Creating a VBAC Plan: How Pelvic Health Physical Therapy Can Help You Prepare
Many women after undergoing an unplanned C-section consider delivering by VBAC for a subsequent delivery. Experiences from previous deliveries vary widely and there is not one right answer to the question “should i have a VBAC”. Creating a VBAC plan is not about trying to control every aspect of your labor or guaranteeing a vaginal delivery. It is about understanding your options, asking informed questions, preparing your body, and creating a support system that helps you feel heard.
Pelvic Health Physical Therapy can be an important part of that preparation. At Cultivate Your Wellbeing, education is at the core of our mission and everything we do. We find that when you better understand your body and how it works, you are a better advocate for yourself, ask more informed questions, and make decisions from a place of empowerment instead of fear.
This decision can often feel overwhelming and emotional and you may feel like you have a long list of questions:
Am I a good candidate for a VBAC?
What are the risks of a VBAC?
What can I do to prepare?
Will my body know what to do?
What happens if labor does not go as planned?
Let’s break down what a VBAC is, whether it is something you want to consider, and if so how to best prepare.
What is a VBAC?
VBAC stands for Vaginal Birth After Cesarean. You may also hear your provider use the term TOLAC, which stands for Trial of Labor After Cesarean. While your goal may be a VBAC outcome, the preparation during pregnancy is geared toward preparing you for TOLAC and is not a guarantee of outcome.
What is the Success Rate for VBAC delivery?
Most women who attempt a VBAC are successful. The Royal College of Obstetricians and Gynaecologists reports that approximately three out of four women who have had one prior C-section, have an otherwise straightforward pregnancy, and go into labor naturally will have a successful VBAC. For women who have also had a previous vaginal birth, that likelihood may be closer to nine out of ten.
While statistics can help guide our decisions, they do not necessarily predict your individual experience.
Is VBAC the Right Choice for Me?
This decision is deeply personal and should be made between you and your obstetric provider. Together you should review your history, current pregnancy, personal preferences and risks and benefits of both options.
Considerations to discuss with your provider:
The type of uterine incision from your previous C-section
Why the previous C-section was needed
The number of C-sections or other uterine surgeries you have had
Whether you have previously given birth vaginally
Your medical and pregnancy history
The health and position of your baby
Whether labor begins naturally or induction may be needed
The resources available at the hospital where you plan to deliver
A successful VBAC avoids another abdominal surgery and is generally associated with a shorter recovery, less blood loss, and a lower risk of infection than a previous C-section. However, while uncommon, there can also be the serious risk of the previous uterine scar opening during labor. The American College of Gynecologists emphasizes that this decision is complex and should include individualized counseling about both possible birth outcomes.
At Cultivate Your Wellbeing, we do not determine if someone is medically appropriate to attempt a VBAC. That decision is up to you and your provider. We can help you better understand your body, address symptoms or movement concerns, prepare you physically for labor, and feel more confident in conversations about your care.
What is a VBAC plan?
Just like any other birth plan, a VBAC plan helps organize your questions, preferences, concerns and support before you go into labor. Having a plan helps you to feel prepared and empowered going into delivery, but is not a prediction of exactly how your birth will happen.
A VBAC plan should include:
Where you plan to deliver and what resources are available
When your provider wants you to call or come to the hospital or birthing center
How labor will be monitored
Whether you would like to move and change positions during labor
Pain-management options
Who you want present for support
How you would like information and changes in the plan communicated
What matters most to you if another C-section becomes necessary
How you would like to be supported after either type of birth
Preparing for the possibility of another C-section does not mean you are giving up on the goal of a VBAC. A flexible plan considering more than one possible path helps you be more prepared and involved in your care if circumstances change.
Preparing for Birth After a Previous C-Section
Just as each birth experience is unique, so are the emotional responses that result. Many women who have an unplanned c-section may have felt disappointed by circumstances out of their control and desire a different type of delivery for their next birth. Others may have felt positive or indifferent toward having a c-section, but would like to feel informed about choices for their next delivery. There is not one right way to feel and often there is a mix of emotions, such as “I am grateful we are both safe” and “I am disappointed my delivery didn’t go as planned”. These can both exist at the same time.
The birth process, especially when it does not go as expected, can be traumatizing and have you feeling fearful toward your next delivery. Mental health therapy can help immensely and we strongly advocate for our patients to seek care when needed and are happy to provide you with references to providers.
At Cultivate Your Wellbeing, we are passionate about helping you understand your anatomy, move better, and feel more connected to your body. This helps build confidence in your body and your plan. Let’s dive into the benefits of pelvic physical therapy as you prepare for your next delivery.
How Pelvic Health Physical Therapy Can Support Your VBAC Plan
Pelvic PT can be an integral part of your prenatal care and is so much bigger than just the end result. Participating in physical therapy at Cultivate Your Wellbeing can help you resolve issues from a previous pregnancy/birth, feel better during your pregnancy, prepare for birth, learn to work with your body and pelvic floor muscles, and set you up for a better postpartum recovery.
1. Addressing Existing Symptoms
Some women begin a pregnancy while still experiencing symptoms from a previous pregnancy or delivery. Sometimes it is simply a matter of not getting around to having those symptoms addressed because life has been busy or overwhelming since delivery. Other times, women wonder, “What’s the point of working on my symptoms now if I plan to have more pregnancies?”
But addressing these symptoms sooner rather than later can help you feel better now while also giving you the education, movement strategies, and tools to support your body through another pregnancy and recovery. By understanding what may be contributing to your symptoms and changing habits that are no longer serving you, you may also reduce the chance that those symptoms worsen or return.
