Danielle's VBAC + High Cesarean Rates

Did you know that in South African private hospitals, where patients are better cared for, the C-section rate is 76%?! Joining us today all the way from South Africa is our friend, Danielle. She shares how she became part of that C-section statistic with her first birth, but also how she refused to let those numbers define her second birth. Though she fought an uphill battle, Danielle’s successful VBAC was an achievement that changed the course of her life. Her strength has paved the way for others in her area to no longer become a statistic and to no longer fear natural birth. Additional linksNatural Birth With Great Expectations MidwivesHow to VBAC: The Ultimate Prep Course for ParentsFull transcriptNote: All transcripts are edited to correct grammar, false starts, and filler words. Julie: Welcome, welcome. You are listening to The VBAC Link podcast with Julie and Meagan and we have a really special guest for you today. This is episode number 186. We have Danielle with us and Danielle is from South Africa. She had her C-section and her VBAC in South Africa. We were just chitchatting before we started recording the podcast. There are private and public hospitals and in the private hospitals, which is where you get the best care, the C-section rate is 76%. 76%!Meagan: It’s so crazy to me. The crazy thing is that it’s where you get better care, but then–Julie: –where you are treated better, I know.Meagan: Yeah.Julie: In public hospitals, the C-section rate is 24%. When you combine those two together– I mean, I guess it just depends on the population density that is giving birth in each of the hospitals and so I guess I can’t really come up with an overall rate there for the country. Maybe Danielle knows when she will share her story with us. But that is very, very large. Danielle had quite the battle to fight during her pregnancies, births, and deliveries, but we are going to go ahead and let her share that with you after Meagan reads a Review of the Week for us.Review of the WeekMeagan: Okay. This is from Brittany and it was actually on Instagram. She sent us a message on Instagram. It says, “Meagan and Julie, I just wanted to thank you for your amazing podcast. I just had the VBAC of my dreams a few days ago and honestly could not have done it without the encouragement of you guys and the women who share their stories. I was hesitant in wanting a VBAC going into my second pregnancy, but you guys gave me the confidence to do it.”Crazy enough, we just got a message today from someone saying, “I am super hesitant. I had a C-section with my first. I didn’t progress past a 3, so my provider is telling me I am not a good match for a VBAC. I don’t know what to do. Is that possible? What do I do?” And that is exactly what this podcast does. It does. It empowers you. It encourages you. It educates you to make the best decision whether it be a repeat C-section or a vaginal birth. So congratulations, Brittany, on your VBAC. We are so happy that this amazing podcast and we could help you. If you guys have had an experience or anything like that with the podcast, we would love to hear it. Feel free to do Apple Podcasts or like I said, Instagram, or Facebook. Send us a message. We would love to read your review on the podcast someday.Julie: I love that so much. I just want to say that whenever people say, “Oh yeah. Your podcast empowered me” or whatever, I will be like, “Well, you had the empowerment in you all along. We may have helped you discover it and open it up a little bit, but you need to own that. You were empowered. You did it You took charge. We might have helped you discover that along the way, but give yourself some credit too because you are pretty awesome.” That’s what I think every time I hear that. It’s pretty cool. I love all of our listeners and I love everybody that takes the time to leave a review, especially. So like Meagan said, if you have felt like the podcast has helped you on your journey, please drop us a review on Apple Podcasts, Google, or on Facebook. We would love to hear from you.Danielle’s StoryJulie: All right. All right. All right. I am really excited and we know that Danielle is really excited to share her story with us as well. So Danielle from South Africa, we are really excited to have you on. Danielle is a busy mom of two little boys and she is an English teacher. She teaches English to foreign learners all over the world online. I think that is a really fun thing to do. I bet you have a lot of stories on that side of things too. But why don’t you come on and share your stories with us about your births?Danielle: Hi. Yes, thank you. Thank you so much for having me here. Okay well, I guess I will jump right in and share a little bit about my first birth. I had a really healthy pregnancy. I carried to about 40+5 weeks, so quite a long pregnancy there. The first sign of labor was my waters breaking. In a flurry, we rushed immediately to the hospital. I had lost my bloody show. I was pretty much hooked up immediately to monitors. They confirmed I was having mild contractions. I was in early labor. This was in the night and I kind of went to sleep and thought I’d be woken up by excruciating contractions, but I wasn’t. So by the morning, labor hadn’t progressed at all. I was given antibiotics because