So you want to have a VBAC?

Awesome! I think you can do it....and so does ICAN.

Obstetrical practice has traditionally operated under the rule of 'once a cesarean, always a cesarean' believing the risk of uterine rupture from the previous cesarean incision was too great in a vaginal birth. More recently, many doctors are coming around to rationally weighing the risks of uterine rupture against the overall risks of a repeat cesarean.

Uterine rupture is a serious complication that is rare, but can even happen without having a prior c-section.

All birth carries risk. Too often the VBAC scenario is presented in a way that implies a repeat cesarean removes danger from the situation and the woman wanting to birth vaginally is putting her own selfish desires above the health of her baby. Anyone who makes you feel this way or makes drastic predictions of the outcome of your child's birth is not giving you truthful information or encouraging informed decisions and is unfairly playing on your emotions. Don't stand for it, you are WAY too posh!

In reality there are very real dangers in elective surgical birth and it is the responsibility of parents and ultimately the birthing woman to educate themselves and be the respected decision makers, if serving a mother and child's best interests is truly the goal.

Thousands of mothers have sought out supportive birth attendants (or forgone attendants completely) and successfully given birth vaginally after a cesarean. Some have done it at home with a breech baby, others at home with twins, triplets have even been born vaginally after a cesarean. Data continues to be evaluated and current research shows encouraging rates of healthy outcomes for both mothers and infants.

So is a VBAC the right choice for you?

Birth is personal! For you, Posh Mama there is an answer that is unique to you and your baby depending on everything from your birth history, current health, the health of your baby, your beleifs and attitude about birth and the birthing options available to you locally.

My friend Jennifer did a super-posh job of connecting with her local ICAN chapter for VBAC education and support. In her hometown of Atlanta she found and retained the services of an excellent obstetrician with an excellent VBAC success rate, Dr. Joseph Tate.

Here is the story of Jennifer & her daughter Greer:



Backstory:
I just knew from the start of my pregnancy with my son that I would have an uncomplicated natural birth. I studied hypnobirthing and read tons of inspirational books by people such as Ina May Gaskin and Grantly Dick-Read. Not once did I pay any attention to the rate of c-sections or how to prevent them. I just assumed they didn't apply to me. I ended up being induced at 41 wks 5 days because my blood pressure had sky-rocketed. I had planned a water birth and labored in and out of the tub med-free until at 9cm, my midwife felt a foot and discovered that my son was breech. Without any discussion or consultation with me, she and the back-up OB decided that I would need a c/s. I recovered very quickly from the c/s primarily because like an ostrich with her head in the sand, I just decided to pretend like it hadn't happened. It stunk, it wasn't at all what I wanted, but I got over it. I did immediately decide that I would go for a VBAC with my next pregnancy.

Birth Story of Taylor Greer
I spent my entire pregnancy absolutely convinced that 1) there was no way labor would start until well after my EDD since I was induced with my son at almost 42 wks and 2) worried that I wouldn’t recognize when labor was beginning. Turns out I was wrong on both counts.

The morning of Thursday, April 14th (my EDD was 4/18) I went to breakfast with my a friend. Throughout breakfast I felt super crampy and kept blaming it on the fact that I had been stupid enough to wear skinny maternity jeans at 39 ½ weeks pregnant.

Throughout the day the cramps became irregular contractions which slowly became more regular. By that afternoon, they were no more than 10 – 15 min. apart and very mild, but still regular enough that I checked in with my doula, Kelly, and my husband, Greg throughout the day joking that I thought we might actually have a baby by the weekend. I even told my son Walker when I picked him up from school that day that I thought he might be meeting his baby sister very soon. That afternoon, Walker and I went on a walk with the same friend from breakfast and throughout the walk I had to stop several times as I suddenly got random inner thigh nerve pains/spasms and contractions. That night, after Walker had been put to bed and Greg and I sat down to dinner, I realized that the contractions were more regular and coming closer together, often every 5-6 min, however they were not very intense and I was able to laugh and talk through them. Nevertheless, I checked in with Kelly and she advised me to go to bed early just in case the prodromal labor became active labor. Fat chance as I never go to bed early and it was already 9pm and I was just sitting down to dinner. I called my parents and told them that they should head to bed early just in case they had to make the drive to Atlanta from Tallahassee, FL in the middle of the night. Unfortunately, by the time I got into bed after 10pm, I was too keyed up and the contractions were becoming more intense and I was unable to fall asleep. I woke Greg up around 2am to let him know that the contractions were coming regularly about 6 – 8 min. apart and were definitely more intense. I could no longer talk through them and had been practicing my deep breathing through each contraction since I had gotten in bed. Greg called Kelly and she told him that it sounded like I was in early labor and that we should go back to sleep (not a chance for me) and call her in a couple of hours. He then called my parents and asked them to start the drive from Tallahassee. At a little after 4am, I woke Greg up to let him know they were now an average of 4 min. apart (ranging from 3 – 5) and were getting even more intense. We called Kelly and she said that she would head over as soon as she could unless we wanted to meet her at the hospital. The plan had always been to labor at home as long as possible so I decided that I would rather have Kelly come to the house and do a cervical check (she is a former L&D RN) and then make a decision based on the results of that. Greg called Dr. Tate’s office to let him know that I was in labor and they advised us to head to the hospital.

