VBA2C

Yes, it is possible.

Yes, in a hospital.

Yes, you can have an epidural.

Yes, they can use Pitocin.

Yes, I have seen it happen.

While I LOVE writing all the “YES”es, I also have to include the NOs….

No, it is not easy to find a provider.

No, it is not easy to find a hospital.

No, it is not easy to prepare your mind, body and spirit.

When my daughter Emily excitedly told me that she had found a provider who would support her TOLAC (Trial of Labor after Cesarean Section) I was skeptical. Even after I attended a prenatal appointment and asked the provider myself, I was skeptical. She had back to back Caesarean sections within sixteen months of each other and I had never, in over a hundred births attended, seen a VBA2C (vaginal birth after two C sections.)

So, I was skeptical.

But, I knew my daughter. Even though her pregnancy was rocked by Hyperemesis Gravidum and the stress of wrangling two toddlers, she was determined to prepare for a vaginal birth. She has been a confident, decisive, persistent and adamant person since infancy. These are the words you get when you type stubborn and headstrong into the thesaurus, by the way…but I digress….back to our VBAC story…

We discussed all the areas of preparation- Physical. Mental. Emotional/Spiritual.

We started with the physical work.

I taught her husband the partner activities from the Spinning Babies® class I teach to all my clients. I encouraged him to try to do them every day so that they would have a better chance of achieving optimal positioning. I taught my daughter the daily activities from the class and introduced her to the Body Ready Method® online program. Serendipitously, I was at the end of my Body Ready Method® Pro training and had been blown away by the information I learned concerning anatomy, birth, and alignment! I assessed her posture and movement, and she tried to do the workouts several times a week. Spinning Babies® and BRM® compliment each other so well! The physical preparedness I have seen in my clients since becoming certified in these two modalities has moved me to include them in my pricing – so if you hire me, you WILL get a Spinning Babies® class and if you purchase the Body Ready Method® program, I will reimburse your cost! But that is another post for another day….back to our VBAC story…..

In addition to the physical body work, we also worked on breathing. Taking full, complete breaths that fill your lungs, and then expelling those complete breaths, takes practice if you want to increase your lung capacity! Calming your parasympathetic nervous system starts with breath work, so we practiced, and practiced. I also encouraged chiropractic visits and gifted a couple prenatal massages in the last trimester with my amazing massage therapist and fellow doula, Leti. She also hit the jackpot and my fellow doula and bodyworker, Alejandra needed a volunteer for some craniosacral work, so Emily was able to benefit from her gifted hands. Oh, how I wish doulas, chiropractors, lactation consultants, bodyworkers and massage therapists were standard gifts at baby showers! But, again, that is another post for another day…..back to our VBAC story…

As you might imagine, achieving the physical goals of moving her body, practicing her breathwork, and getting adequate nutrition, hydration and rest were challenging. Compound this challenge with Hyperemesis Gravidum and some days it seemed impossible…and some days it was impossible! Some days were spent in the ER getting IV fluids, some days were spent in bed, and some days were spent in tears. Being surrounded by a compassionate and helpful support group (in this case, her family) made all the difference. After losing over twenty pounds in her first trimester, she joked that God knew she needed that extra weight for this pregnancy, and she was able to regain it and another 20 by the time labor began. In her case, she ate whatever she could keep down. I usually recommend getting at least 80-100 grams of protein every day and then filling in the rest with unprocessed foods and more water than you think you need! Removing processed food from your diet should be a practice starting preconception…but, again, that is another post for another day….back to our VBAC story….

We started the mental work.

As I shared earlier, once Emily sets her mind to something, she is pertinacious (thank you again, thesaurus!) As in, persistent despite any opposition or discouragement. This would serve her well, which was yet another reassurance to me, her mother, and that I will pass on to you, who may have challenging toddlers, that all the character traits in your child that may have frustrated you during the toddler/teenage years will rise up and be allies in adulthood! but, again, I am digressing….back to our VBAC story….

