Episode 157 - VBAC Tips and Tricks
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Welcome to today's episode of the Great Birth Rebellion podcast. Today we're looking at the topic of vaginal birth after cesarean, what we call VBAC, and specifically how to improve the chances of your next birth after this cesarean being a vaginal birth. Not every woman who has a cesarean section will want to have a vaginal birth for the next birth. Some women will choose to have a repeat cesarean section, but lots of women have feelings of dissatisfaction if they have a cesarean section, especially if they feel like they didn't really need one. So whatever the reason and circumstances around your previous cesarean section, I hope this episode gives you some hope that a vaginal birth is possible for your next birth. In fact, the research suggests that women should be offered the opportunity to have a vaginal birth after a previous cesarean section even if you've had multiple cesarean births. So this is what you want. There are very few circumstances that would rule you out of a vaginal birth.
Mel:
[1:29] And today we're speaking with Marissa from Twice Blessed who just months ago gave birth to her second baby vaginally after an initial cesarean sex for her first baby and her twin sister Bec is planning to do the same with her second maybe after also having a cesarean section with her first. So Beck and Marissa are twins and
Mel:
[1:51] Are both planning VBAC births for their second births, and I'm bringing you Marissa's story because I want to show you what sheer grit, determination, and stubbornness can do for you during your birth. What you'll see in Marissa's story is that her birth circumstances were far from ideal. She didn't have continuity of care. She came to the decision to have a vaginal birth late in her pregnancy, yet she was able to create a circumstance for herself that contributed to her ultimately having a vaginal birth. In this episode, she stacks all the strategies that she used to help have a vaginal birth this time. And as usual, when we share birth stories on the Great Birth Rebellion podcast, we don't do it all the time, but we do it with purpose. So you'll hear little extra bits from me as I add commentary and little educational nuggets scattered throughout the story. So this episode is for you if you're hoping for a vaginal birth for your next
Mel:
[2:53] birth or if you're supporting women to do so. In this episode, I'll highlight particular parts of Marissa's story that were pivotal decision points that increased her chance of getting the birth that she wanted. so let's get into it. Welcome Marissa to the Great Birth Rebellion podcast. Today we're going to hear your VBAC story.
Marissa:
[3:15] Yes, very excited.
Mel:
[3:17] My attention was drawn to your story because you recently had a VBAC and your baby's 14 weeks old. Yes. And you shared a little bit about it online and there were women asking you what kinds of things helped you have a vaginal birth after your previous cesarean section so I'm really keen to talk to you about that.
Marissa:
[3:39] Amazing.
Mel:
[3:40] Before we start how about I'm going to let you introduce yourself so our listeners know who you are I know who you are but if you could share a little bit of what you do with your day and your life who you are and then we can jump into your birth story.
Marissa:
[3:53] Well I'm Marissa I'm one half of a fashion blogger duo with my twin sister Bec our business name is twice less so we've been around for I want to say 12 years so a long time in the fashion industry and we recently launched our own fashion brand major about two years ago now so alongside our business baby I had a baby she had a baby I had another baby just recently and she's freaking marvellous per second so it's been a very full past four or so years now I have transitions in motherhood which I adore beyond anything else so I feel very blessed to be a mum and have beautiful children so.
Mel:
[4:29] Twice blessed which you run with your sister Bec, who also is currently pregnant and you were pregnant together for again, your second babies, and you're both planning a VBAC.
Marissa:
[4:41] Yes. Yeah, it was very exciting. It was funny when before Bec fell pregnant, it was a wonderful surprise. We had always said we can't get pregnant at the same time because someone needs to work and we can't both have pregnancy brain. But alas, she was excited when she fell pregnant as well. So I was in my last trimester. She was in her first trimester. So possibly the worst time to both be pregnant at the same time because we kind of said we had two half brains working together. It was a massive joy to be pregnant together with my twin. It was really special. And, yeah, I'm really excited for her now transitioning, to the last trimester of her pregnancy and aiming for her VBAC as well, which is awesome.
Mel:
[5:18] And she's got you to lean on with planning her next VBAC.
Marissa:
[5:23] I was the guinea pig and I passed. So she can just kind of like copy and paste for herself, which is really, really good.
Mel:
[5:29] Well, I'm hoping that lots of women can copy and paste because there are lots
Mel:
[5:34] of women out there who are listening who want to also have a VBAC. So part of what I really love to extract from your story is what elements of the planning and strategy that you used to get that, which parts of those were most pivotal in you getting a vaginal birth. And I'm sure that's going to be peppered all the way through your story. Let's start with your first pregnancy because, I mean, understanding the reason for the first cesarean can be really impactful for what happens following. So I'm going to give you the floor.
Marissa:
[6:06] Yeah. So I fell pregnant in Feb 2021 and I'm from Melbourne. So that was peak COVID lockdown. Couldn't go to Europe. So we had a baby instead. That was the plan. Easy pregnancy. I was very fortunate to have a blessed pregnancy, no real complications, things like that. So I was very low risk. I was in the midwifery group program at my hospital, my public hospital, which were amazing.
