Episode 225 Heather's VBAC + Postpartum Depression + Patient Advocacy

“I knew I was having a daughter this time. I was like, ‘I’m going to approach this as the model that I want her to have. I want her to know that she is empowered to make whatever choices she needs to in life and I need to practice that now.’” Though Heather’s two birth outcomes were very different, the most inspiring part is what Heather fought for within herself. Heather went from knowing she had a voice and being afraid to use it to knowing her voice and making sure it was heard. In the depths of depression and anxiety, Heather continued to be proactive and choose healing. Through vulnerability, therapy, patient advocacy, medication, and staying attentive to her needs, Heather’s second postpartum experience was drastically better than the first. Additional Links Heather's Website How to VBAC: The Ultimate Prep Course for Parents Full Transcript under Episode Details Meagan: Welcome to The VBAC Link, guys. This is Meagan, your host, and today we have our friend Heather. She is from Kentucky and she is sharing her amazing story. One of the highlights of her story that we’re going to be talking about is postpartum depression which is something I’m really excited to talk more about because postpartum in general and Heather, maybe you would agree, I feel like it’s even more sometimes in preparing for a VBAC because we’re so hyper-focused on the birth and having this vaginal birth and avoiding a Cesarean and all of the interventions. I mean, really. We’re just so hyper-focused that we forget what comes after. Not just recovery after, but mentally and physically. All of the things, and so I’m really excited that you are going to touch on this today and I already want to thank you for your knowledge because I’m excited to hear what you have to say. Review of the Week Okay, I have a review of the week and then we’re going to go into it. Does that sound good? Heather: Great. Meagan: This is actually a review of The VBAC Link course. This is from Ashley and she says, “TOLAC/VBACs should be treated just like any other birthing person but there is a certain preparation and information that needs to be offered to them and this course covered that. The value is held in your careful recognition of how to best support our clients who are doing a TOLAC.” I’m assuming Ashley is reviewing the doula course in this one. She says, “I cannot praise you two enough for the fear release activity. Honestly, it is something I can apply to even myself before and after birth and even in life in general. Thank you for that. It has already helped three of my VBAC clients.” Even starting right there talking about processing and fear release before going into birth can ultimately help us in our postpartum stages. Heather: Absolutely, yeah. That’s a big part of, I think, what I was working through in my second pregnancy. Heather’s Stories Meagan: Okay, well then let’s turn the time over to you. Heather: Well thank you so much. I’m really humbled to be here today. I’ve heard so many amazing stories and I wasn’t sure that mine was really amazing enough, but I really just feel so strongly that talking about postpartum depression is important even now, even five years out of recovering still that I just really want to be there to help others who need that light. Meagan: Absolutely. Heather: All right, so I got pregnant with Theo in 2017. We made the decision in March and literally the weekend I had my birth control out, we looked at each other, and bam. We were pregnant. Meagan: Oh no way. Heather: So I was like, “Oh my gosh. This is amazing. Oh my gosh. I’m terrified.” I had no chance to really start processing this. I was still weaning down from my depression medication. I had been in treatment for depression a few years prior. I had been out of it but still on medication. I was feeling good. I was feel pretty stable. I thought going off of my medication was going to be great. So we find ourselves pregnant and oh man, that pregnancy was hard. I was sick. I was exhausted. I’m a performing musician and teacher of music, so I was getting through my days with little kids and getting to gigs and driving and throwing up in the car on the highway. Meagan: Oh, bless your heart. Heather: I’m still processing this whole, “Wow. Our lives are going to change.” I was really excited too, obviously. I was really happy to be starting this but we were really apprehensive heading into that. I was due Christmas Day that year, so starting in November, we started getting serious about birth prep. We did a very comprehensive birth course. I was seeing midwives for my care during that pregnancy and I thought they were just really great. They had the same view I did. I was really happy with the care I was receiving. It was very encouraging and just like, “Whatever it is that you want, we will get this for you.” The hospital I was going to deliver in had nitrous. It had one room with a tub. It had showers in every room. It had obviously the epidural and the IV meds. I felt good about the options, although something inside of me really wanted a more natural kind of experience. I think looking back, I really did want a home birth, but I was scared and it’s expensive, so this is the direction that we went in. Our birth prep, like I said, was very comprehensive and on top of that, I was reading books. I was making sure that I was informed in case of a Cesarean. I knew about the cascade of interventions and coping with contractions and stuff. We got to the end of that video class and oh my gosh. So they do this, “Congratulations. You’re going to have a baby.” I was just like, “Oh my god.” I was terrified. To be perfectly honest, my husband wasn’t much better. It was about another four weeks before I actually went into labor since that moment and it was an exciting time. I got through 39 weeks at work and then I stepped back because as an organist, I wasn’t going to be playing the day before my due date. My due date came and went and he didn’t come. I was very thankful for that because as an organist, I did not want to have a baby on Christmas Eve. Christmas Day would have been preferable frankly. Meagan: I was going say, did you guys have performances at all? So you took a step back but did you have Christmas stuff at all? Heather: I had backed off by the week before Christmas. Meagan: Oh that’s so nice. So you completely stopped. Heather: Yes. So 39 weeks on, I was on maternity leave. I had some Braxton Hicks, nothing really, not moving too much. I got to 40 weeks. My mom came. 40+1, we go for a walk. 40+2 I think is when I had my next appointment with my midwife who was one of the two midwives I had seen in the office and she was the one who actually was still doing hospital deliveries so we were like, “Okay, let’s get in to see her a few more times in case I possibly see her,” which I did. We decided to do a stretch and sweep. It kind of went. It was possible. I was pretty high and closed and stuff, but I think the sweep worked. I didn’t really experience much from that. My mom was like, “Well, I’m going to go see my sister in the other state,” so we had some space again which was really nice to have. Thursday that week, I go to my massage guys who are also acupuncturists and I was like, “Get this baby out of me.” They were wonderful people. They are not prenatal or anything. One of them is from India and he was like, “So your baby is a little bit over here and is not pushing on your cervix.” He just lightly touched my belly and it was so gentle. Then I had some acupuncture and they left me to chill. Then Friday comes the next day and that evening, I just had a sense. I was like, “Hmm.” I don’t know. I was