of the membranes rupturing, and then taken to the labor ward basically and given Pitocin to open the labor. The contractions got stronger, but they were pretty manageable. When they did an internal, they saw that I wasn’t dilating. I was 2 centimeters.The baby went into fetal distress and I ended up in an emergency C-section. It’s not an uncommon thing, this story. But yeah. It left me feeling rather upset and I definitely just did not want it to go down that way. So almost immediately after I gave birth– this was probably two months after the birth– I came across the option of a VBAC. You know, when you are on maternity leave with a baby laying on your chest all day long, you discover these things. I found an amazing Facebook group and started following along, picking up all of the terms, some advice, and key providers, and I got really into it. I knew this was what I wanted to do for the next baby. When I got pregnant a few years later, it wasn’t exactly a planned pregnancy. It was a little bit of a surprise, being COVID and locked up is not really an ideal situation for a pregnancy, but nevertheless, it was a happy surprise. I knew immediately that I had a lot of preparation to do. Not just physically, but mentally and emotionally because I had this dream of a VBAC that was now a reality and I knew it was time to go to work.The first thing I did was I contacted a doula who was recommended by a friend of mine. She was pretty shocked because I called her when I was only seven weeks pregnant. She said to me, “What are you doing calling me so early?” But she was amazing and she gave me some recommendations. I immediately started interviewing OBs and very quickly started to distinguish between a VBAC-friendly and VBAC-tolerant OB. I realized that unless the stars were going to perfectly align, I just wasn’t going to get my VBAC in a hospital. I just knew that.So I met with Sarah and Elrika who are the midwives of Great Expectations. They are the VBAC dream team. As it is in South Africa, there is quite a stigma around natural birth. Going the midwife birthing center route is considered a little bit reckless and kind of like, “The hippies do it”. It is not really a common thing. So I was a little bit hesitant, but yeah. I went to meet with them. I also met with an OB who is very well known for being VBAC supportive. But still, I had some reservations. I was still very much afraid because we really are conditioned here to believe that natural birth is a scary thing. It’s not a safe thing here. That’s what we are taught.But I knew this time it was different because I knew if I wasn’t happy with my caregivers that I would change the setup. But after every appointment with this team and with these people, I just felt more and more confident and definitely more at ease with my decision. I knew that I was surrounding myself with a really supportive VBAC team.And then I was referred by my midwives to a really wonderful woman called Sally. She is a birth counselor and just an all-around wonderful therapist. I still have session with her today just to deal with all of the struggles of motherhood. We spent about nine months working together because from the outside looking in, everything seemed fine in my first birth and it was okay physically, but emotionally, I was traumatized. I really, really was. So working with Sally was such a big part of the preparation for me. It was so empowering for me because I had to face a lot of heavy stuff. It was a lot of internal work. I really am so grateful that I was able to do that and have that resource because I know there are not a lot of women who do have that available to them. So we made really huge leaps forward, her and I. And of course, there were lots of speed bumps along the way. Even right until the end of the pregnancy, there were some speed bumps, but it was really important for me to get over this trauma. Apart from that in terms of the VBAC preparation, like I said, I was all in. I left no stone unturned. I went to an osteopath regularly. I did pelvic floor physio. Spinning Babies, I did that. I read birthing books. I read The Mama Bamba Way of Childbirth. I don’t know if it’s available in the states, but my doula recommended that one, and a bit of Spiritual Midwifery.I was listening to Solfeggio Frequencies on pain relief and did Epsom salt baths by candlelight. I was also even thinking of intentional things like, “Let me choose a candle that has a beautiful scent that I’m going to use in my birth,” and just holding up those resources that I could use in the birth. And then, educating myself. I was reading Evidence Based Birth articles. I watched the documentaries like The Business of Giving Birth.And then of course, at two months in, I came across your podcast. That, for me, also became such a huge part of my therapy. For about seven months, I would walk three to four times a week listening to the podcast, laughing and crying. I resonated so much with these stories because these women, what they were saying and the things they were feeling, they were my feelings too, so it was really such an important part of this journey for me.So I guess then fast forward to the VBAC itself. This pregnancy was no different. It was very healthy, thank goodness, and I carried quite late. I was about 40+6 when he arrived. We went into