Birth Matters Podcast, Ep 74 - A NYC Doula's Home VBAC

Sophia’s first birth was a planned homebirth that needed to transfer to the hospital for a cesarean due to baby’s position. Today she shares how she was determined to try for a vaginal birth after cesarean, also known as VBAC, at home. Sophia details lots of smart insights based on both her own journey as well as her knowledge as a doula. We talk about kinds of things that can help both parent and baby thrive through the journey to, through and beyond birth such as acupuncture & moxibustion, chiropractic, cranial sacral therapy, pelvic physical therapy, Spinning Babies techniques, emotional support, and more.

Resources:

VBAC resources:

Sponsor links:

*Disclosure: Links on this page to products are affiliate links; I will receive a small commission on any products you purchase at no additional cost to you.

Episode Topics:

  • Sharing about first birth homebirth transferring to cesarean for breech and recovery

  • Deciding to try for a HBAC (homebirth after cesarean) late in 2nd pregnancy

  • Hiring same midwife as last birth

  • Hired a different doula from first since first doula moved to FL

  • Convincing her husband to have a homebirth the first time

  • Preparation for birth - chiropractic

  • Baby was breech in 3rd trimester, so she tried all the things (Spinning Babies, chiropractic, acupuncture & moxibustion is what worked)

  • Labor story -- going later than with first pregnancy and trying things to get things going; nipple stimulation seemed to be what worked; went into labor overnight

  • Doula and midwife come midday

  • Hymenal ring preventing baby from coming out

  • Pushing for 1.5 hrs

  • Kept placenta (didn’t get to first time)

  • 3rd degree tears

  • Wouldn’t say vaginal birth was any easier or harder than cesarean

  • Wasn’t magical or miraculously healing in any way, but she’s glad she did it

  • After the fact they realized 2nd baby was asynclitic; doing cranial sacral work to help that and as a first treatment option for tongue tie / lip tie

  • Labor was 24 hrs

  • Learning she had a hymenal ring, which seemed to slow pushing

  • Scar tissue massage at point of incision after first birth cesarean

  • Going to a pelvic PT, too, first time, to address itchiness around scar tissue

  • Planning to go back to pelvic PT soon after this 2nd birth

Interview Transcript

Lisa: Welcome Sophia.

Sophia: Hi. So I'm Sophia Medina. I'm a mom of two now, so this story is about my home birth after cesarean. My first birth was a planned home birth, which ended in a transfer. And then a cesarean with my older son who is now two and four months. So that was October of 2018. And I just had my HBAC on January 27th --so just three weeks ago yesterday.

Lisa: Just for listeners who don't know, HBAC stands for home birth after cesarean.

Sophia: And I'm also a doula, a new doula and I kind of unofficially am specializing in vaginal birth after cesarean, because that's what happened to me. And there's a lot of misinformation out there about whether it's possible to do a VBAC, what the risks are, what the benefits are. So I'm really excited about helping people to get educated about that and to make like empowered decisions about their births moving forward after cesarean.

Lisa: I'm so glad to have you. This is going to be great. So did you share where you live?

Sophia: In the Bronx, New York. I've been there for about six and a half years now.

Lisa: Fellow New Yorker, which is most of the people I have on the show, but not always. Do you mind saying what the reason was that the cesarean was necessary the first time.

Sophia: Sure. So I had planned a home birth with my first and I had assembled a birth team. I had a home birth midwife and a doula, and I labored at home for --my water broke on Thursday and so I had early labor for two days after that. And then I was in active labor for two days after that. So active labor for about 50 hours. And then finally the contractions weren't getting close together. The midwife did a check. Did not feel the top of a head. She thought he might be face presenting.

So we transferred to the hospital because I was exhausted and she thought I needed help. He wasn't coming. And when we got to the hospital, they did an ultrasound and he was breech so he was butt down. And so she felt his butt and testicles essentially. And when you're at the hospital and your breech it's an automatic cesarean so that's why I had the C-section. And honestly, at that point I was so tired that I was like, just get him out. I don't care how you do it. Let's finish this.

Lisa: I bet; that's a long time to be in labor.

