I think the most important way to increase your chance for a successful VBAC is to find a doctor or midwife that 100% supports and encourages your decision. They should be offering advice on how to be successful and not focus on what would cause you to not be successful. Some doctors might be tolerant of your decision or say "well, you can try" while others help you realize that you can do it! Those that are "tolerant" are usually either looking for reasons/excuses to end up with a c-section or if anything seems at all "abnormal" might just end up saying you need to have the c-section. I have even heard of some that seem supportive, only in the last couple weeks of pregnancy totally change their tune and recommend a c-section. When that happens many women feel it is too late to change doctors so end up with the c-section they were trying to avoid and often times was not necessary. It is important to take the time to interview a few different people and to ask the right questions so you can really see what their philosophy is. Don't just end up with someone because you used them before or your sister/friend uses them and says they are good, or they are the closest, etc. To increase your chances it is necessary to find just the right person. I highly recommend midwives but also know there are some great very pro-VBAC doctors as well. You might even consider hiring a doula to help and support you through your delivery.
In my research I found these other tips to also better your chances of having a successful VBAC.
- Wait at least 9 months before trying to conceive again, even longer is better: I think I was actually told wait a year before trying to get pregnant again while others say even 18 months. I know the longer you wait allows your scar to heal better and become stronger, which is what you want to help decrease any chances for problems with the scar that could lead to complications and a c-section.
- Avoid induction of labor, whenever possible: My research said that induction agents can increase the risk of uterine rupture. Along with that though is that inductions significantly increase the likelihood that you will end up with a c-section---this is true in any vaginal birth, not just VBAC. Because you don't want to be induced you need to find someone who will not pressure you to be induced due to being "overdue" or for having a "big baby". If for some necessary medical reason you need to have labor induced you should avoid the cervical ripening agents such as prostaglandin found in Prepidil, Cervidil, Cytotec.
- Avoid use of synthetic oxytocin (Pitocin or "Pit") early in labor:
- Avoid interventions: Some of these were listed above but the more interventions that happen during any birth have greater likelihood for ending up with a c-section.
- Wait until your cervix is beginning to open to be admitted: You are less likely to have a VBAC if you are admitted before your contractions are well-established. If you go to the hospital before labor is under way the more interventions are usually pushed on you as well. Also some hospitals have time limits for how long they allow VBACers to labor.
- Avoid epidurals and spinals: A common side effect of these pain relievers is that they slow down the baby's heart rate. This is also a symptom of uterine rupture so even though it most likely would be the side effect of the drug most doctors would push for a c-section whenever the heart rate drops even when they are unsure of the cause. I had my baby naturally and there are many techniques, positions, etc. that can ease the pain. I will talk more about these in another post.
- Work on a healthy diet and exercise: The stronger our body is will help during the hard work of delivery. I already talked about the diet changes my midwives suggested but I will list them again: going off sugar, limiting wheat and carbs, no milk, lots of protein, taking magnesium.
- Healthy mental well-being: Take the time to process and work through whatever emotions you went through after your c-section. Don't ignore or suppress them. Visualize the whole labor, pushing, and delivery with the beautiful outcome of a precious baby and a successful VBAC. Positive outlook can do wonders for the mind and body.