Episode 247 Meagan & Julie + Does a 39-week Induction Actually Reduce Your Chances of a Cesarean?

Meagan and Julie talk about the ARRIVE trial and compare those findings with new research released from a retrospective study conducted at the University of Michigan. Many first-time moms and VBAC moms are being told by their providers that an elective induction at 39 weeks will reduce their chances of a C-section. Is this really true? Meagan and Julie will empower you with information about elective inductions to help you make decisions about your birth that are right for YOU.Additional LinksUniversity of Michigan StudyThe VBAC Link Blog: The ARRIVE TrialARRIVE TrialHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode DetailsMeagan: Hello, hello you guys. Guess what? Julie is on today. I have kind of, well not kind of, really missed Julie. I reached out to her a month or so ago and was like, “Hey, would you like to come on with me and we can do episodes?” And she said, “Yes!”Julie: Yes. Meagan: I should have brought chocolate cake. Instead of her proposing to me with chocolate cake, I proposed to her with my smile. I don’t know what I’m trying to say. I don’t know. I don’t know. But she said yes and I’m so glad that she said yes this time. So welcome, Julie. Welcome, welcome. Julie: Welcome. It’s good to be here. Meagan: Yeah. It’s good to have you here. It’s good to see your face. Julie and I are going to be talking about the ARRIVE trial today. That is something that if you’re not familiar with, it was done in 2018, and I think it was published in 2019. Does that sound right, Julie?Julie: Yeah, I think the final analysis was published in 2020. Meagan: Yeah. Julie: The study was completed in 2018. Meagan: Yeah. Yeah. It is where they did a trial to see if elective induction at 39 weeks reduced a lot of things. Not just Cesarean, but because we are in the Cesarean world, it was definitely, I would say, one of the most important topics. Does it reduce Cesarean? But also, does it reduce the chances of preeclampsia, hypertension, and other things? But the big question was does it reduce the chances of Cesarean? So we are going to talk about that today. We have a blog on it today, but there is actually an update. That was done in May of 2023 so we are going to talk about that. Review of the WeekBut of course, we have a Review of the Week and Julie is going to do the honors. Julie: Yes. I’m so happy to be back and joining the podcast anytime. All right. This review is from bethanystaggart or something like that. The title is, “Podcast Was Part of My VBAC After Two C-Section Journey”. She says, “I am so thankful for this podcast. I listened to so many episodes in preparation for my VBAC after two Cesareans. Listening to other women share their stories gave me the courage to keep working and fighting for my upcoming birth. I just gave birth to my third boy and the birth was everything I could have asked for. I am so thankful for this podcast and blog and refer every expecting mom I know to it in hopes that it gives them the courage and confidence it gave me to get the birth they want and deserve.” That just makes me so happy to hear those things and to know that the podcast is making a difference in everybody’s lives. I feel like there is such a feeling of solidarity when we sit and listen to other people’s birth stories. There is so much we can learn and there is so much that we can be inspired by and there is so much that we can use as we navigate our own birth journeys. So thank you, Bethany, for leaving that incredible review. ARRIVE TrialMeagan: All right, Julie. ARRIVE Trial. I feel like when this came out, you and I– I’m going to say for sure I– was just a little grumpy. I was like, “This can’t be. This cannot be.” Being in the birth world, especially since COVID, but this is pre-COVID, we definitely see induction and it can happen just fine, super smooth, with no problems, but then there are a lot of times too where it doesn’t. We see the cascade that leads to that Cesarean. I remember when Julie and I started the birth course and the How to VBAC Prep Course, we were teaching in person. We had a mom who came and when we talked about this, she was like, “I was in that. I was in that trial.” We were like, “Oh, how did it go?” She was like, “Well, I’m here prepping for a VBAC.” She had a Cesarean. She talked to us a little bit about it, but Julie, what do you remember about your first feelings when this trial came out?Julie: Well, I had a really hard time because you and I have been to many, many, many, many, many births in a hospital, out of a hospital, inductions, unmedicated, medicated, scheduled C-sections, emergency C-sections, crash C-sections. We’ve been to all of it. I think that’s really the unique perspective that we have as doulas and birth photographers