Episode 368 Gesa's HBAC with PROM + Differences Between OBGYN & Home Birth Midwifery Care

The VBAC Link

What are the typical differences between hospital OB care and home birth midwifery care? Throughout her VBAC prep, Gesa was able to directly compare the two side by side. She was planning a home birth with a midwife but continued to see her OB at the hospital for the insurance benefits.

Some differences she noted:

• Her OB used ultrasound to determine baby’s position. Her midwife palpated her belly.
• Her midwife ran a blood test to check iron levels, and then suggested an iron supplement. Her OB did not track iron.
• OB visits were typically a few minutes long. Visits with her midwife were an hour or longer in her home.
• The hospital required cervical checks, laboring in a mask, continuous monitoring, and only allowed one support person.

The way Gesa navigated her care is so inspiring. Her midwife was hands-on during pregnancy in all of the best ways and just as hands-off during birth to let the physiological process take over. Gesa’s story is exactly why we love HBAC so much!

Needed Website

How to VBAC: The Ultimate Prep Course for Parents

Full Transcript under Episode Details

Julie: Good morning, Women of Strength. I am really excited to be back here with you. This is Julie, and it is my first official episode back doing regular episodes. Just like we talked about a couple of weeks ago, I’m going to be doing– or was it last week? I can’t remember what week it is. But we are going to be doing every other episode alternating between me and Meagan for the most part. I’m really excited to be back here.

We have a really special guest with us today. But before we get into that, I want to say that I just got back from South Korea two weeks ago. No, two days ago. If you haven’t listened to Paige’s episode for her maternal assisted C-section, go listen to the episode that launched on December 2nd. I do believe it was maybe episode 357. Me and Paige are talking and sharing her story. I am literally so jet-lagged right now. It is going to be a morning for me for sure. If I’m a little clunkier than usual or my brain doesn’t work just right, just be a little patient with me, please, because the jet lag is absolutely real.

Before we do get started though and introduce our guest, I want to read a review. Meagan sent me a review this morning, and I think it’s really interesting because she sent me this review this morning. It’s a 1-star review, and you might be curious as to why I’m choosing to read a 1-star review, but I’ll tell you a little bit more afterward why I picked that.

This one is on Apple Podcasts. This person said, “Listened to 10 episodes, and found that the stories they choose to share are usually always the same with a twist. Didn’t find any episodes that said ‘A C-section saved me and my baby’s life’ so lots of bias and fear-mongering from people who are selling female empowerment. Maybe I’m missing the episode where the hosts say that sometimes it’s okay to have a C-section. With all of these birth stories, you would think I could relate with one, but I find that the anecdotes shared in this podcast are a really easy way to avoid talking about women who are actually statistical outliers.”

I think that episode is really interesting. First of all, I appreciate everybody’s views and perspectives. But also, I think that review is a little bit interesting because she said she has listened to 10 episodes. I’m just assuming it’s a she. Maybe that’s not the right way to do that. She said she has only listened to 10 episodes. It’s interesting because I wonder what 10 she picked.

I feel like, isn’t it maybe a sign that all of the stories are similar because our healthcare system needs a lot of work? Clearly, if so many women are having trauma and unnecessary C-sections, isn’t that a sign that something needs to change? I know that a lot of us have struggled with unnecessary C-sections and really traumatic treatment in the hospital systems, so I don’t know. I wanted to bring that up because first of all, we do have many, many episodes where C-sections were necessary. We’ve talked a lot about that how C-sections are lifesaving procedures when they are necessary.

I feel like we do a pretty good job leaving space for all of the stories, but let me know what you think. Go to the Instagram post today about this episode, and let me know. What do you think? Do you think we do a pretty good job? Do you think we need to have a little bit more talking about C-sections that are actually necessary and lifesaving? Do you think it’s unequally represented? Let me know. I want to start a discussion about this. Go ahead and leave a comment.

Let’s talk about it. But I do know that me and Meagan have been very intentional with sharing a wide variety of stories and outcomes and necessary and unnecessary C-sections. Hopefully, you feel well represented no matter what side of the view you are on.

