Updated: May 30, 2019
Having a good idea of what you want for your VBAC is important. Knowing what the options are and what choices are available can be frustrating. To help guide you, we recommend mastering the art of BRAIN, an acronym to use for making decisions.
What is BRAIN?
The acronym BRAIN is the process of using questions to analyze your options and guide your decision-making process. We will explain the acronym and then apply it to circumstances you may encounter during birth.
Benefits- What are the benefits of this intervention, option, procedure? How does it benefit me and baby?
Risks- What are the risks of this intervention, option, procedure? How may it affect baby and I negatively?
Alternatives- Are there other alternatives to this intervention, option, procedure? How do they compare to XYZ? Are they gentler or more invasive?
Intuition- Ask yourself how you personally feel about the situation? What does your momma gut say?
Nothing- What happens if we do nothing? Is it safe? Is it possible things can change? What happens if we wait? How long is it reasonable to wait for me to decide?
In labor, there are many interventions that can come into play. An intervention is anything done to your body during your labor process and even before labor happens. Knowing what these interventions are and what the BRAIN truly is will increase your chances of having a little-to-no intervention vaginal birth. Below we will discuss a few of these intervention types.
There are some providers that will tell you they will not induce a VBAC. Although it’s ideal for labor to start on its own, VBAC moms can be safely induced and have a VBAC. According to ACOG, a prior low transverse C-section is not a contraindication to induction (other than the use of Misoprostol Cytotec), so a Foley catheter or Pitocin may be used safely in most women. The problem arises when a practitioner does not believe in doing inductions on women with a prior C-section.
Let’s talk about induction some more. There are many ways of inducing labor, and part of mastering the art of BRAIN is knowing what these are and what the pros and cons are to each one for you and baby. But how can one really know if induction or interventions are needed? Providers will often give a Bishop Score before induction. Doctors rate a woman’s cervix from 1-10. Anything less than a six means her cervix may not be ready for labor.
*Signs your cervix is not ready to have a baby: Posterior cervix, high and hard/thick cervix, the body is not showing any signs of labor starting. If induction is something mentioned by your provider, ask why. Why is it medically necessary for me to induce labor?
Evidence-based reasons for induction include: Conditions like polyhydramnios, preeclampsia, fetal growth restrictions, and other dangerous complications. Other examples include if your water has broken but you haven’t gone into labor on your own after 48+ hours, low amniotic fluid, or decreased fetal movement.
Sometimes the cervix is not yet ready to be induced but it is medically necessary to proceed with birth, labor has not started after two weeks past the due date, or labor has stalled.
Assisted Vaginal Delivery
In assisted vaginal delivery (also known as operative vaginal delivery), a device, such as forceps or a vacuum, is used to assist the mom during delivery to achieve a vaginal birth. Approximately 3% of deliveries in the US are operative vaginal deliveries (ACOG, 2016). The overall rate of operative vaginal deliveries is going down; however, we are seeing an increase in vacuum-assisted deliveries, which now account for almost four times the rate of forceps-assisted vaginal births.
Other Interventions You Might Encounter
There are many other interventions that may be necessary or suggested during your labor and birth that do not fall in these two categories. Examples include an epidural, fentanyl, FSE, and IUPC. If you do not know what these things are, look them up or, attend one of our VBAC Preparation Classes. Come prepared to your birth with information and hire a doula to help guide you in unexpected circumstances. Preparation and knowledge is power. Be empowered.
Are you over the VBAC myths and want solid data to back up the facts? Grab your FREE VBAC MythBusters guide here.