Birth Pregnancy

Natural Birth After C-Section

Can I have a vaginal birth if I already had a c section?

The short answer is, “YES! YOU CAN!” While the long answer requires a conversation about various risks – risks of a VBAC, or vaginal birth after cesarean, AND risks of repeat surgery. Unfortunately, it is the second set of risks that are routinely left out of the conversation when you speak with a hospital provider (OB or CNM) about it. And, also, unfortunately, these same providers often offer the VBAC and then find a reason at the end of the pregnancy that either induction of labor is ‘necessary’ (not the best plan for a successful VBAC) or a repeat surgery if the pregnancy goes beyond 39 or 40 weeks. 

Where can I have a successful VBAC?

This drives many women to seek an out-of-hospital birth provider for their planned VBAC, even though everyone agrees that the hospital is the best place due to the easy and quick access to emergency services. Since VBAC is prohibited in Birth Centers, this leaves home birth as the only option. And home birth is not for everyone. It is certainly not the best idea for someone whose main reason for choosing it is to avoid the hospital. It is always better to run towards something rather than running away from something. In other words, the choice to have a home birth should be driven by the desire to have your baby in the comfort and safety of your home, not by the fear of the hospital.

Successful home birth requires dedication and preparation

We have seen a situation like this where the client chose to have her baby with us because of her fear of having another c section and her inability to find a hospital provider who would support her decision to birth vaginally. She did not have a doula or take a birth preparation class. (These are 2 of Midwife360’s 3 keys to successful, efficient birthing. The 3rd is using the birth tub.) Consequently, she was unprepared and unsure when her labor did start, and did not request the midwife presence in a timely manner. She birthed on the toilet and her baby actually went into the toilet! They had the midwife on the phone throughout the process and she was able to guide them verbally (the part about the toilet came out later!) and everything turned out well. 

This is an example of how normal the process is for most people – even those who have had previous c sections – and for most babies. Babies are resilient and born to survive and know how to start breathing with little to no help in most cases.

Most predictions by OB providers are wrong

“Your baby is breech, and even if it turns, your pelvis is too small to push. There’s an 80% chance you’ll have to have a c section if you try, and then it would be an emergency surgery, which is more dangerous. So let’s just schedule the c section as this will be safer.”

I’ve heard this same speech from many clients over the years. This particular client told us this story of her first birth – the baby turned out to be 5#5oz. When she got pregnant the second time, they said she would have to have another surgery – it would be safer, they said. “But my mom had a c section and then pushed my brother out right after – he was over 10# – can’t I at least try?” “No”, they said, “it’s not safe”. There was no discussion of the risks of surgery, all focus is on the risks of trying a vaginal birth.

You can do it!

When this woman got pregnant a third time, she knew that she could birth her baby vaginally. She drove an hour away from her home to find a provider that believed in her and would support her. And although she did not take advantage of the 3 keys to success, (she used the birth tub only), she was so determined and dedicated that she was able to adequately prepare herself mentally for the big day. She was able to birth an 8#3oz baby vaginally in the birth tub with her sisters, husband, mother-in-law, and daughters all present and cheering her on! She pushed for over 2 hours, but barely tore and the baby came out quickly with no problems.

Our bodies and our babies are made for birth

When will OB doctors and other birth providers stop telling women what their bodies cannot do? Women are created with the social imperative to create life and deliver it to the outside world. Among many other things, we are very well designed birthing machines! If you didn’t know this already, then you do now!

Be empowered, be informed, stand up for yourself and your baby!

Healthcare Pregnancy

Call to Action

My name is Fadwah Halaby and I am a certified nurse midwife serving families in Palm Beach and Broward counties. I offer well-woman care with a holistic touch as well as pregnancy and birth services with birth in the clients home. This is a choice that any woman can make and a viable option for all low risk, healthy clients and even with some that have a more complex physiologic pregnancy – such as previous cesarean, twins, or breech.

Pregnant people have human rights too!

