Mabel's VBAM (Vaginal Birth After Myomectomy)

“I don’t have anybody that I can use as a resource or as a reference, but I know that I am not an anomaly. I also know that I am not asking for too much. I am not asking for a vaginal birth. I’m asking for support. I’m asking you to hear me. I’m asking you to give me time. I’m asking you to let my body do the work. Let my body do the work instead of you dictating what you think my body should do.”Mabel is a trailblazer. She walked the lonely road of fighting for her vaginal birth after a myomectomy with very limited resources, support, and anecdotal evidence. Mabel knew her risks. All she wanted from a provider was true support and the chance to try. This episode is a must-listen. Sit back and soak in all of the incredible advice Mabel offers to both VBAC and VBAM hopeful women. We were honored to have such a powerful woman of strength on our podcast today!Additional linksMabel’s Website: Within Her Birth ServicesSpecial Scars WebsiteThe VBAC Link CommunityHow to VBAC: The Ultimate Prep Course for ParentsFull transcriptNote: All transcripts are edited to correct grammar, false starts, and filler words. Meagan: Hello, how are you guys? This is The VBAC Link podcast and we are with you today with our friend, Mabel. We are so excited to hear her stories today. We encourage you to pause and listen up because this is going to be an amazing one. She is from northern Virginia and did you say DMC? Is that what you called it?Julie: Washington DC.Mabel: DMV.Meagan: DMZ. Julie: Everybody’s confused. Mabel: Yeah. I’m from Northern Virginia. In the city and state, I’m from Bristow, Virginia, but it is technically part of northern Virginia. We call it the DMV– DC, Maryland, Virginia.Meagan: DMV like where you go get your license.Julie: Oh my gosh.Meagan: Okay, the DMV area. So if you are in her area, this is definitely one to listen to. But of course, we have a Review of the Week, so I’m going to turn the time over to cute Julie, and then we will dive into this story.Review of the WeekJulie: Okay. You know I can’t just go right into the review. I have to say something. That’s really funny that you said “cute Julie”. That’s really funny because I have a longtime friend from when we were in the military. We hardly ever see each other but when we do, she is one of those friends that you just pick up right where you left off. It doesn’t matter if it has been a year since we talked to each other. Her name is Kelly and I would always call her “cute Kelly”. It’s “cute Kelly” and then she started calling me “cute Julie” and I am like, “Nobody calls me ‘cute Julie’ except for her.”Meagan: Oh that’s funny.Julie: So when you said “cute Julie”, I was like, “Aww. I miss my friend. I need to go call her after this.” Oh my gosh. Anyways, yes. Mabel from DMV, we are so excited to hear your story, but yes. I am going to read a review. OK. I really actually like this review. I read it on a previous podcast, but then I had forgotten to record that podcast and we had to get back on and start over, and I had to pick a shorter review. But I really like this one and I want to tell you why afterward. This is from Informed Mama on Apple Podcasts and she says, “I love listening to the inspirational stories of women of strength trusting their bodies and doing what they were created to do. As a mama who has had a C-section, it’s incredibly encouraging to hear that my feelings about my child’s birth are valid and also exciting to me that this could be our story someday, too.“With this in mind, as a labor and delivery nurse, it hurts my heart to hear of women not consenting to interventions and of the overall mistrust of birth in a hospital setting. I do want to encourage all women that L&D nurses and OBGYNs are not evil, and we are not pushing for every woman to give birth in the OR. There are times when interventions are necessary for the safety of you and your child. We do have good intentions for you and your baby, and the safety of both of you is our utmost priority.“If you are a pregnant woman listening to this podcast and find yourself anxious about your upcoming birth, please remember that the majority of us are honored to be there for this special day for you and want to honor your birth preferences as best we can. Please keep focusing on how strong you are, trust the process, and surround yourself with a birth team that will advocate for you!”I love that review because first of all, I love it when we have OBs, hospital midwives, and labor and delivery nurses listening to our podcast and following along with The VBAC Link because I feel like change has to come from all sides in order for there to be an improvement in maternal health, our outcomes, and the birth privileges and birth rights that we all want. We all want to improve birth in the United States especially, but all over the world so I love that perspective.My three VBACs were at home so just keep in mind my perspective, but I think it is really easy, sometimes, for us to get really defensive with the hospital systems and interventions. Yes obviously, Cesareans are heavily overused. That’s why we are here. We know that interventions are also overused and sometimes the hospital