The VBAC Link

Aubrey shares her three birth stories that tell of resilience, healing, trust, and miracles. She has had a vaginal birth, a crash Cesarean, and a VBAC– all of which presented cholestasis. Aubrey’s first birth was a long but routine induction. Her second birth was a traumatic whirlwind including a complete placental abruption, general anesthesia, and her baby miraculously surviving 15 minutes without oxygen. Though her third pregnancy had many complications, the open and honest relationship Aubrey had with her provider is what ultimately led to her TOLAC and successful VBAC at 37 weeks and 6 days after another medically necessary induction. Aubrey is proof that no two births are the same, and miracles happen even when circumstances threaten to say otherwise. **Aubrey also wanted to mention that after her VBAC, she was readmitted to the hospital for postpartum preeclampsia. She had a headache every day, decided to eventually buy a blood pressure machine, and it was through the roof. She took herself to L&D, and they put her on magnesium. Aubrey had no idea it was even possible to get it postpartum and wanted to share!Managing Cholestasis SymptomsHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. It is almost Christmas, and I am so excited to bring another story your way. This is a VBAC story from a mama who is from Louisiana. She had quite a few roadblocks within her pregnancies that could have easily stopped her from having a VBAC, but she really established a good relationship with her provider even though her provider wasn’t actually as gung-ho or excited about the VBAC specifically because she was nervous, together they communicated their feelings and understood where each other were, and came up with a plan to ultimately have a VBAC.I just respect that so much. It’s important to know. We talk about providers all of the time. Providers are so important, and they make such a big impact on our outcome, but this provider, even though she wasn’t really comfortable with VBAC, she truly believed in our guest, Aubrey, today. You’ll have to hear it from her own words. It’s awesome to hear how everything unfolded. We also have a topic today that maybe isn’t shared a ton. It’s called ICP or cholestasis that we are talking about. It is a liver condition that can occur during pregnancy and cause a range of symptoms. A lot of the times, it is baby being born that is the thing to end cholestasis. We are going to talk a little bit more about that, but I wanted to go over some of the symptoms. We’ve got dark urine, pale or light gray stools, and she’ll talk about this. That is definitely something that is not normal in pregnancy, so if you are seeing that, that is a reason to contact your provider. Nausea, she described some other symptoms there. Decreased appetite, pain in the abdomen, or jaundice. These are some things to look out for. Now, there is a website called icpcare.org. We’re going to make sure to attach that in the show notes, so if you have had cholestasis before or you want to learn more about cholestasis and how to manage the symptoms, and what types of things like healthy diet, they have so many amazing resources on their website. They even have recipes and different types of healthy fats and grains and legumes and things that we can focus on. We know that all of the time in pregnancy, really what we are putting into our body is so important. Definitely check out icpcare.org if you want to learn more about ICP and managing symptoms and resources and community support and all of the above. We do have a Review of the Week, so I want to get into that, and then turn the time over to Aubrey. This reviewer is reneekc89. The review title is, “A Turning Point”. It says, “When I was pregnant with my first, I was one of those ‘whatever happens is fine’ moms about birth. Then I had an unplanned Cesarean after a stalled induction. It wasn’t until I saw family members and friends so easily have vaginal births that I knew I had to try something different the second time around. I found this podcast through a local mom’s group and immediately binged every episode. I continue to listen every week even after my successful VBAC in October 2020.”It says, “Listening to what seemed like every possible outcome helped me release my fear that I might have had. I felt emotionally prepared for anything that might have come my way. I switched hospitals and advocated through my entire 25-hour labor in the hospital, and felt like every decision was a conversation between two adults rather than demands.” Oh, what a powerful thing right there, you guys. She says, “I advocated throughout my entire 25-hour labor in the hospital and felt like every decision was a conversation between two adults rather than demands.” That is how it should be. It says, “I have to thank this podcast for helping me gain that kind of confidence. Thank you also to the Facebook Community for always answering my questions.” Oh my gosh. Thank you, reneekc89, for that review. Just a reminder, you guys, if you have not found us on Facebook yet, check us out. You can find us at The VBAC Link Community. You have to answer a few questions to get in, and then you’ll get into this amazing community. We have the community on Instagram, and Facebook, and in this Facebook group. I believe so much that this Facebook community will empower you along the way. Like she said, you can ask questions, share pictures, and share concerns, and share triumphs and feel that love and support along the journey. I also wanted to throw out that we have a CBAC group, so if you are going for a TOLAC and it does end in a Cesarean, or you choose a Cesarean birth after a Cesarean, this group is here for you as well. You can find that at The CBAC Link Community on Facebook. Meagan: All right, Ms. Aubrey. Welcome to the show. Thank you so much for being here. I know you’ve probably been waiting. I feel like there are so many times when people are really excited to record their story, then I’m like, “Hey, you’re going to be aired this much further out.” You have two months to wait. You’re recording now, and then in two months, you’ll be airing on, but I’m so glad you are here to share your three stories. You had a C-section, then two VBACs, right? Aubrey: I had a vaginal birth, then a C-section, and then a vaginal birth. Meagan: That’s why I’m thinking two vaginal births. So vaginal birth, then Cesarean, then vaginal birth. You’ve got all sorts of different things added to your story. Aubrey: So many. Meagan: Cholestasis is one of them, right?Aubrey: Yes. Meagan: Okay. I’m excited to talk about that, because I think a lot of people think with cholestasis, there’s only one answer. We’re going to be talking about that, but I’m going to turn the time over to you.Aubrey: Okay. I guess we’ll start with my first birth. Heads up if I cry at all during it because I just do that sometimes. Meagan: That is okay. That is okay. Aubrey: My first pregnancy was totally normal. I had no complications. I was big and miserable, but that was about it. I did have SPD, so my pelvis hurt really bad. I didn’t know enough about it to go to a chiropractor to fix it. That was really my only thing until right at 38 weeks, it was that night at about 11:00 at night. I started itching on my feet. I couldn’t scratch the itch. I got my husband’s socks, and I put gel ice packs inside of them and wore them. That helped, then the itching started in my hands. This had been going on for about 2 hours, so I got in a really cold bathtub. The itching had started to spread more. It wasn’t just my hands and my feet. It wasn’t a normal itch. It was coming from underneath my skin. It was like my blood was itching. Meagan: People have described it to me as an unreachable itch.Aubrey: It is. It’s the most miserable. Meagan: You touch the spot, but you can’t get to it.Aubrey: Yeah. It’s like when the inside of your ear itches. You’re like, ugh. It’s like that but all over. Nothing helps. I called the after-hours line at probably 4:00 in the morning. The doctor on call was like, “Pregnancy can be itchy. Take some Benadryl.” I was like, “I’ve already taken Benadryl. It’s not helping.” She was telling me to take some creams, and I knew something else was wrong. I spent the rest of the morning researching. I came to the conclusion that I was 99% sure that I had something called cholestasis, and that I was going to have to be induced.One thing that solidified that was that there were other symptoms that I didn’t know about. My stool was white. It was really weird. It just was white-colored. I had this really violent episode of vomiting beyond anything I had ever experienced in my life. That’s one of the things. It’s this uncontrollable exorcist-style vomiting. Meagan: I actually did not know that. Aubrey: Yeah. It was unnatural. I remember thinking, “That was so weird,” but it was a couple of days before that, and then the next day or so was when I had the weird white-colored stool, but again, I had never been pregnant, so I was like, “I guess this is just pregnancy,” then the itching. That’s when I put it all together, and I was like, “Well, I’ve got cholestasis.” My husband was working that weekend, so I got my best friend to bring me to the hospital. When we got there, I was scratching all over. I was saying, “I’m pretty sure I’ve got cholestasis.” They clearly didn’t believe me. They weren’t being ugly. They were like, “All right. Let’s see what’s really going on here.” They put me in triage, and the on-call doctor came in. She is a lovely person. I don’t mean anything bad, but she walked in. She said, “Okay, here’s why you don’t have cholestasis.” She starts listing off all of these reasons. One of them was that I wasn’t jaundiced. Later on, in my research, there’s only 30% of women who have elevated bilirubin levels when you have cholestasis. I wouldn’t have been jaundiced because my bilirubin wasn’t elevated. I said, “Okay. I understand all of that, but can you please just run the labs?” She was like, “Okay, if you want me to run them.” She brought the lady in there. They did the labs, and about 30 minutes later, she came back in, and she was like, “Okay. You were right, and I was wrong. You have cholestasis, and we are going to induce you right now.” I was like, “Okay.”Meagan: Oh my gosh.Aubrey: I called my husband and told him he needed to leave work. At about 5:00, I think– I guess it was about 5:00. They put misoprostol. Meagan: Mhmm, misoprostol, yeah. Cytotec. Aubrey: Yeah, they inserted that. After the first dose, they determined that my cervix was not tolerating it well. They decided to not continue it. They went straight to Pitocin. I didn’t know then that what they were doing was really, really fast, but they were upping it every 15 minutes 2 milliunits. Meagan: 15? Wow. That is really fast. Aubrey: It is. Now that I know. At the time, I was like, “Okay.” During my birth, I prepped. I read books, and I went to classes, and I did the Bradley method, and all of the things, but I didn’t prepare for induction because I had no idea that I would ever need that, so I knew a lot about birth, but I did not know anything about induction. I was like, “Okay, if you say we’re going to do that, we’ll do it.” I think I felt my first contraction. It wasn’t that long after the Pitocin, but it wasn’t that strong. I had contractions off and on for several hours, and the nurses would come in and say, “Oh, are you okay? That was a really strong one.” They didn’t feel that bad to me, so I was like, “Oh, I can do this.” That went on for a while, and I guess once I got going more, It just felt like I was always contracting. I didn’t know any different, again. I didn’t know any different. I just thought this was what it was. Sometimes, it would be more intense, but there was always a contraction. Even on the monitor, you could see that it never dipped down. She asked if she could break my water at 7:00 that morning. It was my doctor. I don’t know if she came to check on me or if she happened to be on rounds. She asked to break my waters. I told her I didn’t want her to right now. She came back later, and I was okay with her breaking it, so the floodgates opened. I had so much fluid. We did not realize how much fluid I had. That was that morning or maybe the mid-morning. That evening, I hadn’t slept in two days at that point because of the itching the night before, and then the contractions. I asked the nurse, “If I get an epidural, will I sleep?” She was like, “Probably so,” then I was like, “Then give it to me. I am so tired.” I did. I slept like a baby. The nurse, I wish I knew her name, but she was so sweet. She came in the night. She put a peanut ball in between my legs. I was only 4-5 centimeters at that point. She put a peanut ball in, and she would come in every 30 minutes. She would flip me from one side to another while I was sleeping. I woke up the next morning at 6:00 in the morning. I had been in labor at that point for 39 hours. I got the epidural at 30 hours. Meagan: Wow. Aubrey: Yeah. She came in the next morning, and the doctor was like, “Okay. You’re ready to push.” I was like, “I am?” The epidural was so strong. I couldn’t wiggle my toes. I had no idea. She came in, and set everything up. I pushed her out in 15 minutes. Meagan: Whoa. That’s awesome. Aubrey: 14 minutes actually. My doctor was like, “That’s the best I’ve ever seen a new mom push.” I was like, “Wow, yeah. Okay.” Meagan: Go me!Aubrey: Yeah. I didn’t have any reference. For me, I was like, “This is taking so long, but apparently it was very quick.” Now I know it was pretty quick. Afterwards, my uterus would not contract back. My placenta wouldn’t come off. Now I know it’s because afterwards, she told me that my contractions never stopped. There was never a break between contractions, so my uterus was just completely exhausted. Meagan: Uterine atrophy, yeah. Aubrey: Yeah, so she had to manually go in there inside of me and start my uterus to contract again which was not pleasant, but she just basically had to shock it. Meagan: Stimulate it, yeah.Aubrey: Yeah. Eventually, it did, and my placenta just fell out. That was that. When they broke my water, I forgot to say, they did find meconium which is common in cholestasis. It was very light, and she wasn’t worried about it. It wasn’t an automatic C-section because of the meconium. It was really light. She did have to be suctioned, but other than that, she was perfectly fine. We didn’t know any of the genders for any of my babies, so it was fun to find out that she was a girl. That was birth number one, and that was in 2018.A year and a half or whatever it was, I got pregnant right before COVID became a big thing. I was pregnant all through the COVID scare. I was due in September, at the end of September. Again, it was non-complicated. I forgot about this. I had a subchorionic hemorrhage around 16 weeks which I didn’t know about. I didn’t have any bleeding or anything. They just found it on the ultrasound, and then by the next time I went, it was resolved. I was considered high-risk though the whole time because of the cholestasis, so I had frequent scans all the time. That was really the only thing that was weird. We had tested for cholestasis. There were a couple times because anyone who has had cholestasis knows that anytime you itch, you’re like, “It’s back.” There were several times I had her test me, and there were no elevated levels. Right before 39 weeks, I told her about some intense itching on my foot. I told her that this time was it. It was the itch. She was like, “Okay, well because of COVID, and we’re not sure what the hospital bed situation is going to be like, we’re going to go ahead