By Nancy Dellamaria IBCLC
VBAC, or “Vaginal Birth After Cesarean” refers to a type of childbirth whereas a woman in labor has a scar on her uterus from previous cesarean birth(s.) Depending on the Doctor, and the state, a woman may attempt to have a vaginal delivery by what’s called a “trial of labor” vs. planning a repeat cesarean. Both options have risk, but it is felt that the main risk of laboring with a scar from previous cesarean delivery, is Uterine Rupture. Although devastating, the chance of Uterine Rupture during VBAC is considered less than 1%. Prior to the last 25 years or so in the US, , OB/Gyn’s considered a woman who needed prior cesareans to always need cesarean deliveries in the future. “Once a c-section, always a c-section “ was a common phrase describing these women. In the past 25 years, the pendulum has swung both ways around the country, leaving women birthing in some communities with little or no choice in the matter, versus being an active participant in planning her child’s birth.
With the rising rates of first time cesareans in the US, we have needed to take a look at the amount of VBAC’s that have been banned in many communities. Overall, we are doing far too man surgical births. The American College of Obstetrics and Gynecology (ACOG) is the medical body that makes recommendations on this topic. (https://www.acog.org/-/media/ACOG-Today/acogToday0810.pdf?dmc=1&ts=20190519T0159465692)
In addition, The American College of Nurse Midwifery feels that our primary c-section rate in the US has more than doubled the WHO’s (World Health Organization) recommendation, and that many women in the US have poor access to safe birthing practices. http://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000000075/ACNMResponsetoVBACBulletin_082610FINAL.p
Non-profit agencies such as ICAN, (International Cesarean Awareness Network) and La Leche League encourage women to prepare for birth in ways that supports her being an active participant in her birth. A good Childbirth Education class can help parents understand that there are things they can do to attempt to have a more fullfilling birth. By promoting the value of a first time natural delivery whenever possible, supporting Moms who are attempting VBAC, and making sure families have the right information about getting breastfeeding off to a good start, parents are learning how they can keep birth as natural as possible. They learn the differences between home, hospital, and birthing center births, the different types of physicians and midwives who assist deliveries in these locations, and how a Doula, or Labor Coach, can impact how things go tremendously through pregnancy, labor, delivery, and post partum. Having this support team can lead you to other specialists you may need such as Chiropractor or a Lactation Consultant . Planning and preparation can greatly lower the chance that a woman will need a cesarean delivery the first time. There are always some variables we can’t control. There is an expression that it sometimes used by the medical field stating that by the end of the day, as long as there is a “Healthy Mom and Healthy Baby,” then that’s a successful birth. The truth is , a successful birth is one where the family is wrapped in a blanket of love and support, regardless of the outcome.
I took my first doula training when I was pregnant with my first daughter in 1996.
I was inspired by a young friend who had a beautiful water-birth at home with midwives in CT. She shared her birth story with me, and let me see her video. Watching her birth video made me cry. It was so pure and raw and beautiful . I had also attended my sister’s very medical birth of my niece a couple of years later. My sister, an RN, had her first and only child at 30. She went past her due date, and therefore, was induced. I tried to encourage her to “go natural,” but she couldn’t see the value. As an RN, she was used to helping people out of pain. She had witnessed only one very painful birth in Nursing school, which had imprinted on her. She couldn’t imagine why anyone wouldn’t take the epidural from the get-go, and preferably a c-section to cut to the chase. This was simply what she was taught.
As planned, my sister convinced her OB to give her an epidural as soon as possible, Her baby’s heart rate didn’t respond well, and an emergency C-section was done. My sweet baby niece was born healthy and perfect via cesarean. I felt relieved and a bit disappointed, as I had not yet attended a vaginal birth, and wanted my sister to be healthy, and not have to recover from major abdominal surgery. . She had a very difficult time breastfeeding. She had an awful time with engorgement, and couldn’t keep up with 12 hour shifts when she went back to work as an ER Trauma RN at 6 weeks post partum. She had no choice as a single mother, but to go back to work once her leave was exhausted. This was just before President Clinton passed the FMLA, (Family Medical Leave of Absence ) in 1993. I wasn’t sure what to do to help her then. I loved feeding my sweet baby niece bottles of her Mommy’s milk when she went to work. I would snuggle her close just like a mother would when nursing. We lived together as sisters, health care professionals, and came from a huge family of many aunties who had gone before, and yet, her socio-economic situation was different than theirs. I realized, that we still didn’t have all the information we needed. I knew that I wanted to be more prepared when I had my own children. It was then that I decided I wanted to become a Doula, and possibly a midwife.
