VBAC: Vaginal Birth After a Cesarean

I found a groove when I first started this blog – until my husband, Gonzalo, and I welcomed our second baby. Enrique was born in early May 2020 – right as things were ramping up with COVID. I’m back, just under 11 months postpartum and ready to tell my story about having a VBAC with our son. 

It’s hurtful to hear statements like “you and the baby are healthy and that’s what matters” when sharing negative feelings about a child’s birth not going as planned. While I like to believe most people mean well, I would love to offer a different perspective. A healthy baby is what every parent wants – that goes without needing to be said. However, a broken mother is honestly no good to her newborn baby. The birthing mother’s feelings matter – A LOT.

How women are treated during prenatal appointments, while she’s in labor making tough decisions, and how she feels when the big event is all said and done. These things all play a vital role as we transition into motherhood. Whether it’s her first or fourth baby – each postpartum journey is a bit different. For me, it was one of the most vulnerable and challenging journeys. Full of self discovery and sometimes even self loathing. 

Choosing between a Repeat Cesarean or VBAC

Choosing between a repeat cesarean or a vaginal birth is a very personal choice. Birth carries risks regardless of which way the baby enters the world.

Our daughter, Olivia’s, birth was a planned cesarean – read all about my experience in this blog post. When I found out I was pregnant again – I knew I didn’t want another surgical birth. I’m not saying there is anything wrong with a woman choosing a cesarean. However, repeat cesareans carry higher risks. These risks are not discussed as often. I disliked many things about having a surgical birth, so this was definitely not my first choice. 

If you Google VBAC (Vaginal Birth After Cesarean) the amount of information is overwhelming. Is it safe? What exactly are the risks? So many statistics and different scenarios. The dreaded uterine rupture – which is a blanket term for different ways a uterus could separate during labor. Did you know it’s possible for a woman’s uterus to rupture even if she never had a cesarean? It mainly occurs from aggressive inductions. Crazy, but it happens.

Every Pregnancy is Different

I knew I was pregnant before I even peed on the stick. I’m highly in tune with my body, which can be a blessing and a curse. My pregnancy with Olivia was really easy and enjoyable for the most part. With Enrique, I had terrible nausea. I’m talking all day, every day for the entire 1st trimester. I took Vitamin B3 during the day, but it never made the nausea go away. These two very different first trimesters had me convinced (and truly hoping) we were having a boy. 

I spent the majority of this pregnancy learning (well, actually obsessing) about the history of VBACs. Learning how places in the US have VBAC bans, searching for statistics, and listening to hundreds of birth stories on podcasts.

I did my best to prepare mentally and physically to have my VBAC at a local birth center here in the Portland – Alma Midwifery, Regular exercise, Spinning Babies Daily Essentials several times a week, drinking Red Raspberry Leaf Tea, and eating dates at the end of pregnancy. Tried all of the things. I received a copy of HypnoBabies and wanted to follow the program. But, it is a huge time commitment and requires consistency. Which was just too much while I was home caring for our toddler.

Choosing a Birth Center for a VBAC

The main reason I chose a birth center for my VBAC was to be in a low stress, supportive environment. Away from medical machines and procedures designed to monitor (and let’s face it, attempt to control) the labor and birth process. I don’t like hospitals, they remind me of illness and death. As a VBAC mama, they also want you hooked up to continuous monitoring and require you to have an IV “just in case”. You’re automatically labeled high risk. I wanted autonomy and to be supported during my labor where I wasn’t treated differently for having a scar on my uterus.

The Global Pandemic Changed Everything

Gonzalo’s job announced on March 12th, 2020 that all employees will be working from home until further notice. It has now been a year and his job has extended the work from home through for the rest of 2021 as well. 

As stay at home orders started taking effect, I realized I would have to make some adjustments to my birth team. In addition to the midwives from the birth center, we hired a birth photographer and a doula. We had an amazing doula for the birth of our daughter and hired the same one for this pregnancy. Her support while I labored unmedicated was a huge part of my plan for coping with the intensity.

When the company she worked for called us, I knew it wasn’t to deliver good news. The hospitals here in Portland were not allowing “visitors” to accompany laboring women. Therefore, our Doula could not be with us for the birth. We had the option of virtual support – but that just didn’t work for me. Physical support and her touch was what I needed. I didn’t want to talk to her through a computer screen. I couldn’t hold back the tears as I spoke with the owner of the company. Everything was changing and I was scared. We decided to terminate the contract and received a partial refund.

Prenatal appointments were held over the phone until I was 36 weeks pregnant. Nine weeks without hearing the baby’s heartbeat or having my vitals checked. Thankfully the birth center was allowing two support people to attend my birth – but, siblings were no longer permitted at the birth center.

