The VBAC Link by Meagan Heaton

October 21, 2024 Episode 345 Rachel's VBAC After the Unexpected + Back Labor + Strategies for Improving Your VBAC Chances After a Complicated Birth

Rachel is a professor, an author, and a VBAC mom who is here to share her story from a traumatic C-section birth through a VBAC. This episode really dives deep into how picking the right provider is key to improving your chances for a VBAC. They give practical questions to ask your providers, more than just yes or no, to really get to know their birth philosophy and what qualifications and experiences your provider might have that would make them a better fit for VBAC chances.

Rachel and Meagan also give a lot of validation and advice on how to start the process of overcoming birth trauma; it’s reality and to not be ashamed of it. You’re not alone.

Through the many important messages of this episode, they both mention many times to trust your intuition. If something feels off, listen to that. And if a change in provider is necessary…it is never ever too late to change.

Invisible Labor: The Untold Story of the Cesarean Section

How to Naturally Induce Labor

How to Turn Prodromal Labor into Active Labor

Membrane Sweeps for VBAC

How to VBAC: The Ultimate Prep Course for Parents

Full Transcript under Episode Details

Meagan: Hello everybody! Welcome to the show! I am so honored to have Rachel Somerstein on with us today. She is a friend of ours from New York. She is a writer and an associate professor of journalism at SUNY New Paltz. She is an author of Invisible Labor: The Untold Story of the Cesarean Section. And her writing has also appeared in the Boston Globe, The Guardian, The Washington Post, and Women’s Health. She lives in Hudson Valley, NY with her husband and her two children and is here to share her stories with you today.

Rachel had an unplanned Xesarean section with her first child and the experience was anything but routine. I know that there are many of us who have been through this journey and on this podcast, maybe listening today, that also had an unexpected experience and it may have left us with trauma, or doubt, or fear, or all the feelings, right? And so she is going to be talking to us today about her experiences, but then also we’re going to talk about some guidance on how to find peace and to offer ourselves grace and to set ourselves up for a much better experience next time.

We do have a review of the week, so I want to get into that and I’m going to turn the time over to Rachel.

This review is by Deserie Jacobsen. The review title is “Thank You.” She actually emailed this in and it says, “This podcast and parents course is amazing. I am not a VBAC mom, but I have been listening since 2020. I binge listen near the end of every pregnancy to remind me of everything I need to remember in birth and process through my previous births. This time around I felt more prepared than ever before, having plans in place just in case. We were able to have a quick birth of my 5th baby. I love the education, passion, and love this podcast gives. I recommend it to everyone I know, and I have learned so much from it. I am so grateful for this podcast, thank you.”

Thank you so much Deserie for your review! Seriously you guys, I just love hearing that people are finding the information that they need, they’re finding community, they’re finding that they can do this too. Just like them, and all these reviewers and all the people that have shared their stories and all these reviewers you guys can too. This birth, VBAC, is possible too. Better experience is possible. A healing CBAC; it’s possible. You guys, all it takes is getting the information, the prep, finding the provider, to have a better experience.

Meagan: Alright Ms. Rachel, welcome to the show and thank you again so much for being here with us. I kind of talked about this a little bit before we started recording about how I think your episode is going to be so powerful and deep and raw too. You’ve got these feelings and these words. I love it. I love reading your book and I can’t wait to hear it from your own mouth. Which speaking of book, can we talk about that a little bit? What kind of just inspired you, jumpstarted you into writing a book about this?

Rachel: Well, I’m a writer. And I wrote an essay about my birth about two years after I had my baby, my first birth, my C-section. And I realized I had a lot more to say and also I heard from a lot of moms when that came out and that made me start thinking that I think there was a bigger project.

Meagan: Absolutely. And an amazing project that you completed.

Rachel: Yes.

Meagan: And remind everybody before we get into your stories where they can find your book. I actually have it here in my hands. It’s Invisible Labor. So where all can they find that? And we’ll make sure that we link it.

Rachel: Sure, thank you! Yeah, so it’s Invisible Labor: The Untold Story of The Cesarean Section. And you can get it on Amazon, you can get it from Barnes and Noble, you can get it from your local bookstore, you can get it as an audiobook? Or you can also get it as an ebook.

Meagan: For the audiobook, did you record it?

Rachel: I did not. The narrator is Xe Sands and she did a great, great job. It sounds excellent.

Meagan: Awesome. We’ll be sure to link that. I think it’s definitely a book that everyone should check out. There's a lot of power in that book.

Rachel: Thank you.

Meagan: And it’s not even just your story. I mean there’s a ton. Like if you go through the note section there’s a ton of research in there, and history and studies, and so many really great things. Well okay, let’s hear about the story that started the inspiration and behind this amazing book.

Rachel: Sure! Thank you. So like so many moms, I had an unplanned C-section that I was completely unprepared for, which is another reason I wanted to write this book because I think a lot of people go into pregnancy just assuming they’re going to have a vaginal birth and like me, I didn’t even read the parts of the books about C-sections, I skipped them. Because I was not going to have a C-section. Which is whatever, hindsight is everything, right?

But I had a totally textbook pregnancy. I switched to a different group of midwives and OB’s about halfway through because I just didn’t have a connection I felt with the providers in the first one. And frankly, I didn’t have a connection with the providers in the second one either, but by that point, I was like well whatever, it’s fine. Which I think is actually, if I could go back and do it again I would have changed that. But you kind of are like, I don’t want to, could I possibly change again? And I think that for people who are VBACing, yes you can and sometimes you actually really need to, even like late on in your pregnancy, people will switch groups or providers even late in the third trimester, so.

Meagan: Even if you’re changed already, you can do it multiple times.

Rachel: Exactly.

Meagan: It’s not a bad thing to find the right provider for you. It’s not.

Rachel: It’s not. And It's hard. And you can feel like, Oh my god. Am I really going to send all my records over? It can feel like so much effort and it can really be worth it. I just wanted to say that as someone who switched once and then was like, Okay, I’m done, and wished I’d switched again.

So anyways, it was late in week 39 I went into prodromal labor but I didn’t know that prodromal labor even existed because nobody told me about it. And it was my first baby. So I was like is this labor? I think I’m having contractions, these are not Braxton Hicks. And in the end, we talked to the doula I was working with, and in the end they ended up petering out. And at that, I think that that for me marked the beginning of, this is not going to look like the way I had expected it to look.

And again, hindsight is everything. What I wish I had known at the time– and I think this is really relevant to some VBAC moms is that sometimes prodromal labor means that your baby is not in the best position for having a vaginal birth. And I can’t exactly say oh I would have done this or that differently if I’d known it, but it would have helped me understand what I was going into with the labor and the birth.

So anyway, I eventually went into labor in the middle of the night. It was exactly my due date and I knew it was different. I could just feel this is labor. And I was really eager to get it going quickly. And again, I wish someone would have said, “Rachel, rest. It’s early. You’re going to need your strength. You’re going to need your energy however your baby is born.” And instead I quite literally was running up and down the stairs of my house to try to push labor along. Which is, I have compassion for myself, I understand why I was doing that. What I really needed to do was get in the bath, or I don’t know, lay over the birth ball. Watch a silly movie, right? The feelings I was having were real pain and I was scared. But you kind of can’t run through this, especially a first labor as we all know, those take a long time, right?

Meagan: Yeah. And if we were having prodromal labor, our body may be kicking into labor, but still might need some time to help that baby rotate and change positions.

Rachel: Exactly, exactly. And this is the kind of education that is so missing from birth classes. And that is one reason why this kind of podcast is so helpful because that’s how I learned about these different things. I didn’t ever learn about them from a provider being like, “Let’s talk about what will happen in your birth, and let’s talk about why you had prodromal labor.”

So anyway, we went to the doctors office where we met a midwife and my doula for a labor check. And I was hardly dilated, I was at a 2 but I was in extreme pain. And I have to say, I have a very, very high pain tolerance and I now know I was having back labor.

