CBAC - International Cesarean Awareness Network

Birth Story: Anne’s VBA2C

January 18, 2018 by blog Leave a Comment

Originally published in 2012; link to Amazon Smile that donates a portion of proceeds to ICAN

2nd heartbeat For those who don’t know where it all began, I’ll start with my first pregnancy. August 2008 – I got pregnant with my DD and worked with the Midwife Center to attempt a natural delivery. The entire pregnancy was full of complications, which I won’t go into, but it came down to me going 41 weeks when they eventually diagnosed me as having preeclampsia and offered a c-section or induced labor. No labor signs had come up to that point so I elected the routine section given my daughter didn’t seem ready to come out anyway. Recovery was very hard, but I got by.

Three months postpartum, I discovered that I was pregnant again and, needless to say, shocked, but learned about VBACs and found a practice that supported my desire to attempt one. This pregnancy went fine except for the fact that it was full of stress having to move, take care of my DD, and mentally and physically prepare to have another child within a year. I tried everything to go into labor naturally using the advice of a wonderful doula I was working with but wound up going 42 weeks and a day without any signs of labor. After getting an ultrasound, they found that my amniotic fluids were dropping and urged that I get my son out asap. With much remorse, I consented to have a repeat section given I really had no choice; obviously, I wanted my son to come out alive. While they were performing the operation, they discovered that the lining of my uterus was so thin they could see my son through it (aka dehiscence) and said it was good that I didn’t labor since I would have ruptured. The recovery was very rough and throughout the following year, I had numerous health issues which I attribute to having two surgeries so close together.

Fast forward to August 2011. I got pregnant again. Returned to my former OB/GYN practice only to be told that they were not very supportive of me attempting a VBA2C. I went looking at other practices only to be told repeatedly that they would not allow me to VBA2C since it was too dangerous and I could rupture. Desperate, I contacted the Doulas of Pittsburgh in January seeking advice about alternative options for bringing this baby into the world. Was home birth something I could consider? Maybe. So I asked about working with a lay midwife who could give me tips for having a natural delivery. I got the name of a woman and we spoke at length about my past pregnancies to which she said she thought she could help me. The Doulas also gave me the name of a doctor at Magee who was very pro VBAC and recommended I speak with him to seek his counsel.

I made an appointment with Dr. K and, after having looked at my post-op records, said that he felt I could attempt a VBA2C but only because I was double sutured (they sewed my uterine wall twice to make it extra secure). He said I had a 7 out of 10 chance of having a natural delivery but that the damage that could result if I did rupture would be bad. I decided it was worth the risk and, upon his suggestion, worked with the Midwives at Magee for my prenatal care while simultaneously using the lay midwife for the bulk of my prenatal needs. The lay midwife came to my house and spent many hours talking to me about things that were issues from my past as well as problems in the present. She said I had a lot to work through mentally if I was going to have a natural delivery as that, along with hormonal imbalances, was preventing labor. I also went to seek medical help from a chiropractor who worked on correcting my imbalances which helped me tremendously.

After months of emotional healing, reading an awesome book, and getting alternative health treatments, I really started to believe it could be possible to VBA2C, that is until I had a follow up with Dr. K at my 39-week checkup. He told me that the midwives were divided about my being able to labor and were not all supportive of me going forward with it due to my dehiscence. They didn’t know what would happen under my circumstances since so few women have ever attempted a VBA2C knowing they also had a window in their uterine wall. I was their guinea pig, so to speak, and they were going to watch me very closely as this was a birth that they would be talking about a lot in the future, whichever way it goes. I couldn’t believe he was telling me this after working with them for months. I felt like they pulled the rug right out from under me. I was so sick of people telling me I was high risk! Bottom line, he wanted me to know that if something should go wrong that they weren’t to blame. It was such a blow to my confidence that I felt like I was all alone and fell back into worry. I called my lay midwife and explained all this, only to get an amazing pep talk that filled me once again with the peace of mind knowing that whatever happens will be ok but that there is more chance of success than failure, especially if I believed it.

A few more weeks came and went until it was my due date, May 20th. However there were no signs of labor and again, I started to worry. Was all this preparation for a VBA2C in vain? Would my body fail me again? Would people tell me I told you so? Would I survive a natural delivery? The thoughts that went through my head were hard. It was the toughest time in my pregnancy. Days went by and still nothing but the usual stretching until on May 27th, I got my first contraction! It was the most wonderful feeling in the world and I couldn’t believe my body was actually doing what it was supposed to. Something I was doing was working!