and test your blood and find out if it’s present, but in the meantime, let’s go ahead and schedule your induction to make sure you have a place if we do have to induce, then you’re already there.” She wanted me to induce that day. I couldn’t because my husband was gone for the Army. I said, “I just need a few days for him to get back in town.” That was on a Thursday or Friday, and I was induced either Monday or Tuesday. It was on September 1, 2020. I went in for my induction. This time, I had not prepared at all. I was like, “Oh, it’s like riding a bike. I’ve done it once. I can do it again.” I want to say upfront that anything they did during the induction, I was totally a party to it. I agreed. I never said no. I never asked questions. I was uninformed or unprepared or whatever, but I never spoke up, so I don’t blame them for anything that happened because I could have spoken up, but I didn’t. They always asked me. They never told me, “This is what we’re doing.” They asked me my permission for everything. We got there. They did not do Cytotec because it hadn’t worked before. They went straight to Pitocin. Again, the same 2 milliunits every 15 minutes. Meagan: Is this just their way?Aubrey: I think it was. I don’t think it is anymore, because it was different when I went for my VBAC, but yeah. Meagan: Well, I wonder if that’s because you were a VBAC though. Aubrey: No, because one of the conversations I had with one of the nurses, I asked her if we could start slow. She was like, “Well, our policy is to go 2 milliunits every 30 minutes.” I was like, “I’d like to go slower than that.” I think they must have changed their policy. I don’t know. That’s what my hospital records say is that they were doing 2 milliunits every 15 minutes. I got those thanks to y’all. I was like, “Let me go see what that says.” Meagan: It’s nice to see what it says, yeah. Aubrey: Yeah, it is because in my situation especially with what happened to my son, it was so amazing to read what really happened and to know my son is where he is. I’ll get to that. Anyway, so she came in around 7:00 in the morning. My doctor was on shift. She asked if she could break my waters. I was like, “Sure, go ahead.” She broke my water. So far, it had been a pretty uneventful induction, nothing to write home about. I didn’t have an epidural. I didn’t feel like I needed one. I was going to try to do it without one if I could, but that might have been at 8:00 or 9:00 in the morning. I don’t know. It was in the morning. Around lunchtime, they started saying that the baby was wiggly and that they couldn’t really get a reading of his heart. He had been wiggly before, and so they were like, “Is it okay if we insert an IUPC?” I had that with my daughter. It doesn’t harm the baby. It didn’t hurt me. I didn’t mind them putting it in, which is for those of y’all who don’t know, it is a–Meagan: Intrauterine pressure catheter. You’ve got it. Aubrey: It measures the contractions from the inside so you can see how effective they are and all that. I was like, “Fine, yeah.” My nurse, whose name is Becca, she’s lovely, inserted the catheter into my uterus, and the tube that comes out is clear, and it filled with dark red blood. I knew something was wrong. I said, “That shouldn’t be red like that.” She said, “It’s okay. Sometimes we have a little bleeding.” I said, “Not like that. That’s red.” She was trying to calm me down. Meagan: Yeah, and sometimes they can knick the cervix and it can cause bleeding, but you were like, “No. Something’s not right.” Aubrey: Yeah. I just knew something was wrong, but before that, I had no symptoms. I had no clue that anything was wrong. I didn’t feel bad. I didn’t feel any pain. Nothing. I was like, “You need to take it out. Please take it out. Please take it out.” She called my doctor who was in her clinic down the hospital, and she said, “It’s okay to take it out if she’s not comfortable with it.” When she took it out, blood just came shooting out of me. It was gushing. Meagan: Really?Aubrey: I know it was blood mixed with fluid, so that’s why it was so much, but it looked like it was pure blood. It was so dark. I mean, I was like, “Okay, I need the doctor.” Becca was so sweet. She said, “Okay, just give me one minute. I’m going to go outside and get the doctor.” She was so calm. I was freaking out. She went out there. My doctor was in my hospital room within a couple of minutes. I think she was across the hospital in her office. She was there within a couple of minutes. She had an ultrasound machine. There wasn’t a lot of time for talking about what was going on. She just got the ultrasound machine, looked for a second, pushed it up against the wall, and my doctor has the most wonderful bedside manner with the way she talks even when she is stressed out. She said, “Okay, Aubrey, we’re going to have to go back to surgery now. Brandon, I need you to tell your wife goodbye.” As she’s telling him that, they’re pulling my jewelry off. The other nurse handed me a consent form for a C-section. They were prepping me as we were talking. Then they ran me down the hall. It felt like Grey’s Anatomy. They pushed this poor woman up against the wall. I remember her head hitting the wall. It was that fast. We were running down the hall. We got into the OR, and I just remember them prepping my body and prepping the room. They were getting the instruments lined up. There was no time for anything. I didn’t have an epidural, so they didn’t have time to call an anesthesiologist to my knowledge. They started putting the lidocaine where my incision was or was going to be. I started hyperventilating. The nurses threw a bedsheet over my head. They popped up under there with me. They were like, “I’m so sorry, but this is the best we can do. We don’t have time to put a sheet up. We’re going to have to stay under here. We’ll stay here with you.”Meagan: Oh my lanta. Aubrey: Yeah, it was really scary. I remember right before they threw the sheet, I could still see the door swinging. That’s how fast everything happened. They eventually, she was like, “You have to calm your breaths down because the baby needs the oxygen.” Little did I know that it really didn’t matter how much breath I took. He wasn’t getting anything. Eventually, they put me out with gas. Meagan: Did they put you under general?Aubrey: I had to be gassed out. I was hyperventilating. They were like, “We need you to be still.” At the time, they were literally about to cut me before they threw the sheet over. I remember the very last thing that my doctor said to her nurse was, “There’s no fetal heartbeat. There are no fetal tones.” I knew at that point that he was dead. Meagan: That’s the last thing you heard. Aubrey: Yeah. I woke up. I don’t know how much longer it was. It was pretty quickly after surgery because I don’t think they anticipated me waking up so early. I was in a hallway. I wasn’t in a recovery room. Because I wasn’t out all the way, I don’t know, but I woke up, and two of the nurses, because there were like 18 people in the room with me when everything happened. The nurses’ backs were to me. I said, “Is my baby alive?” One of them said, “Oh, she’s awake.” They turned around. One of them said, “They’re doing everything they can.” I passed back out. Then I woke back up in the recovery room. My doctor was waiting for me. It was COVID, so my husband wasn’t anywhere near any of this. Meagan: Yeah, I was wondering. You said his name was Brandon, right? They were like, “Bye, Brandon. We have to take her.”Aubrey: Then he was just left alone in the labor and delivery room freaking out. Meagan: No one talked to him?Aubrey: He told me later that my doctor had come in after the surgery to tell him everything that happened. Immediately afterward, she came in there to tell him. She is the best doctor in the whole world. Meagan: But he had to wait. Aubrey: Yeah, he had to wait. There wasn’t any time for anybody to tell him anything. Meagan: How scary for him. Aubrey: Because come to find out, my placenta had spontaneously 100% completely detached from my body in a matter of a couple of hours. If anybody has ever had a placental abruption, it starts slow. It comes off a little bit at a time. Mine came off in a couple of hours. It was completely detached. We didn’t know why at the time. It was very unexpected. She was there. I woke up, and I said, “Is my baby alive?” She said, “Do you want to know what you had?” I said, “Is the baby alive?” She said, “He’s alive, and he’s a boy.” Then she told me what happened. He was dead when he was born. He was dead for 15 minutes. Meagan: Wow. Aubrey: Yeah, 15 minutes. He had no blood flow or oxygen flow to his brain. A lot of his blood had been drained out of him because my placenta had pulled it out of him because it was detached so quickly I guess. He was not completely exsanguinated, but he lost a lot of blood and he had no heartbeat. According to my hospital records, they tried compressions. They tried the electrode things. They tried an epinephrine shot, and they tried an epinephrine drip, and nothing started his heart, and then after 15 minutes, his heart just spontaneously started by itself. Meagan: Wow. Aubrey: Yeah. That’s why it was so cool reading back my hospital records to see. My doctor and everyone involved was like, “We can’t believe this. I cannot believe he is alive. I cannot believe you are alive,” but reading it and seeing how amazing it really was was really cool. She told me that the surgery had happened in just a few minutes, and that because of how quickly she had to perform that surgery, that my recovery was going to be really intense, and that most people who have a C-section would not be in as much pain as I’m going to be in because they literally had to rip my body open to get him out, but she said, “Your incision is fine.” Luckily, she’s a really skilled surgeon. She did all of that perfectly. She said, “I don’t expect any trouble with you healing or anything with your scar.” He was put on a cooling blanket and intubated and given maybe six blood transfusions. If anybody from the hospital is listening, I’m sorry if I get the numbers wrong. But it was a lot. There were six little stickers missing from his transfusion bracelet. He couldn’t eat. We couldn’t pick him up. We couldn’t touch him. I couldn’t see him for the first 24 hours because I couldn’t move, so the nurses had taken pictures of him and brought them to me so I could see what he looked like. They didn’t show me the really scary ones until later because there were some at the very beginning that were very scary-looking. My doctor came in the next day to check on me. It was her day off. She just came in to check in on me to tell me how grateful she was that I was there. I know it traumatized her too because she said she had never opened up someone and seen their placenta floating inside of their body. My nurse, Becca, came to see me. She was also pretty traumatized. But anyway, it was a lot. Once he was in the hospital, they put him on the cooling blanket and all that. He had to be on the cooling blanket for 72 hours, and then they were going to be able to test him to see how significant the brain damage was because we knew that he would have some. I mean, after 5 minutes, you start to have brain damage, and then we knew having been out for 15 minutes that we were looking at something pretty significant based on science. That was the thing that I think was different about me then than now. My background was in physiological psychology. That’s what I studied in grad school. My immediate thought was, “I know what science says. I know the probability is of my baby,” and that’s what I was looking at. What do we need to do to take care of this baby with significant brain damage?We waited, and on the second day, the day before I was released from the hospital, I had a really cool encounter that was just the way that God changed everything for me which came into my VBAC later because of the faith that it gave me, but I had dragged myself to the shower that morning. It was so painful. My husband was still asleep on the couch. I got in the shower, and the water was cold. That made it even worse pain because it was cold. I was in the shower, but I couldn’t get up because I was frozen in pain. I was like, “Why is this water in the hospital cold? It shouldn’t be cold.” I sat in there for about 15 minutes. The water stayed cold, and it never warmed up. Finally, I said, “God? If you can’t save my baby, can I at least have some hot water?” The water turned hot. I just started laughing and crying at the same time. I just knew that my baby was okay. I don’t know how I knew. I just knew that even if he wasn’t going to be perfect, whatever was wrong with him was okay. It helped me to get through the next few days because it was hard to see him just laying there. Finally, when they were able to do his tests after 72 hours, we had to go to a different hospital. He had to go in a little ambulance and go over there. We had one of the best pediatric neurologists in the area, Dr. Holman. She’s not known for her bedside manner, but she’s an incredible, incredible doctor. I say that in a way that she’s very to the point. She doesn’t sugarcoat anything. My sister, who is a nurse, warned me, “I’m just telling you that she’s the best of the best, but she’s not–” Meagan: She’s blunt. Aubrey: She’ll give it to you straight. That’s what we were expecting. They did his little scans, and when she came back she said, “I don’t have a medical explanation, but your baby is perfect. There’s not a single spot on his brain. The cooling blanket does incredible things, but I should see something, and I don’t see anything.” Meagan: Wow. Aubrey: She said, “Your baby’s going to be perfectly fine.” She told us that he’s probably going to have some issues from being in the NICU and being still. He would have to have physical therapy to help his muscles and all of that, but as far as his functioning as a human being, he was perfectly fine, and nothing was wrong with him. Meagan: Yay. What a miracle. Aubrey: Yeah. That’s what she said. She said, “Your baby is a miracle, and I don’t get to say that with what I do very much.” Meagan: That’s awesome. Aubrey: Yeah. So that was his birth, and after that, that day, my husband left and went back to the Army. I recovered from that. I recovered from that pretty much alone which was almost as traumatic as what happened in the hospital because I was in so much pain, and I had a 1.5-year-old and a new baby who screamed all the time which was one of the things they warned me about after the NICU. They said, “He’s going to cry a lot. We don’t know why, but coolant babies just scream a lot.” He did. For hours and hours and hours, he would scream. It felt like torture in a way because it was like I couldn’t do anything. He would scream and scream and scream. My friend, Ashley, and my sister were the only way I made it through that. I would call my sister, Kelly, and be like, “I need to come over,” at 3:00 in the morning. She was like, “Come on.” She would hold him while he screamed so I could go in the back and sleep because I was so sleep-deprived and in so much pain. Then my friend, Ashley, would come over and help me clean. She helped me with my daughter. They helped me through that part. My husband was gone for the first 6 months of Amos’ life. About 2 years later, I got pregnant again. I was really scared of having to have another C-section. I was on a pregnancy app, and I asked, “Has anyone ever had a vaginal birth after they’ve had a Cesarean?” Somebody on there was like, “Oh, you should try this thing called a VBAC. There is a place called The VBAC Link.” I was