Why I Chose a VBAC :: Allie

Allie's Birth

What was the reason for your initial Cesarean birth?
My body wasn't ready for labor, but I asked my OB to induce me.  She really didn't want to... she encouraged me to wait a few more days.  According to her my cervix was "high and tight."  However, she agreed to induce and after hours and hours of labor, hardly getting anywhere, Charlie, my baby, just wasn't making it down the birth canal.   Even when I was 10 cm dilated, I pushed for three hours and he was too far up the birth canal and also his face was turned toward my inner thigh... so after unsuccessfully attempting vaginal birth with the vacuum, my OB said we needed to just get him out.

Why did you choose a VBAC?
Honestly, I wanted a VBAC soooooo bad... mostly for the reason that so many doctors I know of won't do more than three Cesareans, resulting in no more than three babies if you go with those doctors, and I really wanted the option for four babies if possible.  

What were your fears and concerns (if any)?
I think going into it, I was scared and so desiring a VBAC, but also trying to hold it with an open hand, not wanting there to be any frustration about the birth or negative feelings surrounding Joey's arrival.  But, I wanted it so bad and felt like I had done certain moves, hired a doula, etc. to do my part to make it happen and then just let the rest go.

What was the biggest challenge during pregnancy and then during labor and birth?
This pregnancy with Joey so different from my first pregnancy with Charlie.  Starting at 34 weeks, I was already dilated 2-3 cm.  At 38 weeks I went in and my OB said, "You are 6 cm dilated!  This is crazy!  I can't in good conscience keep letting you walk around like this!" 
 I was induced shortly thereafter.  Similar to Charlie, my body wasn't going into labor.  This time, though, my cervix was at least ready, but my body wasn't cooperating.  I called my doula and she met me at the hospital.  They broke my water and immediately my contractions came on.  After an hour of contractions, I opted for the epidural and within an hour I was 10 cm.  My OB asked me if I wanted to let his head come down further or if I wanted to start pushing.  I asked Morgan, my doula, and she suggested that I just try a few pushes and if we needed to stop and let him progress further, we could.  I started pushing.  Morgan was an incredible support and there was one point where she said something (I don't remember what) that made me think I could actually do this.  I think maybe that she could see his head and that I was pushing correctly and making progress.  I was so encouraged.  The best thing she told me in terms of pushing was to try and poop.  I think most women are so scared to actually poop while delivering, but she made it seem completely normal and said if I could actually poop, then that's the exact right type of pushing I needed to be doing.  My last labor people kept saying 'bear down' and I had no idea what they meant.  After a half an hour, there he was!  It was wonderful.  I called my mom immediately and just started crying and whispered, 'He's here!  He's here!  I did it, mom!!"
It still remains one of the biggest accomplishments of my life.

How did you prepare for your VBAC?
I interviewed a couple doulas and none of them ended up working out for me.  Then I asked a girl I knew who is a L&D nurse if she would be my doula and she said yes.  It was the perfect fit for me.  It took so much pressure off my husband, Josh.

How did you find your care provider and were they VBAC supportive? If so- how? If not, did you think they were and they ended up not being so? How did you respond?
I think my OB was relatively supportive, but I'm not sure that she has strong feelings against C-sections.  From some of our conversations prior, I wonder if she's had a patient lose a baby in childbirth because I think she wanted to let me have a VBAC, but also seemed to just want the baby out.

What would you say to a woman who's considering a VBAC? How would you encourage her? 
I would say- you can do it!   I would encourage women to not just opt for the Cesarean because of fear of what might happen if you ended up needing a repeat C-section.  Most of my friends at least, have just scheduled their second C-section because they're afraid of having to have another emergency or unexpected one... but they have no idea what could happen this time around!!  So, I think I would just say go for it and if you need another C-section, no big deal... you've done that before and everything worked out OK.

Why I Chose a VBAC :: Kristi

Kristi's Birth

What was the reason for your initial Cesarean birth?
My firstborn was footling breech at 39 weeks.  

Why did you choose a VBAC?
Honestly, I was much more afraid of having another needle in my spinal cord than of giving birth naturally.  Also, I had a mild allergic reaction to the morphine in my spinal, and my memories of the first few hours after my son's birth are hazy, at best.  I did not want to repeat that experience. 

