BIRTH STORY: An Unassisted VBAC

(written by Goldie McKee, about the birth of HayLee Marie, born 10.09.09)

My water broke around 2:30am on Wednesday morning. I woke Tommy up to help me put the liner on the bed. He got a little nervous ("I'm not ready yet," ha ha!). When 4:00 am rolled around and nothing had happened yet, I decided to go back to sleep. We got up at 7:30 and took the kids to school and walked around the flea market for what seemed like an eternity, me feeling like I'm peeing on myself with every step. Still nothing. Even the Braxton Hicks contractions I had been having disappeared. Oh well. We went to bed that night. I really didn't think anything was gonna happen yet and I was okay that first night.

Walked the mall Thursday. Nothing. I had a few sporadic contractions. I woke up at about 3:45am that night to a decent contraction, so I woke Tommy up to go get something to eat for me before transition hit and I wouldn't want to eat. How I knew I needed to eat then, I don't know. Labor could have lasted hours and hours for all I knew. But something told me to eat before it was too late. Sure enough, by the time he got back from Wal-mart I had had several contractions I couldn't sit still through. I was already thinking "That's it, I'm done!" So I knew we were close and I just could not believe it was happening so fast.

I wanted to be on the couch bed in the living room. Don't ask me why...Tommy and I had already talked about him having to appease even the weirdest things for me during labor, so he set it up and put the extra liner he bought "just in case" on it. Roseanne was on. That's how I timed things. By episodes of Roseanne.

I never had to ask Tommy for anything. He just knew. He knew to get me water exactly when I needed it. He knew when to talk and when to be quiet. He knew when and where to rub or touch without my ever talking out loud to him. The contractions were just run-on waves by 5:00 am. No break. Then all of a sudden I needed to know where the head was so I felt in there and for a moment when I felt the posterior fontalles it felt like toes. I thought "shit, it's breech!" So I felt again and realized what I was feeling. Then I realized I wasnt having contractions anymore. Whew, a break.

At this point I was on the floor. Tommy put some chux pads under me and I sqauted. When I was on the bed I kept trying to lean so far forward that it was relieving pressure from my cervix, and I knew that was accomplishing the opposite of what needed to be accomplished. So on the floor I go. I needed something but I didnt know what. Tommy put a few pillows in front of me to lean on in between contractions, and it was perfect. Then all of a sudden I felt a contraction coming and started saying "No! wait! Im not ready yet" and Tommy said "Yes you are. You're doing it!" And the weirdest feeling happened. My stomach started heaving. Like I was throwing up. I realized my body was not waiting for my mind to catch up. It was happening with or without my input.

I helped a bit and went back and forth between holding my labia and feeling the head. That was a comfort to me. To know whatever convulsions my body was doing was working. I would have what felt amazingly like ten minutes between the pushing contractions. But it was probably only a few minutes. It was awesome. In between contractions I could breath deep and feel baby move down a little when I exhaled. I felt one more time during a push and felt her about to crown so when I stopped pushing I just kind of held so baby wouldnt slide back up and Tommy was behind me with his hands down there waiting. On the second to last push he said "Wait! I gotta move! Your butt is gonna explode!" Apparently my hemmerhoids got so huge he thought they would explode on him and he wouldnt be able to catch. Ha! So he slid to my side and resumed his stance.

On that push we saw the beginning of a head. I immediately said "Oh no. I can't do this! What was I thinking?" and Tommy said "Well, I'm pretty sure it's too late for that now." It was exactly what I needed to hear. One more involuntary convulsion from my stomach and I had a head between my legs. So I stopped pushing and was going to wait for the head to turn but by the time my body started pushing again baby hadn't turned. Instead a tiny little goo drop slide neatly into Tommy's hands. My hands were under his so I grabbed the baby and he looked at the time. 6:55am. I looked up and realized how dark it was. It was perfect. I realized the cord was over a shoulder and loosely around the neck so I slipped it off and Tommy said "Oh my god! It's a girl!!!" And he started crying.
All of a sudden I was freezing. It was pretty warm in the house. Tommy had put the heat on before he left to get food. But I was shaking partly from nerves and partly from a bizarre coldness. So Tommy got a blanket out of the hall closet and wrapped it around us. A few minutes later out the placenta came. It looked normal to me. I was passing such large clots that first hour that Tommy was getting nervous, and for a moment I thought I was still passing placenta but I felt okay so we got in bed and sometime later cut the cord.