like, “Okay.” I had no idea. I had never heard of The VBAC Link or the term “VBAC”. I found The VBAC Link, and like everybody else, I became obsessed. I listened to every episode, read every article, and every post. By the time it came time for my first appointment with my doctor, I knew that I was going to at least give it my best try. When I told my husband that I wanted to have a VBAC, he was not okay with that. He was really freaked out because, I mean, everybody involved was traumatized. He was. The nurses, the doctors, everybody. He was just like, “Are you sure that’s safe?” I was like, “Yes, actually. I am sure that’s what is safest.” I got on The VBAC Link, and I was like, “How do I make my husband understand?” They were like, “Enroll in the course and show him the course.” Meagan: Yes. Take the course with him. Aubrey: We did. By the end of it, he was like, “Okay. If that’s what you want to do, we will do it.” That’s what we planned for. I was really hoping that I didn’t get cholestasis for the third time. There’s not really anything you can do to prevent it, but I was just really hoping that somehow it wouldn’t show up. About, I guess, 20 weeks, I was told that I had complete placenta previa, so that was super fun. My maternal-fetal medicine doctor explained it, and this is for everybody who gets diagnosed with that. It made my brain so much more calm. He told me that your uterus is a muscle. It’s juicy, and it has all of these blood vessels. Your cervix is a connective tissue. It doesn’t have all of that. Naturally, your placenta is going to gravitate toward where it can get the most nutrients. It almost always resolves itself because it’s not going to get what it needs off of your connective tissue. I just banked on what he said, and by 28 weeks, it had gone so far up that it wasn’t a concern at all. Around 24 weeks, I started seeing a chiropractor for severe SPD. My pelvis was on fire. It was grinding, and all of the things. It was worse than with my daughter. I didn’t have it at all with my first son, but man, it was back with a vengeance with my third pregnancy. The chiropractic care helped so much. If anybody is in the Natchez, Mississippi area, my chiropractor moved to Natchez, Mississippi after she helped me. But anyway, that’s where she is if you’re near there and you need a good Webster-certified chiropractor, she’s amazing. Her name is Dr. Ashley Edwards. She helped me. Then she helped me with positioning and stuff. She’s really good. That was 24 weeks. I started that. Early on in pregnancy, I had been coming from one doctor to the other in the same building, and I was really huffing it. My blood pressure was high. They let me sit for a minute and retest it, and it was fine. I didn’t think anything of it until later on in pregnancy when that happened again. My maternal-fetal medicine doctor freaked out. He was like, “You’ve had two high blood pressure readings. We need to test you for preeclampsia.” That was in my third trimester at some point. I’m probably skipping around. He kept pinching me to see, and asking me if the swelling was normal. I kept telling him, “That’s just my ankles. I just have big calves and ankles.” Every time, he would be like, “Is this swelling always like this?” I’m like, “That’s not swelling. It’s just what my ankles look like, but thank you.”Meagan: Oh my goodness. Aubrey: That was fun. I had to carry around my urine for 24 hours to the urine test. He said that I did have protein in my urine, but it didn’t meet the threshold of preeclampsia, so I was not preeclamptic, but they were going to watch me for it. Toward the end, I did get, “Your baby’s really big,” not from my OB, but from my maternal-fetal medicine. My OB– I guess I should rewind. I didn’t even talk about how we had that conversation. My OB from the very start was so amazing. When I first came in, she was like, “I’m so excited for you.” She was like, “Is it okay if I tell Becca (my nurse from before)?” I said, “Yeah, you can tell her.” She texted Becca and told her. Becca and I stayed in touch through everything. She texted me, and she was excited for me. But I told my doctor that I wanted to try for a VBAC, and she said, “I’m perfectly fine with that. I don’t see an issue.” She was like, “The only thing that could possibly present an issue is if your cholestasis comes back, and it’s early on. But for now, let’s plan for a vaginal birth, and that’s the goal. If something changes, then we’ll talk about it when it changes.”She’s a very great doctor because you can talk to her, and you can be open with her and be honest and never feel like she’s judging you for telling her how you feel. I can’t tell you how many times I cried just with her telling me all kinds of different things. She just listens and never judges. We went through most of the pregnancy with that as the goal until at the end, around 32 weeks, my itching came back. They tested me, and I had elevated bile acids, so I was considered to have cholestasis. They put me on ursodiol. I only itched for a few hours, but I knew what the itching was. It’s so different. I knew what it was. I never itched again the whole pregnancy. Even before I got on the medicine, before I had even picked up the prescription, the itching had stopped. I still took it. At that point, they were like, “Okay. We can’t let you go into labor naturally. We’re going to have to induce,” because that is an automatic induction. Then the whole thing with the preeclampsia came around a little bit after that, so my maternal-fetal medicine doctor was talking about, “We might need to do this at 35 or 36 weeks.” I was like, “I don’t think I’m comfortable with that.” My doctor was like, “We’ll see, but if you have preeclampsia, that changes everything.” My doctor, my OB doctor– I was talking to her about everything, and she was like, “The reality is that what you have could potentially be dangerous for baby. So every week from about 35 weeks on, we’re just going to have to determine if baby is safer in or if baby is safer out, then at that point, we can determine how we are going to deliver the baby because we don’t know what your body is going to be doing. We just have to see.” She said, “I’m not telling you that you can’t have a VBAC. I’m just telling you that we need to be open to the possibility that it could turn into a C-section if this doesn’t go the way we want.” She said, “I feel like as your doctor, I wouldn’t be doing you any service if I didn’t at least have this conversation with you because if it came to the point that we had to have a C-section, and we had never talked about it, then you would be like, where did this come from? I don’t want you to feel blindsighted.” I appreciated it. I did leave really discouraged from that conversation. I cried because I thought that secretly she was trying to bait and switch me. But I should know that my doctor really is great. Anyway, so we went through the next couple of weeks where she would tell me, “Baby is safer in, so baby gets to stay in.” I had scheduled a lunch with Becca. I had asked her if she would be at my new baby’s birth. She said she would be my labor and delivery nurse. We’d get to try it again. She was like, “I’m going to help you have a VBAC. You can totally do this.” We had lunch. I told her about the conversation that I had with my doctor. I said, “I just want the opportunity to try. If I get to try and something happens and it doesn’t work out, then I’ll be okay with that. I just want to try because I know my body can birth a baby.” I said, “I don’t have to have the epidural, but if that’s what makes her comfortable, I’m okay with that because I’ve had the epidural before. It’s not like I’m anti-epidural. I’ll have it if that makes her more comfortable.” I’ve realized that she is a person with trauma, and I knew that what I was asking her to do was scary for her because of what happened and because probably most people don’t know, but cholestasis comes with the risk of placental abruption. It does something to the vascular structure, so it’s not that it causes it, but it makes you more susceptible to placental abruption. I knew that she was worried about that. I knew that everything else that had popped up and popped up and popped up, she probably was like, “I don’t think I want to do this anymore.” I told Becca all that, and she said, “Have you ever told your doctor that?” I said, “No,” because she knows her. She works with her. She said, “I think if you have that conversation with her, and you tell her just like you told me that she would feel a lot differently about it.” The next appointment was the appointment where we were going to do my first cervical check. We needed to know what my body was doing, so if I had to induce, they knew. Meagan: Where you were at. Aubrey: Yeah. It was one that I wanted and that I needed, I think, in that situation. Before she checked me, I knew that this time if she checked me and it wasn’t doing anything that she was probably going to be leaning more toward C-section because I was going to have to be delivering within that week or a few days after based on everything that was going on. When I got in there, I said, “Before you check me, I want to tell you something.” I said, “I just want to tell you this so you don’t think that my response to whatever happens in the check is me begging or anything like that. I just want you to know that this is how I feel.” I told her everything I told Becca. I told her that I wanted to meet her halfway and do whatever made her comfortable as long as I got to try. She said, “Okay. Let’s just check you and see what’s going on.” She checked me, and she said, “You’re soft. You’re 1 centimeter dilated, and we can have a VBAC.” She said– hold on. Let me get myself together. She said, “I’m uncomfortable with this, but the reason that I’m okay with this is because I trust you. I trust you enough to know that when you tell me your body can do this, I believe you. I know that you trust me enough to know that if I tell you it’s time to call it, then you’ll believe me and we’ll call it.” She said, “The reason that we’re doing this is because we have a mutual trust and understanding. We can be honest with each other.”I just sobbed and sobbed and sobbed. I mean, I was just so excited. On the way home, I got into a wreck. I totaled my car. Meagan: Oh my gosh!Aubrey: Yeah. It wasn’t as bad because it was totaled because my airbag came out, but it was in very slow bumper-to-bumper traffic. I had to go back to the hospital. She was on-call, and she was like, “Why are you here?” I had to be monitored for that, but everything was okay. Saturday at midnight was my induction. I came in, and they started my IV. It took them a while because I have really weird veins and they are hard to stick. Eventually, they called in an anesthesiologist to use his machine to find my veins. If anybody has hard-to-stick veins, you can use an anesthesiologist, and it works like a charm. He got my vein, and we started fluids. About 30 minutes later, it was probably at 2:30 or so whenever the Pitocin was in. I had my first baby contraction. Rebecca– a different Rebecca, but her name was Rebecca– said, “Okay, here’s the schedule we’re going to go on.” I forgot to mention this too, but right before my induction, my husband surprised me with his VBAC certification doula course. He had gone through the doula course. Meagan: Oh my gosh!Aubrey: He went through The VBAC Link doula course. He was like, “Surprise! I can be your doula.” Meagan: That is amazing. Aubrey: It was cute. My husband, when she starts telling me the schedule of how we were going to do everything, was like, “Excuse me, I think we need to not be going every 30 minutes. We need to be going every 45 to an hour.” He was so well-educated about the whole thing. She did. She did it slow at first, then we did that through the night. I don’t remember if I slept or not, but Becca came on her shift at 7:00. She was like, “Okay. You’re doing good, but here’s the reasons why I think that we need to increase the interval. We were having contractions, but we need to get a pattern going.” She told me why. I agreed with her that I was okay with it as long as it didn’t go faster than 30 minutes. We did that, and that started to actually get a pattern which was really nice. She is a brilliant nurse, and she knows what she’s doing. She was like, “We’re going to get you moving. Come on. Get up. We’re getting out of bed.” She had me walking down the hall, and with the peanut ball, and sitting on the ball. My doctor came in around 9:00. She told me that she thought we needed to break my water. I was really nervous about that because in my research of what happened to my placenta, I had found that it was likely that I had a placental abruption due to the rapid decompression of my uterus. My doctor agreed that that’s probably what happened, but when they broke my water, because my vessels were already weak, the pressure suctioned it off. I was really worried about breaking my water. She was like– I’ve never seen her be so stern with me before because she’s always so calm and nice. She said, “Aubrey, I’m very uncomfortable right now. I do not want to see you have a rupture. I do not want to see your placenta detach. We need to be real about this.” She said, “You have a lot of fluid. If we do not let some of that fluid out, your baby is not going to drop. You have a lot of fluid.” I did. I guess I forgot to mention that. I wasn’t quite poly, but I was pretty close to having poly.Meagan: Borderline. Aubrey: Yeah. I told her that I was scared. She said, “You cannot make decisions based off of fear. You have to make decisions based off of what is happening and what is fact. The facts are that your baby is high. Your body is contracting. You have a pattern, but your baby is not dropping. There is a reason, and it’s likely because of the fluid level.” So, she said, “I can break your water in a way that is not aggressive. I will just cut a tiny little slit and let it come out on its own, then it will come out.” I agreed. I mean, when I step back and look at it, I was like, “She’s right. Scientifically, the baby is buoyant and is just floating there.” Come to find out, I definitely had poly. I had so much fluid. When it finally came out, Becca was like, “I don’t think I’ve ever seen that much fluid come out of somebody.” It was the exact thing that the baby needed. He came down, and immediately, I went from 4 centimeters to 6 in an hour. I could feel my body doing very differently. It was changing differently than it had before. I started to get nauseous and shaky. I knew that I was probably getting closer to go-time. I told Becca, “You might want to get the guy to come give the epidural now. I promised her I would get the epidural, and if we’re going to get it, we’re probably going to need to get it now.” She was like, “Yep. Let’s go ahead and get it put in.” She had him put it in really light though so I could still move my legs and wiggle my toes. I could even put pressure on my legs which was nice. That was maybe at 2:00 in the afternoon or 3:00. Oh no. I got the epidural at almost 5:00. I was way off on the time. It was almost at 5:00 that I got my epidural. I had been between a 6 and a 7 and about 70% effaced. After the epidural, they had to go to an emergency, her and my doctor. They came back afterward, and me and my husband were playing Scrabble. I started throwing up. I had the bag, and I was like, “I need to throw up.” Becca came in and she was like, “You’re throwing up? This is the best!” She was like, “It’s time. It’s time.” I was like, “How do you know?” She was like, “I’m telling you. I’m telling you.” She checked me, and then