Episode 256 Anneke's Cesareans + Advocating, Trusting, & Finding Success

Anneke is a Pelvic Floor Physical Therapist from Oregon who is a long-time VBAC Link Podcast listener. During her first pregnancy, she would listen to 5+ hours of episodes commuting back and forth from work! Anneke was more than committed to having a vaginal birth with each of her pregnancies, but what she has learned from her births about advocacy, trust, and defining success are beautiful lessons that have changed her forever.At The VBAC Link, we are here to help you achieve your goals of a vaginal birth. But even more importantly, we are here to advocate for empowered decision-making in the birth space. Anneke is an inspiring example of being educated, strong, and finding healing within circumstances that were out of her control.“Since my first birth, I’ve asked, ‘Why? Why not me? Why does this keep happening and why can’t I just be like so many others on the podcast and so many others across the country? Why can’t I just will it into being?’ From these questions, I’m starting to believe that my story actually might begin at the end. I’ve realized that maybe my story isn’t about the mechanism of birth at all, but what it birthed in me which was the ability to see my own strength.”Additional LinksThe Lactation Network WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello. Wherever you are listening from, welcome to The VBAC Link. We have three beautiful stories for you today. They are all unique. They all have certain things along the way that add some unique factors. We have our friend Anneke. I keep questioning that, but it’s Anneke and she has had three Cesareans. Her Cesareans really all have been a little bit different and for different reasons. We’ve got IVF. We’ve got low fluid and we have breech presentation. I’m excited to share your stories or have you share your stories today, but as always, we love starting our podcast out with a review. Review of the WeekToday’s reviewer is from a girl named Megan. It says, “Great resource.” It says, “Such a great resource for VBAC mamas to come and listen to women’s stories and get great evidence-based practice information. I do wish these ladies would do a little less interrupting of the storytellers.” Well, I’m so sorry, Megan. We definitely do jump in so hopefully, Anneke, you don’t feel too interrupted. But we do like to be a part of your story as well because we want you to share your story, but we are listening and we are listening for the first time. We are reacting as if someone else would react the first time they are listening, right? So yeah. Thank you, Megan, for your review. We do love your reviews as always. Seriously, anywhere you listen– Apple Podcasts or Google. You can email us. Write us on Instagram. Let us know what your review is because we would love to read it on the next podcast. Anneke’s StoriesMeagan: Okay, Ms. Anneke. Welcome to the show. Anneke: Thank you. Meagan: Thank you for being here and sharing these stories. I just want to turn the time over to you and have you share away and educate these listeners. Anneke: Awesome, well I am a long-time listener of your podcast actually. I think I found your podcast before I gave birth to my first child. Meagan: Oh really? Anneke: Yeah. I was doing 5-hour drives. I am a pelvic floor physical therapist. Meagan: Oh yes. I wanted to talk about that too by the way at the end. Don’t let me forget. Anneke: Well, I was contracted to work where I am actually working now. It was a 5.5-hour drive. I would go down once a month and treat patients so I would listen to 5.5 hours of your podcast. Meagan: You would get through quite a few episodes. Anneke: Yeah. Lots of episodes. I always had this dream that I would be able to come on The VBAC Link with this triumphant VBAC– well, with this triumphant story. I never expected to have a Cesarean. I don’t think anybody ever does. But after I had my first, I was like, “Okay. My goal is to someday be on The VBAC Link with this triumphant story.” I’m not here today with the triumphant vaginal birth that I was hoping for, but I really think that my births tell three stories. The first one is about advocacy and then the second one is about trust and then the third one is about defining success. Meagan: Oh, that just gave me the chills. That really did. So let’s talk about this. Anneke: So my first pregnancy started after about three and a half years of infertility. We went all the way through to IVF. I’d been having some mental health struggles getting through all of the infertility pieces so I’d been doing counseling and that was amazingly helpful. We get into the pregnancy. Everything is going beautifully and at about 18 weeks, I had some really bad swelling. I told my provider and he was like, “Well, sorry. Sometimes people just get swelling.” I just went with that. A friend of mine who is a pelvic floor PT– I was seeing her because I was doing all of the things. I had prenatal yoga and I was seeing a pelvic floor therapist because I had some pelvic pain and pelvic tension in the past. She took my blood pressure one day and it had always been normal in the OB’s office. She was like, “Wow, you’re a little elevated.” That was in August at about 20 weeks probably. Baby looked fine and he was growing