Alison Spath shares with Adriana the many twists and turns included in her path toward a planned homebirth after two cesareans (HBA2C), including getting things started with castor oil, having to hold at bay the fear-based opinions of random obstetricians, celebrating her victories along the way, and a last-minute trip to the hospital.
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- International Cesarean Awareness Network (ICAN)
- Effect of Castor Oil on Cervical Ripening and Labor Induction: a systematic review and meta-analysis, Journal of Pharmacopuncture
- Castor oil for labor initiation in women with a previous cesarean section: a double-blind randomized study, The Journal of Maternal-Fetal & Neonatal Medicine
- Castor oil, bath and/or enema for cervical priming and induction of labour, Cochrane systematic review
- Inducing Labor with Castor Oil and Dates, Evidence Based Birth
- Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State, Obstetrics & Gynecology
- Planned home birth presents little risk where midwifery is well-integrated, University of British Columbia
- The VBAC Companion, by Diana Court
- The Business of Being Born website
Related Birthful episodes:
- VBAC Facts
- The Problem with Due Dates
- Cesarean Risk: What’s Your Place of Birth Got to Do With It?
- Choosing Your Care Provider
- What You Need to Know About Obstetricians (OBs)
- Is Homebirth for You?
- Evidence Based Care, Castor Oil, and More
- All About Inductions
- Rethinking the Pushing Stage
[Birth Stories] Homebirth After Two Cesareans, With Castor Oil and a Location Twist
Hello there, Mighty One! Right now we are having a birth story-filled summer, and so we’re going to continue sharing some of our favorite stories that you probably haven’t listened to for the next few weeks– and then in September, we’ll return to our topical series.
The story we have for you today courtesy of Alison Spath is one of the very first stories we shared on the show, and so I wanted to mention that since we spoke, there has been more research on the effectiveness of castor oil to induce labor, with the results being more conclusive in that it does help. I even have an episode with Rebecca Dekker from Evidence Based Birth on the topic, and so we’ve included links to the episode and the research in the webpage for this episode at birthful.com
Also, we have some other great topical episodes that were not included in the original show notes for this episode, simply because they didn’t exist at the time. For example, the episode on Rethinking the Pushing Stage with Whapio, and our episode with Robina Khalid where we talk all about homebirth, so we’ve updated those in the resources.
Now one thing I can’t believe I didn’t ask Alison about when we recorded was how much her son weighed at birth. The answer is 8 lbs 14 oz, and that will be important for you to know toward the end! The other thing that came up for me when re-listening to this story is how even though there tends to be a broad apprehension toward homebirth in our culture, we rarely hear about what the process of what transferring to the hospital actually looks like. So I really appreciate hearing how that was for Alison, the interactions she and her family had with all the different providers, the comparisons she’s able to make between the two locations, and especially seeing that even during time-sensitive circumstances, a transfer from home to hospital isn’t intrinsically a scary thing, especially when there is good continuity of care between the homebirth team and the hospital team. This is something that is echoed by the research, and we also included links in the show notes.
Alison is still a mom of three, and a fabulous IBCLC, birth doula, educator, and prenatal yoga instructor at Beautiful Birth Choices in Rochester, NY, which is also where I live.
Alright, enjoy the episode and continue enjoying the summer!
Adriana: Welcome to the Birthful Podcast. I’m Adriana Lozada, and today we’re going to continue with our Birth Stories for the Summer series. Today’s story comes from Alison Spath, and it has a bit of everything, as it was a planned home birth after two cesareans. I won’t tell you just yet how it turned out, so you’re going to have to listen until the end, but I will say there was castor oil involved. Stay tuned!
The Birthful Podcast, talking to maternity pros to inform your intuition.
Today, I have Alison Spath to tell us her most recent birth story. Alison, thank you for being here and thank you so much for wanting to share your story with all of us!
Alison: And thank you for having me! I am so delighted and honored to be here.
Adriana: This is good! I’m looking forward to this story because you have so many elements that come into it. So I’m gonna let you tell us, and you can give us a little bit of background because this would be your third birth.
Alison: That’s right! My son was born in 2012. And my first pregnancy and birth happened in 2003-2004 and I wanted a natural birth. And looking back, I did not do a very good job preparing myself. I knew what I wanted– I knew I wanted a natural birth– but, I didn’t educate myself very well, and just kind of thought, you know, “It’ll all just play out the way it’s supposed to, and my doctor will help me, and it will be fine.” That’s just not the way it turned out.
I ended up being induced at 41 ½ weeks and my daughter went into distress and I ended up having an unplanned cesarean. And while I was grateful that, you know, my baby was healthy and we were all fine, I was still really sad that I didn’t get the birth experience that I wanted. And the second I got pregnant again– two and a half years later, when my second daughter was born– it took me about 20 weeks to decide that I wanted to have a VBAC, but I felt like that was the right option for me. I read The VBAC Companion by Diana Court, and that was when I learned about doulas. And I hired a doula to help support me emotionally, help tell me that everything that was happening was normal, and planned my VBAC. And when I went into labor spontaneously the second time, my water broke at home– that was what started labor.
Adriana: Like in the movies!
Alison: Right! [Laughs.] Except in bed, not at the grocery store. And then when we, like, when I got to the hospital and was checked, we discovered that my daughter was presenting brow-first.
I met the same obstetrician, who had a very high cesarean rate– that I didn’t really think would matter too much, I know a lot differently now– he said it was going to be a very ugly birth and he recommended cesarean. And so I was scared. I was in pain. I said, “Yes, let’s have a cesarean.” Again, sad that I didn’t get the birth experience that I wanted and hoped for for us, but I feel grateful that everybody was healthy, and I felt I had some victories because I went into labor on my own this time and many fewer challenges with breastfeeding. So those are my two cesarean… (briefly!) my two cesarean experiences.
Adriana: So when you went in with a second one and there was a brow presentation… And that means that… so, basically, what was coming first through the outlet was the forehead, right? And also for all the listeners who may not know, VBAC means “vaginal birth after cesarean.” So after that first cesarean, you were having a go at trying to do a vaginal birth with the VBAC.
Adriana: When you went in and they found that the baby was a brow presentation, and your water had broken, and you were having contractions, you were in labor?
Alison: I was, yes.
Adriana: And how far along were you? Do you remember?
Alison: I was 40 weeks and, like, five days– so I was a little bit past 40 weeks.
Adriana: But in terms of… in labor, were you active labor, early labor, dilation?
Alison: Yeah, so I went in earlier than my doula suggested. She’s like, you know, I “could labor at home.” But my doctor said you should come right in and I was afraid– like, looking back, I just had a lot of fear surrounding birth and I was afraid something was going to happen to the baby. And so I went right in and I early labored at the hospital and then by the time the obstetrician arrived… So, my water broke around midnight, obstetrician arrived, you know, at the hospital around 6 a.m. and we had been there for a few hours. And by the time he got there, you know, contractions were coming pretty regularly. I was probably in active labor. And so when he checked me and said, “The baby’s presenting brow-first”– and I didn’t know what that meant either, so, thank you for explaining that it meant “baby’s forehead is coming first”!
And you know, my doula kind of said quietly to me, “Maybe you could ask, ‘Can we try some position changes and we can do some things before we run in for a cesarean?’ Because the baby is doing fine.” And so I agreed. And my doctor, who was very encouraging of VBAC, he wasn’t crazy about that idea, but he let us. And so he let us wait and try some position changes.
So I was laboring regularly. I was in active labor, to answer your question, and we tried lunges, and it was in labor, it was awful. I didn’t want to do any of this!
Adriana: “I don’t wanna move!”
Alison: Exactly! My husband told me later that the obstetrician was out in the hall, like, pacing the hall. He was just agitated, it seemed… And I didn’t know– which, I’m glad– but my mom was in the room, and she was nervous too. Looking back now, it really pays to understand how important it is the people that you surround yourself with when you’re in labor; it’s so important that you not let your mom pick up on those little subtle cues that people are giving.
And if everyone in the room doesn’t have confidence in you, it shakes you. It totally changes the decisions that the laboring mom makes. And it really affected me. And then when the doctor came back in and said, “I think it’s time,” I agreed. I was done. I was scared. So I agreed to my cesarean.
Adriana: Right. And being scared, that oxytocin wasn’t flowing as it would normally. Those things, you know they affect that, so it makes sense that that’s where things went.
Alison: So then, baby was healthy, like I said, and my recovery was smooth. So for all those things, I was really grateful, but still very sad that I just didn’t have the birth experience that I wanted. And I found ICAN (International Cesarean Awareness Network), and it’s an international nonprofit organization for moms who are recovering from cesarean emotionally or physically, or women who are planning VBACs. And I went to ICAN, an ICAN conference, and I felt so wonderful to find all these other women who had had cesareans and… I realized I wasn’t alone in how I was feeling. It was very nice to feel connected to other women who were mourning their birth experiences. And of course a healthy baby matters, but how a woman feels about her birth experience, that matters too. And it was just nice to kind of feel validated that I wasn’t alone.
Adriana: I’m so amazed that you actually went! I thought you were going to say you went to a meeting. You went to a conference!
Alison: Yes, and I ended up becoming one of the ICAN leaders in Rochester, and went to two conferences, and at those conferences– it’s only been one in 2008 and then again in 2010, or somewhere around there, they happen every other year– but when I was at these ICAN conferences I started to learn a lot more about birth, and I wish I knew four years earlier.
Adriana: So, what are some of those things that you learned that you wish you knew?
Alison: I wish I knew how much your care provider matters, and where you give birth, how much it matters. It’s really, really important, and you think, “Oh, it doesn’t matter […] I’m going to be the one in charge. I’m going to say how it’s going to be,” or I’m going to say that “my doctor will tell me exactly what I need to do.”
You know, some doctors have a very medicalized approach to birth, and there are other care providers who believe that birth is a natural event that happens in a woman’s life, and they treat it differently. The different care providers approach birth differently. And I had a care provider who had a very medicalized view of birth, with his very high cesarean rate.
And again, I thought, at the time, when I was pregnant, I thought “So? That’s fine. It doesn’t matter. It’s not how my birth is going to turn out.” So that was really what I took away from these ICAN conferences, was finding a care provider. That’s, like, the most important step– it’s the right care provider. And then where you’re going to give birth is the choice number… It’s just as important.
Adriana: And finding that care provider that fits with what you are looking for– because some moms are fine with a medicalized experience, but it wasn’t what fit with you, what your wishes were.
Alison: Yes, exactly. I needed to find a care provider who was… who matched what I was looking for in a birth experience.
Adriana: So who did you find?
Alison: So it was five years between my second pregnancy and my third pregnancy. And in that span of five years, like I said, I went to these conferences. The Business of Being Born came out, we would talk a lot about homebirths and midwives. And we’re also homeschoolers, and I got to know all these families who had homebirths, like, “Wow, these women all seem perfectly sane and normal, and they chose to give birth at home!” And most of these women had the birth experience that I was looking for. Because when I was pregnant with my first daughter, I knew that homebirth was an option, but I thought, “No way! That is not for me.” That was just not something that I never ever would have considered. But after, you know, going to these conferences and watching these birth documentaries and getting to know families that have given birth at home, it all seemed a lot more normal to me. Something that seemed like a real possibility. So when I got pregnant the third time, I marched straight into the local homebirth midwife’s office without a doubt that this was the right choice for me and this was where I was going to have the best chance at getting the birth that I wanted. A vaginal birth after two cesareans. So home birth midwife, that was where we went.
Adriana: Awesome. So, okay, you found the provider that fit your wishes. Cool. So then what happened?
Alison: So my pregnancy was very normal and uncomplicated. And I took in everything that I could. I already felt like I knew way more about birth now than I did, you know, with my two previous pregnancies. But I did prenatal yoga regularly. I stayed active. I walked all the time. I went to the Spinning Babies website. I did everything that Gail’s always said to do. I watched a million homebirth videos on YouTube so that I could normalize vaginal birth in my head. Like, “This is where my baby’s going to come out. This is where […], or where the baby’s supposed to come out.”
And I did a lot of mental and physical preparation ahead of time because I was worried I would go into labor on my own. It didn’t happen the first time. The second time, I believe, labor only started because my water broke. And I was just… I wanted labor to start on its own, to get baby into a good position, just do everything that I could to get labor to start and have things move normally with a minimal amount of medical intervention. And so I got to 41 weeks again, this time, and I tried to… I told myself I wasn’t going to worry if I got to– you know, it’s normal for me to go past 40 weeks. You know, as I got, you know, into the 41st week or, you know, past 41 weeks, I started to feel a little nervous.
And my midwife said, you know, “You can go and get a… have a nonstress test done, and an ultrasound, and just check, make sure baby’s still doing well, check on the amniotic fluid levels.” You know, she left that totally up to me, what I wanted to do, and I agreed. And so it was like 40, 41 weeks, 2 days that I went to that outpatient ultrasound clinic and had an ultrasound done and a nonstress test. And baby did great with a nonstress test, but ultrasound showed that I had low fluid– very low fluid– and they gave me a weight estimate of 9 pounds, 10 ounces. The obstetrician who reviewed my results came to speak to me and said, “You know, I don’t normally recommend homebirth, but I definitely don’t recommend homebirth in your situation with two prior cesareans and this 10 pound baby.” How quickly they round up to 10 pounds!
And fortunately, my very wise midwife said, you know, before I went in for this ultrasound, she said, “They might panic when you get there and you are, you know, had two prior cesareans and you’re so far past 40 weeks.” She’s like, “So, if something happens, tell them you’re just, you know, ‘thank you…’ for what, ‘Thank you for your advice. I’m going to go home and talk to my midwife and then we will make a decision together.'” And so I was prepared with what I was going to say, you know, depending on how they reacted. And of course, if something was immediately… baby was immediately in danger […] the OB suggested, “You need to go to the hospital right now, start your induction, or just schedule your cesarean because this is not a safe situation.”
And I’m like, “Okay, like, before I panic, I’m going to go home and call my midwife.” And that’s what I did. And, so my husband and I got on the phone with the midwife and she said that the low fluid was concerning and maybe we should try to get labor started sooner. I really didn’t know what she was going to say though, because I understand now that homebirth midwives, they don’t take chances. They want you to have a safe birth. You know, it’s not “homebirth or bust”– like, we’re going to have this baby at home no matter what. It’s going to have a safe birth, and maybe that happens at home, or maybe that happens in the hospital. So, I didn’t know what she was going to say, but she said, “Let’s just see if we can get labor started.” And her prescription to me was, or her suggestion, was castor oil, taking castor oil.
Adriana: That thing tastes so gross.
