Ep 137: Rosanna’s Birth Story – How Education Led To An Empowering Vaginal Birth After Cesarean

Ep 137: Rosana’s Birth Story - How Education Led To An Empowering Vaginal Birth After Cesarean

Nicole: This is a great birth story of a successful VBAC, that's vaginal birth after cesarean. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

Nicole: Hello. Hello. Welcome to another episode of the podcast. This is episode number 137. Thank you so much for spending a bit of your time with me today. In today's episode, we have a birth story from Rosi. Rosi is a pediatric speech language pathologist from Durango, Colorado. She loves to be active and enjoys traveling, that is in non COVID times is anyway. Her hobbies are mountain biking, skiing, rafting, ultimate Frisbee, and chasing around her two beautiful children. Rosi was induced at 41 weeks with her first baby and after 30 hours of labor, she ended up having a cesarean birth. With her second pregnancy, she was adamant about waiting until 42 weeks before agreeing to be induced. And she scheduled an induction for 42 weeks and one day. She ultimately went into labor the night before her induction, went to the hospital around 4:00 AM and had her baby girl by 10:00 AM with no pain medication.

Nicole: There is a lot to learn from Rosi's birth story. She's going to share why her first birth was a bit traumatic for her. She's going to talk about all of the research and things that she did to learn about VBAC and be really informed for her second pregnancy and how she advocated for herself to have a VBAC. And she's going to share a bit about how she actually wondered if she made the right decision about having a VBAC and waiting to be induced because when her baby girl was born, she actually had to go to the NICU for a little bit. Now, this story is not typical in terms of VBAC or induction, going to 42 weeks, but there's no reason there there's nothing about it, where it couldn't be typical. Um, Rosi just does a great job of really sharing about the importance of educating and advocating for yourself.

Nicole: You're going to learn a lot from this story for sure. Now, speaking of educating, of course, there's a lot of information out there about pregnancy and birth, and it can be hard to wade through it all. It's also hard to know if sources are reliable. Well, I have taken all of that stress and out of that process for you and created the Birth Preparation Course. The Birth Preparation Course is my signature online childbirth education class that gets you calm, confident, and empowered for a beautiful birth. The information in the course is research backed it's based on evidence. I actually have a background in research after I did my residency training. I did a two year research fellowship at UNC Chapel Hill, where I got a master of public health with a concentration in epidemiology. So I understand research and I understand studies and that's the lens that I bring actually to all of my work.

Nicole: And then just to kind of bring it home, one of the comments from one of the course members, Lindsay, she said in the group about the course is that it is seriously the best thing, I read three books, countless message boards and mom blogs. And the only one that didn't leave me feeling more anxious was Dr. Rankin's class. So I want you to feel the same way too. So come join us inside the Birth Preparation Course. It's also incredibly affordable for everything you get, check out all the details at drnicolerankins.com/enroll. And I should also say that not only do you get the content, but you get the increased access to me, because right now hearing me, you can't ask me questions and follow up about things, but you can inside the private course community for the Facebook group, you can also ask other mommas as well in a judgment free and mom shaming free zone. Okay. So come join us inside the course drnicolerankins.com/enroll. And let's get into this birth story episode with Rosi. So thank you so much, Rosi, for agreeing to come onto the podcast. I am excited to have you share your story.

Rosi: Thank you so much for having me I'm excited to share.

Nicole: Yes, so why don't you tell us a bit about yourself and your family.

Rosi: I am a pediatric speech language pathologist. I've been married to my husband for six years and we have two kids together. We live in a small town in Southwest Colorado, and we love to do pretty much everything outdoors from mountain biking, rafting, hiking, skiing, and, uh, hope to be able to share that with our kids.

Nicole: Nice, nice. That sounds fun. I know it's beautiful out in that part of the country. I have not visited there yet, but it's certainly on my list.

Rosi: We love it. We can live in the high desert and feel like it's activities to do year round.

Nicole: Yeah. Nice, nice, nice. All right. So we're, we're mostly going to talk about your second birth, which was a successful VBAC yay yay yay for that. But I feel like in order to understand the VBAC, we also need to understand a bit about your first pregnancy and birth. So tell us a bit about what happened with your first birth and specifically why you also mentioned that it was a bit traumatic for you.

Rosi: Sure. So my first birth, um, the pregnancy was pretty unremarkable. Um, at the 20 week growth scan, they noticed that I had marginal cord insertion so that the, um, cord wasn't inserted into the middle of the placenta, but instead it was off centered. So the only thing that really changed that, um, about my pregnancy was that I had some increased, increased growth scan. So I had, um, some more ultrasounds, but, uh, growth seemed like it was right on track. So there weren't any real concerns about that. But, um, you know, as I got closer to my due date, um, I was kind of anticipating going over. Um, my mom and her sister both went two to three weeks over with all three of their kids. So I was thinking it would be wonderful if the baby came on time, but, um, then I made it to 40 weeks and I was being seen by a group of OBs that practiced out of our hospital.