just fine. I’m just continuing to get more and more swelling. They were like, “Well, shucks.” I probably went into OB triage three times because I had systolic pressures above 150. Meagan: Oh!Anneke: Yeah. The third time I went in, they said, “Stop taking your blood pressure. Stop coming in. You’re fine.” Meagan: Did you have protein at all? Anneke: No, so everything was always really clear. I was peeing in a cup every time I went into the OB’s office. They would take my blood pressure and they’d say, “You’re fine.” I went in sometime in October to get my flu shot and they said, “Oh, your diastolic (bottom number), is a little high.” I had an OB visit two days later and they said, “Just let him know.” He put me on metoprolol, a beta-blocker blood pressure medication, and had me start tracking my blood pressure which was kind of validating because I had been trying to tell them for weeks that my blood pressure was high. So I’m tracking it and the metoprolo was working okay. My blood pressure was elevated, but it wasn’t scary. I went to my 32-week visit and I actually did have a little bit of protein in my urine at that visit. So we were living in Salem which is the capital of Oregon so it’s a big city. The big research hospital is only an hour away. It’s really close. They went and sent me for bloodwork after I had some protein in my urine. They called me later that day and said, “Hey, your numbers are borderline so we want you to come in and get these injections.”Nobody had talked to me about preeclampsia. Nobody had talked to me about, “Hey, we’re concerned about this.” They were just like, “Hey, you’re probably looking at an induction at 37 weeks.” They said, “You’re borderline. We need you to come in for these shots.” I was heading down to Lakeview where I live now to do some contract work. I said, “Well, I’m going out of town this weekend. Can it wait until next week?” I could come tomorrow. The shots are supposed to be 24 hours apart. They said, “Oh yeah, yeah. It’s fine.” Now, looking back, in a movie, that’s where they would say, “Dun, dun, dun.” They sent me 5.5 hours away to rural Oregon where the only hospital there is a critical access hospital that does not have a NICU. It does not have on-call anesthesia. It has nothing. Although now, having been here, it has a lot more than what we think. So anyway, I go down. I work that day. I woke up the next morning and had all of the preeclampsia symptoms. I bet I had gained 20 pounds overnight. Meagan: Oh man. Anneke: My blood pressure was 180/25. I came down and my mom and my husband were staring at me because I was so swollen. Meagan: You didn’t look good. Anneke: Yeah, and because of the attitude I got from triage– my husband had me call triage up in Salem and they said, “You need to go in right away.” But they had sent me home so many times before, so I was like, “Well, I have a hair appointment so I’m going to go to my hair appointment.” My hair looked awesome and I walked into the local ER here. This is where I grew up, so I knew everybody working and they didn’t recognize me because I was so swollen. I had gone from borderline preeclamptic on Wednesday to by Saturday morning, severely preeclamptic. I ended up being life-flighted out to Salem. Meagan: Oh my gosh. Anneke: The ER doc that was here said, “If you were one week farther along, I would deliver you.” I was only 33 weeks at that point. They got me up to Salem and they were able to stabilize me. They said, “Okay. We’re just going to go week by week. We’re going to try to hold you off until 34 and 35 and get you as close as we can.” So Saturday went by. Everything was looking better. Sunday, our game plan was to wait, and then by Sunday evening, I had stopped peeing. I was drinking tons of fluid. That was actually the first time– I mean, I’m a medical provider and that was the first time that I was like, “Okay. Something is wrong.”Meagan: Yeah. My body is not happy right now. Anneke: Yeah. The nurse was like, “Okay, come on. Let’s just go pee.” I was like, “Dude. There’s nothing in there.” Lo and behold, I had kicked over to near eclampsia. They worked for a couple of hours to try to get my blood pressure down and stabilize me. It wouldn’t stabilize. The OB who was at the hospital in Salem came in and said, “I think we are going to induce you tonight and you’re going to have 36 hours to deliver or we’re going to take you to C-section.” That was really scary for me. I had a doula. I had a doula team that I loved, but my whole birth plan was movement. I really wanted to go medication-free, but they said, “Look, no. We’re going to induce you. Cytotec, Pitocin, and you’re going to be in bed.” I got really scared and talked to my doula and my husband, and then the OB came back in probably an hour later and said, “Nope. Actually, we’re just going to take you to C-section,” then basically turned around and walked off. The poor nurse. I remember just bursting into tears because even though I was scared of not moving, I really didn’t want a C-section. That actually– my son was born the next morning at 3:00 AM and they whisked him straight to the NICU then because of all of the magnesium they had me on, I didn’t hold him. That was Monday morning. I probably didn’t hold him until Tuesday afternoon. I got to see him