Victory VBAC, Part II: Plan B & Blessingway
by Summer Menkee, CEIM
When I confirmed my 2nd pregnancy with my new O.B. and shared my desire to have a VBAC, she was definitely apprehensive. I had switched OBs upon moving to the Eastside of Los Angeles, which is really like moving to a whole new city (from the Westside). She had just been promoted to maternity ward director and planned to introduce birthing tubs. I got excited! Then immediately deflated when she told me there would be no laboring in a tub for me. What?! That’s crazy. She said because of the risk of potential rupture (Cesarean scar tearing open in labor), it would be too difficult to transfer out of the tub in case of emergency. I said I would prefer to labor at home then, and come to the hospital as late as possible. She firmly said she would not agree for me to labor at home for VBAC, because she wanted to closely monitor me. This triggered all of the bad memories from my first birth. On a table, hooked up to machines, under the knife, drugged out… So, I started to research other options. I contacted a prominent Eastside birthing center, but they said they could only pair me with a Midwife who would basically hold my hand at the hospital- no VBAC deliveries at their facility. I knew deep in my core that the hospital was not my ideal environment to birth “naturally,” given my previous experience. I was open to the right situation, but wanted my best possible outcome. My body, my decision.
CALL THE MIDWIFE
My intuition told me to contact the Tender Loving Childbirth midwife I respected most, whom friends of mine had also birthed with, and who had advised my previous doula on the phone in our final hour. I had also taught Infant Massage classes (my new Mompreneur profession) at TLC after my first baby was born, so we had familiarity. We had several phone interviews before our sit-down in person to see if I was an ideal VBAC candidate. With hubby too, to determine if we, as a couple, were a good fit for home birth. My husband was born at home in his Indian village (near Nepal), but he still had a lot of fears and concerns. Our discussions allowed me to further process my first birth, how I wanted this one to be different, and why having #2 at home was our best choice. My husband went along, but with safety first and foremost in his mind, always worried about the worst case scenario.
My chosen midwife is a nurse practitioner, which means she has hospital privileges that non-nurse practitioners don’t. She can rush into an ER and proclaim, “Mother in labor!” and they have to take in the pregnant mother without delay. She helped me understand the mechanics of my first birth- how baby #1’s posterior position (back of baby’s head against mother’s back) was causing unmanageable back labor, and ultimately the reason he wasn’t able to “descend” down the birth canal. I asked how she would have handled that situation? She said there are techniques to help “spin babies” into a more desirable position.
She shared that some of her past clients had chosen to transfer to the hospital just to get an epidural, because posterior labor is so excruciating. This was enormously reassuring, coming from a top midwife. She asked me why I thought my last birth ended up in C-section? I said my doctor’s reason was ‘failure to descend,’ which I thought was code for “failure to wait.” Pam England writes about this in Birthing From Within. She agreed wholeheartedly, “Failure to wait is spot on. I’m going to use that.” Our midwife concluded that I was an excellent candidate for VBAC, and we all agreed to have a home birth, which none of us took lightly.
Before we signed our VBAC waiver forms, we were sent home a big manual to read – to fully understand all the risks involved. From the research she shared, and my own internet searching, a light turned on for me regarding VBAC misconceptions. It’s actually a very low risk, considering that only .02% of VBAC outcomes (1 in 200) end in uterine rupture, which puts the baby’s (and sometimes mother’s) life at high risk, if not in the hospital. Comparatively, it’s a .01% risk (1 in 100) for first-time mothers (no Cesarean scar) to experience a uterine rupture in childbirth. That’s only a .01% greater risk for a VBAC versus a first time mother. Others may look at these statistics and say, “Oh my God! I have a .02% chance of my uterus bursting open in labor, I’m better off in the hospital!” That was not me. I’m more of a glass half full person.
Why do most hospitals and OBs get so freaked out when 2nd time mothers want a VBAC? According to Marsden Wagner, MD, “In fact, because the number of cases of uterine rupture being reported was on the increase in the 1990s, ACOG (American College of Obstetricians and Gynecologists) responded with a recommendation that VBAC be done only in the hospital with an obstetrician and anesthesiologist at the ready.” This explains why my OB was so adamant I be closely monitored, like an invalid. Pregnant women are not invalids. We are the most powerful beings on the planet ushering in new life! We just need a safe space to feel supported to step into our full power.
Wagner explains the medical disempowerment of the mother further, “This recommendation made the organization’s obstetrician members happy, but was a disaster for birthing women, midwives, family physicians and small hospitals. ACOG, instead of recommending stopping Cytotec induction, recommended surrounding women having VBAC with experts to deal with the rupture when it happens. This would be like children drowning in a lake at summer camp and, instead of teaching the children to swim, the counselors put a couple of life preservers in the lake.” In short, a drug called Cytotec used for inductions was the most probable cause for the increase in VBAC uterine ruptures. In Dr. Wagner’s words, “Doctors find it difficult to admit mistakes. Here we have a big mistake—Cytotec induction with VBAC—that went on for years. Yet, there is no discussion of the error, or what to do so it won’t happen again.” (Midwifery Today, 2003) Instead of highlighting the misuse of pharmaceuticals, many mothers have been made to feel like a VBAC may not be in the cards for baby #2. There are entire cities and communities where hospitals refuse to perform VBACs altogether. We are lucky to have choices in Los Angeles! But, the major misconception to me is the liability hospitals feel based on the prolonged misuse of Cytotec, not because a 2nd time mother isn’t physically capable of vaginal birth after C-section.
PREPARING FOR PLAN B
Our midwife required that my husband and I consult with a backup O.B. – Dr. Wu at Glendale Adventist Hospital – just in case I needed to transfer. Dr. Wu has a successful VBAC rate and one of the lowest C-section rates in Los Angeles. He was the go-to for hospital breech deliveries (almost unheard of) until a recent ban was imposed by Glendale Adventist, followed by a huge protest!!! What is up with our current culture imposing more birth restrictions on a woman’s right to choose?! Ranting aside, I had a huge peace of mind knowing that an “outside the box” O.B. was my backup, should I need it. He did, however, try to persuade me to give birth in the hospital as a “safer” choice. I smiled, assuring him I fully trusted my midwife.
My husband had some freak-out moments along our journey when he wanted me to scrap our home birth plan, and agree to birth in the hospital. I felt SO strongly, deep down in my guts, that I needed to be at home, so I stood my ground! I was going to do my damnst, fully aware and accepting of the fact I may need to transfer. He was like, “Then I’ll order an ambulance to wait outside our house during labor, just in case.” Hell NO! That’s plain mistrust in me and the process… I also didn’t want the mental block to Cesarean birth this time. Been there, done that. It was vital I fully process and embrace my first birth as a learning experience, in order to create a NEW experience with baby #2. My husband needed to fully face his fears, let go of the worries of our more conservative friends and family, trust me, and rest assured Dr. Wu was only a 10 minute drive away.
For baby #2 I definitely felt more centered and confident of my needs. The fact we were now home owners helped me visualize and feel comfortable in my own house. I warned my neighbors, who had become good friends, that that they might hear a lot of primal moaning. I think they were a little worried, but had fun joking about it.
In order to really rock my VBAC, I needed to create a warm, cozy baby cave- both internally and externally. No fluorescent lights, no constant check-ins or unnecessary monitoring. Definitely not a sterile building meant for sick people. Pregnancy is not a disease, it’s a rite of passage. Once you’ve been through it, you know things… Secrets from the deep, dark abyss that no longer seem so ominous and scary. I already knew what intense pain felt like for days on end. I knew that baby’s positioning is everything. I knew that the more interventions I incurred, the longer my labor. I knew, now, that the more people present at my birth, the more stops and starts. I had to get vulnerable with myself, and meditate on the life inside of me. Fuck outside expectations. The only fear I needed to face was my own.
My doula was a huge support, both emotionally and spiritually. We did yoga in the park, long walks, and lots of breathing prep. I actually borrowed the book I keep referencing, Birthing From Within, from her. It really changed my entire outlook on birth and truly helped me go “in.” It resonated with me most because the author/midwife had a Cesarean her first pregnancy, followed by a victorious VBAC at home the 2nd time around. The message I so needed to soak in was that birth is not an external experience that happens to you. It is our own internal work, that is the most important. How we exercise and eat is also connected to our inner world and overall health, but how we visualize, create mantras and talk to baby is equally important. A mantra I created and practiced was, “No more than 8 hours of active labor power.” I set an intention for a quick, smooth labor. An art project I chose from the book was making a belly cast with my doula, which I then painted with the help of my sisterhood circle at my Blessingway. A Blessingway is a ceremony honoring the mother, rather than a traditional baby shower focused on gifts and games. I LOVED zoning in on my colorful, symbolic pregnant belly during labor! We also made a handmade bath salt scrub, which everyone took home in a jar, as well as a candle to light (tub-side) when they got word my labor had begun…
More to come! Subscribe to get Victory VBAC, Part III: Home Birth Delivery