The Journey to My HBAC (home birth after cesarean)

I had a c-section at 38 weeks with my son, and a home birth vbac at 40 weeks 1 day with my daughter. Having a home birth with my second wasn't originally my plan, but after battling through many fears and doubts, it has become one of the best decisions of my life. In order to understand the full context of my thoughts and feelings regarding my HBAC, let me first start with sharing my c-section birth story.

My C-Section Birth Story

My oldest, Miles, was born via section at 38 weeks. My prenatal care was with a "typical" OBGYN office. I had a fairly normal pregnancy, but at some point during my second trimester I started having elevated blood pressure. I was essentially told we will just monitor, and if it ever reaches 140/90 to call. And if it reaches 160/110 to go to the E.R. I had one bout of 140/90 where I called. They had rest, wait and hour, and retake. It went down, so they said just keep monitoring. And then a few weeks lately I hit the dreaded 160/110 and they had me immediately go to the ER. This was actually the same day I dropped off my 24 hour urine sample. I was then admitted and induced.

They started me on cytotec that night, and then the next day inserted a foley balloon and pitocin. I had a doula that we were in contact with, but she kept telling us to let her know when I was 8 cm and she would head that way (red flag, much?).

After recieving the epidural

This was 2021, so just at the end cusp of COVID. During my pregnancy there were hardly any in-person birthing classes. We did a new virtual natural birthing classes, but I don't feel like we got much out of them...hence a huge reason we coughed up $1,500 for a doula. Once those Pitocin contractions hit I did not feel well equipped or supported. With my doula not being there, I ended up opting for the epidural. This gave me so much relief, but now I was bed ridden. My nurse helped me move into some slide positions with the peanut ball, but that was the extent of my movement.

As the day went on I was dilating well, but Miles wasn't dropping. My doula told me when she got there that she could help me with positions that would help baby drop - but again, we were suppose to let her know when I was 8cm. I remember the midwife who worked for my OB at the time (who actually ended up delivering Evelyn, and is AMAZING) saying, "well that's going to be too late" (I mean we were all thinking it...*face-palm).

I did end up reaching 8cm, and my doula headed over. At this point my midwife's shift had ended and the head OB of the practice, who I actually never saw throughout my entire prenatal care, came on shift. She immediately began pressing for a c-section because of baby not dropping. At this point I am so confused, exhausted, and discouraged. My doula gets there and basically agrees, so I agreed. In hindsight one of the biggest red flags should have been when my OB said, "we either need to do it now (it was around 5:30pm), or we will have to wait until after 9:00 because I have some other procedures scheduled." I agreed to do it then, but knowing what I know now, it obviously wasn't an emergency if there was the possibility to wait almost 4 hours...

When they rolled me out of the room my husband was a complete mess, however I actually felt a very strong sense of peace and even excitement. I was about to meet my baby! After almost 24 hours of labor, I actually felt a huge burst of energy. They got me prepped and ready. Once they started, all of that went away. I immediately felt so uncomfortable and out of control. At one point I began throwing up...while laying down...not fun. My husband joined at one point and I remember just squeezing his hand like my life depended on it. I could focus on nothing else, but just trying to get through all that was happening.

Now, I don't say this to try and instill any fear. Everyone's experience is going to be different. I have friends who had a c-section similar to my situation and said it was great.

It breaks my heart to say this next part, but it's the truth and I'm not here to sugar coat things...when they got Miles out and lifted him over the curtain for me to see all I could think was, "get him away from me I cannot and do not want to focus on anything else than surviving this surgery." They took him away to measure him, and my husband went with him. And again, all I was thinking was "please dear god do not come and put him on me!!!" At this point, I think Liam may have been doing skin to skin, but I still felt like I was on deaths bed as they were sewing me back up so he came back to be with me and I guess one of the nurses kept Miles. This makes me so sad thinking back on this now, but I have truly healed and learned so much from it.

