July 28, 2025 • 51 mins
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)
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
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to at Home with Kellyand Tiffany, where we share
powerful tools, excitingeducation, and relatable views
about holistic health,physiological birth, and
thriving in the female body.
We are home birth midwives insunny San Diego.
Passionate about thealternatives that give women
control and confidence inhealth, in birth and in life.
(00:24):
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value offerings.
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way in.
But this podcast.
We want to bring zero costinformation about health and
natural birth and make theseimportant topics accessible
(00:46):
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It really helps us keep thisspace open, ad free and full of
honest, valuable conversations.
Now let's dive into today'sshow.
Kelly (01:08):
Welcome back to at home with Kelly and Tiffany.
I'm Kelly,
Tiffany (01:12):
I am Tiffany,
Kelly (01:13):
and
Tiffany (01:13):
and today we get to talk about vaginal birth after
cesarean.
Kelly (01:18):
a super hot topic that we are excited to kind of delve
into because I feel like.
For the most part, it, it is ahot topic because women are told
so many different things, or somany providers may have
different perspectives on thingsand risk assessment and all of
that.
And so yeah, we're kind ofexcited to chat about the, some
of the alternative perspectives,in particular, our perspective
(01:41):
on supporting vbac, why vbac canpotentially be an option for
you, and sort of how we, how wego about assessing, clients who
are interested in that and howwe go about supporting them in
that goal.
Tiffany (01:54):
We do.
And to get started, Kelly, theicebreaker for today is just
start blank, so fill in theblank with something like advice
that you have for women who needto just begin.
Just need to take a step fromyour perspective.
What is something that women.
(02:14):
Who are on the fence aboutsomething right now?
Just need to start what?
To improve their lives to moveforward to stop overthinking.
Kelly (02:23):
I mean there's a million different ways that this can go.
And the first thing that pops upinto my head, just health, like
health wise, of just wanting tostart something is not assessing
yourself like where you used tobe or where you want to be, but
where you are right now.
I was just thinking,'cause I wastalking to my mom, she's going
(02:44):
to physical therapy.
I had to go through physicaltherapy after breaking my arm a
few years ago and my PT told mewhen, when we went out to like,
try like weight bearingexercises, I had like a half a
pound weight and I was like,this is embarrassing.
I am embarrassed right nowbecause this.
I'm so weak and she was like,you, you have to just, you have
(03:06):
to start somewhere.
Right?
And so it was really hard to dothat half pound weight then
right then, yeah, it just keptkind of building up.
Right.
Obviously getting back to likemy normal amount of strength and
that in particular, if you areinterested in bettering your
health in general.
I always go back to like womenespecially, we need to build
(03:30):
muscle.
We want to feel strong at theend of the day, physically, it's
not about like bulking orwhatever, but it is about like
doing something hard that isreally, really good for you.
And so that's where my mind goesfirst because I was like just
talking about that with my momand how important That
comparison piece is, and howimportant it is to like, even if
(03:53):
you are like, man, I'm not, notwhere I want to be, that is
perfectly fine right where youare, you can absolutely just
simply put it on your calendar.
You can simply take the firststep.
You can write yourself anencouraging note, tape something
somewhere, right?
And like simply just start that.
Tiffany (04:11):
You have the smallest step.
I love that.
That's so good.
And like simplifying it.
I think sometimes we have thisend 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 tryto make progress towards this
big end goal.
I'm gonna have to overhaul a lotor change a lot or learn a lot.
And it's like, no, break it downinto the break.
(04:32):
Like make this first few steps,like stupid easy, like, like you
said, like you're half poundweight easy.
Like mentally it feelsabsolutely crazy.
And too, too, you know, too muchto just get started, but just
make that first step the likethe easiest step you can make.
(04:54):
I love that.
Kelly (04:55):
And, and I mean, obviously it like translates
into a lot of different spacestoo, right?
And so hopefully that's anencouragement wherever you are,
if you are thinking aboutsomething or questioning
something, or like it's in yourmind where you're like, I, I
want that.
And you see the end goal ofsomebody else or the thing that
you're thinking about.
Again, just that first littleteeny tiny, no, of course you're
(05:17):
not there yet, but that's thepoint.
That's the point is that you'renot there yet and that is okay.
Tiffany (05:22):
I love it.
Okay, so getting started todaywith our topic on vaginal birth
after cesarean.
The reason that this matters forwomen, the reason that it is
such a hot topic is because theC-section rate is climbing.
It's in some communities it'splateauing and in some
communities it's increasing.
(05:42):
Some communities it'sdecreasing, but a ge as a
general birthing population,everything that has been done
and instituted since we learnedhow primary cesarean are.
Have a negative impact on womenand babies.
The attempt from the medicalmodel to tone that down, to
(06:03):
bring that number down to closerto what the World Health
Organization recommends, whichis 10 to 15%.
We actually are at 30 to 35% ofwomen across the nation and
probably in other.
Countries too.
And I mean, we know there'sother countries where this
C-section rate is like 80%absolutely crazy.
But the reason that this, thatthis matters is because women do
(06:26):
not want to have the risks andcomplications of major surgery
despite the fact that there isso many pieces that are mental
and emotional and identitychallenging, and.
Because birth is so importantbecause it does make such an
impact.
How we birth really does matterto most women at the core of the
(06:50):
issue, right?
So avoiding that primaryC-section is already really
loaded.
But then we do know that 30 to35% of women in the US are going
to have had that primaryC-section anyways.
Despite what they felt liketheir best efforts were to.
Avoid that.
And some women have a lot ofclarity on how they ended up
(07:10):
with the cesarean and some womenfeel like it was necessary and
needed as a part of theirprevious birth experience.
And some women are completelyclueless.
They have no idea how they wentfrom preferring to have a
vaginal birth to, oh my gosh,this happened to me.
So there's a wide spectrum ofexperiences here, but.
To avoid the risk of this proof, of continued cesarean
(07:35):
because in many birth settingsinside.
Of our country and, and a lot ofother first world countries, a
primary cesarean is equal toanother cesarean, and we're,
we're moving out of that.
We're understanding that thatmyth is not true, but for moms
who want to avoid the risks ofanother cesarean, that is, that
(07:56):
is completely valid for physicalreasons like.
The risks of infection, thelonger recovery, future
potential complications in, infuture pregnancies, like
placenta issues, uterinerupture.
There's tons of emotional andmental health impacts for women
who are processing this type ofbirth.
(08:17):
And I think sometimes we keepthe focus.
A lot on the mom's experiencebecause she is the one who can
communicate and verbalize whatthat was like for her.
But the impact on babiesc-sections can lead to breathing
difficulties even further downin life, not just at birth.
Delayed bonding andbreastfeeding issues.
(08:38):
The reduced exposure tobeneficial vaginal microbes that
support.
An immune system that is indevelopment for babies that we
are seeing implications andcomplications in their gut
health years and years down theline.
So.
So a vaginal birth is better.
And I think most of ourlisteners would probably agree,
but if you're just tuning intothis episode because it flagged
(09:02):
for VBAC and you're trying tounderstand who we are and what
we are about Kelly give like anoverview of a midwifery
perspective with VBAC so thatwomen can understand like what
we're gonna end up sharing inthis episode.
Kelly (09:18):
So like you were saying, we wanna avoid that original
one, right?
Because if we are experiencingthat, or it could be your second
baby or whatever, avoidingnecessa then takes this, all
those risk factors out of it,right?
It kind of puts a little bit ofa flag.
On your chart, on your life asmaybe what it feels like as you
go in and try to move forwardfrom that experience in your
(09:40):
next pregnancy and saying, Hey,I want a different experience.
It is a little bit of a harderhill to climb, to get out of,
you know, like the, the shadowof that flag that's kind of been
placed on you according to a lotof providers.
And so as we assess VBACclients, for the most part, you
know, there's obviously some.
(10:01):
Safety pieces that we areassessing, like where their scar
is and you know, that, that typeof thing.
But for the most part, what weare doing is saying, yes, that
happened to you.
Let's talk about your birthexperience.
Let's talk about like, let'sunwind some of that.
But I.
Physically, for the most part,we are treating our VBAC clients
(10:21):
as we would another client goinginto have their first potential
vaginal birth or, you know, aprevious, depending on where
your cesarean is at in yourstoryline.
But for the most part it's a lotof emotional.
and unpacking that happensthroughout that pregnancy,, that
isn't there for a lot of otherwomen who have that experience.
And so that's a huge part of theway that we care for our clients
(10:45):
is kind of peeling that onion,unraveling, you know, all of
those pieces.
But for the most part, like yousaid, and I know it might feel
controversial to some people,but yes, of course there are
situations in which cesareansave lives.
Of course that amount is verysmall in comparison to the women
and babies who are undergoingthis major surgery.
(11:07):
And so.
Vaginal birth is the goalbecause physiologically it is a
better experience.
It is better for moms, it isbetter for babies.
And again, I know that mightseem controversial, but if we
just go back to how our bodiesare designed to do this, of
course that makes sense, right?
And so yeah, that's kind of likeour general view on all of this.
(11:29):
It is not a moral statement oflike, that's bad.
Is a, just a shift ofperspective on, again, how can
we back, get back to physiology?
How can we get back to providingmoms and babies the best
experience, both physically butalso as well?
'cause all of this matters somuch
Tiffany (11:50):
And we want those benefits for women and women who
have a low risk pregnancy with alow risk developing baby.
And that's gonna be 90% of womenhaving your previous cesarean in
our perspective.
And there's not been, I've,there's, there's.
Not all midwives agree with thisstatement, but our perspective
(12:11):
is barring other risk factors inyour history.
Your previous cesarean alonedoes not make you high risk.
So considering where you givebirth and who you are getting
care from during your prenataltime is going to affect your
risk status and all the thingsthat go along with.
