Ashley came to me 10 weeks into her pregnancy in hopes—high, high hopes—that she could have a home birth after three prior c-sections. Ashley wanted this home birth so fiercely. I went away from our first meeting wanting to support her 100% but was torn by what my license would allow and what responsibility I was taking upon myself if I became her midwife. After discussing with my colleagues and referring to the CA medical board details regarding VBAC, I decided that—although other providers may not—I was going to be Ashley’s midwife and support her goal of having a VBAC. We made plans of what we would do this time to make it happen for her; she discussed with me what happened in her previous labors and what she wished would have happened. I also recommend things to do differently this time. We made lots of plans. We discussed what could potentially lead her to another surgical birth. But because she wanted her vaginal birth so badly, Ashley focused on the details of her home birth. She knew that another transfer to the hospital was possible, I felt like it was likely, but she put the '“what-if” to the side and went for her VBAC.
Not many thought she could do it. No one thought I should do it. Ashley nor I wanted her VBAC to prove anyone wrong. Ashley wanted it for many reasons. She wanted a good, positive birth experience, she wanted to end on a high note, this being her last child and birth, she knew her body could birth vaginally. And me, I wanted to support her, thats my job and my passion! I support women, I want them to have the birth of their hopes and dreams. I want them to feel supported and fulfilled as women and I’ll do what I can to help make that happen.
ACOG (American College of Gynecology) recommends women wanting a VBAC have their “trial of labors'“ in a hospital. VBACs are occurring more often in hospitals but are still pretty uncommon. No doctor I know would do a VBAC in the hospital after two or more c-sections. Many women seeking a VBAC are told they can’t labor if they go overdue or if their baby is “too big”. Women who have successful VBACs have lower rates of hemorrhage, thromboembolism (blood clot), infection, and a shorter recovery period. Mothers who have a VBAC will avoid the risk of hysterectomy, bowel or bladder injury, blood transfusion, infection and placental complications such as placenta previa and accreta that accompany c-section. (*) Uterine rupture is the top concern for all medical professionals when discussing the risks of a VBAC. Uterine rupture can be fatal for both mother and child. The risk of this occurring for Ashley was as low as .09% and as high as 3.7%, according to ACOG. As a doctor in our community so bluntly assimilated “You attempting this VBAC at home is like driving to LA without a seatbelt on, you’ll most likely be fine, but you may die in a horrible accident.”
That is not how I felt about this birth. Ashley and I knew the risk and didn’t feel like it was more than what we could handle. As her midwife I took extra precaution to ensure Ashley and her soon-to-be born baby were healthy and tolerating labor well throughout the entire experience. Ashely labored for 26 hours at home, with the support of her doula, husband and daughter. She dilated perfectly, her baby’s heart rate was healthy and strong throughout labor, not one deceleration. At 8cm though things started to take a turn. In Ashley’s previous labor she progressed to 8 cm after around 40 hours of labor. Her body started to push prematurely, her baby was in a posterior (sunny-side-up) position and would not come down all resulting in another c-section. This time when her body started pushing again at 8cm, with still 2 cm of cervix in the way of her baby being born a bit of panic from all attending started to stir. (If she would have pushed her cervix could have swelled shut and labor would have not progressed toward birth) This is when a technique from Spinning Babies came to mind and literally saved the day.
I had Ashely do the Open Knees- Chest position to help her stop pushing. Ashely did NOT like this position, later she told me it was so uncomfortable and felt un-natural. She was such a trooper, she kept that position for 25 minutes while her doula (shout out to her doula Hannah!) and I took turns holding her hips off the bed with the Rebozzo. In this position she was able to fight the urge to push a little better, because her baby’s head was no longer pushing so intensely on her cervix. After those 25 minutes of Ashley working so hard to let her body dilate and let baby come down a little more before starting to push, I checked her cervix and I was hopeful that the amount of cervix left could by pushed past with a little help. Shortly after Ashley started actively pushing we could see her sweet baby’s head, and what felt like just minutes for me, her baby girl emerged from her body. Ashley’s husband reached down and pulled their baby the rest of the way out and they embraced her together for the first time. “I PUSHED HER OUT OF MY VAGINA!” was one of the first and most memorable things Ashley proclaimed after the birth. Such an accomplishment, such a wonderful and victorious birth to be a part of.
She did it! VBACs are possible and they can be very healing and triumphant. They can be hard, I’d say they usually are hard! And sometimes, for whatever reason an attempted VBAC results in a repeat c-section. No matter what kind of birth a woman wants I hope she can find a team of people to support her in her desires and wishes. Also, I LOVE Spinning Babies. If you are a birth worker or pregnant and don’t know Spinning Babies, please take time to learn about it.