Even though this was baby number three, we reviewed childbirth and all that it entails. Stages of labor, what to expect with each stage, how to prepare the space so that she felt mentally at ease. We made lists of essentials for birth, and postpartum. A plan of action for the care of her girls, and began making meals to freeze. For someone who is goal oriented, making lists and checking off tasks can be a crucial part of mental preparation. We then made a birth plan for a vaginal birth AND for a repeat C section so that whatever route this birth took, she had a concrete map of her wants and needs. An unmedicated, vaginal birth was the dream but we also discussed a medicated vaginal birth and what that may look like, as well as what a repeat C section would look like. We discussed the mental aspect of a repeat C section, and she made her ultimate goal a birth that was empowering no matter what path it took. I reminded her that no one is promised an uncomplicated birth. Sometimes, we do all the right things, and we still don’t get the birth of our dreams….but, again….back to our VBAC story…

We started the emotional/spiritual work.

Emotional/Spiritual work will look different for everyone. Healing from past trauma, delving into the “why” behind your personal beliefs about pregnancy and birth, tapping into your faith or spiritual journey and remaining curious about your feelings can all be part of the emotional preparation for birth. As a Catholic, Emily was drawn to the Made For This app and began practicing calming herself with the meditations and prayers within it. She surrounded herself with positive birth stories, affirmations, and delved deep into preparing herself emotionally for any outcome. She made thoughtful choices about who she wanted in her birth space and decided to invite her best friend, Yesenia, who was an encouraging advocate and had experienced two very different positive births herself, as well as her doula and husband. Then…

We started the REAL work!

Emily was due on Feb 28. If you know anything about a TOLAC, or trial of labor, you know that it is rare to find a provider that will not encourage you to have a repeat C section if you do not go into labor on your own by 40 weeks. So we waited, and we prayed. Did we try all the things that are supposed to ripen your cervix and potentially make labor start “sooner,” like evening primrose oil, hand expression, red rasberry leaf tea, etc.? Why, yes. Yes, we did. Spoiler alert…all of these things may help your cervix be more “favorable” when your body decides, on its own, to begin the labor process, but none of these will “make” you go into labor….but, again….back to our VBAC story…

Early labor signs began on Feb 21 around 3pm. Emily texted me and I resisted the urge to hurry over. I knew better and so did she. She resumed life as normal; being aware of, but not obsessed with, her waves and how often they were coming. Her friend was driving from Dallas, so she called her to head over if she wanted, labor had begun! She arrived later that evening and after the initial reunion celebration, labor seemed to slow down. In hindsight, we might have waited and called the next morning because Feb 22 was a long day of slow but steady labor.

We did it all. We walked and walked. We did all the Spinning Babies moves, all the alignment helps, and all the acupressure and massage techniques. The TENS unit that had not seemed that pleasant during our labor practice session was giving much needed relief and Emily was handling labor like a champ, but she was TIRED. The “shouldn’t we think about heading to the hospital?” question was looming and I could tell she was a little discouraged. I could also tell she wasn’t in truly active labor yet. I know from experience that getting to the hospital too early is an invitation for intervention.

Finally, at 2:30am on Feb 23, Emily’s water broke. I still wasn’t convinced it was time to move to the hospital, based on what I was seeing, but there was a green tinge to her amniotic fluid and I truly felt it was better if we went ahead and transferred. I think everyone was happy to finally be going. There was a feeling of slight dread in the pit of my stomach though. If she wasn’t progressing to the OB’s satisfaction, or if there was concern over the meconium (baby’s first bowel movement) they may suggest an immediate C section. My dread turned to fear when, upon the first cervical check, they said she was 4 cm dilated and -2 station. Based upon my experience, this means we still “probably” had quite a ways to go before we met the baby. Now, I have seen first time moms go from 5 centimeters to to ten in three hours but I have also, more commonly, seen moms take an entire day to be ready to push out their little one. These are the thoughts that were running through my head when the nurse announced that the cervix was 4/70/-2. What this means is that the cervix was “open” 4 centimeters, the cervix was “effaced” or thinned by about 70% and the baby was “high” in the pelvis, or not engaged yet. These pieces of information tell birthworkers a story about what is going on inside but they don’t tell us how fast or slow thing can progress after we get this information…and most OB’s tend to be very conservative with information, and Emily’s OB, the one who had agreed to this TOLAC, wasn’t even the on call OB! So, you can see the reason for my concern…but, I am digressing again….back to our VBAC story…

We had started our hospital journey.

