You've recovered from your c-section and you're ready to welcome your next baby into your family. You've been researching your birth options, and you have decided you want to go for a VBAC (Vaginal Birth After Cesarean). Maybe your c-section birth was traumatic or maybe you just don't want to go through another abdominal surgery unless absolutely necessary - it doesn't really matter WHY you chose a VBAC; the question you're facing now is, "What do I do next?"
Well, I'll tell you, and you should listen carefully. This could be the decision that makes or breaks your VBAC. A quick Google search would produce tons of recommendations for activities, birth classes, diets, supplements, chiropractic care and pretty much anything else you could imagine to help you along in your VBAC journey.
As a successful VBAC mom myself, however, I think there is one vital piece of the puzzle that will make all the difference in your VBAC plans -
A Supportive Birth Team.
You can do everything "right" and have the healthiest pregnancy ever, but if you don't have a birth team that supports your VBAC plans, you will have a much harder time following through with those plans.
First on my list were my mom and husband.
Of course, they both said they wanted to support me in whatever I decided, but it was also important to me that they know the research and the reasons behind why I chose to have a VBAC. I knew that when the exhaustion and hard work of labor took over, I would need them to know my wishes and be able to speak for me if I couldn't.
Next, I needed a new OBGYN.
In the state of South Carolina, there are limitations on VBAC moms. It is against the law in this state for a midwife to attend a VBAC birth outside of a hospital. That rules out homebirths or birth center births for moms like me who are uncomfortable with an unassisted birth. Here in Charleston and throughout the lowcountry though, we are fortunate that the majority of our hospitals do allow VBACs. Only a small number of OBGYN practices ban them altogether.
Unfortunately, I discovered that the obstetrician who delivered Bug via c-section was a part of one of the few practices with a VBAC ban. I knew I would have to break up with my doctor if I wanted to move forward with the birth I was planning. I'm not going to pretend it was an easy "Bye Felicia" to leave that practice. Most of the doctors I had experience with there were kind, wonderful people. My decision to leave was solely based on the fact that their practice did not align with my beliefs about my birth and my care. We women sometimes need to be reminded that we are the decision makers in our own births and health care. We have a right to ask questions or seek other opinions or break up with doctors who may not line up with our preferred standard of care.
If you aren't sure what to look for in a VBAC care provider, VBACFacts.com is a great resource and they have a list of questions to ask your care provider.
When I met with the doctor who would eventually care for me throughout my pregnancy with Bubba, I talked to her in depth about her feelings about VBAC and the success rate at the hospital where I would be delivering. She assured me that as long as baby and I were healthy, we would be treated like any other perfectly healthy mom and baby in the practice. She also told me that even if some special circumstance were to arise, they would not automatically push another c-section before exploring other options first.
Finally, I hired a doula.
A doula is someone who is trained to assist a woman and her family in labor. I knew that the hospital where I would be delivering is a large teaching hospital, and I would most likely end up with whatever on-call doctor was available when I happened to go into labor. I wanted to make sure I had someone with me who understands the labor process and would help me advocate for myself in the hospital.
People often tell me they are surprised that my doctor or hospital "allowed" me to labor as long as I did with my VBAC baby. I always tell them that's the value of a supportive care team. Even though I strongly disliked the resident who ended up delivering Bubba, I will say one thing in her favor - she never once tried to bully me into another c-section. By surrounding myself with a strong, supportive birth team, I was able to have a successful VBAC despite my long, exhausting labor.
There's one person I wish I had on my team though...
A birth photographer. I'm not saying that just because I'm a birth photographer either. We saved up in order to hire a doula, and I wish I had found a way to save more - sold stuff I didn't need - whatever I needed to do - in order to hire a birth photographer. I would give anything to have photos of the look on my face when they put that beautiful baby on my chest.
If you need a birth photographer for your "I did it" moment, click here to learn about my birth photography services.
