The VBAC Link

• Episode 391 Molly Returns Sharing Her Post-date Induced VBAC + Co-Host Allison + The Emotions of Birth

  Molly joined us for Episode 84 talking about her unexpected breech Cesarean and first VBAC story. Today, she returns sharing her second VBAC story!Molly shares her powerful journey through loss, IVF, selecting her powerhouse birth team, preparing for different outcomes, post-dates, a multiple-day induction, a beautiful delivery (where her husband caught their sweet baby!), and navigating a placental lobe.Allison, one of our VBAC-certified doulas, joins Meagan as a co-host talking about her work as a virtual doula and the importance of how women are treated during their births. Coterie Diapers - Use code VBAC20 for 20% offHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. I hope you guys are having a fantastic day or evening and are excited for another episode of The VBAC Link. We have our friend, Molly, today, and she is from central Alabama, and then we also have a co-host today. She's one of our doulas. Her name is Allison. Hello, Allison.Allison: Hi, Meagan. Hi, Molly.Molly: Hi.Meagan: I was going to say, and hello, Molly. Molly: Hi.Meagan: Welcome to the show you guys, and thank you for joining us. Allison is actually one of our doulas. I don't know if you've noticed along the way here and there, we have one of our doulas on as a co-host. I think it's so fun to hear an educational topic from them and then, of course, share where they are at because I truly believe hiring a doula is so impactful. In fact, on Molly's form, that is one of the tips that she gave. Right, Molly? You're like, hire a doula.Molly: Yes, absolutely. It made all the difference this birth.Meagan: Yes. Doulas are incredible. So if you can, hire a doula. Before we get into Molly's story, Allison, I wanted to just turn the time over to you really quick and have you share a little bit more of where you are at. So for the listeners, maybe in your area, they can find you.Allison: Absolutely. Well, listeners, you have a treat because I serve everyone all over the world, globally. All of my work is online. My business name is The Cesarean Doula because I actually support women and birthing people emotionally after having emotionally difficult or traumatic Cesarean births. I do all of my work primarily over the Internet over Zoom. My focus is actually not on birth but on postpartum and on recovering from the feelings of grief, sadness, loss, overwhelm, and confusion that we often have after a Cesarean that's undesired or that goes in a difficult direction. I had one of those. That's what brings me to this work.Meagan: Yes. I love that you mentioned that you're like, this is what brings me here. I think in a lot of ways for doulas, that's what brings us to doing this work is our own experience and wanting to set a different pace and make change. So I love what you're doing. We're recording in 2024, everybody, but hopefully now, it's 2025, and you can go to our website because we're hoping to have a different option for searching doulas where you can actually go and search for online only because we do have a big chunk of doulas that do virtual support. So let's hope that that is the thing. If not, email me and say, "Meagan, get on it. Do this, because I want this option." Okay. Well, Ms. Molly, welcome to the show. You guys, Molly is a full-time mama, a part-time vet technician, and a soccer coach. That is a lot of things all at the same time. Yes. My husband is a soccer coach and just that alone is a lot. Like I said, she lives in Alabama with her husband and her two sons, her mom, and lots of dogs, cats and horses. She said that she also has two daughters in heaven. I'm sure you're maybe going to talk about that a little bit today, Molly.Molly: Yes, it is part of our story.Meagan: Yes. Okay. Well, thank you guys again for being here. In just one moment, we're going to dive in. All right, Ms. Molly. I don't know why I keep calling you that Ms. Molly, like you're a teacher.Molly: It's the song. It'll get you.Meagan: It comes together. Yeah, seriously. Okay, thank you so much for being here and yeah, I would love to turn the time over to you to share all of these stories.Molly: Thank you very much. So if you guys, if you listen to The VBAC Link, I was on a couple years ago talking about my first C-section and then the subsequent VBAC with my first daughter. Unfortunately, a couple years after that, my daughter passed away. And shortly after that, the desire to have another baby was laid on our hearts, and so we decided to try that.For various reasons, that meant we had to go through IVF. We were very lucky in that our IVF journey was short. That's a whole other podcast on its own, the IVF process. We ended up with three embryos, and then in December of '23, we did our first transfer. That one unfortunately failed. And so that's my second daughter in heaven. We did another test after that to see why the transfer had failed and determined that we needed another day of shots. Well, I say we-- me. I needed another day of shots to do the transfer. So in March, we did another transfer with the extra day of shots, and that one was successful. I had the teeniest bit of spotting the next day and just woke up knowing I was pregnant. It was pretty magical, actually. The at-home pregnancy test, seven days after that, was positive. Then the blood tests after that were positive. I did have a little bit of spotting after that which was a little scary. I talked to my doctor, and she upped the progesterone in oil shots I was taking. The amount of those seemed to clear out the spotting. And then we went in for our first ultrasound. I was diagnosed with a subchorionic hematoma, I think is what it's called, which is essentially like a bruise between the placenta and the uterine lining. That cleared up on its own. Fortunately, after that, I was a "normal" pregnancy. We weaned off the IVF shots. My last one was actually on Mother's Day which was a magical little sign. And that's when we dove right into labor prep. We did the Spinning Babies and bouncing on the birth ball. I walked every day. We went back through our birth plan. We tried to cover every single contingency from a repeat Cesarean which wasn't the goal, but we wanted to be prepared just in case. We prepared to labor at home as long as humanly possible. We even prepared to have a car baby. We had a bag with a bowl to catch the placenta and towels and puppy pads just in case we labored at home so long that we had a car baby.We hired a doula this time around. We had originally played around with the idea of doing a home birth, but in Alabama for VBACs, midwives still cannot attend VBACs at home in Alabama. We did find a midwife who was willing to do that for us but because of the restrictions, it wasn't covered by insurance, and that priced it out. So the compromise was that we would do a hospital birth, but I could have a doula this time. We interviewed doulas and found one who's actually certified by The VBAC Link. She's taken y'all's class and she was wonderful. Her name is Jolonda, and she was fantastic. And actually, in the end, my husband said, "I'm so glad we had a doula for me." Not necessarily for me, but for him. He needed her more than I did, and that was pretty cool. We also, this time, instead of going with an OB, went with midwives. They were associated with an OB practice, but we went just to the midwives. That was an interesting and much different experience. It was more like a conversation and less like an exam. We go in, and they would take my blood pressure, and then we would just talk. It was wonderful. She went through my birth plan point-by-point, and then signed it and scanned it into my chart. Anything that wasn't possible, she'd say, "Well, we can't do this because of the hospital we were at, but we can do this or we can try and do this and make that work." She was completely accepting of anything that I wanted to do differently. We decided not to do the erythromycin eye ointment. She said, "Yes." She was fine with that. We delayed, I think, the Vitamin K shot then and the delayed cord clamping. She was all 100% supportive of everything that we wanted to do. I did have to see the OB once just so they could sign off on me being a, quote, healthy pregnancy, and that was a quick in and out. There was a doctor visit, and they said, "Okay, we'll see you back in a couple of weeks." I said, "No, I'm going to go back across the street to midwives. I'll see them in a couple weeks." So that was all. My pregnancy really in itself was pretty normal. And then we got closer and closer to my due date. Now, I was due on November 18, and we got closer. I stopped working as a veterinary technician on the end of October right before Halloween. We had our baby shower. We were getting close to all the guess dates. Everybody had guessed when your baby's going to come. I would text them, "Nope, you missed it. It wasn't today." And so we slowly passed all those days, and then we passed my due date. We were doing everything-- the tea and bouncing on the birth ball and the dates and the pineapple, walking, The Miles Circuit, curb-walked. I knew the closer we got to 41 weeks and 42 weeks even, the more that there was going to be pressure for a repeat Cesarean. Now, to my midwife's credit, she never mentioned a repeat Cesarean. That was the very last thing that she ever talked to us about. We had talked about it in our birth plan, of course, but as we passed the due date, she didn't mention that as a course of action. As a joke, we asked our son, "When do you think Mama will have the baby? Now that we're past our due date, when do you think Mom will have the baby?" And he said, "I think she's going to wait until December." I said, "Buddy, please don't put that on me." So we'll let you know how that goes towards the end.Meagan: Yeah, I mean that would be what, two and a half more weeks? Three? Yeah, two and a half more weeks.Molly: Yeah, it was a long time. And I said, "Bud, please don't put that on me. That's a long more time." So then we made it through Thanksgiving. I consented to a cervical check at 39 weeks and there was no action the cervix, but you and I know that that can change in an instant, and it's not an indicator of anything. Meagan: Nope.Molly: At 40 weeks, I consented to another check and to a sweep of the cervical membranes. That made me feel crampy but really didn't do anything. We started talking about induction at that appointment. We talked about starting with the Foley bulb over breaking the waters or maybe Pitocin. We talked about those options and which ones I was most comfortable with. And so then after the 40-week appointment, they sent me in for a biophysical and non-stress test, and we passed those with flying colors. No problem. Baby was fine, I was fine. She just was very, very comfortable. Then at the 41-week appointment, we did another sweep and this time I was dilated to a really tight 1. But again, that didn't really do anything. We made our next appointment for 41 weeks and 3 days. And the ladies in the front office said, "We hope we don't see for that appointment." And I said, "I hope you don't either," but we did see them for that appointment. So at 41 weeks and 3 days, we talked about the induction again. They did another sweep just in the hope that maybe it would start things. It didn't. So we talked about and scheduled the induction. We'd agreed to start with the Foley and see how that went, and then maybe talk about breaking waters and maybe, maybe Pitocin being our last resort. We stopped for dinner. That was Wednesday evening. We stopped for dinner on the way in because I was like, "We're going to have a baby, and I need my strength. I've got to eat before we go in." So we stopped for dinner, and we got checked in. They got me strapped in with a wireless monitor, which was new this time and was so much better than the wired monitor because I could move. It was much better. And this is the start of what we like to jokingly call birthatory, because it's birth purgatory. I was stuck there in the room. I couldn't leave. My husband left just to get us food, but it just felt like we were there forever with nothing to do. And time moved strangely as well. I watched Friends at night to help me sleep, and I watched Parks and Rec during the day to keep me entertained. We did a lot of walking up and down the room as much as we could. And that Wednesday evening was just to start us monitoring. Jolanda came in, and she was in and out and checking with us that night. They also started me on the Group B strep meds. I think I forgot to mention I was positive this pregnancy. I had a weird reaction to whatever med they put me on first, like my scalp was on fire. It was a really bad reaction. Meagan: Interesting. Is that a common reaction?Molly: I believe they said it could happen, but it's not super common. I wish I could remember which medicine it was they gave me. But, I mean, it felt like my scalp was on fire. I was itching. It was horrible. So they gave me some Benadryl which fortunately helped me nap, so I got some rest. But we didn't want to do too much of that, so they switched me to a different medication. And again, I wish I could remember the name of it, but I can't. And that, I did not react to, so we stayed with that one for the rounds of the Group B Strep meds. So that was Wednesday night, and they were really just monitoring me. Thursday morning, the OB and the midwife on call came in to discuss my case. They discussed options. Pitocin. I consented to a check because we were going to start with the Foley, but I was at a 3 already. So that put the Foley out of commission because the Foley will only work up to 3. We talked about Pitocin versus artificial breaking of the membranes. The OB did do a little bit of pressuring, but we were all prepared for it. He said, "Well, at this point, this many post dates, you're probably definitely going to have meconium." And behind his back, my doula, my sweet doula rolled her eyes. It was what I needed, that support in that moment for the doctor to say, "Oh, well, there's definitely meconium." And my doula would be like, "No, there's probably not." So we asked for time to discuss between us and what to do. And Yolanda had these little informational cards with different affirmations. There was affirmation cards, but different, like facts about, induction from-- oh, I'm blanking.I can't remember. But they were little printed out laminated cards with different facts about different types of induction, and they were really helpful.It's Evidence Based Birth. That's what it was. It was all evidence-based and backed up by studies and stuff. So we discussed what we wanted to do, and we agreed to breaking the waters on Thursday morning. So the midwives came in and broke my waters, and there was no meconium. So that doctor can just go sit somewhere else. My waters are broken. I walked up and down the room, but nothing really happened. That night, there were some surges that we did time, but they petered out, and nothing really happened. So we woke up Friday morning, and that was December 1st. I, with despair in my voice, looked over at my husband and I said, "It's December. We've made it to December." I felt like a balloon that was beyond needing to pop and was just discouraged and tired. I was at the end of my rope, really, honestly. They came in, and I agreed to another check. This was the first check that they'd done since they broke my waters. And so if you're keeping count at home, my water's now been broken for about 26 hours. We happen to be watching an episode of Friends where the character, Rachel, is in labor, and she's having trouble dilating as well. And Ross makes a joke about, "I'm dilated 3." Well, they did the cervical check and checked, and I was still dilated 3. And Michael goes, "I'm dilated 3," and everybody laughed. It was a good break in the tension. After that, they left to go discuss my case. Michael went to go get me some hot water so I could make tea. But he came back in and he said, guess who's here and looking at your chart?" And I had no idea. He said, "It's Vicky," who's the midwife who helped deliver my first VBAC baby. She had retired, but come out of retirement and was only working on the weekends in the hospital. And I looked at him. I said, "We're having a baby today." Just something told me that with Ms. Vicky there with us, we were in good hands, and we were going to be okay. So she came in and talked to me about starting Pitocin. She also told me, because at this point, I was worried about a repeat Cesarean. And she told me, she said, "I'm no longer looking at you as a VBAC patient. You've had a successful vaginal birth. I'm treating you just like any other birth now." And it was such a healing statement for me. It wiped the worry about a repeat C-section out of my mind. It was just the perfect thing to say.Meagan: Yes. I don't want to interrupt you too much, but I love that you pointed that out, because most providers, they're actually looking at no matter if you've had a VBAC or not, you're always a VBAC. But what you just said to me really is gonna connect with so many others. It connected with me because we just want to be viewed as someone going in and having a baby. We don't want labels and these things that loom over our head even if we've had a VBAC before or if we haven't had a VBAC before. We just want to be looked at and treated as someone coming in and having a vaginal birth just like anybody else coming in and having a vaginal birth. So I love that you pointed that out, and I'm sure that that really did just connect and feel so good.Molly: It was a huge release of stress knowing that I didn't have to worry about the repeat C-section, the VBAC anymore, and I could just focus on having the baby and what I was doing and just doing what we needed to do that day to have the baby.Meagan: Yeah.Molly: So we did agree to the Pitocin she suggested. And we got very into the details, and we're almost a year out. I should have written them down sooner. I can't remember the numbers we started at, but she wanted to start at a certain amount over a certain time, and I disagreed. I said, "Let's start lower and slower." And she said, "That's fine. I'll do whatever you want to do." So we started really low and really slow, and I was starting to feel some things, but still not very much. It wasn't anything I had to stop to get through. It was really more just like a tightening. Jolanda came to hang out with us, brought us more food and water, and she brought a puzzle to help distract us. We were going crazy being stuck in that room. Vicky came in later that afternoon, and because still no progress was really being made. They didn't check me, but they could just tell from the contractions on the monitor. She talked about wanting to up the Pitocin a little bit faster and more frequently. I told her that I was worried about the difference in the Pitocin contractions versus natural contractions because I had heard and read so much that the Pitocin contractions are much more intense. And she told me that she'd given birth with and without Pitocin, and the only difference for her was that Pitocin births were faster. I agreed for her to bump it up a little bit, a little bit faster, that. After a little bit of time to talk about it, we agreed to do that. They did check me at that point, and I had worked my way up to a 5, and baby had moved from a -1 to, I believe, a +1. We dilated some, and baby had descended a little bit. At that point, the contractions did start to pick up, and I lost interest in the puzzle. We turned a movie on for me to watch. They were a little bit more intense, but still easy, and I could still talk through them and walk through them. Jolanda did an excellent job. She reminded me to go to the bathroom. And so I went to the bathroom, and when I walked out, I felt the baby drop. I don't know any other way to explain it, but I felt her drop in the birth canal. It was like she was sitting high, and then suddenly she dropped. I said that. I said, "Oh, I felt the baby drop." My sweet doula said, "You felt the baby drop?" I couldn't respond to her because then a contraction hit so hard that I could not talk through it. So, at that point, I told them, I said, "Please turn the movie off," because I couldn't handle the sound of movie. My husband turned on music in the background real low of our birth playlist. I needed to get down on all fours, so I got down on my knees, and I was bent over a birth ball swaying back and forth and moving forward and backwards, swaying my hips and vocalizing through them. Keep your mouth loose and low, moaning through them. At some point I didn't need the ball anymore and Jolanda brought in this inflatable thing. It was U-shaped and it was inflatable, but you could be in it and lean over it. And again, I wish I remember the name of it, but it wonderful because you could inflate and then deflate it to move it and get it out of there. But it was just perfectly shaped for me to be able to lean over it and even sit on it if I needed to, but I just was leaning over it. The contractions were getting more difficult, and she reminded me to relax my hands because my hands had gotten really tight. She was reminding me to breathe and relax my hands. She also suggested counter-pressure on my tailbone. I did not want it on my hips, but she tried it on my tailbone, and that felt incredible. Suddenly, the contractions were so much easier to bear, and they just felt more productive. It was fantastic. So she and my husband, Michael, took turns wearing their arms out, pushing my tailbone through the surges. At, that point, then the wireless monitor got weird because it had been on me for so long. The stickers, I guess, had just given out. So a poor nurse was on her knees underneath me holding the monitor on my belly, and there was either Jolanda or Michael behind me pushing on my tailbone through the contractions. And then I started grunting and felt pushy. Juolanda recognized my grunting because we talked about during my consult during my first VBAC. I get grunty when I'm pushing. She recognized the sound and she said, "Are you pushing?" But I didn't want to answer her because I didn't want to stop pushing because it felt so good to push. I hadn't been checked. So I didn't want them to know that I was pushing and check me and tell me that I couldn't push. And also, at this point, I was practically sitting back against the counter-pressure. The surge would hit, and I would sit back into whoever is doing counter-pressure and practically put my full weight back on my tailbone on their hand and the counter-pressure. Then, my knees got tired being on the floor. So I asked to move to the bed and they asked to check me. The midwife, Ms. Vicky, said, "I would love to check you right now." I said, "As long as I can be on my hands and knees, you can check me however you want."So I got up on my hands and knees on the bed, leaned over, and they checked me, and I was good to push. So at that point, we started actively pushing. Not just me pushing because it felt good, but pushing because we knew we were pushing a baby out. And pushing, it felt so good to push. I needed to push. It felt so good. I could feel her moving through the birth canal. I could feel her head coming down, and it was amazing. And just like with my first birth, it's frustrating to feel the baby move and then go back and then move forward and then go back, but you can tell you're making progress. I don't know how long I pushed for because I was way off in who knows where. Nobody else looked at the clock. Michael would have, but he was getting ready to catch. He had prepped to catch this baby. So I pushed her out into her papa's hands. He had prepped. He watched all kinds of videos meant for midwives, and he was so ready. He did such a great job. Baby Nora was there, and she was perfectly healthy. She was 7 pounds and 2 ounces, and 19 inches. For being 41 weeks and 5 days, she was still just perfectly cooked. I passed the placenta at some point after that. We did the golden hour, and we snuggled in. He cut the cord after it stopped pulsing. That was all very much a blur to me, just a golden, snuggly haze of love. So we passed the placenta, and it was declared complete. We looked at it, and we put in our little cooler to take home and freeze to plant her little birth tree. I did tear a little bit, so they stitched me up and we took some pictures. And then Ms. Vicky went home. She'd stayed 45 minutes late for us. She went home at that point, and I started nursing Nora. At that point, however, I was still in pain. So they said, "Would you like something for pain?" I asked for just Tylenol. I didn't want anything heavier than that, but I was still pushing. I was still feeling the urge to push, and it was getting worse. So the nurses applied some pressure to my uterus, external pressure. It hurt so bad I could barely stand it. Michael took the baby at that point, and Jolanda suggested me trying to avoid my bladder, and maybe that would help. But I couldn't. I couldn't get those muscles to work, so they put a catheter in. That didn't really help. The surges were still coming and I couldn't stop pushing. They put more pressure on my uterus, external pressure, and I passed a huge blood clot. It was like a softball-sized blood clot. That felt a little better, but I was still pushing and I could not stop the pushing. So they gave me some stronger pain meds and talked to the OB who was on call and all agreed that I needed to go the OR and see if something had been left. So we agreed to that and went under sedation into the OR, and they removed a golf ball-sized portion of the placenta. Meagan: Whoa.Molly: Yeah. It was confusing because they had declared my placenta complete and after talking about it, and they looked at all the pieces, and it turns out that I had a lobular lobe.Meagan: I was going to say you probably had a lobe.Molly: Yes. And so after I mentioned "Oh well, I had some spotting early in pregnancy," they figured that the spotting had contributed to that, and that's why the placenta looked complete and there was a lobe and the hematomas all contributed to the early bleeding and the lobe in the placenta. I came out of the OR fine. I got two bags of blood but felt fine. When I woke up, I got to hold Nora in the OR. Well, not in the OR, but in the recovery and nurse her again. And everything was really fine after that. Jolanda checked on us a couple of hours after that. She brought us food. We had talked about what I wanted to eat post-birth. I wanted to eat a cheeseburger with bacon from a specific place near the hospital with fries. She brought it all, and we ate it at like 11:00 PM. It was wonderful. And Michael, like I said before, said later that having a doula this time around was 100% worth it mostly for him because she was suggesting things that he wouldn't have known to offer like the counter-pressure and, "Hey, maybe she needs to pee," and things like that. It saved him and helped him know what to do while I was off in labor land. For that, our sweet doula was so worth it. And after that, recovery was great, and we were fine.Meagan: That is awesome. So still had a little bit of a hiccup there in the end, but overall a really great experience.Molly: It was awesome. And I said before, with the birth plan, we tried to plan for all contingencies, but the one thing we did not plan for was three days trying to be induced naturally. Meagan: Yeah.Molly: I mean, they say time isn't linear, and I have never felt that more true than we were stuck in that room for three days. It was very weird just not being able to get out. It's not something I would do again, the induction part, but we made it through thanks to great support from midwives and doula and my wonderful husband. I would do the birth part, and maybe not the hemorrhaging at the end, but the birth part I would do again.Meagan: Yeah, yeah, for sure. I mean, that's just less ideal. I don't know. Did they ever talk to you? Because I know that IVF parents do have a slightly increased chance of hemorrhaging. Did they ever relate it to IVF, or was it mainly just, "Hey, you had a subchorionic hematoma earlier, then you have this lobe." Maybe it was just that they.Molly: The doctors didn't. No, we were very aware that she was an IVF baby, and we had done a lot of research before that IVF babies have a very "sticky" placenta.Meagan: Yeah.Molly: That was one of the factors