(12:33):
You know, somebody saying,telling you that you're higher
risk in your pregnancy, thatmight not actually be the case.
And we will unpack a little bitof that today.
But before we get started, let'sgo 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 aftercesarean.
And that can have numbers insideof it, so that could be vaginal
birth after two cesareans,vaginal birth after three
cesarean and that particularacronym and label.
(13:06):
Describes the birth thathappens, right?
It is the actual vaginal birththat happens after the cesarean.
Then we have hvac, home birthafter cesarean is just that is
having a vaginal birth at homeafter cesarean, and you'll see
why there.
It has its own acronym and hasits own designation because it's
(13:28):
a different experience.
Having a vaginal birth at homewith a, with history of a
previous cesarean is a differentexperience than having a
vaginal.
Birth in the hospital even withthe best possible hospital care
experience, it's still gonna bedifferent at home.
And then we have tolac, and thatis not a term that we use in our
(13:50):
practice or in it's probably notused 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, butthis particular one is really
irritating because it'sbasically used to say, we'll
allow you to try.
We'll give you a trial, we'llsee how you do, how you perform,
(14:26):
but we're not saying that you'regonna have a vaginal birth or
that we're even planning for avaginal 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 lotof the terminology in the
medical world revolving aroundbirth ends up being somewhat
rude, right?
It ends up being very likeinfantilizing to women, right?
And and it gets prettyfrustrating, but it's helpful to
have some of those.
Foundation so that youunderstand what you are going
(14:58):
into and understanding if peopleare speaking like this or you
see something on your chart orwhatever that you have a little
bit of a, you know, a grasparound around that.
Obviously as we look into VBA Cand hvac, we are.
Pro these things and we're notpro these things just because
like isn't that nice?
And it is.
(15:18):
But there are definite benefitsfor women who are desiring this
experience.
That is not to say that choosinga repeat cesarean is not the
right choice in certainsituations, but mostly if you
are, if you are somebody who'shad a cesarean and you are
considering growing your familyand you are thinking.
it probably is best for me tojust choose a repeat cesarean
(15:40):
because then I don't emotionallyhave 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 understandableplace where you are emotionally,
but we want to tell you there'san entire world out there
available for you.
With the right provider withinthe right scenario, with the
(16:00):
right preparation, that canallow you to experience the
benefits of having a vbac.
And I will say as a midwife, andI felt this way as a doula as
well, when I attended birthswhere moms had had a previous
cesarean and were desiring avaginal birth.
amazing as birth is always VBACbirth.
I was like, did the world juststop?
(16:22):
Like, is there a parade going onlike this did, does anybody know
how incredible this is?
That just happened.
So it's, it's always incredible.
But there's something next levelabout a woman who.
Walks through that and gets tonow enjoy the emotional benefits
of that, gets to enjoy thephysiological benefits of that,
gets to enjoy that recovery,gets to enjoy how her whole
(16:44):
obstetrical history is nowchanged.
So there's a ton of benefits ofthat and hope we're just
providing a little bit of spaceto open up your heart too.
Potentially you know, considerthat for yourself, especially if
you're somebody who has, youknow, kind of these rolling
thoughts of, man, that, thatsounds overwhelming to get kind
of my, my hopes up aboutsomething because you absolutely
(17:07):
can and, and should get yourhopes 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 neededmore tools.
I needed an advocate.
Kelly (17:32):
and
Tiffany (17:32):
then.
Or I just needed to not bemessed with.
Right.
Maybe you don't, maybe it's notmore things, maybe it's less
things.
And I did it, and I can, and I'mcapable, and I get to experience
the way that this was meant tobe and designed to be.
And that empowers women.
That empowers women.
So being a part of thatexperience is really exciting.
Let's talk a little bit aboutcommon fears and myths around
(17:55):
uterine rupture, because therup, the uterine rupture is what
gets.
All the spotlight in thisconversation.
If you talk with people who areafraid of birth and afraid of
vbac, they're gonna bring up theuterine rupture piece.
And once you do a little bit ofdigging and research on this,
you.
Hopefully would under willunderstand really quickly that
(18:17):
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 anemergency most of the time, and
it's important that it, we're athome and we're experiencing
uterine rupture.
That's an immediate transfer.
We need lots of medical.
Care and backup on board, butthe uterine rupture risk is
extremely low.
We're talking about half apercentage.
(18:44):
There's some literature thatsays 0.4%.
There's some literature thatsays 0.9%, and these are
statistics that capture alltypes of uterine rupture.
And I think that that'ssomething that is not.
Given proper information andeducation about in the medical
model of care, all the uterinerupture is on a spectrum.
(19:08):
Not all uterine rupture is anemergency where everybody bleeds
out and dies.
So this percentage that we'retalking about It could be
something like there's a littlebit of separation of the uterine
fibers that cause a little bitof bleeding maybe, or there's a
(19:29):
little we call it like a uterinewindow that is discovered during
another cesarean where we seethat that.
That scar tissue has separated.
The, the fear is that once we'vemade this primary cut into this
muscle fiber, that it's scartissue now.
So as we're sewing it backtogether and it's healing
(19:49):
together, the scar itself can bereally, really strong, but the
tissue around it is being forcedto, pull and maybe adhere and,
and, you know, scar, we know howscar tissue looks on the outside
of our body.
So that's what's happening onthe inside, and it can, it can
change the integrity of that.
Uterine muscle.
(20:09):
So that's, that's the, that'sthe fear and the problem and the
complication.
However not all uterine rupturesare catastrophic.
Actually, a pretty smallpercentage of them are actually
catastrophic.
And so we have to keep thatpiece in perspective.
And then
Kelly (20:25):
need
Tiffany (20:25):
need to look at.
What else causes uterinerupture?
Sometimes the cause is unknown.
Women have uterine rupture thatdo not have previous cesarean
scars.
Uterine rupture almost doublesthe risk comparatively for first
time moms who have a Pitocininduction, which in certain
(20:48):
parts of the country right nowis potentially 60
Kelly (20:52):
80% of
Tiffany (20:53):
of.
Laboring women.
The doctor doesn't say, I hopethat 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 aftercesarean, 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 othercauses of, of uterine rupture
and one of, and, and a moreserious risk increases for women
who have never even had acesarean.
So knowing your statistics,knowing that information, doing
more research, and we'll providesome of those links in the show
(21:31):
notes today so that.
You ladies can get yourselvesinformed.
'cause we could talk hours andhours about VBAC stats and facts
and stuff, but understandingthat the risk that is emphasized
in the medical model of care iscompletely blown out of
proportion and your options arebeing limited because of a
provider preference, because ofhospital policies, because of
(21:56):
culture.
Surrounding birth in that area,in this part, this particular
way of birthing with thishistory.
And so it's so important ladiesto understand the real truth and
facts and do not only collectthose from your care provider.
Kelly (22:13):
Yeah, I mean, I feel like we could just end the podcast
there with like this pitocinrisk factor because I.
That just goes to show you, itcomes down to like, are we
actually going off of facts?
Are we actually going off ofresearch and information?
Are we going off of, are wecherry picking what we wanna
share in order to create somekind of control?
Right.
(22:33):
And it's just, it frustrates meso much to see that happen and
then to see women.
Be basically scared into adecision, which just should
never happen, right?
But what's cool is that if youdo have a supportive care
provider who is not just like,sure, let's see what happens,
but is like, no, I want this foryou.
(22:53):
Right?
How can we go about doing thissupportively?
About a 70 to 80%.
Vbac, we'll call it successbecause right, like you pushed
your baby out of your vagina,you were given the space and the
time and the opportunity, all ofthat.
So it's a very high percentage.
Right?
At home, it's significantlyhigher.
87% of women who are going for aVBAC at home will have a VBAC at
(23:17):
home.
That's not to say that all ofthese other women are going.
To get a repeat cesarean, theymay need to go in and take a nap
or, you know, all of those otherthings.
So it's not saying thateverybody else is going in to
get a cesarean.
The potential at a hospital ismuch lower.
And that also is just simplybecause there's a lot of women
who are going in for a repeatcesarean.
The, you know, there's the, the,the goals and the outcomes and
(23:40):
all of that are a bit skewedbecause we don't know the
mindset of people who are goingin for it.
But it's about 13%.
So.
That's a massive difference.
Right?
And I've been a part of VBACsthat have happened in a
hospital.
Like you were saying, TIFF, it'swonderful when that happens.
It's cool'cause some of thenurses there have never seen
that before, which goes to tellyou something, right?
(24:02):
But just that difference inpercentage is kind of points you
to which space may be a bit moresupportive beyond just like,
yeah, sure.
Let's see what happens.
And so I always am stunned whenI 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 adifferent mindset in general,
(24:24):
but.
As you go, these 13% who aregoing into the hospital is 87%
of women at home, right?
A a vaginal birth is going to bemore likely if you are waiting
for spontaneous labor, right?
You're just waiting for labor tohappen on its own.
Ideally you have lessinterventions, right?
Potentially with that firstcesarean, you may have watched
(24:47):
that cascade of interventions.
Fall over you and all of asudden you're in the operating
room and you're like, oh, cry.
I, like, I knew I knew this, buthere I am, like in the midst of
it.
So starting off obviously withspontaneous labor allows that to
unfold much more easily to havethose less interventions.
If you, your percentage numberof like potentially.
(25:09):
Getting a vbac, obviously ifyou've say you've had a vaginal
birth and then a cesarean ofcourse your risk or your your
chance for having anothervaginal birth, even after that
cesarean is better.
Longer spacing betweenpregnancies, so whether that is
because your uterus has givensome, ti has been given some
time to heal.
(25:29):
Versus fear that might've beeninstilled about, you know, a
baby coming too close and to aprevious cesarean.
And then of course and we cankind of jump into that a little
bit too.
