Parents with a prior Cesarean birth have a greater chance of achieving VBAC when they have 100% support from their care provider and when their providers encourage and promote normal, physiologic birth processes not involving unnecessary medical interventions. There are several options for care providers based, of course, on birth location choice and include OBGYN, Hospital Midwife (CNM), or home birth or birth center midwives.

Knowing what questions to ask potential VBAC providers can be frustrating, especially when they aren’t sure if they are being honest or are just telling the mom what they want to hear. Below, we will suggest some topics of discussion and then show you how to interpret their answers. We suggest you give your clients these questions to ask their providers in your prenatal visit. This way, you’ll also know if that provider truly is supportive.

Most importantly, while she is searching, it is important to make sure to ask open-ended questions. Any provider can agree to any birth plan put before them initially but knowing how they personally feel about VBAC and knowing what requirements they might have can let you know more about whether they are VBAC-friendly or will just “allow” it if everything goes perfectly. Knowing what your client is up against can help you know what to expect during labor and delivery.

The ideal is to find a provider who views vaginal birth after Cesarean as a normal process, who is not afraid to support a woman preparing to VBAC, will only jump in with interventions when there is a TRUE medical indication, and who the woman can form a great relationship with beforehand. Suggest discussing VBAC and TOLAC in the provider’s office, across the desk from one another rather than in an exam room in a gown. This puts a lot of power back in her court.

Here are some great questions to give to your client:

• How do you feel about supporting TOLAC/VBAC and how many of your patients who attempt VBAC are successful?
• What are potential long-term and short-term risks of a repeat Cesarean for myself and my baby?
• If I have a repeat Cesarean, how will this impact future pregnancies and births?
• What requirements do you have to support a woman in TOLAC?
• What is your hospital policy surrounding VBAC?
• What do you consider as “absolutely necessary” reasons for a C-section?
• What do you and your hospital do to avoid patients having an unnecessary repeat Cesarean?
• Are there others in your practice who might be at my birth if you are not available? How do they feel about TOLAC/VBAC?

Studies have shown that a parent would much rather their doula or support team be honest with her if they know the provider is not supportive. This can put us birth workers in a very difficult spot. It is so important for you to be honest while not stepping outside of your scope. If your client asks you if that certain provider is supportive and you have seen them not be supportive, be honest. Just keep it very professional. It’s okay to say something like, “I have worked with VBAC women in the past and have seen XYZ.” However, it is not your place to say, “YOU SHOULD SWITCH, RUN FOR THE HILLS, HE/SHE/THEY SUCKS!” Stay professional by giving them these questions; it is a good way for them to interpret what they think is best. If your client stays with an unsupportive provider, bring your ‘A’ game and make sure to support them the best you can, because they will likely need it.

Interpreting Their Responses:

Now you have all these discussion points, what do you do with them? We have divided things into three categories with suggestions on what to consider when evaluating the provider interview.

Their Personal History

The higher their VBAC success rates and lower their Cesarean rates, the better. You can start by getting a good idea what those are by visiting Cesareanrates.org. This allows you to break down rates by state, hospital, and provider. Knowing what the baseline is for your area is a great way to start off in determining where her provider ranks. Ask for actual numbers here. Answers like, “I only intervene or perform a C-section when absolutely necessary” might be a red flag if they are reluctant to share actual statistics. Asking what their personal belief and philosophy is surrounding VBAC will give both of you a great idea, and don’t let anyone tell her they will let her try. That itself is a giant red flag.

Their Requirements

Many providers have stipulations for allowing a woman to TOLAC. Some of these requirements involve induction methods or even induction at all, giving birth by a certain gestational age, the reason for previous Cesarean, and if they have ever had a vaginal birth. A provider that insists a VBAC client go into labor before 40 weeks or she automatically goes to a C-section is probably not VBAC friendly, for example. The more requirements or policies a provider or birthplace has for VBAC, the less likely they are to be supportive. Also, if they insist a woman’s pelvis is too small or her baby too big, check around and find a provider who practices evidence-based care. A VBAC should be treated as any other type of birth, personal and unique, and not be given blanket requirements based on what may or may not increase or decrease chances of success.

What Do the Others Think?

A lot of providers work in a practice with an on-call schedule. Just because one doctor in the practice is VBAC-supportive does not mean that all of them are. Know if the doctor your client sees will be the one at the birth, if they have any time off scheduled around her due date, and what the hospital policies and the standard of the other providers they work with are. Knowing what the standard of care is for the entire group may make her want to seek other providers if it is not in line with what HER provider does.

VBAC Supportive vs. VBAC Tolerant

Some doctors may appear to be VBAC supportive, but actions speak volumes. Here is a list of characteristics that make a provider tolerant of VBAC, meaning that they allow VBAC if everything goes perfectly, or supportive of VBAC, meaning they are up to date with evidence-based practices and really support VBAC.

Lastly, if she ever finds herself in a position where she is faced with a birth space or birth provider who is clearly unsupportive, she ALWAYS has the right to seek new care, even in the middle of her labor. We know she likely has already hired you to support her, so we want you to know that there is some powerful evidence for doula support in labor. Dr. John Kennell, who co-authored one of the first studies on continuous labor support, said in reference to continuous doula support:

“If anyone said that a new drug or electronic device could reduce problems associated with fetal distress and labor progress to a third, or even that it would shorten labor by half and facilitate mother-baby interaction after the birth, there would be a stampede to make sure this new drug or equipment was available in every maternity unit in the country, whatever the cost involved.” (Kennel, Kalus, Robertson, & Hinkley, 1991)