Rosi: And, um, so then they mentioned induction, um, and they wanted to induce pretty close to my 40 week due date because of the marginal cord insertion. Um, my husband and I kind of pushed to see if we could get an extra week. Um, and they agreed to that, you know, with some non-stress test. And, um, you know, at that point you're kind of just excited to meet your baby and, you know, thought, well, all right, we'll go in for an induction. So we went in at 41 weeks and yeah, it started off, I think, pretty standard with a foley bulb and the cytotech and, um, you know, around 11:00 AM that foley bulb fell out and I was at four centimeters and they broke my water and started Pitocin. And I remember the OB saying, you know what, you just look a little too comfortable. We're going to keep ramping up this Pitocin and kind of thinking that, that wasn't my experience.

Rosi: Um, you know, uh, those contractions did get pretty darn intense. Um, I was planning to just have an unmedicated birth, uh, but was flexible and thought, you know, I've always been great at handling pain and, um, have done a lot of kind of longer hikes and bike rides. And, you know, like I thought a long labor wouldn't be that hard on me, but, um, yeah. Then I think about eight hours after they started Pitocin, I was still only at a four centimeters of dilation. And so I opted for the epidural and that went great. Um, and we eventually, the next morning I had made it to 10 centimeters dilated. And when I was pushing baby's heart rate just kept decelerating. And so eventually they said, you know, like we've been working at this induction for over a day now and we just need to get the baby out.

Rosi: So, um, it ended up being a cesarean. Um, and when they brought him out, they mentioned, oh, he was sunny side up or like posterior. And so that's why they thought that maybe we weren't making progress while pushing, but, um, yeah, kind of the whole experience. So, you know, they took him out and I heard him cry, but I never got to see him. And right after this, this area and I started to get chills and throw up, and I really didn't remember a lot for a couple of hours. And so, like, I don't remember the recovery room or really meeting my son. Um, and that, that kind of is the part that I think was really hard for me. Then when I thought back about, um, kind of that experience, like, first of all, they just kind of kept starting all these different interventions. And we tried to, you know, stop at the beginning of each one and thinking, okay, ask about what are the benefits? What are the risks? What are the alternatives? You know, what if we did nothing, but we just kind of kept ramping things up and it felt like just kind of the whole experience got out of control and things were just happening to my body. And I really wasn't a participant of it.

Nicole: Do you feel like they explained things to you or it just, it just kept, it just kept like going without you, like feeling involved in the decision making process?

Rosi: The OB that I had was would explain things, but I felt like it was just kind of like, we're going with her plan. Like, I didn't really have a lot of, like, I could ask questions about it, but like, this is what we're going to do.

Nicole: Got it, got it. Got it. Okay. Okay. So then after the delivery and you kind of thought back about things, did you have to do anything to process that experience?

Rosi: You know, I didn't really process it until I think I was pregnant again. Um, you know, kind of afterwards, I think I was disappointed by how everything went, but, you know, everyone kinda was like, oh, well, you're healthy and your baby's healthy. So what, you know, like what is there to complain about, but kind of looking back on it, like, it, it felt like the process of delivery also matters. Um, you know, and I think probably OBs, you know, they see birth every day, but to like a mom that this is one of the most important experiences, you know?

Nicole: Yeah. I totally get that and I can see how especially, well, first off I hate it when people say that, like to just be happy with the healthy baby, it's very dismissive, um, like there's opportunity, you know, you can be happy that you and your baby are alive and not be satisfied with the experience, however the experience went. So that always drives me crazy. And, um, I can, I, this is an important point that like, like you said, like there's, there's more to the experience and sometimes we have to step back and say that, like, even though things were fairly straight forward ish, you know that, um, and we do this a lot. You don't, so, so, um, that's, you know, certainly really eye opening for me. So then you go into the next pregnancy and did you go back to the same group that you had before?

Rosi: I did. Yeah. I think that more than anything, I mean, we were hoping to have two kids, you know, close together and didn't really expect it to happen. Cause we had some challenges with getting pregnant with our first. And so at 11 months postpartum, we found out that we were pregnant again. Um, I'd kind of describe us as, as surprised as two people can be, to be pregnant that are having unprotected sex.

Nicole: That always cracks me up, especially when people have fertility issues and then they're like, wait, did you say I was pregnant? Like, I didn't think that that was going to happen so easily. So it sounds like it happened sooner than you thought or sooner than you were thinking it was going to happen.

Rosi: Yeah. So I was 11 months postpartum, you know, I was totally surprised, but we were thrilled. And then I guess I didn't think that much about it. I just called the group of OBs. Um, we live in a small town and so you kind of have two options. You can either go with the group of midwives or the group of OBs, but they both practice out of the hospital. And I figured I had met most of the OBs already, so I just assumed that I would just go there again.

Nicole: Got it, got it, got it. So when did you decide that you wanted to have a VBAC?

Rosi: Yeah, I decided that I wanted to have a VBAC around 20 weeks when I really started to think about delivering this baby and kind of what I wanted for, for the next delivery. I knew that I didn't, well, I was hoping that I wouldn't need to be induced again. And I knew that I just wanted something, something different, that I wanted to feel more educated, more, um, more a part of the process. Um, and I had a cousin that had a cesarean and then went on to have a vaginal birth. And so I never really thought that once you had a cesarean and you would always have a cesarean.

Nicole: Right. So you decided around 20 weeks, like I'm going to go for this VBAC. And I'm curious, you said you wanted to be more educated and involved. Um, the second time, did you do any childbirth education with your first birth?

