VBAC After One, Two or More Cesareans

What is a VBAC?

A VBAC is a vaginal birth after cesarean.

If a woman has had a cesarean and wants to plan a vaginal birth for her next, it would be considered a VBAC, and the number after it depends on how many prior cesareans there were.

What are the chances of having a successful VBAC and who is a good candidate for a VBAC?

The stats range that 60-80% of women, who have had previous cesareans, are candidates for a successful VBAC. In actuality, most healthy pregnant women carrying healthy babies are candidates.

The chances of a successful VBAC are higher if a woman is using a midwife, even higher in free standing birthing centers and home settings.

Going to a hospital and working with an OB/GYN with high cesarean rates, will increase the likelihood that a woman will have another cesarean.

In some hospitals, there are a lot of restrictive procedures, like continuous electronic fetal monitoring, confining a laboring woman to lay in bed, not allowing her to eat or drink, routine IVs and time limits, which increase the risk of a cesarean.

There are many benefits to a VBAC, that are physical, emotional, mental, and spiritual.

These are only a few important benefits on the long list:

• No risks from major abdominal surgery. This is huge.  Unfortunately, a cesarean can lead to trauma to the internal organs or reproductive tract, risk of hemorrhage, complications with scar tissue, long term post operative pain, wound infection, blood clots, stroke, and possible respiratory problems for the baby. High rates of cesarean section contribute to high rates of morbidity and mortality – and this is occurring in modern countries such as the US, which ranks among the bottom of them in terms of outcome stats.

• Easier postpartum healing and recovery.

• Baby receives needed bacteria for optimal health, from mother when passing through the vaginal birth canal.

• Breastfeeding may be more successful

• No potential harm to future fertility.

• Feeling more positive about the birth experience

• Increased sense of empowerment.

• More involvement of family and support people.

• Less risk of postpartum depression and emotional birth trauma.

What is the main risk of a VBAC?

The risk of separation of the one prior uterine scar is approximately 2 in 1000 VBACs, but often it is a mild superficial dehiscence (slight separation of some layers of the surgical wound) that has no clinical significance and does not impact the health of mom or baby. The risk of severe life-threatening emergency from a partial or complete uterine rupture of all the scar layers is significantly lower – a highly unlikely occurrence, significantly less than 1 %., 1.36% after 2 cesareans, slightly higher after three cesareans, with a higher comparative maternal and newborn morbidity with each repeat cesarean - but still in perspective, low, and depends on a variety of factors related to your individual situation. The main risk is of a VBAC is this rare catastrophic rupture of the previous uterine incision. This rare total disruption of the uterine scar risks both the mother and her baby, and can lead to catastrophic outcomes. It cannot be ignored and must be monitored for appropriately; but it cannot be exaggerated or make the risk of repeat cesarean less alarming. Frank uterine rupture is often mistaken for more common mild separation of the previous uterine scar without consequence, happens in less than 1% of all pregnancies. Even ACOG released guidelines that it’s reasonable to consider women with two previous low transverse uterine incisions to be candidates for trial of labor and to counsel on the combination of other factors that affect their probability of achieving successful VBAC.

But, it is getting harder to find a provider to attend to your desired vaginal birth after one cesarean let alone after two or more. It is still possible, and you have the right to decline another cesarean, but it is ideal for you to find a provider and setting most supportive to birth YOUR way safely.

Although every decision has risks, a VBAC is a reasonable, appropriate and safe option. If a woman panning a VBAC decides to give birth at home, I highly recommend working with a well trained and experienced midwife and consider the distance to a hospital (30 minutes or less driving time is ideal).

There are risks and benefits to every kind of birth and in every setting. I provide women with evidence based information, encourage each family to dig deep and look at the pros and cons to having a VBAC in a hospital setting, free standing birthing center or home, vs a routine cesarean and have informed consent for her birth.

Are there benefits to a cesarean?

A planned cesarean is in a controlled environment, and some women find great comfort in that knowing. Perhaps a woman has had a previous traumatic, long labor the first time and they just don’t want to go through that experience again. Some women are very anxious about that and they just feel safer knowing they will have another cesarean.

I take that seriously, because she won’t labor well if she doesn’t feel safe.

Like I mentioned before, the serious risks for a VBAC can be often prevented, treated or transferred to surgical care in time, with a skilled midwife or obstetrician who is attending to the laboring women, aware and mindful of the symptoms that lead up to that.

Thankfully some hospitals are now at least allowing more time for baby to get the cord blood from the placenta, skin to skin bonding, and her partner or main support person in the operating room. Some hospitals and providers are performing “gentle cesareans” – cesareans that are family and woman centered, and try to provide the environment of a natural birth as much as possible. This is a wonderful attempt to restore humanity to birthing in the operating room

In most cases, a VBAC is a safe option.

