#55 | Against Many Odds: Jasmine's Vaginal Delivery After Two Cesarean Sections (VBA2C)

If I knew how beautiful and easy the delivery would be, I wish I could tell myself like Be confident like to just believe in myself more. But it's so hard to believe in yourself in the face of people telling you it's probably not going to happen.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hi, I'm Jasmine Zinser and I'm here to talk about my feedback after two c sections. I would say my birth story kind of starts when I was in my early 20s. Even we had always talked to my house my mom was very open about her birth, she had three natural unmedicated birth with midwives. So, you know, I always knew I wanted to have children and I just assumed that would be my journey as well. I watched the business of being born probably when I was about 23, and nowhere close to having any babies. And so when it came time to have my first I just assumed that I would be delivering with midwives. I hadn't thought about a home birth or anything along those lines, but I figured like a waterbirth something supernatural, and that just wasn't my journey. My first daughter was Frank breech. So I tried everything under the sun to flipper around, I did spinning babies and went to the chiropractor three times a week and basically, you know, stood on my head, tried everything to have her flip. I did a symbolic version that was not successful. And I was told by providers that the only option for me was a scheduled c section. So that's what I had with my first I felt sort of powerless in that decision. And so when it came time for my second pregnancy, I knew I wanted to try for a VBAC. I reached out to you, Cynthia, I think, sounding like a crazy person. I'm just very, very hopeful about having a VBAC. You were so encouraging. I took your hypno birthing class, just got so much great information and felt very empowered. I had a doula I was ready to roll. And I had another Frank breech baby. But in that process, I felt much more empowered, that it was a decision that I was making, that I did everything I could I did a lot of processing emotionally with my doula at the time about just the process of my first birth and how, how unempowered I felt, and in making the decision, and so I ended up having another scheduled c section after going to the chiropractor for weeks, and I even tried mock suction with my second one, you know, tried all the things that had another cephalic version that didn't, didn't work and, and he was born via scheduled c section. That process was better. In general, the recovery was better. And I think the hospital experience was better to by that time they were doing skin to skin right at birth, he never left my side he was on me he was it was a much more sort of bonded experience.

Was that because you had a different provider? Or was that simply a matter of expressing your choices differently, and advocating for yourself with the same provider?

It was simply that I had the information, I think that I didn't have before. So surprise, baby number three comes along. But we were thrilled and I guess I sort of took for granted from the beginning providers had said Look, you've had two Frank breech babies obviously, like that's where they sit in your pelvis that's preferred, it's likely that you'll have another one. Additionally, the providers told me sort of from the get go that they don't like to do vaginal delivery after two c sections.

Did they just talk about what they like to do? Or did they actually provide you with any information or research of any kind to help you make the decision that feels right to you?

Yeah, you know, I think doctors in this area are not used to people not taking what their advices so they did provide the cystic an information I. Unfortunately for them, I'd also done my own research and knew what the numbers were. And you guys can correct me if I'm wrong, but a point 8% chance of uterine rupture with one c section, and 1.8% chance with a uterine rupture. After two c sections.

All I know is that someone who's on their first baby, and someone who's had one c section are at a similar under 1% risk of uterine rupture. But I personally don't know after two c sections, but I know it's definitely higher. But it's not what most women planning a VBAC are led to believe. Is it, Jasmine?

No.

Certainly, providers are very leery of doing vaginal birth after multiple c sections. And that just leads to more to less good information and more fear around doing it. And so in order to actually find a provider who's willing to do it, you really have to kind of dig into the information yourself and really advocate for yourself and really present somebody with the,