Anyway, we are going to go ahead and get started now. Today, I have a really awesome guest. Her name is Gesa, and she lives in Charleston, South Carolina. She is a mom of two boys. She had a C-section with her first baby. The C-section was because of a breech presentation after she tried everything to turn him. Knowing that she absolutely did not want to have a C-section for her second baby, she navigated the difficult search for a truly supportive provider and ended up having a successful HBAC, or home birth after Cesarean, after having some challenges to get labor started.

We are super excited to hear her story. We are going to talk more at the end about how to find the right provider for your birth and your birth after a Cesarean after she goes ahead and shares her story with us. All right, Gesa. Are you there?

Gesa: I’m here.

Julie: Yay. I’m so excited to have you with me today. Thank you so much for joining me, and again, for being patient with all of my technical issues this morning.

Gesa: Of course.

Julie: But I will go ahead and would like to turn it over to you. You can share your story with us, and yeah. I’m excited to hear it.

Gesa: Thank you so much. I’m so excited to be here and share my story.

Okay, let’s start with my first birth which was my C-section. Everything was going well at the beginning of the pregnancy. I was feeling a little bit nauseous, but overall, feeling well. Then at the anatomy scan, I found out that my baby was breech. I was like, “Wait, what does that mean? What does that mean for birth? What’s going on with that?”

We had so much time left. The provider was not worried at all. It was around 20 weeks so we thought we had plenty of time at that point. Babies are little. They flip-flop around. I was not concerned at all.

As time progressed, he continued to stay breech, so he did not flip on his own. During one of my OB appointments, I was basically told, “Well, if your baby does not turn head down, we’re just going to have to have a C-section.” There were really no other options given.

At that point, I was actually planning a natural birth at a hospital, so that was not really what I had in mind. We had also taken a Hypnobirthing class which was awesome. We learned so much about birth and pregnancy that I had no idea about.

Hearing that I was going to need a C-section if he wasn’t going to turn head down was really not what I wanted. I started looking into things I could do to help him turn. I started doing Spinning Babies exercises. I started seeing a chiropractor. I did acupuncture. I even did moxibustion at some point which is really fun. It was a Chinese herb that you burn by your toe, and that’s supposed to create fetal movement and help the baby flip which unfortunately did not help.

I was out in the pool doing handstands and backflips about every day. I was lying on my ironing board at some point with a bag of frozen peas on my belly. I really tried everything possible to get this baby to flip. Nothing worked. I ended up trying to have the ECV at about 37 weeks. That’s the version where they try to manually flip the baby from the outside. She gave it a good try to attempt, and he would not move.

It was that his head felt stuck under my ribs. It was very uncomfortable. He was very comfortable where he was at. They had me schedule the C-section which I was really unhappy about, but at that point, I didn’t really see any other option.

It was about my 37-38 week appointment, and the OB wanted to talk a little bit more about the details of the C-section which made me really emotional because that was not what I wanted. I started crying during the appointment, then the nurse comes in and says, “Hey, we actually forgot to check your blood pressure. Let’s do that really quick.” I was like, “I’m sure that’s going to be great now that I’m all emotional and crying here.”

Of course, the blood pressure was higher than it was supposed to be. The OB started joking, “Oh, maybe we’ll have a baby today. Maybe we’re just going to do an emergency C-section,” which was not what I wanted to hear at all. It made me even more emotional. I remember sitting in the office crying. Now, I had this high blood pressure.

My husband handed me this magazine of puppies or kittens. He said, “Sit here. Chill out and just relax. Look at the kittens. They’ll retake your blood pressure, and I’m sure it’s going to be fine.” I was like, “Oh my god. Nothing is fine right now.” It ended up coming down a little bit. They still sent me to the hospital for some additional monitoring. It was all good, and we ended up being sent home. But I just felt so unsupported and so unheard in that moment.

When I was thinking about the C-section, I was even considering at some point what happens if I just don’t show up for my C-section appointment and just waited to see if I’d go into labor? But then I thought, “Maybe an emergency C-section would not be any better than a planned.” I had a friend who had an emergency C-section, and she said that the recovery was really difficult so that’s also not really what I wanted.

I went ahead and showed up to the hospital for my scheduled C-section at 39 weeks and 1 day. But I was so emotional. I was crying on the way to the hospital. I was crying at the hospital. Everybody was really nice at the hospital, but it was just not what I wanted. The idea of them cutting my body open and removing the baby was just so far away from what I had envisioned.

The C-section went well. I really did not have any major issues. But recovery was pretty rough. He was pretty big. He was 9.5 pounds and 21 inches long. Recovery was a little rough. He had also a really difficult time with breastfeeding. He had a really weak suck. I just kept thinking, “What if he was not done cooking? What if they got him too early? He wasn’t ready to be born yet.” We found out later that he had a tongue and a lip tie that the hospital failed to diagnose which just made things even more difficult.

I, overall, hated my stay at the hospital. I felt like I was not getting any rest at all the whole time I was there. My son didn’t like sleeping in the bassinet because why would he? I felt like there were people coming in all of the time and interrupting the little bit of rest that I was trying to get. They were checking on me, checking on the baby, taking temperatures, the photographer, the cleaning people. It was just like people were coming and going.

The only person who did not show up who I hoped would show up was the lactation consultant. She did not show up for almost two days which was really, really disappointing.

The first few months were pretty hard. I would say they were pretty rough emotionally and physically. When people ask me about my birth, a lot of times, I got comments like, “Well, at least he’s healthy” or “Oh, your baby’s really big, so it was probably good that you had that C-section.” That really upset me because I understand that it’s important for my baby to be healthy. Yes, that is the most important thing. But at the same time, my feelings are valid about it, and my emotions. I felt really robbed of that experience to birth my own child. The fact that I had never felt even a single contraction really was upsetting to me. I felt that my body had really failed me.

Yeah. I knew that if I ever were to get pregnant again, I would not want to have another C-section.

So let’s fast forward to my second pregnancy.

I got pregnant again when my son was a little over a year and a half. Like I said, I knew exactly what I didn’t want, and that was to have another C-section. When I found out I was pregnant, I pretty much immediately jumped on Facebook group and mom groups trying to do my research and find a truly supportive provider.

I did call a birth center here in Charleston, and they told me right away, “We don’t do VBACs. Sorry. You can’t come here,” which was pretty upsetting because they basically see a VBAC or having had a C-section before is a high-risk pregnancy for your next which really does not make a lot of sense because every pregnancy is different. Just because you had a C-section, there can be so many different reasons. You should not be considered high-risk for your next pregnancy.

I found a provider who I thought was VBAC-supportive. It seemed like that was my only option, so I started seeing her. As I was seeing my OB further into my pregnancy, I started asking some questions about birth. I really didn’t like some of the answers she had for me. I asked about intermittent monitoring. She said, “No, we can’t do that. Hospital policy is that you have to have continuous monitoring.” I didn’t love the idea of being strapped to the bed. I wanted to move around freely. That was not going to be an option.

I asked about eating. I got the answer, “No, we don’t really allow eating while you are in labor. You can have clear fluids.” I was just thinking, “I don’t want to eat ice chips while I’m in labor. If I’m hungry, I want to be able to eat.”

I asked if I could labor in the bathtub because they did have tubs at the hospital. She said, “No, because of the continuous monitoring, you’re not going to be able to get in the tub.” Hearing all of that made me really uncomfortable. Whenever I did ask questions, it almost felt like she didn’t really want to talk about it. She didn’t really want to talk about my birth plan which was really important to me.

Now, at the same time, it was also COVID. I got pregnant with my second literally the week before people started quarantining for COVID. On top of all of these things that I didn’t like about the hospital, there were also the COVID restrictions.

I had to show up to my appointments in a mask which was totally fine, but the idea of having to labor in a mask made me a little uncomfortable. I was thinking about hiring a doula, and because they were only allowing one support person at the time, that was also not going to be an option.

I knew my son wasn’t going to be able to see me at the hospital which was something I was really looking forward to. I kept thinking, “Maybe there has to be another option. This can’t be my only option here.” I started looking at places farther away. I was like, “Maybe I can travel to another place further away.”

I was looking into birth centers around the area and all over South Carolina, really. At some point, I did come across a website that said they were offering VBAC support. I didn’t really know what that meant, but I filled out a form. I said, “Hey, I need some help with a provider. I’m seeing an OB, but I’m not feeling super comfortable.” I submitted that form. I want to say that maybe a couple of days or a couple of weeks later, a midwife called me. She was like, “Hey, I’m not in your area, but I actually know a lot of people all over the state. Let me send an email to my network, and we’ll see if we can find somebody who can help you.”

