Why I Chose a VBAC :: Jessica

Jessica's Birth

What was the reason for your initial Cesarean birth?
The baby was posterior, stuck at -1 station after 2 hours of pushing. I had an epidural for many, many hours (labor was 29 hours total until the C/S). The OB said I could try to keep pushing, but she didn't think he would budge and suggested a C/S. Turned out the baby was 9lbs., 1oz and had a very big head. I was also very swollen from the pushing. I guess the official "reason" was failure to progress.

Why did you choose a VBAC?
At first I was leaning toward a repeat Cesarean (RCS) due to a lack of enthusiasm from my care provider and fear on my part. But I saw how much easier it was for a few friends who had vaginal births and I also started doing some of my own reading. I learned about the risks of repeat cesareans and the benefits of vaginal birth. I also desperately wanted to succeed at breastfeeding (which I hadn't with my first), and I knew vaginal birth was a major factor in that as well.

What were your fears and concerns (if any)?
My major fears about VBAC were that I wouldn't be able to have one after all! My major fear about having an RCS was a repeat postpartum hemorrhage or other complications that had happened with my first. Also, thinking about the recovery time while caring for a two-year-old was another consideration. After my C-section, I had a delayed postpartum hemorrhage, and my OB at the time said I probably shouldn't risk labor if I had another baby, because she felt my uterus would be too weak or damaged and labor would put too much stress on it. The CNMs and OBs at Kaiser when I was pregnant with my second didn't seem concerned about it when I told them my history. 

What was the biggest challenge during pregnancy and then during labor and birth?
My pregnancy was pretty textbook and fairly easy until about 36 weeks when my blood pressure went up. They started talking about emergency C-section or induction. At 37w5d, they decided to induce and I thought my dream of VBAC had gone out the window. Fortunately, a Pitocin-induced labor turned out to be quite easy and quick and the VBAC happened after all.

How did you prepare for your VBAC?
I talked with a friend who was a doula and student nurse. I talked with my care providers. I read about it online. I wish I was a part of ICAN (International Cesarean Awareness Network) back then!

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 was and am with Kaiser, so I didn't have too much of a choice. I mostly saw a CNM, who was neutral on the topic but not discouraging. The OB they had me see kept suggesting I schedule a C-section. I was reluctant and asked if I could schedule it for 39w5d or something. I guess I was hoping I'd go into labor spontaneously before they could cut me open! Then I saw a different OB toward the end of the pregnancy who was much more pro-VBAC and reassuring about it and said he thought I was a good candidate and there wasn't any reason I shouldn't have a trial of labor. Then I ended up being induced at 37w5d and having the VBAC after all.

What would you say to a woman who's considering a VBAC? How would you encourage her? 
I would let her ask her questions and express her fears. I would tell her my story (stories, actually - I've had two VBACs). I would talk about the easier recovery time and the benefits to mom and baby. I would tell her about the risks of repeat C-section, especially multiple repeat C-sections. I would tell her there's no reason not to try. If she has a supportive birth team and her birth ends up as a repeat C-section, she'll know she made the right decision and go into it willingly and with eyes open. I would also tell her to come to an ICAN meeting.

If your VBAC became a repeat Cesarean birth, how did this feel? Were there differences this time?
It didn't, but I definitely considered how I would feel if it did. With my first VBAC, I was so gung-ho and determined that I think an RCS would have been, at the least, a real bummer. I would have been upset about it but I also would have known it was necessary. With my second VBAC, I think I was more relaxed about the whole thing and willing to take what came. As it happened, I had a spontaneous natural birth, so I had nothing to worry about. But again, I knew enough about C-sections by that point (and was involved with ICAN) that I felt I could make an informed decision if one was suggested or needed.

Jessica write about birth, babies and related issues on her blog- jessicaonbabies

"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:

Beyond 40 Weeks... An Email

One of my best high school girlfriends sent me the following email that other day and I asked her, pretty please, if I could share it as I thought there might be many women who can relate to the sentiments she shares.  She said that I could post if I included this disclaimer: "I am normally very rational and sweet-tempered!"  Here's to a baby soon, friend... we're all pulling for you! 

Hi friends-

So... my due date has now come and gone (it was yesterday), and I am still pregnant and getting more and more annoyed by the minute.  I know I should be happy to have the baby make it to 40 weeks and yadda, yadda, yadda, but I'm still sick, my ankles are now swelling, I can't sleep, my back constantly hurts, and I'm just down-right GRUMPY!  Since all of you can relate, you are going to bear the brunt of my crabbiness.  Hopefully my effort to expel some negative energy into the following list at least makes you laugh!