Mel:
[6:29] Here, Marissa is talking about a publicly funded midwifery group practice program that she was able to access through her local hospital. So these midwifery programs are free to use in Australia, but access is still limited because they are often only available to women whose pregnancies are considered low risk and for women who get in early. They fill up really quickly. They're quite popular.
Mel:
[6:53] Also, not all hospitals offer midwifery care programs, so your access to these will be impacted by where you live and if you have complexities in your pregnancy. The great thing about midwifery programs is that women get to know the midwives who are caring for them because the same midwife or group of midwives will be providing the care during pregnancy, birth, and postpartum. So if you can get into a midwifery group program, you are more likely to have a better birth experience. Unfortunately, while these programs are evidence-based, they can be very hard to access. My tip here is even if you're planning a VBAC, is to try and get a midwife who will care for you all through your pregnancy, birth and postpartum. You can try and get on a midwifery group program through a hospital or hire your own private midwife, which might be your only opportunity for continuity of midwifery care if your local services don't have a midwifery program. Or if they do have a midwifery program, often those programs doesn't care for women who are planning VBAC. Some do. Some are called all risk models. So it's worth investigating what your midwifery
Mel:
[8:03] options are through hospital when you're planning your VBAC.
Marissa:
[8:06] And I really had a great pregnancy. I was aiming for a vaginal delivery. I had no concerns that I wouldn't achieve that. I went to 42 weeks. So I went overs, in quotation marks, even though I knew that 42 weeks was really one of my end dates. And there was no discussion of induction or anything like that before that point because I was a part of the military group program, which I was very fortunate for. But I kept asking the way through, oh, how is my son measuring? Because my husband was 10 pounds at 38 weeks born. And my sister and I as twins, we were about six and a half, seven pounds each. So we were big as well for twins at Gorda Station. So he's measuring normal, he's measuring normal. Anyway, I got to 42 weeks and I was like, okay, it was kind of that induction time. And we wanted to try the lowest grade induction first of the balloon to try and give my boy the best chance of kind of going to that labor beyond that point rather than having my waters broken and the induction drug put in.
Mel:
[9:06] Marissa is talking about the process of induction of labor for women who haven't started labor yet. If you are new to learning about birth or haven't looked into induction yet, the Great Birth Rebellion podcast has a number of episodes about induction, including about the research, the process of induction, and some of the risks. So there is a list in the show notes with clickable links for you to look deeper into the option of induction and see if it feels right for you. What Marissa is talking about here is that she opted for the balloon catheter, which is a catheter that's about half a centimeter wide, and it's inserted into your vagina and up into your cervix and once it's in your cervix, it's inflated and one or two balloons inflate in your cervix as a way of kind of prying it open to start dilating it.
Marissa:
[9:55] So we did that. Unfortunately, I didn't dilate that much. It was two centimetres overnight and then from then it really was a cascade of interventions from that point. So in the morning, I was still confident I could deliver vaginally. Waters were broken. A few hours after that, nothing really had progressed, so we had drugs put in. And then from there, obviously, with the, yeah, the contractions got really intense really quickly. I couldn't really acclimate to the pain. So from that point, I really lasted four hours, I think, and then had the epidural. And then from that point, it was a slow next 15 hours of just kind of like trying to move around. I still could move around enough, but then my son became posterior. So we're trying to move around different positions. And then from what I remember, almost four years ago now, he was impacted on my pelvis. So I had blood in my urine and then I had a low-grade fever. So they were treating all these things.
Mel:
[10:50] This combination of things that Marissa is describing sounds to me like what midwives call and doctors call obstructed labour. Meaning for some reason the baby is being prevented from coming out. And an obstruction can be caused by a few things. Could be posterior babies, babies in an uneven position, epidural, the pelvis size, the force of contractions, the size of the baby, and things that maybe compact and further push the baby into that compaction, like really strong contractions or an induction. There can be lots of things, but with obstructed labour, we typically see this pattern where there's blood in the woman's urine, fever, an extended period of time in labour, and over time the baby can become distressed if the reason for obstruction isn't resolved.
Marissa:
[11:44] And I think by the end of it I had dilated to around seven centimeters I think but this was like 30 plus hours from the balloon until this point so I was exhausted even with epidural I was exhausted and I had a wonderful OB who came in very calm sweet sweet man and he said hey Marissa there's no pressure at all but, You've been here for a long time now and you're not progressing as much as we'd like to see you. Do you think maybe it's time for a cesarean? And I said, okay. By this stage, I was exhausted. I was like, let's just, I'm done now. I think I've kind of maxed out all my capabilities to what I can do. And I pulled my son out eventually 10 minutes later and they all started laughing because he was humongous. He had a 40-centimeter head, set 4.72 kilos, just like a big, big kid. And so obviously, yeah, he just didn't want to come out and then without laughing. And I was fortunate that I had a very casual style caesarean. It wasn't that emergency caesarean that a lot of people do experience, which I was very fortunate for. And I didn't have the trauma of a traumatic birth, which I'm also very, very fortunate for. I felt very in control of my decisions to have caesarean.
