Ep. 177: Planning a VBAC

Some of the more common FAQs we get as we see the cesarean rate rise have to do with planning VBACs- so here we are, taking a look at VBACs! In this episode we explore vaginal birth after cesarean (VBAC), share some alternative perspectives and our approach to supporting clients. We'll address common fears like uterine rupture and offer holistic preparation tips—physical, emotional, nutritional, and mental—emphasizing the value of strong support and informed decision-making. 

00:00 Introduction to Kelly and Tiffany's Holistic Health Podcast

01:08 Diving into Vaginal Birth After Cesarean (VBAC)

01:54 Encouragement for Women: Just Start

05:29 The Importance of Avoiding Primary C-Sections

08:55 Midwifery Perspective on VBAC

17:52 Understanding Uterine Rupture Risks

22:57 VBAC Success Rates and Supportive Care

26:55 VBAC and Close Pregnancy Spacing

27:45 Provider Policies and Patient Desires

29:03 Hospital Restrictions and VBAC Options

32:34 Interviewing Providers for VBAC

39:18 Holistic Preparation for VBAC

40:57 Emotional and Mental Preparation

41:52 Nutritional Support and Uterine Toning

44:18 Reviewing Previous Birth Records

47:34 Resources and Childbirth Education

50:25 Supporting the Show and Community

Links We Chat About

ICAN (International Cesarean Awareness Network)

VBAC Facts

Intro to Cesarean Recovery + Scar Mobilization + Remediation Tips

Our Weekly Newsletter

Our Childbirth Education Course, use code RADIANT10 for 10% off

Our Monthly Membership

Be sure to subscribe to the podcast to catch every episode. Follow us on Instagram for extra education and antics between episodes at: @beautifulonemidwifery

Transcript

0:00

Welcome to at Home with Kelly and Tiffany, where we share powerful tools, exciting education, and relatable views about holistic health, physiological birth, and thriving in the female body. We are home birth midwives in sunny San Diego. Passionate about the alternatives that give women control and confidence in health, in birth and in life. We've poured a lot of love into creating very in depth and high value offerings. A monthly membership, a physiological birth course, and holistic guides for the women who really want to dive all the way in. But this podcast. We want to bring zero cost information about health and natural birth and make these important topics accessible always. Your support of the show is also zero cost and means everything to us. When you leave a review, share an episode and join our newsletter. It really helps us keep this space open, ad free and full of honest, valuable conversations. Now let's dive into today's show.

Kelly: 1:08

Welcome back to at home with Kelly and Tiffany. I'm Kelly,

Tiffany: 1:12

I am Tiffany,

Kelly: 1:13

and

Tiffany: 1:13

and today we get to talk about vaginal birth after cesarean.

Kelly: 1:18

a super hot topic that we are excited to kind of delve into because I feel like. For the most part, it, it is a hot topic because women are told so many different things, or so many providers may have different perspectives on things and risk assessment and all of that. And so yeah, we're kind of excited to chat about the, some of the alternative perspectives, in particular, our perspective on supporting vbac, why vbac can potentially be an option for you, and sort of how we, how we go about assessing, clients who are interested in that and how we go about supporting them in that goal.

Tiffany: 1:54

We do. And to get started, Kelly, the icebreaker for today is just start blank, so fill in the blank with something like advice that you have for women who need to just begin. Just need to take a step from your perspective. What is something that women. Who are on the fence about something right now? Just need to start what? To improve their lives to move forward to stop overthinking.

Kelly: 2:23

I mean there's a million different ways that this can go. And the first thing that pops up into my head, just health, like health wise, of just wanting to start something is not assessing yourself like where you used to be or where you want to be, but where you are right now. I was just thinking,'cause I was talking to my mom, she's going to physical therapy. I had to go through physical therapy after breaking my arm a few years ago and my PT told me when, when we went out to like, try like weight bearing exercises, I had like a half a pound weight and I was like, this is embarrassing. I am embarrassed right now because this. I'm so weak and she was like, you, you have to just, you have to start somewhere. Right? And so it was really hard to do that half pound weight then right then, yeah, it just kept kind of building up. Right. Obviously getting back to like my normal amount of strength and that in particular, if you are interested in bettering your health in general. I always go back to like women especially, we need to build muscle. We want to feel strong at the end of the day, physically, it's not about like bulking or whatever, but it is about like doing something hard that is really, really good for you. And so that's where my mind goes first because I was like just talking about that with my mom and how important That comparison piece is, and how important it is to like, even if you are like, man, I'm not, not where I want to be, that is perfectly fine right where you are, you can absolutely just simply put it on your calendar. You can simply take the first step. You can write yourself an encouraging note, tape something somewhere, right? And like simply just start that.