Dr. Barrios came in, and she was like, “Okay, Aubrey. We’re going to have this baby.” My husband caught the moment. He has a picture of me the second that she told me I was going to have my VBAC. It was just the least flattering picture I could possibly have, but it’s so cool because it’s a live picture, and I could see the wave of emotion washing over me. I could feel pretty much everything. I mean, I’m sure if I had no epidural whatsoever, and I think Becca said she turned it down, but I’m sure it was way more intense if I was doing it without completely. I could feel everything. I could feel the ring of fire. I could feel opening up. To me, it didn’t feel like I had to poop. It felt like I had a bowling ball just sitting there. They were still setting up while I was trying to push. They were like, “Wait. Let somebody get there, so we can catch it.” Right as they were finished setting up and getting dressed and everything, I was like, “Okay, we’re pushing now.” I pushed. I don’t remember how many times I pushed, but I felt the head come out. I said, “Is that what the head feels like?” She was like, “Yep. That was the head. We just need one more push and we can get the body.” I pushed. He was out in 4 minutes. Meagan: Wow. Aubrey: Yep. It was crazy. I had to go back and make sure I was not crazy. I looked at the timestamps of the pictures because I was like, “There was no way that it was that fast. It felt like an eternity.” It was 4 minutes. Everybody cried. My husband got a picture of the first time they put him on my chest. As soon as I pushed him out, it was like all of the trauma and everything from before just washed off of me. It was so amazing. Meagan: I bet it was so healing for you to see that you could have a different experience. Aubrey: It was. Meagan: Even though you had a different experience with your first, after having that experience the second time, I’m sure that weighed over you for sure.Aubrey: Yeah. I love the fact that both my doctor and my nurse from the time before were there and we all got to do it again. Meagan: Yeah. Yeah. I was going to say that. I bet this was really healing for your provider and your nurse, and not even just healing for your provider, but something that stepped up her experience to see that birth could go a different way after a very traumatic experience. Aubrey: Yeah. Yeah. I think so. I hope that. I would say she’s not, “Woo, I love VBACs.” She was not anti-VBAC at all, but I would like to think that it helped her see VBACs in a more positive and more probable light. Meagan: Mhmm, exactly. I think you probably did a lot for her that she may not have even known that you did. Aubrey: She did a lot for me. She’s the best. The sad thing is that I have different insurance now so if I got pregnant again, I can’t have her. But she’s incredible. She really is. My baby– we didn’t have a name picked out. One of the other nurses, Jordan, who helped me deliver my baby was like, “I know you don’t have a name picked out. You don’t have to use this if you don’t want to, but I was just thinking that y’all wanted a cute, short name that started with A, and Becca’s last name is Anders, and it would just be really cute.” So we named our son Anders.Meagan: Cute. Oh my gosh. That’s adorable. I bet Becca is so happy. Aubrey: Yeah. When she left the hospital that night, because she charted forever and she left at 11:00 that night, we still hadn’t picked out a name. Jordan came in after she had left. She suggested it, and we were like, “That’s it. That’s his name.” I sent her a picture of the announcement with his name on it. She said, “I had to pull my car over on the road. Don’t do that to me while I’m driving.” Meagan: Oh my gosh. That is so cool and so special.Aubrey: Yeah. There were so many times on The VBAC Link where I see people who are like, “I don’t know if I should do it. I’m scared.” Just do it. Just try. If you succeed, it changes you. It’s so, so powerful. Meagan: It really is. It’s hard to explain. It’s so hard to explain that feeling that you get after having a VBAC. It’s unreal. It really is unreal. We just had a client the other day who had to be induced due to some pretty severe preeclampsia, and she was a VBAC. The second she found out that she had preeclampsia and needed to be induced, I think a lot of her faith slipped and her belief that it was going to happen slipped. We too have a very raw, beautiful, live photo of the second she saw her baby and her hands reaching down to grab the baby. It tells the whole story within that and that one image tells her whole story. It’s incredible. It’s incredible. Aubrey: The picture that I submitted to y’all is a picture of right when they put him on my chest, and I mean, it was so surreal. Another thing that I think I didn’t really mention is that there was a point when– because I had so much going on. I had all of these different complications and week to week. We don’t know if you’re going to have a baby this week. It was so stressful. Eventually, I just had to say, “Okay, God. You healed my baby. You started his heart. You healed his brain. You can make my body do what it’s supposed to do. I can only do so much. I can eat the dates. I can drink the tea, but after a certain point, there’s nothing else I can do other than just walk it out and just trust that God’s going to walk me through that.” I had to keep reminding myself of that with every single step because it got really hard. There’s a community called “Labor Nurse Mama”, and I was a member of that community too. There’s a doula on there. Her name is Lamay Graham. I think she’s in Milwaukee. I’m going to tell you where she is, but she’s a doula, and she’s incredible. We would have these live chats and Zoom calls. They would talk to you.She would help remind me, “You can only do so much, Aubrey. You’re doing everything that you can. Stop putting it on you because your body is going to do what it’s going to do, and you’re not going to change that the more you stress yourself out. You have to just trust God.” She is one of the reasons I kept being able to come back to reality. It was because she would remind me, “You have to just remember. Stop trying to do it all yourself.” Meagan: Yeah. We have to trust, have faith, and do everything we can within our own power, but then understand that there are going to be other things, and you have to have faith in those things. The more educated we are and prepared we are, we can navigate through those things. Well, I am just so stinking happy for you. I can see the emotion. I can hear the emotion. I saw the pictures. If you guys are listening right now, go over to our Instagram or Facebook page, and check out this beautiful image of her just holding your baby. You’ve got Jordan in the background, your nurse Jordan. I mean, really, it’s so beautiful and I’m so happy for you. Congrats. Aubrey: Thanks. I’m sorry I was kind of all over the place. Meagan: No. Listen, that’s okay. That is totally okay. I’m just so happy you are here to share your stories. Aubrey: Thanks. I appreciate you. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Marlene joins us from California sharing her journey to a VBAC after three C-sections. She was a teenager with her first, and her doctor suggested scheduling an elective C-section for convenience. Marlene didn’t even know what a C-section was.She became more educated with each birth experience. Still, when it came time to advocate for her physiological VBA3C birth, there were no hospitals, doctors, midwives, or doulas who would support her. Marlene decided to free birth at home with her husband. During labor, she made the call to transfer to the hospital. She arrived at 9.5 centimeters dilated and pushed her healthy baby out in just two pushes. Though she experienced resistance all along the way, Marlene kept fighting for the vaginal birth she knew she could achieve!Marlene's Doula Website: Designed to BirthHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. We are a week away from Christmas. I just cannot get over how fast this year has gone and how many incredible stories we have heard. I cannot wait to hear more stories next year. Today’s story is a VBA3C story. These are stories that we get requests for daily. On Instagram, we get people writing us saying, “I need more stories of VBAC after multiple Cesareans. Is VBAC after two Cesareans possible?” Yes. The answer is yes. We have Marlene here with us. Hello, Marlene. Marlene: Hello. Meagan: She’s going to be sharing her story just showing you how possible birth is. We have a Review of the Week. We’re going to get into that, then we are going to turn the time over to Marlene. This review is by Rachel, and it says, “11 out of 10. Would be best friends with these ladies.” I love that. You guys, we feel like we are best friends, too. Even though we haven’t met half of you, we just love this community so much. We feel like we are best friends. It says, “Amazingly knowledgeable doulas with a passion for compassion and birth. Funny, kind, smart. Specialized in VBAC. If humans are exiting your body, you want them by your side.” I love that. That is such a fun review. Thank you so much for your review You guys, if you have not yet, please help us kick off the 2025 season with some new reviews. You can go to Google and just type in “The VBAC Link” and you can leave us a review there, or you can leave us a review wherever you listen to your podcasts. Meagan: Okay, Marlene. Welcome to the show. Marlene: Thank you. Meagan: I’m so happy that you are here and excited to hear more details about these journeys of yours that led you to the final VBAC after 3 C-section point. Marlene: Yeah. Sorry if I say “like” or “um” so much because I’ve been on a few podcasts, and it never gets easier. For some reason, I am always so nervous. Meagan: It is hard. This is episode 300 and something, and I still say “like” and “um”. It happens. Listeners, just know it happens. Picture yourself sharing your story and thinking about what you’re sharing and who you’re sharing it too and what you need to share for them. It just happens. “Um” slips out.Marlene: Okay. So, I’ll get started. I really want to tell my VBAC after 3 C-sections, so my fourth story, but I will get into a little bit of my first three because that paints the picture of how I had my VBAC after 3 C-sections. I was 18 when I had my first. My son is now 15. He’s going to be 16 in November. Man, time flies. Meagan: Oh my goodness. It really does. Marlene: Yeah. I grew up in the LA area in Norwolk, so the outskirts of LA. I grew up with my grandparents because my parents were drug addicts and in and out of jail. The social workers took us and put us with my grandparents. There were 7 of us. We were fortunate to be together with family and my grandparents. My parents came when I was 16. I’m the youngest of 7. My parents came when I was 16 years old in the middle of my junior year of high school and were like, “We’re clean. We want to take you back.” My grandparents were old. They already raised all of their kids, and they raised all of us, so they were like, “Just go.” They were tired. I understood, so I was like, “Okay.” I went with my parents. They moved me about an hour away from all of my friends and all of my family. It was just us. Probably a year later or 6-8 months later, they started doing their stuff again. I got pregnant. I didn’t have anybody to ask. I wasn’t educated. I didn’t know. I was just like, “I’m pregnant. I’m going to go to the free clinic. I’m going to go to the doctor.” Being a sheep, this is what we do. I go to the doctor and the free clinic. My pregnancy was fine. My son was fine. I’m fine. There were no complications. It was a beautiful, good pregnancy, but towards 38 weeks, on my 38-week appointment, my OB/GYN was like, “Aren’t you so uncomfortable? Wouldn’t you want to have your baby on your due date? Most first-time moms go to 42 weeks.” In my head, I was uncomfortable. I was super swollen, but I didn’t have preeclampsia. He didn’t even mention preeclampsia or anything, but my ankles and my legs were probably 3-4 times the size of normal. I was very uncomfortable. I had back pains and stuff. He was like, “You want to have your baby on your due date?” I’m like, “Yeah.” He was like, “Okay. Let’s schedule you for you C-section on November 12th.”Meagan: Wait!Marlene: I didn’t even know what a C-section was, and not even an induction. Now that I think about it, no. It was straight to a C-section and I’m over here like, okay. I didn’t even know what a C-section was. I thought this is how the process was. I was just so uneducated. I trusted him. I was like, he was the “expert”. He knows best, so I’m just going to trust him. I showed up at the hospital on the time and date that he said. They prepped me for a C-section.Meagan: Wow. Marlene: Yeah. Now, in hindsight, now that I know, I’m like, that’s crazy. I could have probably sued him or something, but anyway. 4.5 years later, I’m 23 years old. I get pregnant again, and I didn’t educate myself still. I was young and living the party life. I was not really caring and not educating myself. I did plan this one though. The first one was unplanned. My girl was planned. We planned to have her, but I still didn’t educate myself. I just knew I wanted a VBAC because I wanted to experience birth the way women are naturally supposed to. I just went. I went to a different OB/GYN in a different city. I came back to Norwolk because I’m an adult, and I have my own place now. I went to my sister’s OB/GYN. She was like, “Oh, he’s good.” I’m like, “Okay.” I just go with him. He was fine. I actually got to go into spontaneous labor this time at least at 39 weeks. My water broke, and straight to the hospital I went. Meagan: Yeah. Marlene: I just went straight to the hospital because that’s what I was told to do. I got there, and my pregnancy was fine. There were no complications or anything. I got there, and they were like, “Okay. You’re not even dilated, but we’ll keep you here since your water is broken.” They let me labor. I didn’t feel anything. 12 hours passed, and they were like, “Oh, there’s a risk of infection. We have to get this baby out. There is failure to progress,” blah, blah, blah, and this stuff. I’m like, okay. I trusted them again, so they gave me another C-section.6 years later, so this is 2019 right before the pandemic, I got pregnant. It was probably actually 2018 because I had my second daughter in August 2019. I got pregnant, and I was like, “This time, I’m a little more educated.” I found the Free Birth Society. I was listening, and decided to do more research. My husband opened my eyes to, “Oh, we shouldn’t be vaccinating our kids.” He had been telling me before, but I was like, no. I was so brainwashed. My family is more medical-minded and stuff. Now, I’m the total opposite. My husband opened my eyes to things. I started doing more research. I can’t just trust the doctors now and stuff. Now, I’m in Fresno, California when I was pregnant. I searched high and low for a good, VBAC-supportive OB/GYN, and a lot of them told me, “No, we can’t do a VBAC after two C-sections.” This one told me that we could do it. She was truly VBAC supportive. I got to decline all of the things. I didn’t even do the diabetes test. I didn’t really do anything except for a little bit of bloodwork. I declined everything, and she was okay with it. Then she told me, “You don’t have to have a C-section. You could try for a VBAC, but I might not be the doctor who is on call. Who’s to say that the doctor who is on call is going to be VBAC supportive.” She said, “Just to warn you, you might have to stand your ground, and fight for your VBAC and stuff.” I was like, “Thank you for being straightforward with me.” My water did break. I went into spontaneous labor again. I went to the hospital right after again. I mean, it wasn’t as fast this time. I took a shower. I ate dinner, and maybe an hour or two later, I went to the hospital. I didn’t get a VBAC-supportive doctor. The whole time after I got there, she was like, “Okay, you can try for a VBAC.” She was telling me all of these things that I can’t do. “You haven’t done it before. What makes you think you can do it again?” Just all of this stuff.This time, I did feel contractions. I was in labor longer than 12 hours, but after the 12 hours, she started saying, “Oh, infection.” I had to keep fighting them off, the nurses, and the doctors. I was exhausted from labor. I believe I got to 6 centimeters or so. Those contractions were pretty hard. She just was like, “Oh, I’m about to switch shifts. Don’t you want me since you’ve already been working with me? Wouldn’t you feel comfortable if I gave you the C-section versus some new person?” They were doing whatever tactics. I was standing my ground, then finally, I threw the towel in because I was having to fight all of the nurses off while I’m laboring naturally. I had monitors, and the IV, and everything else. I was stuck on the bed. They wouldn’t even let me move or anything like that. I was just like, “Whatever.” I educated myself a little bit more, but I wasn’t fully educated. I didn’t know that I was the authority. I thought they still were. I did educate myself a little better, but not as much as I should have. They wheeled me off into another C-section, and then not even a year later, I got pregnant again. It was probably 6 months later. I got pregnant again. It’s funny because my two boys were unplanned, and my two girls were planned. I didn’t plan to get pregnant with my fourth. When I found out, especially because it was in the middle of the pandemic, they had pretty much just announced the pandemic when I found out I was pregnant, so I was bawling when I found out. The future was so uncertain. My husband and I just finally, because my husband wants a big family. He wants 7 or 8 kids, and I’m like, “You’re crazy.” I finally got him to say, “Okay, we’re done. We don’t have to have any more kids,” then I get pregnant again, and everything that was going on with the pandemic, I was bawling. I was like, “I can’t believe this, but whatever. I’m pregnant. I don’t believe in abortion. I’m just going to suck it up. I’m having a VBAC now,” especially since none of them were medically necessary. They were all unnecessary. I started doing way more research, reading books, reading articles, listening to podcasts, then finally, I did hear about the Free Birth Society before, but I really dug in and listened to every episode. They were the ones who made me want to do it and believe in myself. Finally, I tried to go look for a VBAC doctor though, and I went back to my other one who was truly VBAC supportive, but she was like, “Oh no, VBAC after three C-sections, we can’t do this.” I’m like, “Okay, then,” so I went to look for midwives in my area. I interviewed them all, and they were like, “Nope. We would lose our license. Sorry, we can’t do it.” I’m like, “Okay, I guess I’m just going to have to have an unassisted birth or a free birth, so I’m going to look for a doula.” I looked for a doula all in my area, and all of them told me, “No, we can’t be your doula because it’s going to be an unassisted birth.” So I’m like, “Okay, then. I guess I’m going to do it all on my own.” Like I said, I started reading all of the books, doing all of the things. It comes to the day. My due date comes. My water breaks actually on my due date. I’m like, “Okay.” But it was a normal day. I was cooking and stuff. But with my two girls, when my water broke, it was a full gush. This time, it was a little trickle. It might have tore. I knew about it. I was like, “Okay. It might replenish. I’m not going to panic. I’m going to go about my day.” It wouldn’t stop trickling, so I had to put a diaper on, a big pad or a diaper, and I just went about my day.I never felt contractions. I went to sleep, then the next day was a normal day. That night, I went to put my kids to bed, and my husband and I laid down. I started to feel these sensations. They were pretty hard. They weren’t hard enough that I had to get up and walk around, but they were hard enough to keep me up. They were not consistent, but they were happening all night. I didn’t sleep all night because of them. In the morning at 6:00 in the morning, they totally went away. I had another normal day. I went back to sleep, and I got to sleep that night. Then again, I put my kids to bed. Me and my husband laid down. I felt these sensations, and they were a little stronger. The same thing, I dind’t even tell my husband. I was just laying next to him. I put in my Christian Hypnobirthing. I tried to listen to it and breathe through them. They weren’t consistent, then the sun camp up, and they went away. The same thing happened every night for a week and a half. Meagan: Whoa. You were still having trickling and stuff or no?Marlene: No. I wasn’t having trickling. It was just that one day. My water never broke again. I think it really was broken for that week and a half. Meagan: Oh, okay. Marlene: It’s playing with me. I was just like, “Man, is this real? Is it not? Is it prodromal labor? What’s going on?” I’m like, “What’s going on?” Then finally, the day comes, and I had been up all night the previous night, then I had a normal day, then I went to bed, but at 3:00 in the morning this time, I woke up with strong, and they kept getting stronger, faster, and more consistent. I’m like, “Okay.” I couldn’t even lay down like the other day. I had to get up. I didn’t wake up my husband. I went and took a bath. I was like, “Oh.” I didn’t have a pool because I didn’t want to make more work for my husband. I was trying to be not selfish. Even though now, I wish I did have a birth pool, I probably wouldn’t have gone to the hospital if I did. I went in the bath. It was hard and small, so I’m like, “I can’t be in here. I’ve got to get out.” I went to the living room. I was pacing back and forth. I was on the ball trying to watch TV to get my mind off of things, then at 6:00 in the morning, my husband wakes up. He always wakes up early. He woke up, and he was like, “Are you okay?” I’m like, “Yeah.” I was like, “I think it’s the real thing this time though.” He’s like, “Okay, well I’m going to go to Home Depot.” I’m like, “No, babe. Don’t go. I need you. It’s really intense. The baby is going to be coming soon.” He’s like, “No, I’m just going to go.” I’m like, “Okay, whatever. Just go.” He goes, and I go to the restroom. I try to check myself because I never educated on myself how to check myself because I wanted to trust my body, and I didn’t want any cervical checks, but in the moment, I wanted to see how much longer even though cervical checks don’t really tell you how long you have, but in my head, I was like, “I’ve been going through this for a week and a half. I want to know how dilated I am.” I stuck my fingers up there wrong. I only went up to my first knuckle, but now I know you have to go put your whole hand in there and go way high up there. I only felt no opening, so I’m like, “Oh my goodness. How much longer am I going to have to go through this?” I started getting blood dripping down my leg. Meagan: Bloody show?Marlene: It was drops of blood dripping down my leg. My cervix was opening so it wasn’t bleeding a little bit. It wasn’t too much. It was just a little bit. I call my husband. I’m like, “Adam, get home.” That’s my husband’s name. “Take me to the hospital. I need an epidural.” He comes home 20 minutes later, then when he gets here, the first thing out of his mouth, “Are you sure you want to go to the hospital? Because you told me that unless it’s an emergency, don’t take you to the hospital. You told me this.” I’m like, “Shut up, and take me to the hospital.” I’m all mad at him because he left me, and he was not helping me. We drive to the hospital. It’s a 15-minute drive, and I get there. I’m like, “Check me. Check me. I want to know how far along I am.” They check me, and they’re like, “You’re 9.5 centimeters.” My whole mentality changed, and I’m like, “I should have stayed home. I’m here. I’m not going to take that horrible car ride again. I’m guess we’re going to have a baby here.” But when I got there, they were like, “Okay, let’s prep you for a C-section,” because this was the hospital that I had established care with my third, so they already knew I had three C-sections. They were like, “Okay, let’s prep you for a C-section.” I’m like, “I’m not having a C-section. I’m pretty much pushing this baby out. I’m 9.5 centimeters. I’m there.” They’re like, “Okay,” so the  nurse went to get the doctor 10 minutes later. Now, I’m pretty much complete. They didn’t check me any other times, but they were like, “Okay.” They just wanted her to tell me that I needed a C-section. I’m like, “Lady. I’m not having a C-section. I’m pretty much pushing this baby out.” She goes to my husband and says, “Your wife needs a C-section or her or your baby could die.” He’s like, “Lady, get out of here. We’re not going to do a C-section. She’s pretty much there.” Then she leaves, and then 10 minutes later, she gets more fierce. “You need a C-section, or you and your baby will die. Do you understand that?” I’m breathing through my contraction, closing my eyes, and ignoring her, then she goes and tells my husband the same thing. He’s like, “Lady, don’t come back. We’re not having a C-section.” So she leaves and doesn’t come back. I pushed the baby out in only two pushes. Meagan: Oh my gosh. So was the doctor even with you?Marlene: A different doctor which is the doctor who I had seen for my third, came. Actually, I forgot to mention this earlier. I did establish care with her, but since it was the pandemic, I had only seen her about three times throughout my pregnancy. I wanted to make sure I didn’t have placenta previa, the placenta wasn’t in the way, everything was fine. I went a couple of times to the doctor. I told her at the last one around 34 weeks or 36 weeks– I can’t really remember, but towards the end in the last trimester, she was like, “Okay, let’s schedule you for a C-section.” I’m like, “No, I have to talk to my husband and ask him for his schedule.” The whole time, I told her, “Okay, I will have a C-section,” but in my mind, I was planning that I wasn’t going to.She was like, “Well, we could schedule it now, then if it doesn’t work for your husband, then you can reschedule.” I was like, “No, I’ll just not schedule it, and I’ll call you once I get his schedule.” She’s like, “Okay,” then a week passed, then she calls me, but I didn’t answer, and they just left a voicemail, “Hi, we need to schedule your C-section.” I heard nothing from them after that. She never tried to call back. I never tried to call her back until I saw her in the delivery room. That was the lady who delivered my baby.Yeah, when she saw me, and I was pushing, she was like, “Hi, Marlene.” I’m like, “Hello.” She had a look on her face.Meagan: You’re like, “Yes, I’ve been ignoring you” Marlene: Yeah, it was funny. It was amazing. I told them I wanted delayed cord clamping. I didn’t want any vaccines. The whole time, she said, “You’re bleeding a lot. We need to cut the cord.” I did bleed a lot for their comfort, but I felt fine. It was a lot of blood, but I didn’t need a transfusion or anything. I didn’t feel dizzy. I felt fine, but in their case, I was hemorrhaging. I knew some women don’t bleed a lot. Some women don’t bleed at all. Some women do bleed a lot. It’s just different for everybody. I told them, “Leave the cord alone. Leave the placenta alone.” I still had to advocate the whole time because they were trying to cut the cord sooner than I wanted. They were trying to put the ointment on the baby’s eyes, trying to vaccinate, and then before I left, they told me, “CPS came to visit me because of medical neglect.” I didn’t see my OB/GYN too many times throughout my pregnancy. I used the pandemic. I was like, “I have three kids at home. Nobody could watch them. I can’t take them to the doctor with me. What do you expect me to do, leave my three young children at home unsupervised? I don’t know anybody around here to watch them.” They dropped everything. It was crazy.Meagan: What was that process like with CPS? We hear it happening. What did they do?Marlene: I guess they have somebody in the hospital, like a CPS worker working in the hospital for cases like mine or whatever. Meagan: Interesting. Marlene: She just came in. She was really sweet. She was like, “I have to come and check.” She was like, “Can you tell me why you didn’t go to the doctor? You only went three times throughout your whole pregnancy. You didn’t make it to every appointment.” I said, “I have three young children at home. Nobody is willing to watch them, and I can’t take them to my appointments.” She was like, “Okay,” That was it. She was like, “Okay, case closed. I just needed to do my job and ask you.” Meagan: It was like, “I’m going to take this baby away from you because you didn’t go.” This is the hard thing for me. I’m going to get a little salty. Providers need to do better. Hospitals need to do better. If they don’t want people having free birth or unassisted birth, stop pushing people to do that. I also don’t judge anyone who does a free birth. Everyone has their own thing. We’ve shared free birth stories on here, but if they’re going to give people so much crap and call CPS on them which is completely ridiculous because these people are just trying to do what’s best. Stop making people go that route. Providers, if you are listening, please change your ways, and do better because you can’t shame someone for going out of the hospital or not having support from a provider if you don’t offer the support that they deserve in the first place. We’re restricting midwives out-of-hospital. Providers are restricting after two Cesareans, and sometimes even after one. We have to do better in the medical world in order to see change. Then people who decide, “Okay. I’m going to do what I feel is right, and I’m going to free birth or I’m going to go unassisted, or I’m not going to be hounded about everything that I don’t want,” right? It’s so aggravating to me that people put people through CPS and things like that because they made the best choice for them when they were pushed away. You had three unnecessary Cesareans. You were failed from the beginning, right? In your very, very first birth, a provider set you up for failure that they had no idea maybe what the repercussions would be in the next few years with how much you’d have to go through to find the support and to get the support. It’s just frustrating to me. Marlene: Yeah. I totally agree. Honestly, that’s what made me, because I’m a doula, become a doula because I want to try as best as I can. I’m just one person and not a very important person in the medical world, but I try to educate my clients on not getting an unnecessary induction or unnecessary C-section. I’m not against them if they are an emergency, but if they are unnecessary, they’re handing them out like Oprah. “You get a C-section. You get an induction.” That’s how they’re handing them out. In my area, that’s what I see. And also, because the ladies who want to have a free birth like me, if I would have had a doula to support me, then I would have probably done it at home. I’m that doula who I was looking for. I support free birth. I’ll be there if you’re free birthing and you can’t find any other doula. Meagan: Yeah, and there are a lot of doulas who feel uncomfortable with it, a lot of it because maybe they are uneducated on it, but I do think it’s important for people who do decide to free birth just to make sure you are educated. You know what you are doing. You have a backup plan. You have the support. It is good to hear that you and other doulas are able to go and support still. Everybody has to decide what’s best for them and what feels best, but support is needed, so I’m glad that you are willing to support your community. Marlene: Yeah. Honestly, I’ve noticed that the ones who decide to free birth are very prepared and educated even more so than the ones who are doing it in the hospital and stuff because they have to, in my experience at least. Meagan: Yeah. They do. They do have to. I do believe that those people who decide to free birth don’t take it nonchalantly. It’s a very serious thing that they take. We talked about that in the last episode. It’s important to note that. These people are very educated. It’s not just, “Oh, I’m going to go have a baby by myself in my closet.” It’s not like that. Really, these people are educated. I’m so happy for you that you were able to fight through this, and to grow through each of your pregnancies and your births because you deserve that support. I’m sorry that you had to fight so hard in the pushing stages. Big eye roll. Again, we need to do better. We need to do better. Marlene: I agree. I’m grateful for podcasts like yours and other ones to get the story out there because we do learn as a community through storytelling and stuff. That’s actually what helped me a lot.Meagan: Yeah, they do. Thank you so much for coming on and sharing your stories today. Marlene: You’re welcome. Thank you for having me. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