What were your fears and concerns (if any)?
My biggest fear was that I wouldn't be able to have a VBAC.  Since I hadn't "given birth" before, I was worried that I wouldn't go into labor and that I'd end up having another Cesarean.  I think I walked around 300 miles the last week of my pregnancy trying to jump start contractions!    

What was the biggest challenge during pregnancy and then during labor and birth?
I was sick throughout my entire pregnancy.  By 40 weeks, I was so tired of throwing up that I was eagerly anticipating labor and birth.  The biggest challenge the night my daughter was born was finding an open entrance to the hospital at 1am (funny story now - not so funny at the time!).  My labor was very quick, 5 hours total, and I was already at 7 cm by the time we got to the L/D floor, so it would have been a natural birth even if I hadn't wanted one!   

How did you prepare for your VBAC?

I found a doula that I really liked and also talked to my OB/GYN about it at every appointment.

How did you find your care provider and were they VBAC supportive? If so- how? If not, did you think they were and they ended up not being so? How did you respond?
Fortunately, my OB/GYN is VBAC supportive.  He performed my C-section and knew the circumstances surrounding that experience, so he was very encouraging about my VBAC request.  He also shared that one of the reasons he supports VBACs is that the hospital where I was going to deliver has an anesthesiologist on site 24 hours a day (versus just having one on call), so he knew that if things started to go badly for whatever reason (fetal distress, rupture, etc.) he could do an emergency C-section very quickly.  It was also comforting to me that my OB delivers all of his patients' babies instead of rotating nights with the partners in his medical practice.  Thus, I knew that I wouldn't have to do battle with one of his colleagues (who is less VBAC supportive) when I went into labor.      

What would you say to a woman who's considering a VBAC? How would you encourage her? 
Do it!  I had a very easy recovery from my Cesarean (didn't need prescription pain meds, just Motrin for a few days afterwards), but the recovery from the VBAC was still so much better.  It is truly a night and day difference.  Also, my daughter was so much more alert immediately after birth, and she latched on and breastfed for a half hour right away.  The VBAC was such a better experience all around (for both my daughter and me) that I would strongly, strongly encourage it.  Finally, I would recommend doing some research to dispel the "once a C-section, always a C-section" myth and put concerns about uterine rupture in their proper place. 

Why I Chose a VBAC :: Patty

Patty's Birth

What was the reason for your initial Cesarean birth?
The reason for my C-section was the baby's heart rate dropped too low for too long, and despite manual stimulation, they were unable to stabilize him. I had been in labor for about 18 hours at this point and was 6cm. Ultimately, the reason for the C-section was being induced too early (the doctor broke my water to initiate labor) even though I had no medical issues for induction.  Now I know:-) And, based on my first VBAC, I do believe cervical scar tissue was a factor as well.

Why did you choose a VBAC?
I chose a VBAC for several reasons. One, I had a VERY tough recovery from the C-section, both physically and emotionally, and I just knew birth didn't have to be like that. Second, I felt very inadequate after the C-section. Like something was wrong with me and my body. Third, I felt like cattle being shuffled around during my C-section birth and knew that I wanted a birth where I felt in control of the process/decisions, etc. And, finally, I felt like it would help me heal from the emotional scars of my C-section.

What were your fears and concerns (if any)?
My biggest fear in preparing for the VBAC was uterine rupture. That is, until I did my research and got a supportive doctor.  Once I learned how rare it really is and that there would be warning signs, I really felt very comfortable that I was an ideal candidate and had a great chance of being successful.
The biggest challenge during pregnancy was overcoming my mental fears. No matter how much research I did, there was always a voice in the back of my head thinking that I must be missing something!

What was the biggest challenge during pregnancy and then during labor and birth?
The biggest challenge during delivery was second guessing myself after 17 hours of labor and seeing the same signs as before... only 6cm dilated. Once my doctor rubbed out scar tissue, I dilated and birthed within a few hours! After the 17 hours, I got an epidural and was really upset because I thought that meant I wasn't going to be successful.  Having a doula there was great because she reminded me my goal was to have a VBAC, not no epidural. She assured me that a VBAC was possible with an epidural so she helped so much to get me through it mentally.