So you’ve had a cesarean and now you’re considering another baby (or maybe already expecting another)… Now you have to decide what route to go for your birth this time around. Do you plan another c-section or do you plan a VBAC (Vaginal Birth After Cesarean)?
As I mentioned in my C-Section Recovery Tips post, April is Cesarean Awareness Month. Continuing with that theme, I’m addressing another concern that is unique to c-section moms. Often the choice whether to plan a VBAC or a repeat c-section is an emotional one. For moms who had a long labor leading up to their first c-section, the fear of attempting a vaginal birth only to end up in surgery again often weighs heavy in this decision. For others, avoiding major abdominal surgery is the primary concern.
I could write an entire post about the research that led me to choose a VBAC for my second birth. For example, the American Congress of Obstetricians and Gynecologists (ACOG) recommends VBAC as a safe option with very low risk for most women with one or two prior cesareans. Also, a c-section is major abdominal surgery, and as such, inherently carries risks - many of which increase in likelihood with multiple surgeries.
However, this post is primarily about my personal experience with these two deliveries. As someone who has experienced both a c-section and a successful VBAC, I can share first-hand experience with the pros and cons of both types of delivery. After all, statistics can only tell you so much.
Every family has to make the choice that’s best for them based on their own experience and needs, but for me, it came down to one major deciding factor.
I knew that recovering from a c-section was difficult and long when I only had to take care of myself and a newborn. With my second, I was going to have myself, a newborn, and a toddler. I didn’t want the then 3-year-old Bug to be upset that I suddenly couldn’t pick her up and take care of her the same way I usually did. I wanted to make our transition into a family of four as easy as possible.
Usually when people hear about Bubba’s VBAC birth story, they either tell me it scares them into not wanting to try for a VBAC or they ask if I regret not scheduling a repeat cesarean instead.
I can see why they would think that. From an outsider’s perspective, my c-section was complication free. As far as surgeries go, it was pretty textbook. I healed well and honestly, my scar is barely even visible now. My vaginal birth was long and exhausting. Medical interventions were needed. I pushed for 3 hours. There was tearing (I’ll spare you the gory details). However, even taking all of that into consideration, I would STILL choose the vaginal birth every time because the RECOVERY experience was like night and day.
With my complication-free c-section, I struggled to walk normally for the first week. Even beyond that first week, if I was ever on my feet for too long, the soreness would creep in and I would often find myself hunched over, shuffling like a little old lady. I continued to take pain medications for at least 6 weeks, and many of my earliest memories of motherhood are foggy as a result. I needed help getting in and out of bed and generally struggled to take care of myself and the baby the way I wanted. Now, over five years later, I still have areas around my incision that are completely numb and certain waistbands on clothing cause discomfort and irritation.
With my “scary” vaginal birth, I’ll admit that first day was rough. I was exhausted and sore and generally felt like I had been beaten with a stick. However, I quickly started feeling better. I was walking around within 24 hours after birth - slowly but upright. The only pain medication I needed was ibuprofen and after the first couple of days, I only took one dose at night before bed to help me sleep. I stopped taking pain relievers completely less than 2 weeks after birth. As a matter of fact, Bubba was only 2.5 weeks old when I first took both kids on a fun outing by myself. I’m not sure I can truly express in words how much better and more capable I felt after my vaginal birth. My VBAC was two years ago, and I have had no long-term effects from the tearing or any other part of my vaginal birth.
All births are different, and, as I said before, all women need to make the decision that’s best for themselves and their family. In some cases, that may be a repeat c-section. No matter what priorities and criteria a woman uses to make this choice, her concerns are valid and she needs the most accurate information available to support her decision-making.
No matter what kind of birth you choose, you’re going to want a birth photographer there to capture the story of meeting your new baby for the first time! You can see some examples of my birth photography here.
If you’re considering a VBAC for your next birth, check back later this week for my last Cesarean Awareness Month post: The #1 Thing You Need For a Successful VBAC.
This is the story of my son's VBAC (Vaginal Birth After Cesarean) birth. Photos shared in this post are not examples of my professional work. They were taken by family and friends present at the birth.
At the end of Part 1 of this birth story, my support team was packing up and heading to the hospital.
I continued to have contractions all the way to the hospital and during the long walk up to labor and delivery. I was hooked up to a monitor and relieved to find that my baby boy was handling all the chaos perfectly.
Because it was a Saturday, I was assigned to whatever resident was on call that weekend. A medical student was sent in to question me and check my cervix - almost fully effaced, but only 1 cm dilated. It felt like a punch in the gut to hear that after all I had been through in the last day and a half, but then I remembered what my doctor had told me. I mentioned my concerns about cervical scarring to my nurse. She quickly browsed my medical history and said, “You know what. I think you might be right.”
We sat in a small room for a while waiting for the on-call resident to arrive. During that time, Bubba was moving and dancing in my belly. At one point, he rolled so drastically that everyone in the room saw my belly shift and the monitor dropped his heartbeat for a moment. He was back on the monitor pretty quickly and we continued to wait.
The resident arrived and almost immediately launched into her plans to admit me and start a pitocin drip. I stopped her and told her I wasn’t sure I wanted to be admitted yet. I simply wanted to discuss my options if I were to choose to stay.
I expressed my concerns from my first birth where pitocin was unable to make the necessary changes to my cervix. The nurse relayed my thoughts about cervical scarring in relation to my medical history. The resident simply waved away our concerns and continued to push pitocin. I finally had to tell her that I would not consent to jumping straight to pitocin because I didn’t believe it would address the actual problem. I told her I would rather go home. This turn of events did not sit well with her. It was clear she was used to women who came in and blindly did as they were told. She didn’t know how to handle someone who actually expected her to answer questions and explain her reasons for the choices she made.
She resorted to scare tactics at this point. She pointed out that my blood pressure had been slightly elevated when I arrived and tried to tell me I might be in the early stages of pre-eclampsia. It took all my strength not to laugh at her. She had clearly not looked at my chart at all or she would have known that I had experience with that particular condition. I simply smiled and told her that I had no swelling, no headaches, no dizziness, no prisms in my vision, and my blood pressure had been perfect throughout my entire pregnancy. I believed my blood pressure was more likely due to the fact that I had been awake for almost 36 hours laboring, and I was anxious about being in the hospital. I also reminded her that I had already given a urine sample when I arrived, and she was welcome to test it for protein. Of course, my urine sample was perfectly healthy.
I had gotten under her skin and she went for the low blow. She looked at the heart rate strip coming from the monitor. She said, “The good news is it looks like your baby is handling all of this well… except there’s one reading back here that concerns me. He could be showing signs of distress.”
The nurse in the room turned and looked at her like she had three heads. She said, “The baby rolled over. We all watched her belly shift. The monitor just dropped him for a second. The whole rest of the strip is perfect.”
The resident replied, “Maybe. But what if it’s not? What if he’s in distress and you go home and something happens to him? You’ll never forgive yourself and we don’t want that to happen.”
I just stared, incredulous. I imagine my mouth was probably hanging open. I had heard stories of doctors preying on the most vulnerable part of a woman’s spirit - implying that she was endangering the life of her baby in order to coerce her to follow orders, but I thought these stories were rare. I never imagined it would happen to me, yet there I sat. I wondered what would happen if I had been a frightened first time mom who automatically trusted anyone with a medical background. To what would I have consented? What would I have allowed that resident to do to me had she convinced me that I was putting my baby's life on the line? However, this was not my first rodeo, and I was furious.
At this point, the resident stepped out to speak with her attending. I talked with my husband, mom, and doula about everything that had just transpired. I probably should have fired that resident on the spot and demanded another doctor, but I didn’t. I stood up to her instead.
When she returned, I informed her I would only consider staying and being admitted if I were given an opportunity to eat and if we used a foley bulb instead of pitocin. A foley is a catheter with a balloon at the end. It’s inserted into the cervix and the balloon is filled with a saline solution. The balloon puts pressure on the cervix, forcing it to open. I was hoping it would break up any scar tissue present.
The resident, of course, tried to argue, but I held my ground. I also informed her I wanted to speak to her attending myself. The attending was wonderful. She thought the foley was a great solution, but she just wanted to make sure I knew we might have to revisit the pitocin discussion if my contractions didn’t progress after the bulb was out. I was fine with that.
My husband ran downstairs to find some food; I was admitted, and the foley bulb was placed. My doula went home to rest, and my best friend came in to be an extra support person. Thankfully, another resident took over after that. She was younger and seemed a little anxious, but she was, at least, kind. The nurses absolutely saved my birth experience. They were all lovely and supportive. I felt like I had my own personal cheering squad.
I was not anticipating the blinding pain the foley added to my contractions. Ripping through scar tissue is every bit as painful as it sounds. I think I could have handled it if I hadn't been so exhausted, but I was starting to lose control. My sweet husband did a great job talking me through contractions. He was trying to talk me out of an epidural because he knew how much I wanted to do this naturally even though it was killing him to see me like that.
In a calm moment between contractions, I told him I appreciated what he was trying to do, but it wasn't even about the pain anymore. I needed sleep. There was no way I was going to make it through this birth without some sleep. The anesthesiologist had just gone into surgery though, so I had about 2 hours of coping with the foley contractions before he came in. After a total of 38 hours of natural labor, I got an epidural and was able to take a nap.
An hour after the epi was placed, the foley bulb came out and I was dilated to 5 cm! The epidural had slowed my contractions though, so I consented to a low dose of pitocin to get them moving again.
I stalled a little at 5 cm, but the baby continued to descend. My doula came back, and I let my epidural wear off some. I could still move my legs; they were just heavy. With the help of my support team, I was able to get into some more upright positions to help labor along and then the doctor nicked my bag of waters to get it started trickling. After trying some different positions, I told everyone to get some sleep. I pushed the button to give my epidural a boost, and I went to sleep a little after midnight. My mom and doula later told me they don't think the epidural did much because I continued to groan through contractions in my sleep, but apparently exhaustion just took over.
The second resident woke me up at 3 am to tell me that I was at 10 cm and +3 station. It took a few seconds to register what they had said and when it hit, I began to cry. I was actually going to get to push!
Little did I know, I still had a ways to go. The horrible resident returned for the pushing phase much to my chagrin. The first hour of pushing was mostly trying to get me into different positions to move the baby down. The epidural was wearing off again, but at first, I couldn’t feel enough to push effectively.
The second hour of pushing, I was delirious. I was so tired I kept drifting off between contractions. God only knows what kind of weird stuff I said. I vaguely remember something about a horse and a bikini. I’m hoping I didn’t say anything out loud. If I did, no one told me.
In hour three, I could finally see his head and that gave me renewed energy to keep going. It was about this time that I was informed I was developing a low grade fever. I knew I needed to get my little guy out so I pushed with all the energy I could muster.
Fifty hours after those contractions woke me up at 4 am, three of those hours spent pushing, my sweet baby boy was born on January 17th. Despite reminding the resident that I didn’t want to cut his cord right away, the first thing she did once he was out was grab a clamp for his cord. My doula and I were both yelling at her not to clamp it. She rolled her eyes before putting the clamp down.
I immediately started yelling, "GIVE HIM TO ME! LET ME HOLD HIM!"
My mom and husband both later told me that was the moment when they realized just how much anxiety and brokenness I had been holding onto from Bug’s birth. It wasn't the joyful cry of a new mother wanting to see her baby, but one of desperation. I needed to hold him first. I needed to have him placed on my chest still slimy and fresh. I needed to be the first to welcome him to the world.