I think that's an interesting,like question to get into.
But course having the rightsupport as well, understanding
your own self-advocacy, having adoula with you choosing
midwifery care.
(25:50):
Those things are going to setyou up for quote success more so
than going in for the induction,being okay with all the
interventions, you know, ofthat.
And so helpful to kind of keepsome of those pieces in mind as
you are considering what youwant to do, how you want to move
forward what impacts, right?
(26:10):
Going back to repeat cesareanversus, versus a a vaginal
birth.
Tiffany (26:16):
Yeah, and the spacing between pregnancies is a little
controversial.
There's some evidence thatsupports an ideal range of 18
months from one birth to theother.
So waiting until your baby isnine months old before you get
pregnant again, significantlyincreases your.
Kelly (26:35):
your
Tiffany (26:35):
Chances of scar integrity, and that's what makes
most providers feel the mostcomfortable.
But the reason it'scontroversial is because it's
not co, it's not completelyconcrete.
There is evidence out there thatwomen who have closer spaced
pregnancies still deserve achance 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 tohave longer spacing, because
that's what research supports,it's not ne, it doesn't
necessarily mean that noprovider is gonna take you.
In fact, I would consider that ared flag if it's not being
considered, if it's notsomething that's being
discussed.
There's ways that you can checkon the.
(27:18):
Integrity of the uterine scarthrough ultrasound and some
really sound practices for scartissue remediation and those
types of things.
So definitely stuff to do somemore research on, see what's
available in your community andsort through your options.
That way.
If you are having, if you havemore close, close pregnancy
(27:39):
spacing, I would don't thinkthat that's something that's
gonna completely rule out youropportunities..
Kelly (27:45):
And recognizing also kind of like what you're mentioning,
if your provider is sort ofsaying, eh, you know, here's
what we're gonna do, and nottaking into account your
desires, the full picture of whoyou are, that is more so your
provider looking at to say, whatare my policies?
How am I going to decrease myown liability?
What do I like to do?
(28:07):
Right.
Which.
Can matter, but when they mattermore than what you are saying
and what you are desiring andthe fact that you have hired
this person to help you do thisthing, that is a great time to
say, think I need to look intoother options just to make sure
I'm choosing this provider andthis experience with eyes wide
(28:29):
open.
Because a lot of women will goin and realize.
Wow, this seems less about meand more about what might happen
to my doctor legally or likewhat their liability is, or
maybe not even realize thatthat's the heart of it.
But unfortunately, that's justwhere we're at in our society is
that that absolutely plays ahuge part in what options women
(28:52):
are given within certain, youknow, models of care and what
policies are created and whatpreferences providers have.
And unfortunately too.
There are a lot of women thatwe've had DM us on Instagram who
have said, I really want avaginal birth, but my local
hospital doesn't allow it.
Right there, it's just acrossthe board not even allowed which
(29:14):
is wild because happens when awoman, woman is just coming in.
Pushing her baby out, right?
Like, oh, that's, that's notallowed.
And so recognizing that there'salso 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 choicefor me?
(29:34):
Or does that mean that thathospital has.
Problems.
Right?
And usually it is that hospitalhas problems.
Actually a hundred percent ofthe time is that's the problem.
And then as well, you may betalking with other women or your
mom, right?
Or a friend, whatever, who havelistened to these previous
statistics that we've shared orthese ideas that we've shared.
(29:56):
And just assume VBAC is reallyscary.
I know my mom in particular, shehad her, she had my oldest
brother.
He was breach.
They took her out, they took himout by cesarean and was told, I
mean, this was many years ago,like, okay, so next time, right?
We're just gonna, we're justgonna keep doing it because this
isn't the way it's always beendone.
My mom taught me that.
(30:18):
So in high school I rememberspecifically and I'm like a,
almost an adult at this pointthinking that's, that's just
what happens.
I didn't even realize until Iwas in college and was learning
some things and was like.
Oh, you can do that.
I didn't even realize, right?
Not everybody has theopportunity to have that light
bulb moment before they getpregnant, before they have their
baby, right?
That that there are differentstories that you can write.
(30:41):
There is some culturalconditioning that does happen
that can impact what womenbelieve that their choices are
or what women are being toldtheir choices are too.
And I just think, I think that'slike 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 theywere like, are, are you not
allowed to have VBACs inCalifornia?
And I said, no, no, no.
We do'em all the time.
And she said, all the birthcenters around me won't take.
My birth because I am, because Ihad a previous cesarean.
It's against their rules, and Iforgot about that.
(31:17):
The accredited birth centers inCalifornia, it's a part of their
policy and rules because I.
And this is, I think, reallyconfuses women about birth
centers being the perfect equalground between facility and
home.
And it's like, well, who'sriding those policies?
Who, what does the birth centerhave to do to bend?
(31:40):
To getting the physician supportfrom their local hospital and
transfer plan from their localhospital.
They're basically just this, butsometimes this little remove,
you know, partially removedfacility that still has all the
same regulations and policy is.
As the hospital does.
And so I, I know a lot of birthcenters that would not prefer
(32:03):
that to be the case.
I know a lot of birth centerschoose not to become accredited
because of that, but thenthey're gonna have issues with
insurance reimbursement andgetting transfer plans and all
that stuff.
So it can sometimes be reallycomplicated to navigate.
Which is why you're going hearus saying over and over again
that.
Having home birth as an optionis, you know, potentially really
(32:24):
reasonable and also potentiallyyour best chance at having a
normal.
Respectful, beautiful birth, ifthat's what you're looking for.
So we would encourage women tointerview your provider no
matter where you're looking athaving a VBAC interview them the
same way, the same way that youwould in the same questions that
(32:46):
you would ask a midwife or ahome birth, a midwife or a birth
center.
Or a midwife in the hospital ora physician in the hospital, you
want to know what are thestatistics in that setting?
What are the statistics for thatparticular provider?
It's gonna give you a lot ofinformation.
If you say something like out ofthe last 100 women who.
(33:09):
Had previous cesarean that weretrying to have a vaginal birth,
about what percentage, how manyof those women actually had a
vaginal birth.
It's gonna give you a lot ofinformation about that, and you
wanna know what the protocolsare.
You wanna know, are you gonnatreat 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 extramonitoring.
There's gonna be treatmentoptions that are off the table
for you in your labor.
They're gonna have more rulesand protocols in place that make
them feel safer for taking careof you.
And it might not just be yourprovider.
It might be the fac.
(33:46):
And then there are some midwiveswho follow a little bit more of
a conservative view on vaginalbirth, and it could be because
of their standing orders withtheir supervising physician.
It could be, just their beliefabout birth.
It could be the setting thatthey were trained in.
And so it's important to know,are you gonna treat me
differently because of thispiece of my history?
(34:07):
And maybe some women do.
Maybe some women do wanna betreated differently.
Maybe they do want extra care.
Maybe they do want extrasurveillance.
And testing and stuff like that.
So it's good.
It's good to like be assessingyour options from that
perspective.
And you also need to know yourrights and know the research.
You need to be an absoluteexpert in vaginal birth and you
(34:31):
need to listen to other women's.
Stories who are in the sameposition as you, because that's
a huge part of processing,gaining confidence and having
trust in your body.
And like Kelly, you mentionedbefore, the biggest barrier is
not the physical safety aspectfor women.
Usually the biggest barrier isthe mental emotional impact of
(34:52):
the traumatic first birth andprocessing.
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 islike it on display, right.
Of how much it can absolutelyimpact us.
And moving forward now it'simpacting, right?
Like all of the options that youfeel like you, I.
Have at your disposal.
But what I think is extrahelpful too is you're assessing
like, okay, I'm moving, I'm, I'mconsidering moving forward with
(35:27):
this i'm thinking about what myoptions are.
Understanding what, you know,say you've decided, oh, I really
like this provider, but also,right, like interviewing some
other people, getting somesecond opinions potentially
either on your first birth orjust getting ideas of.
Hey, if this happened, whatwould you do?
Kind of thing.
And then understanding also,this is true across the board,
(35:48):
whether you're going for a VBACor your first birth or whatever.
Understanding what the transferof care may look like, what the
options are, what if there'sanything standing of this is
exactly what will happen kind ofthing.
Just so, again, you feel likeyou are going into this with
eyes wide open and as muchcontrol as you can.
(36:09):
With that being said, of course,birth is out of our control in a
lot of ways, but there are somany pieces, especially before
you even get pregnant or at thevery beginning of pregnancy,
months before the birth happens,that you can actually have a
massive impact and have controlover as much as possible by some
of these choices that you aremaking.
And so again, we don't know howyour birth is going to unfold.
(36:32):
But we do know that you, you cangive yourself a better chance
for the desired outcome by someof these very early choices that
you are making as you're doingthis research, as you're saying,
I'm, I'm gonna own it.
This is mine now.
And it's always been yours, butlike, really understanding that
and actually holding onto thatand making some of these
decisions of who you are goingto let in to support you for
(36:55):
that decision.
And where you want to do that,right?
And the, the information andresearch and stories you want to
collect, those have such a hugeimpact and can really change the
course and write a new story asyou're moving forward with this
new pregnancy and new birth andnew 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 avaginal birth after their
cesarean, who their doctor was,or who their midwife was, and
transfer care.
It is absolutely worth theeffort that it feels like to
(37:35):
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 itwould 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 reasonthere 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 hospitalbirth with anyone else that I ha
that I do not know has thereputation in our community to
give the most options to women.
But I would not have a hospitalbirth.
I would be choosing a home birthwhere my chances are high, I am
gonna be treated the mostnormal.
The midwifery model of care justprovides the most autonomy and
(38:24):
choices and respect, and justthe home birth stats for VBAC
are better.
That's what I would want.
So midwives are going to.
Be screening women for theappropriateness of being in a
more le low resource setting athome than in a hospital.
