Chanie joins us to talk about VBAC and why she considered herself technically high risk, though not as high risk as others. Chanie tells the story of her first C-section birth, planning for her VBAC and having a second C-section, and working with a new practice and a doula to have her third baby vaginally.
“VBAC after two cesareans: the will to succeed” – with Chanie
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Dr. Fox: Welcome to the Healthful Woman Podcast, the fastest growing podcast in women’s health. Today is Monday May 16th, 2022. So, we recently decided to combine our two podcasts – Healthful Woman and High Risk Birth Stories – into one single podcast. So now, when you tune into this podcast, Healthful Woman, every Monday, you will have a wider range of topics that include women’s health, wellness, pregnancy, gynecology, as well as personal birth stories. The truth is they’re all interconnected, so I’m happy to recombine back into one—lets say holistic podcast. If you’d like to share your birth story, we’d love to have you do that. You can still reach out to us through the website or you can email me at email@example.com. Or the old email still works, firstname.lastname@example.org. Okay today we’re going to hear about VBAC after two cesareans with my guest, Chanie. Chanie is a listener of the podcast who contacted me about telling her birth story and it’s a really good one that focuses on VBAC (or vaginal birth after cesarean), which is a topic that we’ve covered on this podcast before. Chanie has a great story and I’m certain you will enjoy hearing her tell it.
I also wanted to add that Chanie emailed me after we recorded and asked that I mention, that she does not want anyone listening to feel bad if they were not able to have a successful VBAC or if they did not choose to try. It’s not for everyone for a multitude of reasons, and a repeat cesarean is absolutely a valid choice.
Thanks Chanie for coming on the podcast and specifying that and I totally agree. VBAC is an option, but it’s not always the right one and it isn’t always successful. That’s it! Enjoy Chanie’s story of VBAC after two cesareans. Next week, Dr. Stephanie Melka returns to talk about forceps and vacuum deliveries. Alright thanks for listening, have a great week. See you next Monday.
Dr. Fox: Welcome to today’s episode of “Healthful Woman”, a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.
Dr. Fox: Chanie, welcome to the podcast. Thanks for volunteering to tell your story. How you doing today?
Chanie: I’m doing great. Thank God. Thank you so much for having me. I love this podcast and I feel honored to have a chance to tell my story.
Dr. Fox: Well, I appreciate that. We’ll find out when we’re done, if you still feel honored, but that’s good. How’d you even find the podcast?
Chanie: So, originally, I found the podcast, you were interviewed on another podcast that I listen to called “The Happy Birthway Podcast,” and after I heard you being interviewed, I just felt like, you know, you sounded like a really reasonable OBGYN, and I wanted to hear more of what you had to say. So I found your podcast and I’ve been listening to it ever since.
Dr. Fox: All right, well, I’m sure you listen to that podcast because, you know, she’s also a Chanie, so you have to. All the Chanie podcasts you’re on. You got ’em.
Chanie: Yes, and she’s a nurse just like I am.
Dr. Fox: That’s how you found us. And then, what compelled you to tell your own story?
Chanie: Firstly, I would say I feel a little bit strange telling my story. It took me a long time to think that it was even, like, appropriate to tell my story in this podcast, because it’s called the “High Risk Birth Stories,” and there’s so many, like, different complex stories that I’ve heard. And I didn’t feel like my story really, fit into that because I don’t think of it as super high risk, even though a VBAC is considered to be high risk, but it just seemed out of place amongst all the complex stories.
But being that at least a third of the births in this country are by C-section and it seems to me that there are so many people who don’t know their options or might wanna hear more about possibilities of the VBAC or VBAC, after two C-sections, I felt like it was important to tell my story just for more people to hear about options and about what’s possible.
Dr. Fox: I never really intended it only to be stories that were “high risk.” I think the reason we chose the name “High Risk Birth Story” is because birth stories was already taken and since I do high risk. But yeah, I can see why that would potentially dissuade people from telling their “low risk” birth stories. Although, who really knows what that means? I mean this low risk, high risk is a very strange demarcation because there isn’t like a line in the sand. I mean, everyone has risk of something, I guess.
Chanie: Yes, correct. And VBAC is considered to be high risk, it just didn’t feel as high risk as some of the other stories that I was hearing. Maybe you wanna talk to it about why VBAC is high risk.
Dr. Fox: Well, it could be high risk. I mean, I’m looking forward to your story because I know in advance. Obviously, because we’ve been in touch, you know, where this is heading and this idea of whether someone can or can’t, or should or should not try to have a vaginal birth after a prior C-section, is a…I don’t wanna say it’s a debated topic because it’s not like people debate about it, it’s just people feel very differently about it, around the country, both doctors and women, themselves, who are pregnant about what they wanna do because there is risk, right, with your second birth if the first one was a C-section. It’s not a crazy high risk, but there’s some risk and what to do about that. And so some people don’t want any part of that risk and they just do another C-section.
But that has risk also. And also some doctors or hospitals don’t wanna be a part of that risk because I guess they feel it’s either just not worth it for them to offer this and have that risk or potentially they don’t have the capability for the potential of what’s called the uterine rupture where the scar and the uterus opens up. But because of that, and it’s sort of not uniform around the country, a lot of women, such as yourself, as you’re gonna talk about, are put in a situation where sometimes even if it’s something that they want, it’s not an option for them where they are or they may not even know that it’s an option for them just based on who they’re seeing or where their doctor is.
Chanie: Correct. Yes. I found that people, you know, might ask the doctor who did their first C-section, “What can I do in the future? Can I try for a VBAC?” And depending on, you know, what that doctor’s opinion on VBAC is, they were either discouraged or encouraged. And sometimes people are encouraged and then at the last minute, the doctor changes their mind, which I find that to be a common thing also. So I think it’s important for women to know that there isn’t just one opinion on it and there isn’t just one doctor, one OBGYN out there, there are so many, you know, different people and different opinions. So find the one that, you know, you feel fits your story best.
Dr. Fox: Yeah. And it’s sometimes the doctor, themselves, and sometimes it’s just the hospital in which the doctor delivers, right?
Dr. Fox: You can have a doctor who, you know, works at one hospital and does a VBAC all the time and then goes to another hospital and says, “This is not the right place for it,” or the hospital just says, “We’re not doing it.” And then, you know, it’s out of their control in that sense. But that definitely is true and there’s probably some lines that everyone agrees, not a great idea to VBAC. Those are exceptions, but there’s probably some, but then within the women who are candidates, I agree, you’re gonna hear a lot of different opinions based on who you talk to. Let’s talk about your story. So now we’ve prepped everybody for what we’re talking about here. So tell us about your first birth.