Four years later, when I was pregnant with my daughter, Sage, I believed that the only civilized way to birth was have a water birth at home with midwives, just like my friend had. I established myself with a standard University Hospital variety of OB/GYN in the San Francisco Bay Area in California for the first half of my pregnancy, establishing myself as a patient in case I needed to go to the hospital. For the 2nd half of my pregnancy, I hired local very experienced Certified Professional Midwives who attended home births.
As my due date got closer, we prepared for the water birth by renting a birthing tub in Santa Cruz. It ended up being a durable plastic cattle trough! Yes, I was preparing to have a water birth, in a cattle trough in our 1 bedroom apartment in a very crowded apartment complex in Silicon Valley with people living above, below, and beside us on both sides. “Little Boxes, Little Boxes…….” Afterwords, I realized that I did not feel safe in this environment.
My due date came and went, and there was no sign of my little darling coming.My labor assistants helped try everything. I also had a doula who was sitting for her midwifery boards, as my labor coach. When my time came, I experienced something I hadn’t heard of before called “prodromal labor.” Technically, I had 5 days of contractions every 10 to 15 minutes or so around the clock, that were not changing or opening my cervix. They were just enough to hurt, make me miserable, and exhausted. When active labor kicked in, I spent another 12-14 hours laboring in and out of the tub while by birth team lovingly fed me, and helped me cope. By morning, when I just didn’t seem to be dilating past 6cm, and was absolutely exhausted, my midwives recommended that we go to the hospital for some Pitocin to augment labor. By that time, an epidural as well, since we had not slept for almost 5 days now.
Another 10 hours later, with no change to my cervix, my 42 week, (2 weeks overdue) 10 lb. 2 oz. baby girl came into the world via cesarean section, and arrived with a perfectly round head (she never descended into my pelvis,) and a voracious appetite. My milk didn’t come in for 5 days, due to several factors that I wasn’t aware of at the time such as PCOS, obesity, and not the least of which, a long labor, and a cesarean delivery which included tons of fluids and medications pumped through my system.
My daughter was big, beautiful, and healthy. With the help of midwives, my mom, and La Leche League, we got the hang of breastfeeding. But I couldn’t help feelings of disappointment, and failure that I hadn’t reached my goal. I even heard the term “Labor Dystocia.” Which meant that labor stalled. I lost faith in my body’s ability.
We moved to the east coast to be near my family when my daughter was just a few months old. I became very active in La Leche League, and went on to breastfeed my little Sage for 2 years. Breastfeeding, and another Doula Training once we moved back to Massachusetts, helped me process my grief and renew my faith in my body. We once again, began to try conceiving a sibling for Sage. Little did we know we would encounter additional infertility challenges ! After another year and a half, I was able to conceive again.
This time, we were living near family, and owned a nice home in the suburbs in MA. Although I definitely wanted to plan a VBAC delivery, I was not comfortable with the idea of a attempting this type of delivery at home, so I found an OB/GYN who would support me in this choice. My pregnancy was uneventful. I had been working on and off as a childbirth doula in the 4 & half years since the birth of my first child, while working my “ day job” in healthcare as an MRI Technologist. My best friend and doula partner and I attended each other’s births. Our oldest 2 girls were the same age when we met at a LLL meeting. Two years later, I was her doula when she delivered her 2nd child, in breech presentation. And she, in turn, would attend mine. We learned to become an awesome team in conjunction with our volunteer work as La Leche League Leaders. “Tag Team Doula Service !”
