Birthing Again: A VBAC Experience
By Melissa Aberle-Grasse
I lay on my bed in a square of moonlight, resting. Emma, only seven hours old, slept next to me, her hands folded together as if in meditation. Only my heart's pounding--not with anxiety, but with joy and power--broke the calm. Just hours ago, I had birthed this baby. No outside stimuli or interference, just me: the energy and knowledge of my body, and several strong assistants.
That night stands so bright partly because this second birthing was so different from the first. My first baby was born by cesarean section. My husband and I worked with the same midwives for both births and had desired a natural childbirth with the first. In the first case, I believe that the intervention of surgery was wise. The baby clearly had distress in labor and was born, full term, at only five pounds.
When my second baby was conceived, we again longed for a natural childbirth. Despite discouragement from doctors and medical advertisements, I was able to birth vaginally this second child. Three conditions especially undergirded this birth: supportive assistants, a pregnancy of heart and body, and an active birth.
For a woman interested in vaginal birth after cesarean (VBAC), working with a midwife and a supportive partner is critical. Even though medical research favors VBACs, medical practice generally opposes them. Repeat cesarean section deliveries have increased in the US since 1997, after declining somewhat in the 1990s (ACOG, 1996).
I met this reluctance in the supervising doctor of my midwives. " So, you're planning to use the birthing center?" he said. The tone was clearly dubious. An anesthesiologist friend explained the systemic reluctance about VBACs. " When there's a VBAC, we all have to be on call, ready to go, even though we might not be needed--the anesthesiologist, the neurologist, sometimes other specialists…it's a waste of our time."
Yet medical research favors VBAC for most healthy pregnancies. Of course, there are risks associated with a VBAC. But the facts show that, compared to a cesarean section, a vaginal birth involves less relative risk. In a 1999 study of 500,000 deliveries, the risk of a uterine rupture among those who attempted a VBAC was very low: less than .2 percent (OG, 1999). The American College of Obstetrics and Gynecologists recommends that women who have had a cesarean section consider a vaginal birth, with careful consideration of their individual health and risk factors (ACOG, 1998).
So VBAC is a rational option. Perhaps more important, my husband and I found, was the experience of birthing a baby naturally: my bodies' wisdom and energy, our mutual support, and the miraculous process of growth, pain, and new life.
Every couple entering a pregnancy should weigh the options and choose the birthing plan that works for them. For women considering a VBAC, because of the professional resistance, it is especially important to have supportive assistants. A midwife and a close partner at birth are critical. Knowing and asking for what feels strengthening and calming during birthing is key to a healthy labor. I had two assistants, my husband, John, and a midwife, with me through every minute.
"How about some George Winston to listen to?" John asked. It was about six hours into labor; contractions were about seven minutes apart, and fierce. I was still walking, but groaning or shouting with each step.
"No!" I shouted. "I want the drumbeats!"
I squeezed John's hand like it was rubber. (The next day his fingers bruised fingers showed it!) Having a spouse or partner who can support without fear or judgment is essential. In this, John was a rock. He'd seen my belly cut open for the first baby. He believed in this birthing process and was not afraid of my pain.
With fiery drums sounding in the background, I stamped and leaned over a chair, while a midwife massaged my lower back. I spent time in a Jacuzzi, where the midwife massaged my feet, hard.
I can't imagine pregnancy and delivery without a midwife. (The word comes from Old English, where it means "with woman.") My midwives were licensed and worked in consultation with gynecologists; other midwives may be highly skilled but choose to work outside the medical system. Both kinds are trained to support the natural processes of a baby's fetal growth and birth. They believe that these are mysterious and beautifully designed human processes that usually do not require intervention.
Pregnancy of Heart and Body
Also essential to my second birthing was what I call a pregnancy of heart and body--a time when a woman turns deeply within and cares for and listens to the wisdom of the heart and the needs of her body.
Meditation during pregnancy, I'm convinced, helps mother and baby grow. I used a practice called "mindfulness," as taught by Buddhist peace activist and teacher Thich Nhat Hanh. Mindfulness is cultivated through a daily practice of at least 15 minutes of quiet breathing. The acts of following the breath and perhaps repeating a phrase focus one's awareness first on one's body and the power of breath. Then one can become aware of the present moment and experience gratitude for whatever is in that moment.
This can be done in the midst of daily activities. Waiting at a red light, using the bathroom, or washing dishes, I would take three deep breaths, stop, and rub my belly. I'd focus my awareness on the baby. Is this the foot or the back? This is a new being in me, already listening and playing and feeling. In labor, I concentrated on the contraction as a positive force, opening up a space, moving down the baby.