Right?
And so we're looking for womenwho have a low transverse scar,
(38:45):
which is the majority ofcesarean no uterine anomalies,
so.
There can be some funky littlethings that end up happening
which contribute to risk ofC-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 lowrisk pregnancy, which again is
gonna be most women.
And keeping your pregnancy lowrisk and being inside of a care
model that is gonna emphasizethat is a huge part of what is
gonna create a successfulenvironment for you.
Kelly, can you talk a little bitabout holistic preparation and
(39:22):
why the midwifery model of caredoes this better?
When we are just treating thewhole person, the whole woman,
we're not just looking atclinical 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 andthen going back to what creates
and like sets up the mostsuccessful experience.
It's like, check, check, check,check.
Right?
We just are just naturallyalready there not having to
fight to get to those things.
So, like we mentioned, we're notnecessarily treating these
clients differently and doingsomething very different, but a
(39:58):
lot of it we're giving from thevery beginning of like, Hey,
look into this.
Consider this, this may help youprocess.
This may help you feel reallygood that you were doing.
I.
Quote all the things right?
But there's, in terms ofholistic 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 getgo.
(40:19):
It does not need to wait untilthe third trimester when baby
is, you know, bothering you andtheir positioning and stuff.
Things like body
Tiffany (40:25):
It's.
Kelly (40:25):
and spinning babies, right?
The the daily movements andstretches that you can do to not
only make yourself morecomfortable but also get baby
into a more optimal position canbe really important.
We talk a lot about pelvic floortherapy for all of our clients,
but can be really helpful if youare planning a VBAC specifically
because they can work withwhat's going on with your scar.
(40:45):
Can talk to you about yourspecific anatomy, can get you
excited about.
Reconnecting potentially with anarea of your body that you may
feel disconnected from dependingon your own experience.
physically we're preparingemotionally.
This is a huge part.
We are preparing, right, we'reprocessing some of that previous
birth trauma, birthdisappointment, birth confusion.
(41:08):
We're walking that out,unraveling some of that.
And then we're not just leavingthat there either.
Right.
We're, we're bringing someeducation back to that.
We're bringing not this likeidealistic rose colored glasses
of like, everything's gonna begreat.
Right.
But we are affirming moms andunderstanding like, Hey, I.
What is the truth of thissituation that you can cling
(41:29):
onto, right?
Like my, yes, your body wasstill made for this.
Yes, you're growing the rightsize baby for, you know, all of
those things that we can go backto and say, these are true, and
you can kind of, you can holdonto that.
You have support.
You are not alone in this.
Right?
And so that's a really importantpiece of processing and moving
forward.
And then we of course, and Iguess this also combines with.
(41:52):
Emotional and mental andphysical prep also, but
nutritional support is soimportant.
It's going to help you feel somuch better altogether.
But for VBAC clients or clientswho are desiring a vbac
recognizing their iron storesreally helping as their blood
volume is expanding.
That's true across the boardthough.
Focusing a lot on hydration.
Just keeping yourself well.
(42:14):
Hydrated talking about mineralsand all of that, making sure
you're well nourished in thatway.
And then focusing on anythingthat can support uterine toning
as well.
And so, like I said, that can betrue across the board, but for
clients who are coming in andsaying like, I, I want to be
able to do something.
What's cool is that in our modelof care.
We're gonna say, yeah, and let'stalk about all the things that
(42:36):
you can do, and then you can letsome of them fall off your plate
if you don't wanna keep doingthem.
Right.
But it's cool to be able to,again, assert some control over
a situation and feel like thiswas a problem last time.
I.
How can I make this a moreintegrated experience this time?
And then of course there's amental aspect.
There's the emotional versusmental aspect, right?
(42:57):
The mental aspect being, let'stalk about some of these fears
and try to reframe them.
Let's talk about the trust thatyou and I are building through.
Our comfort together through allof this education, through our
trust of your decisions and ourrespect of your decisions.
Let's talk about letting go ofsome of those pieces that have
(43:19):
been holding you back and let'stalk about what you're going to
embrace moving forward.
It's a huge aspect and range ofwhat you are doing to prepare
for birth that is in many waysdifferent right than going
forward.
If you've had a.
Previous vaginal birth.
Just moving forward with thenext one.
Not to say that there isn't fearthat needs to be reframed or
(43:39):
trust that needs to be built,but it's just, it hits a bit
different.
And then of course there's aspiritual connection as well
that some midwives will havewith their clients.
We don't have the samespiritual, like relationship
with every single client, butthat's a big part of
understanding especially if youhave a specific worldview of,
that may be something you'reable to connect with your care
provider on, or it may besomething that you may say, Hey,
(44:02):
I need to like seek this out inparticular so that I feel
supported again, holistically asthe person that you are.
Tiffany (44:09):
Yeah, and your provider should be at multiple points in
your pregnancy.
Going through another piece ofyour story with you.
So, I mean, for us with r VBAclients, we cut out extra time
for them to give us the entirestory because there are some
clinical pieces that we can takeout of that.
(44:30):
Like, I kind of wanna know, I.
What did your body do?
How did you support it?
What, what, what were theinterventions?
How, you know, what was yourcervix 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'snot necessarily going to happen
the second time, but I want totalk about those pieces.
You know, are, is theresomething we can do now?
Is there cervical scar tissuethat needs.
To be addressed.
What is your pelvic shape?
Do we need to pay a lot?
Really close attention to baby'sposition.
(45:01):
And I would say the majority ofVBACs can be approached just
with patients and anunderstanding care provider.
And we kind of have this.
Opinion, uh uh, a generalopinion that we're going to
approach this labor like it's afirst vaginal birth, well,
because it would be a firstvaginal birth, but we're gonna
approach this labor as if you'rea first time mom and how to
(45:24):
prepare for a birth like that.
And how to prepare you for someof the challenges, you know,
physically and timeline andstamina and all of that stuff,
because maybe.
You have to do all of the workfor the first time in your body,
or maybe your cervix opened allthe way and you and your baby's
heart tones crashed before youhad a chance to start pushing or
something like that, right?
(45:45):
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 chartingpieces so that we can really
understand how best to supportyou from that perspective of
what your body's already doneand 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 withthe flow and not treat you
differently at all.
We're, we're definitely gonnaspend some extra time and care
(46:10):
on your story and unpacking thatemotionally and mentally, but
also as your providers, we, wereally actually wanna know the
clinical details so that we canbe on top of that with you too.
Kelly (46:18):
Yeah.
'cause that can matter, right?
A mom who has had a cesarean andshe got quote stuck at eight
centimeters, right?
And we get to that point inlabor again, right?
That can be a big mental hurdleto kind of get over and to
process as well.
So preparing for some of thosethings can be really helpful for
us.
More so how we can helpemotionally support you through
(46:42):
some of those.
Pieces, but certainly they haveclinical value.
And what's funny too is likerequesting records.
You may, that may be a part ofyour story as you're processing
your own previous cesarean, andyou 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 youremotions and you know, what was
(47:04):
going on in the room and all ofthose things, but, medical model
is very to the point andsometimes, sometimes leaves
things out.
Unfortunately.
And so mostly just that caveatin case you are somebody who is
pulling out your own records asa part to process, and you're
feeling a little bit like, whatthe 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 ofresources to jump off from here
that are listening.
We have some links fororganizations and websites
Kelly (47:39):
and
Tiffany (47:40):
People who have dedicated their entire life work
in business to getting correctfacts about vaginal birth out
there for women and.
There's no lack of that.
There's no excuse for notunderstanding the statistics
better.
But we're also leaving you withthe link to our childbirth
education course because we doaddress all of these pieces in
there too.
And so depending on how you wantto interact with that specific
(48:03):
information as a part of yourpersonal history, you get to
decide.
But we do have specificinformation on processing birth
trauma, on finding supportivecare providers on navigating
previous cesarean things.
We even have information oncesarean themselves, how to
have.
The best cesarean possible ifyou're choosing that again for
(48:26):
yourself.
Recovery from Cesare infectionand then scar tissue remediation
techniques and all that kind oflike follow up care too.
So if you are listening and youknow that you're going to have
another cesarean or you'relistening and you know that
you're, you're that you needresources for maybe a primary
cesarean for whatever reasonthat may be because you're not
(48:47):
low risk or whatever.
Our childbirth education courseis that comprehensive, that we
have covered those pieces forwomen too, because it is worth
having support and worth havingeducation and worth weaving in
as much holistic health andresources as possible.
And obviously you can understandfrom this episode that we're
passionate about those pieces.
So we're leaving you guys with alot of good stuff.
(49:09):
Kelly, any last any partingwords 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 sayingtoo, if you are somebody who has
decided, Hey, I'm gonna, I'mgonna be in a hospital that
makes me feel better.
You're probably gonna noticethat you're not getting the
amount of support that you needin your appointments and your
processing, and even thenutritional piece and the mental
aspect of preparing for birthand all of that.
(49:35):
What's cool about our childbirtheducation class is that you
basically get that midwiferyeducation, you get that support,
you get the hours and hours andhours of education and
connection and emotionalprocessing and physical
preparation, all of those thingsfor birth.
And then if you're deciding tobirth in a hospital, it's a
great mix so that you feelprepared with the type of
(49:55):
education that you deserve toprepare for the best experience
possible and for the bestpostpartum possible while still
choosing the type of careprovider that makes you.
Feel the safest.
So that is my last little pushfor that because I think it is
well worth it.
But again, we we can have maybesome caveat like episodes off of
this one'cause it's a reallyimportant topic and I think a, a
(50:16):
big one that women need moreencouragement and information
on.
And again, our show notes willhave a lot of that for you and
we will catch you next time.
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(50:38):
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(51:21):
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Now let's dive into today'sshow.
Kelly (01:08):
Welcome back to at home with Kelly and Tiffany.