isolation about two weeks before the due date because this was the COVID protocol, and then for a few days, I was starting to lose my mucus plug a little bit. Then one night, I started having some contractions late at night. They were not that strong. I could sleep through them. But I remember it was a Monday morning at 6:00 a.m. when I woke up and they were still there. You just know in your body like, “Okay, something is really happening now.”So I told my husband, Dane, and he took our son Max to school. He came home and we got ready because we actually had an appointment with our midwives, just a routine checkup. They knew what was going down. They said, “Come through. Let’s just have them look.” We went there. They were happy with how everything was going and they said, “Well, there is no need for you to check into the birth center right now. Go home and let labor take its course.” And I really wasn’t sure. I mean, “Should I be walking up and down the halls trying to get this going?” Both of them and my doula said, “It’s going to happen how it’s going to happen. The best thing you can actually do is just rest and chill.” And so that’s what I did. I lay in bed all day. I watched movies. I ate. I drank. I slept and the contractions were steadily there keeping me company all throughout the day. And I was just excited, really, because it felt so different than the first labor already. My husband was around. I told him to let the family know that things were going down. I was very specific about this though because I didn’t really want anyone sending me messages or calling me because as it is, I am such a highly strung, anxious person. I am always in my head and I just knew that the pressure and those questions were going to derail me. It was almost like that big match temperament. I needed to go inside this bubble and just get my head right. So that’s what I did. I stayed in this bubble all day radio silent basically.My mom came over around lunchtime. She was going to stay with Max when we were going to the birth center. By the evening, things were definitely intensifying. I went home and we were going downstairs and having some dinner with the family. I will never forget that it was chicken soup. I always think to myself, “What a fantastic pre-birth meal that was.” And then the midwives told me to get into the bath for about an hour and time contractions. So that’s what I did. Again, using the same candles, the same music, the same space, and just resourcing on that safe space that I created throughout my whole pregnancy was really, really helpful I think.So my husband was putting Max to bed and my mom was with me while I was in the bath. We spoke a little bit just about random things, and we just sat beside each other. I squeezed her hand through all of the contractions. I have to say because I think it’s a rule of thumb that you don’t really have your mom around when you’re in labor for various reasons, but I do have to say that it was such an unplanned thing, and it was such a lovely moment that we were able to have together for her to just be with me during this part of the labor. It was really, really special.And then, yes. The contractions were really strong at this point. Definitely, I was in active labor. So we called the midwives and told them that we were ready to come. We were on the way. And at this point, I could really barely get down the stairs. It was really tough to even walk. So my mom helped us get loaded in the car. I was in the backseat and I just remember feeling that shift. My moans and groans were getting louder. Dane was playing my VBAC playlist that I had created with all my feel-good songs and he was trying to amp me up, and I don’t think I heard any of it. I was just in another zone.When we got there, we were checked into our room. It was so beautiful and so different than the bright lights of a hospital room. It’s crazy. I had to do an internal upon arrival. I really told my midwives that I didn’t want any unnecessary interventions or internals, but that’s when I knew I had to do it, so I was prepared for it. It was really painful by the way. I couldn’t actually believe how painful it was. We also had agreed that I didn’t want to know how far along I was or how many centimeters I was dilating in case it would also derail me or discourage me. When Sarah, my midwife, finished the internal, she said, “Do you want to know how many centimeters?” And that, for me, was just everything because it was like she was really talking to me, not at me, which was what I had experienced before. I have so much respect for her for that. Really, I do. I said, “I only want to know if it’s good news.” She smiled and said, “You are 6 centimeters.” I was so pumped.Julie: Yay!Danielle: It was so electrifying. It was really wonderful. And this was about 9:00 in the evening more or less at this time. So I lay there. My doula was there. Dane was setting up the room so beautifully getting the candles and the same music. Everything was familiar which was really, for me, what I needed. I lay on my side. That was the position I was most comfortable in, my left side. He read the birth affirmations to me that I prepared. They were filling the birthing bath as things were intensifying because I definitely needed something to help with the pain. The whole time, Dane