Tiffany: 4:11

You have the smallest step. I love that. That's so good. And like simplifying it. I think sometimes we have this end goal where we're like, oh, I'm working towards this. That's gonna be a lot of work. I have to figure out how to try to make progress towards this big end goal. I'm gonna have to overhaul a lot or change a lot or learn a lot. And it's like, no, break it down into the break. Like make this first few steps, like stupid easy, like, like you said, like you're half pound weight easy. Like mentally it feels absolutely crazy. And too, too, you know, too much to just get started, but just make that first step the like the easiest step you can make. I love that.

Kelly: 4:55

And, and I mean, obviously it like translates into a lot of different spaces too, right? And so hopefully that's an encouragement wherever you are, if you are thinking about something or questioning something, or like it's in your mind where you're like, I, I want that. And you see the end goal of somebody else or the thing that you're thinking about. Again, just that first little teeny tiny, no, of course you're not there yet, but that's the point. That's the point is that you're not there yet and that is okay.

Tiffany: 5:22

I love it. Okay, so getting started today with our topic on vaginal birth after cesarean. The reason that this matters for women, the reason that it is such a hot topic is because the C-section rate is climbing. It's in some communities it's plateauing and in some communities it's increasing. Some communities it's decreasing, but a ge as a general birthing population, everything that has been done and instituted since we learned how primary cesarean are. Have a negative impact on women and babies. The attempt from the medical model to tone that down, to bring that number down to closer to what the World Health Organization recommends, which is 10 to 15%. We actually are at 30 to 35% of women across the nation and probably in other. Countries too. And I mean, we know there's other countries where this C-section rate is like 80% absolutely crazy. But the reason that this, that this matters is because women do not want to have the risks and complications of major surgery despite the fact that there is so many pieces that are mental and emotional and identity challenging, and. Because birth is so important because it does make such an impact. How we birth really does matter to most women at the core of the issue, right? So avoiding that primary C-section is already really loaded. But then we do know that 30 to 35% of women in the US are going to have had that primary C-section anyways. Despite what they felt like their best efforts were to. Avoid that. And some women have a lot of clarity on how they ended up with the cesarean and some women feel like it was necessary and needed as a part of their previous birth experience. And some women are completely clueless. They have no idea how they went from preferring to have a vaginal birth to, oh my gosh, this happened to me. So there's a wide spectrum of experiences here, but. To avoid the risk of this pro of, of continued cesarean because in many birth settings inside. Of our country and, and a lot of other first world countries, a primary cesarean is equal to another cesarean, and we're, we're moving out of that. We're understanding that that myth is not true, but for moms who want to avoid the risks of another cesarean, that is, that is completely valid for physical reasons like. The risks of infection, the longer recovery, future potential complications in, in future pregnancies, like placenta issues, uterine rupture. There's tons of emotional and mental health impacts for women who are processing this type of birth. And I think sometimes we keep the focus. A lot on the mom's experience because she is the one who can communicate and verbalize what that was like for her. But the impact on babies c-sections can lead to breathing difficulties even further down in life, not just at birth. Delayed bonding and breastfeeding issues. The reduced exposure to beneficial vaginal microbes that support. An immune system that is in development for babies that we are seeing implications and complications in their gut health years and years down the line. So. So a vaginal birth is better. And I think most of our listeners would probably agree, but if you're just tuning into this episode because it flagged for VBAC and you're trying to understand who we are and what we are about Kelly give like an overview of a midwifery perspective with VBAC so that women can understand like what we're gonna end up sharing in this episode.

Kelly: 9:18

So like you were saying, we wanna avoid that original one, right? Because if we are experiencing that, or it could be your second baby or whatever, avoiding necessa then takes this, all those risk factors out of it, right? It kind of puts a little bit of a flag. On your chart, on your life as maybe what it feels like as you go in and try to move forward from that experience in your next pregnancy and saying, Hey, I want a different experience. It is a little bit of a harder hill to climb, to get out of, you know, like the, the shadow of that flag that's kind of been placed on you according to a lot of providers. And so as we assess VBAC clients, for the most part, you know, there's obviously some. Safety pieces that we are assessing, like where their scar is and you know, that, that type of thing. But for the most part, what we are doing is saying, yes, that happened to you. Let's talk about your birth experience. Let's talk about like, let's unwind some of that. But I. Physically, for the most part, we are treating our VBAC clients as we would another client going into have their first potential vaginal birth or, you know, a previous, depending on where your cesarean is at in your storyline. But for the most part it's a lot of emotional. and unpacking that happens throughout that pregnancy,, that isn't there for a lot of other women who have that experience. And so that's a huge part of the way that we care for our clients is kind of peeling that onion, unraveling, you know, all of those pieces. But for the most part, like you said, and I know it might feel controversial to some people, but yes, of course there are situations in which cesarean save lives. Of course that amount is very small in comparison to the women and babies who are undergoing this major surgery. And so. Vaginal birth is the goal because physiologically it is a better experience. It is better for moms, it is better for babies. And again, I know that might seem controversial, but if we just go back to how our bodies are designed to do this, of course that makes sense, right? And so yeah, that's kind of like our general view on all of this. It is not a moral statement of like, that's bad. Is a, just a shift of perspective on, again, how can we back, get back to physiology? How can we get back to providing moms and babies the best experience, both physically but also as well?'cause all of this matters so much