I share the opinion of many concerned with improving maternity care and reducing our rising rates of maternal and newborn death and serious health consequences from the interventions in childbirth, that a woman should not be forced to have a major surgery against her will, rather provided research and empowered to make her own decision, considering she is having a healthy AAOG removed the previous unreasonable restriction requiring immediate availability of a surgical staff for an emergency cesarean, as most hospitals around the country, let alone free standing birth centers and home settings, do not meet this criteria. Most hospitals are not able to have a surgical staff at all times and cannot perform an emergency cesarean in under 30 minutes.

Despite this, research is showing that far too many obstetricians and the midwives they back do not offer VBACs after one cesarean, let alone more. They routinely recommend repeat cesareans because they may fear law suits, succumb to scheduling pressures, have restrictive hospital or malpractice insurance policies, and/or feel pressured to uphold certain standards among their colleagues who are not supportive of VBAC. The hands of a midwife whose collaborative obstetrician and hospital do not support VBAC can often be unnecessarily tied as well for these reasons. Most repeat cesareans are not actually medically necessary, and are commonly recommended due to various non-medical reasons. This is very concerning.

What also concerns me is that the risks of a VBAC are magnified in conversation with women, while the risks of a repeat cesarean are downplayed, so women may feel forced, afraid and powerless.

I want women to feel like they have a voice, as they do have a legal and medically ethical right to autonomy over their bodies, their births and their baby’s.

Some women who want to VBAC have limited options and local doctors in the area are only offering cesareans. Some feel they have no option other than having an unattended homebirth, or labor alone at home until the last minute without any monitoring, or not be truthful with their providers about their previous cesarean birth – all of which can increase the risks for her and her baby.

A trained and experienced midwife who is continuously with the woman in active labor, can detect concerning signs and symptoms before they can become a crisis, and she be transferred and treated in time to save her and her baby’s life and heath.  A midwife wears many hats, one of which is protecting the space so the natural process of birth can proceed with ease and grace, and another is a lifeguard – to know when and how to intervene to prevent problems or manage emergencies.  There are many wonderful obstetricians supportive of VBAC who have this training and style of practice as well; they are just harder to find.You have the right to decline the repeat cesarean, and find a more supportive skilled provider at home. There are midwives and OBs who do it and post about it around the globe. It is worth every penny to even travel quite a distance to a practice who honors your choices. You REALLY have to want it, and you must prepare as best you can to set yourself up to succeed, like it’s your Mount Everest to climb, to have your healing, redemptive beautiful healthy birth.

Last tips:

If a woman knows she wants to have another baby, I would start with research and education. Ask yourself: “What do I want and why?”

A woman should get the support she needs. Most women who have had one or more prior cesarean births have issues they need to discuss and heal from.  One of my dedications and areas of expertise is creating space so a mom can debrief, process and recover from her previous upsetting or traumatic birth experience, as well as plan for a better one next time around. Schedule a coaching call with me for more personal guidance if you need.

I tell mamas to do what they can to educate, prepare and empower themselves in a whole different way than last time as I want them to succeed, build their circle of support, and include in their birth team advocates to speak for them when they are in the heat of labor. I tell them to prepare for a natural vaginal birth. The mind, body, heart and spirit can prepare for a natural vaginal birth - and a deeply positive, beautiful and empowering one. Yes, it takes work and practice, but it is worth every penny, every effort and amount of time you put in, if this is the birth experience you want and dream about. This is one of my passions and main focus of my online childbirth prep course Anne’s Guide to Pregnancy, Birth and Postpartum - sold separately or bundled together in adjunct to my Natural Birth Secrets books 2nd edition and Trauma Release Formula 2nd edition if you need help previous healing birth trauma - both extensive but very different resources that compliment each other to heal and prepare for your different next birth.

I also recommend hiring an awesome doula, as those who have a doula are less likely to have a cesarean.

A doula is amazing because they offer the mothering comfort and support that our ancestors had.  When women would give birth in their tribe or village, and they were surrounded by mothers, aunts, sisters, grandmothers, and the other women of their community, they received that mothering support by women who were comfortable with birth and relaxed around it. Fear has no place in birth, and a doula provides needed calm and loving support.

Remember, In the end it’s not in our control, and we let go and surrender,

If you do all of these things and end up having a cesarean, it’s not a failure. There is no failure in birth. It is a birth, a belly birth, and it’s the birth of your baby and you as a mother. It is the birth of your family and your partner as a parent. Stay present, stay involved and keep a positive mindset. Focus on the blessing, that you did all that you could, and thankful for modern medicine, which saved you and your baby’s life and preserved health. Also, you can ask for a gentle cesarean, which restores humanity to the operating room by doing such things as allowing your support people in with you, enabling baby to emerge from the incision simulating as much as possible a vaginal birth to help baby clear his/her own lungs, enabling you to participate by lowering the drapes so you can see your birth, giving you sterile gloves to receive your baby, optimal umbilical cord clamping so baby can benefit from the cord blood, encouraging immediate skin to skin bonding and early breastfeeding.  

Healing can occur afterwards, and may take time and lots of support. But there is no place for shame and negative self judgement here.

