Episode 381 Colleen's VBAC + Gestational Diabetes, Shoulder Dystocia, and Bait & Switch

“I am not a TOLAC patient. I am a VBAC!” Julie sits down with Colleen, a mother from Long Island, New York, who shares her journey towards achieving a successful VBAC despite facing challenges such as gestational diabetes. Colleen recounts her traumatic first birth experience and the uphill battle she faced with her second pregnancy. She was bombarded with messages that her baby would suffer permanent nerve damage from shoulder dystocia, but her intuition told her otherwise. Though her baby’s weight was predicted to be off the charts, Colleen’s daughter was born weighing just 7 pounds, 15 ounces. This episode emphasizes the importance of understanding your options, having a supportive team, and trusting your instincts during birth. The VBAC Link Blog: The Facts About Shoulder Dystocia Evidence Based Birth® - The Evidence on Big Babies Evidence Based Birth® - The Evidence on Induction for Big Babies CODE VBAC20 @ COTERIE https://www.coterie.com/products/the-diaper?utm_source=VBACLINK&utm_medium=Podcast&utm_campaign=Diaper How to VBAC: The Ultimate Prep Course for Parents Full Transcript under Episode Details ​​Julie: All right. Good morning, Women of Strength. It is Julie Francom here with you today. I am super excited that we have with us Colleen here today. Colleen is going to share her story about her VBAC with gestational diabetes and the struggle that she had working towards her VBAC. Now I am really excited to introduce Colleen to you. She is from Long Island, New York. I do not have a Review of the Week. I forgot to pull that up, so we are going to just do a little fun fact about birth preparation instead of a review because I forgot to look at the review. So sorry, Meagan. I think probably the best thing that you can do to prepare for any type of birth is to find out what all of your options are. I feel like that's like such a good tip for first-time moms or going in for a VBAC or even if you want to schedule a repeat C-section or even an initial C-section. I think that one of the biggest disservices we can do to ourselves is not knowing the options that are available to us and not standing up and speaking up for ourselves when the things that we want are not what is done, normally or typically in whatever setting we're choosing to birth at. I love the phrase "if you don't know your options, you don't have any". I think that that is true. And I think that there's never a circumstance where we can be too prepared going into any type of birth experience. So if you're listening, I know that you're already on top of that because you want to get educated and inspired about either VBAC or what your options are for birthing after a C-section. So stick in there. We have a VBAC prep course for parents and for doulas to learn more about VBAC as well. You can find that on our website, thevbaclink.com. All right, let's go ahead and get into it. I would love to introduce you to Colleen. She is a mom of two. She's a teacher living in Long Island, New York. Her first birth and postpartum experiences were incredibly traumatic. She says, "The moment that they wheeled me to the OR for my C-section, I knew I wanted a VBAC. After being diagnosed with gestational diabetes in my second trimester, I faced an uphill battle to achieving my VBAC." And finally, after delivering her daughter, it was the most healing experience she could have ever imagined. We're going to talk a little bit more about those struggles and gestational diabetes and maybe a bait-and-switch, it sounds like, from her new provider at the end of the episode. So hang in there. I'm excited to hear from Colleen. Colleen, are you there? Colleen: Hi. Julie: Hi. All right, you go ahead and get started, and I am super excited to hear your story. Colleen: All right. I guess I'll start with my C-section because that's, I guess, where every VBAC starts. So my pregnancy with my son was textbook perfect. Everything that you want to go right did go right, so I naively expected my birth to follow that same pattern. Hindsight is 20/20. I know I shouldn't have, especially since I've been listening to different birth podcasts for a while, and I know that's really not how it goes, but I guess as a first-time mom, I didn't think about that stuff. So when I went into labor with him, I think I was 38 weeks and 5 days, just shy of 39 weeks. It was an incredibly long labor. I was in labor with him for 40 hours. We stayed home that first day, and then when things started to progress the next day, we headed to the hospital. When I got there, they checked me and did all of the administrative type of things, and I was already 4 centimeters dilated, so they kept me. The first thing that they asked was about an epidural. I knew that I had wanted one, but I didn't know when in my labor I had wanted one. I just heard from a bunch of different people that sometimes anesthesia can take a very long time to get there. So I requested it immediately, not anticipating them to show up five minutes later. I think my husband walked out of the room to fill out another piece of paperwork when he came back there. The whole anesthesia team was in there. I got it at about 4 centimeters dilated, and then just expected for things to go as birth is "supposed" to go. I ended up dilating very, very