Sophia: It was a long time, I was so tired. Yeah, at that point I had no energy left to keep laboring and the cesarean itself, the experience was pretty good as far as surprise cesarean can be. Healing was really straightforward. No surprises. The baby was really healthy when he came out, no NICU, he started nursing right away. I actually did have quite a good experience considering that it was the opposite of what I had planned.

Lisa: Given that you had been in labor so long and then had to have major abdominal surgery, what was your recovery like? Cause that's a lot for the body to go through.

Sophia: Yeah. So being in the hospital was really rough because anyone who's had a hospital birth knows they come in every like couple hours to check on you. And every time there's a shift change, they come and check on you. So I couldn't get any sleep because basically every couple hours there was someone coming in and turning on all the lights, checking the baby, checking me, which makes sense, that's their job, but I couldn't rest, so we ended up leaving a day early, actually. We were supposed to stay three days and we stayed two days. And then when we went home, like I didn't have any issues recovering. It was like a fairly straightforward, easy recovery. So that was definitely a blessing. And, I didn't have vaginal trauma, which this time I definitely had, so it was a different healing experience, but it was very straightforward. I didn't have any issues. So that was lucky.

Lisa: And it sounds like maybe the baby flipped in labor?

Sophia: Or like right before labor, like he'd been head down the whole pregnancy, so it was really a surprise to everybody, and we were just like what? Like, yeah it was a surprise.

Lisa: Yeah. Because with many midwives that would risk one out of a home birth, if you identify at the end that the baby's breech. Oh my goodness.

Sophia: You know, I'm really glad I got to labor at home. That was a really, really wonderful experience.

And I hope everybody gets to do that. Even if they're planning a hospital birth, it's just really great to be at home for as long as possible. Cause it's just more comfortable.

Lisa: Absolutely. Yeah. Yeah. It helps those hormones to flow more readily being in that private space and that safe space. Yeah. So then It sounds like you conceived during the pandemic.

Sophia: That's right. He's a COVID baby.

Lisa: Do you mind my asking, was that planned or was that a surprise?

Sophia: No it was planned. We had been trying for a couple months and I certainly didn't think COVID would still be a thing in January.

Lisa: Of course, who did.

Sophia: Yeah. So We have been trying, I actually would have liked my kids to be even closer together in age because my sisters and I are very close in age and I loved growing up like that. So they're a little more than two years apart, which I think is still really, really close. So yes, he was planned.

Lisa: Yeah. Yeah. Mine were just shy of three years apart. And I had read that that's a really good, ideal spacing in terms of that closeness. And we've found that to be true with ours. They've been very close growing up, even though it's a boy and a girl, they're very close. Hopefully it'll stay that way. They're getting into the teenage years now. So it was a little more.

Sophia: We were better friends as adults than we were as kids.

Lisa: Yeah. Yeah. That's often the case, it seems like.

Great, so during your pregnancy, through these pandemic times, can you talk a little bit about the decision-making process? Did you automatically want to try again, to give birth at home? Or what did that look like and your choice of your midwife and your doula? Tell us about all that.

Sophia: Yeah. So I because I'm a doula and I had kind of been a birth enthusiast even before that I was just always really into physiologic birth, right? Like vaginal birth, and I very much believed that our bodies were created for this. And the evidence shows that most low risk pregnancies don't require any interventions for the mother and baby to have a birth basically unmonitored and kind of just like stepping back and letting the person do their thing, and the baby just comes out and this is most of the time of low risk pregnancies. And because I had labored with my first and I had dilated to seven centimeters, I was told by multiple medical professionals that I was a really good candidate for a VBAC, but also for home birth, because I didn't have any complications in either pregnancies.

So basically the only, "risk factor" is that I had had a cesarean, which the evidence shows the risks of having a vaginal birth after cesarean are pretty low or a lot lower than the risks of having another major surgery. So I knew I wanted to do a VBAC and my husband and I actually went back and forth between going to a hospital or doing a home birth, mostly just because of the money, because home birth isn't covered the same way by insurance as hospital births are. And so you have a lot more out-of-pocket expenses. And like with our first we had planned a home birth, paid for it, and then the insurance covered some, but then, because we didn't deliver at home, the insurance ended up wanting to be reimbursed back. So we had to pay more out of pocket, like almost two years later than we thought we would.

Lisa: I've always wondered what the finances look like with coverage when that happens. Ugh, that's frustrating.