Midwifery History and Witches

Just a taste of a much larger discussion. History for most of history was mostly ‘his story’. Through the majorly of it, women were mostly illiterate as they were not allowed to be educated like men. But until relatively recently, men would not provide care for women and their gynecological and childbearing needs even when they became physicians - as their reputations would be tarnished if they associated with women’s genitalia and their business. It was the domain of women. Women supported women.

Midwifery is mentioned as far back as biblical times, and recorded in Egypt as early as 1900 BCE. Birth was a normal part of family life, men were kept out, and certain women in each community took on the role as midwife, by following and learning from the elder midwives. They used natural remedies. Some did secretly train under physicians. In the medieval times, there are some conflicting historical accounts whether or not they were falsely accused of witchcraft and were persecuted- especially when some unsuccessful outcomes became apparent, their lack of formal training, and use of natural remedies - all a catch 22, as they were not allowed to do formal training or to practice medicine, had no access to medicines, so they used natural remedies, and were thought to go against the church, medical hierarchy and legislature which were often intertwined.

Today, thankfully there have been many beneficial changes like standardized formal education for women in the practice of midwifery, which includes sexual and reproductive health as well as equal rights of women in most developed countries. We do have a way to go in the United states and other countries, as barriers and obstacles to midwifery practice still exist. Midwifery is respected by the medical profession and encouraged for low risk population by leading health organizations. It’s now organized into a profession and supported by legislation as well as biblical religions. Hard to do the real history of midwifery justice in a blog, but at least I can reassure you I am a good witch.

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Cesarean Birth and Prevention

Blog post featured image: Photo by Jonathan Borba on Unsplash

--- BEGIN TRANSCRIPT Instagram.com/homesweethomebirth ---

Hi. I wanted to come on and talk about cesarean and why I'm so passionate about preventing it. 

But what I want to mention first is that the rates in this country, in the United States, are going up and our outcomes are getting worse. Okay. The national average is 30%.

That's just unacceptable.

Some hospitals around where I live, the rate is 40 to 50%. Unbelievable. Why? There are so many reasons why, but I just want to share something with you.  

My rate is 5%. My rate of cesarean birth is 5%. I'm not bragging. This has nothing really to do with me. I, 

What's different. Why is that?

Why do you think the rates in my practice are 5%, and the rates in the national average of hospitals are 30% and climbing?

The families that come to my practice don't have different bodies. The people don't have different bodies. 

You know what's different. They're getting midwifery care.

They're getting midwifery care. They are low risk and healthy. And maybe someone even labeled them as high risk, but they're not really high risk. They're just healthy. They might have an issue or two, but you know what they're doing? They're taking responsibility. That's also what they're doing.

They're preparing as I recommend them to prepare, and they're taking responsibility for the birth, they're not just saying to me, do whatever, right. 

They are taking it upon themselves. 

Why do they need to prepare? I'll tell you why they need to prepare, because I know that women's bodies know exactly how to give birth. A healthy body knows how to give birth. Right? 

Why in the West do we need to prepare? Because we're in the West. We're in the Western culture.

I feel so strongly about this because I do hospital shifts. I do hospital shifts and I love to do hospitals shifts in hospitals that serve the immigrant populations.

I love that. And I can actually do prenatal care and help a mama in labor as much as possible with my heart and with my Spanish. Now I am not fluent, okay, but I love working with this community, the immigrant population that's coming up, because I'll tell you why. Not just, I love them, but the less Westernized they are, they don't need to take childbirth classes, they just come and birth just like that. 

And you know why? Because the newer they are to this country, the less westernized they are, they came from countries where they were surrounded by people having birth. And in a community. And the women in their community, the elders, the wiser ones would talk to them about it and they would see it. 

I mean, I just spoke with a grand-momma, an abuela, who had 11 babies in her casa - back in her country. 11 babies in her Casa. That's what everybody did.

She didn't need a childbirth course. She was surrounded by everybody doing that. So, she got that education, and she got that by osmosis, that “We know how to do this. This is what we know how to do". And you know what, it's hard, but we can do hard things. Like we don't need to numb ourselves from pain. They deal with pain. They just deal with it. The more westernized they are, the more we are in our brains, the more we are in fear. Not “we”. No, because I've healed myself, I've tried to de-Westernize myself when it comes to helping moms give birth.

And I feel strongly about this, because, we can't help the way of our culture. Okay. We get fear messages. Oh my gosh we get fear messages all over the media. You know, someone sees you're pregnant they're going to tell you a story. And we are addicted to Googling everything. We're just too much in our brains. It's just, it's just the way it is. We have to research this, we have to research that, and we have to numb. We're not comfortable with discomfort.

And that's why I love my yoga training. That taught me, that deep in yoga, to combine that with being a midwife is just an amazing combination. Yoga doesn't come from the West. It comes from the East. To be comfortable with uncomfortable. To be comfortable with discomfort. To be comfortable and relax into intensity. 