Going into Labor for the First Time

Labor started naturally at 1:30am when I was 40 weeks and 2 days. I was experiencing period like cramps for weeks, so when I woke up in the middle of the night to pee, I didn’t really think too much about the cramping. Something was different. When I wiped, there was blood. I was having my “bloody show”. I’ve read and heard from many other mamas that it’s best not to get too excited. Rest as much as possible during early labor, they say. I tried to go back to sleep, but couldn’t knowing I would meet my baby soon.

Instead of waking Gonzalo, I went to the kitchen to make tea. I stood there hanging onto the counter while swaying through contractions. They weren’t too bad, but I felt like I already needed to stop what I was doing to concentrate. I filled my tub to labor there for a while. The water seemed to intensify things instead of slowing it down, like I’ve also read. It totally psyched me out and I started to think how hard it must be to cope when transition started.

I called my midwives around 8am. Contractions were 3-5 minutes apart and lasting around a minute each. A midwife came to our home around 9am to check on me and baby. All of our vitals were fine and we decided I would come to the birth center around 11am. The ride over was a blur. I remember closing my eyes the entire time. I moaned and tapped on the door during contractions. The tapping soothed me. It helped me feel grounded and present.

A warm bath was waiting for me upon our arrival. It was such a low key, peaceful, and home like environment. 

Making the Decision to Transfer to the Hospital

I could not find my groove in active labor. I asked for a cervical check and was surprised to be at 7cm. The sensations running down my glutes and lower abdomen were much harder to handle than I ever could have anticipated. For several hours, contractions double peaked and it felt like there was no time in between to rest. I tried every position… backwards on the toilet, tub, ball, stool, bed, hands and knees. I knew I needed to surrender, but I could not relax my bottom.

After getting in and out of the tub several times, I started to feel cold and began shaking uncontrollably. I asked for another cervical check. Still at 7cm after hours of tough labor. Tapping and moaning became pounding and roaring through contractions. My mouth started to go numb a few times and filled with saliva – you know that feeling right before you’re about to puke? I couldn’t control the noises coming out of my mouth. My body involuntarily began to tense after the first peak. At this point it was expecting the second intense peak. I asked to try nitrous oxide. Unfortunately, it did nothing for me. I was unable to surrender and knew I needed medical intervention that was unavailable at the birth center.

Arriving at the Hospital

Around 3:30pm I decided to transfer (I might have even begged) to the hospital and get the epidural. I was visibly distressed and no longer in control. It took a long time to receive a call from the hospital to make sure there was space for us. We finally left around 6pm. The walk down the stairs in the birth center and out to the car was not fun. At one point during the very short 8 or 10 minute drive I felt like I had an out of body experience. What a disorienting feeling. Almost as if I was no longer connected to my body. 

Because of COVID, the midwives could not transfer to the hospital – which was normal protocol. Our birth photographer also could not come with us. So, we were truly on our own. Thankfully, I educated myself in the birth process and interventions that I might encounter attempting a VBAC. Once we were at the hospital, I got the IV, had my blood drawn, and they hooked me up to several machines. It was going to be a while before I could get the epidural. The nurse offered to put fentanyl in my IV. She said it would help to take the edge off. That was a mistake! It only made me incredibly dizzy. 

Getting the Epidural

I received the epidural around 7:30pm. A huge sense of relief took over after clenching my butt for hours on end. The anesthesiologist gave just the right dose. It was enough to make the electric like sensations magically disappear – and I was able to move my legs pretty well on my own. As I laid in the bed with restricted movement, the exhaustion began to set in. I labored with a peanut ball in between my legs. The staff kept coming in and out of the room to check the monitors and help me turn to the other side every 30-45 minutes. The midwife was attending another birth and did not come in to see us until after 10pm. 

Around 1am the midwife came to check my cervix for what felt like the 5th time in just a few hours. She moved the cover and said “Oh wow! Your bag of water is literally bulging out of your vulva”. I reached 9cm. She offered to break my water and felt this was the “push” my body needed to reach full dilation. Meconium came out with the water, but thankfully she wasn’t concerned. I was one step closer to having my VBAC. 

The hospital staff annoyed me several times. Anytime we met someone new, they always started the conversation with “So, you transferred from Alma”? As if I wasn’t already dealing with enough. With the continuous fetal monitoring, anytime you move it messes up the reading. Enrique’s heart rate dropped once to around 110 after a contraction. The midwife wanted to insert an internal fetal monitor – they put a needle into your baby’s skull to better read their heart rate. I declined. Then she brought in paperwork with a success rate from a VBAC calculator. She told me the risk of a rupture was 1-1.5% and I had a success rate of 79%. Given the risk of my VBAC, she still offered me a repeat cesarean. I had to sign paperwork and everything. Seriously.

My VBAC was Becoming a Relaity

It took about an hour to complete dilation. Exhausted after laboring for over 24 hours with barely any sustenance. I managed to get a bowl of oatmeal down early in the morning when labor started. I made these amazing little treats with dates and oats. But, it was so hard to get anything down while I was unmedicated. The hospital doesn’t allow you to eat “just in case” you end in the OR. Which really does women a disservice. Gonzalo went to get pizza and I took a few bites, but it gave me terrible heartburn.

