TOLAC & successful VBAC

TOLAC= TRIAL OF LABOR AFTER CESAREAN SECTION VBAC= VAGINAL BIRTH AFTER CESAREAN This week, I was honored to be part of an amazing, life-changing experience for several folks: the mom who succeeded in her TOLAC, and my student, who got to experience the thrill of that moment (and catch her 2nd baby). J felt that her first birth experience was incomplete - she had been pregnant, and then laboring, but then had a cesarean due to concerns about bleeding and some concerning fetal heart tones . . . friends thought she was crazy to choose a birth center for this birth, but J felt safe and well-supported by her midwives (me!). J came into the birth center early in the morning about 7 cm dilated, and got "stuck" there for much of the day. This was frustrating to her, but not to us . . . as out-of-hospital midwives, we have the luxury of patience . . .and don't jump to using pitocin as they do in the hospital (we only use pitocin for postpartum hemorrhage, since it is a dangerous drug for babies-still-in-the-womb). J's mother & sister were there, exuding energy that was lovely but not so conducive to laboring (aka, Sphincter Law, see below). So J labored all day with her husband and her doula. It was obvious to me that she was not suffering, so we supported her emotionally through her frustration and occasional "breakdowns," when she cried . . .she also stated a few times that she imagined having her baby at night, and it was a bright sunny mid-summer day! We sent J's family & doula home after a while, to see if the pressure of being "watched or "on-stage" changed her labor pattern or progress. Once evening came, things got more serious, and once it got dark, she started to feel "pushy." Laws in this state require that TOLAC clients have a 2 hour or less second stage (the pushing phase of labor), so I gave J a pep talk about pushing. Typically, I just let women figure it out for a while before I coach them. I think it is intuitive to push, and in most cases becomes spontaneous, but in this case, I wanted her to be sure to be effective and efficient. J got serious, and pushed out her baby in 47 minutes. She was sitting on the birth stool when she delivered. The head delivered, and the baby turned to look at me, with her eyes opened, and then started to breathe and whimper. I nudged the shoulders to deliver, and my student got to truly catch a baby (gravity makes the catch much more important than when someone is laying down), and then handed it off to me. J looked down at her baby, between her legs, and said, "It's a girl!" Baby girl was pink and gorgeous, breathing easily, looking up at her momma. J's mom said, "reach down and pick up your baby!" but J responded with, "I just need to look at her!" Then she said, "IT WAS SO WORTH IT!!!" J had a LONG labor. More than 24 hours at home before coming to the birth center, and then another 16 hours there. And at the moment of the birth (well, at least within the first minute), she was exclaiming the thrill of accomplishment! That brought tears to our eyes - all of us, I think. J reached down and picked up her secretly-wanted daughter. We cut the cord (the placenta had delivered spontaneously after 3 minutes, plopping down into the bowl under her), and moved J and her daughter to the bed to relax, get to know one another, and start breastfeeding. It was beautiful and moving and lovely. Baby girl turned out to be a healthy 8.5 lbs. In rehashing the birth, J wanted to know details that she didn't remember, and she's still trying to figure out why she got stuck. I call it emotional dystocia tied up with performance anxiety, complicated by her desire to deliver a baby in the dark. In the end, it all worked out. They were struggling for a name, and had several options to decide on. Once at home, they were rolling names around, and came up with one that fit. It means, "born at night." Beautiful! It is an honor to be at any birth, but there is something powerful and special about a successful VBAC, especially an unmedicated one. Women are immersed in the experience, and their accomplishment is so meaningful to them. I just love it! NOTE: Sphincter Law - Ina May Gaskin coined this term, and this is my understanding of what it means. The cervix is a sphincter, just like the urethral opening (where we pee from) and the anal sphincter. When we urinate or defecate, we typically prefer to do so privately, and any interruption can slow the process by closing the sphincter. Ina May (and I) believes that the cervical sphincter also operates this way. Women who feel safe and protected in their birth experience labor more effectively. Women who feel violated, unsafe, watched, surprised, etc. often have slower or stalled labors. In the story above, J was worried that her labor was "taking too long." She had a mom, sister, doula, husband and two midwives "watching her." During one vaginal exam, I actually felt her cervix start to close around my fingers (so I pulled them out right away!)! Once we reassured her that stalling was normal, we were patient, and sent her observers away, her sphincter relaxed, and her labor progressed. Go, Sphincter Law! Go!