Rosi: We took that hospital, you know, childbirth education course. And, um, then I think I read some about what to expect when you're expecting and kind of just called it a day and figured I'm young and healthy and strong and you know, everything's gonna go great.

Nicole: Gotcha. Gotcha. So a lot of it was a surprise when things didn't go exactly as you anticipated the first time and you wanted to do the best you could to prevent that from happening the second time.

Rosi: Yes. Yeah. I figured no matter if it ended in cesarean or a vaginal birth, I knew that I was going to feel better about my next birth, just because I was going to put in more research and, and just be kind of a more educated patient.

Nicole: Gotcha. That was my question. I was going to ask, were you going into it, like I know that possible different possible things can happen or were you going into it like I have to have this specific outcome, but it sounds like you were like, I know the different possibilities can happen, but I'm going to take control of all of the things that I can control.

Rosi: Yeah. I would say that the latter and I figured, yeah, I mean, if I had a cesarean birth again, I had discussed with the obs too, about how, like my preferences of how I really wanted to be able to get at least see the baby, if I could hold the baby in the OR and start skin to skin, if you know, and they were a little bit, I couldn't really nail them down on that issue if I would be able to hold the baby in the OR, but they, they said they would try. Okay.

Nicole: Really? Yeah. And that's, this, this is pretty recent, like this isn't that long ago.

Rosi: No. So this is June of 2021.

Nicole: And they were giving you pushback about, or not even like firmly committing to being able to like see the baby as soon as possible and hold the baby, like in the OR.

Rosi: Yes, at least in the OR. They said they changed their policies from what I delivered my first in October of 2019 that now the mom doesn't go into a separate recovery room, but goes right back into the room with, um, the, your labor and delivery room with your baby. But they said that it had to do with staffing if they could have an additional nurse that would be there to help facilitate that skin to skin.

Nicole: Okay. Interesting. Interesting. Okay. I mean, it just shows you that hospitals are at different places in terms of, I mean, and you did the best you can. Um, it's, it's just, it's, you know, I hear it and its frustrating because like what more could you have done other than ask, um, ask in advance, you know? Um, so how did you otherwise feel like you're, you're, you're pregnant? How does your pregnancy go and how was your prenatal care?

Rosi: Um, my pregnancy was pretty straightforward, pretty similar to my first. Um, I feel like I fairly easy pregnancies. I just kind of feel more tired than usual the whole time. Yeah. I feel like I'm always growing a human. They can take a nap every day.

Nicole: And then did COVID change anything about your prenatal care?

Rosi: I would say, um, my husband was not able to come to any of the appointments me except for the 20 week growth scan, but that was fine with me because he came to a lot of the ones during the first pregnancy and I felt comfortable going and advocating for myself.

Nicole: Yeah. I think for this, at least for me, I'm speaking for myself for the second one, I was like, I'm fine. Um, you know, my husband did come for the first one, but the second one, it was like, we'll will be fine. And so I can totally totally see that. Yeah. So once you decided that you wanted to have a VBAC, when did you communicate that with your doctors and how supportive were they?

Rosi: So they said at the 28 week appointment, we'd talk about my birth plan. And, um, so I had done a lot of research about looking into the risks of both a VBAC and a repeat cesarean. And, um, had a lot of questions about induction of a VBAC since I know that can vary depending on where you deliver and who you deliver with.

Nicole: Yep. And I'm sorry, if you don't mind me asking what were some sources of your information?

Rosi: So I looked at, um, ACOG and then I was listening to a podcast called the VBAC Link, and then I looked at the evidence-based birth.

Nicole: Yeah. All great. All great resources. So, um, I actually had the folks who do the VBAC link podcast on my podcast sometime last year, yeah. So, um, so you, it's not like you, you went to like reliable sources of information. Um, and then your question, I mean, your questions are just spot on, like what happens with induction and all of those things. So what was that conversation like with them?

Rosi: So the first or the OB that I met with at the 28 week appointment, you know, was supportive and, um, and I felt like she answered all the questions and, but everyone was kind of a little bit dismissive about, oh, well, you know, we probably won't need to induce second babies come earlier. There's no way we're going to get there. And I was like, no, but I want to know if right.

Nicole: Like what's, what's up, like tell me.

Rosi: Yeah. And so they, they would have induced with Pitocin, um, and foley bulb. Um, and I did say that I really wanted to, like, as long as the baby and I were healthy that I wanted to wait to 42 weeks to induce. Um, and the first doctor was, yeah, okay. No problem. And then I pretty much at every OB appointment, I would just double-check I tried to meet with all the different OBs and I went over the preferences of, okay, like I want to have VBAC, I don't want to be induced until 42 weeks, you know, and we kinda went through the whole, the whole rigmarole and I got different feelings from different doctors. Some doctors were like, yes, of course, like this is going to be great. And other doctors were like, well, it didn't work for you the first time. So, you know, I don't think you have that great of odds of doing it, but it's your choice. I was like, okay, well, oh my gosh, thanks. Thanks for your support.

Nicole: Right, right, right. How did that, how did that make you feel?