Chanie: That was 12 years ago. So it’s hard to remember exactly what my thoughts and what my knowledge was about birth and all of that at that time, but I do know that I felt very strongly about everything being as natural as possible. I didn’t know exactly what that meant because I hadn’t experienced birth yet, but I wanted things to be as natural as possible. I went with a midwife. I had a doula booked, and I took a childbirth class that taught techniques to cope without an epidural with a, you know, natural labor. And I definitely remember that I had this will to just have the most “natural” birth possible.
The way the story ended up going, it just seemed like so many things happened that put a wrench in my plans. First of all, I was group B strep positive, which I knew meant that I had to be at the hospital for a certain amount of time in order to get antibiotics before I gave birth. My water also broke before labor started, so I knew that put me on the clock and I would have to deliver within 24 hours. Now, I don’t know if that’s something that is a policy everywhere, but it was definitely something that was a policy where I gave birth.
Dr. Fox: It was a policy? Like, a hospital policy or just your doctor thought it had to be? Because that’s not a true thing, the clock, meaning there’s nothing that says you have to deliver within 24 hours of anything, certainly your water breaking.
Chanie: So maybe it wasn’t like a super strict policy, but it was generally told to me that I would have to give birth within 24 hours due to the risk of infection if my water was broken and I hadn’t given birth within 24 hours.
Dr. Fox: Yeah, I mean, I don’t know if that’s just a function of, that you delivered 12 years ago and things are a little bit different now compared to then, but I was in practice, you know, 12 years ago and I know we weren’t telling women that, you know, if they came in with their water broken. I think it’s true that if women come in with their water broken and generally the recommendation was to do something to induce the labor, not 100% of the time, but generally. I think it’s true that if you come with your water broken and something’s done to induce your labor, that most, let’s say 95% of women, will be delivered within 24 hours.
But that doesn’t mean that the other 5%, therefore, need to have a C-section at the 24-hour mark. Like, you know, some do, some don’t. It sort of depends on the exact circumstances of what’s going on with their labor and the baby’s heart rate. But we never had, like, an alarm that went off after a certain amount of hours that, “All right, you know, 18 hours have passed, 24 hours have passed, if you’re not delivered or about to deliver it’s over,” because that really doesn’t make much sense biologically either.
Chanie: Right. Well, and, like, I guess with a lot of things in this field, there’s different opinions, right?
Dr. Fox: Yeah.
Chanie: So I do remember that being an issue. And also what happened was there was a big blizzard at the time, it was December. And the blizzard had started and I felt that if I didn’t go to the hospital early, I would get stuck at home and I would be stuck going to the closest hospital, you know, being brought in by EMS. And I didn’t wanna go to the hospital where my midwife, you know, was not there.
So I made the decision, even though I knew that I was in a very early labor and I didn’t necessarily need to be in the hospital, I made the decision to go to the hospital anyway. You know, it was a harrowing journey through the streets of Manhattan, with the blizzard. And, spoiler alert, I ended up giving birth way after the blizzard was over. But anyway, how was I to know that at the time?
Dr. Fox: I’m curious when you mentioned that you had all of these plans for the, you know, “natural,” and again, you said you didn’t really know what that meant, no one really knows what that means because different people mean different things with that. But whatever it was, you had your midwife, your doula, no epidural, I’m curious if you could recall, what was the reasoning behind that? Was it sort of like a sense of, “This is just how it’s supposed to be. This is how women have done it for generations,” or was it that you thought that, you know, the epidural or the interventions were somehow harmful or would increase your risk of a C-section? Like, what was sort of going on in your mind around that thought process?
Chanie: It’s a good question. I think I was always…I thought that’s how it’s supposed to be. I thought that women, you know, were made to give birth and that I was gonna do it, you know, in the most natural way possible. I think I also had some idea in my head about this, again, “cascade of interventions” that people sometimes talk about, you know, where one intervention leads to the next and, you know, then you would end up with a C-section.
But actually, it’s interesting because I ended up having a lot of interventions in the hospital. And I can clearly picture myself in the hospital bed thinking, “Wow, all these interventions are happening to me, but I know that I will not have a C-section because I have a midwife.” And I don’t know why I thought that because, obviously, it’s possible to have a C-section with the midwife the, you know, the covering doctor will perform the C-section.
But for some reason, I thought that it was possible for me to have all the interventions in the world except for a C-section and I did end up having a C-section. So that was just my style. I wanted things to be more natural. I felt like I had a very high pain tolerance and that I would be able to withstand anything that was thrown my way. So I didn’t need an epidural, I would be able to manage without and I just thought that’s the way women should give birth. That was my thought at the time. I didn’t really know, of course, what I was getting into but…
Dr. Fox: Nobody does.
Dr. Fox: Which is normal. I mean, nor should you. I mean, how would anyone know what it’s like until you’re in it? So you get to the hospital, as you said, the blizzard, a little bit in the earlier side than you would’ve wanted, your water’s broken, your group B strep is positive, so they’re giving you antibiotics, but you’re there with your midwife, your doula made it as well?
Chanie: Yes. My doula was there with me.
Dr. Fox: And did they induce the labor or did they sort of wait for it to come on its own?
Chanie: They did induce me. They gave me Cervidil and I think I was, like, maybe just barely one centimeter dilated or less than that. At the time they gave me Cervidil, I was having contractions, it’s hard to remember the exact sequence of events but at some point, is it called tetanic contractions when the contractions just don’t stop, like, back-to-back?
Dr. Fox: Yeah. It’s like the word titanic, but an E instead of the I at the beginning. Tetanic. Yeah.
Chanie: Yeah. So that’s what happened to me. I was having contractions back-to-back, without any break. So at some point, they took the Cervidil and they had to give me some injection to stop the contraction. And then, shortly after that, my blood pressure was high and there was some concern that there maybe was some protein in my urine and they were concerned about preeclampsia, so they encouraged me to have an epidural, which would bring my blood pressure down and then they would, I guess, have a better idea of whether it was true preeclampsia or not.