The bottom line is that we all agree that everyone should have certain rights by virtue of being human – we call them human rights. And these rights are repeatedly denied to many pregnant women because her care provider has decided:

  • that he or she is not comfortable with a given situation
  • has decided on a particular course of action
  • is determined to force the client to comply

This has gone so far in some cases as getting a judge to order a forced cesarean surgery by deeming the client incompetent to make decisions for her own body and that of her baby. It is ludicrous to imagine that a person who has conceived and grown a baby in their womb for 40 weeks does not have the best interests of that baby in mind when making decisions regarding the birth of the baby. No one has more of a vested interest in that baby than that pregnant person. And no one has more of a vested interest in the woman’s body than the woman herself. We have a right to choose to birth at home, in a birth center, in the hospital or anywhere else a person would choose to birth. This is a basic human right and is upheld in the laws and rules of our state.

What is not supported by our laws and rules is the right of that pregnant person to have the trained and licensed provider of their choice attend to them in any of these settings.

Nurse Midwives are trained to practice independently

As a certified nurse midwife (CNM), I am trained and licensed to attend to women in any of these settings. I have maintained hospital privileges without any negative incidents for more than 8 years and over 1600 births. Yet now that I am attending to women in their homes, I am not allowed to continue to care for them should they require a transfer to the hospital either before or during labor. ACOG (American Congress of Obstetricians and Gynecologists, the OB/GYN national organization) recognizes women’s right to choose their place of birth and makes a recommendation that if a woman wants to birth at home she should be a healthy, low-risk candidate, choose a CNM to attend her, and birth in an integrated environment. [ACOG Committee Opinion on Home Birth] And this, my friends, is the missing piece of the puzzle. The lack of integration makes out of hospital birth less safe for everyone.

Transferring from home to hospital is fraught with anxiety for both clients and home birth care providers

How many times have you heard stories of “train wrecks” – home birth transfers to the hospital when things have gone far past the point of being OK? Midwives dropping clients off at the door or not participating in the transfer at all are tales that are told by hospital personnel about home birth transfers. It is true that the out of hospital provider is bound by duty to shift location to the hospital once they feel that it is no longer safe to be at home and if it is for an emergent reason, then the 911 system should be employed to make the transfer. If it is for a non-emergent reason (as 90% of home to hospital transfers are), then the transfer can happen by private vehicle. In both cases, the hospital should be alerted and records sent ahead to facilitate care for the client and to give the receiving provider as much advance information as possible. The provider should accompany the client and be prepared to give a concise report of the relevant details and reasons for the transfer. This is considered a hand-off and according to JCHAO [Joint Commission for Hospital Accreditation] is where most critical incidents happen.

One solution

Giving APRNs (Advanced Practice RNs or Nurse Practitioners) the ability to practice to the extent of their training (why are we being restricted from that in the first place?!) would make this situation much safer. By allowing the clients chosen provider to be a member of the team once the transfer to the hospital becomes necessary. I have not been able to maintain hospital privileges, not due to any malpractice or incidents. This is purely due to not having an obstetrician who doesn’t have a financial stake in me or my practice being willing to “take responsibility” for my actions. Really, why should anyone else take responsibility for my actions?

I am trained to work to the extent of my scope of practice like any other healthcare provider. To make decisions, prescribe medications and tests and to interpret those results and determine when consultation, co-management, or referral is necessary. LIKE ANY OTHER HEALTHCARE PROVIDER. There is no worry that OBs will start trying to treat people for heart failure – they would refer to a cardiologist. If they try to work outside their scope of practice, then they are appropriately reprimanded or relieved of their license to practice. We understand that we would be held to the same standards. However, to require me to find a doctor willing to take responsibility for my work and to require that they sign my application for hospital privileges places an undue burden on me and is effectively restraint of trade. This has to stop now.

Please support Senate Bill 972 and HB 871 to increase the number of health care providers and contribute to reducing the costs of health care. Reach out to your Senator and Legislator with a postcard, email, and/or phone call today! Click here or below to find your elected official now.