Sophia: It depends on the insurance plan and it depends on the midwives and it was just like a whole thing, like years after the birth, so we were kind of torn about, should we even try this again? What if this same thing happens and we end up being out all this extra money that we weren't planning to spend. But in the end we actually ended up my husband switched jobs in November a few months before I was due and his insurance no longer covered the hospital and the midwives I had been seeing.

So then we thought, okay, "Well now we have to switch providers. Okay. Let's just do a home birth," because we had been on the fence about it anyways. And I ended up hiring the same midwife I'd had before, Nur Midwifery. We had become like good friends between my first birth and the second birth.

And she gave me really excellent care for the first pregnancy and labor. And she stayed with me in the hospital when I had my cesarean and helped the baby latch with my older son. And so I felt really safe with her. And so we hired her again and she took me on like very late in my pregnancy, which is unusual for home birth midwives because they book up quickly.

But because we were friends she was really kind about taking, taking me on.

Lisa: And especially during the pandemic, they've been booking up even faster than ever, because everyone's like, I don't want to be in the hospital. Yeah.

Sophia: It's true. And that's part of why my husband and I agreed to do the home birth as well is because I was like, "I don't want to have to wear a mask." And like, we were both with our doula, we were going to be all three basically stuck in our room because they didn't allow people to move around the hospital. So if you left your room, you had to leave the hospital. And I was thinking, what if it's another long labor? And we're all just trapped in this little room together for days, you know?

And the hospital, we were planning to birth that was in New Jersey, which is, 40 minutes away on a good day with no traffic. There were a lot of different factors. So yeah, we ended up going with the home birth. We did hire a doula, a different doula than my first birth. I loved my doula for my first birth, Shay McKay. She used to be the Family Doula NYC, but she changed now, she moved to Florida. So she was not available for my second birth, which was a real bummer because I loved her.

Lisa: She's wonderful. I know her. Yeah. My clients have loved her as well.

Sophia: She was great. And we became friends as well. And she's actually been like, kind of unofficially doula-ing me for this pregnancy as well. She's just like, let me know if you need anything.

Lisa: I love that.

Sophia: Yeah, she was wonderful. And she was part of the reason I became a doula. And so I hired another doula who also just went through the Manhattan Birth mentor program last year. She came highly recommended and she was also wonderful. I mean, there's so many great doulas out there and they make such a difference in your ability to cope during labor, right?

They have comfort measures and she reminded me to eat and drink and she reminded me to change positions and she was wonderful. So and her name is Jennifer Reynoso Ng and her handle on Instagram is @Waterlilybirthing_. And we'll have that in the show notes. So, basically, I had a great team. My husband was on board. The pandemic. These are all factors that led to the decision to do the home birth and it worked out.

Lisa: The first time around when you were choosing to give birth at home, was your partner on board? Was your husband on board with that first time or did it take some convincing or what?

Sophia: It definitely took some convincing, so he's very much, "Let's do what everyone else is doing," kind of guy, and he also has some medical training, so he has a lot of faith in the medical field and he's kind of like, "Doctors do this every day they know what they're doing, let's just do that, that's what everybody does." And he did come around because he knew it was so important to me. And we did do research together. We took a birthing class at Manhattan Birth together, which they talk a lot about nonmedical pain coping methods. They talk about the importance of a doula. They show the partners how to do like hip squeezes and talk about what to expect in labor so that if you're laboring at home and your partner's witnessing it, they're not like, "What's happening?" They're not totally freaked out and unprepared. 'Cause most of what we know from birth is what we see in the media and it's wrong. It's like not what birth is really like look way more dramaticized than what it actually is.

Lisa: Or is definitely the exception to the rule because they're looking for the most dramatic...

Sophia: Water breaking like a burst. And then the person is immediately in active labor and they're screaming and the baby flies out and it's like, then in labor that that's not what happens.

So he did come around. And he was amazing at this home birth that we just had. He was so present. He was really right by my side the whole time. And again, like it's not his thing. So when it was all done, I was just like, "Thank you so much."

And I think he's still processing it because it was a lot for him and, like I said, it wasn't really what he wanted. And if he had had it exactly his way, we would have just gone to the hospital and doctors and nurses would have cared for me, and he would, I've been like on the other side of the room, like, "You got this." So he took a really active role, which was incredible.