My contractions were steady at 40 seconds long every 8 minutes. Sunday night, the contractions stopped only to start again the next morning at about the same rate. That night they tapered back again but still stayed with me. That morning, the 29th, I had an appointment with the Midwives at Magee for a BPP ultrasound and followup. The ultrasound looked great so the baby was in good shape. The midwife, M, saw me and said that I was 3 centimeters dilated and asked if I wanted her to sweep my membranes to get things moving. She did and shortly after, I started getting stronger contractions though still at about the same rate. My husband and I walked around the hospital, ate a good sized lunch, and then felt like it was time to admit myself to triage since the pain was strong enough for me to not want to leave. My lay midwife was called in (under the title of my doula) and she, my husband, and I waited in the labor room for things to progress. My body was feeling the pain but it was nothing overwhelming. And then about 3 hours of the same pattern of contractions, the nurse-midwife offered to break my sack of water, which I agreed to. Immediately my body went into full transition labor and stayed there for about an hour. It was so painful that I felt like dying, but my lay midwife kept telling me to not give into the fear, to ride the wave, and to stay on top of the pain. It could not conquer me, especially after all I had done to get to this point. It was really a battle between my mind and my body, and I had to not let my mind be controlled by that pain but had to just let the two work together.

Once I felt the urge to push, things really went quickly and within 2 minutes, I went from 7 to 10 centimeters and felt my baby coming. Five minutes after that, her head had descended but she was in distress, so they rushed a team of doctors in to prepare to take me to a section and started giving me oxygen. However, the midwife told me to push hard to get her out since she was so close to coming out. I pushed with everything I had in me and soon enough, my baby was born! Her Apgar was very low so they had to resuscitate her and I started hemorrhaging from a severe vaginal and 4 centimeter long cervical tear. They had to rush me to the OR to start stitching me up but thankfully, it was nothing that would have any permanent damage. They had never seen a tear that bad before and couldn’t figure out why it happened but in the end, I was still happy because I had her naturally. Not the ideal labor but whoever gets that anyway, right?

So that’s my story and I pray it gives some hope to those of you who are struggling to believe a VBAC is possible for you. So many people doubted this could happen and yet, with the right physical and emotional support, along with keeping a positive outlook and praying for God’s help, I got what I wanted. It’s so cool to think that I have blazed the trail for other mothers who want to VBA2C as well as provide new hope for those who have had dehiscence. All things are possible if you believe! I wish all of you the best in your journey towards VBACing.

Lucy’s Cesarean Birth After Cesarean

November 25, 2015 by info

by Lucy O’Connor

This birth story is shared by Lucy O’Connor, and appeared originally on csectionmums.com.

I found out I was pregnant in July 2008. I had a miscarriage only a matter of weeks earlier and hadn’t even got my period back! A scan (in the absence of a LMP) set my due date as St Patrick’s Day 2009 – 17th March. Having had a whirlwind cesarean with my first I wanted a normal delivery – to attempt a Vaginal Birth After Cesarean (VBAC). My obstetrician was fully supportive. I had my last antenatal appointment on 15th March and was set for another one on the 20th March before we would decide how to progress after that – induction was not recommended due to my previous section.

On 19th March my waters broke. I was on my own with my then 2-year-old. I called my mum and textedmy husband to let them know and called the hospital. They advised to make my way in for a check. I organised myself and eventually headed in to meet my husband after work. I was assessed and advised that my waters had indeed gone but I was not in labour as yet. The doctor on duty called my obstetrician who asked that I be admitted. I was brought to my bed and my husband had to leave me. I tossed and turned all night but nothing major happened. At 7 am my obstetrician came to see me. A fetal trace was done and an internal and barring a few minor contractions there was nothing happening and my cervix was tight shut! I was given the option of a repeat cesarean that morning or wait it out and see what progressed during the day. Given my VBAC wish I decided to wait it out but mindful that my waters had gone 14 hours previously and I could not wait indefinitely. I reckoned another 12-24 hours would be fine.

I was brought to a private room and checked over by a midwife. She checked baby’s position and reckoned he was posterior and told me I had a lot of work to do and got me a birth ball. I spent the next number of hours bouncing on the ball and walking the corridors and stairs of the hospital. I had a number of contractions but every time they seemed to kick off they stopped just as quickly.