I'm Kelly,
Tiffany (01:12):
I am Tiffany,
Kelly (01:13):
and
Tiffany (01:13):
and today we get to talk about vaginal birth after
cesarean.
Kelly (01:18):
a super hot topic that we are excited to kind of delve
into because I feel like.
For the most part, it, it is ahot topic because women are told
so many different things, or somany providers may have
different perspectives on thingsand risk assessment and all of
that.
And so yeah, we're kind ofexcited to chat about the, some
of the alternative perspectives,in particular, our perspective
(01:41):
on supporting vbac, why vbac canpotentially be an option for
you, and sort of how we, how wego about assessing, clients who
are interested in that and howwe go about supporting them in
that goal.
Tiffany (01:54):
We do.
And to get started, Kelly, theicebreaker for today is just
start blank, so fill in theblank with something like advice
that you have for women who needto just begin.
Just need to take a step fromyour perspective.
What is something that women.
(02:14):
Who are on the fence aboutsomething right now?
Just need to start what?
To improve their lives to moveforward to stop overthinking.
Kelly (02:23):
I mean there's a million different ways that this can go.
And the first thing that pops upinto my head, just health, like
health wise, of just wanting tostart something is not assessing
yourself like where you used tobe or where you want to be, but
where you are right now.
I was just thinking,'cause I wastalking to my mom, she's going
(02:44):
to physical therapy.
I had to go through physicaltherapy after breaking my arm a
few years ago and my PT told mewhen, when we went out to like,
try like weight bearingexercises, I had like a half a
pound weight and I was like,this is embarrassing.
I am embarrassed right nowbecause this.
I'm so weak and she was like,you, you have to just, you have
(03:06):
to start somewhere.
Right?
And so it was really hard to dothat half pound weight then
right then, yeah, it just keptkind of building up.
Right.
Obviously getting back to likemy normal amount of strength and
that in particular, if you areinterested in bettering your
health in general.
I always go back to like womenespecially, we need to build
(03:30):
muscle.
We want to feel strong at theend of the day, physically, it's
not about like bulking orwhatever, but it is about like
doing something hard that isreally, really good for you.
And so that's where my mind goesfirst because I was like just
talking about that with my momand how important That
comparison piece is, and howimportant it is to like, even if
(03:53):
you are like, man, I'm not, notwhere I want to be, that is
perfectly fine right where youare, you can absolutely just
simply put it on your calendar.
You can simply take the firststep.
You can write yourself anencouraging note, tape something
somewhere, right?
And like simply just start that.
Tiffany (04:11):
You have the smallest step.
I love that.
That's so good.
And like simplifying it.
I think sometimes we have thisend 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 tryto make progress towards this
big end goal.
I'm gonna have to overhaul a lotor change a lot or learn a lot.
And it's like, no, break it downinto the break.
(04:32):
Like make this first few steps,like stupid easy, like, like you
said, like you're half poundweight easy.
Like mentally it feelsabsolutely crazy.
And too, too, you know, too muchto just get started, but just
make that first step the likethe easiest step you can make.
(04:54):
I love that.
Kelly (04:55):
And, and I mean, obviously it like translates
into a lot of different spacestoo, right?
And so hopefully that's anencouragement wherever you are,
if you are thinking aboutsomething or questioning
something, or like it's in yourmind where you're like, I, I
want that.
And you see the end goal ofsomebody else or the thing that
you're thinking about.
Again, just that first littleteeny tiny, no, of course you're
(05:17):
not there yet, but that's thepoint.
That's the point is that you'renot there yet and that is okay.
Tiffany (05:22):
I love it.
Okay, so getting started todaywith our topic on vaginal birth
after cesarean.
The reason that this matters forwomen, the reason that it is
such a hot topic is because theC-section rate is climbing.
It's in some communities it'splateauing and in some
communities it's increasing.
(05:42):
Some communities it'sdecreasing, but a ge as a
general birthing population,everything that has been done
and instituted since we learnedhow primary cesarean are.
Have a negative impact on womenand babies.
The attempt from the medicalmodel to tone that down, to
(06:03):
bring that number down to closerto what the World Health
Organization recommends, whichis 10 to 15%.
We actually are at 30 to 35% ofwomen across the nation and
probably in other.
Countries too.
And I mean, we know there'sother countries where this
C-section rate is like 80%absolutely crazy.
But the reason that this, thatthis matters is because women do
(06:26):
not want to have the risks andcomplications of major surgery
despite the fact that there isso many pieces that are mental
and emotional and identitychallenging, and.
Because birth is so importantbecause it does make such an
impact.
How we birth really does matterto most women at the core of the
(06:50):
issue, right?
So avoiding that primaryC-section is already really
loaded.
But then we do know that 30 to35% of women in the US are going
to have had that primaryC-section anyways.
Despite what they felt liketheir best efforts were to.
Avoid that.
And some women have a lot ofclarity on how they ended up
(07:10):
with the cesarean and some womenfeel like it was necessary and
needed as a part of theirprevious birth experience.
And some women are completelyclueless.
They have no idea how they wentfrom preferring to have a
vaginal birth to, oh my gosh,this happened to me.
So there's a wide spectrum ofexperiences here, but.
To avoid the risk of this proof, of continued cesarean
(07:35):
because in many birth settingsinside.
Of our country and, and a lot ofother first world countries, a
primary cesarean is equal toanother cesarean, and we're,
we're moving out of that.
We're understanding that thatmyth is not true, but for moms
who want to avoid the risks ofanother cesarean, that is, that
(07:56):
is completely valid for physicalreasons like.
The risks of infection, thelonger recovery, future
potential complications in, infuture pregnancies, like
placenta issues, uterinerupture.
There's tons of emotional andmental health impacts for women
who are processing this type ofbirth.
(08:17):
And I think sometimes we keepthe focus.
A lot on the mom's experiencebecause she is the one who can
communicate and verbalize whatthat was like for her.
But the impact on babiesc-sections can lead to breathing
difficulties even further downin life, not just at birth.
Delayed bonding andbreastfeeding issues.
(08:38):
The reduced exposure tobeneficial vaginal microbes that
support.
An immune system that is indevelopment for babies that we
are seeing implications andcomplications in their gut
health years and years down theline.
So.
So a vaginal birth is better.
And I think most of ourlisteners would probably agree,
but if you're just tuning intothis episode because it flagged
(09:02):
for VBAC and you're trying tounderstand who we are and what
we are about Kelly give like anoverview of a midwifery
perspective with VBAC so thatwomen can understand like what
we're gonna end up sharing inthis episode.
Kelly (09:18):
So like you were saying, we wanna avoid that original
one, right?
Because if we are experiencingthat, or it could be your second
baby or whatever, avoidingnecessa then takes this, all
those risk factors out of it,right?
It kind of puts a little bit ofa flag.
On your chart, on your life asmaybe what it feels like as you
go in and try to move forwardfrom that experience in your
(09:40):
next pregnancy and saying, Hey,I want a different experience.
It is a little bit of a harderhill to climb, to get out of,
you know, like the, the shadowof that flag that's kind of been
placed on you according to a lotof providers.
And so as we assess VBACclients, for the most part, you
know, there's obviously some.
(10:01):
Safety pieces that we areassessing, like where their scar
is and you know, that, that typeof thing.
But for the most part, what weare doing is saying, yes, that
happened to you.
Let's talk about your birthexperience.
Let's talk about like, let'sunwind some of that.
But I.
Physically, for the most part,we are treating our VBAC clients
(10:21):
as we would another client goinginto have their first potential
vaginal birth or, you know, aprevious, depending on where
your cesarean is at in yourstoryline.
But for the most part it's a lotof emotional.
and unpacking that happensthroughout that pregnancy,, that
isn't there for a lot of otherwomen who have that experience.
And so that's a huge part of theway that we care for our clients
(10:45):
is kind of peeling that onion,unraveling, you know, all of
those pieces.
But for the most part, like yousaid, and I know it might feel
controversial to some people,but yes, of course there are
situations in which cesareansave lives.
Of course that amount is verysmall in comparison to the women
and babies who are undergoingthis major surgery.
(11:07):
And so.
Vaginal birth is the goalbecause physiologically it is a
better experience.
It is better for moms, it isbetter for babies.
And again, I know that mightseem controversial, but if we
just go back to how our bodiesare designed to do this, of
course that makes sense, right?
And so yeah, that's kind of likeour general view on all of this.
(11:29):
It is not a moral statement oflike, that's bad.
Is a, just a shift ofperspective on, again, how can
we back, get back to physiology?
How can we get back to providingmoms and babies the best
experience, both physically butalso as well?
'cause all of this matters somuch
Tiffany (11:50):
And we want those benefits for women and women who
have a low risk pregnancy with alow risk developing baby.
And that's gonna be 90% of womenhaving your previous cesarean in
our perspective.
And there's not been, I've,there's, there's.
Not all midwives agree with thisstatement, but our perspective
(12:11):
is barring other risk factors inyour history.
Your previous cesarean alonedoes not make you high risk.
So considering where you givebirth and who you are getting
care from during your prenataltime is going to affect your
risk status and all the thingsthat go along with.
(12:33):
You know, somebody saying,telling you that you're higher
risk in your pregnancy, thatmight not actually be the case.
And we will unpack a little bitof that today.
But before we get started, let'sgo 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 aftercesarean.
And that can have numbers insideof it, so that could be vaginal
birth after two cesareans,vaginal birth after three
cesarean and that particularacronym and label.
(13:06):
Describes the birth thathappens, right?
It is the actual vaginal birththat happens after the cesarean.
Then we have hvac, home birthafter cesarean is just that is
having a vaginal birth at homeafter cesarean, and you'll see
why there.
It has its own acronym and hasits own designation because it's
(13:28):
a different experience.