And I needed that to help me understand and how to help other people do that. But there are cultures around the world, here are countries around the world that never did any yoga. They just live in a community, and are surrounded by the elders and other women in the community. They just do it. You know, we do hard things. And we just give birth.

So, that’s why I think a huge part of the success of a lot in my practice, and a lot of my colleagues, is that we're really are, to the families that have a baby in the home, in our practice are Westernized. They might want to have a home birth, but it's their first time, they know nothing about birth. They haven't been around it. 

They tell me they don't know anybody that's had a home birth that I can connect them with. Well, I know tons of people that have had a home birth.

So, that's why I love connecting moms and their partners, so that they don't feel so isolated. But a lot of times the families that come to me, their parents gave birth in hospitals with all kinds of interventions and they just, they feel very isolated and unprepared. And, and just looking at videos and pictures, scrolling down, on Instagram is not the way to prepare. I'm sorry. It's not. And that's why I really think a lot of the success comes from myself and my colleagues really being insistent that the family who comes in to have a home birth is going to prepare like a boss, right? 

Get de-Westernized, get primal and get sensual, and learn how to relax into intensity and learn about birth because no one ever taught you. Right. And learn the techniques that you need to do to master your calm. And, and to just let your body do it. And, and I think that's a huge part of our success. 

I track my stats, and unfortunately the 7% of times that I have to go into the hospital, it's not because of an emergency. Emergencies are rare. We deal with them, or I can count them on my hand.

I'm the EMT. The midwife is the EMT at the birth. We prevent and we deal with any problems that come up. And if we need to go to the hospital, we need to go to the hospital.

But that's 7% of the time. That means 93% are having births at home.

But who is my 7% that needs to go to the hospital?
It tends to be, and I track my statistics. I've been tracking them for years. It's people with long, stuck labors, first time birthers, first time vaginal birthers, who did not prepare.

They just didn't want to take a course, they were preparing on Instagram or they, or they just weren't preparing at all before Instagram.

You can't prepare on Instagram. You have to take a class today. Yes. In the West. You have to take a class, unless your mom and your grandparents have given birth at home, and you're surrounded by, natural birth. Because natural birth in the West is very different. It's a very different experience if you've never done it before and you can't prepare on social media. Okay? 

Then, you have to think about who are you going to, who are you going to - let's say you want a natural birth. Well, if the hospital or the provider that you're going to is, let's say you're healthy and you want a natural birth, if the hospital and the provider that you're going to doesn't do natural birth. They're not into it. They weren't trained in it. They're into interventive birth, it's going to be very hard for you to have a natural birth, right? And one intervention leads to another intervention, leads to the other intervention, and unfortunately ends up in too much intervention and complications and cesarean births. 

I am so grateful for cesarean births for when it's necessary and that's why I post on it. And yes, we could have gentle cesareans for those mamas. Five percent - they're still human beings, and that's still a birth, and those mamas are rockstars because they need to have a compassionate, human, respectful family centered, gentle cesarean, and we can have as much as possible that home-sweet-home birth in the hospital or in the operating room, but we still have to prevent. 

So, you have to think about – even if you want a vaginal birth - let's say you want an epidural - if you want a vaginal birth, you have to know. Ask “What's the rate of cesareans in your hospital?”. Is it 30%? Is it 40%? Is it 50%? Then it's very unlikely - unless you prepare. Then have to prepare even more, right, to fight that system. Because, I don’t know, I talk about this all the time and I'm so passionate about it because I think that's how we make the change. 

How we be the change, how we make the change, is for you all to prepare yourselves and take back your birth and know what setting and what provider you're going to. 

And if you are blessed, if you're healthy, or you have a little issue or two, that doesn't risk you out of midwifery care. Find a midwife. 

That's the model of care in a lot of countries where the midwives who are trained. You know, I have seven years of training, it's not just a weekend course. I had to get my bachelor's, and I got my master's, and where I live, I need a master's degree. I have seven years of training and education, and it's specifically focused on supporting the low risk healthy.

Yes, we screen, we prevent, and we look. That's what prenatal care is all about, that relationship, and making sure that it is still safe and appropriate for that mama to have a home birth, or a birth with a midwife in the hospital. 

But midwifery, our specialty, is supporting normal. Keeping it normal. Lay low on intervention. No intervention. No interventions necessary when it's working well. 

What's an obstetrician? What's an OB/GYN. Do you know the difference? There’s a huge difference, and we need them, thank god, but an obstetrician and a gynecologist, OB/GYN, goes to medical school and does residency and extra training for high-risk pregnancies and surgery, to use very highly sophisticated technology to diagnose and treat high-risk situations, medically or surgically. But that kind of provider, I have doctors, I love the obstetricians that I work, but they always tell me they know nothing about natural birth. They're bored of it. They don't know what to do. They love the midwives. If someone's healthy, they say “you're going to get better care with a midwife”. 

So, it's very important for you to know the difference between a midwife and an obstetrician, their training and their background, because if you want a surgical birth, then no, you don't go to a midwife – go to a surgeon.