just feeling this. So that night, I went to bed on the couch downstairs. My husband was upstairs. I woke up around 3:00 or 4:00 AM and I’m like, “Yeah. I’m having contractions.” I was like, “Okay, early labor. I’ve got to rest.” So I went and crawled into bed with my husband and that was just a no-go. It was too painful. I pretty quickly got out of there. Mostly, I would labor bending over, leaning over something. We did lots of different places. I was at home for a good 7-8 hours probably. I was feeling pretty good in early labor there. I just had some food, keeping it light. My husband was packing his bag because of course, he hadn’t packed ahead of time. I guess contractions probably started around 4ish. I took a bath. I know you’re not supposed to slow them down, but I was like, “I need to rest.” Meagan: This is the thing with taking a bath. I don’t want to say full-blown labor like you’re not in labor at all, but if it’s going to progress, it’s going to progress and water’s not going to stop it. If your body responds by slowing down and taking a break, that’s probably what it needed. Heather: Yeah. It still continued. He would put Netlifx shows on for me. He’d put stuff on for me. I’d be breathing through the contractions. After the bath, I guess shower, then bath. I don’t really know. I started having to moan through contractions and they started, “Okay. I’m doing my low breathing. I’m feeling good.” I was feeling like, “Okay. I’ve been prepared so far.” Around 11:30-noonish, things started changing and I started getting antsy and anxious. Contractions started coming much closer together. It was probably about three minutes apart. They’d been a minute long for hours at that point, so we knew that we were really in labor. I was definitely starting to get that worry, that anxiety going then. It was like, “We’re not at the hospital.” We weren’t far from the hospital, but I was like, “We need to get there.” I remember I was using the bathroom and laying down was a no-go. The toilet was absolutely excruciating. It was really intense when I hit a contraction. My dear, sweet husband comes and jokingly brings me something to put on that was lacey underwear or something like that. I was like, “You just do this. We need to go.” I was not having any of it at that point. So it was like, “Okay. We’re definitely ready to go.” We got in the car probably at about 12:30 and we head to the hospital. Man, the car ride contractions were not fun. I’m going, “Ohhh.” I start going, “We’re going to have a baby.” Meagan: All the emotions. Heather: All the emotions. I mean, it was funny but it was also like, I was starting to become a little unhinged there. I had gotten out of my safe, comfortable, “I’m in a space. I’m in a zone.” Looking back on it, I realize now that I was starting to experience back labor. That was still a whole extra level of, “Oh my god. I’m not prepared. This is really intense.” We got there. I insisted on walking the whole way. Meagan: Probably good for you though. Heather: That’s what I was thinking. I was like, “I don’t want to have interventions. I want to get there as late as possible so I’m going to walk.” Every 30 feet, we were stopping to moan through things. We go to where we think triage check-in is and it’s moved because they were doing work. So we were standing there and my husband’s calling the midwives to come from across the hall. It was ridiculous, but the midwife was like, “Let’s get you a chair.” I didn’t really want it, but they could tell that I was in labor. I get to triage and they check me and I was 5 centimeters. I was so excited. I was a first-time mom. I’m halfway there. This is awesome. I’m freaking out though. So I’m freaking out and I’m there and okay. It’s time to admit me. I knew my preferences. I knew in my heart what I wanted and I didn’t ask for that. Meagan: You can’t say it probably right? Heather: Yeah. I thought, “I want a water birth. I want to ask for the tub room, but what if I don’t end up doing a water birth and I’m occupying it and I’m taking it from somebody else?” All these I would say people pleaser things came in. I was like, “You know, I want to get in the shower. I want to labor back in the shower,” but I was starting to shake. I was getting scared. I was getting more and more scared and just feeling out of control. So I was just like, “I’m progressed enough. I want an epidural,” even though I knew I didn’t really want an epidural. I was having this back labor. I had been laboring for a long time. I was 40+5 and I was tired. You’re not sleeping well by that point. The midwife was great. She was supporting me. She was applying back pressure and a lot of tailbone pressure, especially with the back labor and it was really helpful, but I eventually got the epidural. The first one didn’t take. They did another one immediately and that one only half worked. They put me on my left side because I could feel my contractions all the way down my left thigh. It was really, really intense. The medicine worked that way. I guess we got some sleep. A few hours later, they come to move me to my right side. A few hours later, they move me so I’m sitting with my legs and knees out. That was all they moved me. I couldn’t really move. Over the course of having to move, the epidural definitely started wearing off on my left side again. Then shift change happens around 8:00 PM and the midwife that I had been seeing comes on. I was so happy. I was so happy to have her because she was wonderful. She comes in and the room is dark. She checks me and I’m complete. Well, I’m almost complete. She’s like, “there’s a bulging bag of water. We could break them and start pushing or hold off on pushing. What do you want to do?” That voice inside again says, “I want to labor down. I want to have some time to really feel the urge to push,” but baby was having some heart irregularities, so I was like, “Well, then let’s go ahead and break my waters. We’ll start pushing.” Even though in my mind, that really wasn’t what I wanted. Meagan: Your intuition it seemed like so far has been saying one thing, but then your voice said something else. Your mind talks you into something else. Heather: Absolutely. I think that’s really the motif throughout that whole labor. My intuition was in one way and what I was agreeing to and saying I was okay with was another. My midwife was very great. She wasn’t pushy, but having a baby who has nonreassuring heart tones, not dangerous yet was like, “Okay. I’ve got to consider this as well.” So on one hand, I wasn’t thrilled to be accepting breaking my waters, but I wanted to know that he was in a good position. I didn’t know it was a he, but I wanted to know that baby was in a good position, but the labor nurses were like, “Oh yeah. Baby’s ready. Baby’s ready.” Meagan: And you don’t really know about back pain at this point. You kind of maybe do because it’s half working, but you’re not feeling it the way you were feeling it so you couldn’t even really identify where he was at. Heather: Yeah, exactly. I’m a first-time mom. Meagan: You don’t know what you don’t know. Heather: No, you don’t. We start pushing and they were pretty good about letting me push on my sides and on my back. They would turn me to my left side and I would push. They would turn me to my right side. I would push. I did a lot of pushing on my back which was probably where the more effective pushing was happening. At this point, my temperature has been climbing so that was one of the reasons why my midwife wanted to break my waters was because my temperature had climbed a bit. She said, “Sometimes with an epidural, that can happen but if it keeps going and it becomes a fever then we know that it’s not the epidural