Lisa: Well, good for him. I'm always so encouraged to hear when partners are so supportive and especially when it's not what they would have chosen for themselves or for you, you know? So that's great to hear. Nice.

Sophia: It was a big deal in our relationship, actually.

Lisa: This whole process can really either bring couples together and deepen and strengthen their connection, which is always my hope. When people come to birth class with me, we start conversations that will really deepen and strengthen that connection because it's so important to take proactive, protective measures in this journey into parenthood, right. Or the other alternative that's unfortunately very common is that it can actually have the opposite effect is just because there's so much stress in becoming a parent and going through the process of giving birth, but especially into parenthood it can really put a lot of stress on a relationship. So I'm thankful to hear that it's been good so far for you.

Sophia: And I feel like also like traditionally, men aren't typically at birth. It's usually women surrounded by other women, and so for men to be part of that. I mean, some men are of course are the exception, but I think for a lot of men, it's not like their realm and it's definitely not their comfort zone, right. So it takes a lot to, for them to step into that and do what needs to be done.

Lisa: Yeah. You and I both know since we're both birth workers that, assuming your relationship is in a fairly decent place when you're in labor, you guys got that oxytocin factor going on between you, the two of you. So theoretically, that should really help, given that oxytocin creates contractions and strengthens them and speeds up the labor. That's an awesome thing if you do have a loving, supportive partner and it feels like a good fit for your partner to support you. Yeah.

So, anything else about what your pregnancy was like? Was there any difference in what your prenatal visits were like, given the pandemic circumstances? Did you have virtual visits or what did that look like?

Sophia: So we didn't switch to the home birth midwife until near the end of my pregnancy.

Lisa: Oh that's right, you said it was late.

Sophia: So for the first half we were seeing a midwifery group that delivers in a hospital, and their care was fine. I'd had homebirth care for my first pregnancy. So that was the bar that I was used to. My midwife came to my house, every, whatever four weeks for the first couple months. Every other week. And then every week for my whole pregnancy, I laid on my couch.

Lisa: So nice.

Sophia: Yeah she checked my blood pressure and the baby's heartbeat. She did it like most of the testing at home. And then when I needed ultrasounds or any more extensive testing, she would send me to a lab and write me a prescription.

And that was like two or three times the whole pregnancy. So it was super easy. I was working at that time, so it just made it so that I really didn't have to do much. I didn't have to show up somewhere every week, super pregnant. I could be in my own living room, like eating breakfast, during my prenatal which was great.

So then during this pregnancy, I went to this other midwifery group that delivers in a hospital and it was still midwifery care, but it was very different. They only saw me for like five, 10 minutes. They didn't really ask me many questions. They certainly didn't ask me about my diet, whether I was exercising, how I was feeling emotionally which had been things that we always discussed at my prenatals with my home birth midwife.

She would ask me what exercises are you doing? How's your diet? What kind of foods are you eating? How are you feeling about the birth? How are you preparing for it? And so it was a much more holistic, like all inclusive type of care. So because I'd had that with my first pregnancy, for this one, I was kind of like, "Wow; this is not-- I don't really feel cared for." And I realized this is what most people have for all their prenatals for every pregnancy. And that made me really sad because it just doesn't feel like enough.

Lisa: Right.

Sophia: You're bringing a human into the world and you're doing something that you haven't done before, and that's really hard. And every aspect of your life should be reflecting that, right. You're reflecting that you're preparing for that and if your doctor or midwife, isn't even asking you these questions, it might not occur to you that you should be addressing these things.

Lisa: Absolutely. Cause it's all connected, right? The mind body connection, for example, if we are feeling sad that can have ramifications on our pregnancy and the way we labor. And there are things we can do to help that. Yeah. Yeah. So I love that you're highlighting that because that is a big difference.

Sophia: Yeah. So then when I switched care, I was like, "Oh, this is great." Back to the way it was. And it was, it's totally different.

Lisa: Yeah. Yeah. A lot of people just recently somebody mentioned the term medwife that there are midwives and there are medwives and it's not that midwife -- many midwives in a hospital setting can provide that holistic care. It just really depends.

Often when they're under an OB's practice, they have much more limitation because they they're more likely to be in network with insurance, and so they're not being paid as much, so they're having to like, keep the appointments, like book more people and keep them really short.

