Noah’s birth story, part 1: the VBAC journey

To keep this as short as possible, I’ll try not to explain the different terms and evidence, etc. If you have questions about any of it, you can ask me and I’ll be happy to answer and provide evidence and research :)

Ever since my c-section with Eli I was determined to be able to have a VBAC (vaginal birth after cesarean) the next time. I had wanted a natural birth with Eli, but I ignored all the information on c-sections. I thought that I surely wouldn’t have one because I’m healthy and so was Eli. Well, I fell into the cesarean trap set up by my OB/GYN. My due date had been set back by 2 weeks even though I KNEW when he was conceived (letting them do that was my first mistake). She talked me into a cesarean because I was 1 day past that early due date and he had flipped breech. She never said he could flip back on his own or that we could try to flip him manually. If I had been “allowed” to at least go into labor first and try different things to flip him, I may not have even needed a c-section. I could have had up to 4 more weeks until labor to fix this. But I figured the doctor knew best because I was naive and didn’t do more research. 

Eli was 10 months old when I found out I was pregnant again. I wanted to find a midwife and have a home birth, but I didn’t really know how to do that. I googled and found a CNM (certified nurse midwife) close by. Back then I didn’t know that there are different kinds of midwives. In Kentucky, CNMs have to work under an OB. This CNM worked under two. Anyway, on the first visit I told her I had a c-section 10 months before and that I want a VBAC. I asked if she could attend home births and she said “no. You can’t have a home birth because you’re wanting a VBAC.” (What?) Well, okay. So I’ll have a hospital birth. Oh well. She then told me she couldn’t guarantee I’d be “allowed” (as if I can be forced to do something...) to have a VBAC because their policy is that you can only have a VBAC if you’ve had a previous vaginal delivery. Since I never had, I had to get special permission. She said she’d talk to the doctors and see if they would allow it. She then educated me on all the risks of a VBAC (but no risks of a repeat cesarean??). She talked about uterine rupture, of course, and made it sound horrible! I left the appointment being absolutely terrified of trying to VBAC because I didn’t want my baby to die. I did a lot of research and found that what she was talking about was called a catastrophic uterine rupture, which is really rare. Uterine rupture risk is less than 1% and most of those are asymptomatic. Uterine rupture can even happen to people that have never had a c-section. 

I knew I would have a better chance of having a hospital VBAC if I had a doula to help me make informed decisions and make the labor atmosphere more comfortable. I asked Robert to let me have one but since it would cost a few hundred dollars, he said no. After more fear mongering appointments, I cried and begged Robert to let me hire a doula. He finally said yes, if it would help me, then I could have a doula. That meant so much to me :)

I found a doula online and went to meet with her. I loved her! I told her my fears of the VBAC and of a repeat cesarean and she made me feel loads better. She educated me on some facts of birth. I also told her my concerns with having to deliver in the hospital with their crazy, cesarean trap policies for VBACs. She asked if I had considered having a home birth and told me what kind of midwife I would need to do that. I talked about it with Robert it and he said no. The CNM had scared him about the risks, too. Poor guy. I talked about switching providers, but Robert said we didn’t need to do that. So I held off for a while.

At one of the appointments, my fundal height was measuring a little big (like 1 or 2 cm bigger) so they ordered an ultrasound to make sure there wasn’t excess fluid. I prayed about it and hoped it wasn’t anything serious, but the ultrasound confirmed that I had a little excess fluid. My AFI (amniotic fluid index) was 1.5 above normal, which really shouldn’t have been a concern at that point since fluid can fluctuate and my fluctuation was mild. The CNM said that I have polyhydramnios and that “unfortunately, this makes your VBAC out of the question.” I asked why I couldn’t have a VBAC just because of a little excess fluid. She mentioned risks associated with polyhydramnios and mentioned “liability” and the doctors and such. I told her I could just refuse a c-section and she said “yeah, you could, but then I would get in trouble with the OBs and they would ask if I told you about all the risks, etc.” I asked “what decides whether or not I get to have a trial of labor?” She answered, “it depends on which doctor is on call.”

This is when I decided I have GOT to find a different provider because these people are obviously against my VBAC. There were many other red flags that I should have seen sooner (like them saying that my pelvis looks too small to birth a baby the size of my last one by just looking at my body), but Robert assured me that everything would be okay.

Since I was having this fluid problem, they referred me to a perinatologist in Louisville to make sure that there weren’t any problems with the baby that could be causing it. I asked if there were any perinatologists closer to us (Louisville is 3 hours away, plus the time change to eastern). The CNM said there are, but they work closely with this guy in Louisville and it’s just easier for them if I go there. She said this guy is who she would send her daughter to, because he was just that good. So I thought “well, I want the best for my baby, so I’ll go to Louisville.” 

I had another ultrasound a few days before Louisville, and it showed that the fluid had decreased and now I was only .5 over normal. Yay!! Baby was still breech and they made sure to tell me about that. I was 29 weeks pregnant. This concerned me because Eli was breech and I was afraid of that happening again. I met with the CNM after the ultrasound and she said she still wanted me to go to Louisville. I told her I could have my VBAC now and she said I’ll just need to see what the perinatologist says about my wishes for a VBAC. Um, okay...because he decides what I get to do with my body and baby. Over the next few days I prayed specifically that my fluid would be normal and that the baby would flip to head down.

