For a quick peek without the commentary, scroll down to the Table below. 

As it seems half of my clients over the next 6 mos are hopeful VBAC mamas, I am constantly reminded that we have to keep these intervention conversations going not just for them but for our first time moms! Let's please get the word out however we can - PREVENT the PRIMARY CESAREAN! You can do this by informing yourself and other pregnant women of these common maternity practices in the US and how they can change a labor, birth, baby, and woman. The biggie - unnecessary inductions. A woman is not OVERdue just because she has passed her due date. Post term pregnancy begins after the 42nd week, and induction is NOT supported before that date, especially for first time moms, because of the risk of cesarean. Spontaneous labor is your friend! A friend worth the wait! 

Below is a table created by Rebecca Dekker from Evidence Based Birth. Citations are available by visiting her post which she also shared on Improving Birth.Org : 
http://www.improvingbirth.org/2012/11/state-of-maternity-care/

I 



Encourage anyone hoping to avoid a cesarean birth to choose their birth location and provider CAREFULLY and hire a doula! It's great to take an out of hospital childbirth prep class, too, but going into the hospital with professional labor support is invaluable in helping women avoid routine interventions that lead to cesarean birth without improving mom and baby safety, according to evidence. So many women don't know! Believe me, I hear the stories from moms during their second pregnancies all the time at consultations. There are way too many women who just don't ever come across this info and don't know what to expect at the hospital during labor and how it can affect their birth, baby, and future! They trust their doctors and that the hospitals wouldn't do anything unnecessary or that could possibly be risky. And while those of us immersed in helping to change things don't believe that many care providers are ill-intentioned, we do know this - standard and routine practices being used in hospital labor and delivery care are not supported by evidence, not even recommended by ACOG! And yet they are still used on women everyday and leading to UNNECESSARY CESAREANS. Take a look at the chart - for you, your sisters, your friends, your daughters. And while you may be uncomfortable offering unsolicited advice, how would you feel wondering if you had gently passed on this information and it having prevented a woman and baby you love from unnecessary harm. 

I know we all find ourselves asking...but why? Why do hospitals practice this way? Why would our OB's do these things if not based in evidence? If not backed by their own professional organization? I think the simple answer is that this is just how they are trained.  "Managing" every step of the labor process is how they've experienced birth in the hospital setting. Ultimately, it's easier to manage a bunch of women's labors using these routine practices coupled with it being more in their comfort zone. Taking spontaneous labor off the table in the majority of their patients really puts a lot more control in their hands, too, which I believe is a good match for most of their personalities ;) ...and schedules, dare I say. That is, of course, all my opinion. Not based on evidence. ;) 

And for local information and support for managing interventions in a "trial of labor after a cesarean" (TOLAC) as a hopeful VBAC mom, please attend the ICAN meeting this Saturday at 10 am at Ohm Chiropractic in Media. It will be a roundtable discussion featuring tips from local doulas, ICAN leaders, and experienced moms! https://www.facebook.com/events/598029813590109/

Our son joyously arrived at 10:08pm on Monday, April 29th.  He came on his due date, which happily is the first of my expectations he decided not to fulfill.  I had told people for months that we would have a May baby, but he had other ideas.  My husband and I were lounging on the couch in the afternoon of the 28th when I felt a sudden desire to rush to the bathroom.  I knew immediately that my water had broken and remembered to note the color, smell, etc. like Lori had told us.  Water continued to seep from me for the next eight hours or so, in varying amounts.  The amount of water surprised me!  Good thing I had a bag of sanitary napkins on hand.  

Dan (the husband, not the baby!) and I frantically packed our bags and called The Birth Center in Wilmington, which is where we were planning on giving birth.  Because I am Group B Strep positive, the midwife (Durenda) requested we come in and start an antibiotic.  I felt high and expectant on the ride to Delaware.  I had not had any contractions yet.   When we arrived  Durenda confirmed that I had experienced premature rupture of membranes (PROM).  I was about 2cm dilated and 60% or so effaced. She suggested that we take a walk and get something to eat at a local restaurant, which we did feeling anxious and gleeful.  After dinner, we considered getting a hotel, which would have meant that we would have to come back to TBC every four hours during the night so the antibiotic could be readministered.  Durenda suggested we sleep there, saving us the hassle.  Very nice!  