Mel:
[12:55] This right here, this is the key element for women. Even when things don't go to plan in your birth, feeling in control of decisions at your birth are a key element of leaving your birth not feeling traumatized. Your birth might not be what you wanted. You can still and may still feel disappointed by the events. But if you feel like you were in control of the decisions that you made, this is a key element to avoiding trauma at your birth. And I'm going to take this opportunity to let you know about a masterclass that I just ran a few days ago. It was all about how to increase your chances of having a great birth. If you couldn't be there live, that's okay. We've got a recording of the masterclass. If you go to melanethemidwife.com and you can listen to the masterclass for free. It's all about increasing your chances of having a great birth. And this here, what Marissa is talking about, the feeling of being in control of the decisions that are made at your birth is a key element of leaving your birth without feeling traumatized.
Marissa:
[14:07] I just found my induction part the trauma point for me. I hated the idea of being induced and that caused a lot of stress on my body
Marissa:
[14:15] and I couldn't get Levi into the right position because I couldn't move very well the epidural. So then fast forward, fell pregnant again I in between both things I had a miscarriage at a molar pregnancy so I was already very aware of how medicalized system was through that process as well so then this time around fell pregnant post-covid I think a lot of people are swinging to a less medicalized system which I definitely am that kind of person now too and from the start in my mind I was torn between the idea of, oh, cesarean's just easier, it's elective, I can just stroll myself in, leave, I can go to my parents' house, that kind of idea of being a mum and trying to, you know, risk manage everything, it felt like the easier option.
Marissa:
[15:01] So I didn't apply for the midwifery program because of that. I didn't want to steal someone else's spot who really wanted quite a holistic birth. I wasn't going to choose that option in the end. Quite selfless of me, but I was like looking back now, I'm like it was the best decision, but I probably should have just been selfish and applied anyway. I was torn, but deep down I still really wanted a vaginal delivery. I kind of very strongly believe that this is how God's designed us to be able to give birth and carry a child and give birth vaginally, and I really wanted to trust my body that I could do it. I knew that I could do it. I just wasn't allowed to the first time around. My body just didn't allow it for whatever reason and I wanted to fix that for this time around.
Marissa:
[15:40] So got into the system, went to my hospital. The first appointment I had was with an OB actually this time rather than a midwife and the first thing they sent to me was like, oh, you don't want to have 36 hours again for another cesarean. Just go for your elective cesarean. Don't even bother with a vaccine delivery. They didn't even bring up a vaccine delivery. They just said cesarean. and I was like oh okay sure fine so I kind of slipped under the radar for a little bit didn't really say too much about my I guess birth plan or birth options and they just kind of just penned me as this elective cesarean so I was like I'm not going to say anything until I know what I want to do so yeah went through probably most of my pregnancy still tossing up and I think I've got to it was around 30 weeks I was quite late in my pregnancy but I hadn't really decided a debt and I think it was my 28 or 30 week appointment the obstetrician that I saw said oh so you booked him at 39 weeks to cesarean and I was like 39 weeks she's like yeah I'm like I don't want to if I'm going to have cesarean it's going to be after my due date and she's like no no we don't do that here it's 39 weeks and I was like I'll cancel it I was like there's no way I'm getting cesarean before my due date because it's not giving my body a chance to even deliver naturally or go into spontaneous labor I think from then that's when I decided the system isn't in my favor for letting my body to go in spontaneous labor, which is what I need to deliver vaginally in my mind.
Marissa:
[17:00] So from then, I'm also Greek, so I'm really stubborn. So I was like, that's it. Foot's down. I'm not having a cesarean. I'm having a VBAC. That's like, it is final in my mind.
Mel:
[17:11] Here we go. Marissa is about to explain some of the critical elements that I think tip the odds in her favor for a VBAC. Firstly, she talks about her absolute stubbornness and determination. And this gives women a lot of grit and resistance in being swayed.
Mel:
[17:30] So pay attention. She's about to stack some other tips about how she had the VBAC of her dreams.
Marissa:
[17:38] So From then, I just tried to immerse myself with as much information as possible.
Mel:
[17:42] There's another one, immersing in as much information as possible. This is Marissa realising the importance of being educated enough so that if she needed to, she would have the power to make informed decisions that she could feel good about.
Marissa:
[17:57] I joined the VBAC Australia Facebook page, which has been instrumental and just feeling confident hearing other women's birth stories.
Mel:
[18:04] Or there is another one, gathering support and hope from a like-minded community. So remembering this is something that Marissa pursued. She didn't sit back and wait for people to come to her. She took an active interest in her birth experience. And hearing the stories of women who have done what you want to do, it strengthens your resolve because you know it's possible.