In this episode, Meagan and Julie tackle hot topics like the VBAC calculator, epidurals, and uterine rupture. What does the evidence actually say? And why do providers give such drastically different statistics from one practice to the next? When you know the facts, you are equipped to take charge of your VBAC journey!VBAC CalculatorACOG: Deciding Between a VBAC and a Repeat CesareanVBAC Calculator Online LibraryEpidural Side EffectsVBA2C PubMed ArticleEvidence Based BirthⓇ: The Evidence on VBACUterine RuptureHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Julie: Welcome, welcome. You are listening to The VBAC Link Podcast, and guess what? We have a special guest for you today, and that is me. It’s Julie Francom. I am here today with Meagan, and I am joining her for a really cool information-packed episode debunking some common misunderstandings about VBAC and showing you what the evidence is and where you can find more evidence-based information about VBAC. Without further ado, your host, Meagan. How was that?Meagan: Oh my gosh. Thanks Julie for the amazing welcome. Oh, so fun. It’s so fun. Yes. I am so excited for this episode because it’s one of the last episodes with you and I. No, it’s not one of the last episodes. It is the last episode of you and I of the year which is so crazy. It is so crazy. Julie: This year has flown. Time is wild. Time is wild. Meagan: It’s so strange to me, but that’s okay. We will welcome in 2025, and we will say goodbye to 2024. We want to say goodbye to it with, like she said just a really great evidence-based packed episode for you guys.I feel like all year we have gotten messages like, “I had a C-section. I’m being told I can’t ever have a vaginal birth. Is this true? Is VBAC safe or possible?”We’ve had, “I’ve had one and two C-sections. I’ve had three C-sections. Is VBAC possible? My provider gave me a 20% chance to VBAC. Is that true? Can I VBAC? Do I really have that low of a chance?”How about this one? This one was more recent that I’ve heard from our last recording. “You have a 60% chance of uterine rupture if you choose to VBAC.” Ugh. Seriously, so many things that we have heard along the way where it’s just–Julie: Lies, lies, lies, lies. It’s lies. Let’s just call it what it is. Meagan: Aggravating. Julie: For the most part, I do not think providers mean to spread lies or misinformation. I do think that there is a lot of information related to birth in general, but especially VBAC about how this is the way we’ve always done it. They are just regurgitating information that they have heard from some unreliable source somewhere and aren’t really taking the time to keep up with the actual facts about VBAC, about birth, and about anything in general. Also, our system is not set up for continuing educating all of the providers in all of the things. Our hospital providers, I feel like in some capacity we have to give them some grace because they are incredibly overworked. They work crazy hours. They see lots of things and deal with a lot. The medical system is that way. But I also feel like who’s responsibility is it to make sure that you are providing the best care? But how can you when the system is working against not only the parents but also the providers and the nurses and everybody. It’s really hard because it puts the responsibility on you, the parent, in order to really dig and discover what your options are so that you can make the right choices that benefit you because the system is not set up to support you in any other way besides their hospital policies and following their rules, etc. So, yeah. I don’t want this to turn into a provider-bashing episode. I don’t think it will either. Sometimes, I think with me talking especially with me being more salty now, it can come across that we are anti-provider or whatever which we are not, but the system is just really frustrating. It takes everybody’s efforts to try and change it, everybody’s efforts. Not one part of the system can be passive if we want to change it and we want to influence it for better.Meagan: I agree so much. Like you said, we don’t want to ever shame the hospital system or providers, but a lot of times, the things we are saying definitely does happen. But it’s because there is a lot of fault. There is a lot of fault in these areas. Like you were saying, a lot of these things are lies. The biggest and hardest thing that I found when I was going through my VBAC journey. Julie, I wanted to speak for you and probably say that is the same for you, and that’s why we created The VBAC Link: How to Prep VBAC Course is because we didn’t know what was right and what wasn’t. We just didn’t know, and there were so many avenues on Google that you could go down, and you could actually find truth on both sides sometimes even. Julie: And trying to figure out which is true and credible and which is not sometimes is really tricky.Meagan: It’s really, really tricky. We want to talk more about that today. We recently talked about hospital policies and what that means and how to go about those, but along with hospital policies come a lot of other things that providers do or suggest or say, so we’ve got this random policy that was created over here, then we’ve got all of these random things that are being said over here. We want to know our options. We know hospital policies are what they are. If you haven’t listened to the episode, go listen. It’s back in November, last month. Go look for it. But today, we are going to be talking about what is the evidence. What are the facts?Let’s talk about the VBAC calculator. Let’s just start right there because this is where a lot of providers actually begin to determine someone’s ability or qualifications if they can VBAC. They’ll pull out this list, this calculator, that is online. You can actually get it online. If you want to play around with it, I’ll try and make sure to put the link in our show notes because I actually find it very interesting to play around with. We used to do that when we would do in-person courses. We would have everyone pull out their phones, type in the calculator, and type in different scenarios. It was pretty mind-blowing to see how much it could change based off of the answer that you give this computer. You want a VBAC. You have determined that a VBAC is something you want to explore. You want to learn what you can do to have a VBAC. You go to your provider and you go, “Hey, I’ve had a C-section. I don’t want that experience this time. I want a different experience. I would like to have a VBAC,” or what they would call a TOLAC, a trial of labor after a Cesarean. And they’re like, “Great. That’s wonderful.” Then they’re like, “Let’s talk about it.” They pull up their calculator and they ask you questions like what, Julie?Julie: They ask you questions like, hold on. I was just digging into the history of the VBAC calculator a little bit more because I was curious about it. They ask you what was the reason for your previous Cesarean? How much do you weigh? It used to ask what your ethnicity was then they docked you if you were black or Hispanic. It also asks, let’s see. Meagan: It asks if there was an arrest of descent. Arrest of descent is if you needed a Cesarean because your baby didn’t come down. It asks about your history as in have you had a vaginal birth before? Have you had a VBAC? What was the reason for your previous Cesarean? It even asks if you’ve been treated for hypertension. Interesting. Julie: Interesting. Meagan: Yeah. So height, weight–Julie: Oh, because the chronic hypertension requiring treatment is what replaced the race. When they replaced the race question with do you have chronic hypertension requiring treatment? It may serve as an obvious proxy for race and appears to function similarly in the revised calculator in terms of statistical performance. Meagan: Oh my gosh. Yeah, it says that right on the website. “The information on this website describes the outcome of vaginal birth after Cesarean in term pregnancy for population individuals who receive care at hospitals within (blah, blah, blah) network.” It says, “The information on this website is not intended to be the only basis for making care decisions for individuals nor is it intended to be definitive,” meaning it’s not going to be yes, you have to have this or this is the exact chance of you having a VBAC, but yet we have so many providers who go off of this as in point-blank fact.Julie: Like it’s the law and like it’s a crystal ball. Meagan: Really though. It’s so frustrating. Sorry, what were you going to say before?Julie: I just sent you this link from what I was digging into. It’s so interesting about the VBAC calculator. It’s interesting because first of all, a couple things. The likelihood of the VBAC calculator being accurate for you, the higher percentage of having a successful VBAC, the more likely it’s going to be. It’s more accurate when the predicted success rates are above 60%. The lower success rate, the more likelihood it is to be inaccurate. Do you know what that tells me? That tells me that most people who attempt a VBAC are going to be successful. That’s what that tells me. It’s just so stupid because I mean, the development of the calculator was in the early 2000s. From the outside, it actually looks like a good sample size. There were 11,856 people with one prior Cesarean between 1999 and 2002. It was analyzed whether they had a successful VBAC or an unplanned repeat Cesarean. It was analyzed retrospectively. Retrospectively means they looked back on births. It doesn’t mean that they did the study when people were pregnant. They looked at it after it had already been done. I like retrospective studies because there’s a lot. It really removes the chance for bias related to the study. The interesting thing is that the risk factors that they chose were related to BMI, if you’re overweight, age, history of prior vaginal deliveries– so did you have a prior vaginal birth or not– if the prior Cesarean was because of labor dystocia, so that’s stalled labor, or your race– black or Hispanic ethnicity. They used these criteria to determine whether or not you were going to be successful in having a VBAC. Here’s the stupid thing about this. What it doesn’t take into account is the bias in our system against people of color and against people who are overweight. It does not take into account the bias and the different ways people who are overweight and people who are not white are treated in the system. I mean, there are just so many flaws against it as well, but also, I don’t know. It says here– sorry. Before I get to my also. It says here– first of all, there are only 19 academic hospitals that were included, so I feel like the sample size of 19 academic hospitals, so university hospitals, and it’s between 1999 and 2002. Also, there was a lot of backlash from all of the controversies surrounding uterine rupture in the mid-1990s from that carrying over into that as well. If you didn’t know this, they started inducing VBACs with Cytotec in the mid-1990s. It increased the risk of uterine rupture like crazy. I’m not going to do a history lesson right now, but this was only 4 years after all of that. There was probably still a lot of fear and everything related to uterine rupture and everything during all of the time that they were collecting this data. Sorry, I’m probably really nerding out right now. But the thing is that when the predicted success rate was over 60%, it tended to be more inaccurate when it was less than 60%. Accuracy of lower estimates was mixed but generally decreased as predicted success rates declined. I said this before and I’ll say it again. My first client ever as a doula had a predicted success rate of 4%, like the number 1-2-3-4. You count to 4. That was her predicted success rate, and she pushed her baby out in 20 minutes. So, I think the VBAC calculator is garbage.  