and it’s an infection.” I’m thinking, “Okay, then we’ve got to get this baby out.” I’m pushing and an hour goes by. My husband is watching me get sicker and sicker. My temperature finally breaks into a fever around 9:30-9:45 PM. By this point, I definitely have a fever. Baby’s heart is not tolerating it well and I’ve not made much progress in pushing. So my midwife starts consulting with the obstetrician who is overseeing her who comes in and she says, “We need to get this baby out. Our options are C-section and vacuum.” I’m like, “Well, I definitely don’t want a C-section.” So she goes off to get ready for the vacuum. Now, she doesn’t feel that she can do the vacuum because I guess she had an injury or something so she goes and gets the other obstetrician that night to go and do the vacuum. So they’re back ten minutes later. I’m still pushing. I’m still feeling it. My epidural has worn off even more by this point so I’m really feeling the contractions and feeling them build. I’m working with them. I’m feeling like that was a good experience. I appreciated having that knowledge especially when into my second birth. I didn’t really know much about a vacuum. I figured, “Oh, it might be assisting in pushing. I’d push a bit.” They’d assist the baby out over a period of time is what I was expecting. After a couple of pushes with the vacuum, the obstetrician who had come on, not the one who was doing the vacuum but the other one, says, “I’d like to do an episiotomy. Is that okay?” I said, “No. I do not want an episiotomy.” We push again. The next contraction after that, she’s like, “Okay. I need to do an episiotomy. You’re going to tear anyway.” I talked to my husband and I was like, “Okay, fine.” Meagan: Oh, love. I love you and you’re not alone where you’re like, “Fine. I just want this baby out.” Heather: Yeah. I didn’t really understand that that was coercion at the time. Meagan: Yeah, because you are vulnerable. Heather: So vulnerable. I was sick. I had a fever. Meagan: I was going to say that you didn’t feel well probably. Heather: No, my husband was seeing me get sicker and sicker like I said. By this point, it’s probably about 10:00 PM. I’ve been pushing for over two hours. I have a fever. I just consented to something that I really didn’t want going into it. The next contraction comes and I’m feeling all of this movement down there. I’m thinking, “Oh my god. He’s out.” They’re like, “Vacuum just popped off for the third time and we can’t do it anymore.” I’m like, “What?!” Meagan: At this point, they had done the episiotomy. Heather: Yeah. They hadn’t told me that it had popped off at all. I didn’t know where we were in that process. Meagan: There was no communication. Heather: There was not that communication. It was just, “You’re going to tear anyway.” A certainty. “You’re going to have this baby vaginally and you’re going to tear so you need an episiotomy.” Meagan: So you made the decision with the understanding that this baby was then going to come. Heather: By that point, we really had no choices. I was pretty sick. I could feel the contractions. I wanted baby out. Meagan: Yeah. You just want it to be over. Heather: My midwife was there the whole time. She helped coordinate getting my husband to the OR. They turned up my medicine. They wheeled me down. She brings him in after they’ve determined that I’m numb enough which I almost wasn’t. This is the OB who cut me and that’s who she is. When I talk in conversation about my birth, that’s where my mind goes and that’s really what was like, “Wow. That was obstetric violence. She cut me.” I just can’t process it any other way. She almost put me under because they had to numb me and she thought it was an emergency. In my mind, I’m hearing her say to the anesthesiologist, “If the next time, she’s not numbed, we’re going to have to put her under.” My mind is going, “No. Don’t let me. Tell them no. Tell them you do not consent to go under.” Fortunately, they didn’t put me under, but the medicine was high. My husband was there next to me and my midwife was there as a support person. They performed the C-section and my midwife was like, “Do you hear that baby crying? That’s your baby.” That was beautiful. It really was. We didn’t know the sex, so she brought my husband over to the warmer where he was and he came back. He whispered in my ears, “You have a son,” which was a really beautiful moment too. They bring Theo over and I get to kiss him a little bit. I can’t really hold him. I want to ask if I can hold him, but I don’t. But I also just needed to sleep at that point. He was born at 10:38 PM and I had been going since 4:00 AM so I was exhausted. They take him away. Apparently, he was having some breathing issues so I sent my husband with him. They went to the nursery together. I want to back up and say though that while we were having this C-section discussion, the one thing I asked for was delayed cord clamping. That was the one thing and the OB said no. In my mind, I’m thinking, “Can I ask for a clear drape? You want a clear drape. Ask for this.” I knew the things that I could ask for. I didn’t though. I had already just said no to an episiotomy. I just had one anyway. I had just been told no to delayed cord clamping. I think I was just almost out of fight. Meagan: Well, yeah. Like I was saying earlier, it’s to the point where sometimes in labor, we want to use our voice but we can’t. We’re using it in our heads, but we can’t get it out. It’s just this weird thing. I could probably see you too just being like, “I give up. Everything I did want, I’m being told no, or the opposite has happened to me.” Heather: Yeah. That was something I really had to process through. Where was that voice? Where was I? Where were we working together and where were we not working together my voice and me? But he goes to the nursery and because I had developed an infection, they wanted to get him an IV and antibiotics as well. He was there for a long time. I was alone in recovery. At that point, I was like, “I just want to sleep.” At one point, my midwife and the obstetrician came in to have a talk afterward. What I remember from that talk was basically like, “You have a small pelvis. You have an incision where you could have a VBAC, but I think your pelvis is too small.” I was just like, “That sounds ridiculous.” Meagan: Yeah. You’re like, “I know better. I know better.” Heather: I knew better. I knew better. I knew that was ridiculous. Even in recovery, I felt like I timed out because of the fever more than anything and I timed out also because I didn’t have a lot of movement going on. There was no continual positioning during labor. I had been born via C-section. I was OP. That had been in the back of my mind in preparation. I was like, “I’m going to help this baby get into good positions.” I knew the positions to help me. I knew these things and I still ended up with a C-section. The hospital stay, unfortunately, was not better. I finally met him and got to hold him at about 3:00 or 5:00 AM. I’m not sure. It was a really long separation and that was a really hard separation to come to terms with. When he finally came into the room with my husband, we tried breastfeeding and it didn’t really work. He didn’t latch and then we just went to sleep. The lactation consultants came around the next morning. They were fantastic. We started getting a latch. We diagnosed him with tongue and lip ties. We got those revised and then breastfeeding was off to a much better continuation. The next day, so I went into labor and had him on a Saturday. Sunday was New Year’s Eve so we got to look out over the city and see the fireworks. Monday, I had this rash all over my body. We were like, “What is