When it comes to deciding where and how someone welcomes their baby into the world, there are many factors to consider. Birthing parents deserve to know their options and what the risks and benefits of each option are, but it can be hard to figure out where to start when researching providers and asking questions. 
When it comes to discussing a VBAC there are a lot of questions someone may be thinking about. Here are our top 8 questions to ask your provider, and why you should ask them. 

Is your provider VBAC supportive? 

Your provider may not feel comfortable supporting a VBAC, but that does not mean it is not an option for you. You may want to consult with multiple providers. We also recommend making sure other providers in the practice are supportive because the provider attending your birth might be whoever is on call. 

Is your provider VBAC supportive after more than one c-section?

Some providers may feel comfortable attending a VBAC after one cesarean, but that support can change after two cesareans. 

Have they attended a VBAC before? How many were successful? How many were successful in the past year?

It is important to make sure you are confident in your provider's skill set and that they have a proven track record that would allow you to have your desired outcome for your birth. Always remember, you have options when it comes to birth and who attends your birth. If your current provider's views do not align with your own, but you meet the qualifications for a cesarean set by the American College of Obstetricians and Gynecologists, you may want to look into other providers in your area. 
You can also reach out to ICAN, the International Cesarean Awareness Network. They have local chapters and they may provide you with a list of local VBAC supportive providers. You can also join their Facebook group to receive support from other VBAC families. 

What are the risks? What are the benefits?

Research is constantly being released. Make sure that you are up to date on what the benefits and risks for a VBAC are, and what risks are specific to you. A provider who knows your history is the best person to answer this question. 
Gentle Cesareans involve skin to skin in the OR, a clear curtain, and sometimes delayed cord clamping. This may be worth asking about beforehand to prepare in the event that a repeat cesarean does occur. 

How far past your due date will they recommend you go before a repeat cesarean is recommended? If you go past your due date would they recommend trying an induction first?

This question allows you to better know what to expect and ask questions accordingly. If you have the option to be induced you may wish to request that before you reach your due date or you may have questions about what to expect if an induction does occur (if you have not had one before). If being induced is an option there are different routes, one may be an option for you while others may not be. It is important to know what those are. If induction is a no altogether, you may want to know that sooner rather than later. 

What type of monitoring do you recommend for VBAC patients?

Knowing what monitoring is recommended, and will most likely be used, allows you to plan accordingly for different labor positions. If you are going to be restricted to a bed it may be important to you to research bed labor positions, peanut balls, etc. 

How long are they comfortable letting patients labor for, after their water breaks?

This is another question you may want to ask to prepare yourself for what to expect. This may also determine your decision to use Pitocin or request an epidural. Pitocin is typically used to “speed up” labor. An epidural is used for pain management, but can slow down contractions. Someone might not want an epidural if they have a small time limit after their water breaks. 
What policies should you be aware of that may make a VBAC harder to achieve?  Or, what policies should you be aware of?

The hospital or birthing center you are delivering at may have policies that make a VBAC harder to achieve. There may be policies preventing movement or hydrotherapy. The policies may make you more likely to request an epidural. This may impact someone's decision to give birth there or impact the preparation they do to plan pain management techniques. 
For any birthing parent, it is important to know when providers recommend you arrive, based on your medical history. You may also want to know about policies around eating in labor. 

Around 70% of birthing parents who elect for a trial of labor are successful. 
Research is constantly being published showing that a VBAC is safe if the birthing person meets a set of qualifications, these qualifications may differ depending on the practice you attend and a provider's comfort level.

You may be a good candidate if:

• Pregnant with one baby, have a history of one or two prior low transverse C-sections, and have no problems that would prevent VBAC.
• Pregnant with one baby, have a history of one prior C-section with an unknown type of uterine incision, and have no problems that would prevent VBAC — unless it's suspected that you had a prior high vertical uterine incision.
• Pregnant with twins, have a history of one prior low transverse C-section, and are otherwise a candidate for a twin vaginal delivery.

• No more than 2 low transverse cesarean deliveries.
• No additional uterine scars, anomalies, or previous ruptures.
• Your health care provider should be prepared to monitor labor and perform or refer for a cesarean if necessary.
  
  

You may not be a good candidate if you fall into the following categories:

• Stalled labor
• Advanced maternal age
• Pregnancy that continues past 40 weeks
• Body mass index of 40 or higher
• Excessive weight gain during pregnancy
• Preeclampsia
• Previous delivery within 18 months
• History of two or more prior C-sections and no vaginal deliveries
• A need for labor induction when starting with a closed cervix
• A prior high vertical (classical) uterine incision
• An unknown type of prior uterine incision and it's suspected that it was a high vertical (classical) incision
• A prior uterine rupture, in which the cesarean scar on the uterus breaks open
• Certain types of prior uterine surgery, such as fibroid removal

Risks may include:

• Emergency C-Section
• Hysterectomy (removal of the uterus), meaning you would not be able to carry another pregnancy
• Uterine rupture, the rate is 1 in 500 for patients with a low transverse incision. 

