Episode 269 The Most Common Questions of 2023

Meagan finishes out this year of podcasting by answering some of your most common questions! Topics range from the time between births, gentle induction methods, gestational diabetes, “just-in-case” epidurals, home birth, tips for having a successful VBAC, and how to cope if you don’t get your VBAC. “Women of Strength, I just want to thank you so much for all of your continued support. We love your support and we are so grateful that you are here.I love you. I feel so passionate about helping you as an individual find the best path for you.I want to help you walk through this journey and feel loved, supported, and educated.” Additional LinksReal Food for Gestational Diabetes by Lily NicholsHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello. Welcome to The VBAC Link. If you have been with us all year, I just want to say thank you and if you are new to joining The VBAC Link, I’d like to say welcome. Welcome to the show. This is the last episode of 2023 and it’s kind of hard to believe honestly. I went through all of our episodes and we have seriously so many incredible episodes. I am so honored for those who have come and shared their expertise and given us their time. I am so excited today to share this last episode of the year with the most common 2023 questions. We have some pretty common questions, but we have so many others as well. So of course, we have a Review of the Week. I want to dive into that really quickly before I get into those questions. Review of the WeekThis is from cristab. It says, “I am a birth and postpartum doula who is always on the search for a birthy podcast to listen to in my car. I was so excited when I found The VBAC Link so I could listen to these amazing stories from women all over the world who have reached their goals through becoming educated thanks to Meagan and Julie. I’ve recently certified with The VBAC Link and as well, I’m so impressed with the thorough delivery in which their knowledge was shared in their training. I’m super excited to move into this next chapter of my career and I’m thrilled to do so with the amazing community and support.” Thank you so much and thank you for joining our family. Doulas, birth workers, birth photographers, if you love birth and you are wanting to learn more about VBAC and how you can support people out there who are wanting to VBAC, who are wanting to avoid Cesareans, and who are just needing support from the community, we have our VBAC Birth Worker, VBAC Doula birth course where we are going to teach you all of the things about VBAC as well as help you know what us as VBAC moms are up against. And parents, if you want to dive in and get more educated for your future birth, I highly suggest checking out our course. You can check it out at thevbaclink.com.2023 VBAC QuestionsMeagan: Okay, you guys. We have so many questions that we get all of the time. If you haven’t also joined us on Instagram, we do Q&A’s almost weekly. We love answering your questions even if it’s a question that we’ve had before. We’re going to get to it and we’re going to answer it. Here are some of the most common questions that we get. Number one on the list is how long after my C-section do I have to wait until I get pregnant? This honestly is a question that I think is personal. Now, there are suggestions out there by providers who are saying anywhere between 18-24 months is what we commonly hear, but we even have some providers who are like, “Yeah, cool. In 15 months, you can go on and have your baby.” There can be an increased risk of uterine rupture with a really small gap or duration. So if you have had a C-section and then three months later, you get pregnant, you may have a provider who is a little bit more skeptical or even six months later, you may have a provider who is a little more skeptical and talking about the risk of uterine rupture, but that still doesn’t mean that it’s not possible or impossible or that you are for sure going to rupture. I think a common rule of thumb is that 18-24 months, but again, it comes down to a very personal decision. If you want closer babies or it happens or whatever, I think that’s more of a personal choice, and then just finding the support out there to support you in your desires. I did a one-on-one consult with a mom back here in the fall and she had a six-month duration. She went from provider to provider to provider and they all said, “No. Absolutely not.” We got her in contact with another provider and they said, “Yeah. No problem. There is no reason.” I was so excited to get a text message from her after saying that she did it. She had her vaginal birth and she was so happy. That was a duration of six months. Okay, another question that is really common is, “Trying to go for a VBAC and really want to go into spontaneous labor, but her provider is saying they can’t go past 41 weeks.” They cannot go past 41 weeks. Now, I’m just going to say that I don’t like the answer to that. The follow-up question to that question was, “Should I switch my provider?” You know, we’re not here to tell you that for sure you need to switch a provider or anything like that, but if you have a provider that is putting stipulations on you like you cannot have a baby past this day and if you get to that day, you have to have a C-section, you may want to look into some other providers because that’s just not evidence-based.Going past 41 weeks in general is something that has become more and more controversial, especially after the ARRIVE trial. We have episodes on the ARRIVE trial. We have blogs on the ARRIVE trial, so make sure to check those out as well. It’s kind of weird. They did an induction at 39 weeks for