One day, I got a call from a home birth midwife here in Charleston. She was like, “Hey, I got your message. Tell me how I can help you.” We talked a little bit about home birth. At that point, I was like, “Do I really want a home birth?” It was not something I had really considered.” During that HypnoBirthing class when I was pregnant with my first son, we watched a lot of videos of water births and home births. I always thought it was really cool, and I would love to have that experience, but at that moment, when she asked me, “Hey, would you consider a home birth?” I was like, “I need to think about that for a second.”

I talked about it with my husband. I did a lot of research on home birth. I ended up sending her all of my medical records from my first pregnancy. We continued talking and checking. I continued to see my OB, and that was really for a variety of reasons. First of all, I had really good health insurance. All of my visits were covered, so all of the DNA tests, and things like the anatomy scan were covered by my health insurance, and it was just easy to coordinate those things with my OB.

I also wanted to continue my care just in case there was something that would pop up that would prevent me from having a home birth and those plans would fall through. I’m a big planner, so I like having not just the plan, but also a plan B and a plan C.

Yeah. I also like that established relationship just in case I needed a home birth transfer to the hospital. I’ve heard stories where moms were treated very differently when they arrived at a hospital with a home birth transfer, and in the case that I would have needed that, I could have just shown up to the hospital and said, “Hey, I’m a patient. I’m here. I’m in labor,” without them knowing that it was really a home birth transfer.

I did not tell my OB that I was actually planning a home birth. I think she would have been pretty upset. Maybe she would have fired me. I don’t know. But the difference in care that I received from the OB and from the midwife was really, really interesting. It seemed like at my OB appointments, there was a lot of focus on different tests and procedures like my weight. Further down, they wanted to do lots of cervical checks which I all declined.

At the same time, when I talked to my midwife, the focus was a lot more on nutrition and on exercise. She was asking, “What do you do to prepare for your VBAC?” Lots of education on birth. There were lots of books that she suggested for me to read.

I also started seeing a chiropractor pretty early in the pregnancy. I was doing my homework. I was doing my Spinning Babies exercises. I was so focused on doing everything I could to have the birth that I had envisioned.

At some point, my midwife had me do some extra blood draws. She wanted to make sure that my iron levels were okay for the home birth, and they were actually slightly lower than they were supposed to be, so she put me on an iron supplement for a couple of weeks. That was an example of something that the OB never asked about or really cared about.

At some point, I was a little bit nervous about the position of my baby. It almost felt like he was lying sideways, and I couldn’t really tell. I brought it up to the OB. She was like, “Yeah. Let’s get in the ultrasound machine. Let’s take a look.” She was trying to feel, but she couldn’t really tell. Everything was good. He was head down. Well, I didn’t know he was a he because we did not find out the gender.

Baby was head down. Everything was okay. I brought up the same thing to the midwife, and it was so funny because she did not need an ultrasound. She just felt. She felt really good. She was like, “Yeah. I know. I feel all of the different body parts. You’re head down. You’re good.” Of course, she was right. It was just so interesting to see how different things were approached by the two providers.

I also hired a doula, and I made sure she was VBAC Link certified. It was really exciting. She was familiar with the podcast that I was, of course, listening to at the time to prepare for my VBAC.

At some point, I had a situation with my OB that made me pretty uncomfortable. It was time for the GBS testing, and I had done my research. I made an informed decision. I let her know that I was declining the test.

She was not happy to hear it. She kept saying, “Well, if your baby dies–”, and she kept saying that multiple times. It was like, “If your baby dies–”, and I was like, “This is so unprofessional to say it like that.” I totally understand that they need to–

Julie: Oh my gosh. I can’t even believe that.

Gesa: Yeah. Isn’t that horrible?

Julie: That’s horrible.

Gesa: I understand she needs to educate me on the risks that come with declining certain tests, but that was just not a proper way to communicate that.

Julie: Yeah. Find another way. Find another way.

Gesa: Yeah. Right. That situation really confirmed for me home birth was the way to go. I did not want anything to do with this hospital or this OB anymore at that point. I was fully committed to the home birth. I was planning on it.

I continued my OB visits more just to check a box.

At 37 weeks, my midwife brought over the birthing pool and some supplies. I gathered everything that I needed. She had sent me a list of all of the different supplies that we needed to buy and gather, so I started getting all of that. I created a beautiful birthing space for myself in our bedroom. I had my affirmations up. They were taped to my mirror in the bathroom as daily reminders. I had them hung up in the bedroom with some twinkle lights. I had the picture of the opening flower, and everything was ready.

I had my Spotify playlist ready, and I was so excited for baby to come here.

Then, at 39 weeks and 1 day, it was early in the morning, like maybe at 6:30 AM. I was lying in bed, and our toddler had climbed into bed with me. I felt a little pop, and I was like, “Hmm, that was weird,” but I didn’t really think much of it because pregnancy is weird, and our bodies do all kinds of weird things that we can’t explain when we are pregnant. I didn’t think much of it. I went back to sleep.

An hour later, I got up to go to the bathroom. I sit down on the toilet, and water is gushing out. I was like, “Shoot. What is going on? I’m not peeing. What’s happening?” I just realized, “No, my water broke.”

I wasn’t expecting it at that point because you hear about a lot of women going into 40-41 weeks, 42 weeks, especially with their first pregnancy that they are going into natural labor, so I was so surprised that it happened at 39 weeks and a day.

I was feeling a tiny bit of cramping, but definitely did not have any contractions. I texted my husband, “Oh my gosh. My water broke.” He was out for a workout, so he rushed home. I also texted my doula and my midwife just to let them know what was going on, but then the whole day was really uneventful. I was ready and waiting for labor to start. It just didn’t.

I went on a lot of walks. I tried some curb walking. I bounced on the yoga ball. I ended up getting a last-minute appointment with my chiropractor for a quick adjustment. I really spent all day just trying to get labor started. I took some naps. I also tried using the breast pump for some stimulation to get things going. I got some tiny little contractions.

At that time, I thought they were contractions, but now that I know what contractions actually feel like, I realize that was not actually the case. I got some tiny contractions going, but then they fizzled out again. My midwife stopped by a few times to check on me and baby. She had me take my temperature every 4 hours and text it to her just to make sure I wasn’t running a fever.

Baby was moving normally. She wasn’t overly concerned. She assured me that my body was probably just waiting until nighttime when my toddler was in bed and I was relaxed for things to start then. It was weird because I was leaking amniotic fluid all day, so I tried to stay super hydrated and replenish all of that water I was losing.

I went to bed and thought, “Okay. This is it. We’re going to have a baby maybe early in the morning. Labor is going to start.” Nothing happened. I woke up really early and really disappointed that nothing had happened.

My midwife had sent me some information on PROM, so premature rupture of membranes, just to make sure I was making an informed decision. She always gave me the option to go to the hospital. She said that I could go in the evening of when my water broke. She said I could wait until the next day and do whatever I felt comfortable with, but she wanted me to be aware of the dangers with having a long time of broken waters.

She also had sent me a recipe to the midwives’ brew. That was something we talked about to get labor started. She said, “Something to consider for the next day if you don’t have your baby overnight.” My husband went out. He bought the ingredients just in case. It was castor oil, almond butter, apricot nectar, and champagne. It was absolutely disgusting. It actually ruined almond butter for me for at least 2-3 years. I could not have it anymore. It was so gross.

Julie: Oh my gosh. That is so funny. That is funny.

Gesa: I took it around 10:00 AM in the morning. At that point, my water had been broken for over 24 hours. I layed down for a nap, and maybe 2 hours later, I started feeling some contractions. They were coming in. I was just laying in bed breathing through them and listening to my HypnoBirthing affirmations and some relaxing music.

My husband was actually taking a nap at that time with our son.

At some point, things were getting pretty intense. I texted my doula and my midwife. I was trying to time contractions but it was also difficult. They both came over around 2:00 PM and realized pretty quickly that labor was going. They needed to fill that pool because that actually takes a while which was not something I was even thinking about.

They quickly got the birthing pool filled. Once I got in the water, it was such a difference. At that point, I had some really, really heavy contractions and I think I got in there around 3:00 PM. It was such a night and day difference. My doula was awesome. She was rubbing my back. She was giving me cold washcloths on my neck. Yeah. She was super helpful.