this?” It was particularly around my incision and my belly, but it seemed to be everywhere. We were like, “What is this?” It didn’t seem like PUPPPS. It wasn’t just in stretch marks. It was like, “Maybe it’s the antibiotics.” Meagan: The sutures? Heather: “Maybe it’s something you’re wearing. Maybe it’s the sutures. We don’t know.” I had part of my thyroid removed a year prior and I actually had an allergic reaction to the surgical prep. I was like, “Maybe it was the surgical prep.” It wasn’t. We don’t know what it was but they gave me Benadryl. I was like, “Great.” It made me tired. My baby was constantly trying to breastfeed. I was also on medicine for the infection and pain which was just horrendous. That pain was worse than back labor for me. That was almost the most traumatic was trying to walk the day after. It got better quickly for me. I was very fortunate, but it was really scary getting out of bed the first few times. Like really scary, I was in so much pain. So yeah. The Benadryl didn’t really help. The next day, I asked for more because I was still itching and the nurse was like, “It can make your milk dry up.” I was like, “What? I’m not doing that.” We got home eventually and it was just really hard. He very much wanted to be held all of the time. We weren’t sleeping. I felt like breastfeeding wasn’t going super well. We got to my two-week appointment and I saw my midwife who had been there in the birth and I mean, she was wonderfully empathetic. She was just like, “How are you?” I was like, “I am not well. This is not going well. This has been really hard. He’s not gained weight.” She asked me what did we want to do about it? I was really lucky in that the practice and the hospital in general had a licensed clinical social worker attached to it, so I could go to the same place and see this therapist. She was a specialist in postpartum and prenatal counseling and just maternal and child psychology. At two weeks, I was like, “Okay. I want to talk to her.” I went to that probably a week later and I just cried for an hour. I just cried. I talked about the C-section and the episiotomy and about how I was pumping at that point but he wasn’t gaining weight and how this was hard. She just listened the whole time. I was like, “Wow. I just cried for an hour.” She was like, “Is that a good thing or a bad thing?” I was like, “I think it is a good thing. I needed this.” Meagan: Sometimes you need those releases. Heather: Yeah, the release was really important. I was seeing a lactation consultant. I was triple feeding so I was feeding, pumping, and supplementing. We get to, I guess, his one-month appointment and he’s passed birth weight. He’s doing well. I went back to the lactation consultant who was like, “Keep triple feeding.” I was like, “I can’t do this,” so I just started to listen to my intuition on that. By that point, yeah. He was gaining weight well. A few weeks later, I go for my six-week appointment and I still was not myself. At that point, I decided to go back on medication. We found something that was breastfeeding-compatible and I felt comfortable doing that. I knew that I needed to take care of myself and that antidepressants were definitely going to be the next step. I would say after I got on antidepressants, I stabilized for a while. There were a good few months there where I was continuing with therapy. We were dealing with a lot of, “Okay. I still have a newborn. I’m still exhausted. I’m adjusting to motherhood,” but just other things in life were coming up. Like I said, I felt like my mood was pretty stable. At about six months postpartum, somebody in my close circle had a pretty decent vaginal birth and I was really happy for her, but oh my gosh. I just fell apart. I dove right back down into depression. I showed up at therapy the next week and I was just like, “I’m so happy for her,” and was just crying. Again, I don’t know where this is coming from. That’s when we started the next step in processing the trauma. Since my therapist was attached to the hospital system, and since she had the specializations that she did, we were able to go through all of my labor notes. For those appointments, I asked my husband to be there for me as well, so we went together. We went through those over the course of a few sessions. We really dug into some of that. I remember going through the notes around the fever and pushing and I was like, “Yeah. I really did need that C-section.” That definitely helped me take another step forward, but at that time also, my therapist was like, “Just so you know, there are other avenues for discussing this.” That’s when she told me about the patient advocate at the hospital. I didn’t know about patient advocates, but my therapist was like, “She’s really great. She’s not just there to prevent lawsuits or malpractice suits. She will be there. She’ll be emotionally there for you. You call her and she’ll set up a meeting with the doctors and head of obstetrics and neonatology if you want.” So that was something that I decided that I wanted to do. It took me a few weeks definitely because it’s still something very close to my heart. It was still very hard. It was just hard to make the call. I think just making space for ourselves when we find ourselves in a place where there’s another step forward, but it’s still hard. It’s just so important. Meagan: It’s hard to make those steps. Heather: It is. You can feel like you know it’s what you want to do and you can still give yourself the time until it’s really right. But I made the call and in September we had the meeting. It turns out that the doctor who had cut me was no longer at the hospital. Meagan: Oh uh-uh. Heather: It may have been because of her attitude. I can neither confirm nor deny, but I did meet with the head of obstetrics who was actually performing the vacuum and assisting in the C-section. That meeting, I went into it and I wanted to ask about the fever. I wanted to ask about the infection like, “How does this happen? Did I do anything? Should I not have taken a bath that morning?” The doctor was like, “These things happen and you can’t control them and all we can do is make the best choices that we can make.” And then I brought up with her the episiotomy and I said, “That was not okay. I should not have been pressured into that. This hospital needs to know and the doctors need to know that all around, this was not okay and this should not have happened.” She said that they have trainings and there’s one coming up and that she was going to use this scenario in the trainings. That was really powerful for me to hear that they were going to talk about it in whatever way they did. It was really important for me to speak out and say, “This was not okay. This happened. It should not have happened that way,” but then also to have the doctor hear me and agree with me really did help. The meeting was also interesting. She said, “We would be happy to do pre-pregnancy counseling. We could do a VBAC calculator.” I didn’t know about that and was like, “Okay.” I also said, “I think this hospital should have more access to clear drapes, and women in my position should be offered these things, not just expected after all of what we’ve been through to ask for these things. This seems like a basic thing that we can do to be more mother-baby centric.” Meagan: It’s minuscule to make such a big impact. It’s a minuscule thing that changes someone’s experience so much and I love that you brought that up. I love that. Heather: Yeah, so this was back in 2018. I brought that up. I was like, “This could have been and I think this would have helped.” Neonatology was not at that meeting. They were unable to be there, but the head of neonatology