By 6 pm that evening my OBs came to check on me. No progress. He gave me the option of waiting another 12-24 hours but his view was that nothing would change and with the waters gone we needed to pick a point where we agree to throw in the towel. I was tired and emotional and without wanting to risk anything went off to theatre that evening where my son was born by repeat cesarean. The obstetrician commented that he was wedged in a very awkward position and I could have been days waiting on him to budge (and I can tell you that despite the spinal block the tugging and pressure I felt as he tried to pull him out was immense – my obstetrician was practically on top of me pulling him out!!). I had sore ribs for weeks afterwards.

After it was all over I found it very hard to emotionally deal with the VBAC attempt. I guess I felt like I threw in the towel too early – it wasn’t as if I was being forced into theatre – he was perfectly happy to wait it out with me another few hours. It is my one regret about my son’s birth. That said he is here, he is healthy and he is an amazing little boy – albeit at times wreaks the place!!

This story was shared by Lucy O’Connor, Founder of C-section Mums and owner and blogger at www.learnermama.com. She has three children, all born by cesarean and lives in North County Dublin, Ireland with her husband Niall.

The Birth of Baby B

November 23, 2015 by info

By Melissa Debach

This birth story is a reprint from the Spring 2015 edition of The Clarion, the official publication of ICAN. Become a member today to support ICAN and to subscribe! Photos courtesy of Erin Monroe Photography.

Photo courtesy of Erin Monroe Photography.

After the birth of my daughter ended in an unnecessary cesarean, I was determined that my second (and last) baby would be a vaginal birth. I began researching homebirth midwives and doulas years before I became pregnant with my son. He was cephalic throughout the entire pregnancy and it seemed my homebirth would actually happen.

At my 39 week midwife appointment, she said “something’s different,” and she sent me for an ultrasound. My stubborn little guy decided to go two feet down (double footling breech) at 39 weeks. I tried everything to get him to flip. Spinning babies. Chiropractic (Webster’s). Essential oils. Massage. Acupuncture. Moxibustion. Handstands. You name it, I tried it.

When it became clear he wasn’t going to move, I reached out to my local ICAN leader and friend (Angela Ziegler) for some support and education. She suggested I research incidence and prevalence of cord prolapse in a double footling breech. I dove in and read everything I could get my hands on and discussed the risks with my midwife. We both felt that a transfer of care was in order.

I immediately reached out to the hospital where I would be delivering via cesarean. The first email essentially said: “A surgical delivery is absolutely the last thing I wanted to have happen. Please help me make it suck less.”

I asked for: delayed cord clamping, skin to skin immediately, I wanted my photographer in the operating room and I wanted to keep my placenta for encapsulation. I was immediately put in touch with the COO/Chief Surgical Services Officer and the nurse manager for the L&D OR. At 5:44pm on the evening before my surgery, I received an email that said “I think you’ll be pleased with what we can accomplish from your wish list,” but there was no detail. On February 20, 2014 once I was checked in, scrubbed up and prepped for surgery, they came to tell me that they were able to give me everything I asked for. It was such a relief!

Once he was out, they gave him to me, where I had him skin to skin for about 45 minutes while they stitched me up. It was pure bliss and I am grateful for the gentle, family-centered cesarean I was able to have and the photo that illustrates all the feelings of the moment: elation, unconditional love and relief. I truly hope that family-centered cesareans become the standard of care.

There’s No Such Thing as a Failed VBAC- A Letter to the CBAC Mom

November 7, 2015 by info

This post was submitted to us by writer Aprille Donaldson. The original post can be found on her website www.beautifulinhistime.com.

Dear CBAC Mom:

I just want you to know that I get you.

For nine months you carried your baby within you. And for nine months – maybe even longer – you dreamed about pushing that baby out of your body with your own strength.

You planned. You prepared. You hired a doula. You probably spent hours reading books and websites, making sure you were making the right choice for you and your baby.

You exercised. Maybe you changed your diet.

Maybe you had to fight. Maybe you had to drive a long way for your appointments and birth. Maybe you had to explain your choices to the naysayers.

You prayed.

At one point or another, you were probably afraid.

You wondered if you could do it. You wanted to believe you could.

You wanted to believe that this birth would be different.

But for some reason, it didn’t happen.