I was laboring in the tub. At some point, I needed to get out to go to the bathroom. As soon as I got out, I instantly regretted that decision because it was so horrible and the contractions were feelings so much stronger when I was not in the water.

My husband was still sleeping at that point. I was like, “Okay, is somebody going to wake him up before baby comes?” But I also lost track of time of how long I even was in the pool. They did wake him up at some point. It was really funny because when he lay down for a nap, it was just me laboring in bed by myself. They woke up from the nap, and I was in full, active labor in the birthing pool with the doula and the midwife there, full action going on.

He was just like, “Whoa, what’s happening?” Yeah. He jumped right into action and helping me out and massaging and all of that good stuff.

It was really sweet because my son kept bringing toys. He was a little over 2. He was 2 years and 3 months at that point. He kept bringing over toys. He was playing right next to the pool. He was checking on me. It was just really sweet and really special to have him there.

Our dog was also walking around the pool and was really interesting in what was going on. I really lost track of time and of how long I really was in the pool.

At some point, I felt some really, really intense pressure. It was almost like my body was pushing on its own without me really actively doing anything. I had heard of the fetal ejection reflex, but I didn’t realize that that was what was going on. I didn’t realize that baby was already coming.

My midwife just looked at me. She was like, “Feeling a little pushy, huh?” I was like, “Yeah, I guess that’s what’s going on.” It all happened really quickly. My husband got our son situated downstairs because we wanted him to be there, but we didn’t want him to be there right as baby was born. We thought that may have been a little bit too much for him, so we got him situated downstairs.

Yeah, things happened really quickly. All of a sudden, his head was out. It was really fun because we got to feel his hair, and I did not have another contraction for a minute which was weird because his head was out. It was underwater, and it felt like a really, really long time between contractions. But then he was out with the next one, and my midwife caught him. He came right to my chest. My husband got to announce that he was a boy which I knew all along. We didn’t find out his gender, but I just knew he was going to be a boy. My pregnancy was just so similar that I was like, “There’s no way he’s not a boy.”

But yeah. He was born a little after 4:00 PM, so really just 6 hours from when I had the midwives’ brew, so that really worked for me. Of course, I cried tears of joy. The amount of emotions I was feeling was just absolutely incredible. The rush of endorphins, I felt so empowered and so strong in that moment, like literally the strongest person in the world. It was awesome.

We brought my son up and he got to meet his baby brother within minutes of his birth which was so special and such an amazing experience. Once we got settled a bit, I got to take a shower. I got to eat pasta in my bed, and then also safely cosleep with my baby in my own bed and in my own home which was just the complete opposite of that hospital C-section experience.

Yeah, the home birth experience was really healing for me in a way. It gave me closure from my C-section experience. I think because I had the C-section, I just knew what I absolutely did not want, and I think that really helped me fight and prepare for my home birth experience.

I still had to call my OB and cancel my 40-week appointment which was probably one of the weirdest phone calls I’ve ever had to made because I was like, “Yeah, I need to cancel my appointment because my baby is actually here.” They were like, “Wait, where was your baby born? We have no records of this.” I was like, “Yeah, he was born at home.”

They were like, “You need to get him checked out immediately.”

Julie: You’re like, “Yeah, accident.”

Gesa: I was like, “No, we had a professional there. It’s all good. Don’t worry about it. Let’s not talk about it anymore.”

Julie: I love that so much. Okay, I want to talk about a couple of things or maybe just comment. When you were talking about your C-section and how you felt guilty about how maybe he was having trouble nursing or whatever and you were feeling guilty that maybe he had been taken too early or he wasn’t ready to be born yet and stuff, I felt that so hard with my C-section baby.

I just wanted to validate that because I feel like that is not an uncommon thing. I feel like a lot of us have that concern when we have either a scheduled C-section or an induction that results in a C-section or maybe even an induction that results in a vaginal birth. You can look back at it and feel like, “Oh, maybe I made the wrong choice,” or “Maybe he was taken too early,” or things like that. I just wanted to validate that. Know that I see you, and I hear you, and I feel you. And everybody, not just you, but everybody.