with the data, you're so right about that. And then that process is so intimidating. I mean, you know, for me, I'm going to Maternal Fetal Medicine, because I have pre existing conditions that made that necessary. They are the foremost experts in labor and delivery, certainly in in this area of the state. And so little old me going in there with my like, well, but here are the statistics. You know, it's very intimidating. And so I did mention it sort of at my first I don't know, I want to say probably the 12 week appointment to one of the doctors and my husband was with me and he said, you know, if you were my wife, I would not recommend that you do it, you know, it there is a risk of uterine rupture. And, and so I sort of I think I felt very emotionally protective of myself, I guess I would say, like I, my experience with the two previous babies being breached, I sort of didn't try to focus on it very much. I had a very healthy pregnancy, you know, like, felt great the whole time. I'm at about 30 weeks, I developed pneumonia and was hospitalized. Like I went from healthy didn't have a sniffle for the whole pregnancy to like, losing 10 pounds in a week. And being hospitalized, I was really sick for many weeks. So then that sort of put a whole new kind of level of concern around the pregnancy, she the baby was always fine the whole time, according to you know, all their monitors and everything, but so it was sort of even further out of my head, how I was going to deliver her. You know, as I moved along and recovered from the pneumonia, you know, I was still sort of in a weakened state, and yet I was going to be the appointments, you know, for the anatomy skins and things and they were like, well, she's head down. She was in a great position to be delivered vaginally. And so then I am I was faced with this like, Okay, this is what I've always wanted to do. This is how I wanted to have my babies. But I'm, I'm weak, like I'm thick. I don't feel great. You know, I had to leave work. I was coughing so hard. At one point, I broke a rib, and which of course they didn't believe until after I had an X ray after I delivered her and they were like, Oh, you have you had a broken Rep. And yeah, I said yeah, thanks.

They didn't they didn't buy it. They're like, Yeah, but now you officially do.

Yeah. Because we told you so.

Yeah, he told you so. Yeah, exactly. So I did get more serious with the doctors because I was in maternal fetal medicine. So I was going to the non stress tests because of my pre existing conditions. And you know, with seeing them all the time and really started to say like, I think this is something I want to do I want to try and and and the language I use, I feel like was because of the language they use. Try for a VBAC.

We just said in a recent episode, that it's one of the words we try to strike from our vocabulary. And the most common time we hear it is when women are planning a VBAC. They're almost conditioned to learn to say, try, like, are you going to try a VBAC? And we just say, you know, women just say yes, but really, it's like, No, I'm not trying. If someone said that to me, when I was pregnant with my son at work, she said, Are you going to try to breastfeed? And I felt so hurt by that somehow. And I didn't know why. And I said, No, I'm not going to try to breastfeed, I'm going to be breastfeeding, but she was the first person who ever made me question it. It was the first time I ever wondered whether I wouldn't be able to. And it was simply because she said the word try.

Yeah, yeah. I I expressed to them that I wanted to try I definitely found in the practice where I was that the women were more supportive overall than the male doctors, for whatever reason. And they, they said, yeah, we would support you in that. But we won't let you go over 39 weeks.

And there's that next word, let let right?

Did they bring up at any point the statistics or try to discourage you from it? Or was it really just like, sure if that's what you want to do? We support it.

The languaging around, it was definitely like, you know, and I guess they put it to them probably like, this is what I would like to do. I'm sure I left the door open for them to say there is a chance of uterine rupture. Have we seen a uterine rupture? And had it been catastrophic? In our practice? Yes, we have I sort of left the door open for that, I think because, of course, I still think as women and sort of consumers of, you know, medicine, we really still that, like the deferential treatment is kind of, I think, just second nature. So yeah, they did share statistics and, you know, sort of apprehension, but also said they thought it was a viable option, and something that they would support me doing.

It sounds like they said, we'll let you try. Right, yeah. And you will have our support. Right.

But if this happens, or you go past this date, so I mean, exactly.

So many mixed messages for you to carry so much room for self doubt, with language like that. It's not even conscious for most of us, right? Nope, it's not. But it sounds like you were aware. And it sounds like you're taking a lot of responsibility, even though you have the awareness that this is the culture you live in that we are deferential to providers. Yeah. But you're still taking that responsibility that is really such a key component and having your best birth. I think it's one of the most important factors. So I'm not surprised to hear it.