So I was convinced to have an epidural. I got an epidural and my blood pressure came down and everything calmed down and it was not preeclampsia. After that, I just, you know, relaxed in bed, you know, waiting for things to continue. I don’t remember if they then gave me Pitocin in order to keep my labor going. I don’t remember what exactly what happened with that.
Dr. Fox: Probably.
Chanie: I just remember lying in bed. I think I got to the hospital sometime in the middle of the night. It continued on all throughout the day. I got to nine centimeters dilated and the baby was still up very high, I think minus three, they said. And they gave me some more time for the baby to come down. The baby did not come down. So it was about 5:00 PM on Sunday afternoon and they said, “Okay, we’re gonna have to do a C-section.”
Dr. Fox: And this is the midwife who said that?
Chanie: Yeah, and her doctor. She worked with a doctor in her practice. So her doctor was in the hospital at the time as well and she was finishing up another birth. So she said, “You know, if you need a C-section, I’ll be here to do it,” and she did the C-section.
Dr. Fox: What was your thought at the time? Again, you’re trying to have a vaginal delivery, you’re trying to do it as natural as possible, things went sort of little sideways, you know, you have an epidural, you’re on Pitocin, but you’re still with the people that you were with and that you trusted. How did you feel about that decision when the midwife came in and told you that she thinks you needed to have a C-section?
Chanie: To be honest, I don’t know what I was thinking at the time. I think I was kind of overwhelmed. Everything that was going on, you know, just everything wasn’t going the way that I planned and I didn’t really know what to expect with the C-section. At the time, I don’t know if I was thinking this, but looking back, I definitely doubted whether it was truly necessary because I don’t remember that there was anything concerning about the baby. Looking back as well, the fact that my C-section was at 5:00, I wondered if the doctor just wanted to go home.
So definitely, I don’t know if I was thinking that at the time. I was overwhelmed probably to, you know, think clearly, but looking back, I wondered if it was truly necessary, but I tried not to think about it too much because I didn’t wanna think about, you know, all the, what-ifs because it was out of my control. I had a C-section, it was done and my only thought after the C-section was moving forward, “What am I gonna do now?”
I didn’t wanna think like, “Oh, if the situation would’ve been different, maybe I could’ve ended up without a C-section. If they would’ve let me go longer, maybe I would’ve been without a C-section.” I didn’t wanna go down that path, so I just tried to, you know, think towards the future.
Dr. Fox: No, listen, I think it’s a very healthy attitude.
Chanie: They did say that the cord was wrapped around his neck twice and I think they used that as a way to explain he wasn’t coming down and why I ended up having to have a C-section. But one of my subsequent births that was a vaginal delivery, the cord was also wrapped around the head twice, so it didn’t seem to me that that was necessarily a good explanation. It could have been possible that that was what was keeping the baby up.
Dr. Fox: It depends how long the cord is. Your doula, who is with you, was this a very experienced doula?
Chanie: Yes, very experienced doula. Some friends of mine had used her. She had done like, I don’t know, hundreds of births.
Dr. Fox: Right. And what did she think about the decision because sometimes the doulas will, you know, sometimes they’ll bite their tongue and sometimes they’ll sort of say to you, “I don’t know about this,” or you know, “speak out loud about that”.
Chanie: Right. So I don’t know. I’m not sure. It’s hard for me to remember that far back what she said or what she thought. She was with me for a very long time, so I think she was getting tired as well.
Dr. Fox: It’s hard.
Chanie: Yeah, exactly. It’s hard when births go on for a very, very long time, especially being in the hospital for a long time.
Dr. Fox: After that happened, you said you’re looking forward, what did you do with your next pregnancy in terms of doing a C-section, attempting a VBAC? Did you go to the same practice, a different…? How did you play that?
Chanie: So immediately after the birth, I remember just reading a lot about C-sections and VBACs and, you know, just trying to make sense of it all. I definitely knew that I wanted to try for a VBAC. When I went for my postpartum visit with the doctor who’d performed the C-section, she told me, “You know, don’t worry, I know you might wanna have a large family, so there are people who can have up to four C-sections and that’s normal. And I have five children, so I definitely have more than four.”
So I knew that continuing to have C-sections wasn’t the way to go for me. And I started, you know, looking into different practices that would do VBACs and I found a practice that was famous for doing VBACs. They had a very high VBAC success rate. When I got pregnant, I went to that practice and they said I was a great candidate for a VBAC and I went with them.
Dr. Fox: How did you find out their VBAC success rate? I mean, I’m in the field and I would have no way of figuring that out in any practice. Where did that come from? Did they advertise it, like, on their website or something?
Chanie: I think they advertised it and I also heard by word of mouth from, you know, many people who had used that practice, that it was, I don’t know, somehow, just through the internet, somehow I just found out that they were very well known to be advocates for VBACs and would be successful at doing VBACs.
Dr. Fox: And from your conversation with the doctor who did your C-section, it was your impression that they thought it wasn’t an option at all, or just that you weren’t a good candidate or just, in case it didn’t work out, you could have up to four C-sections, which makes no sense to me either, but whatever.
Chanie: I think it was in case, in case it didn’t work out. I don’t remember the doctor telling me that I couldn’t try for a VBAC, but I knew that I didn’t go back to that practice. I didn’t feel like they were the best fit for me. And yeah, there was nothing in my history that made me not a good candidate for VBAC. So I had a low transverse C-section and everything else, you know, there was no other risk factors other than the C-section.
So they said I was great candidate. I booked a different doula, this time, one that I felt was a better fit for me and was also a very big advocate for VBACs. And the pregnancy went smoothly. I do remember that the doctors said that they wanted me to come in at the beginning of labor because of the risk of uterine rupture, they wanted me to be on the monitor. And I think that when, like, when I questioned that, because I said that the hospital makes me feel very nervous and I don’t feel like the atmosphere of the hospital is…it feels like it maybe, like, tenses me up and keeps me from progressing. You know, maybe that’s why my labor took so long, I don’t know, but I just didn’t feel very comfortable in the hospital.
But they wanted to come in early and I think that the doctor had said that she had had recently a case of uterine rupture and that’s why she felt most comfortable with me being in the hospital from early labor. Now, I don’t know what exactly she meant by early labor and I don’t remember if I questioned her exactly about that, I kinda felt that she meant that the minute I started contracting, she wanted me to come in, but that’s what I ended up doing.
