A Positive VBAC Experience!

Dr. Rebecca Acevedo, PT, DPT • June 12, 2025

A Client Success Story!


This week, I want to highlight one of my birth prep clients who came to me at 36 weeks pregnant with the goal of a VBAC (vaginal birth after Cesarean). During the labor and delivery of her first two children, the position of the baby was suboptimal and ultimately led to a failure to progress with pushing, leading to two C-sections. For her third child, she was determined to learn and prepare her body as much as possible in hopes of a vaginal delivery.

 

Over the course of our 1x/week sessions for 4 weeks, we worked to improve the mobility of her hips, pelvis, and lumbosacral spine with gentle joint mobilizations, PNF stretching, cupping, scraping and myofascial release techniques. We addressed tightness of the adductors, hamstrings, quadratus lumborum, lumbar paraspinals, diaphragm, piriformis and gluteals that were contributing to lumbopelvic pain and mobility restrictions. The sidelying release technique from Spinning Babies was one of her favorites each session, as it was hard to find time with her partner to recreate the effective stretch at home. Her stretching program focused on improving pelvic inlet, mid pelvis, and pelvic outlet mobility combined with diaphragmatic breathing to optimize baby’s position in the weeks leading up to and throughout labor. 


When we started push practice, her initial strategy was to hold her breath, engage the core and tighten the pelvic floor. During the internal pelvic floor assessment, there was notable tightness and pain limiting the ability to effectively coordinate pelvic floor muscle lengthening and expansion, which are crucial for a vaginal delivery. After manual release techniques and teaching her how to use a pelvic wand for self-release at home, the tenderness and pain of her pelvic floor resolved, allowing her to improve her ability to lengthen and relax the pelvic outlet. 

After working together, we were able to improve her coordination to where she could exhale, engage the abdominals and expand the pelvic floor in a variety of delivery positions suitable for with or without an epidural. 


She had a calm confidence at her last visit and told me how prepared she felt this time compared to her first two deliveries. Whatever happened, she knew that she had done everything possible to optimize her outcome because she invested in her knowledge and physical preparation. Ultimately, she went into spontaneous labor and was able to achieve the vaginal delivery after two Cesareans that she had hoped for! Mom & baby are both healthy and we are looking forward to seeing them back in the clinic to start postpartum rehab. 


Bringing babies from the womb to the world is a wild experience that is largely out of our control, but we know that knowledge and preparation empower outcomes. Even if things don’t go exactly as we hope, increasing our awareness in advance improves advocacy and can change the trajectory of our responses, leading to less birth trauma carried into the future. 


Dr. Rebecca Acevedo, PT, DPT

Evolve Physical Therapy


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If you’ve ever felt pain in your jaw, heard a clicking sound when you chew, or experienced headaches that seem to start near your ears, you may be dealing with temporomandibular dysfunction, or TMD. This often-overlooked condition affects the temporomandibular joint (TMJ)—the hinge that connects your jaw to your skull and plays a critical role in everyday activities like eating, speaking, and yawning. What Is Temporomandibular Dysfunction? Temporomandibular dysfunction (TMD) is a broad term that refers to disorders affecting the jaw joint and surrounding muscles. The TMJ is one of the most complex joints in the body, allowing both hinge and sliding movements, which allows the jaw to open and close, slide forward/backward, and side-to-side. When something goes wrong with the muscles, ligaments, or joint surfaces, TMD symptoms can develop. Common Symptoms of TMD: Jaw pain or tenderness with opening or closing the jaw Clicking, popping, or grinding sounds when opening or closing the mouth Difficulty chewing or locking of the jaw Headaches and neck pain Facial pain or fatigue What Causes TMD? TMD can be caused by a variety of factors, including: Teeth grinding or clenching (bruxism) Stress and tension leading to muscle tightness Poor posture, particularly in the neck and upper back Injury to the jaw, neck, or head Arthritis or degenerative joint changes Dental issues, such as bite misalignment How Physical Therapy Helps with TMD Physical therapy is a conservative treatment option that can significantly improve TMJ function and reduce pain. A physical therapist trained in TMJ disorders will assess not only your jaw, but also your neck, posture, and muscle patterns to create a personalized treatment plan. Some of the benefits of physical therapy for TMD include: 1. Pain Relief Manual therapy techniques, including soft tissue massage and joint mobilization, can reduce muscle tension and inflammation in the jaw and surrounding areas. 2. Improved Jaw Mobility Therapists use specific exercises to restore normal movement to the jaw, helping to reduce clicking, locking, or restricted motion. 3. Postural Correction Forward head posture and strength deficits of muscles surrounding the spine can put extra stress on the TMJ. PT can help you improve you strength key postural muscles and reduce the strain on your jaw. 4. Muscle Strength and Balance Therapeutic exercises can improve the strength and coordination of the muscles that control jaw movement, reducing dysfunction and recurrence. 5. Stress Reduction Techniques Since stress is a major contributor to jaw clenching and muscle tension, PT often includes relaxation techniques and education on how to manage these habits. Final thoughts If you’re experiencing jaw pain, popping, or limited mobility that lasts more than a couple of weeks, or if you’ve been diagnosed with TMD by your dentist or physician, physical therapy could be a valuable part of your recovery.Temporomandibular dysfunction can have a major impact on your quality of life, but it’s highly treatable—especially when addressed early. Physical therapy offers a safe and effective approach to managing TMD, restoring normal function to your jaw, and helping you return to a pain-free life. References U.S. Department of Health and Human Services. (February 2025.). TMD (temporomandibular disorders) . National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/tmd