was quite hesitant at the beginning of this whole process to have a doula in the first place and I am so glad that we did, and I think he was so glad we did because she drew him in in such a way that made him such a special part of this. She showed him things that I think he wouldn’t have known and wouldn’t have noticed. I mean, how could you? He’d never been to a birth before. Things like when I was leaning over the bed and I don’t know what it’s called, but there’s a little bulge that appears in the lower back where you almost see the baby descending in the mom‘s pelvis. Just amazing things like that that she was able to show him which was really, really amazing.So yeah. I was told to empty my bladder before I got in the birthing bath. Again, it was so painful to even walk to the toilet and walk into the birthing bath. But I got in there and my doula just helped me through all of those contractions. I’ll never forget, she kept telling me to open up my palms and not to clench them. It’s quite an interesting thing going through these contractions and just remembering to keep my palms open. It was there that I really felt that transcendence. The one thing I didn’t do was a Hypnobirthing course, but I read about it. It wasn’t something I was aiming for, but I went into this really trance-like state. I really did. There were moments when Dane said to me– my eyes were closed pretty much the entire time– but there were moments when I would look at him and he said that it was like I was looking at him but I couldn’t see him. My eyes were glazed over. That was such an added bonus for me because again, being such an anxious person, to be able to achieve that level of trance state was amazing and wonderful.I couldn’t get it right in the birthing bath. I couldn’t get into a good position. The contractions were coming hard and fast at this point. I even remember saying to Sarah, the midwife, “Can you give me something for the pain? Or is there anything you can give me?” and I think she said, “Darling, I want to do another internal before I give you anything.” I think I just scoffed at her because the thought of having another internal, I was like, “Uh no. No way. I will just deal with it.”So we continued with no medication at all. She couldn’t really get a good reading of the baby at this stage, so I think they wanted me out of the birthing tub. It was just before I went out that the urge to push just hit me. Like, oh my goodness. It roared out of me and it was just this force that there was no stopping it. I just could not even believe how strong this urge was. But I got out of the birthing bath. I got onto the bed on my side again. I remember my doula whispering in my ear, “Okay. Just listen very carefully to everything Sarah is going to tell you and follow her instructions, okay?” I said, “Okay. I’m going to try.” I was in so much pain at this point. That urge to push just kept coming and coming and my midwife, her procedure or her method is quite slow and controlled. She tries to do it in such a way that is a bit slower but my goodness, that force was like it was bigger than me. I remember also that my doula, Liz, was saying, “Okay. Don’t worry about keeping your palms open now. You clench. You bite. You do whatever you have to do to bear down.” My poor husband got the brunt of it. I was clenching his neck, poor guy.I remember that my hands were flailing above my head and both Sarah and Liz said to me, “Grab the inside of your thigh” or “Grab the back of your knee and pull your head down. Pull that energy downwards,” and my goodness, that made such a difference. I pushed. I think it was about 40 minutes of pushing.Meagan: That’s not very long.Danielle: Not long at all. I know women in hospitals are sometimes told, “Don’t push yet. Let’s wait for the doctor,” and that was impossible.Meagan: Yes.Danielle: I could not have stopped it even if I tried. I really couldn’t. He came out and I was so excited that I reached down and I grabbed him. The midwife was grabbing him and I was grabbing him, and I pulled him out and obviously wanted to put him on my chest. He had quite a short umbilical cord, so I think he only got to my stomach. But yeah. Then he lay there. Thank goodness, he didn’t need any extra medical attention. The energy in the room was just so incredible. As I was getting cleaned up, we were all just talking, laughing, and crying. I think when you go through an experience like that with people– we’d been building this relationship throughout the pregnancy, but once you go through that moment, there’s just this unspeakable connection that’s created between you, the midwife, and the doula. It’s really, really special.Meagan: Absolutely.Danielle: I remember once they had weighed him and I had a little rinse in the shower, I was lying skin-to-skin with him and Dane grabbed my face. I remember he kissed me and he said to me, “You did it. You did it.”Meagan: Aww.Danielle: He said, “I just want you to remember this moment right now. If ever there is something difficult or something you feel like you can’t do, I just want you to remember that you did this.” I don’t think he realizes how impactful that’s been for me because it was such a huge hurdle to get through and I do. I think about how over the past year because it’s almost been a year since the VBAC, and going