Tiffany: 11:50

And we want those benefits for women and women who have a low risk pregnancy with a low risk developing baby. And that's gonna be 90% of women having your previous cesarean in our perspective. And there's not been, I've, there's, there's. Not all midwives agree with this statement, but our perspective is barring other risk factors in your history. Your previous cesarean alone does not make you high risk. So considering where you give birth and who you are getting care from during your prenatal time is going to affect your risk status and all the things that go along with. You know, somebody saying, telling you that you're higher risk in your pregnancy, that might not actually be the case. And we will unpack a little bit of that today. But before we get started, let's go through a couple acronyms.'cause

Kelly: 12:45

I

Tiffany: 12:45

introduced it in the beginning, but the acronym V back VBAC is vaginal birth after cesarean. And that can have numbers inside of it, so that could be vaginal birth after two cesareans, vaginal birth after three cesarean and that particular acronym and label. Describes the birth that happens, right? It is the actual vaginal birth that happens after the cesarean. Then we have hvac, home birth after cesarean is just that is having a vaginal birth at home after cesarean, and you'll see why there. It has its own acronym and has its own designation because it's a different experience. Having a vaginal birth at home with a, with history of a previous cesarean is a different experience than having a vaginal. Birth in the hospital even with the best possible hospital care experience, it's still gonna be different at home. And then we have tolac, and that is not a term that we use in our practice or in it's probably not used as widely in midwifery model of care. This is more a medical term

Kelly: 13:58

That

Tiffany: 13:58

means a trial of labor after cesarean and.

Kelly: 14:04

I'm all

Tiffany: 14:05

all about using accurate terms and medical terminology. Doesn't usually bother me, but this particular one is really irritating because it's basically used to say, we'll allow you to try. We'll give you a trial, we'll see how you do, how you perform, but we're not saying that you're gonna have a vaginal birth or that we're even planning for a vaginal birth. We're just.

Kelly: 14:32

we're

Tiffany: 14:32

only acknowledging that we're gonna allow you to labor.

Kelly: 14:36

head

Tiffany: 14:37

rude.

Kelly: 14:38

Yeah. And I mean a lot of this, a lot of the terminology in the medical world revolving around birth ends up being somewhat rude, right? It ends up being very like infantilizing to women, right? And and it gets pretty frustrating, but it's helpful to have some of those. Foundation so that you understand what you are going into and understanding if people are speaking like this or you see something on your chart or whatever that you have a little bit of a, you know, a grasp around around that. Obviously as we look into VBA C and hvac, we are. Pro these things and we're not pro these things just because like isn't that nice? And it is. But there are definite benefits for women who are desiring this experience. That is not to say that choosing a repeat cesarean is not the right choice in certain situations, but mostly if you are, if you are somebody who's had a cesarean and you are considering growing your family and you are thinking. it probably is best for me to just choose a repeat cesarean because then I don't emotionally have to get involved in this again. I don't have to be disappointed. I don't have to be let down. I can have more control. That is that's an understandable place where you are emotionally, but we want to tell you there's an entire world out there available for you. With the right provider within the right scenario, with the right preparation, that can allow you to experience the benefits of having a vbac. And I will say as a midwife, and I felt this way as a doula as well, when I attended births where moms had had a previous cesarean and were desiring a vaginal birth. amazing as birth is always VBAC birth. I was like, did the world just stop? Like, is there a parade going on like this did, does anybody know how incredible this is? That just happened. So it's, it's always incredible. But there's something next level about a woman who. Walks through that and gets to now enjoy the emotional benefits of that, gets to enjoy the physiological benefits of that, gets to enjoy that recovery, gets to enjoy how her whole obstetrical history is now changed. So there's a ton of benefits of that and hope we're just providing a little bit of space to open up your heart too. Potentially you know, consider that for yourself, especially if you're somebody who has, you know, kind of these rolling thoughts of, man, that, that sounds overwhelming to get kind of my, my hopes up about something because you absolutely can and, and should get your hopes up about something like this, right?

Tiffany: 17:11

Yeah, and I think what it does is it potentially changes the story from I can't, I failed. I'm not capable to, holy crap. I just needed more support. I needed more time. I needed more patients, I needed more tools. I needed an advocate.

