Coaching towards a Successful VBAC

What are the additional challenges of birth givers who wish for a VBAC?

While the coaching strategies are valuable in supporting and leading every expectant woman who would like to give birth healthily and experience high levels of satisfaction, they are even more crucial when supporting and leading a birth giver who wishes for a VBAC because of the additional challenges she faces.

The medical system looks at any attempt to have a vaginal birth after cesarean as a trial; a test of the performance, qualities, or suitability of the birthing individual for a vaginal birth. The acronym TOLAC, which stands for Trial of labor after cesarean is in use because not every attempt to have a vaginal birth after cesarean will be successful. VBAC is therefor the correct term to use only when a vaginal birth was actually achieved. I find that there are four different types of  challenges every birth giver who tries to have a VBAC face:

An OBGYN agreeing to TOLAC is not the same as OBGYN supporting a VBAC

  1. Environmental challenges: Your Clients’ OBGYN agreeing to TOLAC is not the same as them supporting it
    The external constraints this expectant woman needs to react to and overcome are much bigger than a woman who did not undergo a cesarean. Medical providers aren’t supportive of their VBAC decision, and even when she finds a caregiver that will agree to a TOLAC, agreeing doesn’t mean supporting it. The difference is being manifested by the medical imposition and restrictions that aren’t supportive of their vision for their birth.
  2. Informational challenges: Does your client understand that every medical intervention is putting the TOLAC at risk?
    These are the specific action steps taken in order to reach success. The client who desires a VBAC not only has to find a caregiver that will agree to take them on, but she must learn what the biggest hurdles are to achieving their desired goal, such as the need for induction or any other medical intervention, including an epidural. Once this TOLAC is medically managed, the chances of achieving a VBAC meaningfully decrease. Therefore, your client needs to be well informed about this, and take the right steps to be successful.
  3. Personal Capabilities: Can your client hold a strong conviction and ignore everyone who tells her its dangerous?
    These have to do with the mental maps or strategies that lead to success. It obviously takes a mental strategy to go through nine months of pregnancy and to complete all the action-steps in order to achieve a VBAC while all along being told by family, relatives and your caregivers that it is dangerous. Advocating for yourself is another mental capability, and coping with pain is another.
  4.  Beliefs and values: Why is your client choosing a VBAC? What’s their motivation?
    These relate to why a particular path is taken and the deeper motivations which drive people to act. My experience has been that this is one of the most important steps towards achieving a successful VBAC. Clarifying the woman’s motivation in a coherent manner that is also aligned with all her other beliefs is crucial for the actualization of her desired VBAC. Additionally, as their doula, you will be able to tap into their motivation during moments of crisis during their journey and empower them.

It takes a strong conviction to complete all the action-steps in order to achieve a VBAC while all along being told that it is dangerous.

What are the coaching steps that can help your client overcome these areas of challenge?

A series of prenatal coaching sessions is therefore essential in order to successfully achieve a VBAC.

  1. Clarify the birth giver’s motivation for having a VBAC: Ask questions such as: ” Why is it so important for you to have a successful VBAC?”, or: “What do you think will be different in your life when you will achieve your goals?”. Listen to the birth giver motivation. Does she choose a VBAC in order to avoid something (away from) or to have something (moving towards)? Taking actions toward something desired is a stronger motivation than running away from. 
  2. Protect the positive mindset of your client: She already chose to have a VBAC knowing all the risks and objections. Help them adopt strategies to block the environmental ‘noise’ and continue with confidence toward their goal.
  3. Work with Affirmations: Affirmations are word pictures that can engage the mind and attract what we desire. After having an unplanned and unwanted cesarean, your client holds a negative memory of the first birth. Writing and regularly reciting the affirmation is one of the best coaching strategies to get their mind focused on what she wants rather than what she fears. You can learn more about the rules and process of writing a strong affirmation HERE.
  4. Cultivate new coping skills: Since one of the most important actions towards achieving a VBAC is to avoid taking pain medication, you’ll want your clients to practice labor support tools until these become the birth giver’s habitual responses to labor strains.
  5. Help the birth giver avoid an induction: Your clients can’t appreciate the importance of avoiding an induction for their successful VBAC. Help them be proactive in inviting the birth to take place spontaneously. Discuss with your clients all the proactive actions they can take in order to avoid an induction such as acupuncture, homeopathic tinctures, chiropractor’s adjustment, prenatal massage, herbs, sex, and more.
  6. Provide spiritual support: Have faith in your client; trust their body and their process, and trust their caregiver (until proven otherwise). Coaching from a positive mindset while expressing your full trust in their ability to achieve their goal is one of the keys to their success.
Neri Life-Choma

childbirth education, hospital birth, medical interventions in childbirth, VBAC

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