Marissa:
[18:27] Failed VBACs and what they think could have fixed that different story that really helped me. I read the Birth After Caesarean book, which is wonderful as well. They really helped me feel more equipped.
Mel:
[18:39] Here, Marissa is still gathering information and becoming as educated as possible. And this book that she's talking about is called Birth After Caesarean by a friend of mine, Dr. Hazel Kiedel. And we have interviewed Hazel on the podcast before about Birth After Caesarean and about her book. So I've linked the episode in the show notes so you can go back and listen to that one. it's something that helped marissa and it could help you too
Marissa:
[19:03] And then obviously listen to the podcast too which is amazing as well as hearing different stories and from a medicalized point of view the kind of the fear tactics that a lot of the system puts on you that you know the abruption these kind of things if you go overs or not having enough i mean i'm not fluid in your uterus and all this stuff that i was like is it actually valid or is just a minute percentage um in the worst case scenario. So I wanted to feel equipped so I could tell my obstetrics team and everyone else, hey, this is why I'm deciding this. And then I kind of knew that my body probably wasn't prepared enough for a vaginal delivery the first time around. It was COVID. So we were very limited in Melbourne to go see, you know, body work specialists or osteos to get manipulation done. And I kind of felt now looking back at what could have done better was, was my body actually prepared enough with a tightness or sore spots that baby couldn't descend properly from my pelvis that I can actually mitigate this time around.
Mel:
[20:06] Here's another strategy, recognizing and mitigating risk factors or at least understanding your personal circumstances and taking steps to see if there is something that you can do ahead of time to mitigate the risk factors that you might have or change your personal circumstance to give yourself the best chance of avoiding the things that you don't want to happen to you. Here, Marissa felt that there was some work that she could do on her body to avoid what happened last time, that obstructed labor that she was speaking about.
Marissa:
[20:40] So funny enough, a girl that I had seen for my first pregnancy just via Zoom, let's talk about birth preferences, called Gabby. She had now started a body work company called G.Laurie Body Work, Labor and Body Work. And she was actually a big wife at my hospital when I delivered as well. And so I was like I'm gonna reach out to her to see if I get some body work done to see if there's some tight spots that is kind of impacting how baby's moving and the birth canal and I can kind of mitigate and she I would probably say would be the biggest influence into my outcome of my VBAC I saw her and she was like oh your your external body and muscles are actually really loose really you've got no sore spots your hip flexors are really nice and loose it's all great she's like I suspect you've got internal tension and so she directed me one of your podcasts I can't remember what the episode was but it was with you spoke to someone who did internal release work the.
Mel:
[21:35] Episode she's referring to here is the episode that I did with Fiona Hallinan on internal release work I've linked it in the show notes for you easy to find if you want to listen to that
Marissa:
[21:47] And she's like it's a little bit woo-woo but just listen to it she's like that's what we're going to be doing and it was but it was amazing so i was like it just makes sense obviously you've got tights on your on your muscles you can have the same internally so we did two or three sessions i think of internal release work and it was funny the first session she's like there's so much tightness internally on your left side which was talking about the left side as female as a feminine side and how that can impact birth and baby living gradually so, We did a couple of sessions of internal release work, which I think was an absolute game changer. I had a really tight cervix and sacrum at the back, which I was like, that's quite impacting how my son could have come out. It was so tight. There's no space for him to come out and it's so tense. That was, I think my last session with her was around the 38-week mark. And the day after, I had contractions all day, which was huge for me because with my son, I had no spontaneous labor signs whatsoever. So I was like, okay, something's happening. things is great. Beyond those things that kind of helped me mentally prepare and kind of physically prepare, I did all the other things like the dates, the rise relief keys. I was like, I'm throwing everything at this. And if it's still end up the cesarean, I did all I could do.
Mel:
[23:02] Yes, this is it. She's nailed it. Do all that you can do. Find the parts of your journey that you can be in control of. Do all that you can do so that if things don't turn out the way you planned. You know that there was nothing more that you could do to change it.
Marissa:
[23:19] So yeah I was having like six days a day. It was summer so I was having like a chilled rice leaf tea cocktail or mocktail with like pineapple juice and coconut water. So I was doing all the things that I could be doing. I was still exercising regularly three days a week with strength. It's a strength pilates in the gym so I felt really physically strong.
Marissa:
[23:38] Yeah and prayer all the things I could kind of shove into my brain without maxing it out i'm gonna do and then around the 38 week mark i just stopped i was like no more my brain's full i've learned all i can learn now i'm not gonna try and stress myself over anything else that i need it's it's done let's just be confident in my body and what you know i can do from here so that's how it kind of went until that point and then it was like a waiting game and I was getting really over waiting I think when you bring a toddler at home you're like oh and it's hot it was like 40 degrees in Melbourne I was like I'm sweating all the time I'm over this yeah my son being 42 weeks induced I wasn't planning to go any earlier than 42 weeks I was like I'm in the long game it's going to happen again and then yeah so after I saw Gabby that last time I had contractions all day and I thought that's really odd but then it kind of stopped at that point so I was like okay no worries hopefully it's just my body preparing and then at 40 and 5 that's when my daughter was born in the morning at 3 a.m I woke up to like period style pain I was going to go to the bathroom went to the bathroom and I yet had loose bowel motion I was like oh okay that's weird but maybe I just ate something yet again I've never done had so many sleep before so I don't know what any symptoms are I'm like okay maybe I ate bad food but then I went twice again same thing contractions kind of just steady every 10 minutes or so. And I was like, okay, Marissa, that's timing these.
Mel:
[25:05] For those playing at home, it's common for your body to try and purge your bowels just before or during early labour. So that is what Marissa is experiencing here.
Marissa:
[25:17] And then that was 3 a.m. by 5 when my husband woke up. I was having them every four minutes, quite very consistent for like 30 seconds to a minute. And then we were on the way to the hospital at around 9 a.m. Every two minutes at that stage. So I knew that the second I went into labour, I was like, I am trying to stay home for as long as possible. That's what I had heard was the best thing to do, stay out of the hospital for as long as possible.
Mel:
[25:44] She's right. This is another strategy to increase your chances of having a low intervention birth. Research shows that the longer you are in hospital, the more likely you are to be exposed to interventions and increasing number of interventions. So the longer you're there, the more interventions you're likely to get. So Marissa knew this and stayed at home as long as possible to give herself the best chance of a vaginal birth this time.
Marissa:
[26:10] And that was my plan until I felt like my husband was like, let's go now. I'm like, oh, I can wait a little bit longer. I was like, let's leave now, please. Let's pick out traffic. So, yeah. So, I was at home for as long as possible. And by the time I got into the hospital, it was around like 9, 9.30. I consented to a vaginal exam to see where I was. And I was at five centimeters already, which is for me, it was like, oh, my, that's amazing. I'm already halfway. That's better than I had with my son. And the team that I had, so I didn't have a, you know, a continuous care this time around. So, it was just whoever was at the hospital that day. And I had a wonderful midwife, Holly, and I think her name is Christine as well, and two student midwives. They were both on rotation. And they were, yeah, really significant in the outcome of my birth as well. I'd written my birth plan that I didn't want to have, you know, an epidural again, because I was very aware the epidural stalled my labour or just stalled the progression of my labour with my son. But I said on my birth plan.
Marissa:
[27:09] Epidural only if I'm past seven centimeters or only if I'm when I'm in active labor because I knew if I can get to active labor before an epidural I have a much better chance of delivering vaginally because she's already in the right spot she's already descending it's not gonna it shouldn't um impact my labor progression and there were a few times that I think that I with the gas in between been like I want epidural and Holly's like no we'll turn up the gas in a little bit further we'll turn up a little bit further still more to go and that was really instrumental tour and just they were I mean the hospitals are very the midwives are very pro.
Marissa:
[27:42] Feedback so that was really great I knew if I had midwives in my team that'd be they're like go for it and so she was like we're getting you this feedback and we're very pro you just do what you need to do we're gonna ignore us and we're here if you need us but she was really Holly was great and just kind of pushing me saying nope more gas and air you can do this Marissa and then by the time it was like full maxed out gas and air she was like she's like would you like me to check where you are and then you can tell me your number in your mind that's fine and if we're there we can do that and she checked and it's probably after like i think it's probably um 12 so three hours after i'd arrived i was at seven and that for me i was like okay cool i know i was already in that the transition state of labor i could feel my body really bearing down and i was like this is spilling my water hadn't broken yet either so it was so much pressure so heavy and um when she checked me she broke my waters and I was like thank god but then obviously the contractions got worse I was at the point yeah I got there for drill so my story's a little bit different because I got there for drill and I still had the VBAC I know a lot of women who have the VBAC kind of mindset are very no interventions I was okay with intervention if I still got the results I don't think I could have it's my first experience of a proper labor I don't know if I could have done it without epidural so for me I was it took ages it took an hour and a half epidural was allowed to go in took.
Marissa:
[29:11] Forever so I was just like yeah it was painful waiting but after it was in I was down two o'clock after I was in and it only I delivered her just after 6 p.m so from start to finish it's actually a significantly shorter labor than my first my first but my body could actually to acclimate i could still move around i was shuffling different positions i was going my four-point kneeling i was moving around so um i didn't want to have a full block i wanted to still move around i knew that was important as well if there was any i guess um impacting, yeah i kind of say my daughter and i were a good team because she made a she really did a good job as well being in a position being engaged for a really long time and shifting where i needed to be so, Yeah, after that point, it was like maybe quarter past, it was 5.30, she's like, let's try the check on you, my new midwife, Christine,
Marissa:
[29:59] because the OB wants to see where you're at. And she's like, oh, you're 10 plus 2. She's like, you're ready to go. She's like, congratulations, you're not having a cesarean anymore. And it was a really beautiful moment because she's like, she had kind of seen my whole story and I shared everything with her as well after I was nice and calm in the epidural. And she's like, congrats, this is not going to be a cesarean for you. So pushing was very interesting because I'd never pushed before. So I needed a fair bit of coaching because I was like, she's like, bear down. I was like, isn't that what I'm doing? She's like, no. I was like, okay.
Marissa:
[30:30] So I didn't want to deliver on my back in stirrup because I knew as well the risk of tearing would be increased with that. So we're doing a lot of different positions first, sideline, four-point kneel, leaning over the bed. And I just wasn't engaging. The mind-body connection wasn't there for me.
Mel:
[30:45] What Marissa's talking about here with epidurals, this is very common because an epidural significantly reduces the sensations that you feel during labor. So it's very hard to know when and how to push when it's time to push your baby out if you've got an epidural. So usually when it comes to pushing, my advice is to go with your body.
Mel:
[31:06] But when you've got an epidural, the pushing process is different. You do need some guidance from your care for providers because you aren't feeling labor in the same way as you would without an epidural so for this reason women often do need coaching to push and to help them get their baby out and that's what marissa's explaining here so
Marissa:
[31:29] After like 20 minutes okay marissa let's try on your back and see how it goes and i got it straight away it just made the most sense to me so i was pushing for probably about 20 minutes by that stage and the OB is like, hey, Marissa, If you don't get baby out, because her obs were a little bit up and down, up and down. But like, if you don't get baby out in the next five, 10 minutes, we're going to use forceps and episiotomy. I just didn't, I just did not want that. I was like, I'd rather tear. I don't want episiotomy.
Marissa:
[31:54] And I don't know what happened, but I think it was the fetal gestion reflex. My daughter literally just shot out with one push and her head like shot at them. They're all like, slow down, slow down. I was like, I didn't do anything. She shot out. And then after that, I slowly pushed her out for the rest of her. But, yeah, her head shot out. I got a second-degree tear because of it. And she burst through, I think, one of the blood vessels on her way out. So I had a 1.2-litre hemorrhage, and half of it was from before she was even born. But she just did the rest for me. And that was it. They were like, you really didn't want the episiotomy. I'm like, no, I didn't want to be cut. She just shot out.
Marissa:
[32:35] It was all a bit of a blur after that, because, like I say, I was having a hemorrhage. They're called you know emergency and stuff as well so after like five people being there's like 20 people after five minutes and i'm just like a little bit in la la land like my husband's like just white as a ghost being like oh my goodness and i'm like i'm rubbing the cord from her neck like la la la la la just like holding her and rubbing her back but she starts crying and he's just like white stress everyone's stabbing me with like a nice different things blood clotting things and i'm like i don't i'm just i didn't care at that point i was like i'm done with the medical stuff I don't care put the drugs in me just get everything out get done stone me up I'm good and that was it I was I think I'm still in a bit of shock thinking that I had a VBAC I think it was one of those things that.
Marissa:
[33:19] As females, we probably do put in a bit of a pedestal as, like, the ultimate end goal, which it's wonderful. But any birth is beautiful, obviously. I think for me it was just like, oh, I did it. And it wasn't as hard as I thought it would be. The hardest part was going to spontaneous labour. The birth part wasn't. It was like, boy, you should go. I'm like, why do you not know what to do? It was a spontaneous labour that was the hardest hill to climb for me, I guess, and even mentally and physically. And it was awesome. She was just there. And I'm like, it was a great team effort. Everyone at the hospital were sensational which every single midwife OBs they were pretty good but um a lot of the ones I saw during my pregnancy were very anti-feedback but the ones I had on the day were wonderful the midwifery team were just sensational at the hospital and after that all came in they were like cheering me they were so happy and it was just really special I think they have it the hospital's box of hospital in Melbourne they have 80 percent feedback success rate from I'm 70, 80%. So if you go there, you're most likely going to have a VBAC if that's what you're planning, which is another thing that I felt really confident in, that the team there wanted the best outcome for me and they knew it was going to be a VBAC. And it was special that I had two student midwives there too. So they were really happy. They were like, this is amazing. This is the coolest thing ever, seeing a VBAC.
Marissa:
[34:37] So, yeah, it was a really special experience for me and one that I was really proud that I got to do.
Mel:
[34:41] So there were obvious elements in there that really were pivotal in you getting the outcome that you wanted. So already, and I feel like so many women will be in this position where they're in their really close to giving birth really like making the decision at 30 odd weeks to have a V-back there's
Marissa:
[35:02] Not a lot of.
Mel:
[35:03] I mean there's not a lot of planning time you're already into the model of care that you're in you know there's so many things that are already set yes and to me it sounds like the really pivotal points were firstly you know obviously it was a deal breaker to have a cesarean sooner than your due date which I love that you made that conclusion if your last baby went to 42 weeks it's quite possible that your other babies are going to need longer to gestate as well and so a 39 week cesarean section for you could be a birth two maybe three weeks earlier than your baby needs um so that feels like a really pivotal point where you're like do you know what that's a massive deal breaker I need to consider another option and then you kind of made the best out of whatever scenario you were in you know there was no continuity of care at the time it was obvious that the obstetricians preferred that you had a cesarean section again and so then you pursued this work this body work and that the podcast episode you were referring to was with Fiona Hallinan when we talked about internal release work which obviously made some kind of difference to your internal pelvic structure and help the baby navigate your pelvis and a few other things that I think were great that really all women could do is wait at home a bit longer before you go to hospital because like you said you you got there and you're already in established labor
Mel:
[36:32] Can I ask what kinds of things helped you at home because something that holds women back from staying at home is they either feel a bit frightened or unprepared or maybe their partner's a little bit uncertain about being at home in labour. Was there anything that you did at home before going to the hospital that made you feel confident to stay as long as you needed to?
Marissa:
[36:54] Well, I had everything kind of packed and ready to go. So I had my TENS machine here that I'd used for my first pregnancy that I really loved as pain management. I didn't really get around the combs or those kind of things. And the fortunate thing was, as good or bad, that my son is a chronic waker up overnight. So my husband was in his room all night. So I was actually by myself for a bit of the time. So I didn't have to tell anyone. That was probably the best thing. So I woke up and I was like, oh, no, I was not going to be awake for the next couple of hours. I can just like.
Marissa:
[37:23] Just do my own thing and just like be here i found acclimating to pain so much easier to navigate than when you're induced in that pain the threshold is so high straight away because in my mind i had the the experience of an induced contractions i was like my levels up here what they're gonna feel like and it wasn't so i was like oh okay this is fine i can manage this and i'm like the best i don't have the highest pain threshold i was like oh i can manage this and then by the time my husband got up my son was still asleep which is great too so we kind of just he's like do you need anything i'm like i'm gonna eat now i think if i'm gonna eat it should be soon so my husband made me like high protein food so i felt like an energy i'd also got to mention i saw my naturopath as well, previously around 30-ish weeks too so she was also like yes no cesarean have a vaginal delivery and she gave me all these tonics and stuff to kind of help and a kind of like a bit of a care plan for when I go into labor, have your magnesium powders. So it was also on top of that as well. I think it kept me, so during the day I had my hydration station, like all my water and my like magnesium thing going. So I kind of just waited it out. I was timing, just breathing through everything.
Marissa:
[38:32] Trying to be as kind of mind-body-captive as possible when I was at home. And I wasn't supposed to go to the hospital earlier. It was more so like I don't need to go yet. I'm going to go when I feel that I can't manage the pain anymore. That was my threshold. It wasn't about the timing. It was, can I manage this pain by myself? And then also, it was also peak hour traffic time with schools. So I was like, it's 8.39. Sometimes it gets a little bit longer to get to hospital. So we tried to time it around eight-ish. My husband was like, it's every three minutes. Let's go now. I'm like, no, no, no. I'm still happy to stay here. He was kind of pushing me to go. And I was like, no, I'm still comfortable. I'm managing the pain fine. Like, I'm only just with the tens on. Like, let's just wait a little bit longer. There wasn't a hard and fast like we're going to leave this time it was like let's just see how I'm feeling and kind of drag it out a little bit until I feel like maybe it's the best thing to do more intuition let's leave now yeah but I felt comfortable I my wasn't broken so I didn't know about mess yet at that stage so there's no towels needed and just comfortable just kind of sitting on my bed in different positions well.
Mel:
[39:36] So do you think you'll I mean this is a big question I mean, if you had another baby, do you think there's anything you would do differently from this time? Like, it sounds like you're pretty satisfied with the overall outcome. Yeah.
Marissa:
[39:52] Yeah, in an ideal world, I'd have a home birth. I think that'd be so awesome or a water birth because I had the continuous monitoring this time around, which is part of the hospital pulse they didn't really want me to sway from. And I probably didn't, I guess, care enough to say no to. I couldn't do a water birth.
Mel:
[40:09] What Marissa's talking about here is CTG heart rate monitoring for her baby, where two circular monitor discs are strapped onto your belly, about the size of a tennis ball. And they relay the baby's heart rate continuously back to a machine, which gives you a readout of your baby's heart rate. It also can tell when you're having a contraction. So most hospitals won't allow you to get in the water if a CTG monitor is on. Some have waterproof monitors that could work remotely so the cords don't have to be attached to the machine, but that's not always possible depending on where you are. So having a CTG applied is usually part of the VBAC policy in a lot of hospitals. So if you want to have a VBAC in hospital, the staff there and the policy would state that you have to have a CTG. But there are other options and I encourage you to listen to the Great Birth Rebellion episodes that we have on CTG, which I will link into the show notes. We've done multiple episodes. Always remembering that just because it's a policy doesn't mean you need to accept it. You can make an informed decision that is different to the policy.