And that's what an obstetrician and gynecologist, OB/GYN is. And we need them. 

And that's why there are certain countries, that's why the United States ranks the lowest among all developed countries in the world, in terms of maternal and newborn outcomes. We're losing more babies and mamas, or having more serious complications with mamas and babies, than all the other developed countries in the world.

The countries that have the best outcomes are countries where, like Sweden, there's a lot of countries where everybody sees a midwife, if they're healthy. The doctor (obstetrician) is there for the high risk. High-risk and when surgery is needed. When medicine and surgery is needed. 

And that's how we serve the whole population of people having babies, and that's how we get excellent outcomes - live, happy, healthy mamas and babies. 

So last week I talked about a bleeding in pregnancy - this week I thought I'd talk about this.

If you found that helpful, comment, share. I'd love to hear what you have to say, but that's all for now. 

Have a wonderful weekend. Bye.

--- END TRANSCRIPT ---

Plan like a Boss! Create your ideal birth plan and take back your birth!

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Then use these different but crucial resources to prepare like a boss! Prevent that first cesarean or plan your VBAC! It takes work and is worth every penny, but this is your and your baby’s health and life we are protecting.

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Getting Real With A Mama in My Practice Who Rocked Her VBAC

Part one and two of a an awesome video I was invited to do with Joni, a mama in my practice who had a homebirth birth after cesarean, that really brings together many things pregnancy, birth, and breathwork, holistic health and healing.

Learn how to rock your VBAC and have the birth of your dreams with these three different but crucial resources - so you can prepare like a boss!

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HBAC Birth Story - Homebirth After Cesarean

“Having a HBAC was really so special after a totally unnecessary c-section with my first. I’d love to spread the word that it’s possible. So many people think it’s not.

And Then There Were Four

The last time I typed up a birth story it wasn't one I was super excited to share with the world. I'm eager to get this one down before I forget it since labor amnesia sets in quick and because this one could not be more different than the last. A friend of mine who also had a particularly difficult first labor said that when she had a second child she wanted a do-over. At the time I was telling myself that all that matters is getting a healthy baby and while I still believe that, I am very happy that things went the way I wanted them to this time. 

[ I am not sure I need to but I would like to stop here and warn any readers that since this is a blog entry about giving birth, there is some TMI. ]

Last Friday I was 39 weeks. It started like any other day since I became full-term, with me thinking "Will this baby come today?" followed immediately by "Nah, I have tons of time left" followed by a much quieter "...maybe."  

Because Thora's birth was such a mess and because I believe it was the four days in a row of acupuncture that my midwife sent me for before my due date that started my prodromal labor and not Thora herself, ready to be born, I was treating this time like it was my first time. Lots of people said that since Thora was born four days before my due date, this one would be early too, but I was telling myself just in case that I really didn't know when Thora would have come, had circumstances been different. This one could very well wait until long after my due date. I knew four or five other people who were all due around the same time as me and I kept saying they'd all be first, just so I wouldn't be disappointed if I went on to 41 or 42 weeks. 

So on Friday morning I didn't think anything of going to work like usual.  I had a lot to do, including dealing with three chickens I was fostering in my tiny shared work space. (Don't ask!)

Johnny, on the other hand, seemed to know something was up. The night before I'd had what I thought could be a little leaking of amniotic fluid. (Any expecting parent has to be familiar with the awful "here, smell this, is this pee?" ridiculousness) Even though he didn't say so, he was on high alert. That morning he drove me to work so Thora could see the chickens, and en route he announced that he was cancelling the plans he had with his friend for that night just in case the baby came. I told him not to be silly and encouraged him to go ahead because my due date was still a week away and who knew when he'd get to go out again. Likely that leak was nothing. But he insisted. 

At the office, I managed to knock out a few things before everyone else arrived. I did an interview and wrote up a document I really needed to get out. I exchanged emails and calls with a few people. All the while I was having contractions and they were pretty regular but mild so I didn't say anything to anyone, just kept working and waited for them to pass. Around 1 pm when we were discussing lunch options, I felt a sudden gush and ran to the bathroom. Knowing that only 8% of labors start with the water breaking, I wasn't exactly sure what I'd find but I did not expect to see a lot of bright red blood. A lot. I had also passed a clot the size of my pinky. It didn't look like a mucus plug, it looked like a blood clot. And sitting there, I passed another. So I completely panicked. I called my midwife who seemed calm but mildly concerned. A few minutes later she called back: she'd been able to get me an emergency appointment at the women's ultrasound office I'd been going to, which was up on Madison Ave about a fifteen minute walk away. She encouraged me to put on a pad so I could see how much I was bleeding and said I should call her from the doctor's office to let her know what was going on. I called Johnny, who wasted no time getting into the car and on his way.

I threw my stuff into a bag and fled. As I waited impatiently for the elevator, a coworker and mom of three passed me in the hall. She took one look at my face, nodded and said "Oh yeah," in a knowing voice. "Good luck!" In my mind I was thinking "But I'm not in labor!" though I wasn't about to stop to explain.

