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it all depends
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This morning I shared a reader’s experience on social media. Her provider had said the risk of uterine rupture during a planned VBA2C was 80%. And, as a result, ACOG says planning a VBA2C was "against medical advice." Of course, this is inaccurate on both counts, but a reader left this comment: “I've had 2 vba2cs. It all depends on the current pregnancies and the reasons for the previous c sections.” I see every single interaction on social media as an opportunity for education. I feel like the town crier happily declaring the latest news… but laser focused on VBAC. Because while I'm taking "to" this reader, thousands of other people are going to read our exchange. It matters. I replied: Can I examine your statement here? Because I think this is a concept that trips up a lot of parents, clinicians, and professionals….
”It all depends.” What depends? Your ability to plan a VBAC? Who makes that decision?
The reality is, no matter your clinical history or current condition, you, the woman, always has the right to weigh the risks and benefits of your options and make the ultimate decision: VBAC or cesarean.
That’s something your physician/midwife can guide you on in terms of education of those risks and benefits and then making a recommendation.
But the ultimate decision begins and ends with you.
So when we say “it all depends,” that makes it sound like someone else, other than you, gets to make the decision.
The American College of OB/GYNs has maintained this for years and specifically references this framework in their VBAC guidelines.
They state that “universal mandates” (i.e., “you must meet these criteria to be a ‘VBAC candidate’” or “you can’t have/be _____ if you want to plan a VBAC”) are inappropriate because there are always exceptions.
ACOG mentions the scenario of someone with a prior classical cesarean presenting at the hospital in labor and states, the woman and her provider may decide to continue laboring.
As a result, I am very careful how I position and discuss the concepts of VBAC candidacy, informed consent, and medical decision making because planning a VBAC is not something that someone ethically grants or permits you. It’s not something that you ethically must jump through hoops in order to “qualify” for the “opportunity” to labor.
Yes, that is how some (many?) clinicians frame it, but we have to remember:
the best medical care originates from the intersection of evidence and autonomy.
THAT is the ethical starting place. Not what someone else says they will “allow” you to do.
Thank you for your comment because I am grateful every single time I get to discuss this topic. I’m sure there is someone reading this that needed to hear it!!
You can learn more in episode 5 of The VBAC Facts® Podcast which dives deeply into this concept.
Folks, this is why it is so important for parents and professionals to know the facts. Because the reality is, parents are getting this kind of baloney left, right, and center. I see it every. single. day. People ask, "Why 'VBAC Facts®' and not 'Cesarean Facts?'" This is why. Because planning a repeat cesarean is often the default even though it should be the opposite, and is, in countries that have high VBAC rates. Here's what we have done to address this specific issue:
If you are already a VBAC Facts® professional member, you have access to that training and handout right now! This is the work I do. And I love it. Glad you are here!! It matters. Smiling,
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VBAC Facts®
Our mission is to increase access to vaginal birth after cesarean. Subscribe to our emails to learn more!
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