through any tough time when I have this uphill battle, I do. I think back on those words, and what he said, and that experience and I let it fill me up, that feeling, because it’s truly one of the most incredible experiences I have ever had, really.Meagan: That is so amazing. I love it so much and I love that he could say that. Like, “I want you to think about this and remember,” because it is. It’s such an incredible moment. When you say that you go through all these experiences leading up to having the baby and then you have the baby and it’s so much deeper. For me, my team, and the people that were with me that day, there are no words that describe how grateful I am for them and how much I love them and cherish them. I’m sure you will feel the same way forever. It’s so special and it’s so awesome to hear that you had such a great experience.Danielle: Thank you.Julie: Yes.Meagan: Yes.Danielle: It was amazing.Cesarean Rates in South AfricaMeagan: So I wanted to talk about a little bit at the beginning where we talked about how high Cesarean rates are. When you described your experience, I feel like you said this or maybe I said it in my head, but you were like, “This was not abnormal. This wasn’t uncommon.” It’s hard to hear that because it sucks. It sucks that it’s not that uncommon. I hope that over time we cannot just be The VBAC Link, but that the world can make these experiences better because obviously, your body was very, very capable of having a vaginal birth.But yeah. I wanted to talk about some of the main reasons why a Cesarean should happen. Sometimes, Cesareans are very valid. They are very valid and we are grateful for Cesareans. But there are a lot of times when there are things that are said or done and it leaves questions.But I wanted to talk about some of the biggest reasons why a Cesarean may happen. One of them is failure to progress. The cervix isn’t changing, the baby is not coming down, those types of things. It could be for a whole bunch of different reasons– being induced too early, overwhelming the body and not responding, scar tissue on the cervix, baby, and waters breaking early and maybe not coming down, those types of things. And then there are fetal heart problems where our babies’ heart rates aren’t in a safe zone anymore, so the best case is to have a Cesarean. Malpresentation or breech, meaning baby is not in the best position. On a podcast that we did just a week or so ago, she talked about how they confirmed right when they got there that the baby was OP, but then no one ever said anything about it the entire time, and then she pushed for three hours and they were like, “Oh, you have to have a C-section. Your baby is posterior.” And I am curious. I wish I could observe. I wished I could have come there and observed some of this birth to see what their reasons were and where they fit into these.Based off of friends, what are some of the biggest reasons why people are having C-sections in your area?Danielle: Yeah. Well, I am so glad you brought this up. This is such a big thing that I wanted to discuss because it’s happening so much here in South Africa. Even moms that I know have reached out to me because they know that I had a VBAC and they recently had emergency C-sections. They didn’t want them. They were led to believe it was the safer and better option and they were like, “Why has this happened to me?” So this is such a big part of why I want to share my story too. I really hope I can reach some people.So maybe just to give you a bit more background about what is going on in South Africa, you mentioned the C-section rates. A lot of women are actually having elective C-sections in South Africa. A lot of it is due to planning. They want to control the delivery date and a lot of this is based on fear and fearmongering by care providers. I mean honestly, we are led to believe C-sections are safer and better than natural birth. I mean, I heard on a couple of occasions women saying, “Oh, if you have a natural birth, you could really cause some brain damage to your child.”Meagan: Oh!Danielle: Honestly, this is our culture and I’m not even kidding. These are the conversations that I have been hearing and there’s just so much misinformation about natural birth. Because we have perpetuated this culture of fear, it’s taking over. It’s being overused. It’s been overprescribed for sure. Elective C-sections are even often routine to women, to mothers in their OB appointments. A lot of this has got to do especially with the insurance environment that OBs are working in and I am referring to the medical-legal costs which are extremely high in South Africa if you’re in the private sector. This is definitely having a big influence on intrapartum decision making. There are even so many OBs who are going out of practice and only offering gynecological services, not even deliveries. Another big problem is there is such a lack of properly trained staff. There is a huge shortage of trained and qualified midwives in South Africa. Laboring patients in the hospital are often cared for by general nursing staff, not qualified midwives. OBs are getting so scared because of the high level of litigation that they are covering every base. They are covering every base. They are doing every test. Just to give you an idea, in my first pregnancy that was led by an OB, I had about 12 to 14 ultrasounds. 