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Episode 279 What are the chances if…?

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Nội dung được cung cấp bởi Meagan Heaton. Tất cả nội dung podcast bao gồm các tập, đồ họa và mô tả podcast đều được Meagan Heaton hoặc đối tác nền tảng podcast của họ tải lên và cung cấp trực tiếp. Nếu bạn cho rằng ai đó đang sử dụng tác phẩm có bản quyền của bạn mà không có sự cho phép của bạn, bạn có thể làm theo quy trình được nêu ở đây https://vi.player.fm/legal.

We know that unique circumstances in pregnancy can make a VBAC feel farther out of reach. Do your chances of having a VBAC go down if you had preeclampsia in a previous pregnancy or your current one? What if you have a special scar? What are the chances of having a VBAC if you were diagnosed with “failure to progress”? What about fibroids or gestational diabetes?

Julie Francom joins Meagan on today’s episode discussing evidence-based research around all of these topics. They share personal experiences as birth workers and overall takeaways that can help you confidently navigate your VBAC journey no matter what complications arise during your pregnancy.

Additional Links

Special Scars Studies

The VBAC Link Blog: Why Failure to Progress in Labor is Usually Failure to Wait

AJOG Article

Needed Website

How to VBAC: The Ultimate Prep Course for Parents

Full Transcript under Episode Details

Timestamp Topics

02:54 Review of the Week

5:51 Preeclampsia

08:57 Ask questions

12:51 Special scars

17:58 Failure to progress

26:15 Fibroids

27:54 Gestational Diabetes

35:06 Find a supportive provider, ask questions, and educate yourself

Transcript

Meagan: Hello, hello everybody. We are getting out of winter and maybe into some spring weather, hopefully. I always hope for spring weather in March because it’s my daughter’s birthday and she always wants sunshine, not snow for her birthday. So I’m crossing my fingers that this is the month we have sunshine, not snow. I hope you guys are having a wonderful beginning– well, I guess it’s not actually spring, but I hope you’re having a wonderful beginning of March.

We are kicking off our very first Monday episode for 2024. You guys, we have a little surprise for you. We are going to be sending out two, not just one, but two episodes a week. Make sure to tune in on Mondays and Wednesdays for stories and information. Today, we are kicking it off with Julie. Hello.

Julie: Hey. I’m so happy to be here and yes, I’m hoping it’s warm or getting there because I am just a popsicle permanently from November to March so let’s just thaw out a little bit, please.

Meagan: Just a little bit. Even if we just get some little sprinkles, let’s have April showers in March.

Julie: Yeah.

Meagan: You guys, I am so excited for today’s episode. Julie and I feel like these are some questions, I am definitely getting these questions on the weekly Q and A’s, but these are some questions that are often asked and we want to answer your questions today. We’re going to be talking about a whole bunch of things.

Julie: A whole bunch of things.

Meagan: What are the chances if I have preeclampsia? A special scar? Failure to progress?

Julie: Gestational diabetes.

Meagan: Gestational diabetes and maybe uterine fibroids. We are going to talk a little bit more about those. What are your chances for VBAC or vaginal birth if you have these things or have had them? Maybe you are not pregnant yet and you had preeclampsia last time or gestational diabetes last time. What are your chances?

02:54 Review of the Week

Meagan: So without further ado, I’m going to turn the time over to Julie for a review and we’ll dive right in.

Julie: Without further ado, here is Julie. Okay, this review is from Google. It is from Christa and she says, “This podcast is beyond empowering. After my C-section after multiple unnecessary interventions, I knew immediately I wanted a VBAC for my next baby. I found this podcast not long after and have been an avid listener for four years.”

Four years, wow!

Meagan: That’s amazing.

Julie: I know. “The VBAC link lifts the veil on birth and allows women to educate themselves and make their own decisions instead of just blindly trusting providers as many of us have in the past. Because of this podcast, the topic of birth/VBACs has become such a passion of mine and I now feel confident in my knowledge and ability to advocate for myself next time. I recommend this podcast to every mom and expectant parent I know. I am now pregnant with my second due March 2024–” Hey, that’s right now– “and am already preparing and relistening to every episode and have the honor to have Meagan as my doula–” What?! That’s awesome.

“Hopefully you’ll hear my successful VBAC story soon.”

Meagan, this is your client. That’s awesome.

Meagan: I love it. I love it. Thank you, Christa.

Julie: Maybe you’ll be at a birth soon for her. Holy cow, that’s amazing.

Meagan: I know. I love it so much. I love that she said that we lift the veil. That was so cool. Yes.

Julie: Yes.

Meagan: Thank you. You guys, these reviews, as you can see, we are over here smiling and gleaming on this Zoom podcast.

Julie: Smiling and gleaming.

Meagan: Yes, we are. So if you wouldn’t mind dropping us a review, your reviews truly help other Women of Strength find this podcast and find this platform. You can leave it on Google just like Christa did. You can go to Apple Podcasts. You can go to Spotify. Can you? I don’t know if you can on Spotify. Google or you can just email us. Email us at info@thevbaclink.com with the subject “Review” and you never know, you might be read on the next podcast.

5:51 Preeclampsia

Meagan: Okay, Julie. Are you ready?

Julie: Let’s do it.

Meagan: Always, right? Okay. Let’s talk about preeclampsia. You had preeclampsia with your first that did end up ending in a Cesarean. However, you went on to have three HBACs. HBAC if you are just new with us is Home Birth After Cesarean. So yeah. I guess right there I want to point out is it possible to have preeclampsia and then go on and have a vaginal birth? Yes.

Julie: Yeah. Yeah. Heck yeah, it is.

Meagan: Yes, it is.

Julie: I did it. You are speaking to the girl right here. Now, preeclampsia is kind of tricky because a lot of research shows according to the Preeclampsia Foundation. You can find it at preeclampsia.org. According to them, there is a suggested risk that you have a 20% chance of having preeclampsia again after you’ve had it the first time. However, there are some experts that site a range anywhere from 5% to 80% just depending on when you had it in your prior pregnancy, how bad it was, and any additional risk factors that you have.

So I have had clients, most of my clients that have had preeclampsia once don’t have it again, but I have had one client that has had it both times. My pediatrician had preeclampsia in both of her pregnancies. It really just depends on a lot of different risk factors, but preeclampsia also doesn’t exclude you from having a VBAC. You’re just going to have to get induced earlier for the safety of your baby usually around 37 weeks unless it is severe. They might want to induce you a little bit earlier than that.

But yeah, I just feel like me and Meagan– I’m going to go off on a little bit of a tangent and then I’ll bring it back. But me and Meagan were just talking about how a lot of these things– the biggest risk of VBAC is uterine rupture, right? That’s what we talk about. But a lot of these other things like gestational diabetes and preeclampsia and big baby and all of these other things, the risks of those or the perceived risk sometimes don’t have anything to do with VBAC. It’s completely separate. It doesn’t increase your risk uterine rupture. Not even big baby increases your risk of uterine rupture. There are no studies that support that.