quickly. Within 10 minutes, I was 8 centimeters dilated. But with that, because it was such a rapid jump, my son's heart rate wasn't able to keep up with it. So there were a ton of people in the room in a matter of seconds. They ended up giving me shots in my thighs to slow my labor. I'm not sure what the medication was. They just did it, and then that was that. And then I stayed in the bed for about 10 hours. I'd asked my nurse to come in and help me move a little bit, and she told me no. She told me because I had an epidural, I could not move. But things were taking a very long time. So at one point, she came in. She's like, "I'll just give you a peanut ball." But at that point, I was still on my back. They had me laboring on my back. She told me to just shift my legs over, and she draped them over the peanut ball, and then left again. And then later on, I started feeling pressure. They came in and they were like, "Okay, yeah, we can do some practice pushes," or, no, let me backtrack. I'm sorry. It took a while, so they ended up pushing Pitocin before I started feeling the pressure, and then a little bit after that, that's when that happened. So they came in and they were like, "Okay, we can do some practice pushes." And I think they let me do two. During those pushes, my son's heart rate dropped dramatically. At that point, it was me, my husband, the hospital OB, not even my OB, just the staff one, and a nurse in the room. But when his heart rate dropped, I think there were 30 people in the room. So at that point, they flipped me over on all fours and just ran out of the room with me. They didn't tell me what was going on. They didn't tell my husband what was going on, so he was in the corner panicking. They were really shoving him back into the corner. I remember being so, so terrified of what was going on just because I didn't know what was happening. All I knew was they were rushing me to the OR. This was 2022. So it was the end of COVID. I remember crying so hard that my mask was just absolutely disgusting. When I got into the OR, there was still no information on what was happening, and they just pushed the full dose of the epidural or spinal, whatever it was, for the C-section. My OB was in the OR at that point. So the practice I was with was so large that even though I had met with a different OB every single appointment, I'd never met this one. She ended up being absolutely phenomenal, but it was very intimidating not meeting the person who was delivering my baby ahead of time. So they have me in the OR, and she says, "Okay, if you are okay with it, we can try to deliver him vaginally with a vacuum." I agreed to that because the last thing I wanted was a C-section. The idea of major surgeries really freaks me out. I definitely didn't want that if I could avoid it. With the vacuum, they let me push three times to try to get him out. Obviously, that did not work. So I ended up having a C-section. The first thing that my OB had said to me after I delivered was that I was a perfect candidate for a VBAC. She said the incision was low. Everything went beautifully. She told me that the C-section was not my fault, which I didn't realize how supportive that was in the moment because I was already beating myself up from it. So then we move into recovery and the mother/baby unit, and everything seemed to be going okay. And then the day that I was supposed to be discharged, I started having, like, I wouldn't even call it a headache because I get migraines so a headache to me is different than to other people, I guess. But I couldn't move. I couldn't walk. When I would stand up, I felt like I was going to fall over. So they added a couple of extra days to my stay, and I ended up having a spinal fluid leak, but the anesthesia team didn't want to say it was that. They were saying it was everything other than that. They said I pulled a muscle when I was pushing. You name it, and they said it was that. It was everything other than a spinal fluid leak. I ended up having some-- I don't even know what kind of procedure it was. It was like a COVID test on steroids. They put long swabs up my nose and essentially numbed my sinus cavity and sent me home because it helped a little bit. And then five days postpartum, I had to go back to my OB because my liver numbers were elevated. She took one look at me and she said, "You have a spinal fluid leak, and you need to go back for a blood patch." Five days postpartum, I was away from my son for literally the entire day. The hospital did not offer me a pump or anything like that. It was just very scary and traumatic, and it set the tone for my whole postpartum experience. Looking back on it now, I describe it as like being in a black hole in comparison to where I am now. So after that whole experience, my husband and I knew that we wanted more kids, but we also knew we needed to change some things because I didn't want to end up with another C-section, and he was very on board with whatever my birth wishes were because he wanted me to have a very different experience than I did the first time around. So then when I was pregnant with my daughter, at the beginning, they were fine, but also the pregnancy was very, very different. While my son was textbook perfect, this one felt like what could go wrong was going wrong. I know there could have been worse things, but