​The Mayo-Clinic has listed the following benefits:

• A faster recovery. If you deliver vaginally, you’ll spend less time in the hospital. This means fewer expenses. You can also expect to feel physically better sooner.
• A greater sense of involvement in the birth.Delivering vaginally may make you feel like a more active participant in the birth of your baby.
• Less risk in subsequent pregnancies.Risks like infection, organ injury, and blood loss can increase with repeat elective cesarean deliveries. If you’re planning a large family, a VBAC may be a good option for you.

There is no clear consensus on average egg count for those with diminished ovarian reserve. 

What are the signs of poor egg quality?

1. Trouble conceiving 
2. Late or absent menstrual periods
3. Shorter menstrual cycles than average, with the average being 28 days.
4. Heavy menstrual flow
5. Miscarriage

Miscarriage
Poor egg quality causes a fertilized egg to either not implant or only partially implant. If it does implant it usually will not develop properly. This typically leads to miscarriages or birth defects. 
Research has shown the rates of biochemical pregnancy, clinical pregnancy, and embryo implantation in young people with DOR are significantly higher than in older people with DOR. Young people with DOR have ovarian hypo-response and low numbers of acquired eggs and embryos, but the possibilities of high-quality embryo and good clinical pregnancy are higher once eggs are acquired, according to research published in 2018. 
Biochemical pregnancy is where the egg implants, but is miscarried in the first 2-3 weeks after conception. Clinical pregnancy is a pregnancy confirmed by HCG (Human Chorionic Gonadotropin) levels. Embryo implantation is described as an embryo implanting in the uterus. Embryo is used to describe a developing fetus before the eighth week, when we typically describe it as a fetus.
Low Ovarian Reserve
Low ovarian reserve or diminished ovarian reserve (DOR) is used to refer to the number of eggs someone has. About 10% of people with ovaries experience this, according to the Center for Human Reproduction. Treatments do not exist, but recommendations to live a healthier lifestyle can be made. Those recommendations boost fertility and improve conditions for the egg that will be released in ovulation. It is important to improve these conditions three months before ovulation. 
Causes of Low Ovarian Reserve Include:

1. Tubal Disease
2. Endometriosis
3. Prior Ovarian Surgery
4. Chemotherapy
5. Radiation Therapy
6. Smoking
7. Pelvic infection
8. Genetic abnormalities ie; fragile X syndrome
9. Autoimmune Disorders​

Genetic or Chromosomal Abnormality
Poor egg quality can lead to chromosomally abnormal pregnancies. It can also increase the risk of genetic disorder in the baby. Most chromosomal errors occur three months before ovulation when either a chromosome doesn't separate and pair up again properly in meiosis, or chromosomes break, become inverted, or get deleted due to chemicals and viruses. Changing the conditions of the egg three months before ovulation can improve that egg's quality and decrease the chance of chromosomal abnormality. Mitochondria is responsible for the energy used to produce a good quality egg. If mitochondria is damaged, egg quality is poor. Nutrition and lifestyle factors play a role in egg quality. 
IVF
IVF, or in vitro fertilization, allows the best egg to be hand picked. Meaning, while those with poor egg quality may not have as many good embryos they can still get pregnant through IVF. InGenes says, “Patients with poor egg quality have a higher rate of structural genetic abnormalities; however, by transferring chromosomally normal embryos, this technique maximizes the chance of embryo implantation..."
Testing 
A blood test to measure a patient's follicle stimulating hormone (FSH) and estradiol blood levels are performed on day 3 of their cycle to determine ovarian response and egg quality. You can also take an at home ovarian reserve test.
Other forms of testing may include, AMH (anti mullerian hormone) blood level testing and antral follicle count, an ultrasound that looks at the number of visible antral follicles to predict primordial follicles (microscopic follicles that each contain an immature egg). 

Tactile sensitivity begins in the seventh week of gestation and steadily enlarges to include most parts of the body by seventeen weeks and all parts by thirty-two weeks. There are many ways to see a physical reaction and know for yourself that your baby is responding. 
Talk to your baby!
Hearing may begin early in the first trimester or as late as eighteen weeks. Speaking to your baby is a great way to begin bonding. Your baby will begin recognizing your voice specifically. 
This is a great way to check in with your baby about the emotions you are experiencing. Stress is a normal part of life, but telling your baby what is happening and why can reduce the impacts of stress long term. 

Interact with your baby!
The fetus is aware of light even while the eyelids are still fused  and will react to lights flashed on the abdomen. You can try playing with a flashlight on your abdomen, moving your hands along your abdomen and following baby as they follow the light. 

You can also try interacting through noise such as music. You may find your baby prefers Taylor Swift over Beethoven or vice versa!

Dreaming
Premature babies dream more than anybody else! They show the most smiles, frowns, finger movements, neck stretches, mouth movements, and vocalizations in their dreams. Ultrasound has shown that the beginning of REM/dreaming activity is at just twenty-three weeks!

Medical Interventions
Babies in the womb react to medical interventions with accelerated heart activity, turning, or moving away. This can be seen when a fetus moves away from the ultrasound probe or bats it away. Many parents who notice this will opt out of ultrasound and testing that could be disruptive to their baby, but others may choose to talk to the baby throughout the procedure; to let them know what is happening and why. 

Your baby is connected with you and is experiencing your emotions on an even deeper level. While it can be important and effective to reduce stress and keep a positive mindset it can also be important to discuss feelings and experiences directly with your baby. This not only teaches emotional regulation, but also offers more bonding opportunities. ​

Reduce mother and baby separation. The first hour postpartum is when skin to skin is the most important, and especially throughout the first 24 hours. Many policies and procedures are in place for hospital financial gain and efficiency. You have consent and you can say no to something. 
You can also request that routine procedures be done on you! If baby needs to be measured, temperature checked, etc those tasks can be done with baby on your abdomen with minor adjustments from staff. ​

Remember, the best birthing experience is one where you are making choices that are right for you and your family. 
Pain medication and the breast crawl are two important parts of a birthing plan that may not be thought about when it comes to birth psychology. They should be considered!
1. Pain Meds: Pitocin, the synthetic form of Oxytocin commonly used to induce labor, uses all the oxytocin receptor sites. Oxytocin breaks the blood/brain barrier and offers relief, but Pitocin does not. Oxytocin is commonly referred to as the love or cuddle hormone. It is released in the highest doses during orgasm, childbirth, and breastfeeding. It is essential for bonding and should remain flowing through labor and immediately postpartum. It can reduce risk of PMADs (perinatal mood and anxiety disorders) and prevent hemorrhaging. The endorphins naturally released throughout labor reduce pain in birthing parent and in baby, and encourage bonding!
Pain medication may prevent baby or birthing parent from being an active member in the birth, prevent endorphin release, delay milk/lactogenesis, relaxed pelvic floor making it harder for baby to rotate, impact on heartrate, and impact on head molding which impacts ability to suck and swallow. 

2. Breast Crawl: Breast crawl is the instinctive movement of a newborn mammal toward the nipple of its mother for the purpose of latching on to initiate breastfeeding. This movement uses the following reflexes: Babinski, Spinal Galant, Spinal Perez, amphibian, ATNR, and the Bauer crawl.

PAUSE: This is not just the golden hour where bonding between parent and baby is the priority, this is the moment after a busy period where the entire family can take a moment to process and take it all in. The story will be different for the birth person, parents, and for baby.

•Routine procedures can wait! Emergency procedures are best done on the birthing parent with the cord attached whenever possible. (Raylene Phillips, Neonatologist, Loma Linda Medical Center, CA, USA)

"When space is created to help the whole family’s experience be seen, heard, and felt, a new story of what happened can be experienced through connection." - Rebecca Thompson Hitt, MS, MFT

Keep your baby with you. 
This is the period of trust versus mistrust, according to Erikson's. This is the period where baby really needs to be with their parents. It is important to not allow excessive crying during this period.
A great method of keeping baby close and crying minimal is babywearing. There are studies called Why African Babies Don't Cry that explore the story of babywearing in African villages and how it allows babies to nurse on demand and constantly have the comfort of their parent. 

EFT Tapping:
Emotional Freedom Technique Tapping is a great emotional regulation tool to teach infants and a great communication tool from parents to infants. 
It can be great to remind your baby that things are okay when you are feeling emotional. It can also be a great way to signal it is bedtime. Try incorporating this in your nightly routine around the time that you are changing your baby's diaper. Do some tapping just before bed and a foot massage, easy to offer while already lying down on the changing table. Both are great bonding exercises that touch reflexology points. 
​
Speak to your baby and hold healthy eye contact:
Your baby communicates through the universal language of emotion. Our eyes hold much emotion. They are a way we recognize each other and a way that we show we are listening fully. When speaking with your baby practice holding eye contact. You can look them in the eyes and blink until they begin blinking in sync with you, a bonding exercise!

Skin to skin, anytime!
Skin to skin is not just important during immediate postpartum. It should be done well into the weeks following, between both parents. It is a great way too bond and should even be done during bottle feeds. During bottle feeds remember to alternate which side you are feeding on, the same way you would with the breast. 

Family Focused Stress Relief
Sometimes whole family focused stress relief is extremely necessary when a parent is home all day and the other is not. The working parent may come home happy, but actually be bringing in more stress because they are not practicing family focused stress relief. The root prevention for this is setting up support systems. ​