Rosi: I was pretty certain that I wanted to try it and I looked at, you know, the stats and most people that go for a TOLAC are successful. And, you know, I felt like the baby, my son, wasn't in a great position. And that was probably why we weren't able to push him out and that my body just wasn't ready. But I thought if I waited a little bit longer and, um, you know, I was trying to do, like, I was doing some chiropractic care and I was doing, you know, yoga and I was on the spinning babies website and doing some of those exercises. And so, and I was just really aware about, you know, not trying to be too much in a reclined position, you know, doing belly mapping. So I felt like I was trying everything to be successful that I could, and that I just kinda thought that it was going to work.

Nicole: Right, right, right. Right. But I guess I, and also I'm asking like, there's, there's, there's this degree of uncertainty because did you know who was going to be there for the birth? And so how did all that uncertainty make you feel?

Rosi: Yeah, that was a little bit tough. And I did call, you know, like starting at 40 weeks, you can call and see who's going to be the delivering doctor each day of the week. Right. Um, but my plan was just to try to labor at home as long as possible. Um, we hired a doula for the second birth as well. And so, and she was really supportive and my husband was really supportive. And so our plan was just a labor at home. And then to kind of have them to be the buffers if I was with a doctor that wasn't as supportive.

Nicole: Gotcha. Gotcha. Gotcha. I mean, did it feel like, did you feel like you had to work really hard with all of the preparation and planning for things?

Rosi: I feel like I took a pretty deep dive, like into birth and tried to do all the, all the educating that I could. Um, just so that, you know, I would feel like no matter what happened, you know, I did everything that I could to have a safe, healthy VBAC. Um, so yeah, like, and I honestly, I felt so I read Anna Mae's guide to childbirth and some other books. And I honestly, I felt excited about what my body could do. And I, I felt like I just really tried to stay in a good head space. And, you know, during that birth, I did do some processing like of my previous birth and try to do a few release where I wrote down all my fears and burn them. And I took a video of kind of talking about what happened in my first birth. And once I did that, I kind of felt like it was off my chest and just kind of in the ether and

Nicole: Gotcha, gotcha. Again, just controlling the things that you could control. Yeah. Yeah. So, okay. So you're getting, you know, to your due date, what was the discussion about regarding induction? Cause there's one thing when you're like 30 weeks or 35 weeks, it's a different one when you're 40 or even 41 weeks. So what, what did that look like?

Rosi: Yeah, so that is actually very true. Cuz that my 41 week appointment then they're like, well, we should probably induce, you know, soon. And the doctor, you know, told me, like they had the first time around that the rate of stillbirth doubles from 41 to 42 weeks. And, um, and they wanted to induce me soon and, and I even asked her, I was like, well, what does it double from? And to, cause I had looked up some stats and I just wanted to know if, you know, what I found was the same. And she didn't know which I was kind of surprised about because I was like, well, if you're telling people it doubles, is it matters if it doubles from five to 10% or I was like, cause when I looked it up, I thought it doubled from 0.01 to 0.02%. Um, and I figured with a family history of going late, that it was just kind of how my body worked.

Rosi: Right, right, right. So, and I, I went in for a non-stress test at my 41 week appointment and they measured my fluid levels and that all looked great. And um, then I went in for a non-stress test that following weekend and uh, my due date fell on a weekend. They don't induce on a weekend. So we scheduled it for, for Monday morning, when I'd be 42 weeks and one day. Um, and you know, kind of having everyone say like, maybe you should get induced and you shouldn't go so long, you know, it kind of gets in your head. So I definitely was very, um, aware of the, the movement, um, and trying to do kick counts and just wanting to make sure that something didn't happen, you know, at the end and, um, right. But they did well actually they didn't have any openings for inductions on the Friday or Thursday before the weekend. So like, well I guess we just have to wait till Monday. And I was like, oh, drat. But, um, it was with my favorite OB was on, on Monday too. So I was like, okay, you know what? I am going to be bummed about being induced, but at least it's with my favorite doctor, so.

Nicole: Gotcha. Gotcha. And it's always interesting to me that it's like, okay, like you need to be induced. You need to be induced, but wait, nevermind. We don't do it on the weekend or the, or there's no space on Fridays. So, you know, we'll just move it to Monday. So it's like conflicting messages about the importance of it. Yeah. Yeah. Yeah. So what were some things that you wanted for your birth?

Rosi: I guess when I envisioned my birth, like I just, I, I really wanted to just have that immediate skin to skin, like just get that ooey-gooey baby and just, you know, snuggle them up. And, uh, I really wanted to see what natural labor felt like. I felt like getting induced last time. I didn't really know what it would feel like to have contractions that weren't, you know, brought on by, um, medicine. And so, uh, and then we were hoping for delayed cord clamping and just, you know, being able to have that golden hour. And after that, I was just, you know, kind of hoping that hoping for the best, you know, it was like, well, we'll make decisions as they come and, and we'll see.

Nicole: Gotcha. Gotcha. Gotcha. Okay. So, um, oh, I know you said you were thinking about like, well, when you say people, was it mostly the doctors who were like, you should do induction or were any of your family members or friends, like you should just go ahead and get induced

Rosi: Um, I think it was mostly the doctors. My family was supportive, um, and friends, I mean, everyone, like when you're that pregnant, everyone has a suggestion for how to induce labor. And so I heard a lot of those and I was like, you know what? Evidence based birth has a whole natural labor induction series. I've been all over that website, all those podcasts. So I was like, we are trying everything, but yeah, I'll try eating spicy foods and going on a full moon walk.

