Tips for a “Successful” VBAC

As we prepare to welcome our fourth baby, I’ve been thinking a lot about the births of our three children. They couldn’t have been more different. Each birth was amazing and life-altering. And each had a lesson to offer.

  • Our first was born two weeks before her due date via a very fast, not very expected emergency c-section.
  • Our second was supposed to be a scheduled c-section due to breech, but I went into labor seven hours before the scheduled time. She ended up being born via c-section as well, albeit a very relaxed and peaceful c-section this time.
  • Our third decided to show up a month early. After days of prodromal labor, he was born in the hospital via an unmedicated VBA2C (vaginal birth after two cesareans).

This time around, we are hoping for another VBA2C, although we know things can always turn out differently. So I’ve been reviewing the details of my son’s birth and trying to identify what went well and what made things more difficult. I know there are a lot of couples out there who are also hoping for a VBAC, so I thought I’d share some of these reflections.

EARLY LABOR
Stay Busy – But Not Too Busy

Early labor started on Friday morning and didn’t end until Sunday evening. During this time, I focused on staying home as long as possible and keeping busy. Here’s a list of some of the things I remember doing during that time frame:

  • Washing and line-drying all our cloth diapers (which had just arrived the day before!!)
  • Frantically editing articles for work so my colleagues didn’t have to triple their workload (again, I wasn’t planning to have this baby for another month!)
  • Soaking in the bath at least six times
  • Taking at least six showers
  • Kettlebell workouts! When labor started to stall, I would grab a heavy kettlebell and do some single leg deadlifts and swings. I know it sounds crazy, but I felt the biggest positive changes in baby’s positioning and my contractions after doing this.
  • My husband and I did a Rodney Yee Chair Yoga video, and I did a lot of yoga and stretching when the pain got tough to deal with.
  • Drinking a glass of wine on Saturday evening with my husband and having the same conversation we had had dozens of times in the last day (basically it went like this: “Well, I think I’m in labor, but I’m not really sure. What do you think?”)
  • Receiving amazing massages from my two mini-doulas (my daughters, who were four and two at the time)
  • Trying to watch a few movies
  • Feeding the chickens and cleaning the coop out
  • CLEANING
  • Walking at least ten miles (no kidding)
  • Attending Sunday Mass while breathing through contractions (that was interesting)
  • Going to Chipotle to eat a burrito bowl since I knew I probably wouldn’t be able to eat once I got to the hospital
  • Strolling the aisles of Babies R Us buying last-minute items I had planned to purchase on the next payday

Beyond all these activities, though, I think the key to having a VBA2C was taking it easy during early labor. Everyone tells you to stay at home as long as possible, but that’s easier said than done when early labor lasts a long time. The key was to find a good balance between distracting myself with activity and resting as I needed.

When in Doubt, Call

Assuming you have a doctor you trust (which is an absolute must if you are trying for a VBAC), I highly recommend calling him or her when you think you are in early labor.

On Sunday afternoon, I thought that heading to Chipotle for a burrito bowl would be the secret to relaxing enough to go into “real” labor. Things picked up a little bit, but I still wasn’t really sure if it was real or not. So I called my doctor to see if he thought I needed to come in. He told me what I was experiencing sounded like prodromal labor and that he thought I could probably hold off a bit longer. Hearing that was a little frustrating, since I was hoping I was further along. But it also prevented me from going in too early, which would have been discouraging and may have even resulted in unnecessary interventions.

Make Arrangements for Your Other Children

Don’t get me wrong – those massages from my little doulas-in-training were great, but it wasn’t until they were with our trusted friends that I finally went into for-real labor. Some women may be different, but for me it was difficult to have my focus divided between my older children and the process of labor. Once I knew my older children were with our friends, I could let go and focus on having a baby. It was amazing how much faster labor progressed.

This goes for anything else that might hold you back from allowing yourself to go into labor. The power of the mind is incredible, and you might have a mental block that you don’t even realize. Before your VBAC, take some time to reflect on the things that might distract you during early labor and prevent you from surrendering to the process. It might be your children, your pets, your work – whatever it is, develop a plan that allows you to be  at peace when the time comes.

ACTIVE LABOR

On Sunday evening around 6 (I think?) we decided to say goodbye to our older girls and focus on this having-a-baby thing. Within an hour of them leaving, my contractions became closer together and more intense. We headed to the hospital a few hours later. Here are some things that were helpful once we got there:

Remember the Little Things

I can’t express how much I despise and dread IVs. I hate the cords, the rolling thingies – everything. And my veins are hard to find, so it usually takes a few tries to even get one started. So naturally, one of the first things I made sure to ask for once we were admitted was a hep lock.

Basically, a hep lock is an IV that is started with saline solution, but then capped off so you aren’t hooked up to the cords and the machine. It allows you to move freely, but still has you prepped in case you do need IV fluids for some reason. This is standard practice in some hospitals, but it can’t hurt to ask just to be certain.

Familiarize yourself with standard practices at the hospital, and note any you might want to be different for your birth. Usually if you ask, you can work something out with the hospital staff to make your stay more comfortable.

Befriend the Nurses

You have chosen the hospital as the setting for your VBAC. Don’t go in there with your guns blazing, viewing everyone as a threat. Make friends with your nurses. They are your team, and you want them on your side.

We were blessed to have amazing nurses during my son’s birth. From the beginning, I was sure to tell them I intended to have an unmedicated birth, and they were supportive and knowledgeable. They encouraged me to rest and drink as needed, and not once did they mention pain relief. Overall, after hearing some nasty stories about nurses and hospital care providers, my husband and I were happy with their support and encouragement.

Sleep and Rest While You Can

When we arrived at the hospital, I was only dilated to 4 cm, but I was completely effaced and my son had dropped, so they admitted us right away. It was tempting to walk the halls and try to keep labor going, but after a long 2 1/2 days, we both sensed it was time for some shut eye. So we decided to go to sleep around 9:30pm. Of course, the contractions were pretty regular at this point, so I really only half-slept, but it was still a restful experience.

Unfortunately, when we woke up at 5am, I had only dilated to a 5. This was discouraging, but I wouldn’t take back taking some time to rest. It came in handy for the next stage.

Stand Your Ground

When the nurses came in to check me at 5am and discovered my dilation rate was pretty pathetic by most hospital standards, they called my doctor immediately. He advised that I be given Pitocin right away, and told them if I did not dilate to at least 7cm within an hour, we would need to head to the OR for a repeat cesarean.

This did not settle well with me or my husband. I was having a hard time with the contractions already, and I thought if I was given Pitocin there was no way I would be able to deal with the pain. And I’d have to have that IV hooked up. Never!! But most of all, I knew I had been sleeping for the last eight hours, with no movement aside from shifting from side to side in bed. I needed to at least try to change position and move a bit before taking the Pitocin route.

My husband and I politely requested that the nurses give us a moment alone. We talked and both agreed that we wanted to try to use some other measures before receiving Pitocin. We called the nurses back in, and I told them – again, very politely – that I was going to get in the shower for about ten minutes to see if that might help get labor going again, and that we would call them in when finished to discuss Pitocin administration.

In other words, we politely refused to follow doctor’s orders. You can do this in any hospital setting. Just remember, doctors are people, too. So if you’re going to pass on one of their recommendations, do it respectfully.

What happened next is still amazing to me. I walked to the shower and my husband sprayed my back with the shower head. I started to sway back and forth and focused on letting go of tension and anxiety. I thought about my girls and how far we had come in this birth so far – the furthest I had ever gone in labor! And then, as if by magic, I felt my water break and my son’s head was RIGHT THERE.

At this point I began to scream like a madwoman and panic and probably curse (my husband tells me I was calm and meditative, but I don’t believe him). My husband rang the emergency bell and three nurses ran into the room. I couldn’t decide if I was dying or if this was a good thing. I don’t remember how I got back into bed (definitely didn’t walk), but I got there somehow, and they checked to see if I had made any progress. I’ll never forget the words:

“Well that seems to have worked! Eight centimeters!”

So from five to eight centimeters in about fifteen minutes. About 45 minutes after that, we had reached the pushing stage. My OB arrived just in time for the last two pushes. And our son was born – strong, healthy, and very handsome in spite of all the wrinkles.

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We had no birth plan, and were completely caught off guard by his birth since he was so early. But by trusting our intuition as a couple and communicating openly and honestly with the hospital staff, we were able to finally experience a natural birth.

Conclusion

I remember thinking in the first moments after our son was born, while he was on my chest starting to nurse, “If I have c-sections for the rest of my life, that will be fine, because I am so grateful for this experience.”

And now, two years later and weeks away from having baby #4, I feel the same way. Are we hoping for another VBA2C? Of course! But at the same time, I’m at peace with the fact that sometimes, no matter how much you plan and prepare, things don’t go the way you expected – and that’s okay. That is perhaps the most important lesson motherhood has taught me.

Ultimately, the power of birth is not about whether it is natural versus medicated, c-section versus vaginal, VBAC versus repeat cesarean. Birth is about transformation on all levels – physical, spiritual, emotional.

I put “successful” in quotation marks in the title of this article, because honestly, it kind of bugs me when moms say they had an “unsuccessful” VBAC because they ended up with a repeat cesarean. Success is not based on whether or not you get your VBAC. What determines success is whether or not you can tap into the part of yourself that finds transformation in any circumstance.

If you are hoping for a VBAC, my biggest piece of advice is to find a gift in whatever circumstances you are given for your birth experience. Even if  you end up with a repeat cesarean, like we did with our second child – find the gift in it. What has this birth given you? How will you allow it to transform you and help you grow?

Good luck. 🙂

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