Try not to be too hard on yourself. I’m not speaking just to you, but everybody. Try not to be too hard on yourself because you were making the best decisions that you could with the information that you had available to you at the time. So give yourself some grace. Give yourself some love. I think that’s really important is that we navigate our pregnancies and birth after having an unwanted C-section or an unwanted birth experience. Giving ourselves that grace is a really, really important part of it.

I did want to talk about the difference in care. You highlighted a few things in your episode about the difference in care between a hospital OB and having a midwife or especially a home birth midwife. In the hospital, you’re still going to see a little bit of similarities between midwifery and OBs, although midwifery care in a hospital is a lot more hands-on and a lot more personal and a lot more trusting, generally speaking, of the birth process.

I just was thinking this morning about a post. There was a post in not even a VBAC group. It was just a local mom’s group in my community. This woman was talking about how it was her first baby. She hasn’t had an ultrasound or seen the baby since 10 weeks. She had a 10-week scan, and she hadn’t seen the baby since then. She wasn’t 20 weeks pregnant yet, but she was almost. She was just like, “I’m just wondering if this is normal. Every time I have an appointment with my OB, I only see him for 2 minutes. I don’t feel like this is normal. I have some concerns, but I’m not being able to ask questions,” and things like that.

It made me sad. It made me sad for this parent not being cared for in the way that she needs to be. It also made me sad because her experience is not that uncommon. I wanted to say that unfortunately, this is normal. You’re not going to usually see your OB for more than a couple of minutes per visit. You’re not going to have time to ask a lot of questions and get a lot of answers because hospitals are busy and OBs are busy. Most of them don’t have the time or intentionally make the time to give you that kind of attention. It’s just how it is.

Now, I say most of the time because there are some OBs. I saw briefly an OB for my third pregnancy, and I love her. She was always 45 minutes late. Our appointments were always 45 minutes late. My appointment would be at 1:45, and I wouldn’t get in there until 2:00 because she was giving everybody the attention that they needed. A lot of people get frustrated because she was an hour late for the visits, but I wasn’t frustrated because I knew that she was giving other people the same attention that she gave to me.

That is so, so rare in a hospital setting. I love that you highlighted that. I love that you talked about how your midwife took time to address your concerns, how she monitored your iron levels and gave your iron supplements and your OB didn’t. It wasn’t even on his or her radar. I don’t know if your OB was a boy or girl. I can’t remember. Their radar, right? And how your OB needed an ultrasound to confirm baby’s position, but your midwife just palpated your belly because midwives are more hands-on. They are more intimately connected to the female body, to the baby, and to the physiologic birth process.

Gesa: Yeah. She was more hands-on during the pregnancy, but then during the actual birth, she was very hands-off. She let me do my own thing.

Julie: Yeah! Yeah.

Gesa: She wasn’t constantly in my space and interrupting my labor.

Julie: Right.

Gesa: She would come in very quietly and very softly. She would check on the baby and check on me, and if everything was good, she was back out the door. She let me labor in my own space and at my own pace which was awesome.

Julie: Right. I was going to talk about that next actually. I’ve been keeping notes while you have been talking because during your labor, you said you felt that fetal ejection reflex, and your midwife was like, “Oh, feeling pushy are we?” I know exactly what that looks like. I’m not a midwife, but I’m a doula. I’ve been a doula and a birth photographer, and I know what it looks like when a woman’s body is progressing.

But in a hospital setting, what do we do? We connect you to monitors. We put an IV in you. We sit at a nurse’s station and watch the monitor. That’s how we know how you are doing. We use ultrasounds to determine baby’s position. We use data and numbers. We look at data to decide how the parent and the baby are doing. But in midwifery care, especially out-of-hospital midwifery care, you use a completely set of tools. We use observation. We are watching. We are listening. We are seeing. We are noticing the movements that are shifting and the sounds as they evolve and change. We are seeing the belly moved. We are seeing all of the different things, and it’s a completely different approach. I know exactly what an unmedicated parent looks like as they are getting close to transition. I know the noises that change, what sounds are made, what different subtleties there are. You just learn these things when you actually just watch a laboring person, and notice what is happening.