Nicole: Right, right, right. And did you end up trying to most of those things?

Rosi: Yes. So yeah, after 40 weeks I was doing acupuncture. I was seeing a chiropractor from about 35 weeks on was doing the spinning babies. I was using the breast pump, um, sex, prenatal, yoga, curb walking, um, practicing. Like I did a lot of hypnobirthing. Um, I was eating dates from about 37 weeks on that's just, uh, I guess have a faster labor, but, um, Lord Rosi. Yeah. So I felt like I was,

Nicole: You did everything for real. I think that, and then did you finally end up trying castor oil also?

Rosi: I did. Yeah. So at, on my 42nd week, um, it was the day before the scheduled induction. I figured, well, I might as well, you know, try, try castor oil. I looked at evidence on the website and I had my husband listened to the podcast, um, just to make sure that he felt comfortable with that as well. Um, and really all the recent studies don't show like an incidence of increased meconium. So we felt like we might as well give it one last ditch effort. And I tried that Sunday morning. Um, we kinda just hung close to the house because it is a laxative. Um, but I didn't have any GI effects at all. Um, so I kind of just figured it, it didn't work, but then that night I did start to feel some contractions and they just felt so different from the ones with my son, um, that I even like Google. And I was like, what does a contraction feel like? Oh, good. Like tightening in my lower abdomen like this, this is what I'm feeling. So, um, yeah, it was, it was, I don't know if there's been anyone that's been more excited to like, feel contractions than I was,

Nicole: You know, and it's hard to say it, the castor oil actually even did anything. Or if you just went into labor, I mean, you said your family members went into labor late also. So who knows? So then was that actually the start of labor?

Rosi: Yes. Yeah. So it started off pretty mild. Um, you know, it was exciting. And um, so it started probably about seven or eight at night that I started to feel some tightening. Um, and I just figured I'd try to go to bed and get some rest. Um, I talked with my doula and, um, she suggested using the breast pump and I said, you know what? Like, I want to get some rest, but like, I'll wake up soon anyways for a pee break. So I'll do it then. But I really wasn't able to fall asleep, um, because the contractions just kind of started picking up and they weren't painful at first, but, um, coming about every four to five minutes for about 45 seconds. Um, yeah, then around 11 or so at night I got up, cause I just wanted to move around and make some noise, let my husband sleep.

Rosi: And um, yeah, then it just kind of progressed, eventually got in the bathtub. I was just listening to my hypnobirthing tracks and just really excited about the whole process and um, yeah, around one, I probably woke up, my husband was like, all right, you should pack this car. Cause things are starting to pick up in intensity and I want like the car to be ready. And then for you to be able to help support me. Right, right, right. Um, and he kinda was like, oh, we gotta call our doula. And I was like, no, I'm fine. Don't tell her to come. But he called her. And so she was just kind of awake and ready. Um, and then about 2:30, my water broke and then my doula did come over. She told us that she wanted to come over then. Um, and after my water broke, I kind of had a hard time feeling the fetal movement. And so I was just a little bit more nervous about just wanting to make sure that baby was okay in there. So we left for the hospital maybe around 4:30. Um, and yeah, got checked in and they checked me in, I was already six centimeters dilated. So that was, I thought that was great. And then, um, around seven in the morning, I, the doctor was in there and I was just like, okay, what is the scoop with the anesthesiologist? Cause last time it took hours for that guy to show up.

Rosi: And I just want to know like, is he like, where is he? And you know, if it's going to be a 30 hour deal, like last time, like, oh, I want to talk to the anesthesiologist. And so at that point they, they checked me again, which I was a little bit reluctant about since my water broke. I just didn't want to have too many cervical checks, but they said that I was already 10 centimeters dilated. Um, and so, um, yeah, I said, no need to see the anesthesiologist. We'll just wait until, um, I was ready to push because they said the baby was still up, pretty high, like at a negative one station.

Nicole: So you went from six centimeters to completely dilated and a little an hour ish,

Rosi: Two hours. At about 5:00 AM, I was checked when we got in to the hospital at six centimeters and then at seven I was fully dilated.

Nicole: Nice, nice.

Rosi: Yeah. So I labored down. Um, I met with the OB at eight when she came on, um, I was like, well, I guess I'm here for the induction. She said kind of jokingly and she was like, you know what, just listen to your body. And whenever you're ready to push, we'll be here and we'll push. Um, and yeah, I don't think I'm the best at listening to my body. Like I couldn't tell if I should, you know, try to just relax through the contractions or if I should be pushing. Cause it was, you know, there was pressure and just didn't didn't quite know. And then eventually around nine she's like, you know what I think, I think we're ready. Like let's start pushing. Right. Yeah. So we tried some different positions. Um, I didn't think that I'd want to push on my back, but the OB thought that that's where I was making the most progress or that's where she could see that I was making the most progress. And I was like, okay, you know what, if we're making progress, this feels, this feels good. We'll go with that.

Nicole: Gotcha. And so what were you doing to manage contractions, um, during the two hours while you were waiting?