Before the big Louisville appointment, I was secretly searching for a new provider. I did lots of internet searching and just happened to stumble upon people that I could talk to that gave helpful information and put me into private facebook groups that are dedicated to home birth in my area. I was again considering home birth, but I didn’t want to talk to Robert about it again until I had potential midwives and resources to put his mind at ease. I interviewed several midwives, but none of them were going to work. They either couldn’t attend VBACs because their back up doctor was against it or they were too busy for my birth month to be able to take me on. One person even said she wasn’t sure she could take me on because of the possibility of me having a big baby! (I wasn’t going to hire HER!)

After looking at all the midwives I had found from other people and not having any success with it, I accidentally found a midwife in Missouri (close to us) that seemed perfect. 20 something years of experience, half the price of the other midwives, able to provide a birth place free of charge (I’d rather not go to a hotel). I decided to interview her. She seemed wonderful. I liked her voice and she seemed truly supportive of my VBAC. She even told me what I could do to try and keep the baby from getting too big. I was seriously considering hiring her. I just needed to get the okay from my husband. After MUCH discussion and persuasion from a close friend, Robert finally said he’d think about it. He was still unsure about it, but I did everything I could to get his questions answered and make him feel more comfortable. Turns out that his biggest concern was the money since insurance wouldn’t cover it...but we discovered that the hospital would cost WAY more since we didn’t have maternity insurance (LONG story).

When we got to the Louisville office, I got a high tech ultrasound and saw my baby’s sweet face :) The ultrasound showed that he was now head down and that my fluid was within normal range!! I was super happy about this! I was so happy that I cried. Nothing was wrong with my baby!!

Then the perinatologist came in looking gloomy. He hands me a tissue and tries to make light conversation. I was thinking “let’s get on with it already.” He obviously had something bad to say. He didn’t look at my ultrasound results. Now, this part that I’m about to tell is not at all an exaggeration. It is exactly what happened, no embellishment.

He said that with my history of a big baby (Eli was 9lbs 5oz) and the fact that this would be my first vaginal delivery AND it was after a c-section, that my VBAC would fail.

Here are some things he said (again, I promise this is NOT exaggerated. These are his exact words):

-Your passenger (baby) is just too big. He WILL be over 10 lbs.

-You will not be able to push this baby out of your pelvis (funny, since he didn’t even examine my pelvis...not that that would tell them anything about my ability to birth)

-Even IF you can deliver this baby, you will most likely hemorrhage and lose your uterus. You want more children, don’t you?

-And if this baby is delivered vaginally, you will get a 4th degree laceration and have to wear diapers for the rest of your life for incontinence issues. You’re young and you don’t want to have to wear diapers for the rest of your life.

-The second c-section is easy. Even the third one. Just real quick incision and no problem (does this guy know anything about the risks of cesareans!?!?)

-I know you want the best for your baby, but you have to think of YOUR health, too.

-I strongly advise against a vaginal delivery.

-I could be wrong, but I’ve been doing this for 27 years and I’m almost never wrong.
-Whatever happens, please let me know how it went. Let me know if he turns out to be 12 lbs or something. (oh, I’ll let you know how it goes)

Well, maybe if I delivered in that horrible environment with those providers that think pregnancy is a disease then he might be right and my VBAC might fail.

We left the appointment and I cried so hard. Robert was extremely upset by all he heard. Now Robert knew I wasn’t crazy. They really were against my VBAC for reasons that have nothing to do with the safety of my baby or myself. They wanted to cover their butts. Robert couldn’t believe what that guy had said. Also, he didn’t even address the fluid issue which is the whole reason we were there!! For whatever reason, I’m sure that he was told by the doctors back home to tell me all of those things. They think they’re clever. First they pull the dead baby card (that didn’t work), then they pulled the dead mommy card (that didn’t work) and now they’re telling me I’ll never be able to have children again (that’s not going to work either, sorry). 

I wasn’t being stubborn just to obtain an “experience.” You can be sure that I only based my decisions off of actual research of conducted studies and off of ACOG guidelines/bulletins. I was doing this VBAC for the health of my baby and myself AND my future babies (yeah, cesareans can affect future pregnancies in very dangerous ways). I was doing this because I want a healthy baby and healthy self.

Anyway, we left that appointment and Robert said we are going to have a home birth. So I called the last midwife I interviewed, Joann Falcon of Missouri, and hired her. My first appointment with her would be at 33 weeks pregnant. I cleaned out my records from the CNM/OBs office and never showed up to my follow up appointment to discuss what happened in Louisville. 

Now that I hired the midwife, I was much more confident in my ability to do this. My first appointment with her was great. She assured me I was very low risk and that I was doing the best thing for my baby. For the first time in months, I left a prenatal appointment NOT crying. I was happy. She didn’t try to put fear in me. She encouraged me and it was obvious that she believes in the woman’s ability to birth babies. She doesn’t think pregnancy is a disease or a train wreck waiting to happen.

During this pregnancy, I stressed so much over this whole thing. I did SO MUCH research, I could write a dissertation. Someone even told me I deserve an honorary doctorate, which isn’t true, but maybe that gives you an idea of how much work I did.

I also did many things to prepare for birth. I read books and did certain exercises. I only positioned my body in certain ways so that the baby would be in the best position possible for birth (totally hated doing that stuff). I even changed my diet a little and did simple weight lifting exercises to keep the baby from getting too big. I worked very hard for this VBAC to happen and I prayed so hard for everything to be perfect. Many, many tears were shed during this pregnancy. Those tears were few after I switched providers, though :)

For my birth story read: Noah’s birth story, part 2: birth