Ep 82: All About Vaginal Birth After a Cesarean with Julie Francom and Meagan Heaton of VBAC Link

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I have an awesome episode for you this week, and it's the first time I've ever hosted two people on the show at once! Today we're joined by Julie Francom and Meagan Heaton of The VBAC Link, an online education platform for parents who want to have a vaginal birth after Cesarean (VBAC).

Julie and Meagan are passionate doulas and mamas who want to empower moms to play an active role in their pregnancy and birth by finding out the true risks and benefits of VBAC.

We cover a lot of great stuff in this episode, from the basics of what VBAC is and why some parents want to pursue it, to the myths about VBAC you should be aware of. Julia and Meagan also share some great advice about what you should ask your provider to understand their position on VBAC and whether they will be supportive of you if you want to attempt one. And they share some tips for having a successful VBAC and why they think having a doula is such a game-changer.

In this Episode, You’ll Learn About:

  • What a VBAC is and how women decide whether or not they want one
  • What TOLAC means and why it is a normal term for your medical providers to use
  • Why you need to know whether your provider is just VBAC tolerant or fully VBAC supportive
  • Julie and Meagan's recommendations for success for parents about to attempt a VBAC
  • What you should ask your potential provider about VBAC to make sure they'll support you during your birth
  • A couple common myths about VBAC that need to be busted
  • Why you should educate yourself as much as possible before attempting a VBAC

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I want this podcast to be more than a one sided conversation. Join me on Instagram where we can connect outside of the show! Through my posts, videos, and stories, you'll get even more helpful tips to ensure you have a beautiful pregnancy and birth. You can find me on Instagram @drnicolerankins. I'll see you there!

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Nicole: In this episode of the podcast, we're talking all about VBAC with Julie Frankcome and Megan Heaton from VBAC link. Welcome to the all about pregnancy and birth podcast. I'm Dr. Nicole Callaway Rankin's a practicing board, certified OB GYN. Who's had the privilege of helping hundreds of moms bring their babies into this world. I'm here to help you be knowledgeable, prepared, competent, 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 @ncrcoaching.com/disclaimer. Now let's get to it. Hello. Hello. Welcome to another episode.

Nicole: The podcast. This is episode number 82. Thank you so much for being here and spending some of your time with me today. So on today's episode of the podcast, we're talking all about VBAC, which is vaginal birth after cesarean. And I have Julie Frankcome and Megan Heaton on from VBAC link. Julie and Megan are both VBAC moms. They're doulas, educators, and doula trainers who have supported over 700 women on their individual VBAC journeys. And they have a community of thousands of women all over the world. Their mission at the VBAC link is to make birth after cesarean better by providing education support and a community of like minded people. I am a big supporter of VBAC and sadly, I see a lot of misinformation out there from providers about VBAC. And when I came across Julie and Megan's material, I was really impressed by how they present factual, balanced information without a specific agenda. So we have a great conversation about terminology surrounding VBAC things women should know before they consider a VBAC questions to ask. What's the difference between a VBAC tolerant and a VBAC friendly provider. I really liked that. And then some tips for a successful VBAC and much, much more. You are definitely going to learn a lot and enjoy this episode. If you are considering a VBAC. Now I know what else you're going to enjoy. If you're considering a VBAC and that is the birth preparation course, the birth preparation course is my signature online childbirth education class. That ensures you are calm, confident, and empowered to have a beautiful birth. I have a bonus lesson in the birth preparation course all about VBAC. This lesson covers the information you need to have your best chance for success. You learn the most important thing you need to do. If you're considering a VBAC, the benefits and risk of VBAC, as well as evidence based recommendations for management, you can check out everything that's included in the birth preparation course @ncrcoaching.com/enroll. The course is currently 40% off. It's highly discounted because of these challenging times with COVID. So do check that out @ncrcoaching.com/enroll. All right, let's get into the episode with Julie and Megan from the VBAC link.

Nicole: Thank you so much, Julie and Megan for coming onto the podcast. This is the first time that I've had more than one guest on the podcast at a time, and you guys are perfect guest to do this.

Julie and Megan: Oh, thank you so much. We are so glad to be here.

Nicole: Yeah. Well, why don't we start off by having you tell us each of you tell us a bit about yourself and your work and your families.

Megan: Perfect. Julie, you want to go ahead?

Julie: Sure. Um, Oh my goodness. I feel like my answer today would have been different than my answer a week ago, just because of everything that's going on with coronavirus and our self quarantining and all of those things. So I'm going to kind of just adapt a little bit, I guess. Um, I'm Julie, I have four kids right now. They are all under the age of seven for another like two weeks. Then my oldest turns seven. I had four kids in five years, which was like insanely crazy. And it is crazy as it sounds again, number three was a surprise and I decided that, um, that's exactly how she does everything in her life. Exactly the way she wants to. So she's three now. Um, and then I have been a doula for five years. My first birth was an unexpected cesarean. I was induced at 36 weeks and I had preeclampsia. So it was like a legitimate induction, but there are some things looking back that I wonder if I could have done differently or if I would have known differently, if it would have ended out a different way. And so my second birth, I went on to have a VBAC and it's just, they're really long story. So I'm going to try and keep it short. Um, Megan and I story, we have a podcast called the VBAC link. You can hear them if you want to hear the whole story, um, on our podcast, it's just called the VBAC link and we're episodes number two and three. So I won't get too much into my, um, birth stories there, but I went on to have three vaginal birth after cesarean at home, actually just because that's where we felt like we could have the best possible experience for us. It's definitely not for everybody. And we had a solid trained provider that done over a thousand births and we had a really good emergency backup plan just in case. And so I mostly, immediately specialized in VBAC clients when I became a doula because it was very, very passionate to me. And I was like, the reason why I came to doula is because my doula made such a big impact on my labor and birth and everything leading up to it that I just had to be that for other people, it was kind of like a calling. I know it sounds kind of cliche, but like, I really felt like that was my place in the world. And so I started out and then kept having babies and then doing doula work and babies and doula and babies and doula. And now that I'm done having babies hallelujah for that, I'm like shop is closed. We are double done. And it was time to start the VBAC link, which we're going to talk about. Um, a lot, I probably during this episode. So I love the next question. So I'm not going to get into how we started, um, before Megan gets a chance to tell you a little bit more about her.