And it's just the very unfortunate nature of our system that often leads to the difference in care. And it just, it needs to change. Oh my goodness. But I'm so glad that you were able to switch, and you chose to switch there at the end. How many weeks were you when you switched? Do you remember?

Sophia: Like 30, I wasn't that close, but I was I was up there. That was about, yeah, I think about 30 weeks.

Lisa: I switched to a home birth midwife in my second pregnancy as well. I think my, I was like 34 weeks. Wow. I was 30, maybe 32, but, and it was hard to find somebody who was available.

Sophia: Yeah. Because a lot of them, especially if they're on their own, like my midwife, they only take a few clients a month. Right. So they're booked out from nine months earlier. So, I think she took me on as an extra client as a personal favor.

Lisa: Mm that's nice. Yeah. Yeah. It's hard to say no to repeat clients ones that we've already built that personal connection.

Sophia: Definitely, and she knew how bad I wanted a home birth and that it hadn't gone the way we planned the first time. So I think she really wanted to help me get there.

Lisa: You mentioned that you and your husband did a lot of research. I think that was talking about the first pregnancy and deciding to give birth at home. I'm wondering if you did research and might have resources to share on the topic of VBAC and/or HBAC.

Sophia: Yeah, I did do certainly a lot of research on VBACs because after I had the cesarean, which it never crossed my mind that that would happen to me because I was having a home birth. So I didn't really know anything about cesareans I certainly didn't know anything about vaginal births after cesareans. So I wanted to really educate myself because like, as soon as I had the C-section in my mind, I was like, "Okay, can I have a vaginal birth the next one?" And I talked to my midwife about it actually. And she said, "Yeah, because you labored and you dilated and your body like knows what to do now, you'll be able to do it easier next time than you would, if you hadn't labored at all. So The VBAC Link, which is a they have a podcast and they have a website and they have a Facebook group, which the Facebook group has been super helpful to me.

It's, I believe, two doulas who had both had cesareans themselves and they wanted to provide information for people who were trying to do VBACs. And so they have classes for VBACs they have doula trainings that are specifically for VBAC doulas, which I'm hoping to do eventually because if you've had a cesarean your birth experience with a VBAC is going to be a little different than if you've never had one. And so having a midwife who knows about VBACs and who knows about cesareans is going to be really helpful. And, and even just emotionally, like I had interviewed a doula for this second pregnancy and I told her I'd had a cesarean before and she was fine, but she kind of like, I felt like she blew it off a little bit and she was kinda like, "Oh, like, don't worry you can have your vaginal birth this time." And in my mind, I'm like, "But that's what I thought last time," like that kind of magical thinking doesn't make you have a vaginal birth, right?

An open mind about, "Okay, like we're going to, this is the plan, but if the plan doesn't work out, we're going to make alternative plans for a different path if we need to." So having that like open mind for something else to happen was really important to me. And I think for anyone who's had a cesarean and is hoping to have a VBAC, they understand that. Because you could have another cesarean. And then like, for me last time, it didn't enter my mind that that could happen. So I wasn't emotionally or mentally prepared for it, which I think is part of why it was so hard for me to accept. And then this time I prepared myself a lot more for the possibility of it. And of course, I didn't have one this time, but I felt like if I did, that I would be better able to accept it and move forward from it.

So The VBAC Link was really helpful. I followed a few other VBAC accounts on Instagram. There's VBAC Facts. And then I read a lot of articles on Evidence Based Birth which is a website, which has a ton of articles about literally everything pertaining to birth. And it has all these studies linked. So you can really find the most up-to-date information.

Lisa: That's one of my favorite, favorite resources. I'm a professional member of that. So great.

Sophia: So I read a ton of stuff about VBACs on there. And I was like, Oh, the risk of uterine rupture, which people consider the major risk of a VBAC is less than 1% if you've only had one previous cesarean. So why are they scaring us about VBACs when if you've only had one cesarean your risk is less than 1% of a uterine rupture, but the way that you hear people talk about it and especially doctors who aren't VBAC supportive it sounds like maybe there's a 50% chance of it happening and it's just-- and even when I was planning to have my home birth, I didn't tell people I was planning a home birth because I heard everyone's opinions the first time and I didn't want to hear it the second time, but I told them I was planning a vaginal birth and a lot of people were like, "Oh, are you sure you're not going to just do a repeat cesarean?" Like as if that was just a given. Yeah a lot of people think that you have to, like once you've had a C-section that you always have to have a c-section

Lisa: Yeah. cause it used to be that way until --we learned better.

Sophia: Exactly. So so those, those sources have all been really, really helpful for me to see that the risks for a repeat cesarean were higher. And then, and I've seen people in these groups having vaginal birth after three or four cesareans, right. So if they can do it, I can certainly do it after one. And then the Manhattan Birth doula mentor program that I'm in also has been really, really helpful in terms of there [are] a lot of people in there who've had homebirth themselves or who have witnessed home birth because they're doulas and home birth midwives or birth assistants.

And so hearing about their experiences and also the classes we're going through are very informative about helping manage pain at home and helping, and like the physiological nature of birth and how, like I said before, if you don't intervene, most of the time, birth unfolds by itself without needing any help.

So yeah, and then just talking to people who have had VBACs also really helped and made me feel again like, oh, if they can do it I can do it, right. Or at least I can try.

Lisa: And how did you, did you just come across people in the birth professional community or in the, I think you said that one of those resources had a community had like a Facebook group.

Sophia: Yeah. So VBAC link has a Facebook group and then homebirth cesarean is another Facebook group that I'm part of that's specifically for home birth transfers that turn to cesarean and those have both been really helpful in terms of seeing people have their VBACs and also people asking questions about, "Oh, I'm in labor," or, "Oh, should I get induced?"

And people link articles and their professional opinions beneath it. So I've done a lot of reading on those and talking to people who've been in a similar situation.

Lisa: I love it. It sounds like you really did your homework.

Sophia: I dove in head first, I love birth so it was easy for me.

Lisa: Yeah. That helps. Great. Well, unless there's anything else you wanted to share along those lines, then we can jump into your birth story at whatever point you'd like to, it could be the last few weeks or days just wherever you'd like to jump in

Sophia: So for most of my pregnancy, I did a few things to try and prepare my body and my mind and my spirit for for not only a VBAC, but I think it's important to do it for any birth.

 I saw a chiropractor regularly who is Webster certified and so getting adjustments from a Webster certified chiropractor is supposed to help your alignment basically help baby get into the ideal position. And so I saw him quite regularly throughout my pregnancy. I wish I could have done regular massages, but I mean, I had a toddler and it's a pandemic and I'm not rich.

 I did a few massages, but not regularly which can also help get your body ready. I did the daily essential yoga with Spinning Babies

Lisa: Yay. I recommend that to every single one of my clients.

Sophia: Yeah, it's great. And that's also just a great, like, like emotionally and spiritually. It's really nice to center yourself and have a time in the day that's just for you because I noticed, especially with a toddler, because I'm a stay at home, mom, my day would be all about him. And I really like with this pregnancy, didn't take a lot of time to focus on myself or the baby in my belly, because I was like always focused on this toddler.

Lisa: Sure.

Sophia: So the yoga practice really helped me pay more attention to my body and also gave me a time to really bond with and talk to the baby while he was in my belly. So I'd definitely recommend that for everyone. And then, I ate well, the Lily Nichols book Real Food for Pregnancy is a great resource. So that has like all the information for a really, really holistic super healthy all encompassing prenatal diet, right? Cause it talks about healthy fats and liver like organ meats and things like that, that aren't even recommended really by doctors yet, because like the research is ahead of what they're recommending.

So really helped me feel good about what I was giving my baby and what I was giving myself and just preparing us both for the birth and after.

Lisa: I've always heard such good things about that book and it's so funny that you bring that up in, in this timing, because I think it was just last night I was on a Facebook group and maybe it was our local doula group; I can't remember. But somebody was bringing up gestational diabetes, and what are the tips? And somebody recommended that book and said this book, check this book out because it's so excellent. It has specific nutritional you know, tips and things. And so it's been on my to read list for a long time because my to read list professionally is a mile long, but I think I'm going to bump it up. I want to read that one.