A nurse grabbed him from the resident and plopped him onto my chest. I was the first to see his beautiful face and announce to the room that he looked just like his big sister. I could never put into words the emotions running through my body in that moment. I felt victorious. I had conquered my own anxiety, my damaged body, and that terrible bully of a resident. I stood up to someone trying to abuse their power. I stood my ground and refused to allow my voice to be drowned out. I kept going when I wanted to give up.
My precious, perfect Bubba was worth every single second of that 50 hours. Despite all of the struggles, I think back on his birth with a sense of accomplishment.
He has been a whirlwind in our lives from the moment he was born. He is wild, stubborn, loud, smart, funny, and sweet. He tears through our house at full speed, only occasionally braking to climb in my lap and steal my food.
Happy birthday to my beautiful, blonde-haired, blue eyed boy, who adds grey to my hair and joy to my soul.
This is the story of my son's VBAC (Vaginal Birth After Cesarean) birth. Photos shared in this post are not examples of my professional work. They were taken by family and friends present at the birth.
Our culture has compressed birth into those few moments when the baby is actually delivered into this world. We’re led to believe that as long as the baby is fine, then the rest of it doesn’t matter. As a birth photographer, I’m working to change this view - at least here in Charleston, SC.
I work to show that the journey in birth MATTERS. The delivery itself, while the pinnacle, is but one part in an entire story of a woman’s transition into motherhood. The births of my two children were beautiful moments, but they are made even more incredible by understanding what brought me to those moments.
Today, I will begin sharing the birth story of my second child, lovingly known as Bubba. I’ll admit it’s a long story, so I’m breaking it up into two separate blog posts. Before we begin, I’d encourage you to go back and read Bug’s birth story if you haven’t already. There will be some context there that will help you better understand my mindset going into this second birth.
When I was still in the recovery room after Bug’s c-section birth, my doctor came in and said, “Well, the silver lining is that you’ll get to choose your next baby’s birthday because you’ll just schedule another cesarean.”
I looked at her wide-eyed and simply stated, “No. I won’t.”
The anesthesia hadn’t even worn off yet, but I knew I didn’t want to experience that again unless it was absolutely necessary. I knew nothing about Vaginal Birth After Cesarean (VBAC), but it didn’t take long before I started searching.
Before we even began trying to conceive a second child, I was searching for and reading as many VBAC stories as I could get my hands on. After confirming that VBAC is a safe option for most women, I was confident that I wanted to attempt a vaginal birth when we decided to have another child.
A few years later, after some struggles with infertility, I was finally pregnant with a baby who seemed to be sticking around for the full pregnancy.
I continued to read books and blogs about birth in general and VBACs specifically throughout the time we were trying to conceive and my pregnancy. I realized I would need a great team around me to support me in my desire for a vaginal birth. The doctor who delivered my daughter, while a wonderful person, was obviously not going to fit with my wishes for this birth. I started asking in some local mom groups and was pleased to find many mothers who had successful VBACs in Charleston and even more who were on the same research journey with me. There are many doctors here who support VBACs and ALL of the hospitals in the area allow them. The trick for me was finding the doctor with the least amount of restrictions on my labor.
I found an absolutely wonderful doctor pretty quickly. She is well-respected in the birth community, and she was fully supportive of my VBAC plan. She even told me that as long as baby and I were healthy, I would be treated just like any other perfectly healthy expectant mother. Even if complications did arise later on, surgery would not automatically be the first line of response either. My scar did not make me a ticking time bomb.
I also hired a doula to be with me in labor and delivery. I knew I wanted someone with a more objective view to help balance the anxiety coming from my husband and mom (and myself if I’m being completely honest).