Alison: [Laughs.] And so I was, you know, like, “Okay. Castor oil.” I only knew a little bit about it. It seems a little, you know, sketchy to me. And so she answered my questions. And can I explain what castor oil does, like, how it works?
Adriana: Yes, please!
Alison: So castor oil is… It’s basically… It gives you diarrhea, and how I understand it is that when you have this upset stomach, it irritates your uterus from the inside, and sometimes if your body is ready, it can get labor started.
Adriana: It irritates the uterus by proximity! So, because your intestines are not so happy and moving and being, sort of contracting and… not contracting, but more like a spasm with the diarrhea, then the uterus, which is right next to it, goes like, “Ahh! If you’re moving, I’m moving.” And then it might get things going, right? [Laughs.]
Alison: Exactly, yeah. So we made a plan that like that night I would take castor oil, and then I would take it in the evening so that I would potentially wake up in the middle of the night with contractions. And then if I didn’t, we could make a decision then, like, “Do I have another ultrasound? Do I go to the hospital for induction?” You know, we would kind of just… we would take it one step at a time.
Adriana: And you would have– if things didn’t happen, or if it didn’t get things going– you would have a good night’s sleep and you would be well-rested, hopefully!
Alison: Yes, exactly.
Adriana: Yeah, great to start whatever process! Great plan.
Alison: Right?! Yeah, and so the plan was I’d take it at seven o’clock and six to eight hours to work, maybe I would wake up around 1 to 3 a. m. And so that was how we hoped that it would play out. So we spent the day kind of getting ready, and I had been having, like, irregular, mild contractions. So I just had this feeling that it was going to work, that it was… I just believed that it was going to get labor started.
And we had rented a birth tub, so we got the birth tub set up. We’ve got the house kind of picked up and just getting things in order, all like knowing I have this castor oil milkshake looming in my future. And it ended up being like eight o’clock at night when I took the castor oil… And I should back up and say that I tried to take a nap and I only ended up sleeping for like 20 minutes, but it was something.
And so, like, at eight o’clock, you know, took the castor oil and got my girls in bed, everybody in bed. It was finally like 10:45 p.m. that I got into bed and as soon as I laid down, like, my stomach started to cramp and I was thinking, “Oh, no!” like, “What did I just sign myself up for!?” Like, there was no turning back now.
So I spent some time on the toilet and just getting very emptied out and it was… It was intense, to say the least… just kind of dealing with diarrhea. And, you know, I didn’t sleep at all. I hadn’t fallen asleep at all when this all started. But by about 12:30 a.m. I realized that my stomach was like… the diarrhea had eased up, but I was still having these cramps, and then I realized these cramps are coming at about three minutes apart, so maybe this is labor, and I realized, “Okay! Yes! Oh my gosh!” like, “This is working! This is it”.
My husband had been working in his office downstairs, and he thought that I was sleeping, so he was leaving me alone. And I called him upstairs because I was ready for company, and very quickly I realized that things were moving right along. And so we called the midwife. It was like 1:30 a.m. and she said, “Why don’t you wait and see if things continue? We want to make sure that, you know, labor isn’t going to peter out. And call me back, like, in a half an hour to an hour.” And we agreed to that, but I was still feeling like I wanted somebody else there. And so that was when we called doula and said, “Please come and be with us.”
This is the same doula that we had with my first. She was my first plan to be back, somebody we felt very comfortable with and she knew what we wanted. And so she came; it was like 2:30 a.m. in the morning by the time she arrived. And we called the midwife back to say, you know, things were coming… contractions were coming regularly, moving right along here, and so she agreed to come. It was time for her to come too. And we had talked about… I was worried that knowing that baby had low fluid, you know, could baby go into distress with my low fluid? And she said, “We’ll come a little bit sooner than we otherwise might,” so we could listen to the baby regularly, to monitor baby, make sure baby’s doing okay. And we didn’t know if it was a boy or a girl, so that’s why I keep saying “baby.” So when she arrived, I was found to be four centimeters dilated, and baby was at zero station, so, you know, into my pelvis. And she said, “Alison, this baby is in your pelvis.”
And that was really big for me, because I had never gotten that far– I had never had a baby so far down my pelvis, so I felt like a little victory there already, and it just reaffirmed that “We’re doing this! It’s working.” That felt really good to know that I got further than I’d ever gotten before.
Adriana: Fabulous! And I find that with VBACs it can be really monumental because you’re always afraid of getting stuck at the same place… not stuck like physically stuck, but almost mentally stuck in the same place, as far as you got last time. So yeah, knowing you’d already passed that frees up so much mental space.
Alison: Yes, absolutely. So I could just be busy dealing with contractions now.
Alison: So, I continued to labor at home and listen to baby and things were going well. And at some point, I decided I was ready to get into the tub. And we live in the city and our houses are pretty closely spaced, and it’s the end of June and I was very worried, like, “Oh, my gosh, my neighbors are gonna hear me making noise,” But I ended up not caring at all, that I was just gonna do what I was gonna do, and if they heard me in the middle of the night, well, then so be it.
