The VBAC Link
The VBAC Link
Meagan Heaton
Support podcast
Here at The VBAC Link, our mission is to make birth after Cesarean better by providing education, support, and a community of like-minded people. Welcome to our circle, we are so glad you are here!
Episode 278 Rebecca's CBAC + What To Do With a Swollen Cervix
We love hearing stories of how our Women of Strength navigate birth in an empowered way, no matter the outcome. Rebecca’s story shows how she carefully selected the most supportive homebirth midwife, created a safe birth space in her home, labored hard and beautifully with her husband, took time to process information, assessed her situation, and consented to her second Cesarean when the time felt right to her. Meagan also talks about the different types of positioning and some signs that your baby might be in a less-than-ideal position. Rebecca and Meagan discuss tips and tricks to help prevent a swollen cervix and what options you have if that happens to you!Additional LinksNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Timestamp Topics01:54 Review of the Week04:31 Rebecca’s first pregnancy07:25 Consenting to an unexpected C-section for breech presentation8:53 Fertility Fridays11:02 Sparked interest in VBAC and getting pregnant again13:53 Planning for a HBAC18:00 Tachycardia and GBS positive21:27 Early labor24:18 Calling the team30:10 Laboring through the night39:02 Making the decision to transfer44:53 Consenting to a C-section46:43 Tips for when things don’t go as planned50:43 Signs of wonky positioning53:31 What to do57:00 Why you shouldn’t skip the repeat Cesarean storiesMeagan: Hello, hello. It is Meagan with another amazing story on The VBAC Link podcast. Thank you so much for listening to us, you guys. I love this community. I know I talk about it. I know it’s weird that I don’t even know you, but I love you. I love you so much and I’m so glad that you are here with us today. We have our guest today from, let’s see, Virginia. I think it’s Virginia. That’s what my mind is saying. Rebecca: Yep. Meagan: This is Rebecca, so welcome, Rebecca. Rebecca: Thank you. Thank you for having me. I’m really excited. Meagan: Absolutely. Me too. Her story, you guys, today is a repeat Cesarean story so if you didn’t know on The VBAC Link, we do share repeat Cesarean stories because they are important to share as well. I’m excited for you to share more about your story and we’re going to talk a little bit about swelling of the cervix at the end of this episode because this is something that we see and is a little bit of a part of your story. 01:54 Review of the WeekBefore we dive into the story and all of the things, we of course want to share a Review of the Week. This review is from shotsie3 and it says, “Amazing is not a strong enough word.” That is really awesome. I love that. It says, “I cannot say enough good things about The VBAC Link. Listening to this podcast not only saved my mental health but gave me the knowledge and confidence to take control of my second pregnancy. After my home birth turned into a hospital transfer and Cesarean with my first child, I felt broken. When I unexpectedly found out I was pregnant just 7 months postpartum, I felt scared and lost. I was afraid of failing again and doubted my body’s ability to birth naturally, but I knew I absolutely could not have another Cesarean so I started obsessively researching VBAC. That’s when I found The VBAC Link. I’ve been binging episodes ever since. Listening to these stories has been incredible. Each episode is like giving a shot of confidence into the arm.” Oh, I love that. A shot of confidence into the arm. We’re giving you guys a little vaccine of confidence. It says, “Both my midwives and doulas have commented on how far my mental prep has come and I know it’s all thanks to The VBAC Link. Julie and Meagan have given me lots of tools and resources to control my birth.” I love that. Control your birth. “I am now looking forward to welcoming my second child via HBAC in just five short weeks. I want to shout it from the rooftop, ‘EVERYONE SHOULD LISTEN TO THE VBAC LINK!’”This review was a little while ago, so shotsie3, if you are still listening with us, which we hope you are, email us. Let us know how your birth went. 04:31 Rebecca’s first pregnancyMeagan: Okay, cute Rebecca, thank you so much for being here with us today. Rebecca: Yeah, thanks for having me. I’m really excited to share. Meagan: Absolutely. Well, I’d love to turn the time over to you. Rebecca: All right, well I guess I’ll start with just a little recap of my daughter’s birth who is my first C-section. My daughter was born in January of 2021. We got pregnant with her during kind of the height of COVID. That pregnancy went really smoothly other than it was COVID times so of course, my husband couldn’t come to any of the appointments or anything like that. I didn’t really do much prep with her because I wasn’t going to go to a birth class. There weren’t a lot of resources available. All I really did was watch some YouTube videos. I kind of knew I wanted to try to have a natural birth, but I didn’t prepare that much for it really. I read Ina May Gaskin’s Guide to Childbirth and stuff, but I didn’t do too much preparation. She went to 41 weeks with no complications. I didn’t want to be induced, so my OB was like, “We’ll go to 41 weeks and then we’ll bring you in for an NST and an ultrasound.” So we went in on January 10th for her NST. She passed that with flying colors and I had asked them if they would give me a membrane sweep before they would induce me. They said they could try that, so they were going to come in and give me the membrane sweep, but luckily, one of the doctors there was like, “Well, let’s do her ultrasound first just to make sure that everything’s fine because that just makes sense before going down there and doing the membrane sweeps.” They did the ultrasound and she was like, “Did you know your baby’s breech?” I was like, “No, I did not.” Meagan: News to me. Rebecca: Yeah. Every time the OBs would very quickly, I will say, very quickly palpate me, they’d be like, “Yep. Feels like she’s head down. Everything’s good.” She was like, “Yeah. She’s breech so we’re going to go ahead and schedule a C-section for today at 4:00.” It was around 11:00 or something when this happened, so I just immediately started crying because I did not want a C-section. That wasn’t what I was planning for at all. She was like, “Well, we don’t do the (ECV)s here.” Is that what it’s called? (ECV)? Am I saying it right?Meagan: Mhmm, yeah. Rebecca: Yeah. She was like, “We don’t do that here. Your amniotic fluid is kind of low, so yeah. This is your option.” Meagan: I wonder why they don’t do it there. Rebecca: I don’t know. She just said that they don’t offer that service. I guess I didn’t really know to ask for a second opinion or to see what other– I was just like, “Well, she’s telling me that this is my only option,” so we consented to the C-section which was really disappointing. 07:25 Consenting to an unexpected C-section for breech presentationRebecca: My husband had to go home and get a hospital bag ready because we didn’t bring it with us or anything. We were like, “Oh, we will have time to go back if they are going to induce me.” I don’t know. We just weren’t prepared. Anyways, around 4:00, she was born via C-section and it was uncomplicated. It was uncomplicated. She did well. She did have some hip dysplasia because she was frank breech and they think she was probably frank breech for a long time, so her hips and the bones weren’t in the socket at all. But other than that, she was completely healthy. But yeah, I remember that night kind of laying in bed with her nursing, and my husband was asleep. I just was quietly sobbing because I felt like everything that I was looking forward to kind of got ripped away from me and I didn’t really have a choice in the matter. So I never got to experience one single contraction or any of that with her. I didn’t even really have Braxton Hicks with her. It almost felt like there was no closure to the pregnancy. It felt like I should still be pregnant. I definitely, yeah. That was a struggle. That was a struggle for a while afterward kind of trying to find closure of that whole experience because it was just like, “Okay, you’re pregnant and now you’re not pregnant.” There was no transition. That was her story. 8:53 Fertility FridaysActually, to be honest with you, shortly after her birth, I was kind of like, “Well, if we get pregnant again, I think I’m just going to do a C-section again because I know what to expect. My body’s already been through it. You know, I think I’m just going to do a C-section again.” That was kind of what I was thinking. But as I went on throughout my postpartum time, when I got my period back, I noticed throughout the year that I had some weird issues. I was spotting a lot all throughout the month and just different things were happening that I was like, “This doesn’t seem quite right.” When I went to the OB about it, they were like, “Oh, it’s fine. Your body is probably just getting back into the swing of things.”But it would be like, “Okay, well I’ve been postpartum for a while now.” This was two years down the line. I think that there’s probably something going on that needs investigating. They were kind of like, “No, it’s fine. It’s fine.” I ended up finding a podcast actually called “Fertility Fridays”. I don’t know if you’ve heard of it, but it’s really awesome. Meagan: I haven’t. Rebecca: It just teaches women about their bodies. How to track your cycle and what your cycle means, and how to know if you’re actually fertile at that time because that’s another thing. It took us a year to get pregnant with Emma Jean. I was also afraid, “Well, it took us a long time last time. Maybe something was wrong.” I just got really into body awareness and women owning their bodies and the different choices that we make and that our bodies have all of these natural processes that we don’t even really know about all of the time because we are not educated about those things. Meagan: Yeah. Rebecca; So as I educated myself on how my body worked and all of its amazing processes, I also became really interested in physiological birth again. It re-sparked my interest in that and my passion for that. I kind of was like, “Well, my body is set up to do all of these amazing things. Why don’t I let it do that? If I do get pregnant again, I do think I want to try to have a VBAC and let my body do what it’s supposed to do.” 11:02 Sparked interest in VBAC and getting pregnant againRebecca: That kind of sparked my interest back into the VBAC and the physiological birth. I got pregnant again in, I guess it was September of 2023. It’s 2023 now, right? Meagan: Mhmm, yeah. Rebecca: It was 2022 that I got pregnant again with the first time trying because I had used these methods that I had learned to actually know, “Hey, I’m fertile on these days.” Unfortunately, that pregnancy did end in a miscarriage so we miscarried that baby in November around this time of year. That was also crushing, but luckily, we started again in January, and again, right away, the first time we tried, we got pregnant again with my son, Arthur who luckily is here with us today. We got pregnant with him in January of 2023 and that was a pretty scary first trimester because I was definitely worried about miscarriage and things of that nature. But as soon as we got pregnant with him, I started listening to The VBAC Link. I also just started to think about, because you guys talk about it all of the time, finding a provider that was friendly to VBAC, truly friendly. Meagan: Yes. Rebecca: Based on my experience with my OB that I was with, I felt like they were tolerant of VBAC but not necessarily supportive. I figured with her, I went to 41 weeks and I hadn’t experienced a single contraction. I think they would have been like, “Well, if you don’t go into labor by 39 weeks, it’s going to be a repeat Cesarean.” I wanted to look for other options and one of my friends had a wonderful home birth for her second child and she recommended Kelly Jenkins who is Blue Ridge Birth. Meagan: What city are you in? Rebecca: I’m in Winchester, Virginia and she works all throughout the surrounding area so the Northern Virginia area. I called her around 7 weeks. I was like, “I know it’s kind of early.” She was like, “No. This is perfect timing because I’m already almost full for October,” which was when I was due. She was just really great about going through all of the fears and concerns we have as VBAC parents going into a home birth. She just made me feel so comfortable. She was just really thoughtful with all of our questions, had a lot of stats and evidence, and just really practical which was what I was looking for. Somebody who really was practical and knew their stuff, but also wasn’t necessarily a traditional OB. 13:53 Planning for an HBACRebecca: We ended up signing on with her for our care. She would come to our house at the normal time and an OB would come and spend a whole hour with us and just answer all of our questions which was awesome. Meagan: Wow. Rebecca: I never felt like, “Oh, well you’re a VBAC so you are a huge risk.” Everything was just supportive and always gave us all of the evidence for all of the choices we had to make all along the way. I also did yoga throughout this pregnancy. I immediately downloaded the Spinning Babies yoga thing. We watched the Spinning Babies parent class because I was trying to do everything not to have a breech baby. Meagan: Yes. Rebecca: I went to the chiropractor a lot and yeah. I just tried to do everything with my posture and all of these things to make sure this baby was not going to be breech. That was my biggest fear. He never was breech, so that wasn’t the problem. We also took a Bradley class. I have mixed feelings about Bradley, especially as a repeat Cesarean parent. Meagan: Yep. Rebecca: I think Bradley is really great, but I will stand on a soapbox just for a minute and say I also think Bradley is pretty dated and somewhat unfair to parents because it really does villainize any kind of drug or anything. Sometimes you have to do things for the safety of your child and I feel like it really villianizes using a lot of medical tools that sometimes you truly need. Meagan: That are necessary. Interesting, yeah. Rebecca: Luckily, we had a great doula who taught our Bradley class. It was Bethany Bagnell. She definitely gave it her own spin and kind of, I feel like, was more open-minded whereas if you read the Bradley book, I feel like he’s very stringent and I just feel like some of the things he promotes are a little bit outdated in my opinion. But I really liked her so it was a very informative class. We felt really prepared going into the birth. 18:00 Tachycardia and GBS positiveWe really didn’t have any complications until week– I guess it was 34 or 35. Kelly came to our house to do our normal check-up and the baby’s heartbeat was really fast. She called it tachy. She was really concerned about that and so we actually did go to the hospital to get an NST. They were pretty rude to us at the hospital. They were kind of like, “Why are you guys here? I don’t understand why you are here.” We were like, “Our midwife–”Meagan: Just checking up. Rebecca: You know, the heartbeat was really high. I don’t know. They just weren’t very kind to us while we were there. But anyway, they ended up not giving us the test that she asked them for. She wanted them to do an ultrasound and an NST and they refused to do the ultrasound. We ended up having to drive up to Laden to get the ultrasound. Everything was fine. His heart rate had settled back down and he looked fine. He was head down so we were happy about that. But that was the only little scare that we had. The other thing that was a little bit of a complication but not a complication, just something that happened is we did test positive for GBS. That was not a big deal. We could get the antibiotics at home so it did not preclude us from having a home birth or anything. We did research a lot about that because we kind of wanted to avoid antibiotics so we did a lot of research to decide what the best decision was for us whether we wanted to do those antibiotics. We decided we were just going to play it by ear based on how soon my water broke and different things. Meagan: Signs. Yeah, all of those things are really good things to take into consideration. Rebecca: Yeah, exactly. My urine was clear for GBS. It was just the swab so that was another good indicator that it might be okay. Then yeah, we were just going to kind of wait and see. I also went on a really stringent diet. I cut out white foods and a lot of the things that are shown to feed GBS then I added a lot of fermented foods and probiotics and stuff like that. Meagan: Awesome.Rebecca: So those were really the only two little bumps in the road. The whole pregnancy, every time, she would palpate which would be a full belly map by the way. When the OB would touch my belly, it would be for 10 seconds. Kelly would actually go in and she would completely map out my belly and be like, “I can feel his neck here and his butt.” Every time she did that, she would be like, “He’s in a great position. He’s in a perfect position.” We were really hopeful going into things. Of course, he did go over the due date but I kind of expected that because Emma Jean did the same thing. The difference with him was I had a lot of Braxton Hicks and I did actually have a few days where I had some prodromal labor or some episodes that I was like, “Maybe this is labor,” and then it kind of just fizzled out. 21:27 Early laborHe went to 41 weeks and I was starting to get a little nervous that we might have to induce. I really didn’t want to do that, so the day that he was 41 weeks, I started feeling contractions every 10 minutes throughout the day. I was at work and I was just kind of breathing through them. They weren’t painful, but I was definitely like, “Okay. These are kind of timable, every 10 minutes or so.” Right after work, I got together with some of my work friends and we went for a really nice, hilly, 3-mile walk and sure enough, by the time I got home from that, I was feeling contractions become stronger and closer together. They weren’t painful yet, but around the time that I was cooking dinner, I went upstairs and I went to the bathroom and I had blood all over my toilet paper. I was like, “Okay. That’s a good sign. Maybe I am in labor. Maybe this is finally it,” because we had a few episodes and we had been trying all of the things to get things going. I told my husband, “Maybe things are really happening.” I texted my midwife and she just told me, “Go to bed early tonight. After you put your daughter down, go to bed and see if you can get some rest because it sounds like this might be it so try to get some rest.” I got my daughter down and tried to lay down probably around– she went to be around 8:00 and I tried to lay down around 8:30. As I was laying in bed, I just couldn’t get comfortable. What it felt like to me was gas pains. I had always heard period cramps, but I was feeling very strong gas pains. I told my husband, “Maybe I just have gas.” He was like, “Your gas doesn’t come in waves like that. I think you’re having contractions.” I was like, “I don’t know.” Meagan: It doesn’t come in waves. Rebecca: He was like, “You’re having contractions. I think you’re really having contractions.” So he started to time those and they were coming every 5-7 minutes and it was too uncomfortable for me to stay in bed, so I was like, “Well, let’s go ahead and go into the basement.” We have a nice finished basement and we were going to birth down there. That’s where we were going to set up the pool. I was like, “You can get the tub set up and I can kind of pace around and we will make sure we won’t wake up Emma Jean,” who is my daughter. We came into the basement probably around 10:00 and pretty much as soon as we got into the basement, my contractions became strong enough that I wasn’t really feeling like I could talk through them anymore. I was leaning over the ball and breathing. My dog, Maggie, was right beside me. Her face is right next to mine the whole time. She was kind of starting to distract me so I was like, “Let’s call my dad to come get the dog.” I was like, “I think this is really happening.” 24:18 Calling the teamRebecca: We called everyone. We called Kelly and we called my mom and my sister who were going to help and attend the birth. Everybody just started rolling in. My dad came and got the dog. My mom and sister came and then Kelly was coming around midnight. By the time Kelly got there, I was definitely like, Rick was already helping me out with counterpressure because my contractions were so strong in my back. Everything was in my back, not in my abdomen at all. I remember in the back of my head, I was like, “Man, I remember that means position.” Meagan: Usually. Rebecca: It’s probably not what it should be. Kelly, on the phone, had told me to try to do some of the Miles circuit. I had been working through that a little bit when she showed up. When she showed up, I was on the bed in the head down position with the butt up which is part of the Miles circuit and my water broke. My water broke right around midnight when she arrived and that was really cool for me because I had not gotten to experience that with Emma Jean so that feeling is still something that I think of fondly because I never got any of that with my first daughter. Kelly was like, “Just so you know, your contractions might pick up now because your water is broken.” I was like, “Okay,” and they definitely, definitely did pick up. I feel like I almost didn’t even go through that early labor stage. I feel like I kind of went straight into that active, you’ve got to focus. You’ve got to breathe. My husband had to be right there with me with the counterpressure. Things were pretty strong. They were tolerable and I was excited, so I wasn’t like, “Oh, this is really painful.” I was like, “Oh my gosh. It’s happening. This is all happening.” That really, I think, helped with the pain tolerance. I was excited for it. But for most of that part of labor, I was leaning over the bed or the couch, and my sister, I would hold her hands and look at her. My husband would be behind me with the counterpressure. They were getting the tub all going and everything. Then Kelly was like, “Do you want me to check you?” I let her check me, but I told her not to tell me how dilated I was. She checked me and she was like, “Well, he’s really, really, really low. I can already feel his head. You’re almost completely effaced so that’s good.” She didn’t tell me how dilated I was, but I was like, “Okay. He’s low. I’m effaced. Things are sounding good.” Then the nurse got there and we had to decide if we wanted to start the antibiotics for the GBS. My water had broken so I was kind of like, “Um, I don’t know. Let’s see.” Then I asked Kelly, “Can you just tell me how dilated I was so I can kind of get a sense of how much time we have?” She said I was only at a 1. I was kind of disappointed by that, but I was like, “I haven’t been laboring that long. I know that dilation can come really quickly. It’s not the only thing. I’m effaced and he’s low,” so I didn’t let it get me down, but we did decide to go ahead and run the antibiotics. She hooked me up with those and I was able to still be in the tub and everything. She just covered it with a dressing and a plastic so I could be in the tub. I did get in the tub at that point. I got in the tub probably a little after midnight. I don’t know the exact timeframe. The tub was nice, but my husband hates baths so at first, he was like, “I’m not going to get in the tub with you.” I was like, “Okay, well I need your counterpressure so buddy, you’re going to have to.” Meagan: Get in.Rebecca: Yeah. I went through a few contractions in the tub without him in there with me and to do the counterpressure, I would press my butt as hard as I could against the bottom of the tub. I was like, “This is not cutting it. You’re going to swim with me now. Get in.” He did. He got in. He’s kind of a germaphobe which is part of him not liking tubs thing. Meagan: Okay, fair. Rebecca: He got in with me and he did what he needed to do. He was awesome. Basically, I would just press against– I was lined up against his pelvis and I would press my butt into him as hard as I could because every contraction felt like my butt would fly apart if I didn’t have somebody holding it together. Meagan: I  can totally relate. I was in labor. I was like, “He’s going to come out my butt.” Everyone was like, “No, he’s not.” I’m like, “Yes, he is.” Those posterior babies. Rebecca: Yep. It just felt like my butt would fly apart if no one held it together. That was how I was getting through each contraction. I labored in the tub for a while then I had to use the bathroom so they were like, “You should labor on the toilet for a while. People love laboring on the toilet.” So I was like, “All right.” I did not like laboring on the toilet. Meagan: Dilation station. Rebecca: I think I just really needed my husband’s body. I don’t know why. I needed to be pressed against him in some form or another. He was definitely my rock through that whole thing. He was really good. He read The Birth Partner book and everything. He really was with me 100% of the way which is another reason I’m so thankful that I got to labor this time because the bonding between the two of us going through that together was just something that I could never replace. It was just amazing. 30:10 Laboring through the nightRebecca: We kind of went back and forth between the tub and the bed and doing different things. Everything was going well. I remember asking people what time it was a few times and I was like, “Man, the night’s really going by quickly. I feel like I’m laboring really hard, but I’m managing and everything was going well.” We labored all through the night until my daughter woke up at 7:00 in the morning. I wanted to say goodbye to her before she went off to school to daycare. I waited for a contraction to end because I was like, “I don’t want her to come down here while I’m acting crazy.” When the contraction ended, I called up to my mom. I was like, “Bring down Emma Jean.” She was so cute. She was like, “You’re swimming? You’re in the pool? What’s happening?” I was like, “Yeah. Your brother is coming. Kelly is here,” and she was really excited that Kelly was here because she got to know her throughout the pregnancy. She was really excited. She gave us a kiss and we told her, “Probably when we pick you up from daycare, your brother will be here,” so it was really cute. Then my mom took her. She took her to breakfast and was going to take her to daycare. Basically, as soon as she left, that was my permission to make as much noise as possible. Meagan: Let it go, yep. Rebecca: Yeah. My contractions were starting to be really, really strong. I was starting to feel pushy and I was having to basically roar through them. I was really fighting it. I was sounding angry. I was kind of roaring through them with sort of gritted teeth which I know is the opposite. You’re not supposed to grit your teeth. You’re supposed to let your jaw be loose and all of that. I was definitely roaring through those contractions. At that point, Kelly was like, “Look, it seems like you might be getting kind of close. Let’s check you again and see what’s going on.” The intensity of where I was and what I was doing to get through the contractions, I was really expecting and hoping that she was going to say I was maybe a 9 or a 10. She told me later she was fully expecting to tell me, “You’re a 9 or a 10.” But when she checked me, I was only a 4.That was kind of crushing to me, but I was like, “Okay.” Actually, I told her not to tell me at first. I was like, “Don’t tell me. Again, don’t tell me unless it’s time to push.” Meagan: Do not tell me, yeah. Rebecca: She said, “Okay, it’s not time to push.” The way she said it, I was like, “Something’s weird. Something’s wrong.” She was like, “I really need you to relax. We’re not going to get back in the tub. I want you to lay in the bed. I want you to be in a side-lying position.” She put me in very specific positions and she was like, “I really need you to rest and relax.” 33:09 First signs of swellingI was kind of like, “Okay, something is weird,” so I just asked her. I was like, “Well, what am I at?” She was like, “You’re only at a 4.” I was like, “What? I’ve been laboring all night intensely.” She was like, “And the baby’s head is already trying to come through and his head at the top is starting to swell a little bit,” which they called a caput. She was like, “So you know, he’s good. His heart rate’s good. Your heart rate’s good. I’m not worried, but we do have to keep an eye on that.” So she was like, “I’m going to have you go through some different phases of the Miles circuit to see if we can change his position a little bit, get him off your cervix a little bit,” and things like that. I was not able to get those really strong counterpressure that I needed from Rick in that side-lying position, so I was like, “Let’s get some music going. I need some kind of distraction.” I’m a singer. I love to sing and I play music and stuff so we put on our wedding playlist. We were just both lying on the bed. I had him get my comb for me so I could squeeze it and I was just singing through our wedding songs. That was actually a really beautiful part of the labor for me. I was sitting there and singing through our songs. It was kind of a chance to just be quiet and think about things. I just kept saying in my head, “Okay. Dilate. Dilate. You’re going to dilate,” and thinking that over and over again. She had me do 30 minutes in each of these different positions. The one with the head down and the butt up was super uncomfortable I think because my neck was hurting. I was so ready for that to be over. After we went through those, she was like, “Okay, let’s get you up and get you moving again.” This was probably at least an hour later that she was like, “Let’s get you up off the bed and we’ll just move around.” Rick and I danced around. Every time a contraction hit, I would just squat down really low and he would squat down and hold me in a chair almost and just hold onto me, then we would sway and dance. Meagan: How cute. Rebecca: Yeah. It was really special. We did that for probably another half hour, then it was time for me to get another round of the IV which I guess I had been getting every 4 hours is what that generally is. Kelly was like, “How about we do another round of the antibiotics and then I’ll check you again because it will have been about two hours more or so. We will see if you have progressed and what is going on.” At this point, I was starting to feel a little discouraged. I remember I was sitting on the birth ball and Bethany, the nurse, was giving me the antibiotics. I just remember looking at Rick and I was like, “I’m trying so hard.” I was tearful. I was like, “I am trying so hard. I know that I’m a good mom.” He was like, “You’re the best mom.” He was crying and I was crying. He was like, “We’re going to get through this and we’re going to do what we need to do.” Throughout my whole pregnancy, I had told him, “If I don’t get a VBAC, it’s going to be so hard for me. It’s going to be really crushing for me.” His perspective on it the whole time was always like, “Look. We’re going to make the best decisions possible with the information we have.” He was like, “Hopefully, that is you getting your VBAC, but if it’s not, it’s because we had to move to the next plan because it was the best decision.” He was kind of like, “Look. That’s the same thing. We’re going to make the best decisions with the information we have. You’re a great mom and you’re doing a great job. I’m so proud of you.” That was just really special. We were just going through the emotions. After we got the antibiotics, she checked me again. I want to say this was around 10:00 in the morning and she was like, “Becca, you’re still a 4.” And she said, “Now, your cervix is swelling.” She said, “Look. You know, you’re not in danger at this point. The baby’s not in danger. This is not an emergency. But, I can’t tell you that if you keep going for a few more hours, you’re going to have your baby here. I don’t know.” She was like, “Chances are your cervix will continue to swell. You’ve also been in labor for a long time. You’re getting tired.” She just kind of started to talk to us about hospital transfer. She was like, “Maybe if we go to the hospital and you get an epidural and you can relax and maybe we can try some different positions with the epidural and get the baby to come off the cervix some.” We started talking about it and I remember I was going through a contraction on the edge of the bed. I had my arms up on the bed and I was just sobbing. I was like, “I tried so hard. I’m trying so hard.” But I remember as soon as I found out I was still just at a 4 and that my cervix was swelling, it is very mental because my tolerance of the contractions, my pain tolerance, just went down. Meagan: Yeah. Rebecca: All of a sudden, they just felt so much more painful because I was going from being like, “Well, maybe I’ll meet my baby any second,” to “Who knows? Who knows what’s going to happen?” Meagan: Starting to feel the defeat and doubt. Rebecca: Exactly. We talked about it and we were like, “Well, we could labor here for who knows how long and still need to transfer, or we could go ahead and transfer and try something new.”39:02 Making the decision to transferWe made the decision to transfer. Luckily, I only live 5 minutes away from the hospital, so it wasn’t a super long process to do that. We already had our hospital bag packed this time. I was ready with that. I had my hospital bag packed. I had my C-section plan just in case. I had my hospital plan just in case. I at least felt ready to go. Nobody said, “You have to transfer.” It was our decision. We felt like we had the information and we made the decision together. That part of going to the hospital, I remember just wishing I could turn these contractions off now because now, getting in the car, not having the counterpressure, all that, and the funny thing was we walked out onto our patio. I had a contraction on the side of my patio and of course, my neighbors drive by and roll down their windows and are like, “How’s it going?” Meagan: “Are you okay? How’s it going?” Rebecca: Yeah. I was like, “Oh my gosh.” I love these neighbors. They are amazing, but I was like, “This is not what I want to be doing.” But we made it to the hospital. We got to triage. They strapped me all up. I was lying flat on my back in the most uncomfortable position, but basically, we got through triage and everything. From the time I got to the hospital to the time I got the epidural was probably still another hour and a half of labor at least. That was really tough. We made it there. We got there. We finally got the epidural placed. I would say it was around noon when I finally got the epidural placed. I will tell you. I am all about natural labor and if somebody had told me, “You’ll have to labor 10 more hours, but you’re going to push your baby out and everything is going to be fine,” I would have found it in myself to do that.Meagan: Yeah? Yeah? Rebecca: I will still say that epidural felt so freaking good. Meagan: I bet. Rebecca: It was just a warm wave of a warm tingling hug. As soon as I got the epidural, all of the pain just kind of melted away. I was like, “This is where we are so I might as well enjoy this for what it is and take this relief.” Yeah. The other thing was that the doctor was, I would say, VBAC tolerant for sure, the doctor on call. He kind of came in and gave us a big spiel about TOLAC and did we know the risks. He was like, “Look, you can try for a VBAC, but if anything goes wrong, we’re not going to try to fix it. It’s just going to be a C-section because we’re going to play it safe.” I was like, “Okay.” I didn’t have any problems with him. He was a nice guy and everything, but as soon as he said that, I was like, “I have a feeling this is going to be a C-section. I think it’s just going to be a C-section.” The nurse was very great. She put me on the peanut ball. She moved me around some different positions to try to get him to back off my cervix. When they checked me again, I was still a 4 even after that time. I labored with the epidural for about two more hours to the point where I was like, “I’m getting kind of bored and antsy. I sort of want to know what’s going to happen. What’s the plan at this point?” At about two hours in, the doctor came back in and he checked me again. He said, “I could push you to a 5, but you’re still basically a 4.” He said, “Your cervix is very swollen.” He said, “I could give you Benadryl or something like that for the cervix to come down.” He was like, “But I really don’t like to do that because at this point, whatever is happening to your cervix is a position thing. It’s a mechanical, positional thing.” Also, the epidural slowed my contractions way down. They went from being 3 minutes apart to being 10-12 minutes apart. He was like, “I’d probably have to give you Pitocin to get this going again.” He was like, “I’m not comfortable doing that.” He basically said, “I recommend a C-section and that’s basically your option.”Meagan: I was like, “Okay. Can you give us a few minutes to talk it over?” He did. He left the room. My midwife, Kelly, was still there. She stayed on the whole time as my doula. She basically was like, “You know, I do understand what he is saying.” She was like, “I kind of wish he would have told you that earlier and not made you wait for two hours.” She was like, “I agree. It probably is positional and there’s probably not a ton we can do.” Oh, another thing he had said was that the baby was having some decels after my contractions. He was like, “You know, that can show us the baby is in a little bit of distress.” She was kind of like, “You know, I understand what he is saying and I’m not sure that I would give you any other advice. I’m not sure I would tell you anything different.” My husband and I talked it over and we were like, “Let’s just meet our baby. Let’s just meet our baby now.” We had them go over our C-section plan and of course, they weren’t willing to do most of the things that we had on that plan. They didn’t have the clear drapes. There were just a lot of things that they weren’t willing to do, but they did agree that the nurse could take pictures of the surgery for us which was something I didn’t have with my daughter.Meagan: Which is nice. Rebecca: Yeah. She took pictures for me and that’s pretty much the only thing, I think, that was really different. She took pictures of everything that happened. 44:53 Consenting to a C-sectionRebecca: Around 4:00, we consented to the C-section, and then yeah. They just prepped me. My sister took a picture of me giving a thumbs up getting ready to go. She took a picture of my husband and his whole suit and everything. I was like, “Okay. Let’s just do this thing and get our baby now.” I did shed some tears while they were rolling me into the OR and I remember the anesthesiologist well-meaning was kind of like, “What? Are you afraid of a C-section? You’ve already done this!” I know she was trying to be like, “There’s nothing to be scared of,” but I was kind of like, I even said to her, “I’m not scared. That’s not why I’m crying.” She was like, “Well, what’s wrong?” I was like, “I’m disappointed.”Meagan: This is not what I wanted, yeah. This is not what I planned for. Rebecca: That was a little bit like, “Okay. Come on. Empathize a little bit here. There are lots of reasons why someone could be crying going into this.” Long story short, the C-section all went to plan, but as soon as they did pull him out, they did say he was OP. He was sunny-side up and then they also said, “And he’s 9 pounds.” So he was pretty big. I mean, I could have pushed him out for sure but he–Meagan: Yeah, on the bigger side. Rebecca: But he was in sort of a poor position which could be why I had the swelling and everything of the cervix. He came out and he was really, really healthy. Once we got to the recovery room, he nursed right away. He was definitely a hungry little boy right from the beginning so that was awesome. He latched right on and nursed and everything. Yeah, that’s pretty much the story. 46:43 Tips for when things don’t go as plannedMeagan: You know, it’s so interesting how we have these things. We go through all of these things and we end sometimes in the way we didn’t want, right? Rebecca: Yeah. Meagan: I’ve been there too, not nearly as intense as you. You went through a lot. I just had an unsupportive provider from the get-go. I ended up walking down to the OR in general, but we have these experiences, but we still grow from them. Rebecca: Absolutely. Meagan: I mean, I heard little nuggets within your story like bonding with your husband, having faith in your body, working through it, experiencing labor, having support, but are there any other things that you would tell our Women of Strength, our listeners, especially if something doesn’t happen exactly as planned? Rebecca: Yeah. There are a couple of different things. The first one was all throughout when I was prepping for labor in particular, especially for dealing with pain, the word that kept coming up and coming up was surrender. I kept thinking, “Surrender to the contraction. Surrender to the sensation.” I always applied that very specifically to labor and labor pains, but I want people to take it a step further and just be like, surrender to your birth however it’s going to happen because even if you do everything right and you do all of the steps, there are no guarantees in birth that you are going to have the outcome that you wanted. Even if you have a good outcome, most likely, there’s going to be something about it that was unexpected or wasn’t perfect so just try to surrender to the whole experience. Yeah, of course, surrender to the contractions. Surrender to the labor, but surrender to the whole experience and the fact that you can’t control it. That doesn’t mean you are doing anything wrong. Meagan: Yeah. Rebecca: That’s the other thing. I hear it a lot in VBAC and I understand why people use this word, but I feel a little bit, I guess I would say use some caution in using it. A lot of people label their VBAC as a redemption or redemptive. You own whatever experience you have. I’m sure it is redemptive, but I guess what I would say is that we don’t need to redeem ourselves. There is nothing we did wrong that we have to have redemption for. Can the experience feel redemptive? Absolutely, but I don’t want women to then apply that to themselves like, “I need redemption because I failed at something.” You are making the best decision for yourself and your child with the information that you have at that moment. That is what parenting is all about. You can’t control anything when you become a parent either. There are always going to be these little decisions you have to make that are unexpected or huge decisions. I think that was the difference between this C-section for me and the last one was the last one, I didn’t feel like I had a choice. With this one, every step of the way, I was given choices by my midwife with my husband. We had time to talk through things. We had time to think through things. We made the choices that we felt were the best choices at the moment. So those are the two things I would really say. Surrender to your whole experience because you have no idea what it’s going to bring and you don’t need redemption because you are already being the best mom that you can possibly be or the best birthing parent that you can possibly be just by being in the moment and making those good decisions with the information that you have. Meagan: I love that so much. I love that so much. Thank you for sharing that. Rebeca: Yeah, absolutely. 50:43 Signs of wonky positioningMeagan: I want to dial into that. The swelling of the cervix, the “stalling” of this labor and I’m putting it in quotes, but it does happen and sometimes despite all of our efforts, it doesn’t change and sometimes it does change, but I wanted to talk about the swelling of the cervix and what that really means and what kind of signs we can look out for to know that we’ve maybe got a baby in a wonky position that could cause a swollen cervix and then what we can do. I mean, just like you were talking about, we were talking about how you just needed your husband to hold your butt together. That is a sign. If we are having all back or butt labor, that could mean a sign that a baby is in an OP or occiput posterior position. That doesn’t always cause a swollen cervix or a delay or a stall in labor or anything like that, but it can.Another position is called asynclitic and that’s where the head is kind of tipped to the side a little bit and we’re not coming down with a nice chin-tucked position into the pelvis. Another one is where the chin is extended or we’re in that military position. I’ve also seen it sometimes in a transverse. It’s like a transverse asynclitic. I don’t know exactly what that one is where the head is back, the chin is up, and we’re in an asynclitic position. We’re not looking straight up. Those are positions that may mean our babies are in a less-ideal position. Some of the things are prodromal labor beforehand. You had mentioned that. That means sometimes there is a baby that needs help getting in a different position or a back labor or a butt labor. A coupling pattern where there are two contractions and then there is a big break and then there’s a big strong one. Our body is trying to get that baby to rotate. Rebecca: Yep. I did have really long contractions and I did have some double peaks so that makes sense to me.Meagan: Yes. Yes. I call them coupling contractions where that’s what they can do. Our body is brilliant. It’s trying to rotate these babies and work with us, but sometimes, it’s more difficult and sometimes we have to help our body by rotating and moving and working with the pelvis in things like this. 53:31 What to doSome of the things we can do, it sounds really weird and I saw this from a nurse years ago and I was like, “What is she doing?” Then I was like, “Oh my gosh, it worked.” We had an anterior lip where it was swelling on the one side. She said, “I want you to get in the biggest fetal position that you can, the tightest fetal position.” We’re holding her even around and imagine a 9-month belly. So it was a little difficult to wrap ourselves around it, but we brought knees all the way to her chest, had her wrap around her knees like this and she laid there. We had to do a lot of counterpressure. Rebecca: Yeah, I can imagine. Meagan: Because that was not a comfortable position. We did five contractions like that and it was hard, but she said, “I want to do it. I want to do it.” We got into it with lots of counterpressure then we did, I don’t know what you call it, but we did the throne where you sit up feet to feet, knees out, but after that contraction, she got a check and the lip was gone. That was something that was kind of cool that I had never heard of. I had been a doula for years then I saw this and I was like, “Huh, okay.” I haven’t seen anyone do that. Rebecca: Yeah. I read a lot of the books and I didn’t see that anywhere. Meagan: Never saw it anywhere, but yeah. This nurse here in Utah was like, “I know just the trick.” She did it and I was like, “Whoa, okay.” Yeah. Some people will say that sometimes ice, there is a circulation issue and sometimes ice can actually stop circulation. Sometimes ice isn’t the best and then Arnica or Benadryl. You mentioned Benadryl that they wouldn’t give you but they mentioned it. I don’t even know how to say the word. It’s actually something that I just was talking to a labor and delivery nurse in our community who wants a VBAC. It’s Cemicifuga. I don’t even know actually, you guys. I don’t know how to pronounce it, but those, I’ve seen arnica, out-of-hospital midwives will use or getting into a tub. Sometimes that can or sometimes an epidural because it can offer relaxation. But then that always and then yeah, just moving, moving, and working with position. But then sometimes, despite all of our efforts, just like cute Rebecca, for whatever reason it doesn’t change. That’s when we have to surrender on our whole experience and make the choice that is best for us at that point. If that’s a repeat Cesarean, that’s a repeat Cesarean. Repeat Cesareans can also be healing. Rebecca: Yeah. I would say this was because I definitely felt totally different about the experience afterward. I still mourned it of course and you will, but I felt much more empowered and I got so much out of just going through the labor process that I wouldn’t give it up for the world. It still was healing for me for sure. 57:00 Why you shouldn’t skip the repeat Cesarean storiesMeagan: I love that. Well, thank you so much for sharing your stories with us, being here with us today, and talking about swollen cervixes. Rebecca: Yeah. I hope people actually click on this. I know when I was preparing for VBAC, I was kind of guilty of, “Oh, a repeat Cesarean, I don’t want to listen to this one.” So again, hopefully, people will be open because you never know what your story is, or maybe you’ll come back and find it after you’ve had a repeat Cesarean and feel proud of yourself for everything that you did because I think hearing these stories after you’ve had a repeat Cesarean could be really helpful. Meagan: Absolutely. Just like they are helpful after having a Cesarean and preparing for a VBAC, after having a repeat Cesarean, these stories can be very healing and validating as well. These stories, I know that there are so many people out there who won’t click or will avoid them because they don’t want to even think or go there, but a lot of these stories with repeat Cesareans actually offer tools that can help heal if that does happen and ways that you can prepare for if that does happen because it’s any birth. I mean obviously, look at all of us. There are hundreds of us and thousands of us who have had an unexpected Cesarean. We weren’t planning on that Rebecca: No. Meagan: So preparing before for all outcomes is so powerful. Rebecca: Definitely. Definitely. Have that backup plan because I didn’t even have one at all for my first and I was really glad I had it for my second. Meagan: Yes. Oh, well thank you again so much for being here with us today, and congratulations on your baby. Rebecca: Thank you. Thanks for hearing my story. I love what you do and I think it’s really, really important, so thank you. Meagan: Thank you. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Feb 28
59 min
Episode 277 Clair's VBA3C + PPROM + Close Pregnancy Duration