Dr. Fox: When you spoke to them, right, there’s usually two parts of the conversation. There’s the risk side of it, you know, the uterine rupture, “Come in on the early side, you know. We’ll deliver in the hospital. We can go to NICU. If there’s an emergency we could, you know, do a C-section,” you know, all those aspects of it. And then there’s the, “you’re a great candidate”, side of it, meaning, what’s the likelihood it’s gonna work for you, right, because even if the risk is low, if the chance that’s gonna work is zero, what’s the point?
What was your impression from talking to them or from their stats of your likelihood of having a successful VBAC? I mean, did you think, “All right, if I’m with these guys it’s 100%, or it’s 90%, or it’s 50/50, but I’m good with that.” Like, what was, if you remember, what were your thoughts or your impressions from them of how likely it was that you would deliver vaginally?
Chanie: That’s a really good question. I think I remember that on their website, they had, like, some kinda VBAC calculator where you would enter some certain information maybe and included the weight of the baby and I don’t know, some information, and it kind of calculated your so-called chance of a VBAC success. And I remember it being, like, something like 70-something percent.
Dr. Fox: Oh yeah, no, that sounds about right.
Chanie: You know, basically, you know, greater than 50%. So that seemed very promising and that was what my impression was, but in my head. I think I remember thinking, and that’s why this is a great question, I remember thinking that my chance was close to 100% because I felt that if I had the will, I could just will my way into having a VBAC.
Dr. Fox: Yeah, no, it’s interesting because the [crosstalk 00:19:24.604].
Chanie: And my will was very strong. So I thought it was almost guaranteed. Maybe I didn’t think100%, but I remember that I thought probably like close to guaranteed, like 99%, I was going to have a VBAC because I wanted it badly enough and I was willing to put in the effort and that was just gonna guarantee me a VBAC.
Dr. Fox: Right. The reason I’m asking is because when I hear you say, “All right, there’s a practice and they’re very pro VBAC and they advertise it,” that can mean one or two things to me. It can mean we have an, you know, an OB practice who’s really comfortable with VBAC and is an advocate for it and is really open for patients who wanna do it and they’re gonna support it.
Obviously, if it’s safe and, you know, do everything they can, which is great. Or you hear a practice where, you know, false promises, they’re doing this just to advertise, just to bring people in and then they pull the rug out from under you afterwards, you know, and you end up with the C-section anyways. And from what you’re describing, it sounds like the first, because you know, the calculator you’re referring to, it’s a well-known calculator that’s based on very good data where you can plug in, you know, various variables about your first delivery, about you currently and it’ll sort of spit out a percent likelihood of success and the fact that they were using that, or something like that and not just saying, “Oh yeah, 100%, you’re good to go,” I think is really honest of them.
And it sounds like they were truly a group that’s just trying to support people who want a VBAC and doing their best. And I do think that, you know, sometimes like you said, people hear optimism, and then you sort of take it to the next level, which is like, almost like a sure thing, “Okay. You know, that happens, that’s not a problem.” But I was just, I’m curious and it’s interesting that that’s how you felt compared to what they had told you.
Chanie: Yeah. I don’t think they overpromised. And I do believe that they really truly are very successful with VBACs. It just happened to be, again, that my circumstances did not work out well.
Dr. Fox: You’re there, you’re in early labor, you’re on the labor floor.
Chanie: Yeah. So I’m in early labor and my doula was, you know, not so encouraging of me going to the hospital early. She said, “You know, remember, you know, last time you spent so long there and you felt, you know, it was a little bit of a stressful situation. So maybe, you know, stay at home a little longer.” But I said, “You know, if I’m going with these doctors, I have to listen to them. I have to trust them and they wanted me to come in, in early labor. Again, I don’t know exactly what they meant by that, but I have to go in.”
So, probably a couple hours after I started having contractions, we left to the hospital, and then the doula convinced me that I shouldn’t go up to the labor floor right away. So we kind of hung out. We found a little corner to hang out. I continued having contractions and then finally we went to the labor floor. I think I was two centimeters dilated and I was very disappointed about that because it was already a few hours.
And my first labor was almost 24 hours before I had the C-section and at that point, I was nine centimeters dilated. So I knew that, you know, first labors are typically very long. I was hoping this one would be shorter. So I went to the labor floor. I did feel a lot of stress in the hospital. The nurse wasn’t too kind. She was kind of like…it seemed like she was humoring me in my attempt to have a VBAC, like, “Oh no, this is not gonna work out,” you know, but…
Dr. Fox: Really? That’s odd.
Chanie: Again, it could be, that was just my perception. She didn’t say anything straight out like that, but it just felt like she didn’t have patience for my attempt of VBAC. I didn’t wanna have an epidural. So I was, you know, laboring with my doula assisting me and helping me and at some point, I remember the labor was taking a long time. I was there probably for at least 12 hours and the chairman of the OBGYN in the hospital came to my room and said, “You know, we recommend a C-section.”
I don’t remember there being any indication, just the fact that, you know, I had a previous C-section and the labor was taking a long time and he recommended a C-section. And my doctor had actually come into the room before he came in and she said, “He’s going to come in. He’s going to recommend a C-section, but there’s no reason for you to have a C-section, so you can decline.” So I really appreciated that.
Dr. Fox: Well, pause, that’s really strange. You’re saying that your doctor, who’s taking care of you, who you trust, who’s watching you, is fine with your labor and does not think you have a C-section, but the chairman of the department felt the need to come in and tell you that you should have a C-section?
Dr. Fox: Like why? That’s so odd.
Chanie: It was strange.
Dr. Fox: Why would a chairman department care at all what’s going on? Why would he even know what’s going on with you? That’s so odd.
Chanie: I don’t know. It was very strange and I think at some point after I ended up having a repeat C-section, my doula explained to me that she had heard, like, chatter from other doulas. And I don’t know exactly where she heard it from, but the standing of my doctors in the hospital was very precarious and they were about to be kicked out of that hospital.
And the hospital wasn’t very tolerant of their approach to, you know, like, kind of a more natural, encouraging VBACs and my birth was one of the last births with that practice in the hospital, and a few weeks later they moved to another hospital.
Dr. Fox: Oh okay, there you go.
Chanie: So she kinda felt that my doctor didn’t have the power to stand up and say no. So she kind of had to let the head of OBGYN recommend a C-section, but then tell me privately that she didn’t recommend it.
Dr. Fox: I see.
Chanie: And that it was safe for me to decline.