Rosi: Um, so do we were doing hip squeezes? I was just trying to, you know, relax as much as possible through them and just kind of swaying and moving through them. Um, I always kind of felt like, you know, it was intense, but I could do another one. Like I was kind of at that point where I was like, okay, well that was, that was hard during that contraction, but I could, I could handle another one and I knew that it wasn't going to, you know, last that much longer since I was fully dilated. And I was kind of hoping that by waiting the baby would just keep, keep descending. I had this idea that I would just breathe the baby out or that there'd be the fetal ejection reflex, but I don't know for me, I had to, I felt like I had actively pushed to help get my, my baby out. But, um, actually during pushing, I was surprised. I felt like no pain at all the whole time. Like went out to the point that I was like, is that a contraction? Should I be pushing? And they'd be like, yeah, push now.

Rosi: So I don't know, something, something turned off once I started pushing and I felt no pain until like, um, I think the baby's head was maybe like halfway out. And then I was like, oh, this must be what the ring of fire is like, you know? And there's definitely some stinging, but yeah.

Nicole: And you hadn't used anything for pain, no pain medication or anything?

Rosi: Oh, no pain medication. I felt like with my first, it was just kind of a really out of control experience. And I felt like if I didn't use any pain medication, then I I'd just kind of be more in control, but yeah. So I didn't have any, any pain medication.

Nicole: Wow. And then this time it just didn't, it sounds like things just didn't feel nearly as intense as they ended as it did with the induction.

Rosi: And I don't know if that was the Pitocin or if it was because my son was like posterior, so I was probably having back labor, but didn't know it like, and with the Pitocin contractions, like with my first birth, they were just coming on top of each other. So I'd have like three or four contractions in a row and then I'd have like a five minute break. And it just kind of, I wasn't certain when things were going to wait, were going to ease up. And then his heart rate kept decelerating and that was stressing the doctors out and me out. And then I felt like I wasn't able to handle the pain. And, and I think that this time I also had, you know, was practicing hypnobirthing and I think that probably helped or just my breathing. And I don't know, it was just a very, very different experience.

Nicole: It sounds like it, I mean, would you describe it as like calm?

Rosi: I'm trying to think if it would be calm. Cause I definitely had to, like, I don't know about strain to push, but I was definitely trying to push the baby out, but it was, I dunno, it was probably my favorite part of the delivery was the pushing

Nicole: And how long did you push?

Rosi: A little bit over an hour.

Nicole: Okay. And that's not bad at all. That's not bad at all. So, oh, I forgot to ask. Did, did anyone try to encourage you to get an epidural because you had had a prior C-section before?

Rosi: No. One of the OBs did mention that, um, it might be their preference, but that it was up to me.

Nicole: Good. Well, I'm glad to hear that. Cause a lot of times folks want to try to say you have to have an epidural cause you know, the risk of a repeat C-section and things like that. So that's good. Okay. So you pushed for a little over an hour, you said, and it, you were having no pain during the contraction. Some people are going to be listening to this like, oh my gosh, where do I sign up for that? And so then as you're in, is it, I can't remember. Sorry. He or she came out?

Rosi: She, yeah, so she just like shot out, but I didn't realize, um, she had a really tight nuchal cord. So the OB like cut that I think actually like before that she was all the way out. Um, and so then they did, they just, they brought her up to my chest for maybe five seconds, but she was having trouble, they said pinking up. Um, and so they brought her and just put her under some oxygen immediately. Um, and then she had to go to the NICU for about 45 minutes or so. Um, which was, you know, tough because then immediately I was kind of doubting if I made the right choice, trying for a VBAC as opposed to repeats cesarean. And um, but the nursing staff was all really calm about it. You know, they said, you know, her blood pressure's great her heart rates great. You know, her oxygen sat levels seemed good, but um, yeah, they said that she was just a little bit floppy and having trouble picking up. So, um, so they did bring her to the NICU and then they brought her back and, and all the observations, they said that she was doing great. Um, so, but that was, that was a bummer, you know, cause I was like, okay, like I'm going to get to hold this just like gooey baby and just hold her on my chest. Um, but you know, they brought her back in and she was, she latched right away and was able to nurse and she was just alert for hours and uh, man, she has just been so sweet and good tempered and just yeah so

Nicole: That's the wonderful, so yeah, I guess you, did you have flashbacks for lack of a better word to the first time when you also didn't get to see your baby right away.

Rosi: A little bit, yeah. It was definitely tough, um, to see them wheel her away

Nicole: Eventually. I mean, I'm glad she came back quickly, but I can imagine how that thought was running through your mind that maybe you made the, made the wrong decision. So I'm glad you didn't have to wrestle with that for too long.

Rosi: Yeah. Yeah. And I had thought about what I would do if, you know, if it wasn't a smooth VBAC because when I was deciding between a VBAC or repeats cesarean and I, I, to me, it seemed like if you had a smooth VBAC, it would be easier and better for me and for the baby. But you know, if, if something went wrong, then you know, what, what would I do? And I, I had told myself that I wasn't going to blame myself, you know, that I'd done the research and I felt comfortable and confident. And you know, the rest of that, a lot of people would bring up with, um, a VBAC is uterine rupture. And, um, I looked at the research on that and you know, the risk of having uterine rupture is still incredibly rare. Um, and if it were to happen, it can be, you know, anywhere from really minor to, you know, it could be catastrophic for the baby, but since was delivering in a hospital and I felt comfortable with the OB is that they were going to be on the lookout for any uterine rupture that if, if that did happen, that they would get that baby out quickly.