I couldn't have asked for a more beautiful birth. Nicole woke up about 10 minutes before she was born because I was screaming. Then Luke came out and started rubbing my shoulder telling me I would be okay. I was so proud of my three year old. I couldn't believe I was not scaring him. But the opposite. He was comforting me. All the knowledge I had about it never came in to play. Even though my brain knew what to do, my body knew before my brain let me know. It was amazing. Tommy was amazing. It was like we didn't need words to communicate. His subcoscious knew just as much as mine did. Luke didn't want to go to school. He wanted to stay with his baby girl. Hayden is having some "I'm the baby" issues but we're working on it. She nurses great!

My nipples were sore the first few days but are fine now. I feel great. The only thing that "hurt" after were the skidmarks I had on my labia which are now in that slightly itchy phase of healing. No more pain when peeing. No muscle soreness from pushing for nothing. With Luke my muscles were so sore after I couldn't get out of bed without help for two days. She is one week old today. It has flown. HayLee Marie McKee was born Friday October 9th 2009 at 6:55am and was 5.5oz and 18 inches long. She's perfect in every way.

Editor's Note: Unassisted childbirth is legal in the State of Florida. Goldie pursued care with licensed midwives, but the law that regulates their practice prevents them from accepting clients who have had c-sections more recently than two years prior to their estimated due date. Goldie's third child, Luke, was born by c-section in 2008.

Letter to the Editor: VBAC's in Birth Centers

The following is a letter to the editor of the Sarasota Herald-Tribune. Buried under mountains of letters about the school tax and health care reform, it did not print, but as today is the AHCA hearing proposing the ban of VBACs in Florida birth centers, I thought it timely to post.

Kudos for printing Denise Grady’s article “A Hospital Where Babies Can Arrive When Ready” on March 7 (page 9A). The featured Navajo hospital boasts healthy outcomes and a low c-section rate by encouraging vaginal birth after cesarean (VBAC). Their facility has a 32% VBAC rate, four times the national average.

Experts agree that increasing VBAC access is an integral step in reducing our dangerously high c-section rates (Florida ranks second in the nation at 38%). A VBAC conference was held by the National Institutes of Health this month, resulting in a consensus that recommends that “hospitals, maternity care providers, healthcare and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to trial of labor.”

Regardless of this recommendation, which was backed by three days of evidence supporting the safety of VBAC, Florida's Agency for Health Care Administration will move to permanently ban VBAC’s in Florida birth centers this Wednesday. Florida women with prior surgeries are already limited in their choice of birth place, as fewer than half of Florida hospitals allow VBAC. Sarasota Memorial does welcome VBAC candidates, but with fewer than 1% of Florida obstetricians accepting them as patients, SMH only sees about 1-3 successful VBAC’s monthly.

Women are legally obligated to receive balanced information about the risks and benefits of VBAC as well as the risks and benefits of repeat surgery. Armed with this information, the choice of birth place is a decision that should ultimately be made by a woman and her care provider, and not by the state.

Florida Healthy Start Coalitions in Danger

Last week, the Florida House Health Care Appropriations Committee recommended eliminating Healthy Start Coalitions and moving services to county health departments effective July 1, 2010. This proposal would completely eliminate Healthy Start Coalitions and shift service dollars and responsibilities to county departments of health. This concerns me as a taxpayer, a mother with potential future pregnancies, and an advocate for quality maternity care.

Why am I concerned as a taxpayer? While the state may save $4 million by cutting Healthy Start, it will lose approximately $32 million per year in additional funds leveraged by Healthy Start Coalitions. Overhead costs of county health departments are nearly 20%--more than twice the average local Coalition. Coalitions reduce barriers to health care and save taxpayers money through effectively promoting healthy outcomes for babies. As private, non-profit organizations, Healthy Start Coalitions ensure cost-effective oversight of services.

Why am I concerned as a mother with potential future pregnancies? Currently, only 42 out of 67 county health departments provide prenatal care. Healthy Start Coalitions have established reliable provider networks to ensure access to care and commitment to healthy outcomes. This network facilitates universal risk screening for pregnant women and infants. This is the foundation for determining the moms and babies most at risk for poor outcomes. Under the Coalitions' current model, contracted prenatal and infant care services take place in both the private and public sector. In 17 counties, care coordination services are provided by the private sector and no longer by contracted county health departments. In 33 counties, MomCare services are provided in-house by Coalitions. County health departments are not equipped to take on this responsibility.

Why am I concerned as an advocate for quality maternity care? Healthy Start Coalition model is a successful one. Healthy Start Coalitions and their universal screening program for pregnant women and newborns are credited with reducing infant mortality by 20% since their inception. That alone should speak volumes to our elected officials.

As a member of Healthy Start, a former recipient of its services, a mother, and an advocate for the rights of Florida's women and babies, I will strongly urge each member of the House Leadership, the House Healthy Care Appropriations Committee, and my local Representative to reconsider this recommendation.