Dr. Fox: I hear you. When he came in and told you that, how long had your labor been going on for? I mean, you came in, you were two centimeters, how many hours later was this? Was it 24 hours later or 12 hours?
Chanie: I would say it was probably about 12 hours later.
Dr. Fox: And do you recall how far dilated you were?
Chanie: I don’t know. Maybe five centimeters, maybe somewhere in the middle. I was somewhere in the middle of labor, that’s what I remember. And I just remember that it was taking a long time and every time, you know, they would come in and check me or it just, everyone…the attitude that I was getting was, everyone just felt like, “Oh, it’s taking such a long time.”
Dr. Fox: Had they broken your water, put you on Pitocin, anything like that or they just sort of…?
Chanie: No, they didn’t put me on Pitocin ever at all because of it being a VBAC and the risk with that. The doctor had offered at some point to break my water and I said I didn’t want her to yet. So, and then, so after I had declined the C-section when the head of OBGYN came in, you know, we just continued, you know, waiting around, doing different things. I was trying to walk around and do different moves.
Then at some point in the afternoon, I had been there since the middle of the night, at some point in the afternoon, my water broke on its own. And after my water broke, there was a little bit of meconium, and after my water broke, the contractions kind of went, like, got really crazy, very strong and then my baby’s heart rate started dropping. I don’t know how serious it was, I just remember that that was a concern. I thought to myself, “I’m glad I didn’t agree for the OB to break my water because then I would’ve regretted it and here, it broke on its own and there’s nothing I could have done about it. And you know, here’s what happened.” It didn’t become an emergency at that point. You know, the heart rate was dropping, but they gave me, you know, an oxygen mask and I think they don’t do that anymore. Is that correct?
Dr. Fox: Oxygen masks?
Chanie: They find that it doesn’t help. Oxygen mask when the baby’s heart rate is dropping.
Dr. Fox: It’s been shown not to help. A lot of people still do it.
Chanie: Right. So this was nine years or almost 10 years ago, at that point that, you know, that was a very big thing, “Okay, will we put the oxygen mask on to help the baby’s heart rate, to help the baby recover.” It didn’t become an emergency. I think the baby was doing kind of okay. They were okay to let me continue. And then just as the afternoon wore on, they felt like there was less tolerance for the long labor and I don’t remember exactly what happened. I think the OB came in and said, “Let’s try an epidural. Let’s see if that will get your body to relax and go the last little bit.” I was nine centimeters dilated, but the baby wasn’t coming down all the way. “So let’s try an epidural, see if your, you know, your body relaxing will help.”
Tried an epidural, tried some last-minute moves with the doula. She was, like, moving me around at a certain way to try to get the baby to come down and it didn’t help. And then I went for a C-section somewhere around 6:00 PM.
Dr. Fox: You noted that there was this difference of opinion, but did you feel that your doctors had given you a fair chance at it, or did you feel like that they made the call too early?
Chanie: I think they had given me a fair chance, but what my doula explained to me about the politics that was going on in the hospital just made a lot of sense. Looking back, it really did feel like they had their hands tied. They gave me a fair chance. I was there for a long time. Like, I think I was probably in labor there for around maybe 18 hours. I wished I would’ve had longer. And I don’t remember exactly how bad the baby’s D cells were. So I don’t know, like, how much of an emergency it was, but it definitely was never an emergency. They never ran with me to the, you know, to the OR to perform the C-section. At the time when we decided to have a C-section, you know, there was plenty of time, I signed the consent, they prepped me. It was not an emergency situation.
Dr. Fox: Right. No, it’s interesting because I didn’t know this part of the story before we’re talking now, but it’s exactly what we’re speaking about at the beginning of the podcast that it’s not only the doctor, right?
Dr. Fox: There’s also the system that they’re in, whether it’s the hospital, whether it’s the town, whether it’s the department, like whatever it is, there’s more to it because there’s a lot of people and there’s a lot of systems involved in someone giving birth in a hospital. It’s not just you and the doctor. And so, it can sometimes, there can be conflict there absolutely. All right, so you had two C-sections now, how’d you proceed after that?
Chanie: So I kind of remember just being in shock like, “I can’t believe this didn’t work out.” Like I said, I thought I could just will my way into having, you know, a VBAC. But again, I went for the postpartum visit, you know, the doctor tried to explain to me. She was very kind. She was fantastic. I do feel like they tried to give me as best of a chance as they could. But, you know, knowing the politics, it kind of made sense that they couldn’t do more than they did. And then they moved to a different hospital and which I hope they were more successful in.
I do think she told me that I could try for a VBAC after two C-sections, so I had that in my mind, but in trying to do a little research, I found out that it wasn’t so simple. There were a lot of doctors who would definitely not give you a chance for a VBAC after two C-sections and it seemed like it would be very difficult to find somebody who would be willing to do it.
Dr. Fox: It used to be an area of controversy. The American College of OBGYN had a statement on VBAC where they basically said if you’ve had two C-sections and no vaginal deliveries, you should not VBAC, meaning you should just have a C-section. And then several years later, they said if you’ve had two C-sections and no vaginal deliveries, you can have a VBAC. And there was really no difference in the data or the studies, not like someone studied this and found a new finding, they just sort of relooked at it and said, “You know, maybe that was a little bit too, I guess, conservative is the right word, maybe we shouldn’t have made that recommendation.” And they sort of changed it to give people more of a chance.
And subsequently, there’s been many more people who have, you know, VBAC, like, in studies and update on them after two C-sections. And, yeah, it’s a little bit riskier than after one and your success rate’s a little worse than after one, but it’s considered a reasonable thing to do, particularly based on the circumstances of your two C-sections, this sort of depends on those things. So, you know, sort of based on the year on this and, you know, you may find someone who said it is an option versus not an option and sort of the attitude generally shifted about it as well over time.
Chanie: I think, I remember looking up the statements by The American College of OBGYN, and I think it was, like, shortly after I had my second C-section, where they changed their recommendations, I think, if I remember correctly. So happened to be that a friend of a friend added me to a Facebook group, that was for moms who had C-sections and VBACs and on that Facebook group, somebody mentioned that they had a VBAC after two C-sections and I jumped on it. And I was like, “Oh, wow. Here’s somebody in real life who,” well, not real life, but, you know, online, “who actually did it.” So it is [crosstalk 00:31:24.337].
Dr. Fox: What we now call real life, Facebook life.