Your breech or transverse baby didn’t turn. The cord prolapsed. You got chorioamnionitis. Your baby went into distress. Your placenta didn’t move. Your body didn’t dilate – again. Your baby was too big, or maybe stopped growing. Your blood pressure went up. Your uterus ruptured. You pushed and pushed and that baby still. just. wouldn’t. come. out.

A call was made. and you said, “Yes…cut me open.”

I hope that your beautiful baby is safe in your arms.

I hope that you realize how brave you are. You made a choice to try something that very few will try to do.

But when it came to the safety of your baby, you made the best choice:

You said, “I choose you!”

And that makes you a success.

I hope you know by now – I hope all of your children have taught you this:

Moms have to make hard calls. Sometimes, you have to make choices that others will judge and scorn as less than best because they are the best choices for you and your baby. Making those choices is just part of being a parent.

It’s okay to be disappointed. It’s okay to say, “This is not what I wanted.” It’s okay to grieve and cry.

But there’s no such thing as a “failed VBAC.” Because you cannot fail at birth. You cannot fail at bringing a child into the world.

Look into that baby’s beautiful face. You made that! You did that!

You are brave. Strong. Competent.

You are scarred, but you are not broken.

This post was submitted to us by writer Aprille Donaldson. The original post can be found on her website www.beautifulinhistime.com.

Cesarean Birth After Cesarean

November 2, 2015 by info

by Kmom

Reprinted from the Spring 2015 Edition of The Clarion, ICAN’s quarterly online publication. Subscribe today to get yours!

Remember, no effort that we make to attain something beautiful is ever lost. – Helen Keller

Eighteen years ago this spring, my second child was born. He was born by repeat cesarean after a long, hard “trial of labor” which included 5 hours of pushing with no progress because he was big and posterior with an upright (“military”) head position.

I’ve second-guessed that birth for many years. It’s possible that if we’d pushed even longer, his head would have molded enough to fit through my pelvis and turn anterior on the perineum, as many posterior babies do. However, at that point, I was exhausted, in a lot of pain, and was worried about the wisdom of continuing when things had gone so long without progress. I didn’t want to go into a repeat cesarean in true emergency mode because of a rupture or fetal distress, and emotionally I needed to make sure that I didn’t have an anesthesia failure like I did with my first cesarean. At that point, I just had a strong sense of Inner Knowing that it was time to be prudent and stop before things became a real emergency, but it was hard to communicate that to my husband and support team. My doula treated me like I had wimped out and thrown in the towel too easily. I never heard from her again after the cesarean. It was clear she viewed me as a failure.

At that time, there was no ICAN chapter in my town. I dreaded having to go back to the ICAN mailing list and tell them I’d had a CBAC , but I gritted my teeth and did it anyway. I got some sympathetic responses, but mostly I got a lot of silence or tepid responses that felt judgmental. No one knew how to reply to someone who hadn’t gotten their VBAC . Over the years, there was a lot of armchair quarterbacking about my decisions. People meant well, but I was left feeling pretty unsupported. And I didn’t feel I could really emotionally process the birth fully in ICAN spaces because I was afraid of discouraging those who were still planning their VBAC s. No one wants to hear about when VBAC doesn’t work out.

But if about 75% of labors after cesarean end up with a VBAC , that means that about 25% of these labors end with another cesarean. Where is the support for women who have an undesired second cesarean? Where is the acknowledgement of all the work they put in towards a VBAC , the hours of labor, the pain, the worry? Does all that preparation and work not count if you don’t end up with a VBAC ? In time, I began to realize there was a vacuum of support for the mothers who didn’t VBAC . It wasn’t just about my own experience anymore, but also about other moms. How could we make it so that all mothers felt supported, regardless of outcome? Isn’t ICAN about emotional support after any cesarean, whether it’s your first or another one?

I wasn’t the only one, of course. A number of us shared this experience of another unwanted cesarean, including people in the leadership of ICAN, and we began to talk about how to offer better support. One of the first things we did was ditch the terms used in the medical literature, terms like “Failed VBAC ” or “Failed Trial of Labor.” We felt this was too judgmental and insensitive. We were not “failures,” we did not “fail,” and we should not have been “on trial.”

We created the term Cesarean Birth After Cesarean, or CBAC , as a more mother-friendly alternative. It refers to a cesarean that occurs when the mother really wanted and worked for a VBAC but didn’t get one. These women had different emotional needs than those who wanted a repeat cesarean, and terminology needed to reflect that difference. So we used “CBAC ” to differentiate another unwanted cesarean from Elective Repeat Cesarean Section (ERCS), where women truly wanted another cesarean and voluntarily chose it. Neither is good or bad; they are simply different experiences.