Nicole: Gotcha. Gotcha. I mean, you really, you really weighed everything. I mean like everything, um, and made a really informed, um, decision for sure. Um, so, but I guess I'm sorta like also though it wasn't necessarily because you were given that information, you had to find that information yourself. Is that fair to say?

Rosi: Yes. Yeah. I mean, yeah. I think, yeah, the OBs were just busy, you know, they see you for an appointment and then you're kind of in and out. And so yeah, I felt kind of like the onus was on me to do the research and bring up, um, you know, what I wanted and, and that would be as did say, you know, like due to your first birth, you know, you could be a VBAC candidate. So, you know, they just kind of mentioned that, but then I was the one that then kind of dug deep and wanted to do all the research.

Nicole: Yeah, yeah. Yeah. So did you have to have any stitches or anything after your birth?

Rosi: No, I was, yeah. I was really pleasantly surprised by that. Especially since I think sometimes pushing on your back, you can have a higher chance of, of tearing, but yeah, I didn't have any tearing that needed stitches. Um, I was sore, but, um, I think that's expected. Right, right.

Nicole: So then what was the postpartum period like for you?

Rosi: Um, I feel incredibly lucky because my husband had four weeks of paid paternity leave. So he, um, was there for four weeks and we'd take our toddler, um, to do activities and I could just nap and nurse and um, yeah, she has just been really easy. Um, she's been a phenomenal sleeper. Um, and I don't know if it was the manner of delivery or if I'm just the second baby or I don't know what, but I just kind of felt this like immediate connection to her versus with my son. Um, I felt like it kind of, it was kind of forming and we built it over time. Yeah. So I don't know, like I definitely, I felt like there was a different connection kind of immediately post-birth and I don't know if that was because it was a VBAC versus cesarean or gotcha. Or what, but yeah, I feel like I've had a fairly easy going postpartum.

Nicole: Well, that's good. Both physically and mentally. Yes. Yeah. I can imagine I'm sure the recovery physically people say, I hear people say a lot. I don't know, personally that and unmedicated birth you're up and moving fairly quickly afterwards and feeling more like yourself fairly quickly.

Rosi: Yeah. I would say that for sure. And I was, yeah, I was really hoping to avoid the cesarean having a toddler at home who still loves to be picked up. Um, you know, I wouldn't, I, yeah, you're not supposed to pick up anything more than ten pounds.

Nicole: That's like, that's ridiculous. Yeah. My girls are two years apart. Exactly. And I was like, this is just, I mean, it's not going to happen, so yeah. So is there anything that you weren't happy about with your experience?

Rosi: You know, it would've been wonderful if, if, um, she didn't need to go to the NICU, but, um, yeah, that was the only thing that, you know, if I could have changed anything, but I knew that birth was unpredictable and that yeah. Anything could happen. And so I kind of felt like, yeah,

Nicole: Overall things went very well.

Rosi: Yeah. I'd say at least. Yeah. At least with the labor, everything went really well. And then the postpartum, everything went really well. It was just that short period after birth. That was a little bit stressful and

Nicole: Gotcha. Gotcha. So then as we wrap up, what would be one thing or your one favorite piece of advice that you would tell to someone who's thinking about a VBAC?

Rosi: It's hard to think of. Just what I think, I feel like it's a mixture of like staying positive and having positive people around you and also just educating yourself. Um, sometimes I think there's some misinformation or people say, you know, things like, oh, you know what, if you have a rupture and your baby dies, you know, but really if you, if you understand the statistics and you know, the odds behind that, then, then it makes it a lot less scary.

Nicole: Yeah. Yeah. For sure. Where can women connect with you? And you can totally say no, if you don't want to.

Rosi: Yeah. I have, um, just a private Facebook and Instagram account, but if anyone has any questions, um, or wants to talk, I'd happily answer them. Um, on Facebook it's Rosi Philippi and on Instagram, it's rosannahosanna.

Nicole: I love it. Love it, love it. All right. Well, thank you so much for agreeing to come onto the podcast and sharing your story. Um, so many useful pieces of information here. I know folks are going to find it useful.

Rosi: Oh good, I hope so.

Nicole: All right. Wasn't that a great episode? I'm so glad that everything ended up going well. And she had that beautiful unmedicated VBAC birth and, um, got to meet her beautiful baby and things went better the second time around. Now, after I have a guest on, you know, I do something called Nicole's Notes where I talk about my top three or four takeaways from the conversation. And here are my Nicole's Notes from my conversation with Rosi. Number one, I've said this before, and I'm going to say it again because we have to repeat every so often stop saying, just be happy to have a healthy baby. You can be happy or be grateful that you are healthy and that your baby's healthy, but still be upset about your experience. Okay. You don't have to dismiss if you're unhappy with the way your birth experience unfolds. That doesn't mean that you're not grateful about having a healthy baby and about you being healthy.