But they don’t do that in a hospital. An OB and nurses– probably nurses because they are in the room a little bit more, but your OB won’t show up until you start pushing. They don’t know what the signs are. All they have is the data on the machine to see if you are doing. I know what approach I approve. Let’s just say that. It’s no secret that I’m a big fan of home births, especially for VBAC, when the parent feels comfortable there. I just really loved that.

My appointments when I had my three VBACs at home, every time I saw my midwife, we would chat for an hour. She did talk about nutrition. I had preeclampsia for my first. My blood pressure was high. I was like, “I don’t want high blood pressure,” so she gave me all of these nutritional things to do to help take care of my heart and help make sure that my blood pressure wasn’t high.

But then what would happen in the hospital? They wait until your blood pressure is high, then they treat it. They don’t work on preventing it or making you healthier or things like that. I just feel like there is such a big difference in care. It’s not for everybody. That’s not where everybody feels safe, but I wanted people to know that home-birth midwives are very skilled. They are very hands-on throughout the pregnancy and oftentimes hands-off during the delivery because we trust these bodies to do what they need to do. Sometimes they do need help, but also observing and watching can help us know when a little bit of extra help is needed.

It’s such a fun little dance that can be done throughout pregnancy and labor. It’s kind of like an art form as much as it is a medical side of things. Midwives are not chicken-dancing hippies that run around your room with incense and pray for a safe delivery. They are skilled medical professionals that have high levels of training and care and can practice in very similar ways that you see in a hospital setting just without all of the extra crap and interventions that are there.

Obviously, they can’t do surgery, and depending on your state and where you live, there are different restrictions about what out-of-hospital midwives can and cannot do. But a lot of people are surprised to find out how much training and knowledge and skills and procedures that out-of-hospital midwives have access to, so I wanted to talk about that.

Yeah. Anyway, Gesa, do you want to give one piece of advice to anybody preparing for a VBAC right now? What would you tell anybody?

Gesa: I think a lot of people, when they go to the doctor, they see their OB and they heavily rely on what they are telling them. They almost glorify the OB’s advice in a way. We have got to remember that these doctors work for us. We don’t work for them, so if we don’t feel comfortable with what they are saying, we have the option to go somewhere else, and to take our business somewhere else. The doctors work for us. We don’t work for them. It is never too late to switch your provider.

I was going back and forth whenever I was pregnant with my first, and I was very late into my pregnancy. I kept thinking, “What if I just find a provider who does breech births?” In a way, I wish I had, but then you never know what actually would have happened, so it’s hard to say how that would have changed my experience. I could have still ended up with a C-section, but I could have. I could have changed my provider at 38 weeks if I had contacted somebody, but I was just so overwhelmed by the whole situation that I didn’t.

But I was so glad that when I wasn’t feeling comfortable with my OB during my second pregnancy and with what she was saying, that I took the step to find somebody who was truly supportive and who was able to help me with the birth that I had envisioned.

Julie: Yes. I absolutely love that. I think that’s great advice. You make a very good point. It’s never too late to switch providers. I think that the single most important thing that you can do to affect your birth outcome is to choose a provider who operates in the way that you want to birth just naturally. It’s just what they do anyway. I feel like if you do that, then that’s half the battle.

Gesa: Yeah. 100%. I know some people feel very comfortable at the hospital, and a lot of people are not good candidates for a home birth.

Julie: Yeah, and that’s where they should be.

Gesa: When I told people that I was planning a home birth, I got a lot of people saying, “Are you sure? That’s so scary.” If that’s scary to you, then you shouldn’t do it. If you feel safer in a hospital, go ahead. There’s nothing wrong with that. Go to the hospital. Have your baby there if that’s where you feel comfortable.

For me, just the thought of having to fight for certain things while I’m in labor and very vulnerable wasn’t something I wanted to do. I wanted to focus on laboring and birthing and just having that experience. I did not want to get into fights with OBs and nurses over whatever I could or could not do while at the hospital. That just did not sound like a good idea to me.

Julie: Yep. Absolutely. I agree, 100%.

All right, well thank you so much for joining me today. Thanks for sharing your story with us. I’m super proud of you. You said that after your baby was born, you felt like the strongest woman ever. I agree. You are the strongest woman ever along with all of the women listening right now. We are truly Women of Strength, and no matter how your birth outcome ends, you are strong. You are powerful. I’m very grateful to each of you.

Closing

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