first-time moms to see if it would reduce complications like hypertension, preeclampsia, and even Cesareans. It’s kind of been since 2019, I feel like, more of a hot topic, but it’s actually pretty common for babies to go overdue. I am putting big quotes on this. “Overdue”, past 40 weeks. Know that if you have made it to 40 or 41 weeks, it’s very common and you’re okay. There are common things that a provider may do at 41 weeks. They may suggest a non-stress test just checking in on baby and making sure everything is going well, but it’s still okay. In fact, ACOG suggests, I think it’s 42 weeks, really. So, you know. At 41 weeks, you could still be pregnant or a week or you could have a baby in three days or even three hours. They have not really found any increased risk of uterine rupture or other complications necessarily like that after 40 weeks, however, there are things that can come into play where VBAC after 40 weeks may be lower or require interventions because there may be things like hypertension and things like that that come into play. But even if your provider is saying that you can’t go past 41 weeks and you have to schedule C-section, that right there is a red flag and something that would be concerning to me because induction is, which is also another question– can I be induced and have a VBAC or can a VBAC be induced? VBAC can be induced. It’s very reasonable. There are ways to do it. Some tips that I would suggest are doing as low and slow as possible. Now, we got a message back on one of the days that we did a Q&A from a mom saying that she did not believe that it was possible to do low and slow. I do disagree. I think that it is possible to do low and slow inductions. I’ve seen it. It happens all the time. You do have to sometimes fight for it and be educated so you can have that conversation and understand what that means. So let’s talk about low and slow meaning that if we are starting Pitocin, we are not upping it to 4 mL every 30 minutes. A lot of providers out there will suggest that. 4 milliliters every 30 minutes. Boom, boom, boom, boom. It’s a little overwhelming, first of all. Sometimes it takes our body a little bit longer to respond fully. Now, Pitocin, once it starts going in, it’s in the body, but it may not fully be responding so if we up it every 30 minutes and then we take 45 minutes to respond, then it may be too much, right? And 4 milliliters versus 2. So maybe you say, “Okay, let’s cut that in half. Instead of 4, we do 2 or even 1.” Sometimes there is a lot of pushback on that 1 because they are like, “Oh, it’s pointless. It will take forever,” but it’s still okay. It’s still okay so decide what milliliter is best for you and go for that. Fight for that. Low and slow there. Then another thing is avoiding breaking water or too many interventions all at once meaning we are going to place a Foley, start Pitocin, and break your water all at the same time. That is unnecessary. We really, really, really do not need to do that. That is just going to overwhelm everybody a lot of the time including the baby. But breaking waters. Breaking water in that earlier stage. Maybe we have– in fact, we are sharing a story. It’s coming up in 2024. I just recorded it not long ago where the mom was 2 centimeters and they broke her water. She wasn’t really contracting. They broke her water, started Pit, all of the things, and not a lot of progression. If we break our water early on, it’s not a guarantee that our body is going to go into labor, but a lot of the time, there is a selling factor of this breaking the water where it’s, “Oh, it’s the natural way.” Okay, all right. Breaking our water is natural. However, artificially breaking our water does not mean that that’s natural. That means that we are intervening and doing something that our body did not do at that point. So if we do that and we do that early on and our baby is high or our baby is in a weird position and then we have these floodgates open and the baby comes down, and the baby is in a wonky position, now we’ve got a poor fetal position, not a lot of progression because that often happens, a harder labor, a longer labor, maybe we’re introducing more interventions, so it kind of becomes a cascade. Maybe when I say slow, take it slow. Let’s not intervene with every single thing that there is possible in the labor and delivery unit. Maybe we just do a Foley or maybe we do Foley with a low dose Pit of 2 and we don’t up it from there. That’s it. That’s where we start. We wait for the Foley to come out and then we assess after that. Low and slow inductions and yes. You can be induced and no, you do not have to be induced at 41 or 40 weeks. So okay, one of the other questions– well, there are a ton, but one of the other questions I’m going to go to is about hypertension. “Can I still VBAC with hypertension?” So, yes. Absolutely, you can VBAC with hypertension. Sometimes, providers will come back and say that it can increase our blood pressure and things like that. It’s kind of weird. I don’t know if there actually is a study that shows this, but a lot of doula clients who have hypertension go to be induced, once they start labor, their blood pressure seems to kind of chill out. It’s kind of interesting. I do not know why, but yes, you can still have a VBAC if you have hypertension. So another question is, “If you get induced, does your risk of uterine rupture truly skyrocket to an insane amount?” We’ve heard people give us such crazy numbers like, “I have an 80% chance of rupturing.” I don’t know where providers are getting that, but no. Or, “I have a 60% chance or I have a 25% chance.” Now, if someone is telling you that you have these chances, I would like to