in the moment, it felt very big. I ended up having a subchorionic hematoma. The early bleeding was very, very scary, and my OB still wouldn't see me even though I'd been bleeding for a while. Everything ended up being fine with that. I stayed with the same practice at that point. I was going through everything. Later on in my pregnancy, I obviously did the glucose test and ended up with gestational diabetes. That was in the back of my mind. But then as I was going forward with it, there was very little support or information about gestational diabetes. I got a phone call on a Friday that said, "You have this, and here's a number for you to call, and good luck". The first meeting I had with a diabetes educator, I was under the assumption would be a one-on-one meeting. I didn't realize until 10 minutes before the meeting that it was a group meeting. In bold, capitalized, underlined lettering, it said, "You cannot talk about anything personal because of HIPAA." I had so many questions that I knew were specific to me, and I couldn't ask them. We were sitting in this meeting, and the educator is just going through a PowerPoint of doom and gloom situations of what could happen if gestational diabetes isn't controlled. Then she emailed us all a PDF with like a specific carb goal for the day or whatever it was, and then gave us all prescriptions for the glucose monitors and all of that stuff, but no direction or anything, and was kind of just like, "Okay, well let's make a follow-up appointment for individuals with you guys." And then that was that. I still had no idea what was going on. I picked up the prescription and was just like panicked the whole time. I didn't know what I could eat, what was safe and what wasn't. And then on top of all of that, I felt like I did something wrong and there was just a lot of guilt and heavy feelings surrounding it. When I started to try to research things for gestational diabetes, there was very, very little that I could find. It just felt almost like gestational diabetes wasn't something that we can talk about. It's just something that happens and you’ve got to deal with it. So eventually I figured out what worked for me and I realized that it was very, very different from that blanket carb gold sheet that they had given us. Their goals were like 60 grams of carbs or something like that for certain meals, and my body just couldn't handle that. My goal was to try to avoid medication if I could because I knew that could impact my chances of having a VBAC because of different providers' thoughts about it. So after I got diagnosed with gestational diabetes and started navigating all of that, I was still talking with my provider about a VBAC and how that was the goal, that was the plan, and I didn't want anything else. I started finding that some OBs okay with it while others weren't. They wouldn't say that they weren't okay with it. I would go back and look over my notes, and there would be a line that said we talked about a C-section. I'm like, no, we didn't. What are you saying? A C-section never came up. I don't know what you're saying. I got a call out of nowhere one day to schedule a C-section. I'm like, "I have no idea what's going on here, and that's not what I want. That's not what I want to do, so I'm not doing it." At my next appointment, the doctor I had met with was saying like, "Oh, since you had a C-section before, we just schedule one just in case. It's what we do with all previous C-section patients." So at that point, I was like, okay, whatever, I'll schedule it with them, but I'm also going to start the process of switching because I wasn't liking how it was very inconsistent. I thought I wanted a smaller practice. I ended up switching to one that my sister-in-law used. At first, everything was fine. I met with two of the three doctors who could potentially be delivering my baby. One of them was very supportive right off the bat. "Yeah, I'm looking at all of your notes, you seem like a great candidate as long as gestational diabetes stays under control, then there's no problem. You can have a VBAC." And then the other provider had a completely different view on it. My first appointment with her, when we were going through everything, she was kind of just like, "Well, you have gestational diabetes, so you should really think about how important a VBAC is for you, and you might need to switch practices." That really caught me off guard. I had never left an OB appointment feeling that upset. I remember crying in my car for a half an hour before I could even pull out of the parking lot because I was just so overwhelmed and upset and had just so many different feelings that I couldn't put my finger on. At this point, I had hired a doula. I was talking to her before I left, and she was really helpful in calming me down. As my pregnancy went on, that was really the role that she ended up playing before I gave birth was really just keeping me and reminding me what I wanted because as things went on, there were the growth scans and all of the other good things that they do during pregnancy. The first growth skin I had, she was measuring big. And they're like, "Oh, she's in the 80th percentile. As long as she stays here, it's fine, but if she gets to be any part of her gets to be over 90%, then you have to have a C-section. You will have to deliver