briefly, but one of the things that stands out to me the most is being in the PACU, the recovery from surgery, and the doc staying with me for about 2.5 hours. Looking back, docs don’t stay with you. Meagan: No. Anneke: They are very worried about you if they are by your bedside for 2.5 hours. We were really lucky. We had a very short NICU stay. We had a wonderful NICU team. My recovery was rough, but as soon as I gave birth, the preeclampsia started to fade. I lost all of that water and I felt a lot better. But I walked out of the hospital 10 days later with my baby, looked at my husband and said, “Next time, I am doing a vaginal birth.” He was like, “Pump the brakes for a minute.” Meagan: He’s like, “Maybe let’s just not even talk about that.” Anneke: Yeah. But I was so committed. I had really severe postpartum anxiety that I probably should have been treated for because if anyone comes out of the NICU, you come out of this gruesome schedule of waking your baby up and pumping and feeding. So for about 6 weeks, I just didn’t sleep and had really severe postpartum anxiety. I should have been treated probably, but you’re not really in a headspace to think about that. But I remember, thank God for my mom and my husband, screaming at my mom about washing the bottles incorrectly. Thank goodness my mom loves me because she was like, “Okay,” and just supported me. Meagan: Yeah, but those are actually signs of postpartum anxiety where you need things to have to be just so or you’re really nervous about a binky falling on the ground. Yeah. It seems super irrational to other people, but it is so real to the person going through it. Anneke: Right. Right. I think it just speaks to the lack of postpartum care that we have. They discharged me. I mean, I found out about 5 years later that I almost died that night. The Cesarean was life-saving. That was absolutely what I needed. They discharged me 5 days later with just, “All right. We’ll see you in 6 weeks,” and then at 6 weeks, they’re like, “Well, back in the saddle, Sally.” There’s no coverage there. No coverage of care for me. Meagan: I know. It’s where we’re going wrong. Anneke: Right. Meagan: They’re going wrong in the postpartum area in a lot of ways. Anneke: Yeah. I had trauma and nervousness. It was probably 6 or 7 months before I finally came out of that postpartum anxiety, probably a year before I felt like myself. After about a year, I mean, I think just like everybody, you’re like, “Okay. I could do this again.” You know? I started to get in shape. I started to exercise again, and then I had this weird episode of bleeding. I thought, “Oh, it’s just my period coming back and being stupid. It actually ended up being a miscarriage. I had never gotten pregnant before. I had never gotten pregnant on my own before so it was kind of this weird happy/sad experience. Fortunately, we were able to naturally conceive my second child, my first daughter, about two months later. Meagan: That’s awesome. Anneke: Yeah, it was amazing. I was so grateful. I found immediately that I had this focus on wanting this vaginal birth. I felt very fortunate because the other podcast I listened to all throughout my pregnancy was one by Parijat Deshpande. She had a podcast– I guess she doesn’t record for it anymore– called Delivering Miracles. It was all about high-risk pregnancy and doing all you can to reduce your risks of having a high-risk pregnancy and also recovering. I think I emailed her office person every week for a year because I really wanted to work with her. I finally was able to get in with her right around the time we found out we were pregnant. She does a lot of trauma relief work. It’s a lot less of talking out your issues and more using movements and visualizations to help bring down your sympathetic fight and flight nervous system. I worked with her throughout my entire pregnancy. I felt like a rockstar. There was no swelling. I guess in the meantime, the other part of the story is that we had moved down to Lakeview– the really rural, critical-access hospital place. We moved down here in between my first and second child. There are no VBACs here so the closest place is about 3.5 hours away for a supportive VBAC provider. Meagan: That’s a long drive. Anneke: It’s a long drive. We actually made the decision that we were going to go back to Salem to do a VBAC. I love my provider down here. I actually went with the guy who admitted me to the ER the day I had preeclampsia. He was a totally different personality than I thought was going to be a good fit for me. When he admitted me that day in the ER, he explained exactly what was happening to me. He explained why he wanted me to do the things he wanted me to do. I thought being flown– and he explained, “Look. You could have a seizure. You could have a stroke. This is my very strong recommendation. This is not a prison, but this is a strong recommendation.” I just really liked that approach. I felt like I had a lot of trust there. He had saved my life. I mean, it sounds dramatic, but he had saved my life once. I went with him again and he was very supportive of figuring out how to make the VBAC work and when to go and how to transition, but he also had a backup plan for a Cesarean just in case. At about 28 weeks, they always do a little