system feels like it is created to sabotage the birth process a little bit, but I like this reminder because it helps us remember that most people in the hospital system really do want to be there. They really do want to help you and want to see you have the safest and best birth that you possibly can.I do want to add a little caveat in there that I know that there are some hospital staff, nurses, OBGYNs, and maybe even hospital midwives that do operate in a poor manner and can seem like they don’t have your best care at heart. I just think it’s important to remember that most of the time, people are willing to be accommodating, helpful, and supportive. I also don’t want to just discredit anybody that has had a traumatic birth experience. We are how many episodes in? I think 189 or something? We certainly have heard quite a few of those stories too. But I have found that especially being a doula here, most people are willing to accommodate and be supportive of your birth preferences as long as you make them known and as long as it is within their scope of practice as well. Anyways, I’ve been talking for a long time. Meagan, what would you add or should we just kick it off?Meagan: No, yeah. I think that is great.Mabel’s StoryMeagan: I am just so ready to dive into this story. So Mabel, without further ado, we welcome you to The VBAC Link to share your story. Mabel: Thank you. Thank you, ladies. I thought that review was a very helpful reminder, so it was nice to hear that. I will start by saying that a lot of my story is actually a lot of the things that happened before I even got pregnant, so I think the bulk of this story might weigh heavily on my pregnancy and trying to conceive journey which therefore helped me be successful with having a vaginal birth after my myomectomy. I don’t know if you know much about fibroids and myomectomies or if that is something that you have heard of or have encountered with clients or other VBAC stories.Meagan: Especially fibroids specifically, we get messages about fibroids all the time like, “Hey, do you have any stories with people that have fibroids and had a VBAC?” or “Hey, do you know my risks?” I don’t know a ton, so I am excited to learn more. Mabel: Awesome. So I’ll start with that. A fibroid is a benign uterine growth that occurs in the uterus. They are benign so they’re not cancerous, but they can propose a lot of issues for women. Women can experience pelvic pain and excessive bleeding during their menstrual cycle. They may even appear pregnant because the mass is so big and it is projecting out of her uterus, causing her belly to swell.Fibroids are actually a very common occurrence for women not just in the US but in the world. I think the statistics say that about 70% of women will experience fibroids at one point or another in their life. The statistic is quite disproportionate to black women. Black women have a higher risk of getting fibroids. I think the statistic says 8 out of 10 black women have fibroids whether they are symptomatic or not. So no matter your racial background, fibroids are very much a part of the female experience I have come to find out. Depending on where you are in life, you may decide to do something about them or not. In fact, most women don’t realize that they have a fibroid until they become pregnant or they are trying to become pregnant because one of the best ways to identify fibroids is through ultrasound. I have had friends and clients who have said, “I didn’t know I had fibroids until my 6-week confirmation pregnancy appointment.”What happened to me was that actually, I was trying to conceive. I got married at 26. We waited a year before we were serious about trying and then the year we were trying to conceive, nothing was happening. Through a series of tests, I found out that I had fibroids. I had multiple fibroids. It was a wake-up call because, for years, I had been experiencing extremely heavy periods. I wasn’t the girl who got cramps, but I was the girl who literally hemorrhaged every month. And so I was very grateful to find out that I had the fibroids because I had an answer to the issues that I was facing. After some time, I decided that I was going to surgically remove them. Granted, every woman who has fibroids may treat them differently, but one of the more common ways of dealing with fibroids is to do surgery, which is called a myomectomy. Another way that someone may deal with fibroids is to do a hysterectomy, but most women who opt for a myomectomy are trying to preserve their fertility. That’s what I wanted to do, obviously. I was still young and was still hoping to get pregnant. Thankfully, I was a pretty good candidate for a laparoscopic myomectomy. I don’t want to get into the weeds but there are different types of myomectomies that you can do. The laparoscopic myomectomy is known to be minimally invasive whereas others such as an abdominal myomectomy are where they cut your uterus very much like a C-section and they remove the fibroids. Instead of removing a baby, they are removing the fibroid. Thankfully, I didn’t have to have such an extensive surgery as the abdominal myomectomy. Meagan: That’s actually what my tax lady just had– that exact surgery. Mabel: Really? Yeah. Yeah. Meagan: Uh-huh. Mabel: Yeah. Julie: Our tax lady, thank you very much. Meagan: Sorry, yes. Our tax lady. Yes. And you know, she is worried that she will never be able to have a vaginal birth because the doctor said, “Just to let you know if you do get pregnant in the future, it’s C-sections from here on out.”Mabel: That is very, very and I wouldn’t even say very common. That is the feedback that every woman who goes through a myomectomy will receive. It doesn’t matter how invasive her procedure was. It doesn’t matter how many fibroids they removed. It doesn’t matter how well her recovery was. Usually for a woman who goes through a myomectomy, if she ends up getting pregnant thereafter, she will be counseled to have a C-section at 37 weeks. The concern for that is uterine rupture, very much like a C-section. Their concern is that because we have gone into your uterus and we have tampered with it more or less if you are doing an abdominal myomectomy, that’s one big incision. If you are doing a laparoscopic myomectomy like mine, there are these tiny little cuts into the uterus. They cut into the uterus and they take pieces of the fibroid out bit by bit. There are different ways to remove fibroids; however, it is a uterine procedure and every woman is different. Every woman’s experience is different. Some women have multiple fibroids. Some women have one. Some women have fibroids inside the uterine cavities. Some women have it within the wall or outside the wall. It really varies. And so I think a blanket response to avoid uterine rupture is to just go on and have a planned C-section at 37 weeks. Like I said, I was happy I was getting the laparoscopic myomectomy because when I was doing my research beforehand, all the research that I found said that women who had a laparoscopic myomectomy were good candidates for having a vaginal birth thereafter if they were treated as if they were a VBAC patient. In my head at that time, I was like, “Well, this is great. I am going to have this surgery and I am going to have my vaginal birth.” But when I went to one of my post-op appointments to talk about the procedure, my surgeon at the time told me that I had to have a C-section at 37 weeks. Something told me not to push it with her because I felt that, “Okay. She is my surgeon who did the surgery. She doesn’t necessarily have to be the OB that delivers my babies.”So when she told me, I just took it in but in the back of my mind I thought, “I have a lot of work to do.” That was in the sense of finding a supportive provider. Mind you, I was not pregnant at this time, but I knew that when the time came for me to be pregnant, I wanted someone who was confident and supportive of me having this type of delivery. Also at that time, because I had gone through so much with the fibroids, I was young and I realized that I didn’t know much about women’s health. I didn’t know much about pregnancy and childbirth. I didn’t know anything outside of what I was experiencing currently, so I took it upon myself to learn everything that I could. I actually trained as a doula at that time because everything I was learning was fascinating to me, and then also I realized that what I was going through was quite unique and it was not going to be easy. I felt that I had to be confident with my understanding of birth and pregnancy so that I could advocate for myself better. Also at that time, I felt that because nobody that I knew and nothing on the internet pointed me to anybody else who had a vaginal birth after a myomectomy, I just took it upon myself to be the one. So I just was like, “Okay. If ever I get pregnant and I have a vaginal birth, I am going to shout it from the mountain tops and tell everybody what I did, how I did it–”Julie: Yeah!Mabel: Yeah, so if anyone is listening to this and they have heard my story on another birth podcast, it’s not that I’m boasting, it’s that I believe that education and anecdotal evidence is just as valuable as evidence-based information. And so I learned about VBAC. I actually started learning about childbirth by researching VBAC because I looked at myself as pretty much a VBAC patient or individual. I wasn’t pregnant, but I just felt that when the time came, I had to look at myself like a VBAC person. I read a lot of research and I will share a lot of that at the end, but from what I have gathered over the past five years is that the risk of rupture for a woman who pursues a vaginal birth after a myomectomy is anywhere between .4% to 1.7%. You can imagine that with such a low risk of rupture, you would think doctors would be comfortable or okay with supporting women to have a vaginal birth, but what I found out during that time was that most doctors are not supportive of VBAC, so it was going to be quite impossible for me to find another provider who would be supportive of a VBAM. I went on the ICAN website and at the time, they had a list of providers in this DMV area, and they had a list of all the providers and their C-section rates. They don’t have that anymore, but at that time they did. And so what I did is I went down the list and I chose providers who had a rate of 20% or lower and I just wrote it down in a notebook. I