Of course it was pouring rain so finding a cab was virtually impossible. Frustrated, I called Johnny again and reminded him that my first labor was during a blizzard and complained that it wasn't fair that this happens to us during horrible weather. Someone from my office accompanied me to the corner of First Ave with a big umbrella, trying to help me flag down occupied cab after occupied cab. There were a handful of other people doing the same and I ran in front of them, totally focusing all of my fear into anger at them for not seeing me standing there and giving me the first cab that pulled up.

Meanwhile Johnny and Thora were stuck in traffic on the FDR drive on their way to meet me at the ultrasound place. In the cab, my contractions slowed and my bleeding too. I could still feel the baby moving so I knew she was alive, but bright red blood is never a good sign in pregnancy so I was still very worried. I raced into the office and told them who I was. The woman at reception reminded me that I didn't have an appointment, that they were fully booked but would see me when they could. I reminded her as sweetly as I could that I was 39 weeks pregnant and bleeding a lot. Then I sat down to wait. My name was called not two minutes later and Johnny and Thora arrived about two minutes after that. The ultrasound showed that the baby and her heartbeat were fine, there was a lot of amniotic fluid, the placenta was intact, and everything was overall peachy. Both the doctor there and my midwife on the phone said they could not easily explain the blood, that they guessed it was either my mucus plug or a small placental abruption. My midwife ordered me to go right home. "Do NOT go back to work," she said sternly. How did she know what I was thinking?! She insisted I rest and check in with her in another hour or so. Feeling calmer, I apologized to the receptionist on our way out. She looked relieved. I thanked everyone for seeing me so quickly and we headed back out into the rain.

We did go right home. My contractions continued, mildly. Johnny and Thora took a walk to Uptown Juice Bar, our neighborhood veggie restaurant, to pick up some dinner, while I tried to nap. By 5 pm or so we were timing the contractions but they seemed pretty stable at 5 minutes apart and lasting only 30 - 45 seconds. After Thora's birth, which was a full five days of contractions like that and two hospital visits during which I was checked and promptly sent home, I was determined not to be the boy who cried wolf a second time, so I kept telling the midwife it was no big deal, that I wasn't concerned yet.

We got Thora to bed around 7 and settled in front of the TV for some Netflix streaming. I texted my sister to tell her I thought I was in labor. Then I sat on the birth ball and moaned and yelled my way through three episodes of Breaking Bad before Johnny told me that the contractions were obviously getting longer and more intense. I was still in denial because they weren't any closer together. I called our midwife again around 10 - a full 45 minutes later than she'd asked me to, she reminded me. I had a contraction as we talked and I tried my best to talk through it. I did not want her to have to come all the way here only to tell me I was having prodromal labor and then go back home. She said she was ready to go whenever we said the word, but I told her we were still fine. 

Oh the stupid things that go through a laboring woman's head. At this point I was thinking "What would a woman birthing with Ina May Gaskin do now?" I tried to channel the birth stories I'd read over and over in Spiritual Midwifery. These women would have made food, cleaned their RVs, worked in their garden, gone for a hike, hugged a tree, or gone to sleep. Remembering that with Thora I gave up pushing for a c-section because I was too tired to keep going after five days of being too excited about having a baby to rest at all, I picked sleep. I took a quarter of a Bendaryl and lay down. I knew that if this was really it, the contractions would not slow. But they did, to about 8 minutes apart.

I did manage to doze a little between contractions but they kept waking us both up and after an hour or two, they got more and more intense. By 2 am they were 2 - 3 minutes apart, lasting 90 seconds to 2 minutes. I was nauseous and restless and knew sleep was now out of the question. Benadryl or no, I was wide awake and in agony. Soon I was in pain even between contractions and I was suddenly throwing up and having to poop and everything else all at once. This was it. 

Johnny called Joan while I ran the bathtub. She'd been asleep but was instantly alert. The no-nonsense woman she is, she declared me to be in active labor and said she was on her way. Still not wanting to be humiliated for thinking I was in active labor when I wasn't, I was nervous that the bath might slow things down by the time she arrived. But it didn't. 

Between contractions in the water, I was fine. I sat there in the candlelit darkness and tried to relax. I could talk, even joke around a little. The contractions were painful as hell but in between them there was a minute of reprieve. Also they felt very different from the ones I had with Thora. Thora was posterior (meaning she was face up) and the resulting back labor was agonizing in a whole different way. At the same time, this was pain like nothing I ever knew. 

Joan and her assistant S. arrived around 2:45. Joan checked me right away. 7 centimeters. She said "The rest could either be slow or fast but I'm thinking fast" and went back to making her preparations. There was no time, she said, to set up the birth pool. I was going to have the baby in the bathtub.

They started setting things up while Johnny sat with me and made sure I had water, Emergen-C, whatever I would drink. S, Joan's assistant, held my hand ("but only if it's not annoying," she reminded me) and helped me keep my sounds low and my shoulders low and relaxed. The pain got more and more intense and I got louder and louder. I surprised myself by how much I was screaming and howling and growling but it was what I had to do. Joan shrugged. "Some people just need to roar their babies out," was all she said. This kept on. I beat my hands on the lip of the tub with every contraction and screamed this guttural, totally insane scream. I was sitting cross legged, sort of like in lotus position, in the center of the tub, leaning over the middle of it. My head was resting on a towel they put on the lip of the tub and my hands were hanging over the side so I could remember to keep them unclenched. Rayna, my cat, was sitting right beneath my hands keeping a close watch on things. Johnny sat on the closed toilet seat and S sat on the floor next to Rayna. Joan left me to it for the most part, but came back in periodically to tell me I was doing great. I panted and screamed and shrieked and didn't believe her. "I don't think I can do this!" I heard myself whine. "You ARE doing it," everyone chanted, in unison, in response.

Then all of a sudden everything changes. My growl gets deeper and I hear myself scream like I never, ever have before. It gives me chills to think about it now. "That sounds like pushing!" calls Joan from outside the bathroom. She is suddenly there, checking me, asking if I feel like I need to bear down. "I don't know what I feel," I say. I am hoarse and my mouth is dry and I'm starting to whine again. "I feel her in my butt now and it really, really huuurrrtttss."  Yep, she says, that's pushing. And then I am at my absolute least attractive, retching and vomiting and panting and feeling like I'm crapping my brains out and watching the water around me get redder and redder. I'm babbling like a fool, asking how soon I can get an IUD, asking if I am going to make it through this, begging for it to stop. My head is filled with wild images: I'm thinking of my birth mother who should be there with me but isn't, of long-haired hippies who don't feel any pain as they push, of how I am certainly waking our daughter, asleep in the next room, of how I am definitely terrifying our neighbors and scaring my husband from ever wanting to look at me naked again, of being split open, of living through this to meet my baby.

Joan is suddenly all business. She kneels down and makes me change position. "If you are going to have this baby here, you need to stretch out and lie down on your right side and hold up your leg like this." She holds up my left leg like this. She gives Johnny the job of holding it up even further and pushing it back against the wall of the tub. She lets out some of the disgusting water and runs more warm water in the tub and over me, saying now it's too cold for having a baby. 

And then I am gone. What takes over is this primal thing, barely human, screaming and roaring. From a million miles away, I hear "I can see her!" and "She went back in, but that's okay, she's stretching you so you don't tear" and I'm panting and and my voice is saying "I can't" and then I'm wailing again and there are hands on me that I push away and suddenly I feel a pop and I hear "That's the head!" One more howl and a huge push that takes everything out of me and the next thing I know she's crying in my arms and there's a warm blanket and a towel being draped over her and I am spent but I have my baby and I did it, just like the women in the hippie books and exactly how I always wanted, with my husband next to me and my daughter asleep in her room just ten feet away and we are all in our element in our home and I can't believe it. It is 5:33 am on Saturday, September 24. I have been in labor for over seventeen hours and I have pushed for only 23 minutes.

Freyja Rae is teeny. She is coughing and sputtering. I count fingers and toes, look at her tiny face, pick some vernix out of her ears. I push out the placenta and then a few minutes later, I manage to cut the cord myself because Johnny doesn't want to, snipping Joan's finger in the process. I smile and apologize. She shrugs and says she's been cut worse. I ask her if this ever gets old for her and she says with a smile, "Nope. Never." Everything is quiet. Then at some point, I ask how in the world women go through this pain. Her answer is simple. "We can do it because it ends. No matter how long it lasts, it always ends." 

Freyja and I lie there together for a few minutes in the gross bathwater while I think that over. We are happy and exhausted and I'm thinking about Rocky calling to Adrian that he did it. Johnny snaps a few pictures and S snaps a few more.

Then Joan wraps her in another warm and dry receiving blanket and hands her to her father, saying she's not ready to nurse yet but that she needs skin on skin contact with Daddy, and then I am fading away and I'm gone. 

I smell ammonia and hear someone say "smelling salts." My blood pressure is so low they can't even get a reading, but the smelling salts are so awful they wake me up enough so I can turn my head away. This feeling is nothing new for me. I have low blood pressure all the time so when I am sick or weakened I always react by getting dizzy and feeling faint. I am not concerned, but Joan and S are. A peanut butter sandwich appears before me and a glass of some flavor of Emergen-C that I didn't pick out is shoved in my face and a straw stuck in my mouth. I want to be in bed, with the AC on, wrapped in a blanket snuggling with my new baby but I know I can't make it there so I take slow bites and sips and wait.

Gradually I regain strength. We drain the tub and I am able to stand long enough to rinse off in the shower while they make a bed out of a plastic tablecloth and wee wee pads, right there on the tiles. I lie down and as I do, I hear Thora, awake. Freyja is passed back to me and I latch her on for the first time while Johnny brings Thora right to us in the bathroom. She's not fully awake and is very unsure of what's going on. "Mama?" she asks dubiously.