because we get to see the biggest range of births, I feel like, of all of the people that work in the birth world. My first reaction when the ARRIVE trial came out was that it did not reconcile with my real-life experiences and living in all of these types of births. There was this disconnect between what this study said and what I had witnessed. Before I even got into the study and saw all of the flaws and the different little nuances that people be considering that they don’t because I just knew that something didn’t feel right. This cannot be right. This cannot be right. Meagan: Mhmm, yeah. That is kind of how I felt too. It didn’t click. I was like, “So, what? What did they do?” This was my first question as I was reading. I was like, “What did they do to ‘lower the Cesarean rate’? What did they do differently?” I think that one of the most frustrating parts is that we don’t really know exactly all of the protocols and all of the exact nitty-gritty details of this study. They haven’t released it from my knowledge anyway. Julie: Yeah, and I looked too just a little bit before we started recording. Yeah, sure. It’s really interesting because in the study results, the elective induction group had a Cesarean rate of 19%, and the expectant management group, which we’ll go into all of the reasons why that is a little bit crazy, had a Cesarean rate of 22%. But here’s the thing. The national Cesarean rate is 30% so I feel like already, they were doing things in the study that impacted the chances of having a C-section anyways. But we don’t know what those protocols are. We don’t know how they were induced. The results said, “When this induction protocol is followed, then the Cesarean rate is reduced,” but the problem is that we have providers all over the country inducing willy-nilly not knowing what the protocol is, and probably being more aggressive in their inductions. We know the providers that led this study. We know who they are. We have worked with them in their space. We know how they practice and we know that the induction protocol was probably– and again, this is me speaking with no real knowledge, just my assumptions. Take that for what it’s worth. They probably had a pretty gentle, slow induction process. They were probably pretty patient along the way just from what we know of those providers and the hospital that it originated from. That was also a thought. 22% is not a low Cesarean rate, but it’s 8-9% lower than the national average. So that’s something I think to consider as well into that. Meagan: Yeah. It is interesting to me because it was 50,000 patients that were screened for this study. Of those 50,000, 22,000 were eligible but only just over 6,000 actually accepted to be in this trial. Those numbers to me are pretty dramatic. 50,000 to 22,000 to 6,000 is a really big thing. I wish I knew more. We know what people have said who were in the ARRIVE trial. They had to do certain things, but I wish I knew more about why all of those people were declining and then why from 50 to 22,000 were eliminated. Why were people eliminated? But maybe it’s just because, “Yeah, we don’t want to,” because what we had seen is that induction raises Cesarean deliveries. Like Julie said, yes. We are going to share some studies and some numbers and things, but this is all just us brainstorming this out loud really because it is really interesting to me. Like Julie was saying, how long were these people able to be induced? Because induction– I mean, even if you go listen to all of these stories, Julie. Induction is not something that is able to be carried out for days and days and days usually. Julie: But sometimes it is. Meagan: Sometimes it is. Julie: Sometimes and that’s what we were talking about or I was talking about earlier. At this hospital where the study originated and where the providers practice that were the authors of this study, I have been to many, many, many two and three-day long inductions there that ended in vaginal deliveries. Meagan: So have I. Julie: And not all hospitals are that patient. In fact, I don’t know of any that are that patient in our area. Meagan: Yeah. No. I mean, the hardest thing is that if your client doesn’t want to be induced, you want them to not be induced because that’s not what they want, but if they are going to be induced, you almost want them to be induced at this specific hospital because we know that they will let these inductions happen. I think the longest induction or the longest birth– well, it is the longest birth I’ve ever been to, but at that hospital specifically was 52 hours. Julie: Yes. Meagan: I remember crawling up on the ground, putting a towel on the ground and falling asleep trying to take a nap because I as a doula had been there that long. They had called me in the very beginning. That is just not normal. Right? It’s