During dinner and the walk, I had several slight contractions that felt more like the Braxton-Hicks  variety with little pain.  Things were going slowly so we were reminded that if active labor had not begun within 24 hours of PROM we would be transferred to Christiana Hospital. After we returned to TBC, Durenda suggested taking some homeopathic tablets to help speed the process of labor.  She also presented castor oil as an alternative.  After consulting with Lori, I decided to try to castor oil immediately and try the homeopathy in the morning if it was needed. In hindsight, I should have done everything suggested immediately, but at the time I wanted to sleep a little and thought contractions would begin very soon.  I slept on my left side that night with my belly hanging over the edge of the bed to try to help Baby Danny position himself in the ideal position, with the knowledge that he had been on my right side for the majority of my pregnancy.  The castor oil did not kick in until early the next morning, and I had mild contractions through the night and was able to sleep pretty well.  

The next morning, midwife Sarah gave me the homeopathic herbs and Lori arrived with breakfast foods from Wawa. I was still only about 3 cm dilated and a little more effaced, but satisfactory progress wasn't being made.  I started to feel slightly desperate with the thought that we would be transferred, so after some more castor oil I tried nipple stimulation in the shower, which brought some better contractions.  After about thirty minutes in the shower, we tried taking a walk and doing some pelvis-opening stretches, but another exam revealed that I still wasn't 4cm dilated, which had been our indication that active labor had begun.  Sarah told me that we would need to be transferred, which was heartbreaking to me because I saw a C-section at the end of the ordeal.  I had a good cry, then we packed up and went to the hospital.   

As soon as we arrived, my contractions became more painful.  I was incredibly frustrated with the paperwork in triage, including seemingly irrelevant questions like the name of the county in which I was born.  Apparently, my husband, who took over after I showed clear frustration with the questioning, was also asked three times, "Are you sure she has no Spanish heritage?"  Not sure why this was of interest to them.  Finally, Sarah spoke up and asked if I could go to our room and we were told we could. We arrived in the room about 2:00pm.  As soon as we arrived an IV was started and I was given Pitocin to induce more contractions. The nurses were kind to all of us; I didn't feel any animosity about our wanting to do things as naturally as possible.  The nurses even seemed to respect Sarah and Lori's perspective and knowledge. I think they would agree.   

I found not being able to walk, squat, or move in general very difficult.  I turned to my left and waited between contractions. I experienced very little sensation in the front of my body, but the pain in my back was sharp.  Luckily, Dan never left my side and massaged both sides of my spine during each contraction.  Lori or Sarah stayed in front of my face, while the other stroked my leg or applied pressure on pressure points to help the contractions speed along.  

A habit I developed that Lori later said was unique: during contractions I sang or repeated phrases.  In the beginning, I said things like: "OPEN" in a firm, calm voice; "somos juntos" ("we are together"), a phrase that resonates with me after a trip to Mexico a couple of years ago; "ganbare!" ("go for it!" in Japanese); "there is no bliss like this" (a favorite affirmation from yoga practice); and simply "YES!"  I also told myself to be calm and that what I was feeling was a pain that creates, not that destroys.  As the contractions increased in duration and frequency, I sang long high notes or scales and didn't repeat phrases.   Lori told me I also sang "Somewhere Over the Rainbow." I could not have made it through without this comfort measure, which made me feel powerful and as though I was still in control of something.  At one point, the nurses explained that they were concerned about the baby's heart beat, so they wanted to use an internal monitor.  This device sticks into the baby's head using a piece of wire that looks like a screw.  Lori and Sarah said it was a good idea, and with the idea that a healthy baby was the goal I agreed.  

Around 9:00pm someone asked if I was feeling pressure in my bowel, which I said was true. The pressure increased with each contraction, and Lori was coaching me not to push but to use puff breaths during each contraction to avoid the urge.  During the puff breaths, I began to push uncontrollably.  The pushing felt like a sort of muscle reaction that I could not control, similar to what I imagine a seizure might feel like.  Someone (a doctor?  I never saw her again) said that I was fully effaced and dilated, so everyone agreed with smiles that I could start pushing.  A bar was used across the bed for me to put my feet on and the OBGYN on call arrived.  He said the pushing was going very quickly.  I commented to Lori and Sarah that this part was very satisfying and almost pleasurable because it was empowering to feel I was getting things accomplished.  Several other nurses joined us and everyone was shouting "Go, Sara! Push!" which really helped me stay motivated.  The hospital nurses commented that it was unusual for me to be smiling and seemingly enjoying myself. I think around this time I said to Lori, "I am a warrior" and she heartily agreed with an encouraging smile.  