I sit up and nurse cross legged on the bathroom floor while they set up a spot for me in the living room. Moments later, Freyja and I make our way over to the couch. S hovers and makes me eat and sip sweet tea while I nurse Freyja. Johnny is next to me cuddling Thora, who asks for a pinky. A blissful moment: I am with my family.

But I am tired. Joan examines Freyja and prepares to weigh her like a bunch of bananas. "Any guesses?" We venture a few, but we are all off. She is much smaller than her sister was, only 6 pounds and 12 ounces. 19 inches long. Head and chest circumference are both 33 inches. "She's symmetrical!" Joan laughs. Freyja is perfect. And since we are at home, nothing invasive happens. She hasn't been suctioned. There is no ointment in her eyes. Joan doesn't even clean her off. Instead she rubs what's left of the vernix into her skin and wipes her down with some olive oil. She grabs a onesie from the pile, a white one with a pink and black skull and crossbones, a gift to Thora from our friend Missy Church. I smile and say she's dressing her like a punk rocker. "For you, nothing less!" she smiles back.

Johnny gets up to dress Thora. I help her on with her shoes and give her a big hug and kiss. Johnny brings her downstairs to our neighbor to hang out with her two girls for the morning and I throw on a shirt and get into bed with my new daughter. Joan hugs me and tucks me in. I hear Johnny come back in and he joins me a moment later, closing the bedroom door behind him. We hear cleanup noises in the rest of the apartment, and a few minutes later, the front door opening and quietly closing, as we three drift off to sleep.

I did it!”

Mama @thewriteaimee

Photo credit to @db4johnny (my spouse)

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Was your birth upsetting or traumatic? Do you have more questions about processing your birth and need help healing? Arrange some time to chat with me. I’d love to answer your questions and help you heal and get yourself back - I have a program specifically for you, that can also include this revolutionary and powerfully effective, natural healing modality called Clarity Breathwork.  Helping women heal from birth trauma is one of my passions and areas of expertise. So is preventing it in the first place.

This is why excellent childbirth education is a must, why planning for your birth is so important today, and is a major reason why I created my Love Your Birth course. It is a comprehensive online course that teaches women what they need to know about planning and carrying out the birth that they want in all settings - the hospital, birthing center or at home. It’s a course on how to have a holistic, healthy pregnancy for the body, mind, and soul - and is how I have guided thousands of women and their families in my midwifery practice for over 21 years. It contains a rolodex of my favorite resources with over 200 of the best books, movies and supplies I use personally and professionally with my clients, family & friends. Even diving into a fraction of this list will have you feeling empowered and prepared for conception, pregnancy, postpartum and parenting...It includes resources on improving and even ensuring ensuring healthier pregnancy and birth outcomes than the status quo, and preventing and healing from birth trauma so prevalent in the modern world!  Be prepared to do some research on your own, but knowledge restores your power. I also help you prepare your mindset for such a task, to debunk myths, and to reframe any current ideas or conditioning about pregnancy and birth that can use a change in perspective or that are simply incorrect and do serve you. After finishing the course, the idea is that you are now able to create and have the healthy, beautiful and empowering pregnancy and birth that you want - so you can ROCK your birth!

You can get a free nugget from my course - all about creating your ideal birth plan here. A huge part of preventing birth trauma is getting clear your birth preferences, knowing the pros and cons about all the tests and procedures, all the interventions your may be faced with, so you can make informed decisions - rather than simply give over your body, your choice and voice to your health care providers and institution you choose.

I have a holistic approach to life, including healing after pregnancy and birthing. Nothing replaces abdominal toning and exercise for restoring muscle strength and tone - which I encourage for all mamas as soon as they feel up to it postpartum. Nothing replaces touch, slow deep abdominal breathing, and a 'love your postpartum body' perspective that I promote.  But I have found many mamas simply feel comforted by this support garment, especially early postpartum and temporarily as needed....to be used without forfeiting abdominal toning and strengthening exercise, breathing well and touch. I have found Bellefit supportive garments to help like they use belly binding around the world such as in Indonesia. They do aid in early postpartum healing and provide support many mamas feel comforted by. I deal with human beings and the reality is many postpartum mom's struggle with body image, feel frustrated that getting back to themselves takes longer than expected. Being into holistic health and healing includes being sensitive to real human struggles - the mind, body, heart and soul of each person and their unique situation. Having helped countless women with these issues after having a baby as a midwife, I have found many still love that binding and feel better with this support, and ability to fit into their pre-pregnancy clothes comfortably and sooner than they would if they went through a C-section or natural childbirth recovery without it - especially when they have to dress up and fit into a certain favorite outfit for a special occasion or wedding not long after having a baby.

For more info on the Bellefit girdle, check out my blog about it here. Have a Great Postpartum Recovery (with a little help from Bellefit)!