Another long day of doing everything we could to get labor going and get baby to descend into the pelvis. Swaying, shaking, and squeezing. Moving, massaging, and meditating! One thing after another to keep labor going with rest periods in between. The three of us, Yesenia, Hayden and I took turns and I was never so grateful for so many helping hands! We even did the Walcher’s manuever, which I rarely do because it is very uncomfortable and awkward. The IV placement had been rough, and I had to walk away to keep from losing my cool when it took the nurse three tries to get the second IV in! I asked if the second IV was truly necessary. Emily persevered and agreed it was better to be safe than sorry, they would need the second IV if a C section was called for.

The OB did another cervical check at 4:30 and announced 5/90/-2. Emily started to cry. Only 1 centimeter after all this time?! My mama heart was breaking but the doula in me knew that progress was progress and we had a plan. And that was what I whispered as I stroked her hair, “we have a plan, and you can move to the next step if you are ready.” She looked at her husband, as if to get his reassurance that she had given it her all, and he said, ” whatever YOU want.”

“I want the epidural.” Exhaustion and discouragment were taking a toll. It was the best decision if a vaginal birth was in her future. The nurses, who were amazing travel nurses, sprung into action and the OB suggested a low dose of Pitocin to get the contractions back up to their earlier power and consistency. I was shocked. Up until that point, I didn’t think any OB would suggest augmenting a TOLAC much less after 2 C sections, and after she left (they don’t stay long unless a baby is emerging!) I asked the nurse about it. She explained that it would be a very low dose, and had seen it work very effectively in numerous hospitals. At that point the anesthesiologist said that only Hayden could stay for the procedure, so Em’s BFF and I waited in the hall. We would later find out that Emily screamed with shock and pain when the lidocaine (the first step of the procedure) was injected and that the rest of the epidural went smoothly but as we were standing out in the hall, and her piercing voice was heard loud and clear, we were terrified. What had gone wrong? We hugged and prayed as we waited for news.

The time alone was good for them, and the time away was good for us. By the time we went back into the room, Emily was comfortable and Hayden seemed much more at ease. We all tried to “nap” as best we could. I couldn’t help but watch the monitors, praying that she progressed and the baby stayed stable. Everyone got a bite to eat and then I began to move Emily from one side to the other, using a peanut ball to keep her pelvis open, and hopefully encourage the baby’s rotation and descent. The nurse was a game changer at this point. She was so encouraging and bubbly! She was scheduled to leave at 7pm but said, “I am not leaving until I meet your baby!” Her cervical check at 7:15 pm was a celebration! 8 centimeters and 100% effaced, with the baby in the midpelvis!

The doula in me emerged again and began discussing breath work and pushing. Pushing with an epidural can be very challenging for first time moms, and since Emily had never pushed a baby out of her vagina before, so we reviewed pushing again. By 8:30 she was feeling pressure and asked for another check. She was complete! Ten centimeters! The relief in the room was palpable and Emily was ready! Unfortunately, when the nurse texted the OB, she asked that Emily NOT push until she was there. Admittedly, this irritated me. Normally, I would look at my client and say, “listen to your body first and do what it is telling you to do…” but the nurse had been so amazing, and she asked us to please hold off, so we did.

Looking back, there were so many graces and blessings during Victoria’s birth. Deciding to wait for the OB was one of them. When she finally arrived, almost 45 minutes later, the baby had descended to the point that Emily was able to push her out in less than an hour. The look of pure joy and satisfaction as my baby held her baby, was priceless. The extra IV port and the OB’s quick action right after delivery of the placenta was also a blessing. Emily had excessive bleeding and nearly needed a blood transfusion. Thankfully, she recovered quickly, but they left both IV’s in until the next day, just in case.

Sweet baby Victoria latched right away and the next day Emily was able to get out of bed and place her gently in the arms of her two big sisters. Recovery was smooth and, according to Emily, much easier than the C section recovery.

• TIPS IF YOU ARE PREPARING FOR A VBAC
• An unmedicated labor helps with dilation, effacement, and descent. Getting and epidural before 5 cm significantly increases the odds of a cesarean delivery.
• Choose your provider and your delivery location carefully. Check the c/s rates!
• Take a natural childbirth preparation course – hospital classes often focus on patient preparedness rather than strategies for an unmedicated birth.
• Insulate yourself from negativity and read positive VBAC stories.
• Get your partner on board with your plan.
• HIRE A DOULA!
• Be active in active labor
• Keep Cervical checks to a minimum