A Village for a Family: March 21st

On Sunday, March 21, hundreds will gather from noon until dark at a Sarasota Florida cracker-style ranch in honor of a local family in need. The event, titled "A Village for A Family," is being sponsored by WSLR 96.5 and Sarasota’s Midwives, and will feature six local bands, refreshments, fun for children and a spirit of community. Proceeds will benefit the Augsburger family.

Colleen and Brad Augsburger welcomed their third baby, Kaya Soul, into the world on February 16th. Kaya was welcomed by big sister Ivy Magnolia and big brother Rylan Sky to create a new family of five. After Kaya's birth, Colleen was admitted to the ICU at Sarasota Memorial Hospital. A rare but dangerous bacterial infection, unrelated to but exacerbated by the event of birth, began causing organ damage and severe dehydration. Colleen had three surgical procedures at once on February 20th. She remained on a ventilator, on heavy blood antibiotics, and in critical condition for the following week. Due to the thorough postpartum care of her midwives, the quick and expert work of her team of doctors, and the round-the-clock spiritual vigil of her community, Colleen is home now, and beginning her long recovery process. Her family is strong and supported, but Brad will be unable to work as a painter while he cares for them and for his recovering wife.

A Village for A Family will raise proceeds for the Augsburger family while celebrating the amazing community that has rallied behind them. The Augsburgers have been fed by a different family each night since Colleen’s admission to the hospital. Baby Kaya was sustained for the beginning of his life by the generosity and nurturing of the mothers of his community. And through a PayPal account widely generated by social networking media, Brad has been able to pay bills and focus on his recovering family. They have also received donations from several local businesses, including hot restaurant meals from Ashley’s Food Delivery, organic vegetables from Jessica’s Stand, and donations of baby clothes from Mothers Helping Mothers. "Always a contributor to Mothers Helping Mothers, Colleen Augsburger is a model mother and a friend," says Terry Stottlemyer, director. I am confident Sarasota community members will join me in supporting Colleen, Brad, and their three beautiful children in this, their most devastating time of need."

The Stottlemyers will host the benefit A Village for A Family on March 21, and it won’t be the first time they’ve honored the Augsburger family. Their gorgeous homestead is where Brad and Colleen were married almost eight years ago. WSLR 96.5 will bring attendees an afternoon of top-notch local music beginning at noon, from artists such as Tanya Radtke, The Recycled Citizen, My Friend Scott, Cope, Stone Fish, and Radio-Free Carmela and the Transmitters. Guests will enjoy a fabulous raffle from local businesses, southern BBQ from Roadside Rib Shack, Budweiser from Gold Coast Eagle, and shaved ice from The Hukilau Hut. Children are most welcome for face painting from Upscale Artisans, a bounce house and more. The suggested donation is $10 for adults and free for children. The Stottlemyers’ ranch is located at 65 East Road, behind the Texaco station 1 mile east of I-75 off of Fruitville Road.

Dr. Hill Discusses C-Sections and the NIH Examines VBACs: A Progressive Moment for Birth in Sarasota

Dr. Washington Hill, director of Maternal-Fetal Medicine at Sarasota Memorial Hospital, appeared on HealthSmart today on WWSB with Heidi Godman. I would like to thank them both, so sincerely, for bringing maternal mortality, the rising c-section rates, and risks of elective c-sections to the local limelight.



I applaud Dr. Hill for calling out the rise in c-sections as a predominant factor in increased maternal mortality, and for discussing publicly some of the many risks of cesarean section.

The CDC currently reports maternal mortality at 13.1/100,000, and also acknowledges that due to reporting issues, the actual number is more like double to triple that rate. The numbers are high enough now for the Joint Commission to have recently issued a Sentinel Event Alert about the issue, which Dr. Hill mentioned.

While I agree that elective c-sections--both physician ordered and maternal request--are certainly part of the problem, I still have yet to see them among the list of top ten physician diagnoses for c-sections in Florida (which comprise over 75% of the surgeries). I have requested this information specific to c-sections at Sarasota Memorial Hospital.

I cannot thank Dr. Hill and Ms. Godman enough for bringing to public attention the importance of postpartum care. I would love to see Sarasota Memorial implement a permanent program for postpartum visitation.

This segment aired on the same evening that the National Institutes of Health has issued their Consensus Statement on Vaginal Birth After Cesarean (VBAC), following a three day conference on the issue. From the conclusion of the consensus:

"We recommend that hospitals, providers and policymakers collaborate on the development of integrated services that could mitigate or even eliminate barriers to trials of labor (TOL). We are concerned that medico-legal considerations exacerbate these barriers. We strongly recommend that policymakers and providers collaborate in the development and implementation of appropriate strategies to mitigate this problem."