She helped me to prepare for a VBAC hospital delivery. Fortunately, I did not go overdue. I started labor with my second little girl a day or so after my due date. It was the Sat. Night before Halloween. My sister took my little girl, Sage, 4.5 years old for the night. She would be taking my daughter and her’s, my niece now 8 years old, to a family kid’s Halloween Party the next afternoon. I labored through the night, managing my contractions well with no change to my cervix. I started to get discouraged , thinking that this would be another cesarean delivery. But by early morning, my best friend & doula partner, Sheila arrived. We got up, walked, bounced on the ball, and kept moving, and my contractions became “longer, stronger, and closer together.” This is a phrase we often teach in childbirth education to explain how contractions may feel throughout labor. My labor progressed slowly until that afternoon. My Mom came to join us, and I asked for a “squatting bar” to use at the end of the table. Somewhere around 6 cm of dilation, the same point at which my labor stopped in my first birth, the pain, fatigue, and fear became unbearable. I asked for an epidural. Shortly afterwards, I was simply not getting any relief. I did not allow them to do another one. No relief after all that just didn’t seem worth it. Soon, I passed my stuck mark, and when I asked to be checked, we found that I had reached 7cm. A few minutes later, my nurse, by my bedside asked me how I was doing. I told her I was ready to push. She reassured me that I had just been checked, and that we’d check again when the doctor came in.
I started to hear myself grunting, and knew I was pushing the baby down. My nurse, who was also an experienced home birth midwiturned Labor and Delivery RN, she recognized immediately by these signs that I was actively pushing. In only another minute, she looked down to see that my baby girl’s head was starting to show. She hit the alarm on the wall and got into position to catch my speedy little girl. With two pushes, she was out, into the gentle arms of my RN/midlife. My 2nd daughter had arrived on time, weighing only 7lbs. 6 oz. and had been safely delivered by VBAC.
It had been 13 minutes from 7cm of dilation to delivery ! It was as though I had gotten the vaginal delivery I wanted with a midwife, just as I wanted. I was amazed ! I found it incredible that it could hurt So badly toward the end, and then be painless just moments later. She went right to breast and stayed there for 2 years, like her sister. I was amazed that a couple hours after birth, I was able to take a shower, and visit with my family as we welcomed this new member of our family. My sister had showed up with our big girls in Halloween costumes, just as I pushed little Chloe into the world. Even my sister’s faith in birth was renewed.
My milk came in much sooner, after about 48 hrs. I had my own renewed faith in my body and in birth.
A few years later, my sister in law, Tekoa King CNM, co-author of Varney’s Midwifery,
( 3rd edition,) was helping to edit the new edition of Our Bodies Ourselves for a New Era by the Boston Health Collective. She was writing a section which included childbirth quotes from real moms. She asked to interview me and have my story published (anonymously) about my VBAC. Her card and the article read like this:
Currently, we live in a community whose only hospital with a Labor and Delivery dept. has VBAC Ban. With a very high primary cesarean rate, women who stay in the area and have future pregnancies, are not allowed to have a VBAC at the local hospital. We have a wonderful set of skilled Certified Professional Midwives who are able to assist women with VBAC deliveries safely at home. But many women don’t fit the profile, or risk for birthing at home. Another option is that they are able to birth by VBAC in hospitals that are a few hours away. In addition to the inconvenience of possibly leaving other children at home, they must come in early to be induced, so they do not delivery a baby in the car or En Route. These types of options are not for every woman. If she is lucky, she will have learned these things ahead of time, and hire a doula, a labor coach to support her and her partner through her birth. Doulas and Midwives understand how very important it is for women to have access to choices. I believe our community could additionally, benefit greatly from an active ICAN group to help reverse this VBAC Ban. It takes a strong birth community, awareness, and activism in order for change to occur. We grow stronger every year, and hope to continue with our progress. I am incredibly grateful to be part of this community of support who surround women and their families during the childbearing year.
Nancy Dellamaria IBCLC
(International Board Certified Lactation Consultant)
Certified Doula, Childbirth Educator, and La Leche League Leader
Sister to Sister Birth 