at 39 weeks and there is no shot of anything else." Julie: Oh my gosh, that's overwhelming. Colleen: Yeah, it was a lot thrown at me and this is where the uphill battle started because every scan that they did after that, she was measuring big. Toward the end, she was over the 90th percentile. And in the last month of my pregnancy, I had the weekly non-stress tests and scans, measuring my fluid and all of that stuff. But every single week was a conversation about the risks of a VBAC. They really, really, really were pushing a C-section, but they didn't talk about any risks of a repeat C-section which I find interesting now. But something else that I thought was unkind was the way that they were explaining their risks of a VBAC. They really were focusing on shoulder dystocia. So when my mom had me, I was a very big baby and I actually did have shoulder dystocia. I am physically handicapped from it. So them hammering on the risks of shoulder dystocia as if I didn't know and I was unaware of what could happen was really offensive. One of the providers actually at one point had said that my birth injury wasn't that bad. I was so caught off guard by that comment that I didn't even know what to say. Julie: Wow. Can I ask what it is? Do you mind sharing? You don't have to share. Colleen: No, that's fine. I have left herbs palsy. So it's like a nerve damage essentially. The way that they had to get me out of my mom without using forceps or anything like that, they just put too much pressure on one side and ruined the way that the nerve endings are connected. Julie: Oh. Colleen: Yeah. So when I was born, the doctor told my mom I wouldn't have any use of my left arm. My mom had me in physical therapy from the time I was 6 weeks old until I was 12 years old. Because of that extensive physical therapy, I do have a really decent range of motion in my left arm. It's one of those things where I think about it and I'm like, if I had lost the use of it at some point, I think I'd be more upset. It's annoying, but it's my normal. It's my everyday, and it really doesn't impact my everyday lifestyle, I guess. I'm able to take care of my baby. One of the comments that the provider made was actually along the lines of like, "Oh, well, yours is fine. You can actually do things. But what if your baby has shoulder dystocia and your baby can't use their arm at all?" They kept bringing up the risks of stillbirth with it, and it was just very scary. Especially because I personally know what can happen with shoulder dystocia. I guess going through it, I had like this deep, deep sense that that was not something that I was going to experience. I don't know what that feeling was, but I knew in my bones that it wasn't happening. But every week, they were talking about the risk of shoulder dystocia and really expanding on how serious it could be. And my last appointment before I gave birth-- so that appointment was on a Wednesday and I had my daughter on Friday. So that Wednesday appointment, my doctor is going through everything again with the risks of shoulder dystocia. They had made me schedule a just-in-case C-section for the day after my due date. They were really trying to get me to switch it to some time in 39 weeks. Every week they were like, "Oh, just give us a call if you change your mind." I was not changing my mind at any point. So the last appointment, right before I was going to leave the room, my doctor was like, "What was your last growth scan?" And then he looked it up, he's like, "Oh, it's been a month. Let's have another growth scan today." Julie: Oh no. Colleen: Two days before I gave birth. And think you back. I'm like, who does that? There's no room for anything in there so obviously, the baby's gonna look huge. I go in. They do the scan. My fluids are fine. But her belly was what was constantly measuring huge which is why they were so insistent that she was going to have shoulder dystocia. The way that this practice is run, they do the scans after you meet with the doctor. Typically, you don't even talk about the scan until the following week which I found very strange. They did this scan. I was like, "I'm not even going to talk about it with my doctor, so whatever, you do what you want." But he had forgotten to write me a doctor's note, and when I asked about it at the front, they had to call him forward. It was at the same time that the ultrasound tech was logging all of the measurements, so he was asking her about it. They ended up having me go back into the office. And in that moment, I knew it was not going to be a good meeting at all. They're going over it, and the ultrasound tech is talking about the way that the measurements work. They do the diameter of the belly and it'll spit out whatever week gestation that matches. She was essentially like, "This baby's belly is off the charts. I can't even get a gestational week because it's so big." Yeah. So I'm standing there like, this is not going to go how I want it to. So my doctor pulls me into a different exam room, and we're talking about what the ultrasound tech had said. And again, shoulder dystocia. Before that appointment, I had gone in and I was like, "I don't even know if I want a cervical check. I know that they really mean very, very little." So before I had the cervical check, I asked, "If I'm dilated at all, instead of jumping right