Secrets to a Successful VBAC: Insights from a Labor and Delivery Nurse

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Attempting a Vaginal Birth After Cesarean (VBAC) is an empowering journey, but it can also feel overwhelming without the right guidance and support. As a labor and delivery nurse I know how much preparation, determination, and the right support can impact the success of a VBAC.

A VBAC isn’t just about achieving a vaginal delivery after a cesarean—it’s about reclaiming your birth experience and making choices that align with your goals and values. While there’s no single formula for success, there are steps you can take to greatly increase your chances of having a positive VBAC experience.

In this post, I’m sharing seven key secrets to a successful VBAC, drawn from my experience working alongside incredible moms in the delivery room. From choosing the right provider to preparing your body and mind, these insights will help you feel confident and empowered as you embark on this journey.

Please note: The views on this website are personal opinions only and do not represent the opinions or policies of any provider or institution that I am affiliated with. I am not giving medical advice. Information on this website is not intended to diagnose, or treat any form of any disease. This article is for informational and entertainment purposes only. I am only telling you what my experiences are. Please refer to my Disclaimer Page for more information.

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Understanding What Makes a VBAC Successful

Success in a VBAC journey can mean different things to different moms. For some, it’s about achieving a vaginal delivery; for others, it’s about feeling empowered, supported, and safe throughout the birth process. No matter your definition, the core elements of a successful VBAC remain the same: preparation, support, and informed decision-making.

Moving forward with your VBAC, let's set some goals:

1. A Safe Delivery for Both Mom and Baby

The ultimate (note how I didn't say only) goal of any birth is a safe outcome for you and your baby. Success isn’t about following a rigid plan but ensuring that the choices you make prioritize health and well-being – physically, mentally, emotionally, and spiritually.

2. Feeling Heard and Respected

One of the most empowering aspects of a successful VBAC is feeling like an active participant in your birth. When your preferences are understood and respected by your care team, it creates a collaborative atmosphere that supports your goals.

3. A Positive Birth Experience

Whether your VBAC goes exactly as planned or requires adjustments along the way, success often comes down to how you feel about the experience of how it all unfolded. A supportive team, a well-prepared mindset, and flexibility can help you walk away from your birth feeling proud and empowered.

The Role of Preparation

Preparation plays a crucial role in VBAC success. From finding the right provider to strengthening your body and learning about the process, every step you take brings you closer to achieving your goals. It’s about setting the stage for a birth experience that aligns with your vision while remaining adaptable to the unexpected.

Secret #1: Find the Right Provider

One of the most important factors in having a successful VBAC is choosing a provider who genuinely supports your goal. Not all obstetricians or midwives are equally experienced or enthusiastic about VBACs, so it’s crucial to find someone who aligns with your vision and is well-versed in VBAC care.

Why Your Provider Matters

A VBAC-supportive provider will:

• Take the time to review your medical history and assess your VBAC eligibility thoughtfully.
• Provide evidence-based guidance on your options and be transparent about the benefits and risks of VBAC.
• Respect your preferences and work with you to create a birth plan that reflects your goals.
• Have a track record of successfully supporting VBACs and a proactive approach to monitoring and care during labor.

On the other hand, a provider who hesitates or avoids discussing VBAC options may not be the right fit. Red flags include:

• Frequent focus on risks without balancing the discussion with benefits.
• Discouraging VBAC for reasons unrelated to your specific circumstances.
• Overemphasis on scheduling a repeat cesarean without exploring alternatives.

Questions to Ask When Choosing a Provider

During your prenatal visits, consider asking these questions to evaluate whether your provider is VBAC-supportive:

1. What is your VBAC success rate?
2. What percentage of your patients attempt VBACs?
3. What is your policy on labor monitoring for VBAC patients?
4. Are there any specific hospital policies that might limit my VBAC options?
5. How do you handle scenarios where labor is not progressing as expected?

The Importance of a VBAC-Supportive Facility

Even the most supportive provider can face limitations if the hospital or birthing center has restrictive policies. Look for facilities with a history of offering VBAC options and access to emergency care if needed. Some hospitals are designated as VBAC-friendly, meaning they have systems in place to safely support your goals.