When Kelly showed up to our house around 5am, she did a cervical check and determined that I was 4 cm and about 80% effaced. We decided that we would stay put so I could labor in the comfort of our home. Greg called Tate’s office back to let them know that we were staying put for a while. I think he fibbed and said that the contractions had slowed as Tia was telling him that we really should head to the hospital. We went upstairs and I got in our bed in a slanted seated position with my legs in a wide butterfly propped up by a bunch of pillows. I found the position to work wonderfully for breathing through the contractions and stayed put for several hours. I really didn’t have an urge to walk around and found that while I really enjoyed the birth ball in between contractions, I did not like sitting on it during one. For some reason I never got in my tub. Not sure why, since I loved laboring in the water with my son, other than I think I was just so comfortable in bed. The contractions were becoming more intense and longer, but stayed around 4 -5 min. apart. Kelly and Greg did their best to keep me hydrated and nourished, but the thought of food generally made me nauseous. My parents showed up at about 7:30am and Kelly checked me again to determine whether we should head to the hospital. She found me to be about 6 cm and 80% effaced which we took as a good sign as I was opening about 1 cm/ per hour. Still, based on the time of day and traffic, we decided to labor at home for a bit longer. When Walker woke up shortly after, Greg got him dressed and when he asked him if he knew what today was, Walker answered “baby sister coming”! Crazy. Kids are pretty intuitive. Greg brought him into our bedroom and he spent some wonderfully sweet time snuggling with me. He kept saying “that’s my mommy” over and over.
At around 9:30am with the contractions staying the same time apart but becoming still stronger and longer, I decided that I was ready to go to the hospital. We said good bye to my parents and Walker, who got really upset that we were leaving. When we got into our garage, I suddenly got really uncomfortable. I begged Kelly and Greg to wait for me to do some yoga stretches and I got down on our dirty garage floor and did some cat/cow and child’s poses. Once in the car, I threw a yummy smelling eye pillow on and did my best to continue my deep breathing and keep myself focused.

We got to the hospital and I got quite a few stares as we made our way to labor and delivery with me very obviously in labor. I worked through several strong contractions while waiting at registration (and wondering why I had bothered pre-registering if this was taking so long) and suddenly got emotional and starting crying. I think I was tired from not sleeping all night and excited and nervous that this was finally happening. Once we were led to triage at around 10:30am, a nurse strapped a monitor to me and checked me. She determined that I was 5 ½ cm and 80% effaced (slightly less than Kelly had determined when she last checked). I was a bit discouraged that I had gone since 7:30 with no visible progress.

After about 20 min, we were moved into our labor and delivery room and I resumed the same position that I had found so comforting at home. Meanwhile the contractions became stronger and stronger and were often lasting as long as 2 – 3 minutes. I labored in that position for a couple of hours and then Kelly encouraged me to get up and try some new positions as I was becoming increasingly uncomfortable. I tried the birth ball and again found it really uncomfortable to ride out a contraction on. I did sway my hips quite a bit and then lean into Kelly or Greg during contractions and that worked for a while. I then decided to get on the floor and try some stretching – cat/cow, etc. That is when Dr. Tate walked in a little after 2 pm. He had me get in bed and checked me and found that again I was still 6 cm, but now about 90% effaced. He did find that the cervix was very soft and able to be manipulated and he did his best to manually open me. Extremely discouraged at the lack of progress and exhausted after the night without sleep and 12 hours of pretty hard labor, I really began to doubt my ability to do this without any medication. I found myself losing focus during contractions a bit, no longer riding out that peaks but tensing a bit and even found my mind wandering to the thought of a PCB or epidural. I mentioned to Kelly and Greg a few times that I didn’t know how much longer I could do this and they kept encouraging me by telling me that I was doing great. At some point Tate came back and checked me and determined I was at 8 cm completely effaced.

Kelly left us to get some lunch and when she came back an hour or so later I told her that I wanted the PCB. While she was gone, my contractions had stayed no more than 4-5 min. apart but were now consistently 2-3 min. long with multiple peaks. Kelly asked the nurse to call Tate and tell him I wanted a PCB. He came in a while later and at that point I felt like I was at the end of my rope. God bless Tate though, he walked up to me and propped his arms up on the squat bar that we had put up at some point earlier and I was leaning into and looked at me and said he had two options. He said that he knew my plans were to go natural so he could either 1) check and see if there was enough of a cervical lip left to give me the PCB and assuming there was give it to me and see if I dilated the last 2 cm quickly or 2) he could break my water (which had been bulging since Kelly had first checked me at 5am) and that I would probably be pushing in 15 – 20 min. A surge of energy hit me (I could do 15 – 20 more minutes!) and I told Tate that I would kiss him if that was true.
I got on my back and he broke my water. He left the room and in just about 15 min. I announced to the room that I thought I was ready to push. Kelly and the nurse told me to go ahead and try a couple of pushes to see if I could bring her down. I leaned forward against the squat bar and thought to myself if pooping means you are pushing right, then go ahead and try to poop. Ha! Ha! My poor husband, I pushed a few times with contractions and pooped right along with each one. Surprisingly I wasn’t the least bit mortified, I was thrilled. I knew I was pushing effectively!

All of a sudden several people came into the room and set all sorts of things up and then Tate came in and announced that it was great that I had pooped. The back of the bed was pretty much completely upright and broken down for the squat bar. He said he thought we should get rid of the squat bar and despite the fact that I had told him when we discussed my birth preferences that I wanted to choose my pushing position, I agreed. At this point I just wanted to push my baby out fast and I figured he had all the experience and should know what he was talking about. He had me pull my knees up to my chest, but I continued sitting pretty much straight up. At that point, I completely blocked everything out. I was having contractions one after the other with only maybe 1 min of a break in between and I had already figured out how to push, so I went with it. With each contraction I took a quick breath in and then pushed as hard as I could. Amazingly everyone was pretty much quiet (I had told Tate that I didn’t want anyone counting for me or telling me to push unless I clearly needed it). The only thing I heard Tate keep saying was “bring it around the corner”, which I didn’t really understand, and tell me to continue pushing into his fingers. After a few pushes I head everyone exclaim that the head was there and I reached down and patted my baby girl’s head. My only thoughts were – that is really squishy, and man my vagina has to stretch a LOT to get that head out. A few more pushes later and her head was out and then a quick push and I felt an enormous relief of pressure as Taylor Greer was born at 4:48 pm after only 13 minutes of pushing! I was exhilarated and was shaking and kept saying “oh my God” and “sweet baby girl” over and over as she was placed immediately on my chest after Tate yelled out “I need to see boobs”. I couldn’t believe she was here and that I had done it! Never have I felt so amazing and empowered in all of my life. Dr. Tate waited the few minutes we had asked for and then had Greg cut the cord. A few minutes later, I birthed the placenta and lay down exhausted. Greer latched on and began nursing almost immediately as Tate and an intern began stitching up my 2nd degree tear which was almost more painful than anything else.

I am so thankful to Dr. Tate for believing in women and believing in our bodies’ ability to give birth the way nature intended. I will forever remember his care and respect for my preferences and final encouragement to get me to pushing. I am grateful and thankful for the support of my husband Greg and my doula Kelly, who not only was incredible throughout my labor, but helped me begin my study of childbirth through hypnobirthing, and who helped distill the fear associated with childbirth. I will forever be inspired by my sister who I watched birth both of her sons naturally almost 10 years ago. Witnessing her births several years ago made me realize how simple childbirth could be and that there was nothing to be afraid of. Finally, I am so proud of myself and all of the women who take the time to really learn and educate themselves about birth and what their bodies are capable of.



To make individual, evidence based care more available to more women get POSH and PUSH for it!

*Support organizations like ICAN and CIMS who work to change hospital policies and influence the practices of OB's and MW's.

*Give your VBAC supportive obstetricians and midwives a lot of love!

*Respect the right of mothers to birth unassisted, especially in cases where desired maternity care is denied by legal restrictions, hospital policies based on insurance liability or the ignorance and inexperience of birth professionals.

*Share your story! Whether your cesearean birth truly saved a life (or two!) or if it was unnesecarily pushed on you, whether you have positive feelings or are dealing with regret, have succeeded or failed or both with a VBAC the honest stories from one mother help another.

*As generously as you share your own story, give respect to those who have had different experiences, different birth desires and make different choices. You never know ALL the details of someone else's life and even if you do... It's just plain RUDE to pass judgement and criticize.

Be inspired! Be positive, be practical and stay posh.