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Set Yourself Up for a Successful VBAC

Birth is a wild, unpredictable ride that rarely goes according to plan. Maybe it was more magical and empowering than you could have ever imagined. Maybe it was an orgasmic experience that you can’t wait to try again. Or maybe, you tried your damn hardest for 36 hours before being whisked off to become 1 of 3 people who required a cesarean birth.

If you plan to have more kids after a cesarean, you have two birthing options: a repeat elective cesarean (ERC) or a vaginal birth after cesarean (VBAC). According to the American College of Obstetricians and Gynecologists, having a vaginal birth after cesarean (VBAC) is safer for most birthing people when compared to having an elective repeat cesarean section (ERC). But having a VBAC can feel like complete and total uncharted territory with social, individual, and health system barriers that make this option feel fairly scary.

The good news is if a VBAC is your goal, a pelvic physical therapist can help you prepare for and succeed in a vaginal birth after cesarean, and provide insight into why it's becoming an increasingly popular option for many birthing people.

The health benefits of a VBAC

While a medically indicated cesarean is an extremely important option — even life saving in many instances — it comes with its own set of risks and challenges that only increase with subsequent cesarean surgeries:

  • For the birthing person: Infection, hemorrhage, organ injury, and complications related to use of anesthesia, and blood transfusions
  • For the baby: Respiratory problems and obesity in childhood
  • For the future: Uterine rupture during future trial of labor after cesarean (TOLAC), placental implantation problems, ectopic pregnancy, hysterectomy

With these risks in mind, a VBAC is definitely worth exploring. While a trial of labor after a cesarean (TOLAC) comes with its own risks — primarily, a slightly increased risk of uterine rupture, a VBAC comes with many benefits including:

  • Reduced risk of complications associated with repeat cesarean deliveries
  • Quicker birth recovery
  • Much less pain overall
  • Mental health benefits: if unplanned or unexpected, a cesarean can cause you to feel a sense of disappointment or loss in not being able to deliver your baby vaginally. Choosing a VBAC, in this case, can provide a sense of accomplishment and empowerment.

It's important to note that not all birthing people are good candidates for a VBAC. The decision to attempt a VBAC should be made in partnership with your healthcare provider and should take into account factors such as the reason for the previous cesarean, the type of incision used, and your overall health.

5 ways physical therapy can support a successful VBAC

If you are considering a VBAC, one of the most important steps you can take is finding a supportive healthcare provider. Research shows that when people feel informed and supported in their decision making process, VBAC outcomes were more successful. A pelvic floor physical therapist can be a valuable addition to your care team. In addition to supporting your birthing goals, here are 5 ways that seeing a pelvic PT before delivery can help.

1. Essential education

Research shows that one of the single largest barriers to exploring a VBAC is the lack of understanding about this type of birth. In collaboration with your birthing team, your pelvic physical therapist can help make sure that you understand the ins and outs of a VBAC. No question is too silly, because we know this information and support can be so helpful in your decision making.

2. Advocacy & a clear birth plan

It can feel a little like you’re the only one embarking on this journey, but with a pelvic physical therapist on your team, you'll have an expert in your corner. In addition to supporting your birth goals through their own plan of care, your pelvic physical therapist can provide you with invaluable resources, including recommendations for VBAC-friendly OBGYNS, doulas, psychotherapists, or chiropractors. They can also help you design your VBAC birth plan based on your specific needs and goals.

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3. Labor & Birth Strategies

Your pelvic floor PT can help you optimize your vaginal birthing strategies: If the pain management strategies, labor and birthing positions, or pushing techniques you used during your first birthing experience were inefficient, your pelvic physical therapist can work with you to find different strategies that may better serve you in your next birth.

4. Cesarean Recovery and Scar Management

If you had a cesarean, a pelvic physical therapist can help support you while you recover, including helping care for your scar. Proper scar care will help you reduce cesarean scar tissue related complications such as pain, restricted movement, and adhesions.

5. Reducing Your Risks

While obesity, hypertension, and diabetes all increase your risk for having cesarean sections, exercise has been shown to reduce all three of these risks. By keeping your pain free and safely active throughout your pregnancy, pelvic physical therapy can help support your chances of a successful vaginal birth after cesarean.

We’ve got you.

At Origin PT, we will support you in all of your birthing goals. If you have had a prior cesarean birth, and your obstetric healthcare team feels that attempting a VBAC is a safe option for you, reach out to one of our pelvic floor PTs. They will discuss your birth goals with you, and — alongside your healthcare team — help to empower and support you every step of the way.

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Dr. Ashley Rawlins, PT, DPT

Dr. Rawlins is a physical therapist at Origin who specializes in the treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. In addition to being a practicing clinician, she is a passionate educator and author.

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