So I got into the tub and that was really wonderful. And one very clear image I have of my birth– it was so different from my first two– was laboring in my, you know, in a dark room and everybody who’s around me is just silent. The midwife was knitting, the doula was sitting right by me. My husband was there and nobody said anything between contractions. It was just quiet and it was dark and my children were sleeping and it was just, I realized now, like, “This is what labor is supposed to be.” I was just feeling very grateful for the way that it was playing out.
So I remember it was still dark, was when I first started to feel the urge to push and the midwife offered to check me to see how far along my cervix had dilated. And I said, you know, “Not yet.” I was a little afraid, not wanting to get discouraging news.
And she was fine. “We’ll just wait.” And so we continued on for little waves, listening to baby, checking the baby’s heart rate and everything sounded great. And just as the sun was coming up, it was about 6 a.m., the second midwife arrived, and when she came, we were, I was sort of ready then, like, “Okay, yes, let’s see, you know, how far along I am,” and I was checked–
Adriana: I’m gonna interrupt you for just a second, just to say: Why are there two midwives? I think we should explain that.
Alison: Let’s see, you know what? I’m not even sure that I know the answer to that question!
Adriana: So, they usually travel in pairs because for the actual… birth part, not so much the labor, but the birth part, is so that they can have… You guys are two patients, right? Mom and baby. So they can divide and conquer and make sure that in case of any… in case it’s needed, so one of them doesn’t have to be divided between the two of you, that each one can get the attention they need if the situation arose.
I think that that’s what I’ve been told. And I’m gonna get a call from tons of midwives that are gonna say, “That’s not the reason!” Hopefully it is the reason… Now, I’m pretty sure it is.
Alison: Yes. There’s a lot to do. There’s, like, running up and down the stairs, and there’s, like, sterilizing tools, and there’s getting things out of the car, and getting set up, and I think, like, “Many hands, they make light work.” It makes it easier.
Adriana: They do travel with a whole kit and caboodle!
Alison: Yeah! Like, they come with bags, and they have things for, in case baby needs a little bit of oxygen or anything like that. They have… I know that they have, like, Pitocin– or not Pitocin, but, you know, for after the birth, they have some drugs on hand if they need them.
Adriana: Yeah, they do have Pitocin for after the birth.
Alison: Right! Right.
Adriana: Not to augment, but in case of hemorrhage, yeah.
Alison: Right. And then even like moms who are Group B Strep positive, you know, they can administer antibiotics at home. I know that too. So when the second midwife arrived and I agreed to finally get out of the tub and be checked, I was found to be ten centimeters, but I had an anterior lip, so a little tiny bit of cervix left, but maybe it was a +1.
So it was all… you know, everything was good, but I still needed to keep going. But when I laid down, and they listened to baby’s heart rate, baby’s heart rate fell, like, down into the 70s, kind of low, lower than they wanted to see. But when I stood back up, baby’s heart rate bounced back up to the 120s, and they said, “You know, it’s like, oh, baby just likes it better when you’re in this position,” so I just continued to stay upright. And so they suggested that I could either– to get this anterior lip out of the way– so they could manually hold the lip back for a few contractions or I could walk my stairs.
And I decided on Door B because that sounded a little bit more appealing to me. It was just walking my stairs and labor to help, get my pelvis moving and hopefully get this last little bit of cervix out of the way. I was checked again, a little while later, lip was still there. And again, when I laid down, baby’s heart rate fell, but as soon as I stood up, baby’s heart rate came back up, so we continued–
Adriana: At that time, were you feeling like you wanted to push or were you holding back? What were you feeling?
Alison: I was definitely feeling the urge to push, and I felt like I couldn’t. Like I basically said, just only little gentle pushes, no, you know, not a lot of bearing down, because you need to get that lip out of the way before you really, like, can push because the cervix can tear, or just things can happen and or the cervix can swell if you push on the anterior lip. Would you say that’s right?
Adriana: If you push against the cervix it can swell and then you’re kind of going backwards because instead of opening up, you’re reducing the space by having the swelling. And since we’re talking centimeters, which is very small, every little tiny millimeter counts.
Alison: Right. And I definitely knew that. And so I was afraid, like… or not afraid… well, maybe! I just was like, “I will not push. I’m going to hold on here.” And I remember getting to the bottom of my stairs with my doula and my husband and having a very, very powerful contraction. When I made my way back upstairs, I said, “Oh, that sounded like a good one.” “Gosh, that sounded awful. What are you talking about?” And so I was checked again. The lip was out of the way. I was… Baby was +3, but baby’s heart rate fell like it had every time that I laid down. And then this time when I stood up, baby’s heart rate did not come back up and it stayed and we waited and we listened, listening to the heart rate that was definitely not in above a hundred. And I was in Laborland. I was… you know, I was listening, but I was definitely, like, just coping with the physical sensations of what was happening to me.
