A Midwife’s Guide to Planning Your VBAC in 2026: The Forgotten Wisdom, Modern Evidence, and Support That Can Change Your Birth Story
If you have had a C-section & hope to have a vaginal birth with your next baby, there is a good chance someone has already tried to discourage you. Maybe an OB told you that a VBAC is too risky. Sometimes this happens before anyone has carefully reviewed the operative report, listened to the full story of the previous labor, or explained that many women with a prior cesarean may still be candidates for vaginal birth.
I hear these stories from clients all the time. One of my clients came to me after her previous OB discouraged her from attempting a VBAC. Her first cesarean had been labeled a “failure to progress,” and she was even told that her pelvis might be too small to push out a baby. After reviewing her history, I believed she was an excellent candidate. With thoughtful preparation and hands-on support throughout labor, she went on to have the unmedicated vaginal birth she had hoped for.
Her story is not proof that every woman will have the same outcome. Birth is never something I can promise or control. However, it is a powerful reminder that one difficult labor, one diagnosis in a chart, or one provider’s opinion does not always tell us everything your body may be capable of doing.
Sometimes there is a true medical reason that another cesarean is the safest choice, and I will always be honest with you when I see one. However, I believe you deserve a real conversation before that decision is made. You deserve to understand what happened the first time, what may be different now, and whether a vaginal birth after cesarean, known as a VBAC, may be a safe and reasonable option for you.
At The Midwife & More, I provide personalized VBAC care for women throughout western Los Angeles County and Ventura County. My goal is to help you prepare for the vaginal birth you hope to have while surrounding you with the clinical experience, collaborative hospital support, and honest guidance needed to keep you and your baby safe. You should not have to choose between trusting your body and trusting your medical team. You can have both.
You Deserve More Than a Default Repeat C-Section
Many women are presented with another cesarean as though it is the only path forward. The conversation may be very brief. The risks of VBAC are emphasized, while the possible benefits are barely discussed. The risks that come with another abdominal surgery may not receive the same attention.
For some mothers, the discouragement is subtle. Their provider may technically agree to a trial of labor but repeatedly focus on everything that could go wrong. Others are told that they can “try,” but only if labor begins by a certain date, progresses according to a very narrow timeline, and requires almost no patience from the hospital team. That does not feel like meaningful support.
There is an important difference between a provider who permits VBAC and a provider who understands how to support physiologic labor after cesarean. True support means reviewing your history rather than making assumptions. It means helping you prepare before labor. It means recognizing the importance of fetal position, movement, rest, emotional safety, and time.
It also means watching carefully for signs that the plan needs to change. Supporting VBAC is not about refusing intervention or pushing vaginal birth at all costs. It is about giving you a fair, informed, and medically responsible opportunity to labor.
What Are VBAC and TOLAC?
VBAC stands for vaginal birth after cesarean. It describes the outcome when a woman gives birth vaginally after previously delivering by C-section. TOLAC stands for trial of labor after cesarean. This means entering labor with the intention of achieving a VBAC. A TOLAC can end in a vaginal birth, or it can end in another cesarean if labor does not progress safely or a concern develops.
I understand that the phrase “trial of labor” can sound as though you and your body are being tested. It can also make birth sound like there are only two outcomes, passing or failing. That is not how I view it. Attempting a VBAC means making an informed decision to give labor an opportunity. If your baby is ultimately born by cesarean, it does not mean that you failed. Birth is not a test of your strength, your femininity, your preparation, or your commitment.
My role is to support your preferences while remaining grounded in what is happening clinically. We hope for a vaginal birth, prepare carefully for it, and stay open to the possibility that your baby may show us a different path.
What Are the Latest VBAC Statistics?
The latest provisional national birth data show that the United States cesarean delivery rate rose to 32.5% in 2025. That means nearly one out of every three babies in the country is now born by C-section.
The latest final national data that include the VBAC rate are from 2024. In that year, 15.5% of women who had previously delivered by cesarean gave birth vaginally. That 15.5% figure does not mean an individual woman has only a 15.5% chance of having a VBAC. It includes everyone with a previous cesarean, including women who scheduled another C-section, women who had a medical reason vaginal birth was not recommended, women who did not want to attempt labor, and women who could not find a supportive provider or hospital.