not that normal. What kind of piqued our interest in wanting to talk about this again– I mean, we’re talking about something that happened in 2018. Now it’s 2023. It’s that the University of Michigan just released an article talking about this. It’s called “Labor Induction Doesn’t Always Reduce Cesarean Birth Risk or Improve Outcomes for Term Pregnancies”. So we want to talk about that and update you guys because we believe that updates, as we get more information, is important. So yeah. It was a 14,000– Julie, you were kind of analyzing– births. Julie: Yeah, so what I really liked about the Michigan study that was released is that it was a sort of analysis. This study was looking back at births and how they ended. Births that did not enter into a study. Births that were not set up in order to track. Births that just happened without any care in the world in this regard. They looked back at the data that they had already had. I love that because that’s what I love about Cochran reviews. I’m a big Cochran review junkie because Cochran reviews look at a whole bunch of data and a whole bunch of studies and put them together instead of creating a study and moving through it. The ARRIVE trial study was created in order to show if induction reduced the risk of Cesarean or other maternal or fetal mortality rates. How does induction impact that? That’s what this study was designed to do, but this study, the Michigan State study, looked back at data that had already existed without any type of bias going into it. Yes, there were 14,000. They looked at 14,135 deliveries in the year 2020. They analyzed all of those to look at the outcomes. Who ended in a Cesarean? Who ended up with hypertension? Who had postpartum hemorrhages? Who had– what was the other one– oh yeah, high blood pressure? Did I say that already? Operative vaginal deliveries– vacuum and forceps? That’s how they pulled it. There are different ways of looking at data as accurate so I don’t want to say that it’s more accurate, but I love that they looked back and that reflection on it. They showed that the group that was induced in the 39th week had a 30% rate of Cesarean which is what I was just saying. What was I just saying? The national average is 31.2%. That fits more in line with the national average of people that went in and got inductions versus 24% of the people who had the expectant management. 24% is not a great Cesarean rate either but it’s just a 6% decrease in those amounts of Cesareans. Also, for people that are wanting to know, the rest of it was people who were induced had higher instances of postpartum hemorrhage, so 10% versus 8% for the expectant management group. When we say expectant management group, those are the people who were not induced. They were just going through taking pregnancy as it came and then delivering whenever that looked like. When it was medically indicated to have an induction after the 39th week, those are probably included in those numbers as well. Operative vaginal delivery, vacuum, and forceps were 11% in the induction group versus 9% in the expectant management group. Although people who were induced were less likely to have hypertensive disorder which is high blood pressure. Those numbers are 9% in the expectant management group versus only 6% in the elective induction group. There were no significant differences, no other differences, in neonatal outcomes. No differences. Nothing dramatic, nope. Meagan: Nothing dramatic. The researchers mimicked the exact same framework used in the national trial. A CNM said, “We designed an analytic framework mirroring the previous trial’s protocol using retrospective data but our results didn’t reinforce a link between elective induced labor in late pregnancy and a reduction in Cesarean births.” Julie: Yep. Meagan: It did not. It’s so interesting because even now, today, we are still– as a doula still working in the field– seeing these inductions not even just being offered but flat out just being scheduled. Like, “Hey, we are going to schedule your birth at 39 weeks.” They do. They say, “Because that is going to lower your chance of Cesarean rates.” Julie: That’s what they tell you. Meagan: Yes. They do tell you that. When you are expecting for the first time, the second time, or anytime, most of the time, someone is not necessarily wanting to go in for an elective Cesarean, right? I don’t want to say that it doesn’t happen because it does and that’s okay. But it’s really not what’s happening. People don’t just start raising their hands and sign up for Cesareans, especially first-time moms. Julie: Do you mean inductions? Meagan: No, Cesareans. Julie: Oh, okay. Gotcha. Meagan: No. They’re not like, “I want a Cesarean. I want a Cesarean.” So when you have a provider say, “Hey, at 39 weeks, we’ll go ahead and schedule an induction