Yeah, I pushed them to the light, like the last date they would agree to right. So it's just like, there's such a battle that has to take place between our body autonomy and the boxes that they need to check. It's a really frustrating process. And it's so easy to see how women are just, you know, go along with whatever providers say it's just not a very empowering place to be. So the thought process around not letting me go further, I guess was one of my pre existing conditions is that I have hypertension, you know, I had no preeclampsia or anything, but I think it may have had something to do with that

definitely had something to do with that even in women who have had no prior history of seryan. Many providers want to induce early because of this idea that the longer woman is pregnant, the more risk she's taking the more potential complications with the birth. But the hypertension would put a big factor.

Yeah. Yeah. So we scheduled an induction. It was on a Wednesday, you know, we we had childcare set up and my husband and I went into the Yale New Haven Hospital and went into a room and the induction started with the balloon catheter. When we went in, we were in the labor and delivery admitting and they were going to place the balloon catheter. And I have to say, I really had a great experience with the residents that worked with me there. The resident was putting the balloon catheter in, and there was a knock at the door. And she said, we're in the middle of a procedure like, just give me a minute. The door opened. A doctor walked in, I figured out he was the doctor wasn't clear because he was wearing like a blue sweatshirt. So I was like, Is this just some random dad that's walking into? And I'm literally feet and stirrups? You know, like facing the door? Oh, man. He walked in. Why would they ever have the stirrups in that position? Where they're facing the door? Yeah. Come on. Come on. A little segway, please.

All right. Yeah. Yeah, that's so unnecessary.

Yeah, yeah, there was a curtain like in front of the door, but not around the bed. And but anyway. So the doctor walks in. He introduces himself, I'm lying on the table, my husband sex me and he's like, okay, have you seen the statistics on what your chance of success? And I said, No, we haven't. And he said, Okay, well, so we take into account three factors, given your age, your BMI and your gestational age. We put that all in all those numbers together and the calculated number that we've come up with, for you would be only about 30%. So you only have about a 30% chance of having a successful vaginal delivery. This is while they're placing the balloon catheter to start the induction.

Interesting, isn't it? So you were 40 at the time Jasmin, right, yeah. Okay, what did what was your response to that? Did you feel determined in your mind? Did you feel like I'm going to prove him wrong? Or did you think this is never going to happen for me? I mean, what was it feeling like for you?

Yeah, it's a question. Gosh, I think I was, I was so taken aback when he said that. Oh, but I do have to add, after he said that the resident said, well, numbers are in everything. That was the residents are ready for her. So the resident responded to him.

Yeah, I was so glad that she sort of stood up for me in that moment, because again, I'm, you know, I'm in a vulnerable position. I think I just felt a little bit helpless. You needed that in that moment, a little moose? Yeah. I knew that. And then when he left, she was still with us. And my husband, I think made it he made a comment like about the Godfather movie. Like, I think it's something like, never tell me the odds. I don't know what movie it's from. But he he was making a joke about that, like, Don't ever, you know, don't ever tell me the odds, kind of thing. So we were we made a joke of it afterwards. He was such a good partner and all of this, that, you know, we sort of were able to kind of put it all in context. And, and he and I have to say, you know, he was very supportive of whatever my decision was, like, he knew all of the things that I knew I shared all of my concerns, and he was there for you know, appointments and things and he was a great support to me. He was like, if you were my wife, I do what feels right to you.

Exactly. Like the doctor.

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So the nurse came in in the morning and the balloon catheter hadn't fallen out on its own, which I guess is the ideal situation, because you become dilated enough for it to and so she just yanked it, and I was a centimeter at that point. So they moved me down into the labor and delivery area, which was the next step. And that's where we set up shop for several days, we were sort of just left in a room to kind of figure things out, they would periodically come in and check me. The first thing they did that next morning was stripped my membrane.

So they would do everything they could to avoid pitocin.

Exactly. But they did shortly after dark me on a low dose of pitocin. And I was on pitocin for the entire rest of the delivery time. So, you know, I was progressing, progressing. You know, I was on the monitor. I had all of the IVs. So things were progressing, but to have them progress further, they decided to break my water. Very quickly. Thereafter, the contractions started to become more intense. Do you

remember how dilated you were when they broke the water? I

want to say three or four centimeters. Okay. Maybe it was probably about two hours after that, that I decided I wanted to have the epidural placed. I was on pitocin for a long time. And

yeah, and we probably leaning back where you reclined?

Yes, I tried to get up and walk as much as I could. But I was also just tethered because of all of the monitoring that they had to do. I'm sure you are also very tired. Yeah. Yep. They had given me morphine to sleep the night before, you know, IV and also an injection and that helped some but I don't you know, it certainly wasn't a very restful sleep.

It's called therapeutic rest. It's a techniques to try to get you into more active labor overnight.

Yeah, is morphine. the norm. Trisha, that just sounds like overkill to me.

Actually. It was actually my research paper in graduate school was on therapeutic press and the use of morphine

Yeah, so I decided to get the epidural, which was, unfortunately not a great experience. I told them that in my previous c sections, they discovered that I had a curvature in my spine. And they needed to use an ultrasound machine in order to place the final anesthesia. But they sort of brushed me off and they said, Yeah, yeah, some people do that we found a good spot. We're all set.

Mm hmm. What happened?

They place the epidural and the epidural moved in my back, it didn't work. It would like numb one side, it wasn't very successful, then I couldn't move, I couldn't get off the bed. I think around eight o'clock in the evening, we were starting to watch Braveheart. And all of a sudden, things got super intense. And I believe I was basically starting to go through a transition at that point, and the epidural had moved. And it was extremely intense. The anesthesiologists were busy in the alar and doing other things, so it took probably about an hour and a half for them to get down. I was really struggling and the contractions were every minute. You know, that's where the fear really kicked in for me, you know, I couldn't help but feel afraid. I kept feeling like, Is this normal? And I kept asking, Is this normal? Is she okay? Like, I worried that something was wrong. And I just kept thinking like, what if? What if this is uterine rupture? What if? Yeah.

So that so and it was also your first time experiencing labor? It was, it's a big deal, right?

Yeah. It was a big deal.

And everything was working perfectly right. There were no medical indications at hand. Right? It was just what's happening in your mind and your physical experience, leaning back,

and 48 hours into labor at this point?

Yes. Awesome. If you're tired. Um, another thing to consider is that when your body is completely going through the course of natural labor, it's a it's a process that your body has time to adjust and adapt to. And we produce our own endorphins and opioids and things that help us tolerate transition, but you are sort of thrown into the jungle in that moment, because you had been on therapy aggressed, and you had had other medications that weren't giving your body that chance. And so that's in part, what I think to why it would feel very scary, because if anybody just walked in that ground zero and stepped into eight centimeters of labor, it's very overwhelming. It's sort of like the same experience a woman has when she has a precipitous labor, and it goes very fast. And it's so overwhelming that it can't help but trigger the fear response. Yeah.

And and they checked me at that time, you know, when the epidural was replaced, and they said, Well, this is what's going on, you're nine centimeters. But I didn't feel the pressure of her. And that's another thing that just makes me sad is like, they would say, like, do you have the urge to push? And I just didn't, I just didn't.

Why does that make you feel sad?

Because again, I think it's part of the experience that I don't feel like I got to have like, I, I was able to deliver her badly, but it was not the delivery that I would have wanted it to be. And it was successful, and she was healthy. And it was, I'm sure, on the medical side, it went like swimmingly. You know, but emotionally for me, I think I felt a little bit robbed of the experience, primarily because of the languaging around all of it and my own fears. And yeah,

not everyone gets an urge to push the majority of women do but not everyone does. Jasmine is the is the hesitation around the fact that you had an epidural and you feel if you hadn't had the pitocin you wouldn't have needed the epidural, and then you might have felt the urge to push, because for some women, they don't feel that urge and the baby just starts to emerge. It's I don't think it's the common way. But there's the it's absolutely one of the ways that women give birth. But that intuitively that isn't like you were feeling what's going on. You felt like

when they probably kept asking you a question about are you feeling it yet? Are you feeling it yet? And then that's making you be like, why am I not? Yeah, what's wrong? Is this can you get to that place of being able to work with contraction and push with it? That's helpful and it feels like relief but to feel to have one without the other? It's frustrating.

I've had a few women over the years and I could still think specifically I have a couple of them who had stories in which they were saying to the nurses, but the baby is coming. But the women were not feeling anything. They could just feel the baby descending, but no urge to put Nothing, no pressure. And the nurses in each of the stories said something one was like, oh, believe me, you're at least an hour away or Believe me, honey is nowhere near. And they always ended in this humorous way that the head just kind of slid out. And everyone was like, Oh my God, who knew and it's like, well, the mother knew. But again, these are not the most common stories. The most common is just where women are feeling this incredible, irrefutable urge to push. And one of the frustrations and hypnobirthing is that Mickey Mangan almost denounces that urge, you know, her whole thing is just breathe, breathe, breathe. And then when women like me give birth, we're pushing with all our might feeling like what am I doing wrong? I'm getting this urge that I wasn't prepared for and hypnobirthing. So I teach that segment quite differently. But in your case, what's normally this easy birth story, you still felt robbed because of how people were speaking to you the questions they were asking you and the conditions under which you are giving birth? Yeah. What would you do differently?

Good question.

Well, if I knew how beautiful and easy the delivery would be, I would I wish I could tell myself like, you know, be confident like to just believe in myself more. But it's so hard to believe in yourself in the face of people telling you, it's probably not going to happen, right? That's what I wish I wish I could go back and tell myself to just be sure of myself and my body, in spite of it all. You know, once I was, you know, resting after the epidural was was replaced, I rested, I rested, and they said, you know, well let us know when you want to try to push. And so I rested a bit. And then I said, You know, I think I want to I think I want to try. And the nurse said to see, you know, the this process, the pushing process could take up to three hours. In my head. I was thinking, fuck that. Excuse my language. Why did

she say that? She was giving you the outside range of what's normal and a first time Mom, it's true. And probably after, obviously, after 48 plus hours of being labored. That's the last thing you want to hear.

I don't say what purpose it serves.

No, it doesn't serve it. Server. I mean, it's not it doesn't serve a healthful purpose. No,

not at all.

Well, I do have to say though, I think hearing that was sort of impeded cuz I was like, you're gonna watch how fast this baby comes out right now.

She made you determined.

Oh, I yeah, I really dug in at that point. And I was just like, that's, I think, where I found my, my like, Okay, here we are, this is what we're doing now. And so, the nurse was there, they, she, she got one of the residents to come in. It was just one nurse and a resident. I was on my back, you know, and sort of got my knees up, and they sort of explained what to do. And I started and they said, Wait a second, she's her head is right here. Like, you got to slow down. Um, and they had nobody else in the room. So then people started running in the room and it was like, mayhem, they got like her little you know, bassinet area already. And I literally think I may be pushed three times total.

Three times total. So we're talking minutes.

We're talking minutes. Yeah. But I I pushed so hard so aggressively, that I did have a second degree tear. Also, because I at that point, couldn't feel anything. And you were back. And I was on my back.

Yeah. Okay.

But she came right out. She was five pounds, 13 ounces. So she was small. And they put her right on me and I couldn't believe it. And I honestly feel like if, if my body had just been left to go into labor on its own, like I know I could have

done it. I know I could have been a completely different it's completely different.

I had a VBAC in spite of doctors opinions about statistics, I had a VBAC in spite of everyone's belief systems around me the safety of it without even knowing what the facts were, I had to be back in spite of being induced, and I had to be back in spite of being on my back. I had a VBAC in spite of being completely exhausted and recovering from pneumonia, and completely run down. I had a VBAC in spite of all of these factors that were stacked against me including my own self doubt. That was the success.

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