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Claudia: VBA2C

We sat in the office, meeting officially for the first time. Claudia sat across from me, telling me about her previous birth experiences and then her husband, Marco asked me a question: "What makes you more successful at getting people a VBAC?" as I answered his question, he smirked and then giggled at the end. "Claudia isn't going to do anything that she doesn't want to do. Basically, if you tell her to do something, that's when she won't."

At first I felt shocked by his reply and then I looked at her and she laughed. I understood the mindset that he was describing, I as well, might just be what they call stubborn. So then I asked, "Do you really want this? Because these are things you'll have to do to get it." Claudia began to well up, I felt the mood in the room shift from one of teasing laughter to something very heavy, and she replied, "I really want this." and her husband looking across the room at her said, "She really wants it."

The first thing to do was switch Claudia's provider. They were hesitant at first. They had birthed their other 3 children in this city. This was the city they lived in as well as the city they met when their love story began in high school. As I explained the statistics to them and they understood how different their chances could be, they decided to interview with a different practice. Claudia messaged me afterwards and said, "I like them very much. They seem very supportive of what I want. I'm going to make the switch."

Claudia continued to follow every piece of advice I gave her and was setting herself up for the greatest chance of having what she had always wanted, a vaginal birth.

Claudia's pregnancy would include risk factors. One on its own, wouldn't be a big deal, but as the pile of things began to grow, so did Claudia's anxiety. We were now at the end of the pregnancy and she asked me to go with her to an appointment at her obgyn office. Claudia decided she was going to ask about having an induction and the midwife her appointment was with that day, said, "We can't induce you because of a big baby. A big baby isn't a reason."

This is the reason I love and recommend this practice, but in this case, Claudia's gut was telling her something else. Claudia's gut was telling her it was time to get this baby out. I then pointed out all of the other risk factors she had and the midwife, then moved her head from side to side in contemplation, "Those are things we might induce for eventually, actually."

As we stood at the counter making her next appointment I suggested that she have it with a specific doctor, who might be more willing to go with Claudia's gut when she made the request.

She texted right after that next appointment: "Ok so he called the hospital, tomorrow morning but could be pushed off if they're swamped." I called her right away and she was shocked. She wanted this, but the fact that it was happening in less than 24 hours, was a lot to process and let sink in. "Melissa, I'm going to have a baby at some point soon!"

I met them at the hospital on Thursday morning at 9am. Claudia was on the monitors already and was contracting on her own, every 2-3 minutes. However, she was barely feeling them, which meant they weren't strong enough to be making any change.

The obgyn came in and checked her cervix so that we had a starting point. Claudia had a sweep the day prior and it was helping to change things. She was starting at 2cm dilated. This obgyn decided to start her on pitocin in hopes that it would help to strengthen the contractions that Claudia was already having.

At around 3pm Claudia was starting to feel her contractions. She admitted that while I had told her the only job to do the night before was to sleep, that her and Marco were so anxious that they didn't get much rest at all. I suggested that while her contractions were still mild she tried to close her eyes for a bit. However, they couldn't stop talking. They were both tired but buzzing around talking about all of the possibilities of the next few hours

The baby was still high in the pelvis so we worked on doing a few things to help the baby come down and apply pressure to the cervix to aid in dilation. Unfortunately though, her contractions had fizzled out.

At 8pm, Jen the midwife came in to check and see how Claudia had been doing. A cervical check would show that her cervix hadn't changed and was still very thick. Jen decided to place a balloon into the cervix to help with thinning. Marco was really interested in this process, so Jen gave him a tour of the vagina and a peek at what the cervix looked like. He was super excited for the bit of education she was willing to provide him and Claudia also thought that it was pretty neat that he was so engaged in the process.

At around 11pm contractions started to come back and this time they were more intense than before. They were coming in a more natural pattern too of every 3 to 4 minutes. I was hopeful that things were starting to change for Claudia. Marco asked lots of questions, more questions than anyone had ever asked me during this process.

The balloon came right out around 6am and Claudia was now 4cm dilated and 80% effaced which was a great change. They had turned down the pitocin overnight because her contractions were coming too close together. Now that the balloon was out, they decided to start the pitocin again in hopes to get a good pattern going one more time.

At 9am, Claudia's contractions hadn't come back and they suggested breaking her water. Claudia was hesitant. With her first pregnancy, her provider had a time limit on broken water, which is what eventually led to her first cesarean. The doctor assured her that as long as everyone was ok, they wanted her to have a vaginal birth as much as she did, and that they wouldn't put a time limit on her because her water broke. After a bit of discussion with Marco and I, Claudia agreed.

At first the water being broken didn't seem to be helping, however at around 12:30pm, things began to kick into gear again. Claudia began to become very audible and needed our help to cope with contractions. Marco was making jokes in between and I finally started to understand their relationship.

Marco understood what she needed at every turn and all of his questions were in hopes to protect Claudia's heart from being broken one more time. They have been together for over 20 years and he wanted to be able to give her all of the answers and assure her that they made all the right decisions, in case this birth didn't go the way she wanted it to.

Claudia was now experiencing quite a bit of pain and she was struggling to let go. She had been awake for two nights, laboring on and off for 30 hours and she was exhausted. She was holding on for dear life and it was time that we had a talk. I'm going to keep what we spoke about between her and I. However, VBAC is especially VBA2C's are as big of a mental challenge as they are a physical one and she knew she needed to let go of the fear she was carrying in order to progress. We both cried a bit and then went back to work.

We called for nitrous in hopes that it could help her get a bit of rest. She was dozing on and off between contractions. Another cervical exam at 4:17pm would suggest that she had gained another two centimeters.

Eventually Claudia was so exhausted that we discussed an epidural. The midwife was in agreement that Claudia needed rest. I was also hopeful that this could help her to let go a little bit as well.

At 6:12pm the epidural was placed. It worked almost immediately. Claudia was still so anxious that she was talking to me the entire time. She couldn't sleep and that's what we needed her to do.

Another midwife came on at shift, Devon, and around 8pm she examined the cervix. She had suggested that Claudia was a centimeter less than the previous exam four hours earlier. Claudia and Marco felt defeated. I assured them that she hadn't gone backwards, but that cervical checks were really subjective and what one midwife my feel, ano