I almost cannot bear to hear these stories about mothers dying in the OR due to placenta accreta caused by multiple cesareans. Everyday women are told 1) That a primary cesarean is necessary to birth her baby for some reason. In many (dare I say, most, cases is just UNTRUE. 2) That attempting a VBAC is dangerous. Which is also just UNTRUE and NOT what is recommended by ACOG. 

These women are left with option to have no more children or put her LIFE at risk to give birth by more cesarean sections. Which isn't usually explained how risky each subsequent pregnancy becomes. If it's explained, it's usually after her second or third cesarean. What kind of choice is that at that point???

And for a doctor, I imagine it is terrible to lose a baby during a delivery. But, a mother? How do they go on? I'm sure they do everything they can and it must be awful to realize you cannot save her. But we need them to STOP doing all of these unnecessary cesareans! Overmedicalizing birth in the first/second pregnancy is the root cause of mother's hemorrhaging on the operating table a few cesareans later.  

Maybe I'm especially emotional hearing of these stories because I lost my mother at age 9. I don't want any other child to endure this kind of loss. And because of my work, I know it can be different. Giving birth doesn't have to be risky. It can be healthy, respected, and trusted in most cases. And, women can be trusted to make their own informed decisions when given the right information based in research and allowing that along with intuition to guide them instead of FEAR...

I don't want to post the stories that have deeply saddened me recently. I know I have other mothers reading, some facing cesareans that have become necessary and possibly complicated and scary pregnancies. Or maybe just like me, a motherless mother who's heart breaks to think of any other mother leaving her children behind. So, instead, if you'd like to read about how another mother managed to survive when facing what became a life threatening pregnancy, read her story included in a previous post below about preventing the primary cesarean.  Below is a great video on VBAC. 

Today I want to say that ICAN is about supporting the first time mom, too, not just those hoping for a VBAC. It is a great resource for preventing that primary cesarean birth. As is the VBAC facts site and Jen Kamels who runs it and teaches a workshop around the country and online.

http://www.ican-online.org
www.vbacfacts.com

Our local ICAN of SEPA:
http://icanofsepa.wordpress.com
https://www.facebook.com/groups/411506922273373/

I'm also linking a story here that offers a great explanation as to why we fight so hard to help mothers avoid their primary (and too often unnecessary) cesareans and to birth vaginally. It details the risks and dangers to mothers of multiple cesareans. This mother is not alone, more and more of these examples are making news because they are becoming more prevalent problems in pregnancies and in the OR. Just to be aware, though, I had tears in my eyes the whole time while reading. She does a great job writing so that the reader can almost feel her fears through what was a very scary experience. To clarify, MOST 1st and even 2nd repeat cesareans will be manageable by most hospitals and with what blood they have on hand for possibility of transfusing...I do not want to scare moms facing a repeat cesarean where they NEED to trust and depend on a doctor to keep them safe, but this story also shows how a mother did her homework to do just that - be in the best place with the best team to make sure she'd be going back home to her kiddos. This was simply the situation she ended up in during her 7th pregnancy. Her placenta became deeply implanted into her uterus and cervix after multiple previous surgeries to her uterus. 

As a doula, I never want my clients to have any good answer to the question, 'what else could I have done to prevent my first cesarean?' This is especially important when moms desire a larger family. I have had friends and family members tell me that their doctors never once mentioned to them before, during, or after their first cesarean that they'd need to consider limiting family size due to having that surgical birth and the increased dangers of multiple pregnancies and cesarean births following. And not just that, but that they'd not been offered a chance to VBAC and instead told that it is dangerous to try, safer to schedule ANOTHER cesarean, and just accept having 2 children or at most 3 if she really really wants to risk it, but no more! Women are being told this AFTER their second cesareans when their options are nearly nil at that point! It's infuriating. And sad. More women need doula support through their first pregnancies and births, good information, supportive care providers, and to visit their local ICAN group before having their first babies if we want to stop this trend from continuing. Women need the truth! They need their options! They want to make informed choices! 

I recently met a nurse who told me there is a doctor on her floor who frequently says all babies should be born by cesarean and has no problem recommending tube tying after the second to all mothers. I seriously hope he is in the extreme minority. But I have a feeling that while we do have docs who truly believe in the safety of and support less medicalized vaginal birth, the number of docs seeing their norm everyday be cesarean deliveries is increasing by the day. This will just continue to have an effect on moms and babies (physically, mentally, emotionally!!!) if we don't advocate for ourselves and surround ourselves with professional support and evidence based information. 

And while I'm thinking of it. Hug another woman today. Love her with that hug, if even for just a few seconds. We don't always know each other's journey. 

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/

http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf

"The percent of US infants who begin breastfeeding is high at 77%. While there is concern that infants are not breastfed for as long as recommended, the National Immunization Survey data show continued progress has been made over the last ten years. Of infants born in 2010, 49% were breastfeeding at 6 months, up from 35% in 2000. The breastfeeding rate at 12 months increased from 16% to 27% during that same time period."

Why, you wonder? Well, it is attributed to an increase of Skin-to-Skin contact between mother and baby immediately following birth AND the practice of Rooming- In (23 of 24 hrs spent with mom instead of baby away from her in nursery). These practices are being implemented more and more at area hospitals here in and around Philadelphia, PA and we are seeing great results for moms and babies success with breastfeeding. While we hope to lower the rate of cesarean sections happening, we can also hope to increase these numbers even more. The report demonstrates that as the percentages of hospitals and birthing centers where >90% mothers and babies get skin to skin and rooming in INCREASES, so does the immediate and long term success of breastfeeding. This supports the Healthy People objectives for 2020  while making mothers and babies happier! Let's keep it up, America! Let's keep it up PA! Let's keep it up Philly! Support support support! Hospital procedures effect breastfeeding success so greatly, more than mothers realize, so we need procedures to support moms and babies getting the best start to breastfeeding. Come on nurses, docs, midwives, doulas, lactation consultants, and let's not forget our peer counselors - This week is also World Breastfeeding Week and the theme is focusing on the importance of support from moms in the community, ie peer counselors! ;)  And last but definitely not least, let's keep it up, mommies! You can do it!

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.

Ah, the BIRTH PLAN. Dreaded by some, held on dearly to by others. I have to admit, my thoughts on these have evolved quite a bit since I wrote my own birth plan over 6 years ago and even as a newer doula just 3 yrs ago. After attending so many women in labor in different hospital settings in various labor situations, I have developed some, more experienced, ah hem, opinions. Overall, I think the more care providers and hospital staff see them, the less dismissive,  condescending, 'superstitious' they’ll be about them. But, TRUTH - Women are mostly overdoing it when they write these up. And it's not their fault - they don't know better! Maybe it's because of the millions of options presented when they look at the birth planning worksheets all over the internet, I don't know. Moms should also know: all of the major things you 'want' should be verbally communicated with your nurse upon arrival at the hospital no matter what - whether it be for a planned cesarean or unmedicated birth. Talking and connecting with your nurse goes a long way. Humanize yourself. They might need the reminder. They are human, too.

But anyway - I think it's helpful, NO, scratch that - necessary to work on a BIRTH PLAN and  then 'turn it in' like homework that you probably weren’t assigned. Ask to discuss it with your care provider at that time, and also necessary to bring with you to hospital when in labor because... well, things like that don’t tend to transfer ;). Ok. Now while all that is necessary, the purpose of these is not so much to guarantee you'll get everything on your plan but that you learn and grow more aware and confident through the process of writing and discussing it with both your partner and care provider.  Through writing it, you realize all the things that can commonly come up while birthing at a hospital and you find yourself having a mindful discussion with your partner about each of them. You might look into the risks and benefits of things you never heard or thought of or ask your doula or childbirth educator to explain why they might be harmful when used routinely but also when they might be helpful tools. You may discover why you want what you do or why you don't, what to include in your ‘plan’, what not to, how to simplify it, figure out what feels most important, etc. And by the time you've written one up, you REALLY know what you want and SO DOES YOUR PARTNER. That is the goal. Then you put those details aside, take a breath, smile, and refocus again on the simplicity of this event! Birth is normal. I can do this. Women do this and have done this for forever. I know I trust in my body and baby and that I can decline anything I don't feel I need or want. Always remembering that with so many things in life, it's not about the result or outcome but the journey - it applies with birth planning, too. So, while you want them to receive it well and respect every single part of it, the process of planning and writing it is really the key. Some people feel a little discouraged by that, understandably, because it is a reminder of how much is out of your control. For one, we cannot control nature.  Two, even the toughest, smartest, most determined and informed women will lose some control just by stepping into a hospital system.  A recent client said to me after writing her ‘birth plan’, “I realized how much I just have to hope things go smoothly with my labor so that I don’t need all of the things I just planned not to have.”  UPDATE: Her labor and birth couldn't have went any more smoothly and I think she 'got' everything she hoped for, according to her plan and more. The nurse asked if she had a birth plan as we were settling into her room and when the dad handed it to her she looked it over and said, "This is a great birth plan! I think the best one I've ever seen. Nothing that doesn't need to be on there. I love it, thank you!" And then the midwife said, "I didn't even read it yet but I know I must be following it, haha" There was nothing for her to do! Except offer a birthing stool, smile, and wait ;)

Secondly, about that conversation piece at the end of pregnancy.  It’s best to have it between 37-38 wks because you should have your Group B Strep results by then and that does come into play. A positive result may change when you’ll leave for the hospital in labor, how things may change if your water breaks before labor (PROM - premature rupture of membranes), or what to expect if your baby shows possible signs of infection during labor or after birth or you do not receive the recommended doses of antibiotics within enough time prior to birth, etc. So, after you find out whether you are + or -, have this discussion. You'll get your care provider’s  feedback on any questions you have or what is not to worry about at your specific birth location, what might be an issue there, and if you'd like to compromise or fight for certain things and how to best do that. They SHOULD give you some guidance at that appt where you present it to them.  Remember it’s not so much that you get xyz if this particular care provider says so, it’s more about navigating the system one step at a time based on your individual situation, working with the nurse on staff, and within or against certain hospital protocols. Having a doula to help do all of this really helps. And you may find that after taking a tour of the hospital and talking with the nurse there as well as your care provider during your appt, that most of your wishes are actually the norm for your birth location (such as intermittent monitoring, encouraged to eat and drink freely, being able to use the bathroom freely without placing a catheter - unless you have an epidural, accessing shower, etc). But in some cases, you may find that you would be lucky to get any of your wishes (such as a case of a nurse on a tour at a hospital with a 49% c-section rate scoffing at my client's idea of laboring out of bed and pushing on her hands and knees and said, 'no, we prefer to keep you safe here instead. Our patients stay monitored in bed the whole time and push on their backs with their feet in stirrups, it's non negotiable') If you find yourself getting similar feedback from nurses there or your docs, read an older post Choose Carefully or stories of those who've jumped ship and Changed Care Providers even in later pregnancy. It's never too late until the baby is out! But, ultimately I do think low intervention birth is possible in many hospitals. Again, hiring a doula REALLY HELPS. And if she tells you it might be hard to get what you're hoping for at your planned birth location, consider what she is telling you. Doulas are amazing resources and supports in ways you cannot understand until you experience it. Ask anyone who’s had one!

Ok, so...are you ready to start writing your Birth Plan? My advice is to definitely call it something other than a Birth Plan. Wishes, hopes, preferences. Then, as far as format – pick any of the 3 options:

1) Make three large index cards for each 1. Labor and Delivery, 2. Cesarean Section, and 3. After Birth/Baby Care and simply handwrite about 5 most important specific things you want. I suggest trying to keep language positive when possible - so instead of saying "NO IV", you might say "Hep- Loc" preferred. Sometimes it doesn't always make sense as in really not wanting residents - you kind of have to say "NO residents". But do your best to stay positive and SHORT phrases. No explanations, no philosophy sharing - they don't care. You risk looking like a know it all, inflexible, and idealistic and yes, they are very superstitious. I have enough L & D nurse friends to know what they think - "You silly little woman, you'll be sectioned b/c of this PLAN!" And may treat you accordingly. Not always, of course. But it happens. No one wants their nurse to be in the hallway rolling her eyes and shaking her head while reading the hopes for their child’s birth.

2) A one page write up with a one or two brief sentence statement at the top about how flexible you will be if needed for safety of you or baby and then 3 or 4 categories, all with no more than 5 one line bullet statements. Such as "Want to try pushing on hands and knees" or "intermittent monitoring" or "NO erythromycin" or “Remind me to wear glasses before delivery”

3) Take a piece of blank paper and fold in half and fold again. You now have 4 categories for your birth wishes! Again, keep it 2-5 statements per box and SHORT and sweet. J  - Thank you to Kelly Durbin for sharing this one with me, I love it!

There is so much more I could say and I'm definitely not the only doula/educator with opinions on birth planning, check this out:
    - If you are overwhelmed by creating a birth 'plan',  maybe this plan will make you smile and relax a little so you can focus on the normalcy of this event and remember that with some conviction, you can make the staff adapt to you, not the other way around. Enjoy the simplicity. :)

    **And a few days after I published my blog post on birth plans - Giving Birth With Confidence published theirs - coincidence? HA! No, I love this blog - it's one  of two blogs through Lamaze. (This one is more for parents use, and the other is Science and Sensibility, more for childbirth educators and doulas.)  In addition to touching on many of the same themes I did here, the author presents her informative post in a more organized fashion less narrative than mine and gives a good list of questions to consider when writing down your preferences.

Happy New Year and Happy Birth Planning! :) :) :)

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.