Among women who are considered appropriate candidates and actually attempt labor, approximately 60% to 80% achieve a VBAC. Previous vaginal birth, especially a previous successful VBAC, is one of the strongest favorable factors. Statistics can help us understand the larger picture, but they cannot predict your individual birth. You are not one number on a calculator. Your previous labor, uterine incision, current health, baby’s position, cervical readiness, birth setting, and support team all matter.
We Begin by Understanding What Really Happened During Your First Birth
The words written in a medical chart often describe how the labor ended, but they do not always explain why it unfolded that way. “Failure to progress” could describe several very different births. One woman may have been induced before her cervix was ready and never reached active labor. Another may have progressed well until a posterior baby struggled to rotate and descend. Another may have become exhausted after a very long labor without enough rest, movement, nourishment, or emotional support. Those stories are not the same.
During a VBAC consultation, I want to hear what happened from you. I also want to review the operative report when it is available. We look at why the cesarean was recommended, how labor began, how far the cervix opened, whether the baby descended, how the baby was positioned, which induction or augmentation methods were used, and whether there were fetal heart rate concerns.
I also want to know how you were treated. Were decisions explained to you? Did you feel rushed? Did you feel heard when you said something did not feel right? Did anyone help you move or change positions? Did you understand why surgery became necessary, or are you still trying to piece the story together? This review is not about blaming anyone or proving that the C-section could have been avoided. Cesareans save lives, and sometimes surgery is exactly what a mother and baby need. It is about understanding your story well enough that we are not carrying assumptions from one pregnancy into the next.
Who May Be a Good Candidate for VBAC?
Many women with one previous low-transverse uterine incision may be candidates for a trial of labor. A low-transverse incision is made horizontally across the lower portion of the uterus and is the most common type of uterine incision used during a cesarean.
The scar on your abdomen does not always show us what type of incision was made on your uterus. That is why reviewing the prior operative report is important whenever possible.
Your chances may be more favorable when you have previously given birth vaginally, have already had a successful VBAC, enter labor spontaneously, have one head-down baby, or had a previous cesarean for something that is unlikely to happen again.
For example, a cesarean performed because a baby was breech may not tell us much about how your body would progress with a head-down baby. A temporary fetal heart rate concern may also be unique to that labor. Even a previous cesarean for stalled labor deserves a closer look before anyone assumes it will happen again.
Some women with two previous low-transverse cesareans may also be considered for TOLAC. Reaching 40 weeks, having a higher body mass index, carrying twins who are otherwise appropriate for vaginal delivery, or having a baby suspected to be larger does not always create an automatic no. These circumstances require more individualized assessment and appropriate hospital collaboration.
A previous classical, T-shaped, high vertical, or certain other uterine incisions generally creates a higher risk of rupture during labor. A history of uterine rupture or another current condition that makes vaginal delivery unsafe may also mean that a planned cesarean is the safest choice. You deserve an answer based on your actual history, not a blanket policy.
How I Help Create the Best Possible Conditions for VBAC
I cannot guarantee that you will have a vaginal birth. No midwife, OB, doula, birth class, exercise, supplement, or birth plan can make that promise honestly. What I can do is help create the conditions in which physiologic labor is understood, supported, and given a fair opportunity when you and your baby remain well. That begins long before the first contraction.
Unrushed Prenatal Care
Many women are used to prenatal visits that last only a few minutes. The baby’s heartbeat is checked, a measurement is taken, and the appointment is over before the mother has had time to remember half of her questions. VBAC preparation deserves more than that.
During our visits, we have time to talk about the previous birth, nutrition, movement, fetal position, sleep, emotional well-being, pain relief, hospital procedures, induction, recovery, breastfeeding, and what you want this experience to feel like.
My clients often tell me that it is the first time they have felt genuinely listened to in maternity care. They are not being moved through a production line. They have a provider who knows their history, remembers their concerns, and understands why this birth matters so much to them. My practice is designed around that personalized, relationship-based model rather than fragmented care.
Preparing the Mind as Well as the Body
A previous cesarean can leave emotional memories that return during the next pregnancy. You may feel anxious during cervical exams, fetal monitoring, hospital discussions, or any moment that reminds you of the first birth.
Some clients arrive carrying the fear that their bodies will fail again. Others are afraid that nobody will listen if something begins to feel wrong. Many are caught between wanting a VBAC and being afraid to hope too strongly for it. We make room for those feelings.
Fear does not cause a cesarean, and women should never be blamed for what happens during birth. However, emotional safety still matters. When you feel supported and protected, it can be easier to breathe, rest, move, ask questions, and remain connected to your body.