12 to 14.Meagan: Woah.Danielle: With the midwife, I had about 5 or 6. Just to give you an idea of how they are just putting everything on record. They don’t want to miss a thing or miss a beat. I mean, it’s standard now to have a test for gestational diabetes without any history of diabetes. So it’s really, really interesting what is going on, I have to say. And a lot of the gynies– I know you call them OBs, sorry– we call them gynies.Meagan: It’s okay. They’re gynecologists too.Danielle: There we go. A lot of them, even though they themselves are pro-natural birth, they are operating in hospitals that have stringent protocols in place that are saying– in the hospital that I gave birth in the first time, I heard through the grapevine they are no longer doing natural births. They will not. They will not. They’re only doing C-sections. I don’t know how, but this is what I heard. I was digging around.So what’s happening is, you know we talk a lot about interventions during birth and this cascade of interventions, but there are also a lot of interventions that are happening during pregnancy leading up to the birth. I’m talking about the kind of things that start to play on your emotions, like almost playing mind games with you. They really are. I mean, I know that I am, like I said, a typical case. My gynie was so pro-natural. Everything was cool. Nothing was wrong the whole pregnancy, and then the bait-and-switch started. That’s what we call it, the bait-and-switch. You know, you start hearing things like, “The placenta is calcifying. Baby is not moving or descending. There are no signs of labor.” Again, routinely now, women are having internals done at 37 weeks pregnant. Something I didn’t know at the time.Meagan: Is that an internal ultrasound?Danielle: No, just an—Meagan: Oh, a cervical exam.Danielle: Cervical exam, yeah.Meagan: Okay.Danielle: And of course, at that stage, do you expect any cervical changes at 37 weeks? Not really. You are not full term, you know? You are not full term. So those things start to discourage you like, “Oh no. Nothing is happening. Oh, maybe I am not going to go into labor or things are not right.” We’ve seen it. I have heard this in so many different forms where they say that giving birth is like making love for a woman. It’s the feeling that she has to feel, the state of being she has to be in physiologically, mind, body, and soul to relax, give in, and let her body just be. And when your mind is being played in such a way, you can’t get there. You cannot get there. That’s exactly what happened to me. My body, I know, didn’t do what it needed to do because it didn’t feel safe to do so. It didn’t feel safe. I was very afraid and I know that this is happening to so many women. It’s quite a thing I have to say that’s going on here. It’s really, really quite a thing.Meagan: It’s so interesting. It reminds me so much of Brazil. I mean, in different ways. They have different reasons why they do C-sections there because that’s actually a sign of wealth which is crazy, right? It’s a sign of wealth to have a C-section in Brazil from what we have been told.Danielle: That’s crazy.Meagan: It’s so crazy.Julie: Yeah, of privilege and being like you have enough money for people to take care of you, so you don’t need to bother by–Meagan: –having a vaginal birth.Julie: –going through all of the trouble of having a vaginal birth. It’s just a cultural mindset shift.Meagan: Yeah. It’s fascinating to me. It really is. Like you said, I wonder how these docs are getting away with just scheduling C-sections, especially for first-time moms that have no previous C-sections. It’s disheartening to hear and hopefully like I said, they will come around and one day here we will see a shift in the medical system.Danielle: I really hope so. And you know, I think that is why– I mean, a VBAC is not a common thing in South Africa because as you said in the beginning, you are working against the system. You really are working against it. But you know, as with any system, there are cracks in the system. You have got to find them, you have got to work around them, and you have got to fight to get the birth experience that you want because the odds are not in your favor, unfortunately. But I think the more women who push for it and fight for it, then the more we can normalize natural birth in this country.Meagan: Yep. Yeah. Well, it sounds like you are going to be a bigger impact than you even know in your community and I am so grateful that all of the people in your community have you. We are so grateful for your story and I am hopeful that people will listen to this and feel like they can find the tools that they need to get a birth that they deserve and that they want.Julie: Yeah. I absolutely love that. We appreciate you for sharing your story. It was incredible. We love the journey and my goodness, all the way around the world in South Africa. It’s incredible. We appreciate you for being here with us today.Danielle: Thank you so much. This was great.ClosingInterested in sharing your VBAC story on the podcast? Submit your story at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Julie and Meagan’s bios, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link. Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands