Our amazing VBAC journey.

Blissfully pregnant with my second baby, I dreamed of VBAC. I knew I could birth and I knew how I wanted to birth: In my own way, in my own home, in my own power. I did not see the fight ahead of me nor did I know the miles I would travel to do it.

I was first told by my close friend Jill, a midwife, that home birth after cesarean (HBAC) may be nearly impossible. In my home state of Florida, once a woman's uterus has been scarred she does not have the right to choose the place of her baby's birth. Only a doctor can make that decision.

I went to see the obstetrician in my town who has a reputation for being open minded and supporting natural birth. My licensed midwife friend had worked closely with this doctor during her midwifery training. I asked her to consider being our back-up physician. I listened with a heavy sadness as she told me the story of a baby who died during a VBAC trial of labor in the hospital. She said that my chances of birthing vaginally were only 60% because my operative note read "failure to progress'; and in her experience "these things tend to repeat themselves". She would, however, allow a trial of labor under her care in the hospital. My belly tightened at the thought of her coldness and I decided to continue my search for some way to birth the way I envisioned.

I called the Farm and Ina May spent a great deal of time talking with me. She educated me about single layer uterine suturing, a controversial subject I had not heard of before. This is a new way of sewing up the uterus in one layer instead of sewing up the separate muscle layers. This new method was introduced in the 90's and is currently being taught in medical schools. Its effectiveness is being researched. There is speculation that there is a higher risk of uterine rupture as well as a higher incidence of placenta acreta and placenta previa.

My operative note revealed that this type of stitching had been used on me. This left me with even fewer choices than I'd thought, for now even the Farm wouldn't allow my VBAC. Ina Mae herself told me she felt I should have my baby in the hospital. I felt desperate because I was afraid of the hospital. My first daughter was born there and it didn't feel right. I was treated with little (if any) respect as a homebirth transfer. She was taken from me immediately after the surgery and I could not follow her. I had to be calm and patient and wait for the staff to wheel me to her when they decided it was time and even then, they wouldn't let me nurse her.

For this birth, I didn't want fluorescent lights. I didn't want to be strapped to an EFM. I didn't want nurses changing shifts and probing me every hour on the hour to tell me if I was progressing at an adequate pace. I wanted to be left alone. I wanted to birth with my family in warmth and peace.

So I read and phoned and went online and talked to everyone. I memorized statistics. I asked so many questions. I weighed the possibilities intellectually until my brain ached, but my guts were still speaking loudest and they said to keep going. My own mother was worried. She was convinced that the safest place for me was the hospital and her fear kept her from hearing me. She couldn't accept that there may actually be danger there.

I knew my best chance of having a VBAC was with a skilled midwife and that is what drove me. I found a birth center in Taos, New Mexico that was still attending VBACs. My husband and I love that part of the country and saw it as an opportunity to spend some family time together to have our baby there. We're in no way wealthy folks, but are quite resourceful. I was about 4 months along at the time and that gave us enough time to work our butts off and save money. We made our 1984 Chevy conversion van comfortable enough to travel 1500 miles and live in for awhile with a man, a pregnant woman, a 5-year-old (Cypress, my daughter) and a sweet bulldog named Mia. My husband, Adam, built a huge family bed in the back, a counter with hand pump sink and propane stove, and a hand made trailer for all our stuff.

I had already called the birth center and spoke with one of the doctors. I read him my previous operative note, and he said he thought all should go without a hitch. In the months to come as we were busy with preparations I called again with results of my ultrasound he'd recommended to rule out placenta previa. My placenta was fine and I wanted to confirm our plans. I was not ready for his news. He told me that the birth center had recently changed their protocol for VBAC. They had received the research studies Ina May had been working on and would no longer allow VBACs in their birth center for women with single layer uterine sutures. What now? Suddenly I had a revelation. New Mexico had looser VBAC laws, and midwives could make their own decisions to attend VBACs without the supervision of a physician. I asked for the names of local independent midwives and that's how I found Tanja Bolle.

I called her right away, with a feeling of great anticipation. She was rock solid. It was apparent to me that she was a true believer in the power of women, of birth. I could hear in her calm steady voice that she was wise. She listened to me for a long time. I told her my story, from my previous birth up to my current prenatal care and my feelings about it all. After speaking several times we agreed that we could work together successfully. Our plans were back on and we were bursting with enthusiasm.

The road trip with my family was so much fun! It was great spending so much time with my daughter and my man, watching the landscape change through Alabama, Mississippi, Arkansas, Oklahoma, Texas, and finally, the Land of Enchantment. After three days of driving and sleeping in WalMart parking lots we made it to New Mexico. It was August and my baby was due to be born in October.