Chanie: Exactly, real-life. So here’s someone who actually did it. And as soon as I saw that, I think it was probably within a few months after my second C-section, I saw that and I said, “Okay, I know it’s possible, I just have to find, you know, the right practice who will allow me to do this, but I know it’s possible.” And at that moment, I knew that I was going to try. So through the same Facebook group, I found other women discussing a certain practice that allowed VBACs after two C-sections. So I went to that practice when I was pregnant and the whole attitude was, you know, they asked me for my story about what, you know, what caused the other C-section and their whole attitude was like, “Absolutely, you could do it. Like, there’s no reason why you can’t.”
And I just remember feeling extremely relaxed. Like, they were just very laid back, “You can do it. There’s no problem,” just like, it wasn’t a problem. Like, it wasn’t even like, you know, they discussed the risks of course and, you know, they told me that the risk of uterine rupture was double what it would be after one VBAC. But still, it felt reasonable to me. And I knew that the risks of multiple C-sections was also, you know, there were a lot of risks. So it felt like a reasonable decision.
The only thing was at this point, I was not 100% sure that I was going to be successful since I had already failed one trial of labor. So I kind of felt, I remember feeling like it was 50/50, it could go either way, either I would end up with a third C-section and then I would know that that’s it, like, I can’t do it anymore after three C-sections. You know, C-sections was the way to go or I would end up with a vaginal birth, and then, you know, that would be great. And I wanted to try, I remember debating it a little bit during my pregnancy, like, “Is this really the right decision?” And I remember thinking that if I didn’t try, I would regret it my whole life wondering what could have been. So I knew that I had to try, and if I failed, you know, I would be really a upset, but I would know that that’s just how it was meant to be.
Dr. Fox: Were people in your life supportive of this? Like, you know, starting, let’s say your husband, or maybe, you know, other family members or close friends, did they think that you were, like, doing the right thing, “This is great,” encouraging or were they like, “What are you out of your mind,” type of thing?
Chanie: He said, whatever I decide was the right thing. But he was very supportive of trying for a VBAC…
Dr. Fox: Smart guy.
Chanie: And he felt like, you know, “You’re very strong. Your will is very strong. You can do it.” I didn’t talk to a lot of people about it but I was in nursing school at the time and one of my professors, somehow, we got into a conversation about it and I told her that I was trying for a VBAC after two C-sections. And I remember she said something ridiculous like, “You know you’re crazy. Do you know your baby could die?” I don’t know. Something like that.
I don’t know what she said. She said something, like, very extreme that I was like, “Whoa,” like, it stopped me for a second until, you know, I thought about it again. And I remember that, you know, I had a doctor who I could trust and that this was a reasonable decision. So she thought it was crazy, but she, you know, she wasn’t making decisions for me. So my husband was supportive and, you know, my doctor was supportive and it felt like that was good enough.
Dr. Fox: Right. You said it was a group of doctors, I mean, it was a group practice, or was it a solo practice?
Chanie: It was a practice of two doctors.
Dr. Fox: Okay. And they were supportive and as far as you know, the hospital was on board with it also. You weren’t gonna get the same sort of shenanigans that happened the last time around?
Chanie: Right. So the hospital, I heard that they were supportive, but what I did hear is that the practice that I was going to with two doctors, they had some covering agreement with other doctors in the hospital where, you know, my doctors were not on call all the time, so when I was in labor, it could be, if my doctors were on call, they would be there. If they weren’t, then it would be someone else that they had an agreement with.
Dr. Fox: Got it.
Chanie: So I was kind of just hoping for the best.
Dr. Fox: Sure. Okay. And how did it go, your labor?
Chanie: So, I had the same doula I had with my second birth, even though I ended up with a C-section, it wasn’t her fault and I felt like she was very supportive and knew what I wanted. I had her again and she was actually in nursing school at the time as well, so we had a lot to bond over. My labor went, again, it was very long, so I’m not one of those people who have first labor being very long, and then subsequent labors are much shorter. Again, my labor was almost 24 hours and my doula was with me at home.
So this time the doctors, they did not tell me to come in right away. They said, “Yes, you know, you should try to stay at home as long as possible.” I don’t know exactly what they meant by as long as possible. I didn’t question that, but I ended up getting to the hospital when I was 10 centimeters dilated.
Dr. Fox: Whoa.
Chanie: I don’t know if that’s what they had in mind, but that’s what happened. But just to backtrack a little bit about how important the support of my doula was because I felt like I had a strong will to do it, and I was ready to, you know, withstand the very long labor. But without my doula, I definitely, definitely couldn’t have made it. She was with me the whole time at home and at some point my labor was very long, it started somewhere like 3:00 in the morning and then that day at the evening, at dinnertime, she lived quite close to me and she said, “Let me just run home to get something to eat for dinner and I’ll come back soon.”
And when she left, I remember I just broke down. I said, “I can’t do this anymore. I have to go to the hospital, either I’m gonna get an epidural or I’m gonna get a C-section. I can’t stand the pain anymore. This labor is never-ending.” And I just felt like all my will was gone when she left. So she came back and she, you know, she recentered me and, you know, we got through it. But the support of my doula was invaluable. I know I could not have gone through such a long labor, you know, not knowing what the outcome would be without her. So that felt very, very important to me.
So she came back to my house, we stayed at home a little bit longer and then I said, “Okay, that’s it. Like, let’s go to the hospital.” I don’t remember if I felt I was getting close to the end, but it just felt like my labor had gone on long enough. It was, you know, let’s say somewhere around 18 hours, it felt like it was time to go to the hospital. We went to the hospital. Again, she encouraged me not to go up to the labor delivery floor right away. We went to, they had like some meditation room or something like that, and we hang out there for maybe an hour. And then at some point, either she said, or I said, “Okay, let’s go up now.”
And when I went up, that’s when I felt like I was, like, about to give birth. They were trying to ask me questions at the desk and I was standing in the waiting room full of people, waiting, you know, for whatever reasons to go into labor and delivery. And I remember leaning against the wall screaming, “If you don’t let me in, I’m going to give birth right here.” And I remember just looking at the faces of all the people I was trying to avoid looking at me.
Dr. Fox: They’re all like, “Here, take my spot. You’re up. Please, cut me in line.”