My role is not to take over your birth. It is to help create enough safety that you can surrender to the process while knowing someone experienced is paying attention to the full clinical picture.
Supporting Movement and the Mechanics of Birth
Babies do not simply move straight down through the pelvis. They flex, rotate, descend, and change direction as they find their way through. The shape of the pelvis also changes as the mother moves. That is why labor support can be so much more than watching a monitor.
During labor, I may help you use walking, hands and knees, side-lying positions, supported lunges, kneeling, a birth ball, forward-leaning positions, or intentional rest. The right position depends on where you feel pressure, how the baby is positioned, how labor is progressing, and what your body is asking for.
Sometimes the answer is movement. Sometimes the answer is quiet. Sometimes you need encouragement to keep going, and sometimes you need permission to stop working so hard and conserve your strength.
One of my clients described this balance beautifully. She said I offered gentle direction while still giving her the freedom to listen to her body and choose the positions that felt right. This is not passive observation. It is hands-on, attentive care that respects both the physiology of labor and the wisdom of the woman experiencing it.
Protecting Reasonable Time When It Is Safe
Labor does not follow the same timeline for every woman. A cervix may change quickly for several hours and then slow while the baby rotates. A mother may need rest before labor becomes effective again. Progress may show up through fetal descent, position changes, contraction patterns, or changes in the mother’s behavior before it appears in a cervical measurement.
I do not believe women should be kept in an unsafe labor simply to avoid surgery. However, I also do not believe a decision should be made from one number without considering the full picture.
When you and your baby remain stable, we can discuss movement, hydration, bladder emptying, position changes, rest, emotional support, and whether more time is reasonable. When the clinical picture becomes concerning, I will tell you that honestly and help you understand why the plan may need to change.
Spontaneous Labor, Induction, and Going Past 40 Weeks
Spontaneous labor is generally associated with a higher likelihood of VBAC success. A cervix that has already begun softening, thinning, and opening may respond more readily than a cervix that requires induction. However, that does not mean every woman should wait indefinitely or that induction automatically ends the possibility of VBAC. Sometimes a medical concern makes delivery advisable. Blood pressure, diabetes, fetal growth, amniotic fluid, placental function, gestational age, and the baby’s well-being may all affect that recommendation.
If induction becomes necessary, we discuss why it is being recommended, how ready the cervix appears, which methods may be considered, and how the process may differ after a previous uterine incision. Certain medications commonly used for cervical ripening are generally avoided during TOLAC because of uterine rupture concerns. Other approaches may be considered depending on your history and the hospital plan.
Reaching 40 weeks does not automatically mean that your opportunity for VBAC disappears. We continue watching the pregnancy and making decisions from the complete clinical picture rather than one date on the calendar. An informed change of plan should still feel collaborative. It should not feel like everything you hoped for was suddenly taken away.
Understanding Uterine Rupture Without Using Fear
Uterine rupture is the risk most often discussed when a woman is considering VBAC. It occurs when the previous uterine scar opens during labor. It is uncommon, but it is serious. The American College of Nurse-Midwives cites an estimated uterine rupture risk of approximately 0.71% during TOLAC, compared with approximately 0.07% during a planned repeat cesarean. The individual risk may vary depending on the type of uterine incision, number of previous surgeries, labor induction or augmentation, and other clinical factors. I will never pretend the risk does not exist. At the same time, I will not use it to frighten you into one decision while ignoring the risks associated with another cesarean.
A repeat cesarean is major abdominal surgery. It can involve infection, bleeding, blood clots, surgical injury, longer recovery, adhesions, and increased risks in future pregnancies. A successful VBAC generally avoids many of those surgical concerns, while a TOLAC that ends in an urgent cesarean may carry more complications than either a successful VBAC or a planned repeat procedure. There is no completely risk-free option. Informed consent means understanding both paths. It does not mean being handed a list of frightening possibilities and then being told what to choose.
A Hospital Birth That Still Feels Personal
Many women who contact me want a natural, low-intervention, deeply supported birth, but they are not comfortable giving up access to hospital resources. I understand that. It is exactly why I worked so hard to bring private midwifery care into Los Robles Hospital. My practice is designed to bridge the space between a peaceful, relationship-based birth and the reassurance of a full medical team when needed.