And then that was when the midwives said, “We have to go!” And I said, “Go where? Where are we going?” And said, “We have to go to the hospital.” And I just never imagined that we would transfer. I’d never kind of let that be one of the ways that the scenario played out. I never thought that I would transfer. And, you know, they said, “We just want…” you know, “You’re just going to go to the hospital and continue doing what you’re doing at home, what you’re doing here, but we’re going to… We want you to have, like, better, you know, resources available if something happens to you or to baby.”
Adriana: Right. They were just responding to what they were monitoring and they were seeing. And so, just to add some information here, like, usually the heartbeat is more around in between like 120 and 160, like that’s a broad normal range. So, below 100 is a jump from that range.
Alison: Right. Yep. And then after… Being a VBAC, the concern with VBAC is uterine rupture and that you’re… that scar can split. And if your uterus ruptures, it sounds awful. Like, “Oh my gosh!” like “Your uterus exploded!” It’s not like what it is, but still, like, if something happens to your uterus then there can be… there’s lots of risk involved there. And sometimes everything’s fine but other times it can be catastrophic. And so they’re watching for signs of uterine rupture.
And I know that, you know, heart decels is one of the leading signs that something is not right, and so nobody said that to me and I just wasn’t really thinking it at the time, but I know now that’s what they were thinking. They didn’t tell me that until after the birth and I was so grateful that I… Nobody kind of put the plant of this little seed in my head.
Adriana: Right! And you were in labor then, so you were in the process. My goodness. You were fully-dilated and +3, like you were so… baby’s ready to come out. [Laughs.]
Alison: So when she said, “It’s time to go to the hospital,” like, everybody flew into action. And I never even packed a bag! I didn’t want to jinx anything. I realized how much I didn’t think I was going to transfer with it. I didn’t pack a thing. And so my girlfriend was there to help with my children when they woke up, we had two midwives, a doula, my husband. And so we all like… I just grabbed a robe. I had been completely naked at home, of course, just grabbed a robe and, like, ran down the stairs. And we get down to the back door and my shoes aren’t there because we had cleaned up the night before.
And my girlfriend, like, kicked over her flip flops and she’s like, “Here, just wear my shoes!” It was so like… It was just madness, like, getting out the door. And there was definitely some adrenaline. It was a little intense. And as soon as, you know, we get into the driveway– but my driveway, again, like I mentioned, we live in the city, we share a driveway with our neighbor– our driveway’s packed with cars.
And we’re like, “Whose car are we going to take?” like, “How are we going to get to the hospital?” And you know, I’m in the driveway and I… Here comes a contraction! I’m squatting and my driveway outside and I’m pushing and I’m like, “Oh my gosh! Please let my baby be born, like, right now. Let this baby come out right now!”
No, no baby. So, you know, we kept moving. And my girlfriend was parked on the street. And so we made our way down the driveway. And there’s all sorts of hustling around. And we’re moving her car seats, because she has two children, too. And she’s getting her car seats out. And my husband has to run back into the house to get his wallet. One of the midwives was piling into the car with the doula. And my husband and I get in. And I scoot her back to town. Oh yeah, but before I sat down, I’m, like, waiting for all this to happen– like all this removing the car seats– and here comes another contraction, and I’m in my neighbor’s front yard across the street, squatting and thinking, “This will be so… It’s a great birth story if my baby is born in my neighbor’s yard.” That would be wonderful, but that is not–
Adriana: You just want that baby out! “We’re done!” [Laughs.]
Alison: And so I sat down and I thought I was sitting on the baby’s head, but the midwife looked and she’s like, “No, he’s just really low.” And so, we’re on our way to the hospital. And we live very close to, probably, what I consider the best hospital to be in Rochester– if you’re going to have, you know, some emergency situation, this is where we would want to be. We live very close, and we got to the hospital in four minutes. And I remember, like, driving and pushing in the car. The midwife is leaning over the seat listening to baby and the baby’s heart rate has come back up over 100. So that was reassuring, but being in the car and, like, looking down and there’s like blood on my leg and I realize I’m… in this mangled ponytail, and I’m like, “Wow! What a sight I am. I’m going to show up to the hospital like this. This is going to be great.”
And I also remember saying out loud, “I just want the cesarean. I am so done.” And so many times, women say, “I’m done! I want the epidural,” but my out was, “I want the cesarean,” like, “I just want this to be over with.” And like, “I’m done!”
It makes me kind of sad! I gave up. I really gave up. I was so just done. But realizing that a lot of women, you know, when you’re at that point of labor, you’re ready to give up, and everybody has their own way of giving up. So anyway, we got to the hospital, took four minutes, and they dropped me off at the emergency room entrance with my husband, and we were in the wheelchair, and it was totally, like, out of the scene of a movie, like, running through the hall to the elevator in the wheelchair, and when we got to Labor and Delivery, they opened the doors, and there was, like a wall of people standing at the desk, waiting for me, because the second midwife, who stayed home to, like, clean up, she called ahead to tell them we were coming and to explain my situation, you know.