Chanie: And finally, they just stopped asking me questions and a nurse came to take me in. They took me to triage and I just knew that, like, I was ready to push. I just knew that I was ready to go. They were assessing me in triage and I remember they were asking me what my history was. I said, “I had two previous C-sections. I’m going for a VBAC,” something like that. And the nurse practitioner who was the head of triage said, “You mean a TOLAC?” And I just felt like, “Whoa.” Like, it’s true it’s called a TOLAC until you’re successful. It’s called a trial of labor until you’re successful.
But I remember feeling like she didn’t have to put it in my face that way. You know, I said I had two previous C-sections. I was determined to, you know, try to have the VBAC. I know that it was a trial, but for some reason, she insisted on making it very clear to me that it was not a guaranteed VBAC.
Dr. Fox: That is a little petty to correct your acronym at the time. Yeah, I think that’s probably unnecessary. How long did you have to push, ultimately?
Chanie: So right away, they put the monitor on me and I think that the baby’s, like, heart rate was going down because, like, the baby was literally on the way out. So they said, “Oh, she has to get this baby out.” So they ran with the bed to a delivery room and my water had not broken. So they broke my water and I said, “Just let me know when I’m, you know, when I’m going to able to push,” and they told me I could push. I pushed for, I don’t know, just a couple of minutes, and the baby came flying out.
Dr. Fox: Oh my God. Amazing.
Chanie: And I was so overwhelmed. So overwhelmed. Like, I didn’t wanna hold the baby. I could barely speak. I was just, I couldn’t believe that after two tries of having a vaginal birth and all these years, I had finally made it. So I was just completely overwhelmed and I think my husband was the first one to hold the baby. I just said, “I can’t. I can’t look at him. I can’t anything.” I was just completely overwhelmed.
I remember turning to my doula and saying, like, “Did I really do it? Like, did it really happen?” I called my mother to let her know that I gave birth. And I said, I didn’t say I gave birth, I didn’t say if it was a boy or girl, I just said it was a VBAC. That was all I cared about. And it was, I remember the atmosphere of the room being very, like, celebratory. Everyone was very excited because I guess it wasn’t very common to have a VBAC after two C-sections. You know, my husband told me people were staying in the hallway like, “Oh, did you hear she had a VBAC after two C-sections?” There were a lot of people in the room. My doctor did not make it.
Dr. Fox: After all that?
Chanie: The covering doctor did not make it. There was a resident who delivered the baby because I came in and delivered within 10 minutes, so there was no chance for anyone to get there.
Dr. Fox: Wow. And then that’s amazing. And now subsequent to that, you’ve had more VBACs, right?
Dr. Fox: Amazing.
Chanie: I had two more VBACs since then. The difference between, you know, the first VBAC and the subsequent VBACs is that I just found every time it was harder to find somebody who was willing to do a VBAC after two C-sections. My second VBAC I found a doctor and then with my third VBAC that doctor had since moved out of state and it was very difficult to find. There was only two providers that were within an hour of me who were willing to do a VBAC after two C-sections. So when I found out [crosstalk 00:40:50.970].
Dr. Fox: So it’s interesting, should have gotten easier because you’ve already had a vaginal birth.
Chanie: Right. So it was easier as far as they believed that I could do it, but the risk was still the same. And I found out that a lot of it has to do with the hospital. There were doctors who told me, “I would love to do it, but the hospital doesn’t allow it,” or, “The hospital allows it, but they’re gonna require me to be in-house the whole time that you’re there and I just can’t, you know, sustain that sort of thing.” So [crosstalk 00:41:15.562] that’s what I found was a big reason why there were some people who were not willing to do VBACs due to the hospital.
Dr. Fox: Yeah. And some of the smaller community hospitals, again, they’d be very good hospitals, one of the reasons that they’re not in favor of VBAC or after two C-sections is there’s things you need. You need an anesthesiologist there 24/7. They’re gonna want your doctor there the whole time and in a lot of these hospitals, they can’t do that. Like, they have small practices and they can have someone in early labor that the nurses are watching and they’re in their office seeing patients and it’s just not an option for them to sit on the labor floor for 24 hours and cancel all their patients.
And so they just can’t do it. It’s unfortunate, but it’s understandable because maybe not every hospital is appropriate to do a birth that could have more complications. But you’re sort of stuck if you don’t live near one of the bigger ones. It’s tough.
Chanie: I agree that it doesn’t make sense for every hospital to be offering this, you know, a VBAC after two C-sections, but the hospitals that actually couldn’t offer it to me and that people told me, “Oh, you can’t have a VBAC there,” were not small hospitals. They were big, you know, best hospitals in the state, hospitals that had anesthesiologists 24 hours. It just seemed like there was some other reasons why they just didn’t wanna offer it. It wasn’t smaller community hospitals, these were big hospitals that were [crosstalk 00:42:33.287].
Dr. Fox: Yeah, no. Some of the big hospitals that won’t do it, it’s, I assume, it’s just the risk thing that someone from risk management or legal just says, “No, it’s not worth our time.”
Dr. Fox: And it’s unfortunate.
Chanie: It seems that there aren’t enough women who are interested, you know. It’s just not a very common thing. So actually with my most recent birth, I ended up going to a hospital an hour and 15 minutes away, driving for, you know, for every appointment, just to have VBAC. But of course, at this point, knowing that I’m able to do it, it’s important enough to me to make that effort just because I know that the risk of C-sections is not something I wanna take on.
Actually, interesting, I just wanna mention also it’s definitely something that I was never told before. After I had my VBAC, about two years later, I was having extreme abdominal pain. I went to the emergency room and I found out I had a small bowel obstruction and they asked me, “Did you have any previous surgeries?” And I said, “Yes, I had two C-sections,” and they, you know, looked at me like, “Oh yeah, that explains it.” And apparently, you know, a risk of abdominal surgeries is that the scar tissue will somehow cause something to happen, you know, get stuck or wrap around the bowel or something like that and cause a bowel obstruction or other issues.
And that was a pretty big deal. I almost had to have another surgery to resolve the bowel obstruction. Luckily, I didn’t have to and it resolved on its own, but that was definitely something that I never heard of was a risk of having C-sections. But knowing that, that happened to me and that there was a very high likelihood of it happening again, it was a, you know, even more of a motivation for me to avoid having the C-section ever again.