was making phone calls, then I would make appointments and I would go to the offices. And one after one, all of them barely gave me two minutes to even get the words out of my mouth. Once they heard what I was talking about and saw my report, they were like, “No.” I went to a dozen providers within a one-year span. Again, I wasn’t pregnant but I knew that when the time came, I needed support and they all told me, “No.”I was extremely defeated, but I had a mentor. She was my doula trainer and she gave me the name of one provider. She said, “Just go to him. He is really cool. He has a pretty low C-section rate. I know him personally. Maybe he will support you.” And I went. I had an appointment with him and he did. He said, “I have never done this before, but I looked at your report and I feel like it’s worth a try.”Meagan: Wow, that’s awesome. Mabel: Yeah. It was amazing after getting all of those “No’s” to finally have someone listen and hear me. Meagan: Yeah. I totally get it. That happened to me. I went to 12 doctors also and everyone was like, “You can try. I wouldn’t.” To find that doctor to say, “You know what? Yeah. I’ll support you in this. Let’s do it.” It is so amazing.Mabel: It really is. It’s a turning point and I know we talk a lot about supportive providers. I’ll circle back on that, but the freedom you feel when you have a doctor that you respect and it’s reciprocated goes so far. Meagan: Mhmm.Mabel: I always say that appointment was the turning point in my trying to conceive journey because I got pregnant the month after. This is for someone who had been trying to get pregnant for five years. It was like God was like, “Okay. This is your doctor. Now it’s time.”Julie: Yes. Mabel: I just think it was very serendipitous. I am just so grateful for him. Julie: It was meant to be. Mabel: But I did. I got pregnant. Yeah, it was. I got pregnant and y’all, I had a great pregnancy. I was happy. I felt beautiful. I felt sexy. I was my strongest. I just loved being pregnant. It was probably one of the best times of my life. At around 26 weeks though, my doctor whom I love so much died. Meagan: Oh my gosh!Julie: Oh my gosh!Mabel: He did. He had a heart attack and he died. Meagan: Oh my gosh. Mabel: It was a huge blow for me not just because this was someone that I really leaned on for my dream delivery, but he was also a very, very well-respected and well-known OBGYN in this area. And so it was a huge blow for the community. Not just me, but everyone else and every woman who just wanted great, quality care. We lost a giant in the birth world. Meagan: Oh yeah. Mabel: So it was a blow for me because I didn’t know what to do. Meagan: Right. Mabel: I decided to just forge on. At that point, once I knew that he supported me, there was nothing anyone else could say. So even if the other doctors in the practice started to show any type of hesitancy, it went over my head because I was like, “Dr. Gonzalez said he was going to support me. I don’t care what y’all say.” I was very stubborn. However, they weren’t pushy. They didn’t ever talk about a C-section or anything, but the vibe was very different in the office. I decided to switch over to a midwife and OB practice. My doula suggested it and I gave it a shot. I had heard about midwives and obviously, I was trained as a doula so I was familiar with midwifery care, but because of my unique history of having a myomectomy, I just didn’t see myself as eligible to be with a midwife if I could put it that way. Meagan: No yeah, that totally makes sense though because there are a lot of people who rule themselves out of midwifery care. They are totally qualified for midwifery care, but they don’t think so. Mabel: Yeah, it’s so true. Even at that time, I don’t think I realized that there were hospital-based midwives. I had learned and known about birth centers and home birth, but I had never interacted with a hospital-based midwife. I would say it all aligned up accordingly because when I did switch over to that practice, I was 36 weeks. I was very far along in my pregnancy. They also told me, they were like, “Hey, look. We usually wouldn’t do this. We are only doing this because we respect your doctor, Dr. Gonzalez.” So I had a feeling that if it was the other way around– if it wasn’t for him, I don’t think I would have found anybody in this area. So they took me in as a late transfer and at that point in my pregnancy, I was so firm on having a vaginal birth that I called the shots. I went to my appointment with all of the research that I had and I was like, “If you have any questions, you can read these articles. I am not going to talk about this.”Meagan: Good for you. Mabel: I was very, not annoying, but I just felt like at that point in my pregnancy, I didn’t have time for any negative energy. Not from my inner circle and not from my medical team. They weren’t pushy but they had their opinions on things. Long story short, the agreement we came upon was that I refused to be induced because I didn’t want anything to lead to a higher risk of rupture. I was also diagnosed with gestational diabetes during my pregnancy and I had done my research. I had done my own risk assessment and I felt that if my diabetes was well controlled, I should be able to go past my due date. That was a big thing for me, having the freedom and having the respect to go past my due date without any pressure from my birth team. And they agreed. I made it to 40 weeks and eventually, at 40 weeks and 6 days, I went into labor.I will honestly say that it was a very straightforward labor. I went into labor in the middle of the night. I labored at home with my doula for hours. I think my first contraction was at 4:00 a.m. and I was finally ready to go to the hospital at 4:00 p.m. When I got admitted, I was 5 centimeters and I just continued to labor in our labor and delivery room. I did all the things. I was on the peanut ball and on the birth ball and doing all the positions. I was able to negotiate to have intermittent monitoring. They let me on and off the monitors every 40 minutes or so. And so I really, I am just really grateful I had a team that gave me the space to do things my way, despite how unique my uterine history was.At around 9 centimeters, by this time– I got admitted to the hospital at 4:00 p.m– I decided to get the epidural at around 1:30 a.m. the next day. I had labored for a long, long time and I was just so exhausted. They checked me. They said I was 9 and baby hadn’t descended much and so I opted for the epidural to rest. It was the best decision for me. I took a nap maybe for a few hours and when I woke up, it was time to push. I pushed for about two hours and my son was born. I tell you, the minute he came out, I felt like my brain just exploded. We always say, “My mind was blown.” Literally, my mind was blown. I could not believe that for so long, I was told that vaginal birth was never an option for me, that my uterus was going to be destroyed and that I couldn’t do it and that I shouldn’t do it, and then finally, here comes this child out of me. I was like, “I can’t believe I almost missed out on this opportunity. I can’t believe that someone almost took this from me because they had never done it before.” Right? We call myomectomy a special scar. There are other special scars, right? Like classical, T-inverted, J-incision, and a myomectomy is one of them as well. I’m not here on this podcast to tell every person who has had a special scar that they should go and run out and have a vaginal birth. That’s not what I’m saying. But what I am saying is that because many times the literature is– there’s not a lot of it, right? So because there is very minimal research done on this topic, a lot of us are just categorized as extremely high-risk and it’s not even worth it for us to go on to even pursue a vaginal birth.  I feel like the whole process of leading me to the birth of my first son was really a lesson on self-education and self-advocacy. I know that I am supposed to be sharing my birth story, but this is really just about the work that it took for me to have this vaginal birth because, to be honest, my birth story is not any more special than the next woman who has had a vaginal birth. But what it is, is understanding and believing in physiological birth with the hopes that your body will do the work that it is intended to do despite the fact that it has gone through surgery. And so at that moment when my son was born, I was just like, “There is nothing anyone can tell me that I can’t do.”The fact that I had this child after a myomectomy, after multiple fibroids, after such a hard trying to conceive journey, and it was pretty much a seamless delivery, I was so, so, so proud of myself and I truly felt empowered at that moment. He was born and he was beautiful, and he was big. He was 9 pounds, 6 ounces and I am just so happy that I gave myself that chance to have the opportunity to experience a vaginal birth. I will say that birth is not without risk. VBAC is not without risk and the same thing for vaginal birth after myomectomy. After I had delivered him and my body was ready to deliver the placenta, I experienced a hemorrhage and it was quite a severe hemorrhage. It was something that personally blindsided me. After all the research I was doing, I had never really read about things like that. So it was scary. But it was handled swiftly and it was handled very well. I believe I was in the right place and in the right environment to help my body recover immediately after. And so I did have a hemorrhage and I personally will say that I can’t attest it to the myomectomy. It could have been a number of factors as to why I hemorrhaged. Thankfully, through a variety of tools, they were able to manage the hemorrhage and I was able to tend to my baby and breastfeed as soon as possible. I went home within the usual time frame for a vaginal birth. After that delivery and that experience, I was so thrilled and empowered by that experience that I told my husband that if I had the opportunity to do it again that I would love to do it at home or at a birth center. So for my second, I had my second son last year. I pursued a birth center delivery. Again, I had a beautiful and wonderful pregnancy, very straightforward. We did talk about my risk of hemorrhage, and so we came up with a plan as to how to actively manage a hemorrhage, but for my second, again, my body went into