Also, ACOG says in their most recent guideline, actually for the most couple VBAC bulletins that they have put out, is that a low chance of success is not a good reason to exclude somebody from attempting to have a VBAC. But yet, there are so many providers who will not take you if your predicted chance of success is less than 60%. But what did we just say? We just said that if your predicted success rate is less than 60%, it’s less likely to be accurate. Isn’t that stupid?Meagan: Yes. The other thing I have noticed from providers who do the VBAC calculator is that not only if they say your chances are lower, if they are doing it and it is lower than 50-60%, they automatically go in their mind and they’re like, “Oh, she has a lower chance.” They may start being tolerant, but I think it’s something to watch out for. If your provider is pulling out this calculator and putting too much weight on the calculator, it might be something to watch out for and understand that there may be a bait and switch coming up or that provider may not end up feeling comfortable with you being able to VBAC or TOLAC. We’ve talked about this with other providers where they say they are uncomfortable. That is a really good time to say, “You are not comfortable with this. I am comfortable with this. We are not a good match.” Julie: Yes. Don’t let your provider dictate how your birth goes. I love that you brought that up, Meagan, because I’m in a member of a Facebook group for labor and delivery nurses. There are 12,000 labor and delivery nurses in there. I’m mostly quiet. I mostly watch because I like to see the climate of the profession and the attitudes around VBAC, birth photography, doulas, etc. There was a post actually this morning in there. The nurse asked, “What is your hospital’s protocol around vaginal breech deliveries?” I was like, “Oh, this is going to be good.” I went through the comments, and I was stalking the comments because I know that having a vaginal breech delivery in a hospital is a freaking unicorn. It’s a unicorn. You don’t usually see it. It was interesting to see the labor and delivery nurses’ comments. One of them stuck out to me. I almost commented back, but I pulled myself back. I was like, “This is for labor and delivery nurses. I don’t want to stir the pot. I’ll stir this pot in other places, but I don’t want to stir the pot in this community most of the time.” One of the nurses said that vaginal breech delivery carries risks, and it is up to the provider and patient to decide what risks are safest and what risks to assume. I rolled my eyes at that because it should be like that. It should be the provider AND the patient together to decide the risk, but how often is it the provider only who decides the risks that these patients are going to take on? No. It’s not the patient and the provider. It’s the provider deciding. It’s the provider deciding. Nowhere in the normal, typical, standard conversation does it include providers and patients making decisions. Not real ones. Not when they disagree. Not when they want a little flexibility or not when they want to go against hospital policy, right? Meagan: Yeah. Julie: I mean, there are sometimes, but it’s really rare. Meagan: This comment reminds me of the many scenarios that I see or hear within my own clients here in Utah of, “Hi, I really want a VBAC. I met with my provider, and they said they would let me do.” It reminds me of the “let me”. This provider looked at me, read my history, and said that this is what I can and cannot do. This is what they let me do. Julie: Or they led me to the calculator.Meagan: Yeah. We’re losing that conversation. Women of Strength, I encourage you to go forward and have conversation with your providers, especially if you are getting this kickback and especially if you are not being told the risks for both VBAC and repeat Cesarean, and you’re just being told, “Oh, you have a 46% chance of VBAC based off of this calculator, so I’ll let you try, but don’t count on it.” Seriously? If I hear anymore providers, ugh. It’s so frustrating.Julie: They’re doing you a favor. “We’ll let you try. Okay, you can try.” Or they say, “But you have to go into labor by 40 weeks or we’ll schedule a C-section, but we won’t induce you.” Come on. Come on. They’re trying to be this savior. We’ll let you try, but…Meagan: Don’t stand for that unless that’s what you’re okay with. I can’t tell you, “No. You can’t see anybody like that.” That’s not my place, but I will say that if you’re having a provider in the very beginning pull out this calculator telling you that they’ll let you try, but the chances are low, your pelvis hasn’t done it before, don’t know if it will do it again, your cervix didn’t dilated to 10, these are problems. These are red flags.  Okay, so the VBAC calculator, we talked about it. We talked about the stats. We talked about our rant. Now, let’s talk about uterine rupture. This is a big one that I feel like hovers. It’s that dark cloud. Julie: The elephant in the room. Meagan: Yeah. It hovers over people and their fear. I see it daily within our community. “I really want a VBAC. A different experience is so important to me, but in the end, I’m so scared. I’m so scared of uterine rupture.” Valid. I just want to validate your fears right now. It’s okay that you feel scared. It’s valid that you feel nervous about it. Julie: Mhmm. Meagan: It’s also understandable that you may feel extra nervous about it because the outside world talks so poorly about it. Julie: Mhmm. Meagan: They make it sound scary. It is scary. Julie: It can be, yeah, when it happens. It is. Meagan: When it happens, it can be, but the chances are actually quite low, you guys. We want to talk a little bit about it. I know we’ve talked about it in the past, but I feel like you can’t talk about uterine rupture enough. Julie: Yeah, it keeps coming up, so we’ll keep talking about it. Meagan: It keeps coming up. It keeps coming up.Okay, so let’s talk about one C-section. You’ve had one C-section. Your baby didn’t come down. You pushed for 2 hours. You had a C-section. You dilated to a 5. You didn’t progress. They did all of the interventions. You had a C-section. You got an epidural. Your blood pressure dropped. Your baby didn’t do very well. Decelerations. You had a C-section. There are lots of scenarios of why we have C-sections. One C-section– Julie, let’s talk about the evidence of uterine rupture after one C-section.Julie: So here’s the thing. There are multiple studies out examining uterine rupture and things like that. It’s interesting because I feel like it does vary. There are some studies with very small sample studies that have 0% uterine ruptures in their studies, and there are some studies that show higher rates. Now, what I have found as I have been digging is that the studies that are the most credible and most reliable will usually have a rate of rupture between 0.2%-0.9%. I feel like if you have anybody telling you that your chance of rupture is half of 1% or you have a 1% chance of rupture or that the chance of uterine rupture is less than 1% or 1 in 200 or 1 in 100, all of those, I feel like, are pretty accurate representations of what the actual risk of rupture is. Now, there are lots of things that contribute to that of course, but I feel like if you ever have a provider tell you, “Oh, it’s about 1%”, that’s pretty cool. Meagan: Yeah. Yeah. That’s pretty reliable to know that they are within–Julie: Within range.Meagan: They are looking at some study that is within accurate range. Julie: Or I think 0.4%. One of the bigger studies that we cite in our course is 0.4% or 1 in 250. Those are all that for me, personally, I would feel that yeah, you are presenting the data pretty accurately. Yeah. I feel like you’re trying to lead this a certain direction.Meagan: No, I’m not. That’s exactly something I wanted to talk about is how it can range. You may see something that’s 0.2% and you may see something that’s 0.47, and you may see something that’s 0.7, so I love that you pointed that out. Julie: Yeah. I think that’s why the more I go on, I used to say 0.4% or half of a percent whenever somebody would ask me, “What’s the rate of uterine rupture?” Those are the numbers I would go to, but now, I feel like it’s a little more fluid, and I feel like there’s more nuance to that. Meagan: Yeah. I usually say around 1%. What about people who are wanting to VBAC after two C-sections? Because this is another big ask, then it gets even stickier.Julie: So sticky. Meagan: And when we talk about 3+. The evidence after two C-sections– again, everyone has different reasons, but I was told slightly over 1%. Julie: Right.Meagan: 0.7% to 1.1-1.4%. Julie: Well, here’s the thing, too. There are not a lot of studies about VBAC after two Cesareans. There’s just not, but there are two large studies in the ACOG VBAC bulletin that ACOG cites, and it actually says that– I’m actually going to quote the guideline right now. It says, “Women who have had two previous low transverse Cesarean deliveries should be considered for a trial of labor after Cesarean (TOLAC). However, other factors should also be considered to determine the likelihood of successful VBAC.”Now, here’s the thing. It cites two studies in their bulletin as far as risk of uterine rupture. One study that they cite shows that there is not increased chance of uterine rupture from one to two Cesareans. There is one that shows no statistical differences. Now, the other study that they reference shows double the risk of rupture. So, what? 0.5% to 1%? I think it was 1.2% is what the ACOG bulletin says. I’m not sure. I don’t have the actual bulletin pulled up right here in front of my face except for that. Meagan: This is another thing where it depends on what you’re reading. Some of them are 0.1-1.5% or 1-1.5% and that’s even on the higher end of the chances. Julie: Right. The interesting is that ACOG even says that, yet people are going to go say double and triple, or whatever. They’re going to make up all of these crazy statistics. Now, gosh dangit. I literally had that guideline. Do you have it open?Meagan: No. The ACOG? No. I don’t.Julie: I’m going to find it exactly because we’ve been called out for this. We literally quoted the exact phrase from ACOG and got thrown under the bus for spewing misinformation when it was literally a quote from ACOG, but whatever. Meagan: While you are finding that, there is an article showing vaginal birth after two Cesareans There was a systemic review and a meta analysis of the rate of adverse outcomes in a VBAC after two. It talks about how the VBAC after two success rate was around 71.1% and the uterine rupture rate was 1.63%, so that is within this. We will have all of these here. If we are quoting something, we’re going to make sure that we have it here in the show notes. Please, please, please make sure to go down and check it out. You’re going to want more information. We don’t have all the time to go over all of these, but I think these are such great reads.  Sorry, have you already found it?Julie: Yep. Meagan: Okay, go ahead. Julie: Excuse me while I clear my throat and crack my knuckles. I’m ready. Let’s go. Oh, do you know what? This is actually a pdf from an actual publication, so it’s not going to be the exact page that I said. There is a whole section called, “More than one previous Cesarean delivery”. Now, what it says about the studies, I’m going to quote it exactly. “Two large studies with sufficient size to control for confounding variables reported on the risks for women with two previous Cesarean deliveries undergoing TOLAC. One study found no increased risk of rupture, 0.9% versus 0.7% in women with one versus multiple prior Cesarean deliveries whereas the other noted a risk of uterine rupture that increased from 0.9% to 1.8% in women with one versus two prior Cesarean deliveries. “Both studies reported some increased risk in morbidity in women with more than one prior Cesarean delivery, although the absolute magnitude of the difference in those risks was small.”Meagan: Mmm, send me the link so I can put the exact link in the show notes so everybody can go read more.Julie: Yeah. Yep. It also says, “The likelihood additionally retrospective–”. Remember, retrospective is looking back on data that already exists. “Retrospective cohort data has suggested that the likelihood of achieving VBAC appears to be similar for women with one previous Cesarean delivery and women with more than one previous Cesarean delivery. Given the overall data, it is reasonable to consider women with two previous low transverse Cesarean delivers to be candidates for TOLAC, and to counsel them based on the combination of other factors that affect their probability of achieving successful VBAC.” Meagan: Hey, see? They’re even saying that it’s reasonable. Here we are. It’s reasonable. But then, there are so many people who are like, “Nope. Out of the question. It is not acceptable. We will not support VBAC after two C-sections.” Julie: Actually, I don’t think you are supposed to publish this. You might not be able to distribute it. Meagan: Oh. Julie: Because you just do a search on the dark web for ACOG VBAC bulletin 205 pdf and it will pull up. I promise. Meagan: Okay. There you go, everybody.Julie: I just don’t want you to do anything illegal. Meagan: Yeah. Get on a search. Get on a search. I do want to talk when it comes to three. When it comes to three, the hardest part for me with three C-sections being shut down is that the evidence is still not there. The concrete evidence is not being studied that much. Julie: Mhmm. Even the studies that do exist, they don’t have super large sample sizes. They are very old. They are 20+ years old, so that’s the best data that we have to use. Sometimes those studies are just automatically disqualified because of their age, their smaller sample sizes, and things like that so it’s hard to make any definitive statements about its safety or risks. Meagan: Yeah. Then there is evidence with induction. Increasing around 1.1% if you use Pitocin. A lot of people say, “We can’t use Pitocin. It increases it astronomically.” I mean, to some, 1.1% and having that be their rupture rate, that may make sense, but for a lot of people, 1.1% is still quite low. I did just want to throw it out there that the risk of uterine rupture is not dismissed because you schedule a C-section. It’s not. Julie: That’s true. In fact, you are more likely to undergo a uterine rupture during the Cesarean than you are by attempting a VBAC. Meagan: You are? I thought it was 0.06. Julie: No, it’s in our course. I have the charts from the National Institute of Health. Because of the pressure during the surgical procedure, your uterus is more likely to rupture. Now, granted, it’s probably “safer” to have a uterine rupture on the operating room table because baby is already coming out, but there is data that shows it. I’m pretty sure there are graphs and charts in there from the National Institute of Health. Meagan: Yeah. I’m going to go find it. I was reading about it. It was 0.02%. It’s just really important to know that it’s not just eliminated. Your risk is not just eliminated. Okay, let’s talk about– and anything else you want to talk about with that?Julie: Mm-mmm. Meagan: Let’s talk about epidurals and the risk that we have with that. Julie: Not ugh about epidurals. That sound was not about epidurals in general. It’s about how I know where you’re going with this. Sorry. Meagan: No, it’s okay. I just want to talk about the risk with epidurals because a lot of people don’t know that some of the things that happen after epidurals can be placed or things to do before if you’re planning to get an epidural like hydrating and making sure that we’re good there. I want to talk a little bit about epidurals. Epidurals can do a few things. They can lower our blood pressure. That’s one of the most common that I have seen right out of the gate. But it’s given, and the blood pressure drops. Mom’s blood pressure drops. Baby’s heart stops responding. Julie: Baby’s heart rate drops a little bit too.Meagan: Yeah. In fact 13 out of 100 women have epidurals cause low blood pressure. Epidurals can also increase infections. Now, yes. Infections are in our back and stuff, but I’m actually talking about vaginally because I feel like the vagina is an open door. Once an epidural is placed–Julie: Then you have the catheter too. That will give UTIs. Meagan: Yep. Yes. We’ve got a catheter, then it’s like, “Oh, I can check you. You can’t feel that.” We keep introducing bacteria. Julie: More cervical checks. Meagan: Yes. Julie: Increased infection.Meagan: Yes. It also can cause problems urinating because we’ve got this catheter. It can sometimes be placed for hours and hours.Julie: Yeah. 24 hours sometimes depending on how long you’re in labor.Meagan: Yes. Approximately 18 out of 100 women will have urinary issues because of cather and things like that. It’s kind of interesting. Epidurals can also cause itching. Is there morphine in epidural? I think that’s why.Julie: Fentanyl.Meagan: Okay. It wears off, and it can cause itching. It can cause you to go so numb that you’re unable to move and groove. Julie: These are small risks. They are small risks. It’s okay to have an epidural. Don’t be scared out of having one if that’s what you want. You can still have a VBAC with an epidural.Meagan: I want to talk about that. I’m still going over these risks. Going into what you were saying, there’s an article that I’m reading right now. It says that 75 out of 100 women who had an epidural and they were very satisfied with the pain relief that they received. 