Happy podcast Wednesday, Women of Strength! You do NOT want to miss today’s episode. Clair shares her beautiful journey to a VBA3C. After fully dilating and pushing for hours but ultimately ending in C-sections with her first three babies, Clair finally had the vaginal birth she so badly hoped for with her fourth! Clair shows just how powerful birth can be when a woman’s intuition is combined with informed consent and an open-minded birth team. There were unfortunately some technical difficulties during this episode and part of Clair’s third birth story was not recorded. Clair graciously submitted this written account below.24:08 “With my third baby (attempted VBA2C), I dilated quickly and smoothly, baby was descending beautifully, and I started feeling like it was time to push. I pushed for a long time - a couple of hours - and he was coming down, but slowly. We tried many different positions, moving around, etc… but it was taking a while. Looking back, I was having some back labor and it’s likely that when my water broke on its own, he dropped into a posterior position. After several more hours, we could see his head! I thought a VBAC might really happen! But baby’s heart rate started having decels and having a hard time coming back up, so we decided to transfer to the hospital for monitoring. I was pretty exhausted by that point, so I was hoping that IV fluids would help me regain strength and keep going. When we got to the hospital, however, they would only let me labor in the operating room because I was a VBAC patient, so I was very limited in mobility and my options. Baby seemed stable, but they were basically prepping for surgery from the moment I walked in the door and wouldn’t tell me baby’s stats. We eventually called it, opting for a C-section on our terms so we could have delayed cord clamping and a calm environment. Baby boy was almost 10 pounds and had very healthy APGAR scores! I was disappointed I didn’t have a VBAC, but I felt respected by my midwife the whole way through. Postpartum physical recovery was difficult, but emotionally this birth was much less traumatic because I had a supportive birth team. I also took two intentional weeks to do nothing but be with the baby and rest, which I hadn’t done with my previous two births, and that made a huge difference in my mental health and bonding with my baby!”Additional LinksNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Time Stamp Topics01:56 Review of the Week04:30 Clair’s first pregnancy and birth 07:50 Recovering from a C-section while moving 09:24 Getting pregnant at 3 months postpartum & dual care during COVID14:39 Laboring at home to complete & hospital check-in17:49 Clair’s second Cesarean19:08 An emotional recovery23:38 Third labor with a home birth midwife24:08 Pause in story – read caption!24:20 Fourth pregnancy 28:49 Moving to Utah 35:34 Midwifery care in the hospital38:47 Active labor begins45:04 Circumvallate placenta Meagan: Hello, hello Women of Strength. We are at the end of February here and we have a story that I swear– VBAC after multiple Cesareans is very highly requested when it comes to this community so we have a story for you guys today for VBAC after three C-sections. Not only was it a VBAC after three C-sections, but it was also a pre-term VBAC after three C-sections. I think in a lot of places around the world if someone came in pre-term and they have had three C-sections, finding that support is going to be hard. It doesn’t need to be necessarily hard, but I know that it can be so I’m excited for this story from our guest, Clair, today because it’s a story that just shows that it is possible even if you have certain things stacked against you that the medical world looks at in a negative way. 01:56 Review of the WeekSo we are going to be sharing that story here in just a few minutes, but of course, we have a Review of the Week and this was shared on Apple Podcasts. It’s by brittleesmith. It says, “Highly recommend for both VBAC mamas and mamas in general.” It says, “In 2019, after 30 hours of labor, I ended up birthing my son via unplanned C-section. I was devastated and knew my future birth had to be different. I immediately started digging into VBAC resources and came upon your podcast. I listened to every single episode before I even became pregnant with my second baby. The knowledge I gained from both of you as well as your many guests is truly invaluable. This resource is great for any expectant parent, not just VBAC moms and I wish I had discovered you all before my first child. “I am thrilled to announce that I got my VBAC this past February and I owe a lot of thanks to y’all. Keep it up, ladies.” Oh, I love that. I love when people say, “We found you. We learned and then we got our VBAC,” or “We found you. We learned and I didn’t get my VBAC but I had a better experience.” This is what this podcast is here for to help people have a better experience, to learn the information, to feel more empowered to make the best choice for you, and even sometimes when the experience doesn’t go exactly as we planned, to still have a better experience because we know what our options are. As usual, if you guys have not left a review, we would love them. They actually help Women of Strength find this podcast. They help people find the information and the empowerment for their births, do drop us a review. You can leave it at Apple Podcasts. You can even Google “The VBAC Link” and leave us a review there or wherever you listen to your podcasts, drop a review. 04:30 Clair’s first pregnancy and birth Meagan: Okay, cute Clair. It’s been so fun. I just was scanning over your stuff and I was just excited because of all of the people you had at your birth, I know personally because you are also here in Utah. I’m so excited to hear your whole story and your journey. I just want to tell you congrats in advance because it is so amazing. So amazing. Clair: Thank you so much. Yeah. We didn’t expect to be in Utah, but it turned out to be a really great place to birth so we are really grateful to be here. My story actually starts on the East Coast thousands of miles away and I was due with my first in May 2019. I didn’t really know much about birth in general. I’m the oldest child and kind of a rule follower. I was like, “Well, if I just do everything the way I’m supposed to, then birth will just happen.” Yeah. I had a really supportive OB. He has several children of his own. His wife was a friend of mine. He was a really great doctor. But at around 32 weeks, I was flying at the last possible second I was allowed to fly and running through an airport. I kind of felt the baby kind of settled in a weird spot after that. I started having prodromal labor at 39 weeks or something. That went on for about two weeks. What I didn’t realize was that these were all signs that maybe he was posterior and not in a great position. My OB, even though he was really wonderful, wasn’t trained to determine where the baby is, just that the baby is head down. Meagan: Right. Clair: So at 41+1, early in the morning, I was over a week past my due date. I was losing my mucus plug. “Hey hon, we’re going to have a baby today.” I was so excited. We ended up laboring all day at home. We went to the hospital. I had really, really bad back labor so I ended up with a lot of IV fluids. I had a couple more interventions. They broke my water eventually and basically, what ended up happening was that 41+2, so 9 days after my due date, I had dilated to complete, but the baby wasn’t dropping at all. He wasn’t engaged. He was still really, really high and after a while, his heart rate wasn’t tolerating labor well anymore and they recommended a C-section. Meagan: Did they have you push? Clair: I didn’t push. Yeah. They said he was still too high. They didn’t recommend that. Meagan: Interesting. Isn’t that how we get babies down? Clair: Yeah. I’m not really sure. Meagan: Yeah. Yeah. Clair: It definitely was a situation he was not used to or prepared for. He was kind of surprised and honestly very sad that I didn’t have the birth experience that I wanted. He came to visit the next day and just spent a few minutes with us. His wife came to visit who I was friends with. It was really hard and pretty traumatic, but it also could have been much worse. His bedside manner, I was really well taken care of. 07:50 Recovering from a C-section while moving So that was really hard. It was a challenging physical recovery because I had 48 hours of labor and most of it was without an epidural. It was really intense. The hardest part of that birth was that the first time I saw my son, I saw a picture of him that the nurses showed me because they took him away to be measured right away. So that was really hard. He was 9 pounds, just that plus not being in a great position and being with a provider that didn’t have a lot of options of what to do if baby is not descending properly. That was a difficult adjustment to motherhood especially because that baby was born in Louisiana. We were moving back to Virginia where we have a lot of family and friends. We were planning on moving two weeks after the baby was born, but because he came late, we actually left the hospital and started driving north. I would not recommend this. Don’t do it. Meagan: That’s a lot. That’s a lot. Clair: It’s a really bad idea. Meagan: Oh my gosh. Clair: His first night out of the hospital was in a hotel in Birmingham, Alabama. Yeah, don’t do it. So yeah, that was just hard because we were moving and I’m trying to physically recover. So it was pretty wild. 09:24 Getting pregnant at 3 months postpartum & dual care during COVIDClair: That was my first. My second– we surprise got pregnant three months after that baby was born. Meagan: Okay. Clair: He was a cycle zero pregnancy. I had no idea. I just felt off and was like, “Maybe I should take a test,” and I was so shocked that I was pregnant. Meagan: Oh my gosh, yeah. Clair: Like I said, we were in a new state. I found a birth center that would do my prenatal care because I knew midwives knew more about positioning and how to track it and maybe had some recommendations about things they could do to encourage baby to be in a better position because my pregnancy had been great. But because it was right around 12 months between deliveries, they wanted me to have co-care and deliver at a hospital. I kind of just took their word for it like, “Oh, well if that’s what they are recommending, then the risk really must be that much higher.” So then in the middle of all of this, COVID happened and hospitals– I was due in May 2020. Hospitals were kind of changing their– Meagan: Everything. Clair: Yeah, but by the week it felt like. Meagan: By the day. They were changing by the day. It was insane. Clair: Yeah. It was crazy. So it was March. I was due in two months and I had just reached out to the birth center basically begging them to let me deliver out-of-hospital because I was like, “I don’t want to deal with the hospital system right now. I know that they are truly supportive,” but they said that they weren’t comfortable with that. So my plan was to labor at home with the midwife from the birth center, laboring home with me then to transfer to the hospital while I was in labor. She was supposed to be– that midwife was supposed to come with me as kind of like a doula almost in the hospital just as support. Meagan: Yeah. Yeah, a monitrice or whatever they call them. Clair: Yeah, yeah, exactly. So then I had to find a doctor to do co-care with. I had a new friend in the area who had a C-section with her first and she had a not-great experience with this one doctor in the area, but that was the one that the midwives usually worked with so I kind of took her experience as, “Maybe not. I don’t want to work with him.” I found someone else who was really VBAC-supportive historically, but then he had me do an ultrasound to determine scar thickness. This was all in the third trimester. Pregnancy was going really well, but in the third trimester, I had to start doing my appointments with him. Baby was actually breech pretty late on, so I started doing chiropractic care during that pregnancy and she flipped on her own. It was great. I was so grateful. So then at that ultrasound, we determined that yes, she is head down. He was concerned about my scar thickness, although then I did a lot of research and was like, “I’m just not sure that this is actually evidence-based.” Meagan: Yeah. Clair: And then also, they were telling me that she was going to be 12 pounds. I carried a big baby a year before, literally to the day almost and I was like, “This feels just like my first. She’s got to be around 9. I don’t think she is that much bigger than he was.” Meagan: Was the ultrasound saying 12? Clair: Yeah, yeah, yeah, yeah. Meagan: Okay, okay, okay. Clair: Yeah. The ultrasounds measured it and I mean, spoiler alert– it turned out to be way off. She was 9 pounds, 3 ounces. Meagan: Most of the time it can be. Clair: Yeah. Yeah, especially with bigger babies later in pregnancy. I was in a fine headspace with that. I was like, “I know that this can be off. I’m not worried about it,” but they were really nervous and anyway, basically backed me into scheduling a C-section, but I pushed it as far down the due date path as I could because I had gone over with my first and I still really wanted a chance to labor. So chiropractic care this whole time was really helping. I had bad hip pain with my first and I didn’t have any with her after that. They wanted to do another scan at 41 weeks later or another ultrasound at 41 weeks just to check on baby, but I got them to do a non-stress test instead because I was like, “What are we going to look at?” She was healthy at 40 weeks. I was really glad that I had advocated for myself there because that was good. I did have one funky day of pre-labor at 40 weeks where I really thought I was going into labor. It was early labor then it stopped. I was checked after that and I was at 4 centimeters. I was walking around for a week and a half it turned out to be at 4 centimeters dilated so it was kind of interesting to know that that could happen. Meagan: Yes. Clair: The midwives I was with said they see that with VBACs a lot too that the body just takes things slower sometimes which was interesting to hear their experience of that. 14:39 Laboring at home to complete & hospital check-inBut yeah, I went into labor at 41+3– or 41+2 I guess– which was when my son was born a year before. I was in early labor all day. My water broke as I was nursing my one-year-old for bed. Meagan: Oh my gosh. Clair: It was kind of crazy and exciting. I was like, “You’re going to meet your sister.” I put him down for sleep. The midwife came over. I labored from a 6 to a 10 in three hours. By 9:00 PM, I was fully dilated. She was dropping. At that point, looking back, I wish I had just stayed home because she was almost born at that point, but I didn’t because I still had the midwife’s voice in the back of my head, “Oh, it’s only been a year. You’re at a higher risk for rupture.” I just was worried and at that point in labor is not the time to be making decisions like that. Meagan: You’re very vulnerable. Clair: Yeah. We ended up transferring. I get to the hospital. They stick a thing up my nose to check if I have COVID. Meagan: Oh jeez, yeah. Clair: So you’re in labor already really uncomfortable and they’re like, “We’re going to swab your nose.” You’re like, “Thanks.” They wouldn’t let the midwife in which we kind of knew, but she came with us just to see if they would let her in, but they were only allowing one support person so my husband came with me.I ended up getting an on-call doctor who wasn’t the doctor that I had been seeing. It actually turned out to be the first doctor that I was trying to avoid in the first place. Meagan: Oh, really? Clair: Yeah, so that I was not happy about. He literally takes one look at my chart and says, “A VBAC? This baby is going to be 12 pounds? Don’t even bother trying.” I was like, “Um, okay.” Meagan: You’re like, “But I’m 10 centimeters.” Clair: Right. Everything is fine. I’m healthy. She’s healthy. Heart rates are all good. We’re doing it. It’s not a question of can I because it’s happening. But he started– I mean, I won’t tell you the things he was telling me about what happens if I should have had a C-section and I don’t and the whole dead baby thing. The nurses were trying to keep him out of the room for me. It was so bad. It turns out later that he did talk to the midwives the next day and was like, “Why did you send her in at all? Why did you tell her she could VBAC?” Basically, he confided in them, “You don’t know what it’s like to be sued.” I guess he had something in his past where he had been sued for something that had happened, so he was just really scared but he was taking that out on me. Meagan: Which is not okay. Understandable, but not okay. Clair: Right, yeah. It took a long time for me to get over this and forgive him for some of the things that he said. Anyway, so my body starts having a stress response. Labor starts slowing. My cervix starts swelling a little bit. Basically, my body is like, “We don’t feel safe here. We’re not having this baby here.”17:49 Clair’s second CesareanI did push for two hours, but contractions weren’t really working the same way. He started talking about, “Well, if it’s an emergency, we have to put you under general,” and all of this stuff so I did end up getting an epidural. I basically got backed into a corner and eventually, we said, “Let’s just call it and have the C-section because we can do it on our terms and maybe get a couple of the things we still want.” We really wanted delayed cord clamping. I really wanted to be able to see her right away which I didn’t get to do with my son. So we felt like if we just called it, we would be able to do some of those things because it wasn’t an emergent situation. So really, for no medical reason, I had my second C-section. She was 9 pounds, 3 ounces and the doctor actually said to my husband after that, “Oh, by the way, your wife has a fine pelvis. There is no reason she can’t birth vaginally. She can totally do this again in the future.” Meagan: Oh gosh. Clair: My husband was like, “I don’t want to talk to you right now about that.” Meagan: Yeah, like get out of my face. Clair: Yeah, after you just did what you did and backed us into surgery, and he just wanted to be able to control the situation. Meagan: Yeah. 19:08 An emotional recoveryClair: So emotionally, it was really hard to recover from that. I had a really hard time just working through some of the things that he had said and the images he put in my mind, but it was physically a lot easier. Meagan: Yeah. Clair: We did move again after that baby, but we only moved within the state so that was easier. We move a lot and we’ve moved with every baby at some point which is kind of crazy. 21:22 Clair’s third pregnancySo that’s my second baby. And then about, I don’t know, 15 months later, we got pregnant with our third. We were pretty excited. We had a really early, early miscarriage between those two and it was still really hard and painful but it was like the day after we found out we were pregnant so that was a surprise and that made us think, “Well, are we ready for another baby?” I kind of just started like, “Yeah, actually I think we are,” even though at the time, I felt totally overwhelmed. So that’s kind of beautiful because if we wouldn’t have had that baby, we wouldn’t have our third right now. We were in the same state. The VBAC laws in the state are pretty lenient so I end up having the opportunity to find a home birth midwife because I just at this point really did not want to go back to the hospital after everything. There really weren’t any hospital practices that I knew of and I kind of looked around a lot that were VBAC-after-two-C-sections supportive. So I look around. I found a home birth midwife. I had a beautiful pregnancy. Kind of in the back of our head the whole time, we were thinking, “If we just stayed home with our daughter, things would have happened naturally. It just would have been fine.” The whole pregnancy, I was a little bit nervous, but I had some really, really awesome supportive friends– the same friend who had a C-section and had a VBAC since then. She was so in my corner and another good friend of ours were just cheering me on the whole time. My midwife was really, really supportive. I did have some fears and worries, but I was just like, “We’re just going to walk it out. I have no reason to believe I can’t birth this baby vaginally.” I was continuing chiropractic care. The friend who had a VBAC had since become a doula. I planned on having her there. 23:38 Third labor with a home birth midwifeClair: I went into labor six days after my due date after this pretty beautiful, smooth pregnancy in the early morning and then again, I was dilated to 10 by 9:00 in the morning. It was five hours later after my–Meagan: You labor beautifully. Clair: Right. At this point, I was like, “I know my body can do this,” but I just had never made it all the way. I was starting to feel pushy. I pushed for hours and hours and hours which turned out to be really hard. The midwife, when I started pushing was like, “We’re going to have a baby so soon,” and then– 24:08 Pause in story – read caption!24:20 Fourth pregnancy Clair: My son was nine months old when we got pregnant with our fourth. Like I said, we had moved to this mountain town in Colorado. We were far away from a lot of things, so it was really hard for me to find a provider in general let alone one who was going to be supportive of a VBAC after three C-sections. I was really open to if I needed to have a fourth C-section, I was open to that. I just wanted to do what was going to be best so I was looking at all of my options. All of our family was back east though and we were looking at support after the baby was born so we were thinking we might go back to Virginia and have the baby there. I ended up doing remote care with my midwife from my previous birth, my last birth, for all of my prenatals. Everything was looking great. The bloodwork looked great. I was taking my blood pressure and checking with her occasionally. I was doing that with her while also looking for a provider and trying to discern what we were going to do for the birth. I should also mention that during this time, I started going to pelvic floor physical therapy. It had been recommended to me a few times, but I never pursued it before. My chiropractors in Colorado had a really strong recommendation for someone that they really liked, so I started going to pelvic floor PT. She found all of this chronic tension that I didn’t realize I had. Actually, my hip pain had come back this pregnancy and releasing my pelvic floor actually took care of my hip pain. It was all referred pelvic floor pain which was so wild, but I felt relief within a couple of visits. She knew really good exercises to be doing during my pregnancy. It also made me more in tune with the rest of my body. I realized where else I was carrying tension and was better in check with my moods, so that was a huge game changer I think. I want to make sure that I mention that because I think that really, really impacted this pregnancy and birth. So we did an anatomy scan at 20 weeks and everything was looking good. It was a baby boy, but we found out he was measuring big which is normal for my babies at this point. Kind of around the same time, I guess, my husband got this really amazing job opportunity in Utah which meant we would have to move again. I was due in October with this baby and we would be moving during the summer. This time, we would move before the baby was born then hopefully have a couple of months to settle in. Because of that, I switched gears and started looking for providers in Utah so that I could have a pretty seamless transition. I found a really awesome midwife. I told her my whole story and when we were in Utah just interviewing and checking it out during the winter, she heard all of my stories and said, “I don’t see why you can’t birth vaginally. I think you are an excellent candidate for VBAC. I would gladly take you on.” Meagan: She is one of the most amazing midwives in Utah, too. Clair: Yeah. She has a ton of experience, too. I love how she has that much experience, so I really felt like she has seen it all. She has seen a lot and if she says I have a really good chance, but also, I totally trusted her to step in if we needed to step in and try different things during delivery. That’s the one thing I felt like could have gone differently with my third baby was maybe we could have intervened a little earlier and maybe that would have gone differently. She also promised my husband that she would be straight with him because he kind of had an experience of people trying to shield him from the truth or whatever in the past just to kind of protect him in the birth process. He just wants honesty, so she was like, “I’m going to be really honest with you the whole time. I’m going to tell you exactly what I think.” It was just a really good fit for our family.28:49 Moving to Utah Clair: I went back and started packing up the house and everything, but I knew that I had a really solid provider waiting for me in Utah. We moved at the beginning of August. I was maybe 30 weeks or so, 29 weeks, 31 weeks, or something like that when we moved. I thought I had two months or so to kind of get settled and unpack the house and everything, then at about 35 weeks, I started having some pre-labor stuff and a few contractions, but I thought they were just really strong Braxton Hicks at night. I lost a bit of my mucus plug and that was consistent for about a week, but because with my second, I had a whole day of labor and then nothing for two weeks, I thought, “Oh, I’ve still got two weeks. Baby will be here right at 37, but that’s fine. I think I still have a couple weeks left.” I checked with my midwife and she was like, “Are you concerned about going into early labor?” I was like, “I don’t think so.” She goes, “Great. Don’t worry about it.” To my surprise on a Sunday night at 5:00 PM coming back from the grocery store to pack lunch for my husband for his first official day of work the next day, my water breaks. I come home and I’m like, “I think my water broke.” He goes, “Uh, okay. This is really unexpected,” because with all of our other babies, I went past my due date and we had been in our house less than a month. I called my friend who is a doula now. I was just kind of out of it. I didn’t really know what to do. She walked me through. “Okay, call your midwife. See what’s going on.” I called her and she was like, “We can check to make sure that your water broke, but if you are pretty sure, you’ve had several children so if you are pretty sure it’s your water, you should just go to the hospital.” She told me exactly which hospital to go to which I was really grateful for because I had no idea where to go and I really trusted her recommendation. Meagan: You were closer to a different hospital, honestly. You could have gone to this other hospital. Clair: Yes. Yeah, exactly. I was so glad that I called her. I walked in and they were like, “Oh, your midwife called ahead for you. Great. Come here. Let’s check you out.” I was at a 5, so I was 5 centimeters dilated already which was crazy. They did an ultrasound just to double-check his position. He was head down which they were happy with. This OB comes in who was on call. She sits down and just says, “Well, frankly, I don’t think a VBAC after three C-sections is too risky, but it’s just risk. I don’t see any health problems right now. You’re fine.” They hooked me up to a monitor. Baby was fine. “So we’re not going to force you to do anything that you don’t want to do. You’re going to make the call.” We were really surprised because when we knew we were going back in a hospital setting, especially after our last two experiences, my husband and I were like, “Whatever happens happens.” He even said, which was so great, “Let me deal with them. You deal with the baby.” Meagan: Mmm, yeah. Clair: “You don’t need to go in fighting. I’ll go in fighting and you deal with the baby.” But then we didn’t even have to fight. They were disarmed right away.Meagan: Which is amazing because especially with preterm– Clair: Exactly. I expected a frenzy and it wasn’t. It was peaceful. We just basically said, “We’re not going to do that. We’re not going to just do an automatic C-section. We’re going to labor.” They looked at my ultrasound, saw that he was measuring big, and said, “We actually would have changed your dates in our practice with this ultrasound so we think you are closer to 38 weeks.” I was pretty confident in my dates because I had been using a monitor to check ovulation and everything. I still felt pretty confident that he was 35 weeks, so I really didn’t want to induce or make labor happen any sooner than it started because I knew that his lungs could benefit from another couple of days in utero. We talked that through a little bit and the next day, there was a new on-call OB. The nurses were great. They listened to our whole story and they were like, “We are willing and ready and prepared to support you.” So the next day, we get a new on-call OB and she just says the same thing, “I don’t think this is a very good idea, but I’m not going to force you to do anything.” She listens to our reasoning both why we don’t want to induce and also about a VBAC and she goes and she calls the midwife who had been supposed to deliver or catch the baby. She says to the midwife, “I actually don’t think this is a very good idea. Why did you send you here? It is really, really risky.” The midwife says, “It’s not as risky as you think it is. Actually, go do the research a little bit. There are not great numbers out there, but what we have isn’t what you are saying it is.” So that doctor actually called a maternal-fetal medicine doctor at a different hospital that she knew and asked, “Hey, what do you think about a VBAC after three C-sections? Would you recommend it for a mom?” He basically gave her the statistics of the risk of complications with a fourth C-section versus the risk of uterine rupture with a VBAC and he said, “The numbers aren’t great, but as far as we can’t be 100% confident. We don’t have–”Meagan: Enough evidence. Clair: “--a lot of evidence, but I would absolutely support her. It’s actually less risky for her to do this vaginally if she can.” This doctor comes back and tells us that. We were shocked. She said, “I actually think a VBAC is the best thing for you and your baby. I’m going to transfer you over to our hospital midwives–” which was wild and so not what we expected. She was like, “Because I think that’s more like the model of care you wanted.” We were just floored because we never– yeah. We never expected that from a doctor. We had never been respected in that way. That alone was just so healing. 35:34 Midwifery care in the hospitalClair: This midwife comes in and I chat with her a little bit. She made sure I got some food. I hadn’t really eaten much since I got there. Meagan: I bet. Clair: It was great. They just really attended to me as a person. I still was not in labor. They weren’t checking me because my membranes were ruptured and she just talked me through that. “There’s really not that much of an increased risk of infection if you are waiting longer as long as you are not doing checks. If you don’t have an infection already, you’re probably not going to get one essentially.” We did lots and lots of things in that 24-hour period. We prayed. We asked for so many prayers from our friends. We called the midwife and chatted with her a bunch. My husband– I joke that he was my daddy doula during that time because we learned a bunch of things during our other pregnancies. We were doing a Miles circuit. We were doing Spinning Babies and abdominal lifts and everything we could think of. I was pumping. They got me a hospital pump to use. I was showering and trying to relax. We even discussed leaving the hospital and going home. We talked that through with them, but I felt pretty confident that once I went into labor, it was going to be pretty strong labor and I was confident he was pre-term. I wanted to stay. My kids were able to come visit which was huge. That was so helpful. I did a lot of fear release conversation with the hospital midwife was a big deal. I was just really worried. My oldest was only four and I was really worried about, can I do this? Can I be a mother to these four babies? It’s so much more manageable when you are pregnant. The baby is inside, so I think that was actually really helpful. I think that was kind of keeping me from labor in a sense. We just kind of did that for the next day. I was sleeping, but I was continually being monitored so my sleeping was really fitful. At 2:00 PM the next day, my nurses from their first shift are back. They were like, “Oh no, you’re still here and you’re not in labor and there’s no baby. What can we do?” I just said, “I’m so tired. I just have not been sleeping well. Every time I roll over, this monitor messes up the baby’s heart rate with mine so people come flying in the room and I just can’t really rest right now.” She talked with the hospital midwife who was on call that day and she really wanted to get things going. She was a little bit more nervous about the length of time my waters had been broken and was stronger with recommending inducing or something. She said, “Yeah. Let’s just get her off the monitors. We have two days of great readings from this baby. Let’s get her off the monitors. Let’s turn down the lights. Let’s get her in a new room, fresh environment, turn the lights down, and let her take a nap.” My husband even left. He went to go get a snack or something outside of the hospital just to totally give me my space.38:47 Active labor beginsAround 3:30, I finally get tucked in for a nap and fall asleep immediately. I was so tired. Meagan: I’m sure. Clair: It was just a lot of mental stress and I wake up an hour later at 4:30 to a rip roaring, super strong contraction. I couldn’t even believe it. I was like, “Oh my gosh. Napping worked.” It was just what I needed. It was like my body just needed to be left alone. Meagan: And even probably you mentally needed to just get out of the moment and just be. Clair: Yes. Yeah. No, definitely. I start timing them and within five contractions, they were all lasting over a minute. They were all about a minute and a half to three minutes apart. I call my husband. I’m like, “You’ve got to come back to the hospital right now.” They were really strong too, like super, super strong. Meagan: And keeping in mind you were 5 centimeters so you could be tipping into that transition active labor from no labor. Clair: Right? Meagan: No labor to active labor. Clair: Yeah, just thrown right into it. Yeah, it was wild. I felt like I was kind of behind from the beginning like I couldn’t get on top of it for that reason. It was really intense. I called the nurse in the room because I needed to go to the bathroom and I wanted to stand up, but I was like, “I don’t know what’s going ot happen when I stand up, so I’m going to call her in.” She came. She observed me in between some contractions and was like, “I think the midwife should come.” I was like, “No, it just started. Don’t worry. Don’t bother her.” She was like, “No, really. We should get the midwife in here.” The midwife comes in and checks me. I’m only at a 6 so I was a little bit discouraged because it had been a half hour-45 minutes of these strong contractions at that point, but 90% effaced. Baby was dropping. Everyone in the room was like, “This is really good news.” I was like, “Yeah, there is still a lot of work to do.” I just refused to accept that. So I’m kind of wandering around the room just laboring standing up in different positions and supported by a nurse sometimes, then I end up kneeling on the ground and laboring over a couch just leaning on it. The contractions really picked up. There really was not much of a break between them at all so I felt like I couldn’t release the contraction. Everything you hear is like, “Release the contraction. Let all of the tension out of your body,” and I couldn’t do any of that. So I’m telling my husband, “I need an epidural. I’m not going to be able to do this for a long period of time. I’m not getting any kind of a break. I can’t relax.” Meagan: You were already so tired. Clair: Yeah. I need an epidural. I’m not going to be able to do this naturally even though that’s what I planned. He was like, “No, you’re fine.” I was so mad at him, but he would look at the midwife, I guess I found out later and she was like, “No, this is happening.” She was really encouraging him, so he was like, “Nope, you don’t need it. We’re going to be there really soon.” Meagan: Good daddy doula, I guess, there. He knows what you want and will help you get it.Clair: Exactly. Exactly. I’m not saying he was just ignoring me– Meagan: Right, but he was like, “Ah, she’s got this.” Clair: Yeah, exactly. I guess the midwife had observed some kind of a change in me because at 7:00 PM– this is 2.5 hours after these contractions start– she checks me again and she asked to check me. I was at 10. I was feeling pushy, but not in the same way I had before with other labors, so I was surprised. All of the nurses in the room were like, “This is great news!” In my head, I’m like, “I’ve been there before. I’ve been there three times before. It is not over yet.” I was still very much in the mindset of, “No, we’ve got work to do.” I end up trying a couple of different positions to push. I end up pushing on the hospital bed kind of supported by pillows on all fours. They put the back of the bed up and I pushed there for about a half hour or so, maybe 20 minutes in. They were like, “Oh my gosh. We can see the head. This is so great.” Because of my third baby, I was just like, “That’s news, but it’s doesn’t mean it’s over.” Meagan: Not what I need quite yet. Clair: I’ve been here before. So I end up, yeah. I was just kind of like, “I’ve been here before.That’s not news to me, I guess.” But then I really felt a ring of fire and I was like, “Oh my gosh. This is actually happening. This is a new thing. This is a new sensation. This is a new place that I haven’t been before.” So I end up, yeah. He ends up being born. I pushed with all my might. The midwife had to tell me, “Chill out. Slow down a little bit. You don’t want to tear.” But yeah. It was just so beautiful. I was able to birth him vaginally and then they were like, “You have to roll over so you can hold him.” They were telling me what to do because I was in such disbelief when I was born. I got to hold him skin-to-skin for the first time of any of my babies which was such a gift. My husband cut the cord after it stopped pulsing and it was so peaceful. A couple of the nurses were crying because they had been there and were really invested in our story. The midwife was like, “You reminded me why I’m in this field. This is such a beautiful, redemptive story. I’m so happy for you.” I did have a small, little first-degree tear but it really wasn’t bad. He ended up being 7 pounds, 7 ounces so I’m pretty confident that he was late pre-term because that is still small for my babies. Meagan: Yeah, because they are normally 9. Clair: So he was definitely earlier. 45:04 Circumvallate placenta I had a circumvallate placenta which is where part of the placenta turns in on itself when it is developing so there is a smaller area where the placenta can adhere to the uterus. Sometimes that can be related to IUGR and a couple of other things, but it’s really hard to find via ultrasound. I kind of researched it later and sometimes, it’s cause for big concern but there’s really not much to do about it. There’s just not a whole lot to be done. I’m glad I didn’t know that because I feel like would have been a source of worry but unnecessary worry because there’s nothing I really would have done differently in my pregnancy. Meagan: I wonder if that was your body being like, “Okay, it’s time. I’m done doing my job. Now get the baby out.” Clair: Yeah, it can also be associated with pre-term or early labor. Meagan: Okay. Clair: Yeah because I was trying to find a reason. This was so strange. My midwife wasn’t worried about it at all. She was just like, “Oh, interesting. Look at your placenta. This is so cool.” Meagan: In all of the years of encapsulating them, I’ve never seen one like that. Clair: Yeah, it’s kind of rare but also, yeah. They’re not sure why it happens. I don’t know why it happened. Some people say babies that gestate at elevation are sometimes smaller too like at high, high elevation and they come earlier so I’m wondering if maybe that can be connected. I don’t know if there are more placenta abnormalities in that way at elevation. I don’t know. But yeah, he had great APGARs. He latched super well. It was so cool. The first OB that I had called me the next morning in the hospital room just saying, “Congratulations. We’re go excited for you.” My second OB, the one who basically said, “I think this is the right thing for you to try,” came to the room because she was on call again and she congratulated me and just said, “Thanks for letting us be a part of this. This was so impactful to everybody in our practice.” Meagan: Yeah. Clair: I don’t think they would have taken me on as a client upfront. Meagan: Probably not. Clair: For them to see this, and then I talked to the head midwife of that hospital OB/midwife practice and she was just saying that this is their hope that more women who really can labor without intervention or are given the chance to labor without intervention is kind of their goal. She was so happy that so many of the people in her practice got to be a witness to that because they really got to see what happens especially down to napping and leaving me alone is what helped me go into labor. Meagan: Yes. There was a lot of learning happening on all of their behalf, from the OB side, on the nurse side, on the midwife’s side, there was a lot of learning. What I love so much is when places see births like this after– I mean, I’m not saying the midwives or anything. I think the OBs were originally like, “I don’t think this is a good idea,” but then seeing it happen, it’s like, “Okay. Let’s take a step back,” because so many hospitals around the world just shut people out. “No.” They might not, like you said, have supported you walking in. “I’ve had three C-sections. I really want to have a VBAC.” She probably would have said the same. Maybe she wouldn’t have, though. Maybe she would have said, “I don’t know if it’s a really good idea, but we can support you and let you go.” But would it have been the same situtation? I don’t know. They are one of my favorite hospitals in that direction up north, so I love hearing, I love hearing all of this. And then to the point where the OB is like, “Hey, I recognize you are in my care, but I know you came from this care. Why don’t we put you back in that model of care because we offer that here?” Just these fine details that these providers paid attention to was a huge deal. Clair: Absolutely. Absolutely. It’s funny because I had a feeling that whole pregnancy that I was going to have a hospital VBAC. Meagan: Really? Clair: It was in the back of my head. “I think I’m going to end up in the hospital, but I also feel like I’m going to have a VBAC. I don’t know,” but it was this weird thought because I definitely was not going to pursue providers in the hospital, so yeah. The fact that that happened, I was like, “Wow. This is just so crazy for those reasons.” Meagan: So awesome. Clair: Yeah. I just really feel like not being afraid to voice what we wanted was such a big part of this because if we hadn’t spoken up, even though they were very, very willing to listen and were receptive, we didn’t know that so we went in saying, “This is what we want and this is why we want it.” I think that having a conversation where you think the doors might be closed is good to have. Now, it’s also good to be aware of when a provider is not actually going to be supportive of you, but in our case, we really didn’t have any choice. We were where we were and just to, I think, the more calm conversation that is had and the more providers can experience births like this, the more it will become normalized which is really the goal here. Meagan: Absolutely. Well, huge congrats on your beautiful birth and I’m so happy for you. I just love hearing how it all unfolded even though in the beginning and at the end, it wasn’t exactly– well maybe I guess it was something that you envisioned, but what on paper you were putting out that you envisioned this birth center birth with this awesome midwife, but I just love how it unfolded so much. Clair: Yeah. It was so healing for my husband. It was so healing for me. Yeah.” Meagan: Good. Good. Well, thank you again for being here with us. Clair: Thank you.ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Feb 21
51 min
Episode 276 Samantha's VBAC with a Special Scar & Gestational Diabetes
We are following up on last week’s informative episode on gestational diabetes with a gestational diabetes VBAC story! Samantha’s first labor ended in a traumatic Cesarean with her first baby, but she didn’t find out many details of what happened to her until she requested her operative report months later. Samantha found out that she had a lateral scar extension. Despite this and other odds that felt stacked against her (i.e. her gestational diabetes diagnosis!), Samantha was determined to do absolutely everything in her power to put her in the best position to achieve her VBAC. And she DID!Additional LinksLeslee Flannery’s InstagramNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Timestamp Topics2:18 Review of the Week6:32 Samantha’s first birth story  9:37 Scheduled induction13:04 Complete dilation, pushing, and stalling15:49 C-section22:15 Official reason for C-section25:15 Recovery26:57 Second pregnancy42:46 Labor52:34 Feeling pushy55:42 “You’re not going to need a C-section today.” 1:02:39 Finding supportive providers1:05:53 Prep tips for listenersMeagan: Hello, hello you guys. It is likely a cold winter morning or afternoon. At least here in Utah, it’s February and I don’t know. It’s not something that was intentional, but it seems like this month we are talking about gestational diabetes. We talked about it last week and coincidentally enough, the story today that we are recording talks about gestational diabetes today. So I’m excited to dive more into that and talk a little bit more about that. We were talking about this just before we started recording. It’s becoming more common but it’s not talked about enough so it’s probably fitting that we are doing two episodes this month on gestational diabetes. We have a really great story for you today. We have a C-section that was begun with an induction then she got a double-whammy with an asynclitic and a posterior baby. I’m really excited to hear what your diagnosis was on that, Samantha, because I always get so curious when we know we had fetal positioning if we get that CPD diagnosis and things like that. 2:18 Review of the Week But of course, we have a Review of the Week so I’m going to share this and then we will dive right into Samantha’s story. This was by lindseybrynneohara. Shoot. I always butcher names. It says, “An invaluable resource. I found The VBAC Link shortly after my first daughter was born via Cesarean after a planned birth center birth. My second turned home-birth Cesarean as well. I have found a home in a CBAC (Cesarean Birth After Cesarean).” You guys, for everyone that doesn’t know this, if you’ve had a Cesarean birth after a Cesarean, please know that we have a group for you too. We know that sometimes after not having a vaginal birth, it can be hard to be in a VBAC group, so we have created this Cesarean birth after Cesarean group and it’s amazing. She says, “I’ve found a home in the CBAC group these ladies put together. It helped me through some dark days of postpartum and processing my unplanned repeat Cesarean. You can find VBAC groups all over the place now, but a group for those mamas who are grieving the loss of their VBAC, they can’t find. Not so much. This is a very special group where I feel completely supported, heard, and respected for a birth I sometimes struggle to call mine and my baby’s. I am now diving into all of the VBAC after two Cesarean and VBAC after multiple Cesarean content from over the years and I am finding so much comfort and hope in these brave women who have come before me. I just have this strong feeling I will get to be one of them.” Ooh, that just gave me the chills. “I hope to share my story with you when that day comes. I’m learning so much about birth and myself as a birthing woman. I thought I was informed for the first time, but there are so many layers of understanding past births and planning for future births especially when C-section is involved. Thank you for the well-researched evidence-based content and special stories.” Wow. That review literally gave me chills and made me emotional. You guys, when Julie and I– Samantha can see my eyes. No one else can, but really, they are tearing up. When Julie and I created this group and this podcast and this course, this is why we did it– to help people feel exactly how she was describing. To feel loved, to feel heard, to find a place of education, and to understand that you’re not alone because sometimes it can feel so lonely. Just so lonely. So thank you for that review. I am literally crying. Thank you for that review from the bottom of my heart. As you can see and as you know, we love reviews. They truly make everything that we do. It warms our hearts. It helps people just like you find this podcast. It helps people find the course so they can find the information and it helps people find that Facebook group. You can leave it on Google. You can leave it on Apple Podcasts. You can leave it on social media. You can leave it on Facebook. Message us. Wherever. If you love The VBAC Link and you have something to share, please let us know because we absolutely from the bottom of our hearts love it. 6:32 Samantha’s first birth story Meagan: Okay, Samantha. Now that I’m trying to soak back up the tears that wanted to flow, I mean, I don’t know. Yeah. Sorry for being so vulnerable here. Samantha: No. Meagan: Wow. That just touched my heart. But now that I can see the screen again, I would just love to turn the time over to you. And also, thank you for being here with us. Samantha: Thank you so much for having me. I’m so excited. This is my second goal after getting a VBAC. I need to be on The VBAC Link’s podcast. Meagan: Oh. Samantha: But same thing as the review was saying, it’s an invaluable resource. I had no clue what I didn’t know going into my first birth, 100%. My story starts in 2020, I guess. I found out I was pregnant in August on my birthday, actually, I found out. Meagan: Happy birthday to you!Samantha: That was so exciting. My pregnancy went super well. I had a bit of leg pain at some point, but I was seeing a pelvic floor physio. She fixed me up really well and everything was perfect. I had an anterior placenta so I learned a little bit about that, but it shouldn’t have been a problem so it was fine. I was due May 7. That was the due date that they gave me. I don’t think it was necessarily accurate. I think I was due a little bit later. I think the 11th or 12th. I was tracking ovulation and stuff like that. So at 39+5, I had my doctor’s appointment. He sent me for a growth ultrasound. Had I known what I know now, I would have said, “Nope. No, thank you.” 8:19 Blurry vision and feeling offBut he was estimated at being 7 pounds, 10 ounces. Then the week after, Tuesday night, I had this weird episode I want to call it. I was sitting on the couch and all of a sudden, my vision got blurry. I ended up with a headache and I was waiting to see if I should go in or not. I felt off. In the end, I went into labor and delivery because it was the height of COVID. I didn’t want to go to the emergency room and all of my symptoms had subsided by then. They thought it was an optical migraine. He said, “Look. We can’t do anything for you. You’re having some contractions. Nothing crazy.” I wasn’t feeling anything, so they were like, “Look. You have your doctor’s appointment tomorrow. Just talk with them.” Meagan: Talk to them there. Samantha: Yeah. So the next day I went in and he was like, “Oh, it was probably just an optical migraine. You’re fine now, so whatever.” Meagan: I’ve actually never heard of that. Samantha: Right? Meagan: Optimal– Samantha: Optical, like in your eyes. Meagan: Optical. Interesting. Samantha: Strange. But it put me a little bit on edge so that’s why I’m telling that part of the story. Meagan: Yeah, set the story. Samantha: He told me, “You’re almost 41 weeks. It means you’re overdue.” I’m like, “Okay.” He’s like, ”The rate of stillbirth goes way up now.” I was like, “Oh, jeez.” Of course, that puts fear right into your heart.9:37 Scheduled inductionHe’s like, “We’re going to schedule the induction. It’s going to go great. It’s going to be amazing. You’re going to have your baby in the next few days.” He’s like, “Look. We’re really booked next week so I’ll set you for Thursday. Thursday, first thing in the morning, come in.” They call me. They were like, “We are ready for you.” I got there at 9:00 AM. The plan was to put a Foley bulb in, but the doctor who was on rotation at that time came in and said, “You’re already 2 centimeters. It’s not worth doing the Foley bulb at this point. We’re just going to start you on some Pitocin if that’s okay with you.” I was like, “Okay. Whatever you say. I trust you. You are a doctor.” Had I known. Anyway, we stayed in that room until 5:00 PM that night because they didn’t have a room to start Pit yet. So from 9:00 AM until 5:00 PM, I was just sitting there having random contractions that I never felt and wishing. I had a gut feeling. I told my husband, “We shouldn’t be here. I shouldn’t be induced. This is not what I want to do.” Meagan: Oh really? Samantha: But I didn’t know I could leave. I didn’t know that it was a thing. Meagan: Women of Strength, it’s a thing. It’s a thing. You do not have to be there. Samantha: There was nothing abnormal about the baby’s heartrate. There was nothing going on. They did a mini ultrasound just to check his position. He was head down. That’s all I knew really. I was at a -2 station. I was 60% effaced, 2 centimeters. Everything was fine. My body was fine. He was fine. We started Pit at 5:00 PM, but they were ramping it up quite quickly. I wasn’t feeling anything at this point. Meagan: They took forever and then ramped it up. Samantha: Yeah, they were like, “Hello, welcome.” Finally, they broke my waters the next morning at 6:00 AM. Meagan: Do you know what dilation or what station you were at that point? Samantha: I was around 3.5 centimeters at that point. Meagan: Okay.Samantha: Yeah. They were like, “You’ve progressed a little bit, but you are not moving fast enough for us.” Okay, cool.Meagan: Oh, so they broke the water real early. Samantha: Yeah, because they checked me at 1:00 AM and he said that baby was still too high to break the waters so he was like, “Okay, we will wait until the morning.” I was still the same dilation so he was like, “Okay, let’s do this.” I was like, “Okay, whatever you say.” They did that, and then all of a sudden, the contractions got real. 100% real. So by 10:30, I decided to get the epidural because they were messing with the Pitocin like crazy. They kept upping it. My contractions were back-to-back. I had no break. It was insane. I was like, “What is this? I can’t survive this.” Meagan: Yeah. Samantha: I was 5 centimeters at that point and I was like, “I still have halfway to go. That’s a lot.” I got the epidural and my nurse was really fantastic actually. She got the peanut ball for me, put me in the bed, was rotating me every 30 minutes. She was actually my biggest happiness point. She was amazing.  Then my doctor, my actual OB wasn’t on call that weekend and he had left a note in my file saying that if I gave birth while he was there he wanted to attend because he had seen me since I was 18. We had this really good relationship. So he came to see me and he was like, “I’m leaving for the weekend. Good luck. I’ll try to come visit you after the baby’s born.” I was like, “Okay, bye. I wish you had been there, but you know, Cest la vie.” 13:04 Complete dilation, pushing, and stallingMeagan: Yeah. Samantha: so then at 4:30 PM I was complete. It went pretty quickly from 10:30 to 4:30. I had done the rest of the remaining 10 centimeters, but they said the baby was still quite high, so they gave me two hours to labor down. Well, they said two hours. It ended up being about three. Then there was a change in staff and that’s when things stopped going well, unfortunately. My nurse had to leave. She said her son’s birthday was the next day. I was like, “No, don’t leave.” She was like, “I was asked to do overtime, but I really have to go.” I was like, “I get it. Go ahead.” So then this new nurse comes in with a student doctor, a medical student of some sort. It’s blurry because I was at 10 centimeters and ready to push, but things were really awkward between this nurse and the doctor. He wanted to get in there and help and she was like, “No, this is my job,” so he left and then he came back and he was like, “I was told I have to be here.” She was like, “Okay, fine,” so she came and sat next to my head and let him do whatever he had to do. You know, that type of thing. But it was super uncomfortable in the room. Meagan: Weird. Samantha: Yeah, it was so weird and I was so uncomfortable. Anyways, so then I started pushing and they told me his station was about +1 or +2, but he never moved in the hour that I was pushing. He stopped tolerating when I was on my right side near the end. Meagan: Didn’t like that. Samantha: Yeah. I had horrible heartburn too. I felt like I was going to throw up fire. So fun. So finally, we pushed for an hour. The doctor on call came in, didn’t even look at me almost, didn’t really introduce herself, nothing and just said, “C-section.”Meagan: Whoa. Samantha: I was like, “Excuse me?” At that point, I had a bit of a fever. They gave me Tylenol. They said it could have just been from being in labor and from pushing. I was like, “Okay, whatever you say if that’s normal.” They were like, “But we have to get you to a C-section now,” because he had a decel for 4 minutes at 70 beats per minute. They were nervous. At this point, the medical student had his fingers inside rubbing the baby’s head to get him back. Meagan: Yeah, sometimes they do have to stimulate the baby. Samantha: Yeah. Between every push, he was doing that. Then this one was the final, I guess, they called it there. It was really strange. She’s calling a C-section. She was like, “I’m going to call the doctor.” I’m not sure if she meant the OB or the surgeon. She goes off. The nurse is still getting me to push. I’m like, “How is this an emergency if I’m still pushing?” I was so confused. Meagan: Baby’s heart rate returned at this point, I assume. Samantha: Yes, exactly. It was just very strange. 