ultrasound at the visits, and she was breech but everything else looked fine. He was like, “Oh, you have plenty of time.” The weeks go on and she continues to be breech. He’s in the back of his head thinking, “Okay, we need to probably start looking at the calendar and thinking about dates.” I’m just in denial at this point. I’m like, “It’s going to happen.” Like all of the stories on The VBAC Link, you will it. You positively think. You do the stretches and the walking and the whatever and they’re going to turn. Baby is going to turn. We get to 34 weeks and he said, “You know, let’s just check you on ultrasound. I just want to make sure,” because my placenta had been anterior. He was like, “I just want to make sure that your placenta is off your scar in case we have to do a Cesarean.” We were excited because of course, it’s a really small town. Lakeview is where I live and it is a town of about 2,000 people and a county of about 7,000. You literally know everybody. We’re about 100 miles from the closest next hospital. We’re very rural. We know the ultrasound tech of course and she was like, “Oh, we’re going to do 3D,” so we walked in being very excited. She did the biophysical profile and I had a fluid level that day of– my AFI was a 4.1. Meagan: Oh. What week is this? Anneke: 34. Meagan: 34. That’s low. Anneke: That’s low. She was like, “You’re not leaving today.” I was like, “What?” So thank God, I was working with Parjat Deshpande. We immediately kick into all of the things to help keep my anxiety low and help keep it all out of my body. We were tracking so now I was doing biophysical profiles. I think they started every other day and my fluid numbers started to come back up. Our docs here consult with maternal-fetal medicine out of a town about 3.5 hours away. They said, “Okay, as long as you are trending upward, you are fine.” But at that point, we kind of knew that a VBAC was off the table because with that low of fluid, baby is really unlikely to turn. At that point, I was like, “Okay. Let’s just keep her healthy. Whatever we need, whatever we’ve got to do.” So we are chugging along and at about 35 weeks and a couple of days, my fluid level got all the way down to 2.1. It had come up and then it started to come way back down. The earliest that our hospital can deliver babies is 36 weeks. Meagan: You were a week out. Anneke: I’m a week out, yep. Oh my gosh. There’s all of this lore about low amniotic fluid, so I was probably drinking close to 2 gallons of water a day. There is no direct correlation. There is a correlation with hydration and low fluid, but not pathologically low fluid. But there is all of this lore, so I was drinking close to 2 gallons of water a day and also drinking these buttermilk and blueberry smoothies. It was an Indian culture thing to have buttermilk to help with fluids. They are actually weirdly good but I was drinking one of those every day. Meagan: Interesting. I’ve never even heard of that. Anneke: Yeah. I mean, all of the Google things. We were just doing all of the Google things. We made it to– when I was 36 weeks, both my OB and I breathed a sigh of relief. We’re like, “Okay, we made it. Okay, so here we go now. We’re going to keep tracking her to 37 and get her to early term or late preterm.” The MFM was like, “Nope, just go for it.” We ended up delivering her at 36+1 via Cesarean. What was so wonderful about that birth is because of my work with Parijat and really trusting in a medical team that was around me, I felt like that birth was not traumatic. It was scary and we were worried, but she came out of me and just started screaming right away. I was able to breastfeed. She came right to me in the OR and we breastfed in the OR. I mean, the one nice thing about having a Cesarean is that the spinal takes a long time to wear off and you have a catheter. I think I did skin-to-skin for 6 hours. My husband did not hold her for 6 hours. That was one of the things that really left me with some trauma from my son. So I just remembered these goldeny, autumn afternoons and she was just on my chest and I just could not have been happier. Even though it wasn’t the VBAC and it was preterm, it was still like I just had this incredible team around me that ultimately gave me the experience I wanted even though it wasn’t the method. Meagan: Right. That is something that I feel is so important to touch on because sometimes we hear Cesarean stories and we hear trauma. Scary, traumatic. Anneke: Right. Meagan: I don’t want to say that Cesareans can’t be scary or traumatic or that they’re not, but they don’t always have to be. They actually can be very healing. Anneke: Right. Meagan: And redemptive. You might think, “Oh, you didn’t get a redemption birth because you didn’t have a VBAC,” but there are a lot of really amazing beautiful wins that were very redemptive in her birth, right? Anneke: Right. Meagan: That skin-to-skin and being involved and having that team be supportive of the whole team and motivating you, “Okay, we’re going to get to 36 weeks.” All of these things are really awesome stuff. Anneke: Yeah. It was incredible. You know, we’ve had two births now that were– the first one was very scary. The second one was very scary and we almost stopped having kids. I had this dream of having four children. My