75 out of 100 is really great. That’s really great. It says, “50 out of 100 women who were very satisfied with the pain relief.”Of opioids, sorry. It says, “Compared to 50 out of 100 women who were very satisfied with pain from opioids.” There are risks to epidurals, but there’s also a lot of great things that come with epidurals because we can be more present and have less trauma. It comes to a point sometimes where labor– we talk about pain versus suffering, and if you’re suffering, that’s not usually going to lead to a positive experience.But, let’s talk about the just-in-case epidurals. We have talked about this before. Julie: That’s what my sound was for.Meagan: I had a feeling. The just-in-case epidurals are frustrating. We’ve talked about them before. It just doesn’t make sense to me. It doesn’t make sense. One of these days, I would like someone to sit down and try to make this make sense. It doesn’t make sense to me. Is there anything else you would want to share?Julie: Just-in-case epidurals. I just want to do the math on it though. Just-in-case epidurals don’t make sense. It’s not logical. The idea is that a lot of hospitals will have a requirement that you have to have an epidural placed but not turned on. If you don’t want to have it turned on, you don’t have to have it turned on, but you have to have it placed just in case of a uterine rupture so they can give you an epidural quickly and go get the baby out without having to put you under general anesthesia because general anesthesia is riskier. That is true. The problem with that is that in order for an epidural to be dosed to surgical strength, it takes 15-20 minutes to be dosed to surgical strength even if it is turned on already. If you have a catastrophic uterine rupture where baby needs to be out in minutes, 15-20 minutes is not going to do it. You’re going to be put under general anesthesia anyways. Even if you have an epidural, and baby needs to be out in seconds or minutes, then you will be put under general anesthesia. If there is time to wait, there is time to do a spinal block in the OR. It takes effect in 5 minutes, and boom. You don’t have to be put under general anesthesia. So the math isn’t mathing there whenever they do that.I’ve had clients ask when they say, “Hey, just-in-case epidural,” and my clients will be like, “Even if I have the epidural turned on and need the baby out immediately, how much time would it take to get to surgical strength or would I have to be put under general anesthesia anyways?” They’d be like, “Well, we’d probably have to put you under general anesthesia if it’s a true emergency.” Every time you ask somebody, the math doesn’t math. You can’t explain it. Anyways, that is my two cents about that. I think that is the most nonsense VBAC policy ever because you can’t make it make sense. It is not even make it make sense. You have people say that about everything nowadays. Make it make sense, but this one literally doesn’t make sense.Meagan: Yeah. It’s a tricky one. It’s a really tricky one. There are risks to getting an epidural, but don’t be scared of getting an epidural. It’s still okay. It’s still okay. Just know, if you are getting an epidural, do things like hydrate. Wait as long as you can. Make sure you go to the bathroom. Eat before. Get your blood sugar up. I’m trying to think of all of the other things. Don’t think that just because you get an epidural, you have to get cervical exams anytime they want. Julie: Yeah. Meagan: Yeah. Yeah. It’s okay to turn your epidural down if you decide it’s too heavy. Julie: There are also some providers who will tell you that you can’t have an epidural with a VBAC because then how will they know if you have a uterine rupture? Anyway, the hospital policies that we see are just so different. They change and they are so drastically different even from one hospital to the next in the same area. Anyways. Meagan: Okay. Anything else that you want to cover or think that we should cover? Julie: No. Is there anything else pressing? I feel like we intended to cover more things, but we just keep chatting about it, but that’s okay because there are some good stuff in this episode. Meagan: No, I think it’s great. So if you guys have any questions or if you have any studies that you have found that contradict anything that we are saying, share it. Julie: Yeah. Send it over. Meagan: I would always love to read it. There are times where we miss updates studies or there are studies that we haven’t seen, so please, if you have a study that either contradicts or goes along or says something slightly different, share it with us. You can email us at [email protected] you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Listen to today’s episode to hear Meagan talk all about bicornuate, unicornuate, arcuate, and septate uteruses, uterine didelphys, and more.Though there can be complications, research is limited, and vaginal birth is often possible. Chat with your provider about your birthing desires, and don’t be afraid to get multiple opinions!A Case of Vaginal Birth after Cesarean Delivery in a Patient with Uterine DidelphysUterine DifferencesSuccessful Vaginal Delivery after External Cephalic Version in a Woman with a Large Partial Uterine SeptumNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. Welcome to The VBAC Link. This is Meagan, and I am solo today. We will not be sharing a VBAC or CBAC story, but we’re going to focus on our topic of the week. That is uterine abnormalities. So if you haven’t listened to Flannery’s episode last week, or I should say earlier this week, go check it out. Flannery has a bicornuate uterus, and we talked a little bit about the different types of uteruses, and her journey, and what happened or what was most common with her bicornuate uterus. But today, I wanted to talk a little bit more about the different types of uteruses. It’s kind of weird to think about, but we do. We have multiple shapes of our uteruses. I don’t think it’s really talked about a lot, so I thought it would be cool to jump on today and talk a little bit more about the uteruses. But, we do have a Review of the Week, so I wanted to jump on and share this review. It says, “I now recommend this podcast to every mom who will listen, even first-time moms. I tell them this is the podcast I wish I would have listened to before our first traumatic birth. It helped me process, learn, and heal so much after my son’s birth. Two years later, pouring into numerous books, online courses, and more, we are preparing for our October VBAC. Their podcast has by far been the most favorite resource hands down. Thanks, Julie and Meagan, so much for what you do.”Thank you guys for your review. That review was left on Google, so if you wouldn’t mind, press pause in just one moment, and go leave us a review. Your reviews help other Women of Strength come and find this podcast, find the blogs, find the course, find the doulas. You guys, I love this community so stinking much and believe that every mom, just like the reviewer said, and even first-time moms should be listening to this podcast. These stories that you guys share are absolutely incredible. The information that we share is invaluable. If you can, go to Google. Type in, “The VBAC Link” and leave us a review, or leave us a review wherever you are listening to your podcasts. Okay, everybody. Like I said, we are going to be diving into uterine abnormalities. We talked a little bit about Flannery. She had a bicornuate uterus. What is a bicornuate uterus? A bicornuate uterus is a heart-shaped uterus meaning the uterus has two horns making it look like the shape of a heart. With bicornuate uteruses, there are some things to know. There can be a higher chance of a breech baby. I’m going to share my source here with you. It’s pregnancybirthbaby.org. We’re going to have this in the show notes. I think that it is just so great. It’s such a great visual and understanding on the different types. So yeah. They’ve got two horns. It doesn’t reduce your chances of having a baby or getting pregnant. It can increase things like early miscarriage or an early preterm baby, or like I said, it can impact the position of the baby. But it’s possible. VBAC is possible with that. The hardest thing about uterine abnormalities is there is not a ton of evidence or deep studies to dive into how it’s impacting people who want to go on and have a vaginal birth or go for a, in the medical world, TOLAC or trial of labor after a Cesarean. If you have a uterine abnormality, it’s something to discuss with your provider. Know you don’t have to go with that first answer. You can get multiple opinions. Okay, another uterine abnormality or shape is– oh my gosh, you guys. Don’t quote me on this. I will butcher how to say these. I will try my best. It’s a didelphys uterus. It means that your uterus is split in two, and each side of your uterus has its own area. it also can increase your chance of having a premature birth, so if that is something that you have, I think that’s something you want to discuss with your provider knowing that you could have a premature birth. We also know people who have premature VBACs all the time, but it’s something to discuss. There’s acruate, and that is a uterus that actually looks really similar to a normal-sized uterus but has a deeper dip in the top of the uterus in the womb. It doesn’t affect your fertility. It can increase just a little bit of a later miscarriage. That is something to discuss, although sometimes providers will want to induce if everything is looking well at an earlier gestational age. Also, this one can impact the position of your baby, so being aware of that. Then there’s septate. Again, I don’t know. Sorry for butchering this, you guys. If you’re a medical professional, sorry. It says, “A septate womb has the wall of a muscle that comes down the center of the uterus, and then it splits into those two areas and is divided by a membrane or a tight band of tissue.” It reminds me of a rubber band. It splits it down. It can also impact fertility and, again, increase the possible risk of miscarriage in the early stages or cause a premature baby. Once again, discuss with your provider if you have this what that means and what that means for VBAC birth in general. Then, let’s see. There’s also retroverted. That’s a uterus that tips further back instead of that forward stage. Again, there are so many different types and shapes of uteruses. Sometimes we don’t know what we have until we have a baby who is born. Sometimes it’s once we have a Cesarean where they are like, “Oh, hey. You have this type of shaped uterus.” If you really feel like you need to know or you are having issues or anything like that, dive in with your provider and see if they can tell you what shape of uterus you have.Like I said, little is known about the outcome of VBAC with uterine abnormalities, but there is an article and it was back in 2019. It’s called “A Case of Vaginal Birth After Cesarean Patient Who Has a Uterine Didelphys”. I want to talk a little bit more about that. As a reminder, that is the one that is split in two. If I recall, I think they even have their own cervixes. That can be interesting. But this is going to be a little bit more on this. They talk about it. There are only a few studies. The studies are low, like 165 women in the one study. It shows that those women with abnormalities found were statistically less likely to have VBAC. Again, we know that a lot of the time, these people have babies who are in less ideal positions or they are going into early preterm labor. There are things to be said about that. But the other small study is literally teeny tiny. It had 25 women with uterine abnormalities reported, and a VBAC rate was similar to women with a “normal” uterus. There are things to say there.Now, the other study showed that they were less likely to experience uterine rupture than women with normal uteruses, but then this one said that the uterine rupture rate was higher. So such little information. I mean, really, it’s little information that I have been able to find so far. I’m going to dive in deeper and update you, but yeah. It says, “The actual rates in VBAC and uterine rupture in women with uterine abnormalities are more likely to be similar or less favorable than those women with normal uteruses.” So, keep that in mind. It goes on and says, “Some authors hypothesized that uterine abnormalities, especially unicornuate uteruses, are associated with decreased uterine muscle mass. So when we have decreased uterine muscle mass, that means it may not contract as effectively or strongly as it needs to, so that can lead to other things like arrest of descent or we were not getting into that active phase of labor, needing things like Pitocin and things to augment labor or they may have a harder time pushing out the baby because the uterus isn’t helping as well. So we may have a higher chance of an assisted delivery like a vacuum or forceps. With all of this said, you guys, I want to leave it here with you to encourage you to speak with your provider, and get multiple opinions. If you have been told that you can’t VBAC because of a certain situation, dive a little deeper with questions with your provider because again, the hardcore evidence is not really there. It’s just low. I mean, it’s there, but it’s low. There’s another article that says that uterine abnormalities are common in the general population with an estimated range of 1-15 per 1000% women. We know that there are people out there who have uterine abnormalities. I don’t feel like it’s talked about a ton, and that’s why I wanted to come on today and talk a little about the different types, and of course, share with Flannery’s episode with a bicornuate uterus showing that she still did go on to have a VBAC and it is possible. So if you have a uterine abnormality, please know that it doesn’t mean you’re just completely off the table. It still can be an option. Discuss it with your provider. Check out the links. I will include them in the show notes today more on those uterine abnormalities, and what it means, and what these studies are showing. There was another one that said that a septate uterus is clinically significant because it has been shown to be associated with adverse pregnancy outcomes including, like I said, that preterm labor and malpresentation. So it’s a thing that can cause malpresentation and can cause preterm labor, and even miscarriage. But does that mean that you can’t have a vaginal birth? Another thing to ask your providers if you have any of these things are, “Okay, if my baby is in a less than ideal position, say, breech or transverse, does my uterine abnormality or my specific case rule me out of having something like an ECV?” Varying rates of ECV success have been reported, and we’re also not doing them enough. We are not seeing them being done enough, even though they have a lot of success. But the question is if you have a uterus that is a little different, do you qualify? Ask the questions. Be informed, and if you have any questions, let us know.And hey, if you have a uterine abnormality and you are listening, and you had a VBAC, I would love to hear from you because we have people who are searching for stories with uterine abnormalities. I know that our community would love to hear your story. You can message us at [email protected] or if you are a provider who maybe knows a lot more and specializes a lot in uterine abnormalities, I would love to chat with you and discuss a podcast episode in the future. Thank you guys!ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. 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