to the C-section that we have scheduled, can I come in that day and can we try for a Foley induction?" And he was like, "Yeah, I'm okay with that." So then he sees the results of the growth scan and backtracked and was like, "No, I'm not comfortable with that. If you walk in in active labor on your due date, we are going to send you right to the OR." It was very devastating. I'd already talked with him about my previous birth and how I was very scared of another C-section. I was scared of an epidural. My plan was to do an unmedicated VBAC because I didn't want to even risk another spinal fluid leak. He brushed all of that off and was like, "Oh, well, it's a planned C-section, so it's going to be very different. The needle they use for a spinal is so much smaller than an epidural, so the risks of that are so much lower." He was not acknowledging anything that I was saying. He was just still pushing, "You need a C-section. You need a C-section. You need a C-section." A week or so before that, he had even told me if I had wanted to go to 41 weeks, that he was going to give me my files and tell me to find another provider because he did not want to be a part of malpractice. At that point, I think I was just so thrown off and confused by everything that I didn't see it as big of a red flag as it actually was. But also when he told me it was too late to switch, no other provider would have taken me at like 37-38 weeks, especially with the gestational diabetes. I went home after that appointment feeling absolutely devastated. It was the pattern of the last month, just completely devastated talking to my doula about it and her reinstalling that confidence in me. That night, I went to sleep and was starting to be like, "All right, I guess I have to start really thinking about, what if this is another C-section?" The following morning I woke up and I guess because the last thing that I had talked about regarding my birth was with my doula and her telling me, "You can do this. I've never seen somebody as confident. You can do this. Your body grew this baby. Your body can birth this baby. You can do this." I had that in my mind when I woke up. And I was, I guess, a little bit extreme in my thinking because I called a midwife group and was going to switch at over 39 weeks pregnant. I'm like, I'm gonna make this work. Some way or another, I'm doing it. I planned on not showing up for the C-section that I had scheduled the following week because when I woke up, I was just like, they cannot cut me open if I don't consent to it. If I walk in in labor, legally, they cannot deny me care. I'm having this baby the way that I want to, and everyone else can just get on board or they can get out. That was Thursday morning, and I had taken off of work for Thursday-Friday because I just couldn't do it. I couldn't teach and give my students the all that they deserved. I was coming home so exhausted. I took that Thursday as my last hurrah with my son. We ended up walking around. I took them to a local farm, and we had a really good day together. The whole day I was like, I'm walking all day, so maybe I'll go into labor. It did not happen. So then the next day, same kind of thing. I had originally intended to go out with my son, but I woke up and I had this overwhelming feeling of, I just can't leave today. I need to stay near my house. I had listened to an episode of The VBAC Link, and I think the woman whose podcast episode it was, it said that either her midwife or her doula told her to go for a two-hour walk. I'm like, you know what? I'm gonna go for a very long walk. They can't hurt anything. I ended up walking for an hour. While I was walking, I started having some contractions, but they weren't consistent. I really wasn't convinced it was anything because I'd been having such intense Braxton Hicks contractions for a month or so that it was just like, this can't be it. So we got home, and I was just going about the day with my son. Nothing was going on. I decided to pump a couple times, so I did that, and by the time his bedtime rolled around, I was having fairly consistent contractions, but I still was not convinced. I was like, this is prodromal labor. There's no way this is actual labor. I'm just gonna have to be mad about this for another day. I even texted my doula, "If this isn't actually it, I'm going to go build a hut somewhere and hide there until I give birth," because I was so tired of talking to my doctors and seeing them and being upset by everything they were saying. So the night's going on, and my contractions are picking up and getting closer together. I still was not convinced that I was in labor. I got to the point where I was like, "All right, well, if this is actually it, I should rest." So I tried to lay down, but I had one contraction, and I could not stay on my back for it. I had to get up and move. I decided to get in the shower, and I didn't think anything of it, but after I had a contraction or two in there, I asked my husband to just keep an eye on how far apart they were. At that point, I wasn't paying attention to the clock at all. I was in there, and my husband opened the bathroom door, and he's like, "Colleen, your contractions are three minutes apart." I'm like, "Oh, okay. Maybe we should call the doula." So we did that, and I'm still laboring. I listened to podcasts where women