did give me a call a few weeks later and she was lovely to talk to. She said, “I was reviewing your notes.” The obstetrician in the patient advocate meeting had not reviewed my notes. I had really hoped that she would have. But neonatology and I went over the notes for Theo and it turns out that he was in more distress than I had believed at birth. I also think that I just was like, “My baby is going to be fine.” Babies have trouble breathing sometimes. That’s why we have an umbilical cord. That’s why I wanted delayed cord clamping for a little bit of a buffer. But the care that he received was important. She just reaffirmed that getting the mom and baby together is really important from the get-go for us. We do value that and you are right to bring that to our attention, but we will continue this value. I got a lot of closure from all of those meetings. I definitely understood all of the medical things that had gone on better. It didn’t solve my depression. I’m still in therapy to this day, but it really helped turn the page. Meagan: Yeah. Heather: So fast forward to about a year ago, December 2021. I had even written that in my notes. I can’t do the math. Meagan: The years are blowing by so fast. Heather: It’s going by so fast and my daughter is in a sleep regression. It’s just great. We were starting to finally feel like we had our feet underneath us. We moved states. We got settled in another place near my parents which has been great and we were like, “Okay. We want to grow our family.” So that December, we decided to start trying, and two weeks later– Meagan: Did you look at each other? Yep. Heather: Yeah. Yeah. Two weeks later. From my last menstrual period, I was three weeks pregnant and I was like, “How am I getting a pregnancy test positive already?” I was terrified. I was like, “What is up with us? We are never taking risks. This is just too freaky.” Yeah. We got pregnant right away. So right away, I’m like, “Oh. But I have all of this trauma that is resurfacing.” My son was born at the end of December which means that the really hard postpartum was right during my first trimester which was hard again. I was very sick. I was resting a lot but it was also a different feel because we were so much better as a team this time. We were so much more open about how we were feeling. We were more excited. We knew that we knew more this time. But it was still an adjustment getting used to being pregnant again. I definitely had some anxiety and I don’t usually have much anxiety. Going into my first provider appointment, I was so scared. I really was not looking forward to being in prenatal care again because of my experiences before. So because we got pregnant so fast, I didn’t know exactly where I wanted to go, but I knew I wanted midwives again because I just did not feel safe with obstetricians. I went with what ended up being a community clinic for anybody. Anybody can go and it’s price-capped, etc. It’s a rotating group of people who provide the care. It just so happened that the first time I went there, I met with one of the midwives so I thought, “Okay. I’ll be seeing midwives.” I didn’t really know how they assigned people. The midwives were good. From the first appointment, she asked me what I wanted to do for birth and I said that I wanted a VBAC. My second appointment a month later, I was like, “But I have really bad tailbone pain, so maybe I do want a repeat Cesarean.” A few months later, I was like, “Nope. I definitely want a VBAC.” I started preparing for it. I did some more courses online learning more about VBAC. That’s when I got introduced to the Facebook community, The VBAC Link Facebook Community which was really great. I started really digging into that towards the end of my second trimester. I will say, unlike my first pregnancy, my second trimester was lovely. I really had a good time. I was taking medication for nausea which never went away again, but because I had it managed, I was able to enjoy and move a lot more this time. I did a lot of pregnancy yoga and pilates. That was really lovely. It really helped me feel more in charge and in control of that aspect at least. Towards the end of my second trimester, I was like, “Jake, I really don’t want an epidural. I really think that is the whole reason why I had the fever in the first place. What I’m learning now is that epidurals can cause fevers.” What everybody told me back in 2017 was that no, no, no, no. Epidurals don’t cause fevers. They might elevate your temperature, but I really don’t believe that at this point. I really think it was because of the fever. I knew that my epidural had not been great. I didn’t want it. I had back labor. I was like, “We need more support.” We got a doula and she was amazing. I had her by the end of my second trimester going into my third trimester. At the beginning of my third trimester, I went to a prenatal appointment on the regular day that I had been going and this new provider walked in. She said, “So you’re going to have a repeat C-section?” I’m like, “No.” She’s like, “Okay, well I mean, I have one priority, really two priorities and that’s a healthy baby and healthy mom.” I’m like, “Okay, but I signed the trial of labor consent last time.” She’s like, “Okay, well as long as you signed it.” It was a horrible discussion. I kept trying to be like, “No. I don’t want to talk about that. I’ve done my research. I’m good.” Meagan: Well and just what she had said there was pretty much saying, “Well, this is my priority and that’s the way to get it.” It was that. Heather: It was horrible. She didn’t go over my charts. She didn’t go over my gestational diabetes screening which I didn’t have, fortunately. She didn’t go over my TSH levels. She didn’t go over anything. She had a hard time finding the baby’s heartbeat. I was just like, “Man. Who is this person?” So I went home totally shook. I was not okay. This is not a good provider. I am being bait-and-switched. I called every office in town. I called every office two hours away. Nobody could take me by that point. I was bawling and I was just talking to my doula and I was just like, “I feel like I should drive two hours and show up in labor.” We examined all of the options. Because I hadn’t found anybody by the time of my next appointment, I went to my next appointment and my blood pressure was through the roof. It was 150/90 something and I was always fine. This midwife comes in and she’s like, “I was looking at your notes. That other provider does not do births. She can’t see. She is not indicative of this practice, Heather.” Right off the bat, this midwife was like, “I can see from your blood pressure readings and from what happened last time that this was not okay.” I think I just started crying. I brought my husband that time because I was like, “I’m not going in alone.” So we went. We had a 45-minute to hour-long meeting with her. She was just amazing. She really got me back on track. She was like, “Okay. So here’s what we’re going to do. At 36 weeks, you’re going to start the evening primrose oil. You’re going to start doing this. You’re going to stretch that. We’re going to do stretch and sweeps if you want. If you don’t want them, that’s okay. If we have to induce, this is what I envision.” I’m like, “Oh my gosh. They’ll even induce.” You don’t know all of these things and her overall approach was like, “Okay. I’m feeling so much better about this.” So for the remainder of my pregnancy, I pretty much only went in on days when I knew that the other provider would not be there. I started seeing these other two midwives mostly whereas I had seen a third midwife on Wednesdays so I knew a few of the providers. I was like, “Okay.” As we were getting closer and