And so they knew that I would be VBAC after two cesareans, I was coming in, we had heart decel, so they were ready. And that’s, like, one of the beauties of working with homebirth midwives, that they call the hospital ahead and say “This is what’s happening.” So, to think about that, it’s safe… Like, I think that it has this, like, if you don’t know anything about homebirth, you think that it’s, you know, it’s irresponsible and it’s not a safe choice to make. But, you know, I understand now that it is, and that midwives, they don’t take chances. They’re here, you know, for you to have a safe birth.
Adriana: And I think it’s important to, you know, that point is really good, the fact that, you know, she called ahead and they’re ready for you. It took you guys four minutes to get there, probably with the juggling of the cars and all that stuff and getting out the door. Maybe it was 15 minutes from beginning to end, would you say?
Alison: Yeah, it wasn’t very long.
Adriana: So if you were having the decels at the hospital it would probably take just as long as 15 minutes to get everybody ready if you were going to get to go to the OR. So that is a crucial part. I’m glad you brought that up because that is quite something that often is not thought of, that having the midwife call ahead and getting the hospital prepped that they know that you’re coming then, then they’re already on it.
People are waiting for you– and I, us birth junkies, that get into more things– we know that that’s one of the key elements of a city or a community that has a good homebirth practice is that’s the crux, the transfer, the seamless care between the home midwives and for all the normal parts, and then the OBs for the not so… or more emergency or more unexpected higher-risk elements of it.
Alison: And I’m grateful that they have a good relationship and they both have a good relationship, at least that, you know, they can call ahead and, you know, they’re respected in that sense. So, they were ready for me when I got there. And the first person that I made eye contact with was the OB that I had seen at the ultrasound office the day before who said, “Don’t have a homebirth,” and like she made eye contact with, and she totally had this, at least that was what I saw, this look that said, “I told you so.” But fortunately she was not… We were gone in a flash, we were into a delivery room, and they’re getting me into a gown, and they’re strapping me to the monitors, and as I’m getting into bed, it was a different obstetrician.
He said, “You know, we hear this is a really big baby and we might need to get the vacuum to get this baby out.” And, you know, of course, when I hear that, all sorts of doubts are pushing into my, you know, coming into my head. And I remember being in the elevator and on the way to Labor and Delivery, thinking, “It feels like a bowling ball is trying to come through my pelvis,” like, “I don’t know how this baby is ever going to fit out.”
Like, it just was… I had just never experienced anything like this before. It was so, so intense. And so when he says, like, “Vacuum,” and I’m thinking, “Yeah, I’m not going to be able to do this. I can’t do this. And I’m going to, I’m… Do I really need help?” Like, I didn’t know! And it was just very, very different than how it had been at home.
But so I continued laboring, continued pushing, and, as you know, I have my midwife and my husband and my doula, they’re all right there, like, just surrounding me and telling me, “You can do this. I think it’s going great. If something was really wrong with it, it’s taking you off to surgery now,” like, “Just keep going!” And, you know, I have just a lot of disbelief, like, “I don’t know that I can do this.” So, so intense. It’s so, it’s so hard. And…
Adriana: Were you in a room or were you in the OR?
Alison: No, we were in a room. I was not, but we were like… now I know that we were in a high-risk area. I didn’t know that then, but I know that now, that we had been moved. So we were very close to the OR. So I’m pushing, baby hasn’t… like, they started picking up more heart decels on the monitor and a resident OB– you know, student, a resident– came around and brought me the consent form for my cesarean and said, “You…” She’s like going through the item line-by-line!
I can barely open my eyes and she’s like, “If you can just sign the consent form right here…” And I thought, “Okay, no,” like, “This is where I’ve been before. I’m not signing that consent form. They’re gonna have to take me in with an unsigned consent form,” because I just, at that point, that was like my little moment that I had of clarity.
Like, “Nope! Nope. I’ve been here before. I’ve gone through so much. I’m not gonna do that.” And I think that now I know, they just wanted me to sign the consent form so that they were ready in case they had to take me in for a cesarean, but within minutes, like, baby was crowning, and my husband is watching. And for him, this is his first natural birth, too. He was a part of the cesareans, and, you know, this is brand new for him. And I hear his reaction; I hear him let out a little cry when he sees the baby’s head. And that was so like, “This is it!” like, “I’m going to do it!”
And, you know, I pushed the baby’s head out. And I watched so many videos and read so much. I thought, “Oh, baby’s shoulders don’t get stuck.” Like, I actually had that thought, but then before I knew it, like, baby was out. And so, you know, like we didn’t know if it was a boy or a girl– you know, we have two daughters and I had no preference.
My husband, he was very much hoping baby was a boy. And I, that was the first thing I needed to know. Like, “Is this baby a boy?” And I looked and yes, it was a boy, and we were like, “Oh my god!” I got to be the one to say “It’s a boy!” And they put this hot, slippery baby on my chest and I just thought, “Oh my gosh, I did it! I pushed my baby out. We all survived. It actually, you know, it happened. We did it.”