15:49 C-sectionSamantha: Anyways, so then they wheel me down to the OR. We had to go to the regular operating room because they only have certain hours during the day from 9:00 to 5:00 which I guess is when they do the special delivery OR. Meagan: Interesting. Samantha: Yeah and it was a Friday night, so we went to the regular OR. The nurse and the anesthesiologist were amazing. They took pictures and stuff like that before. They gave me the spinal, then my husband was allowed to come in while they were doing the test cut. I didn’t feel anything so he was allowed in. Meagan: It worked, yeah. Samantha: Yeah. They didn’t tell me much during the surgery at all. I don’t even remember meeting the actual surgeon other than them saying, “This is so and so. He’s going to do your surgery. He’s great. Don’t worry about it.” I was like, “Okay. Do what you’ve got to do.” I never heard from this man ever again. He didn’t come to see me post-op. Meagan: Stop, really? Samantha: I don’t know who this person was, really. The person who cut into my body never came to talk to me after. I had no clue what happened. Anyway, so it seemed to go pretty routinely. He was pulled out at 9:13 PM. He was 7 pounds, 10 ounces so what they told me he was a week prior was what he was that actual birth. His APGAR scores were 9 and 9 so he was not in distress. Meagan: He was doing okay, yeah. Samantha: Yeah. My husband cut the cord. Everything was fine. Then they brought me to the recovery room, but it was the general recovery room because L&D was closed for the night so I was left alone. My husband took the baby and went to postpartum. When we got there, the nurses said, “Oh no. Not another one.” Yeah. Meagan: Like another C-section baby or another person? Samantha: Any baby. Another person. Yeah, and he was like, “I feel great.” He has all of our bags. I had my boppy. I had his bag. He’s carrying everything. He’s got the baby in the pushing cart thing and nobody is helping him. They just shove him in a room in a corner and they say, “Do skin to skin. Here. Change his diaper. Done.” They left him there for four hours with a baby. Meagan: Four hours? Samantha: Four hours and didn’t go check on him. Meagan: Oh my gosh, I’m so sorry and you were still in that recovery room for four hours? Samantha: My bloodwork and all of my vitals were all over the place because I had hemorrhaged which I didn’t know at the time. I was shaking uncontrollably. I kept on falling in and out of sleep. I guess they had given me morphine. I was so itchy. The whole time, I’m just worried because you hear about the golden hour, the golden hour. I was freaking out the whole time because my plan was to breastfeed and I was freaking out. So then a nurse comes at one point and she’s like, “Here. Call your husband and ask him what the baby weighed.” I was like, “Okay.” So I call him and he was like, “Yeah, he was 7 pounds and 10 ounces.” I was like, “Okay,” then the nurse was like, “Okay, give me my phone back.” I was like, “What’s going on here?” I was so confused. It just didn’t make any sense to me what was going on. So finally after four hours, they brought me back up because I guess the spinal had worn off and my vitals were stable enough that they could move me. I got there at 1:15 AM. I finally got to meet my baby for real. They had only brought him over for a picture. He was on my chest for 30 seconds and they were like, “Let’s go.” That was that. I found a lot of things after the surgery. I found out I had hemorrhaged because I needed a blood transfusion the next day. I never found out about the extension on my scar until I got my reports when I got pregnant the second time. Meagan: Because no one came in and talked to you. Samantha: Nobody. The medical student came to talk to me about the transfusion. Meagan: And in a controlled– an extension for listeners, she now has a special scar. Samantha: I got it after and it was because of my pelvic floor physio that I had an inkling of it because I went to go see her and she said, “Your exterior scar is very long.” I was like, “Oh, well they told me he got stuck. He was pretty stuck.” They said they tried to push him up during the C-section. He didn’t really move so they ended up using the forceps in my C-section which I found out from the pediatrician the next day. I had no clue. Meagan: Really? Samantha: Yeah. Meagan: Wait, so they used forceps externally pushing up or with you cut open?Samantha: Yeah, with me cut open I’m pretty sure because he had the marks on the sides of his head. Meagan: So that’s where the special scar came from. Samantha: Yes. They cut me further to get him out and so he ended up with a huge hematoma on the side of his head because he was OP and asynclitic. They told me his chin had been extended as well. Meagan: Triple whammy. Samantha: I don’t know what happened to this poor child. Meagan: The baby was high and we broke waters in a less than ideal position and he came down and said, “Whoa, the flood gates just opened,” and came down in a wonky position. Samantha: Exactly. It was great. Meagan: Then we had Pitocin cramming him down there. Samantha: Yes, exactly. So when he came out, he had that huge hematoma on his head that they told me would resolve on his own. He had a pretty intense torticollis looking back now. In all of his pictures, he’s got his head completely to his shoulders, this poor child so he did chiro and everything for that. Meagan: Sideways, yeah. Samantha: And I burst all of the blood vessels in his eyes by trying to push him out so hard. So poor baby. Meagan: Oh my gosh. Samantha: Yeah, so my milk took a lot longer to come in because of all of the trauma. Meagan: And blood loss I’m sure. Samantha: Exactly. He was jaundiced. He lost more than 10% of his weight because they had pumped me so full of liquid that he probably lost all of the excess weight that wasn’t true weight. Meagan: Yes. Samantha: But they didn’t explain that to me so they were all panicked. Meagan: So in retrospect, he was probably smaller than 7lb,10oz. Samantha: Exactly. Yeah, and he also had a tongue tie that we ended up revising at 4.5 months after trying absolutely everything not to, but we did it and everything went well other than that. Our breastfeeding journey was a bit tough at the beginning. But, you know. 22:15 Official reason for CesareanMy official reason for Cesarean was the arrest of descent and fetal distress. Meagan: Okay. Samantha: Yeah. The worst part is in the report, they didn’t mention the forceps in some of the reports. Some of them do have forceps in them. Honestly, I don’t know what happened. It was on some reports, some not. It was very confusing, but it did have the extension on there. They said it was a 4cm extension on my uterus. That’s where the hemorrhaging happened because they hit that nerve on the side apparently. Meagan: Oh. Samantha: Yeah. That’s what the doctors at the new hospital where I gave birth to my second told me when they reviewed my chart. She was like, “Okay. This is what happened to you. It shouldn’t be a huge red flag for your next birth. You didn’t hemorrhage just because. There was a reason.” Meagan: Yeah. That probably actually was nice for you to find out and have that validation a little bit. Samantha: Exactly. On the report, it said my waters had been broken at 6:30 on the night of the 13th when they were broken at 6:30 AM on the 14th. They recorded it as being 12 hours longer than I had my waters broken. Meagan: Interesting. Samantha: So I was like, “Hmm. That’s nice. That’s nice to know.” They never mentioned my fever and they reported that I pushed for two hours, not one. Meagan: Wow. Crazy. Samantha: Yeah. I was very upset when I read these reports. Meagan: Did you have gestational diabetes with this baby? Samantha: Nope. My sugars were completely fine. Meagan: Crazy. Crazy. Samantha: In the moment, I didn’t realize how traumatizing the birth was. I was like, “We’ve got to do what we’ve got to do.” Literally, I said, “Put my big girl pants on. Let’s go.” But it’s when I was going through it in my brain and talking about it that I realized how much it affected me. Meagan: Absolutely. Samantha: That was a huge part of my VBAC prep after. I read “How to Heal a Bad Birth”. I did all of that. Yeah. It was intense. And something they never tell you about C-sections– I had the worst gas pain in my shoulder. Meagan: Oh yeah. It gets stuck up there. Me too. With my second C-section, no one told me that either and I was like, “What? Is this my milk? What is this?” I didn’t know. This was literally what I said, “I want to stab a knife in there to release it,” because it was so strong. Samantha: Right? I thought I pulled every muscle in my body from pushing and it was just gas. Meagan: Our body cavities get air after being cut open and sometimes it can get trapped and it travels up to that shoulder. Samantha: It was the worst so just for anybody thinking they are dying from something when they are just healing from a C-section. You know, it’s fun. 25:15 RecoveryRecovery went pretty well. I was seeing a pelvic floor physio and did a ton of scar mobilization. We were always working on the scar especially because it was huge. It was so long. That was part of my prep even before I got pregnant. Then at my 8-week postpartum– it’s supposed to be 6 weeks but it was just delayed and it was on the phone because of COVID so that was fun recovering from a C-section not knowing if your scar looks okay. They had put Steri strips to close the scar and said, “They should fall off within a week.” Four weeks later, they were still on. I wrote an email and I was like, “Do I take these off?” I started Googling and it says it can cause infection. I was like, “Oh, great.” So another thing they didn’t really advise me on so that was fun. Meagan: They didn’t give you good post-op care. Samantha: No and we were in a semi-private room. It was just uncomfortable. It was not a great experience. One of the nurses made me cry and it was hard to make me cry in those first few days. I was completely numb and done. I was a shell of a human, to be honest looking back on it, and she managed to make me cry. She came in and she was like, “You didn’t do this. You didn’t do that.” I was so overwhelmed. I had a brand new baby. Meagan: I’m so sorry. Samantha: It was not great. So at my 8-week postpartum appointment, I asked about VBAC. My OB was like, “Yeah, you’d be a great candidate. You got to 10 centimeters. You were pushing. Everything is great.” So I was like, “Excellent.” He was like, “Just make sure that your births have to be two years apart.” I said, “No problem. I have marked it on the calendar. We’re good.” 26:57 Second pregnancySo then I did end up getting pregnant really easily again. My due dates were a week apart. Meagan: Oh no way. Samantha: Yeah, so this baby was due on the 22nd. Meagan: Okay. Samantha: Because my son was born on the 14th, but his due date was the 7th but they ended up being a week apart. I was like, “Well, I got my two years. There you go.” Meagan: So they are 24 months apart? Samantha: Yeah.Meagan: Oh, they are. Okay. Samantha: Exactly. I went to see my OB at 10 weeks. That’s when he sees you. He sent me for an ultrasound early around 8 weeks just to make sure everything was good. I was pulled from work because of COVID and for violent children. I’m a teacher, so we just had to make sure that everything was viable and everything. We did that. I went to see him at 10 weeks. First, he tried to date me earlier than I was. I knew for a fact that I was not again. Again. I was like, “No. We’re not playing this again.” Meagan: Good for you. Samantha: I had my appointment with him and he told me. He started saying, “I think your best option would be being induced at 39 weeks. But I can’t make you do anything. But I need you to go into labor spontaneously before 40 weeks if you’re going to have a VBAC.” I was like, “Hmm.” Meagan: Red flag. Samantha: Exactly. I had started listening to The VBAC Link at this point so I was like, “That’s not good. Okay.” I spoke to my chiropractor who was working on my son who had helped him with his torticollis and everything and she said, “The secretary had a VBAC and with this doctor at a different hospital so I’ll text her. I know her well. I’ll text her. I’ll get you in.” She got me in with this new doctor.I went to go see her and she was like, “Yeah. You’re a great candidate for VBAC. I don’t see a problem.” I brought her my operative notes because she had to wait for them to be transferred. She was like, “The extension worries me a little. I just want you to get checked with a specialist.” Meagan: I was going to ask you if she said anything about your special scar. Samantha: Yeah, she did. I made an appointment at the special, I guess it’s maternal-fetal medicine. Meagan: MFM, yeah. Samantha: It’s called [inaudible] in French. Everything is in French, so it is at-risk pregnancies. I had to go see a specialist there. I made my appointment. I waited and I was panicking. I was like, “I need to have this VBAC. I need this.” I show up to my appointment. I waited for five hours then we were told the specialist had to be called for a C-section. I was like “I get it. If I were that person and I needed extra hands, I get it.” But then she told me, “You haven’t even had your ultrasound for 12-13 weeks.” She was like, “There’s no point in me looking at your dossier” or whatever.” I was like, “But it’s not about anything except for my extension.” She was like, “No, no. Just make another appointment after your ultrasound.” I left there in tears panicking still. I was like, “I don’t know if I can even try for this VBAC. I may just have to sign up for another surgery. We don’t know.” So I went back a few weeks later. It was about a month later. It was a long time I felt panic and nerves. So then I saw this other doctor and she was fantastic. I literally left that appointment telling her I loved her. She was so nice and evidence-based. She took out files and showed me statistics and everything. She explained my previous birth. Meagan: Wow. Samantha: She was fantastic. She was like, “You made it to 10 and you were pushing. The baby was just in the wrong position. You’re a perfect candidate.” I was like, “Okay.” She was like, “And the extension is lateral so it was all in the same direction.” She said, “Same direction or low, we have no problem with. It’s if it goes up that we start looking at things a little bit more seriously.” I felt super relieved after that. She told me the reason for my hemorrhage. It was her who told me. She asked me, “Did they try different positions?” I said, “No. They moved me from side to side but pushing, I was all on my back.” She was like, “We would have gotten you up on hands and knees. We would have done squatting. Did they try to manually turn him?” I said, “Absolutely not. Nothing happened. They literally left me on my own.” She was like, “We would have tried all of those things.” It really validated my whole experience. Meagan: Absolutely. Samantha: She is known for doing VBAC after two Cesareans as well. She is one of the only doctors at that hospital who will do it. She is amazing. So that relieved me a lot.In between that, I hired my doula from a company called Mother Wit. She was fantastic. Her name was Megan Tolbert so I felt like I had a little bit of VBAC Link having a Megan of my own. Meagan: I love that. Samantha: I was seeing a chiropractor every two weeks and near the end, once a week. I did pelvic floor physio once a month. I did acupuncture once every two weeks and near the end, I did three intensive types of get-me-into-labor sessions. I did massage therapy just to relax myself because I was pretty high-strung. I did the dates starting at 36 weeks but that was also with the GD diagnosis. It was rough. I did red raspberry leaf tea. I did pumping and hand-expressing colostrum. I had read how important that could be for a gestational diabetes baby. That was something that was really important to me because I had been separated from my first for four hours. I was like, “This poor child didn’t eat.” I brought my colostrum with me to the hospital and it can help with their sugars. That was really important to me. I walked every day. I did curb walking. I did Spinning Babies Daily Essentials. I read How to Heal a Bad Birth. I read Birth After Cesarean: Your Journey to a Better Birth. There was one story on GD in that book. That’s why I bought it. Meagan: Hey, listen. You’ve got to find the stories, right? Samantha: It was so hard to find gestational diabetes stories at the time. It was really rough. Meagan: Was there a lot of emphasis on your diagnosis of gestational diabetes? Was there a lot of, “Hey, you’ve got to do this? This has to happen,” Or anything like that? Samantha: They weren’t as on top of things as I thought they would be because the doctor I was seeing was a family doctor. She was a GP so everything above a healthy, regular pregnancy, she would send me to the at-risk clinic. They were really the ones who dealt with that. She had sent me for just routine bloodwork. My fasting numbers came back borderline so she was like, “Look. Now you’re going to have to do the 75-gram three-hour test, two-hour test, sorry, here.” I did that. I had a gut feeling my whole pregnancy that I had gestational diabetes for some reason. I had no proof. No proof, but it just kept on popping up. It was so weird. I had a feeling that morning and I got my test results that evening. It was really fast. I did them privately. It was 5.3 so here it is measured a bit differently than in the US, but I don’t remember the conversion. But the cutoff was 5.2. So at 5.3, I was just over but because gestational diabetes usually gets worse before it gets better, they are very safe in diagnosing. But I never actually got an official diagnosis. I just had the prescription sent to the pharmacy for my monitor. Meagan: Insulin? Samantha: No, thank goodness. Meagan: I was like, what? Samantha: They were like, “You are booked for the information session in two weeks.” It was two weeks after and they sent you some documents to read over. So I was like, “Okay. This is not enough. I need to find more information.” I spoke to friends. I ended up on a Facebook group called gestational diabetes Canada which was amazing and I ended up following somebody on Instagram named Leslee Flannery. She was fantastic so if anybody needs her, look her up. She is amazing. Meagan: I’ll have to look her up too. Samantha: She is @gestational.diabetes.nutrition on Instagram and she is just fantastic. She really normalizes it because there is so much stigma with gestational diabetes. You think that you caused it and she really debunks that. I really got in my head about that and I was really afraid for my VBAC chances because if you end up on insulin, they really want to induce you by 39 weeks so I was panicking which doesn’t help your numbers by the way. Meagan: It doesn’t. We talked about this in last week’s episode. We talked about cortisol not helping, lack of sleep not helping, and yeah. It’s crazy but cortisol raises things. Samantha: Exactly and for me, it was only my fasting numbers that were the problem. Those are the hardest to control because apparently, those are the ones that are influenced the most by hormones and by your placenta. So that was really rough. Meagan: Yeah. We talked about that as well. We talked about choline and certain foods and not cutting things that impact our hormones. It’s this cycling thing. Samantha: Exactly. So a lot of people are told to cut carbs completely, but what I learned is that if you do that, then you end up spiking your numbers even further because your body takes over. Meagan: You have to find a balance. Samantha: It was really intense and all of my chances of my VBAC were going out the window. I was crying at every appointment. At his 20-week ultrasound, the big ultrasound, he was measured at the 96th percentile. I was like, “Oh my goodness.” I left there bawling my eyes out. I could not get a hold of myself for three days. Everything was just crazy. I redid my bloodwork three or four times and finally, there were no more antibodies so that was just let go. We don’t know what happened. Meagan: Interesting. Samantha: Yeah. It was just another scary bump. I don’t know. It was intense. The gestational diabetes diagnosis really sent me for a loop too. I found this pregnancy I was very stressed because I was so set on getting my VBAC. But thankfully, I had my doula so I could send her all of my crazy emails late at night when I was panicking and she always talked me down from that ledge of panic. I also listened to a podcast from a somatic therapist who said that stress in your pregnancy can be a contributor to things like gestational diabetes and things like that. I know that put a lot of pressure on me and reading about the facts of gestational diabetes really made me feel a little bit better about that. It could have been, but it’s not something that you can stop. It was nice to know that but gestational diabetes diagnoses really are hard when you are trying for a VBAC, I would say. Meagan: It is. It is which is why we had Lily on last week because we get the question so often. We get the text, “I was diagnosed. Can I still VBAC?” Asking the question, “Can? Is this still possible?” The answer is yes. Samantha: Exactly. So apparently, there is a spike between 32 and 36 weeks most of the time. That’s when your gestational diabetes will be at its worst because apparently, there is something to do with the baby’s growth. They have a growth spurt at that time and then usually, it tapers out at the end. My numbers all of a sudden just got better. It was a relief near the end. I was like, “Okay. Let’s wrap it up. We’re doing all of the things.” I was doing my birth affirmations. One of them was, “I am a Woman of Strength,” let me tell you. Meagan: Yes you are. Samantha: My Hypnobirthing tracks– I did the ones by Bridget Teyler. She’s amazing too. All of the things getting ready. So then that leads up to my appointment at 39 weeks and 2 days. Everything with the gestational diabetes was fine at that point. They told me, “Look. We’re going to treat you like a regular pregnancy. We won’t talk anything until 41 and 4.” My doctor was not a big fan of inductions for VBACs because of the increased risk, but she was like, “Look. If we have to, we will look at it then. Until then, let’s get you to go into labor spontaneously.” Meagan: Let’s just have a baby, yeah. Trust your body. Samantha: Yeah, but I did opt for a membrane sweep because I was getting not close. I wasn’t close because I was only 39 weeks and 2 days but I was like, “Look. I want all of the chances on my side of going into labor spontaneously.” I had started losing my mucus plug so my body was doing what it had to do. I had never had any of that with my first son at all. I was like, “Something is going on.” I started having more intense Braxton Hicks a little bit more often. I was like, “Things are going to happen. We need to do this.” Meagan: You could feel it. Samantha: I had the membrane sweep. After, she checked him on the ultrasound. He was LOA. He was head down. Everything was good. So I was like, “Okay. He’s in a good position. Let’s do this. Okay.” 42:46 LaborThe next evening, I started getting my Braxton Hicks. Looking back, I was probably in super early labor but didn’t realize it because they were starting to get uncomfortable. I’d have to sit there and breathe for a minute. Nothing crazy, but I was like, “Huh. I felt that. That’s weird.” I was at my friend’s house and I was like, “Okay. That felt weird. I’m just going to go to the bathroom and go pee.” I came back and was like, “There’s a bit of blood. I’m going to head home just because I want to sleep.” I went to bed and then I woke up at 4:43 AM with a contraction. I was like, “Oh. That’s uncomfortable.” I had listened to so many stories about prodromal labor that I was just convinced that this could be prodromal labor for three weeks. I was in complete denial. I kept on trying to sleep, but they were coming every 10-15 minutes. They would wake me up each time. I wasn’t resting super well. They started picking up around 6:30. I texted my doula at around 7:30 and I said, “I don’t know if I had a bit of a bloody show. There is a bit of darker blood.” She said, “Probably not considering it wasn’t fresh blood,” and all of those things. “But rest. Drink water. Do all of the things. Move around when you need to,” and things like that. It was fine. I said, “Okay. We will continue and I’ll let you know if things pick up or not.” So my husband got up at 7:45 with my first son and did all of the things. I stayed in bed because my body just kept telling me, “Lie down. Rest.” I could not fight it. I was like, “Okay.” I lay down in the bed. Fine. I didn’t even time my contractions. I was really convinced I wasn’t in labor. It was the weirdest thing. I didn’t eat enough. Meagan: This happens. This happens where we’re like, “No, I can’t be.” We want it to be so bad, but we’re like, “But it’s not. It’s not.” Samantha: Exactly. Meagan: We’re in denial. From having zero contractions from the first that I felt and having just Pitocin contractions, I didn’t know what to think of this. I was like, “They are uncomfortable. They hurt a little, but I’m sure they’re just going to fizzle out and we’re going to be fine.” So then my first son went down for his nap around 10:00 and my husband had to go to work to drop off his keys because he was changing positions so that was his last day. He went to go say goodbye and everything then he came back home and went downstairs to watch TV and kind of left me on my own. He figured it was better to just leave her alone. She’s going to be fine. Meagan: Yeah. Just let her do her thing. Samantha: Yeah. So at 11:55, I texted my doula and I said, “My contractions are still far apart.” I feel like they never got much closer at that point. It was 10-15  minutes, but they were getting more intense. She said, “Okay. Do some hands and knees positioning. Maybe take a bath. Continue breathing. Relax,” and all of those things. So then at that point, I said to my husband, “Okay, call my sister.” She was coming to watch my first son. She was on her way to a hair appointment that I didn’t know she had because she didn’t tell me. She knew I’d freak out, so we called my mom instead. She came. She was like, “Sam, are you timing these contractions? Is your husband? What’s going on?” I was like, “No. I haven’t actually taken out my timer. I don’t know.” She started following me around with a pen and paper. “Those were four minutes apart. You need to leave right now.” She was like, “You’re not going to have this baby on the floor at your house. No. You need to go.” Meagan: Was it active like you were really working through them? Samantha: 100%. I was moaning. I was trying to do a low moan to try to get through them. She said I sounded like a wounded animal at the end of each one because they hurt. She was like “You need to leave right now.” I was like, “Well, I need to shower.” She was like, “No, you aren’t showering right now.” I was like, “Yeah, I am.” I had my piece of toast that I took one bite out of. I was like, “Maybe I should eat some more before I go.” Meagan: Yeah. Samantha: I was in too much pain to eat at that point so I was like, “Okay, I’m going to shower. It’s going to be fine.” I got in the shower and it was literally the best feeling of my entire life I think. I was like, “Why didn’t I do this earlier?” But I was not in the mind space to do it earlier. Every time a contraction hit me, I had the instinct to get up and walk or sit on the toilet. I think  my body knew that those were the positions that helped the most and then in between, I would lay down because that’s what my body told me to do. I was just listening. I was along for the ride. Meagan: Hey, that’s good. Samantha: Yeah. So then I texted my doula at 12:45. I said, “I’m going to shower, then we are going to the hospital.” My husband, during this time when my mom got there, was packing his bag because he hadn’t and was getting all of our last-minute things. I had a list like my birth affirmations. I wanted to bring them with me and things like that. I got in the shower and got out. We left for the hospital at 1:06. It took us about 40 minutes to get there so there was a bit of traffic. Meagan: There was a drive. Samantha: Yep, but I was so lucky. I only had about four contractions the whole time. They had spaced out. My body knew what to do, man. Meagan: I was going to say your body knew what was happening. Samantha: Yeah. So then we got there. My doula had gotten there about five minutes before us so I saw her at the entrance. This guy stopped to talk to me for two minutes while I was in active labor waiting to go to labor and delivery. He was talking to me about my day and asking me when my baby was due. I was like, “Today.” Meagan: You’re like, “Right now.” Samantha: I don’t think he realized, but then I met up with my doula and I had a contraction on the way while we were walking. A guy passed by like, “Uh-oh.” I think he realized and put two and two together. So then we got there and went to the front desk. He was doing his paperwork going all slow and whatever then I had another contraction and he said, “Oh.” He got up and he walked away real fast and so they got me to triage and the woman, the nurse who came to check me said, “Look. We’re going to check you really quickly and see where you are at, but I think you are going to be going to a room right away.” My sister-in-law had given birth at the same hospital two weeks before me and she showed up at 3 centimeters in a lot of pain. I was like, “If I am at 3 centimeters right now, I don’t know if I can do this.” But I got in my head. I was like, “I’m going to be super low dilation.” Meagan: Those numbers, they mess with us and they really don’t mean anything, but man, they impact us quite a lot. Samantha: Yeah. I remember saying that to my doula. I was like, “If I’m at 3, I’m going to scream and then get the epidural. I can’t continue like this.” The woman was checking me and I’m waiting and I was like, “So?” She was like, “You’re an 8.” I said, “Oh my gosh.” I was like, “I can do this.” It gave me a new spunk. I was like, “I’m ready. Let’s go.” So they put me right into a room and they apologized. They were like, “We have to get everything ready,” so they were bustling around. They turned down the lights. They got me a yoga ball and all of those things. They were like, “Look, we’re really sorry to be in here. We’re going this as fast as possible then we will leave you alone.” They never even saw my birth plan because we got there at 8 centimeters and there was no time, but they wanted to put in the IV and my doula said to them, “Look, does she need an IV?” They said, “We just want the port at the very least.” I guess just the saline lock. Meagan: The hep lock? Samantha: Yeah, the hep lock, sorry. They did that and they wanted to monitor the baby’s heart rate. Those were the two conditions that they wanted to have. Because I was so far along, it didn’t really bother me. I didn’t want to fight that fight. It was not something that was worth it to me. I was like, “Cool.” I was laboring standing up next to the bed, then the doctor came in and said she wanted to do her own checks so that she had her own line of where things were I guess. So she checked me and by then, I was already 9 centimeters. I had already gone up another centimeter. But what’s funny is I guess I went through transition at some point, but I don’t know that it was. Everyone always says that transition is crazy. I didn’t have that. Meagan: Maybe you went in the car with distractions and stuff. Samantha: Yeah. In between contractions in the car, I was falling asleep. I was so tired. I don’t know. Transition was not that bad for me, so I was lucky for that. So then the doctor said, “Look. Your bag of water is bulging. We can either break it artificially or we can wait and see when it breaks by itself.” I said, “Okay, let me wait.” She left and I continued laboring and I was like, “You know what? We are at this point. I’m 9 centimeters. They couldn’t tell me his position yet because my water was still in tact.” Meagan: It was probably so bulgy, yeah. Samantha: So I said, “Just call her back.” She was like, “Well, it’s going to get more intense.” I said, “It’s going to get more intense. Let’s do this.” I’m like, “Okay, hold on. I have another contraction coming.” I was on the bed. I turned over and all of a sudden my water exploded. They even wrote it on my report that I saw after, “a copious amount of liquid”. There was so much. So I was like, “That’s good that that didn’t break in the car because that would have been a mess.” Meagan: Yep. 52:34 Feeling pushySamantha: So then they cleaned up. I was standing next to the bed again and then all of a sudden, I felt pushy. I was doing the pushing sounds and my doula said, “Look. You need to concentrate. Tell me if you cannot push.” So the next contraction, I was like, “No, no. I’m pushing.” They wanted to check me again because they didn’t want me pushing before 10 centimeters so they did do a lot of checks, but I wasn’t too worried considering how close I was to the finish line for infection and things like that because I wasn’t a huge fan of cervical checks going in, but I was like, “We’re near the end. Hopefully nothing bad will happen.” So they checked me. I was already 10 and he was at a 0 station at this point, but he was LOA. They checked him, so he was in the right position so that was great. I was worried because my contractions were wrapping around to my back at that point, but I assumed that that is probably pretty standard when you’re that low, I guess and things are getting more intense. But I kept on saying to my doula, “If he’s OP, if he’s OP, if he’s OP–” I was so scared that he was going to end up in the same position as my first son especially because I had another anterior placenta. I read somewhere that that could cause positioning issues. I was like, “No, not another one.” He was fine. That was a huge relief in that moment. Then I tried a few different positions. On my hands and knees, I thought I was going to love that but I hated it. I could not push like that. I ended up on my side. I pushed a lot like that, but I was pulling on the rung of the bed and I don’t know if I was using too much energy like that, but the doctor looked at me at one point and she was like, “Look. I know you don’t want to be on your back, but maybe just try. If it doesn’t work, we’ll try something else, but try it.” I really trusted my team at that point. They had really been very aware of everything I wanted. They gave me choices. They were really evidence-based, so I was like, “You know what? This is a good team. Let’s try.” Meagan: Why not? Samantha: So I went on my back and all of a sudden, my contractions were being used. My pushing was a million times better so I guess that’s what I needed in that moment as much as I really hated to be on my back. I was like, “Maybe this is what I needed.” He descended really well to a +3. I had the whole team there around me. I had my husband up here next to my head and then my doula was next to him, then I had the doctor at the foot of the bed, then I had two nurses on the side and they were so good together. Apparently, they are a team that works together a lot, so they bounce off of each other and it was so supportive. They were always there telling me, “You’re doing it.”Pushing was so hard for me though. So many women say, “Pushing was really where I felt empowered and like I could do something with the contractions.” Pushing was the most painful thing I’ve ever experienced, so I don’t think I went in there thinking about that. Meagan: Yeah. 55:42 “You’re not going to need a C-section today.”Samantha: I was shocked by that, but she also, at one point, said, “You’re not going to need a C-section today. We are past that point. This baby is coming out vaginally. No matter what happens from here on out, you’re good.” My eyes just filled with tears. I was so happy at that point. Meagan: I bet. Samantha: They started getting stuff ready at the end of the bed and I was like, “This is a really good sign. This means that baby is coming.” Meagan: Yeah. Constant validation. Samantha: Yeah. They were so nice. They offered a mirror which I accepted. Some people say mirrors really helped them. They were like, “Oh, we see his head.” There was a nickel-sized piece. I was like, “No.” I have so much more to do. I found that not super helpful. The doctor– I don’t know how I feel completely about this, but she did warm compresses and stretching of my perineum while I was pushing. I didn’t end up tearing, so I don’t know if that ended up helping for it or not and they poured a lot of– Meagan: Pelvic floor work before too. Samantha: Yeah, exactly. I did a lot of that. They poured a lot of mineral oil on his head to try to get him to slip out a little bit easier because I was having more trouble. I don’t know if those things are evidence-based necessarily, but in my case, I didn’t tear. They may have helped. They may not have helped. I’m not sure. Though they did tell me I wasn’t using my contractions as effectively as I could have been. I guess they said I was starting to push too early in my contraction and then not pushing long enough. They were really trying to coach my pushing. Meagan: Waiting until it built a little bit more.Samantha: Yeah, exactly. I mean, at that point, he was having a few decels so I think they were getting a little bit more serious at that point. They told me every time I put my legs down between contractions that he was slipping back up a little bit. They had the nurse and my husband hold up my legs at some point. I was exhausted at this point. It was 12 hours. It wasn’t super long, but I think because I hadn’t eaten enough or drank enough water. But they did let me eat in labor even though I was already 8 centimeters. They were fantastic for all of those things so I didn’t have to fight that. So yeah, then at one point, his head was crowning, so the doctor actually had to hold his head in position between my contractions because he kept on slipping back in. Meagan: Oh. Samantha: Yeah. It was really intense and the ring of fire when somebody is holding that ring of fire there is no joke. Meagan: Yeah. Samantha: It was rough. Yeah, then at one point, the mood just shifted in the room. She said, “Look, if you don’t get him out in the next two contractions, I have to cut you.” I said, “Excuse me? You have to what?” I was like, “An episiotomy?” She was like, “Yes. He is getting serious now.” He had a few pretty major heart rate decels so she was like, “I’m giving you two more.” They got the numbing stuff, I guess lidocaine ready. They dropped the bed down at that point so it was completely flat. I guess she wanted to have a better view of how she was going to cut. I pushed harder than I’ve ever pushed anything or done anything in my whole entire life and all of a sudden, I felt his head come out. I was like, “Oh, you didn’t have to cut me.” It was right down to the wire. I pushed him out by myself and it was just like, “Oh my gosh.” It was the best feeling in the whole wide world.” Then she said, “Okay, stop pushing,” to check, I guess, for shoulder dystocia because of the gestational diabetes for the cord and everything. She was like, “Okay, he’s good. Go ahead and push him out.” They said, “Grab your baby.”I pulled my baby out onto my chest. Meagan: Best feeling. Samantha: It was the best feeling in the whole wide world. I cannot describe it. The best. I had my VBA and I just kept saying, “I did it! I did it! I did it!” Everyone was so happy in the room and I had a very, very minor tear in my labia and that was it. It was night and day for my C-section recovery. They put the baby on me. He didn’t budge from my body for 2.5 hours. Meagan: Oh, such a difference. Samantha: Oh my gosh. It was fantastic. He laid on me and I talked with my doula and my husband for an hour and a half until my doula left and then they came in and weighed him and did all of the things afterwards and checked his sugars which they have to do for gestational diabetes. They check sugars four times. Everything was good. It was just fantastic. It was the best, the best feeling in the world. Meagan: Oh, I am so happy for you. So happy for you and so happy that you found the support and the team and everything. All of the things that you had done did add up to the experience that you had. Samantha: Yeah. I went into this birth saying, “I’m going to do all of the things so that if I do end up in a C-section again, I know I did everything possible.” I needed that for myself. Meagan: Yeah. That’s something to point out too because really, sometimes you can do everything and it still doesn’t end the way you want, right? That’s kind of how I was. I was like, “I want to do everything so in the end, I don’t have the question of what if I did this? What if I did that?” Sometimes that was hard because it meant spending more money on a chiropractor and spending more money on a doula. We had to work on that. Sometimes it’s not possible for some people and that’s okay. VBAC can be done doing those things, but that’s how it was for me too. I mentally had to do all of these things to just have myself be like, “Okay, if it happened. I can’t go back and question.” Samantha: That’s it. You’re at peace with everything you did. It’s funny. The doctor that I switched from, so my original OB, my doula had three VBAC clients all at the same time. We were all due around the same time. Two of us switched from him. We all started under his care and two of us switched. I ended up with a VBAC. She ended up with a repeat C-section but dilated to complete so she was very happy. The third person stayed with him and he pulled the bait and switch on her at 36 weeks. Meagan: So she had an elective? Samantha: She ended up with an elective C-section. I was like, “Oh my goodness. Thank goodness I followed my gut and I switched right away.” Intense. Insane. 1:02:39 Finding supportive providersMeagan: Yeah. Support really does matter. Support is important and in our Facebook group, we have The VBAC Link Community on Facebook, if you go under “Files”, you can click our supportive provider as well and this provider will be added to that list. Do you want to share your provider’s name? Samantha: Yeah. Her name was Dr. Choquet. She was fantastic. I think I already submitted her name to be added. Meagan: You did, yes. Samantha: I loved her and Dr. Lalande was the one I consulted with for my extension who was super and is known for doing VBACs after two C-sections as well. Meagan: Lalande? Samantha: Yeah. I also submitted her name as well. Both doctors practice at LaSalle Hospital. It was a further drive, but 100,000 times worth it. Meagan: Yes. Sometimes it’s hard to go far or you get worried about it, but usually, something good comes out of it. Well, congratulations again, and thank you so much for taking the time today. 1:03:53 3-5 prep tips for listenersBefore we leave, what 5 or maybe 3-5 tips would you give to the listeners during their prep? What were your key things for prepping? What information would you give and suggest? Samantha: I would say that the mental prep is 100% the work that I did the most that I think benefited me in terms of Hypnobirthing tracks. We did the Parents Course by The VBAC Link which was very helpful, I found, for getting my husband on the same page. He can tell you everything about VBAC now because he took that course. Meagan: I love that. So it helped him feel more confident. Samantha: 100%. He was pretty on board from the beginning, but it just solidified everything in his brain. He was like, “These stats. Obviously, we’re going to go for a VBAC.” He was super on board after that for sure. Meagan: Awesome. Samantha: Then it armed me with the stats. My parents were very nervous about me trying for a VBAC and things like that so it really helped me arm myself. And just mentally, knowing that my chances of rupture and things like that were so much lower than the chances of actually succeeding in a VBAC so really, the mental prep and knowing that doing everything, I was going in there as equipped as I could be with the most education having done all of the prep work and then you have to leave it up to your baby and your body. Really trusting that and I didn’t think the mental game would be that intense. Meagan: Man. It is. Samantha: It is. Meagan: It is intense and really, it can be especially based on what trauma we’ve had or what experiences we’ve had. There can be so much that goes into it and we have to find the information in order to even process sometimes and work through that and then you mentioned all of the amazing things you did. You did pelvic floor. You did acupuncture. You did dates. Samantha: I wrote everything. Meagan: You did it all. Samantha: And for the dates, I did them with peanut butter and a nut on them to balance the protein and the sugars. Meagan: That’s my favorite way. That’s my favorite way that I eat dates as well. Samantha: I broke them into two in the afternoon and then two after supper because that’s when my numbers were the best for my gestational diabetes and I always took a walk after supper so that really helped. Meagan: Oh, I love that. Samantha: Because a lot of people, I would hear say they couldn’t do dates because of their gestational diabetes but as long as you can balance your numbers, it’s still a possibility so that’s helpful and just finding all of the information about gestational diabetes was tough to find, but really important for my mental game as well. Meagan: Yeah. Absolutely. Oh, I love those tips. Thank you so much again and congrats again. We will make sure that we get your docs added to and your doula and everybody added to the list so people can find them because support is a big deal. It’s a really, really big deal. Samantha: And thanks to The VBAC Link. Honestly, the only sad part is that there is not much of Canada that is covered yet, so finding my alternatives that way, but everything else was covered by The VBAC Link 100%. I tell everybody about The VBAC Link. The other day, I went for my COVID shot and I told my nurse– her daughter had just given birth via C-section and she wanted to go for a VBAC. I was like, “Get her a doula through The VBAC Link.” Meagan: Oh, that’s amazing. I love that. Thank you so much. Samantha: Thank you so much for everything you do. It was a game changer, 100%. Absolutely. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Feb 14
1 hr 8 min
Episode 275 Lily Nichols + All About Gestational Diabetes
We have an incredibly special episode for you today with the one and only Lily Nichols! She is a registered dietitian nutritionist and the author of two books (soon to be three!)-- Real Food for Pregnancy and Real Food for Gestational Diabetes. Lily is truly a pregnancy nutrition expert providing women with access to the most current evidence-based information regarding food. Lily specializes in helping women with gestational diabetes feel empowered with options to help their blood sugar stay diet-controlled. This important work is helping women with gestational diabetes have healthier pregnancies and more birthing options when so much of the conversation around it becomes limiting and fear-based. Whether you have gestational diabetes in your pregnancy, are pregnant, preparing to be pregnant, or just want more nutrition education, this episode is for you!!Additional LinksLily’s WebsiteReal Food for Gestational DiabetesReal Food for PregnancyHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Timestamp Topics09:28 What is gestational diabetes? 11:15 Are there preexisting signs and ways to prevent it?13:59 What can we do? 17:00 How much protein you should get in pregnancy19:11 Best sources of protein22:04 Getting enough protein on a meatless diet26:17 Fats & Gestational Diabetes31:14 Do we have to have a baby at 38 weeks with gestational diabetes?32:28 The problem with the standard gestational diabetes guidelines40:20 PCOS and gestational diabetesMeagan: Hello, hello everybody. This is The VBAC Link and we have a very special episode for you today. This is a topic that if I were to show you in the inbox, you would be like, “Whoa. I didn’t realize so many people have this question.” The question is– I mean, there are lots of questions– but the topic is gestational diabetes. So if you have any questions about gestational diabetes, this is your episode for sure. And then actually, right before we started recording, I learned there are even other things that make us at high risk or are a known risk for gestational diabetes. Even if you haven’t ever had gestational diabetes, you’re going to want to listen because there are things that we can do preventatively before pregnancy or during pregnancy to avoid it. But you guys, we have the one and only Lily Nichols on today with us talking about this extraordinarily common topic. Lily Nichols is a registered dietitian nutritionist and certified in diabetes education. She is a researcher and an author with a passion for evidence-based prenatal nutrition. Drawing from the current scientific literature with the wisdom of traditional cultures,  her work is known for being research-focused, thorough, and sensible. Her best-selling book is Real Food for Gestational Diabetes. I absolutely love that the start of this is “Real Food”. Real food is something that I don’t feel like we focus on enough in our every day– not even during pregnancy– lives. We live busy lives, so it’s hard to focus on real food. But Real Food for Gestational Diabetes and you guys, she has an online course with the same name so Real Food for Gestational Diabetes Online Course. She is absolutely amazing and has even written two books and now what I learned today is going on the third, so Real Food for Pregnancy and Lily, what is the title of your new book?Lily: The forthcoming book is Real Food for Fertility. Meagan: For fertility. Oh my gosh, you guys. She is evidence-based. It’s amazing and you know here how much we respect evidence-based information and getting this to you guys so you can know the true facts and go on and make decisions that are best for you. So Lily, thank you so much for being here with us today and talking about this topic because like I said, it is one of the most common questions we get in our inbox. Lily: Yeah, absolutely. I’ve spent a lot of work working on gestational diabetes so I’m happy to speak about it with you today. Meagan: Yes. Can you tell us a little bit more about your course? I’m going to start there because you have an online course. I think this is a great thing for anyone who has either had gestational diabetes or has it to really learn more about it. Lily: Yeah, absolutely. The course is really designed for women with gestational diabetes not necessarily healthcare professionals and it kind of expands upon the information that is in the Real Food for Gestational Diabetes book so additional, practical resources that support the same principles that you learned in the course but takes it to another level so there are additional meal plans. There are three weeks worth of meal plans and several different carbohydrate levels so you can customize them. There is more information on lowering your fasting blood sugar naturally with the hopes that we can reduce or minimize your risk for medication or insulin which, depending on where you are and who your provider is can limit your birthing options. Also, I generally disagree with it, that is often a policy. We really often try to use food and lifestyle as much as possible to enhance our ability to keep our blood sugar under control. Probably some of the biggest benefits, though, of the course is that we do have a private Facebook community just for course participants and I do host weekly office hours. People will share what’s going on with their blood sugar. “Hey, I’m struggling with this with my fasting blood sugar. I’ve tried x, y, and z and it still hasn’t worked. Do you have any tips for me?” We have a really active community in there. Once you are a member, you are always a member. We have some moms who are on their third pregnancies and still in the course that can offer feedback but I also answer questions every single week. I’ve been told that arguably the biggest benefit is you can get my eyes on it and get a second opinion. Since I don’t have a whole lot of availability for one-on-one clients, it’s really the main way you can get my feedback on what’s going on. That’s helpful, I think because there really isn’t a one-size-fits-all intervention for gestational diabetes. Obviously, there are some general truths that work food and lifestyle-wise, but individual tinkering is something where you really need individualized attention versus, “Here is this snack that works for every single woman.” There really is no such thing. I wish there was. It would make my life way easier. It would make everybody’s lives easier. It would make the diagnosis less frustrating. But oftentimes, it’s like, “Okay. I need to get my blood sugar under control in two weeks otherwise they’re going to put me on medication.” People really need that kind of information right away at a really important time point in their pregnancy. Meagan: I love that you say that. We have private groups too and I feel like these groups are just money. Lily: Oh yeah. Meagan: Even just seeing things that other people are asking and you’re like, “Oh, actually I have that same question,” then maybe you reply to them and it just filters down. Those groups are so awesome. I love that you have created that and created a space for people because I don’t feel like in the medical world– and this is not to shame the medical world– they just don’t have time to do exactly what you were saying. “Okay, you’ve got this diagnosis. Let’s break it down for you as an individual.” It’s, “Here’s a sheet of paper,” that you can pull off of Google. It doesn’t mean that it applies to you. You have the diagnosis so it could help you but it doesn’t mean that it’s going to be the best thing for you as an individual. Lily: And moreso than that, sometimes you don’t have a provider that is well-informed on the updated research so I get a lot of women in the course who are like, “Okay, I don’t know if I really need this course, but I figured it would be a good idea,” then they jump in and they are like, “I have my meeting with the dietitian this week,” then they come back in the group and they are like, “What the dietitian said that what I’m doing is wrong and that I need to eat this way, so I’m going to try it,” then they come back three days later and they are like, “My blood sugar was terrible. This advice didn’t work. I feel awful. I need to go back to the original.” It’s just the ongoing thread of community members who have been through the same thing. Ultimately, that’s why I do the work that I do and write the books that I do because the standard of care just doesn’t often work or it’s 20 years outdated. Meagan: Oh, I can so relate to that one when it comes to VBAC. It’s the same thing when we’ve got one provider saying this and then another provider is saying this. It’s a very similar situation. You’re like, “Well, what is it? What does the evidence really say?” 9:28 What is Gestational Diabetes? Lily: Right. Meagan: Oh, well okay, so I think I would like to just even start off with what is gestational diabetes. What does that mean? If you get this diagnosis, what does that mean? Lily: Yeah. So at its simplest definition, it is blood sugar that is elevated during pregnancy beyond a certain threshold. The whole diabetes during pregnancy, I think, confuses people a little bit because it is like, “How can I develop diabetes during pregnancy but only during pregnancy?” Really, it’s that your blood sugar is elevated beyond a certain threshold. There are other definitions like insulin resistance during pregnancy or carbohydrate intolerance during pregnancy. They are all speaking to the same thing. Your body has a more limited ability to bring your blood sugar down within the normal range for whatever reason. There can be a number of different reasons. Sometimes there are pre-existing issues before pregnancy that we didn’t know about and during pregnancy, we test for things so there are a whole lot of the population that is walking around essentially with pre-diabetes and has no idea. Then during pregnancy, we screen blood sugar levels to rule out gestational diabetes and then it gets caught on that test. You think that it’s something that developed during pregnancy, but it may have been an underlying blood sugar issue that you had for a while. We are simply identifying it at this point. It can be newly developed or it can be pre-existing and we have identified it at this time point. They are technically both called gestational diabetes regardless of the underlying reason. 11:15 Are There Preexisting Signs and Ways to Prevent it? Meagan: Okay. I did not know that. I didn’t know that we could be– it doesn’t just appear. Sometimes it could be preexisting. Are there preexisting signs where we could know that we did have that or are there things that we could do pre-pregnancy to try? Say I have high sugar or whatever right now, but I didn’t know and I get pregnant and I get gestational diabetes, but are there things we can do during pre-pregnancy to– I don’t know the exact way to say it– almost nix it? To try and help reduce it or not have it at all? Lily: There are. There’s kind of a mix when we talk about risk factors because some of the risk factors are things within our control and some of the risk factors are things that aren’t within our control. We can’t control whether our mom had gestational diabetes during her pregnancy or whether we have a lot of Type 2 diabetes or insulin resistance in our family. We can’t control our age. We can’t necessarily immediately change our weight at the time of conception. Over the long term, we can have some influence over our weight, but if we are talking retroactively, we can’t go back four months and be like, “Oh, I wish I weighed 20 pounds less before I conceived.” You can control, of course, the food you are eating. You can control the micronutrients that you are taking in. There are a lot of nutrients that can reduce our baseline levels of insulin resistance like magnesium and vitamin D and inositol and several other things. Eating sufficient amounts of protein seems to be protective. Our sleep habits can impact our insulin resistance and our stress levels can play a role. Gosh, there was one more. Meagan: Does high cortisol impact our sugars and their ability to come down? Lily: Mhmm. High cortisol raises your blood sugar. Physical activity levels both before conception and during pregnancy– the more exercise we get generally speaking, the lower our risk of gestational diabetes. There are things and sometimes we have so many risk factors that are outside of our control like family history stuff and age at conception where perhaps we have a preexisting elevated risk which makes all of those lifestyle factors that are in your control arguably that much more important because those are the areas where we can make a difference. 13:59 What Can We Do? Meagan: Make a difference. So what can we do? We can lower our stress. We can increase our sleep. We can be physically active. We can eat real food, but can we talk more about that real food? What can we really eat during that? Lily: Yeah. The biggest thing to keep in mind, I would say, is your macronutrient balance like your balance of carbohydrates, fat, and protein as well as the quality of the food that you are eating. Specifically looking at eating a sufficient amount of protein, protein tends to be the most stabilizing for our blood sugar levels whereas carbohydrates are the macronutrient that raises our blood sugar levels the most. When we eat enough protein, it also has a regulating effect on our appetites since it stabilizes our blood sugar. We don’t get a huge spike and crash like we do with carbs. We don’t get the cravings and that same intensity of hunger leading up to meal time or snack time. So hitting our protein goals is absolutely essential. Then second to that, the next most important thing is thinking about the quality of the carbohydrates you consume. It’s kind of wild but in the US, 60% of calories consumed in the average American diet are from ultra-processed foods. These are things made where the primary ingredient usually is a refined carbohydrate of some kind. It’s refined starch or white flour, corn starch, something like that, maltodextrin, or refined sugar like white sugar, corn syrup, high fructose corn syrup, and then all of the random additives and junk added to it. Basically, a lot of things that are in the snack and dessert aisle and prepackaged food aisles in our grocery store, breakfast cereals, and that sort of thing. If we simply displace even a portion, even 25% of this majority of our diet that’s coming from ultra-processed foods, we will have better blood sugar levels. Even if they are being replaced by carbohydrate foods but they are not highly, highly processed, you’ll have better blood sugar levels especially if we are replacing some of that with protein-rich foods. So I’d say it’s two-fold. It’s like the macronutrients and then it’s the quality of the food reading, trying to eat as many whole foods as possible to displace the processed food items. When you hit your protein food goals, you’re not going to have intense cravings for as much of the processed stuff. I like to hit it from the front end instead of being reactive like, “Cut out the processed foods.” That’s easier said than done. What are you going to eat instead? Try getting enough protein and you’ll find that you are drawn less to those foods in the first place. 17:00 How Much Protein You Should Get in PregnancyMeagan: And with protein, do you know on average– I mean, it’s hard because we are all different ages and weights and heights and all of the things. But on average, during pregnancy, how much protein should a pregnant person consume? Lily: Yeah, there are ballpark metrics that we can use and there are some that are more specifically based on an amount of protein based on how much you weigh because protein needs are individualized by a person’s body size. If we just use a standard 150-pound woman, in early pregnancy, you need about 80 grams of protein and then in late pregnancy, you need a minimum of about 100 grams per day. Meagan: Okay.This is actually higher than was previously thought. Our first-ever study that directly measured protein needs in pregnancy was done in 2015 and they found that our recommendations are way too low. Meagan: Yeah, 80-100 to me seems really low. I’m not pregnant and typically try to get more protein than that. Lily: Well, 80-100 is a lot more than what the current recommendations are. Meagan: Which is crazy, yeah. Lily: The current recommendations for late pregnancy on average are about 71 grams of protein per day. Meagan: Whoa. Lily: Yeah. Meagan: Wow. So we need to beef it up. We need to get some protein in. Lily: Yep. It depends on the person too. We have some individuals who are highly physically active or maybe if your blood sugar is really, really sensitive to carbohydrates, you might do better having a higher proportion of protein in your diet than another person. So while 80-100 is a good minimum ballpark metric, you might do better aiming for 100 or 110 grams per day in early pregnancy and later on aiming for 120-150 grams. It really depends on the person. Meagan: It all depends, yeah. Lily: Yeah. Meagan: That is pretty crazy. 19:11 Best Sources of ProteinMeagan: Okay, now we know we’ve got to get our protein. What are the best sources of protein? That is something that I do find that sometimes is hard. It’s really hard to get whole protein and sometimes I do have to supplement with a shake or add some protein collagen to my oatmeal or something. So what types of proteins or what sources of proteins or what ideas could we give to our listeners?Lily: Yeah. When you think of protein, there are a lot of different foods that contain protein, but they have proteins in different concentrations or there’s a different balance of amino acids within those proteins. Our highest quality, the best balance of amino acids, and the highest concentration of protein per the amount of food you are eating is from our animal foods. So meat, fish, eggs, dairy, seafood– those have your highest concentrations of protein relative to any of the other macronutrients. As you go into your plant source proteins, you’ll have a lower proportion of protein and just a different or more incomplete amino acid balance. You’ll get a lot more carbohydrates along with that protein, but they, of course, have other positive things in them. Plant proteins come with fiber, for example. Our beans and legumes of plant proteins would be the highest quality ones that you can get. We have significantly smaller proportions of protein in our grains, for example. Nuts and seeds are a decent source. You can also get, of course, all sorts of protein supplements. They can extract protein from anything that is protein-rich and market it as a supplement. We have our grass-fed whey protein and our beef protein isolate and we have rice protein concentrate and all sorts of things. You have your pick. If you are not getting enough from food, you can always supplement with additional on the side, but my recommendation really is to try to get a balance of different protein sources since there are pros and cons of all of our different proteins. Just try to get a mix. That amount and forms might be different from person to person based on their preferences. 22:04 Getting Enough Protein on a Meatless DietMeagan: Yeah. That makes total sense. Kind of talking about how some things have less, for any listeners that maybe are not eating meat or don’t eat meat, how? I mean, just eating a lot of legumes and beans and nuts and stuff like that? Or how? I don’t know. Is there a higher risk there if we don’t eat meat? Does that make sense? Is it harder to get it in and how can they focus more on getting that? Lily: It is. It is a bigger challenge. Vegeterians and vegans do consume on average significantly less protein than omnivores. You can kind of plan around it by having a higher proportion of beans and legumes versus grains and considering some specific high protein options like tempe, and fermented soy products. I’m not a huge fan of a lot of soy, but fermented soy as long as it is organic can be okay and tempe is quite high in protein and relatively low in carbohydrates. Your nuts and seeds can contribute more and you can consider supplemental protein options. It does definitely get tricky particularly as we talk about gestational diabetes with blood sugar management on a vegetarian and vegan diet simply because most of our plant sources of protein if you are consuming them as a whole food, they have a significant amount of carbohydrates. So sure, you can get protein from beans, but beans also have carbohydrates. Meagan: I’m sure. Lily: There’s some protein in quinoa, but it’s 8 grams of protein per 40-something grams of carbohydrates in that serving whereas if you were going to consume 8 grams of protein from meat, that’s literally a little more than 1 ounce of meat and it has 0 carbohydrates. When you are looking at macronutrient balance, it gets a little bit trickier. So for vegetarians and vegans– I mean, with vegetarians, you have eggs and dairy so you can do more eggs. You can do more low-carbohydrate dairy products like cheeses, cottage cheese, greek yogurt, dairy protein powders, and egg protein powders and that makes the macronutrient balance much easier. With vegans, we generally do need to rely on some supplemental protein powders just so we are not overdoing the carbohydrates. It does get significantly trickier. It’s not that it’s not doable, but there are of course, always different trade-offs with different dietary approaches. Meagan: For sure. 26:17 Fats & Gestational DiabetesMeagan: So we’ve talked a little bit about the carbs and the proteins and the fats. A lot of, say salmon or even eggs. We’ve got egg whites but then we’ve got yolks which consume a lot of fat. How does fat play into or does it play into gestational diabetes?Lily: Similar to protein, fat does not raise your blood sugar levels so generally speaking, fat is not something you need to be overly worried about necessarily. That definitely flies in the face of conventional guidelines that tell you to limit your fat production significantly. We have to be really cautious when we talk about limiting fat in pregnancy. First of all, we are in a situation where your hormone production is higher than ever. Our sex hormones like estrogen and progesterone are built on a backbone of cholesterol which you get in fatty foods, specifically your fatty animal foods. Whatever you don’t consume, your body produces. So if we are cutting out all of the fat out of everything, you actually run into problems with hormone production. They have shown this in studies where they limit fat in women. Estrogen and progesterone production can be 20-50% lower. Even though your body has the ability to create cholesterol from other precursors, it still negatively impacts hormone production to not be consuming it. I do get concerned about that. I do also get concerned that when you start limiting fat from food, you’re also limiting your intake of a lot of micronutrients. Egg yolks– you gave the example of egg yolks. Egg yolks are high in cholesterol, yes. They are also the richest dietary source of choline which is a nutrient we need for optimal placental function and optimal fetal brain development, and when we are not getting enough, it’s linked to many significant problems. I mean, we now have very high-quality studies like randomized controlled trials showing that taking in actually more than double– the current recommended intake for choline improves child brain development through their toddler years all the way– the study has now been extended through age 7. They have followed these kids through age 7 and they have better brain function essentially at those later ages. If you are cutting out egg yolks for the goal of reducing your fat or cholesterol intake, you are essentially setting yourself up for a choline deficiency. Half of the choline an average American takes in is from eggs. It is such a concentrated source. You can extend that to many other examples for many other nutrients in foods that naturally contain fat. It’s a significant concern of mine actually. People get so laser-focused on fat that they lose the big picture on what are you missing out on. Meagan: What it’s actually giving you. Lily: Yes, exactly. I’m not a big fan of limiting the fat intake. Particularly, when you are talking about blood sugar control, if you are reducing your carbohydrate levels, then you are reducing the calories taken in from carbs. You have to eat something else, right? We can only eat so much protein so it always ends up being a dance between– are you eating more carbohydrates or are you eating more fat? That’s always how the balance is made up in terms of our macronutrient ratios. Certainly, I love the protein. I’m all about eating protein, but our protein-rich foods do naturally come with fat, so what I am personally not a fan of is people obsessively taking out the fat of all of their protein-rich foods. Just eat the fat that is in there. You don’t need to add massive quantities of fat to everything you are eating, just don’t take out what is naturally there. Meagan: Yeah. Yeah. I love that you talk about that because one of the things– so I’m a doula and I’ve seen this in all the years of being a doula, but then I’ve also seen this trend of messages coming in like, “I’m scared to eat too much. I’m scared to eat fat. I’m scared to eat these things because I’m scared of a ‘big baby’” or “I’m scared of having to have a C-section because my baby is measuring big,” or they are so scared of shoulder dystocia so they are now having to induce me at 38 weeks which we already know with gestational diabetes, a lot of the times, providers encourage induction early anyway. Ladies, do not cut out your fats. Eat your good proteins. Get the right kind of carbs. 31:14 Do we have to have a baby at 38 weeks with Gestational Diabetes?Meagan: What does it look like with gestational diabetes? Do we have to have a baby at 38 weeks like many providers suggest? Do we always have a big baby if we have gestational diabetes? Lily: Absolutely not. Meagan: Right? Lily: Absolutely not. Meagan: Can we talk about that and cross out those myths? Lily: Yep. We have very strong data actually that when we are able to keep blood sugar within range as much as possible– it’s not going to be perfect, but as much as possible, keeping your blood sugar within a healthy level and your provider should give you some healthy guidelines. If you don’t, go read “Real Food for Gestational Diabetes”. Meagan: Seriously. Go get your book and the link is in the show notes, everybody. Lily: Yeah. We see a 50% lower risk of macrosomia. That’s the baby being born larger than expected. Meagan: Too large, yeah. Lily: We see a 60% lower risk of shoulder dystocia. Meagan: Wow. 32:28 The Problem with the Standard Gestational Diabetes GuidelinesLily: These risks absolutely can be lessened with dietary and lifestyle intervention. What frustrates me the most and it’s why I wrote “Real Food for Gestational Diabetes” in the first place, is that the standard guidelines for dietary management of gestational diabetes fail to improve outcomes because they often fail to control blood sugar levels because they are arbitrarily way too high in carbohydrates. So what ends up happening is you get these women who get a meal plan that says, “Eat 45-60 grams of carbohydrates at a meal, a super minimal amount of protein, barely any fat” because this is all just an off-shoot of the standard dietary guidelines, and their blood sugar goes way too high after their meals. They are like, “What is going on? I’m eating per the guideline.” Meagan: I’m following. Lily: Yeah, exactly. Unfortunately, they are simply consuming way too many carbohydrates for what their body can tolerate. I mean, it makes no sense. If you failed a glucose tolerance test meaning your blood sugar was not able to come down within range when you had anywhere from 50, 75-100 grams of glucose in one sitting? Why are we then giving you 45, 60, 75 grams of carbohydrates which turn into glucose in a sitting at a meal, and saying that this is treatment? It is not treatment and anybody with a toddler-level logic can see that it makes no sense whatsoever. Meagan: No sense. Lily: Ironically, it’s very controversial advice to recommend a lower than that carbohydrate intake and that’s precisely what I present in my book with the evidence to back it up, but that still remains the standard of care. So then what ends up happening, you get these women who end up afraid to eat because they are worried about their blood sugar going too high. Meagan: Exactly, yes. Lily: So they eat the same type of meal but a really, really, really tiny portion and they are starving. Meagan: Yes. And they are malnourished. Lily: Exactly. They are malnourished. Meagan: They are not getting the macro or micronutrients in their bodies. Lily: It is tragic and it is unethical in my opinion, so if you do find yourself in that scenario where you feel like you are having to starve yourself to keep your blood sugar within range, after you check your blood sugar after that meal, you are clamoring for a snack because you are so hungry, there is another way. Meagan: Yes. Lily: It does involve nourishing yourself enough. You have to get enough calories in. Meagan: Yes. Lily: You can get enough calories and micronutrients in without the blood sugar spike just with a different macronutrient balance. You need to be eating a lot more protein. You need to ditch the fear of fat. You need to eat a quantity of carbohydrates that your body can manage in one sitting. Oftentimes, that isn’t 45-60 grams or 75 grams of carbohydrates per meal. That might be 10 or 15 or 20 or 30 grams of carbs in a meal. Meagan: Right. Lily: It might mean eating your protein-rich foods first before you have your carbs at the end of the meal. That can significantly change how your blood sugar responds. Meagan: Okay. Lily: But the standard approach is very ineffective and I can tell you when they have actually done studies where they switch people to a lower glycemic index diet, so better quality carbohydrates, more protein, and the chances that a woman will require insulin to manage her blood sugar drops by 50%. Meagan: Whoa. Lily: That can make the difference between your birth being sabotaged, overly intervened, you being denied a VBAC, them trying to scare you into the “your baby is too big” and that whole conversation. That can make a difference of it. So we really need to get better information out because it’s not fair. Gestational diabetes is poorly managed and it’s overly medicalized when it is diagnosed. Meagan: I feel the same. I feel it is. Some people have described it as, “Oh, it checked off a box saying you are in this category automatically because you tested positive.” Then they do. They go down rabbit holes. Women of Strength, if you are listening and you are someone who feels that they can’t eat a lot or you are in that space and you are the person that we are describing, you are not alone. You are not alone in this world. But, you have more options. That is why I wanted to do this episode because it makes me want to cry because I hate and I feel their frustration. It also makes me want to punch someone, not our listener, but it makes me just want to punch somebody and be like, wake up. give different information and stop putting this pressure of, “You can’t have a VBAC. you’re going to have shoulder dystocia. You have to have a baby by 38 or 39 weeks.” All of these things or “Your baby is too big.” It’s just, why? Instead of just diving in learning how to better manage and to eat better. Eat more real foods. Lily: I mean, if your blood sugar is maintained in a healthy range for the majority of your pregnancy, you are not at any higher risk than anybody who didn’t get a diagnosis. All of these things are potential risk factors, I mean, in the macrosomia conversation, you can have women who passed a gestational diabetes test, but maybe they gained quite a bit more weight than is expected over the course of their pregnancy. They are actually oftentimes at a higher risk for macrosomia than the woman who was diagnosed with gestational diabetes and had excellent blood sugar control. Nobody talks about that, right? To me, the difference is really in how you manage it. I think we have to try to lose the fear over the diagnosis. It is an unfortunate reality that for a lot of providers, you can be treated differently because of the diagnosis even though I disagree with that, but you can maintain actually quite a low-risk pregnancy, sometimes an even lower risk than if you hadn’t been diagnosed because if you see this as a blessing in disguise and take it upon yourself to improve your diet and lifestyle and really buckle down on this and get your blood sugar in a healthy range, you now are having a healthier pregnancy than if you didn’t have the diagnosis because you are taking a moment to be like, “Hmm, yes I’m pregnant and I’d like to eat for two, but you know what? I’m actually full. I don’t think I’m going to have that extra cupcake.” It’s all of those consistent blood sugar elevations without a gestational diabetes diagnosis that is contributing to the baby growing larger than expected. When you bring the blood sugar within range, we see a significantly reduced risk of macrosomia. Meagan: Yeah. This episode, I feel like, has so many really great tips on just how to eat better in general during pregnancy even if you don’t have gestational diabetes. Lily: Yes. Absolutely. 40:20 PCOS and Gestational DiabetesMeagan: Before we were recording, we were talking about your new book. You said something that caught my ear and I was like, “Wait, what?” because PCOS which is polycystic ovarian syndrome– is that correct? Lily: Mhmm, correct. Meagan: It runs in my family. You were talking about how PCOS could be a sign. Lily: It’s a risk factor for gestational diabetes, yeah. Absolutely. Meagan: Yeah, so can we talk a little bit more about some of those risk factors and how if we maybe have these things we may need to be extra aware and intentional? Lily: Intentional, yep. That’s a good word for it. With that, PCOS is a bit of a complicated diagnosis. There are different subtypes. There are actually four phenotypes and they are all just a little bit different. They share some overlap, but they are all a little bit different. That said, the majority of PCOS cases do have some degree of insulin resistance going on in their body. Your body doesn’t respond normally to insulin and brings your blood sugar down within range with a normal level of insulin. Your body has to release a lot of insulin to bring your blood sugar within range. Meagan: Wow. Lily: This is a risk factor for gestational diabetes because, during pregnancy, your body naturally becomes a little more insulin resistant. So if you are already coming into pregnancy with that baseline challenge with your body responding to insulin, when your body starts pumping out more insulin, your insulin resistance is going up and up and up, it can just compound and be too much for your body to handle. Your blood sugar will surpass that threshold of so-called gestational diabetes. That is a significant risk factor. It also tends to be– PCOS is the most common ovulatory issue in women, so it can make conception a little more challenging. It can make timing sex accurately for conception more challenging because oftentimes, there are really long cycles or delays in ovulation so it’s harder to time it right although women with PCOS can conceive successfully naturally. It can just be a little more tricky. And then when there already is a blood sugar issue going on ahead of time, there is a higher rate of early miscarriage as well. Now, things that you do for managing PCOS, there is a lot of overlap with the same concepts for managing gestational diabetes. If you do have that diagnosis and you are thinking about becoming pregnant, you can implement some of the same tips that we talked about today or blood sugar management. Higher protein, fewer carbohydrates, better quality carbohydrates, eating your protein-rich foods first at mealtimes, and considering supplementing with certain nutrients to reduce your level of insulin resistance. There is some really excellent data on inositol which is a B vitamin compound for reducing insulin resistance and improving ovulation and ovulatory function in these women and that is a supplement that honestly, they’ve done studies where they have put it head to head with metformin which is the most common medication prescribed for women with PCOS. It is also prescribed for gestational diabetes management and it often performs the same or better than metformin so inositol is a really viable option that women can look into and consider supplementing with. We talk about it pretty extensively in Real Food for Fertility as an option along with many other nutrients. There are a lot of other micronutrients that play a role in keeping our level of insulin resistance down as much as possible. So just improving overall the quality of your diet where naturally, you are just displacing more and more of these processed foods from your life because these also are so rich in micronutrients, you’re naturally improving the function of your pancreas and how responsive your body is to insulin and your blood sugar doesn’t spike as much because you aren’t getting as much refined carbohydrates in. There’s a lot of these things that all work in tandem and they work together. They continue to be important during pregnancy as well, so wherever you are, start now. Start thinking about this now. Meagan: Start now. Yes. Start now. It’s never too late to start. Like I was saying in the beginning, we live a busy life so that quick granola protein bar that is easily unpackaged in the car that you can take a bite of might be an okay snack but might not be the best. Maybe carrots. Maybe you can have carrots. Lily: Or maybe having a bag of nuts or some beef jerky. The nuts would be similar to a granola bar, but they are much lower in carbohydrates. They have more protein, fat, and fiber in them so they won’t spike your blood sugar, but they may fill you up better than a granola bar and with a significantly lower blood sugar spike for sure. Meagan: And I guess carrots are a lot of carbs so it turns into sugar. Lily: I mean, carrots do have carbohydrates, but they have quite a bit of fiber in them, so they are a fine option as well. They are just pretty low in protein and have no fat and they are so low in calories that solely as a snack–Meagan: It’s not going to help you feel full. Lily: Yeah. It’s not going to keep you full. I’ve got nothing against carrots. Carrots are excellent, but maybe having them with a cottage cheese dip or something like that would at least provide you with a little more sustenance. Meagan: Yes. Going back to the protein. See? We forget about the protein. Lily: Yep. Meagan: Focusing on the protein. Wow, I just adore you. I think this is such a great episode. I need to just go get your books now. I mean, I’m not even pregnant. I’m done with having babies, but I want to dive in more. I want to learn more because like I said, it’s such a hot topic for our VBAC community especially because we have so many naysayers like, “Oh, you can’t do this if you have this.” So okay, tell us more. You’ve got your website, lilynicholdsrdn.com and I know you’ve got the blog, your shop, your books, and all of the things. Tell us more about where we can find you and what resources we can use. We’re going to make sure to put everything in the show notes, you guys. Lily: Yeah, so up on my website, definitely click the Freebies tab. You can download a free chapter of Real Food for Pregnancy if you want to dive more into what is real food. What are you talking about? That is available for free. There is a free video series on gestational diabetes that is really helpful to help you if you have just been diagnosed or are worried about being diagnosed. That will narrow down the starting point. The biggest thing I hear is that people are really afraid and overwhelmed by what to do. It just feels very dire. You are given the diagnosis. You are told that it comes with these risks and you are not told any good news, so I try to be the bearer of good news and empowering information so you can actually take action on that. Meagan: I love that. Lily: Probably those two resources would be of most interest to this audience. I’m also on Instagram. My handle is @lilynicholsrdn so pretty much the same as my website. And yeah, keep an eye out for the new book, Real Food for Fertility in February 2024. Meagan: It’s coming out this month. This episode is being aired in 2024. That is so exciting. That one is on infertility, correct? On fertility. Lily: Yeah. It’s on fertility. That one I actually coauthored this book with my colleague Lisa Hendrickson Jack. She is the host of The Fertility Friday Podcast and author of The Fifth Vital Sign. We joined forces to talk about the food and nutrition part, the fertility hormone/menstrual cycle part and it really is the best of both worlds from our respective specialties. Meagan: I love that so much. Well, we will have the links for both of your books and then like she said, give her a follow so you can know when this new book is coming out. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Feb 7
49 min
Episode 274 "I Don't Know Who Needs to Hear This, But..."
I don’t know who needs to hear this, but…You do NOT have to be induced at 39 weeks to have a vaginal birth. You CAN have an induced VBAC. Your cervix DOESN’T have to dilate by 40 weeks.Home birth is just as SAFE as hospital birth, even for VBAC.Your pelvis is PERFECT. You are capable of doing MORE than you even know.Tune in to today’s hot episode to hear Meagan and Julie dive deeper into these topics and many, many more!Additional LinksThe ARRIVE Trial and What it Means for VBACHome Birth and VBACBrittany Sharpe McCollum - Pelvic BiodynamicsNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello everybody. We are already a month into 2024 and we are ending the month off with a nice, spicy episode. I think it will be a little spicy. Julie is with me today. Hey, Julie. Julie: The bringer of the spice. Meagan: The bringer of the spice. You know, ever since you stopped doing doula work as well, you have picked it up a notch in your spice. Julie: Because I’m tired of watching people get railroaded by the system. Meagan: I know. Julie: I have picked it up a little bit, yeah. Meagan: I know. Julie: You have to deal with the backlash by yourself if there is some backlash. Meagan: Seriously. No, this episode is going to be a good one. Women of Strength, I think that this episode is going to be very empowering. Yes, it is going to be spicy. We are going to have passion because if you haven’t noticed over all of the years of Julie and I recording, we have passion. When it comes to like Julie was saying, people not being railroaded by the system or not taken advantage of and really knowing what information is true and not, we are pretty passionate about it. So today, we have an episode for you that is going to be amazing. It’s titled, “I Don’t Know Who Needs to Hear This, But…” We are going to be telling you all of the amazing things. Review of the WeekWe have a Review of the Week so we are going to get to that and then we are going to kick it up a notch. Julie: Perfect. All right, yeah. I’m really excited about this episode inspired by all of you really, all of us, and everybody in the birth community around the whole entire world. Anyways, this review is from Apple Podcasts and it’s titled “Highly Recommend.” It says, “Thank you, Meagan and Julie, for creating this podcast. It holds space for mothers with so many different birth stories and as we know, representation matters. After an unexpected emergency Cesarean with my first daughter, I found myself seeking stories similar to my own. I literally binged your show. It  helped me process my own trauma and was incredibly healing. I have since become a labor and delivery nurse and I find myself recommending this podcast to my patients regularly.” What? That’s awesome. “I’m happy to say that this podcast gave me the courage and confidence to TOLAC and I had the most empowering and beautiful VBAC in November. Thank you a million.” That is incredible. I love it. Meagan: That is incredible. I love hearing when labor and delivery nurses or providers will hear the podcast and recommend it to their patients and their friends and their family. That makes me so happy. If you are like our reviewer and you would recommend the podcast, if you wouldn’t mind doing us a solid, pause right now but come back because it’s going to be great. Pause right now and leave us a review. Go to wherever you are– Apple Podcasts, Spotify, or if you are just listening on our website which you can at thevbaclink.com. You can even just Google “The VBAC Link” and leave us a review and recommend us there because your recommendations and your reviews are what help other Women of Strength find this and find these amazing stories and find the information like what we’re giving today. Meagan & JulieMeagan: Okay, Julie, I am so excited. I am so excited. This idea is amazing. We were talking about this before. This is kind of like a viral reel. This reel went viral. “I don’t know who needs to hear this…”, but Julie said this. Boom. That is what we are going to do. This is amazing. This episode is going to be so fun. We have actually scrolled The VBAC Link Community which by the way, if you are not in The VBAC Link Community on Facebook, we have a private Facebook group that is very safe and very welcoming to all Women of Strength no matter what type of birth they are wanting, vaginal or Cesarean. You can find us at The VBAC Link Community on Facebook. Answer the questions. You do have to answer the questions to get in because we are very, very strict with that and then we’ll get you in. If for some reason, you have a weird decline because sometimes Facebook is declining them on their own, I do not know why, just message us at thevbaclink.com or on Instagram or wherever and just let us know, “Hey, I’m trying to get in,” because we have definitely been having issues. Julie: Weird. Meagan: I know, right? People are writing us like, “We’ve been trying four times and it’s just declining.” But okay, you guys. Julie, do you want to kick it off? “I Don’t Know Who Needs to Hear This, But…”Julie: Yeah, let’s kick it off. Okay, so I don’t know who needs to hear this, but you do not have to be induced at 39 weeks to have a vaginal birth. Meagan: Correct. You do not. Julie: It makes me so mad. It lights my fire. I have a friend who lives in Maryland. He is a major researcher. He researches everything and every topic– politics, home school versus public school, anything. He can give you a one-hour speech on demand because he is on a top-notch level. His head is in the papers. He is just there. But for some reason, we as a culture don’t like to do that amount of research when it comes to having our babies. Right? Why is that? Anyway, so when his wife had their first pregnancy, it was right after the ARRIVE trial came out, and of course, she got induced at 39 weeks. They’ve had two other kids since then. They got induced at 39 weeks every time. Lucky for them, it was super great. They had pretty uncomplicated, straightforward deliveries and everything was fine, but I wanted to scream at him and say, “Friend! You research the heck out of everything. Why are you guys not looking into this for your own babies and your own children and your family, the most important thing in your life?” It’s always been interesting to me for that. So we know by now that everybody is hungry to induce at 39 weeks. We also know by now– I mean, we knew early on, but the rest of the world is catching up now showing that the results of the ARRIVE trial are incredibly flawed. If you don’t know what the ARRIVE trial is, just Google “The ARRIVE Trial, VBAC” and our article on the ARRIVE trial will pop up, but basically it says that induction at 39 weeks lowers Cesarean rates and other complications for mother and baby but there are so many things wrong with that study. There are so many things wrong with that study. I’m not going to get into it because we have a short amount of time, but go look into it. We know now that there have been several research articles from major universities doing research on giant, enormous population groups showing that it actually increases complications and risks associated with induction and it increases the risks of having a Cesarean for mothers. So, guess what though? I hate how fast the ARRIVE trial took on. Everybody is like, “Woohoo! Induction at 39 weeks, let’s do this,” but guess what? Now that we are showing that it is actually harmful to families, everybody is looking away. It’s going to take 10-20 years for this trend to stop. Meagan: But yet it took overnight for it to start. That’s what is frustrating to me. Julie: Because it is more convenient. It is more money. It is easier to manage. Meagan: I have so many feelings. You guys, we have a blog on the ARRIVE trial. We actually have an updated episode on the updates of the ARRIVE trial as well so if you are wanting to learn more about the ARRIVE trial or if you are being told that you need to be induced at 39 weeks in order to have a baby, go check out Episode 247 because we are going to talk more about that topic. Julie: Yeah, absolutely. There’s lots to go into it, but I just want you to know. We want you to know that it’s okay to go past 39, 40, and 41 weeks and wait for your body to go into spontaneous labor. That is really your best chance of having a vaginal birth. Now, there are reasons and times when a medical need for an induction arises that are true and are actually real. Having an induction doesn’t mean you are going to have a C-section, so if you need to go that route for whatever reason that is medically safe for you and your baby, it is safe to do that. “I Don’t Know Who Needs to Hear This, But…”Meagan: So on that topic, I don’t know who needs to hear this, but induction is okay for a VBAC and it is possible to have a VBAC with an induction. So yes, it’s more ideal to have spontaneous labor and for things to happen on their own and not to be intervened. But, if medically, there is a reason for an induction, it is okay. You do not have to just have a C-section because there is a medical reason to have a baby. You can be induced. “I Don’t Know Who Needs to Hear This, But…”And then sort of on the same topic, but I don’t know who needs to hear this, but your cervix doesn’t have to dilate by 40 weeks. It doesn’t have to. It can dilate after. It doesn’t mean it’s not going to. If you are not dilated or effaced by 40 weeks, it doesn’t mean it won’t, right? Julie: Yep. I hate when people say, “I just left my 37-week check-up and I’m not dilated at all. My provider thinks I needed to schedule a C-section.” I’m like, “Your cervix is doing exactly what it needs to do before it’s time to let the baby out which is stay closed, stay tight, and keep that baby in.” Meagan: Yeah. Yeah. I don’t love that because if a provider is checking at 37 weeks and someone’s not dilated, they’re placing doubt that they are not dilated and placing thoughts of, “Oh, you’re not dilated yet. Oh, you’re 37 weeks.” If they’re already having that tune, that, to me, is a red flag because if you are 40 weeks and you are still not dilated yet, what do you think they are going to say then?Julie: It’s just a sign of control. They want to be able to predict and control and yeah. It might not be the best provider to support you. “I Don’t Know Who Needs to Hear This, But…”Julie: Okay, I got one. I don’t know who needs to hear this, but home birth is just as safe as hospital birth even for VBAC. I think that a lot of people don’t know this aside from there have been several major studies in the last 10 years or so showing this, but I feel like what most people don’t realize is that home birth midwives, aside from the random rogue ones– you know, here and there you are going to hear a story– but most home birth midwives are incredibly educated and trained at similar levels as hospital midwives are. Now, depending on whether they are certified or licensed, there are different regulations in every state, but midwives at home can carry Pitocin, methergine, and Cytotec. They can carry antibiotics if you are—Meagan: GBS positive. Julie: They can give you IVs. They can draw your blood. They can do all of the routine prenatal tests that you can do in the hospital. They have emergency transfer protocols in place. Every state is a little bit different, but in Utah, it is amazing. The seamless transition from home to hospital and transfer of care records and everything like that, a lot of people just don’t know that home birth midwives– like I said, it depends on the state and the regulations whether they are certified or licensed and that type of thing– have access to all of the things except the operation room that you have in a hospital. Meagan: And…Julie: Go ahead. You do the and. Meagan: And if there is an emergency like she was saying, there is a transfer protocol in place. Usually, it doesn’t get to anything crazy because we are transferring based on XYZ before there is any true emergency. Julie: Yep. And you know what? Paige is going to be going nuts here because she is going to have to drop so many links into the show notes, but like I said, there have been so many studies that show birth outcomes are similar and some of them are better at home than in the hospital, right? Like a decrease in hemorrhage at home and yes, we can sit here and say that home birth is safe. Meagan: Home birth is safe and a reasonable option for a VBAC. “I Don’t Know Who Needs to Hear This, But…”Meagan: I don’t know who needs to hear this, but your pelvis is perfect. Julie: Your pelvis is perfect. Meagan: Your pelvis is perfect. Your pelvis is not too small, you guys. Yes, there are rare occasions where we have a pelvis that is going to be less ideal to get a baby out or harder where maybe they have gotten in an accident and they’ve had a pelvic fracture. We’ve talked about being malnourished as a child or things like that, but it’s really rare for your pelvis to actually not be able to get a baby out of it. It was designed to do that. It can do that. We all have different sizes and shapes and little ingredients to our pelvis–Julie: Pelvic ingredients. Meagan: It can do it, you guys. Sometimes it’s changing a position because sometimes our babies need to come out posterior. I learned this in a pelvic dynamics class from Brittany Sharpe. She is freaking amazing and we will drop her Instagram in here as well. But you guys, our pelvises mold. They shape. They move. They form. Babies’ heads mold, but they are all different shapes, and sometimes, our babies have to come into our pelvis in a posterior position to get out vaginally, or sometimes they have to come in looking transverse because of the way they are shaped, but it’s really rare that your pelvis is too small. So if your provider in your C-section said, “Yeah, well while I was in there, I looked and it’s way too small. You definitely should have a C-section here in the future,” just move on from that doctor. Your pelvis is perfect.“I Don’t Know Who Needs to Hear This, But…”Julie: Move on. All right. I don’t know who needs to hear this, but big babies are not a medical reason for induction and it does not mean that your baby can’t be born vaginally. Meagan: And it’s not a reason for a scheduled C-section. Julie: Yep. Meagan: That goes with any previous C-section because I’ve seen so many people say, “I’ve had a C-section because my baby measured large.” First baby. Julie: Even ACOG says that it’s not a good reason. Meagan: I know. It drives me batty. Why? Why are we doubting our bodies’ abilities? Women of Strength, if you are one and you said, “Okay,” and that’s why you had a C-section, don’t shame yourself, but know that your body creates a perfect-sized baby. Julie: Yeah. Don’t shame yourself because the system railroaded you. Blame the system. That’s who you blame. Meagan: And don’t lose belief in your body’s ability to get your baby out. If your baby is on the larger side, be like, “Well, dang. I’m going to have a good sleeper and likely a good eater.” Be happy about that and not shame yourself and be like, “Oh, I made a big baby,” because also, what I have seen in next babies, I’ve seen Women of Strength stop eating and restrict themselves of the nutrients that they need because they are so terrified. Julie: Scared that their baby will be too big. Meagan: Yes, they are so terrified of having too big of a baby that they are actually not giving themselves the nutrients. We know, especially with all of the Needed prenatal information that I’ve learned, that we are already malnourished as a society today not even just with taking supplements but in our daily food, our soil has changed. Our food has changed. Our nutrients have changed. We don’t want to be withholding those nutrients and food because we are so scared of having too big of a baby. Do not let a provider– this is my “I don’t know who needs to hear this”, but do not let a provider do that to you. Julie: Yeah, we all have stories that we can pull out of anything about these big babies. I was just at a birth last week. It was a scheduled induction at 37.5 weeks because of baby’s size. They thought the baby was going to be almost 10 pounds at 37 weeks. Baby came out at 8 pounds, 3 ounces. Now, that is a little large for a 37-weeker, but my goodness, it wasn’t a 10-pound baby. Okay? This is one of the harder things about being a birth photographer sometimes is that you are not involved in their decisions prenatally so I don’t always have the opportunity to help them learn things. Some people just don’t want to learn and that’s totally fine, but I have another friend who just left an induction. It was a VBAC induction actually and it ended in a VBAC. It was great, but they suspected IUGR which is a small baby. Meagan: Intrauterine growth restriction by the way for whoever does not know that. Julie: Yes. They expected the baby to be super small and I forget. I think it was in the 39th week. They expected the baby to be smaller than 6 pounds. Baby was born at 7.5 pounds, just fine. Meagan: Perfect. Julie: These things are not accurate and if you are healthy, then I think it’s important to know that your body can do this. Now, okay. Okay. I do want to add a little nuance there that all of these things that we are going to be talking about today there are situations where induction is necessary. With uncontrolled gestational diabetes, for example, your baby might be bigger. But what I’ve found most often with gestational diabetes is that we put these women on really restrictive diets and we tell them to be careful about what they eat and to exercise and all of these things. I find that my gestational diabetes clients usually end up having babies that are a little bit smaller than average because of all the restrictions we put on them like you were just talking about. So I just want to add a little nuance there that there are going to be some exceptions to what we are talking about. What we have a problem with here at The VBAC Link is when people take those 1 in 100 or 1 in 1000 situations where extra help is needed and blanket-apply it to 100% of the people. That’s what we’re trying to combat here. Meagan: Yeah. Absolutely. Julie: All right, Meagan. What you’ve got? “I Don’t Know Who Needs to Hear This, But…”Meagan: I don’t know who needs to hear this, but it’s always okay to say no. Julie: Yes! Meagan: Always. If you are having someone and it doesn’t even need to be a provider, anybody who is telling you what you are going to do and you are not feeling good about that decision, say no. That is okay. I was in another VBAC group during my own VBAC after two C-sections. I was in multiple VBAC groups. I was in a group and there was someone that wrote into their comment. They said, “My provider told me that I could not be induced. I could not do this. I could not do that,” and these things. Did it just irk you? I know you saw it, Julie. Did that just irk you, that comment? Julie: Yeah. It irks me because why do we as doulas, birth photographers, and patients have to be the ones to show our providers what the evidence says? Why do we? Shouldn’t they be the ones practicing that evidence-based care? Shouldn’t they? Oh, here’s my radical acceptance coming in, speaking of radical acceptance. I need to work on radical acceptance of the system, I think. But why? I don’t want to accept it. I want to change it. So there’s part 3 coming out soon. How to change it. Meagan: Part 3 of radical acceptance. How to find radical acceptance through the system. This is the thing. We talked about this, I think, even before we pushed play but a provider or someone who wants to control you in this situation that you are going to be in– your birth. This is someone who wants to control your birth and is telling you what you are or are not going to do or what they are going to do to you.I’m hearing providers saying, “I’m going to strip your membranes at your next visit.” No. No. That is not how it works. Julie: Or they walk into the room while you are laboring, “Okay, we are going to break your water now.” What?Meagan: It is okay to say no. It is okay and I know that it is hard. I know. I have been there. I have been there just in life in general where I’m in a situation and I’m like, “Oh, I just don’t want to cause contention and is it really that big of a deal? Maybe I should just say yes.” No. If your gut– and you’ll know. If someone is coming in like Julie said and is saying, “We’re going to break your water now,” and you’re like, “Ugh,” immediately, that is your intuition saying no. Julie: No. Meagan: It is okay to say no. It is okay for you to say, “I do not want a cervical exam right now. I had one two hours ago. Not much has changed. I’m good, thanks.” It’s okay. Women of Strength, please, please, please. This is how we change the system. We have to be strong and we have to stand up for ourselves. We do and it’s stupid that we have to bring the evidence to the table, but we have to say no. We have to stop letting the system or the world, the world, railroad us especially when it’s to our own body. We would never go down the street to the gas station and walk in and tell someone in that store what we’re doing to them. Never. Would you? I would never. Maybe some would. Julie: I need you to drop those prices of the gas for me. Meagan: Yeah, right now because I’m about to pump my gas. I need you to drop it down 50 cents cheaper. You guys, no. We should not, just because we are in birth and just because we are in labor and just because we have a provider that went to a heck of a lot more school than us, right? I’ll give them that. They went to a heck of a lot of school. I’ve never gone to medical school. It is not okay for them to tell us what you are or are not going to do. Okay, that’s my rant. Julie: Oh, I’ve got one that I just came up with. Meagan: Okay. “I Don’t Know Who Needs to Hear This, But…”Julie: I don’t know who needs to hear this, but you can gain information from Google– accurate and good legitimate information from Google that is similar to information that other people are getting through school. Oh ho, ho, ho. Meagan: Oh ho, ho, ho. Julie: Yeah, take that. This is going to be a little spicy one here. I hate it. I hate it– okay you’ve seen this sign. I know everyone has seen them before or little bugs that are like, “Don’t confuse your Google search with my medical degree,” then be like, “Why the heck not?” If it’s so easy to pull something up on a Google search, then why should I trust your medical degree then? Okay, that’s a little extreme, but what I’m trying to say here is that we have access to the largest collective database of information to ever exist in the history of the world, right? We can literally sit on our computer and order dinner, put in a grocery order, and have it delivered to our house in an hour. We can find information on anything we want to know from legit, credible sources. Right? I could find out how to build an electric outlet into my fireplace above. That’s my project right now. I need an outlet on my fireplace.Meagan: YouTube University. Julie: Exactly. Now, is there a lot of misinformation out there? Sure. But listen, if you know how to find credible sources like Google Scholar, Google Scholar legit has studies and sources and references that university databases pull from. There is accurate information and studies available at our fingertips, so why? The same studies that people are accessing at their universities towards their medical degrees are at our fingertips so I hate when people say, “Don’t confuse your Google search with my medical degree.” Yes, are medical degrees valuable? Incredibly, especially when you can collectively put pieces of information and everything like that together. I feel like there is lots of worth there as well, but when we are talking about individuals, you know your body better than any provider with any level of medical degree is going to know your body. You know it better. Your intuition will guide you better than any provider with any medical degree. I know I’m going to get a lot of cringes right now by talking about this, but your Google search is worth a lot when it’s pulled from a credible source so I hate when people say. That’s one thing I can’t. I usually scroll past the trolls and comments on Facebook now. I just don’t let it be worth my time. I have radically accepted that there are trolls and it’s fine and I’m going to live my life, but when I see someone using those words, “Don’t confuse your Google search with my medical degree,” that is when I’m going to get on there and say, “Why? Why discount these billions and billions and billions of research articles and things like that that we have access to?” Meagan: I think that’s one of the big passions between why Julie and I created The VBAC Link Parent Course and Doula Course because we wanted you to be able to find that information in one spot. It is confusing and it is overwhelming. Those providers, yeah. There are some BS things out there on the internet. It’s really hard to decipher. Julie: Like the ARRIVE trial, right? Meagan: Yes. I think we have three pages of studies and citations and all of these things in our VBAC manual and in our VBAC course so you can take that and take it to your provider and say, “This is what I have found. This is the evidence. Can we have a discussion about this?” Women of Strength, it is okay to have a conversation with your provider. You can ask questions. A lot of the time, you walk in and they are like, “Hey, do you have any questions?” You’re like, “Maybe. Should I have any questions?” You should be encouraging these conversations with your provider. It’s going to help you get to know them. It’s going to help you guys have a better understanding of each other and you’re going to be able to learn about these studies. Julie: I want to cut in here for just a minute before you change gears. I know that when we were putting our course together, this was something that was super important to me and Meagan. You don’t have to take our word for it. I remember uploading lots of studies, the pdf versions of studies and bulletins, and things like that into the course because we wanted you to be able to go and dig deeper on the parts that you wanted to dig deeper from right from these credible sources. I love when I can find a Cochrane review because a Cochrane review is a review of several studies studying the same thing so you can just gather so much more information. We have a Cochrane review in there. We have links to everything. That’s why we are so careful to be so meticulous and cite our sources and where we found this information so that you can go on your own journey to the other parts that resonate with you a little bit more. Meagan: Absolutely. Okay, well we are wrapping up. Is there anything else, Julie, that you are like, “I’ve got to let these guys know”?“I Don’t Know Who Needs to Hear This, But…”Julie: Yeah, I think one more thing without having to really expound on it too much. I don’t know who needs to hear this, but sometimes trusting and believing your body doesn’t work. I don’t know how to say that the right way. Maybe I’m going to expound on it. I loved this affirmation so much because I used it on my home birth and my first VBAC. It was like, “I trust my body to birth my body,” and things like that. I had a lot of trust, but I feel like reframing it to, “I trust my body to know what to do,” is better because what happens when some emergency comes up and your body doesn’t push it out? What happens when you have a traumatic pelvic floor injury and your pelvis really doesn’t know how to push out a baby? I mean, what happens if your baby’s heart starts tanking and baby has to come out right now? That’s not your body failing you. I feel like sometimes that’s what sets people up for failure. They believe so much in their body, but sometimes emergencies happen. There is some nuance there, so yes. Trust your body, but trust it to guide you on the right journey. Sometimes it sets us up for trauma afterward. You’ll be like, “Oh my gosh, my body is broken. How come trusting my body didn’t work?” I feel like trusting your body is a big part of it, but trusting your body to guide you on the right journey for a nice, healthy delivery is more important than trusting your body to be able to push a baby out. I don’t know. What do you say to that, Meagan? Meagan: Yeah. I love that. That, I think, is where a lot of postpartum issues come because we were like, “But, I knew that I could do this.” It’s not that you couldn’t, it’s just that something else happened. Right? Julie: The circumstance. Meagan: Yep. The circumstances changed and that’s hard. That’s hard, yeah. I love that. I love that you said that. “I Don’t Know Who Needs to Hear This, But…”Finally, last but not least, I don’t know who needs to hear this, but you are amazing. You are a Woman of Strength. You are capable of doing more than you even know. Than you even know. I truly believe that. I think through life and experiences, especially when things are hard, it feels like you can be at a loss, like you are alone, and like you couldn’t possibly do these things, right? But Women of Strength, VBAC is possible. VBAC after multiple Cesareans– possible. VBAC with twins, VBAC with big baby, VBAC with diagnosed small pelvis, VBAC with medical induction needed, VBAC is possible. If you don’t want to have a VBAC, that’s my final, final. If you don’t want one, that’s okay. Julie: Yeah. Meagan: That is okay. Vaginal birth is not always desired and that’s okay. But you need to learn. You need to find the information and that is what these stories are here for. That is what Julie and I are here for and other birth professionals here that we have on this podcast. That is what the course is for. That is what the community is for, for you to learn, for you to grow, and for you to know that when you are told some of these things, they are necessarily true. Okay. Julie: I love that, yes. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Jan 31
37 min
Episode 273 Amina's Incredible VBAC + Dialing in & Following Your Heart