because that is going to lower your chance of having a Cesarean.” Julie: Then they’re like, “Oh, yeah. Absolutely. Go for that.” Meagan: They’re like, “I don’t want a Cesarean.” Right. So that’s where we go but then we’re looking at this and we’re like, “Mmm, but does it really lower our chances of Cesarean?” Julie: Mhmm. Meagan: That is where it’s frustrating and that is where I feel like–Julie: People are being misled. Meagan: Yes. I was just going to say that we have misguided people into doing certain things that actually don’t have the most solid data out there. I don’t want to discredit the ARRIVE trial. I’m not saying that it’s completely false or wrong. I’m just saying, “Let’s look at it deeper and why don’t we release more about this trial?” It’s been how many years now and that hasn’t been released but we are still inducing at 39 weeks. Julie: Yep. Well, it’s so funny because– okay. I’m going to change my thoughts actually. Strike that. I feel like I want to go back and talk a little bit more about what you talked about in the beginning about how the number of people that were eligible in the trial versus those who elected to be in the trial. 72% of women who were approached to be in the study declined to be in the study. Meagan: Declined it. Julie: So this is what happens. Your doctor comes up to you and says, “Hey, we’re doing this study.” Some people are just not going to want to be in studies and that’s totally fine. It doesn’t matter, right? But your doctor comes up to you and is like, “Hey, we’re doing a study. We’re going to randomly assign you to a group. You can be induced at 39 weeks or you can be in the expectant management group, but if you hit 40 weeks and 5 days, we’re going to induce you anyways,” because that is another thing that they did. They counted those in the expectant management group. If they got to 40 weeks and 5 days and hadn’t had their baby, they were indued. Now giving intel, ACOG recommends 42 weeks and 6 days before induction is absolutely necessary. They say it should probably be considered in the 41st week so between 41 and 42 so why are we not waiting until 41 weeks? Why are we not giving them two more days? Why are we not giving them nine more days to get to 42 weeks? But that was the cutoff for whatever reason. Meagan: 75% of the group overall had their babies by that day. Julie: Yeah. That’s a big percentage of people that are still being induced at 40 weeks and 5 days. So your doctor comes to you with these two options and you say, “You know what? Sure, that sounds great” or “No, I don’t really want to.” 72% said, “No, I don’t really want to,” for whatever reason. I know for me– well, first of all, you had to be a first-time mom so there are no VBACs included in this at all. It was all first-time moms. So it doesn’t apply to anybody else. This study’s risk findings do not apply to anybody else. Same with this Michigan study. The Michigan study only looked at first-time birthers. So as a first-time mom, I know that as I was planning for my first birth, I wanted a Hypnobirth. I was planning on going unmedicated. That was what I wanted. That was my birth plan and my birth desire. It obviously didn’t end that way, but I wouldn’t have elected into or opted into that study because it went contrary to the things that I knew I wanted for my birth. I feel like the ARRIVE trial automatically excludes it. People will automatically not do it if they are a more naturally minded person who wants a more hands-off birth experience. I feel like you are going to get really honed into a medical demographic that is okay with the medical system, that trusts their doctors, that wants to just go in, get hooked up to an epidural, and have a baby. Not that there is anything wrong with that, but I feel like the mindset going into birth can influence how you respond during birth and how your body responds during birth. That’s the other thing that I really like about this Michigan study. I feel like you have a wider demographic in the mindset department of how these people birth. I feel like there are going to be more types of birth plans involved there. There is going to be a bigger variety of people and of experiences that are sought after in the birth space in the data set for Michigan. Meagan: Yeah. You just kind of talked about this. So how does VBAC and the ARRIVE trial even apply or does it? Julie: It doesn’t. Meagan: It doesn’t. That’s the answer, but you guys, we are still seeing so many, so many of our VBAC mamas being told that they have a higher chance of Cesarean or they have to have a baby at 39 weeks in order to have a vaginal birth because they have a higher chance. The ARRIVE trial is actually brought up to these people because they are viewed as first-time moms because they haven’t had a vaginal birth. But that’s not the case, right