labor at 39 weeks. I labored for a couple of days, and then finally it was go-time. I think I had about three hours of active labor and he was born at the birthing center. With him, I had a water birth.And so just looking at the whole scheme, the whole experience of being pregnant twice, having two vaginal births after a myomectomy, it makes me feel that for anyone who is seeking a vaginal birth after any uterine procedure whether it is a C-section or a myomectomy, there is a lot of work that has to be done emotionally and mentally, but it is very possible. I am so sorry when I hear other women who have had a myomectomy be told immediately that they have to have a C-section because we know what that language does, that terminology of “have to”. It makes us feel that we are incapable, that birth is absolutely dangerous for us and it’s not true. There is a difference between absolute and relative risk and for me, I leaned on the relative risk and I succeeded. For my second born, even though I did not hemorrhage with him, I did have issues with delivering my placenta, and so even though his birth was beautiful and perfect, I did have to get transferred to the hospital to remove my placenta which actually came out quite easily when I got there. But it took some time when I was at the birth center, so we transferred over to the hospital to deliver the placenta.Both deliveries were quite traumatic to my body. Not to me emotionally, but for my body, it was a very traumatic experience. But I like to talk about these things because I think transparency is important, and then I also say this with the understanding that just because it happened to me doesn’t mean it’s going to happen to you. I don’t think that just because we hear other women go through some unique experience that it should deter you from pursuing your goal. I think we are all capable of assessing our own risks and making the right decisions that are important to us. I could go on and on about this.Meagan: No, I love it.Julie: We are just sitting here soaking it all in.Meagan: But it really is, it’s such an important thing to remember that just because someone says this, it doesn’t mean it’s not right for you, and then just because someone had a really good, positive experience doesn’t mean it’s going to be your experience either. It’s so hard. It’s just how we have to go through life in all things because everyone is different. Everyone has a different circumstance. Everyone has a different body, everything. Even though one pregnancy goes one way doesn’t mean the next pregnancy is going to go the other. And so it’s just so important to remember that. But I just love how you fought for what you felt was right for you because that is a really, really, really hard thing to do. Like, a really hard thing to do.Mabel: Oh yeah. It is.Meagan: Yes, and then to have such a traumatic experience like, “What the heck just happened? I just lost my doctor and the support that I was getting after looking for so long.” That had to just have shaken you.Mabel: Oh gosh.Meagan: So I am just so proud of you.Mabel: Thank you. You two are doulas. I am a doula too, so this is kind of going into the doula speak.Julie: Yep.Mabel: As doulas, especially for our VBAC clients, we stress so heavily finding a supportive provider. We do. We make it almost seem as though if you don’t have one, good luck to you, which, actually for me over the years, not just with my experience but with others and my clients, I have come to realize that not every VBAC hopeful is going to find a supportive provider. You have to come to terms and accept the fact that your doctor just may not support you. They may say or do things to deter you from making that decision, but despite that, you must press on anyway. And for me, especially when Dr. Gonzales died, at that point, I could’ve just been like, “Well, you know. I tried.” But at that point, I was like, “I’m going to have this baby whether he is alive or not. I’m going to have this a baby whether he is on call or not,” because we know that happens too. You can get somebody else and everything seems like a chaotic event. That’s something that I really feel personally about is that even if you don’t have a supportive provider, you still have the personal responsibility to know your rights and to know your options for your VBAC birth. You can’t lean on your doctor for the decisions that are only for you to make. That’s how I pursued my birth experience. That’s almost how I lead with my clients in the sense that we are just going to gather all of the information that we can get and use that as a decision as a means to make a decision. Of course, your doctor may say or do certain things and you may agree or disagree, but at the end of the day, this is about you. This is about you and your baby and your body and it’s going to be up to you to make up your mind to press on or to allow all of the negative energy or all of the conflicting information to haze your view.I feel that for me, I am no more special than the next person. I’m not. It’s not like I got lucky. It’s not that I am super smart, it’s just that I made up my mind. I made up my mind and I hope that for anyone listening to this that if you are ever unsure or if you feel like, “Oh, my partner doesn’t support me” or “My mother-in-law says this” or “My doctor doesn’t tolerate me,” you need to make up your mind and then from there, you move forward. If you need to hire a doula, if you need to take 20 different birth classes, if you need to read all of the books, if you need to pray, if you need to replay all of the podcasts, you do what it takes to get to where you need to be. Even if the outcome varies from what you were hoping for, at least you can say you did everything you could. And that’s how I forged on for this delivery experience because I didn’t have– there’s nobody on YouTube. There’s nobody on Google. There’s nobody in all of the birth clubs on Baby Sector. There’s no podcast of anybody who has had a vaginal birth after a myomectomy. However, I know it’s been done. There’s no way that they could have done all of that research. There were women that had to be a part of that research. So even if you don’t know anybody in your life or your inner circle who is pursuing a VBAC or a VBAM, it doesn’t mean that it can’t be done. I think that’s how I looked at it like, “Okay. I don’t have anybody that I can use as a resource or as a reference, but I know that I am not an anomaly and I also know that I am not asking for too much. I am not asking for a vaginal birth. I’m asking for support. I’m asking you to hear me. I’m asking you to give me time. I’m asking you to let my body do the work. Let my body do the work instead of you dictating what you think my body should do.”I don’t think it’s too much to say that if I don’t want another surgery, I don’t want another surgery. I think that’s the part that blew my mind when I started learning about advocating for myself. The fact that my pursuit was not about what my body was able to do. It wasn’t about my body’s ability. At the core of it, it came down to liability. What are these hospitals and doctors liable to? It’s easier and “safer” for them to do a C-section than to let my body have a trial of labor, but nobody was telling me about the risk of a C-section. Nobody told me the risk of having a C-section at 37 weeks. They just told me I had to have one. If I hemorrhaged with vaginal birth, God knows what could have happened with a C-section, but nobody told me about that.So a lot of these things boiled down to pulling what you understand about birth and what you have read as the evidence but then also believing in anecdotal evidence. I believe that a woman’s experience is just as viable as evidence and as something that I have found on a Google search. This is just how I approached my birth. And I mean, I’m sorry. I feel like I am on a soapbox or something. Julie: No, are you kidding me? I am sitting here listening to you and I am just like, “Yes!” I have had goosebumps for days over here. Oh my gosh. I am just like, “Do you want a job?” Because I would love to just sit and listen to you go on and on about all of the things you are talking about. About how you’re not asking for a vaginal birth, you’re just asking to be supported and you are just asking for somebody to listen to you and let you have things the way you want to experience them. Obviously, there are caveats that go in there that we want your safety and we want you to be healthy and everything like that but you just want somebody to support you and believe in you. That just gave me so many chills. I just loved it. Mabel: Yeah. There’s no reason why we should have such a low VBAC rate in this country. Absolutely not. Knowing how successful the majority of women should be, there is no reason why we should have a 9-10% VBAC rate in this country. Learning about VBAC helped me to realize that this is not about the vaginal aspect. This is about women’s rights if we really wanted to get to the core of it. This is about a woman’s right to make an informed decision or to make an informed refusal. And unfortunately, we are looked down upon if we refuse what our doctors or midwives or whatever the medical team says. And so for me, of course, I was like, “No,” and I was looked at like I was crazy. How dare you want to go against our hospital’s protocol. But when it comes down to it, I had the right to do that. It’s almost like if a woman has breast cancer and you tell that woman, “Hey. These are all of your options. You can go do this surgery. You can take this medication or you can do nothing.” If that woman said, “I don’t want to do anything,” it is not that doctor’s place to do and say everything to coerce her or to scare her into changing her mind. It’s not the doctor’s place to do that because you have given her the information. You have given her the risks and the benefits of her options for treatment and if she decides to do something contrary to what you have decided for her, then you have to respect that and the same thing goes for VBAC. If you tell this woman, “Hey, these are all of your risks and benefits. These are all the things,” and she says, “You know what? I still want to pursue a VBAC,” it is wrong to apply every fear tactic and every coercion and every barrier to make that woman comply with what you want. That’s what is going on in America today and that’s why we have such