Amina’s story shows the true POWER of a supportive provider. Both of her birth stories had similar interventions (but given in very different ways) with very different provider reactions and a very different outcome!“That was the biggest change for me. It’s not like the second birth was just smooth. There were moments when there was blood. There were moments when her heart rate was in distress, but there was that confidence that this woman could do this. This baby is safe and we are doing this together.” - AminaAmina also shares a very special story about visualization during pregnancy and how that can come into play during birth. Her story is a perfect example of listening to the heart, mind, and body in all stages of childbirth. Additional LinksNeeded WebsiteAmina’s AppHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. We are in mid-January and we have an amazing story for you today. We have our friend, Amina. She and I were talking before we started recording. She was like, “You are changing lives. You are inspiring. You are changing people’s pregnancies,” and I just want to talk on that. One, it’s absolutely an honor to even hear those words, and is so touching, but two, I’d like to counteract that even and say you guys, you, Women of Strength, you, Amina, you– every single person that has been on this podcast, is who is changing lives and these Women of Strength wanting to VBAC and know their options. I’m just here creating the platform. I’m so grateful to do this. It really, really is so amazing to hear story after story, to hear journeys, to hear how people overcome fear and anxiety and doubt.You know, we’re not here to prove people wrong, but I do love a good proving someone wrong story when it’s like, “Yeah, you tell me my pelvis is too small. I’m going to show you.” No, but really, it’s just such an honor to be here. I’ve been on the podcast now for a year solo without my partner in crime, Julie, and it’s been really hard without her because I just loved being with her, but I’m still so grateful to be with you guys today. Like I said, our friend, Amina, has a VBAC story. I just want to tell you a little bit about her. She is an International Yoga Teacher. If you haven’t checked out her page, you definitely need to. She’s a mother of two and the founder of Honey Studio and of the Movement and Mindfulness App. We know mindfulness, breathwork, and movement are all things that are going to benefit us through our child-birthing years. She is uncovering the infinite possibilities within your body and mind. I love that. Uncovering the infinite possibilities within your body and mind. Review of the WeekAmina, we’re going to get into your story in just one moment, but of course, we have a Review of the Week. I love reading these reviews so as always, if you haven’t had a chance to drop us a review, please do so. You can do so on Apple Podcasts. I don’t know, Spotify? Maybe. Maybe. I don’t know if I’ve ever seen reviews on Spotify, or Google, or you can just email us. This is from sydhayes and it’s from Apple Podcasts back in May of 2023. It says, “A Wealth of Information.” It says, “This podcast has so many helpful tools when it comes to birth and especially when avoiding a Cesarean. I listened to it every chance I had when I was planning for a VBAC and I know it helped me achieve my goals. Hearing other women’s stories is so powerful. Thank you for this resource.”Look, she’s saying it too. Your stories are so powerful. We love them so much and if you also didn’t know, we are sharing them on social media because we do have so many inquiries on the podcast. We’d like to try to share more stories on social media. So if you haven’t submitted your story, you can do so and you can also submit for social media. Amina’s StoriesMeagan: Okay beautiful lady. I am just smiling. I feel like my cheeks already hurt just looking at you. You are glowing. I can just see the excitement and the beauty coming out of you to share this story. Well, to share your stories. I’d love to turn the time over to you. Amina: Thank you so much for having me. Like I was telling you before we started recording, this is a dream moment of mine. It’s a very manifestation kind of moment because when I was listening to all of these empowering stories, to get to share mine is a true, true honor. It’s something on my vision board so I’m just so grateful to be here. Meagan: Well, thank you. I love that you are talking about your vision board. I think sometimes when we step back and we close our eyes and we truly visualize our life, our journey, and our goals, we truly can help achieve those by doing so. Amina: Totally. I’m going to track this a little bit later on, but I was sitting with a friend in the very middle of all of this. She was telling me that she visualized her whole birth from the beginning to the end and that she saw it all. When I heard her calmly sitting over coffee saying that, I was like, “Wait a minute.” I went home and did my homework and I wrote down the kind of birth I wanted to have which I ended up having. Yeah, I’m going to walk you through the story. Meagan: Yes. Let’s hear the stories. Amina: Yeah, so basically in 2017, I had very, very painful periods and I decided I wanted to have a baby. I went to just check out just to get a little check-up to see that everything was okay before we started trying. We hadn’t started trying yet. I go to the OB/GYN at the time. It was in Dubai. I’m like, “I have very painful periods to the point that I’m crying on the floor and sobbing. No painkiller is working.” She says, “Are you on birth control?” I’m like, “No.” She says, “Well, if you’re not on birth control, then don’t complain.” These were literally her words. Meagan: What?Amina: I was like, “Well, can you check me first just to see what’s going on?” because I was very connected with my body. I had been doing yoga for a few years and I knew something was off. I had this intuition. Something in my body was telling me, “Something is off.” So she’s like, “Sure. Let’s check.” She checks and finds a big polyp in my uterus that would prevent implantation from happening. She’s like, “I’m sorry. You were right. This has to be removed before you start trying to make any babies.” So that was a moment for me where I was like, “This is weird.” We really need to fight for ourselves to be heard. So anyway, we did the polyp removal, and then they said, “Wait three months and then start trying to have a baby.” We waited the three months. It was September 2017. We tried and I got pregnant. Meagan: Yay. Amina: It was just like that. It was amazing. Pregnancy– I felt good. I wasn’t nauseous. I was pregnant with a boy. We did all of the testing and throughout the pregnancy, I started to find my way through Ina May Gaskin’s book. I started to read about it and just learned a little bit more about the system of birthing in the U.S. at the time. I decided I wanted to have a midwife instead of a doctor so I switched out. Again, uneventful. I wanted the birth at a birthing center and I felt like I was super prepared. We did a HypnoBirthing course and on the due date, on the due date exactly, I started to have a little bit of bleeding, not even a period kind of blood but just a little brownish discharge. My mom was like, “Oh, you are not supposed to be bleeding. Why do you have blood?” I’m like, “I don’t know,” but I was super excited. I’m like, “We’re doing this. I’m having the baby.” That was at 4:00 AM. I went to sleep. I woke up soaking in a lot of water. The water had broken. We’re like, “Okay, let’s go to the hospital.” The water was a bit tinted with some blood. I’m still very calm. It’s fine. My body knows what it’s doing. I had all of the mantras and I showed up to the hospital and everybody was panicking at the hospital. I don’t know why, but they were panicking. They’re like, “You’re bleeding. You shouldn’t be bleeding during birth. You have to be monitored.” All of the things that I was prepared for which is to deny interventions, to say, “I don’t want to be checked,” I just remember it being a very intrusive experience where I was constantly being bombarded by nurses and by faces I didn’t know. I was definitely not relaxed and then my doctor was like, “Look, I’m going to give you a few hours to labor on your own because I know what you want.” It was basically a doctor with a group of midwives. A doctor was there and one of the midwives was also there. The doctor said, “I’m going to let you labor for a little longer. I’ll give you the afternoon to labor and we’ll see what  happens.” I go into the room and I start to have very intense contractions that were not stopping. It was just like one long contraction. I was just breathing through it and doing all of the coping tools that I was prepared for. My husband is doing the hip squeezes. We’re in that labor land, but then someone keeps coming in and I have to constantly argue for myself because you know how they monitor your belly with the contractions, something will move and then they won’t get the baby’s heart rate and the panic and they run in all of the time. I wasn’t really relaxed I would say. Then the doctor comes in. She’s like, “Okay, look. We’ve been monitoring your contractions from the office. You should be in the transition phase at this point, but your contractions are very intense and they are not stopping. I’m suggesting to give you an epidural just to help relax you and we see what happens.” At that moment, I was in so much pain that I was like, “I want a way out. Give it to me. Give it to me.” Meagan: Yeah. Amina: They gave me the epidural and within minutes or so, everything started turning black. I heard the monitors starting to beep and 30 doctors were in the room. Everyone was panicking and my midwife’s hand was inside of me moving the baby or doing something and saying, “We’re losing him.” I just remember that moment. I was just fighting, fighting, fighting the whole time. In that moment, I was just like, “Surrender. I just want to see my baby. I want to be okay.” My mom was there with me by my side, her and my husband. My mom is this source of strength for me who is always very strong. She didn’t panic, but her face was just stricken with fear. I was like, “This is not good. I need to let go of my dream of birthing this way. I can’t do it. I give up.” In that moment, my doctor, after they get the baby’s heart okay, was like, “Look, I don’t know what’s going on, but I know that neither you or your baby can handle any more of this labor. We have to get the baby out.” I said, “Okay, go ahead.” I was very okay with it like, “Just do it.” So very quickly, I was in the emergency room or the C-section room. Meagan: The OR. Amina: The OR. I was just in total panic. I was shaking from the drugs and it was just so much. I remember looking into my husband’s eyes. He was like, “Just breathe with me.” It was like yoga. I was breathing in, breathing out. This moment was all that mattered. I was just going to stay present.We had the C-section. I had my baby and all of this. He was placed on me in the recovery room and honestly, from then on, it was a very smooth postpartum journey. I healed very well from my C-section. It led me to learning a lot about the core and how to heal and just all of these really amazing things that I didn’t know about before. It strengthened my knowledge of its nature. That journey was great and then I think it took me a little while of, “I don’t think I want to have any other babies. This was the worst experience of my life.” I kind of just shoved it away. I just didn’t think about it. Then he was 3.5 years old. I was like, “Okay. I am starting to miss the baby phase and I would love for him to have a sibling, but I really don’t want to go through another birth.” That was just the trauma. But I think the love for him and bringing him a sibling overcame that fear. I was like, “Let’s just do it.” So 3.5 years later, we tried to get pregnant and I was expecting it to be just like that just like the first time, but it didn’t happen. It was, I think about 6 months that we were trying and when we got into the 7th month, I was like, “Okay. Something’s up. Maybe I have another polyp. Maybe I have a fibroid.” I started going from doctor to doctor to check why I was not getting pregnant. It turns out that they were like, “Everything is great. Everything looks perfect. There’s no reason why you’re not getting pregnant.” Then, in the end, I decided to go the IVF route. I was like, “Let’s just do this. Let’s save some eggs.” I was 34. I said, “Let’s save some eggs in case I want to have future pregnancies and also get genetic tests taken and all of this stuff.” We started doing IVF in July of 2021, I believe, 2022. Yeah. We started doing the first round. We got the eggs out and all of this. It was an easy, breezy IVF cycle I would say. The embryo transfer was in September which was the same time I got pregnant exactly four years apart, almost the same due date so it was crazy. I did the embryo transfer. She stuck and I felt very nauseous for the first few months. I was just super nauseous and I looked up the doctor next to me that was just a great surgeon. I was like, “I’m going to do another C-section. I don’t want any surprises. I just want the easiest, safest option.” I go and see him and he’s like, “Yeah, you probably had a placental abruption the first time.” Meagan: I was going to ask you if they ever gave you an answer and if it was placenta-related. That’s what it sounded like to me. Amina: Yeah, they said that they suspected that the placenta was shaped funny because of my polyp surgery being so close. They said it was a bilobed placenta but they didn’t say anything about it was an abruption. They didn’t mention those words. They were scared of it at the birth and when I would say, “Is my baby okay?” they were like, “Yes.” So okay, they let me labor until it went to a C-section because of the epidural. It was more that it was the epidural that caused a bad reaction to me and the baby. Meagan: Yeah, blood pressure drops which is going black. Amina: Yeah, going black, exactly. I had all of this fear from all of this and I was like, “I want something very low-risk and safe with a great surgeon, but I want to meet with a doctor.” He was like, “How do you want to deliver this baby?” I said, “I would love to have a repeat C-section.” Then I started to get curious. I was like, “But what if I go into labor?” He said, “Well if you go into natural, spontaneous labor on your own, we can do a trial of labor.”I was like, “Okay. That sounds fair.” Throughout, I think, once I was in the second trimester, I started to feel really good. I started to feel very empowered and strong. I was working out and I was just loving the pregnancy. It wasn’t like I felt an alien with the first pregnancy. The second time around, I was savoring it a lot more. I was a lot more in tune and a lot more connected. I was pregnant with a baby girl. Yeah. I was just in this confident feeling. I noticed that whenever I thought of the birth, I started to feel fear. I was like, “I’m going to do a repeat C-section because it’s too scary otherwise.” Then I asked myself this question. “Are you avoiding trying for a vaginal birth because you are scared or because it feels like the right thing to do?” It was 100% because I was scared. There was nothing beyond that. There was pure fear. So I started to talk to my therapist. I started to tell her, “I want to dive deeper into my first birth. Why am I feeling this way?” We started to really dive deep and realize that it was a mystery. We’re never going to fully know why it happened. I’m not going to get the answer that I need of the reason for my Cesarean. It was just something. This was how he was meant to be born and there was really nothing in my hands. I started to listen to The VBAC Link as soon as I felt that spark of curiosity. I would get on my treadmill and I would walk for, I think, an hour every single day on an incline listening to the stories of all of these women. I started to feel like, “Wait. Maybe this is a possibility. Why am I so scared? Let me see what’s on the other side of this fear.” So I decided to have a real conversation with my doctor. He was always throwing around the words “39 weeks”. “When you’re at 39 weeks, if you go into labor–” I was like, “Wait a second. The first time, I went into labor at 40 weeks. Why do I have to get to a very small percentage that I go early?” I started to ask him. I was like, “You know what? I would really love to avoid another surgery if possible.” His response was, “First of all, don’t glamorize vaginal birth because, with vaginal birth, you’re going to most likely tear because you’ve never had a baby come out of there before. You’re not going to be able to hold your pee. You will be in pain sitting down. It’s not something glamorous. It’s not likely to be the better option,” was what he was telling me. I was skeptical. All the stats that I read was that a repeat C-section is the more risky option. It’s not the less and it’s a major surgery. And then I said, “The reason that I had a Cesarean the first time was a bad reaction to the epidural most likely.” He said, “No, it was placental abruption and you can rupture your placenta again.” Again, I researched this and I was like, “Wait, just because even if you say it was–” because we don’t know it was, “the chances of getting that– it’s a whole new placenta, a whole new baby, and a whole new story, so the chances of this repeating again is quite low.” He kind of scared me with these stats that I wasn’t convinced with because they are very low. Then I said, “Also, I would love to avoid the epidural because it was the reason everything literally turned black in the birth.” He said, “Well, no. That’s not possible because I need access in case I need to get the baby out in 10 seconds.” I realized at that moment that I was just an emergency to this doctor. I am just this emergency case. I’m not seen as a human. I’m not seen as a mother wanting to birth the way that I’m designed to and I’m seen as this scare and this risk. Then he boasted, “I’m very fast. I’m known to be very fast. I don’t waste time.” Also, I asked for a gentle C which is like, “Okay, let’s get the baby out. Give me a few seconds for the pulsation of the cord.” He was like, “Well, absolutely not. You are cut open. This happens in seconds. I’m very fast.” I felt like I was a medical emergency and also, I felt like, I didn’t want someone so fast by my side when I was doing the most intense, intimate thing of my life. I don’t want to have this rushed energy by me so I knew I had to get out of there. That was my screaming intuition, “Get out of this practice. Search for a supportive OB/GYN.” Your podcast, The VBAC Link, helped me realize so much with realizing how much that actually can change the outcome. Meagan: Absolutely. Amina: I felt like I was empowered to know that no matter what happens, even if I wasn’t with a supportive doctor, I would still try to get my way, but I was like, “Let me just search through my options.” I remember I had seen one of the doctors when I was trying to figure out what was going on with why I wasn’t getting pregnant. I had met this beautiful doctor. She was a radiating source of warm, calm energy. I was like, “Why didn’t I go to her?” She’s more holistic and loves HypnoBirthing and all of this stuff, but she is an excellent surgeon which is why I went to see her. I was standing– I remember this moment. While I was standing in a museum, I was like, “I need to do this.” It was a “yes” in my body. I called them and right away, they were like, “We can take you.” I met with her and as soon as I met her, she was like, “We are going to have this VBAC.” It wasn’t “you”. It was “we”. Meagan: As a team. Amina: It was this feeling of a team. She works with a bunch of other female doctors in the same clinic. She was like, “Look, I can’t guarantee that I’m going to be there at your birth, but I want you to know that every single person here will advocate for you here in just the same way.” I felt very in touch with her and I would always book my follow-ups with her. I developed this bond with her. But when I would go for my check-ups with her, my body felt relaxed. I wasn’t feeling that something was intrusive which was also something. I had faith, I would say. At about 38 weeks, we started to check for dilation. One time, I got this email from her clinic team saying that we were scheduling a C-section for 39 weeks just by mistake. I was like, “I would love to not see that or not have that.” She was like, “I’m so sorry. That was an internal error. There is no C-section being scheduled.” I love that she was just behind me every step of the way. We started to check for the dilation and it was 0. I was like, “Okay. This doesn’t mean anything. It’s still gonna happen.” Then I was listening to one of the episodes that was talking about the Foley catheter and the low-dose Pitocin. I was very intrigued because I was like, “Okay.” They are starting to say that the baby was getting to 3 kilos or 7 pounds-ish. In the hospital when they would monitor me, they would start to raise the fear of, “Oh, the baby is getting big,” and starting to hint at that. I want to have at least a plan B that’s not a C-section but maybe some light interventions. I read about the catheter and I mentioned it to my doctor. She was like, “Yeah. If the time comes and we need to use it, I’m totally fine with it.” She was very humble. She would research things that I mentioned to her that maybe she hadn’t tried before and she would be like, “Oh yeah, let me do some research on this,” not as if she knew everything. Meagan: I love that. Amina: She also refers to a HypnoBirthing doula that me and her work with. That’s how I knew her from the HypnoBirthing doula. She is so open to maybe we don’t have all of the answers already right away. We can go explore our options. I was being monitored consistently at the hospital and they were saying because of the history of the suspected placental abruption. They were always saying, “Yeah. Baby seems very happy. Baby seems very happy.” That made me feel good. Then I heard also about the membrane sweeps so I asked her, “Can we do a membrane sweep at 39 weeks?” She said, “Yes. Let’s do a membrane sweep at 38-something.” I went in and I wasn’t dilated at all, but she was having a hard time even doing the sweep so she said, “Let’s try after you are 39 weeks. Maybe you will be a little more dilated and there is another doctor who has longer fingers who is very good with sweeps.” She said, “I want you to try her next time.” So 39 weeks comes and then I do the sweep. I feel some cramping, but nothing really happens. That day, I go to the hospital and they are monitoring and they say, “The baby is getting big. The baby is over 7 pounds and the more you stay pregnant, the less likely you are to be able to birth vaginally.” I said to my doctor, “Okay, can we book an induction with a Foley catheter and the low-dose Pitocin?” She said, “Let’s do it.” I go to the hospital at 6:00 AM with my birthing bag prepared. It ws going to happen. I had read about how painful it is to insert the catheter, but she’s just incredible. I was relaxed. Everything was in and it started to do its job. It started to mechanically dilate me because I was at a 0. I was in the room with my husband and my sister just joking and laughing and watching episodes and just not someone in labor. It had nothing to do with labor. Then they would come in. They would check and be like, “Yeah, okay.” I think after 8 hours, they took it out. I was at the 3.5-centimeter dilation from the Foley but she said, “It might close up a little bit.” She said, “Yeah. Let’s just see.” So they started the low-dose Pitocin and I remember sitting there on the ball trying to ease into contractions even though they were very mild. I was like, “Wow. I have really good pain tolerance the second pregnancy. I’m not feeling those contractions,” because they weren’t real contractions. I’m like, “Oh, wow.” Then I started to feel my baby moving up into my ribs. She was bumping into my ribs. They go and check and they’re like, “Yeah, she’s at a 0 station. She’s not moving down. We have to up the Pitocin a little bit higher.” That day, I had seen an osteopath who had checked me. I was like, “Yeah, I’m going for my induction tomorrow.” She was like, “Why are you going to an induction?” I said, “Because the baby is too big and I need to get the baby out.” She was like, “Your baby is not ready. You shouldn’t have the induction.” She said, “Your baby is not ready.” I was like, “Well too bad. I’m not going.” I remembered her words while I was sitting on the ball and feeling the baby move up into my ribs. I was having pain in my ribs. They checked at 6:00 AM. It had been from 6:00 to 6:00, 24 hours in the hospital. My doctor came in. She was like, “Okay, I have the options. You have two options. I either break your water. This has its own risks or you go home. Now you have a more favorable cervix, and let’s let labor start on its own.” I thought about it. I was like, “No. I don’t want that.” My body was telling me just to go home. So this was 39 weeks and 3 days. My due date was on Saturday and I had all of these things planned that the baby was coming out. My son’s birthday, my son’s graduation from pre-K. I show up very pregnant and everybody is asking, “Oh, where is the baby?” That was so annoying. I wanted to switch off my phone because everybody knew my due date and was texting, “Hey, where is the baby? Did you have the baby?” I’m just feeling all of this pressure. She was cozy. She was just there happy and not moving down at all. So I started to go to acupuncture just to soothe my anxiety. In the acupuncture, I was just drifting off and then I started to see this round, black, sticky thing. I was like, “What is this? Why does this keep coming to my head? What is this round, black, sticky thing?” Then I realized, it was a head. It’s a baby’s head. It’s black and sticky and has blood on it. I was like, “Why do I keep seeing this? But this is amazing.” Then I realized it was my baby’s head. I was like, “It’s a good thing I keep seeing a head when I’m doing acupuncture even though I’m not trying to see it.” Two days later, I went back to acupuncture again. I’m drifting off to that space where you’re not asleep. You’re not awake. You’re just in this crazy, floating space. I start to see that I’m feeling my baby’s head with my hands and I’m feeling her come out and she’s on my chest and I’m sobbing, “We did it. We did it. We did it.” I was like, “Okay, this is beautiful, but I don’t know what to do with this. It was just a very cool vision.” Meagan: Hold onto it. Amina: Yeah, hold onto it. The due date comes. The baby is not here. The baby is cozy. We go do another sweep a few days later. I started to feel some cramping and the dilation had even moved backward like she had warned me. I was about 2 centimeters. I was like, “Oh, this baby is never coming out. This is so stressful.” But I was trying to stay positive. The wait was so anxiety-producing because I was like, “What’s going to happen? What if I wait all of this time and I end up still having a C-section?” My mind was all over the place. But then I went to see my osteopath four days post-due date. I saw my osteopath. She checks me and she works on all of this deep tissue stuff. She’s like, “Yeah. Your baby is ready now.” I was like, “Really?” She’s like, “Yeah. All of the muscles that are normally hard and tight are very soft and loose now. Your baby is ready.” That’s all she said. Then my mom gets seen by her as well for a session after. She tells my mom, “Make sure you get some rest tonight. Tonight’s going to be a big night.” She knew.” Meagan: Oh my. That just gave me the chills. Oh my gosh. Amina: I know. It was crazy. I had no idea. That day, I felt pretty good. I had done the sweep. I had seen my pelvic floor therapist and she was like, “Yeah. Everything looks good. There is no tension.” She was allowed to do internal work at that point. She was like, “Everything looks good.” I was like, “Do you think my pelvis is too small?” She was like, “No. I think everything looks great and you will birth this baby vaginally.” She gave me this boost. It was like someone had seen me on the inside and was like, “You’re good to go.” Meagan: You’re good. Amina: Yes, you’re good. So that day, I went for a walk in the rain with my husband. I came back and I was just suddenly, my mind was somewhere else. I was very distracted. It was like this wave and this film of dreaminess was on top and I wasn’t stressed about the time. I wasn’t stressed about when she was coming. I just felt very relaxed. My body was super relaxed. After that osteopath, I sat on the ball. I was bouncing and I started to feel a little something. It quickly started to intensify. I couldn’t put my son to sleep as I normally do. I was holding his hand while I was on the ball rocking, listening to a playlist that I made that was calming labor music that I liked. While I’m putting him to sleep, I’m holding his hand and I’m just in that world. By the time he fell asleep, it was 9-something and they were ramping up. So my husband was like, “Look. If baby is coming tonight, we should get some sleep.” Meagan: Sleep. Amina: Yeah, right. Yeah right, get some sleep. I got into bed and I tried to start sleeping and it’s very intense. I can’t sleep. Then I’m like, “Oh. That’s the contractions that I forgot about 5 years ago. That’s it.” I started to get on all fours and I tried to lay with the ball between my legs in the bed and it ramped up a lot that by midnight, my husband called the hospital, the doctor, and said, “She’s having 5-minute contractions. They’re getting intense.” The doctor was like, “Okay. Just monitor her for a bit, but if you want, she can come in now and we can get her checked in. She can labor in the room. Let’s see.” Oh, the next morning, I had an induction plan already. They had planned it. So she was like, “We’ll get her in the room early and she can just labor there and be checked.” I didn’t want to go. I said no. I waited for a few hours and I think by 2:00, I was like, “We need to go to the hospital now. Now. This baby is coming now.” I just felt that it was not going to be a long time. We go and this time, the different thing I did from my Cesarean is I had my headphones in and I was not talking to anybody. I was just listening to the song in that dreamy state. I was kind of riding the wave of dreaminess. I was just in that world and listening to the music. My husband was giving them my insurance info, my name, and all of this logistical stuff that didn’t make sense at the time with all of the bright lights. Then I’m having contractions. I’m breathing through them. Then comes a resident who is like, “I need to check you. I need to see if your baby is still head-down.” I said, “My baby is head-down. I know that she is. No one is going to check me except my doctor.” He got very angry and he was like, “You’re risking your life and the baby’s life.” I said, “I know my body. I know my baby. I know that she’s head down. I was just at the hospital this morning. If she flipped, I would know.” I was just confident. I was like, “And my doctor can check if she wants, but you’re not doing any exams. Thanks, but no.” My husband is the nicest guy. For him to have this kind of confrontation makes him super on edge. Meagan: Uncomfortable?Amina: Yeah. He’s like, “He’s just doing his job.” I prepped him before. “Look. No means no. No one is going to check me. I’m not being nice to anybody that’s in my body or my vagina. No one is looking inside unless I’m comfortable.” We had done also a HypnoBirthing crash course just to remember as a refresher course. We had decided that also, no one can offer me the epidural. If I want it, I’ll ask for it, but hopefully, I’m not going to ask for it. At this point, the contractions are super intense. I have to sign this thing that says I’m okay with me and my baby dying. I’m in my world. I’m like, “Sure. Here you go.” Then we get to the room and the contractions get so much that I start to feel paralyzed. I start to feel like first of all, my intention with this birth is to feel good. I want to have a good experience and if I don’t get the epidural or if I don’t stop this pain, I’m not going to feel good. I tell my husband who is very well-intentioned, I’m like, “Look. I need the epidural now.” He’s like, “Amina. We talked about this. We said you’re going to ask for this and I’m going to tell you that you can do this.” I’m like, “I don’t care what we spoke about. I want the epidural now.” He’s like, “You can do this. You said that this would happen, but trust me. You’re almost there.” Meagan: That’s so cute. Amina: He’s really doing all of the stuff that he was told to do, then he gets kind of upset. He’s like, “Let me go talk to your doctor.” He goes outside and calls her on the phone. She comes and checks me. I’m still at a 2 so she was like, “Okay. It’s going to be a long night.” She explains to him, “Maybe this will help her feel better.” It’s going to be a very long night. Let her have it. Let her relax. She’ll get some sleep. We’re going to be very careful because of the bad reaction last time. We’re going to give you a lot of IV fluids. We’re going to give you a very tiny dose. We’re going to monitor you so well that hopefully, we’ll avoid the blood pressure drop thing.”It was very hard to get the epidural in because I was contracting so intensely. It was a lot. They managed to get it in and they were like, “Okay. This is the button. You’re going to press it if you want more.” I was terrified. I’m watching the heart rate monitor and the blood pressure watching it and waiting for the emergency. They were like, “You’re fine. Relax. Everything is good. Now you can rest.” They put such a tiny amount that I could probably move around if I wanted to. I have the ball in between my legs. I was lying on my side and I could still feel the contractions, but they were just a little bit more manageable which was very nice. This was around, I think I got the epidural around 3:00ish-4:00ish. Someone came to check and I was at a 4. I was like, “Ugh.” They were like, “It’s still going to be a long time. Don’t worry.” When I was a 4, a woman came in, a resident, and she was like, “You’re at a 4. Would you like me to break your water?” At that point, I was in this very surrendery kind of state. I was like, “Sure. Do it.” So she did. She broke my water. As soon as I look, there’s red all over the sheets. I was like, “It’s blood!” She’s like, “Yeah. Birth has blood. There’s always going to be blood in birth.” I was just like, “But there’s no one panicking around me that I’m bleeding and it’s a lot more blood than the first birth?” They were like, “Baby is okay. You’re okay. Blood is normal. You’re fine. Just relax.” Meagan: Wow. Amina: It was the reverse situation where instead of me being calm and everyone is panicking, it was the other way around where I’m like, “Guys, look. You should panic now!” They’re like, “You’re okay. Everything is good.”That was just such a moment for me where I was like, “Okay. Blood is normal. I have to not freak out when I see blood.” My doctor had warned me. She was like, “I know you’re going to panic when you see blood, but trust me. Bleeding in birth can happen and it’s okay. It doesn’t mean that something is wrong.” That was a very powerful moment for me. She broke the water and then this was at 6:00 AM. At 6:15, I suddenly felt something shift. I’m like, “I feel a lot of pressure.” They had told me it was going to be a few hours. I tell the nurse, “I feel like I have a lot of pressure like I need to poop suddenly.” She’s like, “Poop?” She runs. She gets the doctor and they check. They were like, “You’re 8 centimeters. Baby’s head is right there. You’re almost ready to push.” I start crying. When I heard the 8, I was like, “This has never happened.” That was the first moment that I was like, “This might really happen.” They had this dilation poster on the wall in front of you where you can visualize and see 1 centimeter, 2 centimeters all the way to 10. I would constantly look at it and I was like, “10. It’s possible. It’s going to happen.” That really also helped me, I think.” So when they said 8 and the baby’s head was right there, I had shivers. I was just so happy and so elated. Then they were like, “But it’s still a few hours. It’s not going to be right away. You’re 8. It could take a while until you are ready to push.” 15 minutes later, I was 10 and I was ready to push. Meagan: Oh my goodness. Amina: From 4 centimeters to pushing was in 15-minute chunks. It was very fast, crazy fast. So then at that point, the doctor changed shifts and it was a new doctor, the one with the long fingers who had given me the sweep. She comes in and she’s like, “We’re having this VBAC. Let’s go.” The energy of the room was where everyone was excited for you and cheering for you. It was such a beautiful, beautiful experience. I was like, “I don’t care. I’m just so happy to be here.” The epidural stopped working on one side, so I was feeling everything on the right side of my pubic bone, all of this pressure. They were like, “Yeah. It’s normal. Sometimes it happens. You’re only numb on one side, but the baby is stuck behind the pubic bone, so we need to do some pushes to get her past that.” The pushes, for me, were the hardest part because I felt like I couldn’t do the pushing that I prepared for with my pelvic floor therapist or the stuff that I read. It was all just like, “You’re going to inhale and then you’re going to hold your breath and push, and then you’re going to exhale.” It’s so counterintuitive to what I was taught to do that I was like, “I don’t know if this is doing anything. I don’t feel anything. I don’t know. Am I doing it?” They’re like, “Yes, but you have to keep going.” Her heart rate was kind of in distress in between the contractions and they were like, “You have to push.” She’s like, “I’m not telling you that this is an emergency, but I’m telling you that we can’t stay here for long, so you have to push.” My husband was like, “Come on, Amina. Push!” I’m like, “Okay. I’m trying,” but I can’t connect to it. Meagan: “I’m trying!” Amina: So then I guess I keep purple pushing so much that her heart is going crazy. My heart is going crazy. There is all of this chaos and they were like, “Just forget about all of the monitors. Just push. Push the baby out of your vagina. You can do this.” She moves past my pubic bone and there is a sigh of relief. They start getting out their instruments. There was a guy, a male resident, in the room who started to say, “Can we get out the instruments?” or something like that like the suction. I can’t remember what it was called. Meagan: The vacuum? Amina: The vacuum, yes. He started to say, “Can we get out the vacuum?” Meagan: It goes right on their head like that? Amina: Yeah, I didn’t even see. He just mentions, “Can I get out–?” The doctor says, “I don’t want to hear that word inside of this room.” I was just amazed. Meagan: YES.Amina: Then basically, they were like, “Okay. She moved past your pubic bone. Now is the time to really push.” I’m really struggling with the pushes. I have no idea what I’m doing. I’m getting so tired. I’m about to cry. Then I had this moment of, “Let me just reach down and feel my baby.” I put my hand down. I feel my baby. The doctor is not even cueing me to push at this point, and suddenly, I feel her head. My body’s super strength takes over and pushes the baby out without cueing, without noise, and without anything. Just by feeling her head, I don’t know what happened. It was like this super strength of all of the women in the world. I pushed her out of me and then out came her shoulders and then she was placed on my chest. I was just sobbing with joy. It was the same moment as my acupuncture. It was like, “We did it. We did it.” I’m just sobbing. Meagan: I was going to say that. It sounds exactly like your visualization. Amina: It was. Meagan: You saw this head. You saw this head and then boom. Out on your chest. Amina: There was another moment while I was pushing. The doctor was like, “I see her head. She has black hair just like her daddy.” I was like, “That’s the head I saw the first time.” Meagan: Oh my gosh. Amina: My son was born with lighter hair, so I’m like, “This is that moment, the black, sticky head.” I’m like, “This means it’s happening.” She was placed on my chest. My husband cut the cord and it was just the most healing, incredible moment of my life because I felt like in that moment, I was invincible. If I can do this, you just feel like you are so strong, but also so humbled by the experience. Yeah. It was the most beautiful moment of my life. Meagan: You grew right there, right? I think there are so many things to say about birth. We grow through all of these experiences and you grew through your C-section and you have grown through your healing. Look how long this journey has been and you have grown in every single aspect of becoming pregnant, learning how to follow your body from the very beginning, something is not right, and then they find out, “Oh, she has this polyp.” You have grown into this person and you are just amazing. This story is so beautiful and I love how your provider was there to back you up and be there for you and be like, “Nope. Don’t even say that. Don’t even talk about that.” Amina: “Don’t say that word here.” Meagan: “We are here.” Something else that I love is that you recognized. Breaking water is something, especially earlier in labor that we kind of stay away from a little bit, and in your mind and your body, you were like, “I feel good about this. I feel like I’m going to surrender to this. I feel this is right,” and then you did it. Then 15 minutes– and then you have a baby. Amina: So fast, exactly. It’s not this black-and-white intervention or no intervention. That’s what I love about The VBAC Link because I was learning that, “Oh, the Foley catheter balloon can be a great way to have a VBAC.” There are so many different interventions that can actually help you and I think for me, even trusting the epidural again was a big, big, big lesson. Meagan: Huge. Amina: I was like, “This is the moment where I lost all control in my first birth.” Control is an illusion, but that was the moment where I was like, “Just cut me open. I give up.” Meagan: Well, everything went in a different direction from that moment of your blood pressure dropping and maybe there were placenta issues, maybe not. You know, when you were talking about how this may not be something you’ll ever know, you may not ever know the exact reason why you were bleeding in that first pregnancy and things like that, it reminded me of our radical acceptance episodes and me too. There are things about my birth I will never know. It doesn’t take the wonder route, but it doesn’t consume me anymore. Amina: You are accepting.Meagan: Yeah, you accepted that it was that birth. That was that experience. You’ve grown from that. You’ve learned from that. You are going on to this next birth with what you know and accepting this next birth as this new birth, right? I think that is so important because so many times in life in general, but birth specifically, especially if we have maybe had a more traumatic experience or a Cesarean or something that really seems to relate just like you were saying. I got this epidural and then my control was lost. I did this and then this happened. I think we can tend to relate and then fear those things to happen ever again. Yeah, I mean, when my water broke for the third time, I mean they say so few people– 10% of people have their water break before labor begins and then it happened again, I was immediately triggered even though my mind knew that my body just needed time. I triggered back and I started having those doubts creep in and all of these things. We have to be able to dig really, really deep and be strong enough to say, “Okay. This is the situation. This is how I feel about it,” and be willing to make different choices. Going in for an induction again, you were scheduled to go in again. I also love that about your doctor that they were like, “Hey, here are your options. We can push this forward and see what happens or this isn’t happening right now. We can send you home.” So powerful. So powerful. Amina: This was unheard of. This was unheard of. Meagan: It’s not very heard of, yeah. Amina: Yeah, yeah, yeah. You know, when I told the nurse that day, “My doctor said I can go home now,” she looked at me and started laughing. She was like, “No, she didn’t.” I’m like, “Go ask her. I’m going home.” She came back and she was like, “I guess you’re going home.” She was baffled. This person was here to have a baby, but they’re going home without a baby because that was how much she honors what her patients want, that they are women, that they are about to have a very important experience in their lives, and that they should be a proactive part of it. That was the part that was so important. To be with a provider that doesn’t inherently believe that vaginal birth is always safer than a C-section, I think that was a trigger moment for me. He believed that they were the same or that one was better than the other. Meagan: Well, he was putting a lot of things like, “You’re going to pee yourself,” and this. Let’s be real here. Those are real risks of a vaginal birth. We can have serious urinary incontinence. We can have serious tearing that needs reconstruction. Those are real. What he was saying is real. He was using them as a fear tactic to steer you away and that’s where it’s wrong. That’s where, okay. I’m sorry. I can’t say it’s wrong. That’s where I believe it’s wrong. We should be educating very well on both sides and also talking about the risks of a Cesarean and the risks of having our bladder cut, our baby cut, and having blood issues like having to have transfusions. Also, uterine rupture is not eliminated with a scheduled C-section. It’s just not, but we don’t talk about those things, right? Amina: We don’t talk about it, yeah. Meagan: It’s just pushed so heavily. You could tell that he was pretty cool, “Oh, you could TOLAC,” until you were like, “Actually, I want to do that.” He was like, “Wait a minute. No, you don’t.” That’s where we are lacking here in the world of medicine and that’s, I think, a lot of the times why some people don’t trust providers and don’t trust the hospital because of things like this. We need to steer more into your second provider’s direction of, “Let’s talk about it. What does she want? We know the risks. We’re going to talk about the risks, but what does she want and how can we help her get that in a very safe manner?” Right? We want everyone to be safe, of course, but yeah. Amina: Totally. Staying open. Staying open. If she hears about something that she hasn’t used before, she has the modesty to say, “Let me research that,” not just like, “I haven’t used this before, so hard no.” It’s like, “Oh, let me do some research. Let me ask my doula friends what they know.” I love that about her. Meagan: I love that so much about what you said about this provider. The fact that she was like, “You know, I don’t know. Let me look at that.” We can have a conversation that’s productive. That’s what that is offering is a productive conversation between the two of you and not just shutting you out. She may have seen a different study about that and be like, “Nope. I’ve seen that. That’s not going to work.” But you’re like, “This study–”. I love that so much. It sounds like your provider was amazing. We had talked about providers. Sometimes I think on this podcast, we sound a little provider-bashing maybe because we are like, “Don’t do that. Why would they do that?” We kind of speak poorly sometimes about certain things that providers do. That is absolutely not the case. We love providers here. We love any provider– OB and midwives both. But what we don’t love is when our community is mistreated, when they’re gaslighted, when they’re completely shut out of any options in their own birth experience, and when they’re really pushed in the direction of trauma or lack of support. That’s what we struggle with. It’s not the provider. It’s that this is happening to people who we love in our community. I know I say this time and time again. I love this community. I love you guys so much. You mean the world to me. I see posts and there have been times at 2:00 in the morning. I’ll be scrolling my phone in the community and I end up crying just feeling, truly feeling those emotions from these people where they are like, “Help. What do I do?” But then I also start crying when I pull up Zoom to record a podcast like this and I see you just gleaming and bursting for joy, so excited to share your story and inspire someone. So I truly love you guys so much. I am so grateful for you being here with us today and sharing this amazing story. It sounds like I might need to connect with your provider because this is amazing.Amina: She is amazing. Meagan: Remind me where this provider is located. Amina: New York City. In New York City, it’s hard to find a provider that’s supportive for some reason. I went all over in the first pregnancy even. It’s quite hard, but really finding a provider who believes in you, who knows you can do it, who is excited for you, and who doesn’t just see you as a number and someone who believes you are a woman. Meagan: Or an emergency. Amina: Yes. You’re not just an emergency. That was the biggest change for me. It’s not like the second birth was just smooth. There were moments where there was blood. There were moments where her heart rate was in distress, but there’s that confidence that this woman can do this. This baby is safe and we are doing this together. Meagan: Yes. Which is so powerful. That’s only going to help you during your birth. That’s only going to help build you up and move you forward and help you feel like overall, it’s a better experience. Like you said, sometimes things don’t go exactly as planned or it doesn’t go so smoothly where sometimes you have to move around because baby is struggling or there is blood or whatever, right? But because you were built up in this experience and the support was truly surrounding you, you were able to have that better experience. Amina: Mhmm, exactly. I think also, I just learned so much from this the difference between fear and intuition. If you have that feeling within yourself, you can really easily mistake fear as, “This is my feeling,” but actually, is it fear or is it your real intuition? They can be blurred and when you just sit with that for a bit, you will see your body saying, “Hell yes,” then it’s most likely a yes. Meagan: Yes. I love that you talked about that with your therapist. Let’s dig deeper here. Let’s find out. Is it that I’m scared or is it that this is really what I want? Don’t be scared, Women of Strength, to dig into that and dive deeper into those feelings because sometimes, it can be fear. You’re on social media so much. You’re seeing scary things and you’re like, “Nope. I’m not going to do that,” but once you dive deeper, you might realize something else. Amina: Yep. Meagan: Yes. Okay, well thank you again so much. Amina: Thank you so much for having me. Thank you. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link. Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Jan 24
57 min
Episode 272 Grace's Traumatic Cesarean & Beautiful VBAC + Warning Signs for ALL Birthing Moms
Grace: “'If you are COVID-positive as the mother, you are not allowed to do skin-to-skin, you are not allowed to breastfeed your baby, and you are only allowed to hold your baby two times a day for 15 minutes.'”Meagan: "That’s what they told you?"Grace: "That’s what they did. That was their policy."Today’s episode is a must-listen for everyone in the birthing community. We know 2020 was an especially tough year to give birth and Grace’s first birth story shows exactly why. Grace unexpectedly tested positive for COVID upon arriving at the hospital for a recommended induction after providers were worried about her baby’s size. She was immediately subject to the hospital’s policies for that day. Grace felt like her birthing autonomy was slipping farther away with every intervention. She ultimately consented to a C-section for failure to progress. Her lowest point was watching a nurse feed her new baby a bottle in her hospital room while she felt perfectly fine and capable of doing it herself. Grace was a compliant and obedient patient, but her heart was broken.Though she went through so much, Grace’s positivity and commitment to a redemptive second birth experience are so inspiring. Grace is sharing all of the warning signs she wishes she recognized before along with so many helpful VBAC preparation tips. While we wish Grace didn’t have to go through what she did, we are SO very proud of her resilience and strength!Additional LinksThe VBAC Link Blog: 10+ Signs to Switch Your ProviderThe VBAC Link Blog: How to Find a Truly Supportive VBAC ProviderNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. I am bringing another VBAC to you for you today. I always do that. To you, for you. It is for you today. We have our friend, Grace, and she is actually from New York, right? Yes. Grace: Yes. Meagan: New York. Yes. That too, is something I want to start highlighting on the podcast because we have a lot of people being like, “Well, where are they from? I want that provider. How possible is it for me to get that provider?” She is from New York, everybody, so if you are from New York, definitely listen up extra sharp on this one. Yeah. She is going to share her traumatic C-section story and her healing VBAC. It just tickled me so much when she said in the beginning when we were chatting that this podcast truly helped her so much. It truly is so heartwarming to hear those things because this is exactly why I’m still doing this podcast. It is because I want everyone to have these stories, to be able to feel empowered, and to learn along the way because I think in addition to inspiring, these podcasts really, truly inform and educate. We can learn from other peoples’ stories. We can be like, “Oh, I didn’t even know that was a thing.” Even though birth is really the same, it’s just the same concept. Our cervix gets to 10 centimeters. We get 100% effaced. Our baby comes out through our pelvis and we push a baby out, it’s just treated so differently truly worldwide. That’s what is kind of crazy to me still that we haven’t caught up to evidence-based birth in every state or country and we do things so differently. I think that’s something really cool too to learn where people are from so we can learn what birth looks like in that state or in that country. Review of the WeekWe are going to read a Review of the Week and then we are going to turn the time over to our cute friend, Grace, to share her stories. Grace: Yay. Meagan: This is from stephmeb and her title is “Positive Stories Inspire Birthing Women”. It says, “As a VBAC mama myself, I have to say that one of the things I drew strength the most from were the most positive birth stories. I wish this existed with my previous babies and cannot wait to listen and gain strength from the stories that we are blessed enough to have one another sharing.” It says, “What a beautiful thing to have and it all is in one place.” I love that she highlighted that. That is something that we love to do here at The VBAC Link. That’s why we created it. We wanted you to have all of the things– the stories, the information, the education, the resources all in one place because I too, when I was going for my VBAC, had a hard time scrambling all over the place trying to find out the information. It says, “These ladies are really blessing and inspiring birthing women, VBAC or not.” I love that. Thank you so much. As always, we love your reviews. They truly make us smile. They keep us going. I even still to this day will get a review and send it over to Julie so she can see that her legacy is still carrying on today. So if you haven’t left a review, we would love one. You can help us on Google if you just Google “The VBAC Link”. You can leave us a review there. It helps everyone out there looking for VBAC to find us, to find this podcast, and to hear these amazing stories. Or on Apple Podcasts or you can even email us. Thank you so much for your review. Grace’s Stories Meagan: Okay, Grace. Before we were talking, we talked about not the best C-section experience. Grace: Horrible. It was horrible. Meagan: We talked about being COVID-positive. That was a really hard time. We are still having COVID. COVID is not going away, so I think this is also a really good thing to hear about what things to do or what things to know if you are COVID-positive. Fortunately, the hospital system has changed substantially since then. I was probably one of the most angry people that I have ever been. I was a very angry person during COVID watching what was happening to my clients and what was being told to my clients. It was heartbreaking to see and I can’t imagine going through that. So if you are a COVID mama birther whether you had COVID or not, just know I am sending you so much love because I know you went through hell a lot of the time. And then you had a redemptive VBAC. I am going to turn the time over to you to share with the listeners your stories. Grace: Awesome, yeah. Going back, since my first birth which was a C-section, my first is three and a half. It’s been crazy trying to go over what happened before I started recording with you just so I had all of my points down. I started to cry at one point just because it was so traumatic. I don’t know if other women have gotten as traumatized as I have, but I’m sure some have because it just was terrible. So maybe that’s why it’s good I have everything written down. I don’t know where I should start because it’s just so much. So again, I was COVID-positive. This was 2020 and this was right when COVID started becoming so serious that they shut everything down. So March and April 2020, I had to start working from home. At that point, I was 6 or 7 months pregnant with my first baby. I didn’t think anything of it. COVID at the time was scary, but because of my age– and I didn’t have any other conditions. I wasn’t a diabetic or anything where COVID can be really scary. Other than that, we were just isolating the way we were supposed to. I am a teacher and we didn’t have to go to work so that was actually kind of nice. I got to work from home. I went on really long walks and just enjoyed the end of my pregnancy. Nothing was phasing me. I had a regular OB. I picked this OB. Why did I pick this OB? I think it was that I wanted to give birth at this hospital that when I was picking hospitals in my area, I was told that this hospital has the best NICU. I’m like, “Okay.” I had no reason to think my baby should need a NICU, but when you are picking, you’re like, “What are the pros and cons?” I picked that one and I went with the OB practice that was connected with that one. It was, I think, private. There were a lot of providers in that practice. A few people did say, “Just so you know, a lot of people have C-sections there.” I already knew two women who went there and both had C-sections. Warning sign number one, if you are hearing people say that a particular provider or practice is likely to give you a C-section, just be aware of that. Meagan: Yeah. Yeah. Grace: I didn’t listen to that. So probably in mid-April, I started losing my sense of smell. Immediately, I’m like, “I might have COVID.” My husband and I about a few weeks earlier than that did have five days where we didn’t feel great. We were tired. We were run down. We kept thinking, “Maybe it’s COVID,” but our symptoms were super mild. No fever, no difficulty breathing. And remember, in early 2020, everybody was petrified of COVID and expecting it to be this super terrible thing. You’re going to go on a respirator and all of these things. We had that one week. We weren’t feeling great and then mid-April which was a few weeks after that, I lost my sense of smell so I was like, “Crap. I think I might have COVID.” I hope I can say that. Meagan: Yeah, you can. I just said “hell” so “crap” is good. Grace: I called my OB and I called a few other people. I said, “I don’t know what to do. I lost my sense of smell. I feel fine.” I felt fine. They were like, “Okay. Isolate for two weeks. Let us know how you are doing.” We were. We weren’t going anywhere. We were just working from home. I would go out with my mask and my gloves. We did all of the things then, but we didn’t really go to work or anything. So then those few months go by. This is something I didn’t want to forget to mention. Even at 20 weeks of my pregnancy, almost every appointment that I went to whether it was a checkup or a sonogram, they started saying, “Your baby is very big. It’s big. He’s going to be–” Not that they would give me a weight, but they were like, “He’s going to be a big baby. He’s going to be a big baby.” He was a boy, so I was big in the front. I was gaining weight which was concerning me. Meagan: Also normal to gain weight. Grace: Right. Totally normal, but when they started saying that so early, and then at the time, my sister had her first and her son was, I want to say 8 pounds, something. She really struggled to get him out. I’m not going to tell her story, but the things she had to go through to get him out were tough. She didn’t have a C-section, but when I started hearing, “Oh, he’s big,” it started making me concerned like, “I hope I can get him out.” Again, another foreshadowing that you’re not seeing the right people because they shouldn’t be saying that to you. They should just be letting the baby get where it needs to get and letting you know that everything is going to be fine. So I’m going through isolation. Time goes by and I’m getting into my third trimester. As we all know, women who have been pregnant, when you get to the end, you start to lose your mind. You start to get very vulnerable. You start to be like, “Please get this baby out of me.” By that point, I was rotating OBs so I had met everyone because you don’t know which OB you’re going to get. So I went to this one OB and he was the main OB of a girlfriend. She would only want to see him. He did make a comment that was bad bedside manner and it should have been an indicator that this guy was not looking out for you. He said, “Oh, you’re having a boy? We don’t like when you ladies have boys.” Meagan: Oh, whoa. Grace: Yeah, he said that to me. I giggled out of awkwardness, but after leaving, I was like, “Who says that to somebody?”Meagan: Yeah, I don’t like that. I don’t like that at all. Grace: I didn’t like it either. I think that was the first time I had seen him. I only had seen him twice during my whole pregnancy and then the last time was before I got admitted to the hospital. It was at 40 weeks. I think I went in to see them and he goes, “Okay, again. Your baby is really big. Let’s give it a few more days and then we’ll schedule an induction for you.” You know, at the end of your pregnancy, you’re like, “Yeah, get it out.” Meagan: Vulnerable, yeah. Grace: Vulnerable. And because my sister had gotten induced that January, inducing didn’t seem like any kind of fearful thing to me. I had heard stories of women getting induced and getting a C-section, but I just kept thinking, “I’m full term. I’m healthy. There’s nothing wrong.” Again, I didn’t want my baby to get too big. They kept putting that thought in my head. They scheduled my induction and right when I told my mom, my mom had five kids all natural. She never had any chemicals put in her body every. When I told my mom they scheduled my induction, she flipped out. She was like, “No!” Another warning sign for me that I should have listened to. “Don’t do the Pitocin. Don’t do it. It’s not good for you. You don’t need it. Your labor is going to be really hard. It’s going to be really long.” She was telling me, “Don’t. This is a terrible decision.” “You know,” I’m like, “But they’re telling me that this baby is going to get too big. I don’t want it to get any bigger. I don’t want to go too far.” Meagan: It’s scary.Grace: And it’s scary. They do say my risk goes up once you go past the 40 weeks and all of these things. But I did it anyway. I go to the induction. We get to the hospital. They’re like, “Oh, you have to do a COVID test when you get there.” I thought it was a good thing. I’m like, “Oh, good. They’re making sure the COVID people are separate. It’s such a good thing.” No thought in my mind that I would ever be positive. I felt perfectly fine. We were keeping ourselves in the house, wearing the masks and doing all of the things. They do the test. Meanwhile, my husband and I are sharing a water bottle in the room. Then they were taking a really long time to get back in the room. I remember thinking, “That’s not good. Where are these people? We took the test at least 30 minutes ago and these tests don’t take that long.” They come back in full get-up, all three– the OB and the two nurses– full get-up of the gown and everything. Immediately, my heart sank. They’re like, “So it turns out that you are COVID-positive. Your husband is COVID-negative so he can stay.” If he was COVID-positive, he would have had to go home. Yes. I’m hearing this. I’m starting to freak out. Remember, I’m a first-time mom. I’m already petrified of giving birth in general, so hearing that, I’m like, “Oh my god. Oh my god.” Then they told us that the policy that day– because the policy with COVID patients was changing every day. They were like, “So if you are COVID-positive as the mother, you are not allowed to do skin-to-skin and you are not allowed to breastfeed your baby, and you are only allowed to hold your baby two times a day for 15 minutes.” Meagan: Shut up. That’s what they told you? Grace: That’s what they did. That was their policy. Meagan: No. See? This is why I was the angriest doula in my life. It was the angriest time I have ever been because of this stuff. That doesn’t even make sense. Grace: It made no sense especially because I’m thinking, “I’m bringing the baby home with me.” The baby is going to be 100%. I’m going to nurse this baby. I’m going to have this baby on me.” If I was coughing and had a fever and a runny nose and all of these horrible, contagious symptoms, obviously, it’s like, “Yeah. I shouldn’t maybe hold my baby. I don’t want to get my baby sick.” At that time, COVID was scary, so it’s like, “Okay, if I am this COVID-positive, deathly-looking patient, fine. I get it. Baby’s safety first,” but I was fine. I said I was sharing germs with my husband who was negative. I kept saying, “Please retest. Please? Clearly, these tests are wrong.” I actually did all of this research that the COVID-positive gene or swab or whatever it is in you will stay in you for months and I was pregnant. My immune system was not what it normally is. Meagan: Well, and you were pregnant meaning you were sick. You had the antibiotics. Guess who has the antibiotics? Baby is inside of you. I don’t actually know the evidence, so I can’t say that there is no way, but in my head, it doesn’t connect. There’s a disconnect there. How did baby not– anyway. You were the same human– I mean, human in human during that time. Grace: Yeah, like you said, not only could I not do the skin-to-skin, but neither could my husband which all of the antibodies and all of the healthy things, my baby really didn’t get any human skin touch until he got home which was three days later. Meagan: I’m so sorry. Grace: Yeah. I mean, I know he’s fine, but there are these things. Now he’s three and a half, when he has sensory issues or anything, I always go back to how his birth was horrible. Obviously, there’s more. So that hit me like a ton of bricks. I’m just devastated and I’m calling all of my family. I can’t see any family. No one can come to the hospital and I’m just crying. Already, it’s like the downhill is starting. So that happened. I have to just– over the few hours that I’m there getting everything set up, I have to come to terms with, “I can’t have skin-to-skin. I can’t nurse. I don’t know how I’m going to handle that.” Still thinking about that makes me really upset. Meagan: Even the nursing too, those are good antibodies and strong. That’s what helps our babies. Grace: Yeah. I know. It’s completely backward. The OB that was there was actually no one I had met before. She really didn’t seem concerned. She was totally– what’s the word– I use this when it comes to these healthcare workers in the hospitals. They are desensitized. That’s the word. They were desensitized to my reaction and my husband’s and all of it. They were just like, “Yep. This is how it is. Whatever.” Anyway, they get us in the room. We had to be locked in the room. Anytime another nurse came in or whatever, we had to put a mask on. Meanwhile, every time they came in a room, it was the full getup so obviously, I was already a patient that they didn’t want there. That was how you kind of felt. The nurses weren’t nasty or anything, but they gave you the vibe of, “Oh, great. She’s hitting the button. We gotta go help the girl with the whole getup.” You know? I know I’m not the only COVID-positive one there, but you don’t want to feel that. You don’t want to feel like that type of patient. So you know, they started me on Pitocin. We’re trying to get through it. We’re watching TV. The contractions weren’t too bad. I was getting through it. I’m moving around like crazy. The first nurse I had made a joke. She said, “I’ve never seen a pregnant woman move around as much as you.” I was trying so hard to get contractions going. Meagan: Movement is good. We should be moving around in labor. Grace: 100%. I mean, I had to do it in my room. I couldn’t go anywhere which was dumb, but I’m doing all I can do. Hours are going by. Again, Pitocin is slow to go. I think after, I’d say maybe 10 hours of it, I go, “I am so tired and I’m not really progressing.” I think I was only 2 centimeters after 10 hours. I’m like, “I am so tired.” I was feeling contractions at that point that was enough that I needed a break. This is another warning sign that I should have said no to. I was only 2 centimeters. She comes in and maybe it wasn’t 10 hours yet. Maybe it was 8 hours. She comes in. She checks me. She’s like, “Yeah.” I’m only 2 centimeters. She suggested to break my water. She said, “Yeah. That’ll get things going.” I’m like, “Oh, great. Break my water. Totally. Do it.” Now, I shouldn’t have done that. I had read books and I had learned things, but again, you don’t even– it all goes out of your mind when you are trying to have a baby and get from A to B. You’re uncomfortable and you don’t have support around you and all of the things. Already, my vulnerability was so high because of COVID and the fact that I couldn’t hold the baby. At that point, I said, “Great. Break my water.” 2 centimeters? Who does that? Crazy. What was I thinking?Meagan: You’re not alone. You’re not crazy because you weren’t in the space to make a “better informed” decision. You were being told by your medical staff that this is what could help so you are not crazy. Offer yourself some grace, but yeah. It’s just one of those things that we take as a learning experience and a nugget for next time. Grace: Yes. That’s what I think is upsetting. She knew that. My OB knew that. She wasn’t technically who I would consider my OB to be because the one woman I was seeing each time, I don’t think would have done that to me. Meagan: The attending OB. Grace: Exactly. It’s like whoever you get in that Russian Roulette lottery of that day. She didn’t even know me. She clearly didn’t care about me. Oh, and she also made a horrible comment to me that day. I don’t remember if it was before or after she broke my water. I think it was after. She breaks my water. Contractions are going again and they are way more intense. At that point, so much time had gone by that I was exhausted. It was maybe 10 hours. I don’t totally remember exactly, but I think it was 10 hours that I spent. I said, “Let me get an epidural because I can’t take it anymore. I need sleep.”After I got the epidural, I was in bed and I feel like either the next morning or maybe it was the night right before I went to sleep, I was crying to her. I said, “I’m really upset. Is there anything we can do? I would really like skin-to-skin with my baby.” I said, “Wrap me in a garbage bag. I don’t care. I really hate that I can’t have that with the baby.” She looked at me and she said, “Well, you don’t want to give your baby COVID.” I couldn’t believe she said that to me. I was crying already. I’m like, “Of course not.” It made me cry more. How could you put that out there and look at me right now? If it was you and it was your baby, how would you feel that it got taken away from you and I felt perfectly fine? I’m like, “Obviously, it’s not me. My husband just took a test and he was negative.” For her to say that to me, I didn’t want her back in my room again. So the epidural came and I was under the impression– again, looking at my sister’s birth– that with the epidural, I would go to sleep. I’d wake up at 9 centimeters and I wouldn’t even feel a thing. I didn’t know. Again, because my sister did something similar. I don’t think she woke up super dilated, but she definitely progressed after she had gotten her epidural, so I was like, “You know what? Maybe that’s what I need.” And my water was already broken. I get my epidural. I go to sleep. I get some rest and then the next morning, the OB comes in and I’m relaxed. I’m calm. She checks me and I’m only 3.5 centimeters. I barely moved. It was very disappointing. I couldn’t even handle it. I’m like, “Okay. Will I have more time? There is more time now. It’s okay. It’s okay.” But then, yeah. No. I didn’t progress again. This is another warning sign. The OB comes in around a quarter to 4:00 and I remember hearing this on other podcast episodes that it’s that 5:30 PM C-section time, right? Meagan: It does happen.Grace: It’s before the end of the day. I mean, listen. Maybe it was coincidental, but given the fact that she comes in. She checks me. She’s like, “Listen, you don’t have much more time because you broke your water however many hours ago.” I don’t remember the amount of hours after you break your water. You probably know. I don’t remember. Meagan: Well, there’s a lot of other factors than just the time. It’s like, “Are we having signs of an infection? How is baby doing? How is mom doing? Are we making change in other areas?” You know? So after 6 hours of getting in labor, 6 hours after waters have been broken with no progress, they will start discussing things but it doesn’t always have to be a C-section. Grace: Oh, so she definitely gave me a lot of time. She gave me more than 6 hours, but I wasn’t progressing at all. I don’t really know. I will be honest that my timeline will be a little funky because of how long ago it was. This I do remember because of the time he was born. He was born at 4– oh my gosh. I should know the exact time. I think it was 4:36 or something like that. Meagan: Whoa. Really fast after. Grace: That’s just it, right? She comes in. “You’re not progressing. We really don’t have much more time before we’re going to have to give you a C-section. Otherwise, the safety of the baby is going to be at risk.” Now that she says that, I’m freaking out, right? Meagan: Of course. Grace: I’m like, “Oh my gosh.” You know what? A lot of women I had spoken to before said that C-sections are no big deal. It’s fine. Don’t be afraid of them. They’re fine. At that point, I said, “You know? I’m already going through hell right now. Let’s just do it. Let’s just get the baby out.” It’s so crazy how they are so slow to do so many things, but the moment I sign that form, nope. The operating room is ready to go. The team is ready to go. It’s within seconds. They are so ready to get you on that operating table. It’s almost like they want to get you out of the door. She wants to get out of the door. We all know that C-sections are going to bill your insurance way more than if you just had the baby naturally. I hate to think that is how a provider would think, but given the time and given everything that would happen, it’s like, what else am I going to think now? It’s not clear, but I feel like that was a piece of it. They were just trying to get me in and out. Oh, on the operating table, she yelled out, “Just know that this patient is COVID-positive!” to the whole staff. I’m just the diseased person that is in the room. I was walking around like a perfectly healthy person. It was just so awful. So they begin the C-section. I hope I’m not sharing too much and talking about things that don’t have meaning, but I guess I have to live through it a little bit. Meagan: This has meaning. You’re sharing them. We can feel it. Yeah. Grace: Okay. Now, at that point, during the C-section, you’re on a lot of pain meds. I come out of the operating room. Everything is fine. I’m not having any issues. I didn’t throw up or anything. All I wanted was to see and hold my baby. I heard the baby cry. My husband got to see the baby. No one got to hold the baby just yet. We’d get in the room. They immediately put the baby, I think, in the isolette. This is at the time where if you were COVID-positive, the baby could be in the room with you, an isolette I think? Or an isolette? Is that what it’s called? Meagan: Like another room? I don’t know. Grace: You know for NICU babies, they’re in this– Meagan: Oh yeah, I do know what you are talking about. I don’t know what it’s called actually. Grace: I think maybe it’s called an isolate and that’s what the rule was. When you are COVID-positive, your baby would stay in the isolette. You couldn’t hold your baby unless it was those two times during the day for 15 minutes. He went into that. My husband came in. I think that the attending nurse I had at that time–Meagan: Your husband wasn’t with you in the C-section?Grace: No, no, no. He was. I’m in a bed. I’m just trying to go through it again in my head. Meagan: No, you’re fine. Grace: So the whole time, I kept thinking, “I just want to hold him. Please just let me hold him. I won’t do skin-to-skin. I’ll follow all of your rules, whatever. Just let me hold him. It’s my brand new baby.” Again, I’m a first-time mom. I do think regardless if you are or not, I totally get it. It could be your fourth baby and you would still feel that way. When my mom had my sister who was her second, she was like, “The nursery can have her. I need rest.” There is a sense of, “I’ve been there. I’ve done that. I don’t necessarily have that need to hold them in that moment,” but as a first-time mom, seeing my first baby, that was all I wanted in the world was just to hold the baby. So this one nurse comes in. I don’t know. I think she was just a post-delivery nurse and she was very tough. I was like, “Please, can I hold him now?” She was like, “You need to wash your hands. You are COVID-positive.” Nasty. I’m like, “Okay, fine.” I can’t move becaus I just had surgery. They bring me over this bucket of soap and everything. I’m washing my hands and I’m just constantly looking at him trying to get him. She yelled at me. She was like, “You’re not washing your hands enough.” She was like, “I’m an ER nurse during COVID. You have to take this seriously,” just belating me. It was so horrible. But they did finally let me hold him. It was great, but it was obviously short-lived. Then after that, they took him. The nurse had to feed him a bottle. I wanted to breastfeed. I didn’t want to give him any formula. I remember just seeing her sitting there with him thinking– I’m so sorry– that I failed. My body failed. This woman has to feed my baby for me and I’m right here. I can do it. I couldn’t even give him a bottle. I just felt like such a failure at that moment. I did not think I was going to start crying, but just to see a stranger do that just really upset me. That was pretty much that. Right then, I was there and then that nurse would come and feed him every 15 minutes. You know, it’s a baby. You have to feed them every 30 minutes or something. But then that moment when she first did it, I thought I was such a failure. Meagan: Not a failure. Grace: I know. My husband had no idea what was going on. They never really do. He was very much like, “We have to listen to the hospital.” When they would leave the room essentially, I was like, “Give me the baby. Let me just hold him. What are they going to do? There are no cameras. Even if there were, what are they going to do? Kick me out? I just got cut open.” Honestly, I was so ready to break those rules. The baby was going to be right there. My husband was like, “They could walk in. You could get in so much trouble.” He didn’t know what could happen so we had to just follow the rules. He got to hold the baby, but every time he’d pick up the baby, he had to put on a new thing of gloves, a mask, and a gown, and he ended up having to feed the baby because he was allowed to. That started to drive him crazy because he was also on no sleep. If you go back from when we got to the hospital to when we had the C-section, it had already been two days of time where we were just there. He wasn’t really getting the best of sleep. He has had so much going on, so now he has to care for this newborn baby. He’s never held a baby in his life. That ended up being what was going on at that point. Now at this point, the epidural was still in me and I wasn’t in any kind of crazy pain. Then the nurse comes in. She’s a new nurse and was actually very nice. She goes, “Listen, I have a few other pills.” I can’t remember what they are but then she goes, “I have oxycodone for the pain.” I was like, “I really don’t want to take any opiates because I’m going to try to breastfeed when I get home and I am pumping. I don’t want to have any opiates in my system.” I was saying this while the epidural was still in my system. She looked at me like, “Okay,” and I have a Motrin allergy. I can’t take ibuprofen so all I was taking at the time was Tylenol. She gives me probably the Tylenol at that point. The epidural was still there. I’m like, “This will be fine. I’ll just take Tylenol.” But it was a dumb thing to think. When that epidural wore off, I don’t know how many hours later, I was in so much pain. I could barely talk. Motrin and Tylenol work together because some women don’t take the opiate, but working together helps a lot. But when I wasn’t getting Motrin, all I had was Tylenol. It just was so, so painful that she got to my room. I look at her. I go, “You need to get me the oxycodone right now. I can’t move. I’m in serious, serious pain now.” So she gets it for me, but the thing is with pain– oh, I’m sorry my friend texted me– when you don’t catch up to the pain and you have the pain meds in your system, you kind of can never stay on top of pain. Does that make sense? Meagan: Mhmm. Chasing it.Grace: You’re chasing it. So even with the oxycodone in my system, the pain would finally subside, but then once it came back, it came back so bad that I just never felt okay anymore. I just constantly was uncomfortable and in pain. Those moments when the meds would wear off to get your new set of meds, I could barely talk. It was so intense. Then also when you get surgery, you get gas that radiates up and that was insanely painful. The night nurse ended up being late with the oxycodone at that point. It was 3:00 AM. My husband was sitting next to me. He couldn’t even sleep because he was so worried about me because of that pain. I wasn’t myself anymore. I don’t know if other women with C-sections have gone through anything like that, but it was just really bad. He was sitting next to me. It was 3:00 AM and he was like, “I’m really worried I’m going to lose you.” I actually muttered, “I think I’m going to die.” That’s how intense it was. She was probably 45 minutes late with the medication and again with pain meds, if it’s not in your system, you feel everything. That made it even more intense and horrible on top of everything else– all of the emotion, the fact that I didn’t even want a C-section, and it just kept spiraling into horribleness. I will say one positive good bit though that I look back on and I remember. The attending nurse that I had during the day of my C-section actually came in after and was so sweet. She did know that I wanted to breastfeed, so she was trying to get the colostrum to give to the baby. One thing my sister told me to do was she goes, “Make sure before you are planning on giving birth that you start eating lactation cookies and getting your supply to come in.” Because I had done that, when I showed up and she wanted to get colostrum, there was tons of it. He was in shock. He was so happy. He was a bit older, almost like you could tell he was old school. He was like, “I’ve never seen anything like this. This is amazing.” It made me feel like somebody had faith in me instead of some diseased, horrible person. That’s what I felt the whole time. That was nice having that moment. But yeah, so then with the pain, that was starting to make the whole experience really bad. We ended up leaving a day early and even the day we left, the pediatrician made a point to me. He was telling me about the baby and things to do with the baby and everything. I go, “I’m so really worried. I’m COVID-positive. I don’t want to get the baby sick. Everyone is making it like I’m going to make the baby sick and what should I do? Can I hold the baby? Can I do these things with the baby?” She looks at me and says, “Of course you can. You are going to take your baby home and you can nurse your baby. You’re going to hold your baby.” She was like, “Wear a mask,” and was almost looking at me like, “This hospital is crazy. This policy is horrible,” but because this is the routine for them and they are desensitized to everything, I wasn’t getting that from anyone else. It was just common. It made me really look back and say, “How stupid that they put me through this.” I don’t even know. I think there were some COVID-positive mothers where their babies went in other rooms and they couldn’t even see them at all. Meagan: Mhmm. Grace: I mean, I’m sure you’ve heard other horrible stories. So we go. We get to leave and my husband at that point had no sleep either. It was maybe three or four days that we had been there with no sleep. I had no sleep because I was in so much pain. We get home and my mom opens the door because she was waiting there for us to help us. My mother was really upset too. She was crying all night that I was going through that. She looked at me and was like, “Oh my god. What did they do to you?” I had dark circles under my eyes from being exhausted but also from crying. Meagan: Yeah. I was going to say, I’m sure that you instantly knew that you wanted a different experience next time. Grace: Oh my god, yeah. I wanted it different and you know, I have a beautiful, healthy baby so it’s not like it was the worst experience it could have been, but it wasn’t at all what I wanted or what I thought it would have been or that it really should have been. So many things went wrong and I take a lot of blame that I should have researched providers better. I should have researched the policies better. I didn’t know, you know? You never think it’s going to happen to you. You think everything’s going to be fine. My one girlfriend, I think had placenta previa. Something like that, but she said, “I immediately knew I was having a C-section. There was no question there.” That’s one thing. You have physical limitations where it is very dangerous. Okay. It’s fine. You have a C-section. It’s fine. But when you are put in a horrible hamster wheel of horribleness where they already know you are going to have a C-section and they don’t even care, it’s so long. And the COVID-positive on top of it was just really, really hard.My husband said, “Honestly, Grace, the C-section wouldn’t have bothered you as much had you been able to actually hold your baby.” Yes, and all of that positive adrenaline and endorphins in your body probably would have helped you heal faster. So when I brought him home, we had to get him latched and that was a whole other hurdle, but I did. I had a lot of nursing issues with him because he had this torticollis. He had all of these issues, but I totally powered through and I still did it. But now with my daughter, I’m sharing her VBAC story, right? I’m sorry. I hope I’m not talking too much. With her, I had no issues. Nursed fine. She is a thriving, wonderful, beautiful baby and I totally believe that it is because of the birth with her and it went so differently that it is just so much better for me and it was better for her. It was better for my husband. It was better probably for my son too. That was my horrible, horrible C-section birth. Meagan: I’m so sorry. Grace: I think I covered everything. I’m sorry too. I keep talking. Yeah. It was horrible. I mean, looking back, I’ve learned so much and hopefully, other women can learn from it. I hope I covered all of those warning signs I want women to look out for. I don’t know but hopefully I did, but yeah. My heart goes out to the COVID-positive mothers who went through something similar or worse. I can’t even imagine. I do think that if you are positive and you are sick– if I were visibly ill, it’s so different to me. My mindset would have been way different. I would have still been sad, but I wouldn’t have felt like my autonomy was taken away from me. Meagan: Stripped. Grace: Yeah, stripped, which is much more where you feel like you are at their mercy. You don’t feel like you have freedom at all and it’s horrible. Meagan: Yeah. Grace: Yeah. So I get pregnant. My son at that point, I think, was about a year and four months. He wasn’t 18 months just yet. I got pregnant with my daughter and again, I knew I definitely wanted a VBAC, however, I had known a lot of other women who wanted VBACs too, and still ended up getting a C-section. They would say, “Yeah, we are going to try for the VBAC, but if it doesn’t work, you will have to have a C-section.” Every woman I spoke to who said that, ended up with one. As I was going through my pregnancy, I was trying to educate over time. I was like, “What is this that they are missing that I don’t want to miss?” I did not want another C-section. I did not want to ever go through that pain unnecessarily again. Obviously, listen. C-sections save babies. I am not against them. Meagan: Absolutely, yeah. Grace: You know that and you know that in so many ways, they are super important, but for me, if I have a healthy pregnancy and a healthy baby and I don’t have anything going on that would require that other than I had a C-section prior, then I am going to do everything I can to not have another C-section. So I discovered The VBAC Link, I want to say it was further into my pregnancy. I want to say I was at least 5 months into my pregnancy. Meagan: Yeah. Grace: How many weeks would I have to be for that?Meagan: 20?Grace: Was it 20?Meagan: 20 weeks is about 5 months so probably a little over. Grace: It was a little over 20 weeks and I discovered The VBAC Link. I am like, “Okay, I will give this a thought.” I already found a midwife. I didn’t want an OB and the midwife that I had, I really liked her. She had VBACs of her own. Meagan: Awesome. Grace: I was super adamant. I’m like, “I do not want another C-section.” She understood. Here’s the thing, though with these providers and I liked her. I’m not trying to make it seem like she did anything wrong, but they don’t educate women on what to do. There are so many things that women can do to get themselves in the best situation to have a nice, vaginal birth potentially not even needing medicine. They don’t. I don’t know if it’s that they don’t on purpose, but a midwife is not an OB. She’s not going to give me a C-section, so why wouldn’t she want to give all of the resources to her patients? I didn’t even know what Spinning Babies was until I listened to your podcast, then I researched Spinning Babies and I used Spinning Babies. So anyways, I discovered you guys or you ladies and I started listening to you every day on the way to work and the stories were just so wonderful. I learned a lot. I learned that one of the big ones was to find a hospital that is more likely to support a VBAC and has a high success rate of a VBAC. Now, the hospital I picked, I was told it was a good one. It is a good hospital. Nothing specific about childbirth or anything. It was very close to me. I had known other people who had delivered there and it was fine, but I’m like, “You know what? Let’s look at their success rate versus other ones.” Their success rate was 7%. Is that high or is that low? Meagan: That’s low. 7% of their success rate of a VBAC, that’s low. Grace: That’s low. That’s low. There was another hospital I heard about from someone who gave birth there and it was an hour away. Most women who gave birth there had the best experience. It’s a hospital and then it had a birthing center connected to it. Because I was a VBAC, just birthing centers wouldn’t have let me go there because if they needed an emergency C-section. That setup was great. I looked at their VBAC success rate and it was 22%. Meagan: Higher than 7. Grace: Now that you say that, it was probably still fairly low, but that was the highest I found. Meagan: Yeah. Grace: Yeah, and now I went ahead and listened to your podcast for a few months and I started getting scared. I was like, “I don’t have a doula. I don’t have a lot of information that a lot of these women had.” Now that I have it, I was already at that point, I want to say 7 months in my pregnancy. Not going by weeks just because I don’t know why months make more sense to me. That’s when I started becoming very much doing more research and being more actively aware of my birth and wanting to make sure that this birth goes better. I find this hospital. At that point, I go, “I’m going with this hospital and no one is going to stop me.” But because I was already so close, I was actually in my third trimester already and I told my– the way it works is I was very lucky. My provider was part of a bigger company. I’m not going to give out any names or anything unless should I? Meagan: If you have a supportive provider that you would suggest, I highly suggest giving the name because also, Women of Strength if you are listening, we have a provider list. We actually have that, so we will be adding this one to your list. But if you guys have a provider that you highly suggest as being VBAC-supportive especially if there are multiple Cesareans, please send us that at info@thevbaclink.com because we want to add them to our list. Grace: Okay. Okay, yeah. I definitely will. At the time, they were called CareMount near the area where I was, but they just got bought out by a new company called Optum. Meagan: Optum, okay. Grace: Most adults of my age remember them as CareMount because it was super recent that it changed. Optum was in my area and because they were big, they also had a practice up near this hospital. I called the practice up near the hospital and I said, “Listen. I’ve been going to midwives down by me, but you have all of my information because it’s all the same system. I want to go to your office because I want to deliver at this hospital.” Can I say the name of the hospital? Meagan: Yeah. Grace: I can, right? It was Northern Dutchess. They are amazing. They have a birthing center. The staff there is incredible and yeah. I said, “That’s what I want.” The immediately were like, “We don’t take on patients so close to the end like this, but given that you are in the system, I guess it’s okay.” I was going to say to them, “I don’t care if it’s allowed or not. You’re going to help me give birth in your hospital.” I also was going to be like, “I don’t want to see any OBs. I only want to see midwives.” They still had me see two OBs and it’s actually fine because even their OBs were just better. They were more understanding. Believe it or not, the male OB was even more. I was scared to see the male. Nothing against men, but the fact that with my son it was a man and he made that comment to me, treating me, I don’t know. They didn’t give him any kind of nickname, but I think he was known for only really doing C-sections. I was so scared to have a man especially because by the time I saw him– so before I even get to that, they do the switch and at that point, again, I was listening to your podcast still and I’m like, “You know, I really should get a doula.” I’m in my 35th week or something. I’m like, “I need to get a doula. I need this birth to be what I want it to be.” I find a doula in my area. She is amazing. She said the same thing. She was like, “We’re meeting pretty late, but it’s okay.” She was super understanding. I told her about my whole horrible birth and she said, “You’d be surprised but that part is super common.” Not the COVID part, but the whole story. Meagan: The whole story, yeah. Yeah. Grace: Also, I think me being allergic to Motrin and that recovery being so– I hate to say it but traumatic for me because when you’re in so much pain and you are already in so much emotional pain, it is just horrible. She was like, “Yep. It’s a super common story. I’m not going to guarantee you a VBAC, but you’re going to get through this birth. It’s going to be beautiful. You’re going to have a wonderful connection with your baby.” She said, “Don’t worry about the COVID thing anymore. It’s not at all what it was in 2020. Try to think of all of the positive things.” She introduced me to Spinning Babies. I started researching so much of my own and I was like, “Should I do all of the dates and tea and the stretching and the walking?” She goes, “Do all of it.” It’s what they say. It’s like an old wives’ tale, but it’s not going to hurt. Do all of it. Take a deep breath. I started to get almost obsessive at the time. I even made a joke to my provider at an appointment. I was like, “I’m sure it says in my file that I’m the crazy VBAC girl.” He laughed. He said, “It doesn’t say that,” but I was very determined. Again, your podcast helped me so much because there were so many women who have gone through so many things and had to work even harder to get the providers that they wanted and get the support that they wanted. It’s so important and it’s so wonderful that you have it. So thank you. Meagan: Mhmm, yes. Thanks for being with us. Grace: So then, yeah. I changed my provider. I get the hospital. I get the doula and then I start those last, I want to say 5 weeks. I’m walking every day. I’m eating a disgusting amount of dates. I don’t think I’ll ever eat a date again. I’m sure you’ve heard that, but it’s true. Doing the tea and I was doing these stretches I saw on YouTube every night. My husband was very supportive. He was a little scared for me. He was kind of like, “Oh my god. If this girl doesn’t get her VBAC, what’s going to happen in the world?” I was very intense about it and then, yeah. We just waited and waited. Toward the end, this part was scary for me. We also joined this Evidence-Based VBAC Facebook group and it was not– I can tell by your face. Yeah. Meagan: Ugh. Grace: It was not what I thought it was going to be. Meagan: No, unfortunately. Grace: Because I did this all kind of late, by the time I was up to 40 weeks, I went on that page maybe a week before or at 39 weeks. I started reading and I’m like, “Oh my god. Now I’m terrified to go into labor.” Note to listeners, please don’t go on that Facebook page. Meagan: Join The VBAC Link Community. Grace: Yes, 100%. Meagan: Shameless plug right there. I think our community is just one of a kind. Grace: 100%. But the thing is at that point in time, to read any of that at 39 weeks put me into a fear mode. At 40 weeks, I started crying every day that I wasn’t going into labor. I wanted to go into labor at 39 weeks, but that likelihood I think was very low because I was late with my son. I never even technically went into labor with my son. With my son, I was 40 weeks and 5 days when they induced me. So from 40 weeks on, again, because of reading those posts, I started really freaking out. I was crying. I was calling my doula every day. I’m like, “I’m not going into labor. I really don’t want a uterine rupture. I’m scared.” This and that. She was so great. She just was like, “You need to relax. Everything is going to be fine.” She said, “If something is going to happen, it could have already happened. One of my best friends is a nurse and she actually was a nurse in an OB’s office for a while. Every time I would go to talk to her, she would go, “You need to stop.” She would be like, “Anything could happen.” Meagan: Spiraling. Grace: Yeah, yeah. But it was good to have that. It was good to have somebody say, “Anything that could happen. You can’t sit there and say that just because you have this thing which is unique to you that you want to have a VBAC doesn’t mean that you’re definitely going to have something happen. You could have a perfectly healthy pregnancy and everything would be fine and then something bad would happen. You can’t worry about it. It’s not in your hands right now. You need to just relax.” That was a tough part though, just going through that week and then I started getting really bad prodromal labor about a week after at 41 weeks. I started getting it really bad and I kept thinking, “Should I go to the hospital? Is this it? Can I get the baby out?” I was so excited and my doula every time would go, “No, no, no, no, no. You’re not going anywhere near that hospital right now.” Thank God she said that. So then I think I had prodromal labor for about three days or four days or something. Then finally, on the final day, my mom was over and I was in so much pain just from all of the prodromal labor. I’m like, “Something is not right.” She looked at me and she was like, “You are in active labor. I can see your stomach contracting.” I’m like, “But I called. My doula said I shouldn’t go. I don’t know what to do.”I already lost my mucus plug a few days before that. I had never gone through anything like that. Nothing like that. Meagan: You’re getting into labor though, yeah. Grace: Yeah, but my mom again, has five kids. She goes, “No, no. This is labor now. You really should go.” She even talked to my doula two nights before that because I thought that two nights before that I was going into labor and my doula was saying to my mom, “No, not yet. She’s not ready yet.” I don’t know how she knew that. At that point, I called my doula again. She said, “You know what? Your mom is probably right.” I was timing them. I don’t remember what the times were, but they were so strong. I think my mom was like, “I don’t even think it matters. This is labor now.” I get to the hospital and I was 100% effaced and 5 centimeters dilated. Something to start. Meagan: Yay! Getting ready to get into active labor right there. Turning that transition. Grace: Yes. He tells me that. I was COVID-negative. It was like the clouds were opening up. Things were falling into place. The only thing is and this is a totally okay thing. My doula had another birth that night so she couldn’t go. I forgot to mention this. She already knew she was going to not be there. She actually called a backup doula and this was actually the morning before I went into the hospital. I called her. We had a nice conversation. She was like, “I will definitely be available.” I go, “I’m having a lot of prodromal labor. It’s really uncomfortable. I’m tired.” I’m like, “I just don’t know what to do. When should I go?” She was like, “Okay, at this point in pregnancy, it’s totally normal. Why don’t you just go on a two-hour walk?” What? Meagan: A two-hour walk? Grace: I was walking every day for two months. A two-hour walk? I’m struggling to sit. I’m like, “Okay.” She told me at 9 AM. I went on a two-hour walk and listen, I was at the hospital by 4:00 PM that day. She totally knew. She ended up coming and she was so sweet and amazing. I had never even met her before. I would totally recommend either doula if anyone is asking. If it means anything, their rates were nothing crazy. I listened to a bunch of doulas which again, I got from your podcast that you want to really interview your doulas and make sure you know your doulas. They were super reasonable and both were wonderful. That all fell into place. I was just starting to have my contractions. She was there to do all of the lunges together and all of the movements together. She put me in all of the right positions and I ended up not needing an epidural. Let me rephrase that. I ended up not having to require an epidural even though it was very, very painful. But it was a very welcomed pain. I was in labor for about 14 hours. It was a long, long day. I made a birth playlist which I did for my son too and I never got to really use it. One moment during labor, that particular experience was when the doula goes– this was around 6 centimeters, maybe 7 centimeters. She goes, “Why don’t you go dance with your husband?” I had my birth list on and I think it was a Justin Timberlake and maybe Beyonce song. It was a very romantic, lovey dovey song. We were just standing there. The lights were off. We were dancing and it was just so beautiful. The nurse told me after. When you’re in labor, you’re not totally aware of your surroundings. She told me the next day after the baby was born and everything and she goes, “I almost started crying when I saw you and your husband standing there dancing.”Meagan: Such a precious moment. Grace: Both she and my doula I remember were kind of off to the side standing there. It was just so wonderful and yeah. She got me through labor and I had to push for a solid, I think, hour which was fine. It was really painful. At one point, I screamed, “I want someone to help me!” You know, it was really hard, but she was there. I give a lot to her. She did all of these things to help me feel comfortable and safe. I was with someone who was going to make sure I was going to be okay. Yeah. The midwife came and I loved the midwife. She was wonderful. I had met her before. She was very knowledgeable. She wasn’t necessarily the most nurturing. She was much more like, “I’ve given birth to thousands of babies. I’ve done VBACs before. We’ve got this, no problem.” At one point, she came in and she was worried my contractions had slowed down, but right after she left, my doula was like, “All right, let’s go. Get up. Ramp up the speed. We’re going to do this. We’ll put you on the peanut,” and all of the things because she knew I didn’t want an epidural. I am curious about having the doula there if that is why they didn’t push anything on me. They didn’t push anything. Meagan: Good. Grace: Part of me is curious but I also think the hospital is known to not do that. My sister gave her second baby there and they didn’t push anything on her. So now again, you want to go to a good hospital that takes care of you. Meagan: Yes, you do. Grace: She came out and how big was she? She was 7 pounds, 8 ounces. My son was 8 pounds, 5 ounces. He really wasn’t even that big. Meagan: No. Grace: He could have come out. Meagan: He wasn’t. Yeah. Grace: No. I actually forgot to mention that before. He wasn’t even that big. They gave me all of that nonsense and yeah. Everything about her birth was wonderful. She went right on my breast. He latched not right away, but within 24 hours. He latched and was eating fine. It was wonderful. I didn’t have to change rooms or anything. They let me stay in the same room. I got to get up and walk around. Yeah. It was exactly the experience that I had wanted. Meagan: Yeah. Grace: Yeah. Meagan: I’m so happy for you. I’m so happy that you could have that more healing, redemptive experience where you felt the love. You felt that connection. You had the people there for you. You felt safe. You weren’t being pushed. You weren’t having people rushing in like you were some scary alien. You weren’t having these things that honestly doesn’t help our cervix dilate. There are so many things from your first story where I’m like if we can create a special environment, a comfortable environment for us, then that is going to help us progress in labor. We know one of the number one reasons for a Cesarean is failure to progress and a lot of the time, it’s situational. We did this and it’s baby’s position or something like that, but a lot of the time, I think it’s truly the environment and what we’ve got going on and if we feel safe because our bodies are smart. If we don’t feel safe and if we don’t feel comfortable, we are not going to progress. We’re not going to have those things and so yeah. I’m just so, so happy for you. I’d love to touch on a couple of signs when it is time to switch your provider or time to switch your location because I think it is one of the most daunting things to change your provider mid-pregnancy. It can be hard. Grace: Yeah, yeah. Meagan: And/or change your location. I changed my provider and my location at 24 weeks and it was emotional a little bit too. It was just like, “Oh, I hope it’s okay. I don’t want to hurt any feelings and this and that.” Anyway, just so much. We have some blogs on so many topics that we talked about today. But number one, I want to talk a little bit about some of those warning signs because like you said, you were like, “That was a warning sign. That was a warning sign. That was a warning sign,” but you weren’t in that space. Sometimes that’s how it goes. I had the same thing. I go, “Whoa. I should have switched.” One, I want you to know, Women of Strength, that it’s okay to switch. 100%. We do have that provider list if you are looking for a provider in your area or you start hearing some of these signs and you’re like, “Oh crap.” If one of those fits, email us at info@thevbaclink.com and remember VBAC is spelled V-B-A-C instead of V-B-A-C-K. Email us and our team will get you that list. Okay, so warning signs. Recommending a third-trimester ultrasound to check on the baby’s size. When you go in for that 20-week ultrasound and they’re like, “Oh, this baby is big.” Right there, that’s a huge warning sign. I’m just going to say, if your doctor is talking about your baby being big in general, that’s a red flag. That means that they are starting to doubt your ability. Their confidence in you is going down to get that baby out and they will probably push things like induction and all of those things, right? So talking about your placenta dying. They actually use these words. “Your placenta could die if you go past 40 weeks pregnant or past 41 weeks pregnant.” Not true. Not needed. You know? It’s not. You don’t need to have an induction just because you are 40 weeks. Your placenta is okay. Yeah. Making those one-off hand comments of, “Your baby is big. Your pelvis could be too small. You’re looking big. You’re really a petite person.” I don’t like that. Refusing to let you go past 40 weeks. Refusing to induce at all. If your provider is completely refusing to induce you because you are a VBAC, they are not following evidence-based care. I cannot tell you that enough. We see it all the time in our community where it’s like, “I can’t be induced because I’m a VBAC.” False. False, false, false. False. Big F. False. Now, is induction ideal?Grace: No. Meagan: It could be less ideal. It is less ideal. Not even could be, it is. It is less ideal. But it is not impossible. If you are facing an induction or a C-section, do the research. Learn about it. Know that it is still possible and you will not just for sure rupture because you are induced with Pitocin. That’s another myth out there. Overemphasizing the risk of uterine rupture. Telling you that you last time didn’t have good success so you are unlikely to have good success this time, putting doubt there, and so much more. We actually have a blog about it. We are going to put it in the show notes today on 10 Signs it Might Be Time to Switch Your Provider. I also think there are some really good tips for preparation. You talked about that. You did the Spinning Babies. You ate dates until you literally probably couldn’t eat any more or you couldn’t stand the smell of them. You did all of these things. Preparing for birth. You got the doula. You found the location. You researched your area. You found your birthing location. You found your hospital and midwife. You found a VBAC doula. Even in the end of pregnancy, you can find a doula and if you didn’t know, we have a resource online at vbaclink.com where you can find a doula that is actually VBAC-certified. They have taken our course. They understand all of the things about VBAC. They can help you find a VBAC-supportive provider. They can help you find that confidence. They can help you and see those moments of, “This is a really great time. Go dance with your husband. Let’s release the oxytocin naturally,” or “This is prodromal labor. Maybe don’t go to the hospital right now. This is what you can do instead.” Okay, you know? Those types of things. Mental– Grace: Get you off the ledge. Meagan: Yes, talk you off of the ledge. Mental preparation– preparing, we have the VBAC Link Course. We have the blogs. We have the stories. We have the communities. This is what this is for. Mental prep, finding the confidence, processing your op reports, and these things. Physical prep– doing those things. Eating the dates, drinking the tea, and making sure you have good nutrients like our favorite Needed. You’re making sure that you are taking care of yourself nutritionally so that you can also prep in other ways and so many more. We’re going to make sure to have that. We’re going to have blogs and books and things to suggest at the bottom of the show notes. I think that this story although it did start off with a heartbreaking experience– I could see you. I could feel it. Your experience is hard. It’s three and a half years ago and it’s still with you. These experiences stay with us. I think that’s where we owe it to ourselves to give us the best experience and to put us in the best situation possible. Sometimes, I think it’s, “Oh, well a doula could be more expensive. Oh, taking a course is a lot,” but in the grand scheme of things, if we look back at our experiences, my first two C-sections and even with my second, I had educated pretty okay. I’d say okay, not great. If I had looked back and taken the course to help me know that information, if I would have hired the doula to help me feel not so backed in a corner, absolutely. Yeah. I would have paid that no matter what. Grace: Yeah. Money is of no value at that point. Meagan: It’s of no value and it is. Money is a huge thing in this world, especially with the way our world is going. Money is a big deal, but in the end, you deserve it. You deserve to get those prenatal massages, to go to the chiropractor, and to get those prenatal vitamins that are going to truly help you. You deserve these things. Women of Strength, it’s okay to spoil yourself for your birth. Grace: Right. Meagan: Recognize these things and get the tools we can so that in the end, even if it ends in a repeat Cesarean, it can hopefully be a more healing experience. You’re going to know the things. You’re going to know your options. You’re going to know you did everything. I just think there is so much power in these two stories all along the way that you can take from this. Grace: I also think too, one thing I never really even thought about is if you are a mother and you have had children and you have had wonderful births, you’ve had wonderful vaginal births, don’t support new mothers that are pregnant to do those things anyway because just as maybe it didn’t work for you, they might need it. My mother had five natural births. She didn’t have a doula. She had none of that and she made it seem like it was like that. She made it seem like, “Just go to the hospital. They will take care of you.” That’s what I did. I read baby books and everything, but I did not think I was going to be one of those moms. Meagan: None of us do, really. Grace: None of us do, but just because it was okay for you and everything was okay for you if you know a mother and she is nervous or something, tell her, “You know what? Get a doula. It’s going to help you. It’s going to guide you. Did I need it? No, but if you are nervous, do it anyway. It’s only going to make things better. It’s going to lessen your stress.” Like you said, take a course. Support women anyway with those resources so that it can prevent them from falling into those pitfalls which now I think maybe it’s a generational thing. I don’t think my mother had a lot of pressure when she was giving birth to children back then. I don’t really know, but that was my guess because she was my main resource. Yeah, if you’ve had good births, still support other new moms to have more support and resources at their luxury even if you didn’t need it at the time because they might. Meagan: Exactly. Yes. Grace: Yes. Meagan: Oh, well thank you so much for being here with me today and letting me go off on this little passionate rant at the end. Grace: Thank you. I feel like I talked so much. I’m like, “Oh my god.” I don’t know what it is that I wanted to share so much. It’s just so important. Meagan: These stories matter to us and they matter to everyone listening. Women of Strength, thank you for listening today. I hope and I’m sure that you took some information out of these stories. Remember that we are always accepting stories also for social media so if you are ever wanting to share your stories on social media, email us at info@thevbaclink.com.ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link. Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Jan 17
1 hr 13 min
Episode 271 Dr. Nathan Fox Returns Sharing Evidence on Uterine Rupture, Induction, Cervical Exams & More