Preeclampsia and VBAC should be treated separately although a lot of times, providers don’t treat it separately. They think, “Oh, you’ve had a C-section and preeclampsia so we should just schedule a C-section.” That is where provider bias comes into play and these perceptions when there are just not a lot of studies and evidence to support any of that, right?

Anyways, circling it back to preeclampsia, there are lot of things you can do to make your body healthy overall that may reduce your chances of preeclampsia although I guess we are still not entirely certain about how preeclampsia comes about in the first place.

But yeah. I don’t know. What do you have to say about that, Meagan?

08:57 Ask questions

Meagan: Yeah. I think it’s important to do what you were saying and separate the thought of, “If I have this, I have to do this,” when a lot of providers, especially if it is severe and we’ve got really, really high blood pressure and we are severe, they may specifically say, “You need to schedule a C-section,” but that doesn’t necessarily mean you have to and if you have preeclampsia in general, it doesn’t mean you are going to have a C-section. I think that’s one of the biggest takeaways from this episode.

Julie: There is no “have to” ever. There are no absolutes.

Meagan: There is no “have to”. Yes. There are no absolutes. There are things where you may be at increased risk of Cesarean, but that’s typically because of those things like induction, right? So yeah. There’s really no concrete evidence on what mode of delivery is best if you have preeclampsia. So again, it comes down to your provider. Get a supportive provider. Talk about it. Really ask them. If they tell you, “Okay, because you have preeclampsia, we are going to have to schedule a C-section,” ask them. Do not stray away from getting the evidence and the information that you need. You can say, “Okay. Can we talk about the evidence of why I have to?” Right? Ask questions. Don’t feel bad for asking questions. It’s okay. If you have that question, ask it.

Meagan: So yeah, I think that’s kind of it.

Julie: Yeah. I think the overall theme of this episode and maybe the whole entire VBAC Link period is asking questions to your provider, talking with your provider, and having a mutual trust with your provider where they trust you and you trust them. Right? It’s a two-way street where you guys can collaborate together and create a plan of care that is comfortable with you and comfortable with them. I know that a lot of care is centered around the provider and what they are comfortable with. Some providers are not comfortable with doing VBAC for preeclampsia or after two or more Cesareans or after a special scar or with gestational diabetes or whatever.

You need to have a plan that you are comfortable with and that your provider is comfortable with because I promise you that you don’t want a provider who is nervous about your care because they are doing something they are not comfortable with. I feel like that’s so important to have that mutual trust between yourself and your provider where they trust you that you are not going to do anything dangerous or stupid and you trust them that they are not going to do anything dangerous or stupid. Do you know what I mean? I say stupid loosely. That’s a very medical term, “stupid”, but it’s important. It’s important that there is mutual trust that you can discuss your plan with your provider. If you’re not on the same page with your provider, it might be a good idea to look for a different one.

Meagan: Yeah, it’s also important to ask, “Well, what are the chances of the negative outcomes for a scheduled C-section?” because on the NIH, and we’ll make sure to include the links so you can read them, but it did say, “An increased risk of various postpartum complications was found in patients allocated directly to having a Cesarean section including blood loss.” When we have preeclampsia, it seems that we have a higher risk of issues potentially, but bleeding is not a great thing. We have platelets being affected and things like that, we may have increased chances of blood loss which we already know, Cesareans in general have an increased risk of blood loss. So you may want to ask questions about what kinds of risks you have if you do schedule a C-section with a scheduled C-section in general. What are the risks there? What are the risks to you and your baby there? Yeah. Anyway, ask questions.

12:51 Special scars

Meagan: Okay, we’re going to talk about special scars. With a special scar, we do have a blog on that and it does have an attachment of a lot of studies and things that our favorite group of Facebook, Special Scars, Special Hope– is that? Am I brain farting?

Julie: Mhmm.

Meagan: If you have a special scar meaning you have anything other than a low transverse, so a J, a T, and all of those things, definitely check out that group. The unfortunate thing is that the studies we do have are not really up to date. We don’t have a ton of concrete studies that are really recent or even large particular studies. So we want to talk about just in general, what are the chances if you have a classical or a special scar? The chances are there. You can still VBAC. There may be slightly increased chances of things like uterine rupture, but it is still possible. We have stories on our podcast even of people who have gone on to have vaginal births with special scars. I’ve supported a client that had a special scar. All was really well and they just took a little extra precaution. They wanted to make sure that they knew the signs of uterine rupture and they knew which I think everybody should. They wanted to make sure that baby was doing okay and mom was doing okay. All was well and it ended up beautifully.

But all in all, I think in the end, it’s going to come down to finding the support and finding that support. That can be tricky. What are the chances to have a vaginal birth with a special scar? Possible. I don’t have a number for you. What are the chances of finding a supportive provider with having a special scar?

Julie: Harder.

Meagan: Lower. Yeah. It’s going to be lower and that sucks.

Julie: It does suck. It does suck. The special scars website at specialscars.org/studies has links to all of the notable studies, but the biggest studies that are out there show that your chances or uterine rupture are less than 2% with a special scar.

I feel like that might be an acceptable risk for some parents and that might not be an acceptable risk for other parents. I feel like that’s really important to acknowledge that what is an acceptable level of risk is different for everybody and each of your providers is going to have a different level of risk that they are comfortable with as well.

The hard thing is that there are not a ton of studies on special scars but special scars are not just about if you have different C-section incisions. It’s also about myomectomy, different types of uterine surgeries, and things like that. Basically, anything that is not in the lower uterine segment and has been cut or severed in some way. I don’t know the right way, I don’t know the nice way to say that, but if you have a history of any type of uterine surgery that is not on your lower uterine segment, that is considered a special scar. That could have absolutely nothing to do with pregnancy.

Meagan: Yeah. Yeah.


17:58 Failure to progress

Meagan: Okay, let’s talk about failure to progress. What are your chances if your last Cesarean was due to failure to progress? Imagine me putting big, giant air quotes around “failure to progress”. You know, I don’t know if this is one of those things I take to heart because it personally happened to me and I was told “failure to progress” and it kind of ticked me off, but your chances if you had a previous diagnosis of failure to progress to have a vaginal birth the next time around are pretty dang, stinking high.

A lot of the time, failure to progress is due to certain factors like failure to wait, meaning a provider pushed or a mom– maybe you were like, “I’m done being pregnant. I want to be induced,” and your provider is like, “Cool, yeah. Let’s do it.” Failure to wait for spontaneous labor or failure to wait for labor to kick in while you are in your induction. However, then they are like, “We’ve got to start getting this labor going. Let’s start Pitocin. Let’s start this and they are starting to intervene instead of just allowing the body to receive the induction method and then go forward. I feel like so often in the birth room, I personally, I don’t know, Julie, maybe you would say something differently, but I personally see Pitocin being upped way too fast and often too much instead of going 2mL every 45 minutes or so. We are doing 2-4 mL every 30 minutes and we are not really giving our uterine receptors time to fully, fully react.