Having a vaginal birth at homewith a, with history of a
previous cesarean is a differentexperience than having a
vaginal.
Birth in the hospital even withthe best possible hospital care
experience, it's still gonna bedifferent at home.
And then we have tolac, and thatis not a term that we use in our
(13:50):
practice or in it's probably notused 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, butthis particular one is really
irritating because it'sbasically used to say, we'll
allow you to try.
We'll give you a trial, we'llsee how you do, how you perform,
(14:26):
but we're not saying that you'regonna have a vaginal birth or
that we're even planning for avaginal 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 lotof the terminology in the
medical world revolving aroundbirth ends up being somewhat
rude, right?
It ends up being very likeinfantilizing to women, right?
And and it gets prettyfrustrating, but it's helpful to
have some of those.
Foundation so that youunderstand what you are going
(14:58):
into and understanding if peopleare speaking like this or you
see something on your chart orwhatever that you have a little
bit of a, you know, a grasparound around that.
Obviously as we look into VBA Cand hvac, we are.
Pro these things and we're notpro these things just because
like isn't that nice?
And it is.
(15:18):
But there are definite benefitsfor women who are desiring this
experience.
That is not to say that choosinga repeat cesarean is not the
right choice in certainsituations, but mostly if you
are, if you are somebody who'shad a cesarean and you are
considering growing your familyand you are thinking.
it probably is best for me tojust choose a repeat cesarean
(15:40):
because then I don't emotionallyhave 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 understandableplace where you are emotionally,
but we want to tell you there'san entire world out there
available for you.
With the right provider withinthe right scenario, with the
(16:00):
right preparation, that canallow you to experience the
benefits of having a vbac.
And I will say as a midwife, andI felt this way as a doula as
well, when I attended birthswhere moms had had a previous
cesarean and were desiring avaginal birth.
amazing as birth is always VBACbirth.
I was like, did the world juststop?
(16:22):
Like, is there a parade going onlike this did, does anybody know
how incredible this is?
That just happened.
So it's, it's always incredible.
But there's something next levelabout a woman who.
Walks through that and gets tonow enjoy the emotional benefits
of that, gets to enjoy thephysiological benefits of that,
gets to enjoy that recovery,gets to enjoy how her whole
(16:44):
obstetrical history is nowchanged.
So there's a ton of benefits ofthat and hope we're just
providing a little bit of spaceto open up your heart too.
Potentially you know, considerthat for yourself, especially if
you're somebody who has, youknow, kind of these rolling
thoughts of, man, that, thatsounds overwhelming to get kind
of my, my hopes up aboutsomething because you absolutely
(17:07):
can and, and should get yourhopes 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 neededmore tools.
I needed an advocate.
Kelly (17:32):
and
Tiffany (17:32):
then.
Or I just needed to not bemessed with.
Right.
Maybe you don't, maybe it's notmore things, maybe it's less
things.
And I did it, and I can, and I'mcapable, and I get to experience
the way that this was meant tobe and designed to be.
And that empowers women.
That empowers women.
So being a part of thatexperience is really exciting.
Let's talk a little bit aboutcommon fears and myths around
(17:55):
uterine rupture, because therup, the uterine rupture is what
gets.
All the spotlight in thisconversation.
If you talk with people who areafraid of birth and afraid of
vbac, they're gonna bring up theuterine rupture piece.
And once you do a little bit ofdigging and research on this,
you.
Hopefully would under willunderstand really quickly that
(18:17):
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 anemergency most of the time, and
it's important that it, we're athome and we're experiencing
uterine rupture.
That's an immediate transfer.
We need lots of medical.
Care and backup on board, butthe uterine rupture risk is
extremely low.
We're talking about half apercentage.
(18:44):
There's some literature thatsays 0.4%.
There's some literature thatsays 0.9%, and these are
statistics that capture alltypes of uterine rupture.
And I think that that'ssomething that is not.
Given proper information andeducation about in the medical
model of care, all the uterinerupture is on a spectrum.
(19:08):
Not all uterine rupture is anemergency where everybody bleeds
out and dies.
So this percentage that we'retalking about It could be
something like there's a littlebit of separation of the uterine
fibers that cause a little bitof bleeding maybe, or there's a
(19:29):
little we call it like a uterinewindow that is discovered during
another cesarean where we seethat that.
That scar tissue has separated.
The, the fear is that once we'vemade this primary cut into this
muscle fiber, that it's scartissue now.
So as we're sewing it backtogether and it's healing
(19:49):
together, the scar itself can bereally, really strong, but the
tissue around it is being forcedto, pull and maybe adhere and,
and, you know, scar, we know howscar tissue looks on the outside
of our body.
So that's what's happening onthe inside, and it can, it can
change the integrity of that.
Uterine muscle.
(20:09):
So that's, that's the, that'sthe fear and the problem and the
complication.
However not all uterine rupturesare catastrophic.
Actually, a pretty smallpercentage of them are actually
catastrophic.
And so we have to keep thatpiece in perspective.
And then
Kelly (20:25):
need
Tiffany (20:25):
need to look at.
What else causes uterinerupture?
Sometimes the cause is unknown.
Women have uterine rupture thatdo not have previous cesarean
scars.
Uterine rupture almost doublesthe risk comparatively for first
time moms who have a Pitocininduction, which in certain
(20:48):
parts of the country right nowis potentially 60
Kelly (20:52):
80% of
Tiffany (20:53):
of.
Laboring women.
The doctor doesn't say, I hopethat 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 aftercesarean, 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 othercauses of, of uterine rupture
and one of, and, and a moreserious risk increases for women
who have never even had acesarean.
So knowing your statistics,knowing that information, doing
more research, and we'll providesome of those links in the show
(21:31):
notes today so that.
You ladies can get yourselvesinformed.
'cause we could talk hours andhours about VBAC stats and facts
and stuff, but understandingthat the risk that is emphasized
in the medical model of care iscompletely blown out of
proportion and your options arebeing limited because of a
provider preference, because ofhospital policies, because of
(21:56):
culture.
Surrounding birth in that area,in this part, this particular
way of birthing with thishistory.
And so it's so important ladiesto understand the real truth and
facts and do not only collectthose from your care provider.
Kelly (22:13):
Yeah, I mean, I feel like we could just end the podcast
there with like this pitocinrisk factor because I.
That just goes to show you, itcomes down to like, are we
actually going off of facts?
Are we actually going off ofresearch and information?
Are we going off of, are wecherry picking what we wanna
share in order to create somekind of control?
Right.
(22:33):
And it's just, it frustrates meso much to see that happen and
then to see women.
Be basically scared into adecision, which just should
never happen, right?
But what's cool is that if youdo have a supportive care
provider who is not just like,sure, let's see what happens,
but is like, no, I want this foryou.
(22:53):
Right?
How can we go about doing thissupportively?
About a 70 to 80%.
Vbac, we'll call it successbecause right, like you pushed
your baby out of your vagina,you were given the space and the
time and the opportunity, all ofthat.
So it's a very high percentage.
Right?
At home, it's significantlyhigher.
87% of women who are going for aVBAC at home will have a VBAC at
(23:17):
home.
That's not to say that all ofthese other women are going.
To get a repeat cesarean, theymay need to go in and take a nap
or, you know, all of those otherthings.
So it's not saying thateverybody else is going in to
get a cesarean.
The potential at a hospital ismuch lower.
And that also is just simplybecause there's a lot of women
who are going in for a repeatcesarean.
The, you know, there's the, the,the goals and the outcomes and
(23:40):
all of that are a bit skewedbecause we don't know the
mindset of people who are goingin for it.
But it's about 13%.
So.
That's a massive difference.
Right?
And I've been a part of VBACsthat have happened in a
hospital.
Like you were saying, TIFF, it'swonderful when that happens.
It's cool'cause some of thenurses there have never seen
that before, which goes to tellyou something, right?
(24:02):
But just that difference inpercentage is kind of points you
to which space may be a bit moresupportive beyond just like,
yeah, sure.
Let's see what happens.
And so I always am stunned whenI 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 adifferent mindset in general,
(24:24):
but.
As you go, these 13% who aregoing into the hospital is 87%
of women at home, right?
A a vaginal birth is going to bemore likely if you are waiting
for spontaneous labor, right?
You're just waiting for labor tohappen on its own.
Ideally you have lessinterventions, right?
Potentially with that firstcesarean, you may have watched
(24:47):
that cascade of interventions.
Fall over you and all of asudden you're in the operating
room and you're like, oh, cry.
I, like, I knew I knew this, buthere I am, like in the midst of
it.
So starting off obviously withspontaneous labor allows that to
unfold much more easily to havethose less interventions.
If you, your percentage numberof like potentially.
(25:09):
Getting a vbac, obviously ifyou've say you've had a vaginal
birth and then a cesarean ofcourse your risk or your your
chance for having anothervaginal birth, even after that
cesarean is better.
Longer spacing betweenpregnancies, so whether that is
because your uterus has givensome, ti has been given some
time to heal.
(25:29):
Versus fear that might've beeninstilled about, you know, a
baby coming too close and to aprevious cesarean.
And then of course and we cankind of jump into that a little
bit too.
I think that's an interesting,like question to get into.
But course having the rightsupport as well, understanding
your own self-advocacy, having adoula with you choosing
midwifery care.
(25:50):
Those things are going to setyou up for quote success more so
than going in for the induction,being okay with all the
interventions, you know, ofthat.
And so helpful to kind of keepsome of those pieces in mind as
you are considering what youwant to do, how you want to move
forward what impacts, right?
(26:10):
Going back to repeat cesareanversus, versus a a vaginal
birth.
Tiffany (26:16):
Yeah, and the spacing between pregnancies is a little
controversial.
There's some evidence thatsupports an ideal range of 18
months from one birth to theother.