I continued reading and researching and discussing my birth preferences with my doctor. At one point, I came across several birth stories of women who were discovered to have cervical scar tissue. Their stories sounded so similar to what happened in Bug’s birth: regular, intense contractions that would normally be indicative of a progressing labor, but little to no cervical dilation. After reading more, I found that I have one of the primary risk factors for cervical scarring (without going into too much personal information). I brought up my concerns to my doctor and she said it was definitely a possibility. If this were an issue for me, I would find that my cervix was effacing (thinning out) in labor but not dilating (opening). *Keep this little bit of information in mind because it comes back later.*
My pregnancy continued to progress normally, and I found myself creeping up on my due date. In the last week of my pregnancy, I often had contractions that were regular, but they always fizzled out after a few hours. I was getting frustrated and tired because these contractions often disrupted my sleep.
I woke up at about 4 am on Friday, January 15th, with what I thought were gas pains. It didn't take long for me to realize that gas pains generally don't come exactly 6-7 minutes apart lasting 45-50 seconds. I didn't get my hopes up though because this wasn’t the first time I had experienced regular contractions. It reached a point where I was having trouble sleeping through them, so I got up and got moving for the day. After a few hours, they still weren't going away, and they were getting more intense. They were still 6-7 minutes apart, but I was often having to stop and breathe through them. My husband stayed home from work, and my mom came over to help with the then 3-year-old Bug. After several hours, I decided to watch a movie and doze off for a while. When I did that my contractions spaced out to every 10 minutes. After resting for a bit, I got up and my husband and I walked for about a mile and a half. Eventually, my contractions returned to 6-7 minutes apart.
Late that night, my contractions were STILL 6-7 minutes apart but pretty intense. I was getting frustrated that they weren't progressing, so I told my husband I was going to eat something and try to sleep for a while. I hoped that sleeping would make the contractions space back out like they had before so I could get some rest. Well, of course, that’s not what happened. Shortly after I climbed into bed, the contractions got closer together. By about 3 am, my husband was begging me to call my doula because my contractions were 4 minutes apart and I was on my hands and knees in bed, groaning through each contraction. I called my doula and told my husband to get some sleep while he could. When I went to unlock the front door for the doula, I found my parents (who had decided to spend the night) sitting awake on the couch. My mom could hear me back in the room and had been timing my contractions based on my cries and groans. She rubbed my back and kept me calm until the doula arrived and then everyone rallied around me to help me through.
The hours dragged on and morning came and went. My dad had taken over Bug’s care. She struggled with seeing me in pain, so he kept her away and entertained as much as he could. My contractions stayed 3-5 minutes apart and intense, but nothing we tried would bring them closer together and progress my labor. Exhaustion was setting in and I was starting to fall asleep between contractions. When I fell asleep, the contractions would only come every 10 minutes, but they were significantly worse than the contractions I had been experiencing. It was as though I had 2 or 3 contractions rolled into one. The contractions would peak 2 or 3 times before coming back down and I quickly realized the little nap I was getting was not worth that pain. I made myself stay awake and keep moving. Around lunch time, we had passed 30 hours of labor and everyone was exhausted. Doubt and defeat were beginning to creep in.
My husband and my mom sat with me and said, "I think it's time to go to the hospital. You don't have to be admitted if you don't want to, but I think we should at least check and make sure the baby is okay.”
On one hand, I did want to check on the baby, but mostly I was frustrated and scared. Frustrated that, yet again, my body couldn't just do what it was supposed to do. Scared that I would be pushed into another surgery. I made everyone leave me alone in my bedroom, and I curled up on the floor and sobbed. I often find that I need to have a big, ugly cry before I can move forward.
Once I had my moment, I talked with my doula about the possible scenarios we might face at the hospital. We talked about what I would do in each situation and what I most wanted to avoid. I am so thankful I hired a doula for many reasons, but in retrospect, that conversation alone was worth every single penny I paid.
Once I made sure that my husband and mom knew my wishes and would support me in whatever I decided, we grabbed our bags, and headed to the hospital.
Read Part 2 here