Kelly: 17:32

and

Tiffany: 17:32

then. Or I just needed to not be messed with. Right. Maybe you don't, maybe it's not more things, maybe it's less things. And I did it, and I can, and I'm capable, and I get to experience the way that this was meant to be and designed to be. And that empowers women. That empowers women. So being a part of that experience is really exciting. Let's talk a little bit about common fears and myths around uterine rupture, because the rup, the uterine rupture is what gets. All the spotlight in this conversation. If you talk with people who are afraid of birth and afraid of vbac, they're gonna bring up the uterine rupture piece. And once you do a little bit of digging and research on this, you. Hopefully would under will understand really quickly that yes, this is a serious risk. Yes, uterine rupture is

Kelly: 18:22

a

Tiffany: 18:22

major complication. It needs to be handled as an emergency most of the time, and it's important that it, we're at home and we're experiencing uterine rupture. That's an immediate transfer. We need lots of medical. Care and backup on board, but the uterine rupture risk is extremely low. We're talking about half a percentage. There's some literature that says 0.4%. There's some literature that says 0.9%, and these are statistics that capture all types of uterine rupture. And I think that that's something that is not. Given proper information and education about in the medical model of care, all the uterine rupture is on a spectrum. Not all uterine rupture is an emergency where everybody bleeds out and dies. So this percentage that we're talking about It could be something like there's a little bit of separation of the uterine fibers that cause a little bit of bleeding maybe, or there's a little we call it like a uterine window that is discovered during another cesarean where we see that that. That scar tissue has separated. The, the fear is that once we've made this primary cut into this muscle fiber, that it's scar tissue now. So as we're sewing it back together and it's healing together, the scar itself can be really, really strong, but the tissue around it is being forced to, pull and maybe adhere and, and, you know, scar, we know how scar tissue looks on the outside of our body. So that's what's happening on the inside, and it can, it can change the integrity of that. Uterine muscle. So that's, that's the, that's the fear and the problem and the complication. However not all uterine ruptures are catastrophic. Actually, a pretty small percentage of them are actually catastrophic. And so we have to keep that piece in perspective. And then

Kelly: 20:25

need

Tiffany: 20:25

need to look at. What else causes uterine rupture? Sometimes the cause is unknown. Women have uterine rupture that do not have previous cesarean scars. Uterine rupture almost doubles the risk comparatively for first time moms who have a Pitocin induction, which in certain parts of the country right now is potentially 60

Kelly: 20:52

80% of

Tiffany: 20:53

of. Laboring women. The doctor doesn't say, I hope that you know that your chance of uterine rupture

Kelly: 21:01

Is

Tiffany: 21:02

almost double what we advise women who are trying to have a vaginal birth after cesarean, who we won't even give Pitocin to.

Kelly: 21:11

I

Tiffany: 21:11

mean, gosh, that's just like absolutely mind blowing, right? Like there's, there are other causes of, of uterine rupture and one of, and, and a more serious risk increases for women who have never even had a cesarean. So knowing your statistics, knowing that information, doing more research, and we'll provide some of those links in the show notes today so that. You ladies can get yourselves informed.'cause we could talk hours and hours about VBAC stats and facts and stuff, but understanding that the risk that is emphasized in the medical model of care is completely blown out of proportion and your options are being limited because of a provider preference, because of hospital policies, because of culture. Surrounding birth in that area, in this part, this particular way of birthing with this history. And so it's so important ladies to understand the real truth and facts and do not only collect those from your care provider.

Kelly: 22:13

Yeah, I mean, I feel like we could just end the podcast there with like this pitocin risk factor because I. That just goes to show you, it comes down to like, are we actually going off of facts? Are we actually going off of research and information? Are we going off of, are we cherry picking what we wanna share in order to create some kind of control? Right. And it's just, it frustrates me so much to see that happen and then to see women. Be basically scared into a decision, which just should never happen, right? But what's cool is that if you do have a supportive care provider who is not just like, sure, let's see what happens, but is like, no, I want this for you. Right? How can we go about doing this supportively? About a 70 to 80%. Vbac, we'll call it success because right, like you pushed your baby out of your vagina, you were given the space and the time and the opportunity, all of that. So it's a very high percentage. Right? At home, it's significantly higher. 87% of women who are going for a VBAC at home will have a VBAC at home. That's not to say that all of these other women are going. To get a repeat cesarean, they may need to go in and take a nap or, you know, all of those other things. So it's not saying that everybody else is going in to get a cesarean. The potential at a hospital is much lower. And that also is just simply because there's a lot of women who are going in for a repeat cesarean. The, you know, there's the, the, the goals and the outcomes and all of that are a bit skewed because we don't know the mindset of people who are going in for it. But it's about 13%. So. That's a massive difference. Right? And I've been a part of VBACs that have happened in a hospital. Like you were saying, TIFF, it's wonderful when that happens. It's cool'cause some of the nurses there have never seen that before, which goes to tell you something, right? But just that difference in percentage is kind of points you to which space may be a bit more supportive beyond just like, yeah, sure. Let's see what happens. And so I always am stunned when I see those numbers side by side. Because it's just so vastly, it's just so vastly different. It's such a it's such a, such a different mindset in general, but. As you go, these 13% who are going into the hospital is 87% of women at home, right? A a vaginal birth is going to be more likely if you are waiting for spontaneous labor, right? You're just waiting for labor to happen on its own. Ideally you have less interventions, right? Potentially with that first cesarean, you may have watched that cascade of interventions. Fall over you and all of a sudden you're in the operating room and you're like, oh, cry. I, like, I knew I knew this, but here I am, like in the midst of it. So starting off obviously with spontaneous labor allows that to unfold much more easily to have those less interventions. If you, your percentage number of like potentially. Getting a vbac, obviously if you've say you've had a vaginal birth and then a cesarean of course your risk or your your chance for having another vaginal birth, even after that cesarean is better. Longer spacing between pregnancies, so whether that is because your uterus has given some, ti has been given some time to heal. Versus fear that might've been instilled about, you know, a baby coming too close and to a previous cesarean. And then of course and we can kind of jump into that a little bit too. I think that's an interesting, like question to get into. But course having the right support as well, understanding your own self-advocacy, having a doula with you choosing midwifery care. Those things are going to set you up for quote success more so than going in for the induction, being okay with all the interventions, you know, of that. And so helpful to kind of keep some of those pieces in mind as you are considering what you want to do, how you want to move forward what impacts, right? Going back to repeat cesarean versus, versus a a vaginal birth.

Tiffany: 26:16

Yeah, and the spacing between pregnancies is a little controversial. There's some evidence that supports an ideal range of 18 months from one birth to the other. So waiting until your baby is nine months old before you get pregnant again, significantly increases your.

Kelly: 26:35

your

Tiffany: 26:35

Chances of scar integrity, and that's what makes most providers feel the most comfortable. But the reason it's controversial is because it's not co, it's not completely concrete. There is evidence out there that women who have closer spaced pregnancies still deserve a chance at

Kelly: 26:53

at

Tiffany: 26:54

having

Kelly: 26:54

having the

Tiffany: 26:55

Vaginal birth after cesarean, even when the, the spacing is closer. So even though it's ideal to have longer spacing, because that's what research supports, it's not ne, it doesn't necessarily mean that no provider is gonna take you. In fact, I would consider that a red flag if it's not being considered, if it's not something that's being discussed. There's ways that you can check on the. Integrity of the uterine scar through ultrasound and some really sound practices for scar tissue remediation and those types of things. So definitely stuff to do some more research on, see what's available in your community and sort through your options. That way. If you are having, if you have more close, close pregnancy spacing, I would don't think that that's something that's gonna completely rule out your opportunities..

Kelly: 27:45

And recognizing also kind of like what you're mentioning, if your provider is sort of saying, eh, you know, here's what we're gonna do, and not taking into account your desires, the full picture of who you are, that is more so your provider looking at to say, what are my policies? How am I going to decrease my own liability? What do I like to do? Right. Which. Can matter, but when they matter more than what you are saying and what you are desiring and the fact that you have hired this person to help you do this thing, that is a great time to say, think I need to look into other options just to make sure I'm choosing this provider and this experience with eyes wide open. Because a lot of women will go in and realize. Wow, this seems less about me and more about what might happen to my doctor legally or like what their liability is, or maybe not even realize that that's the heart of it. But unfortunately, that's just where we're at in our society is that that absolutely plays a huge part in what options women are given within certain, you know, models of care and what policies are created and what preferences providers have. And unfortunately too. There are a lot of women that we've had DM us on Instagram who have said, I really want a vaginal birth, but my local hospital doesn't allow it. Right there, it's just across the board not even allowed which is wild because happens when a woman, woman is just coming in. Pushing her baby out, right? Like, oh, that's, that's not allowed. And so recognizing that there's also some inconsistent access there too, recognizing, Hey, just because this hospital says no, what are my other options? What does that actually mean? Does it mean that's a bad choice for me? Or does that mean that that hospital has. Problems. Right? And usually it is that hospital has problems. Actually a hundred percent of the time is that's the problem. And then as well, you may be talking with other women or your mom, right? Or a friend, whatever, who have listened to these previous statistics that we've shared or these ideas that we've shared. And just assume VBAC is really scary. I know my mom in particular, she had her, she had my oldest brother. He was breach. They took her out, they took him out by cesarean and was told, I mean, this was many years ago, like, okay, so next time, right? We're just gonna, we're just gonna keep doing it because this isn't the way it's always been done. My mom taught me that. So in high school I remember specifically and I'm like a, almost an adult at this point thinking that's, that's just what happens. I didn't even realize until I was in college and was learning some things and was like. Oh, you can do that. I didn't even realize, right? Not everybody has the opportunity to have that light bulb moment before they get pregnant, before they have their baby, right? That that there are different stories that you can write. There is some cultural conditioning that does happen that can impact what women believe that their choices are or what women are being told their choices are too. And I just think, I think that's like a little important piece to unravel for yourself as well.

Tiffany: 30:55

Yeah, and I think I'm thinking back to like someone who emailed us recently and they were like, are, are you not allowed to have VBACs in California? And I said, no, no, no. We do'em all the time. And she said, all the birth centers around me won't take. My birth because I am, because I had a previous cesarean. It's against their rules, and I forgot about that. The accredited birth centers in California, it's a part of their policy and rules because I. And this is, I think, really confuses women about birth centers being the perfect equal ground between facility and home. And it's like, well, who's riding those policies? Who, what does the birth center have to do to bend? To getting the physician support from their local hospital and transfer plan from their local hospital. They're basically just this, but sometimes this little remove, you know, partially removed facility that still has all the same regulations and policy is. As the hospital does. And so I, I know a lot of birth centers that would not prefer that to be the case. I know a lot of birth centers choose not to become accredited because of that, but then they're gonna have issues with insurance reimbursement and getting transfer plans and all that stuff. So it can sometimes be really complicated to navigate. Which is why you're going hear us saying over and over again that. Having home birth as an option is, you know, potentially really reasonable and also potentially your best chance at having a normal. Respectful, beautiful birth, if that's what you're looking for. So we would encourage women to interview your provider no matter where you're looking at having a VBAC interview them the same way, the same way that you would in the same questions that you would ask a midwife or a home birth, a midwife or a birth center. Or a midwife in the hospital or a physician in the hospital, you want to know what are the statistics in that setting? What are the statistics for that particular provider? It's gonna give you a lot of information. If you say something like out of the last 100 women who. Had previous cesarean that were trying to have a vaginal birth, about what percentage, how many of those women actually had a vaginal birth. It's gonna give you a lot of information about that, and you wanna know what the protocols are. You wanna know, are you gonna treat me differently because

Kelly: 33:24

because

Tiffany: 33:24

had a.

Kelly: 33:25

a

Tiffany: 33:26

Cesarean in the medical model, almost always, they're gonna label you as high risk. They're gonna want extra monitoring. There's gonna be treatment options that are off the table for you in your labor. They're gonna have more rules and protocols in place that make them feel safer for taking care of you. And it might not just be your provider. It might be the fac. And then there are some midwives who follow a little bit more of a conservative view on vaginal birth, and it could be because of their standing orders with their supervising physician. It could be, just their belief about birth. It could be the setting that they were trained in. And so it's important to know, are you gonna treat me differently because of this piece of my history? And maybe some women do. Maybe some women do wanna be treated differently. Maybe they do want extra care. Maybe they do want extra surveillance. And testing and stuff like that. So it's good. It's good to like be assessing your options from that perspective. And you also need to know your rights and know the research. You need to be an absolute expert in vaginal birth and you need to listen to other women's. Stories who are in the same position as you, because that's a huge part of processing, gaining confidence and having trust in your body. And like Kelly, you mentioned before, the biggest barrier is not the physical safety aspect for women. Usually the biggest barrier is the mental emotional impact of the traumatic first birth and processing. How to put your hope into. A potential quote unquote, failure again, right, and, and processing that. It's huge.

Kelly: 35:04

And I, I just think it, it goes to show when we say birth is important it that is like it on display, right. Of how much it can absolutely impact us. And moving forward now it's impacting, right? Like all of the options that you feel like you, I. Have at your disposal. But what I think is extra helpful too is you're assessing like, okay, I'm moving, I'm, I'm considering moving forward with this i'm thinking about what my options are. Understanding what, you know, say you've decided, oh, I really like this provider, but also, right, like interviewing some other people, getting some second opinions potentially either on your first birth or just getting ideas of. Hey, if this happened, what would you do? Kind of thing. And then understanding also, this is true across the board, whether you're going for a VBAC or your first birth or whatever. Understanding what the transfer of care may look like, what the options are, what if there's anything standing of this is exactly what will happen kind of thing. Just so, again, you feel like you are going into this with eyes wide open and as much control as you can. With that being said, of course, birth is out of our control in a lot of ways, but there are so many pieces, especially before you even get pregnant or at the very beginning of pregnancy, months before the birth happens, that you can actually have a massive impact and have control over as much as possible by some of these choices that you are making. And so again, we don't know how your birth is going to unfold. But we do know that you, you can give yourself a better chance for the desired outcome by some of these very early choices that you are making as you're doing this research, as you're saying, I'm, I'm gonna own it. This is mine now. And it's always been yours, but like, really understanding that and actually holding onto that and making some of these decisions of who you are going to let in to support you for that decision. And where you want to do that, right? And the, the information and research and stories you want to collect, those have such a huge impact and can really change the course and write a new story as you're moving forward with this new pregnancy and new birth and new postpartum experience with this baby.

Tiffany: 37:15

Yeah, and if you don't like how that's going for you at any point in your pregnancy. Get another opinion. Ask women who that have had a vaginal birth after their cesarean, who their doctor was, or who their midwife was, and transfer care. It is absolutely worth the effort that it feels like to change your plan. Mid pregnancy. There's usually

Kelly: 37:39

a

Tiffany: 37:39

a few physicians in every community that are more VBAC friendly, and of course it would be ideal to start with that one. Those I I personally, if.

Kelly: 37:49

I've

Tiffany: 37:49

had a previous cesarean, so if I needed to have a hospital birth for some reason there are like three MDs that I would go to in our town. I would not.

Kelly: 38:00

go

Tiffany: 38:00

to anyone else. I would not have a hospital birth with anyone else that I ha that I do not know has the reputation in our community to give the most options to women. But I would not have a hospital birth. I would be choosing a home birth where my chances are high, I am gonna be treated the most normal. The midwifery model of care just provides the most autonomy and choices and respect, and just the home birth stats for VBAC are better. That's what I would want. So midwives are going to. Be screening women for the appropriateness of being in a more le low resource setting at home than in a hospital. Right? And so we're looking for women who have a low transverse scar, which is the majority of cesarean no uterine anomalies, so. There can be some funky little things that end up happening which contribute to risk of C-section, but also contribute to risk of other issues

Kelly: 38:58

on a

Tiffany: 38:59

a laboring uterus. We wanna rule that out. And then just generally a low risk pregnancy, which again is gonna be most women. And keeping your pregnancy low risk and being inside of a care model that is gonna emphasize that is a huge part of what is gonna create a successful environment for you. Kelly, can you talk a little bit about holistic preparation and why the midwifery model of care does this better? When we are just treating the whole person, the whole woman, we're not just looking at clinical medical aspects, but we're helping women prepare for, prepare their whole selves for a birth like this.

Kelly: 39:36

Yeah, I, I was just thinking it was interesting, you know, choosing a home birth and then going back to what creates and like sets up the most successful experience. It's like, check, check, check, check. Right? We just are just naturally already there not having to fight to get to those things. So, like we mentioned, we're not necessarily treating these clients differently and doing something very different, but a lot of it we're giving from the very beginning of like, Hey, look into this. Consider this, this may help you process. This may help you feel really good that you were doing. I. Quote all the things right? But there's, in terms of holistic prep, that means like all of it, right? The whole person that we're, we're walking with. So physically,? We're talking about from the get go. It does not need to wait until the third trimester when baby is, you know, bothering you and their positioning and stuff. Things like body

Tiffany: 40:25

It's.

Kelly: 40:25

and spinning babies, right? The the daily movements and stretches that you can do to not only make yourself more comfortable but also get baby into a more optimal position can be really important. We talk a lot about pelvic floor therapy for all of our clients, but can be really helpful if you are planning a VBAC specifically because they can work with what's going on with your scar. Can talk to you about your specific anatomy, can get you excited about. Reconnecting potentially with an area of your body that you may feel disconnected from depending on your own experience. physically we're preparing emotionally. This is a huge part. We are preparing, right, we're processing some of that previous birth trauma, birth disappointment, birth confusion. We're walking that out, unraveling some of that. And then we're not just leaving that there either. Right. We're, we're bringing some education back to that. We're bringing not this like idealistic rose colored glasses of like, everything's gonna be great. Right. But we are affirming moms and understanding like, Hey, I. What is the truth of this situation that you can cling onto, right? Like my, yes, your body was still made for this. Yes, you're growing the right size baby for, you know, all of those things that we can go back to and say, these are true, and you can kind of, you can hold onto that. You have support. You are not alone in this. Right? And so that's a really important piece of processing and moving forward. And then we of course, and I guess this also combines with. Emotional and mental and physical prep also, but nutritional support is so important. It's going to help you feel so much better altogether. But for VBAC clients or clients who are desiring a vbac recognizing their iron stores really helping as their blood volume is expanding. That's true across the board though. Focusing a lot on hydration. Just keeping yourself well. Hydrated talking about minerals and all of that, making sure you're well nourished in that way. And then focusing on anything that can support uterine toning as well. And so, like I said, that can be true across the board, but for clients who are coming in and saying like, I, I want to be able to do something. What's cool is that in our model of care. We're gonna say, yeah, and let's talk about all the things that you can do, and then you can let some of them fall off your plate if you don't wanna keep doing them. Right. But it's cool to be able to, again, assert some control over a situation and feel like this was a problem last time. I. How can I make this a more integrated experience this time? And then of course there's a mental aspect. There's the emotional versus mental aspect, right? The mental aspect being, let's talk about some of these fears and try to reframe them. Let's talk about the trust that you and I are building through. Our comfort together through all of this education, through our trust of your decisions and our respect of your decisions. Let's talk about letting go of some of those pieces that have been holding you back and let's talk about what you're going to embrace moving forward. It's a huge aspect and range of what you are doing to prepare for birth that is in many ways different right than going forward. If you've had a. Previous vaginal birth. Just moving forward with the next one. Not to say that there isn't fear that needs to be reframed or trust that needs to be built, but it's just, it hits a bit different. And then of course there's a spiritual connection as well that some midwives will have with their clients. We don't have the same spiritual, like relationship with every single client, but that's a big part of understanding especially if you have a specific worldview of, that may be something you're able to connect with your care provider on, or it may be something that you may say, Hey, I need to like seek this out in particular so that I feel supported again, holistically as the person that you are.