Nicole: Yeah. So Megan, why don't you tell us a little bit about yourself?

Megan: Yes. So, um, my name is Megan Heaton. I am a mom of three kiddos and I'm a wife of an awesome husband who I could never do what I do without him. My kids are eight six this weekend. Um, this is March and then 3 and they definitely keep me busy. I became a doula stemmed from my second birth. Um, my first was a C-section and it was unplanned unexpected. Um, unfortunately it was just, I was with a provider who didn't really, I would say want to wait, but, um, allow my body to do what I needed to do. Um, and so we had a C-section and then the second one, I really wanted to have a vaginal birth. And he said that he would support me in that. However, um, I really didn't receive a lot of support in the end and I'm walking into the, or for a second C-section I had learned about a doula just before that birth. And, um, after that birth, I was like, okay, I want to help birthing people out there, know their options and feel supported because I didn't want anyone to feel the way I felt that day. Um, leading up to my C-section. And so right out of the VOR, I started Googling how to become a doula. And the rest is really just history, five years here, we are still doulaing and I'm loving everything about it. And then with my third I, still wanted a vaginal birth. I felt deeply, um, that I needed a vaginal birth and that I could have a vaginal birth despite the things that were said to me. And so I interviewed many doctors and midwives and providers in and out of hospital. Um, and ultimately, um, at 24 weeks decided to birth with a midwife, a CNM out of hospital in a birth center with, uh, two actual OB'S one in an out of hospital network for a backup in case there was a true emergency and one in an, in the hospital network for that maybe not being a true emergency and, um, was able to have a vaginal birth with him, which was just completely empowering and amazing, um, one I'll cherish for the rest of my life. Of course. Um, and so, yeah, and then after that birth, I joined Julie with the VBAC link. And so here we are.

Nicole: Got it, got it. Now, let, let me get this out of the way, just because I know somebody is going to ask me, so me and me as an obstetrician, you know, my background, my training, home birth after cesarean gives me palpitations and, that is recommended by our society, but I support women and their ability to make informed choices and having gone through the, um, Julia and Megan's website and their information, they have tons of great information out there. So on that particular point, we may disagree, but that doesn't mean that we can't still learn from what they do and their experiences and their work. So let's just keep chugging right along.

Julie and Megan: Yes, absolutely. We can still be friends and we also support all women's choices, just like you. Yeah, exactly. Like know 90% of our clients deliver in hospital.

Nicole: Okay. Well, why don't we get into then? How did you all come to work together?

Julie: All right. Do I, Megan, do you want to tell this part of the story, or do you want me to, it's kind of funny cause we tell it a little differently and I always like hearing Megan, um, tell the story. So, um, I always knew like almost right when I became a doula that I wanted to do something more than just like local doula support. I want, I, I felt like there had to be something bigger to do than just taking VBAC, doula clients and helping educate our local community. So I just kind of was just always in the back of my mind, but then I kept having babies and so like screwed up my plans for that. But then when I was done having kiddos, my youngest just turned two in January and I just kind of felt that like little inkling, that little calling and I'm like, okay, how am I going to do this? Like, what does it look like? What is this time to start creating something like this? And so I kind of like dinked around a little bit and created a website, just kind of playing around because I liked doing those types of things. And I'm like, okay, like look and things just started to form in my head. And I'm like, gosh, I really need someone to do this with me. Because first of all, I am horrible at being accountable to myself. And second of all, I need someone to kind of like balance me out because I'm really like nitpicky and anxious and like to the point and structured and in very direct. And I needed somebody to, of like that has, that was more soft in their personality and like super chill. Like my husband's chill. We balance each other out. Like, I'm the, like, let's do this. No. And he's like the hold on a minute. And I needed somebody like that to work with me. And so I knew Megan had just recently had a VBAC after two C-sections and she is a powerhouse in our doula community. Like she, she put her husband through law school just by being a doula. Like she, yeah, like she's taking like six to eight clients a month. She's rocking the world. She knows she has lots of connections in the birth community. And so I knew that, um, she was just kind of the choice. Like it wasn't even a lot for me to think about just because of how, how badass she is. Can I see bad-ass on this podcast?

Nicole: Sure. Twice.

Julie: I mean, if not bleep me out. So I approached her, I was like so nervous. I was really nervous. And so I, I called her and then she will tell you this. She was like, like, why is Julie Frankhome calling me. This is so weird because usually people don't call each other anymore. Right. And so she almost wasn't going to answer, but then she answered the phone and I was like super secretive. I said, Hey, I have this idea. Cause I was like really protective of it. I didn't want anyone else to like, get the word out until I knew exactly what I was going to do. I'm like, I have this idea it's super, super secret. Like on the download right now. I really want to tell you about it. Can I take you out for chocolate cake because who doesn't like chocolate cake. And so we went off for chocolate cake and it's so funny. We laugh about it now because I had like a presentation about my plans, like a spreadsheet. I brought my computer with me and like, and showed her, my website and everything in it. It's like exactly what I do. And Megan just laughs at that because like looking back because she didn't need any of that because that's just her personality. And so I was just really kind of up on thing. And then she thought about it for a week and couldn't stop thinking about it for a week. And I felt like I was like some guy like the, her proposed to a girl. And she's like, let me think about it. She finally said, yes. We started out as you taught VBAC link and educating our local community. But we soon realized that there was a need so much bigger than that. So we started the podcast and we started our online courses and teaching and training doulas, how to support VBAC clients better. And it's just been such an incredible journey. And I am so grateful for Megan for getting on this crazy train with me because it's, it's been crazy for sure. But also very fulfilling.

Nicole: Yeah. Yeah, of course, of course. Awesome. And you guys have been working together for how long? Two years. Yeah,

Megan: Almost it'll be two years in May.