Secret #2: Understand Your VBAC Candidacy

Knowing whether you’re a good candidate for a VBAC is an essential step in setting realistic expectations and making informed decisions. While many women are excellent candidates, certain factors can influence the likelihood of a successful VBAC.

What Makes a Good Candidate for VBAC?

Several factors contribute to a higher likelihood of success, including:

• Type of Previous Cesarean Incision: A low transverse (horizontal) incision on the uterus poses the least risk of complications, making it the most favorable for VBAC.
• Reason for Prior Cesarean: Non-recurring issues, such as breech presentation or fetal distress, suggest that a vaginal birth may be achievable this time. In contrast, issues like failure to progress or arrest of descent may require closer evaluation.
• Time Between Births: An interval of 18 months or more between deliveries is generally recommended, as it allows for better healing of the uterine scar.
• Overall Health and Pregnancy: A healthy pregnancy without complications (such as placenta previa or severe preeclampsia) supports VBAC eligibility.

How to Discuss Your Candidacy with Your Provider

Ask your provider to review your medical records, including details of your previous cesarean. Important questions to ask include:

• What type of uterine incision was used in my prior cesarean?
• Are there any specific risks in my case that could impact VBAC success?
• Based on my history and current pregnancy, what are my chances of a successful VBAC?

Your provider may use a VBAC calculator, which considers factors like age, BMI, and obstetric history to estimate your likelihood of success. While this tool can be helpful, it’s not definitive; your provider’s clinical judgment and your preferences should carry significant weight in the decision-making process.

Factors That May Require Extra Consideration

While VBAC is safe for many women, certain factors might warrant additional precautions or make VBAC less advisable:

• Multiple Prior Cesareans: Having had more than one cesarean can increase the risk of complications, though some women still successfully achieve VBACs.
• Short Pregnancy Interval: If less than 18 months have passed since your last cesarean, there may be a higher risk of uterine rupture.
• Previous Uterine Surgery: Other types of uterine surgeries, such as fibroid removal, may also influence your eligibility.

The Role of Informed Choice

Understanding your VBAC candidacy allows you to make informed decisions about your birth plan. Even if there are risk factors, many women find that with the right provider and preparation, a successful VBAC is achievable. The key is open communication and a collaborative approach with your care team.

Secret #3: Build a Strong Support System

Having a supportive team by your side can make all the difference in achieving a successful VBAC. Labor and delivery is not a solo effort—it’s a collaborative journey where encouragement, advocacy, and expertise come together to support your goals.

The Role of a Doula

A doula is a trained professional who provides continuous emotional, physical, and informational support throughout pregnancy, labor, and postpartum. Their role in VBAC success includes:

• Emotional Support: Helping you stay calm and confident, even during challenging moments.
• Physical Comfort: Using techniques like counterpressure, massage, and position changes to ease discomfort and promote labor progress.
• Advocacy: Acting as a bridge between you and your care team, ensuring your preferences are understood and respected.

Studies show that having a doula can reduce the likelihood of interventions and improve birth satisfaction, making them an invaluable part of your VBAC support team.

Related Read: Is Hiring A Doula A Good Choice For Me? A Guide to Birth Support

Involving Your Partner

Your partner plays a crucial role in your VBAC journey. They can:

• Educate Themselves: Encourage your partner to learn about VBAC so they feel confident in supporting you.
• Be Present: Their physical and emotional presence can provide reassurance and comfort during labor.
• Work as a Team: Together, you can practice coping techniques and review your birth plan to ensure they know how to advocate for your preferences.

Connect with Other VBAC Moms

Hearing success stories from other moms who have achieved VBACs can inspire and motivate you. Consider joining a VBAC support group, either locally or online, where you can:

• Share experiences and ask questions.
• Gain practical advice from those who’ve been in your shoes.
• Find reassurance and encouragement from a community that understands your journey.

Related Read: From A Traumatic Birth To 4 Successful VBACs 

Choose the Right Environment

Your labor environment can also be part of your support system. Surround yourself with positivity and trust by selecting a VBAC-friendly provider and facility.

• Creating a calming birth space with dim lighting, music, and comforting items from home.
• Having a team that believes in your ability to achieve a VBAC.

