This weekend I supported a VBAC mother through both in-home visits leading up to her due date and during labor. Her previous c/s was for failure to progess when in fact she had a persistent posterior presenting baby boy and her labor was augmented with pitocin (a drug dripped intravenously in the hopes the drug will speed up labor) after just 12 hours of laboring naturally on her own and following her own instincts to labor on her hands and knees. This labor began spontaneously with her water breaking. She proceeded to labor on her own until Dad called to say mom would like to have me there now. Mother labored with me providing answers to her questions about what she was experiencing and Dad providing her with answers to how well she was doing, how beautiful she is. We arrived at the hospital with Mom fully dilated and initially beautiful fetal heart tones. Expectations were that she would begin pushing when she felt like it. This was just after midnight. She was never on her back but rather tried pushing by hanging over the back of the hospital bed, side lying and ultimately squatting. The parents listened to the request from the supervising OB for an internal fetal monitor due to a slow heart rate and a need for consistent fetal heart tone documentation. Changing positions to squatting provided a happier baby and supportive evidence for mother’s informed decision to try positional changes before continuing discussions on the baby’s well-being. Upon baby’s birth the OB supervising for the midwife who now supposedly had a birth to see to proceeded to immediately clamp only to have parents tell him to remove the clamp. There was much pressure to change mom’s mind about a natural delivery of the placenta. There was a commentary from the doctor that perineal tearing always accompanies natural childbirth. FACT: Natural childbirth proponents do not claim no woman will ever tear. Rather, normal birth experience shows women are less likely to tear in such a way as to need a repair or are not likely to tear at all when they are encouraged to push only to the point of comfort, push only if they feel they need to be proactive in pushing, and when pushing in any position that feels best to them.
One year ago I supported a VBAC mother through both a natural childbirth series of classes and as her labor support. Her labor began spontaneously at 41 weeks. She called to let me know she was in labor so that I could make arrangements for my family’s care. Around 3pm that afternoon Dad called to say she would like me there now. I arrived to her moaning through contractions yet speaking to me in between. She let me know how she was feeling, what she was feeling, what she’d been doing to cope and how being on her hands and knees felt so good right now. Her biggest concern? That she would dirty the brand new slate flooring! Around 8:00 p.m. she decided she was ready to go to the hospital. We left a clean home and we arrived at the hospital with her bearing down. The midwife on call wanted mom on her back for an exam. Mom went to her side, midwife propped one of mom’s leg’s up, saw the baby’s head and decided there was a dystocia. Dad stated mom did not want an episiotomy, midwife said she’d let mom have one more push. After the next push contraction the midwife cut an episiotomy and proceeded to ‘guide’ the little baby girl (just under 8 pounds) out. We were all subjected to a lecture on how mother’s previous C/S was due to ‘failure to progress’ and she probably had pelvic issues. FACT: This mom’s ‘failure to progress’ was in actuality a posterior presenting baby whose birth had been augmented with pitocin and the back-up OB for this subsequent VBAC birth was on his/her way in to the hospital.
Two years ago I provided labor support for a VBAC mother whose labor began very slowly at 40 weeks. Her first birth was a scheduled cesarean without labor for twins with Baby A presenting breech. At the 12 hour mark with mother wanting nothing more than to just hang out at home Dad became fearful…both family and friends were calling to tell him he was crazy not getting her to the hospital right now. We arrrived at the hospital shortly thereafter and mother proceeded to labor at the hospital for 48+ hours. Again, the labor was never intense. She did not experience the classic, intense transition. More than once cesarean was brought up, not by the doctor. Rather a second cesarean was ’offered’ by her husband and sister who was now also present for the labor. The doctor did however bring up time. Mom went through two doctors’ shifts and two other women’s deliveries by c/s for failure to progress. Mom’s sister’s c/s had also been for failure to progress as she had ‘made it’ to second stage (with an epidural) and after almost two hours of pushing had made no progress. Fortunately for mom, Dr. Carolyn Zelop of the Boston study on VBACs (and co-author of the most recent ACOG VBAC practice guidelines) was on and in the hospital (she is not affiliated with the primary careprovider) for this labor. Dr. Zelop smiled at mom and stated the best care for VBAC is to allow for the labor to progress gently and naturally. Were it not for two women secure in their knowledge of the birth process this mom would have been coaxed into a second cesarean. FACT: This mother was experiencing labor for the first time. She labored spontaneously, naturally and consistently slowly as is typical of most first labors. The coping mother did wasn’t easy to see because the physical aspect was not the main influence. In other words, mother’s mind was not reflecting on pain, but rather that it was truly laboring, something she didn’t ‘know’ her body would do and did not believe her body was doing until the final release of her son into her arms.abor is physiological and nowhere is the power of the mother’s frame of mind stronger and a greater aspect to appreciate than that of the VBAC mother. Patience and respect for the mother’s sense of security in her body are crucial to the positive VBAC experience.
Women reading this post are likely to be aware for the first time of two pieces of birth consumerisms: posterior labor knowledge is scarce among the medical birth trained practitioners and that natural, spontaneous labor is a good thing for VBACs and are likely to lead to healthy outcomes. Families and friends reading this post are mulling over their fears over some aspects of the births and probably empathizing with the father and sister in the second birth. Practitioners are thinking one thing and one thing only: these mothers labored without any hands on medical observation or protocols which equates with ‘not under their control’ and therefore, must be stopped.
Have these births had an impact on VBAC care? Yessss, in a way. The midwifery group mentioned in the first and second births continues to support their client’s informed choice but their back-up OB group is now pushing (no pun intended) to have VBAC birth plans submitted for their review/scrutiny and approval/counterfire. The practice mentioned in the third birth no longer takes VBAC mothers.
The VBAC mother continues to confound the medical birth world. She is in the precarious predicament of representing evidence of and liability for the obstetrician’s or his/her colleague’s previous actions.
More birth consumer’isms’ – VBAC mothers require mental and emotional support on a greater level than the physical coping with labor. Medically trained birth practitioners offer little by way of mental and emotional support for laboring women as that is not in their scope of care admittedly. A medically trained birth practitioner as the primary careprovider is NOT the best choice for VBAC labors. It is difficult for a mother to find a VBAC pracitioner at all let alone one who has the vision to see that the midwifery model of care can provide the support VBAC mothers need and can fill the void in hospital-focused birth advocate’s call for improving maternity health care.