You can move, use comfort techniques, discuss pain relief choices, create a calming environment, and remain involved in decisions. At the same time, obstetricians, nurses, anesthesia, surgical care, and newborn resources are available if the birth requires them.
I bring more than 27 years of maternal and newborn experience into that room, including my background as a NICU nurse and my training as a Certified Nurse Midwife and Women’s Health Nurse Practitioner. I also collaborate with an experienced obstetrician and maternal-fetal medicine resources when a client requires additional care. This is what I mean by the best of both worlds. You have a provider who believes in the natural process of birth and knows how to support it. You also have someone trained to recognize when your body or your baby may need more.
When the Birth Plan Changes
A birth can be beautiful without unfolding exactly as planned. One of my clients intended to deliver at a birth center and began her labor there. Circumstances changed, and we went to Los Robles. That experience reflects something I care about deeply. When a mother needs a different level of care, she should not feel as though she has been handed off, abandoned, or forced to begin again with people who do not know her. The location may change. The medical needs may change. The method of delivery may change. The relationship should not disappear.
Supporting VBAC does not mean continuing labor at any cost. If your baby is not tolerating labor, significant bleeding develops, labor stops progressing despite appropriate support, or another serious concern arises, a cesarean may become the safest and most loving recommendation. If that happens, I stay with you.
I help explain what is happening, communicate with the hospital team, support your partner, advocate for your preferences when circumstances allow, and continue caring for you after the birth. A better birth is not always defined by the way the baby exits your body.
The Woman’s Wisdom Behind a Supported VBAC
Midwifery support during a VBAC is not simply standing beside the bed and offering encouragement. A skilled midwife is continually reading the mother’s body, the baby’s position, the pattern of the contractions, and the way labor is moving through the pelvis. She notices whether the baby appears high, tilted, posterior, unevenly engaged, or having difficulty rotating through a particular part of the pelvis.
This is a form of knowledge women have carried for generations. Before laboring women were routinely placed flat in beds, they moved, leaned, rocked, knelt, squatted, rested on their sides, and followed sensations that told them where their bodies needed more space. The women attending them learned to recognize those movements and offer their hands, fabric, warmth, pressure, rhythm, and reassurance at exactly the right moment.
Modern hospital monitoring gives us valuable information about the health of the mother and baby. However, a fetal heart rate monitor does not tell the whole story of how the baby is moving through the pelvis. Midwifery adds another layer by combining clinical observation with hands-on knowledge of the body.
First, I Try to Understand Where the Baby Needs More Space
The pelvis is not one fixed opening. It has an inlet at the top, a midpelvis through which the baby must rotate, and an outlet through which the baby is born. Different maternal positions change the shape and available space at each level.
If a baby remains high and has not entered the pelvis well, the mother may need positions that create more room at the pelvic inlet. If the baby has descended but seems unable to rotate, we may use asymmetrical positions intended to create more room in the midpelvis. Later, during pushing, we may choose positions that free the sacrum and widen the outlet.
This is why I do not give every laboring woman the same sequence of positions. A deep squat may be useful when a well-positioned baby is descending, but it may not be the first choice when a baby is still high or needs room to rotate. The technique must match what the mother and baby appear to need.
Rebozo Sifting to Release Tension and Create Movement
A rebozo is a long woven shawl traditionally used by Mexican women and midwives during pregnancy, labor, postpartum recovery, and infant care. During labor, it can be placed around the mother’s abdomen, hips, or pelvis while the midwife or doula creates a gentle, rhythmic sifting motion.
The goal is not to shake or force the baby into position. The soft vibration may help the mother release tension through the abdominal muscles, pelvic floor, hips, and uterine ligaments. It can also provide comfort between contractions and allow the baby a little more freedom to settle or rotate.
I may use rebozo sifting while a mother is standing, leaning forward, resting on hands and knees, or lying in a supported position. The movement is generally gentle and is stopped if it feels uncomfortable or interferes with fetal monitoring.
Research on the rebozo is still developing. Recent trials suggest it may reduce labor pain, anxiety, and tension while improving the mother’s experience, but its ability to correct fetal position or increase vaginal birth has not been established conclusively. It remains a valuable example of traditional women’s wisdom that is now beginning to receive formal clinical study.
The Abdominal Lift and Tuck
When the baby remains high or is not applying even pressure to the cervix, a midwife may use an abdominal lift and tuck during contractions. The mother stands or leans against a stable surface while the lower abdomen is gently lifted upward and inward. At the same time, the mother slightly tucks her pelvis rather than arching her lower back.
