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A Fight for a Twin VBA2C Birth in the Hospital!

A Fight for a Twin VBA2C Birth in the Hospital!

I had my first son at age 18 and he was delivered by an old school OB who told me I wasn’t trying hard enough to push him out. He didn’t exactly offer a forceps or vacuum extraction because he told me these interventions were not designed to do 100% of the work. After a total of twelve hours in labor and pushing with an extremely strong epidural for two hours I was told “It’s time” and he discussed how he had tickets to a golf opening later that day while he operated on me. I was told I had a narrow pelvis and the baby never would have come out. My second birth was another scheduled cesarean due to me “not being a good candidate for VBAC” without reviewing my surgical report, just based on what I was verbally told was the reason I had a cesarean. With my third baby I put my foot down, found birth without fear, my local ICAN chapter, and found a lovely midwifery practice that actually reviewed my report and discovered the first doctor had noted “failure to progress” as the reason for my cesarean. I had a lovely and successful hospital VBAC at 40 weeks and 5 days.

My husband and I had three lovely boys but we decided to give it one more shot to get a baby girl, and if it ended up being another boy we would know what God was trying to tell us. Seventeen months after the birth of our third, and just one week after I stopped nursing him, we were pregnant. I knew the day I took the test it was twins. We told all our friends and family it was twins. At the 8 week ultrasound I asked my husband if he was nervous to see how many babies there were and he said no. The moment the wand hit my belly, there they were and all I said was, “I knew it”. Unfortunately the midwives that had helped me achieve VBA2C with our third were leaving the practice to start their own birth center, one that could not deliver twins. So I left the practice at sixteen weeks and moved to another midwives’ office that came highly recommended by my previous midwives. The new office was fantastic, very supportive and my pregnancy progressed beautifully. At each appointment I was given encouragement that I was perfectly capable of birthing these babies vaginally, and My OB Dr G. went over scenarios with me to explain all the risks associated with twin pregnancies but all of my options as well. I felt very well informed. I hired a doula, and set up a birth photographer and waited for the babies to be ready.

I had an appointment November 28th and had an ultrasound and confirmed baby A (a girl!) was head down while baby B (little brother!) was transverse. I was 35 weeks and 2 days pregnant. As previously discussed with Dr. G and all my midwives this was an acceptable situation to proceed with a vaginal delivery. Dr. G would even have been comfortable with Baby A being in a breech position but he warned me the other doctors on call in the practice would be uncomfortable. That night around 7 pm I started getting the all too familiar cramps and I started timing them. They were bearable and consistently 10 minutes apart. I texted my doula and she told me to try and sleep but to call her if they became unbearable or if my water broke. All of the sudden I started second guessing myself because it seemed like the contractions had skipped from 10 minutes apart to 4 minutes apart. I began to wonder if these were contractions at all or if I was just having stomach cramps. We called our doula and told her we were headed to the hospital to determine if I was even in labor or not and we would text her with an update. This was at 10:00 pm. My dad came to pick up the baby (the big boys were already at my parents’ house) and we were off.

The thirty minute car ride was unbearable and I just wanted to lay down in the seat because everything else hurt so badly! We got checked into the hospital and into triage and I let the admitting nurse check me for dilation expecting to be told I was 1-3cm and I could go home or walk around. Nope. 8cm dilated already. My husband was frantic and just texted the doula “8cm” she told me later she read the text and shot out of bed like a cartoon character.

In triage I was greeted by one of the OBs from my midwife’s office from a different office location (they all share the on call schedule) Dr. K and she told me she needed to have an ultrasound completed to confirm the position of the babies but that if baby B was still transverse it was going to depend on the way his spine was facing, up towards my face or down towards his exit, if it was whichever direction she didn’t favor, she would recommend a C-section. Dr. G had never mentioned spinal positioning of Baby B so I had a feeling already a fight was coming. The ultrasound confirmed baby A was head down and very low and baby B was transverse, and I never got a clear answer on which way his spine was facing only that she recommended a cesarean and she left to give my husband and I time to think about it. My doula arrived shortly after and we told her the situation and the doula asked if we wanted to pray about it. I said I didn’t need to because my husband and I both knew what we wanted to do.

We called Dr. K back in and explained we would like to try a vaginal delivery and that Dr. G and midwives had told us during our pregnancy this was an option as long as baby A was head down. I also had mentioned I did not want an epidural and should I need a cesarean for baby B I was willing to risk having to go under general anesthesia. Dr. K dropped open her mouth and asked if I understood her medical opinion was that I have a cesarean. I said yes but Dr. G had assured me this situation did not warrant an automatic cesarean. She told me Dr. G was not the one on call, and that he should have explained I have to listen to all the providers. I assured her I was listening, but asked if that means I do not get to make my own informed decision? She called me crazy, said she did not understand me and told me not a lot of doctors would even allow a woman who had two previous cesareans even attempt to deliver vaginally. I said I understood this and that is why I sought out this practice and my doctor specifically. She then told me I was risking baby B’s life and if I would need a cesarean it could take her as long as 10 minutes to get him out depending on the amount of scar tissue I had and that if his cord were to prolapse baby would be without oxygen and he would likely die, or be permanently brain damaged or have cerebral palsy. I knew cord prolapse and shoulder first presentation were only some of the possible outcomes and not guaranteed so I again said I understood and I still wanted to move forward with a vaginal birth. She asked me to repeat what it was that I understood because she wanted to hear me tell her I was ok with the risk of baby B dying. I looked her square in the eyes mid contraction and said, “I’m ok with the risk of baby B dying”, knowing full well it was a small risk and she was just trying to be a bully. She threw the consent form at me that I needed to sign showing she wasn’t liable if baby B died and I looked around and said loudly, “does anyone have a pen?” Dr. K also informed me that after baby A was born she was likely going to have to internally manipulate baby B and I was not allowed to retract from her or move up the table to get away from her. I said I understood and she again asked me to explain what I understood and I said “I’m not getting the epidural, you’re going to put your arm in me and it’s going to hurt like a bitch”.

After Dr. K stormed off the nurse asked if I needed anything so I said “Yeah, can I have a new doctor?!” I was half joking but she said I absolutely could, and she went to get the doctor on call from my previous practice that delivered baby 3. Dr. S. very calmly explained the risks and where doctor K was coming from but she admitted it was also possible that baby would turn head down perfectly fine. She suggested however I get an epidural port placed in case I need an internal version or if I need a cesarean that way the baby wouldn’t have the anesthesia in his system. I agreed to have the port placed and Dr. S. let me know she was going to attend the birth alongside Dr. K which I found to be pleasing. Scrubs were administered, apparently we were going straight to the OR for delivery, no time for an L&D room!

I asked for some scrubs for my doula and birth photographer and was informed they were not permitted in the OR. My doula has attended three twin births at this hospital and was allowed in the OR for all of them so it’s not hospital policy so I asked them to confirm this with the charge nurse and it turns out it’s up to the anesthesiologist so they wheeled me in and the anesthesiologist said my doula could come in but she needed scrubs. Dr. K loudly interrupted and said my doula could absolutely not come in there were far too many people in the room. I argued that my OB and all the midwives had assured me my doula was perfectly welcome in the OR but I was again shut down with an impatient firm glare from Dr. K. It was clear she was trying her best to control my birth anyway she could. They shut the door on my lovely doula and photographer and started helping me onto the table.

The anesthesiologist placed the port and then asked about administering the medication and myself as well as Dr. S informed him I wanted no medication just the port placed. Dr. K loudly exclaimed of course I needed the medication administered why else would I be getting the port. I was pouting at this point and just furrowed my brows looked straight ahead and said fine. The anesthesiologist said quietly to me that no, he would not just administer the epidural if I didn’t want it, I was the one that got to make the decision. Bless this man. I told him Dr. K was being a very insistent bully so we agreed together that I received just a small dose of medication to make sure it was properly placed. I was checked for dilation and was told it was a good time to start pushing now, so when I had contractions I could start pushing. I pushed two or three times and I hear Dr. K ask for a hook for AROM and I shot my head up and said wait what are you doing?! She said “Oh, did you not want me to do that?” I said, “UH NO!” But a few more pushes later and Dr. S explained if I let them break my water she would likely come right out. So I conceded and pop went the water and out came the head. 3:13 am my beautiful baby Girl Brinley Harper was born. She didn’t cry right away but when she did it was loud and she was pink. 9/9 Apgar scores and she weighed a whopping 5lbs 7oz. Dad was not asked if he wanted to cut the cord (which he did).

As soon as baby A was delivered Dr. K was elbow deep in my business and grabbing baby B’s head while Dr. S pushed from the outside to get babies body to turn. I heard Dr. K call for the anesthesiologist because they needed to “section” me open but Dr. S asked for the ultrasound to determine position. After about fifteen minutes of scanning and waiting not at all patiently, baby B was finally in position head down and ready. No cesarean needed, but he was still very high up so I needed to push him down and I had to somehow do this without the assistance of gravity.

An hour and a half it took to push him down all the while Dr. K is trying to break my water. They call it “membranes of steel” I tell them all it was my high protein diet. A nurse to my left shifts on her feet and repositions herself and I remember turning to her and asking if she’s alright or if she needs a break so clearly I am full of jokes. I can see baby girl in the warmer to my right and she’s just quietly looking in my direction. I am tired of pushing and just want to hold my babies so I announce I am done pushing and want the cesarean. Everyone thinks I am not serious. Another contraction comes and I do not make a sound, no one realizes it is happening. I am so clever I think. Someone sees it and says “hey a contraction! Push!” “NO” I shout. At this point I am so parched I am dying for water. I asked them to wheel me out of the OR so I can have a drink then they can wheel me back so I don’t contaminate their precious sterile environment they are forcing me to deliver in. I’m brought a wash cloth and told I can wipe my mouth out, I am not pleased. Then someone tells me baby B is almost there, I call them liars. Dr. K finally is able to break his waters and I give a mighty push roaring with intensity and my sheer will to make my baby appear. Someone tells me not to make noises with my pushes, I shout “I WILL MAKE NOISES IF I WANT TO!” And out baby B comes. They place him on my belly and dad gets to cut the cord. Despite having an arm inside and two babies coming out, I am intact. Thank you tiny baby Jesus. Declan Oliver is born at 4:47 am weighing 5lbs 3oz. Dr. K walks over to my bedside takes a long look at me and says “good job” I take a long look at her and say “thanks for not cutting me open even though I asked you to.”

Both babies got to come home with us three days later. I hear now from my OB that I am an inspirational story for the practice, and that he is so proud of me for being able to stand my ground and make sure I was a part of the birthing process. And I’m proud of myself as well. I honestly hope maybe my success story will help give Dr. K more positive personal experiences to draw from when she’s delivering future babies and dishing out her personal statistics. And with that, my birthing career is complete and my family is whole!

Story submitted by Stephanie Shuman. 

Photographs by Hillarie Laver.

VBAC: What ACOG Really Says {Birth Without Fear}

VBAC: What ACOG Really Says {Birth Without Fear}

VBAC – Vaginal Birth After Cesarean.

The term and action is wrought with political and emotional meaning in the birth world. Can  you have a VBAC? Does your doctor or hospital “allow” a VBAC? Under what conditions can you have a VBAC? Should it be called a TOLAC (trial of labor after cesarean)? What sort of prior birth history is preferred? Once I have one successful VBAC, will I still have to jump through hoops in subsequent pregnancies?

All these questions and more come up when we start to discuss the mine field that is VBAC in today’s world. But I wanted to know what ACOG really says. I am not talking about the public statements – which you can read HERE. I want to know what ACOG is saying to the doctors, what they put out in their practice guidelines.


The document I found is HERE. I encourage you to not only look at the document for yourself, but to also follow the many links I have scattered throughout this article.

At the opening of the document, ACOG has this to say:

Trial of labor after previous cesarean delivery (TOLAC)* provides women who desire a vaginal delivery with the possibility of achieving that goal––a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient’s preference for vaginal delivery, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. At a population level, VBAC also is associated with a decrease in the overall cesarean delivery rate (1, 2). Although TOLAC is appropriate for many women with a history of a cesarean delivery, several factors increase the likelihood of a failed trial of labor, which compared with VBAC, is associated with increased maternal and perinatal morbidity (3–5). Assessment of individual risks and the likelihood of VBAC is, therefore, important in determining who are appropriate candidates for TOLAC. The purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and provide practical guidelines for managing and counseling patients who will give birth after a previous cesarean delivery.

Lets start with noticing that ACOG automatically terms all VBACs as TOLACs first. If you complete the trial with a vaginal birth, then it is a VBAC. The issue with this sort of wording (and thought process) is that it sets women up with doubt and it sets the doctor on the defense against the failure of the trial. I will use the term interchangeably only because the document that I am citing uses the term so often. But moving past this unfortunate wording we do see that they know VBACs are beneficial. They state that VBACs lower the maternal morbidity rate and risk of complications in future pregnancies and that as a whole they lower the cesarean rate. They do also point out that there are certain factors that make a TOLAC less likely to succeed, and that when they do “fail” you are more likely to have morbidity (which makes sense, as a major surgery is considered a morbidity to begin with).

In the “Background” section at the start of the Practice Bulletin we see several points that seem to be denied in the general obstetric community. First they state that the cesarean rate has increased rapidly since the 1970s, from 5% to more than 31% in 2007. They blame this increase on the introduction of electronic fetal monitoring, and the decrease in breech births and forceps births. I put emphasis on the EFM use, since we are often told that it is needed for a safe birth, even though research proves that it does not lower fetal morbidity or mortality. Again and again, research also shows that it increases the chances of a cesarean, which in turn increases the risks to mother and baby. Yet, ACOG still insists on the use of EFM as standard care.

They also state in this section that after the 1970’s VBACs gained popularity. By the mid 1990’s the rates of VBAC (28.3%) were such that it was actually reversing the cesarean rates. However, this increase in VBACs seemed to come with an increase in uterine rupture – though the literature does not state what sort of uterine scars were common (since certain types are known to have more risk, such as classical), whether induction was used, or what type of rupture occurred (most ruptures are not catastrophic but are instead considered a “dehiscence”). Due to this increase in ruptures, the case for VBACs was again set back to “once a cesarean, always a cesarean” in many practices. They finish this section by stating that it is known that liability is a large part of why VBAC is not offered to many women who are actually good candidates.

Now we get into the nitty-gritty of what they say about VBAC. I am going to take questions and statements from the document to break this down. All noted pages are from the Practice Bulletin unless otherwise stated or linked.

  • What are the risks and benefits associated with TOLAC? (p2)
    • Neither an Elective Repeat Cesarean (ERC) or a TOLAC are without risks.
    • Most maternal morbidity that occurs during TOLAC is related to a failed attempt when a cesarean becomes necessary.
    • VBAC is associated with fewer complications than an ERC.
    • Thus, the risk of a VBAC really comes down to whether it is achieved. If it is a “failed” TOLAC it has more risk than an ERC, but if it succeeds, it has lower risk than a ERC.
    • The main risk of TOLAC/VBAC is a uterine rupture. However, as stated in the background, some studies do not give background information about what type of ruptures are occurring nor on what type of prior incision or induction methods.
    • They include a chart of maternal risk in this section and it is interesting to note that maternal death risk can be almost double (0.2%-0.4%) with a ERC compared to a TOLAC after one prior cesarean (0.2%), and that TOLAC with more than one prior cesarean had no death risk within those studies. It is also noted that a ERC also comes with the risk of uterine rupture (0.4%-0.5%).
    • It is noted that for families wanting several children a successful VBAC takes away the risks of multiple surgeries which includes hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as previa and accreta.
    • They include a chart of neonatal risk factors when comparing ERC to TOLAC. It should be noted that there is no significant increase in neonatal death or neonatal admission (NICU admission). We see a much higher rate of respiratory distress (1%-5% vs. 0.1%-1.8%), transient tachypnea (too much fluid in the lungs which causes breathing issues) (6.2% vs. 3.5%) and hyperbillirubinemia (jaundice) (5.8% vs. 2.2%) in babies who go through an ERC.
  • What is the vaginal delivery rate of women who have a TOLAC? (p3)
    • Most studies show a 60-80% success rate.
    • Studies show a decrease in success if the same circumstances happen again, such as stalled labor, which lead to the first cesarean  (however, I will note that the definition of “stalled labor” is more likely the issue than anything else).
    • The chances of success are increased if the mother has spontaneous labor with no augmentation.
    • One VERY interesting note is that being “non-white ethnicity” lowers your chances of success. This speaks to the huge disparity in maternity care in ethnic groups in this country. Simply taking one look at the maternal mortality rate in non-whites gives a clear and horrible picture of this undercurrent in our maternity care system.
  • Who is a candidate for VBAC? (p4)
    • The best candidate is one in whom the risks and benefits balance out in a way acceptable to the client and care provider, this may be different for each woman and there is no specific “formula” to come to this answer.
    • Decisions about the first VBAC should be considered with future pregnancies in mind. This is due to each subsequent cesarean increasing the risk for future pregnancies, and the inability in some areas to find care providers to attend a VBAC after multiple cesareans.
    • For most women with one prior cesarean and a low transverse incision VBAC is a good option and they should be counseled and offered a TOLAC. Women with other incisions (T-incision or classical) or with prior ruptures and surgeries of other sorts to the uterus should be evaluated more.
    • Individual factors should be considered in all cases (i.e. – no hard and fast decisions to ruling mothers out of VBAC), and in the case of women presenting in labor, VBAC should be strongly considered as spontaneous labor increases the success rate of a TOLAC.
    • More than One Prior Cesarean:
      • Studies addressing TOLAC in women with more than one prior cesarean find rupture rates ranging from o.9% to 3.7% – again, without specifying the type of prior incision or level of rupture. They also have not consistently compared these findings directly to women with only one prior cesarean.
      • One large study in particular found no significant increase in rupture between VBAC and VBAMC (vaginal birth after multiple cesarean) – o.7% vs. 0.9%. A second large study only found a slight increase – 0.9% vs. 1.8%. They also found no significant increase in morbidity.
      • The chances of success are similar to that of a VBAC after only one cesarean.
    • Macrosomia (Big Baby):
      • Some studies show a decreased chance of success with a baby larger than 4,000g, and posibily higher rupture rates. However, these studies are based on actual birth weights, and not the estimates given before birth. This is significant given the inability to accurately predict birth weight before the birth.
      • Suspected macrosomia alone should not rule out TOLAC.
    • Gestation of more than 40 weeks, according to the largest study done which looked at this factor, does not increase risk. There is evidence that after 40 weeks chances of success decrease but we must consider that induction of some sort may be common at that point (given current practice trends) and that lowers the chance of VBAC in general. Gestation of more than 40 weeks should not rule out TOLAC.
    • Previous Low Vertical Incision:
      • Studies show similar rates of success compared to low transverse incisions (the most common).
      • Studies do not show increased risk of rupture or morbidity for mother or baby.
      • Studies are limited, but a low vertical incision should not rule out VBAC given the current information.
    • “Unknown” previous uterine incision should not rule out VBAC. The two large studies done at large tertiary hospitals show that there is no increase in rupture rates or morbidity, and success rates are similar. Unless there is a high clinical suspicion of a complicated previous uterine incision TOLAC should not be ruled out.
    • Twins Gestation:
      • In all studies available it is shown that in women with a previous low transverse incision there is no increase in risk to VBAC a twin gestation.
      • Success rates are similar to those of singleton mothers. Twin gestation should not rule out TOLAC.
  • How does management of labor differ in a VBAC? (p5)
    • Induction of labor for maternal or fetal factors remains an option for TOLAC. However, the increased risk of rupture that comes with any induction and the decrease in success rates should be discussed.
    • One large study of over 20,000 women found that rupture rates increased slightly with induction. Spontaneous labor had a 0.52% rupture rate, non-prostaglandins induction with a 0.77% rate, and with prostaglandins a rate of 2.24%. However, again the types of rupture were not specified and the context of the inductions are not known (unfavorable cervix, need for multiple induction methods, etc).
    • Another study of over 33,000 women found a slight increase in rupture (o.4% for spontaneous labor, 0.9% for augmented labor, 1.1% for oxytocin alone, and 1.4% with the use of prostaglandins). An analysis of this same study noted an increase in rupture rates when the highest levels of pitocin were reached, however no upper level of dosing has been decided for VBACs.
    • Studies done on the risks of misoprostol (cytotec) show an increase risk of rupture and should not be used for TOLAC. (Actually, it increases risk of rupture in ANY mother so it should not be used for induction, period.)
    • Due to the small absolute risk found in several studies, ACOG notes that use of pitocin for labor augmentation is not ruled out for VBAC.
    • Mechanical cervical ripening (such as the foley bulb) are also considered acceptable for labor augmentation/induction in VBAC.
    • ECV (External Cephalic Version), such as to turn a breech baby, are not contraindicated in a woman who wishes to VBAC.
    • Epidural/Analgesia use is not contraindicated and studies show it does not effect success rates. However, epidural use in general is shown to increase the chances of cesarean in all mothers. (to view that study, right click and select “copy link location” and input into google)
    • Electronic Fetal Monitoring is suggested since the main sign of uterine rupture is abnormal fetal heart rate (up to 70% of cases). It is noted that internal monitoring does not help in diagnosing ruptures.
  • How should future pregnancies be managed after uterine ruptures? (p7)
    • If the rupture is in the lower segment of the uterus, the chance of another rupture is 6%. In the upper sections of the uterus it is around 32%.
    • ACOG suggests an elective cesarean for births after a rupture.
  • How should women be counseled about TOLAC/VBAC?
    • Each woman will weight the risks and benefits differently. Therefore, the options should be discussed at length and documented.
    • Counseling should always consider the future plans for more children and discuss the risks of multiple uterine surgeries. Women should also consider that family plans can change or there may be unexpected pregnancies.
    • After counseling the ultimate decision should be made by the client. Global mandates (aka – hospital wide) should not be made as they do not consider the individual factors and wishes of each client.
  • What resources should be available at a facility where a woman will VBAC?
    • The previous suggestion of ACOG was that VBAC should only be offered in facilities with “immediate” access to surgical facilities and staff. However, this severely limits the locations where women could VBAC.
    • ACOG now suggests that care providers and clients consider the facilities available, their individual risk factors, and the availability of other locations where more resources are available.
    • Health care providers and insurance companies should do all they can to facilitate women in achieving VBAC through transfer of care or co-management of care.
    • If there is no way to transfer care, a woman’s autonomy should be respected. If a woman wishes to VBAC in a hospital without immediate access to surgical facilities steps should be taken early in care to develop a plan of action in case of rupture.
    • It should be noted that coercion into a repeat cesarean is not appropriate. A policy of not allowing TOLAC at a facility should not be used to deny care or force a woman into a repeat cesarean. If appropriate, transfer of care should be arranged to a facility and care provider who is better able to support TOLAC.

Now I would like to take a moment to talk about the notion of only “allowing” VBACs in facilities with immediate access to surgical teams and facilities. Lets compare the risk of rupture, 0.7% in most studies, which is not always catastrophic, to the risk of other obstetric emergencies. Cord prolapse, a very dangerous situation in which the cord proceeds the baby down the birth canal and gets pinched, occurs in about 0.28% of births. This situation requires immediate access to a cesarean in most cases. Placental abruption, another very serious complication, occurs in about 0.7% of pregnancies. This also requires immediate access to cesarean in almost all cases. Notice that the risk of abruption and the risk of rupture are the same. The rate of shoulder dystocia, which is considered an emergency that may necessitate a cesarean (or an instrumental birth) is around 1.29% though some studies report it at higher rates in the current birth climate.

Now looking at the rates of these complications, which are on par with the risk level of rupture, we have to wonder why ALL hospitals offering birth services are not required to have immediate access to a cesarean. After all, placental abruption happens with the same frequency and can happen in any pregnancy and ACOG does not seem to be concerned that EVERY pregnant mother does not have access to immediate surgical care. At the end of the day, the risk/benefit analysis needs to be decided by the mother and what she feels comfortable with since the rate of rupture is comparable to the risks of any pregnancy and birth.

The point of this article is not to suggest any particular course of action for every mother. This is about giving you the facts to make your own decision. This is about looking at what ACOG really says about VBAC/TOLAC and not just what your doctor tells you they suggest. Arm yourself with information and consider your own personal factors and Birth Without Fear, no matter how you choose to birth.

VBA2C: Deployed Husband Listens and Supports Over the Phone

VBA2C: Deployed Husband Listens and Supports Over the Phone

This is a story of love, courage, and service. Birth and newborn photos by Christy Pellicer, of Doulananda and Bliss Photography.

Mama writes, “Here is one of my all-time favorite pictures ever: me right after my hard-earned VBA2C, holding our precious baby boy. It was an unmedicated birth at a Naval hospital – my poor husband (active duty Navy) was on the phone, floating out in the Persian Gulf somewhere, the entire time I was pushing.

On phone

On phone with baby

My doula said I pushed for almost three hours – I can’t remember – it’s all a blur!

Newborn smileI am so thankful he was able to listen in on the phone as I delivered our 9 lb, 2 oz baby.

Newborn cuddles

My doula took this photo from my phone so I could email it to my husband…

photo (4) copy - watermarked

After the birth, six more long weeks went by before he was finally able to hold our beautiful baby boy in his arms.”

photo (3) watermarked

A Supported TOLA2C Cesarean Birth Story

A Supported TOLA2C Cesarean Birth Story

A little background about why I started to seek out a way to birth the way I knew my body was able to.

First we start with my first born, Bridgit, who is currently 4 and half.  She’s a spit fire just like her mom, who knows what she wants and will do what it takes to get it.  I did spontaneously go into labor with her.  My water had broken in the middle of the night.  We of course went straight to the hospital.  There they immediately put me on Pitocin.  After 6 hours of Pitocin I was asking for an epidural.  6 hours after the epidural I still had not progressed passed a 2.  My OB at the time stated, “You can have a C-section now, or you can wait to see what happens in another 12 hours and have a C-section.”  Not knowing what I know now, I opted to have the C-section.  I mean shoot, if it was going to happen anyways might as well beat it to the punch right?  She was brought into the world via C-section on Dec 22, 2007 @ 3:58pm CST.  Recovery wasn’t so bad either.

Next is my second sweet and adorable boy, Brenden.  Currently 20 months.  I continued care with the same OB I saw with Bridgit.  At 38 weeks, he was still high up, cervix thick, and my OB opted that it could be a fit issue, and recommended a repeat C-section as he wasn’t going to let me go past 40 weeks.  Again, not knowing what I know now I agreed and figured my body was broken and just didn’t know what to do.  Brenden was born via repeat C-section Nov 18, 2010 @ 1:09pm CST.  The recovery was much different, and the feeling of him being taken from my body is one I remember and never wanted to experience again.

At the end of Oct 2010 I got the surprise of a lifetime… I’m pregnant again!  And in Colorado (we just moved from Texas to CO) I started to seek out information on VBAC’s and my chances of being able to achieve this.  At first I stuck with OB care, and of course that OB was very against me wanting to VBAC.  She put the fear in my husband at our 20 wk appointment.  But it still didn’t seem right.  I just knew if my body could get pregnant that I could birth this baby to, or even let myself have the chance at labor! I attended an ICAN meeting with my husband and upon listening to the information given there; we were armed with the knowledge that I can do this!

I first got a doula, Lisa, whom we clicked with right away and were very excited to get her onboard.  She was so supportive and it felt great to have someone on my team that knew I could do this.   I was also on the move to find a new care provider.  Upon recommendation from ICAN leader, I sought out care at with a midwife group at the local hopsital.  They too were on board with my plans to TOLAC (trial of labor after caesarean) and to VBAC.  Now it was time to get myself mentally prepared and ready to tackle the biggest challenge I’ve faced head on.

My guess date came and went.  I was okay with this.  I knew my best chances to achieve this was to let him come on his own.  The hospital and midwifery group had a policy to induce by 41 weeks 5 days.  I was able to get that pushed back until 42 weeks.

July 15th was the set date.  I called up at 6am and they said they had room for me!  So we packed up and headed on down to the hospital.   We arrived right on time, only to our surprise that about 7 other momma’s decided it was time to go into labor, and took up all the available rooms.  Already being downtown, we decided to stay and wait.  Finally around 12pm we were told I had a room.  We get up to the room, and continued to wait some more until a nurse came in to get me all settled.  It wasn’t until much later that the IV was placed and a little later that the Pitocin was started.  This is when I like to think that my labor started.  So at 3:50pm my Pitocin was started at a very low dose, and my doula was on her way.  I had already sent my husband home because our two children were done being at the hospital.

When my doula arrived, contractions weren’t much so we decided to get up and walk around to try and help things along.  We did several laps around the labor and delivery floor.  I made sure to include squats, and lunges.  The staff thought it great to see me working at getting labor in a groove.  They slowly increased the dose of Pitocin, and slowly contractions got closer and more regular.  At one point my midwife came in to recommend some sleep options.  As I didn’t want to be groggy, I opted to just rest on my own.  Which I did get some sleep, although it was not enough for what I had ahead of me.

Mel's TOLA2C

The morning of the 16th, I was checked to find that I had made some progress and we could now talk about doing the Foley Bulb.  I knew that I would need some more help in the dilating process as I did have some small amount of cervical scar tissue for a leep several years ago.  Mind you at this time I still had not opted for any pain medication, and was starting to be very vocal (low moans) with my contractions.  I was very internal, I kept to myself and thoughts in my head were just one step closer.  They inserted the Foley catheter and boy oh boy you want to talk about one of the most intense things ever!  It was painful, and had me so wanting to scream our code word for pain help.  (Our code word was Yo Gabba Gabba, my son’s favorite TV show.)   My doula sat on the bed with me and talked me through each contraction and each moment that I just wanted that damn thing out!  After about an hour they came to check, giving the catheter a little tug to see if it would budge.  It wouldn’t budge.  So I had to sit with it for another hour.  It didn’t want to end!  It seemed like forever with that thing in me!

Mel pushing during a TOLA2C

The nurse came to check after another hour passed.  She gave it a little tug, and it was loose!!  Thank the powers that be!  As she pulled it out… I swear that thing was the size of a peach and felt so great to be out of my body.  Upon a cervical check I was confirmed and a 3-4.  I got in the tub again, and we did more walking.  I tried to rest more.  I also sat on the birthing stool since that was one of my favorite places.  At this point I lost more of my mucous plug and started to have a bloody show.   I  called up my husband and he was there.  It was such a relief to have my husband.  It was such a pillar of support that I needed but had no idea how important it was to have him there.  When he walked with me, we danced through contractions, and I even cried on his shoulder.  He just held me and it felt great to be in his arms!  From that point on I knew I didn’t want him to leave my side.

Husband helping

Things continued to get stronger as the Pitocin was slowly increased more and more.  Eventually things got really intense through the night and I felt like I couldn’t do it anymore!  I needed some pain relief as the contractions and lack of sleep were bringing on the tears. I actually screamed our code word!  Instead we opted for the Fentanyl.  It was wonderful relief! Although around this time was when they put in an internal scalp/contraction monitor to make sure all was going ok.  I was able to move around a bit more and feel much better about things.  But my labor had started to stall.  At this point I had been on Pitocin for about 32 hours. Upon discussing with the nurses and midwifes it was time to turn off the Pitocin, get some rest, and see if my body would keep up the labor, or we would have to turn it on. I was at a 5-6, very vocal through each contraction or even cry, and the tub didn’t help manage things.  No matter of talking/coaching seemed to help get me through.  Not to mention I had managed to throw up whatever food I had left in my belly.  Throwing up is a big deal to me and was a point I didn’t like very much.  TRANSITION.

I also spiked with a fever, which also with transition meant no more eating.  When that time was up I was almost scared to start the Pitocin back up.  I knew it meant more labor and more pain was on its way.  I was so done at that point.  The discussion for a C-section started at that time.  It was about 2 or 3 in the morning. If it weren’t for Lisa, my husband, and a wonderful team of nurses and midwives, I would’ve been on the path to another C-section.  But they convinced me to continue to labor on.  The new plan was to get an epidural, rest, and to start back up the pit at a normal pace.  I was able to get some rest.

On July 17th, about 40 hours into labor, getting the epidural was painful.  I managed to jerk upon insertion causing the poor doc to lose the spot.  She had to try another 2 times to get it to go in and work.  Even when it did it worked more on my right side, and had to rest on my left side to help move the medicine.  This helped but only so much.  I was able to rest. I recall thinking to myself I feel like I need to push.  I could feel my body curling around my body.  I was checked and sure enough I was 9cm and baby’s head was half way out of my cervix.  We were so excited!  Who knew I’d get this far!  I was ready to take it on! By this time I had one of my favorite midwife’s on board, Beth.  I was so ready to get the pushing party started and get the VBAC I always wanted.  I can remember being so thrilled and telling myself my body was not broken!


I did some practice pushing, and as I did this each contraction intensified!  I was working hard.  I could feel him moving down.  I was getting excited.  Beth was also trying to help by pushing up on my pubic bone to help get Blaine’s head down.  He had gone from LOA to LOT and his head was kind of in a funky position.  We tried different positions to aid in pushing, as well as fingers constantly on that bone to help move that pubic bone out of the way.  At one point I was grabbing on my leg so hard that I left bruises.  By hour 2 of pushing Beth said “we can either keep going for another hour upon which we’ll have to confer with the OB’s to see what they’d like to do”.  The contractions were intense I could feel every one.  I was slowly losing steam.  I wanted to keep going.  Things started to slow again. I was getting exhausted.  Not to mention I had gotten sick again, and with nothing in my stomach I had lost all the water I was drinking.  I even got so sick that bile had come up too.  I was also getting so hot that no matter how they applied a cold cloth or sprayed cold water on me I couldn’t keep cool.  I was still pushing but losing steam and fast!  Hour 3 dawned upon us and it was time for Beth to go confer with the OB’s.

An OB came in, and with my next push continued on with what Beth was doing to my pubic bone.  Only this time it was excruciating.  I couldn’t bare it.  I screamed at her to get her hands out of me, even mixed in a few obscenities as well.  I almost kicked her and had I been able to move my legs better, I may have.  Finally after the contraction calmed, the suggestion was to bring in another OB who could help move the baby’s head and from there use forceps or vacuum to aid in getting him out.  I looked at my husband & Lisa and we both had that look of “NO WAY!!!”  At this time everyone left the room and I spoke with my husband.  I cried and cried because I was out of gas.  Something in my body was telling me that the pushing was done.  This baby needed to come out and he wasn’t coming via subway tunnel (my vagina).  As much as I wanted my VBAC I wanted my baby out just as badly.  My body just knew it was done and there was an unknown reason for it too.  So it was agreed to do C-section.  I was also later told that the OB was actually moving the baby’s head and in doing so also discovered an anomaly of a point in my pubic bone area, the reason why baby wouldn’t move down, and that even if we got baby’s head moved and down, the body may not have been deliverable.  Basically a heart shaped pelvis with some anomaly at the bottom.

At almost exactly 48 hours of the start of my Pitocin it was agreed that we would do C-section.  By this time I was laying on the bed naked as I had soaked myself in my own vomit.  I was hot, and in tears.  Part of me felt like I failed.  Lisa then reminded me of how far I’ve come, that I was able to get to complete and to push.  I wasn’t giving up I was doing what my body needed.  There was so much going on at this point.  Everyone moved fast, while I laid there and cried as another contraction would come and I didn’t want to push any more, which was terribly painful and I think I even gave in to push at some point.  I eventually got more pain medicine, and was able to rest.  I heard mention of Chorio (infection of the uterus), but it didn’t really dawn on me.  I just knew baby had to get out and hopefully it wasn’t that bad.  In the OR I was better explained what Chorio was, but was shaking uncontrollably.  I couldn’t relax. I was tense and continued to shake.  Eventually my husband and midwife came in.  My husband rubbed my neck as they started the surgery.  They did have an issue with scar tissue which took some time.  But I was concentrating on not shaking, breathing, and staying calm.  I was still really hot, and shaky, from the adrenaline.  The OB’s made mention of puss around the baby and in my bag of waters.  I didn’t hear this, but reminded of it later.

CBA2C attempted VBA2C


I soon heard the screams of my son!  I cried and cried.  I did it!  I didn’t care how it happened, I did it!  My midwife looked at me too and said you did it Melena.  All that hard work and you have your baby boy!  My husband was off to take pictures and cut the cord.  I cried and cried!  It wasn’t a failure after all.  My son was safely brought into the world and would soon be in my arms.  He was soon brought to me where I just couldn’t take eyes off of him.  I stroked him with my free hand and told him how much I loved him.  My husband was so happy, and looked at me with such love.  All that hard work he said, and we now have our little boy.


Blaine Carter Cox was born 4:35pm, almost 49 hours from the start of Pitocin.  In recovery he immediately latched.  It wasn’t until the next day that I was properly informed of the puss and that he would have to endure 7 days of antibiotics.  He was a pro at nursing from the start and did wonderfully.  It was a wonder if he was ever really sick from the infection of my uterus, but we stayed on the side of caution.  While in the hospital my blood pressure was high but I think I was just stressed of seeing my wonderful baby boy getting poked to get an IV, and having to endure that.  Not to mention it took me some time to come to terms with the infection of my uterus.

I realized that I had done everything I could do to have him vaginally.  It wasn’t in my cards.  I did everything I could.  I was strong.  I did the best I could ever do by waiting for him to come on his own and to labor as long as possible.  He came just the way he was meant too.  I showed strength I never thought I had.  My husband still calls me his momma bear.

We finally came home on July 25th.

The Long Journey Home: An HBA2C Story, {Part IV}

The Long Journey Home: An HBA2C Story, {Part IV}

Yesterday, we shared the third part of Rose Homme’s HBA2C story. In this five-part series, she shares her journey to home birth: the emotional ups and downs, the pain of her first births, and how believing in herself and her body guided her through. Here, you can read the goals and intentions she set for herself for her third labour. Check back tomorrow to read the birth story!

“I know that our bodies are not flawed. All of us were built to birth regardless of our size, weight or height. I’m 4’11, I look huge when I’m pregnant, and I had to get to a point where I embraced my body and size for the work it was doing. That my size is normal for me and my babies. I think this played a part in my first birth experience as well, where I was as surprised by my size as everyone around me. I think that was the seed of doubt that started me questioning my ability to grow and birth a baby.

It is important to keep in mind that our bodies must work pretty well, or their wouldn’t be so many humans on the planet. 
― Ina May Gaskin, Ina May’s Guide to Childbirth

I also had to get to a place where I accepted my previous births and could acknowledge the strength and lessons they taught me. One of the last things Amy (my therapist) and I worked on was being “ok” with a hospital transfer, and epidural; it was like accepting those possibilities let them go into the universe, and I was no longer attracting them or inviting them to our birth.

I knew one of my goals for this birth was to be completely conscious, responsive and active in the process. I acknowledged that it was as much our baby’s birth as it was mine and we were going to work together. Through the pregnancy I had to remind myself that I could listen to my instincts throughout the labor and my body, mind and baby would tell me how to move and cope.

Our bodies know how to birth. Our babies know how to be born.

Sue had embedded in me that we were going to ignore my labor, and treat it like any other day. On one level this sounded completely crazy to me, but I believed it to be the best way to handle labor. Since I was induced with my first and in la-la land with my second, I was very unsure of what to expect. Even with doubts popping up here and there, I knew that if I trusted my body it would lead the way.

I let go of any expectations or ideals of perfection, the IF – THENS I had during Oliver’s pregnancy. I knew I wasn’t going to make it to yoga class, so I just did yoga daily at home, totally ok with kids jumping all over me, interrupting me. I would stretch on the floor or crawl around the backyard, some days that would be all the exercise I could get. I did one yoga DVD from about 20 weeks on and memorized it. I modified it so that it felt right for me, staying in some positions longer and skipping others altogether. I walked as often as I could. I knew that our daily lives didn’t accommodate daily strolls, so I went for distance. As a family we would take walks on Sunday to the Orange Circle about three miles away.

I tried to keep my activity level the same in late pregnancy as it was early on. I made sure to do the stretches and squats Sue recommended. I always had my car seat set in an upright position with my bottom slightly higher than my knees (good for babies’ positioning, see spinning babies). I sat on my yoga ball, and saw my chiropractor, Britney Cicon, on the same schedule as my prenatal appointments. I was probably the most active during this pregnancy. Because of my previous ectopic I had been treated like I was sick or slightly handicapped during my first pregnancy – no one wanted me to lift anything or do too much. Which is sweet, but really pregnancy is the time to keep up your endurance.

Two young children are awesome endurance trainers! They didn’t let me sit and put my feet up – half the time I couldn’t even acknowledge I was pregnant. I continued to chase after them and carry them throughout the pregnancy, which made me feel strong. I took a holistic approach and listened to Sue. Sue wanted me to watch my sugar intake – so even with a major sweet tooth, I listened. I took my supplements and really appreciated the care and knowledge Sue provided me as a whole person, not just a uterus.

Gardeners know that you must nourish the soil if you want healthy plants. You must water the plants adequately, especially when seeds are germinating and sprouting, and they should be planted in a nutrient-rich soil. Why should nutrition matter less in the creation of young humans than it does in young plants? I’m sure that it doesn’t. 
― Ina May Gaskin, Ina May’s Guide to Childbirth

I knew that I believed in this and wanted it more than anything! Here I am at 39 weeks.

These are some of the things I believed without a doubt and wanted for this birth:

-Home birth was the best option for me and my baby
-I wanted a peaceful birth for both of us
-We didn’t need intervention
-Home birth was safer than a third C-section
-I needed to surround myself with positive supportive people
-I was going to ignore labor for as long as possible
-We would have immediate skin-to-skin contact after the birth
-We would do delayed cord clamping
-I needed to move around during labor
-I would eat and drink during labor
-I would have a conscious, vibrant birth experience
-It was as much my baby’s birth as it was mine
-My baby played a role in this and I needed to communicate with her.

You can read Part V and the HBA2C birth story here!
Rose owns the natural baby store, Rosie Posie Baby, in Anaheim, California. You can read more about her and her family on her blog, Rosie Posie Baby.
The Long Journey Home: An HBA2C Story, {Part III}

The Long Journey Home: An HBA2C Story, {Part III}

Yesterday, we shared the second part of Rose Homme’s HBA2C story. In this five-part series, she shares her journey to home birth: the emotional ups and downs, the pain of her first births, and how believing in herself and her body guided her through. Here, you can read about how she worked through the trauma of two emergency cesareans. Check back tomorrow to read the goals and intentions she set for herself during labour.

“This third pregnancy there was no IF in my mind. It helped that Sue wanted a home birth for me just as much as I did. Of course I had doubts and fears that came up throughout the pregnancy, and most I acknowledged, thanked and sent on their way. Some I just told to go away, and some I knew would be joining me through the birth. Other things I chose to avoid, or not read. Months before I became pregnant Sue told me she had a dream I achieved my VBAC and I was laboring in the swimming pool. Once I became pregnant she told me constantly, “We’re just going to ignore your labor, I’m going to get there and you’ll be ready to push, have a pool party!” I loved hearing those things from Sue. I’m not sure if I really believed I was going to be able to ignore my labor and have a pool party, but everything she told me was positive and felt right.

Like anything, normalizing is a HUGE step! I am so incredibly thankful to all the women who helped me heal and get to this point of truly believing birth is normal and my body is not flawed. My research had already given me the facts on the safety of a VBAC, the statistics on cascading interventions, the benefits of natural childbirth, risks of cesarean, etc. Now I had to work on believing in myself and my body’s capabilities. I had to work on calming my doubts and fears and coping with my defeat and sadness from my previous births. I had to not only trust birth, but trust nature on a deeper level. I miscarried in April of 2011, and though it was a deeply painful experience, it actually reenforced my trust in my body and healed some of my previous experiences. It gave me faith that this pregnancy was perfect, and absolutely meant to be.

Remember this, for it is as true and true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth as well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.
― Ina May Gaskin, Ina May’s Guide to Childbirth

When people would ask about our birth plans, I could see the doubt in their eyes. Whether it was real or imagined, it felt like a weird pressure, so I tried my best to avoid those conversations. I couldn’t explain myself to anyone since I was still working through some of those emotions myself. I carried my own self doubt – I couldn’t deal with anyone else’s on top of that. I actually went into a bit of hibernation in the few weeks before the birth, which was a safe place for me and I’m thankful I honored what I needed.

In keeping my “bubble of peace” by not discussing the birth publicly, I added two weeks onto my due date of June 22 and gave that to anyone who asked. Even though I had a strong feeling baby would come on June 19th, I tried not to get my hopes up and reminded myself that 42 weeks was perfectly normal and possible.

I chose not to take any classes or have a doula this time, but both are great tools in expanding your community as well as preparing for childbirth. I was fortunate enough to cultivate relationships with my birth team from Oliver’s birth and through the store. If you do not have a community I highly recommend building one – take classes, come to the store and hang with us, find a doula! Talk to someone about your true feelings, find someone with whom you are comfortable sharing any doubts or fears. Maybe, a doula, midwife, or friend.

I’m a super private person, so I found it easier to work with a stranger. Amy St. Hilaire offered a holistic approach to finding the issues and resolving them effectively. This private approach worked for me and I never really shared I was going to therapy with anyone besides my midwife and chiropractor. I really appreciate the growth and knowledge I gained.

I kept the option of having a doula open, and knew I would figure out what kind of support I needed. It wasn’t until late in the second trimester that I knew I would better acknowledge my feelings on my own. I knew I had a lot to work through and being somewhat guarded, I needed to be alone so I could express myself freely. You’ll read all the wacky things I told myself in the next installment!”

Rose owns the natural baby store, Rosie Posie Baby, in Anaheim, California. You can read more about her and her family on her blog, Rosie Posie Baby.
VBAC Ban? Say What?

VBAC Ban? Say What?

Mandy took this fun, messy picture of her 3 year old, who is not only adorable, but was also her VBA2C baby. So why not add a caption to make a point? 😉

“There is a VBAC Ban in the hospital of the town we just moved to last week. It happens to be the same hospital where I ended up with my first csection. 🙁 Highest rate in the state of Idaho.” ~Mandy

Labor Pictures of a Beautiful Mom with Body Art

Labor Pictures of a Beautiful Mom with Body Art

“These are from the time I spent laboring at home before transferring to hospital. My son was born via C section at 5:25pm dwc 4th, 9lbs 15oz. The women with me are my best friend and Massage Therapist Tara and my Midwife Buffy. My hubby and daughter were both great as well it was amazing to go into labor on my own and feel my body working so hard. My VBAC was so close I could taste it. I’ll be planning a VBA2C for our next!” ~Gail

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