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The Doula Diaries: VBAC

Today's birth story is about a client who came to me looking for support on her second birth. Her first birth saw what we call the cascade of interventions. She was induced due to gestational diabetes, right from the beginning it was not an enjoyable experience, with dilation not happening, to a painful foley catheter to try and get things moving, then artificial oxytocin which creates really strong and painful contractions, to an epidural that she was fearful of, to a cesarean section.

She knew she wanted it differently this time around and was planning for a VBAC (vaginal birth after cesarean).

Her planning began with a new doctor and hiring a doula, me!

Her first birth was very much a go with the flow plan, which was more of a do what you're told plan, which didn't feel like she had any control or input at all. This time around she was planning, preparing, and arming herself with knowledge and support to feel in control of her birth experience.

When we met for her first prenatal visit we went over the things that were most important to her, which was the goal of a vaginal birth, little to no intervention, and to breastfeed after, another thing she had issues with the first time around including baby being fed formula shortly after birth due to blood sugar concerns.

She went for her standard gestational diabetes test, and unfortunately it came back positive. Starting her down a similar path as her first, with the likelihood of being told to get an early induction.

We knew baby's blood sugar would be monitored more closely due to the gestational diabetes so she planned ahead to express some colostrum to have something to offer baby at birth if needed. I referred her to meet with a lactation consultant to help prepare! This worked great for her and was able to collect a few syringes of that liquid gold.

As she got closer to her due date the induction talk had begun, and while this brought on fear of all the same things happening again, she decided to move forward with the induction as it felt like the best thing to do for her & baby.

She went in on a Thursday to start the dilation process and was sent home to wait for things to kick in. Almost immediately some light contractions began, the process had gone much smoother than the first time and my client was feeling positive about the induction experience so far. I reminded her just because it's starting similar to her first birth, doesn't mean it needs to end the same. She was already so much more prepared, and in a much better mindset as well. The light contractions slowed down into the evening and she was able to get some sleep. They headed back to the hospital Friday afternoon to check in on the process. She was about 3cm dilated and they were ready to move on to the next step. I headed down to the hospital to join them and hopefully meet their new baby soon! Synthetic oxytocin was started to bring on contractions as at this point there really wasn't much happening. It took about an hour or two for contractions to really kick in and they were still pretty light at this point. They maintained like this for awhile. The doctor suggested breaking the water to help move things along if nothing changes by 7pm. My client was getting anxious about more intervention. I suggested using Clary Sage oil as its known to help increase contractions. She accepted and I massaged the essential oil blended with coconut oil over her back and belly. A few moments later, "pop!", her water broke all on its own. The energy shifted in the room from feeling pressured to start another invention to excitement that things were progressing on their own! The water breaking can bring on more intense contractions, plus the increase of the synthetic oxytocin, things were starting to ramp up. She was managing the pain as best as she could, with support through massage and counter-pressure, but was getting tired, and the breaks between contractions were less and less. It was getting close to 11pm, having been in the hospital now for over 10 hours, she was ready for a break. Unfortunately the anesthesiologist was in a c-section, so she was going to have to wait. She could start receiving narcotics through her IV to help but this was something she was hoping to avoid. She agreed to a cervical check to get an update on dilation. There was progress, but still a bit to go. She was at 6cm. She opted for a half dose to get her through and around midnight the epidural had arrived.

Nap Time.

She was exhausted and the epidural gave her a chance to rest. When getting an epidural you need to lay flat for an hour for it to kick in evenly. I told her to have a nap, and I went to grab a snack and a coffee to give her and her partner some quiet time. I told them I'd be back after the one hour mark to help her get up and moving again to try and get things progressing.

She just needed rest.

The body progresses best when relaxed, and that's all she needed. When I came back after the one hour mark, they did a cervical check and she had fully dilated in that hour. This is a reminder that dilation isn't a time line indicator! Dilation can happen super fast sometimes. Baby was still a little high so we worked on getting her upright to have a few contractions to bring baby down. She was still very tired and rotated between being upright over the back of the bed, and then side lying to rest. Things were progressing slowly, but progressing! It took a few hours of this back and forth but the nurse was able to feel baby's head and suggested for my client to feel it too. The motivation of being able to feel her baby's head and the fact that the VBAC she wanted so badly was becoming a reality, it gave my client that motivation to get baby out. Through some guided support, she got the head out and her doctor asked if she wanted to grab her baby, one last big push and Mom pulled her baby up to her chest, she did it!

Pure joy and excitement.

All the preparation paid off, even if there were still some interventions along the way, it was so much smoother, and my client felt in control of every decision along the way. Making a birth plan that creates priorities makes it easier to go with the flow when you can keep some priorities in the process, and make those go with the flow decisions with knowledge and confidence, not in fear. I'd love to work with you to support your birth!

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