Have you been thinking/wanting a VBAC (vaginal birth after cesarean) but don’t know if you’re a good candidate or what to even ask your midwife or OB? I had the most wonderful conversation with Evelyn Simmons, CNM as she gives us some insight on what she looks for in women who want to have VBAC and some invaluable advice.
Secretly wanting to know for myself as a previous C-section mom, I asked her what she looks for in a good VBAC candidate. The main things she looks for are:
- Commitment to having a VBAC
- Research you’ve done on having a VBAC and on providers
- Acknowledging your birth story cause it was REAL. Most of the time women just want their birth stories heard and they need to know it was real and for someone to listen. Birth is traumatic in itself and hoping that having a VBAC or going through the next birth is a more healing process.
- Mom needs to exercise, be nutritionally sound and not gain 60-70 lbs during pregnancy
- Get pre-natal care and don’t miss any appointments.
- Also seeing a chiropractor all through pregnancy. We don’t take care of our bodies as well as we should, so it’s important to work with a chiropractor and the whole idea of not progressing in labor won’t be there.
- Most importantly, your INTENTIONS. Sometimes you can feel it in your heart if you’ll have your VBAC. If you set your intentions to be successful then you will be successful. And if you don’t get your VBAC, at least it was a healing birth.
Another important factor to having a successful VBAC is to trust your provider. Evelyn states “you need to have an open relationship with your provider and to trust the process of birth”. When looking for a provider and doing your research, Evelyn states that you should find someone “who is receptive to a VBAC as a provider and you should eliminate the process before going in and interviewing them”. I agree, this is completely necessary; you can call the office and ask if the provider is VBAC friendly before making an appointment. Asking other birth workers like midwives, doulas, birth instructors and pregnancy chiropractors for a referral or advice is also helpful in making your decision. Also, talking to other VBAC moms who have had a successful VBAC (or not) on who their provider was and if they would recommend them.
Evelyn works closely with two OB-GYNs, Dr. Clay Young and Dr. Ruth St. Victor who are both VBAC friendly at Conroe Regional. Dr. Young was not always VBAC friendly but his wife convinced him he needed a midwife and he has transformed with pressure. The biggest issue with a VBAC that makes OB’s nervous is the risk of uterine rupture. But Evelyn states that the “risks of rupture is not any greater than not having a C-section and waiting 18 months” between pregnancies. Studies show that “ a uterine rupture from a prior cesarean with a low-transverse scar is a rare event and occurs in less than 1% of women laboring for a VBAC….Uterine ruptures have also been known to occur in some women who have never had a cesarean. This type of rupture can be caused by weak uterine muscles after several pregnancies, excessive use of labor inducing agents, a prior surgical procedure on the uterus, or mid-pelvic use of forceps.” (1)
Some women have who have done their research on VBACs also the question of finding out if they've had single stitch or double stitch uterine suture. Regardless, "you should always ask for the low transverse double stitch", says Evelyn. She also says most providers don’t read the operative report to determine if you’re a good VBAC candidate. Having a low transverse suture/scar puts you at less risk for uterine rupture.
Not many people know that you can give birth with a midwife in a hospital. Conroe Regional is a wonderful place of birth with a nursing staff that supports a woman’s choice of birth. You don’t need to have an IV or a constant fetal heart rate monitor and you can labor in the shower (Conroe Regional does not have a tub). It’s almost a true home birth but in a hospital. On a side note, Conroe Regional does not do VBA2C which is a VBAC after two cesareans. Also, if you are trying for a VBAC you have to be on a wireless electronic fetal heart rate monitor, but it’s waterproof so you can still labor in the shower.
Some other facts I learned is that Evelyn has prescriptive authority and can give pain medications as necessary or at mom’s request. Your midwife in general will give you nutrition and exercise advice, preparation education and endless support. She will be there with you through your pregnancy and the whole birthing process. In the last 4 years Evelyn has only missed 6 births!
The big take home Evelyn wants to share is to encourage women to utilize the support they have and to seek a support team to have a healing birth. Birth should be a growing experience however birth happens. Talk about your birth plan and understand it. Then talk to the nurse on unit about your birth plan, your nurse is a key person.
A little about Evelyn Simmons, CNM she has been a midwife since 1995 and currently works at Conroe Regional Medical Center for the last 4 years. She has always worked in a hospital setting and has been called from Texas to Iowa and back to Texas to help set up midwifery service in hospitals. Evelyn was actually in Davenport, Iowa for 13 years next to Palmer College of Chiropractic. A chiropractic school where she learned all the benefits of chiropractic care! Bonus! She has also delivered 6 VBACs since being at Conroe Regional. She loves that she can create a true home birth setting in a hospital for women.
It was such an honor and an amazing opportunity to have this conversation with Evelyn. You can tell that she absolutely loves being a midwife and it was her true calling. She genuinely cares for women and hopes that every woman can have an amazing birth experience and a healing second birth if that’s their story. I have to say I have learned so much for myself and I hope that you took a lot from this as I have. Evelyn Simmons is a true blessing to the birth world and I’m so glad to have had the opportunity to meet and speak to her and hope to work with her in the future!