Nicole: Okay. Your experience is your experience. And that means that even if other people think it's fine, um, it may not be fine for you. Okay. And that is okay. Honestly, when I listened to Rosi's story, um, getting up to the C-section, it sounded pretty straightforward and typical in terms of what could happen in terms of how an induction foal unfolds. And if the baby's in a certain position and pushing for three hours and then heading for cesarean now the part afterwards where she didn't get to see her baby for a while and didn't feel connected. That part didn't seem right, but really leading up to it. Um, nothing stood out to me as red flags, but it doesn't matter what I think Rosi felt that that experience was not good for her. And so she made some steps and did some things to change that the second time around.

Nicole: Okay. Number two, uh, Rosi made a point that her doctor didn't know like specific numbers about stillbirth and that is not uncommon. Actually, the doctors don't know specific numbers off the top of our head, to be honest. And it's not something that we necessarily carry around as part of our regular information, I think would have what would have been appropriate. And it's something that I do is say, you know what? I don't know that exact number off the top of my head, but let me look that information up and get back to you. We walk around with personal computers in our pockets and we can certainly access those types of information or that type of information relatively quickly. I think sometimes there's some stigma or hesitation about feeling like or appearing that you don't know something. And so it's uncomfortable to say, you know, I don't know, but it's not uncomfortable that we are not unusual.

Nicole: I should say that we don't necessarily know the stats. Like I don't know the stats for stillbirth, like right off the top of my head. I know it's a low number, like less than 1%, but I don't know those exact numbers. So, um, give yourself, or give your doctor some, some grace in that regard and do feel comfortable saying, um, well, would you mind looking it up and getting back to me, um, to, to follow up the conversation? I do appreciate though that, uh, Rosi was insistent with getting answers to real questions, not just about stillbirth, but in general. So you may need to be insistent in order to get those answers. But as far as the numbers go, we may not know those exact numbers, like right off the top of our head. Okay. Number three is control what you can. So much of what Rosi described was uncomfortable about our first birth was that she felt like she was out of like things were happening to her in her body that were out of her control.

Nicole: And the truth is that birth is an unpredictable process. And there are many elements that are out of our control that are out of your control, that are out of your doctor's control. And when people are unhappy with their birth experience, sometimes it's because they don't realize that that is a possibility that things may not go exactly as they intend. Um, and they're not prepared for that. And it sounds like, or it was the case at the second time around Rosi took a different approach where she's like, I'm going to do all of the things that I can. And if things don't go a certain way, then I know that at least I did everything that I can. Okay. And she had a much more open mind to the process and how things can unfold. And I think that that made a difference in things being successful for her.

Nicole: That's not based on science. Of course, that's just my opinion, but being open to the possibilities and the unpredictability of labor is really important in order to ultimately be satisfied with your experience, because it's not that people aren't happy that they didn't have a vaginal birth or they had a cesarean birth. Usually when people aren't happy it's because things didn't go the way they expect and they weren't prepared for that possibility. Now I, and again, that, of course being prepared or part of being prepared is childbirth education. So do check out the Birth Preparation Course, my online childbirth education class. Um, it's wonderful. And I just love being able to serve folks in a more intimate way and connect and provide that evidence-based information to help you get ready for your birth. You can check out the course at drnicolerankins.com/enroll. Okay.

Nicole: And the last thing I'll say, I feel like I'm being a little bit chatty today, but the last thing I'm going to say is that you have to be comfortable with your choices and accept the possibility of all outcomes, whether good or bad. And this one is tricky. Okay? Because you don't want to like give energy to negative possibilities happening, but you have to be aware and accept the fact that there are these small chances that bad outcomes can happen. Sadly, bad outcomes do happen rarely in obstetrics. It's not something that's common, but it is a possibility. And Rosi had obviously done her research and she had accepted those possibilities. She knew that stillbirth was a possibility. She knew that uterine rupture was a possibility and that it could be bad. Um, but she felt comfortable with the numbers and the team and the support that she had in order to manage that.

Nicole: So you have to not put blinders on, you have to be comfortable with all of those possibilities happening. This is one of the things that happens in obstetrics, at least from our side as providers, that kind of terrifies us in a sense that when there's a bad outcome, often people want to place blame and that can end up in lawsuits. And sometimes there is blame to be had and the way care was managed, the way care was, was given that kind of thing. But sometimes the reality is that bad outcomes happen. And there's nothing that could have been done to make that bad outcome not happen. And you just have to be comfortable with that possibility. That's the possibility of life really in birth is no different than that. All right. So there you have it. Be sure to subscribe to the podcast wherever you're listening to me right now.

Nicole: And if you feel so inclined, I'd love it if you leave an honest review in Apple Podcast in particular, also do connect with me on Instagram. That's another way for us to connect outside of the show. I'm on Instagram @drnicolerankins. There, I share information, helpful tips about pregnancy and birth, short stuff that you can read. I do reels even something that I never thought that I would do. Of course I do them in a way that works for me. There's no pointing or dancing involved, but I do do nice fun reels sometimes. So do check me out on Instagram @drnicolerankins. So that's it for this episode do come on back next week. And until then, I wish you a beautiful pregnancy and birth. Thanks so much for listening to this episode of the All About Pregnancy & Birth podcast, head to my website, drnicolerankins.com to get even more great information, including free downloadable resources on how to manage pain and labor and warning signs to look out for after birth. You'll also find information for my free online class on How To Make A Birth Plan That Works as well as everything you need to know about my signature online childbirth education class, the Birth Preparation Course. Again, that's drnicolerankins.com and I will see you next week.