I am so grateful and hopeful tonight.

Action Alert: VBAC Ban in FL Birth Centers

On Wednesday, March 24th, the State of Florida's Agency for Health Care Administration will move to permanently ban Vaginal Birth after Cesarean (VBAC) in Florida birth centers. Currently, women who choose to give birth normally after surgery must do so in a hospital that will allow it, which encompasses only half of those in the state, or at home with a Licensed Midwife and physician consult sign-off. VBAC's are currently not permitted in birth centers, but only because of a 'de facto ban' due to outdated language in the regulations. After a request that the language be updated to include legalized VBAC's at birth centers with Licensed Midwives and physician consultation, the State used the opening to move to make VBAC's illegal in state licensed birth facilities.

This is a dangerous proposition. The State has evidenced already this year its assumed position as medical surrogate, in the January case of a Tallahassee woman who was confined to a hospital bed and subsequently court-ordered to have a c-section. This sort of treatment completely negates a patient's right to informed consent. Further, if the State feels women should have VBAC's in hospitals, then by the same medical surrogate token, they should mandate that AHCA hospitals allow women adequate trial of labor and welcome VBAC's. If fewer than half of Florida hospitals 'allow' VBAC, and fewer than 1% of obstetricians 'allow' VBAC candidates as patients, and Florida women are limited in their choice of birth place and care provider...well, you do the math. Our primary c-section rates aren't getting any lower (Florida's average is around 37%). The best way to begin to chip away at these epidemic and very dangerous numbers is to increase the VBAC percentages. Women who attempt to VBAC are successful over 75% of the time without necessity for intervention, yet at Sarasota Memorial Hospital, for example, only 1 to 3 women have successful VBAC's each month. Why? Because they cannot find supportive care providers. Many providers, pressured by insurance and medical malpractice concerns, scare (for lack of a better word) women into believing they are making an unsafe choice (read this thorough comparison to learn for yourself). While it is true that a uterine rupture (the primary concern of providers hesitant to accept VBAC patients) can be a devastating obstetric event, it occurs in fewer than 1% of VBAC candidates, and is responded to by emergency c-section--a procedure our hospitals are fully equipped to execute effectively. For those undergoing repeat c-sections, rates of serious placental complications, infections and NICU admission for the babies of those sections are rising rapidly. Women should and are legally obligated to receive balanced information that includes the risks and benefits of VBAC as well as the risks and benefits of repeat surgery. Allowing the pursuit of VBAC at home or at a state licensed birth center with a Florida Licensed Midwife will keep healthy, safe options open for Florida's families, and will dramatically reduce taxpayers' investment in unnecessary surgery.

There is virtually no difference in medical equipment between a birth center and the gear of a homebirth midwife. If the state considers VBAC with a Licensed Midwife at home safe, it is literally contradictory to ban VBAC's in birth centers. Many women would feel more comfortable in a birth center than in their homes, for a variety of reasons, and should be offered this opportunity. Physician consultations for VBAC's take into account several factors regarding the woman's previous surgery(s) and current health risk factors. Once again, we should be striving toward a collaborative model, one in which normal, healthy woman can choose the safe, cost-effective, nurturing care of midwives, and be reassured that obstetricians are available to provide their expertise and intervention if necessary--and only if necessary.

For these reasons, I urge you to sign the following petition and make your voices heard in support of legalizing VBAC's in Florida's licensed birth centers:

To: Florida Agency Health Care Administration

While we recognize the need to change outdated language in the rule, it is our position that the state consider similar language to that of F.S. 467. Such language would work to insure the patient received competent care from a licensed practitioner and respects the right of the patient to make an informed decision. We ask the State of Florida to remain a regulatory body and not take on the role of medical surrogate.

This is a very timely discussion, as tomorrow begins the first conference from the National Institutes of Health on VBAC issues. The conference will address the following key questions:

--What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States?
--Among women who attempt a trial of labor after prior cesarean, what is the vaginal delivery rate and the factors that influence it?
--What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
--What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
--What are the nonmedical factors that influence the patterns and utilization of trial of labor after prior cesarean?
--What are the critical gaps in the evidence for decision-making, and what are the priority investigations needed to address these gaps?

I am hopeful that the findings of this conference will further support the safety, cost-effectiveness and good common sense of allowing women to make their own informed decisions about VBAC, and will encourage the practitioners in attendance to do everything possible to combat the primary c-section rate. We wouldn't be holding conferences or discussing legislation regarding VBAC policies if the primary c-section rate were at an appropriate, healthy level.