I expected to be shocked by my baby, so had done a lot of visualizing during pregnancy of the moment when he emerged.  There was no shock involved, he felt like mine and someone I already knew. I don't think the visualizations had anything to do with this feeling; I just think it was the first hormonal reaction of motherhood to know that this creature is mine and no one else's, not even my husband's in the same way as he is mine.  

The placenta came away quickly, though I think the doctor had something to do with that as his arm was somewhere inside me just before it emerged.  The stitching process was not pleasant; I had a third degree tear because our baby was on the larger side (9lbs, 14 ounces) and came out with his arm wrapped around his head. I am disappointed with doctor's performance; he was by far the least caring member of the team and did nothing to keep me informed of what he was doing.  He almost seemed annoyed by my questions.  Our baby spent the next 3 and a half days in the NICU, which is another long story!  If anyone is interested I'd be happy to share.  The end result of all of this is currently asleep on my lap.    :)

Last thing for all you first timers who might come across this: a short list of recommendations.
1.  Hire a doula.  I VERY HIGHLY recommend Lori.  If possible, also have another support person plus your partner for a total of three.  I know that these people's presence there meant that the interventions were kept to an absolute minimum.
2.  Pack a bag in advance and pack as though you'll be gone for several days.  Better to have to much than too little.
3.  Get in shape NOW.  Even if you're already pregnant, find something to do that will keep you fit.
4. I hate to say this, but expect to be disappointed in the doctors you meet.  Find others to trust.   

THE END! Ah, but also a huge beginning for our family!  

How's this for informed consent? First time mom says to her favorite doctor at 38 wk check up,

SO. MANY. PROBLEMS. WITH. THIS. Where to even begin? Now, I feel pretty comfortable in my knowledge base of the evidence as well as ACOG guidelines, etc., so there are a few things glaring at me that I want to JUMP on... big time. But I fear if I start to address each untruth and danger within this OB's responses, I will write a book tonight, not a blog post! And frankly, I don't have the time! Ok, Breathe. In....all things good and right in the world, Out....all things &U#&$$*ed up....ok, again....nice and deep and slow. Repeat.

Ok. If this was your sister, friend, or anyone you cared about - what would you say to keep it short and simple!?!? For you doulas and childbirth educator's out there - what information would you be sure to relay to this client/student?

I tend to think that if I was involved with this woman either professionally or personally I might start with this:

I realize we can't save every woman and baby from similar doctors who are, believe me, absolutely still out there practicing in a hospital near you - but, if you heard a similar conversation being relayed to you, WHAT DO YOU SAY? And why do you speak up or not? I'm curious of the different perspectives on this topic.

Lamaze International lists the TOP 5 Barriers to Breastfeeding. And while everyone who experiences these things when having a baby assumes they must be necessary, they are SO OFTEN NOT. Get the word out - moms have to know that they can ask for alternatives and while the practices may be 'normal' for that hospital, they are NOT normal for babies or getting breastfeeding off to a good start. Remember, the staff only sees moms through day 2 or 3 usually! What they don't see is the struggle afterwards that moms often encounter because of these barriers, and all too much without support. This is why our initial rate of 77% breastfeeding when discharged drops so drastically each week following.

Below is copied from their website: http://www.lamazeinternational.org/p/cm/ld/fid=324

In honor of breastfeeding awareness, Lamaze calls out the following top five breastfeeding barriers within the first 24 hours of birth to help expecting moms prepare for the best breastfeeding experience:

1. Unnecessary birth interventions:  While there are many unknowns during the birthing process, women can seek maternity care practices backed by science that can make birth safer and healthier. Fetal monitors, confinement to bed, artificially starting or speeding up labor and cesarean surgery can make birth more difficult and lead to a harder start for breastfeeding. For example, women whose babies are delivered by cesarean surgery can face a delay before the mature milk comes in. Pregnant women can find more information about reducing these and other challenges in childbirth by visiting Lamaze’s Push for Your Baby resources at: www.lamaze.org/ChildbirthChallenges. 
2. Separating mom and baby: Abundant evidence shows that mother-baby, skin-to-skin care beginning right after birth and continuing uninterrupted, for at least one hour, or until after the first feeding for breastfeeding women, helps mothers, babies and breastfeeding. Skin-to-skin care helps a mom feel more confident, respond more quickly to her baby’s needs, reduces stress and makes breastfeeding easier. There are also clear benefits for babies: they breastfeed sooner, longer and more easily, they cry less, have more stable temperatures and blood sugar levels, have lower levels of stress hormones, and adjust more easily to life outside of the womb.[i]
3. Use of pacifiers or other artificial nipples before breastfeeding is well established: Does the hospital nursery use pacifiers or bottle-feed babies without need? It’s an important question for expecting parents to ask. Studies show that early pacifier use may interfere with breastfeeding, and could decrease mom’s ability to exclusively breastfeed and reduce the duration of breastfeeding. Artificial nipples should be avoided until breastfeeding is well established (after about four weeks).
4. Supplementing breastmilk with formula: Breastmilk is best for babies. Formula simply does not provide the added nutritional and health benefits of breastmilk that’s naturally packed with antibodies, and should not replace formula unless there is a compelling medical reason to do so. Even the few days following birth are vitally important. The breasts produce a vital substance called colostrum, which protects the baby from illnesses and provides important nutrients
5. Lack of postpartum breastfeeding support: Many new moms need breastfeeding support after hospital or birth center discharge. Support may include: a home visit or hospital postpartum visit, referral to local community resources, follow-up telephone contact, a breastfeeding support group, or an outpatient clinic. This is a good time for a mom to talk about any challenges she may be having, and get the help she needs to give her baby the healthiest start.

"While breastfeeding decision-making can spark controversy among moms, improving breastfeeding awareness is not about passing judgment,” said Deck. “It’s about considering the scientific evidence and giving women the support they need to achieve their breastfeeding goals."

Some women find that they get to a certain point in pregnancy and realize they are not totally comfortable with either their care providers or their place of birth, yet do not know what to do about it.  Some women see red flags during an office visit or while asking questions during a hospital tour and they decide to make a change that they become forever happy about.  Some women just completely follow their intuition and go along their journey how they are comfortable.  If you trust where you are and who you are with, that's great! But it's important to Choose Carefully, and here are some stories of women who did.
______________________________________________________________________________________________________

Changing Care Providers

1) Mayumi's story 

2) Rupal's story  

3) Angie's story

4) Jess' story 

A collection of birth stories are posted below. Variety is included - medicated and unmedicated births, unplanned cesareans, VBAC's, homebirths, hospital births, birth center births, waterbirths, large babies, midwives, OB's, with and without doulas and more!  From a first birth to a fourth, these are real stories of women's birth experiences, told by the women themselves. Thanks to all who have shared already!  Others learn so much from hearing all the variations of labor and birth.  It is encouraging to read and hear other women's stories of birth - it builds a sense of community that we are sometimes missing in our 'real' lives since most of what we hear and see of birth from other women nowadays is on t.v. or negative, scary, dramatic events people like to share sometimes.  If you'd like to share your birth story on my site, please email me and I'll add it.

***For a collection of stories specifically about changing care providers, read here.***

   
Birth Stories

1) Rory's unmedicated hospital birth (3rd baby)

2) Isaiah's unmedicated hospital birth (1st baby - BIG baby)

3) Jonah's homebirth (4th baby, 2nd homebirth, born in the caul!)

4) Lakshman's birth (first baby, birth center) - Momma Rupal's blog "From Doctor to Mother

5) Nonah's homebirth (first baby, 10 lb baby!)

6) Luke's birth (first baby, hospital, cesarean)

7) Julia's hospital VBAC (Luke's sister!)

8) Gabe's birth (third baby, RCS)

9) Leo's birth (unmedicated hospital birth, 3rd baby, after a traumatic 1st birth and 2nd baby loss)

10) Lilliana's birth (postdates hospital induction after birth center transfer)