husband is like, “Well, I wanted two. You wanted four so we compromised on four kids.” That’s what he says now, but at the time, he was like, “No. I can’t go through this again.” I was actually kind of along, especially for the first year, on the same path. I felt so grateful to have a positive experience. Everybody was healthy. Our family was wonderful. About a year out from her birth, maybe 7 or 8 months out from her birth, I really started feeling like I wanted to pursue our dream of having four kids. My husband really struggled with that so he and I both went to counseling. We went separately to counseling because we both had a lot of trauma actually left over from the first birth, my son’s birth. Both of us– he did some EMDR work which was really powerful and I just did some talk therapy which was really good. Ultimately, we decided that we wanted to have a third baby and then eventually go on for a fourth. It took us a little bit longer to get pregnant. At that time, I found out that in my first birth, they were tracking my labs and one of the things they track is sodium. That fluid imbalance, sodium is a very important lab value that we need. I was digging through pages and pages and pages of notes trying to figure out, “Why did they never even give me a chance?” Because even though my daughter’s birth was very redemptive, I still had this fire in me for wanting to know what a contraction felt like. In the meantime, I’ve developed this pelvic floor and OB program at our little local hospital here and I’m a childbirth educator and I’m just touting the virtues of vaginal birth and feeling like we have totally overmedicalized birth. So I’m digging through all of my notes and I find that my sodium had been trending over the 12 hours before even I realized that I wasn’t peeding. My sodium had been trending down. By the time they made the call to go to C-section, I was three data points away from being a 50/50 survivor. My sodium had gotten so low. I didn’t have 36 hours to try to labor. Meagan: Well, and when sodium gets really, really, really low, can’t you actually have a stroke? Anneke: Yeah. Yeah. Meagan: And a major stroke. Anneke: Yeah. Like 50/50 coin flip on survival. It actually gave me a lot of closure to see that. I wish they had explained it to me like that at the moment, but it was like, “Okay, that was the right call.” Meagan: Validation.Anneke: Right. I hate it when you’re given platitudes about, “Well, healthy mom and healthy baby.” It’s like, “Well, obviously.” I wouldn’t wish for something different, but there’s also an experience that I’m looking for. So rolling into our third pregnancy, shoot. Being pregnant with two kids is no joke. I kind of had a harder pregnancy. We were able to conceive naturally again. Meagan: Yay!Anneke: Yeah. This time, we started with maternal-fetal medicine. They were tracking us from 16 weeks on. I had monthly visits with them all the way up to 36 weeks. Again, everything is going swimmingly. She looked lovely. My fluid is great. My blood pressure is low. We get to 28 weeks and she’s breech. Along with being a pelvic floor PT and a mom of two at the time, I am a varsity volleyball coach and my husband is a wildman firefighter. If you haven’t been out west for the last couple of years, it’s been insane or I guess living under a rock because it’s made national news. So this is during the summer rolling into volleyball season. I’ve got a breech baby. I’ve got this whole plan for a VBAC. I’m going to go into labor. We’re going to drive 3.5 hours. I’m going to labor in the car with my husband driving like a grandma. We’re going to do this. I was back to every day listening to a VBAC Link podcast and just willing it into being. I hit about 33 weeks and I’m doing uterine ligament mobilizations on myself. I bought a Spinning Babies class and was doing close to 2 hours of exercises a day to do inversions and side-lying and all of the rebozo sifting. At about 33 weeks, a friend of mine told me about this postural restoration physical therapist over in Grants Pass which is about 4 hours away from here and I went. I got an appointment with her and drove 4 hours one way to go see her. I got in with an acupuncturist. We did all of the things. Meagan: Literally, yeah. Anneke: Literally all of the things. A little after Labor Day, my husband was home. So firefighters work for 2-3 weeks on and then they get 2-3 days off. Usually, in busy fire burn season, they will turn and burn and go back out. He came home after Labor Day and I was a wreck because I was so stressed out with trying to get her turned. It was the middle of volleyball season. It was a busy fire season. They were supposed to leave the next day to go on another 2-week assignment and I just burst into tears. He was like, “Do you need me to stay?” I’m not very good at asking for help, but I knew that if I didn’t leave everything out on the table, I would always wonder if she didn’t turn, I would always wonder, “What if?” We made the decision that he was going to stay back from what would have probably been his last fire assignment before she was born anyway and we did, like I said, 2-2.5 hours of exercises daily to try to get her to turn. I drove back and forth to Grants Pass several more times and then finally, I was really