Sophia: She has two books and the first one I think she wrote is Real Food for Gestational Diabetes, and then she wrote Real Food for Pregnancy, because there was just a hole in the market for both types of diets and she's a dietician, and she was like, how are people still being prescribed like this many servings of whole grains for pregnancy when like that's really not appropriate. And like they're steering people away still from like healthy fats, which you should be eating a ton of healthy fats when you're pregnant and nursing, right? So I'm still nursing right now and I'm just like constantly hungry and I'm trying to focus on like really healthy food instead of just grazing on like cookies.

So all those things really helped me like prepare my body and my mind. And I also talked to a lot of people. I'm like an open book and talking for me is very therapeutic. So I talked to a lot of, especially birth professionals about my fears, about trying for an HBAC, my concerns about well, it didn't work out last time and I was so convinced that it would.

And even with my husband just voicing my concerns and my emotions leading up to it, and to my midwife as well and my doula, it helped me feel like I was preparing somehow by just getting it out and having people's feedback as well.

Lisa: That's huge because we know the big role fear itself can play in hindering a healthy labor and the position of the baby, quite honestly, as well, because if you have fear, there's tension in your body and then things get out of whack and too tight, and it's harder for baby to settle into a good position, right? I'm so glad you're bringing all this up because the minute you said that the cesarean was due to the baby's position I was like, "Okay, well, I wonder if she did bodywork in the next pregnancy," and you did. I love it.

Sophia: Yeah with my first one, I really didn't do it that much because I was working full time; I just didn't. And I didn't know; I was young and I was like, "I don't really need that; it's fine." And plenty of people can have easy vaginal births without that, but it certainly doesn't hurt and it can only help and so this time I did it. The other thing I've totally forgot to mention is that when I switched to my home birth midwife she did an ultrasound at one of our appointments early-ish in my care with her so I was maybe like 32 weeks and the baby was breech and I was just like, "No way." And and then I was like, "Oh my God, is my uterus a weird shape? Why are both of my babies breech?" And so I was like, okay, but I know early this time, so I'm going to do everything I can to turn this baby. So I started doing the Spinning Babies protocol for turning a breech baby, which it requires lying on the ironing board, like upside down propped on the couch.

Lisa: Called an inversion.

Sophia: Yeah, multiple times a day. Kneeling on the couch and putting your arms on the floor, like with your head down multiple times a day. And then a few other things that I did with my husband. So I did those a bunch, but what actually ended up turning him was one session of acupuncture and moxibustion. Which for anyone who doesn't know moxibustion it's like an ancient Chinese technique--

Lisa: Modality or technique. Yeah.

Sophia: Where mugwort, which is an herb, is burned near one of your meridians, which is basically next to your pinky toes. And it's supposed to move your chi in a different direction while you're having acupuncture on your legs and feet. So I went-- on the Upper West Side, there's a place called Qi Li I believe it's called and it was recommended by one of my doula friends.

And I had one session there, which was like 40 minutes maybe. And as I was doing the session, I could feel the baby moving like crazy. And when the doctor came in at the end, I was like, "The baby was moving so much, what's going on?" And he like, felt my belly was like, "It's head down." And he was so chill. And I was like, "Oh my God!"

And he's like, "Yeah." And I was like, "Does this happen all the time?" And he was like, "Yeah." Like apparently they had a lot of people in there trying to turn their breech babies. And he stayed head down after that. I mean, I kept doing some of the Spinning Babies things to make sure he stayed head down.

And I did a lot of like walking on stairs and bouncing my birth ball to try and get him to engage like deeper in my pelvis. But he didn't flip back. So it worked. I didn't have to worry about breech, but--

Lisa: Big sigh of relief.

Sophia: Oh my gosh. I was totally freaked out when I found out I was like, "You have to be kidding me."

Lisa: Seriously, oh my gosh. I'm curious in your appointments with the chiropractor. Did they ever mention, do you happen to have any like slight scoliosis at all?

Sophia: No. He didn't say that I had anything out of the ordinary happening. And I think it might've just been, like you said some kind of like tightness or stress or strain. I don't know.

Lisa: Sure. I only ask that because my personal chiropractor who's here in the neighborhood and I send all my students to him. Cause he also does Webster technique has this theory that --he sees a lot of people with even just mild scoliosis or not so mild, that that seems to have an effect on breech babies needing to be in a breech position. He wants to do a study on it because it's not proven as far as I know, and as far as he knows but it's his kind of theory. So that's why I asked.

Sophia: Interesting I've never heard of that.

