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If you’ve already had a child via cesarean section, you may be curious, or even adamant, about trying for a vaginal delivery for your next baby. In many cases, a VBAC, or a Vaginal Birth After Cesarean, is considered safe and has a 60 to 80 percent success rate, according to the American College of Obstetricians and Gynecologists (ACOG).
While there are certainly risks associated with both vaginal deliveries and cesarean sections, VBACs often result in shorter hospital stays, fewer blood transfusions, and a decreased risk of postpartum fever. And although there is an increased possibility of uterine rupture with a VBAC, this happens in less than 1% of cases. Still, it's something to consider as you weigh your options with your healthcare provider.
So, how can you prepare your body for a VBAC?
If you are set on trying for a VBAC, you may be wondering how to strengthen your body for the a successful vaginal birth. We spoke with Dr. Jessica Ryniec, who is double board certified in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, about how women can best prepare for a vaginal birth after cesarian delivery.
But first, is it even possible to strengthen your uterus?
It's important to note that you cannot strengthen your actual uterus, but rather the muscles and ligaments around it. When women set out to strengthen their uterus, what they are really trying to achieve are stronger pelvic floor muscles. The pelvic floor muscles support the uterus and, in turn, strengthen the ligaments and tissues of the uterus. Strengthening the pelvic floor can help reduce the risk of uterine rupture during labor, even a VBAC.
How to strengthen your pelvic floor muscles and prepare for a VBAC
1. Exercise during pregnancy
Unless your healthcare provider has advised against exercise during pregnancy, staying active can help prepare your body for labor. Exercise during pregnancy will look different for everyone and will depend on whether or not you were regularly working out prior to pregnancy, but regardless of your pre-pregnancy routine, walking, stretching, doing yoga, and swimming are all safe and excellent options to keep your body moving as you grow your little one.
2. Do pelvic floor exercises and pelvic floor physical therapy
“I definitely recommend people seek out a pelvic floor physical therapist if they would be comfortable and open to their care,” says Dr. Ryniec. Pelvic floor physical therapy can include exercises, stretches, manual therapy, biofeedback therapy or electrical stimulation to strengthen and/or relax your pelvic floor muscles. Your therapist might also give you exercises to perform at home to further strengthen your pelvic floor.
“Kegels are the most well-known pelvic floor exercises and are easily done at home,” explains Dr. Ryniec. “These can be done while sitting or lying down and involve squeezing the muscles you would use to stop urinating or prevent passing gas, holding them for a few seconds (increase as you go), then relaxing, and repeating. It's important to keep leg muscles relaxed and breathe while doing these exercises.”
Some other at-home exercises will help strengthen your lower back and core, such as hip openers, pelvic tilts, and stretches to decrease tension and increase flexibility.
3. Stretch
Stretching during pregnancy will not only make you feel better, but it can help increase flexibility, improve your range of motion, and reduce the risk of injury — all things that can come to your aid during pregnancy, labor, and delivery.
Some of the most beneficial types of stretching that can help you prepare for a VBAC include:
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Hip openers: these create more mobility in the hips
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Pelvic tilts: these strengthen your core and take stress off your low back
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Mid and low back stretches: these can relieve back tension and improve rib cage mobility
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Quads and hip flexor stretches: these help support and open hips
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Foam rolling glutes and inner thighs: these can help alleviate tension around the pelvic muscles
In addition to the list of physical preparations, Dr. Ryniec doesn’t want women to forget their own power of advocacy. “I would advise women to speak with their provider in-depth and learn if they are a good candidate for a VBAC or if they have a lower likelihood of success based on their prior obstetric history and indications for their previous cesarean section,” she says. “I also want them to make sure they talk to their provider about their comfort and experience with TOLAC & VBAC, what the success is for someone like them, as well as the risks and benefits specific to them so they can make an informed decision. Being mentally & emotionally prepared is just as important.”
Remember: Every woman is different. Every labor and birth is different. The best way to prepare for a VBAC is knowing your medical history and seeking guidance from your healthcare providers. If you are still adamant about trying for a VBAC and believe the benefits of attempting it outweigh the risks, then prepping your body through exercise, PT, and stretching will be your best friend. Best of luck!
Brighid Flynn is a freelance writer based in Philadelphia where she lives with her husband and puppy. She is just beginning her journey toward motherhood.