How did you prepare for your VBAC?
I prepared by hiring a doula, joining ICAN and going to meetings, hearing all the success stories I could and reading absolutely all the data available.

How did you find your care provider and were they VBAC supportive? If so- how? If not, did you think they were and they ended up not being so? How did you respond?
I found my doctor through referrals from ICAN. Yes, he was VERY VBAC supportive! At the first appointment, he said, "you can and will have this baby through your vagina!!" I knew it was the right fit.  He never discussed a C-section with me.  He never discussed "due dates" or anything like that.  Instead, he said, "the baby will come when he's ready," and... he did!

What would you say to a woman who's considering a VBAC? How would you encourage her? 
EDUCATE yourself.  Hire a doula.  Find a supportive care provider based on referrals from actual patients who had VBACs with him/her.  Surround yourself with those supportive of this process rather than the naysayers. And, TRUST your body, trust your instincts and know that it IS possible!!

Why I Chose a VBAC :: Nona

Nona's Birth
(Nona is an MD who specializes in Family Medicine) 

What was the reason for your initial Cesarean birth?
I went past my due date.  At 41w5d, my OB recommended that I undergo an induction of labor.  Once my contractions started, my doctor ruptured my membranes.  She said there was "some meconium" but she was confident everything would be fine.  I still wanted to forego the epidural, but Pitocin can really intensify the pain.  I was only dilated to 3 centimeters when the contractions were stronger than I could bear.  For 10 hours I labored, blissfully ignorant of the pain.  I fell asleep for about an hour.  When I woke up, I felt rather warm and I could hear the fetal monitor beeping at what seemed to be a rapid rate.  I asked my husband to read the monitor and he told me it was reading in the 170's.  The nurse took my temperature and told me that I had a "low grade fever."  By then I was 7 cm.  The doctor came in and told me that she was going to give me another hour, but if I wasn't fully dilated by then, I may need a C-section.  Unfortunately, I only dilated another cm over the next hour, to 8 cm.  The baby's heart rate persisted in the 170-180's.  My doctor returned and told me that we could wait a little longer, but she was concerned that if the baby continued to be tachycardic that she may have to do a crash C-section.  She reminded me about the meconium she had seen earlier.  Frightened and emotionally exhausted, I consented to the surgery.  My 9 pound baby boy was occiput posterior.  He was pink and healthy and latched on to nurse as soon as they brought him to me (an hour later).  The official reason for my C-section was fetal distress.

Why did you choose a VBAC?
Even with my first pregnancy, I had wanted the most natural experience possible.  I came to motherhood as a medical profession in my late 30s.  As a medical student and resident, I had personally delivered over 100 babies.   I was curious about what the experience must be like as the patient and wanted to have the least medical intervention possible.  Having my first baby by C-section sent me into a bit of an emotional tailspin.  When I found out I was pregnant with my second son, I was really confused about what to do.  My OB told me she would support me if I wanted to try for a VBAC, but on a subsequent visit, I saw one of her partners who told me a "story" about the last VBAC she had attended.  In summary, she told me that the woman had suffered a uterine rupture, but the doctor had found it in time and the baby was fine, the woman "just had to have a hysterectomy, that's all".  I left the office that day very unhappy.  At that point, I was already 29 weeks pregnant and didn't even know if I had any options.  By chance, I ran into my friend that night who is a doula, Annely Allen.  She became my doula and was so encouraging.  It was through her recommendation that I found Dr. Cobb.  I had to jump through some hoops with the insurance company to change providers so late in my pregnancy, but we made it happen.

What were your fears and concerns (if any)?
My biggest fear was one I think many health care providers that attend VBACs have--the possibility of uterine rupture leading to fetal and/or maternal death.  Of course, childbirth can be dangerous under the most ideal circumstances, but the added risk of allowing a scarred uterus to labor is something to consider.  My other concern was regarding damage to my genitourinary system.  Having already suffered surgery and a scar on my abdomen, it seemed almost silly to also risk the urinary incontinence and chronic pain with intercourse I had heard some women complaining about after a vaginal delivery.