why we didn't do a home birth was because if the placenta sticks, and then you're at home, it can be a rush to the hospital. But the doctors at the hospital didn't mention the IVF possibility as the reason I hemorrhaged. Maybe it played a part. I don't know. They seemed to put it on the sub-chorionic hematoma. But it could have been both. I don't know.Meagan: Yeah. Yeah. All of the little factors could have been. The best thing is that it seemed pretty minor and a quick fix. A quick fix. I just wanted to remind everybody, so I'm pretty sure this is your episode. It's Episode 84. So if you want to go hear the breech Cesarean and the first VBAC, definitely go back and listen to those on Episode 84. Thank you so much for sharing your story, and I'm so glad that it was so great and that your husband got to catch a baby. That's like my favorite, you guys.Just to let you know, that's happening more and more. At least it has been here in Utah as we're attending births. Sometimes, all you've got to do is ask. So if you have a partner who is interested in that, I think asking is not harmful. Just ask. It can seem intimidating, but it's not too bad. It's not too bad. They really help these partners catch these babies. Allison, I would love to have you share your two cents and your educational topic on healing after Cesarean. We're doing these topics instead of reviews sometimes when we have guests. I love what you do because just like Molly and myself, we've been there having an unexpected-- well, maybe with the breech it was kind of planned. I'm trying to remember back in your story.Molly: So with the breech, with the Cesarean, we had planned a C-section, but then he broke my water early, so it was not necessarily an emergency Cesarean, but we had to go in before we were "scheduled" to for the C-section.It was planned, but unexpected at the time. The wrong timing. Yes. Okay. Well, tell us more, Allison.Allison: Yeah, and I want to say thank you so much, Molly, for sharing your story. I actually want to point out a few things that I think are really important here. I work with so many people who have had a birth that feels difficult or traumatic. And oftentimes, there are women who come to me who say, "I don't understand why I feel upset about my birth even though I have this baby who's healthy and alive, if we're lucky enough to have a living baby or a healthy baby or both." And one of the things I talk a lot about is that oftentimes it's not the events themselves in the birth that create a difficult or traumatic birth, but it's how we feel, right? And so, what makes a birth feel good or bad? Like, I listen to you talk about this experience where you had some challenges leading up to it, right? Especially preconception, and then during conception. I felt your joy. I felt your connectedness, and I felt your power throughout your story even as you talked about the really difficult part at the end with the placenta needing to be retrieved. I want to just point out that that's what I heard, and you've got to tell me if this feels right for you, Molly. But what I heard was many moments where you talked about feeling connected. You talked about your sweet doula. You talked about that surprise midwife coming in to support you. You felt connected. You felt seen like that moment where you said, "Oh, well, the monitor wasn't working, but then the nurse got underneath me," so instead of actually you accommodating the hospital's protocol and policy, I love this idea. I'm imagining a nurse laying on her back under you while you're on all fours. You're empowered. That's truly centering you. Right? You're in control in a lot of these moments. You said you wanted the Pitocin lower. The doctor or the midwife honored that. It sounds like you were informed. You used some examples of the cards from Evidence Based Birth, and a lot of the information you engaged with prior to birthing. One of the things I talk about with my clients is maybe you even feel sexy during birth. You didn't mention that at all, but that might have been. There might have been moments, maybe not. Are there any other emotions that come up for you? Did I leave anything out hat you're like, oh, I really felt another positive emotion?Molly: No, you've nailed it 100%. I felt very supported this birth from the midwife listening to me and, like you said, honoring my requests and my husband being there and the doula. I felt very supported. So even the end and the hemorrhaging which should have been scary, I don't look back on as scary. I don't want to repeat it, but I wasn't scared in that moment because I felt taken care of and supported.Meagan: Mhmm. Allison: Right. That is so textbook. I love this story because that's a really, really scary thing. And if you hadn't had that support, that attunement, that communication and that safety, it could have felt different. It could have made your story feel like there was this turning point into a dive. I love that your advice was getting a doula, because in your story, I really feel how your relationship and respect for her are a big component of your support and empowerment. So I just want to end by saying that birth is really about those emotions, not the modality or even the environment where we birth. If we can create those experiences for ourselves as much as possible, we don't always have the ability to do that. Lots of things have to come together, but if we can focus on, how do I make myself feel empowered, connected, sexy, seen, in control, informed during my birth, however I birth, then the likelihood of having a positive outcome emotionally is so much higher. And when we have a better emotional experience, we're more likely to be able to have a supported breastfeeding experience and also go into motherhood feeling centered, feeling capable of taking on this new role or another baby when we already have littles at home. So thank you so much for sharing your story. I feel really touched, and I can imagine that others are too.Molly: Thank you.Meagan: I do love that you pointed that out, Allison. The way we feel during our labor, the way we're treated, the way we're communicated to, it really impacts that next step going into that motherhood era. I think back on your story. I remove your doula from your story, and I remove your supportive provider. That birth very much could have unfolded very differently especially because it was a longer induction. Right? And so when you put that powerhouse team with that true love and support back into the story, it's like, well, I don't understand why it wouldn't unfold that way anyway.But really, if you look back without that, it's questionable sometimes. And so we talk about it, you guys. I think I will probably talk about it until I die. I mean, truly, I will probably not even be in this work when I'm 80 years old, but I will still be educating people on hiring a supportive team and provider because it really does impact. I had an interview the other day with a first-time mom and she was telling me who her provider was, and I very much remember this provider as a resident. And she was fine, but not great, right? She wasn't my favorite. I very much knew, oh, in the future I would not suggest her as a provider. And so as I was talking, and I didn't want to project my opinion on her, and I was talking to her, she said that her and her husband had actually been feeling a lot of pressure and that when she goes into her visit that she normally has a voice, but when she's there, her voice is muted. She feels like she can't say these questions and can't communicate. I think right there is that big red flag that if you cannot communicate with your provider in a prenatal appointment, then that is a big sign that you will not be able to communicate with your provider efficiently during labor, and they're not going to respect you. I love that your midwife came out of retirement and started working on the weekends because she probably loves this so much and that you got her. It worked out so, so well. But guys, again, find a good, supportive provider. If you're feeling like my interview did the other day, don't hesitate. Move, change, find that support because you want to be like Molly where you're in the situation and you feel that love and empowerment. And even though there was something that ,went awry and not according to plan, Molly felt that support. And so like Allison said, that could have been a very traumatic point in your labor where it wasn't ideal. You wouldn't do it again. You wouldn't choose it. You wouldn't suggest it. But even though it happened, and I don't want to downplay it like oh, least everyone's happy and healthy. I don't want to do that. But it happened, and because you had that support, your overall view is different. So great tips, Allison. Beautiful story, Molly. Again, go back and listen to Episode 84 for the rest of her stories. And once again, thank you for being with us.Molly: Thank you so much for having me.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

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  39:52
• Episode 390 Johanna's HBAC + PROM + Supportive Provider + Postpartum Planning

  Johanna is a girl mama joining us today from Canada. She had an unplanned C-section with her first, an HBAC with her second, and was pregnant with her third at the time of recording! Johanna reflects on her experiences with both supportive and unsupportive care during her pregnancies. Meagan and Johanna dive into your options surrounding PROM,  the significance of intuition in decision-making, the impact of provider choices on birth outcomes, and the nuances of VBAC postpartum recovery.The VBAC Link Blog: Home Birth VBACEverything You Need for Your HBACSupportive Providers10 Signs to Switch Your ProviderWhat to Do When Your Water BreaksLabor GuideCoterie Diapers - Use code VBAC20 for 20% offHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. We have our friend Johanna with us from Canada today, and she's going to be sharing her HBAC story. So for those who may be , new to the VBAC world, or just all of the acronyms that the VBAC world has, HBAC is pronounced home birth after Cesarean. So if you are one of those who really wants to look into all of your options for birthing locations, which I encourage everyone to do, definitely listen up here. We're going to be talking about a lot of really great things including picking a provider and PROM knowing that you maybe had a provider that wasn't ideal the first time and more about HBAC. So we are going to be diving into a lot of really, really great, juicy topics. But in place our review today, Johanna and I are actually going to talk a little bit more about picking the right provider. So, Johanna, welcome to the show.Johanna: Thank you.Meagan: I am so excited for you to be with us today and so grateful that you are here to talk about this topic. Because like I was saying before we pressed record, I see daily in our community, every single day, and not even just our community, in other VBAC communities or this is weird, but people's statuses, like my friends and family's statuses on Facebook, where you type like, "Hey, I'm looking for this," or "I'm feeling very frustrated," or "I need prayers." People will seriously say, "I don't know what to do, you guys. Has anybody ever heard of VBAC?" on their own status? But especially in the VBAC groups, I see people and I just want to yell, "Hey, you over there. You're with the wrong provider" or, "Hey, you should move." That's a really hard thing because especially when I type that it can be like, oh my gosh, who is this broad telling me that I'm with the wrong provider and that I chose wrong? I'm not trying to say that. I'm not trying to say you chose wrong. Like, how dare you choose wrong? It's just like, hey, what you're telling us in this community is screaming, you're the wrong provider. So, Johanna, you , mentioned before we press record that you realized after your first birth that you were with the wrong provider. What made you realize that you were with the wrong provider? And were there signs during pregnancy that you recognized and maybe pushed away? Or was it really not something that you recognized until after? Because I know really, it can go both ways.Johanna: Yeah, I think that there were signs during the pregnancy. I mean, one of them, and I just didn't listen to my gut because you don't know what you don't know. I put too much blind faith that it was all gonna work out. But I never felt comfortable with her. I didn't have a good connection with her. I was asking a lot of questions about what I can be doing because my first birth, I really wanted to be a home birth. She basically just didn't give me very much information about what I can be doing. She sent me to your generic birth course through the hospital. Yeah. I didn't really feel like she was really invested in the outcome of my birth. I was just like another one of her patients. So I didn't feel great about that. And then when push came to shove with my birth and things weren't going great, she threw her hands up in the air and just took a step back and didn't really advocate for me or try and help me through things. So I was left with a pretty unpleasant taste in my mouth.Meagan: Yeah, I mean, exactly what you said just a minute ago. You didn't feel that she was invested in the outcome of your birth. And then it proved. It proved to be true when she just threw her arms up. So you had that experience, and you're not alone. There are so many of us out there. Me too, me included and a lot of people on The VBAC Link team included. We have all been in a similar situation where our providers, threw our hands up, weren't invested in our birth and our experience and had to go out there and seek that support that we deserved. So if there's anything we talk about on The VBAC Link, and I'm sure you've heard it, is find the right provider. I mean, seriously, you guys, I say it daily, every single day. If I'm not typing it, if I'm not voice memo-ing it, if I'm not saying it in my mind, it's find the right provider. Johanna, what would you give for tips for our listeners to find that right provider? And how did you find that right provider?Johanna: So I found my midwife that I used for my second birth and I'm actually using again for my third birth because I am 31 weeks pregnant today.Meagan: Oh my gosh. Oh my gosh. Yay.Johanna: I found her actually because when I got pregnant for the second time, the first thing I did was get a doula.Meagan: Uh-huh.Johanna: I asked her for recommendations on a VBAC friendly midwife. She had recommended this midwife. So immediately I was like, yes, I would like to meet her. When I met her, instantly, I felt so much more at ease.So I would say going with your gut. If something doesn't feel right, even if it's the tiniest thing, just look for a new provider. Just find someone where it feels right.Meagan: Yeah. I can relate to that so much because that's how I was feeling. I was searching, I was searching, I was searching. I mean, it was insane. I interviewed a lot of providers, but that's what I was searching for is that immediate like, oh, I'm in the right place. You are my person. And it took me a long time. And that sucks. It sucks that it took so long. I know that in some areas they're really rural and it's almost impossible to find that feeling. But I agree. So just as a reminder for those looking, before we get into the story, I wanted to make sure that you know to ask open-ended questions. Do not say, "Do you support VBAC? Yes or no?" Do not say, "Do you support me to go to 40 weeks? Yes or no?"Let's ask open ended questions. "How do you feel if I approach my due date and I haven't had a baby yet? How do you feel about VBAC? What is your experience with VBAC? How do you support your VBAC clients to make sure patients get the birth that they want? How do you advocate for them?"Asking these big open ended questions and then like Johanna said, diving deep. What is your heart and your gut feeling and saying? If at any point you are questioning, which I think is when people come out on social media, that is when I think they comment and they're writing, "Hey, I'm, feeling defeated. Hey, this is what my provider said." It's because they're doubting. They're questioning. That's their intuition. If that even comes into play at all, it's time to switch. It is time to switch. And first-time parents, if you are out there listening, this applies to you too, right? We have to avoid these unnecessary Cesareans which are happening all over the world. We have to follow our intuition. So that's another thing we talk about until we're blue in the face-- intuition. So follow that intuition. Ask open ended questions. Really dive in deep because your provider really can make an impact.And really, really quickly, we're going to just barely skim the surface on PROM. PROM is premature rupture of membranes. Johanna and I have both experienced it. She's two for two. I'm three for three. Maybe you won't be three for three girl. I don't know. I'm hoping you're not. Johanna: Fingers crossed. Meagan: I'm hoping you won't. But if you are, we know that it's okay. Vaginal birth still happen. But talking about providers, if you have PROM, which means your water breaks before labor begins, and just to let you know, it can take hours, even days for your body to turn over into labor after your water breaks. But if you have PROM and you don't have a supportive provider, that is right there the beginning of a fight. It shouldn't have to be a fight, but that can impact things because they want to get things going. Some providers won't even induce labor or touch you or 12 hours later they're like, "Nope, you haven't had a baby. You have to have a C-section." So yeah. So really quick Johanna, do you have any tips for our listeners who might have had PROM or may have PROM?Johanna: Yeah, it's difficult because especially when I experienced it, I mean, I experienced it for both births and the second time I really felt anxious because I was like, oh no, I'm on a ticking time-clock again.Meagan: Yeah, yeah. Because that's how you were treated.Johanna: Yes. I was lucky that I have a super supportive provider. And she was like, "Baby's fine, you're fine, everything's fine. We're just going to wait it out."Yeah, I mean crucial to have the right provider that is going to give you that grace and give you that time and that space, but just know the facts. Just arm yourself with information that as long as the fluid is clear, as long as you have no signs of infection-- at least here they make you come in for non-stress tests like every, I don't know if it's 12 hours or 24 hours when your water has broken. As long as everything's looking okay, you can wait, I think, up to 72 hours.Meagan: I've actually even had a client wait five days. Johanna: Holy smokes. Meagan: Five days. Close monitoring you guys, really close monitoring. But it was nothing that said a baby needed to be born. So five days is maybe abnormal. This was a home birth transfer to hospital. Even with five days rupture of membranes, the hospital did not "make" her, as I'm putting quotes up, have a Cesarean or do anything different because she advocated for herself. But it really can. 72 hours. It really can happen. So okay, we are going to stop talking about this, you guys. We're going to have links in the show notes to dive deeper into questions for your provider. What about premature rupture of membranes and things like that. So we're going to have those in the show notes if you want to dive more into that. You can dive in. But we're going to take one quick break for the intro, and then turn the time over to Johanna. Okay girl, thank you so much for chatting with me about that. I really do think it's so important.Johanna: I think knowledge about everything is your best friend when you're planning for any birth, but especially a VBAC.Meagan: Right. I know. It does suck that VBAC has to be so much more intense in our prep and our research and all these things because we're just moms going in to have vaginal births. That's all we are. But, but unfortunately that's not how it's viewed. That's just not how it's viewed in most areas of the world. So yeah, all right. Let's talk about that first birth.Johanna: Okay. So I got pregnant with my first daughter Mila in the summer of 2020. So heavy, COVID times. So that was scary enough. Because of COVID and the shift in culture towards socialization and going into hospitals and stuff like that, me and my husband decided to look into home birth which was not really on my radar before, but the more that I looked into it, I was like, oh, this is super beautiful, and I love the idea of birthing my baby at home in the piece and quiet of our own space.Meagan: Yeah. And a lot safer than a lot of people think.Johanna: Yeah. Yeah, for sure. The more I looked into it, the more I was like, okay. This is a totally viable option for us. I had a pretty uneventful pregnancy. I was very lucky. I had very minimal symptoms. Everything went well. I didn't have anything scary happened during the pregnancy. I will say that I didn't take the best care of myself. I am usually a pretty active person and I totally just didn't do much exercise or working out. I think in the back of my mind, I was scared that something bad was going to happen if I overdid it. It was just a lot of first-time mom anxieties.Meagan: Totally get it.Johanna: Yep. I didn't eat the best. I didn't take the best care of myself. I didn't do a whole lot to prep for the birth other than your typical childbirthing classes, bringing baby home through the hospital, generic courses that I think a lot of first-time moms, that's what they do, right? I read a couple of books. I read the What to Expect books, and I think I read Ina May's Guide to Childbirth.Meagan: Great book.Johanna: Yep. But I had no idea what to expect. When it came to labor and birth, I really was going in blind. I will say, I just put my faith in that my provider was going to hold my hand through it. That was a mistake. So yeah, I mean, it was a pretty uneventful pregnancy. There wasn't a whole lot to say other than it was COVID and everything was scary and didn't really know what was going on. When I was 41-ish weeks, my water ended up breaking. It was the middle of the night, and I didn't really know what happened. It was just like a little squirt and went back to bed. And in the morning, it was like when you move a position and a little bit comes out and you move a position and a little bit. It was one of those. And then I lost my mucus plug. So I was like, oh, I better call my midwife. So I gave her a call, and she totally brushed me off. She was like, "No, I think it's probably just discharge. I wouldn't worry about it." So that was another red flag was her just totally brushing off my feelings and what I believed was going on. So I hung up the phone and I was like, well, I don't really know what to do now. I'm fairly certain that my water's broken. So I waited a couple of hours, and it continued to trickle out. I eventually called her again and she was like, "Okay, okay, you can come in. You can come in and I'll check, but I'm pretty sure it's just discharge." So I went in and sure enough, she was like, "Oh, your water did break and it's amniotic fluids. Look at that."Meagan: Interesting.Johanna: Yeah, I could have told you that. So I was like, "Well, what do we do now?" And she was like, "Well, we can wait up to 72 hours as long as everything's healthy. That's fine, so we'll keep monitoring things." She sent me home and told me to just relax. She said, "If labor doesn't pick up today, go to bed and in the morning, do a castor oil induction." I did that. When I woke up the next morning and nothing had happened, I did do the castor oil induction. I will say that I will never do that again because it was horrible. Sorry for the TMI, but it just gave me severe diarrhea, and then nothing happened, and I was super uncomfortable. So that wasn't fun. That wasn't fun. That didn't work.I went in for a non-stress test that afternoon. She decided to check me, and I had made zero progress. I was not dilated at all. I had zero effacement or anything like that, so no progress. I felt super discouraged. My water has been broken for however long at this point-- 36 hours, I think, probably. I've made no progress. The castor oil induction and failed. I had barely slept the night before, so I was tired and I was just stressed. I was like, when is this going to happen?Meagan: But at this point you weren't really thriving with contractions. Nothing was too intense to be telling you that there should be progress, right?Johanna: Literally not a single contraction or anything. Nothing was happening.Meagan: True PROM, and so your defeating feeling is super normal because in our minds we were told our water breaks, we should be having a baby. But if we have PROM, don't expect to be dilated. Right?Johanna: Yes.Meagan: I did too. I expected to be way dilated and I wasn't.Johanna: So I felt super defeated. And like I said, I wasn't sleeping. I barely got any sleep the night before because I was just anxious for birth to get going. I ended up crying in her office about how stressed I was to end up in a C-section because my sister had a long, pretty terrible labor that ended in a C-section. It was just not a great experience for her. I don't exactly remember what my midwife said, but I did not feel reassured leaving that appointment. But we did end up deciding that if I didn't go into labor that night, I was going to be induced the next morning because I was just not sleeping well. I was not able to rest and relax because I was just anxious. So I was like, okay. I guess my home birth plan is out the window, but at least there's a plan. I ended up going home. We had dinner, and I started getting contractions just after dinner which was exciting.Meagan: Yeah.Johanna: But then they petered off after, like, I don't know, an hour or two. So we went to bed, had the hospital bags packed and everything ready to go for an induction the next morning. Labor started around 2:00 AM. It started on its own around 2:00 AM.Meagan: How many total hours is this until labor comes?Johanna: I think it was about 48 hours after my water broke that I had the rupture of membranes that my labor actually started. I will say, it was pretty intense right off the hob. I hear a lot of women say that their early labor is like, "Oh, I took my other kids for a walk. I baked a cake. I did this. I did that to distract myself." My labors are not like that. My labors are intense right out the gate. I tried to eat something for breakfast. A few hours after that, I woke my husband up. We tried to eat breakfast. I got in the bathtub to try and relieve some of the discomfort. I hung out in there for a while. We had rented a birth tub. My husband got that set up. I called my midwife. She came probably around 11:00 AM, so at that point, I'd probably been laboring for like, I don't know, eight or nine hours. I was not coping well. It was very intense and I was not coping well with the pain. She checked me, and I was a 3. I was like, dang it. In my mind, what I know now is that it's not a linear thing and that it's not going to take another 18 hours to go from a 3 to 9. But in my mind then I was like, oh no, I can't do this for however many more hours because I'm already not coping well and I'm only at a 3. So I told her I was totally deflated and I told her, "I want to go to the hospital and get an epidural." She was like, "Okay, if that's what you want to do, that's fine." So I think between the time that she checked me and I was at a 3 and the time that I got the epidural, it was about two hours. That car ride to the hospital, wow, was not fun. But yes. So, in that two hours that it took between her checking me and me getting the epidural, she checked me again right as soon as it kicked in and I was at a 9.Meagan: Whoa.Johanna: Yeah. Meagan: 0 to 100. Johanna: Yeah, when I say that car ride, it was ripping through me.Meagan: Yeah, you were in transition at that point.Johanna: Yeah. When we were in the hospital waiting for the anesthesiologist to come in and do the epidural, my midwife and husband are joking around trying to make me laugh. I'm like, "This is not where are at right now." I was not having it because, obviously, I was in transition, and it just was not where I was at. So yeah, she was like, "Okay, well you're at a 9 now, that's great. So rest for an hour and then we'll