Julie? So many people who have had a Cesarean actually labored and dilated to some degree, if not all the way, right? Julie: Yep. Meagan: So why are we applying it at all to anyone– I mean, if I had my way? Julie: They shouldn’t. I feel like there is probably something a little bit unethical about doing that. Saying, “Hey, look. There’s a study that came out saying that inducing you at 39 weeks reduces your chances of having a C-section.” I feel like when that alone is being said and offered, it’s a little bit unethical. Meagan: Yeah. I just don’t love it. I don’t love it at all. So let’s talk about some other ways. I guess let’s wrap it up. Does inducing at 39 weeks as a first-time mom or according to the ARRIVE trial, does it really reduce your chances of Cesarean? What would you say, Julie? Based on what we’ve got, what would you say? Does it really? Julie: I would say, if somebody asked me that, this is exactly what I would say. I would say maybe, but there are a lot better things that you can do to reduce your chance of having a Cesarean besides being induced at 39 weeks. Meagan: Yeah. That would be my thing. Possibly. Possibly. However, it depends on how it’s done. It depends on the hours that you’re going to be given. It depends on the patience of the provider. Julie: On your doctor, on your provider, on their Cesarean rate. Meagan: Yep. It depends on a lot. So could it actually lower your chances of Cesarean? In my opinion, maybe. Maybe. But does it yes or no? I would say there’s not an answer there. No. There’s not a yes or no here. Could it? Maybe. But okay, what are other ways to reduce your chances of Cesarean? Right? I think induction really is a hard one because sometimes there are things that are coming up. In this ARRIVE trial study where it’s like, “Okay, it seems to lower chances of hypertension and hypertension can be an issue for vaginal birth so if we can reduce our hypertension levels, maybe an induction at that point can reduce a Cesarean.” Julie: Maybe. Maybe, yes. But maybe– here’s the thing though to consider because I think this is so individualized. It should be individualized but it’s not being individualized. Here’s the thing. If you have a history of pregnancy-induced hypertension, then maybe elective induction at 39 weeks is something that you heavily consider. I guess if you’re a first-time mom, then it doesn’t matter. You don’t have a history of anything because it’s your first pregnancy. But if you have a history of hypertensive disorders in your family, if your blood pressure is starting to creep up a little bit, if you’re having signs of preeclampsia or something like that, if there’s a reason where you might be at a higher risk for pregnancy-induced hypertension, then maybe that’s something that you consider. Meagan: Right. Julie: If there are other ways to manage hypertension, first of all, there are lots of dietary things that you can do. There is medication that you can take, pharmaceuticals, and things like that if it starts to creep up. That’s why I’m saying that it’s such an individualized thing but I hate how we apply– we as in our healthcare system– the same standards to every single person. That’s my biggest peeve about it I think. Meagan: Yeah, yeah. Exactly. It’s the same thing when we look at VBAC. It’s like, “Oh, well this, this, and this. The calculator or whatever.” You cannot do that. You have to look at the individual. You have to. You have to. You have to. Because guess what? Julie and I are not the same person. We do not have the same body. Our cervix isn’t the same. Our uterus isn’t the same. Any of that, nothing is the same. We might have similar characteristics in our bodies or the way our cervix does things, but we are not the same. You cannot say. I don’t love and I don’t feel comfortable that they are grouping so much in this wide range because it’s not necessarily the case. So let’s talk about it. What are other ways to reduce your chances of having a Cesarean? I know that Julie and I got a little passionate on an episode in the past about home birth but there is something to be said about home birth and what it can do to a Cesarean rate. We know that it’s not for everybody, but it is there. It is there and you are going to have fewer chances of having induction or interventions which can lead to reasons for a Cesarean. So choosing a home birth and a provider. A provider is one of the biggest things you can do to have a vaginal birth and to lower your chances of Cesarean. Mine and Julie’s– if you’re just new to us, Julie and I actually had the same provider who performed our Cesarean with her first and my first and second. I mean, I don’t know Julie. Did you know about him that he had such a high Cesarean rate? I didn’t. Julie: No, not until years later. Meagan: Me neither. Yeah, I didn’t either, and then