Pitocin is actually usually quick. It can– what’s the the terrm, Julie? The receiving time? I don’t know. There is a term.

Julie; Oh yeah.

Meagan: It gets into your body quickly.

Julie: Like how long it takes to take effect.

Meagan: Yes. You know what I’m talking about. It actually reacts quickly. There is a quick reaction. However, to a full extent, sometimes it can take a little longer than a half hour fot the body to really, really kick in. Or maybe we are like, “Okay, let’s start Pitocin then we will quickly break your water, “ and all of these things so we are not waiting for labor to kick in, we are just forcing labor whether it’s spontaneous labor and things are going slow, then you get in and they check you in and they are pushing it or you are an induction.

So, failure to wait. I personally don’t know if there is actually any solid, solid evidence. Julie, you probably would because you are incredible on numbers, but on breaking water too early, I feel like so many times, we will see our clients in our practice be told they need to get their water broken and babies are at -2 station and we’re at 2-3 centimeters. We haven’t even gotten into a solid labor pattern and now we just open the floodgates. Baby is coming down in we don’t even know what position then we have a harder labor. Now we’re trying to intervene even more trying to get labor to go because maybe baby came down in a wonky position so labor is not starting and then it’s the cascade there.

I think avoiding AROM, artificial rupture of membranes, is something that we should particularly pay attention to. Maybe have a checklist of what is my contraction pattern like? What is my labor like? Is it all in my back? Is there maybe a sign that baby is in a wonky position right now? Because if so, it’s going to be harder a lot of the time once that water breaks to get that baby to rotate. Not impossible, just harder.

Is baby too high? Do we have a higher risk of cord prolapse? We’re talking preeclampsia so “pre” is in my mind. Why are we breaking water at 2 centimeters to begin labor? Why don’t we do something else and do a low-dose Pit or do a Foley to try and get us to a 4-centimeter state?

I think that’s something. Failure to wait, inducing too fast, introducing things, and then baby’s position. That’s another one that I think is a lot of the time for failure to progress.

A lot of the time when our babies aren’t in an awesome position, it can be harder to put an adequate amount of pressure on the cervix and dilate the cervix properly and in an “adequate time”. Anything else, Julie, that you think about failure to progress? I know I’m probably missing something.

Julie: Yeah, no. You pretty much got it. I do have one thing to add though, but first, we have a blog called Why Failure to Progress is Usually Failure to Wait. It’s at thevbaclink.com/failure-to-progress. I just want to say I feel like sometimes failure to progress is actually misdiagnosed because ACOG and the Society for Maternal-Fetal Medicine put out guidelines on what constitutes failure to progress. This is what the guidelines are.

I’m just going to read it right from our blog. It’s quoted right there and there is also a link to the guideline if you want to go to the blog and find the guideline. It says, “The new guideline says that a woman is not considered to be in active labor–”

Okay, so first of all, you cannot be a failure to progress until you hit active labor. That’s the first thing. Active labor is not until you are 6 centimeters dilated according to all of the guidelines that are out there. I was diagnosed with failure to progress and I was only 4 centimeters dilated so that was a misdiagnosis for sure.

It says, “You cannot be considered–”

Meagan: I was failure to progress as well at 3 centimeters.

Julie: Yeah, for real. Everybody is I feel like. You are not considered to be in active labor until 6 centimeters dilated and “cannot be termed as failure to progress until she is at least 6 centimeters dilated–.” We just said that. “Her waters have ruptured and no cervical change has been made in 6 hours of labor.” Okay? You have to be at least 6 centimeters dilated. Your waters have to have been broken and you have no cervical change in 6 hours.

Now, listen. A lot of the time we think of cervical change as only dilation. Cervical change is way more than just dilation, okay? Cervical change is where your cervix moves from the posterior to the anterior position. It straightens out. It ripens and softens which means it gets thinner. It not only opens but it gets thinner so that’s effacement. If you go from 80% effaced to 90% effaced in 6 hours, that is cervical change.

Meagan: That is change.

Julie: That is not failure to progress. It gets softer. It effaces which thins. It dilates which opens. The baby’s head rotating, flexes, and molds are all considered part of cervical change and baby is descending. If your baby goes from -1 station to 0 station and you don’t dilate any further, that is still considered cervical change because the baby is moving downwards.

So I feel like a lot of times, failure to progress is misdiagnosed and lots of other things could have helped progress that baby if like Meagan said, we were just patient and given more time.

Meagan: Yes. I wanted to add to that. All of those things that Julie just said and sometimes, we might not be making changes like dilation or effacement necessarily, but our cervix that was really once posterior is now more anterior. Our cervix is coming more forward which to me, is a sign of change and that our body is working because sometimes, our cervix has to come forward to do some work.

Julie: Yeah, that was the first thing I said. It moves from posterior to anterior. It straightens out.

Meagan: Oh, I missed that. Yeah. I totally missed that.

Julie: That’s okay.

Meagan: I just think it’s so important to know that if you’re not dilating, it doesn’t mean you can’t. Sorry, I totally missed your first half.

Julie: No, you’re totally fine.

Meagan: Okay, anything else?

Julie: No, I think that pretty much covers it. Like I said, all of the things that Meagan talked about and the link to those guidelines are in that blog that should be linked in our show notes.

26:15 Fibroids

Meagan: Okay, so let’s see. What else is one of the other ones? We wanted to talk about fibroids. This is something we don’t talk about a ton actually but it’s something that we get on our– did we talk about gestational diabetes? We did, right?

Julie: We haven’t yet.

Meagan: That’s what I want to talk about first.

Julie: But fibroids, let’s do fibroids because fibroids is pretty much the same as special scars. You have a surgery to remove your uterine fibroids and it leaves a scar.

Meagan: Okay, yeah.

Julie: And the scar is on some part of your uterus. It just depends on where the fibroids are. That would be similar to your chances of success with a special scar because it is a special scar.

Meagan: Yeah, I guess so. I never even thought about it actually like that. A lot of people will be told that if they have a fibroid, they can’t have a vaginal birth and there are studies that show you might have increased chances of a breech baby or preterm birth or even Cesarean because sometimes those fibroids can grow a lot and can cause some issues so there may be some increased chances of Cesarean, but that doesn’t mean you can’t have a vaginal birth. It should never not be considered.

Like she was saying, sometimes people will also get those removed before they get pregnant so there’s that to consider.

Julie: Yeah, for sure.

27:54 Gestational Diabetes

Meagan: Okay, let’s go to gestational diabetes now. I feel like this one is a really hot topic and if you are listening and you had gestational diabetes with your pregnancy, with your VBAC, we actually are looking for some stories to share this year because it has been one of the most requested stories to get on the podcast.

But let’s talk about what are your chances of having a vaginal birth after a Cesarean with gestational diabetes. I think it is important to note that even despite you can be the healthiest you can possibly be and sometimes you can get gestational diabetes. We don’t know exactly why sometimes. You should never shame yourself for having gestational diabetes. I feel like so many times, it’s like, “Oh, I should have just been healthier.” I’m like, “No, no, no, no. That’s not what we should be doing.”

Then I think with gestational diabetes, sometimes we panic with trying to control our numbers and sometimes we cut eating or we don’t necessarily manage the right way. I think with gestational diabetes, number one, try and learn how to manage it properly and to be as healthy as you can with it, but know that you do not have to have a C-section if you have gestational diabetes.

However, you may have a provider who wants to induce your labor. When I say may, I don’t know if I’ve ever ran into a client who had gestational diabetes and didn’t get induced. Do you, Julie? Have you ever had a client that was not, even controlled gestational diabetes, that wasn’t induced by at least 39 weeks?

Julie: Yeah, but it was a home birth. I mean–

Meagan: Okay.

Julie: It was kind of complicated. There is more nuance to it than that, but yes. She had a home birth. Her gestational diabetes was managed well. It was even managed with insulin. That’s all I’m going to say about that. Sorry.

Meagan: No, that is just fine. That is just fine.

Julie: Her baby was 6.5 pounds by the way.

Meagan: Seriously, no. You haven’t had a gestational client that hasn’t had a provider aka a hospital provider I should say?

Julie: Well, no. Actually no, yeah. I just had one but she was induced too. Yeah. The nurse I was telling you about.

Meagan: She was induced.

Julie: She was induced.

Meagan: I’ve never had a client who has not been induced so that is something that you probably need to take note of. If you have gestational diabetes, you may have a discussion coming your way from your provider about being induced.

Julie: Well, all of the guidelines and recommendations from ACOG are to induce at 39 weeks right now.

Meagan: Exactly. I just want people to know that that could most likely be a thing. It’s not that they are not, like she said, following evidence. That is what is suggested by ACOG, but just know that that can be. We know that potentially an induction could increase the chances of C-section because we have all of the things we were just talking about earlier, all of the interventions that could lead to failure to progress or baby in a wonky position or baby is not tolerating it well or maybe your body wasn’t quite ready to be induced yet and is not responding properly to the medication that they are wanting to give you.

But in a journal by the American Journal of Obstetrician and Gynecology which is an off-shot journal of ACOG, they said, “In a total of 1,957,739 women were eligible for TOLAC across the study period, 386,092 underwent a TOLAC. Overall, 74.0% of non-diabetics, 74.0% of non-diabetic, 69.1% of gestational diabetic, and 58.2% of pre-gestational diabetic mothers achieved a VBAC.”

I’m looking at those numbers and I’m like, “Okay, those are pretty good.” It says that in general, there were some lower odds with large gestational for age infants, babies, so we already know that the big baby thing, sometimes providers are scared of big babies or babies coming down wonky or there is whatever, so sometimes big babies will be taken by Cesarean. However, it’s also to note that if your baby is suspected as large, that doesn’t mean they are large. Also, if they are large, it doesn’t mean they can’t come out vaginally. We have lots of people who have big babies that come out vaginally. Julie has personally attended a birth. Wasn’t it 11 pounds? Her baby? That home birth, do you remember?

Julie: Shoot, I’m trying to remember. Which one? I’ve had several.

Meagan: Her name starts with an L. She is little, you guys.

Julie: Oh, okay yeah. With an A, not an L. Yeah. Her baby was 10 pounds, 7 ounces I think.

Meagan: Okay, yeah.

Julie: Her most recent one, but all of her babies– well, not all. One was just a 7-pounder, but 9-10 pounds.

Meagan: I totally thought that her other baby was just over 11.

Julie: No, not 11. But she is 5’2”. She is little teeny. A little teeny girl.

Meagan: Yeah. So it is possible. Knowing that if you have gestational diabetes, you will more than likely be induced, I think that if you do have gestational diabetes, control it as much as you can and prepare for induction and learn all of the things that you can about induction. We will have in the show notes a link for all of the things. We will have the ways to self-induce or all of those things– not self-induce, but induce non-medically and the ways to induce with a provider and the pros and cons on that, so check that out.

Julie: Right. Also, I think it’s important to note that there are other complications with gestational diabetes besides just big babies. Inducing at 39 weeks has been shown to reduce the chances of these things happening because the more pregnant you are, the higher your chances are of these things.

Meagan: Preeclampsia is one of them, right?

Julie: Yep. Hypertension which is high blood pressure, preeclampsia, lower blood sugar, obviously, and higher chances of a bigger baby for sure. We just talked about that. Up into needing a C-section as well. There is some pretty sound evidence for inducing at 39 weeks just because it will decrease your chances of developing those complications during pregnancy as well, but yes.

Meagan: Yeah, so all around, just doing the education, getting the education, looking at the information, and making the best choice for you.

Julie: Yeah.

Meagan: Okay. What else do we have? Is that about everything? I think that’s about everything.

Julie: Yeah, I think we talked about it all.

35:06 Find a supportive provider, ask questions, and educate yourself

Meagan: All around, at the end of the day, I think some of the biggest things to take away from this episode that you can do is find a supportive provider. How often do we stress that? Find a supportive provider. We have, if you didn’t know in our VBAC Link Facebook group, we actually have a list of VBAC-supportive providers under the Files tab. If you are not part of our VBAC Link Community on Facebook, check it out, answer the questions, and you go find that file. You can find your state or even country and see if there is a provider on there that is supportive.

Also, if you have a name of a provider that you don’t see on that list, please send it over to us with their location and name so we can add to that list and help more Women of Strength find the support that they deserve.

Ask questions. Asking questions is powerful and it’s not done enough. I feel like if I look back at all of my pregnancies, even my VBAC, I don’t think I even asked nearly enough questions to statements that were made or just in general, so ask questions. If you are unsure of something or something is being told to you, ask the questions.

And get the information. Educate yourself. Education is power. It is so powerful and you need it. You truly need it. Check out our blogs. Check out this podcast. Keep listening to all of these stories. Every single episode that we put out every single week is going to have little nuggets of information for you. You might be blown away to find out how many of these stories actually relate so much to yours. We also have a VBAC course that Julie and I spent a lot of hours putting together and wanted to bring all of the evidence to you in a– I want to say regurgitated form from studies because I feel like we read those studies. You can read them and it’s like, “Wait, what?” We regurgitated it back into English and presented these facts to you and gave you all of the things about the history of C-sections, the pros and cons of VBAC, uterine rupture signs, and all of the things, so check out our course.

Then, of course, check out our Instagram and Facebook. We are always putting information out there and learning from our community on our Q and A’s on Thursdays. Other than that, I just wanted to thank you guys for being here and of course, Julie, thank you for being with me. I always love when I get to see your face and record with you. It’s just something I miss all the time.

Julie: Yay. Always a pleasure.

Perfect, well thank you so much for having me. It’s always fun.

Closing

Would you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.

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Episode 279 What are the chances if…?

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Nội dung được cung cấp bởi Meagan Heaton. Tất cả nội dung podcast bao gồm các tập, đồ họa và mô tả podcast đều được Meagan Heaton hoặc đối tác nền tảng podcast của họ tải lên và cung cấp trực tiếp. Nếu bạn cho rằng ai đó đang sử dụng tác phẩm có bản quyền của bạn mà không có sự cho phép của bạn, bạn có thể làm theo quy trình được nêu ở đây https://vi.player.fm/legal.

We know that unique circumstances in pregnancy can make a VBAC feel farther out of reach. Do your chances of having a VBAC go down if you had preeclampsia in a previous pregnancy or your current one? What if you have a special scar? What are the chances of having a VBAC if you were diagnosed with “failure to progress”? What about fibroids or gestational diabetes?

Julie Francom joins Meagan on today’s episode discussing evidence-based research around all of these topics. They share personal experiences as birth workers and overall takeaways that can help you confidently navigate your VBAC journey no matter what complications arise during your pregnancy.

Additional Links

Special Scars Studies

The VBAC Link Blog: Why Failure to Progress in Labor is Usually Failure to Wait

AJOG Article

Needed Website

How to VBAC: The Ultimate Prep Course for Parents

Full Transcript under Episode Details

Timestamp Topics

02:54 Review of the Week

5:51 Preeclampsia

08:57 Ask questions

12:51 Special scars

17:58 Failure to progress

26:15 Fibroids

27:54 Gestational Diabetes

35:06 Find a supportive provider, ask questions, and educate yourself

Transcript

Meagan: Hello, hello everybody. We are getting out of winter and maybe into some spring weather, hopefully. I always hope for spring weather in March because it’s my daughter’s birthday and she always wants sunshine, not snow for her birthday. So I’m crossing my fingers that this is the month we have sunshine, not snow. I hope you guys are having a wonderful beginning– well, I guess it’s not actually spring, but I hope you’re having a wonderful beginning of March.

We are kicking off our very first Monday episode for 2024. You guys, we have a little surprise for you. We are going to be sending out two, not just one, but two episodes a week. Make sure to tune in on Mondays and Wednesdays for stories and information. Today, we are kicking it off with Julie. Hello.

Julie: Hey. I’m so happy to be here and yes, I’m hoping it’s warm or getting there because I am just a popsicle permanently from November to March so let’s just thaw out a little bit, please.

Meagan: Just a little bit. Even if we just get some little sprinkles, let’s have April showers in March.

Julie: Yeah.

Meagan: You guys, I am so excited for today’s episode. Julie and I feel like these are some questions, I am definitely getting these questions on the weekly Q and A’s, but these are some questions that are often asked and we want to answer your questions today. We’re going to be talking about a whole bunch of things.

Julie: A whole bunch of things.

Meagan: What are the chances if I have preeclampsia? A special scar? Failure to progress?

Julie: Gestational diabetes.

Meagan: Gestational diabetes and maybe uterine fibroids. We are going to talk a little bit more about those. What are your chances for VBAC or vaginal birth if you have these things or have had them? Maybe you are not pregnant yet and you had preeclampsia last time or gestational diabetes last time. What are your chances?

02:54 Review of the Week

Meagan: So without further ado, I’m going to turn the time over to Julie for a review and we’ll dive right in.

Julie: Without further ado, here is Julie. Okay, this review is from Google. It is from Christa and she says, “This podcast is beyond empowering. After my C-section after multiple unnecessary interventions, I knew immediately I wanted a VBAC for my next baby. I found this podcast not long after and have been an avid listener for four years.”

Four years, wow!

Meagan: That’s amazing.

Julie: I know. “The VBAC link lifts the veil on birth and allows women to educate themselves and make their own decisions instead of just blindly trusting providers as many of us have in the past. Because of this podcast, the topic of birth/VBACs has become such a passion of mine and I now feel confident in my knowledge and ability to advocate for myself next time. I recommend this podcast to every mom and expectant parent I know. I am now pregnant with my second due March 2024–” Hey, that’s right now– “and am already preparing and relistening to every episode and have the honor to have Meagan as my doula–” What?! That’s awesome.

“Hopefully you’ll hear my successful VBAC story soon.”

Meagan, this is your client. That’s awesome.

Meagan: I love it. I love it. Thank you, Christa.

Julie: Maybe you’ll be at a birth soon for her. Holy cow, that’s amazing.

Meagan: I know. I love it so much. I love that she said that we lift the veil. That was so cool. Yes.

Julie: Yes.

Meagan: Thank you. You guys, these reviews, as you can see, we are over here smiling and gleaming on this Zoom podcast.

Julie: Smiling and gleaming.

Meagan: Yes, we are. So if you wouldn’t mind dropping us a review, your reviews truly help other Women of Strength find this podcast and find this platform. You can leave it on Google just like Christa did. You can go to Apple Podcasts. You can go to Spotify. Can you? I don’t know if you can on Spotify. Google or you can just email us. Email us at info@thevbaclink.com with the subject “Review” and you never know, you might be read on the next podcast.

5:51 Preeclampsia

Meagan: Okay, Julie. Are you ready?

Julie: Let’s do it.

Meagan: Always, right? Okay. Let’s talk about preeclampsia. You had preeclampsia with your first that did end up ending in a Cesarean. However, you went on to have three HBACs. HBAC if you are just new with us is Home Birth After Cesarean. So yeah. I guess right there I want to point out is it possible to have preeclampsia and then go on and have a vaginal birth? Yes.

Julie: Yeah. Yeah. Heck yeah, it is.

Meagan: Yes, it is.

Julie: I did it. You are speaking to the girl right here. Now, preeclampsia is kind of tricky because a lot of research shows according to the Preeclampsia Foundation. You can find it at preeclampsia.org. According to them, there is a suggested risk that you have a 20% chance of having preeclampsia again after you’ve had it the first time. However, there are some experts that site a range anywhere from 5% to 80% just depending on when you had it in your prior pregnancy, how bad it was, and any additional risk factors that you have.

So I have had clients, most of my clients that have had preeclampsia once don’t have it again, but I have had one client that has had it both times. My pediatrician had preeclampsia in both of her pregnancies. It really just depends on a lot of different risk factors, but preeclampsia also doesn’t exclude you from having a VBAC. You’re just going to have to get induced earlier for the safety of your baby usually around 37 weeks unless it is severe. They might want to induce you a little bit earlier than that.

But yeah, I just feel like me and Meagan– I’m going to go off on a little bit of a tangent and then I’ll bring it back. But me and Meagan were just talking about how a lot of these things– the biggest risk of VBAC is uterine rupture, right? That’s what we talk about. But a lot of these other things like gestational diabetes and preeclampsia and big baby and all of these other things, the risks of those or the perceived risk sometimes don’t have anything to do with VBAC. It’s completely separate. It doesn’t increase your risk uterine rupture. Not even big baby increases your risk of uterine rupture. There are no studies that support that.