probably be pushing." The epidural was heavy. I felt nothing from my ribs down. So an hour went by and she's like, "Hey, you're complete. Start pushing." I felt nothing. I'm trying to push, and she's telling me that I'm doing a pretty good job considering I have an epidural, but baby was still high. And then all of a sudden, I think I'd pushed a couple of times and all of a sudden, all of these doctors and nurses and bunch of people just start run into the room and they're all speaking French because it's a French speaking hospital.Meagan: Oh my gosh.Johanna: So I have no idea what's going on. Nobody is telling me anything. They're all speaking a different language. And I was just like, "Can somebody please tell me in English what's going on?" They told me that she was having late decal every time that I was pushing.Meagan: Okay.Johanna: So between pushes she was fine, but every time I'd push, her heart rate would go down and then have trouble recovering. At no point did anybody recommend maybe trying a position change or anything like that. Like maybe her cord was being pinched in that position. If only I knew now or knew then what I know now.Meagan: Yeah, like hydration, movement, doing something, pushing in a different position.Johanna: Yeah, yeah no. So like I said, my midwife threw her hands up and stepped back and let the OB take over and didn't say anything to me after that. The OB basically let me push three times and then was like, "Nope, this is going to take too long. We need to have a C-section," and she called a C-section.Meagan: Wow. Do you remember how low your baby's heart rate was getting?Johanna: No, I have no idea.Meagan: Okay, interesting. I mean late deceleration are less ideal, right? We don't want them to happen late. We want that to be the recovery period.But yeah, there could have been some things done.Johanna: Yeah, and looking back, it's frustrating to know that maybe if one little thing had been changed, the outcome could have been totally different.Yeah, but you can't blame yourself for that either. It's hard to look back and be like, the what if's. But yes, you did whatever you did in the moment with the information you were given.Johanna: Exactly. So I went in for the C-section. It went fine. There were no complications, but being strapped down to a table in a really cold room and having the shakes and not feeling that, not being the person to get to hold your baby. I mean, everyone listening to this podcast pretty much knows what thats like and how it was demoralizing and traumatizing for sure. But it went fine. She was born healthy. I didn't have any complications. But yeah, the emotional trauma was real and not just for me, but for my husband too. We got discharged about 24 hours after the C-section and going home and seeing the birth tub still set up in our living room was a very emotional experience. We both ended up breaking down crying.Meagan: Yeah.Johanna: So I had to do a lot of emotional recovery from that birth as well as physical recovery because the physical recovery from C-section was also extremely rough. I remember every time I would have to get up out of bed, it felt like I was being ripped in half. It's rough, but I knew right from the moment she was born that I would be VBACing my next baby because we had always planned on having a few kids.Meagan: I want to point out to everyone, too, the importance of postpartum support and postpartum help and planning. We never know the outcomes of birth. I didn't know the outcomes. I didn't realize that it was going to take me 15 minutes to walk 10 stairs up to my bedroom. I didn't realize it was going to take me 15 minutes to walk down the stairs. I couldn't be holding anything. I didn't realize how exhausting it was going to be to get out of bed to go to the restroom let alone taking care of a newborn baby and also thriving as an individual. So it's really important to really try not to ignore the postpartum period. I think it's easy to do because we're so focused on the birth. Especially with VBAC, I think we're so hyper, hyper focused on that VBAC, that outcome, and that experience which I do not shame anyone for being. I just want to plug it in. Don't forget about your postpartum because whether it's physical or emotional.You came back to this space of seeing a plan that didn't unfold the way you wanted it to. That can be very emotional, very traumatic even in some ways. So yeah, having some resources for postpartum as well. I just want to plug that in.Johanna: Yeah, that's a really good point. I did no prep for postpartum for my first birth.Meagan: Me either.Johanna: It wasn't even something that like dawned on me to think about. When I was in postpartum, I was like, wow, this is really intense. Like the sleep deprivation, the recovery, the breastfeeding, everything. It;s super intense. So for sure, don't neglect postpartum plans and getting the support that you need.Meagan: Yeah.Johanna: So anyway, I think from a couple weeks postpartum with Mila, I ended up finding your podcast and absolutely just binging it and trying to intake any knowledge I could get about VBAC natural childbirth-- just anything I could get my hands on, I was consuming because I knew that I was going to VBAC. I knew that I wanted to have a birth that was as intervention-free as possible for my second. So I ended up getting pregnant with my second daughter Bailey in the summer of 2022. The very first thing I did was I hired a doula. I already knew what doula I wanted before we even got pregnant because we had interviewed a few, and the doula that I found was actually a VBAC mom herself. And she just had a beautiful calming energy about her. I was like yep, that's who I want. So with that test, the lines turned pink, and I was already getting her on board. I ended up hiring the midwife that she recommended as well. I was intent on doing everything that I could this second pregnancy to set myself up for a successful VBAC that I could possibly do because I knew that if I did everything that I could possibly do and it still ended up in a C-section, then I don't have to have any lingering questions of well, what if I had done this? So it was like, I was going to do everything I could to set myself up for success. I was super diligent with eating well, exercising, and chiropractic care. I did all of the Spinning Babies' exercises, walking, and yoga. I did a HypnoBirthing course which I really, really liked, and I'm doing again for this pregnancy. I put up my birth affirmations. I did all the things You name it, I did it. My husband was super, super amazing and supportive and he was there with me every step of the way through every appointment and did all the coursework with me and everything like that. I'm very lucky to have a super supportive husband. I had another pretty uneventful easy going pregnancy. Other than a little bit more morning sickness and some SPD, it was pretty easy. I will say there's one thing that they make you do here, and I don't know if you guys have to do it in the US but if you're planning for a VBAC you have to see an OB around 36-37 weeks. Do you guys have to do that as well?Meagan: Yeah, so not if you're out-of-hospital. You don't have to do it. Some midwives still out-of- hospital will be like, "Hey, I want you to consult with a partnering physician," as in, "Hey, this is someone we would transfer to.: I went a consult with them, but with the midwives in hospital they require them to do a VBAC consult, and it's pretty much a visit where the OB is like, "Hey, this is what you're doing. Here is your risk. Do you comply?"Yeah.Johanna: Yes. So I ended up having to do that, and I knew it was going to be a negative experience. I knew it was just going to be fear-mongering and throwing scary statistics out. So I already had my guard up for that. And then it was also at the hospital where I had my C-section, so even just walking into that environment was very triggering.Meagan: Yeah. So I went to that and I was right. She told me, "As soon as you go into labor, you need to go to the hospital and you should have continual monitoring and and epidural just in case," and all of these things where I'm just like, no, that so goes against everything that I believe will lead to like a healthy, happy birth.I definitely didn't tell her about my plans. I actually was hoping this would end up in a home birth. I didn't actually mention this. My plan-- I didn't want to commit to a home birth. I was a little bit anxious because of my first birth ending up transferring to hospital, that I would end up having to do that again and then have that crushing disappointment that it didn't work out again. So my plan with my midwife was that I was going to labor at home as long as possible, and we were going to play it by ear. As long as everything was going well, then I would potentially have her at home. But I just didn't want to have that pressure that I needed to stay home because this was going to be a home birth. Do you know what I mean?Meagan: No, I totally do. I mean, when I was planning my, it wasn't a HBAC, it was a birth center birth. It's like a downplayed HBAC. I mean, I was in a different home. Right. I totally do. I know exactly what you mean.Johanna: Yeah.Meagan: Yeah, yeah.Johanna: So yeah, I definitely did not tell the OB that my plan was to have a home birth because I just did not even did not want to get into that. So I nodded my head and was like, "Yes, sure. Okay, great."Meagan: Yep.Johanna: At one point, also during my midwifery care for the second pregnancy, my midwife was like, "It's standard for you. The hospital wants you to sign a release form with a backup C-section date."Meagan: What?Johanna: And I was just like, "Yeah, I will also not be doing that." And she was like, "That is totally fine. Just sign that you won't do that." Meagan: I do not consent. Yeah, I do not consent in doing this.Johanna: Yeah, yeah. I was like, I don't need that to clock above my head.Meagan: No.Johanna: So again, my due date arrived and passed. I ended up getting a couple membrane sweeps to try and move things along, but they were unsuccessful. And wow, they are very, very painful.Meagan: So can I super quick touch on that?Johanna: Yes.Meagan: Membrane sweeps-- that's a really big question we see as well. And when you talk about them being painful, that's actually a sign that the cervix wasn't ready. Like it wasn't forward. It wasn't open. If a membrane sweep is painful, it's a real big sign-- it's not a guarantee, but it's a real big sign that your cervix isn't ready. So quick rule of thumb, if you are dilated 2+ centimeters, 3 or more is more ideal. Your cervix is really forward, meaning they don't have to reach back and in, and you are effaced at least 75-80%, that's a little bit more ideal and less painful. But if they are going back, a lot of the times is because they have to reach back and in. And so that is, that is that. And then it can cause pain, prodromal labor, things like that and, and frustration because you're wanting it to work and it's not working.Johanna: Yes. So yeah, they didn't work for me, but my midwife did tell me that I was actually 3 centimeters and she could stretch me to 3. Meagan: Great. So you were at least dilated.Johanna: Yes. So despite the fact that it was super painful and didn't work, I was still feeling very encouraged to know that my body was doing something good. Meagan: YesJohanna: Because you'll remember my first birth, I was completely closed and nothing was happening after my water broke. So I was feeling pretty good about that. At about 40 weeks and 4 days, my water broke again before labor started. It was another one of those slow trickles, and it was the middle of the afternoon, so I called my midwife, and she was like, "Okay, come meet me." She asked if the fluid was clear and I said, "Yes." And she said, "Okay, come meet me at the office later, and we'll do the non-stress test and check you out and make sure everything's dandy." So I went and everything was fine. We were just waiting again for labor to start. I felt okay because I had been through this before, and I knew my body would go into labor, but at the back of my mind I was a little bit stressing out because I was like, okay, I'm on a clock again. I went home. Nothing happened. I woke up the next day and tried to get things going with the breast pump. That got contractions going, but they never stuck around. I ended up confiding with my doula about how stressed I was feeling that I was on a clock and feeling like why can't my body just go into labor? She was extremely reassuring. She came over, and we just talked for a bit, and I felt a lot better after that. That was in the evening, the day after my water broke, and I was supposed to go in for a non-stress test. So I went and met my midwife for a non-stress test that night. It was 36-ish hours after my water had broke. Still, everything was looking good. Baby was good. She was happy. I was fine. There was no need to rush into an induction or anything like that. But she could tell I was stressed. My midwife could tell that I was a bit stressed and she was like, "It's fine. We've got lots of time. You don't need distress.: And she's like, "But I can give you these tinctures or whatever if you want to try them." It was like the blue or black. Meagan: Cohosh.Johanna: Cohosh, yes. I was like "Sure, I'll do anything at this point. I'll try anything. I don't care. So they almost look like tiny, tiny little white beads. I don't know if they're always in the same form.Meagan: Yeah, sometimes they're in drops like tincture drops or almost like you said, a pill-like bead type. Johanna: So she was like, "Okay, let's give you one now." She wanted me to take four doses an hour apart.Meagan: Did you put them under your tongue?Johanna: Yeah. So she got me to take one when I arrived for the non-stress test and then when the non-stress test was over, it had been about an hour, so she gave me a second dose, and then she sent me home with two more. So we went home, and then I took one an hour after the previous dose and it was probably 10:30 at night at that point. Contractions started going after I took the third dose and I was like okay, they're probably going to peter out again because that's what they've been doing all day. I'm tired and I want to go to bed and I don't feel like staying up another hour to take the fourth dose. So me and my husband both took a gravel because my midwife told me to take a gravel and go to sleep.Meagan: What's a gravel?Johanna: A gravel is like an anti-nausea medication, but it makes you sleepy.Meagan: I did not know that. I've never heard of that. I don't think I've never heard it.Johanna: Yeah. Interesting.Meagan: Cool. I love learning. A gravel.Johanna: Gravel.Meagan: Yeah. Okay.Johanna: So yeah, she told me to take one and go to sleep because it makes you drowsy. So I think we had fallen asleep for maybe an hour and a half and I was woken up again with very intense contractions. And this time I was like okay, this is it for real. And like I said, with both my labors, contractions were intense straight out of the gate. So I woke my husband up. Taking the gravel was a mistake because we were both super drowsy. I woke him up and I was like, "I think you need to call the doula because this is definitely happening." And so he called her over and I labored in bed. I did my HypnoBirthing tracks. I did a lot of breathing through the contractions and the HypnoBirthing was super, super helpful, I will say that. We hung out for a while and just did that. My husband tried his best to stay awake despite how tired he was. Eventually, I think I waited maybe a bit longer than I probably should have to call my midwife because I was so determined to stay at home as long as possible. I didn't want her to come and be like oh, you're a 3, right?Meagan: See? Your mind. Even in labor we trigger back. We process things as they're happening from how they happened before, and it's really hard to let go. But your mind was doing it too, right? You're like no, I can't do this because I can't be that.Johanna: Yes. So what we waited, I think it was, I don't know. I have no concept of time. But we waited a couple hours or a few hours and my doula was like, "I think we should call the midwife." I was like, "Okay, can you call her?" So we called her and shortly after we called her, I was having contractions so intense that I was having an out-of-body experience. Like very, very intense. I was getting the shakes and hot and cold lashes. In my mind I was like, I'm going through transition. For sure, for sure. I'm going through transition. My midwife was not there yet and she would not arrive for probably like another hour.Meagan: You progress quickly from history.Johanna: Yes. So, by the time she arrived, she ran upstairs to my room. She checked me and she's like, "Okay, you're at an 8, so if you want to do a hospital transfer, if you want to go, we've got to go now." And I was like, "No, that ship has sailed. We're doing this here. As long as Bailey's healthy and I'm healthy, I'd like to stay here." So she was like, "Okay, we're doing this here." And she called over the other midwife because she wasn't actually sure that it was going to be a home birth, so she didn't have the other midwife with her, so she had to call the secondary midwife to show up. It was all very hectic. This time around, I plan on calling them much more ahead of time so that it's not so hectic when they arrived because lights got turned on, equipment was shuffled around and set up and definitely took away from the vibe a little bit. But yeah. So shortly after she arrived, I was complete and I had that very stereotypical moment where you feel like you got a poo.Meagan: And sometimes you just hold back because you're like, oh crap, wait. Do I need go poo first or should I have? Wait, what should I do? I don't know. I want to have the baby, but I don't want to poop.Johanna: Exactly. So I was like, "Oh my gosh, I feel like I have to poo." My midwife's like, "It's okay. This is normal. You're good." She was just encouraging me to just do what I felt like I needed to do. I ended up pushing for probably an hour, give or take, in a sumo squat position with my midwife on one side and my doula on the other side and then my husband would switch out for the midwife supporting me on either side. And yeah, I only had to push for maybe an hour, give or take. Her head got a little bit squeezed at one point when she was coming out, so when she came out, she was in a bit of shock. Because of where I was in my room, and the equipment was on the other side, my midwife had to make the decision to clamp and cut her cord and take her over to their equipment to give her a little bit of help which was very scary. She didn't end up needing oxygen, but they thought that she might. So she ended up being okay, but it was definitely a scary couple of minutes where I didn't know what was going on. But yeah, she ended up being okay. The only thing I was a little bit disappointed in was the second time around, not being the one who gets to be the one to hold my baby and bring her to my chest and missing out on that experience again.Meagan: Yeah.Johanna: But obviously I was amazed that I had done it. I had gotten my home birth, I had gotten my VBAC. I was in shock.Meagan: I can so relate. Sometimes you're so focused on pushing that baby coming out, and then it happens and you're like, am I dreaming that this happen? And you're looking around and you're like blinking and you're like, no, I'm awake. I just did this. I just did this. And you're so excited.Johanna: I was still in La La Land because I had labored so hard for eight hours and yeah, you're out of it and just in disbelief.Meagan: Yeah. Yeah.Johanna: Like, did this really just happen?Meagan: But it did. It just happened.Johanna: Yeah. So that was a really good feeling. Recovery was like night and day. I could immediately just go and have a nice shower and walk back to my bed and crawl into my bed. It was comfortable and I wasn't in pain. I had mobility, and I could lift my baby up. It was a good feeling. Although I will say that without the epidural, the fundal massage was a really unpleasant experience.Meagan: Yes. So for everyone that doesn't maybe know, fundal massage is something that they do after labor and delivery, they essentially put their hand, sometimes fist. Now it's not like they punch you, but think about a fist. Look at the bottom of your fist. They put the bottom of their fist along your uterus, the top of your uterus. They push down and massage. They push down and they massage. And sometimes they do it three or so times. You take a deep breath, they do it. You take a deep breath, they do it. And why they're doing that is because they're checking to one, make sure your uterus is clamping back down to its normal size right after birth and the placenta is out. It starts doing its job and going boop boop, boop, right back down to its normal size. But sometimes it can get a little boggy or bleeding can occur. So yeah, you want to make sure that. Now, really quick tip. If for some reason your uterus is still staying boggy and not clamping down as much, something you can try to do if you are able is urinate. Go to the restroom. That's a really big thing to help the uterus clamp back down. And even if you have an epidural, sometimes you have to get a straight cath. And if you can't go to the bathroom, sometimes you can get a straight cath to release. But yeah, that is not as friendly when you're unmedicated. But take deep breaths. If you can, get that baby on your chest or hold someone's hand-- your doula, your partner, your midwife, anybody's hand and just take really deep breaths and know that it's okay. It's okay. It doesn't last too long. But yeah.Johanna: So going back to our chat about postpartum.Meagan: Yeah.Johanna: So the recovery of vaginal versus C-section night and day for sure. But I will say that my postpartum with Bailey was way harder than with my first. It had nothing to do with the birth. I think she was asynclitic in my uterus. And so when she came out, she had a pretty bad case of torticollis and a tongue tie which made breastfeeding very difficult. I got mastitis twice in the first four weeks, like a really bad case twice in the first four weeks. I ended up with a bad case of food poisoning at three weeks postpartum.Meagan: Oh no.Johanna: And I had some prolapse symptoms as well. I will say that there were a lot of things happening in the first month, month and a half of my postpartum that I didn't expect and were very intense and difficult. I mean, just for breastfeeding, I was in so much pain that there were many times that I wanted to just give up and be like, nope, never mind. Forget this.So having good lactation support was really crucial.Meagan: Oh yes. And get lactation support before you have your baby. It sounds weird. It sounds really strange to connect with someone about breastfeeding before your baby is born. But oh my gosh, you guys, it's so impactful. I mean, we've talked about it before with The Lactation Network and other IBCLC supports. It's so important. I had similar. So my baby was born be a Cesarean. So in a Cesarean, a baby can also develop torticollis too with the way they are and the way they come out. But my baby had torticollis and she had a tongue tie. So very, very difficult. Challenging for sure and frustrating.It can impact things like mastitis and yeah, I love that you pointed that out. My was recovery all around better, but that doesn't mean my experience was all sunshine and butterflies. I really want to just highlight that one more time, you guys. Vaginal birth doesn't mean your postpartum journey is going to be the easiest. Mine wasn't. My VBAC after two Cesarean birth was not the easiest. It just wasn't. So again, get those resources beforehand. Right?Johanna: Yeah. And I will say, I don't know what I would have done if I wasn't with midwifery care and having them on call for the six-week postpartum because I swear, I called them every second day about something that was going on.Meagan: Well, and that's more unique to home birth too because even with the hospital birth midwives, it's not the same. They usually say, "Oh, I'll see you in six weeks," and you can call. You can call any OB or midwife. You can call any provider, but there's a different level of care and follow-up in that postpartum stage and it's very impactful. It's very, very impactful.Johanna: Oh for sure. Yeah.Meagan: Yeah. Oh my gosh. I love everything and I love all these tips. There are so many tips and nuggets along the way. Is there anything else that you would like to drop here for the listeners in regards to home birth or preparing or postpartum or any words of encouragement that you may have?Johanna: I mean, I think that, like I mentioned at the start, just arming yourself with as much knowledge as you can is going to be your best bet to get the outcome that you want and just feel empowered throughout your pregnancy and your birth. So just arming yourself with as much knowledge as you can get your hands on and yeah, getting a good provider, trusting yourself, believing in your body, and setting yourself up for postpartum too because that's an important thing when you're so focused on getting your VBAC is letting the postpartum stuff fall to the wayside.Meagan: Yeah.Meagan: Taking care of yourself afterwards too is important.Meagan: Yes. Taking care of yourself. We don't. We don't take care of ourselves enough, you guys. Really pamper yourself. If that means you have your postpartum doula. If that means you hire a house cleaner to come in every other week. If that means you hire or have family come in to help, just whatever. Light house cleaning or holding baby or playing with toddler. Johanna, she's going to have two, you guys. She's almost on her third, and it's another baby girl.Johanna: Oh, yes. Yes. That's three for three.Meagan: So three baby girls. I mean, you've got your hands full in your postpartum experience.Right. So really do it. I don't want to stereotype women, but sometimes we get into this space of,  we can do it and we don't need to spend money on ourselves and things like that, but this stage of life is so important to invest in yourself. Really, truly invest in yourself because you deserve it. And your sleep and your experience and your mental health, it all matters so much. So yes, you might hire a cleaner and you might be spending that money, but guess what? That's okay. Do it. Johanna: And when you're taken care of, then you're a better mom to your kids.Meagan: Yes, yes. My husband always says, "When mom is happy, everyone else is happy." But really, really, you deserve it. Women of Strength, you deserve to be pampered and loved and supported. So Johanna, thank you so much again for such a powerful episode. I'm so grateful for you. And please keep us posted on this baby number three.By the time this episode comes out, you will have had this little baby girl.Johanna: Yes. I'm due January 4th, so I will definitely be sending you a message when she makes her entrance.Meagan: Please do. Please do. Okay well, thank you so much.Johanna: 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

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  56:15
• Episode 389 Kristin from Ask the Doulas Podcast + VBAC Prep + Assembling Your Dream Team of Experts