Mel:
[41:25] So another thing to mention here is that even if you do manage to avoid the CTG monitoring, lots of hospitals will also state that women having a VBAC can't use the bath during labour or birth. So not all hospitals, but just so you know that VBAC policies can be restrictive like that. So if you're planning a VBAC in hospital, it can be helpful to get them to print out their labour and birth policy for VBAC so that you know what to expect from them. You can research which parts of the policy you're willing to accept and which parts you would like to decline.
Mel:
[42:02] This just means that you're ready so that your expectations can be met. If you're going into hospital expecting to be able to use water for labour and birth and then you're surprised when you get there, that's going to be a harder situation to manage than if you're prepared ahead of time
Marissa:
[42:19] That would be like ideal situation my only drawback is the fact that I have had, both pregnancies and my miscarriage I had um postpartum hemorrhaging every single time so that's my only drawback for having a home birth although I could be transferred to the hospital but a water birth that could be in the hospital I don't mind that would be like an ideal situation but it seems like really tranquil and like nice I like heat it makes me feel calm so that would be really helpful I think.
Mel:
[42:46] And what because your sister Bec is planning her V back now what advice have you given her about what she can do to also have a vaginal birth this time?
Marissa:
[42:59] I think that I think that what I've been telling her is definitely get her body physically right. I think the mental thing is easy to kind of build upon for weeks and weeks as you progress just our personality type the physical part was something that we really need to get right early on so then the mental thing kind of fit in place because she's had a lot of spd pain a lot of because she had a very traumatic cesarean um like category life life and siren baby out in five minutes kind of thing she has a lot of adhesions on a cesarean scar and i'm a lot of nerve pulling through that so i was like beckett the one thing you have to do and she saw gabby before i did for initial pregnancy but she's getting a lot of scar adhesion work and She's actually going today for her first internal release work. She knows that that's going to be significant just because of the stored trauma in her body. I think once you have a cesarean, regardless if it's a traumatic cesarean or quite a casual one, you have a lot of stored trauma in your body. Your body remembers that even if your mind has kind of taken at peace with it. I had a funny, fine, nice cesarean. I'm taking photos. But my labor was really traumatic. I really disliked that part of my experience. Now, I had stored that trauma as fear of.
Marissa:
[44:12] Being able to feel confident in my body so i think the the body work and the internal release really helps release that and allow your voice let it go so your body can be ready and prepared enough for the journey your baby needs to take in your pelvis to you know be birthed vaginally so, that i think is yeah definitely the number one thing that i tell everyone in the vipx support group and facebook like what do i do i'm like body work do the body work like i'm having predominant labor i'm like do the body work get your body right your baby say it wants to come out and it can't do body work and I think that's that's my key I thought you can kind of be as stubborn as you want with your providers if you've got you know um different care model you can kind of uh risk manage that or mitigate that um the body work stuff if you don't get right it'll be an uphill battle I think in the labor process trying to get deliver your baby if.
Mel:
[45:03] You're listening thinking great my next step is to go get some body work I'll link to all those podcast episodes and then, you know, you can make some decisions about who you're going to see. Certainly the option of osteopathic work and chiropractic work and internal release work in order to optimize alignment. Thank you so much for telling your story. I'm sure there's going to be definite parts of this that women can pick up, take away and go home with. And there's just so much hope, particularly for women who have left planning maybe till later in their pregnancy that this is absolutely possible and the other really big things that I took away from that as well is that your midwives are on your side they were on the team to get you there and that there were things that they could do for you particularly in points of weakness where you're thinking okay I really want to have an epidural now they're like let's keep going let's keep going let's keep going I think that sounded really pivotal as well that they were on your side for it and obviously that your body was like absolutely not we're not doing this episiotomy and forceps like I'm this is my time to shine I
Marissa:
[46:11] Think you've got to be stubborn you've got to really dig your heels in and if you want the feedback you're going against a system who doesn't want you to have the feedback so you've got to be stubborn and just say I don't give an SHIT I'm going to do this and give it all I have until I can't do it or if I can't do it I'm not opposed to the medical system working when it needs to,
Marissa:
[46:31] but I was like, don't sell me short what my body is designed to do. I can do it. My body's been designed to do this. And unless there's some kind of medical reason why I cannot, let me be and let me just do what I need to do.
Mel:
[46:45] Yeah, you just wanted to go all the way to the very last point and find your limit. And then obviously if you found your limit, then you're like, do you know what? and willing to accept whatever needs to happen here, not before your personal limit is met.
Marissa:
[47:03] 100%.
Mel:
[47:04] So valuable. Thank you so much for coming on the podcast.
Marissa:
[47:08] Loved it.
Mel:
[47:10] To get access to the resources for each podcast episode join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch atthegreatbirthrebellion.com follow me mel @melaniethemidwife on socials and the show @thegreatbirthrebellion all the details are in the show notes
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