challenge you to challenge them. Now, I never want to say to be combative and blah, blah, blah. That’s not what I’m saying, but I’m saying don’t be scared to ask, “Where do you get that information? Is there a link? Can you provide me with printed information on this topic or on this stat? I would like to see that. I would like to go over this so I can make the best, educated decision for myself.” If they are like, “Oh, well I don’t know. I don’t know if I can find that,” well, yeah. It’s because there’s not one. If there is one and you do receive that, will you please email me at [email protected]? I would love to see that. I’ve never seen a study that says that someone has an 80% chance of rupture because they have had a previous Cesarean. So statistically, uterine rupture really happens in about 0.4 to approximately 1%, maybe 1.2% depending on some providers and some studies. But overall, that’s pretty dang low. That’s really, really, really low. So if someone is telling you that you have a 60, 25, or 80% chance, that’s just not true.Then another common question is about ways to avoid uterine rupture. Now, we don’t always know why uterine rupture happens. It’s hard to say exactly what caused that uterine rupture. I don’t know if you knew this and it’s very, very small, but uterine rupture can even happen in people who have not had a previous Cesarean. So that’s a thing too, but things that we can do are try to avoid those inductions that are absolutely unnecessary and if you do get induced, talk about those best methods like what we were talking about. We have a blog about that as well and we talk about that in our course. Really learn about those methods and avoid aggressive augmentation. Avoid Cytotec completely. That’s a big no. You know, and do everything you can to make sure that your baby is in a better position so maybe Spinning Babies, the Miles Circuit, hands and knees, do pelvic floor therapy so we can help our pelvic floor be in a position where we can push a baby out that way and things like that. Educate yourself. Listen to these stories. Attend our Q&A’s. All of these things can educate you so you can help reduce these things that may increase chances of uterine rupture like Cytotec or aggressive inductions. Okay, another common question is, “If I have gestational diabetes, can I have a VBAC?” Yes, yes, yes, and yes. Yes, if you have gestational diabetes, you can still go and have a VBAC. Sometimes, a provider may suggest an induction at 39 and I’ve even been hearing 38 weeks with gestational diabetes especially if it’s not managed well. One tip that I would highly suggest is really understanding gestational diabetes. Knowing that food and exercise and things like that can impact gestational diabetes and learning how to manage those if you can. Talking with your provider, understanding what they’re going to be looking for, what they’re going to be doing because that’s also going to help you stay more relaxed when you understand the process from them instead of just being caught off guard. I highly suggest checking out the book Real Food for Gestational Diabetes by Lily Nichols. We’ll make sure to put the link in the show notes as well, but that’s a really, really, really wonderful book to check out and it’s going to help you understand a little bit more about how to manage those sugars and just more about gestational diabetes. But also know that you do not have to be induced if you have gestational diabetes. You just don’t, but it’s going to be really common to have that be offered. Okay, so a couple of other questions that we get are, “I had failure to progress. Big air quotes, ‘failure to progress’ and my doctor is telling me that because my body didn’t do it the first time, it won’t ever do it again.” I’m sorry, but your provider is a big, fat liar. Such a big, fat liar. Just because you didn’t progress with one labor doesn’t mean you won’t with another one. Honestly, it’s more likely that you didn’t progress because of an environment, because of a rushed labor, because of a rupture of membranes artificially and baby was coming down so we got a wonky position, lack of ability to move during labor, and things like that. Progressing and trying to push labor on and it’s not progressing because labor wasn’t ready to begin– these are things that truly are going to be more of the reason for a failure to progress other than the reason that your body doesn’t know how to get to 10 centimeters. Truly, it does. Know that if your provider is putting doubt in your mind, that you can’t have a baby because your body didn’t do it before, you may not be with the right provider or you may have to fight hard. And again, it all comes down to, I think, finding that education and support. Another common question is, “Can I VBAC with twins? Is it safe?” Yes, you can VBAC with twins. Yes, it is safe. Sometimes, providers will have some stipulations as far as Baby A needs to be head down and Baby B is okay to be breech, or sometimes it’s like they both have to be head down. They might have some restrictions on that and a lot of the time, they will have you actually give birth in the OR. They’ll have you push and give birth in the OR, but yes. Research shows that a vaginal birth for twins is generally safer than a Cesarean, truly, even though some providers still discourage it. A podcast to check out is Dr. Stu and Midwife Blyss. They have an amazing, I think it’s Birthing Instincts, podcast and they talk about twins and delivery and things like that as well. Okay, so a common question is, “How can I prep? How can I prep for a VBAC?” I’m going to give you a couple of tips right here. I already have said it a couple of times, but your provider. Your