  In this special episode, Kristin, host of Ask the Doulas podcast and founder of Gold Coast Doulas, gives tips on building your supportive birth team. Kristin and Meagan talk specifics on HOW to switch providers if you’re feeling the push to do so.Once we have our dream team, we’re good and don’t have to do any more work, right? Nope! We keep educating and preparing ourselves. That’s the way to truly get the most out of that dream team. Kristin’s book ‘Supported: Your Guide to Birth and Baby’ is a one-stop shop where you can get all of the education you need for pregnancy, birth, and postpartum. Her advice is so valuable for VBAC moms and birth workers, too!Supported: Your Guide to Birth and BabyAsk the Doulas PodcastNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello. Hello. We have a special episode for you today. We have my friend, Kristin, who is actually the owner of Ask the Doulas Podcast on with us today. She is going to be talking about establishing our birth team and the importance of it. We're going to talk a little bit more about what to expect when we might not find a provider that's supportive and how to navigate it. She's going to talk more about her book and so many things. You guys, I'm really excited. Kristin is a woman who has always had a passion for supporting other women both personally and professionally. In college, Kristin served on the executive committee of her sorority and organized events on campus related to breast cancer and other women's issues. After the birth of her daughter in 2011, a new passion awoke within her. Kristin began reading and studying birth from all perspectives, philosophies, and medical approaches. She joined organizations like The Healthy Kent Breastfeeding Collation and used her event coordinating skills to build and promote the organization and create community awareness. You guys, she has done so many incredible things. Kristin's research has led her to learn more about doulas, and in 2012, she hired doulas herself for the support of her second birth. The level of compassionate care and comfort that she received from her doulas ignited a spark within her and led her down the path of becoming a doula herself. And man, can I connect to this because this is exactly what happened to me. When you guys have a doula who inspires you and touches you and motivates you the way it sounds like Kristin did and I did, even though my doula wasn't a hired doula, she was just a nurse that was a doula for the time being, it does something to you. She earned the certification and became teaching sacred pregnancy classes in 2013. But as you'll see, Kristin is a firm believer in achieving the highest level of education available when providing a service. Shortly after, she earned the following credentials-- you guys, are you ready for this? She's amazing. Oh my gosh. Certified Sacred Doula in 2014. She is a Certified Elite Labor through ProDoula. She is the Elite Postpartum and Infant Care Doula through ProDoula. She's trained in Spinning Babies, Newborn Specialist, Mother Ship, Certified Health Service Provider, certified in VBAC. She is certified in transformational birth and a birth coach for the Birth Coach Method. She is a certified pregnancy and infant loss advocate and certified gift registry expert through Be Her Village, who we will talk about. We both love them so much.She is also an author of a book which we will be sharing more about. It's called Supported: Your Guide to Birth and Baby. So without further ado, we are actually going to be skipping a review today and an educational topic because this is such a great episode to be educated and learn more about what Kristin is offering in her community. Okay, my love. Hello. Kristin: Hello.Meagan: We're officially getting going talking about this amazing topic. Tell me what you think about this. I think sometimes people want to assemble this dream team, but they let finances or even partners or other opinions get in the way.Kristin: Yes. Partner comfort level, especially with VBACs is key, or with clients of mine who want their dream is to have a home birth and their partner isn't supportive, so then they say, "Oh, it'll be with the next baby if everything goes well in the hospital." But then if they're a complication, they might risk out of the option of home. I think as consumers, we don't fully appreciate the ability to choose all of our birth and baby team. We can change providers. I switched providers with my first pregnancy early on because I didn't feel like that particular OB was on board with my plans to have an unmedicated hospital birth. I ended up switching to Certified Nurse Midwives and completely changed practices, completely changed hospitals in fact. It's a lot. Meagan: Yeah.Kristin: But it was worth it. And I had the time where it was easier to switch, but I've had clients switch very late in pregnancy. It was harder to find the right office to accept them, but with VBACs, it is crucial to have not just a VBAC-tolerant provider, but someone who is fully on board with your unique desires because we are all individuals.Meagan: Yes. I love that you said your unique desires. Everybody is different. I think it's really important to tell these providers what your desires are. We have a list of questions that we give people in our course and, of course, on the podcast. You can go down that list and check and be like, "Okay, this provider seems pretty supportive," but you guys have to tailor your questions and your provider. You have to tailor it to what your individual unique circumstances and desires are because everyone's is different. I would love to know. You said, I was realizing that this wasn't the right place. What kind of things were you hearing or being told or feeling when you were realizing that maybe your first provider wasn't going to be as supportive and in line with your unique decisions?Kristin: Just when I was talking about my wishes, I could tell that that particular provider liked structure and patience to get that epidural, and so once I started talking about movement, delivering in different positions and some of the things I had researched-- I hadn't yet taken a childbirth class because it was early in pregnancy, but I had done a fair bit of research before knowing what a doula was. I didn't hire doulas until my second. But I could just tell in that gut feeling which I rely on. Again, we're all unique. And yes, I do research, but I make decisions on am I comfortable spending my entire pregnancy with someone who can tolerate me and will say, "Okay"? But I could tell it didn't light her up. So once I found a practice where my nurse-midwife spent time with me, I had longer appointments, I could ask questions, and she was 100% on board with me, and then I was able to meet the other midwives and the OBs who oversaw them throughout the remainder of my pregnancy. I felt very cared for. And again, we are consumers. Whether your insurance pays for everything or you're paying for part of it, you don't get a do-over of your birth, and so it is so important, especially with that first birth to get the care team that aligns with you. That could be everything from a Webster-certified chiropractor, a physical therapist, a mental health therapist to deal with any anxieties that may come up with having a VBAC and getting a lot of fear-filled advice from friends and family members. I find that again, my clients are all unique individuals, and my students in Becoming a Mother Course, and now the readers in my book, have different goals, so I want them to choose the best plan for them. I love that you have worksheets and templates, but knowing that every situation is different whether it's a home birth, a trial of labor, or a hospital birth, that setting is different and the type of provider whether it's a nurse-midwife or an OB practice, how likely is the OB that is very VBAC-supportive going to be attending your birth? Are there 12 providers or are there only 4? And so there's just so many things to factor in when deciding what is important to you.Meagan: Yeah. That point that you just brought up, are there 12 providers? Are there only 4? Does your provider guarantee that they'll be there? These are things that I think a lot of people may not be aware of that because they found their provider. They're feeling good about their provider. They're jiving. They're having the feels, but then they may not be the ones to be there, so there are 11 other options. It feels overwhelming to be like, "Wait, wait. Do I interview all 11?" Yeah, guys. Yeah. You set up visits. It's okay. Go and see if you can meet with those. Make sure that that full team is aligned. It is a lot. That's a lot to take on, but it's okay to rotate and say, "Hey, I saw Dr. Jack last time. I'd like to see Dr. Joe this time," or whatever it may be. Really, really dive in, find out more about your provider's team if they have a team, and make sure that they align with your unique decisions and desires.Kristin: Absolutely. And that goes for doulas as well.Meagan: Oh, yeah.Kristin: So for VBAC clients, I, over the last couple of years, I do all of the matchmaking, I like to call it, between client and the birth doulas and postpartum doulas on my team, in fact. I like to find out what they're looking for. If they are attempting a VBAC, then many times, they're telling me they want a VBAC-certified doula. I have doulas that have gone through your program and are certified through you and other different VBAC trainings. They're not just wanting VBAC experience like in my early days of having Gold Coast Doulas. Now, they're wanting that certification because they know that information is being updated as things change. And there's more evidence for VBACs. They also want more than just, "Oh, I've attended four VBACs." They want the education behind it. So I think that is crucial. I'm not going to match, unless there's no one else available on my team, a client with someone who is not certified as a VBAC doula.Meagan: Yeah, I do the same thing with my group here where they're like, "This is really important to me. I want this specific type of doula." Some of my doulas have taken The VBAC Link course. And so I'm like, "Yep, this would be who I would suggest." But I also want to point out that even if you assemble your dream team doula, and they've got all the education and information on VBAC, and they're up to date, I want to just point out that it doesn't mean that you shouldn't inform yourself that you shouldn't get the information because sometimes I feel like it's easy to want to just hire your provider or your doula or your person and let them who know VBAC kind of help and guide you. But it is really important. You're doing yourself a disservice if you personally do not learn more about VBAC and your options as well and rely only on your provider or your doula.Kristin: 100%. The doula, I mean, unless you're paying her for it, will not be attending every one of your prenatal visits during pregnancy. The education that you have to make informed questions and decisions surrounding your birth plan or birth preference sheet, so those conversations are critical. The more information you have as a patient, the better. And as we all know, unless you're having a home birth, your visits are short even with a nurse-midwife. And so it's important to have those questions and to have time to really express concerns. Or if you're finding that that practice or that provider is not in line with your plans, then you can look at other options. And the hospital-- are VBACs even allowed at the hospital that you plan to deliver at? Are they going to induce? What are the Cesarean rates? And looking at all of the different options, and if you need to consider NICUs, that's always a factor in hospital selection as well.Meagan: Yeah, I'm going to kind of go back to where we were in the beginning where you realized based after your feelings and other things that this provider was not the right provider for you, you then changed to CNMs and had a much better experience. Can you discuss your process of that change? How did you change? Did you find the CNMs, have them request your information from the OB? Did you do a formal breakup with your OB? What suggestions would you give to someone who is wanting to do that? I know that sometimes, you were talking about it, in the end, it's a little harder to find, so that's why we stress so importantly to find your provider from the beginning. But we know that sometimes things change. So can you kind of talk about that process in then assembling that dream and getting the steps to get to that dream team?Kristin: Yes. So for me, I had asked friends about which providers they had worked with. So the original OB, a friend of mine, it was her doctor, and she had a great experience. I just wasn't feeling it. She had a student. We have teaching hospitals in my area, so there was a student in the room. I wasn't feeling like she was 100% on board. I could tell that she was very medically driven. I wanted essentially a home birth in a hospital. So I talked to more friends and did research online, and a friend of mine had used this particular practice. I ended up going with the midwife that delivered her three children, and it worked out beautifully because it was early in pregnancy. That practice had openings. It took me a while because I was changing hospitals and practices completely. My insurance, luckily, covered all of the options. But that's another thing to look into. Does your insurance cover the hospital where the provider you want to switch to delivers that if it is a hospital birth? Of course, you can VBAC at home in certain states. So just looking at all of the factors that would come into play. So for me, it was dealing with the paperwork of switching out of that practice, getting admitted, and going to that initial get-to-know-you visit with a nurse and doing my labs before I got to meet with the midwife that I had wanted to work with. And so it took a bit. I mean, no one likes to deal with the paperwork and the phone calls it takes, but your health is so important and especially again, for VBACs.Meagan: Yeah. So you essentially did all the paperwork and the transfer yourself.Kristin: Yes.Meagan: Okay.Kristin: I made all the phone calls, dealt with insurance and made sure that the initial visit was paid for along with the nurse visit, and then that insurance was comfortable with me.Meagan: Yeah. Awesome. Yeah, I did, when I switched, because I switched it 24 weeks, my midwife just faxed a request to my OB office. It took them a while to send it. We had to ask five times which I think probably would have been faster if I, like you, made the phone calls and did all the things, but I was like in this weird, vulnerable spot of like, I don't want to go back there.Kristin: Right. You don't want to deal with it.Meagan: Yeah, I don't want to deal with it.Kristin: Even just talking to the front desk.Meagan: Yeah, yeah. So we waited for it and they eventually got it. But I think that that's important to note. You guys can make the calls too. You can call and say, "Hey, I'd like to request my records to be printed out or to be sent to this place." Kristin: Yes, and that's what I did. Because otherwise it's six weeks oftentimes or you have to keep calling. They get lost. so I just handled it. But it can be challenging. And as doulas and certainly VBAC doulas, we know the providers who would be not only tolerant but supportive of VBAC. So we get those questions frequently from potential clients and clients of, am I at the right place? And of course, we support whoever our clients choose to have care from. But there's also, if asked, I will tell them about the practice and my own experience as a doula or the agency's experience. And again, in those large practices, there might be four who are so VBAC-supportive. They love it, but then there might be some physicians who are not as comfortable. They feel that a surgical birth might be the better route to go, ad so there's that. So what I like to do as a VBAC doula is to have my clients talk to their provider. Again, go over a birth plan or birth preference sheet and have them sign off on it. That way, if they don't attend the birth, then the other physicians know that this was approved. It's not just a birth plan that is thrown out there, but it has been discussed. It doesn't work all the time, but it has been helpful for my clients no matter if they're a VBAC client or this is their first baby, and again, they have certain goals that they want to achieve like potentially avoiding an induction unless medically necessary.Meagan: Oh my gosh. So I'm just going to re-touch on that, you guys, because that was really, really, really good advice and something I've actually never done or even thought about or suggested to my own doula practice clients. Get your birth preference sheet or birth plans everyone calls a difference. I call it a birth preference sheet, which is a list of all your preferences that you desire. Go over that with your provider, and have them physically sign it. Physically sign it and date it showing that your provider went over it. And like she said, every provider may not be willing to do that, but I will say, if a provider is willing to do that, that says something to me.Kristin: It does. Yes.Meagan: Yeah. Super powerful. Oh, my gosh. Okay, nugget. Grab it, put it in your pocket, everybody. Sign your birth preference sheet so you can have it and keep that in your bag, so if you do have that random on-call doctor who may not even know you or not be so supportive, be like, "This has already been discussed. We were aware of this. My doctor has signed off." Also, you could maybe ask if your provider could make a copy of that and put it in your chart.Kristin: Right. Because yes, it's not just the one that they have on file, but it's also for the ones that you have, that copy that you're bringing and showing the nurse so the nurse and everyone is on the same page. Meagan: Love that. Kristin: And again, with teaching hospitals, you might have residents in and out. There can be some difficult conversations with VBAC and residents who have never seen a VBAC. We're not fully trained yet to support VBAC, and so they might be making suggestions while the provider is not in that check-in. So every state, again, every area is different. I just happen to be in an area with multiple teaching hospitals.Meagan: Same here. We have seen it where I think, I don't want to say this badly. The VBAC world is a world that can have a lot of negativities in it, negative things and big words like uterine rupture. We've got residents who may be coming in and may be training under a provider who has seen a uterine rupture or has maybe molded an opinion on VBAC and is projecting their opinion to that student. Whether or not they're consciously doing it or not, they're saying their opinion, and those opinions might morph that resident's opinion into negative for VBAC. You never know. And so they might be doing things or be more hesitant in areas that they don't need to be, but they are.Kristin: Yeah, it's such a good point. And as you mentioned, I mean, we don't know the traumas that our nurses and medical team, even home birth midwives, have experienced, and they carry that with them. And how can they not? Even as doulas, we witness, but we don't have the liability and the medical training to make it, but we are witnesses of trauma and have our own healing to do to be able to better move on and support the next client. So certainly keeping that in mind that they may have seen something that alters the way they practice.Meagan: Yeah.Kristin: It's not just fear of lawsuits.Meagan: It's really not. It's not. There's a provider here in Utah who is literally so scared of vaginal birth herself. She scheduled all of her Cesareans, even the very first one from the get. She never had trial of labor or TOL. She just doesn't. So can you imagine what her Cesarean rate may be? And she kind of reminds me of the provider you're talking about. She really likes it just so controlled. Come in, start Pitocin, and get the epidural. She likes those things, which we know can sometimes lead to those Cesareans. And so really also discussing with your provider, how do you feel about birth? Have you had babies? And then we have another OB who's like, "I work in the hospital, and I love the hospital, and I trust the hospital system, but I actually gave birth at home with all three of my babies," and so really getting to know your provider, I think, is so good. Okay, let's keep going on this topic of assembling your dream team of experts when planning for birth and baby. What other things would you suggest to our Women of Strength?Kristin: Yes. So as we know, birth is as physical as it is mental, and just the opposite, as mental as it is physical. So preparing with a childbirth class, a comprehensive class, even if you took one before, use the lens of your goal of attempting a VBAC, a trial of labor. And so for us, we happen to teach HypnoBirth at Gold Coast Doulas and that mind/body connection that HypnoBirthing or a gentle birth offers where it's more of using the visualization the way an athlete would in preparing for a marathon or a triathlon, you are using things to reduce fear. You're understanding all of your options. It's very partner involved. I think taking a comprehensive childbirth class, whichever meets your individual goals, is great. That childbirth instructor is a great person to add to your birth and baby team. And then moving your body. So taking a fitness class that is appropriate for pregnancy. So prenatal yoga, there are Barre classes for pregnancy. There are prenatal belly dancing classes, whatever it is. Meagan: Aqua aerobics.Kristin: Yeah, water aerobics are amazing. And so thinking about baby's position and helping labor to go on its own or be quicker. There's acupuncture, acupressure, the Webster-certified chiro for positioning or body balancing experts, so many different options. But I am a big fan of educating yourself and preparing because as you mentioned earlier, Meagan, a doula is not your end all, be all. Just because we have the information and the training, we can't think for you. We don't want to think for you. The more informed you are, the more likely you're going to feel like birth didn't happen to you this time around and you were a direct participant, even if you end up having a surgical birth again.Meagan: Yeah, yeah. Yes. Oh my gosh. So talking about courses, you guys, we have our VBAC course. This VBAC course goes into VBAC, the stats about VBAC, the history of VBAC, the history of Cesarean, the stats of Cesarean, the questions, finding the provider, a little bit more of the mental prep, and physical prep. But when it comes to a childirth education course like with the course that she has, they're on different levels. I actually suggest them both.Kristin: Yes, me too. Absolutely.Meagan: But it's so important to know the information that is in your course. I know you go even past preparing for birth and then birth and then postpartum. You go into all of it. We're going to talk more about it. But you guys, we as doulas, love getting information and we love sharing information. But like she said, we don't want to be the only one that knows the information in a team. When our clients come in, at least here in my group, when our clients come in and they are fully educated and we're like, yes. And then we can come in with our education and our experience and knowledge, you guys, it is a powerhouse team. It is a powerhouse team. We have clients who, when they take child birth education classes like yours, they are able to advocate more for themselves. They feel stronger to stand up and say, "Hey, thank you so much, but no thanks" or "Maybe later," when our clients who haven't had that childbirth education or just any information other than maybe what we're providing, which is great, but not enough in the full length of pregnancy, it's a little harder. We have to try to encourage those clients a little bit more because it's harder for them because they don't know everything. We're there to help guide them and help advocate for them and educate them, but it is very different.Kristin: It is. It's so different. And I feel like, again, partners, especially male partners, want to fix things. They don't want their love to feel any pain, and so they may have the fear of a VBAC. So taking a VBAC class course, having a VBAC doula, giving information is just as helpful, if not more for the partner and their comfort level and to have them fully get on board because they may be resisting and just going along for the ride, but if you can get them to be an active participant in education, then they're going to be able to help you. And sometimes in labor, we get to a point in transition where we can't fully speak for ourselves. But if our partner understands, is educated and on board, and if there's time to talk through the risks and benefits and alternatives with your doula, then yes. But sometimes decisions have to be made quickly, and so for that partner to be informed and educated is crucial.Meagan: So crucial. It's so powerful. My husband-- he was not so on board. He was like, "Whatever. I don't care. You can go to the courses. You can do these things."Kristin: And that's very typical.Meagan: It's very typical. And I did. I did do those things. When I said, "Hey, I'm going to birth out-of-hospital," and he was like, "No," I was like, "Well, sorry. I've done the education. I know this is really where my heart is pulling." We touched on this in the beginning how partners really can influence decision making. And in no way, shape or form am I trying to say partners are terrible or don't listen to your partner or anything like that. That's not the goal of what we're saying is have an educated partner. Know that you can assemble a birth team, like a provider, a chiropractor, a massage therapist, a doula, a PT, or whatever it may be, but don't forget about your partner. Your partner is a huge part of your team, and if they're not educated and they're not able to help guide you through, or if they're not being supportive, find ways to help them be supportive by taking a course with them and helping them realize, oh, VBAC actually isn't that scary. Oh, that chance isn't really 50+%. Oh, okay. Hospital birth, out-of-hospital birth. Yeah. They're both reasonable, and really understanding that.Kristin: Absolutely. And sometimes I find that my students and clients may have not had success with breastfeeding the first time and potentially didn't take a class. So if their goal is to breastfeed or pump exclusively, then taking a breastfeeding class and having that IBCLC as a resource for their dream team in case it's needed because many times, you have the lactation consultant who's teaching the class, at least in my practice, and then they're also available for say, a home visit or a hospital visit, depending on where the class is taking place. And so I think that that's something. Even if it isn't your first baby and maybe you breastfed for a little bit or had supply issues or challenges after a surgical birth, that it is important to consider any education during pregnancy because it's much harder to get that education after you have your baby.Meagan: It really is. I love that you're touching on that, really getting into all the things and having your partner go with you. I remember I was like, I had a C-section, and I was swollen and tired, and I couldn't move very well. I was sore and all the things that sometimes come with C-sections. I'm trying to nurse, and I'm engorged. I don't feel my letdown, and I'm just so engorged. I don't know. All I know is I have really big, swollen boobs. It's all I could tell. I couldn't latch. My husband was like, "That's it. We're going to the store. We're getting formula." Formula is fine. Not anything against formula.Kristin: He's trying to fix the problem and make you feel better.Meagan: Yep, yep, yep. Trying to fix that problem. But I was like, "No, I really want to breastfeed." At that point, I wasn't able to communicate. Like, I didn't get the birth I wanted. I already felt like a failure because I was actually told that your body failed. That's what I was told. So I was already dealing with this mindset that I failed. I had a C-section. I didn't want a C-section. And now the only thing I could try to do because I couldn't take that C-section back is breastfeed my baby. I wanted to breastfeed my baby. And again, we didn't take those childbirth education classes. He for sure didn't download any apps. I at least had an app trying to help me at that point, but he didn't understand. He didn't understand.And I'm like, no.I'm crying, and I'm like, "Please, just help me. I don't know what I need to help me." And he's like, "No, we're going to the store. Our baby's mad. You're crying." He was trying to fix that problem. But if we had already done that information education before and found that IBCLC before and him understanding how important that was to me, he could have been like, "I'm going to call her IBCLC. I'll get her over here right away."Kristin: Exactly. The last thing you want to do is go into the hospital to see a lactation consultant there if you can even get in.Meagan: Exactly. Yeah. So it just could have been so much smoother. Sometimes I feel like we were against each other at that point because he didn't have any education. With our first, I really didn't have much education. But with our third, it was like he really didn't have a lot of education. and I was over-the-top educated, so I