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Is it possible to have a VBA2C in Fort Myers? Why yes it is! Welcome baby Elise Camille born 2/24/19

From Christine: Jennifer came to us as a mom seeking a VBAC, or a vaginal birth after cesarean. She actually had 2 prior cesareans, making her officially a VBA2C. Why is this significant? Well, to us as doulas, it’s really not. We’ll support every parent through every birth in any setting (almost!). But for providers, doctors and midwives, it’s not always that easy. And pregnant parents are often left with the question, can I have a VBA2C in the hospital?

There are many factors that come into consideration for a provider to “accept” a patient as a VBAC. They like to say they are supporting a TOLAC, or “trial of labor after cesarean,” as opposed to VBAC; in other words they will support that their patient goes into labor on their own without heading straight to a repeat cesarean. In 2014, we (myself and some amazing birth colleagues) formed the VBAC Advocates of Lee County and we pushed back against the then-standards that were informally in place in our area hospitals. What was happening was many if not most of our local OB practices would deny VBAC patients care, or would say it was against their practice policies, or would find reasons to risk them out of care. Many if not most VBAC patients were being silently “forced” into repeat cesareans; some were outright coerced. There are a myriad of reasons why this was happening, which go beyond the scope of this post; let’s just say liability played a major factor, as well as the logistics of OBs needing to spend extra time at the hospital attending potential VBAC patients’ labors while they also had an office full of patients that needed to be seen.

In 2014 the VBAC Advocates of Lee County met with the head of OB at Lee Memorial as well as Lee Memorial CEO. We had one main question: How can mothers have a VBAC in the hospital? Dr. John Edwards of Mama’s Chiropractic created an entire presentation on our behalf and presented it at an OB department meeting. We spoke, called, pushed, followed up and didn’t go away. Then something incredible happened; Lee Memorial moved forward with adopting the Hospitalist Program much like we advocated for. In a nutshell, this allowed OB coverage at the hospital 24/7, freeing up the OB practices to attend to their patients even in the case a VBAC patient came into the hospital in labor. Following? This is a huge win! VBAC became possible at Health Park Medical Center!

What started to unfold was that *some* OB practices started to accept *some* VBAC patients on a case by case basis. While we celebrated every single win, as time marched on we could see, sense and hear that our cause had a long way to go. For example, a patient seeking a VBA2C was hard-pressed to find an OB who would support them. Now the question for mothers became, can I have a VBA2C at Health Park?

In the decade that I’ve been attending births in SWFL, I’ve grown to have a deep appreciation in my heart for VBAC parents. They are simply pregnant parents just like you or me, who wish to push their baby out of their vagina. They deserve the right to make that decision for themselves and their baby, and have the conversation with their provider including informed consent and refusal on an individual basis, not just because of policy or litigation concerns.

So when Jennifer realized her first OB at North Collier Hospital (NCH) was not willing to support her VBAC, she expressed her concern to us, her doulas at Mindful Birth. (I want to make mention that we have an extremely supportive homebirth midwifery practice locally, LifeSong Midwifery, who happily accept VBAC patients into their practice! At this time, VBAC is not supported at free standing birth centers in Florida). Having been deeply rooted in the VBAC plight in Lee County, we were able to recommend an OB who was known for supporting VBAC as a solo practice OB. So even though she was into her 2nd trimester, she switched. Best. Decision. Ever. Not that her journey was without conflict; it wasn’t smooth sailing. But she had a chance. And as a VBA2C, to have this opportunity is again, a huge win.

Enter our doula Tara! One thing that I have worked hard to create at Mindful Birth is the doula team model. While each of our doulas has their own caseload, we provide back up care for each other. Even beyond that, we are able to provide emotional support for each other’s clients if we are called upon as backup, and as the agency owner I have taken on the role of providing individualized birth coaching services and group birth coaching, too. So when Tara was at another labor when Jennifer also went into labor, I was happy to jump in, talk with Jennifer, and coach her through a plan for the overnight hours. I even had another of our agency doulas, Emily, on her way to the hospital to support Jennifer and her husband until Tara could be available. But get this! The Birth Fairy can be *really* touchy sometimes, so imagine my surprise when Tara’s first client delivered speedily, enabling Tara to literally walk from one birth right down the hall to meet Jennifer in labor at the same hospital. It was all meant to be.

From Tara: When I first met Jennifer and Kevin they were struggling to find a provider who would support a vaginal birth after two cesareans. We talked through their options and within a few weeks they transferred to a doctor at Health Park who was willing to agree to the possibility of VBA2C. As a VBA2C with some other health concerns, Jennifer’s pregnancy was filled with worry and doctor visits. We tried to focus on the good parts of her pregnancy and doing some things during the week that she enjoyed. She was exhausted from her many doctor appointments and keeping up with her two younger children. Throughout it all, Jennifer impressed me with the steps she took to help her obtain her VBAC. She ate well, practiced Spinning Babies exercises and practiced her “ice contractions,” finding different ways to cope with intense physical sensations.

The evening that Jennifer let me know she might be going into labor, I happened to be at another birth. I immediately contacted Chris for support who contacted Jennifer. I am so thankful for this team of doulas who can step up in the rare occurrence that my clients go into labor at the same time. I then said a little prayer that this baby would wait just a little longer so I could make it on time; I really wanted to attend Jennifer’s birth.

In the wee hours of the morning I was about to leave my previous client who had just birthed her first baby when Chris let me know Jennifer was on her way to hospital with her husband, and was in full-blown labor! I walked down the hall and met Jennifer and her husband at triage. Jennifer’s contractions had come on strong and only a few minutes apart right from the beginning of her labor, but a cervical exam showed that her cervix was dilated only 2-3cm. To compound matters, Jennifer was already exhausted due to a cold she had been fighting for a few days. By 8am Jennifer and Kevin decided it was too much for her and agreed to a cesarean. The nurse let us know there was a wait to get into the OR but gave Jennifer some pain medication to cope. Kevin and I helped Jennifer cope through her strong contractions through breath work and encouragement. Just before noon, we were taken to prep for her cesarean. By this time Jennifer’s contractions were even stronger. The OR nurses decided to check Jennifer’s progress because she could hear that she was sounding grunty through her contractions; she was at 9cm!! A moment I’ll always remember was the OR nurse calling out, “Failed cesarean!” We are rushed back to Labor and Delivery, and within thirty minutes Jennifer was holding her little girl in her arms!

Chris: In the midst of the morning, I received a text from Tara sharing that Jennifer was on her way to the OR for a cesarean. We shared some encouraging words and I expressed my gratitude to Tara for being there with our clients. Imagine my surprise when I received a text a couple hours later stating, “Just kidding! Jennifer just delivered vaginally!” Words can’t express my bewilderment and satisfaction on Jennifer’s behalf! She got her VBA2C in the hospital in Fort Myers. Jennifer and Kevin, my congratulations for you could not be any more tremendous!

So to answer your question, “Can I have a VBA2C at Health Park,” the short answer is YES. Jennifer did a lot of work to get herself in this seat, and you can too. Your birth team matters, having a doula on your team matters, having support throughout your pregnancy matters. We would be thrilled to help you achieve your VBAC or VBA2C in the hospital. You can do it!

Please join us in welcoming Elise Camille who born on 2.24.19 at 12.34pm. She was 7lbs 13oz and 20 inches long.

In doula love,

Tara and Christine


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