Building a strong support system ensures you feel surrounded by people who understand, encourage, and celebrate your VBAC journey. With the right support, you’ll approach labor feeling confident and empowered.

Secret #4: Prepare Your Body for VBAC

Physical preparation is a cornerstone of VBAC success. By focusing on strengthening your body, optimizing fetal positioning, and maintaining overall health, you set the stage for a smoother labor and delivery.

1. Stay Active During Pregnancy

• Why It Matters: Regular exercise improves endurance, flexibility, and overall strength, which are crucial for labor. Staying active also helps maintain a healthy weight, reducing unnecessary strain on your body.
• What to Do: Engage in low-impact activities such as:
  • Walking: A great way to keep your body moving and your pelvic area aligned.
  • Swimming: Reduces pressure on your joints while strengthening muscles.
  • Prenatal Yoga: Promotes flexibility, relaxation, and optimal fetal positioning.
  • Pelvic Floor Exercises: Strengthen the muscles that support your uterus and baby, improving labor efficiency.

By the way, I highly, highly recommend downloading the Expecting and Empowered App during your pregnancy. This app gives you tailored workouts to your gestational age. Exercise is important during pregnancy, regardless of what your birth plan is.

2. Focus on Optimal Fetal Positioning

• Why It Matters: A baby in the optimal position (head-down, facing your spine) increases the likelihood of a smoother labor and reduces the risk of interventions.
• What to Do:
  • Spend time in forward-leaning positions, such as on hands and knees or using a birthing ball.
  • Avoid reclining for long periods, as this may encourage the baby to move into a less favorable position.
  • Consider techniques like spinning babies, which are designed to encourage proper alignment.

3. Nourish Your Body

• Why It Matters: A well-balanced diet supports your baby’s growth and gives you the energy needed for labor and recovery.
• What to Do:
  • Include plenty of whole grains, lean proteins, healthy fats, and fresh fruits and vegetables in your meals.
  • Stay hydrated by drinking plenty of water throughout the day.
  • Add pregnancy-safe foods rich in calcium, magnesium, and iron to support uterine health.

4. Manage Stress and Tension

• Why It Matters: Stress can hinder labor progression by increasing tension in your body and interfering with your ability to relax during contractions.
• What to Do:
  • Practice relaxation techniques like deep breathing, meditation, or progressive muscle relaxation.
  • Schedule time for activities that bring you joy and keep you calm.

5. Consider Prenatal Support Options

• Chiropractic Care: Aligning your pelvis can create more space for your baby to settle into the optimal position.
• Acupuncture or Massage: These therapies may reduce stress and help with common pregnancy discomforts.
• Birth Preparation Classes: Courses like The Empowered Birth Academy can provide additional tools to prepare your body and mind for a successful VBAC.

Taking care of your body during pregnancy not only enhances your chances of VBAC success but also helps you feel stronger and more confident heading into labor.

Secret #5: Create a Flexible VBAC Birth Plan

A well-thought-out VBAC birth plan is your roadmap to a positive birth experience. It outlines your preferences and ensures that your care team understands your goals. However, flexibility is key—labor can be unpredictable, and being open to adjustments helps you stay calm and focused.

Why a VBAC-Specific Birth Plan Matters

A VBAC birth plan takes into account the unique aspects of attempting a vaginal birth after cesarean, such as:

• Balancing your desire to avoid unnecessary interventions with safety monitoring for you and your baby.
• Addressing potential contingencies, like the need for an emergency cesarean.
• Ensuring your preferences are clear, even in high-pressure situations.

What to Include in Your VBAC Birth Plan

1. Pain Management Preferences:
   • Specify your preferred methods, such as breathing techniques, movement, or hydrotherapy. Indicate whether you’re open to an epidural or other pain relief methods.
   • Example: “I’d like to try non-medicated pain relief first but am open to an epidural if needed.”
2. Monitoring Options:
   • Decide whether you’re comfortable with continuous fetal monitoring or prefer intermittent or wireless options to allow for mobility.
   • Example: “I prefer wireless monitoring if continuous monitoring is necessary.”
3. Interventions:
   • Address your stance on induction methods, augmentation, or assisted delivery tools like forceps or vacuum.
   • Example: “I’d like to avoid Pitocin unless labor stalls and all other options have been discussed.”
4. Emergency Cesarean Plan:
   • Outline your preferences for a gentle cesarean, including skin-to-skin contact, delayed cord clamping, and support person presence.
   • Example: “If a cesarean becomes necessary, I’d like immediate skin-to-skin contact and my partner present.”
5. Post-Birth Preferences:
   • Include plans for delayed cord clamping, immediate skin-to-skin contact, and early breastfeeding.
   • Example: “I’d like to hold my baby skin-to-skin immediately after birth unless medically unsafe.”

Tips for Making Your Plan Effective

• Communicate Early: Discuss your plan with your provider during prenatal visits to address any concerns.
• Use Positive Language: Frame your preferences as requests rather than demands to encourage collaboration.
• Stay Adaptable: While a detailed plan is helpful, being flexible allows you to navigate unexpected changes with confidence.

A flexible VBAC birth plan empowers you to approach labor with clarity and confidence while maintaining the adaptability needed for a safe and positive outcome.

Secret #6: Mentally Prepare for Labor

Labor is as much a mental journey as it is a physical one, and preparing your mind can have a profound impact on your VBAC experience. Cultivating the right mindset, addressing fears, and building confidence are key steps in mentally preparing for labor.

1. Address Your Fears

It’s natural to feel nervous about attempting a VBAC, especially if your previous birth experience was challenging. Take time to identify and address your fears:

• Talk to Your Provider: Discuss any concerns you have about VBAC safety or potential complications. A supportive provider will offer reassurance and evidence-based answers.
• Consider Counseling: If fear feels overwhelming, speaking with a therapist or counselor can help you process those emotions and build confidence.
• Learn from Others: Connecting with moms who’ve had successful VBACs can provide inspiration and reduce anxiety.
• Take an empowering birth course that discusses overcoming your fears and how you can achieve your best birth.

2. Build Confidence with Knowledge

Knowledge is empowering. The more you understand about labor, VBAC, and your body’s abilities, the more confident you’ll feel:

• Learn about the stages of labor and what to expect at each phase.
• Familiarize yourself with pain management techniques and interventions.
• Take a birth course, like The Empowered Birth Academy, to gain tools and strategies tailored to your journey.

3. Visualize Success

Visualization is a powerful technique to help you stay focused and positive:

• Picture yourself handling each contraction with strength and grace.
• Imagine your baby being born vaginally and the joy of holding them for the first time.
• Focus on the feelings of accomplishment and pride that come with achieving your VBAC goals.

4. Set Realistic Expectations

While preparation is key, labor can be unpredictable. Mentally preparing for flexibility allows you to adjust your plans as needed without feeling defeated. Remind yourself that a successful VBAC isn’t just about the outcome—it’s about making informed decisions and feeling empowered throughout the process.

By addressing fears, building confidence, and practicing relaxation techniques, you’ll approach labor with a calm and empowered mindset, ready to embrace the journey ahead.

Secret #7: Educate Yourself About Labor and Delivery

Knowledge is one of the most powerful tools you can have as you prepare for your VBAC. Understanding the labor and delivery process equips you to make informed decisions, manage challenges, and approach your VBAC with confidence.

1. Understand the Stages of Labor

Learning about the stages of labor helps you anticipate what to expect:

• Early Labor: Contractions start and gradually become more regular. This phase can last hours or even days.
• Active Labor: Contractions intensify, and cervical dilation progresses more quickly.
• Transition: The most intense phase, just before full dilation.
• Pushing and Delivery: The final stage, leading to the birth of your baby.

Knowing the progression of labor enables you to recognize signs of progress and stay calm as you move through each stage.

2. Learn About Interventions

While the goal of VBAC is often to minimize interventions, understanding when they might be necessary helps you feel prepared. Key interventions to learn about include:

• Continuous Fetal Monitoring: Often recommended for VBACs to monitor how your baby is tolerating labor.
• Induction and Augmentation: Methods like Pitocin or membrane sweeps may be used if labor stalls.
• Assisted Delivery: Tools like vacuum or forceps may be needed in certain scenarios.
• Emergency Cesarean: While rare, it’s important to understand what this entails and how to advocate for a gentle cesarean if necessary.

3. Practice Coping Techniques

Labor requires physical and mental stamina. Practicing coping techniques ahead of time ensures you’re ready to use them when the time comes:

• Breathing Techniques: Practice different rhythms for managing contractions.
• Movement and Positions: Learn how to use positions like squatting, hands-and-knees, or leaning on a birthing ball to ease discomfort and encourage labor progress.
• Visualization: Imagine a calm, steady labor and a positive birth experience to stay focused.

4. Take a Birth Class

A birth class, like The Empowered Birth Academy, provides tailored guidance to help you prepare for labor. These classes often cover:

• Challenges and how to navigate them.
• Strategies for pain management and staying calm.
• Tips for creating a birth plan and communicating effectively with your care team.

5. Learn to Advocate for Yourself

Knowing how to communicate with your care team during labor is essential. Use open-ended questions to ensure you’re fully informed about any recommended interventions:

• “What are the risks and benefits of this option?”
• “Is there a less invasive alternative we can try first?”
• “How urgent is this decision, and can we take some time to consider it?”

Educating yourself about labor and delivery builds confidence and ensures you feel prepared for whatever your VBAC journey may bring.

Frequently Asked Questions About Successful VBACs

As you prepare for your VBAC journey, you may encounter questions and concerns about the process. Here are answers to some of the most common questions to help you feel informed and empowered:

1. Is VBAC safe?

Yes, VBAC is a safe and viable option for most women who meet the criteria. Studies show that the success rate for VBAC is about 60–80%, depending on individual factors. While there are risks, such as uterine rupture, these risks are relatively low and are carefully managed by VBAC-supportive providers.

2. Can I have a VBAC after multiple cesareans?

While VBAC after one cesarean is more common, some women successfully achieve a vaginal birth after multiple cesareans (VBAMC). This depends on factors like your uterine incision type, overall health, and provider’s recommendations. If this applies to you, discuss it thoroughly with a VBAC-experienced provider.

3. How can I reduce my risk of uterine rupture?

The risk of uterine rupture during VBAC is less than 1% for most women. Steps to reduce this risk include:

• Allowing labor to begin and progress naturally rather than inducing and augmenting it.
• Having a provider who monitors labor closely for any signs of complications.
• Spacing pregnancies at least 18 months apart to allow for optimal healing.

4. What should I do if labor doesn’t progress as planned?

If labor stalls or complications arise, your care team may recommend interventions such as augmentation with Pitocin or AROM or a repeat cesarean. But if your labor begins to “stall” before you reach 6 cms, this could just be a sign that your body wasn't quite in active labor yet and you may have the option to go home and wait for labor to continue to progress naturally. This would only be an option if you and baby are both stable and your water isn't broken at the time. A flexible birth plan can help you navigate these scenarios with confidence.

5. Is VBAC worth it if there’s a chance I’ll need another cesarean?

Many moms find that attempting VBAC is worth it, even if they ultimately require a repeat cesarean. The process of labor itself can be empowering, and attempting VBAC allows you to explore your options. Additionally, planning for a gentle cesarean can make the experience more positive if it becomes necessary.

Successful VBAC Conclusion

Achieving a successful VBAC is a journey that combines preparation, support, and trust in your body. While there’s no guaranteed formula, the steps you take—like choosing a supportive provider, building a strong team, and preparing your body and mind—set the foundation for a positive and empowering birth experience.

Remember, success isn’t just about the outcome; it’s about feeling informed, respected, and confident in the choices you make. Whether your VBAC unfolds exactly as planned or requires flexibility along the way, every step you take toward your goal is a testament to your strength and determination.

As a labor and delivery nurse and a mom, I’ve seen firsthand the power of preparation and support. If you’re looking for more in-depth guidance on how to prepare for your vaginal birth, I invite you to explore The Empowered Birth Academy. This course is designed to equip you with the knowledge, tools, and confidence to navigate your VBAC journey with clarity and empowerment.

You’ve got this, mama. Your VBAC journey is uniquely yours, and no matter how it unfolds, you are capable, strong, and supported.