terrible outcomes. I am speaking this as a black woman, right? A black woman who is highly susceptible to fibroids, a black woman who is highly susceptible to maternal mortality, a black woman where in America, black women have the highest rate of C-section. We do. We also have the highest rate of poor outcomes, not just maternal mortality but even neonatal mortality. So this is bigger than what anybody can think about. This is really coming down to the core of what type of care are we giving women? Are we just giving everyone the run-of-the-mill care or are we individualizing it according to this woman’s needs? Obviously, it’s not the latter. If we were individualizing maternal healthcare, we would see better outcomes. We would see more VBACs. We would see fewer hemorrhages. We would see less death. But until that day comes, you as a woman can’t go into birth blindly. You can’t go into VBAC blindly. You can’t go into your first birth blindly. You have to have your eyes, ears, heart, and mind open because a lot of things can be unpredictable, but I’ll tell you, it’s not birth. Birth isn’t as unpredictable as everyone says. Usually, what makes it unpredictable are a lot of the factors that our medical system imposes on us. So I don’t know. I’m going to stop talking because I’m getting hot, but I had to say this. Julie: No, I love it. Mabel: I do say this by saying that vaginal birth after myomectomy is possible. It is. I had one. I know many women have had one. I am a part of a special scars group and our rate of vaginal birth after myomectomy is quite high. For the women who did not have a vaginal birth, it was not due to uterine rupture. So I’m saying that for the small number of women who have pursued vaginal birth after myomectomy, they either had the vaginal birth or they had a C-section but it was not related to rupture. I had even counseled other women who reached out to me and a number of those women have gone on to have vaginal births. I have had three clients who hired me. They had a myomectomy and they went on to have a vaginal birth. A couple of them have even had unmedicated vaginal births for their first child. So I feel like anything is possible if you have the support and the heart to go for it. Julie: I absolutely love that. You are 100% right. You had a lot of things working against you. You had the myomectomy. You had provider switching. You had to change providers near the end of your pregnancy and you’re dealing with a unique type of a special scar which, yes, plug in for the Special Scars Facebook Group page, and the website is specialscars.org. Like you said, as a black woman birthing in America, your Cesarean rate is four times as high. You are two to three times more likely to die in childbirth. Those are things that are inherently wrong, frankly, just wrong with our medical system right now. I absolutely love that you kept saying in your story that there’s nothing special about you, but I disagree 110%. I think that everything about you is special and I am just so grateful. I know Meagan is going to talk in just a minute, but I just wanted to thank you so much for coming on and sharing your story today because you are an incredible woman. Are you still practicing as a doula? Mabel: I am, but this is my last year practicing because yes, I am going back to school to be a midwife. Meagan: Yay!Julie: Yes. We need more. Meagan: I was going to say, “To be a midwife!”Julie: Yeah, yeah. Meagan: Oh, that makes me so happy. Seriously though, you are going to change your birth community. You are going to completely change your birth community. Julie: Absolutely. Meagan: You are mind-blowing. I got the chills listening to you. Like Julie said, you could go on and on and on. Julie: We would just eat you all up. Meagan: Yeah. Julie: We are eating all of your words up. Meagan: There’s not one second that I would be like, “Oh my gosh, this chick is talking forever.” Nope. I’d be like, “Give me more. Keep talking.” You are amazing. Mabel: Oh my gosh, no.  Meagan: You are so awesome. So awesome. And same as Julie, I am so grateful that you could be on the podcast and share this story because like I said, we have people writing us asking and saying, “We want a vaginal birth. Is this possible? Is this possible at all?”Seriously, so, so happy for you.Mabel: Yeah. This is not your typical birth story podcast. I guess the flow of this conversation isn’t like the others but I do hope for anyone who’s listening if ever they had a question or inquiry or if they even just wanted to chat, I do offer consultations. Even though I won’t be practicing as a doula for a while, I am still available in different ways. Julie: Absolutely. How can people contact you? Mabel: Yeah. You can reach out to me. I am very active on Instagram. The name of my business is Within Her Birth Services. You can find me on Instagram @withinherbirthservices and through that platform, you can find my email address or DM me. Also, you can check me out at www.withinherbirthservices.com. So yeah, that’s how you can find me. Julie: Perfect. Meagan: Oh my gosh, amazing. Thank you so much, seriously. Seriously. Julie: Yeah, thank you. 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