Thank you to Tracy, my dear client who is sharing with us her latest birth story and photos. She has had quite an amazing journey.  I felt connected to her and her husband from the first time I met them at an ICAN meeting. They were so full of passion after all of their past experiences and they were determined to make truly empowered decisions this time around, hoping for a VBA2C.  When we met for our prenatal appointments, it was so obvious how much they LOVED each other and how they thought and worked like a TEAM. I was lucky to join their team and be a part of their third child's birth...Gabriel. After an rollercoaster of events in the last couple weeks of Tracy's pregnancy as she navigated quite gracefully through a pretty nutty bait and switch routine from a supposed supportive doc, Gabe was born via a second repeat cesarean, delivered by another doc she trusted and very much on her terms for many reasons...finally. It was a beautiful moment watching her meet her son. I was and am so happy for her and her husband Brian (who was such an awesome support). I also thought it was cool that Gabe now shares a birthday with not only his dad, Brian, but also my son, Keegan! :)

Gabe’s Birth Story

To tell the story of the birth of my 3rd child Gabe I have to begin with the births of my first 2 children. Lucas was born in 2007, after a comfortable and very uneventful pregnancy. I had done everything that all of the books and pamphlets tell you to do, I had all the tests done, I went to birthing classes at the hospital, I took a breastfeeding class, I was ready to give birth, and anxiously awaited the moment that I would realize that labor had begun. That moment never came. I had fallen while I was walking our dog when I was 38 weeks pregnant and it was discovered then that he was in a frank breech position. When a doctor from my group finally came to see me, I asked for an ECV and was instead scheduled for a section 2 weeks later. I pressured them for another week to try to turn him and they finally consented but it was too late, my ECV was the day before my “elective c-section” and they wouldn’t perform it because I was just too far along, Lucas was too big, and I didn’t have enough fluid. So they sent me off to get pre-op blood work done. I sat in the waiting room crying, my mother sitting next to me trying to tell me that it was going to be okay, but I didn’t believe her, How did this happen? To me of all people, I was so ready to feel the pain, and wonder that childbirth had to offer, and was ready to see the life that had grown in my body enter the world. There was a middle aged woman sitting across from me in the waiting room and she asked why I was crying, my mother told her, and with the best intentions the very nice woman told us she had 4 wonderful children all born by cesarean, and that she had never been in labor and that it was going to be ok. My response to this was even more tears, I didn’t want to go through life never knowing what it was like. The next day my beautiful son was born, delivered by a doctor I had never met, I saw him for a few minutes and then he was taken away from me for more than 4 hours, because “that’s just how they do things.” Later on (4months later) we discovered that Lucas had a cranial defect that also would have prevented a vaginal birth, regardless of his presentation. This still didn’t make me feel better about anything.

About 5 seconds after Lucas was born I started planning and hoping for a VBAC, something that I had read about, and seen on TV’s various birth shows. I was going to VBAC and that was that. I left the practice that had delivered Lucas, and found Midwives that I really liked and felt very comfortable with. When Lucas was 13 months old I became pregnant with my daughter Lilly, I had talked to my midwife about VBACing and she told me their hospital policy is strict about who attempts a VBAC and that I would have to speak with the head OB later on in the pregnancy. I did go to speak with him, he was polite, and kind, but disclosed that because of various reasons they are only able to provide VBACs to women who had already VBAC’ed or delivered vaginally before their c-section. My husband and I decided that after all we had been through with our previous OB that leaving and trying to find another provider would do more harm then good, and that since we felt safe and cared for by our midwife and her partner OB that we would stay and have another cesarean. I still cried about it . . . A lot. My hope for a natural birth experience was dead, gone forever I was marked with the scarlet C, I would never know what a contraction felt like, never know what the burning felt like, never know what it was like to see my child emerge from my own body and into my arms. In my head I told myself that this was okay and that for some reason babies just aren’t supposed to come out of me that way, but that I get to be a mom and have a healthy me and a healthy baby. In my heart I felt as though I must be being punished for something I did in another life to be robbed of something so normal, and I began to really dislike people who I deemed to be unworthy of their own vaginal births, those that didn‘t appreciate what they had been given. Lilly was born in 2009, she was perfect and healthy just as I had expected, and this time she wasn’t taken away like her brother was she was with me right away in recovery, and overall this birth was much better then my first, I was in less pain both emotional and physically, and I was at peace with my lot in birth, and had stopped loathing the scores of women around the world who delivered vaginally, because really that was kinda unreasonable to begin with.