This position changes the angle between the uterus and pelvis. The intention is to help bring the baby more directly over the pelvic inlet so the head can apply more even pressure to the cervix. It may be especially useful when the abdomen hangs forward, the baby remains high, or contractions are strong without producing expected engagement.
The lift is generally used only during a limited number of contractions before the labor is reassessed. It should never feel painful or forceful, and it is not appropriate in every clinical situation. There is limited direct research proving that this specific maneuver changes birth outcomes, so it should be described as a traditional body-balancing technique rather than a guaranteed way to bring the baby down.
Side-Lying Release to Soften Uneven Tension
Sometimes one side of the pelvis or pelvic floor appears tighter than the other. The mother may consistently feel contractions on one side, the baby may seem tilted, or cervical examinations may suggest that the head is not pressing evenly against the cervix.
A side-lying release is intended to create temporary length and relaxation through one side of the pelvis, pelvic floor, uterine ligaments, and surrounding muscles. The mother lies safely near the edge of the bed with her lower leg supported and her upper leg gently lowered with assistance. She remains supported throughout the technique so that the movement is controlled rather than forced.
After the release, the mother may stand, walk, lunge, or move onto hands and knees so the baby has an opportunity to use the newly created space. The technique may be performed on both sides or chosen according to the baby’s suspected position and the mother’s pattern of tension.
The side-lying release is commonly taught in modern body-balancing birth education, but high-quality research on the specific maneuver remains limited. Its use should therefore be individualized, clinically supervised, and described honestly as a way to encourage balance and mobility rather than a proven method for rotating the baby.
Asymmetrical Lunges to Open One Side of the Pelvis
When a baby appears to be positioned sideways, tilted, or having difficulty rotating through the midpelvis, symmetrical positions may not provide the space needed. An asymmetrical lunge places one leg higher than the other, which changes the shape of one side of the pelvis.
The mother may place one foot on a stool, chair, raised section of the bed, or supported surface while leaning gently toward or away from that leg. She may also lunge during a contraction, walk with one foot briefly elevated on a low step, or use a supported stair position. The exact direction depends on where the baby is believed to be positioned.
These movements are not random exercises. A midwife watches how the mother’s pain, pressure, contractions, and fetal descent respond. If the position makes labor more effective or creates a feeling of increased space, it may be repeated for several contractions before changing sides or returning to a resting position.
Hands and Knees for Back Labor and a Free Sacrum
Hands-and-knees is one of the oldest and most instinctive labor positions. It takes the mother’s weight off the sacrum, allows the abdomen to hang forward, and can reduce the intense back pressure sometimes associated with a posterior baby.
In this position, the mother may rock her pelvis, circle her hips, lean over a birth ball, lower onto her forearms, or alternate between a neutral back and a gentle pelvic tuck. A rebozo can also be used around the hips or abdomen while she remains supported.
Research has not consistently shown that hands-and-knees reliably rotates a posterior baby into an anterior position. However, studies do show that many women find it more comfortable and that it can reduce back pain during labor. It remains a valuable position because comfort, pelvic freedom, and the ability to continue labor matter even when fetal rotation cannot be promised.
Open-Knee Chest When the Baby Needs More Room to Reposition
An open-knee chest position may be considered when the baby appears to need more room to move away from the pelvis before attempting a better angle of descent. The mother begins on hands and knees, lowers her chest toward the bed, keeps her hips elevated, and separates her knees while maintaining support and comfort.
This is not usually a position in which a woman remains for a long period. It may be used briefly between or through several contractions, followed by upright movement, side-lying, or another position designed to encourage the baby to settle again.
The purpose is sometimes described as helping the baby move slightly upward before rotating and descending more effectively. That explanation is based largely on traditional and biomechanical reasoning rather than strong clinical trials. It should be used only when the mother is stable, the fetal heart rate is reassuring, and the position does not interfere with necessary care.
Walcher’s Position to Make Room at the Pelvic Inlet
When a baby remains high above the pelvis, a midwife may consider a supported position sometimes known as Walcher’s. The mother reclines near the edge of a bed while her legs are carefully supported in a lowered or extended position.
This posture changes the angle of the pelvis and may create additional space at the inlet. It can be physically intense, so it is generally used for a limited number of contractions and only with strong support from the birth team.