Preeclampsia and VBAC should be treated separately although a lot of times, providers don’t treat it separately. They think, “Oh, you’ve had a C-section and preeclampsia so we should just schedule a C-section.” That is where provider bias comes into play and these perceptions when there are just not a lot of studies and evidence to support any of that, right?

Anyways, circling it back to preeclampsia, there are lot of things you can do to make your body healthy overall that may reduce your chances of preeclampsia although I guess we are still not entirely certain about how preeclampsia comes about in the first place.

But yeah. I don’t know. What do you have to say about that, Meagan?

08:57 Ask questions

Meagan: Yeah. I think it’s important to do what you were saying and separate the thought of, “If I have this, I have to do this,” when a lot of providers, especially if it is severe and we’ve got really, really high blood pressure and we are severe, they may specifically say, “You need to schedule a C-section,” but that doesn’t necessarily mean you have to and if you have preeclampsia in general, it doesn’t mean you are going to have a C-section. I think that’s one of the biggest takeaways from this episode.

Julie: There is no “have to” ever. There are no absolutes.

Meagan: There is no “have to”. Yes. There are no absolutes. There are things where you may be at increased risk of Cesarean, but that’s typically because of those things like induction, right? So yeah. There’s really no concrete evidence on what mode of delivery is best if you have preeclampsia. So again, it comes down to your provider. Get a supportive provider. Talk about it. Really ask them. If they tell you, “Okay, because you have preeclampsia, we are going to have to schedule a C-section,” ask them. Do not stray away from getting the evidence and the information that you need. You can say, “Okay. Can we talk about the evidence of why I have to?” Right? Ask questions. Don’t feel bad for asking questions. It’s okay. If you have that question, ask it.

Meagan: So yeah, I think that’s kind of it.

Julie: Yeah. I think the overall theme of this episode and maybe the whole entire VBAC Link period is asking questions to your provider, talking with your provider, and having a mutual trust with your provider where they trust you and you trust them. Right? It’s a two-way street where you guys can collaborate together and create a plan of care that is comfortable with you and comfortable with them. I know that a lot of care is centered around the provider and what they are comfortable with. Some providers are not comfortable with doing VBAC for preeclampsia or after two or more Cesareans or after a special scar or with gestational diabetes or whatever.

You need to have a plan that you are comfortable with and that your provider is comfortable with because I promise you that you don’t want a provider who is nervous about your care because they are doing something they are not comfortable with. I feel like that’s so important to have that mutual trust between yourself and your provider where they trust you that you are not going to do anything dangerous or stupid and you trust them that they are not going to do anything dangerous or stupid. Do you know what I mean? I say stupid loosely. That’s a very medical term, “stupid”, but it’s important. It’s important that there is mutual trust that you can discuss your plan with your provider. If you’re not on the same page with your provider, it might be a good idea to look for a different one.

Meagan: Yeah, it’s also important to ask, “Well, what are the chances of the negative outcomes for a scheduled C-section?” because on the NIH, and we’ll make sure to include the links so you can read them, but it did say, “An increased risk of various postpartum complications was found in patients allocated directly to having a Cesarean section including blood loss.” When we have preeclampsia, it seems that we have a higher risk of issues potentially, but bleeding is not a great thing. We have platelets being affected and things like that, we may have increased chances of blood loss which we already know, Cesareans in general have an increased risk of blood loss. So you may want to ask questions about what kinds of risks you have if you do schedule a C-section with a scheduled C-section in general. What are the risks there? What are the risks to you and your baby there? Yeah. Anyway, ask questions.

12:51 Special scars

Meagan: Okay, we’re going to talk about special scars. With a special scar, we do have a blog on that and it does have an attachment of a lot of studies and things that our favorite group of Facebook, Special Scars, Special Hope– is that? Am I brain farting?

Julie: Mhmm.

Meagan: If you have a special scar meaning you have anything other than a low transverse, so a J, a T, and all of those things, definitely check out that group. The unfortunate thing is that the studies we do have are not really up to date. We don’t have a ton of concrete studies that are really recent or even large particular studies. So we want to talk about just in general, what are the chances if you have a classical or a special scar? The chances are there. You can still VBAC. There may be slightly increased chances of things like uterine rupture, but it is still possible. We have stories on our podcast even of people who have gone on to have vaginal births with special scars. I’ve supported a client that had a special scar. All was really well and they just took a little extra precaution. They wanted to make sure that they knew the signs of uterine rupture and they knew which I think everybody should. They wanted to make sure that baby was doing okay and mom was doing okay. All was well and it ended up beautifully.

But all in all, I think in the end, it’s going to come down to finding the support and finding that support. That can be tricky. What are the chances to have a vaginal birth with a special scar? Possible. I don’t have a number for you. What are the chances of finding a supportive provider with having a special scar?

Julie: Harder.

Meagan: Lower. Yeah. It’s going to be lower and that sucks.

Julie: It does suck. It does suck. The special scars website at specialscars.org/studies has links to all of the notable studies, but the biggest studies that are out there show that your chances or uterine rupture are less than 2% with a special scar.

I feel like that might be an acceptable risk for some parents and that might not be an acceptable risk for other parents. I feel like that’s really important to acknowledge that what is an acceptable level of risk is different for everybody and each of your providers is going to have a different level of risk that they are comfortable with as well.

The hard thing is that there are not a ton of studies on special scars but special scars are not just about if you have different C-section incisions. It’s also about myomectomy, different types of uterine surgeries, and things like that. Basically, anything that is not in the lower uterine segment and has been cut or severed in some way. I don’t know the right way, I don’t know the nice way to say that, but if you have a history of any type of uterine surgery that is not on your lower uterine segment, that is considered a special scar. That could have absolutely nothing to do with pregnancy.

Meagan: Yeah. Yeah.


17:58 Failure to progress

Meagan: Okay, let’s talk about failure to progress. What are your chances if your last Cesarean was due to failure to progress? Imagine me putting big, giant air quotes around “failure to progress”. You know, I don’t know if this is one of those things I take to heart because it personally happened to me and I was told “failure to progress” and it kind of ticked me off, but your chances if you had a previous diagnosis of failure to progress to have a vaginal birth the next time around are pretty dang, stinking high.

A lot of the time, failure to progress is due to certain factors like failure to wait, meaning a provider pushed or a mom– maybe you were like, “I’m done being pregnant. I want to be induced,” and your provider is like, “Cool, yeah. Let’s do it.” Failure to wait for spontaneous labor or failure to wait for labor to kick in while you are in your induction. However, then they are like, “We’ve got to start getting this labor going. Let’s start Pitocin. Let’s start this and they are starting to intervene instead of just allowing the body to receive the induction method and then go forward. I feel like so often in the birth room, I personally, I don’t know, Julie, maybe you would say something differently, but I personally see Pitocin being upped way too fast and often too much instead of going 2mL every 45 minutes or so. We are doing 2-4 mL every 30 minutes and we are not really giving our uterine receptors time to fully, fully react.

Pitocin is actually usually quick. It can– what’s the the terrm, Julie? The receiving time? I don’t know. There is a term.

Julie; Oh yeah.

Meagan: It gets into your body quickly.

Julie: Like how long it takes to take effect.

Meagan: Yes. You know what I’m talking about. It actually reacts quickly. There is a quick reaction. However, to a full extent, sometimes it can take a little longer than a half hour fot the body to really, really kick in. Or maybe we are like, “Okay, let’s start Pitocin then we will quickly break your water, “ and all of these things so we are not waiting for labor to kick in, we are just forcing labor whether it’s spontaneous labor and things are going slow, then you get in and they check you in and they are pushing it or you are an induction.

So, failure to wait. I personally don’t know if there is actually any solid, solid evidence. Julie, you probably would because you are incredible on numbers, but on breaking water too early, I feel like so many times, we will see our clients in our practice be told they need to get their water broken and babies are at -2 station and we’re at 2-3 centimeters. We haven’t even gotten into a solid labor pattern and now we just open the floodgates. Baby is coming down in we don’t even know what position then we have a harder labor. Now we’re trying to intervene even more trying to get labor to go because maybe baby came down in a wonky position so labor is not starting and then it’s the cascade there.

I think avoiding AROM, artificial rupture of membranes, is something that we should particularly pay attention to. Maybe have a checklist of what is my contraction pattern like? What is my labor like? Is it all in my back? Is there maybe a sign that baby is in a wonky position right now? Because if so, it’s going to be harder a lot of the time once that water breaks to get that baby to rotate. Not impossible, just harder.

Is baby too high? Do we have a higher risk of cord prolapse? We’re talking preeclampsia so “pre” is in my mind. Why are we breaking water at 2 centimeters to begin labor? Why don’t we do something else and do a low-dose Pit or do a Foley to try and get us to a 4-centimeter state?

I think that’s something. Failure to wait, inducing too fast, introducing things, and then baby’s position. That’s another one that I think is a lot of the time for failure to progress.

A lot of the time when our babies aren’t in an awesome position, it can be harder to put an adequate amount of pressure on the cervix and dilate the cervix properly and in an “adequate time”. Anything else, Julie, that you think about failure to progress? I know I’m probably missing something.

Julie: Yeah, no. You pretty much got it. I do have one thing to add though, but first, we have a blog called Why Failure to Progress is Usually Failure to Wait. It’s at thevbaclink.com/failure-to-progress. I just want to say I feel like sometimes failure to progress is actually misdiagnosed because ACOG and the Society for Maternal-Fetal Medicine put out guidelines on what constitutes failure to progress. This is what the guidelines are.

I’m just going to read it right from our blog. It’s quoted right there and there is also a link to the guideline if you want to go to the blog and find the guideline. It says, “The new guideline says that a woman is not considered to be in active labor–”

Okay, so first of all, you cannot be a failure to progress until you hit active labor. That’s the first thing. Active labor is not until you are 6 centimeters dilated according to all of the guidelines that are out there. I was diagnosed with failure to progress and I was only 4 centimeters dilated so that was a misdiagnosis for sure.

It says, “You cannot be considered–”

Meagan: I was failure to progress as well at 3 centimeters.

Julie: Yeah, for real. Everybody is I feel like. You are not considered to be in active labor until 6 centimeters dilated and “cannot be termed as failure to progress until she is at least 6 centimeters dilated–.” We just said that. “Her waters have ruptured and no cervical change has been made in 6 hours of labor.” Okay? You have to be at least 6 centimeters dilated. Your waters have to have been broken and you have no cervical change in 6 hours.

Now, listen. A lot of the time we think of cervical change as only dilation. Cervical change is way more than just dilation, okay? Cervical change is where your cervix moves from the posterior to the anterior position. It straightens out. It ripens and softens which means it gets thinner. It not only opens but it gets thinner so that’s effacement. If you go from 80% effaced to 90% effaced in 6 hours, that is cervical change.

Meagan: That is change.

Julie: That is not failure to progress. It gets softer. It effaces which thins. It dilates which opens. The baby’s head rotating, flexes, and molds are all considered part of cervical change and baby is descending. If your baby goes from -1 station to 0 station and you don’t dilate any further, that is still considered cervical change because the baby is moving downwards.

So I feel like a lot of times, failure to progress is misdiagnosed and lots of other things could have helped progress that baby if like Meagan said, we were just patient and given more time.

Meagan: Yes. I wanted to add to that. All of those things that Julie just said and sometimes, we might not be making changes like dilation or effacement necessarily, but our cervix that was really once posterior is now more anterior. Our cervix is coming more forward which to me, is a sign of change and that our body is working because sometimes, our cervix has to come forward to do some work.

Julie: Yeah, that was the first thing I said. It moves from posterior to anterior. It straightens out.

Meagan: Oh, I missed that. Yeah. I totally missed that.

Julie: That’s okay.

Meagan: I just think it’s so important to know that if you’re not dilating, it doesn’t mean you can’t. Sorry, I totally missed your first half.

Julie: No, you’re totally fine.

Meagan: Okay, anything else?

Julie: No, I think that pretty much covers it. Like I said, all of the things that Meagan talked about and the link to those guidelines are in that blog that should be linked in our show notes.

26:15 Fibroids

Meagan: Okay, so let’s see. What else is one of the other ones? We wanted to talk about fibroids. This is something we don’t talk about a ton actually but it’s something that we get on our– did we talk about gestational diabetes? We did, right?

Julie: We haven’t yet.

Meagan: That’s what I want to talk about first.

Julie: But fibroids, let’s do fibroids because fibroids is pretty much the same as special scars. You have a surgery to remove your uterine fibroids and it leaves a scar.

Meagan: Okay, yeah.

Julie: And the scar is on some part of your uterus. It just depends on where the fibroids are. That would be similar to your chances of success with a special scar because it is a special scar.

Meagan: Yeah, I guess so. I never even thought about it actually like that. A lot of people will be told that if they have a fibroid, they can’t have a vaginal birth and there are studies that show you might have increased chances of a breech baby or preterm birth or even Cesarean because sometimes those fibroids can grow a lot and can cause some issues so there may be some increased chances of Cesarean, but that doesn’t mean you can’t have a vaginal birth. It should never not be considered.

Like she was saying, sometimes people will also get those removed before they get pregnant so there’s that to consider.

Julie: Yeah, for sure.

27:54 Gestational Diabetes

Meagan: Okay, let’s go to gestational diabetes now. I feel like this one is a really hot topic and if you are listening and you had gestational diabetes with your pregnancy, with your VBAC, we actually are looking for some stories to share this year because it has been one of the most requested stories to get on the podcast.

But let’s talk about what are your chances of having a vaginal birth after a Cesarean with gestational diabetes. I think it is important to note that even despite you can be the healthiest you can possibly be and sometimes you can get gestational diabetes. We don’t know exactly why sometimes. You should never shame yourself for having gestational diabetes. I feel like so many times, it’s like, “Oh, I should have just been healthier.” I’m like, “No, no, no, no. That’s not what we should be doing.”

Then I think with gestational diabetes, sometimes we panic with trying to control our numbers and sometimes we cut eating or we don’t necessarily manage the right way. I think with gestational diabetes, number one, try and learn how to manage it properly and to be as healthy as you can with it, but know that you do not have to have a C-section if you have gestational diabetes.

However, you may have a provider who wants to induce your labor. When I say may, I don’t know if I’ve ever ran into a client who had gestational diabetes and didn’t get induced. Do you, Julie? Have you ever had a client that was not, even controlled gestational diabetes, that wasn’t induced by at least 39 weeks?

Julie: Yeah, but it was a home birth. I mean–

Meagan: Okay.

Julie: It was kind of complicated. There is more nuance to it than that, but yes. She had a home birth. Her gestational diabetes was managed well. It was even managed with insulin. That’s all I’m going to say about that. Sorry.

Meagan: No, that is just fine. That is just fine.

Julie: Her baby was 6.5 pounds by the way.

Meagan: Seriously, no. You haven’t had a gestational client that hasn’t had a provider aka a hospital provider I should say?

Julie: Well, no. Actually no, yeah. I just had one but she was induced too. Yeah. The nurse I was telling you about.

Meagan: She was induced.

Julie: She was induced.

Meagan: I’ve never had a client who has not been induced so that is something that you probably need to take note of. If you have gestational diabetes, you may have a discussion coming your way from your provider about being induced.

Julie: Well, all of the guidelines and recommendations from ACOG are to induce at 39 weeks right now.

Meagan: Exactly. I just want people to know that that could most likely be a thing. It’s not that they are not, like she said, following evidence. That is what is suggested by ACOG, but just know that that can be. We know that potentially an induction could increase the chances of C-section because we have all of the things we were just talking about earlier, all of the interventions that could lead to failure to progress or baby in a wonky position or baby is not tolerating it well or maybe your body wasn’t quite ready to be induced yet and is not responding properly to the medication that they are wanting to give you.

But in a journal by the American Journal of Obstetrician and Gynecology which is an off-shot journal of ACOG, they said, “In a total of 1,957,739 women were eligible for TOLAC across the study period, 386,092 underwent a TOLAC. Overall, 74.0% of non-diabetics, 74.0% of non-diabetic, 69.1% of gestational diabetic, and 58.2% of pre-gestational diabetic mothers achieved a VBAC.”

I’m looking at those numbers and I’m like, “Okay, those are pretty good.” It says that in general, there were some lower odds with large gestational for age infants, babies, so we already know that the big baby thing, sometimes providers are scared of big babies or babies coming down wonky or there is whatever, so sometimes big babies will be taken by Cesarean. However, it’s also to note that if your baby is suspected as large, that doesn’t mean they are large. Also, if they are large, it doesn’t mean they can’t come out vaginally. We have lots of people who have big babies that come out vaginally. Julie has personally attended a birth. Wasn’t it 11 pounds? Her baby? That home birth, do you remember?

Julie: Shoot, I’m trying to remember. Which one? I’ve had several.

Meagan: Her name starts with an L. She is little, you guys.

Julie: Oh, okay yeah. With an A, not an L. Yeah. Her baby was 10 pounds, 7 ounces I think.

Meagan: Okay, yeah.

Julie: Her most recent one, but all of her babies– well, not all. One was just a 7-pounder, but 9-10 pounds.

Meagan: I totally thought that her other baby was just over 11.

Julie: No, not 11. But she is 5’2”. She is little teeny. A little teeny girl.

Meagan: Yeah. So it is possible. Knowing that if you have gestational diabetes, you will more than likely be induced, I think that if you do have gestational diabetes, control it as much as you can and prepare for induction and learn all of the things that you can about induction. We will have in the show notes a link for all of the things. We will have the ways to self-induce or all of those things– not self-induce, but induce non-medically and the ways to induce with a provider and the pros and cons on that, so check that out.

Julie: Right. Also, I think it’s important to note that there are other complications with gestational diabetes besides just big babies. Inducing at 39 weeks has been shown to reduce the chances of these things happening because the more pregnant you are, the higher your chances are of these things.

Meagan: Preeclampsia is one of them, right?

Julie: Yep. Hypertension which is high blood pressure, preeclampsia, lower blood sugar, obviously, and higher chances of a bigger baby for sure. We just talked about that. Up into needing a C-section as well. There is some pretty sound evidence for inducing at 39 weeks just because it will decrease your chances of developing those complications during pregnancy as well, but yes.

Meagan: Yeah, so all around, just doing the education, getting the education, looking at the information, and making the best choice for you.

Julie: Yeah.

Meagan: Okay. What else do we have? Is that about everything? I think that’s about everything.

Julie: Yeah, I think we talked about it all.

35:06 Find a supportive provider, ask questions, and educate yourself

Meagan: All around, at the end of the day, I think some of the biggest things to take away from this episode that you can do is find a supportive provider. How often do we stress that? Find a supportive provider. We have, if you didn’t know in our VBAC Link Facebook group, we actually have a list of VBAC-supportive providers under the Files tab. If you are not part of our VBAC Link Community on Facebook, check it out, answer the questions, and you go find that file. You can find your state or even country and see if there is a provider on there that is supportive.

Also, if you have a name of a provider that you don’t see on that list, please send it over to us with their location and name so we can add to that list and help more Women of Strength find the support that they deserve.

Ask questions. Asking questions is powerful and it’s not done enough. I feel like if I look back at all of my pregnancies, even my VBAC, I don’t think I even asked nearly enough questions to statements that were made or just in general, so ask questions. If you are unsure of something or something is being told to you, ask the questions.

And get the information. Educate yourself. Education is power. It is so powerful and you need it. You truly need it. Check out our blogs. Check out this podcast. Keep listening to all of these stories. Every single episode that we put out every single week is going to have little nuggets of information for you. You might be blown away to find out how many of these stories actually relate so much to yours. We also have a VBAC course that Julie and I spent a lot of hours putting together and wanted to bring all of the evidence to you in a– I want to say regurgitated form from studies because I feel like we read those studies. You can read them and it’s like, “Wait, what?” We regurgitated it back into English and presented these facts to you and gave you all of the things about the history of C-sections, the pros and cons of VBAC, uterine rupture signs, and all of the things, so check out our course.

Then, of course, check out our Instagram and Facebook. We are always putting information out there and learning from our community on our Q and A’s on Thursdays. Other than that, I just wanted to thank you guys for being here and of course, Julie, thank you for being with me. I always love when I get to see your face and record with you. It’s just something I miss all the time.

Julie: Yay. Always a pleasure.

Perfect, well thank you so much for having me. It’s always fun.

Closing

Would you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.

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