Once they finished up, I believe they gave me Miles as they wheeled me back to our room. I know for sure once we got to our room and got him and my doula helped him latch before leaving. But honestly, it was all such a blur. I don't feel like I really came to until the next day...which makes sense sine I had just undergone major abdominal surgery and had every medication known to mankind in my system.

My C-Section Recovery and Postpartum Complications

The next day, I honestly felt great. Besides the normal pain after having major abdominal surgery, I was ready and wanting to move around. I will say, although I would consider the c-section itself pretty traumatizing, the recovery was pretty easy. In fact, I actually felt that my c-section recovery was much easier physically than my home birth (more on that later). We were able to be discharged a day early, and I was so ready to get home!

However, that next evening my blood pressure spiked again and I had my friend take me to the ER. Miles stayed home with Liam. I assumed they would just give me some meds and send me on my way, and I didn't want Miles exposed to all the nasties of an emergency room. Well, little did I know, I ended up staying the night there without my baby and on a magnesium drip again confined to the bed. I was emotionally distraught. My husband was able to bring Miles the next day, which helped lift my spirits A TON. We ended up staying in the hospital for about a week.

I finally became stable enough that they were able to discharge me with blood pressure medications. I had a follow up appointment a few days later with my OB, and my blood pressure was still higher than she would have liked. Thank goodness, before sending me back to the hospital she let me try a second dose of blood pressure medications. That seemed to do the trick, and I was able to wean off meds completely within a few weeks.

My Post-C-Section Breast-Feeding Journey

Pre-birth, I was adamant that I would exclusive breast-feed. However, given all the stress I was under, all the medications I was on, and some incredibly bad breast-feeding advice from a nurse at the hospital, Miles was considered "failure to thrive." At his once month appointment I believe he had only gained 0.5 oz.

I met with an in-home IBCLC, who honestly overwhelmed me even more and made me feel incredibly guilty as a mom. When she left the game-plan was to continue breast-feeding while using the SNS stem. This system brought me so much stress. It was during one of the middle of the night feedings that I had a complete mental breakdown, and had my husband give a bottle of breast-milk while I got some sleep.

From then on, I continued nursing while offering supplemental bottles of breast-milk that I had stashed. Once that ran out, we began supplementing with formula. This was not my ideal, but when you become a parent sometimes you learn it's okay when things don't always go the way you wanted. In fact, in this particularly unique situation, I like to say that formula saved my breast-feeding journey. While I would have loved to exclusively breast-fed, I was still able to breast-feed until almost 2 years when Miles weaned himself.

The Aftermath of My Birth Trauma

As the months went on, I definitely felt better and better emotionally and physically. However, there was still the looming trauma of my birth in the background. I knew I wanted to have more kids, but I was terrified of pre-eclampsia and going through that experience again.

I gave into very unhealthy habits of staying up way too late in the dark depths of the inter-webs "researching" pre-eclampsia is subsequent pregnancies. I joined multiple Facebook groups, read hundreds of forums, articles, and more. Some would give me hope, and others terrified me. I finally reached the point where I realized I probably needed some professional help.

I scheduled with a counselor, who was truly amazing. She helped me work through a lot of my trauma, and break out of the unhealthy tendencies I had formed. While I got to a point where my trauma wasn't taking over my life, I still had some fears and anxieties about a second pregnancy.

I remember having a phone call with my cousin where she said something along the lines of, "If you're waiting to feel 100% ready and free of fear, I'm not sure if it will ever happen. I think you need to make the decision from a stand-point of if you want a second or not." She worded things much more eloquently than that, but I remember coming to terms with the fact I may never feel 100% free of fear and anxiety. My son was approaching the age where we knew it was a good time to start trying for another, given the ideal age range we'd like. It was either I face my fears now and start trying, or I face my fears later. So I decided to face them head on, and two months later I was pregnant with Evelyn.

Choosing Prenatal Care for My Second Pregnancy

Two things I knew for certain: I didn't want another c-section, and I wanted midwifery care. However, at this point I still planned on delivering in the hospital. I can be an overly-anxious person, especially when it comes to medical issues. What I thought I liked about the hospital setting was that they are equipped for any possible scenario.

There is an amazing, VBAC supportive midwife group in my area that delivers at one of the most VBAC friendly hospitals. This was the route I was planning on going, and had even scheduled my first prenatal appointment with them. In the meantime, the home-birth midwife, Teri Mitchell, who delivered my cousin's baby (who I had been following on Instagram for a while), announced she would be offering a hospital path soon. The midwife at my OB's office with Miles, Amber Castleberry, had also since joined her practice. I loved Amber during my care with Miles, and I remember telling my husband, "if Amber says we need to do xyz I will trust her 100%." However, she wasn't on call when my c-section happened. Which is out of my control, and hers.

Both of these things seemed like a sign to me, so I went ahead and booked a consult with Teri.

Let me tell you. I have never felt more seen, heard, encouraged, and cared for. I remember tearing up during my consult with her, and I am NOT a crier. One of the things I appreciated the most was that she had things right then and there for me to start doing to help fight against pre-eclampsia. There was no "we'll just wait and see and figure out if and when it happens." It was immediate proactive care. She even assured me that if my blood pressure were to start spiking at any point during my pregnancy there were multiple "midwife tricks" we could try at the first sign before waiting until the point where an induction becomes necessary.

I immediately booked my care with her, and canceled my other prenatal appointments. I also immediately booked my doula, Shelly Brittain, who was recommended by Teri and supported my cousin. And let me tell you, best decision ever.

My Second Pregnancy Midwifery Prenatal Care

Throughout my prenatal care I rotated appointments between Teri and Amber. Both were, and are, absolute angels and would spend forever with me during my appointments just talking through my questions and fears. The care I received was thorough, intentional, and personal - much different than my first experience.

At this point they were in the process of becoming affiliated with the local hospital (actually, the one I delivered Miles at). Some of the higher-ups recognized the type of care they provide is wanted by many hospital-birthing mothers. They even had an OB willing to sponsor them. However, there were some issues with some of the other providers and higher-ups at the hospital, which continued to push out their "start" date. They assured me worse come to worse, we could always walk-in to a hospital while in labor and they could support me. They wouldn't be able to deliver, but they could support me in all other areas. I honestly, wasn't too concerned about this. In fact, knowing that in that case I could choose any hospital to walk-in to gave me some encouragement, as there's a particular hospital known for VBACS that would be my ideal (they are very used to walk-ins).

Deciding on a Home Birth

At my 28 week appointment, I was talking with Teri about my usual fears. She very kindly told me that she has been thinking about me a lot, and every time I pop into her mind she has the feeling that I am not meant to deliver in the hospital. She went on to say that she isn't just saying that, because she's especially passionate about home-births. In fact, she said she has met and cared for many women who a home-birth would not be the best decision for them.

She told me I was interesting to her because usually women who have a traumatic hospital birth come to her, because they don't want to be in the hospital again. Yet, here I am wanting to go right back (literally even to the same hospital) where I had traumatic experience.

We talked through how I find comfort (although now I realize it was false comfort) in the fact that "all the options" are available at the hospital. As I was saying this I realized that I had all the options available to me with Miles, and pretty much all the options performed on me, and it was one of the worst experiences. So, are having "all the options" always the best thing? This was eye-opening to me.

Teri encouraged me to take some time to think and pray about if a home-birth is something that I might consider. I went home and talked with my husband, talked with my doula, and talked with many other women who had home-births with Teri. I remember, around 10pm that same evening as well, Amber messaged me on FB with such an encouraging note. I felt so loved and cared for.

I began walking around our house imagining what it would be like to labor in certain areas, and just felt such a strong sense of peace and excitement. I definitely had fears in the background of "what if's" like uterine ruptures, but the peace and excitement was definitely stronger,

I officially made the decision to move forward with a home-birth.

Which, was totally God's timing as just a few weeks later Teri and Amber found out they would not be given the rights to deliver out of the hospital like they were hoping. At this point I had already made my decision, so that was one less thing I had to worry about!

How I Battled Fears Leading Up to My Home Birth

Like I mentioned, while the peace and excitement was definitely stronger, I still had lingering fears of the "what if's." Some of the biggest ones I had were...

• What if I can't handle the pain, and regret not having the option of the epidural?

  • To this, my midwife simple said "then we get in the car, go to the hospital, and get the epidural. You always have options, and you will always have choice." This made me chuckle. Like, duh! It's so hard to remember you have complete choice and autonomy over your body after having a traumatic medical experience.

• What if I have a uterine rupture?

  • This was a big one. My midwife, along with a podcast episode I listened to, encouraged me in the fact that when you are having a home-birth in the comfort of your own home and with no interventions you are much more in-tune with your body. And 9/10 times you can actually spot the beginning stages of a rupture before it becomes serious, giving ample time to get to the hospital for further care.

  • Also, the stats helped me. Uterine rupture, even after having 1 c-section is INCREDIBLY low.

Another thing that really helped me, is research. I say this cautiously, because sometimes research can stress me out...but this time it actually helped. I left Teri's office after my 28 week appointment set out to find research showing that a home birth VBAC is not safe. I thought that if I could find that then it would make my decision for me. Well...low and behold, I actually found the complete opposite. That home-births, including home-birth VBACS, actually have a higher percentage of success.

It also helped that we live about 5 minutes from the nearest hospital, and the route does not require any highways.

How I Prevented Pre-Eclampsia

Please note: there is no way for me to know which of these (if any) were the actual cause of preeclampsia prevention in my second pregnancy, but I wanted to share what I did under the guidance of multiple healthcare providers that I have deep trust in. 

• Pathogen Saliva Testing: I took Direct Diagnostic’s HR5 high risk pathogen saliva test before I got pregnant. My results showed high levels of Fusobacterium nucleatum (Fn) which has been linked to multiple pregnancy complications such as preeclampsia (1). Initially I tried treating it the “natural” way, which did not work. I am not usually one to go the antibiotic route, but knowing it could ~potentially~ help my odds of not developing preeclampsia again, I decided to take the risk. I did one round of antibiotics, which significantly brought down the Fn levels.

• Body Work / Emotional Work: I know an amazing Doctor of Osteopathy (Dr. Matthew Barker) who specialized in bodywork. We have seen him as a family for years for bodywork and craniosacral work. He also does emotional work/releases. I do believe that emotions can have immense power over the physicality of our bodies. However, his method of emotional releasing I was skeptical about (and may still be), BUT I was willing to try anything and everything to prevent pre-eclampsia and have a healthier pregnancy. I did some emotional work with him pre-conception, as well as post-conception.

• Baby Aspirin & L-Arginine: Baby Aspirin is one of the top researched preventive measures shown to prevent preeclampsia (2-5). I began taking two Baby Aspirin’s every night at around 5 weeks.There is also emerging research that L-Arginine may lower the risk of preeclampsia by promoting vasodilatation through increased production of nitric oxide (5). I started at 20 weeks with 1,000 mg/day, and upped it to 2,000 mg/day at 36 weeks.When it comes to any medication or supplement during pregnancy I always recommend consulting with your trusted provider first.

• High Protein Diet: One of the first symptoms of preeclampsia is excess protein in the urine. This usually means that the mom is not getting enough protein in their diet, causing the body to break down its own tissues to try and nourish the baby with enough protein - which is then excreted in the urine. I aimed for 100-150g of protein a day - although, most days I barely made it to 100; and many days didn’t even reach that goal. One study showed that pregnancy diets high in protein were found to be associated with reduced odds of preeclampsia (6). Personally, I found if I could hit close to 60g at breakfast, I could hit my goal easier. I would do a protein shake (this is my favorite cleaner protein powder) after my morning workout, shower, get my son up, and then get in the rest - usually between the shake, eggs, milk, cheese/cottage cheese I was able to hit that breakfast goal.

• Hydration + Electrolytes: Research shows (7) that dehydration is a strong predictor of gestational hypertension (8) and preeclampsia (9). For most people water alone doesn’t quite cut it, and electrolytes are needed. Electrolytes help keep the amount of water in your body balanced, as well as maintain pH levels and help move nutrients in and out of the cells. Electrolytes also help the muscles, nerves, and organs work properly. I aimed for 60-80oz of water a day. For electrolytes, I would either add Nectar electrolytes to 16 oz of water and/or I would place a few flakes of Celtic salt on my tongue before every cup of water. 

• Daily Exercise: According to a 2003 study, regular physical activity during the first 20 weeks of pregnancy can reduce the risk of preeclampsia by 35%. The risk may decrease further with more intense activities that use more energy (10). A 2016 study found that women who were active for more than 8.25 hours per day had a significantly lower risk of preeclampsia than those who were active for less than 4.2 hours per day (11). I aimed for two days of cardio and two days of strength workouts a week. I didn’t do anything crazy - usually just 15-20 minute videos on YouTube. My favorite are Juice & Toya. 

My HBAC Birth Story

I wish I had Liam do a better job of keeping track of time, but obviously he had bigger things to focus on. So time stamps are VERY rough speculations based on the photos we have, and the things we remember.

Eating an apple sauce pack in the bathtub. Apple sauce packs were a game changer. Ha!

At 40 weeks 1 day I started having mild contractions at 2am. They only lasted about ~30 seconds, but where coming every 3-5 minutes very consistently. I got out of bed, and ended up on the couch with a heating pad to try and continue getting some rest as best as I could.

My mom came and got Miles around 11:30am that morning. I found in this earlier stage it felt best to get into a deep squat when a contraction came on. I tried to rest as best as I could, but with the contractions coming so close together it was difficult. Around 2:00pm I got in the bathtub, and stayed there until my doula and midwife showed up around 3:45/4:00pm. Based on the sounds I was making they decided to go ahead and fill up the birthing tub, which I got in a little before 5:00pm.

Things were getting very intense, and I started to hit that “I don’t think I can do this” phase. I decided to let my midwife check me, and I was 9.5 cm - and she confirmed I was in transition. This is where things got wild. Typically transition (the hardest part of labor) lasts about 15min-60min. Mine lasted about 6 hours.

My water wasn’t breaking (which ironically is what I wanted…thank you Vitamin C lol). However, they discovered she was in an OP position (meaning baby is head down, but faces mother’s abdomen vs her back) , so that on top of the barrier my water sack was making, it was very difficult for her to descend, and was causing lots of back labor. I got into a ton of different positions, and finally my water did rupture. And then, with my permission, my midwife went back in at one point to fully break it.

However, we were still dealing with an OP baby. Babies can be born OP, but it can take extra long, be extra difficult, and cause lots of back pain/pressure - all of which I was experiencing. 

I had been pushing in the pool, but because of the OP position they wanted to get me out and on the Rebozo for some gravity work. I think at one point they may have had me trying to labor on the toilet? It honestly was such a blur. We did this for a bit, and then they decided to put me in bed in a side lying position and have me rest (as best as I could) in order to avoid maternal exhaustion. I was doing lots of horsey lips and only pushing if I felt the unbearable urge to, which was happening at the tail end of every contraction.

I finally had enough and let my midwife help manually rotate her. This worked, and made contractions a little more bearable - it took a ton of the pressure off my back. However, she rotated back at some point.

Finally, we decided to start trying some guided pushing. Before labor I wouldn’t have wanted this, but man did it really help. I’m not sure exactly when this started, but probably somewhere around 10pm. I guided pushed for a hot minute, and then she finally rotated again on her own and I was able to push her out at 11:30pm.

At one point I truly thought I may be the first woman in history to not have her baby come out and just stay in labor forever. Lol! It was definitely not for the faint hearted, but when she came out...talk about an incredible experience! Literally all the pain went away, and I felt such a rush of energy and emotions.

Liam was shocked by how quickly I "came to" emotionally, and how wide eyed and alert Evelyn was. All he was used to was how out of it I was after my c-section, and how un-alert Miles was due to all the medications I had (he was also jaundice, and Evelyn wasn't).

Evelyn Grace born May 28th at 11:33pm.Weighing 7lb 8oz and 19 inches long.

My blood pressure remained normal the entire labor, and I had very minimal bleeding afterwards. I had zero external tears or stitches, but did need some inside stitching. Her chord clamping was delayed for an hour, and she was able to breastfeed almost immediately.

It was truly a night and day difference in care from my last birth. All thanks to my incredible birthing team. I mean, they stayed with me and cared for me 7-8 hours straight (and then immediately left to go help another girl in my birthing class who was in labor). Literally superwomen.

After debriefing with my midwife at my two day in-home follow up, she told me (which I suspected) had I been in a hospital they absolutely would have called it and pushed for a repeat c-section saying my pelvis just isn’t shaped right to push out a baby. She also mentioned that Miles' possibly could have been in the same position as Evelyn and that's why he was having a hard time dropping. Possibly my pelvis is shaped in a way that favors putting babies in that position, but it does NOT mean my body is incapable of pushing a baby out...clearly.

I am so thankful for a team who believed in me and trusted in my body!

.........

Sources:

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2 2health.harvard.edu/blog/preventing-preeclampsia-may-be-as-simple-as-taking-an-aspirin-202111092634

3 Wang Y, Guo X, Obore N, Ding H, Wu C, Yu H. Aspirin for the prevention of preeclampsia: A systematic review and meta-analysis of randomized controlled studies. Front Cardiovasc Med. 2022 Nov 9;9:936560. doi: 10.3389/fcvm.2022.936560. PMID: 36440041; PMCID: PMC9682183.

4 Ren Y, Zhao Y, Yang X, Shen C, Luo H. Application of low dose aspirin in pre-eclampsia. Front Med (Lausanne). 2023 Mar 8;10:1111371. doi: 10.3389/fmed.2023.1111371. PMID: 36968826; PMCID: PMC10030847.

5 Hegde CV. The Use of l-Arginine in the Management of Pre-Eclampsia and Intrauterine Growth Restriction. J Obstet Gynaecol India. 2012 Feb;62(1):1-2. doi: 10.1007/s13224-012-0146-8. Epub 2012 Apr 20. PMID: 23372281; PMCID: PMC3366568.

6 Zhu Y, Liu Y, Fu W, et al. Associations of dietary patterns and pre-eclampsia: a matched case–control study. British Journal of Nutrition. 2023;129(2):247-254. doi:10.1017/S0007114522001210

7 Lusambili A, Nakstad B. Awareness and interventions to reduce dehydration in pregnant, postpartum women, and newborns in rural Kenya. Afr J Prim Health Care Fam Med. 2023 May 15;15(1):e1-e3. doi: 10.4102/phcfm.v15i1.3991. PMID: 37265162; PMCID: PMC10244926.

8 Valensise H, Andreoli A, Lello S, Magnani F, Romanini C, Romanini C. Multifrequency bioelectrical impedance analysis in women with a normal and hypertensive pregnancy. Am J Clin Nutr. 2000;72(3):780–783. 10.1093/ajcn/72.3.780

9 Yasuda R, Takeuchi K, Funakoshi T, Maruo T. Bioelectrical impedance analysis in the clinical management of preeclamptic women with edema. J Perinat Med. 2003;31(4):275–280. 10.1161/CIRCULATIONAHA.114.009029

10 Recreational Physical Activity During Pregnancy and Risk of Preeclampsia

Tanya K. Sorensen, Michelle A. Williams, I-Min Lee, Edward E. Dashow, Mary Lou Thompson and David A. Luthy

Originally published28 Apr 2003https://doi.org/10.1161/01.HYP.0000072270.82815.91Hypertension. 2003;41:1273–1280

11 Spracklen CN, Ryckman KK, Triche EW, Saftlas AF. Physical Activity During Pregnancy and Subsequent Risk of Preeclampsia and Gestational Hypertension: A Case Control Study. Matern Child Health J. 2016 Jun;20(6):1193-202. doi: 10.1007/s10995-016-1919-y. PMID: 26910608; PMCID: PMC5538351.