What was the biggest challenge during pregnancy?
Not to give in to the fear that I was making the wrong decision.  Personally, I'm a Christian, so I found a lot of peace in prayer.  Every time I was fearful, I asked God to care for me and my unborn baby.  He brought me a lot of peace during that time as I trusted Him and learned to let go of something that I had no control over.  I also was careful to only read things that would encourage and uplift me.  I read Ina May Gaskin's Guide to Childbirth--I would highly recommend this book just before delivery.  It's like a giant pep rally right before a big game.  It contains the birth stories of dozens of women, written from a very positive perspective.

What was the biggest challenge during labor and birth?

I went into labor at about 11pm.  The pains became very intense rather quickly.  As soon as my doula arrived (about 90 minutes after the contractions had started), she took one look at me and told me it was time to go to the hospital.  When I got to my hospital room about an hour later, I was already at 8 cm… where I remained for the next 5 hours.  Five hours without progression, still getting intense pains every 2 to 3 minutes was the most discouraging part of the process.  I gave in and asked for the epidural--I even used my "panic word."   My doula looked at my doctor and they both told me I didn't need it.  Dr. Cobb offered me a shot of Fentanyl, which I accepted.  It helped me to relax which allowed Gabriel to finally descend into the birth canal.  It would be nice to say I had an entirely "unmedicated" delivery, but I did the best I could. I had hated the feeling of the epidural with the first delivery and was happy not to have to deal with that.

How did you prepare for your VBAC?
I did a lot of research.  I talked to a lot of moms-- including some of my patients!  I tried to keep in shape and not to gain too much weight.  I did a lot of stretching to keep my hips and pelvis flexible.  I spent a lot of time in prayer.  I prayed for the safety of my child and myself, I prayed for peace and calm.  I did a lot of reading about different methods for dealing with the pain.  In the end, it was the face of my doula that kept me calm.  Her moment to moment encouragement and support made the labor bearable.

How did you find your care provider and were they VBAC supportive?

Yes and at the recommendation of a friend/ my doula, Annely.

If your VBAC became a repeat Cesarean birth, how did this feel?

Fortunately it didn't.  I certainly considered how I might have felt if my delivery had gone in that direction.  For me, I felt that I had done everything possible to have the VBAC.  I was prepared to take it easy on myself and let it go if I was unsuccessful.  That's how I try to deal with most of the challenges in my life.  I think that is the encouragement I would leave with any woman considering a VBAC.  I believe that a vaginal delivery is really the best way to have a child.  Do what you can to try.  If it doesn't work out, it's okay.  I'm sure we will all agree that having a healthy baby is the most important outcome when the day of our delivery comes. 

How was your experience different with the VBAC compared to the Cesarean? 

(Nona asked that I include this additional question and answer)

I had both of my children later in life (ages 37 and 40), so that may have affected my healing time, but I recovered so much more quickly from the VBAC.  After my C-section, it took me more that 6 weeks to feel like I could even go for a walk without being in pain.  After my VBAC, I sat on an ice pack and sprayed numbing solutions on my vulva for a week and that was it.  I had recovered.  I could lift my baby and my toddler.  I could do chores (although I didn't have to-- thanks to my husband, Robert).  It was a big difference.  My body healed so quickly when I had my baby the way I was created to have him.

Also, even though labor and delivery hurts, I really "enjoyed" the sensation of Gabriel being pushed out of my body.  It was a cathartic experience.  I had a real sense of accomplishment when it was over, that I lacked with the C-section.  I was able to hold and nurse my baby immediately after delivery (as I mentioned above, I had to wait for an hour to see my first son).  I was definitely left with a sense of empowerment, a feeling that this is how it's supposed to be, and the idea that what had been taken from me with my first delivery had been returned to me unblemished.  It's almost as if, without the C-section, the gift of the vaginal delivery would not have been as poignant…