“I think that’s why there is so much discussion about this because it is not the numbers. It is the attitudes. It’s the opinions. It’s just trying to make sure that you have an aligned vision with your provider and with your hospital.” One of the most important things you can do during pregnancy is to find a provider who loves and believes in VBAC. Dr. Fox is back today giving more tips on how to know if an OB is VBAC-supportive and why there is so much variation out there in how practices feel about it.Dr. Fox answers questions like: Why do some providers refuse to induce VBACs? Why do some providers require it? Are routine cervical exams necessary for VBAC? Does a uterine window in my operative report mean my uterus will rupture during my VBAC?Additional LinksNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, guys. This is The VBAC Link. Welcome back or if you are new to the show, welcome. We are so happy that you are here. My name is Meagan and I am so excited to have a returning guest with us today.We have Dr. Nathan Fox who is a board-certified obstetrician and gynecologist with a sub-specialty in maternal-fetal medicine. He is here answering your guys’ questions. This community is amazing and every time we reach out and say, “Hey, what are your VBAC questions?” We do. We get a ton. I love bringing on guests, especially within the medical world, OBs and midwives talking about these things with you and what they are seeing and what the evidence says. It’s always fun to get a different provider’s perspective and get a better idea on what really the research is showing. Review of the WeekSo welcome back, Dr. Nathan Fox. But of course, we have a Review of the Week so I wanted to quickly get into that and then get into these amazing questions. By the way, they are questions about induction– when or is it really necessary? Can I be induced with a VBAC? We are going to talk a little bit more about uterine rupture and the risk which is, of course, a burning question that everyone always has. We are going to talk about maybe if a provider has told you that they have seen something like a uterine window, dehiscence, or even a niche. We are going to talk a little bit more about those so definitely stay with us because this is going to be a really great episode. This review is by Elizabeth Herrera. Hopefully, I did not botch that. She actually sent us an email. If you didn’t know, we love getting reviews in emails as well. You can leave us a review on social media. On Instagram, you can message it on that. You can email us at info@thevbaclink.com or you can leave us a review on Spotify or Apple Podcasts. You can even Google “The VBAC Link” and leave us a review there. All of your reviews help Women of Strength just like you find us and find these incredible stories and these incredible episodes like today’s episode with these providers to learn more about their options for birth after Cesarean. Elizabeth says, “Thank you so much for creating this whole community. After my emergency C-section in 2019, I looked up everything possible about being able to VBAC. This led me to your wonderful podcast and blog. I devoured everything. I owe my knowledge to you all and my doulas. I’m happy to say that I had my VBAC on March 31st and it was the most magical experience ever. Thank you so much for all of the materials that you have provided which all helped me succeed. I hope to one day share my story on your podcast. Many, many thanks.”That was in 2022 so a couple of years ago she left that review. So hopefully, Elizabeth, you are still with us and listening to all of these amazing stories. We would love to share your story which also leads me to remind you that we are always looking for submissions. You can submit your story on our website at thevbaclink.com/share.Dr. Nathan FoxMeagan: Okay, you guys. We have Dr. Fox back on the show today with us. How cool is that that he has come on now twice with us to talk about VBAC and answer your guys’ questions? Dr. Fox, welcome to the show again, and thank you again for being here. Dr. Fox: Back on VBAC. Meagan: Back on VBAC. Back talking about VBAC. Tell me what you think about this VBAC topic and how VBAC looks for OBs. I think a lot of the time, OBs and midwives and providers in general can get some backlash honestly, even from us here at The VBAC Link where we are like, “Oh, that’s not a good, supportive provider.” I think there is a lot from the community that we really don’t take into account on where a provider is coming from maybe with what they’ve seen or what they’ve gone through. Maybe they want to support VBAC but their location doesn’t support it. Can we talk about VBAC from an OB’s standpoint? What does VBAC look like for an OB?Dr. Fox: Yeah, listen. It’s a great question. Thanks for having me again. I’m always happy to come on. I really like this topic medically, but also, it’s just very interesting because there is so much that comes up with VBAC in terms of the medicine surrounding it. It’s also a really good paradigm for how people look at risk. By people, I mean doctors. I mean nurses. I mean hospitals. I mean women who are pregnant, thinking of being pregnant, their families, and their friends because there isn’t a ton of disagreement about the numbers. What is the risk percentage-wise? We have that worked out pretty well. I mean, there are some things that are maybe a little bit more nebulous. There are those situations, but most people agree on what the actual numbers are. The issue is what do you do about that when someone has a small risk of a big problem? Right? Meagan: Right. Dr. Fox: What do you do? That personality comes into that. I think that’s part of the reason that there is so much variation in VBAC practices, VBAC attitudes, and VBAC rules. It’s risk. I talk to people about this all of the time in other contexts like with genetic screening. I tell people, “All your genetic tests are normal. All of the screening tests were normal that we did. Everything is fine which means that your risk of having a baby with a genetic condition now is 1%.” I’ll tell them that. Some people hear that and say, “That’s awesome,” and then they walk out. Other people go, “Oh my god. 1%. That’s unbelievably horrible,” then they sign up and do a CVS and amnio. Neither of them are wrong. 1% is 1%. It’s 1 in 100. People are going to look at that differently based on their understanding of math, based on their personal experiences, based on the stories they’ve heard, based on their own anxieties, based on who is in their family. All of these things contribute to someone’s opinion about a risk that is low. Take VBAC for example. If everything is otherwise ideal– a healthy woman who had a prior C-section that was standard with nothing crazy about it. Pregnancy is going fine and she is deciding whether to attempt a VBAC or whether to do a repeat Cesarean, people are going to talk to her about the risk of uterine rupture. That risk is a ballpark of 1%. Whatever. It’s about 1%. Okay. It’s the same thing. How does everyone look at 1%? I could look at it and say, “Well, 1% is pretty low. It’s only 1 in 100. I really want a vaginal birth because I want it or because it’s going to give me an easier recovery potentially or because I’m afraid of a C-section” or whatever. Or they can look at it and say, “Holy crap. 1%. I don’t want any part of that risk and I’m just going to do a repeat C-section.” I don’t think any of those opinions are unreasonable. I think they are both reasonable based on how you look at it. So if you have a situation where everyone’s aligned– the doctor thinks it is reasonable, the patient, the woman thinks it’s reasonable, and the hospital thinks it’s reasonable, then it’s not a big discussion. Okay, we talk about it and the VBAC happens. Where I practice, that’s the culture in my practice and in my hospital amongst my patient population. We talk about it. Many people want to do a VBAC. They want it. We are supportive. The hospital is supportive. The nurses are supportive. Great. Some patients don’t want to have it. Fine. We’re supportive of a C-section. The hospital is supportive. All is good. I think the issue comes up when there is a disconnect like the patient wants it. The doctor thinks it’s too risky for the patient and the doctor thinks it’s fine, but the hospital thinks it is too risky or whatever. There are all of these situations. Meagan: Yes. Dr. Fox: Since doctors are humans and patients are humans and even though the hospitals are buildings, they are run by humans, you are going to have a lot of humanity and humans and all of our fallabilities and flaws and quirks come into this. That’s a very long-winded answer to your question, but I think that’s why there is so much discussion about this because it is not the numbers. It is the attitudes. It’s the opinions which is why so much about VBAC is not trying to figure out your number. It’s just trying to make sure that you have an aligned vision with your provider and with your hospital. Meagan: Right. I love that you pointed that out. It’s the perspective on this number. We know the number is say 1%, but to some people, that 1% may be 60% in their mind. It might as well be 60. Do you know what I mean? I love that you talked about being aligned. That is something that we talk about here a lot is really being aligned with your team. Find your team because your team is super important. The mom, the doctor, the hospital, the location, and the nurses, everything is aligned so that maybe we don’t have to fight so hard. I feel like this community ends up feeling like they have to fight for their birthing right. Dr. Fox: Yeah. Meagan: Like the way they want to birth, they feel like they literally have to come in with punching gloves and punch their way through to get this vaginal birth. That’s where it is just so hard. We are so vulnerable as pregnant women. Dr. Fox: Yep. That’s an unfortunate reality. It’s obviously a reality, but I would not counter it because I don’t disagree with it. I would advise that instead of coming in with gloves up ready to fight, you need a different provider. I’m not saying this to disparage a provider who is less pro-VBAC. They are humans. Whatever it is. Maybe the doctor had a really bad outcome once with a VBAC and they are scarred from it. Meagan: Exactly. Exactly. Dr. Fox: Maybe where they were trained, the attitude is very anti-VBAC so they are just not used to it. Maybe they would be okay with it, but they practice in an environment where the hospital is not so happy with it or the nurses aren’t. Whatever it might be, if your provider is telling you, “I am not a big fan of VBAC,” they are telling you this. Listen to them. Okay, that doesn’t mean they are a bad person. It doesn’t mean they are a bad doctor. It just means that’s who they are. So if you have an opportunity, seek someone who is more aligned with you. And again, obviously, that is easier said than done. It requires some work. It requires some legwork. It requires asking around, going on message boards, and finding people. If you have a prior C-section and you’re interested in a VBAC, if the doctor says that he or she is uncomfortable, I would first ask why. If they give you, “Listen, normally I am in favor of VBAC, but since you had a classical C-section, it’s too dangerous.” All right, that’s a very reasonable explanation that pretty much everyone is going to tell you, and switching around is probably not going to help you. But if they say, “I just don’t do VBACs or my hospital just doesn’t do them,” they are telling you that for a reason. Say, “Thank you. Have a good day,” then try to ask around and find someone or some hospital or someplace that is in favor of them as opposed to trying to convince someone to do something they are not comfortable with. Meagan: Absolutely. Dr. Fox: That ends up being a combative relationship and ends poorly for everyone. It would be great if all doctors were totally supportive. It would be great if all hospitals were totally supportive. There are sometimes logistical issues meaning since VBAC has the potential for an emergency, hospitals need to have 24/7 anesthesia. They need to have a blood bank. They need to have certain things in place in order to safely offer a VBAC. Some hospitals are just too small to do that. It’s not an attitude. It’s, “Logistically, we just can’t do this.” Fine. Again, try to go to a major medical center that does a lot of VBACs. Most major medical centers are comfortable with VBAC. Most doctors who practice in those centers are comfortable with VBAC. So I think if you do the legwork, you can probably, not always, but probably find someone who is a better match for your VBAC as opposed to trying to convince someone to do something they are not comfortable doing. Meagan: Yes. I love that, so we don’t have to try to convince. That’s why listeners, when you are with your provider– OB, midwife, or whoever it may be– talk to them. Have that discussion. Ask that question. Don’t be scared to ask them why. For me, with my second, I had this feeling that maybe he wasn’t as on board for VBAC as I wanted him to be. I was scared to leave or scared to hurt his feelings. But I think that it probably would have been better for both of us in the end to have found a different provider that was more on board and comfortable versus me trying to go in and push and try and make him do something that again, he wasn’t comfortable with. He wasn’t comfortable with that and that’s okay. For a long time, I had a lot of anger, and a lot of our community has harbored anger, but I’d like to drop a message to our community. Try not to harbor the anger. My provider is a great guy and a great doc and all of these things. He just wasn’t the doc for me, so find the doc for you. Dr. Fox: Right. Listen, obviously, there are a lot of doctors in the world and I’m sure that there are bad doctors or mean doctors or people who aren’t good people out there. I’m sure they exist. But I would say in my experience that most doctors are good people who are trying to do right by their patients. It’s too much work to go into medicine and train to go into it to dislike patients. It just doesn’t make any sense. My experience is that most people are trying to do right by their patients. But we are all human. We all look at risks differently. We all have different experiences. That happens. Humans are varied. It’s part of the reason it’s wonderful to be a human. We are all different. That’s all great. But it’s not complicated to get this answer from your doctor. I think it just requires some preparation meaning ask these questions very early either before you get pregnant or early in pregnancy. Again, they are not complicated questions. I would say the first question you should ask is something related to the numbers. Say, “What is my risk if I try a VBAC? Me, personally?” If they say, “Well, your risk of it is a uterine rupture,” say, “What is the number risk?” The risk is uterine rupture and if they say, “Well, it’s probably about 1%,” okay. That is the number. If they say it is much higher than 1%, well why? Is it because I have had a classical C-section or I have had three prior C-sections, okay, but get the number. Then the second question is very open-ended. Nonjudgmental. Say, “What are your thoughts or opinions about VBAC?” That’s it. Open-ended. They will tell you. Right? No one’s going to hide it from you. They will tell you overtly and say, “I love it. It’s awesome. I’m all over it. This is great. I hope you try it.” Or they’ll say, “Not a big fan. I don’t really like it. It’s not my thing. We don’t do it. I haven’t done it in 20 years,” okay. Or potentially, they will be somewhere in the middle and say, “I kind of like it,” but you’ll know. You’ll know right away what their thoughts are. Then the second question is, assuming they are supportive, about the hospital where you deliver. What’s the attitude there about VBAC? If they say, “You know, I am really in favor of it, but the hospital is awful. They torture me every time there is a VBAC. They make me be there the entire time. They always make me do C-sections. It’s just a terrible environment–”Meagan: Maybe not right. Dr. Fox: Right. Either of those two reasons is probably a reason to look elsewhere but if they tell you, “I’m on board. The hospital is on board,” it doesn’t mean you will have a VBAC, but you have a plan in place and you are ready to go. If they tell you, “I don’t like that. I don’t do that,” then turn around and say, “Okay, I really appreciate that. Thank you for your perspective. Thank you for your honesty. I am really interested in VBAC. I might be seeking a different doctor or a different hospital. Please don’t take that personally.” They will probably say, “Thank you.” Meagan: Yeah, exactly. Dr. Fox: Doctors don’t want a situation where they have a combative relationship. That is horrible. We hate that. It’s awful. That is what keeps us up at night. Do it at the very beginning and no one is going to have hard feelings over that. I would say it’s unusual that people are going to try to convince you to stay for the money. Doctors don’t want that. They would rather have you go to someone else than go to them and want something that they don’t want you to have. That’s just how doctors are. Meagan: I love that you just made that point because it is hard to leave. You get worried about hurt feelings and all of that, so thank you so much for saying that. Dr. Fox: Yeah. InductionMeagan: Okay, so let’s shift gears a little bit and talk about induction because this is a really hot topic when it comes to someone wanting to TOLAC or have a VBAC. I guess the question is when is it really necessary? What is the evidence on induction and VBAC? Because just like support, it varies all around where some people are absolutely no induction. You have to go into spontaneous labor. Some are like, “Yeah, cool. No problem. You can be induced.” Some are like, “You have to be induced.” Then when it comes to induction, that also ranges. Maybe we can’t do a Foley or a Cook or we can’t use Pit and we can only break your water and all of these things. Can we talk about the evidence specific to VBAC? Induction can be necessary. There are a ton of reasons for induction, but when is it really necessary? Dr. Fox: Right. Instead of talking about when it is really necessary, I think the question is why is it even a question? The reason is that the best evidence we have– it’s not perfect evidence, but the best evidence we have is that for someone who is undergoing VBAC who has induced labor, her risk of uterine rupture is about 1.5 to 2x as high as if she went into labor on her own. For example, if your risk was about 1% for a uterine rupture and you get induced, your risk is now about 2%. 1.5-2%. If your risk was a little bit lower because maybe you have had a vaginally delivery before so if you have had a vaginal delivery before, your risk isn’t 1%. It’s closer to .5%, it will raise it to maybe 1%. Again, I say it’s the best data available because the studies that were done, there is a little bit of a flaw in them because they are not randomized, but it seems to be correct that inducing increases your risk likely. The one exception is if you induce with misoprostol, the risk seems to be much higher so pretty much no one induced with misoprostol if there is a prior C-section. That’s usually something that nobody does, but the other ways of inducing whether that’s breaking the water, whether it’s Pitocin, whether it’s a Foley balloon, and all of these things seem to increase the risk slightly. Again, it’s the same thing as before. If now I have a risk in someone whose risk isn’t 1% but 2%, how do I view that? How does the hospital view it? How does the patient view it? Obviously, 1% and 2% are not hugely different from each other, but you could also look at it and say, “It’s double.” You can think of it in two different ways. Based on that, there are definitely doctors or hospitals who would say, “I’m comfortable with VBAC, but I’m not comfortable with inducing labor in someone who is a VBAC.” In our practice, that is not our position. We will induce someone’s labor. We tell them, “Your risk is a little bit higher. It’s 2% versus 1%,” or something like that, but again, if there is a reason not to, we would induce someone’s labor but different people look at it differently. So again, another question to ask to your doctor is, “Not only how are you with VBAC, but how are you with inductions and VBAC?”If they say, “Well, I’m okay with VBACs if you go into labor on your own, but I’m not okay with VBAC if you have to be induced,” does that mean you have to switch doctors? Well, it just means you have a potential limitation. Meagan: A potential roadblock in the end. Dr. Fox: Right, a potential one. Again, it depends on the circumstances. Obviously, each case might be unique. So that’s number one. Number two, there is some data that when you induce labor in a VBAC, your success rate is lower. That data is weaker and it’s a little bit complicated because the data in non-VBACs is that if you induce labor, the success rate is not lower meaning it does not increase your risk of C-section. Whether it’s different for someone who had a VBAC has not been studied appropriately to know for sure. It either has no effect like in everyone else, or we can use the older data that is flawed and say it does increase the risk of needing a C-section, but that’s really more related to the chance of success not so much related to the risk.Now, some people will use in order to make a decision about VBAC, they are weighing the risk versus the chance of success so it may impact the balance of the scales, but that’s really the concern with induction. Now, the only reason that I can think of that someone would insist that someone who is having a VBAC be induced always is only because they are concerned about them laboring at home and they want to have their entire labor watched in a hospital. That’s not the strategy we use, but again, it depends geographically on how far people live from the hospital. Meagan: We talked about that on our last episode. Dr. Fox: Yeah, do they typically wait forever to come to the hospital? Again, is it worth a slight increase in risk of 1% to induce as opposed to having them go into labor and wait four hours before they get to the hospital? That’s a strategic decision that is going to be very individualized obviously, but that would be as far as I can think of off of the top of my head the only reason one would say, “You need to be induced because it’s a VBAC specifically.” There are reasons to be induced all over the place obviously obstetrically, but as someone we are talking about here, if someone needs to be induced then they need to be induced and there is a decision about that. When I counsel people about VBAC, essentially they fall into three groups. Again, assuming it’s a safe option for them. Option one is, “I want a VBAC.” Option two is, “I don’t want a VBAC. I want a C-section,” and option three is, “I want a VBAC, but only if I go into labor on my own. I don’t want to be induced.” That’s based on again, the risk, the chance of success, the experience, all of those things, and those are sort of the three places that people land. That’s fine and obviously, you can switch from one group to another over the course of pregnancy based on how things are evolving, but that’s really the decision that someone is going to make. “I’m trying for a VBAC.” “I want nothing to do with VBAC,” or “I’m into it, but only if I go into labor on my own.” That’s something you want to make sure to see what your doctor thinks about that as well. Meagan: Yeah, okay. I love that so much because yeah. Like we said, there are so many reasons why like preeclampsia and all of these things, but yeah. Just wondering why you would have to be induced in order to VBAC. Cervical ExamsOkay, so let’s talk about cervical exams. This is also a hot topic in our community about routine cervical exams or having a cervical exam prior to even labor beginning to determine the likelihood or the success of a VBAC. Can we talk about the evidence of cervical exams during labor in general, right? In physiological birth, everyone is like, “We just don’t want to be touched. We just want birth to happen,” but when we come to hospitals, sometimes it’s a little bit more routine where they want to know the data of what’s happening with the cervix and everything like that. What is the evidence on actually determining someone’s success rate before labor even begins based off of where they are dilated? Dr. Fox: Those are two totally separate reasons why we would check the cervix. In terms of someone in labor, there is a tremendous amount of variation in the frequency of cervical exams in labor based on the provider, based on the culture, based on the patient, and so there isn’t one way to do it, but the reason one would have their cervix checked in labor is just to assess how the labor is progressing. Everybody does it. Doctors do it. Midwives do it. Home birth attendants  do it. The question is not do you check the cervix? It’s how frequently do I check the cervix and what do I do about it? That’s going to vary greatly across everything. The evidence is actually that it’s not harmful. Again, I’m not saying it’s not painful or annoying or uncomfortable certainly if you don’t have an epidural. I’m not talking about that. I’m just talking about the risk involved. There are people who say that more cervical exams increase the risk of an infection. The data on that is actually pretty weak amazingly. When we do the exams, we wear gloves. These are sterile conditions, number one. Number two, some of the data that indicates more cervical exams are associated with more infection is really just that more cervical exams are a marker for a longer labor. The longer you are in labor, the more cervical exams you are going to have and a longer labor is definitely a risk factor for infection. So it’s not exactly clear in that sense and also, if anything, if it’s ever going to be a risk, it’s only once your waters are already broken. If your waters are not broken, there is no reason to think that it should increase your risk of an infection or there is at least no good data to support that. I would say in labor, there is a lot of variation in that. Again, it’s hard to say. There isn’t one way of doing it, but the reason to do it is just to assess how labor is progressing to make decisions like do I need to get Pitocin or not? Do I need to do a C-section or not? Is this someone who I want to break their water or not? Is this someone who we can tell, ‘You know what? Just rest and I’m going to go home and come back in the morning’ or not? All of those things, when is she going to deliver? Fine. Before labor, examining someone’s cervix in the office or before we do anything in labor, the data on that is originally meant to give a prediction of when someone’s going to go into labor on their own meaning if you examine someone, the term we use which is kind of crude is “ripe”. If the cervix is ripe versus unripe– for some reason, doctors love to compare things to foods, specifically fruits. I don’t know, whatever. Maybe we grew up in a tree-based society. I’m not sure, but whatever. It’s crude, but that’s the term that is out there. The thought is if the cervix is ripe and the components of that are a little bit open, it’s short,  it’s soft, it’s what we call anterior meaning in front of the head versus all the way behind the head and the head is low, the likelihood that person is going to go into labor on her own in the next week or so is higher than if her cervix is unripe. That’s why it was invented. I personally have found that to be mostly useless because okay. If someone’s chance is, let’s say 40% versus 20%, what does that mean? Nothing. You can have a very unripe cervix and go into labor that night and you could be 3 centimeters dilated and not go into labor for 2 weeks. What’s the difference if your chance is 40 versus 20%? What are you going to do about that? Nothing. In our office, in our practice, we don’t routinely check the cervix before 38 weeks and then after 38 weeks, we offer it as an option. A lot of people want to know what’s going on with their cervix. There is a lot of curiosity out there. If someone doesn’t want to know, that’s fine. We’re not going to do it. But one of the reasons it might be helpful practically might– I’m not saying definitely– let’s say someone called me at night. It’s 3:00 in the morning and they are like, “I’m having some cramping. I’m having some contractions. They’re not so bad. They’re this. They’re that. I live 2 hours away,” and I saw her that day in the office and her cervix was long and closed, I may feel differently than if I saw her and her cervix was already 4 centimeters dilated. So, okay. There is some practical information that is to be gleaned, but it’s not always that useful. When you’re inducing someone’s labor, it does give you a sense of the likelihood of success and what agent you’re going to use or not use, so that’s the reason you’ll do it either on admission to labor and delivery for induction or maybe in the office just before to sort of plan the induction because what we do is based on the cervix. For VBAC specifically, it’s not like it needs to be done, but obviously, my thoughts about someone who is trying to VBAC are going to be different if, at 38 weeks, she’s 3 centimeters dilated, the cervix is soft, and her head is low versus her cervix is long and closed and firm and the head is way up near her nose. I’m just going to think about it a little differently and then I’ going to counsel her a little bit differently and then it may be practical. It may, but it’s not usually tremendously helpful clinically is what I would say. Meagan: Okay. So for our listeners, kind of what you were saying is that you can get the information, but it doesn’t mean that you’re not going to be able to have a VBAC or you’re no longer a good candidate if at 38, we’ll say 38 weeks, you have a long, hard, posterior cervix. It doesn’t mean– you might just have different counsel or have a different discussion. Dr. Fox: Right. Yeah. Again, it might be that. It might slightly change your odds one way or another, but it’s not usually something that we use as a decision-making tool about whether you should or shouldn’t VBAC. Again, let’s say– I’ll give you an example where it might be useful. Let’s say we have a situation where someone has a prior C-section. They’re thinking about VBAC or they’re interested in it, but they have some concerns, right? Like most people, they’re interested but they have some concerns. They’re 38 weeks and let’s say the baby is measuring a little bit small and her blood pressure is a little bit high. I say, “We need to deliver you. We need to induce. We need to deliver you.” At that point, there isn’t an option of being in spontaneous labor. It’s either I induce her and if I don’t induce her, we have to do a C-section. Those are the two options on the table because waiting is not a safe option anymore. Fine. It’s possible that my counseling will be different if when I do her cervical exam, it’s long and firm and the head is high versus the head is low and the cervix is dilated and soft because I’ll tell her, “Listen, inducing your labor in one situation is likely going to take a long time. Your success rate is a little bit lower” versus “It’s going to be a shorter time, again, likely not definitively and your success rate is going to be higher.” It’s possible that she might say, “All right. I don’t want an induction if my cervix looks like this” or “I do want an induction if my cervix looks like this.” It’s part of decision-making potentially, but that’s usually if I’m about to induce her labor versus do a C-section. If she’s going home either way, if it’s just the Tuesday and it’s 38 weeks and there’s nothing wrong and I’m just sending her home and she will either come back in labor or come back in a week, then it’s not going to matter much if her cervix is open or closed on that day. It’s really if I have to make a decision about delivery that I’ll be more practical. Meagan: That’s something that I love about you is just that–Dr. Fox: Oh, all right. Meagan: I do. It’s like, “Let’s talk about this.” You offer counsel. I don’t know. You just offer more. It’s not just like, “You have.” It’s the way you talk anyway. I mean, I’ve never been a patient in your clinic so I’m talking very broadly of what I feel like I love about you, but it doesn’t seem like you’re black or white. It’s, “Hey, this is what we have. This is what we’re showing. This is where baby is or where you are and it’s no longer safe to be pregnant for you or for baby. Here are the options and based on that person as an individual, it might be different versus the lady that you had four or five years ago is now the standard for every person that walks into your clinic. Dr. Fox: Right. Right. I mean, listen. Medicine– there’s a lot of balance here. On the one hand, there is this push to be very standardized and that everybody should be the same. There are advantages to standardization. Less mistakes, it’s more clear, everybody has rules versus individualization which has its advantages as well because you can personalize medicine. You can tailor things to the individual. They are not a conflict, but there are two sides to the coin. On the one hand, you want things to be standardized and on the other hand, you want things to be individualized. One of the arts of medicine is knowing which way to lean and that’s where people differ. Experience gets involved. There is also, I would say, this idea in medicine where there are certain times where the doctor is supposed to say to the patient, “This is what you should do,” to be very directive, right? There are other times where the doctor is supposed to say, “Here is option A. Here is option B. Here is option C. Here are the pros and cons of all of those. What do you want to do?” Right? The problem is you don’t want a doctor who is always telling you what to do because that’s authoritative and it’s very–Meagan: It doesn’t feel good. Dr. Fox: Right and it’s also usually not appropriate, but you also don’t want a doctor who can’t make up his or her goddamn mind. You see the problems. When we’re training young doctors, we always talk about patient autonomy, patient autonomy, which is correct. Patients should have autonomy to make decisions for themselves, but you also have a duty as a doctor and as a professional that if you believe one option is better than the other, tell them and tell them why. If my plumber said to me, “Well, I could use the copper pipe or I could use the steel pipe. Which one do you want?” I’d be like, “I don’t know which one I want. Which one is better?” Meagan: Which one is best? Dr. Fox: Right. If he said to me, “Listen, you should absolutely have the copper pipe because they are better,” I would say, “Fine, do that.” But if he said to me, “Well, there are pluses and minuses. The copper is a little bit better but costs a lot more,” then I have to make a decision and that’s appropriate. The same is true in medicine. If I have a patient with pneumonia and I said to her, “Well, you could have antibiotics. You could not have antibiotics,” then I’m an idiot. I should be saying to her, “You have pneumonia. You need antibiotics,” because this is why I trained, why I went to medical school, to tell you, “You need antibiotics. This is the one you should have.” Fine. That’s appropriate. But in a VBAC, I don’t think it’s necessarily appropriate to say that. I say, “Okay. You have a 1% risk of uterine rupture. On the one hand, you could try a VBAC. Here are the advantages. Here are the disadvantages. Here are the risks. On the other hand, you could have a C-section. Here are the advantages. Here are the disadvantages. Here are the risks. I think they are both reasonable. Do you have a preference and which risk scares you more?” That is appropriate. I would say for people who are trying out figure out, do you have a good doctor? Do you have a good midwife? It’s not just, “Are they kind?” You want them to be kind. It’s not just, “Are they smart?” You want them to be smart. It’s not just, “Does their office run on time?” You want their office to run on time. It’s also, do you get a sense that they have a good balance between when it’s appropriate to tell you what they think is correct and when they give you options and have you participate in your healthcare decision-making? If they are always telling you what to do, it’s probably too much on one end. If they never tell you what to do, it’s probably too much on the other end. You need to strike a good balance. Getting back to what you said about the reason you love me, I definitely have situations where I tell people, “VBAC is not a good option for you. You shouldn’t do it. It’s a bad idea. I’m telling you it’s a bad idea.” Again, we’re not the police. I can’t force someone to do something. I’m not going to tie someone down and do a C-section, but I will tell them, “This is a bad idea.” I would say that’s the exception. Most of the time, it’s, “All right. Here are the options. Here’s what we are doing.” It’s not that we always tell people, “Here are your options,” and it’s sort of touchy-feely, we do that when it’s appropriate. It’s frequently appropriate, but sometimes, we have to tell people, “It’s a bad idea. This is why it’s a bad idea. You should not choose this option because of A, B, and C.” I’m very comfortable telling someone that, but I usually just don’t have to. Uterine Window, Dehiscence, and NicheMeagan: Yeah. I love that. Awesome. Well, we’re going to go into the very last topic. I know we are kind of running out of time, but this is one where we’re going to get stuff like that or we’re going to be like, “You shouldn’t do this” or the other opposite where it’s like, “We could do this. We could see how this goes.” It’s uterine rupture. We talked about uterine rupture, but more specifically to uterine window, lots of people are “diagnosed” or told that they had a uterine window maybe in their first Cesarean or multiple Cesareans later and that they shouldn’t VBAC or that they can’t VBAC or my specific provider told me that I would for sure rupture. He said those words– for sure, guaranteed.Then we have dehiscence which is chalked up into a full uterine rupture, but we know it’s not. Anyway, there is some stickiness in there. So can we talk about that? If someone was told or if it was put in an op report that they had a uterine window or a slight dehiscence, as an OB in your practice, what would you suggest or how would you counsel moving forward? Dr. Fox: Right. Right. I will give you the short answer and the long answer. The short answer is if I have someone who I think has a uterine window, I would tell them not to VBAC because I think the risk of rupture is too high. I would never tell someone, “You are for sure going to rupture,” because that is not true with anybody. Meagan: You can’t predict that. Dr. Fox: Even in the worst-case scenario. Someone who has had a prior classical C-section, they have a 10% risk for rupture. Someone who has a prior uterine rupture is not even 100%. I don’t think it’s 100%, but it’s usually too high for comfort. The problem is not so much me making the recommendation, “Don’t VBAC if you have a uterine window,” it’s how do you make that diagnosis? I think that’s part of the trickiness. Some of the confusion is that there is different terminology and some of the reason is we don’t have definitive definitions. So for example, uterine rupture is very clear. That’s when you are in labor and the entire uterus opens up internally and the baby and the placenta come out. It’s exactly what you would think a rupture is. That is pretty clear. The terms dehiscence and window are used interchangeably and what they basically mean is the muscle of the uterus is separated, but the very thinnest outside layer of the uterus, what we call the serosa, which is like a saran-wrap layer on top of the uterus did not open, so the baby did not protrude through this defect in the uterus. Meagan: It didn’t go through all of the layers. Dr. Fox: But it basically went through all of the muscular layers which is basically like one step short of a rupture. Now, we don’t know how many of those people would go on to rupture if you continued laboring then in that labor or in the next pregnancy. No one knows because no one’s really tried it. No one has really pushed that envelope because they are too afraid to. It’s hard. It’s very unusual to be diagnosed with a window on your first C-section because usually, it’s not going to happen unless you’ve already had an incision in a C-section. Usually, it’s someone who has had a C-section, then on their second C-section, when someone goes in to make the incision whether they tried to VBAC or didn’t try to VBAC, they see this and then they are talking about the next pregnancy. Most people are not going to recommend VBAC because the risk of rupture is too high in that circumstance. I fall into that camp as well. I am humble enough to say it doesn’t mean someone will rupture, but I think that risk is too high and I’m not really willing to test it out on someone because I think it’s probably not safe. Now, sometimes, someone may have been told they had a window and they really don’t. It’s hard to know. There’s another situation that is different which is when someone is not pregnant and they have an ultrasound of their uterus and they see some form of a defect in their prior C-section. So someone had one C-section, had the baby, they’re not pregnant. They come to my office and they do an ultrasound. I looked at the area of the scar and it looked like it wasn’t healed perfectly, so instead– Meagan: Properly.Dr. Fox: Well, it’s not proper or improper, it just frequently doesn’t heal to full thickness. Let’s say the uterus is a centimeter thick and I see that only half of the centimeter is closed and the other half of the centimeter is open, right? We call that sometimes a uterine niche. We sometimes call that a uterine defect. Some people call that a window, though it’s not technically a window. The question is A) What does that mean? and B) What do you do about it? The answer is nobody knows. That’s the problem. Meagan: Yeah. That’s the hard thing. Dr. Fox: Nobody knows exactly what you would do to allow VBAC, not allow VBAC, this or that, generally, what a lot of people will do is if they have only had one C-section, they’ll usually let them VBAC, but there is some data that if it’s less than 3 millimeters remaining of closed, the risk of rupture is somewhat higher. Again, that data itself is pretty weak. No one knows for sure. Should you use that? Should you not use that criteria? It’s very, very difficult and you’re going to see a lot of variation out there. In our practice, we don’t use that test so much to decide whether someone should VBAC or not after their first C-section because the data doesn’t support that. What we use it for is someone who has had multiple C-sections and they are already not planning to VBAC, but we are trying to figure out if is it safe to get pregnant at all. Do we need to fix this during pregnancy or if they get pregnant, do we need to deliver them at a different time? That’s a much more complicated discussion, but that’s how we use it practically. If someone has had one C-section, I don’t generally recommend doing that test to check the thickness and then making decisions based on that because it’s not clear that your decision-making is going to be any better with that information than without that information. So I don’t use it personally, but definitely, people will find it out there. They measure the thickness and they say it’s too thin. That data is all over the place, unfortunately. Maybe one day, we will work it out, but it hasn’t been worked out yet. Meagan: Yeah. So you can technically fix a niche? Dr. Fox: You can technically fix it, but that doesn’t necessarily mean they are safe to deliver vaginally the next time. Meagan: Because that’s a uterine procedure. Dr. Fox: Yeah. These are all new questions that are being sorted out. It may take a very long time to sort it out, but I would say for the more typical person who has had one C-section that was basically fine, it went well, and she is trying to decide to VBAC or not, the current data does not support measuring the thickness of the scar routinely either prior to pregnancy or in pregnancy and then making decisions about VBAC or not. There are people who do it and I’m not saying it’s wrong, but the data to support that is pretty weak so it’s not something that is universally recommended to do. It’s a different situation if someone had a C-section and then someone saw with their own eyes there is something wrong with this uterus or if someone has had multiple C-sections and then they see it, those are different clinical situations where it might come in handy. Meagan: Okay. Great answers. Awesome. Thank you seriously so much. It’s just such a pleasure to have you. I do. I just enjoy talking with you. I think it’s awesome and I think this community is just going to keep loving these episodes. Dr. Fox: It’s my pleasure. It’s your wonderful Salt Lake City disposition. Meagan: Yes. Next time you are in Salt Lake, come say hi. Dr. Fox: Love it. We’ll do it. I love Salt Lake City. Good stuff. Meagan: Yes. I love it here except for the cold. Dr. Fox: Except for the cold. I hear ya. I grew up in Chicago which is where my pleasant disposition comes from, but yes. It’s also cold in the winter. Meagan: That’s a whole different cold. Dr. Fox: We don’t get the skiing. We get the cold, but not the skiing so at least you get the mountains so you did it right. Meagan: Yes, we did. Awesome. Well, thank you so, so much. Dr. Fox: My pleasure. Thanks for having me. Always a pleasure. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link. Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Jan 10
51 min
Episode 270 Crystal Nightingale Returns + Postpartum & Lactation Tips
Crystal Nightingale from The Mama Coach joined us a few months ago and is back again today diving deeper into postpartum and breastfeeding than we’ve ever gone before!Did you know that new research is showing that cold compresses are more effective in helping clogged ducts than warm compresses or showers?Crystal shares her valuable insight gained as a registered nurse and IBCLC of over 10 years. Meagan and Crystal discuss everything from appropriate newborn weight loss to all types of infant feeding to how to have a successful breastfeeding journey starting even before birth. As we kick off 2024, we promise to bring new topics, deeper discussions, and exciting changes that will empower you even more to continue to have better birth AND postpartum experiences.  Additional LinksCrystal’s WebsiteThe Mama CoachThe Lactation NetworkHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello you guys. It’s 2024. I cannot believe that 2023 went so stinking fast and we’re already here. I think the new year is super fun because I think about all of the exciting things that we want to do for the year and we have this extra motivation. Today, we’re actually going to be talking about something that we don’t talk about a lot on the podcast. This is going to be postpartum. I’m excited to talk about postpartum because, with The VBAC Link, we are all Women of Strength. You are all preparing for birth. You’re all preparing for pregnancy sometimes. We’re so focused on the birth, but we forget about what comes after the birth. So we have our friend, our dear, dear friend, Crystal. Hello, Crystal. Crystal: Hello, good morning. Happy New Year. Meagan: Good morning. I am so excited to have you on today. Crystal: I’m excited. Thank you. Meagan: Yes. You are a registered nurse, an international board-certified lactation consultant which is an IBCLC and for everyone who has never seen an IBCLC, you guys, I have three babies and I breastfed with all three of them. I’ve seen an IBCLC with each baby because I’ve found that each baby is so different. Crystal: Yes. Meagan: If you haven’t seen an IBCLC before, I would highly suggest it. They can help so much. But Crystal is from The Mama Coach and she is going to be talking with us today about postpartum and mood stuff and breastfeeding and so many powerful things. So hold on tight. We’re going to do a review and dive right in. Review of the WeekThis review is from– I don’t even know how to say it– miralamb04 on Apple Podcasts and it says, “A Must Resource During Pregnancy.” It says, “The VBAC Link was most helpful and encouraging during my TOLAC (trial of labor after Cesarean) preparation. I used all of the episodes to everyone’s different expectations and outcomes to help me prepare for my VBAC. Finding out I was pregnant six months postpartum after a planned C-section due to a breech baby was frightening at first.”We have talked a lot about this close duration. It says, “I knew immediately I wanted to VBAC and started doing my research. The VBAC Link was constant during my stroller walks with my baby and helped me mentally prepare for my second pregnancy. I used the resources provided to help open up conversation during my prenatal appointments and ultimately advocate for myself and my baby for a planned, hospital TOLAC. I successfully had my second baby via VBAC a few days ago and I’m so happy that I did. Everything I could have wanted and so much more. Thank you, Julie and Meagan.” I love that so much. You guys, this is what this platform is for. It’s for you to have the education, the information, and the empowerment to go on and make the best decision for you no matter how that is and what your birth outcome looks like. I love how she said, “To advocate for me and my baby.” Right? Crystal: Yes. Love it. Meagan: I love it. That is so cool.Crystal: Very, very. Meagan: Thank you so much for that review. They touch me from the bottom of my heart and if you haven’t, please drop us a comment. Drop us a review. Let us know what you think about The VBAC Link. Crystal Nightingale Meagan: Okay, cute Crystal. Welcome, welcome. Crystal: Hi. Thank you for having me. Meagan: Absolutely. I’m so honored that you are here and taking the time out of your very busy day to talk more about that topic that we just don’t talk about. It’s not even that we don’t talk about it. I think it’s just that we don’t think about it. Crystal: Yeah, yeah. Meagan: It’s so far over there because we have such an event to get through. Birth is an event. Crystal: Yeah, it’s huge. Meagan: It’s such an event to get through that we can’t think about what we’re doing here or over here because we are right here in this moment preparing for this event. Crystal: Yeah. Yeah. Meagan: I mean, I have ridden tons of bike rides, races, long distances, and ran half marathons. I’m telling you that at mile 10, the only thing I was thinking about was where that finish line was, not where the next starting line was or that next experience. So I’m excited that you are here with us to talk more about this next journey because it is a whole other journey that leads us down a path through life in general and it can impact us for our next birth. Right? Crystal: Yes. Right. Meagan: It’s a circle. It all goes together. Let’s talk about it a little more. Let’s talk about your professional background. What got you into this? What got you into your passion for postpartum and serving moms and babies through postpartum and through breastfeeding? Crystal: Yeah, so I always knew that I wanted to work as a nurse or in the nursing field. I was just fascinated with labor and delivery and women’s health. Of course, being a woman and all of the amazing things that we can do. I had my oldest children younger so I was very naive. After I became a nurse, I really got into postpartum and mother and baby and just seeing new babies come into the world and helping the parents, the whole family, with breastfeeding and helping them take care of their newborn baby and just all of that fascinates me. It’s just incredible to me. I’ve been working with mothers and children as a nurse for a little over 10 years now and you know, just through my time in the hospital and the clinic, I have seen a trend. A lot of parents have the best intentions. They want to breastfeed and they want to do this, but then there is not a lot of support. The WHO, World Health Organization, and CDC all recommend breastfeeding for at least six months, but what? Then parents go back to work at six to eight weeks maybe? Some even sooner. I’ve seen some moms who have to go back to work within two or three weeks. So just seeing that lack of support postpartum for families just triggered, “Okay.” It’s very frustrating to be in a hospital or a large health organization setting and not be able to do as much as I want to because of all of the policies and regulations and things like that. So I teamed up with The Mama Coach to start my own private practice and being part of The Mama Coach has been awesome. We are a group of registered nurses and some nurse practitioners all around the world helping parents to make parenting easier through education, evidence-informed solutions, support, assessment, individualized plans, and all of the stuff to help support parents from the prenatal period to postpartum to feeding and starting solids, all the way up to five years of age with sleep and CPR and things like that. So yeah. That’s a little bit of my background. I have four kids and I did not get to breastfeed my older two because again, I was young and naive. I didn’t know anything. I “tried” to breastfeed not knowing that cluster feeding was normal. I just thought, “Oh no. I need to give formula because they sent me home with formula.” Then all of a sudden, my milk dried up and I was like, “Oh well. I guess I’ll just formula feed.” That wasn’t what I wanted to do. I just didn’t know how to continue the breastfeeding journey. Meagan: Yeah. This isn’t like anything that we talked about, but I kind of am wondering if you know the answer to this. We are talking about how all of these organizations– big organizations– encourage breastfeeding. We talk about how we don’t necessarily have the support but not only do we not have the support, but we have the alternatives given to us so easily which I think is great. I’m not saying it’s a bad thing, but it makes it easier or if we don’t know. Like with cluster feeding, you think you’re baby is starving. You think, “I’m not giving my baby enough. They are always hungry, always hungry and I have to supplement with formula,” when that’s not necessarily the case. Why do you think these companies are providing so much formula right out of the gate?Crystal: You know, I’m not sure. I can say it probably is because they are not thinking of the long-term effects of starting formula. If it’s needed, how I always was taught especially working in the hospital is that really, formula should be used and treated as a medication. Use if absolutely needed. But, when some staff or doctors or whatever see that a mother is struggling maybe, they don’t automatically think, “Let’s support her and see how we can help her reach her goal. Let’s just feed the baby and deal with it later,” not knowing that that can negatively impact the breastfeeding relationship down the road. You know, like you said, that is there for a reason, and if a baby really needs it, of course, use it. I think the organizations are getting better, but they can still be better. Meagan: Yeah. Do you know what I would like to see more? I know that this can be tricky because of all of the things that are put into our bodies and in this world, but I would love to see milk bank donations more. Crystal: Yes. Meagan: There are certain countries that are literally like Winder Dairy and they bring breastmilk to your porch for people who are struggling. It’s so awesome and there are parents out there. There are moms out there who have an insane overproduction, but their baby isn’t necessarily using it and it could go to a preemie baby or to a mom that may have a little bit of a rough start or have had a Cesarean under general anesthesia and isn’t able to really even be present in that moment. I would love to see that happen more. I don’t even know. There are all of the things out there. There are all of the apples off of the tree that I would like to grab and make happen. Crystal: That would be so amazing. Meagan: But they are out there too. So if you are struggling in your breastfeeding journey, it doesn’t hurt to ask, “Hey, is there a breastmilk donation in our area or in this hospital?” because there are situations where some hospitals– it’s not talked about and it’s not big enough yet, but there are banks where people who donate. And because of the craziness in this world, they are really, really strict on who can donate. My cousin did one and you have to check a million boxes to be able to donate. So anyway. Crystal: It makes sense. Meagan: It could be weird to people like, “Someone else’s milk, what?” Crystal: I’ve definitely encountered that before. Everyone has their feelings, beliefs, and opinions, so it’s like, “Well, it’s there.” I am seeing more hospitals in my area up in northern California have donor breastmilk available in the hospital, but the problem with that is they give the donor milk in the hospital, but when they go home, there is still not that support or continuation of care because now, mom’s milk maybe is not quite sufficient yet and how do we help them when they go home? Meagan: Right. Crystal: That’s another thing that we’re seeing too. Meagan: Okay. So that is a question right there even. We can go home, but I’m going to go back and talk about breastfeeding with that. What do we need to not forget about the postpartum journey during the birth preparation? What are some things that people who are pregnant, preparing for birth, and preparing for their birth– they are so excited. They are figuring out if birth is right for them. What do we need to focus on and not forget about during that pregnancy journey? Crystal: Yeah, so of course, like we were saying earlier, getting ready for birth and preparing for birth is a huge event. We prepare for that and all of that, but then we don’t think about like we were saying, the postpartum. Think that postpartum can last a year or two years, sometimes even longer depending on how long you breastfeed if you plan to breastfeed. It takes 9-10 months for your hormones to increase and grow this baby and things like that, then of course, it can take– to me, this is my thinking– at least nine months for it to go back down to somewhat normal levels. If you’re breastfeeding, you’ve still got all kinds of hormones going on. So think about that. Babies have to be fed, so how are we going to feed them? Are you going to breastfeed? Do you know what to expect? Do you know what kind of bottles and what kind of formula to use? Do we know what to expect with just newborns in general and newborn care and diapers? Because babies’ poops look funky. They are different from ours, so it’s like, okay. All of these things, I feel like if parents are a little bit more prepared, then they will have less anxiousness for one because it’s a whole new thing whether you are a first-time parent or even if it’s your third or fourth baby– even with me for my fourth baby, I was like, “Wait. Is this normal?” I’m a nurse and I work in the field, but it’s so different when you’re on the other side. So just to be prepared for that so that way you have the expectations and you know, “Okay, what’s normal? What’s not normal?” Have somewhat of an idea of how to manage some things and know that there is support out there when you need the support. Meagan: Absolutely. Something that I– with my first baby, I ended up going back to work at 12 weeks postpartum. I already wasn’t prepared for a Cesarean, so then I was recovering from that, but when it came to feeding my baby and even my emotional status, I really wasn’t prepared for all that was happening in such a short period of time and then to shift. As soon as I started feeling like I was kind of getting the hang of it and things were in control or I had a routine, it was like my feet got swooshed underneath me and it was changing again. I was all of a sudden in a back storage room pumping every three hours. I was storing my milk in a fridge where everyone stored their lunch and then trying to figure out that and trying to get enough production for my baby while they were with the babysitter. It was so much. Crystal: It’s a lot, yeah. Definitely, going back to work after having a baby, no matter how soon whether it’s six weeks or six months is definitely a big change as well. That’s something that a lot of parents aren’t really thinking about or prepared for which is totally fine. There is so much more going on at the moment, but knowing that, “Okay. I need to prepare and be ready before I go back to work so I know what to expect.” And like I said, getting some support on how to manage that. Get a plan together. Get a schedule together. Meagan: Yeah. So as a doula, I work a lot with my clients right before pregnancy and sometimes they are a little caught off guard when I’m like, “What’s your postpartum plan?” They’re like, “Huh? Aren’t you a birth doula?” I’m like, “Yeah. I am a birth doula, but I know a lot about postpartum and I didn’t plan for it either. Let’s talk about it. How are you going to eat so you can feed your baby? How are you going to get sleep?” because just like you were talking about before, a lot of moms have to go back 12 or so weeks after. Some of them two weeks after. We also have an issue with our paternity leave– Crystal: Paternity leave for the fathers or the partners. Meagan: Yeah. We have one week. Especially if you have multiple kids, we have one week a lot of the time and then they’re gone and we’re like, “What are we going to do?” Get your meal trains. Get your support. Rally up together. Have your birth team. Have your postpartum team. Have a plan. We know plans change no matter what– birth, postpartum, everyday life. I sometimes plan to go to Costco and then I don’t go to Costco that day because something happened. Plans change, but if we can have a baseline of an idea, I will be like, “Okay.” I have a friend who gets mastitis with every baby. Crystal: Oh gosh. Meagan: With her third baby, she was like, “I’m going to do everything.” She had her IBCLC to go to the hospital on day one to get a good, established latch. She met with her as soon as she left the hospital. By day four, she was meeting with her again to make sure. You guys, she was on sunflower lecithin. I don’t know how you feel about that, but that helped her personally to not be so sticky. She was like, “I have got to get this under control. I have two other kids. I cannot be sick with mastitis.” Then she would end up getting thrush after that so she took a probiotic. Crystal: Oh my gosh. Meagan: There are things we can do and it’s really hard to focus on that in the pregnancy stage. Crystal: Yeah, yeah. Meagan: But there are things. We can get on those probiotics. We can contact those IBCLCs. We can have a plan in place so we are not just thrown into the fire. Especially in my case, where I did have a Cesarean and a repeat Cesarean, those were just things that were unexpected so prepare the best you can. I love that. I love your advice. This is so important and get that support. Crystal: Yeah, for sure. I just thought of something because I talked a lot about breastfeeding and feeding your baby, but you brought up a good point. As mothers, we for sure neglect ourselves all of the time so like you were talking about with eating, make sure you eat and hydrate. Moms are recovering too from birth so whether it’s vaginal or a Cesarean, planned or an emergency Cesarean, your body is doing a lot postpartum. It’s just crazy. Meagan: We’re amazing. We are amazing human beings. We are incredible.Crystal: Yes. We are. We are. We so are, but then we have to remember to take care of ourselves as much as possible. That’s where the support and village come in because you can’t do it all yourself. I guess you could. I’m sure some women have, but you shouldn’t have to do it by yourself. Meagan: No, and I think like you are saying, we shouldn’t have to but for some reason, we do. Crystal: Yeah. I know. I know. Meagan: We don’t ask for help. We struggle asking for support. We struggle spending money on ourselves. We struggle getting postpartum doulas or going to an IBCLC because it costs so much and insurance doesn’t cover it. You guys, you are worth it. You are worth it. You are amazing. You grew a human. You birthed a human. You are now taking care of a human. You are feeding a human. There is so much to it. It’s okay to get that support and give back to yourself. Crystal: Totally, totally. I 1000% agree. Meagan: Yes and sometimes, that is finding a coach and just getting some advice or talking to someone and just being heard. Maybe you don’t physically need anything, you just need to be heard. Crystal: Yeah, yeah. Meagan: Yes. Okay, so now we’ve had our baby and everything. What can we look for in the first few weeks to know that maybe we need to ask for more help or get more resources or take care of ourselves? What are some things that we can look for in those first few weeks with nursing and postpartum just in general? Crystal: Yeah, yeah. So for moms, I have spoken to a lot of moms who weren’t aware that there would still be bleeding afterward so there is that. Meagan: That is a thing. Crystal: Yes, that is a thing. You are still bleeding. That is normal, but obviously, from a nursing standpoint, if there is excessive blood or you are filling a pad every hour, then for sure, you want to reach out. A lot of women tend to swell postpartum. Some are like, “No, I didn’t have any swelling during the pregnancy,” then all of a sudden postpartum, you just blow up. Your feet are swollen and things like that. That could be due to some IV fluids or other stuff going on, but for sure, you want to reach out to your provider with that. Contractions and cramping afterward are still a thing, especially with breastfeeding. Some women are just like, “Oh my gosh. I did not know about this.” Some women feel great after delivering. They are like, “Yeah. I don’t need to take my meds. I’m feeling okay,” but once they start breastfeeding and they start feeling these contractions, it’s like, “I’m in labor again.” That is normal. I know it’s uncomfortable, but that is definitely normal. If you still feel that when you’re not breastfeeding or it’s not relieved with pain meds, then for sure, I would highly recommend reaching out to the provider. Meagan: That can also get worse with each baby, right? Crystal: Yes. Yes, it can get stronger. Meagan: It can last a little longer and be a little bit more intense, yeah. Crystal: I know which is like, “Why? We already went through this. Why do we have to make it worse?” Meagan: Our uteruses have to shrink down. Crystal: I