TOP 10 THINGS THAT ARE REALLY PISSING ME OFF AT 40 WEEKS PREGNANT

10.  Everyone breathlessly answering the phone when I call.

9.  People asking me if "I'm still hanging in there."  As if I have a choice!

8.  People's eyes popping out of their sockets when they see how big I am.  Get a good look at the freak show, folks!

7.  Even better, the people who apparently can't help themselves when they see me and exclaim, "Whoa!"

6.  Men who claim that they "know what I feel like."  Dude, just shut up.  Just. Shut. Up.

5.  People who gleefully tell me that God makes women uncomfortable in the last few weeks of pregnancy so that they look forward to labor.  This is so dumb I can only respond with a blank look and walk away.   

4.  People asking me when I'm going to get induced.  Like a ride on the Pitocin train will make it all better! 

3.  My coworkers walking into my office, feigning surprise, and saying, "Oh!  You're still here!"  Umm, duh.  You're looking right at me. 

2.  People asking me how much I weight I've gained.  See #8.  Answer - "a lot." And beyond that, it is none of your damn business!

1.  My coworkers asking, in front of a room full of people, about my Dr. appointments and whether there is any indication that the baby is coming.  Do you honestly think I'm going to talk about the status of my cervix in a meeting?  In front of my 60 year old male boss?  Seriously! 

Alright, off to scrub some floors....

K

Pregnancy Loss and Infertility... Books & Other Resources

I was recently asked for some suggestions of books that might be helpful for couples who are dealing with pregnancy loss and infertility.  I posted the question in a doula support community that I am a part of and thought I'd share the suggestions here in case they might be of help to anyone who's reading or knows someone who might be encouraged through them.  I'm also sharing the comments from the women who made the suggestions.

I've not suffered loss or infertility myself... but I know a number of couples who have.  Often, I'm at a loss for words and I think that's ok.  While I know there are a number of books, as well as blogs and organizations (see below), I try to keep in mind that while some are looking for resources such as these, others are not.  My usual rule is to listen and speak if it seems helpful or needed... but most of the time, to simply listen.  Those who are looking for books or resources will ask or find them.  Please offer the suggestions below with great discretion and only if you're asked.  Be a friend and know that it is absolutely ok to not have answers.  Your presence and willingness to listen and walk beside friends who are dealing with loss and/ or infertility is enough. 


A says: "Here are 3 books that helped me through 3 losses... #1 and #2 have a Christian perspective to them, and #3 is a little more secular."
Silent Grief by Clara Hinton
Empty Arms by Pam Vredevelt
Free to Grieve by Maureen Rank

C says: "I loved this book.  It is written from a Christian perspective and does have some photos so it might be disturbing to some people. For me it helped to know what I might see and experience. I wanted as much information as possible about fetal development etc. so I loved it. It might be too much for others though."
Answers in a Time of Miscarriage by Bethany Marie Kerr

R says: "I will carry you is AMAZING- but maybe better for someone who had a stillborn. But still Amazing. The second was was great for me after having 2 miscarriages in a row before I got my 3 boys."
I Will Carry You by Angie Smith
When the Cradle is Empty by John and Sylvia Van Regenmorter

I have a few online organizations listed under the heading "Pregnancy & Infant Loss" on this resource page here on my site.

Doula Jenna "Families Reunion" 2012

As I supported families throughout 2011, I had the idea to host a gathering at the end of the year.  The main reason was to reconnect in person with the parents and babies that I had a chance to work with.  I was also excited for many of them to meet one another and for my own family, my husband and daughters, to get a chance to meet my clients as well.

On a Sunday in January, we met up at a local park (my favorite one) and enjoyed lots of yummy treats and a few hours of talking, laughing and playing together.  One of my dear friends and also a client of mine, graced us with her photography talent and captured some priceless shots.  This is something I plan to do annually.  If you are a doula, or anyone who works with people, for that matter, I encourage you to do the same.  We need to take advantage of reasons to gather and celebrate.  It's wonderful on so many levels.

some of the 2009-2011 babies

 i get to meet and work with some of the coolest women

 the best husband this doula could ask for (the man sans stroller)

 sweet twin girls and their wonderful mama

so many amazing families!!

 an attempt at a "chronological order of birth" shot... close :)

 special family... babies number one and sixteen for me

* all photos taken and posted with permission by Katherine Nagel

A Day in LA with Ina May

You know those days where you have a hunch that what you're doing and who you're interacting with seems like it very well might be a once in a lifetime opportunity?  That was me on January 6, 2012.  I found myself headed northbound to LA in the company of my dear friend and co-doula, Annely Allen.  Our destination was BINI Birth, a unique space that's dedicated to offering support, education, and resources for families and birth professionals.  I've been familiar with BINI for a few years and was thrilled to have the chance to see it in person.  I'd received notice a few weeks earlier that Ina May Gaskin was going to be speaking there.  Double hooray.  I've read some of Gaskin's work and her book Ina May's Guide to Childbirth is one that I recommend to women often.  She is someone who has had a deep influence in maternity care worldwide and the way childbirth is perceived.  I wouldn't say that I am her #1 fan, as there are others who would rightfully claim that title, but I do have great respect for who she is and the work that she has committed her life to.  Below are some photos and bits of wisdom I gathered from what she shared.

"We always think that paying more for something = better and typically, this is true... but not when it comes to the birth industry."
- Referring to the cost of maternity care and how often because hospital birth costs more (before insurance contribution) it is seen as the superior environment to give birth in

"Birth is not about making money... especially when the people making the most aren't the ones actually caring for the women and babies."
- Talking about insurance companies and policy makers

"When you don't have midwives, you don't have obstetrics either.  You just have surgery."
- Voicing the need for midwifery to continue to play a vital part in maternity care throughout the world... the need for both midwives and obstetricians to care for women and babies.  Not either/or.  Both have a rightful place.


"Wouldn't it be amazing if our little girls grew up knowing that the place babies came out of went from little to gigantic?"
- Talking about the fear women often have of giving birth vaginally and not fully understanding that the vagina is created to expand and accommodate birthing a baby.

 

Ana Paula & Ina May

Following the workshop, Ana Paula Markel, founder of BINI and a childbirth educator and doula herself, graciously invited anyone who was interested over for dinner and more discussion time with Ina May.  Annely and I looked at each other and without saying a word knew that the other was thinking "no-brainer."  There were a handful of other San Diego doulas who were in attendance and had the same reaction.  We headed to the grocery store and picked up some pasta, salad, and bread and made our way over to Ana's house.  We arrived before she and Ina May got there.  I LOVE how Dawn, one of the SD doulas, made Ana's kitchen her own and along with a few others, started working on preparing dinner.  Over the next few hours, we shared a meal and talked more with Ina May, Ana, and the 20 or so other women who joined for dinner.  It was a rich opportunity to connect with women who all have the goal of supporting and caring for women, babies, and their families. 

 

San Diego Doulas & Ina May Gaskin

In closing, after spending the day listening to, talking with and observing Ina May, here's what I most admire about this woman...

• She's one of those people who you know has so much wisdom and a wealth of life experience and yet is humble and quite unassuming.
• She's approachable and engaging.  I never felt like she was looking past the person she was talking with or that she was annoyed by the hundreds of requests to talk or take a photo with her.  
• She speaks very plainly and candidly.  While she has great passion in the things that she shares, yet she doesn't get lost in the emotion, which would be so easy to do.
• She's respectful and appreciative of many obstetricians and medical doctors.  She calls many of them personal friends.  
• She's an avid reader and learner.
• She appreciates the diversity and beauty of cultures throughout the world.
• She's funny.  
• She's a normal woman, who early on in her life, saw that there was a need and rose to the occasion.  She didn't assume that someone else was going to step in and do what needed to be done.  Instead, she got her hands dirty (literally) and looked for ways to learn and grow and teach others. 
• She's a wonderful picture of someone who isn't slowing down as she ages.

Me, Ina May & Annely

Closing Remarks for 2011

With the close of this year and a new one on the horizon, I naturally look back and find myself reflecting.  I've decided to share these here.  It may seem a bit scattered and a smattering of thoughts... I'm ok with that.  These are thoughts I've had this past year-- take them or leave them.

