This past February, I had the privilege of supporting a couple who were planning a VBAC for their second birth.    Jennifer’s first birth was an induction at 9  days past her due date.  There was no medical indication for the induction – she was simply post-date (for a great post on post-dates check out The Unnecesarean).  The Cervidil kicked her into labor and she managed quite well for a long time with the support of her husband and a great L&D nurse.  Then in the middle of the night when her husband had to sleep off a migraine and the shift changed leaving her with a nurse who was much less attentive, she requested an epidural.  Eventually her son was born by cesarean section under general anesthesia because of fetal distress  when she was close to 7cm.

Pregnant the second time, Jennifer was determined not to repeat her first experience.  Her first order of business was to find a supportive caregiver.  She had two litmus tests for each doctor she interviewed: “Do you support VBAC?” and  “Do you encourage repeat cesarean  for women who haven’t gone into labor by 41 weeks?”  Both of these were deal-breakers for Jennifer.    Coming from a family who has a history of babies being born between 41 and 43 weeks, she was not going to settle for a practice who routinely induced at 41 weeks.  It was imperative that she be given the opportunity to let labor begin on its own.  Committed to putting herself on a different path for this second birth, if she didn’t like the answers to either of those two questions,  she scheduled another interview with yet another doctor.

After several interviews with several practices she finally found an OB who was more than nominally supportive of VBAC and who looked at the big picture before encouraging induction.  Then as she educated herself about the various interventions, she decided that this time around she wanted to avoid an epidural for as long as possible as she was convinced that this had significantly slowed things down last time.

As her due date came and went,  she was sent in every 3-4 days for a biophysical profile.   She made sure to stay very hydrated so that she had the best chance at her amniotic fluid not appearing too low.  She also made sure to eat something before the visits so that her baby would be awake and energetic during the tests.  She stayed calm and did not stress out as 41 weeks passed.  41 weeks 2 days.  . . 41 weeks 4 days. . .

Her due date was just around the corner and still there were few signs that labor would be commencing any time soon.  Stripping the membranes wasn’t an option as she wasn’t dilated enough for the doctor to perform the procedure.   Her OB finally gave her a deadline of 42 weeks 3 days.  If her body hadn’t done something by then, medical interventions were going to be pursued.  The clock was ticking, but Jennifer stayed calm.

Of course Jennifer did not wind up becoming the first eternally pregnant woman.  At about 11pm on the eve of 42 weeks past her due date labor began.   Throughout this labor she and her husband  made many decisions to help make sure she stayed on a path that had the best chance of ending in a vaginal birth.

The first nurse assigned to care for her did not want her out of her bed when hooked up to the fetal monitor.  Jennifer immediately knew this was not a good fit.  She requested a new nurse from the charge nurse and was presently assigned a nurse who was studying midwifery.  Much better!

Later when her blood pressure was showing high readings, she labored on her left side even though this made dealing with the contractions much more difficult.    Jennifer knew that if her blood pressure didn’t come down, she wouldn’t even have the option of dealing with contractions as she would soon be having another surgical birth.   Laboring on her side was super effective at keeping her blood pressure in the normal range.

When the doctor on call (not the same doc who had cared for her during the pregnancy) lectured her on the risks of VBAC while she was in active labor, and later the risks of shoulder dystocia as this baby looked large, Jennifer kept her cool.  She had educated herself on these things before the birth and was more comfortable with VBAC  and birthing a large baby than she was with the risks associated with major abdominal surgery.

Lastly, she changed positions every 4 or 5 contractions while pushing to effectively use gravity and lots of movement to bring her baby down.   It so amazing when  Jennifer finally eased the baby out. Not quite two hours since she had begun, Jennifer pushed out all on her own body’s power, a 9lb 5 oz.  baby boy.  It was so amazing to see.  He slipped right out and was placed right on her chest to hold and cuddle and nurse.

VBAC moms always impress me.  Not only becasue they face the normal challenges of labor and birth (which are significant!) but they have the added challenge of birthing in a system and an environment that is not designed to facilitate VBAC.  It took determination, patience, and  skilled high pressure negotiation (there’s not much more pressure than when your doctor tells you that your baby might die from the decision you are making!) just to get to the moment where she could even have the opportunity to go into labor.     She later told me that the next day a nurse came in and told her that she was the only one of the floor to birth vaginally that night.

Jennifer had learned since her first birth that it was not her body that had failed in her first birth, but the induction. Her body simply wasn’t ready to give birth yet when she went in for the induction and so the labor was more difficult and ended in a surgical delivery.  This time around, Jennifer’s determination to trust in her body and give it the time it needed payed off.

Good things come to those who wait.