nervous about doing a version, but that was something that my OB in Medford had suggested as a possible thought and my OB here was like, “Look, we can’t offer you a VBAC here. I don’t feel comfortable doing a version here because we just don’t have the resources.” So at my 36-week appointment, I said, “Look. I don’t know how comfortable I feel with a version. Is that going to be too much?” This is what I love about my OB. He leaned forward and said, “I have never known anyone as committed to wanting a VBAC as you. I think you need to do everything.” We drove over to Medford. We took all of our bags just in case it threw me into labor or something. Meagan: Right, or you had to stay. Anneke: Right. We went over and saw my OB there. He was like, “Okay. You’re going to go to the hospital.” He explains the whole procedure. They couldn’t give me the uterine relaxing medication because I had a little cardiac event in the pregnancy earlier that was just a one-off but he didn’t feel comfortable giving that to me. For anyone who has been through a version, those are really uncomfortable. I mean, it wasn’t the worst pain I’ve ever felt, but it’s like being squished, very heavily squished by a full-grown man. You could see it in his face. He gets a hold of my daughter and he turns her 90 degrees and then she slips back. You can see that he’s like, “Oh yeah. We’ve totally got this.” He hooks his hands on again and turns her 90 degrees and she slips back. So he’s like, “Okay. Third time’s the charm. Third time’s the last time. We’re not going to do it anymore, but we’re going to get her.” He gets a good grip on her and he gets her to 90 degrees and gets her a little bit farther. I felt her jerk and her heart rate dropped to 60. We all just held up our hands and we’re like, “Nope. Nope.” I didn’t know this guy very well. He came very highly recommended. He was very friendly, but I’d only seen him a couple of times. He was just like, “Okay, well you can drive back to Lakeview and go schedule a C-section. We’ll see you later. I have more patients to see.” I really liked him, but I’m starting to get a little sniffly and teary. He was just like, “I’m really sorry,” and left. I think I cried the entire way home and then I cried the whole next day. I told my husband, “I’m not calling my local OB. I’m not calling him.” He was like, “Yeah, but the baby’s got to come out at some point.” I did finally see my OB the next week which would have been close to 38 weeks. I mean, the poor guy. I know he felt so bad, so he was like, “Okay, what can we do?” I really wanted to go into labor. I mean, this OB puts up with a lot of my shenanigans, but that was a hard no. He was like, “Absolutely not. You’re not going into labor. We’re not going to introduce bacteria when we don’t need to.”I’d read a lot about a gentle Cesarean where mom gets to pick baby up or baby gets to go straight to her chest. Meagan: Mother-assisted Cesarean. We’re seeing it happen. Anneke: I know. I’m very committed to the next one to maybe making this happen. I’ve got to work on this guy for a little bit, but that was a hard no on this one. One week was not enough time to prepare him, but what we were able to do is I had good friends who were OB nurses. We were able to schedule it on a day that they could be there. Our normal procedure for Cesareans here is that baby is born and then they do the cord clamping and then baby goes to the warmer, but my OB for delayed cord clamping instead of just laying her on my legs, held her out with full arms extended, probably burning to let me see her. She was a big kid. She was almost 9 pounds. That’s actually the picture that I sent to go along with it. Then he took her over to the warmer and my friend, the nurse, was right behind him and swooped her up and brought her right to me. It was as close to that immediate skin-to-skin as we could have gotten. My struggle in the week between the version and her birth was that I just felt so broken. I really felt like my body had failed me and that for whatever reason, I wasn’t destined to ever feel a contraction or to even try to give birth vaginally. I worked with my therapist over that week and actually did some EMDR myself because I just really felt like what I had done was valuable. I did everything I could to give her a vaginal birth and I under no circumstances wanted that feeling of brokenness to be passed to her even via osmosis. I worked really, really hard to have that open, brave feeling the day of her birth. When she got put on my chest, I didn’t want any of my insecurities to get passed on to her. It was difficult after her birth too. I really struggled with feeling like I was worthy and like I had done enough. The other thing too is that I felt like I was going to have difficulty teaching childbirth education. Who am I to teach in this space? Meagan: I get that. When I became a doula, people would say, “Oh, so how was your vaginal birth? Did you go unmedicated?” I’m like, “I had two C-sections.” They’re like, “Well, how do you feel qualified to support me through a vaginal birth then?” It’s like, “I totally do.” Yeah. It was really something hard to overcome not having ever had a vaginal birth. Anneke: Right. Right. I had one patient. She sticks out to me. She said, “Well, okay. What do