As the EDDs of women I'm supporting approach and come and go, I find myself in a similar mindset as a doula to what I felt like waiting for my own labors to begin.  "Should I schedule our car for service tomorrow, plan to go to the zoo as a family, host dinner with friends this weekend or will baby decide that this is the day and I'll be called to a birth?"  It's easy for me to get antsy from time to time and to hear myself say "Well, it all depends on if there's a baby being born or not."  What I'm trying to remember is that like all of life, we make our plans and then adjust accordingly.  I encourage the women I'm working with to go on with life and to enjoy the moments and memories they have before birthing their baby... and I'm telling myself the same thing.  Live today.  Live now.  Live.

I've seen doctors mention possible interventions to their patients (my clients), such as "cutting a small episiotomy because the perineum seemed short" and then changing their minds moments later, resulting in a woman birthing her baby just fine with very little natural tearing.  I keep on hearing that "episiotomies aren't used all the often anymore," and while this may be the case, I can count at least five births where I've heard them be discussed or used in the past year.  My advice here would be to ask your care provider under what circumstances they would suggest this procedure and then make certain that they know that you are wanting to avoid one unless absolutely medically necessary.

I posted this on my Facebook page in November and it's truly at the core of who I am as a doula.  "I'm all for 'healthy mom, healthy baby,' as being of the utmost importance when it comes to birth... BUT I'm for 'HOLISTICALLY healthy mom, healthy baby,' meaning that mom's and baby's emotions and psychological state are of utmost importance too.  Women giving birth deserve to look back on their experience and feel that they were heard, respected, and cared for on all levels and that they were an active participant in making decisions regarding their care."  At the end of the day, whether a birth went along without a hiccup or a birth took unforeseen and surprising twists, my deep desire for the families that I support is that they know without a shadow of a doubt that they made the best decisions for their specific situation.  This looks different for each woman and each situation.  Whether a labor and birth are intervention-free or riddled with necessary interventions, my hope and prayer for the maternal care system is that women and their families have trusting and mutually respectful relationships with their care providers and that they have the information and space to make informed decisions for their individual labor and birth. 

I'm convinced more and more that choosing a care provider is one of the most important decisions a woman will make.  I want to shout from the rooftops that just because you've gone to a specific care provider for your gynecological care DOES NOT mean that they are necessarily the best fit for you when it comes to prenatal care.  You might find that your OB/GYN is too medical for you and you'd fit better with a midwife or an OB/GYN who takes a more "midwife model of care" approach to pregnancy, labor and delivery.  Before conceiving and then in the early prenatal period, it is vital that you think about what approach to birth you are more in line with.  I go into this at length in this post.  It's unlikely that you've been concerned with your OB/GYN's cesarean rate, their birth philosophy, or under which circumstances they'd recommend induction when only seeing them for gynecological care.  However, these are of utmost importance to know and be on the same page with as you're figuring out what your values are for the birth of your baby.

This year I witnessed the following:

• a medically necessary induction that went on and off for three days resulting in an otherwise unmedicated, vaginal birth
• women overcoming deep fears they had about giving birth
• women taking ownership of their care and switching care providers at the end of their pregnancies
• an unmedicated, vaginal birth of twins
• women showing up at the hospital complete and ready to birth their babies
• babies born in their homes
• women who were planning for an unmedicated birth choose an epidural and it being the very best decision they made... helping me shape my opinion that epidurals are not all good or all bad, but that it's key to be wise with when to have it, if you have it
• women having uneventful labors and births and very eventful third stages (postpartum)... showing me again and again that birth is unpredictable
• a baby being born en caul
• women who go to the hospital thinking they are in active labor only to be sent home since they were not dilated 4cm yet, only to head back to the hospital a few hours later in very active labor, almost transition... showing me that letting go is everything
• women laboring very quietly and women laboring very vocally... women birthing very quietly and women birthing very vocally
• husbands and partners being AMAZING supports and anchors to the mothers of their children
• women knowing what they want and what their rights are and in a firm-but-kind-manner, communicating their wishes to hospital staff
• women who have rapid labors and make giving birth look like such a piece of cake (yet I know that it is intense for them, all the same)
• women birthing with their families surrounding them- children, husbands, mothers, sisters, dads, in-laws, friends... all privileged to witness new life entering this world

Thank you to all of the families who invited me into their deeply life-transforming moments as their babies were born.  I am so, so honored and grateful.  Thank you to the OBs and midwives, doulas, L&D nurses, childbirth educators and others in the birth world who encouraged, mentored and taught me something new this year.

Here's to 2012 and all that it brings.  I'm ready for it... eager to learn and grow and be shaped some more.