Nicole: So why don't we hop right in then and just talk about VBAC and then how to help women who are interested in doing it. And I thought we would start off first with just let's define for folks where do the basics, like what's a VBAC, what's the toe lack. And what do the numbers mean when you see V be a, like a number

Megan: Number? Yeah, that's such a good question. And um, a lot of people even going for a VBAC, like I've had an interview with a client and she was like, telling me what she's like, yeah. I just want a vaginal birth. This I'm like, Oh yeah, you want to go for a VBAC? And she's like, I don't know what that is. You know, she wanted to run. Um, so the VBAC VBAC, not VBack is vaginal birth after cesarean. And it is exactly what that means. It is someone who is desiring to deliver vaginally after having a previous cesarean. And when you have numbers with like VBA to C, which is what I did with my kiddo is vaginal birth after two cesareans or vaginal birth after three cesareans. And then some people also say H B a C, which would be the home birth after cesarean or something like that. So, um, the numbers are sometimes thrill or sometimes it's like two VBAC, even it's like their second vaginal birth after cesarean. So that's just what that means or for VBA to see it at all. But all it means is that it is a vaginal birth after cesarean and I'm in the medical world. People call it a total lack trial of labor after cesarean or toll, trial of labor. And so it doesn't actually become a VBAC until after you have delivered vaginally. So we always tell people out there listening that if you are called a toll act, try not to take offense to that. That's just the medical term trial of labor, but you could still call it a VBAC. Like I'm going to VBAC. You don't have to say, I'm going to toll lack. If you don't want to one everyone's a trial of labor, whether you've had a cesarean or not that she has a medical abbreviation trial of labor or trial of labor after cesarean. So we always like to see like Yoda do or do not. There is no try, but if you can kind of reframe that thinking of, Tulloch just meaning like you are getting ready, you're preparing for your VBAC. Then after your baby comes out of your vagina, it is a VBAC. And that kind of really helps. Especially just because most people don't mean to like be offensive when they're seeing tulloch it's just the medical terminology.

Nicole: Exactly. Yeah. And more, more medical professionals will say toe lack and in conversation. And exactly like you said, it is not meant to be offensive at all. So if a woman wants a VBAC and she comes to you and she's like, Hey, I want a VBAC, what are three things that you think she should know right off the bat?

Julie: Man, this is crazy because it's kind of a little bit of a different than like how to have a successful VBAC. It's like, what are the first three things you should know? Like, and I think one of the most important things you need to do is get your operative report from your previous cesarean because having that information and knowing what's written in your operative report is going to dictate how your next provider is going to respond to your request for having a trial of labor. And so a lot of times women are told that there cesarean is happening for one reason. And in their operative report, it says something different. And so having that information ahead of time is going to prevent you from being caught off guard. For example, both Megan and I were told our pelvises were too small. And we were at, when people say that I was literally diagnosed with CPD and like I'm a size 18. So I'm pretty sure these hips are not too small, but they didn't tell me that at all at the hospital, they told me, um, that my C-section was for fetal heart tones and a non reassuring, fetal heart tones and nothing about that was mentioned in my operative report at all. So it's really confusing. And I think I'm getting your hands on that ahead of time is going to bring, give you information and power and also enable you to do research about the reason for your cesarean. The next thing I would say for you to do is find a good support team. Don't be afraid to talk to several providers and find the right fit for you. Um, and just because of providers highly recommended for VBAC doesn't mean that they're the right provider for you too. So don't be afraid to talk to multiple providers, um, let your education and what, you know, match up with your intuition and what your heart and gut are telling you. And then you'll find your perfect support team. We obviously advocate a lot for doulas because yes, I'm very good. Um, finding a doula, hiring a doula that's um, within your ability to do so is going to be very valuable to have somebody that can help you process through anything that comes up in which kind of leads me into my third tip is process through and talk about your experience with your cesarean birth. Because a lot of times there's hidden trauma in there that can be triggered either during the birth process or at the end of pregnancy. And we encourage you to prepare for that early on so that you know how to respond to it. If it does get triggered during your birth, we kind of like jokingly and not-so jokingly say that once a woman or a birthing person hits the point in their labor where their C-section was called, then they can like relax and breathe a little better. For example, if you were at four centimeters, when your doctor said, Hey, it's time for a C section, because whatever, the reason once that parent gets to five centimeters, there's like happy dancing in the room. Like everyone's excited. So yeah, so like mentally preparing and knowing what your triggers are and discovering them and also trauma for your birth partner. Because a lot of times these husbands and support people that are in the room with you and you're having your cesarean have hidden unknown trauma, and it can sometimes manifest as anger or frustration, or like Megan's husband said, I don't know why you don't just let them unzip you right for her. And that was his way of man, like expressing his trauma that he didn't even know he had from watching well through those scenes. And so the in short summary, um, get your operative report, find a solid support team and process through any feelings that are related to your cesarean birth and get your partner to do so as well.

Nicole: Okay. I knew the first two, I hadn't thought about the third one. That's a really, really good point. And I'm sorry, Megan, where you, where you getting. Yes.

Megan: Yeah, no, you're fine. I was just going to say processing can really like help a labor pan out in a much better and healthier way to the next time. I would just add, um, education to the mix of all of that. Um, processing the birth is so important and can really help bring a different feeling and vibe to the next birth. And then in addition is education. Um, I was, I just like to think of it, like I would never get a dog or, you know, something big like that without researching it and knowing the pros and the cons to that breed and, and what it's like and everything. Um, and I feel like it's just the same as birth, right? Like going into a big event or big thing, or making a big decision in your life. You want to prepare for that and, and really educate yourself. So when you're in it, you can be armed and ready and can have that educated discussion with your provider with, um, anything that comes up.

Julie: Yeah. And that's what we really want for these birthing parents is not to like fight with your provider and argue and, and be angry, but have enough information that, you know, what's available to you. And so you can have that educated conversation, like Megan said, because there's a lot of power in knowledge and most providers are very willing to accommodate your requests that might go outside of what they normally practice. If they just know what they are.

Nicole: Right, right. Right. And I would add that education is especially important for a VBAC because some provider I'm not going to call them liars, but they will tell you, you can't have a VBAC. And the reason is because their hospital doesn't do it or it's because they personally don't do it. Not that that woman can't have it. So you really need to be educated about VBAC in particular. Cause not, um, I'm sad to say that some providers won't, won't tell you that, they'll just say you can't have a VBAC.

Megan: Yeah. Or that you'll have a 50% chance of uterine rupture or because of your specific circumstances. We've heard that. And there's just a lot of things. And I think sometimes you say somebody's a 50% chance. Oh yeah, yeah, yeah, no, really. That really happened to some, to one of my friends and she believed it and she went on and, but you know, that's where having that knowledge and power or that knowledge that gives you power comes in and says, well, wait a minute, that sounds like a really unrealistic number. Can we talk more about this? And then she might decide to change providers or she might decide to go with the repeat cesarean. There's no wrong answer, but knowing what your options are, are so important.

Nicole: Exactly. Exactly. Now speaking of providers, I love, you know, just like you all mature, you all's materials, you talk about a VBAC tolerant versus a VBAC friendly providers. So what is the difference between the two?

Julie: Know? Yeah. Oh, sorry, go ahead. I say that, you know, there's, there's a difference and a lot of people don't know the difference. And so that's one of the reasons why we talked about it because a provider can easily say, yeah, I support VBAC. Like, you know, someone's like, hey, I want a VBAC, do you support that? Yeah, no problem. Okay, great. Do you do Vbacks yeah, totally. Do you know that habit ever birth you want, that makes someone I feel supported, right. Like completely supportive, but, um, there's a lot more to it. And so a lot of providers that have a lot of restrictions, like you must go into labor by 39 weeks on your own, you cannot be induced. You must have perfect blood pressure. You never can have protein, those types of things. Those are not great things. Yeah. I think it really just comes down to the more restrictions they have for parents wanting to tollac that are different than a parent that just wants a vaginal birth is less likely that they're going to be VBAC supportive. So like induction is perfectly safe for VBAC going gently. Um, and slow is, is recommended. The only thing you can't use are cervical ripe inners or prostoglandins for VBAC parents. But if they're very supportive of you and say treat, you just like they would any other parent wanting a vaginal birth, you know, but also being aware that there is a small chance for you to rupture and talking about what those risks are. Then that's a really good sign that they're VBAC supportive. But if they overemphasize the risk of VBAC and don't talk to at all about the risks of cesarean, or like Megan said, if they need you go into labor on your due date or by 39 weeks, and then they won't induce you and you have to have a schedule to cesarean. If you don't go into labor by 40 weeks, then those are really, really bad signs. Or if they constantly refer to as high risk, just because you had a previous cesarean and there's no other factors that make you high risk, that's a big red flag as well. And also like knowing what, how their views differ from the hospitals, views and policies surrounding VBAC is huge because you could have a provider who just loves VBAC parents and is so supportive of them. But they're really bound by hospital policy of, Oh, we don't let VBAC parents go past 40 weeks or 41 weeks, or there's no inducing VBAC that could look very different from what the individual provider thinks. And so knowing that, um, and what their reputations are and connecting with people, um, through ICANN or through our, our feedback link community on Facebook, um, we have a lot of really good resources out there to help you find that support and kind of makes sense about what your provider's telling you. We talk about it a lot in our class as well.

Nicole: Yeah. So, and of course we will link to all of the things that you have, um, available in the show notes, but it just sounds like you really need to ask like those specific questions about what are your thoughts about induction, um, in the setting of, of VBAC and, um, what does the hospital, what are their policies, those kinds of things. Are there any other questions that you think are important for the hospital or the, um, any other important questions to ask the hospital or the provider? Either one.

Julie: Yeah. You know, I think the most important thing is just asking open ended questions. Um, don't say, hey, do you support VBAC? Oh yeah, I do, or hey I'm, is it okay if I do XYZ? Yeah, sure. You can do whatever you want because that leaves a lot of room for interpretation on both of your ends, but like asking, you know, asking those questions. How do you feel about VBAC? How many of your clients that have had C-sections go on to have a vaginal birth, like just really having a dialogue is going to help you really get a feel for how that provider is about supporting VBAC. I wouldn't even say there's necessarily specific questions to ask as much as there is just asking open ended questions and knowing what the realities are of vaginal birth after cesarean, so that you can like pick up any red flags that come up in their answers. Megan, what would you, what would you add?

Megan: There are a couple of questions that I feel like for me as a, when I was looking were really important to me because the medical world works differently than they used to way back when, um, a lot of the times providers are in groups with other providers and they're there. They don't see, I say special. They don't special, um, people anymore, but as far as like, seeing them only, like they see them through pregnancy and they deliver their baby, no matter what. And so one of the questions that I asked when I was looking was okay, like I asked them all the open ended question, what their view of VBAC was, but then also do you work in a group of providers? Okay. Yes, you do. All right. Who are those providers? And are you open to me seeing all of your providers during my prenatal visits to assure that I feel comfortable with all of you and a couple of them are like, yeah. A couple of them are like, yeah, that's no problem at all. All you need to do is tell the scheduling. Once we get established, and then a couple people were like, no, you see me. And then you get whoever's on call. And I was like, okay, well, dr. Joe might not be as supportive as you and Joe. I know. Right. And we have, we have doctors here in Utah where we know that one or two providers in that group are completely supportive, but then the, the other six of them really are more of that tolerant provider where providers like, Oh, like your baby had one D cell next D cell we're going to a C-section or, or you haven't progressed in two hours, we're going to start pit. Or they won't start pit, you know, and they have very different views. And so I just feel like that would be a really good question specifically to ask. Um, and the same thing with midwives. Cause there are midwives that are called med wives that people call them where they're a lot more medical, um, based care than the traditional midwifery care. And so you want to get to know all the providers that are going to be in a practice if you have potential seeing that provider, because it really can, it can actually throw you off in labor when you have a provider that comes in and you're like, wait, wait, wait, wait, me and doctor, whoever, like we had this understanding and now they're saying no, you know? So I think that that would be something that I would add is just know who you're with.

Julie: Yes, absolutely. And it's all biological. If you, if you ever reach anything unexpected or like causes you to pause and like be hesitant or reserved or like, Whoa, crap. I got the one midwife that I don't like in this practice, your cortisol levels rise. You have matched your stress, hormone and cortisol levels fight with oxytocin hormones, which are the hormones that you need for labor to progress in a effective manner. And so if you have oxytocin and cortisol competing with each other, your labor is going to slow down because they cannot exist in high levels at the same time.

Nicole: Yeah. Everything you're saying is so, so crucial and being a hospitalist, I work with different practices and it is very true that you can have some groups or practice where everyone is very VBAC supportive and they will use Pitocin if need be. They will induce need be and other practices where it can mixed. So knowing the person is, and the possibilities is, is really, really important. And there may be a spectrum. There may be some who are, I won't do it at all. And then ideally, you'll find somebody who, you know, who supports it, who will support induction. I, you know, I probably, I have no, I lean towards the more, I guess if there's a word liberal spectrum of it, of, um, induction and being able to like, if you've had two prior cesareans, you certainly can attempt a VBAC. I personally don't like the calculators because I don't find them helpful either.

Megan: Oh, we hate the calculator.

Nicole: It's going to happen or it's, or it's not. And we won't know until we try the calculator, doesn't help that either way. I've seen plenty of people who I thought may not, or people thought may not be successful, be successful. So if women want to try and they're informed and they should be able to try, and then you find some people who fall in the middle where like you said, well, if you're not in labor by a certain period of time, so really just like we're saying, just know the person is really important because it's going to be a wide, a wide spectrum for sure. And we don't want to, I don't want to like discourage people. I think there certainly are many providers who are supportive of VBAC, but you just may need to do a little bit of research before you find one.

Julie: Yeah. And do you know what? I think every provider has their little nuances, the things that kind of bugged them a little bit more than others or things that they maybe bug, them's not the right word, but like things they are a little more wary about doing. And I think a lot of it has to do with providers have seen a lot of trauma in the birth room. Like most births are normal and uncomplicated and might need some intervention and that's okay. But surely providers spend practicing for awhile has seen some very traumatic things in the birth room and some of those scenes can be triggers for their providers as well. And like how they respond to certain situations might be based on some of that unprocessed trauma. But I think it's really important to know like what their triggers are and what things they're very particular about. So you know how to navigate through that with them, if they'll seams come up for you.

Nicole: Absolutely. Absolutely. So if a woman is in the hospital and she's, she's going for her VBAC, what are some things that you recommend to help increase their chances of success

Megan: Movement movement, for sure.

Nicole: Movement movement, more movement,

Megan: Movement, movement, you know, just really like moving and letting baby find the right spot and labor. Obviously, sometimes people desire an epidural. Um, but it's movement can still happen even with an epidural, but, um, movement is a big one is hyrdration big one. Understanding like again, that education understanding what a good and bad heart rate looks like. And then what to do usually is movement movement. Um, you know, sometimes we can like kind of compress little chords and you change on your hands and knees and that baby's doing great. Right. Um, having a meeting going on medicated as long as possible is awesome, right? Because it does allow more movement and things like that, and also decreases the chances a lot of the times of other interventions needing to come into the factor. And so obviously avoiding interventions would be another one that I would suggest, um, as Julie mentioned, like as safe we wanted you, you know, you want the safe mom and safe baby, of course. So making sure that you're working with your provider and knowing what's the best thing. And sometimes, sometimes, honestly moms are they're exhausted and they need an epidural and the epidural can be the best tool ever. Um, really, truly it can, it can really impact the delivery. And so, you know, trying to do the best you can to, to get things going as naturally as possible. And if Pitocin needs to come in, um, you know, working with your provider and making sure that's all done in a professional and gentle way. So yeah, those are kind of, some of the biggest things for me is movement. Um, I've just seen movement be such an impactful thing, you know, labor and even not even just VBAC moms, but any labor movement is so amazing.

Nicole: Yeah, for sure. What about you, Julie? Anything that you have to add about being in the hospital to help increase your chances?

Julie: You know, I would say absolutely have a doula with you. I can't enforce that enough because the thing is when you're in the hospital, nurses are in and out of the room, your provider is in and out of the room and it's going to be just you and whoever you have supporting you there. But having somebody that has a good education about birth, and that knows what positions are helpful. If you are birthing with an epidural and that can help you get in different positions based on what station babies at or what position babies in or knows comfort measures to help facilitate a really good connection between you and your partner. There are so many valuable things that doulas will do for you even before you get to the birth, um, to help you process and prepare and know your options are and get educated. And some people, the most common objection we would get about hiring a doulas, Oh, doulas cost so much money. I just can't afford a doula, but let me tell you, based on my experience with a doula and my experiences as a doula, doulas are worth more than you're paying them. I promise you most doulas have professional businesses. They're licensed, they pay taxes on their income. They have expenses driving to and from you and, and they prepare and educate themselves to support you. But also a lot of doulas I know are willing to work out payment plans and trade. I love a good trade. Megan's not as big a fan of trades, but I love doing trade work for people. Like I traded birth photography for my birth for doula support, for my birth photographer or like things that I need. Like I literally just bartered for two handmade twin sized beds to birth support somebody in October because my girls are gonna need new twin size beds, something as simple as like baking for people or making freezer meals for your doula or things like that. Like ask questions. And there's always a wide variety of experience doulas. There's newer doulas that usually charge a little bit less than your average price. And then there's more experienced doulas that have been around the block a lot of times. And you know, there's a there's price ranges. So don't let the cost affect your choice of whether to hire doula or not and most doulas take HSA and FSA payments. I know both Megan and I do, and we, um, are very willing to help any client achieve the capability of having a doula with them for your birth.

Nicole: Nice. And one thing I also will add is that it's a great thing to put a doula on your baby registry. You can guess baby list.com and you can ask for whatever you want essentially, um, with that. So that's another great thing that you can to try to get a doula cause that would do, I mean, I'm a research back nerd person and there's research that shows that continuous labor support from a doula improves outcomes. So it's, um, you know, try.

Megan: Yeah. And we actually have a blog about that with links to those studies. Um, if you want to go to our website, VBAC.com/blog, it's called, um, doula MythBusters, five things that you didn't know about doulas. And so, um, it actually decreases your chance of cesarean in generally by 41%, which is pretty, pretty significant, pretty remarkable,

Nicole: Pretty remarkable, indeed. So let's talk on a very briefly. I know the vast majority of women can have a successful VBAC. I don't know if we've said that at any point during the conversation, but let's say that now the vast majority of women are appropriate candidates and will have a successful VBAC, but sometimes that doesn't happen. And sometimes those undesirable outcomes happen like uterine rupture or even an injured baby. I will personally say in my experience, I have never seen knock on wood, a baby, be effected through, um, a uterine rupture or, you know, a VBAC that, um, did not go as intended, but I have seen uterine rupture before, and it can be traumatic for some people, for sure. Have you come across experiences? And I, and I know you've had guests on your podcast that have had not so ideal experiences with feedback.

Julie: Megan has a great story about uterine rupture.

Megan: Yeah. Yeah. And this was actually one of my really, really good friends that asked me to be her doula. Um, and so it was just a VBAC after one cesarean and she thinks we're going really well. She started laboring. Um, she went in, she was like three centimeters and things were just really intense. The, the uterine contractions were pretty intense. And so she was like, okay, like, I don't know how much longer I can do this. Um, and she got an epidural, which was a really good choice. I think. Um, she started resting and everything was going really well. Um, she only had progressed to about a five and then that was in like, I think it was like six or seven hours. And so the provider was like, you know, I'd like to start some Pitocin. We kind of want to start seeing this progress a little faster. And she agreed. And so they started doing Pitocin and, um, she got to like 9 and half, and kind of just like hung out there for a very, very long time. Um, and I mean like very long time, like at 10 hours, she was still a nine and a half and I was just so weird and they were still letting her go, which was honestly like I was in her best. It was like, even you were like, do we maybe need to think about.... Interesting to me. And, um, but she was resting and everything was fine. And so the providers like, you know, it's okay. Like maybe we just need to get rid of this lip. And so we started doing peanut ball and everything. And after the whole day at the 10 hour mark, they were like, okay, like let's kind of assess, like, let's see. Cause the, her cervix was really stretchy. And so the provider's like, you know, I want to see if maybe we can push past it and like stretch it over the baby's head, which I've heard of many providers doing. Um, I don't necessarily like, always love the idea. I think that my midwife actually did that to me too. And it worked and it was great and I'm grateful for that. But sometimes I think, um, that can cause some irritants to the cervix, but she was willing to try because it had been a long time. Um, and so they started doing it and they wanted to make sure that the fetal heart rate was really tracks the whole time during pushing for good reasons. And so they were checking the baby's heart rate and she was pushing and doing great and it would slip over the baby's head and then she'd stop and it would come back and then it'would slip over the baby's head, I don't know. And so they started assessing with the whole team with the midwives and the OBS everybody was assessing and they were like, you know, maybe we'll get a little bit more pit. So they gave a little bit more Pitocin and um, they started pushing again and the nurse had the little monitor on the, on her belly and she touched it and she moved it. And my client said, Oh, wow, that hurts. And I thought to myself, okay, this is weird. We've got a cervix. It's like not really dilating anymore. A uterus that doesn't seem to be contracting at its full strength anymore. Now we've got this pain. And I started thinking to myself and knowing the symptoms of uterine rupture said, Oh my gosh, Oh my gosh, this is like, this is happening. And I just thought about it. I thought about it. I talked to the dad about it and he's like, okay. And then, and I kind of mentioned it to the provider, like, okay, like, do you think this could be a thing, but they're like, no, no, baby's heart, rate's fine. And they're like, we think it's just a hotspot because she'd had an epidural for awhile. And so they had anesthesia come in, they did, um, more anesthesia and they were like, okay, that's fine. We're gonna keep going. Well then it became a point where no one had to touch her. She was feeling it up really high. Like almost towards her breasts, like in her ribs, she was feeling this pain and she's like making, Oh my gosh, it hurts so bad. I'm like, you should not be feeling this. You should not be feeling this. And I was like, I don't think this is a hot spot. Like I really, this is what my guts telling me. And they were like, no. And so they had an anesthesia, we'll do it again. And they came in and the doctor's like, yeah, I'm okay with let her keep going. Um, you know that this is fine. Like it's okay. And it got to the point where it was just so bad. And they were like, okay, we're going to go get this baby out still. No baby's heart deceleration or anything. And they went in and she had a two centimeter rupture, and this was two hours after I had started like, thinking about it and mentioning it.

Julie: She knew before any of the providers knew. And, and even the people there in the room didn't believe it was a rupture until they tell them,

Megan: Oh, they confirmed it. They confirm it. Yeah. Yeah. And so that was a really interesting experience for me in a whole many list of factors because she is one of my best friends as well, but it was interesting to see that no one would believe that it was possibly even though like all the other symptoms. Oh, and, or can't remember, I don't remember if I said this, but the baby had gone up a little bit. So baby's at like a zero station and was that minus two? And I thought that was a strange, well, go backwards. Don't go backwards. Like, especially from a zero to a minus two. So that was one of my experiences. And as a doula, you know, I just had to continue to, I said some, some things, my suggestions and continue to trust and follow the medical staff. Um, and fortunately there wasn't anything, you know, substantial as far as like hysterectomy or anything like that. Nope. No crazy bleeding baby was fine. Never had an issue. But, um, that, that's my experience with ruptures. The only rupture I've ever seen, but, um, it was definitely an experience.

Nicole: My, yeah, my mouth is my mouth is open kind of hearing that story because it's not typical. Most of the time providers sent to air on the, or on the other side where anything goes wrong and they're like jump into a section. So, wow. That is not a typical, it really wasn't for sure. Yeah.

Megan: It wasn't. And as a doula, I'm like, Whoa, this is kind of impressive. I can't believe they're still letting her go. And like, I'm cheering her on. I want this for her. But at the same time, my gut saying, this is probably not the best plan anymore.

Nicole: Right, Right.

Julie: I wanted to just kind of speak to two, two things. First of all, um, Megan and I decided very, very early on that at the VBAC link, we are going to share every story with you. We are going to be real and we are never going to hide anything from you. Um, I feel like in some ways our society has this mentality, especially for people preparing to have unmedicated birth or a vaginal birth after cesarean or things like that, where they're like, oh, positive stories, only positive stories. Only. I only want to hear the positive stories because I'm preparing for my birth, which gosh, I'm going to like probably speak out and get a lot of people frustrated right now. But I think that that attitude is a little bit detrimental because sometimes VBAC is not all sunshine and butterflies and sometimes repeats cesareans are very, very healing for parents and things are not going to go to plan just like your wedding day, right? Like sometimes your wedding day is almost perfect, but like somebody brought their own color pens for your signature book. And sometimes everything's a complete disaster. The florist doesn't show up the catering is the wrong order and it got rained out, like think of it like that. Because if you're not, if you're not willing to listen to the more difficult stories you are doing yourself, a huge disservice, because if something goes not to your plan, then it is a bigger setup for you to be more traumatized and have a poor birth experience. In fact, there's studies out there that show that the things that have more power over how a parent feels about their birth experience is whether or not they felt heard, supported and included. So preparing, knowing all the different outcomes that your birth could take is probably one of the best things that you can do for yourself, which is why we share uterine rupture stories and repeat cesarean stories on our VBAC podcast. Because we want people to know, I have had a couple clients that were preparing to TOLAC and they ended in repeat cesareans and, and they were true emergencies. Like they're really crazy things going on. Uh, the thing is, is every one of those clients look back and say, Hey, you know, I'm really bummed. I didn't get my VBAC, but I felt so much more in control this time. And I am so glad that I made the choices that I did when I did, because I know that it was a true emergency and that we made the right choices. And that's another thing a doula can help you with is navigating through those unexpected things and give you those different options that are available to you if you just ask for them. So I think that I wanted to just share that because, um, we have a few people that will, occasionally someone will say, gosh, I had to stop listening to the podcast because everybody was just all doom and gloom and they're, and, and can we get the podcast where know where somebody doesn't share their cesarean story and just shares their VBAC story? And we talked about that a lot and, and we listen and we hear those people, but ultimately we decided we, we are not going to do that. We are going to be real and raw and true, and you are not going to be caught off guard. If you listen to our podcast, that's kind of our goal.

Nicole: I love that. I love that. And I do the same thing with how I approach birth as well. I think that is so, so, so important. So I really appreciate that you take that approach. And again, we're not like being negative Nancys or anything, but it's just, it's being realistic, just being realistic and highlighting. We still highlight like most of the time it's a positive experience. Most of the time things are great, but it's an unpredictable process and you need to be prepared for all the possibilities. Yeah, yeah, yeah.

Julie: Getting a dog like Megan said, which I did not do. I am not happy with my dog, but I can't get my dog away because my kids love them. And I wish I would've done more research on the dog. Don't mean don't be like me.

Nicole: Right. Right. Well, just to, um, as we're finishing up here, are there any big misconceptions that you see surrounding VBAC that you want folks to know about?

Megan: I'm giggling as you started as like, Oh, there's so many, uh, you know, um, I mean, there really are a lot of misconceptions. Things like big baby, for some reason, people believe that. Yeah. People believe that babies are huge. Um, and any baby over like eight pounds can't get out vaginally. Um, although there are big babies, Julie's had a client, I think her baby was like 11 pounds and a half. And this mom was five feet, two inches tall and gave birth unmedicated, yes, there, there are clients that deliver big babies and some of them come out vaginally and some of them are not and that's okay. But big babies, small pelvis, you know, I had, I had one mom call me yesterday and she was telling me that she has slightly elevated blood pressure. So because of that, her provider said that she, it would be seriously dangerous for her to deliver, um, vaginally. And she said, there's, it's not preeclampsia. It's not anything that she's had to put like medication on or anything. It's just been slightly elevated the last week. And so they were like, you can't make any sense. I know there's just a lot of things, even like, COVID-19, you know, like, Oh, you might have COVID-19 okay. We can't deliver your baby vaginally. I mean, there's tons of things, but, um, yeah. So big baby smell, pelvis diabetes, um, is something that obviously can make a big baby. And so a lot of people encourage cesareans because of that, the blood pressure thing, GBS, I had a client be told because she was GBS positive. She couldn't deliver vaginally. Um, she needed to have a repeat cesarean, I mean, it is, it's so crazy. It's so crazy. Once cesarean always cesarean. And that's probably the biggest misconception out there. I mean, when people, when people hear like, Oh, you can do that. Like, yes you can. And that's why we're here. I mean, there's, there's full out, lies out there. And so that bringing it back to, uh, why Julie and I are even here at the VBAC link in general is because we wanted that this education course and platform for everyone to know what's true and what's not. And what the evidence is showing. And even though you might not choose a vaginal birth, at least you knew what the true evidence was and you weren't lied to. And I'm not saying everyone lies. I'm not saying no, but their absolutely don't lie. No. Yeah.

Julie: People don't even know they're lying. Like they're just repeating information that they've heard time and time again. And I think, um, I feel like it's time, like for us to be wrapping up here, but I do want to see, um, we have a free download on our website called VBAC MythBusters, and we talk over the five, most common VBAC myths that people face. And then we have the evidence and studies and support to back up why those are myths. And so if you want to go to our website, it'll actually be a popup right now. If you stay on our website for 36 seconds, I don't know why it's 36, but it is that way. Um, then it'll just be a popup. You can enter your email address and get that right in your inbox. Um, and we also have a lot of information on our blog about all the different topics we've talked about today and more. And obviously we teach an online preparation course for both parents and doulas. We have an advanced feedback, doula certification. We have a directory of VBAC change doulas for parents. If they want to go and find a doula that has been specifically trained by us. And they're just packed full of information. There's six hours of videos, 110 page manual, and study guide all about VBAC, and we're just ready to just support you in any way that you feel like you need support.

Nicole: I love it. Love it, love it. Well, just to wrap up since, you know, we are at the end, how about you tell us just what's the most frustrating part of your work and what's the most rewarding part of your work?

Megan: Um, I think a lot of frustration and I'm just totally like no one hate me for this. The most frustrating part is when providers use vulnerability in the end of pregnancy, and this is providers in, out of the hospital, midwives, OB all around. Um, people are very vulnerable, the very end and they just want their baby. And this also goes with frustration with parents because one of the biggest things I feel like we are unable to do, um, these days are trust that our body is going to go into labor on its own and that it knows how to do it. And so a lot of the times we've got parents feeling like they have to induce themselves because they're getting pressure from the other side or it's vice versa. And we've got providers being very easy, killed. You know, we understand babies come between this time and this time. And then we've got people trying to speed up their labor, which those types of things remember are intervening on both ends. And one of the frustrated, most frustrating parts of my job is when I get text messages from people saying, how do I get this baby out? How do I get the baby out today? What can I do today? And it's like, let's just wait and give our bodies time and trust that our baby and our body will connect and let us know when the baby's time, you know, ready to come. Or they're like my provider said, I'm almost 40 weeks and I'm not dilated. So I have to have the baby by next week. Or I have to have a C-section like those types of things. Those are probably one of the most frustrating things for me as a duet that I see. And then one of the most rewarding is when I have a client tell me that no matter how their burns ended, either vaginal birth or a scenario that they felt empowered and a part of their birth.

Nicole: Nice. Nice, nice, nice, nice. And what would you say, Julie?

Julie: I would say, um, Megan spoke to my frustrations probably exactly as I would have said then. Um, so I'm not gonna say anymore than that because it just amen. You know? Um, but the most rewarding part of my job is kind of very similar to Megan's. But when I hear from the father of the baby, what an impact I made on their birth or what an impact, the choices that they made had on their birth, that really makes my heart swell. I had a daddy want to just recently who's like six foot four. And he wasn't really like very personable or, I mean, like he was great guy, really nice family, not really the touchy feely type. And I'm not a hugger unless like I'm in a doula role, obviously I'm touching and people like, but like generally outside of my doula role, I am just not a hugger, but right after his baby was born, he came up and this guy's like six, five, and I'm five, seven. And he just gave me a big hug and picked me up in the air and like crying and saying, thank you, thank you so much. And this was a VBAC parent and I'm just like sitting there, like looking up at him. You're welcome. Can you please put me down sir? Like you could say, could you put that? But like, but it's just Really, really powerful. And, and the reviews, we always love whether the VBAC Link or a personal doula business, like really knowing that we're having an impact, especially with the VBAC link where, where that's really, the only payment we get is people's feedback. And our reviews are just really keep us going, especially when it's, when it's hard.

Nicole: Yeah. Yeah. Well, I appreciate that. And I appreciate you guys spending some time with me this afternoon and dealing with all the technical glitches and, um, going over a bit. So I totally, totally appreciate it. And we will, um, you, you are obviously very passionate about your work and committed to helping women in a way that really serves them and their best interest. You don't have an agenda or anything like that. You're just really trying to genuinely help women from the heart and that comes through.

Megan: Well, thank you so much. We were so excited to talk to you today.

Nicole: Yes. And we will link to all of your things in the show notes, your podcast, your website, all of those downloadable resources that people have. If they're interested in VBAC, your Facebook, your Instagram, all of that. Good, great stuff.

Megan: Perfect. You can just find this really easy by searching anywhere for the VBAC link.

Nicole: Thanks. Thank you so much, Julie and Megan for being on the podcast. I so appreciate it. And you guys take care. Thanks. Bye. Bye. Isn't that a great discussion. We had some technical difficulties getting things recorded. This is the first time I've had two guests on the podcast and it also ran a little longer than intended.

Nicole: So I really appreciate their time now, you know, after every episode, when I have guests on, I do something called Nicole's notes, which are my top three or four takeaways from the episode. So here are Nicole's notes from my conversation with Julian, Megan, number one, I really liked the concept of saying that you have to find the right provider for you. Providers are not one size fit all. I love how Julie said that just because one provider is good for someone else doesn't mean that they're necessarily good for you. Not every provider is going to be perfect for every person. So take the time to get to know the individual provider and make sure that that person is a good fit for you. Number two, those VBAC calculators. I know I said it in the episode, but they are so inaccurate. They are especially inaccurate for black women. I actually think those calculators are useless. I'd never used them. So do not feed into those VBAC calculator numbers. Okay. And this goes to my next point is that you will not know whether or not you can have a successful VBAC until you try. I'm not saying that you have to try, but I don't want you to be discouraged because of what happened before, even if it was because the baby didn't fit before that, doesn't the next one can't fit. Babies come down into the pelvis differently with every pregnancy. One of the most memorable Vbacks that I participated in or delivered was a patient who had a C-section at 34 weeks because the baby just would not come out the provider at the time, try to deliver the baby with forceps babies still wouldn't come out. And she ended up having a C-section. So she came back this time, full term, 37, 38 weeks in labor, wanting to do a VBAC. And even I was like, Oh, this feels a little, I don't know if a 34 week baby, which is a lot smaller didn't fit then is the 37 or 38 week baby going to fit. And lo and behold, she had a beautiful, lovely VBAC. You just do not know until you try. And then the final thing I want to say about VBAC is do the best you can to prevent yourself from being in a situation where you have to think about VBAC, educate yourself to do something that's called prevent the first cesarean. And so if you have not had a VBAC and your listening, it's really important to prevent the first cesarean, because we know that having once a cesarean increases the risk of women, having more cesareans, not so much, because there's something wrong with the women, but because of our system and how we approach VBAC. So educate yourself to do everything you can to prevent that first cesarean. So ideally you're not in the situation where you're needing to consider VBAC.

Nicole: All right? So that is it for this episode of the podcast, be sure to subscribe to the podcast and Apple podcast or wherever you're listening to me right now, Spotify, Google play. And I would love it. If you leave an honest review in Apple podcast that really helps the show to grow. It helps other women find the show. I also do shout outs from those reviews. So do do that if you have a minute as so, so appreciate it. Now, another thing that's important when you're planning a VBAC is having a birth plan and although my free online class on how to make a birth plan that works doesn't necessarily specifically focus on VBAC. It does contain tons of information that all mama's can benefit from. If you're planning to give birth in the hospital, you can check out that free online class how to make a birth plan that works at NCRcoaching.com/register. It's an on demand class offers several times a day. So do check that out.

Nicole: So next week on the podcast, I am talking about fetal growth restriction. I've had a few requests to talk about that. So do come on back next week and until then, and wish you a beautiful pregnancy and birth. Thanks so much for listening to this episode of the, all about pregnancy and birth podcast, head to my website and ncrcoaching.com to get even more great info, 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 on my free online class, on how to make a birth plan, as well as everything you need to know about the birth preparation course. Again, that's NCRcoaching.com and I will see you next week.