Walcher’s position is not something a mother should attempt alone. The midwife must account for comfort, balance, fetal monitoring, epidural status, blood pressure, and the overall clinical picture. Like several traditional positioning techniques, its proposed mechanical benefit is plausible, but direct evidence showing that it prevents cesarean birth remains limited.
The Peanut Ball When Mobility Is Limited
A mother with an epidural may not be able to walk, squat freely, or move through the room, but that does not mean she must remain flat in one position. A peanut-shaped birth ball can be placed between the legs while she lies on her side, sits upright in bed, or assumes a supported semi-prone position.
The ball keeps the legs separated and changes the dimensions of the pelvis while the mother rests. Different placements may be used depending on whether the baby is still high, rotating through the midpelvis, or descending toward the outlet.
ACOG’s current labor-management guideline specifically discusses the peanut ball as a positioning tool that may help widen the pelvis and facilitate fetal descent while the mother is lying on her side. It is a particularly helpful example of adapting traditional freedom of movement to a modern hospital setting.
Sacral Counterpressure and the Double Hip Squeeze
Strong pressure against the sacrum can be deeply relieving during back labor. The midwife or doula may use the heel of the hand, a fist, a massage tool, or a warm compress to provide steady counterpressure during each contraction.
A double hip squeeze is performed by placing the hands on the outer hips and pressing inward during contractions. Many women instinctively ask for this because it creates a feeling of stability around the pelvis and may soften the intensity of back and pelvic pain.
These techniques do not directly dilate the cervix or rotate the baby. Their value is that they help the mother release guarding, remain mobile, and continue working with her contractions rather than becoming overwhelmed by pain. Massage and warm packs are recommended by the World Health Organization as nonmedical options for women requesting labor pain relief, although the quality of evidence for individual manual techniques varies.
Warm Water to Help the Body Soften
Warm water is one of the simplest and most powerful tools available in labor. A shower directed across the lower back or abdomen can soften muscle tension and give the mother privacy and relief. Immersion in a tub, when available and clinically appropriate, surrounds the body, reduces the feeling of heaviness, and allows easier movement.
Water does not guarantee faster dilation or a vaginal birth. However, evidence suggests that immersion during the first stage of labor may reduce the use of epidural pain relief without increasing adverse outcomes in appropriate candidates.
In a VBAC labor, water use must be balanced with the need for reliable fetal monitoring and the hospital’s policies. Sometimes a shower is more practical than full immersion. Even a warm compress across the lower back, abdomen, hips, or perineum can help the body soften.
Low Sounds, an Open Jaw, and a Relaxed Pelvic Floor
Women have used sound during birth long before anyone taught formal breathing classes. Low moans, humming, sighing, and open-mouth breathing can help release tension and create a rhythm through contractions.
A midwife may gently remind the mother to soften her jaw, drop her shoulders, unclench her hands, or breathe the contraction downward. The jaw and pelvic floor are not mechanically connected in a way that guarantees one will relax the other, but they often tighten together when a woman is frightened or bracing against pain.
The goal is not to make the mother quiet or perform a perfect breathing pattern. It is to help her move away from short, panicked breathing and return to a slower rhythm that conserves energy. Relaxation, breathing, music, mindfulness, and similar techniques are recommended options for women who want nonmedical help coping with labor pain, although they have not been shown to guarantee a particular mode of birth.
Acupressure During Labor
Acupressure uses firm finger or thumb pressure on specific points of the body. During labor, commonly used areas include the lower back and sacrum, the webbing of the hand, the shoulders, and points above the ankle.
A trained midwife, doula, acupuncturist, or partner may apply pressure during contractions and release it between them. Some points are used primarily for pain and tension, while others are traditionally believed to support stronger or more coordinated contractions.
Research suggests that acupressure may provide a modest reduction in labor pain, but the evidence varies and the ideal points, duration, and pressure have not been standardized. Because certain points are traditionally used to stimulate contractions, they should not be treated casually during pregnancy or used to induce a VBAC labor without guidance from the medical provider.
Walking, Swaying, and Letting Gravity Help
Some of the most useful birth techniques are also the simplest. Walking, standing, swaying, slow dancing with a partner, circling the hips, leaning forward, and sitting upright allow the mother to respond instinctively to labor.
Gravity may help keep the baby’s head against the cervix while movement changes the angles of the pelvis. Upright positions can also make contractions feel more purposeful for some women.