contractions feel like?” I had to be like, “Well, people describe them as–”. I wasn’t able to tell her and that tore me apart. Since she was born, I’ve taught two series of childbirth education. I’ve had a bunch of pregnant patients and I’ve helped patients labor and helped teach them positioning and counterpressure. I realize looking back, I’m a pelvic floor PT and I threw my entire base of knowledge into my drive and journey to achieving a vaginal birth three times. When that failed, I literally went with blind faith. Anything that the internet or anyone suggested to me, I tried. I prayed and I meditated and I positive-affirmed myself every day and it still didn’t happen. So in the end, I’ve never had that chance to be able to actively tell her or from experience tell my patients what a contraction felt like. Since my first birth, I’ve really asked, “Why? Why not me? Why does this keep happening and why can’t I just be like so many others on the podcast and so many others across the country? Why can’t I just will it into being?” So from these questions, I’m starting to believe that my story actually might begin at the end. After my belly has been cut into for the final time after the scar tissue knits back down and I can cough without pain, I’ve realized that maybe my story isn’t about the mechanism of birth at all but what it birthed in me which was the ability to see my own strength and give that to my people who are in a world where victimhood and fragility eat away at our resilience and our grit. I thought that not being able to labor to not meet my children has broken me but I can’t be broken. I can’t be a broken mother to them. I want my kids to be strong, confident, and powerful. I can’t teach them that if I can’t model that. So I didn’t get a vaginal delivery. I didn’t get to experience labor pain and comfort measures and to have my partner doing counterpressure and using a comb and work together to bring my babies through my pelvis. I didn’t get to look adoringly at my husband as I pulled my baby onto my chest myself, but what I did was I made the choice to put my child’s needs before my own desires and I sacrificed my body in order to protect theirs. My labor was really giving my control and placing trust in my medical team and God to bring my babies into the world. I’m not broken by my births. I really feel like I’d been remade into what a mother is supposed to be. Meagan: Absolutely. I’m just crying over here. That was beautiful. That was absolutely beautiful. You know, I’ve talked about this before, but the way we give birth doesn’t define us. It doesn’t say that we are a successful mom for giving birth vaginally or by a Cesarean. It doesn’t mean that our children are going to be weak or struggle because they didn’t come out vaginally. Anneke: Right. Meagan: Wow. I just love everything. I’m seriously crying here. That was just beautiful. You are beautiful. Anneke: Thank you. Meagan: Every single one of these births is beautiful. You don’t have to give birth vaginally to have a beautiful experience and to be a powerful mom. Like you said, “I’m not coming here today to share the vaginal birth that I wanted so badly and that I longed for,” but look at what you have done. Look at how you’ve grown. Look at how strong you are. I believe that our children– right now, they are little. They probably don’t really understand the magnitude of what a Cesarean birth or a vaginal birth even looks like and what that means, but I promise you that no matter what, these babies are going to be grateful for you. Women of Strength, as you are listening, know that the way you give birth does not define you. You are incredible. Anneke: It actually hit me during the last childbirth education series that we taught. We go around and we talk about all of the interventions for birth– epidural, IV meds, Cesarean, or vaginal. So often, we have people who say, “Well, whatever baby needs.” It actually struck me during this last class. I said, “Look, of course, it’s whatever baby needs. What you need is to cope. You need to know your strength and what will keep you strong because that is what takes you through this without trauma and takes you through feeling stronger and successful no matter the mechanism, no matter the medications, or the delivery method. It’s about how you approach your birth and how you are going to continue to be strong whether you are pushing them or whether you are being brave and being cut open. No matter what it is.” Meagan: No matter what, yeah. Well, thanks for that. That was amazing. Anneke: You’re so welcome. Meagan: Sorry for the sniffles, guys. That was beautiful. Congratulations. Anneke: Thank you. Meagan: Huge congratulations to all of your growth. Even through your journey with pelvic floor, you are going to help so many people. And with pelvic floor, tell us a little bit more about what you’ve learned even both ways with vaginal and Cesarean and how the pelvic floor actually is connected to both, and how even Cesarean mamas need guidance through pelvic floor. Anneke: Yeah, absolutely. I actually see a lot of the same issues post-vaginal and post-Cesarean birth. With vaginal birth, usually what happens is you’re pushing a watermelon through a quarter-sized hole so those muscles and your joints are designed