So waiting until your baby isnine months old before you get
pregnant again, significantlyincreases your.
Kelly (26:35):
your
Tiffany (26:35):
Chances of scar integrity, and that's what makes
most providers feel the mostcomfortable.
But the reason it'scontroversial is because it's
not co, it's not completelyconcrete.
There is evidence out there thatwomen who have closer spaced
pregnancies still deserve achance 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 tohave longer spacing, because
that's what research supports,it's not ne, it doesn't
necessarily mean that noprovider is gonna take you.
In fact, I would consider that ared flag if it's not being
considered, if it's notsomething that's being
discussed.
There's ways that you can checkon the.
(27:18):
Integrity of the uterine scarthrough ultrasound and some
really sound practices for scartissue remediation and those
types of things.
So definitely stuff to do somemore research on, see what's
available in your community andsort through your options.
That way.
If you are having, if you havemore close, close pregnancy
(27:39):
spacing, I would don't thinkthat that's something that's
gonna completely rule out youropportunities..
Kelly (27:45):
And recognizing also kind of like what you're mentioning,
if your provider is sort ofsaying, eh, you know, here's
what we're gonna do, and nottaking into account your
desires, the full picture of whoyou are, that is more so your
provider looking at to say, whatare my policies?
How am I going to decrease myown liability?
What do I like to do?
(28:07):
Right.
Which.
Can matter, but when they mattermore than what you are saying
and what you are desiring andthe fact that you have hired
this person to help you do thisthing, that is a great time to
say, think I need to look intoother options just to make sure
I'm choosing this provider andthis experience with eyes wide
(28:29):
open.
Because a lot of women will goin and realize.
Wow, this seems less about meand more about what might happen
to my doctor legally or likewhat their liability is, or
maybe not even realize thatthat's the heart of it.
But unfortunately, that's justwhere we're at in our society is
that that absolutely plays ahuge part in what options women
(28:52):
are given within certain, youknow, models of care and what
policies are created and whatpreferences providers have.
And unfortunately too.
There are a lot of women thatwe've had DM us on Instagram who
have said, I really want avaginal birth, but my local
hospital doesn't allow it.
Right there, it's just acrossthe board not even allowed which
(29:14):
is wild because happens when awoman, woman is just coming in.
Pushing her baby out, right?
Like, oh, that's, that's notallowed.
And so recognizing that there'salso 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 choicefor me?
(29:34):
Or does that mean that thathospital has.
Problems.
Right?
And usually it is that hospitalhas problems.
Actually a hundred percent ofthe time is that's the problem.
And then as well, you may betalking with other women or your
mom, right?
Or a friend, whatever, who havelistened to these previous
statistics that we've shared orthese ideas that we've shared.
(29:56):
And just assume VBAC is reallyscary.
I know my mom in particular, shehad her, she had my oldest
brother.
He was breach.
They took her out, they took himout by cesarean and was told, I
mean, this was many years ago,like, okay, so next time, right?
We're just gonna, we're justgonna keep doing it because this
isn't the way it's always beendone.
My mom taught me that.
(30:18):
So in high school I rememberspecifically and I'm like a,
almost an adult at this pointthinking that's, that's just
what happens.
I didn't even realize until Iwas in college and was learning
some things and was like.
Oh, you can do that.
I didn't even realize, right?
Not everybody has theopportunity to have that light
bulb moment before they getpregnant, before they have their
baby, right?
That that there are differentstories that you can write.
(30:41):
There is some culturalconditioning that does happen
that can impact what womenbelieve that their choices are
or what women are being toldtheir choices are too.
And I just think, I think that'slike 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 theywere like, are, are you not
allowed to have VBACs inCalifornia?
And I said, no, no, no.
We do'em all the time.
And she said, all the birthcenters around me won't take.
My birth because I am, because Ihad a previous cesarean.
It's against their rules, and Iforgot about that.
(31:17):
The accredited birth centers inCalifornia, it's a part of their
policy and rules because I.
And this is, I think, reallyconfuses women about birth
centers being the perfect equalground between facility and
home.
And it's like, well, who'sriding those policies?
Who, what does the birth centerhave to do to bend?
(31:40):
To getting the physician supportfrom their local hospital and
transfer plan from their localhospital.
They're basically just this, butsometimes this little remove,
you know, partially removedfacility that still has all the
same regulations and policy is.
As the hospital does.
And so I, I know a lot of birthcenters that would not prefer
(32:03):
that to be the case.
I know a lot of birth centerschoose not to become accredited
because of that, but thenthey're gonna have issues with
insurance reimbursement andgetting transfer plans and all
that stuff.
So it can sometimes be reallycomplicated to navigate.
Which is why you're going hearus saying over and over again
that.
Having home birth as an optionis, you know, potentially really
(32:24):
reasonable and also potentiallyyour best chance at having a
normal.
Respectful, beautiful birth, ifthat's what you're looking for.
So we would encourage women tointerview your provider no
matter where you're looking athaving a VBAC interview them the
same way, the same way that youwould in the same questions that
(32:46):
you would ask a midwife or ahome birth, a midwife or a birth
center.
Or a midwife in the hospital ora physician in the hospital, you
want to know what are thestatistics in that setting?
What are the statistics for thatparticular provider?
It's gonna give you a lot ofinformation.
If you say something like out ofthe last 100 women who.
(33:09):
Had previous cesarean that weretrying to have a vaginal birth,
about what percentage, how manyof those women actually had a
vaginal birth.
It's gonna give you a lot ofinformation about that, and you
wanna know what the protocolsare.
You wanna know, are you gonnatreat 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 extramonitoring.
There's gonna be treatmentoptions that are off the table
for you in your labor.
They're gonna have more rulesand protocols in place that make
them feel safer for taking careof you.
And it might not just be yourprovider.
It might be the fac.
(33:46):
And then there are some midwiveswho follow a little bit more of
a conservative view on vaginalbirth, and it could be because
of their standing orders withtheir supervising physician.
It could be, just their beliefabout birth.
It could be the setting thatthey were trained in.
And so it's important to know,are you gonna treat me
differently because of thispiece of my history?
(34:07):
And maybe some women do.
Maybe some women do wanna betreated differently.
Maybe they do want extra care.
Maybe they do want extrasurveillance.
And testing and stuff like that.
So it's good.
It's good to like be assessingyour options from that
perspective.
And you also need to know yourrights and know the research.
You need to be an absoluteexpert in vaginal birth and you
(34:31):
need to listen to other women's.
Stories who are in the sameposition as you, because that's
a huge part of processing,gaining confidence and having
trust in your body.
And like Kelly, you mentionedbefore, the biggest barrier is
not the physical safety aspectfor women.
Usually the biggest barrier isthe mental emotional impact of
(34:52):
the traumatic first birth andprocessing.
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 islike it on display, right.
Of how much it can absolutelyimpact us.
And moving forward now it'simpacting, right?
Like all of the options that youfeel like you, I.
Have at your disposal.
But what I think is extrahelpful too is you're assessing
like, okay, I'm moving, I'm, I'mconsidering moving forward with
(35:27):
this i'm thinking about what myoptions are.
Understanding what, you know,say you've decided, oh, I really
like this provider, but also,right, like interviewing some
other people, getting somesecond opinions potentially
either on your first birth orjust getting ideas of.
Hey, if this happened, whatwould you do?
Kind of thing.
And then understanding also,this is true across the board,
(35:48):
whether you're going for a VBACor your first birth or whatever.
Understanding what the transferof care may look like, what the
options are, what if there'sanything standing of this is
exactly what will happen kind ofthing.
Just so, again, you feel likeyou are going into this with
eyes wide open and as muchcontrol as you can.
(36:09):
With that being said, of course,birth is out of our control in a
lot of ways, but there are somany pieces, especially before
you even get pregnant or at thevery beginning of pregnancy,
months before the birth happens,that you can actually have a
massive impact and have controlover as much as possible by some
of these choices that you aremaking.
And so again, we don't know howyour birth is going to unfold.
(36:32):
But we do know that you, you cangive yourself a better chance
for the desired outcome by someof these very early choices that
you are making as you're doingthis research, as you're saying,
I'm, I'm gonna own it.
This is mine now.
And it's always been yours, butlike, really understanding that
and actually holding onto thatand making some of these
decisions of who you are goingto let in to support you for
(36:55):
that decision.
And where you want to do that,right?
And the, the information andresearch and stories you want to
collect, those have such a hugeimpact and can really change the
course and write a new story asyou're moving forward with this
new pregnancy and new birth andnew 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 avaginal birth after their
cesarean, who their doctor was,or who their midwife was, and
transfer care.
It is absolutely worth theeffort that it feels like to
(37:35):
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 itwould 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 reasonthere 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 hospitalbirth with anyone else that I ha
that I do not know has thereputation in our community to
give the most options to women.
But I would not have a hospitalbirth.
I would be choosing a home birthwhere my chances are high, I am
gonna be treated the mostnormal.
The midwifery model of care justprovides the most autonomy and
(38:24):
choices and respect, and justthe home birth stats for VBAC
are better.
That's what I would want.
So midwives are going to.
Be screening women for theappropriateness of being in a
more le low resource setting athome than in a hospital.
Right?
And so we're looking for womenwho have a low transverse scar,
(38:45):
which is the majority ofcesarean no uterine anomalies,
so.
There can be some funky littlethings that end up happening
which contribute to risk ofC-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 lowrisk pregnancy, which again is
gonna be most women.
And keeping your pregnancy lowrisk and being inside of a care
model that is gonna emphasizethat is a huge part of what is
gonna create a successfulenvironment for you.
Kelly, can you talk a little bitabout holistic preparation and
(39:22):
why the midwifery model of caredoes this better?
When we are just treating thewhole person, the whole woman,
we're not just looking atclinical 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 andthen going back to what creates
and like sets up the mostsuccessful experience.