It’s 2011 and I’m pregnant again. Not even thinking of VBACing this time because I know that no one will touch a woman with 2 prior uterine scars, so I sign up for a repeat cesarean before I even get the first ultrasound. It wasn’t painful this time to sign on the dotted line, to willingly have my baby cut from my body, because I thought that there was no other way. Fast forward 5 months, I’m in my kitchen doing dishes and it hits me like a Mack truck, the tears start coming and I can’t make them stop, all the pain and mourning that I had avoided and pushed away with my other 2 births was here, now, in my kitchen, torturing me. My heart actually hurt, all the hope, anticipation, fear, happiness, sadness, defeat, and anger that I had carried within my body came out in one violent moment. Once I was able to collect myself enough to speak in full sentences, I called my husband, and poured all of this out to him, he told me that he knew in his heart that I could push a baby out, and that if there was a way we would find it. Our search began, I had papers and printouts of doctors, their on-line reviews, I found ICAN and after all this research we had finally found a doctor that was supportive of our attempt to VBA2C. I broke up with my midwife, which was really hard to do because I had such a good relationship with her, but it just wasn’t a journey she could take with me, we both knew that. Are parting of ways was gracious and she extended her best wishes and told me the door was always open to me should I want to return. I was 6 months pregnant at this point.

Our new provider, an OB, was very optimistic about our VBAC. I asked him lots of questions at our consultation, about various things that effect VBACs, post dates, baby’s size, baby’s position, duration of labor . . . He had all the “right” answers, both anecdotal and research based (and who doesn’t love a good meta-analysis??). My last trimester went quickly as I had expected it would, and was rather uneventful. We met and hired the most wonderful doula. As my due date approached with each passing week I began to worry, if the VBAC rug was going to be pulled out from under us yet again. If all my searching and hoping was going to be for nothing . . . Again. My husband, our doula, and even the OB assured me that we were all on the same page and that everything was on the up and up, everyone was really excited about the birth, and how great it was going to be, eventually myself included. At 37 weeks my OB requested that I get and ultrasound to access the size of our baby, he wanted to me to get it done in the 39th week. I scheduled it, reluctantly, but since he, the OB had stated to me before that he had several VBACing moms deliver large babies, I wasn’t to frightened that it would effect our vaginal birth. Our doula accompanied me to my next doctor’s appointment, and I asked him point blank if the ultrasound results suggested a larger baby if that would end our VBAC attempt, he said no it wouldn’t and that he was merely gathering information so that I could make a decision based on “informed consent.” The next week I had the ultrasound and low and behold, I grew another 8lb + baby, I wasn’t shocked because my other 2 children had been the same size. I also wasn’t worried about our vaginal birth disappearing because of the conversation I had with the OB the previous week. Two days after the ultrasound, and 5 days before my due date, my phone rang , I didn’t get to it and it went to my voicemail. The message was from our OB, and in it he said that because of the size of our baby that he was no longer going to be able to support us in a VBAC attempt, but that he wanted to “honor our agreement” and that he would let me go until my due date, since he was going to be on-call and would be able to be there to deliver me if I went into labor prior to that day, but after that he wanted to section me. So here I am in the kitchen, on the floor, completely lost and broken . . . Again. The next day I got a call from the office telling me that they had scheduled my c-section for my due date, Tuesday 3/20, I declined to confirm it until I had a chance to talk to the OB to find out why he had changed his mind. When I did speak to him he was cold and unrelenting about performing a c-section on that day. When I brought up all the things he had told me about all those other women that he delivered with big babies and all the studies about fetal size, and due dates in relation to VBAC he told me that I couldn’t hold him to conversations that we had months before and that he could produce studies that stated the contrary to the ones I had, I asked him to e-mail me the information he had . . .I’m still waiting. After a long attempt to negotiate another day for the section and him not budging I agreed to it, to try and buy more time to figure out what to do and to keep him happy so that if I did go into labor in the next 5 days I would have a happy doctor waiting for me at the hospital. I called my husband who was shocked, and we agreed that we were going to cancel the surgery on Monday (all this happened the Thursday before I was due), because it seemed as though his motives were not completely medical. I called our doula, who was equally shocked, all 3 of us worked together and came up with a plan of how to handle this now very complicated situation. The next 5 days came and went and despite my best efforts at DIY labor induction I remained pregnant. On Monday 3/19 I called and cancelled the section, which of course sent everyone in the office into a tizzy, I was on hold I was disconnected . . . Blah blah blah. When I did speak with our OB he was less then pleased with my decision and told me that he wouldn’t be able to be my doctor anymore after Tuesday and that we would have to find another provider, and that it was going to be impossible for us to find someone to take us at 40 wks and that no one would touch us if we still intended to VBAC. We conversed back and forth for awhile about this, he told me that if I were to show up to his hospital in labor that I would only be offered a cesarean, and I told him that I accepted and understood that, but that since there was no danger in my remaining pregnant that I wouldn’t consent to a scheduled section until I was 41 wks, which was when I had decided that I no longer wanted to pursue a VBAC, because of the decrease in success rates ( I had already decided this long before all of this had happened). He continued to persist that I had to be sectioned the next day, it wasn’t until my husband joined the conversation on speaker phone that our Ob changed his tune, to “of course I won’t abandon your care” and “of course I won’t deny you pre-natal care” and “we will work something out.” I had my 40 wk prenatal visit scheduled for Wednesday 3/21. On Tuesday 3/20 late in the afternoon I got a call from the OB’s office saying that I had an appointment that they had scheduled for me to see a perinatologist I hadn’t been informed of a need to see one nor had I consented to see one. When I asked them why I had to see one they said they didn’t know and that the OB had requested it. I kept asking why and got no answer, so I called the perinatologist and was told by their receptionist that it was a VBAC consult. I saw no need to go but wanting to be compliant I went, the appointment was just before my prenatal checkup the next day. My 2 kids and I spent an entire hour listening to him read off stats that I already knew and when he realized that I was clearly intelligent enough to discuss this and not be intimidated by his power point presentation (yes it was a power point print out he was reading) , he decided that he was done with our consult. I will say that although some of his information was old and outdated, he was very polite and professional. I went down one floor and checked in for my prenatal appointment. I saw the nurse, and during the BP and urine check she also prepped the vaginal ultrasound wand. I asked her why she was doing that and she said that the OB had asked her too. I told her it wouldn’t be necessary because I wasn’t consenting to a transvaginal ultrasound, unless I had the medical reasons behind it explained to me, and even then I would only think about it.

Enter my OB, he checked baby’s heartbeat and did a cervical check and then with my children present proceeded to tell me that I was ruining his personal like and his professional life, that I had the hospital in an uproar because I was refusing to be sectioned. He told me that if I were to go into labor that I would surely have shoulder dystocia and a ruptured uterus, and that he didn’t want to get sued. He said that when I came into the hospital either for a section or in labor that my reception would be cold at best. My interpretation of that was that I wouldn’t get the same care that everyone else was receiving or the care that as a human being I was entitled to . . .do no harm I think is what it‘s called. I told him that my intention wasn’t to ruin anything but to only protect my body and baby from an unnecessary surgery, or a surgery of convenience. Of course if I needed a c-section I would consent but that I didn’t believe based on the information that he gave me that it was indeed necessary, since the main reason was that he wouldn’t be on-call and another doctor would have to deliver me, and “they” weren’t comfortable with VBA2C patients, yes my OB had said this exact statement in our conversations/recorded voicemails, that had taken place. .He called me self-serving, and demanded that I consent to schedule a c-section for the Friday 3/23. I told him that I would have to discuss it with my husband because I don’t make these decisions without him, we do things as a family. He told me that I needed to find another provider, but that we wouldn’t find anyone to VBAC us, let alone take us at 40+wks. I told him that I would of course let him know if we were able to find another provider, and that I would let him know about the section for Friday, I then told him that we were finished talking and asked him to leave the room. Oh and that vaginal ultrasound, I guess it wasn’t medically necessary after all. It was during this visit that I knew that this man was not going to get anywhere near my baby or my body, ever again. I left the hospital, called my husband and we made a decision of what we were going to do, I called our doula, told her what happened, and what hubby and I had decided to do. She was on board of course, because she is the best doula EVER! I got home and got on the phone. I called my old midwife, yes the one that couldn’t VBAC me. I knew that calling them meant a repeat section, but I was quickly approaching the end of my VBAC comfort zone anyway, and it was becoming impossible to dodge our now very persistent OB. I knew that I had always felt safe in her care, and that her partner was a great surgeon, and also as caring as she is. I told her a watered down version of what had transpired and asked if she would be able to help me deliver via cesarean, because I did not feel safe going to the OB anymore and did not feel safe at his hospital. She agreed to try to get me in, she called me back about an hour later and told me that of course they would deliver me, and that I was now scheduled for Friday 3/23, also my husband’s birthday. I went in the next day saw the OB to sign some papers, again told the watered down version of what happened, he hugged me, told me he would keep us safe. Friday came, we checked into L&D, talked with the midwife and OB, went over some things that we wanted for the birth, and they obliged. They allowed my husband and doula to be with me in the OR, they lowered the drape at the moment of birth, I saw my son enter the world, saw him breath air for the first time, I still can‘t verbalize what that was like without bursting into tears it was so moving I can‘t explain it, they delayed clamping his cord, and they kept him with me in the OR for quite a while. We were only separated for what I can guess was 20 minutes or so. My little Gabe weighed 9lbs 1oz. And was perfectly cooked.

So in the end, a baby didn’t come out of my vagina, even though I had hoped and wished for it, for a lot longer then this story documented. Am I disappointed that I never labored? Never pushed? Never had any of that burning that everyone talks about? Well I’d be lying if I said I wasn’t disappointed a little. I’ll always wonder, always imagine what it might have been like. But I have a birth that I am proud of. I not only experienced things during Gabe’s birth that I never thought I would see or feel, but I found strength within myself, to stand up for what I knew was right. I was not bullied, I was not a victim, I chose to birth my way, on my own terms. There are people who thought I was crazy for having done all of this, only to end up back to where I started, but I needed to take the road less traveled, and stay on it just once. It led me to a place where I feel peace, I feel strong and I feel empowered, all things that anyone would want out of the birth of their children, and after 6 years, and 3 children I finally have them.

Care provider matters. Location of birth matters. Choose very carefully. Do not choose based on location's proximity to you, an appealing renaming of a facility, it's where your mother or sister gave birth, where your GYN is, or new beautiful renovations. Choose because you FULLY trust your care provider and the location where he or she delivers. Be sure you are getting personalized CARE and not just the routine. Ask specifics of nurses who work there, find out if the nurses and doctors have THEIR babies there, talk to doulas who have been to births there, take a PRIVATE childbirth class and ASK them, ask your provider how they like to work with doulas, what they will do in a stalled labor, when you're past due, how detailed and valued their nutritional education is, etc.  Do your research on statistics for each location, and do not stop until you are totally satisfied with your options.  Find out how often they see normal.  If they don't see it except for moms who come in pushing, then they also don't know how to react or support normal without trying to medically mange it. Recognize red flags and act on them.  Change is good in this case. Changing again is sometimes even better.  Often, it is not ever too late.  As a friend and mentor once said to me "You cannot go into Taco Bell and expect a Pizza."   And...I must add to her metaphor just a bit.  If you do go into Taco Bell wanting a Pizza and are ultimately talked into a taco being just as good, just know that you may never have an opportunity to eat a pizza ever again.  And maybe that taco will be just as good for you again and again and you'll only slightly desire a pizza in the future, but for some - it will become much more than just satisfying the need to eat, it will affect you in every part of your life more than you could have imagined.  Your birth depends on your choices more than anything else. You and your baby's birth deserve more research than your house, car, major appliance.  Maybe even as much consideration as when you chose your partner. Do not settle.  But, if you do - be ready to accept whatever outcome you get, knowing you had control to look into options and make choices about them.  Do not rule out anything because it scares you or because you don't know enough about it.  Learn.  Ask tons of questions.  If you don't know what to ask, find out.  Ask a doula.  Ask a childbirth educator.  Go to a birth friendly website to find out. Information eases fears.  Evidence based research cannot be manipulated as some people's words and opinions CAN be.  Also, a hospital is not the only place to give birth.  Feeling a certain loss of control at some point prenatally should tell you something about what to expect when you walk into the L & D room.  There really are care providers out there who will work with you and your individual situation as a respectful partnership and not impose strict protocols just because you have to go into a certain box.  And as much as I advocate for hiring a doula, there is really only so much a doula can help with at certain locations, up against a staff who finds us very counterproductive to their agenda. Sometimes our presence and mere suggestions alone are seen as interfering with 'the way they do things', no matter how safe, helpful, or important it may be to the birthing woman. And, yes...in the end, what we all need to have is a healthy baby and healthy mom.  In addition to that, though, as women...we desire to feel respected and supported and loved through the birth process.  It is important to our beings whether or not we realize before our first birth or after.  PEACE.

To read stories of women who've changed care providers and were glad for it, read here.