Meagan: Baby’s position.

Rachel: Exactly. And the contractions were like boom boom boom boom. They were not, I didn’t have any rest in between them. Which again, I think my baby was like I gotta get in the right position, this isn’t working out, I’m freaking out, ah! Plus my mom is running around, ah! Right?

Meagan: Yeah.

Rachel: So we went to the hospital and I was checked in and the midwife who checked me in was like, “Oh you’re actually not even 2 centimeters, you’re just 1 centimeter dilated.” And they checked me because I was in so much pain I think. And I don’t know that that was necessarily wrong, but again, no one was sort of explaining, “Here’s what we think is going on.”

And it’s partly because I believe those providers thought I was exaggerating what I was experiencing physically. They didn’t know me. Well, they didn’t know that I’m usually pretty stoic. They didn’t know that I’m not a squeaky wheel. And I wasn’t like screaming or crying or pounding. I was like quiet and I was like I’m in a lot of pain.

Meagan: An intense quiet.

Rachel: Intense quiet. Exactly. But that doesn’t look like what we think pain looks like to people. And the fact is that people are very individual and how they express pain especially during labor where you’re already kind of like leaving the regular plane of reality.

Meagan: Yes.

Rachel: So an important takeaway is like, even experienced providers cannot read your mind and make mistakes in assessing what's truly going on with you. And this comes up later in my second birth, but my husband now does a much better job of saying, “You might look at Rachel right now and think she looks like she’s doing great, but this is what’s really going on with her.” And he does that in a way that’s not like he’s speaking for me in a way that’s annoying, but it’s like I actually can’t advocate for myself, I can’t express this.

So anyways, I asked for an epidural. They said that the anesthesiologist was busy. Which may have been true, but may have been they were trying to put me off because I was hardly dilated. And they told me to get in the birth tub. And I remember hanging over the side of the tub and staring at the clock on the wall and being like, I actually don’t know if I’m going to survive this hour. I was just in so much pain. Incredible pain from back labor that was incessant.

Eventually he showed up. They hooked me up to all the monitors. At that point, one of the nurses was like, “Oh, you are having monster contractions.” Like the contractions that were being measured were so intense they were going each time to the edge of what was measurable. And now that the computer said it it was like oh…

Meagan: You’re validated now.

Rachel: Exactly. Right. And the anesthesiologist, it took him three tries to get the epidural working properly which would echo problems to come. But he did, and it took away the pain. And then I was just in the bed and kind of left there. And the nurses and the midwife did not use a peanut ball, they didn’t move me around. And obviously, listen, I’m attached to the monitors. You know you cannot really move that well, the belt slips, and that increases the chances you’ll have a C-section. And there are still things that can be done. It’s not like you’re a loaf of bread, you just lay in a bed. But they didn’t do that stuff and I wasn’t dilating. The nurse and doula eventually basically were like, “Well, we’re going to go out for dinner and we’ll be back in a few hours and we’re going to give you this thing to sleep and if you haven’t dilated by the time we get back you’re going to have a C-section.”

And at that point I was exhausted. It’s evening now, I’ve been up since the middle of the night. I’m totally like, what is happening with this birth? No preparation; I took birth classes, I read books, no preparation suggested that this series of events could take place. I felt completely abandoned by my providers, including my doula who I was paying out of pocket. And one thing that came up at this time also was I had this colposcopy in college, like scraping of cervical cells. I didn’t hide it from anybody, I was open. And the midwife said well maybe that’s why you’re not dilating is because of this colposcopy.

Meagan: Do you think you got scar tissue?

Rachel: That’s what she said. And I remember at the time being like why are we only talking about this now? Why has nobody brought this up in any of the prenatal visits that I’ve done? And I felt blamed. This thing about your body is defective.

After a few hours when the midwife and the doula came back and I rested and it was quiet, I had dilated to a 9. And I think what that’s about is that I had been in too much pain to dilate. I was so frozen up and tense and also extremely scared.

At this point people are like, “Oh wow.” And finally my water broke,y water hadn’t broken. So you know, things are kind of continuing and I am starting to actually feel even more fear and my room is getting really crowded with people. And the midwife asks me to start pushing. And I was afraid and I was excited. They turned on the baby warmer, and they were like, “Okay, your baby is going to come out.” And I started to push but I couldn’t feel what I was doing. I had no idea. And the midwife was like, “Do you have an urge to push?” And I was like, “No.”

The epidural that hadn’t gone well from the beginning had then come down with a very heavy hammer and I felt total numbness. It was not helpful. I needed someone to have turned it off or something, or turned it down so I could feel an urge to push and feel how to push, where to push, what muscles to use.

And at a certain point I could tell something was going not right and it turned out that my baby was having heart rate decelerations. So just to sketch the scene. At this point it’s 1 o'clock in the morning, I’ve been awake for 24 hours. I’m exhausted. My husband is exhausted. Neither of us has any idea that things could have gone like this. The midwife says I think it’s time to do a C-section. And I don’t disagree with her. I don’t even know what to think at that point.

I’m also feeling tremendous fear. I was like I’m afraid I’m going to die, I’m afraid my baby’s going to die. And the overall sense in the room…and people were like, “Oh no, you’re going to be fine”. And the sense in the room was that I was hysterical and I was not in my right mind. Which I wasn’t in my right mind; I had been awake for a long time, I’d been trying to have this baby, nobody really told me what was going on and I felt totally unsupported. Actually, my response was completely reasonable given the circumstances and nobody really attended to that and saw that and recognized that as completely valid.

Plus, I don’t have evidence to stack this up absolutely, but I have since come to find out that there is a medication that some laboring women are given to help them rest and one of the side effects is an impending sense of doom. And I have a friend who had a baby at this same hospital and had the same response after having been given something to rest during her labor. I could go back and look at my records and I may do that but I’m like, well that would explain also why I had the response I did.

Meagan: Mhmm.

Rachel: Anyway, we go to the OR. I hunch my back for the spinal that the anesthesiologist has to do a couple of times to get it right. I’m still contracting at this point. My body is still like, Come on, let's get this baby out. Let’s get this baby out. And I’m so uncomfortable. And you know that advice to not lay down flat on your back when you’re pregnant, but that’s what you have to do when you’re in the OR. The whole thing felt like I was going to choke under my stomach and very exposed like you are in the operating room.

Meagan: Yeah, it’s cold and it’s bright and you’re very exposed. And you can’t move your body normally, especially if you’ve had a spinal.

Rachel: And also in retrospect, again I’m like I cannot believe that the first time I learned what happened in a C-section was in my C-section. I really should have at least learned about this even though it would have still been scary and I still would have been surprised.

So when the OB goes to operate, he starts his incision and I say, “I felt that.” And he says, “You’ll feel pressure.” And I say, “I felt that.” And he continues operating and I was not numb. I felt the operation. And according to his notes..parts of this I don’t remember…but he wrote it down and my husband has also told me that I was screaming, my legs were kicking. There’s no question that I was in tremendous pain. And I was moaning and it was horrible. And it was horrible for the people in the room too by the way.

Meagan: I’m sure.

Rachel: Right? Like it’s really important to say that. My OB didn’t listen to me. That is a super common thing that happens in healthcare, especially for women. Especially for pregnant women. He’s not a sociopath. He didn’t want to be evil, but he didn’t listen and the consequences were so steep and so dire. And I think that it was traumatizing to him and I know it was traumatizing to some of the other providers in that room, the nurses to watch this.

He kept going and when the baby was born, which I don’t remember, apparently they held her up to my face and they put me under general anesthesia and sent my baby and my husband away and stitched me up. Then I woke up in recovery. The doula and the midwife had gotten the baby to latch while I was unconscious and were talking about me without knowing that I was awake about her latch which really, really bothered me because it just underscored how it felt like I was just a body. And even people who were supposed to be there to take care of me and be tender and advocates, I felt they disregarded me. And under other circumstances I really would have wanted to breastfeed my baby like right away. But I wasn’t even there to say yes I want to do this or no I don’t want to do this.

It was a terrible birth and I would not wish it on anybody.

Meagan: And I think, kind of talking about what you were just talking about with breastfeeding and stuff, these people in their hearts and in their minds were probably like this is what she would have wanted. We’re trying to help. But in whole other frame of mind over here, I’m not present. I haven’t said those things. And I know you’re trying to help and I know that’s where your heart is, but I’m not okay with this.

Rachel: Totally.

Meagan: And I think sometimes as doulas, as birth workers, as any one of you listening, remember that words matter. Actions matter. These moms' feelings matter and it’s sometimes in our minds we’re trying to do what’s best, but it might not be.

Rachel: Totally. Absolutely. Yes and I again, it’s so important to point out. Yes they were coming from a good place. They really were coming from a good place. But it wasn’t the way that I felt it or experienced it.

Meagan: And it left you with trauma and angst and heartache.

Rachel: Absolutely. Totally. Yeah.

Meagan: Well that definitely sounds like a really rough birth. And it’s so crazy because it’s like you went from not progressing to baby in a poor position, to getting an epidural. I love that you talked about that. That can be an amazing tool. A lot of people are very against epidurals, and there are pros and cons with epidurals. We’ve talked about those. Fetal heart decels is one of them. I don’t think, maybe in this situation it sounds like a lot of other things happened; baby’s position being one of the biggest ones. But that can really be a tool that helps you just relax and be more present and have less trauma.

We talk about this in my doula practice of where there’s a difference between pain and suffering. And pain, progressive positive pain that’s bringing our baby to us that’s one thing. But when we’re suffering and we’re so tense that our body’s not even able to try; that epidural could come into great play. But again, we’re not that loaf of bread in a bed and it is important to move and rotate. And it doesn’t have to be drastic. It doesn’t have to be crazy big movements. Just subtle movements to change the dynamics of the pelvis and to encourage our baby to keep coming down.

So there were so many things that just went poorly but also went well, and then poorly again and then well and then real poorly there at the end.

Rachel: And I think like to your point, I went into my birth I should say, I was planning on having an unmedicated vaginal birth. I was like I’m not going to have an epidural. And I think that if my providers had different skills I would have, I may have been able to have that baby vaginally. And I say that based on what happened in my second birth.

So it’s not just like wishful thinking, right? And I’m really glad I had that epidural. I really needed that. I was suffering. The pain I was experiencing was not productive pain. And an epidural can help you with suffering, alleviate your suffering. But it can’t and doesn’t substitute for emotional support. And I think that’s what was missing for me, throughout that first birth. Even if I had gone on to have ok fine, a cesarean, or even a vaginal birth, I still think I would have been like that wasn’t a good birth because I didn’t feel emotionally supported. And an epidural can’t do that.

Meagan: Yeah. No an epidural cannot do that. And I, for anyone listening who supports birth, or even who are going for a birth you kind of mentioned it. You’re in this other land and sometimes it’s hard to advocate and open. You might be thinking something and you might so badly want to say it. It’s right here, coming out. And you can’t say it for whatever reason. It’s a weird thing, it doesn’t make sense sometimes but it can happen. But really being heard, validated, understood; which are so many things you weren’t. Right? And when we’re not heard and when we don’t feel safe, and we don’t feel supported, those things leave us with PTSD. In fact there was, in your book, I’m just going to read it. It says, “2022 study by anesthesiology and obstetrics professor Joanna and colleagues found that what’s important about women who feel pain during childbirth is how mothers feel about their pain. And how their providers communicate with them overall…”

You were communicating, and no one was communicating to you.

“...feeling positively about pain and heard by providers protects a mother from developing PTSD.” And I mean it goes on which is why you need to get the book so you can read more about it.

Rachel: Yep.

Meagan: But really, feeling heard.

Rachel: It’s not just crunchy whoo-hoo feels good, feels right, sounds good. It really matters. And I have to say that I’m participating in and helping to work with providers on designing some studies about providing different pain options for moms during C-sections.

We literally had a conversation about this yesterday. And one of things we were talking about is it’s not just the pain. It’s not just pain relief. It’s also being listened to. Because there will be people who are like, I might say I’m in pain, but that doesn’t mean I need an epidural or want an epidural. But I’m feeling pain and I want to be heard and I want somebody to…even if you can’t express this. You can’t even express it because you’re the one having labor.

What you’re needing is someone to see you and look you in the eye and be like you’re going to be okay. And I think as mothers we totally are experienced with that all the time. When your child is hurt or sick, part of your job obviously is to get them the help they need, but it’s also to assure them this nosebleed is going to end. You’re not going to have a bloody nose for the rest of your life. Which, when you’re going through something really hard you can sometimes forget, right? And you’re pointing out from the studies this helps to prevent people in birth, in labor, from developing PTSD. The stakes are really high. They matter so much.

Meagan: When you were just talking, I don’t know if you saw my eyes kind of well up a little, but I connected a lot with my first birth when I was clinging to a bed, literally clinging. And I was looking at my husband and I’m like, “Do something!” I had a baby in a poor position. I was being jacked full of pitocin. My water had broken, there was a lot of discomfort going on. I had told him I didn’t want an epidural and he’s like what do you want me to do? And I was like I don’t know, I just need something!

And I was terrified and desperate. And he was just like… It wasn’t fair for me to put him in that position either but at the same time he was like I don’t know, I don’t know what to do, right? And the nurses were just like we’ll just get you an epidural. And I was like no, I don’t want an epidural. And then it just was like epidural, just went down from there.

And I wish so badly that there was something else. Let’s get you out of the bed. Let’s get you in the shower. Let’s give you some nitrous. There was so much more that I could have had, but wasn’t even offered. And I think too, I needed someone to tell me that nosebleed was going to end.

Rachel: Yes.

Meagan: And it was going to end and it was going to come back every five minutes and it was going to end again and I was going to be okay. And I was going to survive that. And just hearing you talk about that, why my eyes got all welly, is that I don’t know if I realized how much that impacted me until just barely. And here I am, my daughter is almost 13.

Rachel: Just like how powerful these things that, I don’t know, this is part of why we have these conversations. They shed different corners of light on our experiences that it’s like oh my gosh, I didn’t even know I knew that. And that’s so why we, even though I’m not postpartum immediately, it’s valuable for me to talk about it too; to hear what you’re saying, you know?

Meagan: Yeah. Ah, so after a not-so-amazing experience, going into that postpartum, you’ve talked a little bit about that in your book. Well, not a little bit, you’ve talked about that a lot. Tell us about that journey and then what led you to deciding on VBAC and ultimately going and having a VBAC.

Rachel: So I should say, I was really…Talk about not realizing things right away. It took me a long time to figure out how traumatized I had been by that birth. And I was about two years postpartum and I was having a procedure for something else and I just completely, I had a panic attack. I had never had a panic attack before, I didn’t know what it was and couldn’t have explained what was happening. And when the anesthesiologist who did this procedure was like have you ever had any issues with anesthesia, which is exactly the question that should be asked, and I had said what had happened he was so taken aback. He was shocked and didn’t know what to say and walked out of the room.

Not in the way of, I’m abandoning my patient, but just like from his perspective here’s this kind of routine thing. This patient is crying and shaking and talking about this very traumatic incident which I had not talked about. I didn’t go to therapy. I had talked about it with friends and my family, it wasn’t a secret, but I felt a lot of shame. I felt like I must have been this total freak of a person that this had happened to me.

And after that I remember saying to my husband, I just don’t know if I’m ever going to be able to get over this trauma enough to have another baby. And I didn’t even know if I wanted another baby, like separate from the trauma. In therapy I started to see that I felt very stuck in my life and that included how and whether to grow my family. And that was actually because of the traumatic birth. It just like made this big block.

I think one thing that’s important to think about for those who have had a traumatic birth is that sometimes that can show up in your life in ways that you don’t expect.

Meagan: Yes.

Rachel: And so to be compassionate with yourself about that and also to be open to that. We’re in the era of warnings and trigger warnings and those are important, but sometimes for a traumatized person the things that are triggering or activating are not what you would think. Like for me, I couldn’t watch a scene of a hospital birth even if it was happy without getting very uncomfortable and having to walk away and there wouldn’t be a content warning on that. So it’s just to say be patient with yourself. Accept that…don’t, I guess if you’ve had a traumatizing birth you don’t have to struggle against these things. As horrible as they might feel, as uncomfortable as they might feel it’s normal and it’s ok and it shows up differently for everybody.

Rachel: Yeah so I had this big question and then I was like ok, it took awhile for me to be like I do want to have another baby. But I wasn’t ready emotionally. And so I waited. And then about, let’s see, October of 2019, I was like I think that I’m ready to try to have another baby.

And we had met this midwife who lived in our community, who my daughter actually made friends with her niece at our public pool which is so beautiful. I ran into her one night while she was walking her dog. She was like your husband shared a little bit with me, if you ever want to talk. And this, I feel like, I could not be more grateful that this person came into my life. She just is, her skills are phenomenal. Just as a clinician in terms of trauma-informed care, and I’ve felt safe enough going to her for prenatal care to decide that I was ready to get pregnant.

My joke is that I should tour high schools and be like it only takes once to have unprotected sex to become a parent. And I was really lucky that I got pregnant right away and at that point I was 37. So I should say I had my first baby at 33 and I got pregnant again at 37. And that’s not always the case for people. Obviously it can take a long time and especially after a C-section, secondary infertility is real.

Meagan: It is.

Rachel: Yeah. Not talked about enough. Really not talked about enough.

Meagan: There’s a lot of things, right, about C-sections that is not discussed about. For personal, for the mom, for the individual, the infertility, adhesions, all those things. Just the emotional and the physical. Then even the baby. There’s risks for the baby, the allergies, the microbiome getting messed up. All the risks, it’s just not discussed.

Rachel: No, it’s really not. And you kind of only find out later if you’ve had a C-section and you’ve had a problem down the road that you’re like, maybe that’s because of my C-section. It’s ridiculous.

So we got pregnant and I was not sure if I wanted to have a VBAC, but I started thinking about it from the beginning. And I also was like, if I don’t have a VBAC how am I ever going to get myself into an OR, I just don’t know.

And I really think that VBAC is the under-discussed pain point for moms. And I’m preaching to the choir here but we’re talking about half a million moms every year have to make this decision, if it’s even available to them.

Meagan: I was going to say, if it’s even offered.

Rachel: If it’s even offered. Which is totally not a given. But theoretically, they do have this decision and I really have not…I should say, in the course of writing this book, but also just being a mom who had a bad C-section and then had a VBAC, I hear from people a lot about their journeys just like on the playground. Every person I’ve talked to, they agonize over it. No matter what they choose, no matter what. Why is that not talked about more? I mean that part of what this podcast is doing that’s so important, but I still can’t believe how under the radar it is, yet it’s such a big deal when you’re going through it.

So anyway, I told myself I did not have to decide right away about a VBAC or a C-section. My midwife was like you can totally have a VBAC, you can totally have a C-section. Even if you have a C-section you can keep seeing me. I was worried like oh would I get bumped out of midwifery care. One of the things I’m really fortunate about and that I think is really good about that practice is that she has a very close relationship with one of the OB’s there. Like they kind of share patients, I should say that. And that’s because she’s worked with him for a long time and he really respects her clinical skills and vice versa.

The other thing about her that’s unique and that I didn’t know how important it is she’s a Certified Nurse Midwife, so she attends births in the hospital. But she previously had been a homebirth practice and at a birth center as a CNM. So her skills are, like I said are phenomenal. A C-section is truly like we have to do this. I’ve run out of my bag of skills or like the baby or mom’s health suggests that like we need to do this now.

She worked with me to work with the scheduler so that I saw her for every visit which helped me to learn how to trust her and she didn’t pressure me. Either way she was completely open. She also worked with me to make sure that I could see her for virtually every visit so that way she earned my trust. And I got to show her who I am. She got to understand me which was really important to the birth.

Meagan: Yes, which I want to point out. There are a lot of providers these days that are working in groups. And I understand why they’re working in groups. They’re overworked, definitely not rested. There’s reasons why, both midwives and OBGYNs are working in these big practices. But the thing is it’s really nice to have that established relationship but for some reason specially for VBAC it’s so important to have that one-on-one relationship. So if you can, during your search for finding providers, if you can find a provider that is going to be like Rachel’s midwife where she’s just like I want to get to know you, I want to establish this relationship. Yes, we have this OB over here but I want to be your person. I definitely think it’s impactful.

Rachel: I totally agree with you and I didn’t even know that was possible. And she works for a big group and even so she told the schedulers, hey make sure you schedule her with me. She didn’t just do that with me by the way, it wasn’t just a special favor for this traumatized patient.

And frankly it’s better for the providers too because they’re not coming in cold. Like ok who’s this person, and she’s saying this. And what’s her prenatal care like? What’s her pregnancy like? Of course they’re looking at the notes, but it’s not the same.

Meagan: It isn’t. And I love that she said that. But I also want to point out that you can request that.

If you’re in a group and you can connect whole-heartedly with someone and you feel it’s definitely who you need, it’s ok to ask hey. I know that I am supposed to meet Sarah Jane and Sally, but can I stay with whoever.

And maybe you might not get every visit, but if you can get more visits than only that one? It’s worth asking.

Rachel: Totally. And also then you know their style. So like she was not an alarmist. Let’s say I was over 35; I had to see a MFM just because of my age. That went fine, but if something had come up, like let’s say I had a short cervix or there was something I found in an appointment with an MFM specialist I would know her well enough to take that to her to be like, put it to me straight. How worried should I be about this? As opposed to maybe this one’s an alarmist, this one is more like ahh let me put this in…

And the only way you’re going to learn about that is from meeting with them again and again. And for VBAC that’s so so important.

Meagan: It is. It kind of reminds me of dating. It’s weird. I had said this with my provider when I didn’t switch. I was like, I feel like I’m breaking up with him. Like he’s my second boyfriend, it’s just weird. It’s not really boyfriend but you know what I mean.

But it is, we’re dating them. And anyone, in my opinion, can come off really great for that first date because they’re wanting to make that impression. They’re wanting you to like them. But the more you get to know them, the more they may show their true colors. And you also may realize, I don’t think I’m the right person for you. My desires aren’t something that aligns with you and so I don’t want to put you in this situation. And so if we date our providers, “date our providers,” a little bit more than just one time it really will help us know. And like you said, if something were to come up you could have that trusted person in your corner, which is so important for VBAC, that you can go to.

Rachel: Totally. Yeah. So yeah, so pregnancy went well. And then right as I entered my third trimester it started to be COVID.

Meagan: Mhmmm. The joys.

Rachel: Nobody saw that coming. And then you know, things for the entire society obviously went completely off the rails. Obviously something like COVID is, we hope, not even once in a generation. Once in a hundred years experience.

But given all the stuff that was up in the air, boy was I glad that there was one provider who I trusted. Who I could be like ok what do I do, what do I do. And I have to tell you that she and my daughter's pediatrician…I’m a professor. So I should say I’m in the classroom with young people who, you get sick a lot anyways. They’re living in dorms, like they’re not taking the best care of themselves. So COVID was circulating, and we live right outside New York City, COVID was circulating early here and I have a lot of colleagues that ended up getting it. And both my midwife and my child's pediatrician told me early you need to stop going in person, it’s too dangerous for you.

And I trust my daughter's pediatrician a lot, you know we have a nice relationship and I really trusted my midwife. Right? So I followed that advice and was really fortunate because boy. You know what you don’t want while pregnant? COVID. And you know what you really didn’t want? COVID in 2020 when you were pregnant and nobody knew anything, you know?

Meagan: Right?

Rachel: So, the blessing in disguise was that I was able to work from home. And it was super stressful because I had my daughter and my husband was here and you know, my husband is a photographer…I mean the funny thing is that I ended up, not my head but my body, being in these different photos he ended up taking and my belly was getting bigger and bigger and we kind of had to hide it. I’d be holding a book, or cleaning something. It was an absurd, crazy, isolating, scary, and also funny time.

You know the blessing in disguise was that I wasn’t on my feet as much and I think that that was really good for me as a pregnant person. There is also data that preterm birth went down during the lockdowns because people got to stay home and they don’t necessarily get to do that leading up to birth, which tells us a lot about what we need and the rest we need and aren’t getting.

So anyway, at first everything went virtual and then when I started going in again for my appointments I had met the OB who works closely with my midwife. And we talked about what would happen if I went over 40 weeks. And he was like well, we’re not going to automatically schedule a C-section, we would talk about potentially waiting or induction. And I really appreciated having that conversation with him because I understood where he was coming from and it wasn't again like we’re going to schedule a C-section right now. So we know if you get to 40+3 and you haven’t had the baby, bing bang boom. And that was very important information about his risk tolerance and his stance.

Just like with my first birth I went into prodromal labor a few days before my due date. I had had a membrane sweep with my midwife. My in-laws came to stay with my daughter and we went to the hospital on a Saturday night. I didn’t know this but my father-in-law told my husband I think she’s getting ahead of her skis. And he was right in the end.

So we get to the hospital and my contractions stop. And I’m like oh no. And my midwife was like, they put me on the monitor to get a strip which is like you know, what happens.

Meagan: Normal.

Rachel: And my midwife was like listen, your baby, he’s not looking that good on the monitor. I want you to rest for a little bit and let’s see. So I’ll check back in with you in like half an hour.

And I was so upset. I remember being like I can totally see where this is going to go and I had learned about VBAC in terms of like what could increase the chance of rupture or not and I was like I’m going to end up with another C-section and I’m going to be caught in the net. I didn’t even have a shot, is what I felt.

And then she came back half an hour later and she was like, “He looks great. I think he was just sleeping, and if you want to go home you can go home.” And it was like 1 o’clock in the morning. And I was like, “I think we should go home.” I just felt like he's not ready. He’s not ready to be born. And remember, I trusted her so much. She would not tell me this if she thought that there was something…

Meagan: If there was something wrong.

Rachel: Exactly. She wasn’t trying to be my friend. She was my provider. And so it felt really weird to leave and come home and not have a baby. And I thought was this the wrong thing to do, because I live like half an hour from the hospital, and was like no this is it.

And then everything was quiet for a few days. And then just like my first labor, my daughter, I went into labor in the middle of the night and I had intense back labor, and I knew like this is the real deal, here we are. And this time I tried to rest. I did like cat/cow and just like anything, child’s pose, just anything to feel more comfortable. And I called my midwife at 7 in the morning and she was like, “Okay, I want you to come in and be prepared to go into the hospital from this appointment.”

So we did that and at that appointment, I had a headache, I had higher blood pressure, I was dilated to a 6, and she said to me, “Listen. Just so you know, they’re not going to let you go home. You’re going to the hospital, no matter what if your contractions stop or not whatever. This is what’s happening because of how dilated you are, the fact that you have this headache, this BP readings, whatever.” And I was like that’s completely reasonable, I felt that way too. You know what I mean? But I really appreciated she communicated that with me so clearly and explained why.

So I planned initially to try to have an unmedicated, vaginal birth. My midwife and I had discussed these saline boluses you can have in your, by your, what’s it called. Like the triangular bone in your back? I’m totally blanking.

Meagan: Your sacrum?

Rachel: The sacrum. Yeah, that that can alleviate some pain. And very quickly the pain was, I found it to be unbearable. And I asked for an epidural. And the anaesthesiologist came right away and did a very good job. And the nurses and the midwife who were at the hospital were using a peanut ball and helping me move and really supportive emotionally.

And I was still really scared, right? Because I had had this terrible birth before, I thought something would happen to me. And nobody treated me like I was exaggerating or you know like, unreasonable. And that mattered a lot. And I think what’s important is you shouldn’t have to have gone through a bad birth for people then to take you at face value. With your first birth, it should be the standard for everybody.

Meagan: Such a powerful saying right there.

Rachel: And they were wonderful, truly, clinically and beside.

Meagan: Good.

Rachel: And then my midwife surprised me by showing up. She was not on call, she came in at like 9 o’clock, no she came in at like 5 o’clock, like once she'd seen her patients and I was just like oh my god, so moved to see her.

And you know, I was pretty far along at that point and she kind of helped me get into different positions and then it was like okay, it was time to push. And they had managed that epidural so I could feel when it was time to push, and I could feel how she and the nurse were telling me to like push here, right? Like use this, make this go.

The pain was really intense but it wasn’t suffering, like okay, I’m getting instruction. And as I was pushing I could feel that it wasn’t going to work. I was like he’s not, his head…I could just feel it. Apparently he was kind of coming and kind of going back up, like his head forward and back. And my midwife was like do I have permission from you to try and move his head? I think his head is not in the best position. And I said yes, and she tried to do it and she couldn’t. Her fingers weren’t strong enough and then she went to the OB and she told me this later.

She said to him can you come and move his head? He’d been trained by midwives in the military, by the way, which is one reason his clinical skills are so amazing.

Meagan: That’s awesome. Okay.

Rachel: Awesome. And at first he apparently was like, oh she’s a VBAC, like I can’t believe you’re asking me to do this. And my midwife, again they trust each other right, and she was like the baby’s doing great and the mom’s doing great. I really think this is going to work. And he was like okay.

So he came in, asked my permission, I said yes and he moved my son’s head. My water had not broken again, right? So it’s like the same thing as the first one. And once he got in position and I started pushing my water broke in an explosion all over my midwife. That’s why they wear goggles, now I know. And she went and changed her clothes. I pushed for 45 minutes and then he came out.

Meagan: Oh my gosh.

Rachel: It was amazing and I felt so proud and I was completely depleted. I was so high and also so low. And I think what's amazing to me is that it was almost the same labor as my daughter, which just tells me that's how my body tends to do.

Meagan: Your pelvis. And some babies need to enter posterior or even in a weird position to actually get down. So that can happen.

Rachel: Thank you. And also my water didn’t break until the very end so there was buoyancy to be moved, right? And again who knows what would have happened if I had been with this provider the first time. Like maybe these decels really meant that my daughter had to come out like then. That is possible. And that first team did not have the skills of the second team. None of this was even brought up, wasn’t even a possibility.

And I should say that first birth, I didn’t even mention this. The OB that gave me that C-section, later told me that my daughter's head was kind of cocked when he took her out. Which suggests that it was just like my son. And how I’m grateful for my epidural. I’m grateful for, you know, all the things that technological kept me safe, but it was these skills of facilitating vaginal birth that made the difference for me to have that VBAC.

Meagan: Absolutely. And the hardest thing for me is seeing that these skills are being lost.

Rachel: Yes.

Meagan: Or maybe it’s not that they’re being lost, they're being ignored. And I don’t know which one it is. I really don’t know because I see people using them. So I feel like it’s got to be there. But then I go to other births and I’m like, wait what? You’re not going to do anything to help her right here?

Or you know, it probably could have been a vaginal birth if we had a provider come in and be like we have a little asynclitic head, why don’t we change into this position and let me see if I can just ever so slightly help this baby’s head turn. It just isn’t even offered.

Rachel: Yes.

Meagan: And that’s something that I think needs to be added to questions for your provider. In the event that my baby is really low and coming vaginally, but is in a wonky position, what do you do to help my babys’ position change to help me have a vaginal birth. And then even further what steps do you take past then if it doesn’t work and my baby’s so slow. Do we do assisted delivery? What do we do, let’s have this conversation. So if it does come up, you’re aware.

Rachel: I love that.

Meagan: I was going to say if your provider says, I don’t know/I don’t really help, then maybe that’s not your right provider.

Rachel: And I think what’s so smart about that framing is that it’s not putting the provider on the defensive of like, what’s your training, right? Then it’s like, what is your problem? But you’re actually asking about their skills and you’re asking about their approach, without coming from a place of seeming doubt. Just like, I’m just curious.

Meagan: Yeah. Like what could I expect if this were to happen, especially if in the past. Say your C-section was failure to descend, mostly based off on position, we know that this is a big thing. But if your past cesarean was failure to descend, ask those questions to your provider. What steps can you take? What steps can we do together, you and I, to help this baby come out vaginally?

Rachel: Totally. And I think also, that way, let's say the VBAC doesn’t work out, you won’t then be looking back over your shoulder and being like I should of/could of/why didn’t I/if only. And you know, what do you want out of your birth experience? Well a lot, but part of it is a sense of peace. Right? That I did the best that I could. That my team did the best that they could.

Meagan: Yes. Yeah and really interviewing your provider. Again, dating your provider and asking them the questions, learning more about them and what they do and their view. Taking out the yes and no questions and really trying to get to know this provider and letting them get to know you. I think it’s just so impactful. I also, kind of like what you were saying with your first birth, also learning the other types of birth that could happen, you know learning about assisted birth.

This is a new thing. Learning if assisted birth trumps a cesarean for you. Would you rather go for an assisted birth, even if it may end in cesarean, would you rather attempt that? Or would you just rather skip that and go right to the cesarean. Really educating yourself and trying not to push off the scary even though it can be scary.

Rachel: Yes, yes. I love that you’re saying this and I was just thinking about this and talking about this with a friend; there’s stuff we hope doesn’t happen. But not talking about it or thinking about it isn’t going to protect us from it happening, it's just going to mean you’re not prepared.

Meagan: Yeah.

Rachel: If it does happen. And yeah.

Meagan: It’s a disservice to ourselves. And it’s weird. And it’s hard to hear those stories. It’s hard to hear the CBAC stories, it’s hard to hear the uterine rupture stories that we do share on this podcast. Kind of what you’re talking about the trigger warnings earlier, yeah it might be a trigger. It really might. But if we know all the signs of uterine rupture leading up to, we can be aware. And it’s not something to hyperfocus on. We don’t want it to be like oh my gosh I have this weird pain, right now, I don’t know.

It’s not to make you scared, it really isn’t. It’s to just help you feel educated. Kind of what you were saying too. I don’t know what a C-section looked like until I was in my own C-section.

Rachel: Yeah. I’ve been talking about this recently with an anesthesiologist, some anti-anxiety medicine which you might get during a C-section, can cause memory loss. That’s a side effect. So the time to decide…Let’s say you’re not planning on having a C-section. And then you’re having a C-section and you’re really anxious, really reasonable. The time to decide whether to take that anti-anxiety medicine which might cause memory loss; you should have an opportunity to reflect on that and talk about that and think about that not only in the moment when you’re scared and should I take it right now or not.

Meagan: Yeah.

Rachel: It’s just like that’s not a good way to make a decision, you know?

Meagan: Yeah. And also learning about alternatives. Okay, these are the side effects of this medication, and I don’t think I’m willing to accept that. So let’s talk about other medications and those side effects so we can see if we can switch it up. They have a whole bunch of things in their toolbox when it comes to medication.

Rachel: Exactly.

Meagan: For nausea. You know I had a medication and it affected my chest. It went all the way into my chest and I had to consciously focus on my chest moving. It was the weirdest feeling.

Rachel: Terrifying, yeah.

Meagan: I wish I would have known the alternatives to that. Right? So having these educated discussions, learning as much as you can. It’s hard and it’s scary and it’s intimidating to not learn what you don’t want. It’s understandable, too.

Rachel: Completely, completely. But that's informed consent, right? The risks, the benefits, the alternatives. And to go back to the anti-anxiety thing. You might be like okay, what could you do for me non-pharmacologically? Let’s say I have a C-section and I’m feeling really anxious. Can I have a doula with me there who’s giving me a massage? Can I have a doula there who’s maybe put some lavender essence on a washcloth to hold to my nose. Can the anesthesiologist hold my hand and tell me it’s going to be okay? And then you start actually opening up real options. Like wow I can have a doula with me?

Meagan: Yes. That is something that I am very passionate about. We need to get doulas in the OR way more than we are. And I understand that it’s like oh we don’t have PPE, or oh it’s an extra body, and oh it’s a very big surgery, like I understand that. But I have been in the OR a good handful of times. And I understand my position in that room. I understand and respect my position in that room. And I always let an anesthesiologist know, if at any point something happens where I need to leave this room you just tell me. I will leave. No questions asked. But please let me be here with my client. Please let me stroke her hair. Please let me talk to her when dad goes over to baby so she’s not alone.

When you were put under general anesthesia to be there by your side, whether or not you were waking up in the OR. Because sometimes you could wake up sooner, or waking up in post-operative. Let's get these people here. Let’s play music. Let’s talk to them. Let’s communicate the birth.

I mean with my first C-section, they were complaining about the storm outside, they weren’t even talking to me, right? And it would have impacted my birth in such a more positive light if I would have been talked to. And I wouldn’t have felt like, what’s going on. You know and all those things, you talked about it in your book. This drape that is separating us from our birth, it’s just wild.

So one of the questions we ask when you sign up to be on the podcast is topics of discussion that you would like to share, and one of those things is you said, why it’s important to balance preparation for VBAC with an understanding of the systemic forces that promote C-sections. We’re kind of talking about that, but do you have anything else to say on that?

Rachel: I think that there is so much self-blame for having a C-section, when you wanted to have a vaginal birth. And go back to pain and suffering, that causes suffering. And it’s heartbreaking to see that and to feel that. And when I think about it, I think what’s important to keep in mind is like there are the particulars of your experience, right? Like your providers had the skills or didn’t. They listened or they didn’t. Your baby had decels or didn’t. Like all that is real. And you’re not the first or only person any of that is happening to.

So why are we hooked up to electronic fetal monitoring, EFM, as soon as we walk into the hospital? Well that is because of how technology reigns supreme right now in every aspect of our society, but medicine too. And also that like it’s an efficient system and medical birth, medicalized birth is all about efficiency and making as much money as possible frankly.

Meagan: And there’s even deeper history, we talk about that in our VBAC course, about why that was happening around cerebral palsy and what it actually did for cerebral palsy rates. All of these things. It’s pretty fascinating when you get into it and understand one, why they do it and does it work? Does it make sense? They do it and just became practice and norm, but it did it actually impact the things that, okay how do I say this. Does it impact the things that they were originally creating it to impact?

Rachel: Right. Totally. And it’s actually the opposite; it was supposed to bring down the number of C-section rates, or the number of C-sections, when the number was like 4.5% in the early seventies and it’s just gone in the opposite direction.There’s so much evidence that you use it and it makes you more likely to have a C-section. And so yeah, okay, not your fault. That’s the system. And I don’t mean it in this way like, that’s the system, give up, lay down, don’t try to make your own feet, but also just to accept that that’s what you’re operating in and that’s what your providers are operating in too. Right? Use it as a way to let go of the guilt and the shame and the, I messed up. My body messed up.

Meagan: Yeah. Because there’s so many of us that feel that.

Rachel: Yes.

Meagan: And it goes into the next topic they were saying that I think really can help us walk away with less of, I messed up. My body messed up. My baby failed me. You know whatever it may be. And doing effective research about the hospitals and their employment patterns and the chances of you even having a VBAC. That does kind of go into the balls in our court where we have to get the education and understand. But even when we do that, even when we don’t have the best experience, in the end we’re still going to look back at it as we did, WE did, the best we could. Right? And it takes less of that blame on us in a way because we know we did everything we could.

Rachel: Yes.

Meagan: And sometimes it just still happens. Even if you have the doula. Take the VBAC course. Read all the VBAC books, listen to all the podcasts, understand all the risks. Sometimes it still happens.

Rachel: Totally. And I mean I think about in my case, like let’s say my midwife hadn’t come in for me and my OB hadn’t been the one who had been attending that night, maybe I would have had a C-section. Because maybe the people there wouldn’t have known how to effectively move my son’s head. Even though I like did my best and that’s okay. It has to be okay because you can’t kind of change it.

And again, not to be defeat-ist. But to find peace, just to find peace.

Meagan: Yeah. I wish that for our VBAC community is finding peace and giving ourselves grace along our journeys. Because we’ve had 100’s of podcast stories and there are so many of us who are still searching for peace. And still not offering ourselves grace, and putting that blame on us, or whatever, right? Everyone’s so different and again, we talked about this earlier, it’s just different. But I would love to see our community offering themselves more grace and finding more peace with their experiences along the way.

And I don’t exactly know what that healing looks like and how that peace is found. Do you have any suggestions on ways you have found peace with a very very very traumatic experience that not only led to trauma in that experience, but even in future procedures, in future experiences you know. Do you have any tips on just, guidance on finding peace?

Rachel: I mean, I struggle with this still. And it sounds counterintuitive, but I think like not pushing away your feelings. And in the sense of not wallowing, but also not like struggling against them, trying to quiet them, make them be like ugh I hate this. Ugh I hate that I feel this way. Ugh if only I could get over it.

So I’ll say like, when I go to the doctor now, I get really scared especially if it’s a new person and my blood pressure goes up and sometimes my heart rate goes up and it just sort of happens. And I hate it. And there are times when I’m like ugh I hate this part of me. I just hate it.

But then when I’m kind of more accepting and it’s like, this is how my body responds. It’s understandable that this is how my body responds. And I take a Xanax actually. I say that to really take away the stigma I think that still exists around medical trauma and taking medication to manage your symptoms. I take a low dose Xanax before I go to see a provider and it helps me with my suffering.

And also just like accepting. Because also there’s this saying, if you struggle against the feelings of suffering, then you kind of suffer twice over. Right?

Meagan: You do.

Rachel: So I would say that, and then specifically for people who feel they had a traumatic experience, I’ve found EMDR treatment to be very effective, to deal with stuff in the body. That was pioneered more to deal with people who’ve been in like combat trauma, but it’s very effective for traumatic birth. Tapping is another thing that can be very effective. And you can find that online, like there are different…

Meagan: I was gonna say, you can go to YouTube and google trauma tapping or anything like that, and you can actually find some pretty great videos for free on how to do that. And it’s pretty wild actually how well it works.

Rachel: It really is.

Meagan: Sometimes it’s like wait, how is this working? It really does work.

Rachel: Totally. And also I would say like in terms of again, peace, I think it’s really important to speak openly about what has happened to you. And to the extent possible, we’re conditioned to be like I’m just going to tie this up with a bow and it’s okay. Someone says to you, you’ve expressed something hard, and they’re like oh I’m so sorry and you’re like it’s okay, I’m going to be okay. Like you don’t have to worry so much about reassuring your listener. You can be like yeah I had this C-section, and I’m still kind of upset about it.

And yeah, that’s how I feel. You don’t have to self-qualify that. You know, but my baby is healthy. But I’m okay. But I love my baby. We do that; there’s a lot of pressure to do that. And it’s okay not to do that. It’s okay to be like these are my feelings. And two things can be true at the same time. You can love your baby, and you can also be like I’m not that thrilled with the birth.

Meagan: Awe yes. Julie and I have talked about that for years. They don’t have to be separate. They can go together. You can love your baby and feel connected to your baby and really not like your birth experience. And you can also, we have found that people prep and then they have a vaginal birth and they’re like I actually didn’t really like that either.

So you know, they don’t have to just always be separate. You can be really happy and really be upset at the same time. It’s okay to have those feelings, right? I have had things in my life where I’ve done something and I’m like dang. I really like how it turned out, but I hated the journey to getting there. And that's okay. So I love that you pointed that out.

Rachel: Yes. or if you think about how you feel on your children’s birthdays. So like I have very different feelings on my daughter’s birthdays then my son's birthday. I had a good birth with my son. And it was good not because it was a VBAC, but because I was respected and I felt safe. That’s what made that a good birth. Right? Just to be totally clear. I’m really glad I had a VBAC, I’m happy I got what I set out to do. One hundred percent. Recovery was easier, like I’m not going to lie. And like you said, sometimes you can have a vaginal birth and you don’t come out of it being like, that was a good birth, right?

So I feel differently on my son’s birthday but I also still feel that mix of happiness and a little sadness that he’s getting older. Right? He’s four now. You can contain both of those and they don’t cancel each other out, they just make you have a more I don’t know, dynamic emotional person.

Meagan: Well-rounded.

Rachel: Yeah, right? I’m experiencing all these parts of life, right? Like I have access to all of them and they’re complex and that is okay.

Meagan: That is okay. Last but not least you say, what kinds of qualifications to look for in a midwife, obstetrician, and a doula to ensure your team is best experienced in supporting a safe VBAC? We talked about that a little bit. Asking those questions that seem kind of random, but also what to expect and what those trainings are. Do you have any tips or advice on any qualifications that you were looking for or you think impacts someone's qualifications.

Rachel: I would say I learned this more having had a VBAC and having recorded my book. So in addition to the questions you suggested, which I thought were so excellent, like what would you do if whatever, we had failure to progress, would you proceed or would you use assistive technologies. I would look for a provider who has, especially if we’re talking about an OB or a midwife but especially an OB, who has been practicing for a long time.

The providers who were trained earlier have more experience not only attending VBAC, and attending twin births, and things now we tend to automatically kind of have a C-section for. But they’re also more open to it typically. Not all the time, but I think that there’s this feeling in general like oh a younger person’s going to get me better and duh duh duh, but really sometimes these providers who are older would be a better match in terms of their clinical skills and their risk tolerance.

A lot of time, some of the OB’s coming out earlier, or more recently from their residencies, their risk tolerance is not very high. Even some OB’s have joked to me, who are now really working to help bring down the C-section rate, like in the beginning my like auto reaction was like we should do a C-section.

So they get better with time and age and that’s something to remember.

Also providers who are trained not in the United States. So in Europe, for instance, VBAC in most of the countries, not every country, VBAC after C-section is the automatic choice. Here, it’s not even an option all of the time and the default is to have a C-section. So again, you're going have a provider who has a totally different mentality if they trained in the UK for instance. That’s another thing I would look for.

I mentioned about my midwife, that she’s a Certified Nurse Midwife, but she also had attended births at home and at a birth center. If you can find someone with that kind of experience I think that means they’re drawing on all different types of skills that would really assist with a VBAC. And they have the bedside manner, and they know how long labor takes, and a deep interest in being with you through it. There are providers like that out there, she’s not the only one.

Meagan: Yeah. She’s not, she’s not. We have some providers here that were out of hospital and then needed to go into hospital just because of schedules, and there’s a big difference in midwives lives I feel like sometimes in the two different locations. But there’s this weird sense of trust in these providers that, and it shouldn’t be weird let me just say that, but it’s this trust in the ability to birth that I feel like sometimes is lost in the system, in the hospital system.

Rachel: I totally agree with you.

Meagan: It’s just this weird thing. Where it’s like oh no, it’s been four hours and we've only gone 2 centimeters so we have to do these other things. Where’s it’s like no, let’s step back and let’s let this body go and progress. That’s something I learned with my third birth. I mean 42 hours long. My body takes its time. My babies, like you, go into weird positions. I had back labor and oh my gosh you guys, back labor is another beast of a labor. It’s so different. But you guys, trusting the process is so important. And so if you have a provider that’s like yeah after a few centimeters we’re not progressing we’re going to need to start pitocin or…well wait, that might be a red flag.

Unless you want that. Some people want that.

Rachel: That’s a great point. Think about it, if you choose any provider, do you want someone who is like more into like medical interventions, or like let’s see if we can address this with lifestyle changes. Right like more exercise and diet as opposed to like oh your blood pressure’s high, we’re going to put you on medicine right away. That’s a really personal comfort preference. But I think to your point, these providers who’ve been out of the hospital now are in the hospital midwives, they know. They have seen physiologic vaginal labor and birth. And so many people who attend birth exclusively in the hospital just haven’t. So they’re exposed to it.

So they have the trust because they’ve seen it, they’ve attended it, and they’re like sit on your hands. Be with her. Comfort her. Let it be.

Meagan: Yeah. Let it be. I love that. Last but not least…I actually just lost my train of thought, I wanted to talk about something very specific. What was it?

Rachel: Um, trained providers, trained overseas. Midwives.

Meagan: Oh my gosh. Oh! I wanted to go back to it. Last but not least I wanted to talk about what we talked about earlier in your first pregnancy where you didn’t have a provider who wasn’t jiving and then you went and they still didn't jive and we kind of said that you can change. Can we talk a little bit about the process of changing? We talked about it being scary. It can be very intimidating you guys, but it’s so impactful.

So as we’re learning about our qualifications about our providers and as we’re learning more, we’re realizing we’re not in the right place, right? We want to do something.

A couple tips. One, getting your own op reports from your history. So then you don’t have to request anything to be sent over to anybody else, you can just take them with you and go to another provider and meet with them.

Two. If you’re like I know this is like my person, then you don’t even have to go in and say goodbye. You could just transfer it over. Guess what? If you find out, like Rachel did, that it’s not going to work, you can do that again. Okay? But do you have any tips for anyone who may be coming to terms with the fact that maybe they’re not with the best provider. Maybe say they’re 39 weeks. Do you have any tips, from your standpoint, to anyone going through that?

Rachel: Well just to say that it’s really there’s a lot of evidence; meaning researchers have looked at this and people who seek VBAC, are likely to switch providers like through after week 33 even. And I don’t have the exact study in front of me but that it’s done, and it’s okay. And you will get pushback, I mean realistically providers are going to be like whoa whoa whoa. And that it’s really different to be seeking a different provider late in your pregnancy when you’ve been getting care all along. Just keep that in mind. You’re not like wandering in from the woods being like uh I haven't seen anybody, I don’t know. That’s a scenario that providers would potentially be very uncomfortable with, with good reason right? Because you know…

Meagan: They don’t know who you are.

Rachel: Exactly. And there are some providers who, from talking with them, they’re really at the edge of what their hospitals will tolerate and they are the ones who are probably the most willing to take somebody right at the end. And I’m talking about, there’s probably one in like every cluster of states, you know what I mean, especially just, I don’t even know so much in the South at this point but in the Northeast.

And I would think about, to that end, there are some OB’s who work with midwives to run birth centers and those OB’s will also sometimes see people in the hospital; and if you can find them, they deeply know what you’re up against. They understand the system in a way that moms can’t even put their hands around right? Because this is like their workplace and they're working against it.

So I would look for, you’re probably not going to be able to have the baby in the birth center right, the birth center would like lose their accreditation, they can’t do that, but a lot of those OB’s will also attend births in the hospital. I would go that kind of back route if you know what I mean. If I were week 36 or 37 and my provider’s like alright let's get you scheduled, you know what I mean? Suddenly we’re not talking about, like wait I thought I was going to have a VBAC, that’s what I would do.

Meagan: I love that, thank you so much for your advice. And to your point, what you were just saying, you know if the majority of people who do switch is around that 33-35 week period, there is a reason because this is what happens. We got this bait and switch, which then goes more into you guys, find the right provider if you can in the beginning. Ask all the equations, do the research, establish that relationship, and follow your gut. What is your intuition saying?

And the second your intuition is saying something’s up, like mine did at 36 weeks, do something about it. It’s okay too. And I know it’s intimidating, I know. I do know. But it is worth it. And maybe it’s that you need to do a pros and cons list. Like what do you want for this birth, and what do you want to do to make it happen.

Rachel: And I would also add like do you imagine having more children. I think that’s the other part of this. When people ask me like…I have a couple friends right now who are pregnant and have had C-sections and they’re like what do you think I should do, as my friend?

And I’m like well, what I would think about is like do you want to have another baby? Do you want to have a…because this person is facing a third C-section or trying to VBAC after 2 C-sections. Do you want to have a fourth baby? Would you be comfortable having a fourth C-section? If the answer is absolutely no, then that means it’s really important to find a provider who would potentially attend a VBAC and that is partly intuition. And sometimes you don’t know till you’ve had that third baby or whatever. Sometimes you do have an inkling, like I don’t want that potentially to be closed to me or I wouldn’t feel comfortable with that fourth or fifth cesarean.

Meagan: Yeah. And it’s harder every time to find the support. Not only do the risks keep following us and keep growing, it is harder to find the support if you do change your mind after that third cesarean and you don’t want the fourth cesarean and want to VBAC after 3. Which we know can be done, and we know is relatively safe right. But it is really difficult to find that support.

So even ask yourself then, really dig deep. Am I really okay with more? And if you are, that’s amazing and wonderful. If you aren’t, make change. It’s okay to make change.

Rachel: Yes. Yes. Yes. I think that it is so important to call that attention to that. That the likelihood of finding that provider who will attend a VBAC after 3 C-sections, I know a handful of OB’s that will attend those, and it gets harder for them to do it even every year. I wouldn’t bank on that as like well next time.

Meagan: It’s harder. It’s hard enough after two. It’s hard enough after one. It’s way hard after two, and it’s extremely difficult after three. After three, we know again we know people do it but you guys they go through so much. And so really sit back and think about that. And also asking your providers what the risk of that repeat cesarean is. There are risks you guys, so yeah.

Okay. Well, is there anything else you want to share? I feel like I’ve taken up so much of your time today.

Rachel: Oh no. I wanted to say, when I was working on this book I was thinking about a lot of stuff, but I was really thinking about moms facing VBAC or not to VBAC. That was one of the driving forces for me and I just want to say you’re not alone. And it’s a tough road no matter what you decide. And you know I hope that you can share resources with the people around you to help them understand what it’s like for you. Because you’re not alone. And part of not being alone is like having your community, right?

And for people who have not had to do this they really don’t know. They really don’t understand that first you have to find someone, maybe you have to find someone else, then you have to work up your own courage.

Meagan: I know.

Rachel: Right? Then you have to look at well why did I have that last C-section, why did I really have that last C-section. There’s so much involved in this, so to the extent that you can draw others into it with you I think that that is super super important.

Meagan: Yeah, it’s really impactful. Tell us where you can be found and we’ll make sure to link you in the show notes. You guys there’s going to a lot of links in the show notes today, things like prodromal labor, what is it, what can we do to help. Membrane sweeps and things like, it’s not necessarily non-traditional, but non-medical induction methods things like the membrane sweeping and everything. Of course all your book links and now yeah, where we can find you.

Rachel: Yeah. On Instagram it’s @rachelesomerstein with an O. I’m on Twitter and I have a website that’s just rachelsomerstein.com. And I will be in Providence doing an event on November 21st and then possibly on the West Coast in the spring but I’ll have details on my website.

Meagan: Awesome, awesome awesome. And a reminder if you are not in the show notes and you have been on our Instagram, we’ll also have her tagged there so it will be really easy to just click and go follow and go check out when and where she’s going to be. Thank you so much for being with us today!

Rachel: Thank you. Thank you so much!

Meagan: Like seriously. Like just after reading the book and having this book in my hands and then getting to talk to you and see you and hear this story through your own words in a way that is not written, to hear them not read them, it’s just been such an honor. So thank you so much.

Rachel: Thank you. Oh, it’s an honor for me too. Thank you so much.

Closing

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