tissue there, even after a VBAC. We highly recommend seeing a pelvic floor physical therapist for specialized care of your scar and scar tissue. As they will likely recommend, scar care and massage is also super important. There are different types of massage you can do from the very beginning to improve healing and blood flow, flatten your scar area, avoid the appearance of a “shelf,” decrease pain and improve elasticity. 

For more on “safety and risks associated with VBAC,” listen to podcast episode 194 and read “C-Section Scar Massage: What it is and how to do it” and “Your VBAC Guide to Pelvic Floor Physical Therapy.”

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As always, I’ll leave you with this affirmation and reminder…