Rachel and Steven welcomed their fourth child on October 9 in a 2VBA2C! (Second VBAC after 2 c-sections!) Rachel’s road to meet each of her babies had unique challenges so she was prepared for every possible outcome, even a c-section. I admired her willingness to be flexible but hoped very much for her sake that she wouldn’t have to. Well, as any experienced mother would tell you, Rachel’s body was gearing up in those final weeks. Her uterus was full of baby and her house was bustling with 3 busy kids. There was no rest for the weary! But she managed those last weeks well, resting in the fleeting moments she could, and stayed grateful for another baby on the way.

At her 38-week appointment she was curious for a cervical check and learned she was dilated 2 cm. It was encouraging to know things were starting to change but Rachel also knew that it could still be weeks before meeting her baby. In the meantime, though, and for the remaining couple of weeks, she had bouts of contractions that caught her attention and her imagination. She breathed through them and even did some positional things to help ease them. The contractions became a regular feature of each day and night and Rachel greeted them with patience. I was proud of her ability to face them and roll with them. In fact, Rachel thought it was the real deal at one point, but the contractions ended up petering off. With so much activity, I hoped when the time came, she would have the advantage of at least some sleep.

Steven sent me a text three days later on October 8 just past 10:00 am telling me Rachel’s water had broken. She was having contractions and thought to err on the safe side of getting to the hospital so she could get settled. It was also a relief to have her children taken care of and no longer under foot. She was dilated 3 cm, 80% effaced, and baby was at -2 station. It was a good start to her labor. Once settled, she labored with the peanut ball on her side. Cold cloths helped on Rachel’s face and Steven applied light strokes to help her relax. Counter pressure on her lower back also helped. She was in significant pain at this point which had me wondering about her baby’s position.

Sure enough, it was conveyed to us that baby was tilted a bit to the right. With all of her prodromal labor we weren’t surprised her baby was a little off kilter in there. We got busy trying some Spinning Babies things to help him find a more direct position. Fighting nausea, Rachel was willing to do it all – the jiggle, even the forward leaning inversion, and finally the side-lying release (on each side). She threw up soon after and around 2:00 pm got an epidural. It didn’t work perfectly at first, however. Rachel struggled with a window of pain on her left. It resolved after some time and adjusting the medication and I recall hearing her breathe deeply in slumber just past 3:35 pm.

The sleep was fleeting though because the window was not 100% gone. The nurse did a check and Rachel was dilated 4-5 cm but stretchable to 6. We worked on shifting Rachel into positions that would improve the pain management as well as help coax her baby boy more midline. Rachel was game for all of the positions we tried, even though the window remained. She used the PCA button when she could, and a heating pad and strategically placed pillow gave some comfort.

Rachel’s contractions were steady at 3 minutes apart and we were hopeful for cervical change. The biggest struggle was the pain management though, as the window remained a challenge. She labored in a variety of positions with the peanut ball under one leg and then the other, laying on one side and then the other, and even using the stirrup to hold her top leg in the runner’s position. By 6:30 pm she felt the pressure lower and more central which got us all hopeful that her baby had moved.

At 7:00 pm she was dilated 8 cm! Her cervix was 90% effaced and her baby was lower at -1 station. These were good changes, and we continued our repertoire of positions to help him find his way out. At 7:19 pm Rachel felt more pressure and her baby seemed lower. By 8:30 pm we positioned her bed in the throne position to make use of gravity to help.

Steven continued his gentle support in light touches and loving words. He told Rachel how proud he was of her and that he loved her. You could see the love reflected back from Rachel and it was a beautiful framework for them to welcome their fourth child. And by 9:27 pm, Rachel’s baby was at +1 station! She still had a bit of cervix, but we were very excited to know that her baby was on his way out of the pelvis!

She returned to an upright position, and we shifted her knees together to make more space in the lower part of her pelvis and rubbed her shoulders with Stress Away essential oil blend to help her release tension there. She lay back on her left side and the window of pain had returned. She received a second bolus from the CRNA, and it seemed to help some. And by 10:45 pm her cervix was gone! Her baby was still lingering around 0 station though and needed to come back down. So, we encouraged Rachel to rest as she labored her baby down.

Thankfully, the latest bolus of medicine really helped to manage the pain from the lingering window and Rachel was relaxed and comfortable enough to sing with the worship music that was playing. She remarked on how wonderful her team was and how well they listened to her. It was important that she feel heard and supported and every single person was very attentive to her needs.

By 12:25 am on October 9, her baby was very low, so she was encouraged to give a push and see what happened. Well, Rachel was a good pusher because one try had her nurse assembling the team. Her midwife was in the room by 12:35 am. Rachel wanted some oxygen to help give her extra stamina through pushing and it kept her mind clear. And she pushed for about 20 minutes or so and welcomed her not so little baby boy at 12:52 am! He weighed in at 8 lb. 11 oz.

Landric Steven didn’t cry out loudly at first, so he got some support at the warmer with some CPAP to open his lungs. There was meconium in the amniotic fluid as well and it was an added precaution to set him up for a good transition. He was back in his mom’s arms a little while later.

When the room was less crowded and quiet again, Rachel and Steven took in their son and reflected on the road to meet him. Rachel is so very patient and mild, and I admired her quiet hope for a positive birth. Rachel held her baby lovingly and enjoyed her first meal of pizza and a cranberry juice and ginger ale mocktail! It was a beautiful celebration of life and love as we welcomed this new person into the world. And it was also a healing birth for Rachel in many ways and reassured her that she could indeed have a VBAC…twice!

Trigger warning: This birth involves a uterine rupture, however mom and baby are fine.

Gabby and Jeff welcomed their third child, Campbell Robert in a very surprising sort of birth on August 28, 2022. This birth journey would be much different than her others for various reasons, but most notably because Jeff would be deployed and not present. Gabby accepted this reality and made sure she had a team of support who could be there in his stead. She also had a strong desire for a VBA2C and chose providers whom she felt could help her get there. But her birth would be vastly different in some other ways that remained to be seen.

As her pregnancy neared the due date, Gabby’s doctors who had originally been very supportive of her VBA2C intentions, changed their stance. Since her baby was measuring large on ultrasound, they no longer recommended nor would support her decision to do a VBA2C. Gabby left that appointment feeling letdown and frustrated, and quite frankly, backed into a corner. But she also wanted to do what was best for her son and took her providers advice to move forward with the repeat c-section. She got the call that afternoon and the date for the c-section was set for August 2 at which point she would be 40w4d. She hoped to have some time to let the change in plans settle in her mind and heart as the date of the c-section drew near. She also found out that day that her husband would make it home two days later in plenty of time for the scheduled c-section. So that was a huge relief.

Contrary to her expectations, Gabby would not have as much time as she thought before meeting her son because the very same day of her appointment she felt contractions. They began that morning and were persistent, but mild and far apart. She didn’t think anything of them, chocking them up to late pregnancy discomforts. But that evening at home the contractions changed. They became more intense, growing longer and closer too. She texted me a shockingly close contraction pattern around 10:40 that night. I told her the pattern looked like it was time to head to the hospital, even though they had only been that close for an hour. It was confusing but within the hour Gabby decided she just needed to go to the hospital. If the c-section was the plan, then so be it. She didn’t feel she was coping well and knew she would feel safer once she got there and had options, whether it be an epidural and/or the c-section.

Gabby walked into the hospital with her aunt who had driven her. She refused a wheelchair and preferred to walk, her body already sweaty from the work of labor. When they placed the monitors around Gabby’s belly, it was immediately apparent that her baby’s heart rate was dangerously low. When the midwife went to do a cervical exam, she noticed a lot of bleeding. There was no bleeding at home, but had come on suddenly right then. The mood in the room instantly changed and people swirled around Gabby quickly mobilizing toward the OR. Her baby had to be born asap by emergency c-section for any chance at life, not to mention Gabby’s risk from the potential blood loss if she was rupturing. Campbell Robert was born at 12:38 am and his mom didn’t even know it yet. Gabby was put under general anesthesia because there was simply no time for any other way. Waiting for an epidural or spinal to be placed could have had a catastrophic effect on Campbell’s already tenuous outcome.

Gabby woke up afterward to learn that her uterus had ruptured, and her baby had been pushed by her uterus through the incision into her abdomen near her diaphragm. Campbell was alive, which was miraculous considering he had apgars of 0/4/4, but he would need to be on advanced support in the care of the staff of CHKD, the local children’s hospital, and his prognosis was guarded. As Gabby lay in bed coming to terms with all that had happened in so short a time, her baby was wheeled into the room for a beside visit before flying to CHKD. He wasn’t there long, maybe a couple of minutes before he was gone. Jeff was on his way home the next day as planned and would be there by Gabby’s side through the challenging weeks ahead. Campbell was also a very big baby weighing in at 10 lb. 1 oz. and measuring 22 in. long. Those details only added to the wonder of what happened and how he moved through the scar the way he did. Gabby was also stable, and thankfully her blood loss was kept at a very safe level.

Campbell would spend about 5 weeks in the NICU at CHKD getting stable, growing stronger, and most importantly, learning how to eat. Gabby was patient and persistent in her dedication to her family, her new baby, and the positive outlook for his health and recovery. I am happy to say at the time of this writing, Campbell is home enjoying time with his parents and adoring big brother, Walker, and big sister, Mayven.

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Gabby’s birth may be scary to some, for it illustrates that a uterine rupture can be a devastating risk factor. Remember that it is also a very rare one. (Gabby was the first client of mine to EVER have a uterine rupture after nearly 900 births over 20 years.) But her birth journey is a striking reminder of the importance of having hospitals, surgeons, fetal monitoring, in addition to options like VBAC, representing the balance struck every single day in obstetrics between options but also having life-saving alternatives when the situation warrants it, and mom and baby’s safety depends on it. Thanks to Gabby’s intuition and the rapid response by the providers at Mary Immaculate Hospital that night, she and Campbell have a bright future ahead. And she is grateful for their support and honesty of her providers along the way, even if it might have been a difficult thing to hear at that last appointment.