You know, it was wonderful and it was… there was a lot… there was some disbelief there that, you know, after everything that we had been through, I did it. I did it. I pushed my baby out. So it was wonderful. And I’m, you know, very happy with the way that it all played out. Even with the transfer, like, it played out the way that it was supposed to. So that’s pretty much my story!
Adriana: Wow, that’s a fantastic story, that has, like… I really appreciate you sharing also what you were thinking through the process and how there always seems to be all these little moments of doubts, because it is such an emotionally intense process that you’ve never been through. You know, it seemed like there was always that “Is this going to happen or not?” And feeling like you gave up, and then when you were sort of cornered and signed here, you were like, “Oh no!” [Laughs.]
Alison: And yeah, and I think that I think it’s normal for all, you know, for all my most mothers to have these moments of doubt, but especially VBAC moms, you know, that have… that didn’t… that have these doubts, “Can they do it? Is my body broken?” You know, like, “I’m amazing!” You’re not a lemon. Your body is not a lemon, but you are designed to give birth. And so, yeah, doubts, and it’s normal.
Adriana: Wow. Yeah, so much there, and just so much, I’m soaking it in still, because I hadn’t heard the full story beforehand. And so now you’ve really become a birth junkie in this process of learning everything, going to ICAN conferences and what… For full disclosure, what are all the things birth related that you do?
Alison: So now, like, after my birth experience, I ended up realizing I wanted to teach prenatal yoga. And then I went to the doula training. And, you know, just so that… I took doula training just so that I could have something else to offer my prenatal yoga students, but no, like, that didn’t work out like that.
Like, now I am a doula and I love, love, love supporting women in labor! I know how important it is and how important support is, like, having someone who really believes in you. And that’s just so crucial for us– a positive birth experience, even if it doesn’t work out exactly the way that you hope it might, to know that you had somebody who believed in you, who helps you feel safe, that’s really important. And I love, love this work so much.
Adriana: And all those families that you support are very lucky, because you bring to the table this wide range of experiences that you’ve kind of been through it all.
Alison: Yeah, so that sort of helps, that helps me kind of find meaning in my three very, very different experiences. Now I can take what I’ve learned, and I can have that help motivate me to… the things that I offer and the way that I offer it and the way that I, you know, help support women, that that brings meaning to these experiences that I had that were less than… that weren’t what I wanted. Everything happens for a reason.
Adriana: And both the yoga training and the doula training you did after this birth?
Alison: Yep, after my son was born, those things, that day that came after. And I felt, you know, I felt like, “Wow, I had this vaginal birth,” like, “Now I can do this.” And that’s sort of silly because there are plenty of wonderful doulas out there who have never had a vaginal birth or not even had a birth. And there can be wonderful doulas as well. But like, that was, like, what I needed, was where I was coming from. So, which I, you know, realized it’s not necessary, but for me–
Alison: –it was my journey.
Adriana: Well, I’m so glad that you are here to share it with us, and that you came on the show to share it with us, because like I said, we’ve known each other for quite a bit, But I hadn’t heard this story in its full extent. So yay!
Alison: Well, thank you! Thank you for the opportunity to share it. I really appreciate that.
Mighty Ones, I love to hear from you. Go to birthful.com where you can learn more about me, the show, send me messages, and more. This episode was produced by me and made possible by you. The title song for this podcast is Vive Ace by Kevin McLeod. And the sponsorship song is Air Hockey Saloon by Chris Zabriskie.
Find them both at freemusicarchive.org. I’m Adriana Lozada. Please join me next week when I’ll be talking to another maternity pro to inform your intuition here at The Birthful Podcast. Thanks so much for listening.
Lozada, Adriana, host. “[Birth Stories] Homebirth After Two Cesareans, With Castor Oil and a Location Twist.” Birthful, Birthful. August 16, 2023. Birthful.com.
About Alison Spath
Alison Spath is a mother of three and works as a private practice lactation consultant, birth doula, educator and prenatal yoga instructor at Beautiful Birth Choices in Rochester, New York. Alison began her work in the birth community as a volunteer, first as a Chapter Leader of Rochester’s International Cesarean Awareness Network in 2007, and then went to become a La Leche League Leader in 2008. Today Alison is an International Board Certified Lactation Consultant (2018), Certified Birth Doula with DONA International (2014) and Registered Yoga Teacher (2014).
Alison is honored to support families from early pregnancy through early parenthood. Her goal is to help families work toward their goals: whether someone desires a non-medicated or medicated birth, or hopes to exclusive breastfeed/chestfeed, exclusively pump, or to combo feed their baby, Alison cares deeply about the importance of personal and informed decision-making and aims to provide her clients with evidence-based information in all things related to pregnancy, birth, feeding, and early parenthood. Alison’s own birth and lactation experiences, along with her work with hundreds of families over the years, has taught her that there can be some unpredictable bumps and turns on the journey to parenthood. What’s most important to her is that families were informed of their options, feel supported, heard, and respected throughout all the many decisions they will make during this unique time in their lives.
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