Research comparing upright and recumbent positions during the first stage has found that walking and upright labor may shorten labor and reduce cesarean birth in women without epidural anesthesia. The evidence does not mean a woman should be kept upright when she needs rest, but it supports giving her freedom to move instead of placing her in bed by default.
Supported Squatting and Making Room at the Outlet
As the baby descends, squatting may create more room at the pelvic outlet and allow the sacrum to move backward. The mother may squat while holding a bar, leaning against her partner, hanging from a rebozo, or being supported beneath the arms.
However, squatting is not always the correct answer. If the baby still needs to rotate or remains high, closing the upper pelvis through a deep squat may not be helpful at that moment. A midwife uses the position intentionally rather than assuming every labor should end in a squat.
Flexible-sacrum birth positions, including kneeling, hands-and-knees, side-lying, and supported squatting, have been associated with a shorter second stage in some studies. The strongest choice is often the position in which the mother feels grounded, the baby remains well, and descent is visibly occurring.
Laboring Down Instead of Beginning Directed Pushing Immediately
When the cervix becomes fully dilated, some women feel an immediate and overwhelming urge to push. Others do not. If the mother and baby are stable, especially when an epidural is in place, there may be circumstances in which the baby can continue descending before strong directed pushing begins.
This is sometimes called laboring down. The mother rests, changes positions, and allows contractions to bring the baby lower while conserving her strength.
When active pushing begins, I do not automatically believe every mother needs to hold her breath while people count loudly to ten. Open-glottis pushing allows her to exhale, vocalize, and follow the natural urge to bear down. The approach must remain flexible because changes in the fetal heart rate or maternal condition may make a more immediate delivery necessary.
Warm Compresses and Slow, Supported Crowning
The final moments of birth also contain generations of midwifery wisdom. As the baby’s head begins to crown, a warm compress may be placed against the perineum while the mother is guided to slow her pushing and allow the tissues time to stretch.
The midwife may support the perineum, encourage small breaths or gentle sounds, and help the mother resist the instinct to push with maximum force through every sensation. The goal is controlled, gradual birth of the head rather than rushing the baby through the tissues.
Current evidence supports warm perineal compresses during the second stage as a way to reduce severe perineal trauma. Perineal massage may also help in some circumstances, although the mother’s comfort and preference should guide its use.
Warm Compresses, No Tear Mama Oil, and Slow, Supported Crowning
The final moments of birth contain generations of midwifery wisdom. As
the baby’s head begins descending through the birth canal, the tissues
of the perineum are being stretched from the inside. At the same time, I
work from the outside to help those tissues become warm, lubricated,
flexible, and better prepared for the baby’s birth.
During the pushing stage, I generously apply No Tear Mama Oil, my
unique blend of organic oils created to deeply moisturize and lubricate
the perineal tissues. I combine the oil with gentle, intentional
perineal massage throughout pushing, rather than waiting until the baby
is already crowning and the tissues are under their greatest pressure.
As the baby’s head moves lower, I use the oil to help stretch and
prepare the perineum from the outside while the baby gradually creates
space from within. This creates a well-lubricated, more pliable pathway
and allows me to feel how the tissues are responding as the baby
descends.
I also guide the strength and rhythm of pushing. There are moments when
a mother may need to push with strength, but there are also moments when
I may ask her to soften, breathe, make smaller sounds, or pause briefly
so the baby’s head can emerge slowly. The goal is not to rush the final
part of birth. It is to allow the perineum time to gradually stretch
over the baby’s head.
Warm compresses may also be placed against the perineum to increase
comfort and encourage the tissues to soften. Current evidence supports
warm perineal compresses during the second stage as one way to reduce
the risk of severe perineal trauma. Perineal massage may also help
reduce significant tearing in some circumstances, although every woman’s
tissues, baby, position, and birth are different.
In my practice, the combination of generous lubrication with No Tear
Mama Oil, hands-on perineal massage, warm support, controlled crowning,
and careful guidance during pushing has contributed to a low rate of
significant tearing among my clients. No technique can guarantee that a
tear will not occur, especially when a baby must be born quickly or
additional assistance is needed. However, preparing the tissues
throughout the pushing phase may help create a gentler birth for both
mother and baby.
Reducing perineal trauma can make an important difference after birth.