Dr. Fox: I mean, listen C-sections are safe, but yeah, you’d really prefer not to have them because there are possible complications in the future. There’s complications at the time, obviously, but also in the future. You have scar tissue, things like bowel obstruction, your next C-section could be harder if you have another one. I mean, yeah, there’s problems with them and so they’re best to be avoided unless it’s absolutely necessary.
And it’s tough, you don’t always know. What do you, you know, your stories are awesome that you had, you know, you really tried for two pregnancies that didn’t work out and then the third one, like, “Boom,” it just, everything worked out perfectly and it changes your entire birthing course moving forward because then you have three vaginal births instead of three more C-sections and that’s huge for your recovery and [crosstalk 00:44:49.159].
Dr. Fox: Huge. I mean, for, you know, the difference between, you know, a third vaginal birth after two C-sections versus your fifth C-section can be life-altering. I mean, you could end up with a hysterectomy after your fifth C-section if you have a placenta previa. It could be a real big deal. So, it’s really awesome.
Chanie: And the recovery was just like, you can’t even compare it. I felt so good after my vaginal birth, just absolutely amazing.
Dr. Fox: What did you take away from all this or what you wanted to impart on our listeners from your story? I mean, you’ve been through this, you’ve seen both sides of the coin, you’ve C-sectioned, failed TOLAC or VBAC, a successful one, you’re in healthcare yourself, you know, what’s going on in your head with all this?
Chanie: So, first of all, I’m very thankful to God that He, you know, allowed the circumstances to be this way. I realized that the circumstances of each of my birth is not something that I can necessarily control. I could control, you know, what practices I go to. I can control my will. I can control, you know, whether I wanna, you know, go to the hospital right away or have an epidural. I can control certain things, but there’s some things I just can’t control. And, you know, I’m very thankful that, you know, God just let it work out and, you know, the way that I wanted it to work out.
And another thing that I think is, like I said before, that my doula was just invaluable and I know not everybody, you know, feels that way about having doulas. Some people feel it’s unnecessary, some people feel it’s intrusive. But for me, I know that I could not have had my vaginal births without having a doula. The other thing that I wanted to say is, the way that I found all of the providers that I went to, who were encouraging of having VBACs after two C-sections, was by word of mouth, like I said, through a Facebook group and, you know, through other means. And I feel that word of mouth is actually very powerful in this instance because you can go to a doctor and they’ll tell you one thing, but you don’t really know unless you speak to people who have used, you know, that practice and given birth with them, you don’t really know what will happen in the end.
I’ve heard that there’s, you know, a lot of doctors who will say, “Oh yeah, sure, you can try for a VBAC,” but really they only mean you can try for a VBAC in certain circumstances. If you give birth before 39 weeks, if you, you know, if this circumstance and that circumstance, but anything that’s a little bit out of the ordinary, they’ll actually tell you that you have to have a C-section. So when finding somebody who is supportive of VBAC, I feel like the best thing is word of mouth and that’s how I found all of the doctors that I used. So I feel that was very powerful, you know, just mothers talking to each other, women talking to each other and telling their birth stories and telling, you know, who was supportive and who wasn’t. And then the hospital atmosphere is super important.
Dr. Fox: Yeah, like we were discussing, that it’s not just the doctor, it’s the whole system.
Chanie: It’s the whole system. And also, you know, the system that you don’t see, like, for example, like, what’s going on with politics or the head of OBGYN is not something that I would see. But what I do see is, you know, what’s going on with the nurses. And when I come in, how do I feel about the atmosphere? How do I feel about, you know, what they want from me in labor? My first VBAC, I was there for a very short amount of time in the hospital before giving birth. But my second and third VBACs, I was in the hospital for a couple of hours before giving birth.
And I can just, like, still remember the atmosphere that I felt in the room was totally supportive, totally laid back. It wasn’t, like, people rushing around and nervous and trying to, “Oh, no, we have to get the baby on the monitor.” Yes, they were monitoring the baby, of course, and everything was safe, but it just didn’t seem like a frantic type of… So the birth atmosphere and my subsequent VBACs was just very relaxed. I remember that the, again, with my second VBAC, my fourth birth, my doctor did not make it ,and the covering doctor who was in the hospital. I remember him coming in, like, he was wearing, like, a sweatshirt.
And I just remember the fact he was wearing a sweatshirt made me feel, like, really relaxed. Like, he wasn’t in a white coat and all official, like, he was just like, “Oh yeah. Okay, let’s deliver this baby.” “Sure. No problem.” Like, it was just, everything felt very relaxed. And with my third, most recent birth, it was just a few months ago, the nurse was just fantastic. Like, she was, some hospitals, I think it’s especially with teaching hospitals, the resident, or the doctor will always be the one to check your dilation, and this hospital, the nurse was checking me. And I remember she checked me and she said, “You’re nine and a half centimeters and if you turn a little bit this way, that will get rid of the last little bit that we need to get rid of before you’re ready to push.”
And she showed me exactly how to turn and how to maneuver, and within a minute of doing that, I was ready to push. And it just felt like she was so supportive and just trying to help me achieve that natural birth or the vaginal birth. And I think the atmosphere made all the difference, feeling supported and feeling like I was able to do it. And they supported, you know, a VBAC and, you know, gave me the will to continue.
Dr. Fox: Wow. No, listen, that’s a really important lesson for all of us in healthcare that, you know, people can read our faces and if we have negative attitude towards a patient or towards what they’re doing, or a decision they’re making, you know, either we shouldn’t have a negative attitude towards it. Or even if we can’t control, we have to be very cautious about how we interact with people and to try to be as supportive as possible because that mood in the room is a big deal, right? You can feel tension in a room versus relaxation. You can feel optimism versus pessimism.
It’s a real thing, certainly in labor and delivery and it’s important to try to keep the vibes good and positive in those circumstances. And I think that you experienced all of those like you just said. Chanie, thank you so much for volunteering. You do have a great story, I could tell you that right now, so I’m glad you volunteered. It’s really important for people to hear this, particularly those who are considering a VBAC, you know, sort of both sides of the coin, you can try and it might not work, or you can try and it will work and you know how to find people who are supportive of it. And I really appreciate it. Thank you so much.
Chanie: Thank you so much for having me.
Dr. Fox: Thank you for listening to “High Risk Birth Stories,” brought to you by the creators of the “Healthful Woman Podcast.” If you are interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at email@example.com. If you like today’s podcast, please be sure to check out our “Healthful Woman Podcast,” as well, where I speak with the leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Have a great day.
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