provider is really, really, really, really important. You need to find a good provider, a provider that’s going to support you, a provider that wants this birth for you just as much, right? A provider that is not going to disregard you and pull out bait-and-switches in the end with non-evidence-based information to scare you and then make you feel like no one’s going to want to take you because you are already so late in pregnancy. Ask these questions before you settle in with a provider. Ask questions like, “How do you feel about VBAC?” not, “Do you support VBAC?” How do you feel about VBAC? Open-ended questions allow a provider to give you a lot of information without you even saying a word. If they stumble and say, “Oh, yeah, yeah, you know. I feel good. It’s fine. It’s fine. It’s fine.” Okay, know. If it’s like, “I actually feel like it’s a better option and this is something I would suggest and this is why. There are going to be pros and cons to it on both sides. There are going to be cons to having a VBAC for these. Here are the risks. There are going to be cons of having a C-section. Here are the risks.” Yes, there are risks to having a C-section. Also, if your provider ever tells you that there are no risks to having a C-section, that’s bullshit. I’m sorry. I’m saying. It’s the end of 2023. That is B.S. That is not true. So, talking to your provider with open-ended questions. How do you feel about VBAC? Another question, “How do you support your VBAC moms? What does that care look like?” If they’re like, “Yeah, totally. It’s just going to be like normal. We might check you if you go over 41 weeks. We might want to do an NST or we might want to do this,” or something like that and it’s lining up with evidence-based. Okay, that’s to be expected. If it’s like, “Yeah, no totally. We love VBAC, but you have to have the baby by 41 weeks. It has to be spontaneous. You can’t induce. You have to get a just-in-case epidural.” Those are all, again, the B.S. answers that are going to tell you that you’re probably not in the right place. Have open-ended questions for these providers. Number two– get the education. Educate yourself so that if you do have a provider coming in and telling you things that you are unsure of, you will have that resource to go back to and be like, “Oh, I actually do remember that and that’s not true,” or, “Yep, that’s right in line with evidence-based care.” It can also help you have a better discussion with your provider because you want that. They come in and they ask you. They say, “Do you have any questions?” They don’t really have a lot of time, honestly. These poor providers are overworked. They don’t have a lot of time, but too, it will help your time be better when you do go to those prenatals. I remember going and they were ten minutes long and it took a lot of energy to get there. I’m just like, “Why? What is the point of these visits?” Make a point to these visits. Ask these questions. Learn the education so you can have those educated discussions and get a better feel for your provider. They can get a better feel for you. They can learn that they can trust you also because you are educated. They are not going to second-guess you if you are saying no to something that they are offering to you in labor because they know that you are educated. Take a class. Listen to these podcasts. Read the blogs. Get into the Facebook communities. Learn about what people are saying. Read the links that are being shared. Education is important. Another way to prep truly is finding the support even outside of your provider. I feel like if you can have the support and the sounding board, it helps so much. With my VBAC after two C-section baby, I had it, but in places– I loved it in the places that I had it, but it lacked in the places that I wanted it, from my family and friends. That was really hard. I think that’s also another tip for where education comes in because you can help educate your family and friends along the way when they are like, “No. You can’t VBAC. No way.” Truly, finding that support is important, and also, prepping in a way that if you don’t have that support, let those people know that you love them with all of your heart, but unfortunately, you are not going to be sharing your desires and things. Nutritionally and physically, be healthy. Eat good food. Get good supplements like Needed. Drink your water. Stay hydrated. Make sure you are trying to get at least 30 minutes of walking a day and staying active. Of course, if you have certain situations, you want to always make sure with your provider that it’s all in line with your birthing plan and your personal situation, but taking care of yourself is truly important. As we have learned with Needed and things like that, we know we are not getting the nutrients. We know we’re not getting the hydration that we truly need every single day. If we can try and get that, it can help our pregnancy be better. It can help your birth be better. It can help in all areas and also mentally. I think if we are fueling our bodies with the right things, then we are truly going to be in a better spot. Okay, so another question that I have seen here and there and even more in the CBAC community is, “How do you deal or how do you cope with not getting a VBAC?” Now, this can be hard and this can be sensitive. Sometimes we have things in our head or we are told certain things and then it’s in our op report and we were led to believe something that actually didn’t happen or we were led to believe something that actually wasn’t documented. I think that’s a really good way to process. Really undersatnding that it’s okay to be mad or sad. It’s okay to feel those feelings, welcoming them in, and then working through the process step by step. I definitely think that knowing that sometimes we don’t know the answer and accepting that, we talked about that this year with our radical acceptance episodes. Sometimes not knowing the answer can hang us up and really, really impact us and bring us down, but knowing that sometimes we may not know the answer. We may not know the why. We may not know what happened and trying to accept that and let that go is really, really difficult. But trying to practice that radical acceptance is really powerful. Yeah. There are so many questions along the way that we have been asked, but these are kind of some of the most common. Another one, I think probably the last one that I will share today is about an epidural. “Do I have to have an epidural if I have a VBAC?” No, you don’t. No, no, no you don’t. You do not have to have a “just-in-case” epidural if you are wanting to go for a VBAC. You just don’t. It takes time to dose an epidural, so I think if you look at it and you think about it you’re like, “It kind of makes sense. Okay. They place the epidural. It’s already placed. That can take some time.” But then they have to dose it and then wait, what? Maybe it doesn’t make sense, right? Okay, so I’m just going to walk you through it. It sounds like it makes sense until you walk through it. So then they have to dose the epidural which then takes anywhere between 20-30 minutes to really work and get to a point where they can perform a C-section. So a “just-in-case” epidural, although yes, it takes the time of placing it, it doesn’t take the time of dosing. The “just–in-case” epidural is typically placed just in case there is an emergency. If there is a true emergency, they’re not going to have the time to dose the epidural and get it to a point that it is ready for you. They’re going to probably do general anesthesia at that point. The “just-in-case” epidural, I think, is just bull. I don’t like it. I don’t like when a provider puts a restriction on someone like that. Like, “You want to go unmedicated? Well, okay. Sorry, you can’t. You can VBAC, but you can’t go unmedicated or you have to have a ‘just-in-case’ epidural.” Do you have to have an epidural?Another common question is, “Can I have a VBAC if I have an epidural?” Yes. Absolutely. Going unmedicated is not for everyone or if you want to go unmedicated and then you have a really long labor or something is happening and you decided to change your mind, that is okay. Women of Strength, plans change in labor. It changes all of the time. I see it time and time again through clients and through things. It doesn’t always mean the plan is to change from an epidural to no epidural. Maybe it’s from this to that. Maybe it’s, “I didn’t want IV fluids and now I need IV fluids because I can’t keep anything down.” It changes. Plans change, but yes, you can have an epidural with a VBAC and still have a VBAC.Know that if you are wanting to VBAC, but you are not wanting to go unmedicated, you can still do that. If you are wanting to VBAC and you want to go unmedicated and your provider is telling you that you have to have an epidural or you have to have a “just-in-case” epidural, that is also false. Find what works best for you and it all circles back to education and finding the support in the provider and in the system. Okay, I lied. One more. Home birth. “Is home birth safe?” Yes. You can have a home birth. We have HBACs, home births after Cesareans, all of the time. We have them on the stories. We have them on the blogs. We have them on our Instagram. We see them in the community. Home birth is a reasonable option for VBAC. Now, the providers and ACOG are probably not going to suggest it. We go off of ACOG a lot, but know that these providers are probably not going to suggest and out-of-hopsital birth, but can you? Yes. Can you do it safely? Yes. Are there signs of uterine rupture typically before uterine rupture happens? Yes. Usually, do you have time to get to another location? Yes. So know that if you are desiring a home birth after Cesarean or even a home birth after multiple Cesareans like me, a VBAC after two C-sections, that is possible. It is totally, totally possible. Women of Strength, I just want to thank you so much for all of your continued support. We see it on Instagram. We see it on Facebook. We see it in our group. We get it in reviews here. We love your support and we are so grateful that you are here. We truly are here for you because we love you. I know I’ve said this before. It’s weird for me to say I love you because I’ve never met you, but I do. I love you. I feel so passionate about helping you as an individual find the best path for you whether that is VBAC, whether that is CBAC, whether that is unmedicated, medicated, in-hospital, out-of-hospital, inductions, or spontaneous. I don’t even care what type of birth you have. I want to help you walk through this journey and feel loved, supported, and educated. So again, if you are just with us, welcome. I’m so excited for 2024. We’ve got so many amazing things coming. If you have any questions about anything we offer on our podcast, our course, our blog or anything like that, always know you can email us at [email protected]. If you’ve been with us and you’ve had your VBAC or you are still working for your VBAC or you are a birth worker or whatever it may be and you are with us and you have been with us forever, thank you from the very, very, very bottom of my heart. I truly love you and I’m so grateful that you are here. We will see you in 2024. ClosingWould 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/donationsAdvertising Inquiries: https://redcircle.com/brands