There are many shades of CBAC . Most of the time, it refers to someone who labored and ended with another cesarean, but it can also refer to a cesarean performed before labor for medical reasons, because the mother had no choice, or because the mother was coerced or scared into a repeat cesarean. Some women prefer CSAC (Cesarean Surgery After Cesarean) because they consider the term “birth” too emotionally loaded. Our position is that women get to choose the term that seems right for their own experience. The important thing is to acknowledge and validate the range of feelings that women have over this experience.

Of course, all CBAC mothers are not alike. Having the shared experience of a CBAC doesn’t mean other details of our situations are similar. Each CBAC is unique, and each carries its own particular color and resonance of pain. Some CBAC mothers felt they had a “prudent CBAC ,” where although it was difficult, a repeat cesarean felt like the right choice under the circumstances. Some had an “empowered CBAC ,” where even though there was disappointment and sadness, there was powerful learning and healing too. Some go on to have a VBAC eventually, while others never do. Some have multiple CBACs, each with their own emotional resonance. Some have a VBAC and then a CBAC , which has its own particular pain. A few have had the bitter experience of having lasting physical and emotional damage from their CBAC, including uterine rupture, hysterectomy, or damage to or loss of their baby. As always, each person’s experience is different and unique, and each CBAC mother needs safe space to process all the varying feelings about those experiences. But sometimes this is difficult to do within regular ICAN channels.

Over the years, we have tried to expand resources for CBAC mothers within ICAN. We have created an online support group and Facebook page for CBAC mothers. We have offered several CBAC sessions at ICAN conferences and at local chapter meetings, and we have had many heated discussions online about CBAC . But even now, some people don’t think there needs to be any separate support for CBAC mothers (“a cesarean is a cesarean”), and to this day, many of us with CBACs still have our birth decisions questioned and second-guessed. Although many doubters have come around to offer more support, CBAC still remains a topic of some friction at times within the community.

In 2011, I offered another CBAC session at the St. Louis ICAN conference. The session was derived from discussions by mothers on the Yahoo CBAC Support Group, and many graciously consented to sharing their thoughts and quotes to help others. At that session, we brainstormed ways to offer further support for CBAC moms. One of the main ideas was to have an online website devoted to CBAC support and information.

So last year, Melek Speros, Catherine Kowalik Harper, and I created a CBAC Support website. On this site, we share CBAC research, websites where CBAC moms can go for emotional healing, information on the unique emotional needs of CBAC mothers, suggestions for processing a CBAC , CBAC birth stories, inspirational quotes for healing, and suggestions for birth professionals to help support CBAC mothers. In future years, I hope we can create even more ways to help support CBAC mothers.

Eighteen years after my own CBAC , it remains a potent memory. My sweet little boy is a man now, ready to fly off on new adventures, but his birth is still a touchstone for many different emotions. Although I did eventually go on to have 2 VBAC s after the CBAC, those experiences didn’t really heal the CBAC . They simply are different entities – not better or worse, just different. Although there are things I still mourn about my CBAC, I have learned to honor all my birth experiences, difficult or easy, because they are a big part of the person I am today.

The lessons I learned from my CBAC remain powerful and still resonate in my life. My CBAC helped me to be more compassionate about other people’s births, to recognize that sometimes there are just things that are beyond our control in the moment. It helped me to realize that sometimes birth is more about the willingness to heal and change; that it’s more about the journey and less about the destination. In time I learned to honor both the disappointment and the joy in all my births, to remember that what counts most is the parenting we do throughout life rather than how we birth, but also that how we feel about our births counts . I found that out of my suffering came the ability to transform pain into advocacy. I found my voice in a new and potent way, and I have endeavored to channel the power of that voice to create change, as well as to create and hold safe space for other women and their unique experiences.

A CBAC is never an easy thing. The pain and disappointment of it stays with you forever. But in time, out of the pain and conflicting emotions can come great growth and power to create change for yourself and others. Just give yourself the gift of time and space for that healing. It will come.

Kmom is a childbirth educator, speaker, free-lance writer, and well-rounded mama to four kids. She writes at: www.wellroundedmama.blogspot.com (blog) & www.plus-size-pregnancy.org/ (website).