was saying these things, and he was thinking I was demeaning him or saying he was stupid because it was just this weird thing. So if we can just come together with our partners and get all the education and get it all before really, find out a postpartum plan. Find out a breastfeeding plan. Right? Find out what you want. You guys, it just makes the pregnancy journey and the postpartum journey, so much better. It truly makes you feel like you're on that team because you are.Kristin: Yes. Absolutely. And certainly, I mean, you mentioned apps. Not everyone has the means or even lives in an area where they can take a comprehensive five, six, ten-week childbirth class. There are, obviously, online classes. There are some Zoom virtual ones where students are all over the place. But there are watching birth videos and YouTube and in my book, Supported: Your Guide to Birth and Baby, we talk about apps, so count the kicks. Especially for VBACs, doing the self-monitoring if there's fear of fetal movement and any sort of distress during the end of the pregnancy, then really understanding your own body and doing monitoring. It's not just when you're in your provider's office being monitored. You can make a difference yourself. So having some different apps and some education on your own, listening to podcasts like yours to get this information and reading books. So there's more than if you can't afford a childbirth class like HypnoBirthing, there are still ways that you can get educated and your partner can get educated. So yeah, take a look at all of your options and your budget.Meagan: Yeah, and we talk about this all the time because I love them, but Be Her Village is a really great resource where you can go fill out a registry and, hopefully, get some help for these things. Childbirth education classes, doulas, IBCLCS. But I want to dive a little bit more into your book, actually, while we're talking about different resources. We talked about the childbirth education, but can we talk about more about Supported: Your Guide to Birth and Baby and how this came into fruition and what all is included in this amazing book.Kristin: Okay, Meagan. So essentially the book came out of our online course. Becoming a Mother launched in the early pandemic when everything was shut down and our classes all had to go virtual. I was fortunate to be in a state where doulas who were certified were able to work thanks to our governor. So we were working, but there was still a lot of isolation even with our clients' prenatal visits. They wanted a connection, so we launched this course. We had talked about and did three live launches, got VBAC from our students, pulled people in from all the moms' groups before creating the first draft of the course. And then the course just led to the book. So the content in Becoming a Mother is what is in the book in a different format. So in Becoming a Mother, we have expert videos, so VBAC specialists and Webster-certified chiropractors talking about what that is. Pelvic floor physical therapists, car seat safety technicians, cord blood banking donation centers.Meagan: Awesome.Kristin: We have the experts speaking for themselves-- a pediatrician. And so in the book, anything that is medical and out of the scope of a doula, we had expert contributors, so I have a pediatrician friend of mine who contributed a newborn procedure section of the chapter and a prenatal yoga studio instructor, she's also a certified body balancer. She contributed to some of the fitness options in the book, and a mental health therapist who is PMA focused and certified contributed to the mental health chapter. We have an IBCLC that contributed to the feeding chapter, and so a lot of involvement, and then sharing client stories throughout the book and then our own wisdom. We have doula tips and wisdom at the end of every chapter. Meagan: Wow.Kristin: And so as clients were asking me for books over the years, I couldn't find anything that was positive. I felt like there were a lot of, this is your cry-it-out method for sleep because we have a whole chapter on sleep and it's very attachment-focused. It's like, one way for feeding, and we wanted our clients, with their unique choices for themselves, to have a book that supports people who want to plan surgical birth like that OB and that's their comfort level and a book for the same person who wants a home birth. You don't have to buy five different books. It's not always Ina May which is a great book but not for everyone. All of her different-- she's got Spiritual Midwifery and so many different books. It is great for grandparents to read and partners but is targeted to the mother or the mother-to-be and is great in preconception in that early planning. But also, we wanted to make it similar to the course and just as valuable for seasoned bombs as it is for new moms. And again, it's affirming. We tried not to have any fear-filled information in a simple, easy-to-read guide that you can pull out for reference and a lot of different, again, apps and podcasts and books to read and resources and evidence-based information about Black maternal health and where we're at in the country now and how the pandemic impacted birth especially, but also that postpartum time.Meagan: Wow. That book sounds amazing. So amazing. And you guys, you can get it in every form, even Audible. I'm a big listener. I like to listen to books. Kristin and Alyssa actually recorded it. She was telling me they had 10+-hour days recording this this book. You can get it, and we will make sure to have the links for that in the show notes. I found it at goldcoastdoulas.com/supportedyourguidetobirthandbaby.Kristin: It's there. You can find it off that website or it has its own page. It's supportedbook.com. Meagan: Supportedbook.com, okay. We'll make sure that's all in the show notes, so you guys can grab that. Okay, so you know a lot. Obviously, you wrote a whole book and a whole course and all this stuff. Is there anything else that you would like to share in regards to just our final assembling of that powerhouse birth team?Kristin: So don't forget, I know we're talking a lot about pregnancy and birth prep, but don't forget your recovery phase. And you had talked about your own personal struggles with breastfeeding engorgement, recovery after a surgical birth. If you have, well, you do have other children at home with VBACs, and so looking at childcare, postpartum doula support, or what kind of family support you're going to have after, it's more than just meal plans and prepping the nursery. We strongly believe that as part of your dream team, the postnatal team is crucial as well. So whether it's a lactation consultant, a pelvic floor physical therapist, if you want to get back to running marathons again or are leaking. I mean, we can all use pelvic floor physical therapy. It's not just the athletes who they support. Some people, again, with building a home or other life occurrences like a wedding or preparing for college, you look at your budget. You look at your main goals. For a wedding, it might be food. For postpartum, it might be sleep. So hiring a sleep consultant when baby's old enough or an overnight postpartum doula or a newborn care specialist. What are your priorities? And take the budget. What might be paid for by insurance or, a health savings flex spending plan that you need to run down? What might be gifted? Like you mentioned, Be Her Village. There are different ways you can budget. And in the book, we talk about all of that and looking at employer plans, how to navigate that, what questions to ask your HR department about other members, like a chiropractor, could that be covered? A therapist? Oftentimes, we don't know our own benefits and certainly, I don't know my husband's benefits fully, so to be able to investigate that early in pregnancy and figure out what might be fully or partially paid for.Meagan: Wow. That is incredible itself. I feel like that's a whole other conversation of, how to navigate how to do that. So definitely go get the book, you guys, because it sounds like there are just so many things in there that are honestly crucial to know. really, really important things to know. You are incredible. Kristin: So are you.Meagan: I just enjoy chatting with you so much. Anything else? Yeah, anything else you'd like to add?Kristin: And obviously, take taking trainings and courses. If I know you have doulas who listen. It's not just parents.Meagan: Yes.Kristin: As doulas go through The VBAC Link. Get certified as a VBAC doula. Keep up with information that is ever-changing. We all want to be the best doula for each of our clients, but I am a firm believer in continuing our own education and that more and more of our clients are choosing to attempt VBACs, and so the more information you can get as a professional, the better you're able to support. It's just not the number of VBACs you've attended anymore. It's clients wanting that knowledge so you can be busier and also a more effective doula by getting that training and then going through the certification process that you offer.Meagan: Yeah, have a directory actually with birth doulas where people can go and find it because when Julie and I created this company way back in the day, we knew that we were just two people here in Utah. We couldn't change the VBAC world. We could give as much information as we could. We could share the podcast. We could do those types of things. But when it comes to birth workers, we wanted to reach birth workers everywhere. It's so great that we have and we're still having more people come on because they're helping people so much. I mean, we know you have doulas that do it all the time. These doulas do help and there are actual stats on doulas that do it. But I agree. If you're a birth worker, stay up to date. Be in the know. Know what's going on because you will likely need to help guide your client through it. Kristin: Then you can charge more. So take that investment in a training like The VBAC Link, and then you're able to charge more because you're more experienced. You have more certifications. So don't look at like, oh, I don't have any money for continuing education. Look at how that's going to change your career.Meagan: Yeah, and I think sometimes too you can charge a little bit more, take less clients, and be more personal with those clients and dive into it. Especially because we do know that VBAC does take some extra stuff that goes on with VBAC. There's some extra work to be worked through. There are some extra things and so yeah, I love that.Kristin: Well, thank you so much for having me on Meagan, I loved our chat.Meagan: Thank you. You as well. As always, I loved our other chat as well. We have to keep going. I think I'm going to order your book today and get going on that. Even though I'm not a mom preparing, I think this would be such a great book to suggest to all of my clients. So thank you for sharing. Thank you.Kristin: Yeah. My secondary audience is certainly anyone who works with families in the birth and baby space, but it is targeted again, just similar to my podcast. It's like I have the listener of the pregnant individual and family, but also birth workers. The book is similar. Thank you for ordering.I appreciate it. Meagan: Yes. And can you also tell everybody where to find you not just in your book, but Instagram, podcast, and all of the social medias?Kristin: So my podcast is Ask the Doulas. You can find us on all the podcast players and you were a guest recently, so very fun. And certainly, we're at Gold Coast Doulas on everything from Pinterest to YouTube to Facebook to Instagram. I don't have separate social sites for my book because I honestly don't have time for that.Meagan: That's okay. Yeah, it's a package. It comes with everything, so you don't need to have another book page. Well, awesome. Well, thank you again so much.Kristin: Thank you. Have a great day.Meagan: You too.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

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  52:39
• Episode 388 Liz's HBAC After an Unexpected Cesarean Following a Late Hypertension Diagnosis

  Liz, a mama of two from Long Island, New York, joins us today sharing her experience with preeclampsia, an unexpected C-section, and her successful VBAC with her second. Liz had a perfect health history and never had any surgeries before her C-section. It was so frustrating to feel so out of control. In between her birth and her second pregnancy, Liz’s mom unexpectedly passed away. She shares how she has been processing the intense grief from her mother’s passing and from the positive birth experience she wasn’t able to have. Liz made lots of changes going into her VBAC birth including diet, switching providers, and choosing to birth at home!Liz's DoulaCoterie Diapers - Use code VBAC20 for 20% offHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan Hello, everybody. We have our friend, Liz, from New York with us today. She is a mom of two and almost two years old. Right? Your VBAC baby?Liz: Yes.Meagan Almost two years since your VBAC baby.And then an almost six-year-old. And yeah, like I said, she lives in New York, and she's going to be sharing her stories with you guys today. With her first birth, she actually had preeclampsia, so she's gonna talk more about that. And then with her second birth, she didn't have preeclampsia. I think this is an important thing to talk about because we know that having preeclampsia again is a possibility, and it might be slightly increased if you've had it, but it doesn't mean you will. So I'm hoping that we can talk a little bit more if you did do anything to try to avoid it. The second one, we'll talk more about that in a little bit. But knowing that it's still okay. If you have preeclampsia, you can still VBAC. Now, in her second one, she didn't have preeclampsia, but you can still VBAC if you have preeclampsia. So we're going to talk about that a little bit after your first birth too, because I want to know more. All right. We do have a Review of the Week today, and this is by jess2123. It says "Best Podcast for VBAC". It says, "I listened to the podcast after my son's birth. I learned so much that I knew I wanted a VBAC for my second birth. When I became pregnant again, I would listen to this podcast during my walks. Thanks to the wealth of knowledge that I gained, I had my unmedicated VBAC in 2023." Congratulations, Jess, on your VBAC, and thank you so much for your review. I know this year we're tossing it up between reviews and educational pieces, but I just do want to remind you really quickly that if you haven't left us a review yet, we would love it. You can push "pause" right now and listen or leave a review on Apple Podcasts or Spotify. You can go over to Google. Google "The VBAC Link", and leave us a review there. These reviews really do help us and bring us so much joy. So without further ado, I want to turn the time over to you.Liz: Thank you so much. I guess every VBAC story starts with the Cesarean story, or at least there's one in there. My pregnancy journey did start with a Cesarean as far as the first birth. As Meagan mentioned, I am a mom of two. With my first son, I fortunately have been reproductively very healthy and otherwise healthy my entire life. I was able to track everything. I had regular cycles and really no issues there, so I feel really, really blessed in that regard. I was able to get pregnant pretty easily. I believe I got pregnant in about February 2018 for the first time. I found out mid-March after I tested in my bathroom and just ran out with the test to my husband, nothing super special. I think I was just shocked. I remember I had gone to a St. Patrick's Day parade and felt so tired that I said to my friend, "I'm going to go home and nap in between that and another event." They were all like, "Why are you napping?" I was like, "I don't know, I'm just really tired." I took the pregnancy test to rule out pregnancy. It was immediately positive which was amazing. My EDD, my estimated due date, was supposed to be Thanksgiving that year, so it was November 22nd which was Thanksgiving 2018. That just made me laugh because I was like, wow, what a far cry from Thanksgiving Eve spent even a decade previous. But yeah, so my pregnancy started out pretty status quo, I would say. I definitely experienced that nausea. My morning sickness was definitely an all-day thing, so it was a little tough. I think it threw me for a loop because I didn't know what to expect. I had always wanted to eat healthier, especially being pregnant, but it was like my body would not allow me to eat what I wanted or what my brain wanted me to eat. It was a lot of carbs to start out. I know that's pretty common. I remember when I went for my first appointment, I had called an OB's office. I'm trying to think. I think I had gone for one well-woman visit before, but I had two friends, actually three friends who had delivered with this OB and had good experiences, so I figured I would give it a try. The funny thing is, pretty much from the jump, I could tell that we weren't very aligned. I didn't really see eye-to-eye with him, but he had this nurse practitioner who was wonderful, and I feel like she drew people in because she was just very nurturing and calming, and she just had that great energy. I knew, obviously, she wasn't going to be at my birth, but I still stayed there.Meagan Oh yeah. So can we talk about that a little bit? So you had one provider that you're like, "I don't know, our energy doesn't match." And then one that you're like, "Our energy totally matches." But then they wouldn't be birthing with you. So tell me a little bit more of what that provider was that wasn't matching your energy.Liz: Yeah. So I guess because I had always been so healthy, my experiences with medical professionals were very limited. I had just gone to doctors for routine checkups my entire life, and everything was always fine. I think because I wasn't very experienced in the medical world, I almost had this aversion to it. I just was like, they're there if there's an emergency, but it'll be fine. Everything will be fine. I'm trying to do this as naturally as possible. He seemed very old school. I don't know how to describe it, just very set in his ways. I remember, I'll circle back around, but towards the end of the pregnancy when I had finally gotten the gall to tell him that I really wanted to try and do this unmedicated because I was so nervous to say that, he was like, "Well, don't expect this baby to just fall out of you. You're a first-time mom."Meagan Wait, what?Liz: He literally said that to me. And I was like, "Okay, I didn't think that." Meagan: I wasn't saying that. Liz: Yeah, I wasn't saying that I didn't think I wouldn't have to work hard. That's not what I'm saying. So just comments like that. The bedside manner just didn't seem very nurturing. He was very by the book, quick appointments, and asking me his little checklists of items, and that was it, whereas I felt like his nurse practitioner was very warm, had great bedside manner, and really just cared about mothering the mother in that situation. It wasn't just about the baby and how I was going to give birth or how I preferred to give birth. It was the entire experience. I remember at one point, she even said, "Obviously, there is a need for testing certain things and for keeping an eye on everything, but I really just feel like if we left women more alone to go through their pregnancies, they might be better off because we're so hands-on in the United States, and it just causes sometimes more anxiety throughout a time that's supposed to be really beautiful."So she did mention that she reminded me of, I don't know, a woman who crouched down in the field and gave birth to her babies in the woods. That's who she reminded me of. I don't know if that's the truth for her. I never did ask anything about her birthing experiences, but that's who she reminded me of. Just super warm and nurturing. I think also I maybe just aligned more with a female provider. It could have been just that too.Meagan: Yeah, it could have been. But I mean, what you were saying, comments like that, if I'm being super straight, we've interviewed providers on here that have come across really great, and then the more I've interviewed them, I'm like, "Oh, I don't know if I like that. I don't know."That can just happen. I think that's where it comes with vetting your provider and going with who makes you feel warm and fuzzy. But at the same time you're in this place where you're like, well, we've got this medical. We'll see how it goes. I've got this to also like, I've got this warm, fuzzy, filling-my-cup over here. So it seems like it's an okay match, right?Liz: Yeah. And I also manipulated it to the point where I would only make appointments when she was available throughout my pregnancy where the office was like, "You have to see the OB. You have to. He is going be the one who's attending your birth." I'm just like, "But I don't want to. I don't want to do that."Meagan: Yeah.Liz: I just stuck with the practice, I think, because I was nervous. I was new to it and like you said, I was getting my warm and fuzzy cup filled by that nurse practitioner's presence. Things progressed. I finally outgrew that morning sickness. By the second trimester, it was week 12 or 13 and it let up, and I was feeling good. I was pretty energetic. I was doing yoga on a somewhat regular basis. Nutritionally, I do want to mention because I think this does play a role in how things may have gone with the preeclampsia. But nutritionally, I was actually coming off of a vegetarian diet. I had been a vegetarian for a few years. I had gotten really deep into yoga in the early 2010s, and I became a vegetarian when I was doing teacher training for that. So I was purely vegetarian for a few years, and then I started integrating poultry back into my diet. I ate very little because my husband also doesn't consume a lot of meat, so we just didn't eat a lot of meat. I feel like I'm already a picky eater even as an adult. I definitely was as a child, but even as an adult, I still have things that I just don't like, so I feel like my diet was pretty limited, and I perhaps was not getting the nutrients that I needed, especially when my body underwent this or got pregnant and was going through this stressful event.Meagan: Yeah. Growing a placenta and a baby. Yeah, it needed its nutrients.Liz: Yeah. So I feel like during my pregnancy, especially once I started to feel good again, I ate whatever I wanted. So that whole like, I'm just going to eat so healthy, I was just like, yeah, no. I'm eating for two. I totally knew that's not what you're supposed to do. Meagan: I did the same thing. Liz: Yeah. I was like, whatever. I'm feeling great. I'm going to eat it. It's there. I'm going to eat it. So I get to my 20-week anatomy scan. I'm not even sure if it was exactly at 20 weeks, and everything goes well. Fortunately, no complications with the baby. Oh, I had also gotten a NIPT to find out the sex of the baby, so I knew I was having a boy. The anatomy scan did validate that. But that week, I don't know if it was right before or right after my anatomy scan, I noticed that I was starting to swell just on my right side of my body. My right foot was swollen. My right ankle leg was a little swollen. I remember reaching out to my social media friends. I just put out a status like, "Hey, pregnant lady here. I don't really know what's going on. Is this normal? Is this something I should bring up to my provider? What do you guys think?" There were plenty of people who were like, "No, it's totally normal to be swollen at that point." I even said, "It's only on one side though. It's weird."Meagan: Yeah, yeah.Liz: So they were like, "Just elevate your feet. See what happens." It would always go down, but it was just odd that I happened to notice just the swelling on one side of the body. So definitely interesting. Yeah. So I keep going. I'm getting bouts of pretty much every pregnancy symptom, but it would always be very short-lived. I definitely had some reflux, short-lived. I got sciatic pain so bad one day that I couldn't get out of the car. I remember I was sitting in the passenger seat and I said to my husband, "I can't walk on my right leg right now because of my sciatic nerve." So I was doing all these exercises to try and get the baby off my nerve and all of that, and everything just waxed and waned. Nothing was long-lived by any means. So I get to 30 weeks. I think it was at my 30-week appointment, and I believe it was the medical assistant who come in and took my blood pressure and wait like they always do. I don't know if it was her or the nurse practitioner who said that I had my first high blood pressure reading. Like, "Oh, it's elevated a little bit." And I was like, "Oh, that's so strange. I've been a 120/80 girl this entire time, and my whole life, I've never had blood pressure issues." And they're like, "Okay, well it's something to keep an eye on. Let's see. We're going to let you lay on your side, and see if we can have it come down. We'll take it at the end of the appointment again." And it did. It would come down, but they definitely were like, "We're going to keep this in our back pocket, and we might have to have additional monitoring if this progresses." I didn't really know what high blood pressure and pregnancy could mean, so of course, I go to Dr. Google like a good pregnant lady does, right?Meagan: Yep. A lot of us, I'm guilty.Liz: Guilty. Yeah. I was like, okay, so it could be hypertension in pregnancy or it could turn into preeclampsia. I was reading all the things, how this could turn and what that all meant. So in the back of my head, I always thought like, okay. I'm aware of what could indicate preeclampsia, but that's not going to be me. I am a healthy person, right? I've always been healthy my entire life. There shouldn't be any issues while I'm pregnant. And that wasn't the case, unfortunately. But I did go in a few more times, and I did get elevated blood pressure readings. So I don't know what week I was, but I know it was the beginning of October. I saw this other nurse practitioner who was not warm and fuzzy. She was new to the practice and she saw me. She took my pressure, and you could see the alarm in her face, but she wasn't saying much. This stuck with me to this day. It's just so crazy. She handed me this paper. The hospital that I was delivering at is a small community hospital, but it's affiliated with this Catholic healthcare system where I live, so they have a few different hospitals that are also within that same system. She just gave me this paper that had a listing of all these numbers for these different departments at these hospitals, and she just said, "You need to call them and make an appointment." And I'm like, "I have literally no idea what this is about." She's like, "Your pressure is high. You need to go make an appointment with them," but that's all she said to me. Meagan: For what? Yeah. Liz: Yeah, what is happening right now? I remember even that day, she asked me about my face. She was just like, "Is your face swollen? Does your face normally look like that?" I was like, "I have a very round face. I have big cheeks. To me, my face doesn't look different." Yeah. So she handed me that paper, told me to call, and like the good patient I am, I was like, "Sure, I'll call." So I called. I found out it was maternal-fetal medicine, which for those of you out there that don't know what that is, that's a high-risk doctor, and I had no idea. So this is my first experience with that. I did call. I made an appointment, and my OB office had me do a 24-hour urine drop or urine drip, however you want to call that. Meagan: Urine catch? Urine catch, probably?Liz: Yeah, so for those of you who don't know what that is, they give you a jug from a lab, and you have to put your urine into that jug for an entire 24 hours. They test it, and they're checking to see if there's any protein that is spilling into your urine because that could indicate decreased kidney function. Meagan: Preeclampsia. Yeah.Liz: Yeah. That is a symptom of preeclampsia. So I did do that. I went and saw MFM, and in the office there, my pressures were labile. They even called them that-- labile. It had elevated a little bit, probably in the 130s over 90s, but then by the end of the appointment, it had come down. My labs for that urine catch did indicate that there was protein present, but it wasn't within a diagnosable threshold. It was below that lab threshold, so I basically wasn't diagnosable. But they were like, "Now we're going to watch you." Most people like to see their babies on ultrasounds. That's an exciting thing. I became so fed-up with having to go in. I was, at that point, a frequent flyer. I was going in weekly earlier than a pregnancy that wasn't having any sort of complications. I was getting not only an ultrasound, but an NST every time I went in, so I'd have to lay there for 45 minutes while they looked at the baby's heart tones and everything. Yeah, at that point, I was just really stressed out because I was like, is that what this is turning into? But I don't have preeclampsia. I think I also saw my OB within that timeframe and he mentioned, "If this progresses, we will be doing a 37-week induction." And I was like okay, so I'm going to keep that in mind. But again, this isn't going to progress to that because I'm healthy and we're going to make it past 37 weeks. I probably wouldn't get the type of delivery that I wanted. And that's probably something I should mention. If I was induced at 37 weeks, I was preparing to have an unmedicated birth, a vaginal birth, and I was even taking a HypnoBirthing class to try and labor as long as I could at home. My whole thing was that I didn't want to go to the hospital until I needed the hospital or until I felt I needed the hospital. So here I am thinking, okay. I want this unmedicated, low-intervention birth, but I'm having all these interventions right now because they need to monitor me. There's some sort of issue that might be brewing. Yeah. I already said I went to MFM and all of that. My symptoms, at that point, were mostly swelling. I was getting very swollen at this point. I had that pitting edema in my legs, so I could press my finger into my leg. Meagan: It stayed. Liz: It stayed, and then my feet were like little loaves of bread. My feet will never forget what they went through. My husband would just massage them every single night, trying to get the fluid to move out of my tissues. It was crazy. I had another experience with a different OB who was not my OB, but I was out at a family event at this restaurant, and this woman approached me, told me she was an OB, and asked me if I was okay because my legs and my feet did not look so great.Meagan: What?Liz: Yeah. I was just standing in the lobby minding my business, and she's like, "Are you okay?" as if I'm not being monitored, but do you think I'm just going through this free and unaware of what's happening? Yeah. So that was interesting. She said that she was an OB. Yeah. So I went for weekly NSTs, the ultrasounds, and everything looked great with the baby. He was never under any sort of distress. No concerns of intrauterine growth restriction, nothing like that, but my pressures just kept being labile. I actually borrowed a blood pressure cuff so I could monitor at home. There were some mornings where I'd lay down on the couch after I woke up, and my blood pressures were reaching into those like 140s over 90, 91 maybe. I just would cry. I was just hysterical. Like, why is this happening? I don't want to go to labor and delivery right now. I don't want to be monitored. I'm already being monitored so much. There were probably some weeks towards the end where it was more than once that I went into my OB's office for monitoring. So fortunately, we made it through that 37-week mark. We made it all the way to, essentially, the end. And we get to Thanksgiving Eve, right? So my due date is the next day. I'm at 39 and 6. This was one of those appointments where they said, "You have to see the OB." I know I just kicked and screamed, not really, but in my head like, "F"ine, I'll see him. So the medical assistant comes in, takes my pressure and my weight, doesn't say anything, and leaves the room. He comes in, takes my pressure in my weight, and he asks me to meet him in his office.Meagan: Really?Liz: Yes. So I get myself dressed out of the gown that they had given me, and I go meet him in this fancy office. And he's like, "Your pressure is very high today, very high. So you're going to be going to labor and delivery straight from here." He's like, "I have a few meetings that I have to attend to here, but I will meet you over there in a few hours." And I was like, obviously, on the verge of tears. I'm just like, "Can I please stop home and get my stuff? Like, I have bags, I have a dog."Meagan: If you can go to your meetings, I can go to my house.Liz: Right. And yeah, my OB's was maybe 12-13 minutes away from my house, and the hospital was about five minutes down the road. So I was just like, "Can I just go home and grab my stuff?" And he's like, "No, no, no. Go straight to the hospital." And he goes, "And you're probably going to have a Cesarean."Meagan: What?Liz: This is after I tell him my natural birth, or my unmedicated, definitely wanting a vaginal birth. I was like, what? Literally, that was when the tears of waterworks really started. I was just like, "there's no shot at me having a vaginal birth?" And he's just like, "Well, I'm going to be putting you on medication to prevent seizures, so you can either labor with that and have it cancel out my induction medication, or you can just be calm and go to a Cesarean." Like, go to the OR, essentially.Meagan: What were your pressures?Liz: 170/110 that day.Meagan: Okay. Okay.Liz: So, high. Meagan: Yeah. But he's like, "You can do this, but it's not going to work, or you could just calm down and do this."Liz: Yeah, yeah. It was like, those aren't options, so that's not really an option. Right? That's what you're telling me. Meagan: Yeah. Liz: Yeah. So I called my mom. I called my husband, frantic. I was just flipping out. I get out of the office, I'm crying in the parking lot telling everybody. They're telling me to go right to the hospital. So, of course, my husband rushes home from work. He was at work. It was a Wednesday, and he got my dog. He had to bring my dog to my mom's, grab our bags to the extent that they were packed, and he met me there. I was crying. I walked myself into the hospital. It was the most surreal thing. I checked myself in knowing that I was going to come out with a human being, which was bizarre. And when I finally got to labor and delivery, my nurse was so sweet, but I was crying so much that she was just like, "Are you going to be okay?" And I was like, "I really want a vaginal delivery." And she's just like, "Honey." She goes, "I understand. I do think he's making the right choice. I do think you're making the right choice," which again, I don't really feel like I had a choice in that.Meagan: Yeah, you're like, "I wasn't really given a choice."Liz: She was also trying to relate. She's like, "I've had three Cesareans. I promise you're going to be okay. You're going to be okay." I was just like, "I've never even had a tooth pulled. I don't know if I could do this."So my husband arrived again. I'm just crying. He's trying to cheer me up, trying to keep our eyes on the prize and the fact that we were going to hopefully have a healthy baby at the end of all this. I want to say between check-in and when my OB arrived and scrubbed himself in, it was probably about three hours. Yeah. And I walked into the OR, another bizarre experience. I just walked in.Meagan: Yeah. Yep.Liz: Okay, so everybody scrubs in. There's a whole host of people in there, including my nurse. I had never had surgery, so they're giving me all the instructions as to how I need to lean forward so that they can put a spinal block, I think, at that point, the anesthesiologist, and it was so bizarre. It felt like the most claustrophobic thing. If any of you have ever had Cesareans, hopefully you can relate to me, but feeling the numbness just go up your legs.Meagan: It is very strange. I walked in for my second one. With my first one I just had an epidural, but the second one I had a spinal.Liz: Yeah, yeah. So I mean, so bizarre. Then, like I had already mentioned I was so swollen, so they had to just take my very swollen-- I felt like a beached whale-- body parts and put them onto this operating table because I couldn't move once. Obviously, the spinal had activated. So that was bizarre. But my husband, I mean, this man is the calmest person and the nicest person I know. Thank God for him and his presence on that day. He kept me nice and calm. Everybody was really, really nice in the OR. The only thing I happened to notice at one point was they had my blood pressure cuff on. That's why I'm here, right? Because my blood pressures are so hig,h and it had slipped down to my wrist, so I had my arms out. I don't think my arms were strapped down. I don't remember that. I had them out, and I look over to the extent that I could to the anesthesiologist, like, "Hey, does somebody want to maybe put this cuff on? Because that's why I'm, here. That's why we're in this position right now." But yeah, my husband and I just chatted and laughed the entire surgery. Everything worked out really well with the spinal. I did not feel any pain. They did talk me through to an extent about what I would feel as far as tugging or pulling or pressure. My son was fortunately born really healthy, screaming, great Apgar score, the whole nine. He came, and oh my god, what a feeling. Obviously, I was so emotional because of how the birth had gone and what had led me there. But becoming a parent and seeing your child for the first time, you can't really describe that. It's amazing. I have really nice photos and video that the nurse took. They brought the baby over to me. They did not do skin-to-skin with me. Again, I had all of these birth plans, preferences, and, none of that came to fruition. None of that pertained to my or situation. I was so, so happy and also so sad. I don't know how to describe it. It was like the happiest and saddest day of my whole life up until that point. So recovery was interesting. I feel like I got maybe 5 hours of sleep in the hospital total. I was on a magnesium drip. People had told me that the side effects could be a little bit gnarly with that, but I fortunately didn't find anything abnormal. I think I had so much adrenaline. But I did try to get my son to latch, and he was having a really hard time latching. They had a lactation consultant from the hospital come in and see me, and I could not get him to latch. I happened to notice that his tongue was really tethered, super tethered. I could see the tie was really far forward, and he couldn't lift his tongue. So I kept telling them, I was like, "He can't lift his tongue up the way that I feel like he needs to." They just kept telling me how to hold my own body to try and breastfeed properly. I'm like, "I don't think that that's the problem though." So that was really challenging. They did want me to stay extra time for some monitoring. So the next day was Thanksgiving. I don't think my OB wanted to be there. It was a holiday, right? He took his sweet time coming in because they wouldn't even let me eat. That was the thing. I was on magnesium. They brought breakfast in at like 7:00, and he strolls in at like 10:30. I just watched my breakfast get cold in the corner. So that was interesting. But yeah, I think at that point, if you had had a Cesarean without complications, they were looking at about a 48-hour stay. But they asked me to stay an additional day because my pressures were still labile. They were still elevated. I did get put on-- I can't remember the name of medication, but it was blood pressure medication. I was taking Motrin for pain management, the hospital-grade Motrin for my Cesarean. I cannot even describe what it was like trying to get up and walk around that first time after surgery. It's insane. That was something I didn't expect. But yeah, I didn't get much sleep. The last day that I was there, my dog had gotten into a place in my mom's house that she couldn't get him. He had gotten into something, and she couldn't reach him, so she was flipping out. She called my husband. She didn't call me and just told him, "Listen, you have to come get the dog. I can't get him." So he did. I told him, "It's fine, it's fine, you can leave." While he was gone, I had friends come and visit me. They were still visitors pre-COVID. The covering physician came in. I had my son on Wednesday. Thursday was Thanksgiving and I saw my OB, and then there were covering physicians for Friday and Saturday. So we're at Friday now, Friday evening. He came in and saw me and he's like, "You know what? I might be able to discharge you tonight." I got so excited because I was like, this is my first experience having a newborn baby. My husband is trying to go deal with my dog. How awesome would it be if we could just go home tonight?So I got super excited. He said this right in front of my friends, too. He comes back in a short while later and was like, "I just looked at your chart. I looked at your pressures." He didn't clear out the room, nothing. And he's like, "You know what? I can't discharge you. Not with pressures like this. I can't do that." And he's like, "And the covering physician tomorrow won't be able to discharge you any sooner than late afternoon, early evening because that is when he will be here." I was like, okay. So here I am in my head thinking I could go home tonight, and now you're telling me I might be able to go home tomorrow afternoon or evening. I'm already very hormonal. I'm very emotional. My husband's not here.My friends wound up leaving, and I just sobbed. I just sobbed in my room like, oh my god. this is a nightmare. Why can't my body get it together? Why can't I just have normal blood pressures again?Meagan: Yeah.Liz: Yeah. We did wind up getting discharged the next day, but I remember that physician just being so the last straw for me in that experience. You didn't have to say anything at all, and then you also set it in front of all of my friends.Meagan: Uh-huh. Yeah. So you didn't stay with this provider, did you?Liz: I did not stay with this provider.Meagan: For your VBAC? Okay.Liz: No, absolutely not. Absolutely not. Yeah. I guess I should probably get into that story, right?Meagan: No, this has been great. This has been great. Yeah. Yeah. So you were done. You went home. You're like, last straw, no more, never again.Liz: Yeah. Yeah. And I did have my. My son assessed by a lactation consultant, and she said that was one of the most severe tongue ties that she had ever seen. She did recommend a release. I was four days postpartum at this point. I wound up supplementing with formula which was something I so didn't want to do, but I was just like, this kid is starving. He can't latch properly. I did. I went and saw a specialist, and I had his tongue and lip ties both revised, and it was severe. That was a severe tongue tie. I know people have mixed feelings about that, but he needed it. Even in my opinion, as a lay person.Meagan: Yeah. Yeah.Liz: But yeah, pretty much immediately I knew I wanted things to be different the following pregnancy and birth. I think I started thinking about my VBAC probably that day. It was probably the day I gave birth to my son. This cannot be how this goes every time.So it took me a really long time to even want to conceive again. Not only did I have all these complicated feelings about my birth because yes, I did have a healthy baby. Yes, I ultimately weaned off of blood pressure medication and my body came back to however you want to phrase normal, but I had had this experience that I was holding onto a lot of trauma from, and unfortunately, my son was four months old and my mom suddenly passed away. So yeah, it was unexpected. It was sudden. I still to the day am shocked that I didn't lose my milk supply, but I was able to pump in the hospital and get my son milk. That is a crazy, surreal experience losing a parent, but I don't think that there's much more cruel than losing someone that you care about so much. My mom and I were so close in a postpartum period that's already complicated by birth trauma. So now I had this grief for my mom. I had this grief for the birth experience I didn't have. I think that largely contributed to me waiting to conceive again. I also wanted to try and find out as much as I could about what causes preeclampsia. What exactly goes on in the body that would cause that to happen? Funny thing is the verdict is still out there. They're not exactly sure what causes it.Meagan: Yeah. And there are things that we can do to try to help avoid it, but there's nothing specifically that's like if you do this, you for sure won't have it.Liz: Yeah.Meagan: The same thing with gestational diabetes. It's within the placenta, but we don't know. It needs to be further studied.Liz: Yeah. I have heard that it has to do with the father. Have you heard that too?Meagan: I have heard that as well, that there's a connection. Yes.Liz: Yeah. So I wound up, I remember I saw a home birth my wife just for blood work between having my son and conceiving my daughter. She did mention, "Preeclampsia is largely a first-time pregnancy illness. Largely. It doesn't mean you can't have it a second time," but she was the one who mentioned to me you have a higher instance of getting it again if you have the same father for your child. And I'm like, "Well, I'm married."Meagan: Well, I am going to have the same father.Liz: Yeah. So that was always in the back of my head. It's like, okay well, subsequent pregnancy, less of a chance. But same father, more of a chance. So I was just wondering what my odds were. It definitely was there on my mind for a long time. I studied as much as I could about what could cause it. I've read Lily Nichols, Real Food for Pregnancy, cover to cover. Obsessed with her. Obsessed with everything she has to say. There it is right here.Meagan: And right here and right here. Real Food for Gestational Diabetes. Real Food for Pregnancy. Food is powerful, you guys. It's very powerful. But it's changed over the years.Liz: I know. I love how she presents the research because she's the one who really delves into it and presents it in such a digestible way. It was such an easy read. I was like, okay. Okay, here are some things that I can control. Can I control everything? No. But here are the things that I intend to do the next time.Meagan: Yeah.Liz: So my mom passed away in April 2019. It took, again, a few years, but by spring 2022, I was feeling ready. And my husband and I kind of discussed it. It was in little passing. "Hey, should we try and get pregnant again?" And it was one time. It's not lost on me how lucky I am in that sense that it took me one shot to get pregnant.Meagan: Which is awesome. Liz: Yeah. I found out my EDD for that pregnancy was going to be on Christmas Day.Meagan: Oh my gosh.Liz: Yeah. And I just said, "Wow, I can't avoid major winter holidays, apparently, with my pregnancies."Meagan: Yeah. Oh, my gosh.Liz: So we did not find out that we were having a girl, but she did wind up being a girl. Spoiler alert. But, yeah, I was really not feeling well that pregnancy. It was like aversions times 1000. I had this really bizarre one that I had never even heard anybody discussed before, but I had so much extra saliva in my mouth. I'm sorry. That might sound disgusting. It felt like when right before you're going to get sick, how your mouth fills up with saliva but all day.Meagan: Like your saliva glands were just excess all the time, giving you all the spit possible.Liz: Yeah, it was disgusting.Meagan: That is interesting. I don't think I've ever heard of that.Liz: Yeah, it was terrible. Fortunately, I was working from home. I was working full-time, but I was at home. I would just walk around with a spit cup. Like, how disgusting. It disgusts me to even talk about it. It's just like, what is happening? I was waiting for those aversions to let up because I couldn't stand the smell of coffee, which, I love coffee. Basically the sight of anything that wasn't pure oxygen was disgusting to me. The sight of opening up my refrigerator was like, ugh. Exactly. The gag reflex. That lasted my second pregnancy until 22 weeks. So it was rough. I joked that I was horizontal for 2022, and that's not even a joke. I really was lying down. I had so much guilt because my son was so energetic at this point. He was nearly four years old, and he had so much energy. He wanted to do things, and I could not muster up the energy most of the time. My husband was the default parent, and I never thought that that would be the case. That was really, really hard. That was probably the hardest part of the pregnancy. But yeah, so I started to really actively plan for that VBAC. I started to see a hospital-based group of midwives. I loved them. I had gone for well-woman visits between as well. But every provider that I saw was just amazing. I didn't have any bad things to say. I knew that I would be with them if I was in the hospital. But deep down in my heart, I really, really wanted to be at home. I had seen so many beautiful home birth videos when I did HypnoBirthing. And I also associated hospitals with sickness. I had been there because I developed preeclampsia.Meagan: Uh-huh.Liz: I had been there when my mom was sick and passing away. It was a sick place. I wanted to be at a place where I felt most safe. For me, that was home. I know people have a lot of feelings and opinions about that all over, but for me, that was what I wanted to do. I wanted to do all of the things to keep myself low-risk and able to birth at home if possible while still making plans for transfer and even surgery if it was needed again. So I wasn't ignorant to the fact that it could turn into that, but I was going to try all of the things.Where I live, there actually aren't a lot of home birth midwives who support HBACs, VBACs at home. But I found one and we clicked immediately. When I spoke to her on the phone, I was like, she is my girl. I need her. I need her energy at my birth. We met in person a few weeks later, and she was so, so gung-ho about it. She had mentioned that her mom actually had an HBAC, and she witnessed her mom having that HBAC. It was just ingrained into her. She really supported me with advice on diet. She helped me with supplementation. I was on a lot of supplements for this pregnancy. I'm not even going to front. I had so many alarms set for all my supplements daily. So yes, I was trying to support myself with diet, of course, but I was trying to also fill in any gaps that might be there with supplementation. I just know my diet's not perfect, and it certainly wasn't when I was feeling terrible.Meagan: Yeah, no one's is. No one's is. That's just the reality of it. We can be eating the best we can, and we still are often falling short. That's why supplements are really great.Liz: Yeah. Yeah. I was seeing a Webster-certified chiropractor the entire time to get myself into the best alignment to have that vaginal birth. The supplementation, I was doing reformer pilates. I had started it the year before, and I did it all the way until the very end of November 2022, so I was staying active. I was really trying. I basically said that I will do almost anything to keep myself at home. That was really my motto. Yeah, I really can't say I was totally worry-free. I was waiting for something to go wrong. I was. I was trying to keep this brave face as like, okay. I can do this. I can birth the way that I want to. I can have this complication-free birth and pregnancy experience. And in the back of my head I'm thinking, when is the next shoe go going to drop?Meagan: I mean, it's what you've experienced in the back story, the last story. And it's hard. Even if we've processed through things, there's still sometimes those little creeping thoughts that come in.Liz: Yeah. That is for sure. My midwife did recommend that I get a third-trimester ultrasound. That was more for her, but it was also for me. She never ever said, "You have to do this." Everything was really a conversation. The appointments, especially with a home birth midwife were an hour long or more sometimes. Just amazing. I loved going to see her. So I did get that third trimester ultrasound. It was more to check to make sure that the placenta wasn't compromised in any way and whether it was in a good position. There was no accreta. That was something that we really wanted to rule out to keep me low-risk and at home. I agreed with that. I am not anti-medicine by any means. I just want to put that out there just because I chose to have a home birth. I do respect medical professionals and their jobs and the need for surgery but I also wanted to keep myself in a place, again, that I felt safe, and that's really what it came down to. So in my head, I had mentally prepared to go to 41 weeks. I think that's where I prepared to go because I had learned that many, many women, especially first-time laboring women, because I did not labor with my son, I neglected to mention that I didn't labor at all. So first-time laboring women will go into labor typically, but somewhere between 40 and 41 weeks. Post-dates is very, very common. So in my head I prepared to go to 41 weeks and we got there. We got to Christmas. We through there. I was like, I'm going to go somewhere before New Year's Eve. No, nothing. So we got to New Year's Eve and here I am in my 41st week, and I'm just trying to keep myself calm. What am I going to do? I cannot go to 42 weeks. I can't do it. Mentally, I can't do it. Physically, I can't do it. I'm going to wind up at the hospital. Of course, all of these negative thoughts are swirling. I went for another adjustment with chiropractor. I went for an acupuncture session. I went for a few of them, but I did induction points with my acupuncturist. I was just trying to do all the things-- curb walking, I did the Miles circuit and all the things to try and help this baby engage. So we get to 41 and 1 for me, which is a Monday, and I was woken up with contractions that felt like period cramps. That's how I would describe them. Around 2:00 AM, I started timing them. They were 12 to 15 minutes apart at that point, but they weren't letting up. They were consistent. I woke up my husband getting all excited like, "Oh my gosh, this might be it. Here we are." And they weren't getting closer, but they weren't easing up. So they just continued like that for the rest of the day. I had gotten up from the couch at one point, and I felt like this small trickle. I went into the bathroom, and it didn't look like anything to me. It didn't look like much. There wasn't a huge gush of fluid, nothing. So I was like, oh, I think it's probably just discharge or maybe part of my mucus plug. I have no idea. I have literally no idea. But I was like, nothing seems off to me, and it wasn't enough fluid to be concerning. I did text my midwife to update her and she mentioned to me, "A lot of women will drop into more active labor when the sun goes down. Things get quiet. It starts to get calmer. I can almost guarantee that we're going to have a baby at some point in the next 24 hours." So I go to bed that night and thinking, I'm going to wake up Tuesday probably either be having a baby or have a baby already. I woke up Tuesday, and I was still pregnant. Here I was.Meagan: You're like, this is not what I was thinking.Liz: I remember I would wake up with a contraction, but again, they were 12 to 15 minutes apart. I would go to sleep between no issues and just wake up, breathe through the contraction, and go back to sleep. And that's how the whole night went. I just couldn't believe I was still pregnant. I really was starting to get a little down on myself. I was like, these aren't coming closer together. They're not intensifying. They're not letting up, but there's nothing really happening at this point. I texted my midwife again that morning, Tuesday morning, and she said she needed to come see me for the 41-week appointment anyway, so she said that she would come by that day. She was going to come to my house. And then we get to the mid-morning. It was probably around 10-10:30 and my contractions stopped, like literally up and left. Like, what is happening right now? I can't. I was in shock, literally in shock. Especially because labor had been going on for over 24 hours. It was absurd to me. But she's like, "Don't worry. I'm going to come see you for your appointment anyway." When she arrived later that day, I did ask her to do a cervical check because at this point I'm like, "Something has had to happen whether the baby moved down into a better station or I'm a little bit more dilated or just more engagement. Whatever it is, I just want to know at this point."Meagan:: Yeah.Liz: So she did. She said, "I'll go in there. I can do a cervical check and if I can get in there, would you like me to do a membrane sweep?" And I was like, "I would love that. Anything to get this going. Let's get the party started." I'm at my house. She does the cervical check. She's like, "I can do a membrane sweep." And as she basically finishes up, I feel this gush of fluid.Meagan:: Your water.Liz: Yeah. She stopped, and I said, "Was that fluid?" She's like, "I'm going to make sure it's amniotic fluid. I have the test strip," and of course, it lit up like a highlighter. She's like, "Yes." She goes, "So guess what? We're going to go after baby today. We're going to get this. We are going to get this party started." I had kept telling her, "I can't go to 42 weeks," and she kept saying, "Let's not go to 42 weeks. You'll be fine. We're going to get it moving." And here we are. She did mention, I was at that point, about 3-4 centimeters dilated, so pretty good. But she was like, "I can offer you, I have a Foley. I can offer you a Foley balloon just to put a little bit more pressure on the cervix and maybe we can get those contractions to start to start up again, and then hopefully come closer together." Yeah. So she did. She put that Foley in and she waited with me at my house, and we just chatted. It came out a short time after. It took very little. I didn't have discomfort with that, thankfully.Meagan: That's, good. I mean, your cervix was starting to come forward. Things were going.Liz: It was going. Yeah, yeah. So again, she stayed with me and once the Foley came out, she just advised me to put on some sort of protective underwear whether it was the adult diapers or a pad because now we knew that my fluid was at least leaking, but it wasn't coming out consistently anymore. I don't think it fully came out. It wasn't a big enough gush for it to be all of the fluid, if that makes sense.Meagan: Yeah, yeah, yeah.Liz: So she told me to do a few things. She's like, "I'm going to head out. You're going to call me when you need me," which, at that point, I was like, I have no idea what that means, but okay. And she's like, "Here are the things that you can do. Obviously nothing in there anymore, because we know that your amniotic sac is open.Meagan: It's broken. Liz: Yeah. Yeah, exactly. But she said, "You could do some pumping. You could use some clary sage essential oil." She gave me her TENS machine, and she's like, "You could try the TENS machine." I had never known that you could actually use that not for pain management. I only thought it was for pain management. So I was like, "That's so interesting." So she's like, "Do the pumping. Do that." So I did. I did one session, I think, before I put my son to bed for the last time as an only child. I did. I went and laid down with him and just knew that was probably going to be the last time that he would wake up or the last time he had woken up as an only child. And then I did it one more time, and not only did my contractions come back, I started timing them on the app, and I'm watching them get closer. They're going from 10 minutes to 8 minutes to 7 minutes to 5 minutes. I'm just watching them like, oh, my gosh. So we get to 11-11:30 at night, and it's just me and my husband there, and they are three minutes apart, and they're not easing up, and they are getting intense. So there it was. They came back.Meagan: And labor begins.Liz: Oh, it began. It began. I have so many interesting photos that my doula wound up taking. Thank God for her. Not only for the photos, but for everything that she did during the labor and delivery. It was intense. It gets intense, or in my experience, active labor when you get the breaks between the contractions and you are able to rest. I took every opportunity to rest. My doula was trying to guide me into different positions. She would help by putting a warm compress on my back at times. She would encourage even location changes in my house just to see if I could use the toilet. She told me to get into the shower at one point. I was like, "I'm too claustrophobic in here." I didn't like that, but she was trying to get me to try different things. But it was so intense. The craziest part for me was transition. That was truly an out-of-body experience. Everybody was doing these hands-on manipulations, my husband and my doula. But I could not do anything but just sway. I was standing, swaying back and forth in my living room, arms up. Why were my arms up? I have no idea, but they were up. I was doing that horse lips, breathing. Yep. It was just what my body did intuitively. I just, at that point, wasn't really getting a break. It was just insane. So that was intense. Out-of-body. I cannot replicate that level of pain in my head. There's just no doing that, but I knew that even if I needed to transfer, which I wasn't planning, but even if I needed to do that for pain management, I couldn't sit down in a car. I was at that point, so I thought to myself, the only way to this is through this. Like that is it. You've got to do it. We're just going to do it. So I knew that in my head. At no point did the pain concern me though. I mean, was it so intense and crazy? Yeah, but it was never like, there's something wrong.Meagan: Uh-huh. Yeah.Liz: So that was really good. I didn't think anything negative during that time except that I was in an intense amount of pain. But it was like pain with a purpose, if that makes sense.Meagan: Productive.Liz: Yes, yes. In the meantime, my doula had set up a birth pool because I definitely wanted to try to be in the pool when I gave birth, but I wasn't sure how I'd feel about the water since I didn't really like the shower experience. It took a while because the hose kept slipping off of our faucet or whatever, so they had to boil pots of water. I just remember my doula walking back and forth. In the meantime, they did call my midwife. Somebody did, and she showed up with her assistant. So there were like three or four adults trying to hold me in transition or do some sort of physical manipulations and then pour hot water into this birth pool.Meagan: Oh my.Liz: Yeah, it was very interesting. But yeah, my contractions, at that point, were 30 seconds apart and they were lasting a minute and a half. It was intense, yes. But the pool was finally filled at 6:45 in the morning on Wednesday, and the only reason why I know that is because we have pictures of me right before I got into the pool. When I got in, my body just relaxed. I didn't think I was going to be wanting to be in a supine position at all, beyond my bottom at all because I couldn't have even tried to sit on land. But once I got into the pool, everything relaxed and it was like, oh, this is what I needed. This is what I needed. I needed some relief. I also kept telling everybody how tired I was. Anybody who walked past me, I was like, "I'm so tired." They were like, "Yeah, no. We know. We know, but we're going to keep working."Meagan: Yeah.Liz: But yeah, I was in there for a really short time and I had heard of this before, but to actually experience it is next level. I had the fetal ejection reflex.Meagan: Oh yeah.Liz: So I did not even have another cervical check. Nothing. My body just started pushing that baby down and out. I couldn't have stopped it if I wanted to. I was making the most primal sounds. I have video of it, like low guttural sounds. It was probably going on for about 15 minutes. My son walked down, I heard his little pitter-patter of his feet, and he walked down. My stairs go right into my living room where I was. And the whole time the most nerve-wracking part of having a home birth for me was that I knew he was going to be home with us, and there really wasn't an adult aside from my husband and my birth support team who I wanted in my birthing space. So there was no other option of anybody to take care of him besides my husband if it came to that. I think in the back of my head, that was the most anxiety-inducing part of this.Meagan: Yeah.Liz: So down he walks. And of course, he's hiding. He sees these three other adults in our living room. I'm in the tub groaning.Meagan: Yeah.Liz: He's a little nervous. He's a little guy. Fortunately, I think it was either the birth assistant or my doula handed him his little digital camera that I had actually bought as a gift from the baby for him. Yeah. She encouraged him. She's like, "Why don't you take some pictures? Take some pictures of mommy and daddy." The minute that she said that and he started to do that, he calmed down and just wanted to be in it and part of it.Meagan: Yeah.Liz: Yeah. And I told him, "Mommy's making some interesting noises, but I'm okay. I'm safe. I'm okay." And he was just really good about it. I feel like all that anxiety went away, thankfully.Meagan: Yeah. Yeah. That's awesome.Liz: Yeah. I noticed my midwife was starting to gather her supplies and in my head, I actually probably said it out loud like, "Wait, we're doing this here?" And she was like, "Yeah." I was like, "I'm having a baby here in this room." She's like, "Yeah." I was like, "I don't need to go to the hospital?" She's like, "No, no, no. You're okay."And, yeah. My body just kept pushing the baby out. And it was an hour, not even an hour. It was less than an hour from when I first got into the pool until my daughter was out. My husband got to reach down and put his hands there. As she came out, he felt her really chubby cheeks. She has big cheeks like me and her ear, and brought her up to my chest. I was just in shock. I couldn't believe that I had done that. But then, of course, I look and I see that she's a girl. I just knew my mom had sent me her. That's how I felt.Meagan: Oh, that just gave me the chills.Liz: Thank you.Meagan: Oh my gosh. That is so beautiful. I love that your son was able to be involved, and you could feel your mom. Oh huge. Congrats. Liz: Thank you so much.Meagan: Yes. Liz: My mom's name was Faith, and so my daughter's middle name is Faye because everybody who loved my mom called her Faye. She was Aunt Faye to everybody, every cousin. So my daughter's name is Luna Faye. So she is her namesake, and she's amazing. And like you said, I can't believe she's almost two. I can't believe this was almost two years ago.Meagan: Two years ago. I know. We get so many submissions and sometimes we can't get to everybody, but it does take a while sometimes. I'm so glad that you were able to come and still record your beautiful stories and give us so much detail of each one and guidance, and the experience. Yeah. I'm just so happy for you.Thank you so much. I don't think I'll ever come down from that high, that birth high. Like, I think I'll be riding it out for the rest of my life. I'm not sure I'm going to have any more children. I think we're pretty much done, but I would love to give birth like that a thousand more times. It was the redemptive story that I needed. It helped so much with my previous birth trauma, and it made me feel so strong. I have never felt more strong and more powerful than that experience. I don't think I ever will.Meagan: Yeah, well, and there's so much that went into it-- time preparing, research, finding this team, and then even dealing with the prodromal. I mean, that could be defeating within itself. You're so tired, but then you just kept going.Liz: Yeah, I kept doing the things. I mean, that was one thing that my doula and my midwife both commented on. They were like, "You did everything that you could, and you tried to control everything that you can control, and look what happened. That's amazing."Meagan: Yeah. Thank you again so much.Liz: Thank you. I'm so happy to have been able to talk to you and share my story.Meagan: Me too. Do you have any final advice to any of our listeners?Liz: I think my ultimate advice for any birthing person is to find a provider that you align with. I think they can really make or break that experience. No matter where you choose to birth or where you wind up birthing, have that provider that you trust, that you feel like you could have open conversations with. If you say you want a natural birth, they're not going to scoff at that, and somebody who's going to have conversations with you instead of talking at you.Meagan: Yeah, I agree so much. I want to add to just vet them. If they're feeling good at first, okay, stay. And if something's happening, keep going. Keep asking the questions, and if something's not feeling right, don't hesitate to change.Liz: I know. And I not only hesitated, but I knew I had to change with my first provider, and I just didn't. I think at that point, I was so tired.Meagan: Yeah well, it's daunting. It's a daunting thing. I mean, I was there too, so no shame in it. It's just hard when you realize looking back, oh, I could have. I should have done something different. I didn't, but that's okay. We've learned, we've grown, and we've had healing experiences moving forward.Liz: Yeah. 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

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  1:05:32
• Episode 387 VBAC Q&A With Dr. Nicole Rankins + Preeclampsia, Scar Thickness, and More

  Meagan welcomes Dr. Nicole Calloway Rankins, a board-certified OB/GYN, to discuss everything related to pregnancy, childbirth, and the VBAC experience. With over 23 years of experience and more than 1,000 deliveries, Dr. Rankins shares her insights on common questions and concerns from expectant mothers. From the importance of mindset during labor to understanding the implications of the word “allow” in provider-patient relationships, this episode is packed with valuable information. Don't miss out on Dr. Rankins' tips for a calm and confident birth, and learn how to advocate for yourself in the birthing process!Dr. Nicole Rankins' WebsiteNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength, It's Meagan, and I am so excited to be joining you today with our friend, Nicole Calloway Rankins. Dr. Nicole Calloway Rankins is incredible. We've been following her for a long time and have collaborated with her in the past and are so excited to be having her on the podcast today. Dr. Rankins is a board-certified practicing OB/GYN, wife, mom and podcast host here to help you get calm, confident, and empower you to have a beautiful birth you deserve. She was born into a family of educators, and she felt a pull to medical school the day she looked in the mirror and saw a vision of herself in a white coat. And get this, it all happened while she was studying to be an engineer. She says, "I know that sounds crazy, but that vision has led me to exactly where I am supposed to be today- serving pregnant women." She's delivered more than 1,000 babies and has de-mystified childbirth for thousands more through her 5-star rated All About Pregnancy and Birth Podcast which she's going be talking about a little bit more today. I'm so excited for her. She has over 2 million downloads and her online birth plan and childbirth education classes. You guys, she is really changing so much about the birth world. She's incredible. You're going to hear it today. I love chatting with her. You can find her at drnicolrankins.com and of course, we'll have all of her other podcasts and Instagram and all that in the show notes. So get ready, we're excited. We're going to be talking a little bit more about common questions for an OB/GYN, but then we're also going to be diving into questions from you personally. I reached out on Instagram and said, "Hey, what are your questions for this doctor?" She is so excited to answer them, and she did. We went through every single question that was asked on our Instagram community. I'm so excited. I'm going to get to the intro, and then we are going to start with Dr. Rankins. You guys, Dr. Rankins is back with us today and I'm so excited. Funny enough, I keep saying that you're back, but you've never done the podcast with us.Dr. Nicole Rankins: I don't think so. Yeah, I think we did a class.m: We did a class which was phenomenal and everyone ranted and raved about it. So we're back together ,but we have you for the first time on the podcast. So welcome. Dr. Nicole Rankins: Well, thank you. I'm excited to be here.Meagan: We just adore you and I love getting your opinion on things. I think from doulas, from midwives to OBs, we all have different opinions and experiences, and if there's anyone that has hands-on experience, it is you and a midwife, like someone who is physically handling.Dr. Nicole Rankins: Yep. I've done this a couple thousand times. Yes.Meagan: Versus my 300 and something verse.Dr. Nicole Rankins: Don't discount it. That's very excellent.Meagan: It's still super great, but when it comes to thousands and an understanding on an even deeper level, it's just so fun and it's a compliment to the podcast to have your expertise.Dr. Nicole Rankins: Yeah, I've been at this 23 years, so it's a long time.Meagan: And still going. It's still going.Dr. Nicole Rankins: Still going. Yes.Meagan: And okay, tell me we can edit this if you want, but you have a new podcast coming out. I do know it's not going to be by the time this airs. It's not going to be out just yet. But can you tell us a little bit more about it and where people can find this?Dr. Nicole Rankins: Yeah. So it's still going to be in the same feed. So if you subscribe to the old podcast, it's just going to change, keep the same feed, but it's going to have a new name and a bit of a new focus still related to pregnancy and birth, but it's just a bit tighter. I want to say the name so bad, but I'm not going to.Meagan: Okay. Don't let it out. We will find out it is released.Dr. Nicole Rankins: Yes.Meagan: Tell them where to follow right now.Dr. Nicole Rankins: Right now? Yeah, if you follow me on Instagram, even though I'm taking a Little break now, you'll get it there. But the podcast is called All About Pregnancy and Birth. Go ahead and subscribe, and you can be the first one to know when the first episodes come out. I just have lots of new ways to present information about pregnancy and birth and frameworks and things. Okay, I'll give a little hint. One of the first things I'm talking about is one thing that's so important to pregnancy and your birth experience is your mindset. So one of the things I created is this MAMA mindset framework. MAMA stands for meditation, affirmations, move your body, attitude of gratitudes. I have practices, exercises, and things we're going to talk about. That's just one little, tiny sliver of the things that I've been working on and writing, so it's just good, great stuff.Meagan: Yay. Oh my gosh. I'm so excited. That is even more applied with just birth in general. But VBAC, I feel like mindset attitude, and all these things that you were just saying, is so important because even though we're just moms going and having babies, we have some extra things that some extra barriers that sometimes we have to either break through or we run into.Dr. Nicole Rankins: Absolutely. Yeah. I mean, a calm mind creates a confident birth. So when you have that calm mind, that is the first step to helping you create a confident birth experience. So mindset is really important.Meagan: Yeah, it really is. Well, I'm excited to chat with you today, and I'm excited to listen to that sometime here in the near future and listen to more of what you are bringing to the table. Okay, so one of the questions that I would like to go over is the word "allow".What does the word "allow" mean? How does someone navigate something that maybe doesn't feel right for them? And on both sides-- Dr. Fox and I have talked about how sometimes it's not right for the provider. You're not the right patient for that provider because what you want is not comfortable with the provider and vice versa.But we often hear or actually more see it on The VBAC Link Community on Facebook. There are comments of, "My doctor said they will allow" or "My midwife said they'll allow me to." If so when you are saying that or maybe have you said that, what does that mean?Dr. Nicole Rankins: Yeah, I don't say that word.Meagan: Okay.Dr. Nicole Rankins: It's a word that should not be in the discussion about birth because allow implies a hierarchal relationship where I get to make the decisions about what does or does not happen in someone's pregnancy, birth, labor, body, and that is not true. You as the person giving birth are the one who ultimately makes the decisions, not your doctor or your midwife. We can't really allow anything. We're not your parents. Do you know what I mean? So "allow" shouldn't be part of the conversation. It's a left overturn from just a general patriarchal foundation of OB/GYN, particularly when men took over into the specialty and banished midwives is how that language came about is that we need to tell folks and we need to control. So it really shouldn't be the case, but it still hangs around. Words matter, and it's important. Even though people don't necessarily mean it with any sort of ill-intent or that they mean that they're trying to control you, and inherently sort of subconsciously implies that. So I strongly dislike the word "allow".Meagan: Yeah, I am with you too. As someone who has had that word happen to me, it made me feel like I had to do something to meet their standard quota to get that allowance.Dr. Nicole Rankins: Right.Meagan: That just didn't feel great.Dr. Nicole Rankins: Yeah. Yeah.Meagan: So if someone is saying that, are there any tips of advice that you would give?Dr. Nicole Rankins: Yeah, I mean, first off, if you hear it, that's a little notch of a red flag potentially that it's not going to be a shared decision-making process because really, it should be that my role is to give you information and share my expertise with you to help you come up with the best decision for yourself. That looks like various things for different people. Some people want tons of information. They want to think about it and then talk about it. Some people are like, "Just tell me what to do," which if that's what you want me to do, then I can do that too. So if you hear "allowed", then it's concerning that there may not be that shared decision-making. So that's a little bit of a red flag to know.But then to open it up for discussion, it kind of depends on what the situation is. So is it we don't allow you to eat or drink during labor or we don't allow TOLAC? Then the next question is really, why? Especially if it's something that's important for you, why? If you want to use the language back, you can even use it back. "But why is that not allowed? Why is that the case?" And then kind of take the discussion from there.Meagan: Yeah. I think asking the question just in general, "Why?" or "Okay, I hear you. Can you explain to me?"Dr. Nicole Rankins: Yes.Meagan: It really helps there be a discussion like you were saying. I feel like when it comes to birth, like you're saying, I'm not your parent, but it needs to be collaborative effort here. We're trusting you to help us with this really amazing event in our life, but at the same time, we have to have equal trust from you. It's this collaboration of like, let's talk about what we want this to look like.Dr. Nicole Rankins: Yeah. Definitely, tust and collaboration are key in order to have a great birth experience. And ideally, you want to try to work on that foundation during your prenatal appointments so that by the time you get to the hospital, you know that you're going to have that relationship actually, regardless of what doctors there or nurses say. You create this environment of trust and collaboration. So when you ask the question why, don't necessarily start off-- and this is part of the psychology of human behavior. You don't necessarily have to start off with, "Well, why?" attitude because advocacy is not about creating conflict or creating chaos. Advocacy is really about creating that collaboration and creating that trust. It's the end result. So start from a place of trying to connect. Ask, learn information, and then kind of go from there.Meagan: Yeah. Love that. Well, thank you. Okay. Fetal monitoring. I know this is actually going to be a question down the line, or maybe it's a little different, but fetal monitoring with VBAC in hospitals is typically required. Can we talk about the evidence on that of why? Why? Again, here's the question, why? Why is that done? Dive in deeper. We talk about that in our course. But I think it's so great to talk directly to an OB/GYN like you to understand your point of view.Dr. Nicole Rankins: Yeah. The reason that's the case is that one of the first signs of uterine rupture is going to be a change in the fetal heart rate. So that's why we always want to see the fetal heart rate because it's going to be the first indication that there's potentially an issue. So it's really that simple. It may even be potentially before you start having pain. Some people may or may not have bleeding, but fetal heart rate changes and pain are going to be the things that will clue us in and we don't want to miss that if it happens.Meagan: Yeah, so when a fetal heart changes, we know, through labor-- this is a spin-off of the question. We know babies' heart rates fluctuate up and down. Sometimes they might have a compression in the cord that causes the heart rate to go really down during the uterine contraction and that goes up, but it goes really down. It's like, oh, that's low, and then it goes right back up to its baseline. So what is a concerning fetal trace in this scenario?Dr. Nicole Rankins: Right, yeah. So this is the part where I have to say, this is the reason we do four years of OB/GYN residency, why we have to get take fetal heart rate monitoring training every couple of years to stay up on it. This isn't something that can be had in a subtle conversation because it's not just what you see in the moment, it's what you see in the moment. The things we look for in general are a baseline of the heart rate between 110 and 150, 160, roughly. We look for things called accelerations, decelerations, and the variability, which is like the squiggliness of it, that's the big picture. But when we look at it, it's like, okay. We assess it, and then we try to do some things to improve the heart rate. We look at how the heart rate looks over time. Has it gotten worse over time? If we do some things to get it better, then that's considered good. So we can't really say if you see this specific snapshot of a fetal heart rate, then that's going to be the thing that triggers things. It really just depends.Meagan: Makes total sense.Dr. Nicole Rankins: And it can also be contractions because sometimes if you're having too many contractions back to back and there's no time to get a break, so the baby's like, "Can I just have a minute to breathe in between these contractions, please?" So maybe we need to slow down the contractions. So really, it's a lot of things that go into it, and that's where our expertise comes in.Meagan: Yeah, it's a big math equation in a lot of ways when it comes to tracings and things like that. Okay.Dr. Nicole Rankins: I do want to say that a lot of times people think monitoring equals no movement. But more and more, hospitals these days have wireless monitoring so you're able to move. That's definitely a question you want to ask ahead of time if wireless monitoring options are available so that you're able to move around.Meagan: Yeah, yeah. Because they've got, at least I don't know if it's what it's called there, but we call it the Monica.It's just that little sandpaper on your belly and that's kind of nice. Sandpaper sounds harsh. It's a light little scrub so it gets the oils off your skin. So that's a really nice thing.Awesome. Okay. And then scar thickness. This is a really big one, and we've talked a little bit about it with Dr. Fox in the past. But scar thickness and double versus single stitch closure is a very, very common question that we are getting wondering about the evidence that shows that someone maybe shouldn't TOLAC or the evidence on thinner scars because it seems like it's becoming a new standard. It's coming in with the VBAC calculator. That is what we're seeing. It's like we're doing the VBAC calculator and we're measuring the scar and those kind of two things are becoming routine. And then of course, once we review OP reports. Double versus single.Dr. Nicole Rankins: Yeah. So the double versus single doesn't make a difference. So whether you