Mama Jacqueline, Big Sister Tory holding baby Travis, and Daddy Travis at postpartum home visit

VBAC as Women’s rights issue

 Jacqueline called me about 3 months ago looking for someone to help her birth her baby without having to have another c/section.  She did not seem to be a particularly strong homebirth advocate, but she was scared to have another surgery and she knew she could get her baby out vaginally.  This was her 5th pregnancy, her first baby was born via “emergency” c/section when late in her pregnancy it was discovered that he had spina bifida.  Jacqueline asked about a VBAC with her second pregnancy, but was told very firmly, NO, absolutely not.  When she showed up at the hospital thinking she was in early labor, her cervix was checked.  Even though she was 6cm, she was whisked quickly away for a repeat c/section.  She went into labor between 37and 39 weeks with her second, third, and fourth births, and each baby weighed less than 7 pounds.

When Jacqueline called me with this pregnancy, she was about 30 weeks along.  She had been seeing an OB who did not seem to be hearing her concerns about having another repeat c/section.  She had called many OBs and several midwives and no one felt comfortable helping her.  She told me recently that she had only found four cases of VBAC after 4 cesareans when she googled it.  When she first called me, I told her I would be happy to talk to her, hear her story and see how it “felt”.  I can’t say I wasn’t nervous, but I feel very strongly that women should have the right and choice to birth how they want.  I also thought if I don’t help her, no one else will.  Having had a home VBAC myself, I know how powerful and life changing the experience can be.

Jacqueline and I met several times over the few months until she was due.  I asked her to get the surgery reports from each of her previous c/sections.  The first one, from her son’s birth, 11 years ago, was not available.  Each of the other reports stated they were repeat low transverse c/sections.  We also knew that her placenta was not near the incision based on several ultrasounds she had early in this pregnancy.

As Jacqueline’s due date approached, I had mixed feelings.  I was not worried about her ability to get her baby out or that her uterus would rupture. I know uterine rupture is extremely unlikely, even though there is very little research about vaginal birth after 2 or 3 c/sections, much less four.  What I was worried about was what it would look like to my peer group, other midwives and birth professionals, both from Austin and around the US.  What if something happened? What if??

Still, my desire to support this woman’s well-researched and informed choice to have a vaginal birth out-weighed my fear of what others would think.

Jacqueline had many days of warm-up labor starting around 38 weeks.  I was encouraged by these contractions and kept reassuring her that this practice labor was important for the uterus to get strong for the actual birth.  Her baby continued to move well, she was not in pain, and she was determined.  She called me the day before her due date with regular contractions that she was not sure was labor, but she was having some bleeding.  It was not much, it was red, it was not dripping, but it was not mucusy.  I wanted to go check out what was going on.

When I arrived at their home, Jacqueline was happy and walking about, and the bleeding really was minimal and looked like regular bloody show from the cervix opening.  She was about 4 cm dilated, 90% effaced, and the baby’s little round head was low.  Jacqueline did not like sitting still, or sitting at all, for that matter.  I said, well, don’t sit.  At some point she realized she had to take an online school exam before midnight.  That’s when labor really got going….she would answer a question, have a contraction, leak fluid, answer a question, have a contraction, leak fluid….this went on for about 45 min, she finished the test and we discovered her cervix was 8cm, very stretchy.  With this exam, there was more bloody show.  More than usual, but not more than I would have been worried about in a non-VBAC birth, about ½ cup total, on the chux pad.  I suggested she get up and sit on the toilet for a few contractions.  The baby’s heart tones continued to be stable, decreasing a bit with the contractions, increasing again after.  The bleeding that I as concerned about did not continue on the toilet.  She started bearing down some and then pushing more.  I suddenly got a glimpse of her vulva and there was shiny black head just inside.  We moved back to the bed and she pushed the baby out all in one contraction, from seeing little peep of baby’s head to toes out in a millisecond.  All of us were a little stunned I think.  She was so happy she had done it.  Travis, her husband, was thrilled and surprised.  The placenta came out easily, with very little bleeding from the uterus.  Six-ish hours of labor, 10 minutes of pushing, 10 minute wait for the placenta, routine postpartum time, leaves me wondering why?  Why did Jacqueline have to go through all of those other surgeries when they were so unnecessary???

I don’t know the full answer to this, nor will we ever.  What path each person’s life takes can be changed at any given moment, but had this one women’s choice been honored long ago, it would have saved her a lot of pain, money and heartache.  It raises so many questions for me, questions about birth and beyond:

Why is there so much fear around VBAC?

Why are more people not scared about c/sections?

Why do other people think they know what is best for everyone else?

Why is choice not honored more in our culture?

Why do women’s rights consistently get pushed aside?

Why do we think we can control birth?

I am grateful to Jacqueline for trusting me to hold the space for her to have her baby, and for allowing me to write about it so that others will know and be encouraged.  Stories are the best educators. My hope is that more and more stories of women who dare, will overcome the stories of women who fear.

This one story of VBAC homebirth seems so small compared with all of the other women’s rights issues around the world, but for one woman, her family and a midwife it feels like a grand accomplishment.

Thank you to Brielle, Paula and Jenni for helping me be there for Jacqueline.

Little big sister Texie helping change one of baby Travis’ first wet diapers