The staff wanted me to start pushing as soon as I reached 10cm. I tried one push and felt my stomach acid rising into my throat. My heart dropped and all I could think was how will I find the strength to push this baby out. Maybe I won’t be able to do this – I should just ask for the cesarean and then it can all be over. Instead of making an impulse decision (which I do often), I asked if I could rest before trying to push again. The midwife said she would come back in about an hour. There is an illusion you are being left alone. But, the nursing staff was in and out of the room making noise. It was impossible to rest. 

I Pushed a Baby out of my Vagina

This was my first vaginal delivery and the midwife said I would push for 2-3 hours. All I could think was – there’s no way I’m going to sit here and push for hours. She inserted her fingers during every push to coach me. At first it felt annoying, but she was really helpful and encouraging. I pushed 3 times per contraction – while a nurse and my husband each supported a leg. I grabbed behind my knees for leverage. Definitely not how I envisioned giving birth.

I made progress with every push – I was finally feeling like I would have my VBAC after all. After about 30 minutes of pushing the midwife asked if I wanted to reach down to touch his head. I have to admit, it was pretty powerful to feel his goopy little head there. It gave me that last bit of energy I needed to bring him earthside.

After 45 minutes of pushing, we were finally ready to meet Enrique. Even with the epidural I was surprised by the pressure in my bottom. I’ve heard many birth stories where the woman refers to feeling like she needed to take the biggest poop of her life as the baby was emerging. After I pushed for what was supposed to be a 3rd time, the midwife stepped away. I could tell by the stinging sensation on my perineum he was crowning. The pressure was so intense and I wanted some relief. I took another deep breath and pushed a 4th time expecting his head to emerge – as I’ve seen dozens of times in birth videos. Instead, he came flying out plopped right on the bed, surprising everyone. I was so tired and gave it all I could. There were a few tears on my labia that needed stitches. 

Once the Dust Settled

I had a meltdown once I was able to relax and begin processing those intense 26 hours. And honestly, even 11 months later I still have days where I struggle to be kind to myself. I tend to think about how intentional I was and put so much time and effort into preparing for this birth. Then I so easily gave up on my desire to have an unmedicated birth. How there are many women in my life that gave birth unmedicated. Or, how the pandemic took away our doula. I cannot help but to believe if I had our doula there to support me I might have made it to the end. I’m still really damn proud that I got my VBAC, and proved that it is a safe and perfectly acceptable option for most cesarean section mamas. But, my mental health has suffered in a big way.

The pediatrician at the hospital commented on the shaping of Enrique’s skull and said he was presenting asynclitic. Which means his head was tilted to one side making it difficult for him to enter the most narrow part of the birth canal. Spinning Babies has a great explanation on their website. This explains the electric-like shocks going down my glutes and legs, why my contractions were double peaking, and why I stalled at 7cm for hours. 

Enrique screamed for almost an hour after he was born. No interest in latching to eat for the first time. After dealing with an inconsolable baby for over a month, I took him to my acupuncturist. If you are local and looking for an amazing provider – pregnancy, postpartum, or pediatric – Sivan Dirks is truly special. He had so much tension in his neck after getting stuck in the birth canal all crooked. He had terrible discomfort whenever lying on his back. We were able to help loosen his muscles and ease the pain with a combination of craniosacral and acupuncture appointments. 

Postpartum Recovery After a VBAC

My recovery from this VBAC was very different from Olivia’s cesarean. We stayed 3 nights at the hospital for the cesarean. With the VBAC we discharged when Enrique was 12 hours old. I was able to get around and didn’t have searing pain from an incision. The tears on my labia healed nicely. I took several sitz baths and allowed my vulva to breathe whenever I could. It was scary the first time I pooped! One of the midwives told me to use a warm compress and put counter pressure on my perineum. Definitely gave me the confidence to just let it go! 

I asked for a vaginal exam at my 6 week postpartum check in with the midwives. When I finally got the courage to look in the mirror, my vagina still appeared swollen. Turns out I developed bladder and uterine prolapse. Too much to share about that. So, I will defer that to a later blog post!

Final Words

My mental health suffered greatly these past months. Not only is postpartum already isolating, but this pandemic made it worse. Enrique was a difficult newborn. We had many struggles breastfeeding. We worked with 4 different lactation consultants before finding the right one.

Even though it seems like enough time has passed, I still have trouble talking about Enrique’s birth without feeling sadness or embarrassment. Gonzalo likes to remind me that hindsight is 20/20 and that I accomplished what I wanted in the end – to have a VBAC. But, just as I said in the beginning of this post – a broken mother is honestly no good to her newborn baby.

Did you have a traumatic birth experience? A VBAC? Repeat cesarean? Have advice on how to cope when birth doesn’t go as planned? We’d love to hear from you!

Until next time!

XO

Brittani