Tiffany: 44:09

Yeah, and your provider should be at multiple points in your pregnancy. Going through another piece of your story with you. So, I mean, for us with r VBA clients, we cut out extra time for them to give us the entire story because there are some clinical pieces that we can take out of that. Like, I kind of wanna know, I. What did your body do? How did you support it? What, what, what were the interventions? How, you know, what was your cervix doing?

Kelly: 44:40

A

Tiffany: 44:40

lot of women get, get kind of caught up at certain points in their labor, and it's not necessarily going to happen the second time, but I want to talk about those pieces. You know, are, is there something we can do now? Is there cervical scar tissue that needs. To be addressed. What is your pelvic shape? Do we need to pay a lot? Really close attention to baby's position. And I would say the majority of VBACs can be approached just with patients and an understanding care provider. And we kind of have this. Opinion, uh uh, a general opinion that we're going to approach this labor like it's a first vaginal birth, well, because it would be a first vaginal birth, but we're gonna approach this labor as if you're a first time mom and how to prepare for a birth like that. And how to prepare you for some of the challenges, you know, physically and timeline and stamina and all of that stuff, because maybe. You have to do all of the work for the first time in your body, or maybe your cervix opened all the way and you and your baby's heart tones crashed before you had a chance to start pushing or something like that, right? So all of those little pieces, they actually matter.

Kelly: 45:48

We

Tiffany: 45:48

might get your records from your previous birth so that we can read through the charting pieces so that we can really understand how best to support you from that perspective of what your body's already done and what we need to encourage it to do. So it's, it's not. It's not so just like, oh, whatever. We're just gonna like go with the flow and not treat you differently at all. We're, we're definitely gonna spend some extra time and care on your story and unpacking that emotionally and mentally, but also as your providers, we, we really actually wanna know the clinical details so that we can be on top of that with you too.

Kelly: 46:18

Yeah.'cause that can matter, right? A mom who has had a cesarean and she got quote stuck at eight centimeters, right? And we get to that point in labor again, right? That can be a big mental hurdle to kind of get over and to process as well. So preparing for some of those things can be really helpful for us. More so how we can help emotionally support you through some of those. Pieces, but certainly they have clinical value. And what's funny too is like requesting records. You may, that may be a part of your story as you're processing your own previous cesarean, and you may be somewhat let down by what you receive. I just laugh because we are so, we have so much detail in our charting about like your emotions and you know, what was going on in the room and all of those things, but, medical model is very to the point and sometimes, sometimes leaves things out. Unfortunately. And so mostly just that caveat in case you are somebody who is pulling out your own records as a part to process, and you're feeling a little bit like, what the heck? That's not the whole story. No, it's not. And just validating you in that.

Tiffany: 47:27

Yep. Absolutely. Okay, so you guys have a lot of resources to jump off from here that are listening. We have some links for organizations and websites

Kelly: 47:39

and

Tiffany: 47:40

People who have dedicated their entire life work in business to getting correct facts about vaginal birth out there for women and. There's no lack of that. There's no excuse for not understanding the statistics better. But we're also leaving you with the link to our childbirth education course because we do address all of these pieces in there too. And so depending on how you want to interact with that specific information as a part of your personal history, you get to decide. But we do have specific information on processing birth trauma, on finding supportive care providers on navigating previous cesarean things. We even have information on cesarean themselves, how to have. The best cesarean possible if you're choosing that again for yourself. Recovery from Cesare infection and then scar tissue remediation techniques and all that kind of like follow up care too. So if you are listening and you know that you're going to have another cesarean or you're listening and you know that you're, you're that you need resources for maybe a primary cesarean for whatever reason that may be because you're not low risk or whatever. Our childbirth education course is that comprehensive, that we have covered those pieces for women too, because it is worth having support and worth having education and worth weaving in as much holistic health and resources as possible. And obviously you can understand from this episode that we're passionate about those pieces. So we're leaving you guys with a lot of good stuff. Kelly, any last any parting words on this topic?

Kelly: 49:13

Yeah, I mean I have a, I have many words I could say, but mostly what you were just saying too, if you are somebody who has decided, Hey, I'm gonna, I'm gonna be in a hospital that makes me feel better. You're probably gonna notice that you're not getting the amount of support that you need in your appointments and your processing, and even the nutritional piece and the mental aspect of preparing for birth and all of that. What's cool about our childbirth education class is that you basically get that midwifery education, you get that support, you get the hours and hours and hours of education and connection and emotional processing and physical preparation, all of those things for birth. And then if you're deciding to birth in a hospital, it's a great mix so that you feel prepared with the type of education that you deserve to prepare for the best experience possible and for the best postpartum possible while still choosing the type of care provider that makes you. Feel the safest. So that is my last little push for that because I think it is well worth it. But again, we we can have maybe some caveat like episodes off of this one'cause it's a really important topic and I think a, a big one that women need more encouragement and information on. And again, our show notes will have a lot of that for you and we will catch you next time.

50:27

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