We headed straight for Santa Fe to meet Tanja. I felt nervous because my due date was only 10 weeks away and I knew the feeling between us needed to be cozy. She had attended a few VBACs without trouble and felt confident, but the fact that I traveled cross-country for it added more weight to the situation. She had a way of quietly noticing everything and also a directness that put me at ease. That was exactly what I was looking for in a midwife though I could never have articulated it at the time.

We looked over records and moved on to prenatal stuff; blood pressure, etc. It was fun, the two of us sitting on her couch together. I remember thinking that this is how it should be and felt sad for all the women waiting in cold doctors' offices for their embarrassing five minute exam with no time to get to know each other. Yes, this was going to be good.

We spent the night in the WalMart parking lot once again--it was pretty late and we were tired. The next morning we set out for the hot springs to soak up the beauty of this new land. We relaxed in the spring and listened to the Rio Grande swooshing beside us, at peace and feeling welcome by the mountains surrounding us. We camped for the night after cooking a pot of rice and beans and picking guitars, singing together under the vast New Mexican sky.

The next morning we woke, took another dip and headed back to town for treats and information at Cid's, the local health food store. We were hoping to find an affordable place to stay for 3 months. As I scanned the bulletin boards, my heart sank. It was all so expensive. We were headed out when we met a man named John. He was passing by and on a whim we asked him if he had any ideas on finding cheap housing. He told us about the place he lived, on a mesa just outside of town where the land was real cheap and there was a fledgling community. He had a 4-year-old daughter and loved the life there. He gave us directions to the man who owned the available land and who also resided there.

Ben showed us around in his little Nissan pickup, introduced us to a few of the locals, and then showed us the maps of available land. We camped out there that night and spent the next three days hanging out and meeting more families. By the fourth day, we picked a spot, bought it for less than typical three months' rent and settled in. We were the proud owners of a 3/4 acre plot of land with nothing on it but sage brush. It was just enough to enjoy the panoramic view of the Sangre de Cristo range and park our van for awhile. We were stoked!

Life on the mesa proved to be exhilarating. In just a couple of weeks we made so many friends. Most everyone there was building a house and buying solar panels and cisterns. There were a few families that were already set up and their places were magnificent! There were always work parties on the weekends with children and bonfires. I became close with two women expecting babies also, and my husband found comeraderie with local fathers and musicians. This place felt like home to us.

During our stay on our new land I still had other issues on my mind. I needed a back up OB, for my own peace of mind in case of transfer. Tanja recommended a woman OB an hour's drive south. I went to see her and she was great. She said to me, " I have to say that I think HBAC is a terrible risk. I was just at a convention where the subject of uterine rupture was the focus and it's scary, but it's your choice and you'll probably be fine." I appreciated her frankness. She did not lecture or try to talk me out of it. It was obvious to her I'd made my decision and she respected that. On my way out she said to me, smiling, "Hope 1 don't see you again- I probably won't." Humor and all, her words felt like support to me.

At 36 weeks, while eating with neighbors on the land outside our van, I was sitting, rubbing my belly, when I felt what was obviously a round head between my ribs! During this pregnancy, I took it upon myself to read midwifery texts and learn about palpating my baby's position (my cesarean was due to an asynclitic presentation and l found out I have a heart-shaped uterus which can lead to fetal malpresentation). I figured if anyone was going to notice that my baby wasn't presenting right it would be me. I asked my friend Megan to feel and I could see it in her eyes that she knew the baby was breech. I went to bed that night questioning myself. Had I come all this way for nothing? Why did I leave my family behind? Was I taking unnecessary risks?

I dreamed that night of ballet and music, my lifelong passions. When I awoke in the chilly desert stillness of our van, I said to my baby, "I don't think you really want to be born this way. Do you want to try and turn around?" Lying on my back, I cupped my hands beneath her little bottom just behind my pubic bone and lifted her upward ever so slightly. She twitched to my left! I could feel the curve of her back on my right side and she was disengaged and headed the right way! Keeping her head flexed, I massaged her millimeter by millimeter round the circle of my big belly. We leaned this way and that as I felt the pull of gravity aiding us. I rolled to my knees and sometimes, I lay on my back. We slow danced for hours, pausing frequently to listen in the stillness for her signal to continue. I can't explain how I knew what to do. It's true that I had a rudimentary understanding of midwifery basics (from Elizabeth Davis' "Heart and Hands"), but mostly my baby told me what to do. She guided me and I followed. Finally, when the sun was rising pink over the mountains, I woke my husband and we sat together in the peace that our baby was now vertex, and that I did it with only the help of my baby.