"You Win Some, You Lose Some"... Thoughts on Interviews

Within the first two months of this year, I interviewed with eight women who were looking for doula support for their upcoming births.  Of those eight, four of them hired me and four of them found a better fit.  I'll confess that when I heard back from three of them in a row that they'd chosen another doula, I couldn't help but ask myself why?  Was it something that I said or didn't say?  Did I talk too much?  Did I leave out helpful information?  Did I have spinach in my teeth?  The more I thought about how the interviews went, I was reminded of what I've believed all along since starting down this path of doula work:

• There is the right fit for every woman and I am not always that right fit
• As my friend and fellow doula Val Peterson has said many times, "There are births that you are meant to be at and others you are not"
• For every birth that I am not supporting, another fantastic San Diego-based doula is, and I am so happy that a family has found the doula who felt right

I was still curious though, what it was that made me the choice for some and not for others.  I decided to take a risk and email a few of the women who'd chose another doula.  Here's what I wrote:

Four Precious Babies, Three Incredible Women, One Unforgettable Week

Never before have I experienced something quite like I experienced this past week... and I have a feeling that it will be a long time before I do again.  Between Tuesday, March 8 and Tuesday, March 15, I had the privilege (and I mean PRIVILEGE) of supporting three beautiful, strong, inspiring women as they labored hard and birthed their babies.  With their permission, I want to share some of their stories and give you a look at what this week was like for me.

Mama Knows Best... Thoughts on Switching Care Providers

This post has been brewing in me for some time now.  Let me start with a disclaimer... as a doula, I have enormous respect for the men and women who are medically trained to provide care for pregnant women and their unborn babies.  I believe that most have the best intentions in mind when it comes to caring for their patients.  I know that they pay one of the highest malpractice premiums out there.  I think that many are doing the very best they can do.

That being said, I've had a number of women in my life, friends and clients alike, who've shared that as they got further along in their pregnancy, they felt uneasy about their relationship with their respective OB.  For some of these women, as they brought up their hopes for labor and birth during a prenatal appointment, they found their OB not all that supportive or willing to really listen.  When asking to discuss their birth preferences plan, their OB snidely responding with "It's the patients who come in with a birth plan who end up with an unplanned c-section."  For others, they felt like their OB had a typical way of going about things (suggesting induction at 39 weeks and/ or urging induction at 40 weeks, performing cervical checks starting at 37 weeks, etc.) and when the patient questioned if this was medically necessary or just routine, the OB growing visibly frustrated and curt with the patient.

These women who've shared with me aren't demanding or inflexible in nature.  They aren't trying to be difficult or suggest that their OBs don't know what they're doing.  They've simply wanted to have a two-way relationship with their doctor- one where they can ask questions and share their wishes for their prenatal care and impending birth, without feeling belittled or like what they've researched is all bunk because they're not the one who went to medical school.  They are hoping that the one they've entrusted with the care of themselves and their unborn baby would be open to conversing and making the best decisions for their care based on their individual situation.  Some of these women have chosen to stick it out and remain with their OB despite not seeing eye to eye and others have chosen to look elsewhere for a care provider who is more in line with what they're looking for.

A Doula's Role... great YouTube video snippet

Thought this was well said...
From the Mindful Mama website... click here

So it begins...

I've been thinking about starting this blog for a few weeks now. It's been an exciting and full spring with the opportunity to assist three women with their births... one in February- baby A, and two in May- baby E and baby I.

I'm left utterly amazed at each of these births... all three shared the commonality of an expectant mama who nourished and grew their precious babe for 9 months (give or take a little) and then lovingly labored to bring them into the world... but each labor and birth having a beautiful spin of it's own. As a student of birth- I had front row seats to three very unique births... a first time mama who labored and birthed much quicker than any of us expected... a second time mama who had a much more positive birth experience this time around... and a first time mama who labored long and hard and beautifully surrendered her expectations as complications arose.

I find myself now reflecting on these births and the lessons they hold for me. I'm humbled that I was allowed to witness and learn from these women and their stories.

I'm not sure exactly what this little piece of the blog world is going to look like... but I hope that it's a place where I can share what I'm learning and what I'm thinking about and invite others to do the same. Let's face it... we're all in the process of being born into something... we've been given lifetimes to find new things and to spend our days discovering and growing and asking and wondering. For me, I'm in a season of being born into birth and all the beauty and deep wonder it holds.