This post is sponsored by HealthOne.
Riana Manley’s first pregnancy went smooth as silk. Healthy mommy, healthy baby. Until the end, when baby girl decided to be breech. Riana and her care team tried every trick in the book, to no avail. Baby girl would not turn. Riana ended up having a caesarean section. Result: healthy mommy, healthy baby.
A couple of years later, when Riana was pregnant again, she knew she didn’t want another C-section. She also knew, with her pregnancy history, that she was an ideal candidate for a vaginal delivery – a VBAC or vaginal birth after caesarean in medical terms. At the very least, she was ready to try it – in medical terms, that’s called TOLAC or trial of labor after cesarean.
“For moms wanting a TOLAC, the first thing to find out is exactly why you had a C-section the first time around,” said Dr. Natalia Arango, an OB/GYN at HCA HealthONE Consultants in OB/GYN-Denver – a part of HCA HealthONE. “Was the indication maternal (failed induction of labor, arrest of dilation, arrest of descent) or fetal (breech presentation, placenta previa, non-reassuring fetal heart tones, etc.)? What sort of incision did you have on your uterus? Have you had other C-sections or other vaginal deliveries?”
Not every pregnant mom is a candidate for a TOLAC.
“You need a full debriefing after your cesarean,” Dr. Arango, who delivers at HCA HealthONE Presbyterian St. Luke’s, said. “A lot of women never know the details of why they needed a C-section.” She recommends asking for a full copy of your medical records from your C-section, especially if seeing another practice or provider in a subsequent pregnancy.
One of the biggest concerns for a TOLAC, said Dr. Arango, is related to the uterine scar from your first C-section.
“Tissue in the area of the prior uterine scar is never as strong as the intact uterus once was, and thus there is an increased risk of uterine rupture” she said. The more C-sections you’ve had, the higher the risk of a rupture. And different types of incisions carry different rupture risks, according to the American College of Obstetricians and Gynecologists.
For Riana, a vaginal birth was important.
“It’s sort of a rite of passage, physically, emotionally and spiritually,” she said. “Having that stripped away the first time was something I had to process.”
She also dreaded the recovery of a second C-section. After her first delivery, she had a hard time going to the bathroom alone for a couple of weeks.
“I was recovering from major surgery,” Riana said. “I felt torn during this time.” Torn between settling into a new family life and caring for baby girl or looking after her own health.
For her second pregnancy, Riana had armed herself with all necessary information – including the type of incision she’d had — and knew she was an ideal candidate for a VBAC. She was disappointed to get pushback from some providers. The first provider, after listening to Riana’s story, still suggested a scheduled C-section, even though this was her first prenatal appointment and only because she was due to have a Christmas baby.
“I felt disregarded,” Riana said.
The third provider was supportive. “They said, ‘VBAC? Oh, yeah, there’s no reason why we shouldn’t prioritize that,” she said.
“It’s important to know your options and advocate for them,” Riana states “I felt more confident in my birth because my providers and I were working towards the same goal.”
Dr. Arango and Riana agreed that it’s important to ask your potential OB or midwife lots of questions, including asking about the views of ALL the providers in the practice, since occasionally your own provider ends up not delivering your baby.
“What are the benefits of a VBAC? What are the risks? What are the alternatives?” Riana said. “What does my gut tell me? So, no matter what you decide – whether that’s a C-section or VBAC – you’ll feel good knowing you’ve educated yourself and participated in your own decisions.”
Ideally, Dr. Arango said, a TOLAC candidate goes into labor naturally, because after a C-section, our options for induction are limited, as some of the medications are contraindicated. And a VBAC shouldn’t be attempted at home.
The benefits of a VBAC include a faster recovery, avoiding major surgery, less time in the hospital, possible quicker start of milk production, and a better chance of another vaginal delivery later.
And even if a VBAC isn’t for you, it’s OK. Dr. Arango said, no matter how you deliver, it doesn’t change the long-term outcome for your baby or have any impact on your parenting capabilities. And no matter what’s said on social media, you’re still a good mom.
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