talk about being in labor land, and I didn't understand what that was until looking back on my birth experience because after I told my husband to call my doula, I have very little recollection of interacting with him or talking to her on the phone or anything because the contractions were just so intense. I got to my bedroom and was leaning over the side of my dresser. I didn't move for I don't even know how long it was, but I was there. I couldn't move. I was drinking a little bit of water, and then all of a sudden my water broke. I guess at that point, that's when I was like, oh, okay, I guess I am in labor, and this is happening. So my husband was on the phone with his brother asking him, "Hey, potentially, you might need to come over and watch our son." And while he's on the phone, my water broke. So he's like, "No, you need to come now." In that time, he had his brother on one phone, my doula on the other, and he's trying to corral me to the car, but I was paralyzed and could not move. I was there until all of a sudden I had this mental break almost where I was like, "I need to move right now. If I don't move, I'm having this baby in my bedroom. and that is not the plan." So I waddled myself to the car, and it was hands down the most dangerous car ride of my life. I didn't buckle my seatbelt. I was backward on the seat just trying to like get through everything. My doula had given me a comb, so I was squeezing that during every contraction. I lost my mom when I was pregnant, so I had a very deep connection with her at that point and was talking to my mom, like, "Don't let me give birth in the car, Mom. Do not let me do that." So we eventually get to the hospital, and I had no recollection of this car ride. I remember being at the last major intersection before the turn for the hospital, but other than that, no idea that we were even in the car really. We get to the hospital, and things were picking up so quickly that my husband didn't even find a parking lot. He just pulled into the drop-off area and stopped the car, turned it off, and we made our way into the hospital. My doula met us there, and we had an off-duty nurse end up bringing us a wheelchair, and one of the security guards at the front ended up literally running us back into labor and delivery. That was around 11:00. When I got into the delivery room, it was three or four people, but it felt like a lot of people were there, and they were all trying to get my information and all the forms that I would have filled out beforehand. So at one point, somebody had mentioned a C-section. I remember saying, "I'm not having a C-section." The OB who was on call had said something about me being a TOLAC patient. I yelled at her, "I am not a TOLAC patient. I am a VBAC." They got me onto the bed finally, and they're trying to get the monitors on me. When they finally did, the way that I was kneeling on the bed, the baby's heart rate wasn't liking it. Again, the OB was like, "Okay, maybe we need to think about a C-section." When she said that, I said, "I'm not consenting to a C-section if I'm not guaranteed skin-to-skin afterward." The nurses were kind of a little nervous with the way that I was responding there. My doula was like, "Okay, before we jump to that, let's turn her over and see if things change." So after that contraction, they moved me, and the baby's heart rate was fine. In that moment for me, I didn't really recognize what was happening. But afterward, my husband said that he was very nervous, and he was just yelling for the doula to help in that situation because he didn't know what to do. At that point, when they finally got me situated, I was ready to go at 10 centimeters, fully effaced. Baby was at a zero station, ready to go. And somebody was like, "Oh, do you want an epidural?" And me, my husband, and my doula were all like, "No, there's no epidural happening." So, they got me situated, and I think I pushed maybe five times before the baby was born. Julie: Wow. Colleen: Yeah, I came in hot. Julie: Yeah, you did. Colleen: I pushed. I felt the ring of fire. And the most incredible feeling was after that, feeling her body turn as it came out. It was the ring of fire, and then she flew out after that. There was absolutely no shoulder dystocia there. She was born at 11:38. We parked the car at 11, and she was born at 11:38. At my last scan, they were saying she was going to measure over 9.5 pounds. She was born, and she was 7 pounds, 15 ounces. My doula looked at me and she's like, "If you had had a C-section for a baby that wasn't even 8 pounds, I would have been so mad for you." I got my golden hour. I got skin-to-skin for that entire time. They did all of the baby's testing on me, and they were so respectful of that mother/baby bonding time that I really lost out on with my son. I didn't realize how much it impacted me until after I had my daughter, and I got what I had my heart set on. It was the most healing thing. I didn't realize I had things that needed to be healed in ways that they were. I felt so incredibly powerful, especially after everything was said and done. The nurse who stayed with us and then ended up bringing us to the mother/baby unit, I had asked her, "How often do you see unmedicated VBACs?" And she was like, "It's very, very rare because the providers are nervous about it. They want to have the