VBAC Questions When Choosing a Care Provider

I read through several lists and compiled them, adding the questions I asked care providers during my VBAC consults. (I knew who my primary care provider would be but I wanted to find out back up options in case I needed them.)

Do you work with a lot of VBAC moms? How often do they have a vaginal delivery?

Under what circumstances do you advise a mom to have a repeat cesarean instead of a VBAC? During labor what would cause you to suggest another cesarean? (Cesareans are advised in cases of transverse presentation of the baby, complete placenta previa, and a few other circumstances that may become apparent during labor such as cord prolapse. They are not necessarily needed due to an estimated "big" baby, going past 40 weeks gestation, breech presentation, twins, water broken more than 24 hours, etc. It will of course depend on a variety of factors but those cases should not automatically rule out a VBAC.)

What do you feel the risks are for a VBAC? How often do you see serious complications? How often do you see uterine ruptures? What were the circumstances and outcomes? (The generally accepted uterine rupture rate based on numerous studies is 0.48% for moms with no prior vaginal deliveries, and even lower for someone who has delivered vaginally before. ACOG says 0.4%-0.9% based on mom's personal situation. If the doctor says rupture rates are higher than one percent, be concerned!)

What is your protocol when working with a VBAC mom? (This is an incredibly open ended question if you want to hear the doctor's genuine response, and not have them be biased by the questions you ask. If you want examples of more questions to facilitate discussion then keep reading!)

What if I go past my due date? To 42 weeks? What methods would you use to induce or augment labor? (Pitocin CAN be used with VBAC moms with close monitoring, but other types of medication can be riskier - do your research. You also want to be able to bake your baby up to 42 weeks without them insisting on a repeat cesarean.)

What if my baby is estimated to be larger than average? (This is NOT a good reason to schedule a repeat cesarean unless there are other factors at play.)

How long are you comfortable with me laboring? Pushing? If my water is broken? (If your water is broken the standard answer is you need to deliver with 24 hours, but if there's no indication of fever or distress then this is something important to discuss - will your doctor automatically advise a c-section at that 24 hour mark? In that case will your doctor avoid amniotomy during your labor so as to not start that countdown?)

At what point in labor do you advise a VBAC mom to come into the hospital? What if my water breaks and contractions have not begun? (The sooner you come into the hospital the higher the risk of interventions and infection, so it's good to wait until active labor is established - which may not happen for a few hours after your water breaks.)

What type of monitoring do you advise for VBAC moms? Constant, intermittent, internal, external? (Baseline monitoring of 20 minutes is standard, with intermittent monitoring for a few minutes at intervals advised by your doctor - it may be 15, 30, or 60 minutes. They need to see certain behaviors from your baby's heart rate and see how the baby responds before, during, and after contractions so you may be monitored longer at times to assess those things.)

How often do you perform episiotomies? Vacuum or forceps assisted deliveries? (Episiotomies should be RARELY performed, and assisted deliveries should also be unusual.)

What comfort measures for labor? May I get in the shower, sit on the birth ball, get into the tub, etc?

Do you advise moms to have an epidural? If a cesarean becomes necessary, how is anesthesia handled? If I need an emergency cesarean how quickly will the hospital be able to be prepared? May my partner be with me? (The hospital should be prepared with an anesthesiologist in house and the ability to get you into the OR promptly - in a true emergency you have minutes, not an hour. If they do not have someone ready then they are not prepared for emergencies for any laboring mom - not just VBAC moms. An epidural is NOT necessary for a VBAC mom and in fact can increase the risk of a repeat cesarean because of the associated interventions.)

How much time do you spend with a mom in labor? A VBAC mom? (Many doctors aren't called in until mom is pushing, but current ACOG guidelines advise the OB to be quickly accessible for the duration of labor with a VBAC mom. This may be in their office on the hospital campus, they generally are not in the L&D with you the entire time.)

Do you attend your VBAC moms' births or do you share call? Do your partners share your views on VBAC? What experience do they have? (You do not want to go into labor one weekend and find out your OB isn't on call and their partner isn't supportive of a VBAC.)

What positions have moms used for birthing - with a squat bar, all fours, assisted squat, etc? (You want an OB open to catching babies in whatever position is the most comfortable for you.)

How do you feel about working with midwives and doulas? (Whether or not you plan to receive some of your prenatal care from a midwife or hire a doula, if your doctor speaks negatively about other care providers then this is a red flag!!)

Photo from the talented Jessica Rockwell!

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