had a double layer closure or a single layer closure, you're still a candidate for a VBAC. So that one is pretty easy. I don't even look at OP notes for double versus single layer. It really just needs to be a low transverse incision on the low part of the uterus. So that's that. As far as the scar thickness, the rationale behind that is that when the uterus ruptures, it literally just thins out. Thins out and thins out until it ruptures open generally. So when we're measuring this scar thickness, the physiology of it makes sense that if it's really thin and then you start to put the pressure of contractions on it, there may be a higher chance of it rupturing. Now, is there hard data that if it's this amount that is definitely going to rupture or you should or shouldn't TOLAC? Not necessarily. In our area, it's not routinely measured or talked about. It's not anything that we discuss, so it's not a routine part of practice, but that's the thought behind it. And typically it may come up if it's noticed, or if it's very noticeable. If the ultrasound, the maternal fetal medicine specialist or whoever does the ultrasound says, "This uterine scar, where it is, is really, really thin," and then it may come up. But in general, I don't see that come up very often.Meagan: Yeah, well, that's good. That's good to know. Yeah, it just seems. Yeah. Like, oh my goodness. Are you hearing that ding?Dr. Nicole Rankins: No.Meagan: Okay, good. I hope you're not hearing it. On my end, my computer keeps dinging, but it's on mute, so I'm not really sure what's going on. I'm having all the technical issues today.Anyway, that's really, really good to know though, because it is something that so many people are hyper-focusing on. Sometimes I think there are other things to hyper-focus on like our nutrition and finding that supportive provider and getting the education and really understanding the choice that we're making when we VBAC.Dr. Nicole Rankins: Yeah, definitely. I'm not focusing on it, so I don't think you should focus on it.Meagan:Yes, yes. But it is. I think it is probably hard for these people when they go to these visits. They're so excited. They want to have a TOLAC or a VBAC, and then they're like, "Oh well, we have to do these things first to see if you qualify."Dr. Nicole Rankins: And scar thickness is just not part of ACOG's recommendation. It's not part of what determines whether or not you can have VBAC.Meagan: I know. It shouldn't be anyway. Yes, yes, yes. But for some reason, we're still seeing it. So I think it's good to know that you guys, if you're having that, maybe just think twice about it.Dr. Nicole Rankins: Or get a second opinion.Meagan: Yeah, I was going to say, get a second opinion.Dr. Nicole Rankins: Yes.Meagan: Okay. So our community asked questions. I went on and said that we were going to have you on. And they were so excited and kind of just asked all of the questions. So one of the questions was, if you don't get an epidural for a VBAC and you need a C-section, will you have to be put fully out, so under general anesthesia?Dr. Nicole Rankins: Yeah, no. Not necessarily, and most likely not. Generally, as long as it's not an emergency, there's time to do a spinal. The difference between an epidural and spinal, the epidural is a catheter that stays in place and medicine continually gets fed through the catheter where a spinal is a one-shot dose of medicine that lasts for two to three hours. So as long as there's time and you can sit up for the spinal or they can lay you on your side for the spinal, then they can do the spinal for the C-section, and you don't have to do general. General anesthesia is only reserved for if it's truly an emergency and there's not enough time to do the spinal.Meagan: Right. And for this is another, I'm adding this. But epidural versus spinal longevity of effectiveness meaning like you're numb enough for them to perform the surgery.Dr. Nicole Rankins: Yeah. The spinal's going wear off.Meagan: Yeah. Quickly, but it's going to go on quicker. Right or no? Or deeper?Dr. Nicole Rankins: Yeah, it's a denser numbing than what you get with an epidural. When you get an epidural before, if you have an epidural and then you go to a C-section, then you just get a bigger dose of medicine that kind of mimics what you get through the spinal. So the thing about the spinal is that it's meant to cover a surgery, so it's going to be a larger dose of medicine, so you're going to be more numb because we don't actually want you to be completely numb during labor. The spinal is really just to make sure you're nice and is numb and don't feel the surgery.Meagan: And how long does it take to kick in to be numb enough? Like 20 minutes? 30?Dr. Nicole Rankins: Yeah, yeah. I would say it's actually pretty quickly. So yes, you're right. It can kick in a little bit faster than epidural because it's a lot more medicine. So typically, I would say within 5-10 minutes, you're going to start feeling numbness pretty quickly. But by the time we've laid you down, washed your belly, put in the catheter, done those things, then you're numb.Meagan: Yeah. So in that non-emergency situation, you're going to have plenty of time to be numb and not have to be put under general anesthesia. In an emergent situation, we have minutes. We have minutes to work with. How many minutes if we're having fetal distress? And obviously, it could vary for a lot of patients, I'm sure, but major fetal distress emergent like true emergent under general anesthesia. What are we looking at a timeframe before we get baby out before we're really concerned?Dr. Nicole Rankins: Yeah. I mean so if it's true, like an emergency, because a lot of people say they had an emergency C-section. It's actually not emergency. Meagan: Right. Baby was born two hours later. D; Yeah, or even 30 minutes later. So emergency is going to be like we're ripping the cords out of the wall. We're running down the hall to the operating room. When we get in the operating room, the heart rate is still in the 60s. So we want baby out in five minutes.Meagan: Okay.Dr. Nicole Rankins: We want baby out as quickly as possible, and the quickest way to get a baby out is general anesthesia and then go, if you don't already have a spinal.Meagan: Right. Perfect. That's also another common question of like, well, how long do I have if I don't have that? Because that's a big deciding factor for people with not wanting to go unmedicated or wanting to go to medicated but not wanting to be in an emergent situation. Those emergent situations, they happen. We can't sugarcoat it. They happen, but they are more rare. I love that you pointed that out. A lot of people say this was an emergent situation and we hear, well, then they went out and they came back, and 25-30+ minutes later, they had a baby.Dr. Nicole Rankins: That's not an emergency. As a matter of fact, emergency C-sections are fairly rare. Knock on wood, I can't remember the last time I've had to run somebody down the hall for a C-section.Meagan: And I call those crash like crash sections. Everybody crashes and goes. Yeah.Dr. Nicole Rankins: Mhmm. Mhmm. Things are moving so quickly.Meagan: Okay. So someone says, do I need an OB for a VBAC? I have lost all trusts in nurses and doctors after being forced into a C-section which breaks my heart that this question is a thing. I see it all the time. People have been "wronged" or bullied, and it shouldn't be that way. Dr. Nicole Rankins: It should not.Meagan: Sometimes it happens for whatever reason. But yeah, like do you have to have an OB? Obviously, we know the answer is no.Dr. Nicole Rankins: No, you can have a midwife. For sure.Meagan: But maybe I want to spin it to more of a positive. If we have an OB, how can we better establish a relationship with them so we're not in a situation in the end feeling pressured or bullied?Dr. Nicole Rankins: Yeah. And actually I want you to even back it up even further, and this is for anybody having a baby. What you want, you don't specifically want a midwife. You don't specifically want an OB. What you want is someone who's going to listen to you, respect your wishes and really center you in your birth experience. So yes, midwives are great at that, but sometimes midwives can be tricky too. The way that the reason I said that is because I know people who were like, "I had a midwife and I thought it was going to be great," and it wasn't. And they were hanging too much weight on that midwife hat.Meagan: The midwife word, yeah.Dr. Nicole Rankins: Yes, yes. So you really need to start with is this person listening to me and respecting me? So whether that's midwife or OB, okay?Meagan: Yeah.Dr. Nicole Rankins: So take that away first. And then if you have an OB, again because the midwife is also going to work with an OB, I'm assuming you're doing in the hospital, you want someone who is not just like, "Oh, if you go into labor, you can have a VBAC. I mean, I guess that's okay." Or you want somebody who's really actually supportive of it. I think you've used this language before, not just tolerant of VBAC that they actually you and don't just tolerate the possibility.Meagan: Yeah, I have kind of been thinking about that. Like we as doulas. It's like, oh, I want someone to advocate for me. That big word "advocate", and what does that look like? But in a lot of ways, I think that's what I want a supportive provider to do is advocate for me. Like I understand, validate me. I understand this is what you want, and we're going to do everything we can in our power to do this. If there's something along the way that is saying maybe we shouldn't, I will have that discussion with you. I will not just tell you what you have to do. Dr. Nicole Rankins: Exactly. Meagan: Again, it goes back to that conversation we were having in the beginning of that collaborative relationship. If that is there, I think you set yourself up for better expectations no matter who it is with an OB or a midwife.Dr. Nicole Rankins: Definitely. Definitely. Yeah.Meagan: Nurses can be tricky. We love our nurses. They're incredible, but sometimes they have opinions, and sometimes they come in and they put it on us.Dr. Nicole Rankins: Here's the thing that people don't realize. You can ask for a new nurse.Meagan: You can.Dr. Nicole Rankins: Yes you can. You can absolutely. There's always a charge nurse who's in charge of making patient assignments. You can ask to speak to the charge nurse, and you can get a new nurse. Don't feel bad or guilty or like you're hurting anybody's feelings. People will be fine. I promise you. They'll go home, and they'll keep going on about their lives if you ask for a new nurse. So I know it can be challenging, especially sometimes for women to speak up about things, and you're worried about hurting people's feelings and things like that, but you can always ask for a new nurse.Meagan: Absolutely. This is not related to birth, but I signed up with a personal trainer at my gym, and I was assigned to this amazing person, and she was great, but I realized a couple weeks into it that maybe we weren't the best fit for one another. I hesitated for two more weeks to say, "Hey, can I switch?" And now that I've switched, oh my gosh, it's the best decision I made, and I get to see her at the gym all the time. I went up to her and was like, "I love you. Thank you so much. This has been great, but this is what I'm doing." It was a wonderful breakup. You don't even have to break up with someone like that, though. You really don't. It doesn't have to be. I was so nervous, but this is your space. This is your birth. This is your experience. You have to protect it and keep it what you need. If someone's not jiving that or that nurse specifically, you can say, "Hey, thank you so much for your services, but I would like to switch." It's okay.Dr. Nicole Rankins: Definitely, Absolutely.Meagan: And you don't want to go back at the end of the day and be like, oh, I had this nurse, and it was the worst seven hours. That's not positive. We want to look at our birth with a positive view, not a negative view.Dr. Nicole Rankins: Yeah. And your nurse is going to be there way more than your doctor. Way more. You definitely want to be in sync with your nurse.Meagan: Yeah. And something else, too. I tell our clients all the time, our doula clients, like, "Hey, upon arrival, if we're not there, say, 'Hey, I would really love a nurse that fits in line with blah, blah, blah.'"Dr. Nicole Rankins: Exactly.Meagan: And a lot of times, they assign it right then, and you're like, "Oh my gosh, you guys are amazing. Thank you."Dr. Nicole Rankins: Yeah, exactly.Meagan: Okay, so next question. What should I consider if my goal would be to have a home birth? So from a hospital OB/GYN, where do you fit in that? What would you suggest? I know a lot of JOBs are like, "Don't go to home."D So yeah, so I personally I would TOLAC at home makes me nervous, but that's because I've seen uterine ruptures before and how quickly things can change. So but however, like in Canada, I think their specialty society guidelines support doing a TOLAC at home after one C-section. So it's not that it's unheard of, but I will say it makes me nervous. Now, if you do want to do it at home, then absolutely have someone who is experienced. This is not the time to have like a brand new midwife. I think you want to have somebody who has some experience in particular with looking for any signs and symptoms of when to go to the hospital. We also need a clear plan for hospital transfer and ideally, that midwife should have a relationship with the hospital so that she feels comfortable going to the hospital in a timely fashion. One of the things that I've seen unfortunately happened during my career with home births that have not turned out optimally is that people are afraid to go to the hospital, so they stay at home too often, and then by the time they get to the hospital it's a train wreck. That's not good for anybody involved. So you want it to be a situation where the midwife feels comfortable going to the hospital in a timely fashion. For example, I work with home birth me bias in my community. I have gone out to the birth centers and things and say, "Hey, if you want to transfer somebody, just let us know. Call."Meagan: I love that you've done that.Dr. Nicole Rankins: Yeah, it's, it's important. So call. Send the records. We have a really smooth process. Nobody bats an eye now when there's a transfer from home birth. Meagan: Oh good.D; So you really want to have those two things in place. A skilled midwife and a good backup plan, preferably with the relationship to the hospital.Meagan: I love that. Such great advice. That's awesome that you're doing that for your community. I just had an interview the other day with a VBAC mom who's toying with the idea, not sure where to go. She asked me and I was like, "Well, you could do dual care. You could establish a relationship with a provider. You can ask your provider out-of-hospital of choice if they do have that relationship," because I do think it is important because sometimes even the midwife is like, "I don't know where to go," so I love that you've done that and gone into the birth centers there. Okay. So we just talked about fetal monitoring, but one of the question was, is intermittent monitoring safe with VBAC just in general?Dr. Nicole Rankins: Yeah. It hasn't really been studied very much, and it's not going to be. That's the thing. It's just not something that anybody's going to sign up for and say, "Hey, you get monitoring. You don't get monitoring," and see what happens in assess that situation for VBAC. So I can't answer that question based on data. I will just say that in general, we want to do continuous monitoring.Meagan: Right. That makes sense. Okay, so small lumps under my C-section scar. What could that be? Would/could it impact the outcome of my VBAC?Dr. Nicole Rankins: It's probably scar tissue.Meagan: That's what I thought when I saw that question come in. I think that dials into like going and chatting with someone like askjanette or a pelvic floor PT or someone who can help massage that scar tissue because anytime we have a cut whether it be from a C-section or you fell and scraped your knee and cut your knee open on a rock or a twig, our body will develop scar tissue, and sometimes it clumps. Sometimes it gets that.Dr. Nicole Rankins: It's probably just scar tissue. And no, it should not impact your ability to have a VBAC.Meagan: Have you ever seen this within your TOLAC world, your VBAC world where sometimes we've got thicker scar tissue and sometimes there's separation within the scar tissue internally as babies coming down and making their way through or uterus is contracting? And so sometimes it can be like, oh my gosh, I've got this burning sensation in my scar which we hear, and it's like, that's concerning because we know that sometimes uterine rupture can be that feeling of burning sensation or pain, and usually that pain doesn't go away and just keeps improving. But have you ever seen that with someone and where they're like, "Oh, I've got this burning sensation," and could it be scar tissue stretching maybe?Dr. Nicole Rankins: Not that I can think of off the top of my head. Definitely, sometimes you have to be careful when you hear people say they're Having pain in their abdomen. Could it be scar tissue stretching? Possibly. That's definitely a possibility.Meagan: It's something that's crossed my mind, over all the years, especially as baby's coming down and putting that extra pressure there.Dr. Nicole Rankins: Right.Meagan: Okay. So again, yeah, this is something that we asked talked about earlier. So to what extent are decels considered normal in early and late labor? Dr. Nicole Rankins: We don't categorize decels based on the stage of labor necessarily. It's based on how they look, and again, over the course of how the tracing looks. Now sometimes right at the end, we're going to tolerate during pushing some decels, because you're pushing and squeezing, so there's going to be decels. So we may tolerate them more towards the end, but other than that, it really just depends.Meagan: Okay, that makes sense. I feel like sometimes as a doula, we're getting into that transition, almost pushing stage and they come in and they're like, "Hey, so we're wondering if maybe you're ready to push here soon or something's going on based off of some decels." Not that they were concerning, but they're seeing them. But really decels in general, overall, you're going to look at a whole versus one contraction or two contractions.Dr. Nicole Rankins: Yep.Meagan: Okay. PROM. So premature rupture of membranes and pre-e with VBAC it says is it still safe? I will answer from my own experience.Dr. Nicole Rankins: Yes, absolutely.Meagan: Yeah, but yeah, time too, with PROM So if we're not having labor begin or we're maybe contracting, like what's handled in that situation, especially knowing that in some hospitals around the world and in the US don't allow Pitocin?Dr. Nicole Rankins: Right, yeah.Meagan: Even though that's also not necessarily a contraindication.Dr. Nicole Rankins: Correct. So with PROM, so water breaking before labor starts, it's not as common, but it does happen. You can do expectant management and roughly within 24 hours, most people will start to go into labor on their own. So you can do expectant management, but Pitocin is actually quite safe in those circumstances. The risk of uterine rupture is low. So Pitocin can definitely be used. You just want to use it carefully.Meagan: Yeah. You mentioned that most people within 24 hours will start contracting and having labor, whether it be active at that point or not. But at what point could it be concerning? And maybe if we have GBS or something like that as a factor, would we be like, "Hey, we could keep waiting for the 24-hour mark," and that's not to go in and have a C-section, that's just maybe to augment. When would you encourage augmentation sooner?Dr. Nicole Rankins: So I'm a little bit of an outlier. I just offer the options, and we can talk about that it may take longer if you wait to augment and that's it. It may take longer, and that's it. That can potentially increase the risk of infection. But we don't really do time limits. I don't do 18 hours or 24 hours. I kind of pick. These are moments for us to have discussions about where things are. So definitely usually 6, 12, 18, 24 and just to touch base and see where things are and develop an ongoing plan. Not necessarily have a hard and fast rule that you have to be delivered or by a certain point makes sense.Meagan: And then preeclampsia. So we have seen this quite a bit in our community, on Facebook and on Instagram where they said, "Hey." There was a post just the other day that said, "Hey ladies, I just wanted to thank you so much for being here in this group. You guys have been amazing. Unfortunately, I have to sign off of this group because my provider said I have to have a C-section now because I've developed preeclampsia," so they didn't even offer the option to TOLAC or monitor. And everyone's like, "Wait, what?" This is a thing? So obviously, we know that we can, and everyone's numbers vary. If we've got severe preeclampsia and maybe that's not gonna be best for the stress of mom and baby and everybody, but do you have anything to say on that? I don't really know if I'm asking a question.Dr. Nicole Rankins: But yeah, no. You can definitely try for a TOLAC in the setting of preeclampsia. Now, if even in severe preeclampsia, it just may take longer. But if we're seeing that you're getting sicker and labor isn't progressing or the baby is under distress, then the safer thing may be a C-section. So if you have severe preeclampsia, for example, and it's affecting your liver and your levels of your liver enzymes are going up, up, up, up, up, and we're not close to delivery, then it's going to be safer for your health to expedite birth, and that's going to be a C-section. So it really depends.But the option of completely taking it off the table, that is not standard or that's not evidence-based.Meagan: Yeah, yeah. And for HELPP syndrome, where it's gone to that extreme. Now we've got platelet issues and things like that. Can someone with HELPP syndrome TOLAC or is that truly a better option to have a C-section?Dr. Nicole Rankins: I would actually prefer if someone ideally is in labor with HELPP syndrome. Actually, a vaginal birth is going to be safer because when your platelets are low and then we're adding surgery, the risk bleeding goes up.Meagan: That is what is so weird to me. My fifth birth was a HELPP syndrome. She was a VBAC, and they're like, "You have to have a scheduled C-section." But then we did all these transfusions and all these things and in my head, I was like, but isn't platelet meaning we have a higher risk of bleeding? But so yeah, that's another question.Okay, I think there's only one or two maybe. Oh, this is a really great question. Is it safe to TOLAC? So again, listeners, TOLAC, if that's new for you, is a trial of labor after Cesarean. I know I've thrown it out a couple times this podcast. After having a hemorrhage in a C-section. So had a C-section hemorrhaged. Now they're wanting to TOLAC. Is that considered safe?Dr. Nicole Rankins: Sure.Meagan: Okay.Dr. Nicole Rankins: Okay. I want to discourage people from using the word "safe" because I think what you really want to know is what are the risks of something happening again? So yeah, because what do you mean by safe?Meagan: Right.Dr. Nicole Rankins: What you really want to know is what are the risks of this thing happening again? So there are no identified increased risks in having a TOLAC after you had a postpartum hemorrhage during a previous C-section.Meagan: Okay, I love that. So that's good because I mean anytime anyone hemorrhages with birth, I feel like it's a little bit on everyone's radar.Dr. Nicole Rankins: Right. Okay, and then I have one more question for you before I let you go, and I don't know if it's Bandl's ring or Bandl's. How do you say that?Meagan: Yeah, Bandl's ring. What is a Bandl's ring for those who it's very new to, and then can you TOLAC or have a VBAC with Bandls ring?Dr. Nicole Rankins: It's a really tight ring of muscle in the uterus where it's just really tight, and it doesn't contract. I can only recall seeing it, like, once in 22 years, so it's not common.Meagan: It's more rare.Dr. Nicole Rankins: Yes, very rare. So it's just really hard to have a vaginal birth if there's a really tight ring of tissue that is preventing the uterus from opening. If the uterus can't open, then the baby can't come out. So that's the issue. It's not like we can release it or clear it up or anything. I don't know why. We don't know why it develops, but it's just, like anything, if it's tightly closed, it's really difficult to open.Meagan: Yeah. Okay. That makes so much sense. And is there a way to find out if we have that beforehand?Dr. Nicole Rankins: Not really.Meagan: Not really. Okay. And the signs of that Bandl's ring is just lack of progression it seems like.Dr. Nicole Rankins: Overall, it seems like lack of progression. And also, the baby usually doesn't come down in the pelvis.Meagan: Yes. Yeah. Okay. Thank you. That was a one-off random one that crossed my mind. I keep seeing that one too. Anything else that you'd like to touch on? I love all of your points of stop considering the word safe and talk about, what are the risks here? What do we need to know to make the best educated decision? Having a collaborative discussion and relationship with our provider. So many great points along the way. Anything else that you'd like to add or say to the community to someone who really is wanting to know all the information they can to VBAC and are unsure of which way to go?Dr. Nicole Rankins: I think that the best thing is just to really find a supportive provider, doctor, midwife, and do that in the prenatal appointments. Ask those questions early, and don't be afraid to change to someone else if you feel. And sometimes you may not have options, but if you have options, then find someone who is the most appropriate for you because that is going to be the thing that most sets you up for success. Oh, also, get a doula.Meagan: Hey. I love it. I will never not advocate for doula, but really, I mean, I love that you're pointing it out again. Before birth, early on, ask those questions. Always have a conversation with your provider. If something is switching, it's okay to switch. I know it's daunting. It is daunting. It really is. I didn't want to cheat. I felt I was cheating on this doctor. We had this relationship. I don't even know what I thought. I thought I was cheating on him by leaving him. And I didn't leave him, and I didn't find myself having the experience that I wanted or feel like I deserved. And, looking back, I probably should have switched. Well, I didn't. I have learned, but I don't want anyone else to be in that situation of, dang it, I saw all the red flags, and I didn't switch because I felt bad.Dr. Nicole Rankins: Yeah. Yeah. I don't mean to sound flippant, but I can guarantee you. Your doctor, if you leave, they're just gonna keep seeing patients. They're just going to go home and keep living their lives. It's going to be fine.Meagan: I know. I had a friend, and she was like, "Looking back, do you realize how it wouldn't have impacted his life at all?" And I was like, "Yes. But in my mind, I had a deeper connection."Dr. Nicole Rankins: I know. In the moment, you can't because you have that emotional connection, and you care about those things? So that's totally natural.Meagan: Yeah. And in a lot of ways, he was saying, "Yeah, sure. I'll support you." But then in a lot of other ways, he wasn't saying this with his words, but he was saying, "No, that's not my thing."Dr. Nicole Rankins: Right.Meagan: So, yeah, you deserve the best and keep doing your research. Find the provider. Get a doula, hands-down. Just a reminder, everybody, we have VBAC-certified doulas on our website all over the world. And yeah, thank you so much. You're the best. And everyone, go follow her podcast and wait it out for these new updates. Yes.Dr. Nicole Rankins: Yes, these new updates are so exciting. I'm so excited.Meagan: I'm so excited for you. That's so awesome. You are just incredible. We really enjoy you. So, thank you.Dr. Nicole Rankins: Thank you so much for having me. 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

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