obviously, years later when the numbers were actually there for a little bit but also seeing other people go to him and them all having Cesareans. I was like, “Hmm. That’s weird.” I still to this day know people who are having babies with him and are still having Cesareans. Julie: Yeah. Meagan: He’s not all Cesareans, but he’s very high in the Cesarean rate. So choosing your provider who is comfortable with birth, who trusts birth, who trusts you as an individual to make decisions for your baby and body, right? What are some other suggestions, Julie, that you would give? I mean, there are so many. Julie: We know that having a doula decreases your chances of having a Cesarean by 25-39%. I think it’s actually 39% but in our blog, it says 25%. It’s interesting how they break it down. There’s a study about doula support. They break it down by having continuous support and then continuous support from a doula. I feel like the numbers probably got switched out. I think 25% by having anyone with you continuously like your mom or somebody and then a doula is even higher at 39%. Having intermittent monitoring versus continuous fetal monitoring reduces your chance of having a Cesarean by 39%. I could go off on a whole soapbox on continuous fetal monitoring, but I will not so I don’t want to turn this into an hour-and-a-half-long episode. But obviously, your provider, like Meagan said, is so, so, so important. Look into alternative methods of pain relief like laboring in the water, different types of counter pressures, different types of birthing positions, and laboring at home as long as possible. I think you already talked about that a little bit too. All of those things– having a supportive environment and being able to move freely is going to help with all of those things. I would also argue that waiting for labor to start on its own and waiting for spontaneous labor is also going to decrease your chances of having a Cesarean just by the things that I have seen in my own practice as a doula and now birth photographer as well. It’s not going to get rid of your chances all the way doing any of these things or even doing all of these things are not going to guarantee that you’re not going to have a C-section but they’re going to drastically reduce your chances of needing lots of interventions including a Cesarean. Meagan: Right. And really too, in all of this, education is so, so important because as you’re going through this, you’re vulnerable you guys. It’s hard. Especially when we are actually in labor, it is not easy. If you have a provider coming in and saying this, this, and that, it’s not easy to say, “Oh yeah, well the evidence says this.” It’s not, but at the same time, if you have the education in your mind and a provider comes in and says something, you’re less likely to get spooked or scared because you’re going to know the evidence. Whether or not you’re in a spot where you can actually talk about the evidence, you mentally are prepared because you’ve educated yourself to know that what they are saying is maybe true, maybe not, but you know the alternatives to those things or you know the evidence against those things so you can say, “Okay, I really appreciate the conversation. I’m going to need some time.” Maybe you feel comfortable with that because you know the evidence. I think all of these things along the way are so impactful for you to truly have a better birth experience. Even if it does go the Cesarean route, again, with being educated, feeling supported, and all of these things, you’ll likely have a better Cesarean experience because you’ll have the options. You’ll know and you’ll feel better about making the choice and the decision. Julie: And you’ll feel like you have made a choice. Okay, so except we’re in extreme circumstances where there’s a really life-threatening emergency, you will feel like you did everything you could. You will feel like you were in control of what was happening. You will feel like you called the shots. I just had a client a few weeks ago. She was going for a VBAC after two C-sections. She felt like she wanted to be induced in her 39th week. She followed her intuition. She leaned into it. She trusted her doctor. Her doctor was super, super supportive and he was really just trusting her. He had his recommendations, but he also felt good with the choices that she made even though they weren’t necessarily always in line with her recommendations. He supported her and it was a really beautiful relationship to see that happening. But she chose to be induced at 39 weeks. Her provider was comfortable with her going beyond that, but she felt like it was time for baby to come. I won’t talk about all of the reasons why. So she ended up getting induced and they went for almost 24 hours. She told me the night before– the induction was, she wasn’t