VBAC is a safe, empowering, healing experience for women/couples who have had a previous cesarean section. In 2010, ACOG revised its stance on VBAC, stating that "Most women with one previous cesarean delivery with a low transverse incision
are candidates for and should be counseled about vaginal birth after cesarean
delivery (VBAC) and offered a trial of labor after previous cesarean delivery
(TOLAC)." Also, "Women with two previous low transverse cesarean deliveries may be considered candidates for TOLAC. Women with one previous cesarean delivery with a low transverse incision, who are otherwise appropriate candidates for twin vaginal delivery, may be considered candidates for TOLAC. External cephalic version for breech presentation is not contraindicated in women with a prior low transverse uterine incision who are at low risk for adverse maternal or neonatal outcomes from external cephalic version and TOLAC." (source: ACOG Guidelines Practice Bulletin #115)
One of the key factors in having a vaginal birth after cesarean is wisely choosing your care provider. While many physicians and midwives may philosophically support VBAC, their practices and policies (and insurance companies) may limit your chance of a vaginal birth.
I encourage you to shop around for your care provider just as you would a new car, or a wedding venue. Attend a local ICAN Chapter meeting and ask for recommendations, read testimonials from other VBAC women, and most importantly, request a consultation, and ask smart questions. When you interview your potential care provider, take note of the information given, and also be aware of how you feel in this person's presence. Here are some questions to get you started. Remember, you are the customer. Ask proudly and choose wisely!
1. What is your overall cesarean rate? How does that break down into primary c/s and repeat c/setions?
2. What is your VBAC success rate?
3. About how many VBACs do you attend each year?
4. Do you use intermittent electronic fetal monitoring? If not, will telemetry or wireless monitors be available to me?
5. Do you recommend routine use of IV fluids?
6. How far past my "due date" are you comfortable with my pregnancy progressing before recommending an induction?
7. Under what, if any, conditions do you use pitocin to augment labor?
8. Will you use a foley bulb/foley balloon if labor needs help progressing?
9. Which positions do you feel are best for the second stage of labor?
10. Can I labor in a tub? Can I birth my baby in a tub?
11. Are you comfortable with me laboring at home and coming to the hospital after active labor is well established?
12. If my water breaks early in labor, how much time are you comfortable letting the labor go before considering augmentation or cesarean section?
13. Should I require a cesarean birth, could I have a "family centered cesarean" with immediate skin-to-skin contact and non-separation from my baby?
You deserve to fall in love with your care provider. Remember, the person you choose may be the first touch your baby feels as she or he emerges into this world. You, not your doctor or midwife is the authority int he room, and the center of your birth. Your birth is sacred, and choosing the right person to attend your birth is an important part of creating a healing, soul-nourishing experience.
A Tribute to Dr. Judy Banks
It is a joy to work with a client who is in
harmony with her primary care provider.
Whether she chooses a Midwife or an OBGYN, when the relationship is
created intentionally and thoughtfully, a wonderful childbirth experience
This weekend, I was present at a beautiful VBAC (Vaginal Birth
After Cesarean) with Dr. Judy Banks in the role of care provider.
Dr. Banks brings patience and humor, along with deep respect for the
laboring woman to the bedside (or, the birth-ballside).
In the 30ish hours that my client labored, Dr Banks stayed at the
hospital. She checked in frequently, looking at my client for cues to her wellbeing, not the fetal monitor screen. It was a blend of my client’s deep faith in herself and Dr.Bank’s skill and expertise that created a beautiful VBAC experience. I sit
in gratitude and joy that my client had the birth experience she wanted. But even if unwanted interventions became necessary, they would have been suggested from a place of compassion and performed with loving hands. And so, an empowered birthing experience would have been co-created regardless of whether the baby was pushed out or lifted out. Gratitude to you, Dr. Judy Banks and to all who love women and support their healthy journey into Motherhood.
When I found out, 21 weeks into my pregnancy, that there were two, not one, people growing inside me, I collapsed into tears. Visions of not missing a beat in my professional life disappeared. Dreams of popping my baby into a sling and cruising forward in my life as a birth professional went down the tube with my intentions to birth my babies at home. No candle lit living room, no tub of warm water, no big brother witnessing the birth of his siblings.
I crawled out of bed after a day or two of bearing my soul to my midwife and soul sisters and started to dream a new dream.
With fervor I came to understand the obstacles that I would need to overcome in order to experience a low-intervention birth and began to eat, eat, eat and eat some more. Despite constant nausea, I rallied my body to accept 100+ grams of protein a day. When I woke in the middle of the night to pee, I drank 600 calorie, 30g protein shakes and ate macadamia nuts. As the days passed, I began to move from overwhelmed to empowered and felt occasional glints of excitement for what lay ahead. By the time my 36th week of pregnancy rolled around, I was enjoying the constant chivalry of strangers and wide eyes gawking at my watermelon belly. And, by the time all names were chosen: Eliana and Rosa if they would be girls, and Mateo and Sebastian if they were boys, I was in love with these two mysterious beings within me. Scared, but in love.
On a trip to Cape May, I walked the beach, asking the Ocean to provide me a shell that would come with me to my birth place and infuse me with the wisdom of the ocean: resist the waves and be knocked over- flow with them and enjoy the wild ride. After a few laps up and down the beach, I gave up the search and looked up to see my husband Jose waving his arms in the surf. He dunked under again and came back with his hands full. On the beach he showed me the treasures he had found: The core of three conch shells, displaying the spiral that has always been my strongest image of birth- spiral in, spiral out.
On the morning of the beginning of my 36th week, I woke with contractions. I took a bath to see if they would fade, but they stayed with me and I knew that the last leg of my quest lay before me. I hopped into the car with my son and returned home 9 hours later after a day of errands: chiropractor, shopping, and tying up loose ends. My husband returned home around 6 and between increasingly intense contractions, I submitted our quarterly sales tax report right before the deadline. Thinking that we might need to leave in the middle of the night we called my parents to pick up our son Liam. I cried and cried when my little love walked out the door and I knew that our twosome would be forever changed. Over the next hours, I called my doula and dear friend Amy and told her not now but maybe tonight and called Dr. Banks and said the same.
Bath, ball, I should eat but I can’t, rocking, don’t talk to me, okay fine I’ll go to the hospital though I am certain it is too early.
We arrived to Morristown Memorial Hospital and my water broke. Amy, who arrived just 5 minutes after we did though she drove from Reading, PA, ran downstairs to move the car out of the ambulance zone and was back in a flash. I got checked and I was 8, no…9cm.
The flurry of activity set in: doc called, a million questions, and needing to be on the monitor. Before all the questions were answered I was feeling pushy. We rolled into the OR and within a few minutes, my body was pushing those boys out on its own. The nurse shouted “push!!” She kept on directing me to lay on my back and grab my legs and “PUSH!!!” but I new that within minutes it would all be done whether or not I put forth any effort. My dear doula had one hand and whispered in my ear “stay on top of it” and “remember your perineum.” My husband had the other and I lay on my side staring at the floor and bedrails saying bad words. Amy’s voice carried through those overwhelming waves. It was all I had to do- stay on top of it. Only stay on top of it and nothing else. For all the times I have whispered words of love and encouragement into the ears of laboring women, I never knew how much they mean. I clung to her words like a life raft that helped me not be knocked over by those waves. I can’t way I enjoyed the wild ride, but I made it through to the other side.
Mateo was born after I gave into the urge and pushed along with the contraction one or two times. Sebastian’s feet popped out and one push later he joined us. Amy, remembering that I really wanted to experience the birth of my breech baby said “Flynnie, I think you really want to see this.”
And that was it. All the fear, all the fighting for the birth I wanted and like Christmas morning it was over in a breath. I saw my boys for only a moment and away they went although they were healthy, loud, pink and healthy weights. Jose went with the boys and Amy and I went back to the room where I downed a piece of my placenta (totally freaked out Dr. Banks) and rode the wave of elation until Amy reminded me that time was passing and the staff would soon come to suggest formula feeding. Perhaps my only regret is that I was wrapped up in my accomplishment and didn’t get into mama tiger mode when I could have. By the time the hour had passed so quickly, their blood sugar was dangerously low and their first meal was not of my body but of a plastic bottle. I still shed tears when I remember our first hour apart. Their first moments are unknown to me and are forever lost.
Looking back on my labor, it seems more something that happened to me than something I did. I had prepared for the fire of birth to burn from my soul the things that no longer served me. I intended to hold in my heart the patters I wanted to be stripped of and ask birth to do with them as she may.
Though I did not hold anything to the flames of birth’s fire that night,id emerge from the experience prepared to mother my three boys. Although my babies were not born in my home, they were birthed consciously and with respect and love.
A fork has appeared in my road. I keep on looking at it from every which angle... climbing up a tree to look at the big picture, then crouching down to the gravel and inspecting every detail. Standing off to the side to try to peer around the corner, and asking my trailmates if they see anything that I am missing.
Thing is, on either path, I will do the work I love which is to serve families as they birth their babies. Both paths will have both spots where the sunlight filters beautifully through the trees as well as tough climbs up steep hills.
I tell women: "Trust your body." "Listen to what your body is telling you to do."
And so I will take some of my own advice. My body and my soul are singing out, and I can not ignore its song.
As a doula I help help families make informed choices. Choices that honor their personal truth. Choices that come from a place of calm and inner knowing. I provide information and step back to let families choose. And then I honor and support those choices, doing all I can to help each family experience the fullness of birth. And so, I trust that the Universe will treat me in-kind. I have made a choice that honors my work, my motherhood, and myself. And I know that the universe will support my choice.
My nurse, a former midwife from Ireland, held my hand. My husband, who had never shone so brightly in the three years I had known him, stood behind me, stroking my hair. My midwife, who is perhaps the most open, compassionate, strong women I have ever had the honor to know decreed "in a few more pushes, you will hold your baby!"
And I, in this center of this circle of love and support, was scared out of my mind.
I was scared I would tear. I was afraid of the pain. And I was terrified of becoming a mother. I was afraid I wouldn't have the strength to soothe my child when he would cry at 2am. Then 3am and 5am. I was feared I would lose my freedom. I was dreaded that I would forever be torn between my work and my family and would need to give up working fervently for organization that I loved so.
And in the middle of this fear came another surge, and an instinct stronger than fear took hold. I went inside, to a cave I had curled up in through countless waves of pain and exhaustion through my labor. My body pushed. It was doing what it needed to do. A scared girl went into that cave with each contraction. And as I pushed my baby out of my body, a mother emerged.