know. It’s a good thing. The cramping is a good thing. It’s a normal thing. We want that. It controls bleeding. It gets the uterus back down to the normal size and all of that. Engorgement. Even if a mom is not breastfeeding, the body’s natural, physiological response is to bring in milk. With the delivery of the placenta, your hormones drop and that triggers, “Oh, okay. Baby has been born. Let’s make milk.” Meagan: We have to feed it. Crystal: Yes. So whether you breastfeed or not, if you don’t breastfeed, you may not get as much engorgement, but there is still stuff going on there. If you are breastfeeding, you will almost 100% get engorged in the first few days anywhere from day three to five. Sometimes it is a little bit longer, but around there, your breasts will feel really full. Some women say their breast sizes double or triple. Meagan: Mhmm. Crystal: They can get really rock hard. That’s pretty normal because your milk is coming in. Getting support with latching well so the baby can empty it or if you need to, maybe you have to pump a little bit, but like I said, of course. Reach out for lactation support because depending on the situation or what’s going on, the lactation consultant can further guide you on how to manage that. But lumps, you may feel little lumps in the breast. That is pretty normal. Those are just basically milk ducts that are swollen or filling with milk because of the postpartum period with increased swelling and things like that. After engorgement, I’m thinking of the progression of things, a lot of parents see clogged ducts, but now we know that it’s called ductile narrowing instead of clogged ducts. Meagan: Oh. Crystal: Yes. Before, we thought that the milk was getting clogged. Meagan: Getting sticky. Crystal: Yes, then we had to somehow remove this milk plug, but the new research by the Academy of Breastfeeding Medicine is saying that it’s not that. It’s inflammation and swelling of the milk duct itself that causes the narrowing of the channel or the passageway that milk goes through and that makes it back up. It backs up the milk. Management for that beforehand was warm compresses and massage, massage, massage, dangle feeding or something like that. Now, they are saying that we should be using cold compresses. Meagan: Oh, okay to reduce inflammation. Crystal: Exactly, to reduce inflammation. I always tell parents that if we have a swollen ankle and the breasts are swollen, we wouldn’t put a hot or a warm compress on it. Meagan: No. Okay, I’m noting it. Crystal: You would do the ice or the cold compress to reduce the inflammation and when we reduce the inflammation in those milk ducts, now that passageway opens up, everything can calm down, and milk can flow a little bit easier. Meagan: Mind blown!! Crystal: I know. Meagan: That is amazing. That would have been nice to know a long time ago. Crystal: I know. When I see moms say, “Oh my gosh, I have this lump and my breasts don’t feel empty even with breastfeeding or pumping. I’ve been doing hot showers and massaging it.” I’m like, “No. Try cold.” Almost always, it helps. Meagan: I am totally adding this to my doula toolbox. Crystal: Yes. Yes. Meagan: This is really good information. Crystal: It is. It’s so amazing when parents come back and they are like, “Oh my gosh. It worked. I can’t believe it.” Also, breast tissue is very delicate. It’s soft tissue. Some moms are just aggressively massaging their breasts like, “Oh my god. I have to get this out.” You don’t want to do that because you can further damage and cause trauma to the breast tissues. Meagan: More inflammation. Crystal: Yes, more inflammation, exactly. Light massage. If you need to, cold compresses for that. For moms, I’m going on and on right now. This episode is going to be forever. It’s going to be hours long. That’s kind of the basics of the immediate thing that we need to look for in mom physically. Emotionally and mentally, parents are sleep-deprived so we definitely want to make sure, like you said, have those meal trains. I even suggest adding this to the baby registry when you are pregnant like meal cards, Door Dash cards, a postpartum doula even. It’s like, “Whoa. Instead of giving me all of this, this is what I’m going to need help with in the first couple of weeks.” I know for me, I guess I’m thinking of myself and my baby, but I’m also thinking of everything else in the house that I need to do like, “Oh my gosh, I need to do the laundry. Oh my gosh. The other kids need to get rides to school,” or what have you. If there is anything, you know how friends and family are always saying, “Let me know if I can do anything to help,” please ask for help because moms and parents need sleep definitely. That helps because, for one, sleep is just a human need. Two, for sanity, and three, because the more rest that we can get as mothers, as a breastfeeding and lactating parent, the better our milk supply will be too. Meagan: Yeah, 100%. Like we were talking about, we are not thinking of drinking and that helps our breast supply. That helps our healing physically and keeps us in our minds. On that topic, Be Her Village– I’m sure you’ve heard us talk about it. Check out Be Her Village. You guys can create a registry just like Crystal is describing where you can go and register for a doula or childbirth education or money for an IBCLC or pelvic floor health or mental health. All of these things, if this is your registry– Crystal: Pelvic floor health, oh my gosh, is another thing. We don’t know about that. Most mothers are just– not that we don’t care, we just don’t know. There are just so many things going on down there that for sure you need some kind of pelvic floor rehabilitation afterwards even if you have a C-section. Meagan: 100%. It’s aggravating. I’m not going to spiral off on this tangent. It’s aggravating to me that so many insurance companies do not cover this as a standard part of postpartum. But they’re not covering postpartum pelvic floor issues. They’re not covering this. Crystal: Yeah. Meagan: I went and it was $250 per visit and as a new mom, especially if we invested in a doula and an IBCLC and a photographer or whatever. Crystal: All of those things, yeah. Meagan: It’s like, “Oh, whatever,” and now we have a newborn that has to have diapers at $50/box. It’s really hard. Crystal: Right and that’s where we neglect ourselves again. Not that we want to, but I don’t even know who to blame. Healthcare or insurance or whatever is preventing us from getting the proper care or support. I did the same thing. I just wanted to touch on that. I did the same thing. I was having issues holding my bladder and I asked for a referral from my doctor for pelvic floor health because doing our own research, we’re like, “Okay. I think I need to see a pelvic floor therapist.” They did not. They were like, “Well, normally we don’t do that.” I’m like, “Why?”I did the same thing. I tried to look into it myself to pay out of pocket and it was expensive and I just kind of gave up and was just like, “Okay. I’ll just do my own research and find out some exercises on my own and just do it on my own,” which is sad. We shouldn’t have to do that. Meagan: I agree. I agree. Crystal: But okay, so on to what to expect because there are still a couple of other things. There is so much, but I just want to touch on the emotional and the mood disorders because that is very, very important and huge. I always recommend that when moms take classes prenatally they have a partner or a birth partner or something that is along for the ride with them who comes to the classes and things like that. I really recommend that postpartum too. Any time of postpartum class, newborn class, or breastfeeding class, the partner or caregiver should definitely be involved as well as the birthing parent because as moms, we don’t initially see that there is something more going on with us for postpartum anxiety, postpartum depression, and things like that. It’s usually a close family member who notices things going on first. Definitely, I feel like the whole family should be involved in that and if parents are just struggling with coping and with new life as a parent breastfeeding and all of the things, then definitely reach out for support because that can definitely happen with all of the hormones going on and the stress. Meagan: Lack of support. Crystal: Lack of support. Meagan: Lack of sleep. Crystal: Lack of sleep, yes. That’s definitely something big. Meagan: I want to talk just slightly about this. It’s really hard as a new mom to and I hope this isn’t triggering, pass your baby to someone so you can take care of yourself. We had a client years ago that was really struggling. She had a series of things and was really struggling. One of the things that we ended up coming up with was for her to go to her mom’s for the night. We came up with a good plan and had help with dad and the kids for baby. She ended up pumping and coming up with a supply and for one night– she did wake up engorged– she slept all night. All night. She went to bed at 8:30. She pumped before and went to bed. She woke up. I think she said it was at 6:30 which is still early, but 8:30 to 6:30 is a good stretch. She was probably so engorged that she had to wake up, but you guys, she was a new person. She said that. She was like, “Whoa. It’s like my funk was just sucked out of me just by getting that sleep.” That was really hard for her to do that. Crystal: Of course, I’m sure. Meagan: It was really hard for her to be like, “I’m giving up my baby who is four days old overnight.” It’s not ideal. It wasn’t ideal, but she spiraled quickly and she got to a place where that’s ultimately what she thought was going to be best. Anyway, it was amazing. She still had trials to get through because the next night, she had lack of sleep but she was able to build up that foundation a little bit more by getting a good night’s rest. Crystal: Of course. Exactly. Meagan: Her mom seriously had all of these broths and all of this high-protein food and all of these amazing things to fill her being with all of the good things. Crystal: Yeah, because as mom, we are filling everybody else’s cup usually, but we aren’t filling up our cup. Meagan: Yeah. You don’t have to leave your baby with anyone overnight, but going back to that, have someone fill your cup. Have someone fill your cup. Food, all of those things. Crystal: Everything. I’ve heard of some parents when they finally get three or four hours of sleep straight, they’re like, “Oh my gosh. That was amazing.” Same thing. “I feel like a new person.” Just because sleep is a human need, so we need that and if we’re just constantly days upon days upon days of getting only 1-2 hours at a time of sleep, that’s definitely not sustainable and not enough. Meagan: Yeah. Yeah. She started resenting her baby. Crystal: Yeah. Yeah. I’ve heard of that too. Meagan: She started having anxiety at nighttime. Crystal: Yeah. Yeah. I could definitely see how that can come about for sure especially if you’re breastfeeding, especially with that. We all know that of course, breast is best. Breastmilk is best, but we also have to think of the whole picture. I always tell this to all of my clients and patients that I work with. Mental and sleep health is very important. Very. I know breastmilk is too, but you do the best that you can. Meagan: It’s like when we’re on the airplane and they talk about if we’re in an emergency and the masks fall down, prepare your mask on you first before you help someone else. Crystal: Yes. Meagan: It’s a similar concept to me where if we cannot fuel ourselves with the oxygen and the sleep and these things, we cannot 100% take care of this baby. Crystal: Right, yeah. Meagan: We can’t make milk. Crystal: Right. Meagan: Because our body is going to protect us and sometimes we will see a milk dip with stresses and things like that. I have clients who are nursing really, really well and then a stressful event happens in their life and they’re like, “I’m losing my milk. I’m losing my milk. Is my baby not eating enough?” It’s crazy how just mentally our body can do that. It can stop making as much milk. Have you seen that?Crystal: Yeah. I have. I have actually. A stressful event or if mom starts a new medication, especially birth control. They don’t know. They just don’t know. When I talk to my doula consultation, I say, “Any new medications?” They say, “Well, I just started taking birth control but my doctor said it should be fine and won’t affect my milk supply.” I’m like, anything new can. It can. Meagan: Hormones. Crystal: It’s not to say that we can’t get the milk supply back up, but at least being aware of it. Okay, this is why. It’s not because of something else or whatever. So yeah. I’ve seen that. Meagan: Yeah. Crystal: Periods, too. Moms starting their period again, it can–Meagan: Throw it off. Crystal: Every month during your cycle, yeah. It throws it off. Lots of different things that could happen and will happen, so just something to have in the back of your mind like, “Okay. This is what I remember Crystal, The Mama Coach, saying or whoever saying that this can happen, but there are ways to work around it.” Meagan: This next question is a did-you-know. I feel like this is something actually that a lot of people do not know and that is that babies lose weight in the first few days. They can lose even more than the recommended loss if there was an induction, or a lot of fluids, or a surgery. Can we talk about that? Crystal: Yes. Yes. Correct. Meagan: Can we talk about what is normal? Because I feel like again, mentally, there is so much stress on feeding the baby, getting enough, cluster feeding, and all of these things, then we have this baby that weighed in at 7lb, 12 oz and is now weighing in at 6lb, 15oz, and we are like, “Whoa. This is a big loss.” We’ve got providers freaking out about it, suggesting supplements, and things like that. What’s normal? What is the average loss just without induction and things like that? Can we talk a little bit about that so we can offer some comfort to these mamas who might have a baby that’s losing weight? Crystal: Yeah, yeah. So babies can lose up to 10% of their birth weight within the first three to four days or so. Normal weight loss is about 2-3% per day. So with that being said, when babies are in the womb, they are swallowing amniotic fluid. They are swallowing, swallowing, swallowing, so technically, they are born full and their first stool is that sticky, black, tarry meconium that is just getting rid of all of that amniotic fluid that they were swallowing while they were in the womb. So that’s some weight loss because they are probably pooping five or six times within the first one or two days and it’s super sticky. Then, like you said, if mom was inducted or induced or got a lot of IV fluids, antibiotics, and a Cesarean, then they got extra fluids. Anything that mom gets during labor, baby gets some of it too. Really, some providers are saying that a newborn’s true weight can be seen 24 hours after birth versus one or two hours right after birth. That weight loss takes into account that. Fluids, getting rid of the meconium, and things like that, and then anything more than 10%, then we get kind of concerned. Like you said, some providers are like, “Oh my gosh. Let’s do all of this.” Me, as the lactation consultant, I am less freaked out because I know that especially if a mom is breastfeeding, babies’– we’re getting to probably one of our next questions– bellies are really small, so in the first couple of days, they are only taking 2-10 milliliters per feeding which is less than half of a teaspoon up to two teaspoons per feeding. That is the colostrum that they are receiving from mom, that yellow, thick, first milk that is expressed from mom’s breast and although it’s smaller in volume, it’s really packed with a lot of nutrients and antibodies and things like that. It is nutritionally–Meagan: I say dense. Crystal: Dense, yeah. Nutritionally dense. So baby is getting what they need, it’s just a smaller volume because it makes up for the fact that it takes a couple of days for mom’s milk to increase and increase in volume and things like that. Babies are losing all of this excess fluids, pooping out all of this meconium, and then they’re just getting smaller, frequent amounts of colostrum. All of that are factors in weight loss. And then when mom’s milk starts to increase around day three to seven, they start taking in more volume and then we start to see some weight gain there. Now of course, as a lactation consultant, we look at the whole picture. What happened with the mom’s labor and delivery experience? Is this baby number one or two or multiple for them? Do they have any medical background that might be a factor in milk increasing or milk coming in? All things like that and when I look at that, I’m like, “Okay. Maybe we need to supplement just a little bit if we need to.”And then I will tell moms, “Let’s maybe have you pump or hand express. Any extra colostrum or transitional milk that you can express, give that to baby first and we will see how that goes,” especially if they are not wanting to start formula. Every baby and family is different so I look at the whole picture, look at their goals, and see how best I can help them. But obviously, if a baby loses a significant amount of weight like 13-15%, then we are like, “Yes. We probably need to supplement.” So like I said in the beginning, formula is used when we need it if we need it, not just automatically, “Oh my gosh. Baby is at 9 or 10% weight loss. We need to give formula.” I definitely disagree with that. And it’s all the parent’s choice as well. I give them the options and they decide what they want to do and then I support them in whatever they decide. Meagan: Right. So as we are kind of working on getting our milk to come in and recovering and things like that, we talked about sleep, mental health, food, water, and things like that. That’s all going to help our breastmilk. But are there other things that we could be doing or should be doing to help our milk to come in quicker or once it comes in, to help it be more– savory comes to my mind, but really rich for the baby? You just talked about how some babies do lose up to 13% and then I guess a side question is, do we know why some babies lose a little bit more? Is there a reason or is there something that we as parents could do or should we just be like, supply and demand? Nurse your baby. Your milk will come in. Your milk is great. Just because your baby is not gaining as much weight doesn’t mean you should shame yourself or your milk is not good enough, because there is a lot of that too. Is there anything you would give us tip-wise to help milk come in? There are a lot of questions within this one question so I’m just going to turn the time over. Crystal: Okay. So yes. The best thing we can do is early hand expression. Typically, after birth, during the first 24 hours, babies are super sleepy. Super sleepy that it’s hard to get them to latch or want to nurse frequently. Thinking about how breastmilk supply works, the more you demand on the breast or remove milk, the more milk you will make. So if the baby is sleeping the first 24 hours, the baby is not expressing as much milk and that is where hand expression is important. Frequently, newborns tend to eat at least 8-12 times in a 24-hour period, so if we break it down by hours, it is just so much easier. Every 2-3 hours or so, attempt to put baby to the breast. Do what you can. If the baby is too sleepy or not latching well, then hand express. Hand expression and get out that colostrum. You can spoon-feed that to baby or cup-feed or syringe-feed that to baby, and then you’re still stimulating your supply. Sometimes, I hear parents say, “Oh my gosh, the first day or two, my baby was just so good and slept for four hours.” I’m like, “Did you hand express or pump at that time?” We just don’t know. They were like, “No, I didn’t. I slept too.” I’m like, “I’m glad you got sleep,” but to help your milk supply increase for baby, it is very, very important to express milk every few hours whether it’s hand-expressed, latching, or pumping. I’m trying to think what was the other question you had. Oh, how we can make it more savory. I always recommend doing breast massage prior to any breastfeeding or pumping or expressing session. That’s just because especially in the first couple of days, colostrum is very thick, so by massaging– and light massage. Not too hard, not too aggressively. You’re basically unsticking or loosening up that milk so that way it can be expressed and you can collect that good, sticky, fatty, colostrum or milk. That’s for even at any time. You might have heard of a foremilk and a hindmilk type of thing. That’s basically when you express, you see a little fat layer in the bottle or in the milk and to increase that, some researchers say that you can’t do anything to increase that, but we can help it to come out a little bit more. That’s by hand-expressing or doing what we call a breastmilk shake. I’ve done this myself with my last baby is just doing the breast massage before breastfeeding or nursing. I have seen a thicker fat layer on the milk, so you can do that. Meagan: That’s really good to know. With my son, he was kind of small to begin with, but when I would pump, I was like, “Oh my gosh. There is this much fat in this milk.” All of it separated and I had someone kind of suggest that, but it was a warm compress, not a cold compress. It was a warm compress, slight massage, and then nurse or even hand-express for just a second, and then nurse. Crystal: Yeah, yeah. Yeah. You can do that too. You can breastfeed or even hand-express a little bit too just to help that milk supply especially if baby didn’t have a good feeding or wasn’t quite latched very well just to ensure we stimulate the breast properly to give that signal of, “Okay, make the milk. Bring the milk in,” and things like that. I just wanted to say as a side note, all breastmilk is beneficial for baby whether you have a thin fat layer or not. Meagan: Good to know. Crystal: Your body still tailors and makes the breastmilk to your baby’s needs. Meagan: Awesome. So hand-expressing during pregnancy, we were talking about postpartum, but is it suggested to do a little bit during pregnancy? Crystal: You can, but you have to be considered at least term which is about 37-38 weeks or so, and of course, check with the OB provider because it depends on what risk factors you have. Meagan: Yeah, because it can stimulate. Crystal: It can stimulate because it does with the hand expression, the same hormone is released when you are having a contraction which is oxytocin so it can cause some cramping or contractions so you definitely want to get cleared by the OB first before just starting the hand expression, but yes. Once you get cleared, you can start antenatal hand expression and start collecting. It may be nothing or you might get drops. I’ve actually tried it on myself before and I didn’t get anything. I was kind of discouraged, but I was like, “No, knowing what I know, it’s fine,” but it’s good practice, too for hand expression postpartum. So practice, collect drops, and then you can freeze it and then bring it to the hospital if for some reason baby needs to be supplemented if they have low blood sugar or jaundice or whatever, so yeah. Meagan: So good to know. Okay, and then last but not least, we have different types of feeding. Bottles, paced bottle feeding, we talked a lot about breastfeeding. Can we talk about all of the different types of feeding?Crystal: Yeah, yeah. So of course, you can do exclusive breastfeeding and that’s just feeding baby at the breast, or you can do breastfeeding and pumping so feeding breastmilk in some type of vessel whether it’s a bottle or syringe. I typically see bottle and syringe usually especially when the milk volume increases or you could do combo feeding which is breastfeeding, pumping, and formula feeding so you can do a combination of all three. Some moms do exclusively pumping. They don’t put baby to the breast at all for whatever reason. It could be their own preference or they were just struggling with latch and it just was not working out for them, or sometimes it takes a long time to breastfeed, 30-45 minutes, so some moms feel like that works better for them to just pump for 15-20 minutes and bottlefeed. Or some, whether it’s their own personal preference or medical reasons, exclusively formula feed. With that, when you do any type of feeding other than breastfeeding and you bottlefeed, you want to pace bottlefeed. We do that for several reasons. For one, sometimes, newborns don’t really know how to pace themselves and they will just take that whole bottle. Meagan: Chow it down. Crystal: Chow it down in one minute flat and we don’t want that because I always tell parents to think about how we eat. We don’t just shove food in our mouths. Meagan: Chew your food. Crystal: Yes, chew your food and things like that. One, it can help baby learn how to slow down their feeding and then learn their own hunger cues like signs of fullness which in turn can help in the longer term as they get older knowing their hunger cues and knowing when they’re full and not overeat. Then three, it can help with digestive issues. Gulping too much too fast or drinking too fast, they can take in more air which means they will be more gassy and more fussy and then we are like, “What’s going on? Why is my baby so fussy?” It’s because they are gassy most of the time. A lot of the time, babies are just not very comfortable when they have gas and they definitely express it and communicate that they are uncomfortable, so we want to prevent that. By pace bottle-feeding, we help to remedy that. Meagan: That makes total sense. Sometimes, I feel like when they are gasping all of that air, then they spit up a lot. This is not really one of the questions we talked about, but when a baby spits up, a lot of the time we see it, and it looks like a lot and we are like, “I can’t believe I just fed my baby and it’s right here on this blanket or all over myself.” Is there a rule of thumb to be like, “Okay, really, that is true. Every little ounce of that just came out?” Or is it like, “Okay, your baby still got quite a bit.” Crystal: That’s kind of hard to say because like you said, it does visually look more than it is which is why pace bottle-feeding is important because we want to take frequent breaks, little, quick breaks of a couple of minutes or so to burp, let that move down their belly, and get that excess air out, and then continue feeding. I always recommend that if your baby spits up and it looks like a lot, see how they’re doing and go by their cues. If it seems like they are looking for food again, try and give a little but maybe a smaller amount just to see how it goes. Meagan: Mhmm. That’s a good rule of thumb. Crystal: Keeping babies upright after feeding, if you can,  will help to lessen the chance of spit-up, but then again, sometimes babies spit up out of nowhere an hour after feeding. Parents are like, “I don’t know what’s going on. He spit up.” If that happens and you are burping your baby and keeping them upright after feedings, I would definitely talk to a provider because sometimes it can be the formula if they are drinking formula or something to that effect. Meagan: Mhmm. Yeah. Awesome. We’ve gone over so much. Crystal: I know. Meagan: I want to just end on The Mama Coach. How can people find you? What do you guys offer? How does The Mama Coach? I mean, I know how. It’s in amazing ways and who is a good, qualifier to go and find a Mama Coach?Crystal: Yeah, like I mentioned earlier, The Mama Coach is a group of registered nurses all over the world. I am the owner here in Vacaville, California which is in Northern California. Our goal is just to help make parenting easier. Like I mentioned, we do have prenatal services. We have postpartum services and newborn services, helping with any type of feeding even if you are not breastfeeding. Meagan: Sleep?Crystal: Sleep, yes. We have sleep. We help with newborn sleep, toddler sleep, potty training, CPR and choking classes, starting solids as well as one-on-one services here. For me, locally, I do home visits and home lactation visits. I can do any of the workshops one-on-one in home or virtually. My niche is breastfeeding– prenatal breastfeeding education and consultations as well as postpartum of course, newborn care, and sleep because those are all important things. Meagan: Very, very important things. Crystal: Very important. Meagan: You guys make it really, so easy. You just go to themamacoach.com. There is a “Find a Mama Coach”. You can search what you are looking for or you can type in your zip code and you can pull up all of the Mama Coaches near you and go over all of their services. I don’t think there is a single one that only does one thing. Crystal: No, we all pretty much do a lot. Yes, correct. Yep. For sure. If you are a new or expecting parent or even a parent of a three-year-old– any parent that is struggling and your baby is five years old or under, we can help you. I am on Instagram. My Instagram is crystal.night.themamacoach. We also have a website like you were saying. The main website is themamacoach.com. We each have our own individual sites as well and I’m sure we’ll post that information somewhere, but yeah. Reach out to any one of us and myself if you are in Northern California in the Vacaville area. We, like I said, almost all do virtual and then also locally in person too. I do ongoing workshops and that’s always posted on my website in the classes or on my Instagram. Meagan: So amazing. You guys are doing so much. You even have a blog where you can look specifically at pregnancy, newborn, sleep schedules, and parenting in general. I mean, these guys have amazing things so make sure to go follow. We’ll make sure to tag you today on our Instagram and our Facebook so you can go and find it. We’re going to have the website in the show notes. We’ll have all of the things we have talked about and seriously, thank you so much for helping our community because like I said, we don’t talk about postpartum as much. We don’t focus on it as much. We don’t focus on feeding and all of the things, so thank you so much for kicking off the 2024 season with a new type of topic. Crystal: Yes. Yes. Awesome. I was so happy to be on here. Thank you. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link. Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Jan 3
1 hr 6 min
Episode 269 The Most Common Questions of 2023
Meagan finishes out this year of podcasting by answering some of your most common questions! Topics range from the time between births, gentle induction methods, gestational diabetes, “just-in-case” epidurals, home birth, tips for having a successful VBAC, and how to cope if you don’t get your VBAC. “Women of Strength, I just want to thank you so much for all of your continued support. We love your support and we are so grateful that you are here.I love you. I feel so passionate about helping you as an individual find the best path for you.I want to help you walk through this journey and feel loved, supported, and educated.” Additional LinksReal Food for Gestational Diabetes by Lily NicholsHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello. Welcome to The VBAC Link. If you have been with us all year, I just want to say thank you and if you are new to joining The VBAC Link, I’d like to say welcome. Welcome to the show. This is the last episode of 2023 and it’s kind of hard to believe honestly. I went through all of our episodes and we have seriously so many incredible episodes. I am so honored for those who have come and shared their expertise and given us their time. I am so excited today to share this last episode of the year with the most common 2023 questions. We have some pretty common questions, but we have so many others as well. So of course, we have a Review of the Week. I want to dive into that really quickly before I get into those questions. Review of the WeekThis is from cristab. It says, “I am a birth and postpartum doula who is always on the search for a birthy podcast to listen to in my car. I was so excited when I found The VBAC Link so I could listen to these amazing stories from women all over the world who have reached their goals through becoming educated thanks to Meagan and Julie. I’ve recently certified with The VBAC Link and as well, I’m so impressed with the thorough delivery in which their knowledge was shared in their training. I’m super excited to move into this next chapter of my career and I’m thrilled to do so with the amazing community and support.” Thank you so much and thank you for joining our family. Doulas, birth workers, birth photographers, if you love birth and you are wanting to learn more about VBAC and how you can support people out there who are wanting to VBAC, who are wanting to avoid Cesareans, and who are just needing support from the community, we have our VBAC Birth Worker, VBAC Doula birth course where we are going to teach you all of the things about VBAC as well as help you know what us as VBAC moms are up against. And parents, if you want to dive in and get more educated for your future birth, I highly suggest checking out our course. You can check it out at thevbaclink.com.2023 VBAC QuestionsMeagan: Okay, you guys. We have so many questions that we get all of the time. If you haven’t also joined us on Instagram, we do Q&A’s almost weekly. We love answering your questions even if it’s a question that we’ve had before. We’re going to get to it and we’re going to answer it. Here are some of the most common questions that we get. Number one on the list is how long after my C-section do I have to wait until I get pregnant? This honestly is a question that I think is personal. Now, there are suggestions out there by providers who are saying anywhere between 18-24 months is what we commonly hear, but we even have some providers who are like, “Yeah, cool. In 15 months, you can go on and have your baby.” There can be an increased risk of uterine rupture with a really small gap or duration. So if you have had a C-section and then three months later, you get pregnant, you may have a provider who is a little bit more skeptical or even six months later, you may have a provider who is a little more skeptical and talking about the risk of uterine rupture, but that still doesn’t mean that it’s not possible or impossible or that you are for sure going to rupture. I think a common rule of thumb is that 18-24 months, but again, it comes down to a very personal decision. If you want closer babies or it happens or whatever, I think that’s more of a personal choice, and then just finding the support out there to support you in your desires. I did a one-on-one consult with a mom back here in the fall and she had a six-month duration. She went from provider to provider to provider and they all said, “No. Absolutely not.” We got her in contact with another provider and they said, “Yeah. No problem. There is no reason.” I was so excited to get a text message from her after saying that she did it. She had her vaginal birth and she was so happy. That was a duration of six months. Okay, another question that is really common is, “Trying to go for a VBAC and really want to go into spontaneous labor, but her provider is saying they can’t go past 41 weeks.” They cannot go past 41 weeks. Now, I’m just going to say that I don’t like the answer to that. The follow-up question to that question was, “Should I switch my provider?” You know, we’re not here to tell you that for sure you need to switch a provider or anything like that, but if you have a provider that is putting stipulations on you like you cannot have a baby past this day and if you get to that day, you have to have a C-section, you may want to look into some other providers because that’s just not evidence-based.Going past 41 weeks in general is something that has become more and more controversial, especially after the ARRIVE trial. We have episodes on the ARRIVE trial. We have blogs on the ARRIVE trial, so make sure to check those out as well. It’s kind of weird. They did an induction at 39 weeks for first-time moms to see if it would reduce complications like hypertension, preeclampsia, and even Cesareans. It’s kind of been since 2019, I feel like, more of a hot topic, but it’s actually pretty common for babies to go overdue. I am putting big quotes on this. “Overdue”, past 40 weeks. Know that if you have made it to 40 or 41 weeks, it’s very common and you’re okay. There are common things that a provider may do at 41 weeks. They may suggest a non-stress test just checking in on baby and making sure everything is going well, but it’s still okay. In fact, ACOG suggests, I think it’s 42 weeks, really. So, you know. At 41 weeks, you could still be pregnant or a week or you could have a baby in three days or even three hours. They have not really found any increased risk of uterine rupture or other complications necessarily like that after 40 weeks, however, there are things that can come into play where VBAC after 40 weeks may be lower or require interventions because there may be things like hypertension and things like that that come into play. But even if your provider is saying that you can’t go past 41 weeks and you have to schedule C-section, that right there is a red flag and something that would be concerning to me because induction is, which is also another question– can I be induced and have a VBAC or can a VBAC be induced? VBAC can be induced. It’s very reasonable. There are ways to do it. Some tips that I would suggest are doing as low and slow as possible. Now, we got a message back on one of the days that we did a Q&A from a mom saying that she did not believe that it was possible to do low and slow. I do disagree. I think that it is possible to do low and slow inductions. I’ve seen it. It happens all the time. You do have to sometimes fight for it and be educated so you can have that conversation and understand what that means. So let’s talk about low and slow meaning that if we are starting Pitocin, we are not upping it to 4 mL every 30 minutes. A lot of providers out there will suggest that. 4 milliliters every 30 minutes. Boom, boom, boom, boom. It’s a little overwhelming, first of all. Sometimes it takes our body a little bit longer to respond fully. Now, Pitocin, once it starts going in, it’s in the body, but it may not fully be responding so if we up it every 30 minutes and then we take 45 minutes to respond, then it may be too much, right? And 4 milliliters versus 2. So maybe you say, “Okay, let’s cut that in half. Instead of 4, we do 2 or even 1.” Sometimes there is a lot of pushback on that 1 because they are like, “Oh, it’s pointless. It will take forever,” but it’s still okay. It’s still okay so decide what milliliter is best for you and go for that. Fight for that. Low and slow there. Then another thing is avoiding breaking water or too many interventions all at once meaning we are going to place a Foley, start Pitocin, and break your water all at the same time. That is unnecessary. We really, really, really do not need to do that. That is just going to overwhelm everybody a lot of the time including the baby. But breaking waters. Breaking water in that earlier stage. Maybe we have– in fact, we are sharing a story. It’s coming up in 2024. I just recorded it not long ago where the mom was 2 centimeters and they broke her water. She wasn’t really contracting. They broke her water, started Pit, all of the things, and not a lot of progression. If we break our water early on, it’s not a guarantee that our body is going to go into labor, but a lot of the time, there is a selling factor of this breaking the water where it’s, “Oh, it’s the natural way.” Okay, all right. Breaking our water is natural. However, artificially breaking our water does not mean that that’s natural. That means that we are intervening and doing something that our body did not do at that point. So if we do that and we do that early on and our baby is high or our baby is in a weird position and then we have these floodgates open and the baby comes down, and the baby is in a wonky position, now we’ve got a poor fetal position, not a lot of progression because that often happens, a harder labor, a longer labor, maybe we’re introducing more interventions, so it kind of becomes a cascade. Maybe when I say slow, take it slow. Let’s not intervene with every single thing that there is possible in the labor and delivery unit. Maybe we just do a Foley or maybe we do Foley with a low dose Pit of 2 and we don’t up it from there. That’s it. That’s where we start. We wait for the Foley to come out and then we assess after that. Low and slow inductions and yes. You can be induced and no, you do not have to be induced at 41 or 40 weeks. So okay, one of the other questions– well, there are a ton, but one of the other questions I’m going to go to is about hypertension. “Can I still VBAC with hypertension?” So, yes. Absolutely, you can VBAC with hypertension. Sometimes, providers will come back and say that it can increase our blood pressure and things like that. It’s kind of weird. I don’t know if there actually is a study that shows this, but a lot of doula clients who have hypertension go to be induced, once they start labor, their blood pressure seems to kind of chill out. It’s kind of interesting. I do not know why, but yes, you can still have a VBAC if you have hypertension. So another question is, “If you get induced, does your risk of uterine rupture truly skyrocket to an insane amount?” We’ve heard people give us such crazy numbers like, “I have an 80% chance of rupturing.” I don’t know where providers are getting that, but no. Or, “I have a 60% chance or I have a 25% chance.” Now, if someone is telling you that you have these chances, I would like to challenge you to challenge them. Now, I never want to say to be combative and blah, blah, blah. That’s not what I’m saying, but I’m saying don’t be scared to ask, “Where do you get that information? Is there a link? Can you provide me with printed information on this topic or on this stat? I would like to see that. I would like to go over this so I can make the best, educated decision for myself.” If they are like, “Oh, well I don’t know. I don’t know if I can find that,” well, yeah. It’s because there’s not one. If there is one and you do receive that, will you please email me at info@thevbaclink.com? I would love to see that. I’ve never seen a study that says that someone has an 80% chance of rupture because they have had a previous Cesarean. So statistically, uterine rupture really happens in about 0.4 to approximately 1%, maybe 1.2% depending on some providers and some studies. But overall, that’s pretty dang low. That’s really, really, really low. So if someone is telling you that you have a 60, 25, or 80% chance, that’s just not true.Then another common question is about ways to avoid uterine rupture. Now, we don’t always know why uterine rupture happens. It’s hard to say exactly what caused that uterine rupture. I don’t know if you knew this and it’s very, very small, but uterine rupture can even happen in people who have not had a previous Cesarean. So that’s a thing too, but things that we can do are try to avoid those inductions that are absolutely unnecessary and if you do get induced, talk about those best methods like what we were talking about. We have a blog about that as well and we talk about that in our course. Really learn about those methods and avoid aggressive augmentation. Avoid Cytotec completely. That’s a big no. You know, and do everything you can to make sure that your baby is in a better position so maybe Spinning Babies, the Miles Circuit, hands and knees, do pelvic floor therapy so we can help our pelvic floor be in a position where we can push a baby out that way and things like that. Educate yourself. Listen to these stories. Attend our Q&A’s. All of these things can educate you so you can help reduce these things that may increase chances of uterine rupture like Cytotec or aggressive inductions. Okay, another common question is, “If I have gestational diabetes, can I have a VBAC?” Yes, yes, yes, and yes. Yes, if you have gestational diabetes, you can still go and have a VBAC. Sometimes, a provider may suggest an induction at 39 and I’ve even been hearing 38 weeks with gestational diabetes especially if it’s not managed well. One tip that I would highly suggest is really understanding gestational diabetes. Knowing that food and exercise and things like that can impact gestational diabetes and learning how to manage those if you can. Talking with your provider, understanding what they’re going to be looking for, what they’re going to be doing because that’s also going to help you stay more relaxed when you understand the process from them instead of just being caught off guard. I highly suggest checking out the book Real Food for Gestational Diabetes by Lily Nichols. We’ll make sure to put the link in the show notes as well, but that’s a really, really, really wonderful book to check out and it’s going to help you understand a little bit more about how to manage those sugars and just more about gestational diabetes. But also know that you do not have to be induced if you have gestational diabetes. You just don’t, but it’s going to be really common to have that be offered. Okay, so a couple of other questions that we get are, “I had failure to progress. Big air quotes, ‘failure to progress’ and my doctor is telling me that because my body didn’t do it the first time, it won’t ever do it again.” I’m sorry, but your provider is a big, fat liar. Such a big, fat liar. Just because you didn’t progress with one labor doesn’t mean you won’t with another one. Honestly, it’s more likely that you didn’t progress because of an environment, because of a rushed labor, because of a rupture of membranes artificially and baby was coming down so we got a wonky position, lack of ability to move during labor, and things like that. Progressing and trying to push labor on and it’s not progressing because labor wasn’t ready to begin– these are things that truly are going to be more of the reason for a failure to progress other than the reason that your body doesn’t know how to get to 10 centimeters. Truly, it does. Know that if your provider is putting doubt in your mind, that you can’t have a baby because your body didn’t do it before, you may not be with the right provider or you may have to fight hard. And again, it all comes down to, I think, finding that education and support. Another common question is, “Can I VBAC with twins? Is it safe?” Yes, you can VBAC with twins. Yes, it is safe. Sometimes, providers will have some stipulations as far as Baby A needs to be head down and Baby B is okay to be breech, or sometimes it’s like they both have to be head down. They might have some restrictions on that and a lot of the time, they will have you actually give birth in the OR. They’ll have you push and give birth in the OR, but yes. Research shows that a vaginal birth for twins is generally safer than a Cesarean, truly, even though some providers still discourage it. A podcast to check out is Dr. Stu and Midwife Blyss. They have an amazing, I think it’s Birthing Instincts, podcast and they talk about twins and delivery and things like that as well. Okay, so a common question is, “How can I prep? How can I prep for a VBAC?” I’m going to give you a couple of tips right here. I already have said it a couple of times, but your provider. Your provider is really, really, really, really important. You need to find a good provider, a provider that’s going to support you, a provider that wants this birth for you just as much, right? A provider that is not going to disregard you and pull out bait-and-switches in the end with non-evidence-based information to scare you and then make you feel like no one’s going to want to take you because you are already so late in pregnancy. Ask these questions before you settle in with a provider. Ask questions like, “How do you feel about VBAC?” not, “Do you support VBAC?” How do you feel about VBAC? Open-ended questions allow a provider to give you a lot of information without you even saying a word. If they stumble and say, “Oh, yeah, yeah, you know. I feel good. It’s fine. It’s fine. It’s fine.” Okay, know. If it’s like, “I actually feel like it’s a better option and this is something I would suggest and this is why. There are going to be pros and cons to it on both sides. There are going to be cons to having a VBAC for these. Here are the risks. There are going to be cons of having a C-section. Here are the risks.” Yes, there are risks to having a C-section. Also, if your provider ever tells you that there are no risks to having a C-section, that’s bullshit. I’m sorry. I’m saying. It’s the end of 2023. That is B.S. That is not true. So, talking to your provider with open-ended questions. How do you feel about VBAC? Another question, “How do you support your VBAC moms? What does that care look like?” If they’re like, “Yeah, totally. It’s just going to be like normal. We might check you if you go over 41 weeks. We might want to do an NST or we might want to do this,” or something like that and it’s lining up with evidence-based. Okay, that’s to be expected. If it’s like, “Yeah, no totally. We love VBAC, but you have to have the baby by 41 weeks. It has to be spontaneous. You can’t induce. You have to get a just-in-case epidural.” Those are all, again, the B.S. answers that are going to tell you that you’re probably not in the right place. Have open-ended questions for these providers. Number two– get the education. Educate yourself so that if you do have a provider coming in and telling you things that you are unsure of, you will have that resource to go back to and be like, “Oh, I actually do remember that and that’s not true,” or, “Yep, that’s right in line with evidence-based care.” It can also help you have a better discussion with your provider because you want that. They come in and they ask you. They say, “Do you have any questions?” They don’t really have a lot of time, honestly. These poor providers are overworked. They don’t have a lot of time, but too, it will help your time be better when you do go to those prenatals. I remember going and they were ten minutes long and it took a lot of energy to get there. I’m just like, “Why? What is the point of these visits?” Make a point to these visits. Ask these questions. Learn the education so you can have those educated discussions and get a better feel for your provider. They can get a better feel for you. They can learn that they can trust you also because you are educated. They are not going to second-guess you if you are saying no to something that they are offering to you in labor because they know that you are educated. Take a class. Listen to these podcasts. Read the blogs. Get into the Facebook communities. Learn about what people are saying. Read the links that are being shared. Education is important. Another way to prep truly is finding the support even outside of your provider. I feel like if you can have the support and the sounding board, it helps so much. With my VBAC after two C-section baby, I had it, but in places– I loved it in the places that I had it, but it lacked in the places that I wanted it, from my family and friends. That was really hard. I think that’s also another tip for where education comes in because you can help educate your family and friends along the way when they are like, “No. You can’t VBAC. No way.” Truly, finding that support is important, and also, prepping in a way that if you don’t have that support, let those people know that you love them with all of your heart, but unfortunately, you are not going to be sharing your desires and things. Nutritionally and physically, be healthy. Eat good food. Get good supplements like Needed. Drink your water. Stay hydrated. Make sure you are trying to get at least 30 minutes of walking a day and staying active. Of course, if you have certain situations, you want to always make sure with your provider that it’s all in line with your birthing plan and your personal situation, but taking care of yourself is truly important. As we have learned with Needed and things like that, we know we are not getting the nutrients. We know we’re not getting the hydration that we truly need every single day. If we can try and get that, it can help our pregnancy be better. It can help your birth be better. It can help in all areas and also mentally. I think if we are fueling our bodies with the right things, then we are truly going to be in a better spot. Okay, so another question that I have seen here and there and even more in the CBAC community is, “How do you deal or how do you cope with not getting a VBAC?” Now, this can be hard and this can be sensitive. Sometimes we have things in our head or we are told certain things and then it’s in our op report and we were led to believe something that actually didn’t happen or we were led to believe something that actually wasn’t documented. I think that’s a really good way to process. Really undersatnding that it’s okay to be mad or sad. It’s okay to feel those feelings, welcoming them in, and then working through the process step by step. I definitely think that knowing that sometimes we don’t know the answer and accepting that, we talked about that this year with our radical acceptance episodes. Sometimes not knowing the answer can hang us up and really, really impact us and bring us down, but knowing that sometimes we may not know the answer. We may not know the why. We may not know what happened and trying to accept that and let that go is really, really difficult. But trying to practice that radical acceptance is really powerful. Yeah. There are so many questions along the way that we have been asked, but these are kind of some of the most common. Another one, I think probably the last one that I will share today is about an epidural. “Do I have to have an epidural if I have a VBAC?” No, you don’t. No, no, no you don’t. You do not have to have a “just-in-case” epidural if you are wanting to go for a VBAC. You just don’t. It takes time to dose an epidural, so I think if you look at it and you think about it you’re like, “It kind of makes sense. Okay. They place the epidural. It’s already placed. That can take some time.” But then they have to dose it and then wait, what? Maybe it doesn’t make sense, right? Okay, so I’m just going to walk you through it. It sounds like it makes sense until you walk through it. So then they have to dose the epidural which then takes anywhere between 20-30 minutes to really work and get to a point where they can perform a C-section. So a “just-in-case” epidural, although yes, it takes the time of placing it, it doesn’t take the time of dosing. The “just–in-case” epidural is typically placed just in case there is an emergency. If there is a true emergency, they’re not going to have the time to dose the epidural and get it to a point that it is ready for you. They’re going to probably do general anesthesia at that point. The “just-in-case” epidural, I think, is just bull. I don’t like it. I don’t like when a provider puts a restriction on someone like that. Like, “You want to go unmedicated? Well, okay. Sorry, you can’t. You can VBAC, but you can’t go unmedicated or you have to have a ‘just-in-case’ epidural.” Do you have to have an epidural?Another common question is, “Can I have a VBAC if I have an epidural?” Yes. Absolutely. Going unmedicated is not for everyone or if you want to go unmedicated and then you have a really long labor or something is happening and you decided to change your mind, that is okay. Women of Strength, plans change in labor. It changes all of the time. I see it time and time again through clients and through things. It doesn’t always mean the plan is to change from an epidural to no epidural. Maybe it’s from this to that. Maybe it’s, “I didn’t want IV fluids and now I need IV fluids because I can’t keep anything down.” It changes. Plans change, but yes, you can have an epidural with a VBAC and still have a VBAC.Know that if you are wanting to VBAC, but you are not wanting to go unmedicated, you can still do that. If you are wanting to VBAC and you want to go unmedicated and your provider is telling you that you have to have an epidural or you have to have a “just-in-case” epidural, that is also false. Find what works best for you and it all circles back to education and finding the support in the provider and in the system. Okay, I lied. One more. Home birth. “Is home birth safe?” Yes. You can have a home birth. We have HBACs, home births after Cesareans, all of the time. We have them on the stories. We have them on the blogs. We have them on our Instagram. We see them in the community. Home birth is a reasonable option for VBAC. Now, the providers and ACOG are probably not going to suggest it. We go off of ACOG a lot, but know that these providers are probably not going to suggest and out-of-hopsital birth, but can you? Yes. Can you do it safely? Yes. Are there signs of uterine rupture typically before uterine rupture happens? Yes. Usually, do you have time to get to another location? Yes. So know that if you are desiring a home birth after Cesarean or even a home birth after multiple Cesareans like me, a VBAC after two C-sections, that is possible. It is totally, totally possible. Women of Strength, I just want to thank you so much for all of your continued support. We see it on Instagram. We see it on Facebook. We see it in our group. We get it in reviews here. We love your support and we are so grateful that you are here. We truly are here for you because we love you. I know I’ve said this before. It’s weird for me to say I love you because I’ve never met you, but I do. I love you. I feel so passionate about helping you as an individual find the best path for you whether that is VBAC, whether that is CBAC, whether that is unmedicated, medicated, in-hospital, out-of-hospital, inductions, or spontaneous. I don’t even care what type of birth you have. I want to help you walk through this journey and feel loved, supported, and educated. So again, if you are just with us, welcome. I’m so excited for 2024. We’ve got so many amazing things coming. If you have any questions about anything we offer on our podcast, our course, our blog or anything like that, always know you can email us at info@thevbaclink.com. If you’ve been with us and you’ve had your VBAC or you are still working for your VBAC or you are a birth worker or whatever it may be and you are with us and you have been with us forever, thank you from the very, very, very bottom of my heart. I truly love you and I’m so grateful that you are here. We will see you in 2024. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link. Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
Jan 2
33 min
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