epidural in place as a just-in-case." But I knew, for me, the fear of a repeat spinal fluid leak was bigger than the fear of any of the pain that would have happened. I know from listening to The VBAC Link that if it were a real emergency, having an epidural ahead of time wouldn't have done anything because it takes a while for the epidural to kick in. Even if I had gotten an epidural when I got to the hospital, it would not have helped me in any way. But she was completely healthy. There were no issues. She passed all of her blood sugar testing which I was really worried about. And then, my blood sugar was fine afterward also. Even still, it's very confusing trying to navigate this super strict diet that I had for so much of my pregnancy to now just being like, "All right, you're fine. It didn't even exist. Go back to eating however you wanted." I don't know. It's very, very confusing. Out of all of the things from my pregnancy, having no support from my providers on the VBAC side of things, and then having no guidance, I should say, with gestational diabetes, those were hands-down the most difficult things. But I did it and I'm still feeling very powerful for that. Julie: Yes, I love that. How old is your baby now? Colleen: She's four weeks. Julie: Oh, my gosh. You are fresh off your VBAC, girl. Colleen: Yeah. Julie: Ride that high as long as you can, man. I still feel really awesome. My first VBAC baby is 9.5 now. 9.5 years old. Okay, so this might sound really weird, but I wish that it wasn't something that we had to feel so victorious about. Does that make sense? I wish it was just way more common and just a normal thing, but it's not. Lots of people have to overcome lots of challenges in order to get the birth experience that they want, and that is sad. As empowering and incredible as it is when it happens, it's also kind of sad that, you know what? I don't know. Does that make sense? Colleen: It makes complete sense. I was going back and trying to research things on VBAC statistics and this, that, and the next thing and listening to other podcasts. Julie: You have to work so hard. It's sad that we have to work so hard. Colleen: A lot of it came down to providers being scared of the consequences that they would face if anything went wrong. I'm like, well, that's not fair because you're not even giving somebody a chance. Everything that I read was if the quote-unquote problem is on the baby's end, then mom has no reason to think that she can't have a VBAC, but so many providers don't see it the same way. Julie: Yeah. Yeah. I have 500 things that I want to talk about right now. First of all, I feel like this is the gospel according to Julie. This is not, I don't think, anything that I could find any evidence for or not. But I think sometimes when we, we as in the medical system. We have a parent who has gestational diabetes and change their diet drastically and so completely and eliminate carbs and sugars and all of these things. I feel like when that happens more often, I see babies with significantly smaller birth weights than if we were to make more subtle adjustments to their diets. Colleen: Yeah. I had a couple of gestational diabetes groups on Facebook. So many of the women who would post, after their baby was born, they had either very small babies because they changed their diet so drastically, or their babies were larger because of the insulin, so I agree with the gospel according to Julie. Julie: Yeah, thank you. So that's two of us. I'm pretty sure Meagan would agree as well. So three out of however many. Okay. Let's just leave that right there, first of all. Second of all, just saying that ultrasound measurements are grossly inaccurate. It's not uncommon for them to be. My sister-in-law, right now, is going to get induced on Monday as a first-time mom, completely ignorant to a lot of the birth process and everything and doesn't have a desire to-- she's completely the opposite of me. They're inducing her at 38 weeks because she has gestational diabetes, and they expect her baby's going to be big, and they don't want shoulder dystocia, etc. etc. etc. We know the whole thing, right? I was looking up evidence on shoulder dystocia, and it's really interesting because there are some studies that say first of all, Evidence Based Birth has a really great article on the evidence for induction for C-section or big baby. That will be linked in the show notes. Now it's really interesting because I was looking up rates for shoulder dystocia for big babies versus regular-sized babies. There are some studies that show that smaller babies have up to a 2% chance for shoulder dystocia, and larger babies have anywhere from a 7 to 15% chance of having difficulties with birthing their shoulders. There are other studies that show half of shoulder dystopias occur in babies that are smaller than 8 pounds, and 13 ounces. I feel like there's a little bit of disconnect out there in the research. However, like Colleen, permanent nerve damage occurs with shoulder dystocia in 1 out of every 555 babies, Permanent nerve damage will occur due to stuck shoulders in 1 out of every 555 babies who weigh between 8 pounds, 13 ounces, and 9 pounds, 15 ounces. I'm curious, Colleen, how big were you? Do you know what your birth weight was? Colleen: Yeah, I was 9 pounds 2 ounces. Julie: Okay, so you were barely a big