Some of the symptoms you may notice that can be addressed during pregnancy:
C-section scar sensitivity, numbness, tightness, or discomfort
Abdominal weakness or a feeling of disconnection from your core
Leakage or urinary urgency
Constipation or difficulty emptying your bowels
Pelvic pressure or heaviness
Pain with intimacy
Hip, back, pelvic, or tailbone pain
Fear or uncertainty around exercise and movement
Addressing these concerns will not determine whether you have a VBAC. But feeling more comfortable and capable in your body can make a meaningful difference in how you experience pregnancy and approach birth.
2. Feeling better during your pregnancy
How you feel throughout your pregnancy matters. Tailbone, low back and pubic symphysis pain, pelvic pressure, and urinary issues are common during pregnancy. These symptoms can cause fear of movement, make it difficult to complete daily tasks or stay active, and decrease your quality of life during pregnancy. Seeing a pelvic health physical therapist at Cultivate, can help decrease pain, improve movement patterns, and provide modifications as needed to keep you active and feeling good. To learn more about the benefits of physical therapy during pregnancy read our blog: Reasons to go to Pelvic Health Physical Therapy During Pregnancy.
3. Learning to coordinate your pelvic floor
When most people hear the term “pelvic floor” they immediately think in terms of strengthening. While strength is important, learning to coordinate your pelvic floor is even more instrumental to your delivery, recovery, and overall wellbeing.
Before you can learn to coordinate your pelvic floor, it is important to know where these muscles are and how they actually function. The pelvic floor is a group of muscles that forms a bowl-like structure at the base of the pelvis. These muscles are important for:
Support of our pelvic organs
Stability of our spine, pelvis, and hips
Continence (or preventing leaks)
Sexual Function
Lymphatic Function
For optimal functioning, we need strong and flexible pelvic floor muscles. This means we must know how to contract our muscles AND also lengthen our muscles. Relaxing and lengthening are often more difficult for our patients to learn than contracting.
Pelvic health physical therapy can help improve your awareness of and connection to these muscles. With verbal, manual and tactile cues your therapist can help you feel more confident that you are accessing the correct muscles. Once you know your are using the correct muscles you will work on improving your coordination. While an internal exam is always optional, and only with consent, it can be a helpful tool in guiding you to improve your ability to strengthen, lengthen and coordinate your pelvic floor muscles.
4. Birth Preparation
Pelvic health physical therapy supports birth preparation whether or not someone has had a previous C-section.
At Cultivate Your Wellbeing, we begin with education. We explain how the pelvic floor works during pregnancy, labor, pushing, and recovery. The pelvic floor does not simply need to be strong. During a vaginal birth, it also needs to lengthen, adapt, and coordinate with your breathing, abdominal pressure, and the movement of your pelvis.
During birth-preparation visits, we may work on:
Understanding how the pelvic floor responds during labor
Coordinating breathing with pelvic floor relaxation
Exploring different ways to direct effort during pushing
Practicing positions that may feel comfortable during labor
Improving hip, pelvic, and spinal mobility
Building strength and endurance for pregnancy, labor, and postpartum life
Managing pressure without teaching you to fear it
Addressing scar or abdominal concerns from the previous C-section
Modifying exercise so you can continue moving comfortably
Discussing ways a partner or support person may help during labor
We are not teaching one “perfect” way to give birth. Labor positions that feel helpful for one person may not feel right for another. The way you breathe or push may change based on your position, comfort, fatigue, medical needs, and what is happening during labor.
Our goal is to give you options, help you understand what you are feeling, and allow you to practice before you are in the intensity of birth. To learn more read our blog: Birth Prep with Pelvic Floor Therapy: What to Know Before Delivery.
5. Preparing for Postpartum Recovery
One of the benefits of establishing pelvic health care during pregnancy is that postpartum care is already established with a therapist you know and trust.
When you come to Cultivate before birth, we learn about your previous delivery, current symptoms, activity level, concerns, and goals. We understand what your body felt like during pregnancy and what you were working toward before labor.
Whether you have a vaginal birth or another C-section, you already have a pelvic health provider who knows you. We can help you navigate early movement, bowel and bladder concerns, pelvic floor symptoms, abdominal recovery, scar healing, returning to exercise, pain with intimacy, or any new concerns that arise.
ACOG recommends thinking of postpartum care as an ongoing process rather than a single appointment and encourages postpartum planning to begin during pregnancy.
At Cultivate, we believe that continuity matters. Pregnancy, birth, and postpartum recovery are not separate events. They are connected parts of your experience, and your care should reflect that. To learn more about postpartum care read our blog: Postpartum Pelvic Floor Physical Therapy: Why Every Postpartum Person Deserves Support
Building a VBAC Plan that supports you
A thoughtful VBAC plan should include medical conversations, emotional support, practical birth preferences, physical preparation, and a plan for postpartum care.
Start by talking with your obstetric provider about whether TOLAC is considered medically appropriate for you. Ask about your individual risks, your previous uterine incision, hospital policies, induction options, monitoring, and what may happen if plans need to change.
At Cultivate Your Wellbeing, we are here to help you understand your body, ask informed questions, and prepare in a way that reflects your individual experience. We cannot promise a VBAC, and we will never tell you which type of birth you should choose. What we can offer is education, individualized care, and a place where your questions and concerns are taken seriously.
Because when you understand your body better, you are better equipped to advocate for yourself. When you feel more comfortable moving, you may approach birth with greater confidence. And when you already have support in place, you do not have to navigate postpartum recovery alone.
A VBAC plan is not about controlling birth. It is about helping you feel informed, empowered, and supported through whatever path your birth takes.
Interested in including pelvic health physical therapy in your VBAC plan? Contact Cultivate Your Wellbeing to schedule an evaluation or begin with a free 15-minute consultation at our Mequon or Brookfield location.