dilating. They started Pitocin. She wasn’t dilating. She told me, “If I’m not dilated to a 3 which is the farthest I’ve ever gone in my other two pregnancies and my other two inductions, then I’m calling it in the morning.”I was like, “Okay. I support you in your choice.” I was doing doulatog for her, so doula and birth photography. “Just let me know when you want me to come. I will be there.” She ended up not dilating at all overnight so she called it and she had a C-section. Her provider was there along with her the whole way supporting her and he was like, “Okay, well we can do this. We can keep going if you want. We can call it if you want. Whatever you want.” She was literally calling her shots the whole time. I was also her doula for her last C-section and it ended similarly. She was induced a couple of weeks earlier for preeclampsia and she labored for a long time and just didn’t dilate. Both of these two Cesareans were relatively calm for her even though it wasn’t the end goal that she wanted. She feels confident that she made the right choices all along the way. She had all of the information and all of the knowledge.Here is the thing. On another note, I had another client. No, it wasn’t a client of mine. I’ve had many similar clients. I was just talking to another birth photographer friend a few weeks back. She had a client who was a first-time mom who was 39 weeks. This client didn’t have a doula but she was her birth photographer. She called her up one day and she said, “Hey, just so you know, I’m going to be induced at 39 weeks. This is the day that I’m being induced. I’ll let you know along the way when I’m ready for you to come.” The photographer said, “Oh, why are you being induced?” She said, “Well, my doctor just told me that it’s going to be better for me to avoid having a C-section. It’s going to be safer for my baby.” I don’t know why they said that. Keep in mind, this is also secondhand information. Then my photographer friend was like, “I just don’t know why she’s being induced because she says she doesn’t want to be induced but she also trusts her provider.” Okay, we trust people too. You have to let people make their own path. Anyways, the long story short is that my friend’s client ended up having a C-section. My friend was allowed in the operating room which is really good when that happens, but it’s really funny because who knows if it would have been able to be avoided or not? We just will never have the answer for that by waiting but I feel like I tell these two stories. They both ended in Cesareans after 39-week inductions because one didn’t want an induction but she was just doing what her provider said and the other worked with her provider and her provider trusted her and she made the choice. Who do you think is going to be the one that has questions about how the birth went or one day wakes up and says, “Wow, I feel like I just got railroaded by the system”?What I wish more parents could understand is that we have a responsibility for our education around birth. Meagan: Yes!Julie: I feel like it’s a big disservice that we aren’t teaching parents more about these options and choices and what’s available to them, but you have a responsibility to step up, to learn more, to figure it out, to trust your intuition, and to ask questions of the people supporting you and if they will not answer them or if they make you feel uncomfortable, then you have the right and the responsibility to seek care elsewhere. Meagan: Yeah. Yeah. Absolutely. We know it’s not easy. We know it’s not easy, but you have the right. You always have the option. There are so many times when we get hired as a doula and we hear, “This is what happened. I just didn’t know I had an option. I just didn’t know. I just didn’t know.” It’s hard because you can’t blame yourself for not knowing but at the same time, it is our responsibility for getting an education. It’s the hard thing because I didn’t know what I didn’t know, but at the same time, I could have learned more. It’s a really hard topic but get the education. Get a good, supportive provider. If you can, hire a doula. Eat really healthy. Do all of the things you can to lower your chances of having a Cesarean and know that if you are induced at 39 weeks as a first-time mom or a first-time vaginal birther, that doesn’t mean that your Cesarean percentage is absolutely factually going to be lower. It just doesn’t mean that. We hope that through listening to this, you’ve gotten some information. You’ve learned more about the ARRIVE study. As updates come through in all aspects of birth, we want to be here. We want to update you and share these. Julie, thanks for being with me today.Julie: Absolutely. ClosingWould 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.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands