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1. Select birth attendants and a birth place friendly to VBAC's. Be sure both your practitioner and your hospital are up on the latest studies. The nationwide success rate is around 20 percent. Yet if a mother is under the care of a practitioner who regards VBAC as no riskier than any other delivery, the mother delivers in a hospital that does not consider VBAC women "high risk," and the mother uses the suggestions for helping the labor progress that are mentioned below, the VBAC success rate is 75-90 percent. This means that a mother choosing a VBAC may, in fact, have an even smaller chance of having a cesarean than the general population. Find out what your prospective birth attendant's VBAC success rate is. For normal low-risk pregnancies, it should be at least 70 percent. Shun practitioners and hospitals that try to label you "high risk" even if you have no risk factors besides a previous section. Studies show that even mothers with two or three previous cesarean births have a 70 percent success rate with VBAC if they deliver in a birthplace supportive of VBAC's. Obstetrical centers that specialize in VBAC's do not consider most VBAC candidates as high risk, and treat them no differently than any other obstetrical client. In fact, they consider it counterproductive to attach the "high risk" label to VBAC mothers. Most women wishing a VBAC should be treated like any other woman delivering a baby. They require no more or less technology, intervention, or monitoring. Beware especially of birth attendants who have a "pelvic prejudice" against small-hipped mothers wanting a VBAC. Many petite women have successfully pushed out big babies.
2. Employ a professional labor assistant. If you're serious about delivering your next baby vaginally, a PLA is a must. In our experience, mothers using a PLA were much more likely to have the birth they wanted.
3. Don't let technology or the measurements it produces scare you. VBAC studies fail to show any correlation between the size of the baby and the chances of uterine rupture. Also, estimates of fetal size and weight by ultrasound are not always accurate, especially in the final month.
4. Join a support group. There are support groups for mothers who need help in grieving about their previous cesarean or in avoiding another one. ICAN (International Cesarean Awareness Network) is one of the best, and has chapters nationwide. This support group will help you deal with feelings of regret from your previous cesarean while arming you with information on how to avoid another one. You will hear helpful suggestions from mothers who have gone the surgical route once and were highly motivated to try a VBAC the next time. One great piece of advice from this and other support groups is to keep your mind in your present labor and not allow yourself to have flashbacks from the labor that led to the cesarean. Otherwise, you may panic at the first monitor alarm and undo all the good work of a previously efficient labor. If you want to feel fully empowered for VBAC, a support group is your best bet.