Planning a VBAC? Is a nurse-midwife a good choice?

November 03, 2016 | by Brigitte Raahauge, CNM, APN
Categories: Healthy Driven Moms

Today, one in three mothers in the United States gives birth via cesarean (c-section). Maybe you are one of them. If you’re pregnant again or thinking of having another baby, you may be hoping for a vaginal delivery this time around.

A National Institutes of Health study notes that about 74 percent of women who have previously undergone cesarean birth can successfully give birth vaginally—called vaginal birth after cesarean (VBAC). It’s an option that many woman are seeking now.

After all, vaginal delivery is generally easier on a woman’s body, and recovery is usually shorter and less painful. A successful VBAC has fewer complications than an elective repeat cesarean, says the American Congress of Obstetricians and Gynecologists.

Benefits of a VBAC include avoiding major abdominal surgery, and a lower risk of postoperative hemorrhage, infection and blood clots. Cesarean sections are also associated with higher rates of bowel and bladder injury, and abnormal attachment of the placenta in subsequent pregnancies.

What are the risks of VBAC? The greatest concern for women is the risk of uterine rupture during vaginal birth. Although rare (there is a less than 1 percent chance), a rupture of the uterus is very serious for both mother and baby.

Deciding to attempt a VBAC is a personal decision best made with your provider, as there are factors which might make a woman too high risk to safely attempt a vaginal delivery. About 90 percent of women who have had a previous c-section are candidates to attempt a vaginal delivery. The ideal candidate has had one previous c-section with a low transverse (side to side) incision and has no other major medical problems or contraindications to vaginal delivery.

If a VBAC is an option for you, there is something else you should know. Having a supportive team around you is essential and will increase the chances of meeting your goals for a successful VBAC. This is where a midwife can really help.

Research suggests women cared for by certified nurse-midwives have fewer cesareans and more VBACs. Nurse-midwives spend a lot of time prenatally getting to know what’s important to you, assessing your individual risk factors, and helping you develop a birth plan to achieve your goals.

During labor, a certified nurse-midwife can provide personalized support, recommend positions and activities to encourage progress of labor, and offer a range of options for relaxation and pain management, including hydrotherapy in a shower or tub, narcotics or epidural. Due to this unique approach to care in childbirth, women attended by nurse-midwives often have less need for pain medications.

For a woman who has had a previous c-section and is attempting a VBAC, the hospital is the safest place to have a baby, where there is immediate access to emergency care if something should go wrong.

For the safety of mom and baby, certified-nurse midwives provide interventions for women attempting a VBAC, such continuous fetal monitoring and placement of an IV. Midwives also work with collaborative physicians who can perform c-sections if complications arise, or if a woman decides to have a repeat c-section for any reason.

While most women are good candidates for midwife care, some are not. If you’re pregnant or planning a pregnancy, the certified nurse-midwives at Elmhurst Clinic offer a free consultation to review your history and determine if you are a good candidate for midwifery care.

Learn more about midwifery services at Elmhurst Clinic.

Read our blog about what every expectant mom should know about c-sections.

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