Another "heart and body" activity for me was a yoga class for expectant mothers. One night, as we squatted, rocking softly on big flexible exercise balls, our bellies hanging out, our teacher said, "I want you to write down all of your fears about this birthing. What do you imagine that you wouldn't want? What are you afraid of? What negative things have you experienced or heard about?" As I wrote, I felt tears come to my eyes, as the longing and disappointment about my cesarean section surfaced.
"Okay, now," she continued, "imagine what you'd like this birth to be like. Picture it. Describe it. Talk about the most unifying, hopeful, powerful birth experience that could happen."
This class was not just about information. It encouraged us to connect with our deepest energy, courage, and health--again, centering. Each week we stretched, massaged, and rolled the different parts of our bodies. We learned all about the childbirth and pelvic muscles; we experienced the connection between the jaw and the pelvis (noticeable when you sneeze!). We looked at life-size paintings of childbirth and unborn babies.
One image I often prayed to during my pregnancy was from the Judeo-Christian story of the mother of Moses. She gave birth to a boy when some ruthless rulers decreed death to all boys born to her people. In an act of ingenuity and great faith, she wove a cradle, laid her son in it, and hid it on the banks of the river, hoping he would be saved. I kept her image close, releasing my baby and childbirth to the good and tender Hands holding him/her.
By bringing together spirit and body, mind and soul to prepare for giving birth, a woman draws into her center. During labor, she can become aware of muscles and emotions, thoughts and energy. I did this in many ways. While walking or rocking, I practiced rhythmic breathing--no specific technique, just whatever felt right. I shook my hands, walked, stuck out my tongue to keep muscles loose. I groaned or shouted aloud, being aware to keep my throat and voice relaxed. One of the first things I did at the birthing center upon arrival was to cover up all clocks.
By listening within and preparing her body, every woman can know what she needs to do during labor to let the contractions do their work and to stay relaxed.
An Active Birth
For a healthy birth, according to Janet Balaskas, childbirth researcher and educator, a woman will be active and fit throughout pregnancy, remain mobile during labor, and choose a dynamic participatory position for the birth.
Ordinarily not a model for fitness, I did focus on regular exercise during pregnancy. I found I had to be flexible. I walked and swam until about six months. Once my midwife asked about my August walks. I told her that the two-mile walk from my office to the metro, mostly uphill, had gotten quite strenuous and sweaty. She recommended that I let that one go!
It's easy to get sedentary during pregnancy; most women are more tired during at least part of the time, and busier than usual. But exercise is key. One friend who is normally athletic said, "During pregnancy, it just didn't occur to me at first to swim laps. I thought I'd feel too heavy or be too winded. But when I started to swim at seven months, I felt so much better--less achy, more energetic."
My labor began with walking all night, pacing from kitchen to dining room and back. I tried lying down between contractions, but the ten-minute intervals didn't allow me to sleep much. I tried stretching and curling through the contraction, but only wailing allowed me to "stay with it," not tense up or focus on the pain. And I continued pacing, stamping my feet or rocking in the Jacuzzi throughout my labor.
Some women will not have the urge to be in constant movement as I did. But being in a strong position, a place that allows her to breathe well and release muscles, and changing positions, is essential for an active birth.
My first urge to push came in the Jacuzzi. Suddenly, this was not just pain: The earth itself was pushing down inside my body. I was helped out of the water. I squatted by the tub, but that felt terrible. After several more pushes, I followed the midwife to the bed. There I crouched on all fours, head tucked down, pelvis in, breath held, concentrating on my pelvis and pushed. There was my baby's head. I reach down and touched the fuzzy scalp.
That heaving force of last-stage labor symbolized to me the power a woman can grasp throughout the pregnancy and childbirth. With my first baby, born with a cesarean section, I missed out on this energy flow. I am grateful for the supportive assistants, centering exercises, and active birth that allowed me to participate fully in this second miraculous beginning of life.
ACOG (American College of Obstetricians and Gynecologists), Guidelines for Vaginal Delivery after a Previous Cesarean Birth, (Washington, DC: ACOG, 1998).
ACOG, Evaluation of Cesarean Delivery: National Task Force Report (Washington, DC: ACOG, 1996).
K. Gregory, L. Korst, P. Cane, L. Platt, and K. Kahn, "Vaginal Birth after Cesarean and Uterine Rupture Rates in California," Obstetrics and Gynecology 94 (1999): 985-989.