It's like, check, check, check,check.
Right?
We just are just naturallyalready there not having to
fight to get to those things.
So, like we mentioned, we're notnecessarily treating these
clients differently and doingsomething very different, but a
(39:58):
lot of it we're giving from thevery beginning of like, Hey,
look into this.
Consider this, this may help youprocess.
This may help you feel reallygood that you were doing.
I.
Quote all the things right?
But there's, in terms ofholistic 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 getgo.
(40:19):
It does not need to wait untilthe third trimester when baby
is, you know, bothering you andtheir positioning and stuff.
Things like body
Tiffany (40:25):
It's.
Kelly (40:25):
and spinning babies, right?
The the daily movements andstretches that you can do to not
only make yourself morecomfortable but also get baby
into a more optimal position canbe really important.
We talk a lot about pelvic floortherapy for all of our clients,
but can be really helpful if youare planning a VBAC specifically
because they can work withwhat's going on with your scar.
(40:45):
Can talk to you about yourspecific anatomy, can get you
excited about.
Reconnecting potentially with anarea of your body that you may
feel disconnected from dependingon your own experience.
physically we're preparingemotionally.
This is a huge part.
We are preparing, right, we'reprocessing some of that previous
birth trauma, birthdisappointment, birth confusion.
(41:08):
We're walking that out,unraveling some of that.
And then we're not just leavingthat there either.
Right.
We're, we're bringing someeducation back to that.
We're bringing not this likeidealistic rose colored glasses
of like, everything's gonna begreat.
Right.
But we are affirming moms andunderstanding like, Hey, I.
What is the truth of thissituation that you can cling
(41:29):
onto, right?
Like my, yes, your body wasstill made for this.
Yes, you're growing the rightsize baby for, you know, all of
those things that we can go backto and say, these are true, and
you can kind of, you can holdonto that.
You have support.
You are not alone in this.
Right?
And so that's a really importantpiece of processing and moving
forward.
And then we of course, and Iguess this also combines with.
(41:52):
Emotional and mental andphysical prep also, but
nutritional support is soimportant.
It's going to help you feel somuch better altogether.
But for VBAC clients or clientswho are desiring a vbac
recognizing their iron storesreally helping as their blood
volume is expanding.
That's true across the boardthough.
Focusing a lot on hydration.
Just keeping yourself well.
(42:14):
Hydrated talking about mineralsand all of that, making sure
you're well nourished in thatway.
And then focusing on anythingthat can support uterine toning
as well.
And so, like I said, that can betrue across the board, but for
clients who are coming in andsaying like, I, I want to be
able to do something.
What's cool is that in our modelof care.
We're gonna say, yeah, and let'stalk about all the things that
(42:36):
you can do, and then you can letsome of them fall off your plate
if you don't wanna keep doingthem.
Right.
But it's cool to be able to,again, assert some control over
a situation and feel like thiswas a problem last time.
I.
How can I make this a moreintegrated experience this time?
And then of course there's amental aspect.
There's the emotional versusmental aspect, right?
(42:57):
The mental aspect being, let'stalk about some of these fears
and try to reframe them.
Let's talk about the trust thatyou and I are building through.
Our comfort together through allof this education, through our
trust of your decisions and ourrespect of your decisions.
Let's talk about letting go ofsome of those pieces that have
(43:19):
been holding you back and let'stalk about what you're going to
embrace moving forward.
It's a huge aspect and range ofwhat you are doing to prepare
for birth that is in many waysdifferent right than going
forward.
If you've had a.
Previous vaginal birth.
Just moving forward with thenext one.
Not to say that there isn't fearthat needs to be reframed or
(43:39):
trust that needs to be built,but it's just, it hits a bit
different.
And then of course there's aspiritual connection as well
that some midwives will havewith their clients.
We don't have the samespiritual, like relationship
with every single client, butthat's a big part of
understanding especially if youhave a specific worldview of,
that may be something you'reable to connect with your care
provider on, or it may besomething that you may say, Hey,
(44:02):
I need to like seek this out inparticular so that I feel
supported again, holistically asthe person that you are.
Tiffany (44:09):
Yeah, and your provider should be at multiple points in
your pregnancy.
Going through another piece ofyour story with you.
So, I mean, for us with r VBAclients, we cut out extra time
for them to give us the entirestory because there are some
clinical pieces that we can takeout of that.
(44:30):
Like, I kind of wanna know, I.
What did your body do?
How did you support it?
What, what, what were theinterventions?
How, you know, what was yourcervix 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'snot necessarily going to happen
the second time, but I want totalk about those pieces.
You know, are, is theresomething we can do now?
Is there cervical scar tissuethat needs.
To be addressed.
What is your pelvic shape?
Do we need to pay a lot?
Really close attention to baby'sposition.
(45:01):
And I would say the majority ofVBACs can be approached just
with patients and anunderstanding care provider.
And we kind of have this.
Opinion, uh uh, a generalopinion that we're going to
approach this labor like it's afirst vaginal birth, well,
because it would be a firstvaginal birth, but we're gonna
approach this labor as if you'rea first time mom and how to
(45:24):
prepare for a birth like that.
And how to prepare you for someof the challenges, you know,
physically and timeline andstamina and all of that stuff,
because maybe.
You have to do all of the workfor the first time in your body,
or maybe your cervix opened allthe way and you and your baby's
heart tones crashed before youhad a chance to start pushing or
something like that, right?
(45:45):
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 chartingpieces so that we can really
understand how best to supportyou from that perspective of
what your body's already doneand 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 withthe flow and not treat you
differently at all.
We're, we're definitely gonnaspend some extra time and care
(46:10):
on your story and unpacking thatemotionally and mentally, but
also as your providers, we, wereally actually wanna know the
clinical details so that we canbe on top of that with you too.
Kelly (46:18):
Yeah.
'cause that can matter, right?
A mom who has had a cesarean andshe got quote stuck at eight
centimeters, right?
And we get to that point inlabor again, right?
That can be a big mental hurdleto kind of get over and to
process as well.
So preparing for some of thosethings can be really helpful for
us.
More so how we can helpemotionally support you through
(46:42):
some of those.
Pieces, but certainly they haveclinical value.
And what's funny too is likerequesting records.
You may, that may be a part ofyour story as you're processing
your own previous cesarean, andyou 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 youremotions and you know, what was
(47:04):
going on in the room and all ofthose things, but, medical model
is very to the point andsometimes, sometimes leaves
things out.
Unfortunately.
And so mostly just that caveatin case you are somebody who is
pulling out your own records asa part to process, and you're
feeling a little bit like, whatthe 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 ofresources to jump off from here
that are listening.
We have some links fororganizations and websites
Kelly (47:39):
and
Tiffany (47:40):
People who have dedicated their entire life work
in business to getting correctfacts about vaginal birth out
there for women and.
There's no lack of that.
There's no excuse for notunderstanding the statistics
better.
But we're also leaving you withthe link to our childbirth
education course because we doaddress all of these pieces in
there too.
And so depending on how you wantto interact with that specific
(48:03):
information as a part of yourpersonal history, you get to
decide.
But we do have specificinformation on processing birth
trauma, on finding supportivecare providers on navigating
previous cesarean things.
We even have information oncesarean themselves, how to
have.
The best cesarean possible ifyou're choosing that again for
(48:26):
yourself.
Recovery from Cesare infectionand then scar tissue remediation
techniques and all that kind oflike follow up care too.
So if you are listening and youknow that you're going to have
another cesarean or you'relistening and you know that
you're, you're that you needresources for maybe a primary
cesarean for whatever reasonthat may be because you're not
(48:47):
low risk or whatever.
Our childbirth education courseis that comprehensive, that we
have covered those pieces forwomen too, because it is worth
having support and worth havingeducation and worth weaving in
as much holistic health andresources as possible.
And obviously you can understandfrom this episode that we're
passionate about those pieces.
So we're leaving you guys with alot of good stuff.
(49:09):
Kelly, any last any partingwords 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 sayingtoo, if you are somebody who has
decided, Hey, I'm gonna, I'mgonna be in a hospital that
makes me feel better.
You're probably gonna noticethat you're not getting the
amount of support that you needin your appointments and your
processing, and even thenutritional piece and the mental
aspect of preparing for birthand all of that.
(49:35):
What's cool about our childbirtheducation class is that you
basically get that midwiferyeducation, you get that support,
you get the hours and hours andhours of education and
connection and emotionalprocessing and physical
preparation, all of those thingsfor birth.
And then if you're deciding tobirth in a hospital, it's a
great mix so that you feelprepared with the type of
(49:55):
education that you deserve toprepare for the best experience
possible and for the bestpostpartum possible while still
choosing the type of careprovider that makes you.
Feel the safest.
So that is my last little pushfor that because I think it is
well worth it.
But again, we we can have maybesome caveat like episodes off of
this one'cause it's a reallyimportant topic and I think a, a
(50:16):
big one that women need moreencouragement and information
on.
And again, our show notes willhave a lot of that for you and
we will catch you next time.
Hey ladies, if you're loving theshow and want to help us keep it
ad free so we can keep talkingabout all things birth and
women's health, without cuttingto an ad about electrolytes or
(50:38):
grass fed beef sticks, here ishow you can support us.
First, leave us a quick reviewor a rating.
It helps more women, new moms,and birth enthusiasts find our
show.
And it honestly means so much tous to be reminded that you love
what we are doing here.
Second, share this episode witha friend, with a doula buddy, or
(51:00):
anyone who is on their ownholistic health or natural birth
journey.
And third hop on our newsletterlist.
This is where we share.
Bonus goodies behind the scenesstuff.
Fun little extras you just won'thear on the show.
You can find that link to joinin our show notes below.
Thanks so much for being a partof this growing empowered
(51:21):
community.
We could not do it without you.
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