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I believe in VBAC- thoughts from a midwife

“Once a cesarean, always a cesarean.”  That often-heard adage does not reflect the reality of birth today.  While it can seem astoundingly easy to end up with a cesarean surgery for the birth of a baby (roughly 1 in 3 babies in the United States are born this way), finding a provider to support a TOLAC (trial of labor after cesarean) and VBAC (vaginal birth after cesarean) can seem astoundingly hard, depending on the part of the country you live in. 
                There’s always things out of our control that contribute to cesarean section being the choice way to have a safe birth for mom and baby: a baby coming breech, a pregnancy of twins where the first baby is coming breech, baby’s heart rate in labor becoming abnormal, placenta over the cervix, mother having certain active infections, some medical conditions of mother or baby.  Despite all this, the World Health Organization says the number of women birthing by cesarean should be closer to 10-15%.  I am happy to be part of a group that overall tries to help women achieve vaginal birth rather than cesarean in the first place, but that also supports women when they desire a VBAC. 
As midwives, we work together with our pregnant women to help them stay as healthy as possible through healthy diet and regular exercise.  Moms can’t change genetics, but they can make  good decision prior to and in pregnancy to be healthy and grow a healthy baby and placenta.  These seemingly simple things can impact mom’s health and stamina, which impact her risk of cesarean; they impact growth of a healthy placenta, which supports the baby through pregnancy and during labor to help the baby’s heart rate stay in a normal range; they help grow a healthy baby.
Another aspect of care that midwives are attuned to is the baby’s position in the third trimester.  At 28 weeks, about 75% of babies have figured out that down is out, are head-down, and stay that way.  The other 25% are still figuring it out, and by birth, only about 3-4% of babies are still breech (not head-down).  We start checking the baby’s position around 30 weeks, and if baby is not head-down, we work with moms to do things that encourage the baby to flip.  We are able to help with external cephalic versions for those babies who insist on staying breech despite our other efforts. 
When we feel the belly to find if the baby is head-down, we are also feeling the position the baby is in, and we suggest positioning and exercises to help babies be not just head-down, but also in the most ideal position for birth.  I feel like I have seen more cesareans done because the head-down baby came into the pelvis in a not-ideal position, and then was not able to change positions or fit to get out.  We work really hard with our moms to have babies start out in good positions or get there during labor to prevent cesareans. Chiropractic can be especially valuable for this.   
Despite all the prevention measures we take, sometimes women do end up with cesareans.  It is our pleasure to be able to work with those women in all the same ways to prevent a repeat cesarean. When it comes to labor, we know women can be apprehensive about reaching the same point in labor as when the cesarean happened the first time. Sometimes women pass that point with no problem, but other times women need extra encouragement to get through that point mentally. We stay with laboring women to be physical and mental support especially through that challenging point. 
It is so rewarding to help a mom work through labor after a previous cesarean, to have a vaginal birth, and for her to know her body is not broken.  I truly believe women are strong, their bodies are powerful, and given the right support, most women will be able to birth vaginally after a cesarean.


Betsy McCanse CNM is finishing her 4th year at the birth center.
When she isn't catching babies she enjoys traveling and dancing.
Follow her hasttag on Insta and Facebook #gbconthego.


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