Less tearing may mean less swelling, less discomfort when sitting or
walking, and an easier transition into breastfeeding, newborn care, and
the first days of motherhood. My intention is to protect the tissues as
much as possible so recovery can feel more comfortable and the mother
can focus on her baby rather than significant perineal pain.
How These Techniques May Help Protect a VBAC Opportunity
No single natural technique creates a successful VBAC. Rebozo sifting cannot promise to turn a baby. A side-lying release cannot guarantee dilation. Squatting, acupressure, water, and breathing cannot eliminate the possibility of needing surgery. The value comes from having many tools and knowing when to use each one.
If a baby is high, we create space at the inlet. If the baby seems tilted or unable to rotate, we use asymmetrical movement and positions that free the midpelvis. If the mother is exhausted, we stop asking her to work harder and help her rest. If back labor becomes overwhelming, we use warmth, counterpressure, water, and hands-and-knees so she can continue without losing herself in the pain.
This is where midwifery care may support VBAC in a way that cannot be captured by a calculator. I am not waiting for the cervix to “fail.” I am watching how the mother and baby are working together and asking what might help them find a better rhythm. I am combining the old knowledge of women’s bodies with fetal monitoring, clinical assessment, hospital collaboration, and the ability to recognize when a natural technique is no longer enough.
That is the woman’s wisdom behind midwifery. It is not rejecting modern medicine. It is remembering everything the female body already knows, then surrounding that wisdom with the safety and resources women deserve.
Frequently Asked Questions About VBAC
Can I have a VBAC after two C-sections?
Some women with two previous low-transverse cesareans may be considered candidates. Your operative reports, current pregnancy, previous vaginal birth history, hospital resources, and individual medical concerns must all be reviewed.
Can I have an epidural during a VBAC?
Yes. An epidural does not automatically prevent a VBAC. Some women prefer unmedicated labor, while others decide that pain relief and rest will help them continue. You do not lose your voice or your birth plan because you choose an epidural.
Can I be induced after a previous cesarean?
Induction may be possible in selected circumstances, although the available methods may be different after a uterine incision. The reason for induction, readiness of the cervix, previous birth history, and well-being of you and your baby all matter.
Does going beyond 40 weeks rule out VBAC?
No. Reaching 40 weeks does not automatically disqualify you. We continue assessing the pregnancy and discussing whether waiting remains reasonable or whether another plan is becoming safer.
What if an ultrasound says my baby is large?
Ultrasound weight estimates are not exact. Suspected size should be considered alongside your complete history, diabetes status, previous birth weights, fetal position, and other clinical factors rather than being treated as a perfect measurement.
Is VBAC safer than another C-section?
Neither option is completely without risk. A successful VBAC avoids abdominal surgery and often allows a faster recovery. However, TOLAC can result in an urgent cesarean and carries a small risk of uterine rupture. A planned repeat cesarean avoids labor-related rupture risk but introduces surgical risks and may affect future pregnancies.
When should I schedule a VBAC consultation?
Earlier in pregnancy is ideal because it gives us time to retrieve your operative report, understand your first birth, address medical concerns, and prepare without feeling rushed. However, women do change providers later in pregnancy. It may still be worth reaching out even if you are well into your second or third trimester.
Let’s Talk About the Birth You Hope to Have
At The Midwife & More, we will begin by understanding you. We will review your history, evaluate whether you may be a candidate for VBAC, prepare thoughtfully for labor, and create a plan that respects both your intuition and your safety.
You will not be expected to navigate pregnancy, labor, hospital decisions, and recovery alone. You can have a provider who believes in you and also knows when you need more. You can have a birth that feels calm, intentional, and deeply personal while still having hospital resources available. You can be deeply cared for and expertly cared for at the same time.
Schedule Your Consultation
Choose a time that works for you, or call and we’ll help you plan your next birth.
VBAC Support Near You
The Midwife & More serves women throughout western Los Angeles County and Ventura County. Clients come from Agoura Hills, Calabasas, Hidden Hills, Los Angeles, Malibu, West Hills, Westlake Village, Woodland Hills, Thousand Oaks, Newbury Park, Oak Park, Simi Valley, Moorpark, Camarillo, Oxnard, Ventura, and surrounding communities. My hospital-based births take place at Los Robles Hospital in Thousand Oaks.
Many families are willing to travel because they are looking for something that can be difficult to find. A provider who believes in birth, understands the medical side, a provider who knows their story before labor begins, and a provider who will remain present if the plan changes.