closer, I’m checking back in with my doula and I’m like, “This hospital doesn’t have the things that I want. There are only two shower rooms. There are no tubs. There is no nitrous. It’s just two medication options, but I don’t feel like I can drive. I don’t want to be laboring in the car. I want to stay home as long as possible.” But I definitely was starting to feel more comfortable with that decision. Knowing that my husband and I had done the self-work since our first birth, knowing that we had all of this time to really talk through things, knowing that we had a doula, we just felt so much better prepared to advocate and face this. This time around, I did a hospital birth course which included a tour of labor and delivery. I was not prepared for how anxious I got in the labor room. I really was back in that place. Meagan: Triggered, yeah. It triggered you. Heather: I’m heading to the hospital. I’m having a baby. There are going to be interventions. It’s not what I want. But we got through it and I just had to take it by faith that I was going to be okay and I was going to be able to stand up for myself. Fast forwarding a little bit, we get to 34, 35, and 36 weeks and I’m just having tons of Braxton Hicks contractions. My job is keeping me on my feet a fair bit teaching little kids music, so I’m wiggling around and every time I’m moving, I’m feeling tightening. I’m like, “Wow. I’m getting ready. This is so amazing.” I was feeling very positive about that. By 35-36 weeks, every night from 10:00 PM on, it was like baby dance and squish hour. So I’m having those tightening Braxton Hicks. Sometimes they were timeable. They were pretty regular. They were not stopping, but I wouldn’t call them painful. I was on the link, “What is this? Okay. It’s probably prodromal labor.” So I was having that quite a bit. I started at 36 weeks. I started, “Okay. I’m going to do the evening primrose oil,” and boy did that make my uterus angry every time I would do it. I’m like, “I don’t know if the midwife really intended this. Maybe I shouldn’t do it.” I go to my 36-week appointment. I go to my 37-week appointment and I’m like, “Yeah. This is crazy.” I didn’t have any checks by that point. I did have a check, I guess, at 35 weeks when we did the GBS positive swab and I did come back positive. I was so upset. I was like, “Man, I really should have just declined that,” because I wasn’t going to change what I was going to do for labor anyway. I had one of the nice midwives check me at that point. She said, “You’re soft but you’re still pretty high and baby is right there. She moved when I poked her.” I thought that was pretty funny. I’m not sure if my son had ever gotten down that low, honestly. At 38 weeks, we go for a walk. I stopped working. I just had so many contractions. I had been bringing my husband to work with me because I work an hour away. I was like, “I’m not going to drive if I’m contracting. It could literally be any time.” But we had the appointment and the midwife was like, “So Tuesdays, Wednesdays, and Thursdays are the midwives that are really on board with your birth plan. They’re the ones that you really want to see.” I was like, “Awesome.” So Monday night, I’m 38+3 and I do my prenatal yoga, pilates, and birth ball bouncing. It’s probably 10ish, 10:00 PM. My husband is like, “Let’s get this baby out of you.” He’s bouncing me on the ball. We’re just being lighthearted and silly and just like, “Okay, whatever.” But that night, I woke up at 3:00 AM which was not unusual having contractions which were not unusual. I get up to pee which is very usual as we all know. At that point in pregnancy, I just could not sleep and my water broke. I went to the bathroom and then I’m still leaking and it was dark. I’m like, “What’s going on?” I sit back down on the toilet. I get some light and I’m like, “Oh my gosh. There’s vernix in it. This is really my water.” I was so excited. I wasn’t really feeling any contractions and I was like, “Of course,” because I’m GBS positive, my water breaks prematurely. Meagan: Your water breaks first. Heather: I was so mad but I was like, “I’m not going yet. This could still be a day or more,” but I started calling my doula and let my husband sleep a little bit longer. I go into the room finally probably at almost 4:00 and I’m like, “My water broke.” He was dead asleep but his face lit up and he was so excited. That’s one of those really sweet memories from labor for me was just seeing his face get so excited like, “We’re having a baby! We’re having a baby!” Another hour and a half goes by. I canceled all of the things that I had to do that day. My parents come to get my son and I had a very tearful goodbye because by this point, I was definitely in labor and I was emotional. I was like, “My baby.” So my parents show up for my son and I’m in the shower. I’m groaning, moaning through things and I’m definitely having back labor. My doula isn’t there yet, but we still have a lot of time. Contractions were fairly close by that point, probably 3-4 minutes apart for a solid minute, really, really strong ones. Meagan: Which is common with back labor and posterior babies where it’s really, really close. That’s really common. Heather: Yeah, I was like, “The shower is great, but you know what would be even better? A bath.” So I drew a bath and I’m emotional. My son is gone and I’m crying to my husband. He’s like, “You’re going to see him again.” But I’m like, “But he’s not going to be my only baby.” The doula shows up and she’s like, “Now, is your bath too warm?” I glared at her. I was like, “No. I was a good girl. I didn’t make it too warm.” All I wanted was to be in the sauna. But I get out. I was like, “Okay. It is time to go to the hospital. I’m facing that reality. I’m going to have to go to the hospital now.” So I used the bathroom and I’m on the toilet. Oh man, once again it was just so painful being on the toilet. I start feeling my body push. I’m like, “Okay. We need to go.” So we were packed up. I put on a robe and underwear and nothing else. Meagan: That’s great. Heather: We show up in August to the hospital in the south and I’m in my not regular robe, like a fuzzy robe. Meagan: Like fuzzy warm? Heather: Yeah, yeah. That’s what I wanted. I was beyond rational thought at that point. My husband parks right in front of the doors. It’s totally fine. We’re in a small enough town. It’s great. He gets the wheelchair and wheels me up. People are clearing the elevator for me and I’m like, “Uhhhhhhh.” We only had a ten-minute ride to the hospital, but I had at least five contractions so I was in full-blown transition at that point. I’m horse-lipping it. I’m doing whatever I can to not push. We get up to the room. We skip triage. We go right into the room and they’re pretty calm. My birth plan never made it over there, so they don’t know who I am really. I’m like, “That’s great. I’m happy with that because I’m a VBAC person and I don’t want the monitoring. I don’t want to be in your constrictions, rules, whatever.” It took them a long time actually to figure out I was a VBAC person. They’re kind of intermittently monitoring me but I’m moving around. I’m fully naked at this point. I had no modesty. I did not care. Oh, I had a TENS unit and I had a comb. Meagan: Combs are amazing. Heather: They really are. I’m leaning against the back of the hospital bed and I’m screaming through them. I got checked and I was like, “Can I have medicine?” They were like, “Uh, it’s too late for that. You’re at a 9.” I was like, “Oh my gosh.” I started labor maybe around 3:30 or so and I’m at the hospital by 8:30. Meagan: Wow. Heather: So I’m at a 9. I had my TENS unit turned way up. I’m screaming for things. As my husband, I want to say this. As my husband was wheeling me into the room, I was like, “I’m going to ask for an epidural. I want the epidural.” He was like, “No, you don’t. No, you don’t.” That moment was so important because at that exact moment, I forgave myself for that first epidural. I don’t think I could have in any other situation. I really was like, “No. I did what I had to that first birth. I understand again why I did it. This is no joke.” Just that thankfulness and that gratitude for that started. One of the nice midwives was on call so she comes in and she checks me. Even though I’m a 9, my cervix is moving out of the way, so she was like, “You have the green light to push.” So I’m pushing and I probably got ten minutes into pushing and I was like, “This isn’t working. I want a C-section. I want to be awake for my baby’s birth. I don’t want her to get stuck.” The midwife was like, “This was your choice. We have not been doing this for long enough. Okay. We are not there yet.” Everybody like my doula is in the back saying, “No, Heather. You’re doing great. You’re fine.” My husband is like, “No. We’re not doing that.” I was like, “Okay. Okay, no. I know how to push. I remember this. I can do this.” So I was pushing. I started off pushing holding the back of the hospital bed. I pushed on my hands and knees. I wasn’t feeling like it was super effective at that point. I really wanted to try the squat bar. They didn’t really know where it was. They had to figure out where it was. I guess they don’t use it a lot, but I was like, “No. We’re doing this.” I pushed squatting for a while. That was pretty good, but we were like, “Okay. Let’s find a position where I can rest in between contractions too.” I tried on my left side for a while and then I turned to my right side for a while. One of the pushes on my right side, I felt a shift and I was like, “Oh. Now we’re in business.” I could tell. She had moved farther along. I actually ended up pushing on my back for a little while. That felt good too. It felt really effective. While I was on my back, I asked for a mirror which was something in my first birth, my voice had said, “Yeah. Go for the mirror,” but my fear had gone, “I don’t want to see. I don’t want to see that.” But this time, they didn’t have a mirror so my husband whips out his cell phone and I was like, “Don’t you dare.” He’s like, “No, no. It’s just so you can see. I wouldn’t do that Heather.” I was like, “Okay.” Meagan: That’s actually a really great idea. Heather: Yeah, honestly. I got to see that. I got to really be so much more present. By the time I was pushing, yes contractions were really intense, but I was so thankful to just be able to do something about them. I had experienced this in the first labor too. With the epidural wearing off, pushing felt good. Ring of fire did not. I could feel that. That was super intense, but I had really gotten back into the zone at this point. I guess I had tested out my provider and she was like, “No. You’re doing it. You’re doing great.” They really could never get the monitors to continuously monitor me. They tried one of the wireless ones and baby girl and I were just moving too much. I was thinking, “That’s fine. We’re moving. That’s what we need to do.” So I would push and then the labor nurse who apparently was a little snarky about me not being on continuous monitoring would slide the monitor down and at one point, the midwife was like, “That’s your baby’s heartbeat. Your baby’s doing good.” A few times, they reminded me to take really slow breaths in between so we kept that oxygen going. After a while, probably about 45 minutes or maybe longer of pushing, I got back up on the squat bar and it really got serious by this point. I remember the midwife was like, “Okay. There is about this much, about two inches between you and the bed, so once this head is delivered, we’re going to carefully roll you to your back and then we’ll deliver the rest of the baby.” I was like, “Oh my gosh. I’m having this birth.” So the next contraction comes and it builds. I push and I feel her just slip out entirely. Meagan: Whoa. Heather: She fell out of me at that point. In one motion, I had my eyes closed and I had been on the bar. She’s out of me and I roll back onto the back of the bed. All of a sudden, I have this very slimy, meconium-covered baby on my chest. She wasn’t covered, but she had all of this fluid come out. Meagan: Warm and sticky. Heather: Yes, very sticky. I was just like, “Oh my god. I did it.” It was an amazing feeling. I didn’t have this huge rush of love. It was a little bit like when I had held my son for the first time like, “Oh my gosh. There is this beautiful stranger in my arms,” but that was kind of nice. I was like, “Okay. I’m used to that. That doesn’t mean anything. I did it.” They did all of the APGAR scores and everything watching her on my chest. The nursery nurse was like, “If you see her starting to peck around, you can nurse her.” We had a successful first latch. My doula was taking pictures so we have some beautiful pictures of my husband and me just looking at this baby and looking at each other and grinning. I mean, I would say the biggest feeling I had after Juniper’s birth was just gratitude. I really felt so cared for in the hospital this time. I knew the midwife and she was really, really supportive. Having my doula and my husband there was great. My husband was a rockstar this time. I would say we were both kind of deer in headlights the first birth. This time, he was giving me sips of water. He was encouraging me to put on chapstick. He was holding my hand. He was just an amazing partner through this and I mean, I know my doula did a lot but I feel like she was also just kind of there. I know at one point when they were like, “There’s no birth plan. What does she want?” my doula was on it because at that point, all I would have been able to say it, “I want the things,” which would have been, “I want skin-to-skin. I want delayed cord clamping.” My husband cut the umbilical cord while she was on my chest. We got to see the placenta. We got alone time just to have that golden hour. I was very sore but it was nothing compared to the back labor. I just felt really like, “Okay. I can handle this recovery this time.” Important to note, I did have a mental health plan in place for postpartum. I still saw my providers two weeks later and it was the really warm and fuzzy midwife. She was like, “How are you feeling?” I was like, “Honestly, I’m great.” I had a little bit of baby blues a few days after where I was comically crying because my babies were growing up when one is four days old, but it was honestly a night and day difference between the baby blues and postpartum depression. Baby blues, I felt great most of the time. I had this abiding sense of gratitude and love for my husband, for my kids, thankfulness and so appreciative of the staff. My midwife had actually told the labor nurse to back off because she was freaking out that I wasn’t being monitored as a VBAC person but my midwife had said going into it, “I think number one, we’re going to get you a better birth this time and I think that’s going to help your mental health but number two, we’re here. We can up your dose.” I had therapy appointments already scheduled. My therapist was like, “If you need to see me twice a week, that’s fine. We’ll make this work.” Ultimately, I went into it having done a lot of preparation for postpartum and knowing that I had been through the fire the first time and I could do it if need be. Actually, it was a lot easier than I had expected. I think the other reason why this postpartum reason was easier was because I did do so much intensive work since my first child’s birth. I really dug into the trauma. It took a long time. There’s no timeline where you have to have it all figured out by and even during pregnancy, I was still figuring out bits and pieces of it and piecing it together and facing difficulties, but I had just told myself going into that birth, “I’m going to l listen to myself. I’m going to listen to that voice and if baby needs to be born via C-section, it’s going to be okay because I will have listened to myself this time.” That’s going to be the big difference. So I really tried to manage my expectations but also just to hold onto what I knew I could control and what I knew I could do. Meagan: I love that you say that. Hold onto what I could control. Hold onto what you can control We know in birth and in life, in everything in life, there are so many things that are truly out of our control, but for this birth, you held onto what you could control and then you were open-minded for the things that you couldn’t control. It didn’t go another route which is awesome, but if it did, you were much better prepared this time. Through this birth, I feel like we saw such a shift in you, Heather. We saw such a big shift in, “I’ve got this voice. I don’t feel I can use it. I’ve got this voice. I’m going to use it and I’m going to get my team. They’re going to know what my voice is before I get there even so if I don’t ever feel like I can use it because I’m in a space where I’m vulnerable, my team knows and they’re advocating for me.” Heather: Yeah. That was such an important part for me. I knew I was having a daughter this time. I was like, “I’m going to approach this as the model that I want her to have. I want her to know that she is empowered to make whatever choices she needs to in life and I need to practice that now.” I also want my kids to know sometimes life is uncontrollable and that we can trust things but we can also just accept that some things are going to be hard. We don’t know what the outcome is going to be. I really had this saying in the back of my head, “Don’t push the river. The river of labor is going to come. It’s going to take me where it takes me.” From the water breaking to her being out, it was maybe 7 hours. She was born at 9:58 AM so an hour and a half after I got to the hospital. So much did go how I wanted. So much was a lot harder than I expected, but I had prepared myself in so many ways. I knew I was strong. I knew I had been preparing my body, my mind, and my emotions. I really had just been so vulnerable with my husband and myself. I knew I could tap into that vulnerability as strength which is honestly one reason why I am here today is that I really hope that we can all find that. It’s hard. Meagan: It is hard. It’s really hard. We’ve talked about this in other episodes. It’s hard to even recognize or accept that you need to do that. It’s hard to even get to that point. There are so many times when we just brush it away so I love it. I love that you go through all of that work for for yourself. Look at what that did. Look at the impact. Like you said, it’s okay. You’re still going through things. You’re still working through things and you are probably going to for a while and that is okay, but you’re helping you and you’re taking charge for you. Heather: Mhmm, yep. I feel so good about the example that’s for my kids. Meagan: Exactly. Exactly, yes. Thank you so much for coming into this space and being so vulnerable and sharing these beautiful stories. I know as a mom myself going through two undesired Cesareans and both in different ways, I understand that space of wanting to be that strength but not feeling like you can and then through work and processing and education, being able to be there and say, “Okay. I’ve got this for myself. I’ve got this for myself.” Listeners, you can do that too. If you are like Heather and I and have been in a moment, and it doesn’t even just apply in birth, it may apply in all things in life where we feel vulnerable and we feel stuck, you can do it. You can trudge through the mud. Sometimes it’s really feeling like you’re trudging with ankle weights on. It’s thick and it’s heavy, but you can do it. You are strong. Something I also wanted to mention is patient advocacy. I don’t know if that’s ever been spoken about on the podcast. I don’t know if many people even know it exists. I believe from my knowledge that it exists in every hospital because there unfortunately are things that happen in hospitals where patients need to go in. But if you are like Heather and you’ve had this experience, don’t shy away. Heather, do you have any tips on how to maybe approach a provider in that way of, “Hey, I’ve got this going on.” How could someone start that conversation or who in the hospital can they contact to find the patient advocacy program? Heather: Yeah, so I knew about it because my social worker was also a therapist. I would say that finding social workers is going to be the first step because they are the ones trained to know the systems. I know that there are always going to be some kind of social worker attached to the hospital system. When I had that awful doctor appointment with that obstetrician, I actually did approach the social worker. She’s not a therapist but she was like, “Here’s the name of the person who you should talk to.” I actually have that card but I haven’t contacted them yet because I’m giving myself space and grace but I will. I will at some point and say, “This happened and it was not okay.” I would say if you are afraid to talk to your provider about it, just ask your provider who the social worker is and how to get in contact with them. I don’t think hospitals usually advertise that super well at all. Meagan: They don’t. Heather: But telling your provider if your provider is the one that you are reporting, telling them that you want to talk to the social worker is a neutral way to go about it. If you’re like me and had a wonderful midwife but had an issue with another person, you could probably talk directly to your provider about like, “I need to talk to a patient advocate. What happened was not okay and I want somebody to listen to me.” Meagan: Yeah. This is the thing. I think you touched on it earlier. It’s not always to just be like, “I want to sue this person.” It’s not about that, but I will tell you right now, it’s going to make change. It’s going to make change. You are advocating for another birthing person who is walking in and maybe is in a vulnerable space and doesn’t feel that they can speak for themselves or maybe after some more education from a provider’s standpoint or a nurse’s standpoint, they can step back and be like, “Okay. I’ve learned about this and I’m not going to take this approach because it’s affected someone else.” It’s okay. It’s okay to do that. You really are. You’re advocating for the future people. Heather. Yep. It really can help you heal too. Meagan: Absolutely. That’s one of the biggest takeaways from personally doing that. Like you said, it didn’t help everything. It didn’t cure all of your feelings, but it gave you some validation. It gives you power in your healing. So I love that you spoke about that and all about the postpartum. I’m so glad you had a much better and healing and beautiful experience the second time around. Heather: Yes, me too. I really felt so much better cared for this time. Meagan: Good. Good. Well, congratulations again. Heather: Thank you. Closing Would you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com . Congratulations on starting your journey of learning and discovery with The VBAC Link. Support this podcast at — https://redcircle.com/the-vbac-link/donations Advertising Inquiries: https://redcircle.com/brands