to stretch. There are lots of movements and things that can help. It would be like overstretching your hamstring. It just reactively spasms and tightens back down. That’s even in the absence of tearing and things like that. Pelvic floor tension is really, really common after a vaginal birth but also after a Cesarean birth. Now you’ve lost stability from your abdomen. You can’t even sneeze for 8 weeks without feeling like you’re going to burst open. My nose actually wasn’t better for a year after my first son because it was just so fast. Oftentimes, I actually see a reactive spasm of the pelvic floor in women with Cesarean deliveries as well because your pelvic floor is overcompensating through your lack of abdomen support. I actually treat those women a lot of the same and then of course, we do a lot more of scar tissue work with Cesarean. It’s a lot more like abdominal training early on in women with vaginal delivery, but yeah. I mean, it’s almost identical. The initial recommendations are a little bit different, but by 6 weeks, I’m treating women the same. What I actually love, I wanted to mention this about rural hospitals. People get scared to deliver in rural hospitals, but what’s beautiful about our situation is that your OB will also likely be the one to come deliver and will also see you for the 3-day weight and color check, the 2-week visit, the 4-week visit, and the 8-week visit. They’ll see you at the 6-week visit for you too. We have so much better follow-up for mom and baby here than I got in a big, fancy hospital in the city. I think I see people way sooner than I would see them in the city. I’m seeing people easily 4 and 6 weeks out where in the city, it might be 6 or 8 months. Meagan: Right. There are so many of us that it’s 6 weeks out. That’s when we are going in for our first visit and they’re like, “Oh, what birth control do you want?” That’s what we’re asking. We’ve gone weeks and weeks and weeks with the pelvic pressure and that bulge or the leaking or that disconnect when we could have been doing something. Maybe 2 weeks out, we’re not doing the exact same things, but there are things that we can do even through breath with our scar or mobilization for a Cesarean and all of these things that we can do. If you are like the many of us who don’t get seen as you have which is the way it should be in my opinion, I think that we should be seeing people 3 days out or 2 weeks out and all of these things because that’s when so many things are not caught. Know that it’s okay. You can still turn to a pelvic floor specialist and therapist even while you’re waiting. Anneke: Yeah. I’ve started a program at our hospital where I actually try to catch C-section moms in-house. I’ll give them laying on your stomach and early abdominal work and how to get out of bed. Nobody teaches you how to get out of bed after a Cesarean. You can really screw up your scar tissue by straining on it too much or just be in a lot of pain for a really long time. The other really great thing about PT and insurance companies now is that you actually don’t often have to wait for your doctor to refer you. If you are 2 weeks out and you are still leaking or you have a lot of peeing, you don’t have to wait to see your doc. You can actually just call a pelvic floor PT and a lot of insurances will let you self-refer. It’s pretty awesome. Meagan: Right. It is awesome. I just think, like you were saying, we just don’t talk about pelvic floor after a Cesarean very much because we just don’t think about it. We haven’t pushed a baby out of our vagina so probably are okay, but the disconnect with our abs– Cesarean birth really is quite intense internally. So yeah. Don’t hesitate. Go out. Can you tell everyone where to follow you?Anneke: Yeah, so where I talk most about pelvic floor and PT stuff is actually called @teamgriffith2011 on Instagram. If you are interested in finding a pelvic floor PT near you, if you go to the section on Pelvic Health, just Google that on the internet and there is actually a PT locator. That is how you will be able to find someone close to you. Meagan: Fantastic. Do you suggest people do it even before birth? I know you did with yours, but as a pelvic floor PT, do you suggest people go before?Anneke: Especially if you don’t have a program in your hospital where PT tries to snag you before you leave, I would think it would be helpful. I do what I call a labor and delivery biomechanics visit. I’ll have people come in. We’ll talk about positioning and counterpressure and then I almost always give them vaginal delivery and Cesarean early-stage exercises. That would be something that a PT would be able to tell you what are the very first things you should start doing, when to start doing kegels, or how to get back. A lot of times, it’s just teaching you how to diaphragmatically breathe because that will teach you how to coordinate your pelvic floor to the yoga breath. Meagan: Awesome. Well, thank you so much for giving me a good cry today. Anneke: You’re so welcome. Meagan: And educating us on pelvic floor. Seriously, it was beautiful, and congratulations to all three of your babies. Anneke: Thank you so much. Meagan: Yep.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. 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