baby. Colleen: Yeah, I was born three weeks early. Julie: Oh my goodness, girl. Yes. Okay, so yes, that was definitely large for gestational age too. But that's okay. Honestly, that means 1 out of every 555 babies will have permanent nerve damage from shoulder dystocia. When we get babies that are 10 pounds or bigger, it's actually 1 out of every 175 babies. I don't want to discount when that happens, but I mean, 554 out of 555 babies don't have that permanent nerve injury, too. I think it's really important that when we look at risks, that we have a really accurate representation of what those risks are in order to make an informed decision. So just like with uterine rupture, we don't want to discount when it happens because it does happen, and it's something that we need to look at. But what are the benefits compared to the risks? Why? What are the benefits of induction compared to the benefits of potentially avoiding a shoulder dystocia? The Evidence Based Birth article is really amazing. I don't want to go on and on for hours about this, although I definitely could, but most of the time, when shoulder dystocias happen, they're resolved without incident. I mean, it can be kind of hard and kind of frustrating and difficult to get the baby out and maybe a little traumatic, but yeah, most of the time everything works out well. Colleen, I'm glad that your birth injury is--I mean, I just feel so proud of your mom for putting into therapy and stuff like that earlier on because it could have had the potential to be a lot worse if she didn't do that. So kudos to your mom. I'm super excited for you. When you were talking-- not excited for you. That is the wrong word to say. I'm grateful that you had access to that care to help you. When you were telling me about your injury, it reminds me of my oldest who has cerebral palsy. It's really, really mild. Most people don't know. He has decreased motor function in his right arm and his right foot. He walks on his toe. He can't really use his right hand too well and his ambidexterity is a little awkward for him. But you said something that really stuck with me. That's just your normal. That's just what you know. I feel like that with my son too. While his disability is limiting in certain ways, he's also found lots of very healthy ways to adapt and manage and live a very full and happy life despite it. I might be putting words in your mouth, but it kind of sounded like you had said similar to that. Colleen: Oh, absolutely. It's just what I know. I don't know anything different. Julie: It's just let you know and yes. It's really fun. It's really not fun. Oh my gosh. Words are hard today. Please edit me out of all of these words. Gosh, my goodness. So not to discount any of that because it does happen, but we also want to make sure that we have accurate representation of the risks. Also, I want to touch on Colleen leaning into your intuition and following that and letting that guide you because I think that's really important as well. Sometimes our intuition is telling us things that don't make sense, and sometimes it's telling us things that makes absolute perfect sense and align right with our goals and our vision. I encourage everyone to lean into that intuition no matter what it's telling you because those mama instincts are real. They are very real. I feel like they deserve more credit than sometimes we give them. So, yeah. I don't know. Colleen, tell me. I know that you had a really awesome doula helping you. Besides hiring a doula and doing your best to find the best support team and advocating for yourself, what other advice would you give people who are preparing for a VBAC? Colleen: I think, like you said at the beginning of the podcast, looking at your options. I didn't know what my options were with my son, and then this time around, I had a better idea of what the options were. And then listening to positive VBAC stories. So, like, I remember maybe six weeks before I had my daughter, just trying to find anything. I searched VBAC on Apple podcasts, and this was the first thing that came up. I listened to two episodes a day until I ended up giving birth. Having all of that positive information was really helpful, and then having my husband so be on board with everything and my doula really talking me off those ledges of absolute devastation after my appointments to the next morning having that confidence again. So those are the things. Julie: I love that too. Yeah. Believe in yourself. Not everyone that tries to VBAC is going to have a VBAC. That's just the unfortunate reality of what it's like. But I think believing in yourself to not only have your best birth experience and having that belief in order to have a VBAC, but also having belief that if your birth doesn't end up in a VBAC that you can navigate those circumstances in order to still have a powerful and satisfying birth experience. Trust yourself. I think that's really, really important. Coleen: Yeah, I agree with that. Julie: Cool. All right, Colleen. Well, thank you so much for spending time here with me today. I loved hearing your stories. I love hearing the little baby noises in the background. Those always make my heart happy. And yeah, we will catch you on the flip side. 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 . 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