Three weeks before my due date my midwife gave me incredible news! A previous client had a place we could stay for the birth and postpartum period. It was a beautiful 4 bedroom house on ten acres just ten minutes from the hospital with a fireplace and gorgeous view! All she asked in return was that we water the plants there and keep it clean. It was on the market for sale for $375,000!!! I'd never imagined such a selfless gift could be given to our family. We moved in two weeks before my due date, just in time for my oldest and dearest friend Grace to arrive. She would help me with Cypress during the birth and the days following.

Now, for the climax of our trip, the whole reason for coming ... the birth! It's difficult to describe my own birth. In retrospect, I understand what happened, but at the time it was all physical, emotional. It went something like this ... just before dawn on Wednesday, October 25th, I felt a delicious tingling in my womb, like a longing. I got out of bed and my mucous plug slipped from my body a little while later. I made myself some wheat biscuits and noticed that the hibiscus in the greenhouse had bloomed this morning. I knew my baby would come that day. I had tightening and squeezing feelings throughout the day and when evening fell, my body surged into painful labor. Tanja arrived around 5:45 and by then my whole body was shaking. I expected Tanja to tell me that I was in transition but I was only at 2 centimeters. I began to vomit and scream. I spun out of control and all I could think of was that my uterus could rupture and my baby could die, and that if I didn't go to the hospital right away the chances of cesarean would only increase. By 9:00 when I was still not dilating I completely panicked and decided to transfer.

The doctor that I chose was not on call, and in her place was a woman my midwife had never heard of. By now, I was in such a state of distress that all I wanted was to be knocked out. I had relinquished all expectations and given in to the fear. The doctor arrived and stood beside me quietly and watched. She watched the monitor I swore I'd never be hooked up to and she watched my howling, grimacing face. In the seconds between ripping contractions, I said to her, "I know I'm not handling this well." I was overcome with shame and embarrassment--this was not how I wanted to be. And she said, "Those contractions are coming pretty fast and furious. I think you're handling it quite well." I trusted her. She was respectful and wanted to encourage my strength. She waited a good hour through my begging for narcotics before she finally acquiesced and even then she gave me only 2 mg of stadol and said it would only last about 45 minutes. The drugs settled in and I sat back, breathing in the oxygen from the mask strapped to my face.

I faded in and out for awhile and then noticed that Tanja and Adam seemed distant and far away. If I breathed 8 deep breaths, I could make it through each contraction. Labor still hurt, but I was unable to be too intellectual. I forget about my scar. The haze began to lift and about an hour after the drugs were administered the doctor announced that I was entering transition at 6 cm. Suddenly, I was acutely aware that my uterus was functioning and that I would birth my baby. The birth team left to prepare for the birth and I recall a moment of stillness, of sweetness. When they came back the doctor discovered that I was completely dilated except for an anterior lip. Tanja and Adam helped me to my knees, I held onto the bed post and panted through insane pushing contractions. I was doing it! And when the lip was finally gone, I squatted with Adam on one side and Tanja on the other. I yelled and grunted and pushed and nobody counted or told me when to push. In 20 minutes the baby was bulging on my perineum and I screamed at the pain. Her body came through my bones, through my flesh and I don't even recall a moment that she wasn't touching me. They handed her slippery baby self to me at once and I could barely see her through my tears and laughter. I was shaking now again but with fulfillment. I birthed and she was with me and she never left me. Cypress and Grace arrived within minutes. Our doctor did not discourage our decision to sign out AMA. She knew that we had good follow-up midwifery care.

We named our daughter Naylen. In Turkish it means fulfilled wish (we changed the spelling a little). I'd say we fulfilled a wish in each other, together. That's what we do as mothers. We initiate, integrate, sustain. We moved back to Florida two weeks after the birth to be with our families. I'm glad I followed my intuition. Who's to say the birth would have been much different had I stayed? All I know is that now I don't have to wonder if it could have been better if I'd listened to my heart, my instinct ... because I did, all the way to New Mexico and back.

For me it was a successful journey. Mostly what I learned was that birth takes a lot of courage. No one can give you the strength to birth. It truly does come from within. I tried to find my strength from statistics, midwives, my mother, but in the end, the strength was in me; my uterus, my baby. I think that's what we need to tell each other, that no one can save us from birth, that we don't need saving. We were born with the power to birth. We have to practice finding our power every day. I am learning how to feel fear without giving in to it.

Katherine Easterling is an ALACE trained childbirth educator. She lives in Tallahassee, FL with her husband, Adam, and her two daughters, Cypress (8) and Naylen (3).