Lisa: Pandemic stress alone could have caused some tension in your body or having a toddler.

Sophia: I mean, it's it's or like my positioning, I don't know. Who knows, you know.

Lisa: These things can be very mysterious

Sophia: Absolutely and it's, and it's such a small amount of babies that are breech at full term that, yeah, I feel like it really hasn't been properly studied. Like what can cause it other than your uterus being bicornuate or I'm not sure some other kind of issue with the space.

 So then after that, the rest of my pregnancy was pretty normal like no red flags. The only thing is I had a lot of swelling, but my BP was always normal. It wasn't preeclampsia. It was just, that's what my body does; I had that with my first son, too. Where I just got my hands and feet just got really swollen towards then and it just stayed like that, which is not comfortable. But yeah, no other issues. And then should I talk about the labor and stuff?

Lisa: Yeah, absolutely. We'd love to hear your detailed birth story, whatever details you'd like to share.

Sophia: Okay. Yeah. So the labor was fairly straightforward. My first son was born at 39 weeks exactly. And so I figured this one would come early, too. But then I got to 40 weeks and 40 weeks. And so finally at like halfway through 40 weeks, I said to my midwife, "What are we going to do?" Because if you get to like 40 two-ish weeks, they want you to go to the hospital because that's considered postdates.

And there's a little bit of evidence that the placenta can be deteriorating or, you know, the baby passes meconium in the amniotic fluid that there can be issues there. So I didn't want to get that far. And I was kind of like, "Well, why isn't he coming?" Because the first one was so early.

So I started, she told me that, "Okay, you can do a few things at home, including like castor oil," which taking castor oil internally is like really gross. And I didn't want to have to do that. Cause it makes you poop a lot, which stimulates contractions. She said, "Okay before you go to that, why don't you try pumping on the breast pump a little bit cause nipple stimulation can also lead to contractions." So I did that on the day before he was born and it worked, I started having contractions in the afternoon on the 26th, just like far apart, 10 minutes apart or so like really not that bad. So I went to bed at night. And then in the middle of the night, I woke up at like 3:00 AM and I was like, I can't be in my bed anymore.

Cause I was having contractions every like five-ish minutes. And they were getting strong. So I got out of bed, went in the living room, let my husband and toddler keep sleeping cause I was thinking if this is another long labor, I need everyone to be rested as much as possible. But I called the midwife and doula and just let them know things were starting.

And then the doula came by in the morning and my contractions were like closer together she helped me start eating something and she was doing hip squeezes to help kind of counter pressure the contractions, which definitely made them easier to deal with. I knew that from my first birth, cause that's what the doula did and it was incredible, like so much better. And she helped me change positions and I got in the shower for a little bit to get a little bit of relief. And then the midwife came at like, I don't know, 10 or 11 in the morning; labor land is so weird with time. Like, I don't know what time anything was. We sent my toddler to go be with my sister; my sister lives in Queens.

So he went with her for the day. Sometime in the morning he went with her again, like I had packed all his stuff and I had everything planned out before so he was gone. Our apartment was just too small to have him there while I was laboring and he's only two and I just didn't want him to be freaked out by seeing me in labor.

There just wasn't enough space for him to be there. And I didn't want to have to put any attention on him while I was doing it. So in the midwife and birth assistant came around midday. And everyone thought he was coming right away, because my contractions were getting closer, I was moving around a lot. And he wasn't coming. And I kept asking midwife, like, "Is he close?" And she's like, "Stop asking me because you're going to be disappointed every time I tell you now." We had set up the birth tub, so I started like pushing in the tub, pushing on the birth stool, pushing on all fours and it was just like really slow. And I could put my fingers in and feel him, his head, but he was still kind of like far back. And so they, they were behaving like, Oh, he's just going to come right out. And he wasn't and I was just like, what's going on? So finally the midwife was like, "Okay, let me see what's going on."

So she checks me and she's like, so you have a hymenal ring. And I was like, what the hell is that? Have you ever heard of that?

Lisa: I'm not sure that I have.

Sophia: I had never heard of it, like in all my research and like doing all these birth classes and stuff. So apparently like when your hymen breaks, it can, there can be like like remnants left behind and it can be like, for some people it's like nothing.

It's like really thin skin basically. But for some people it's like really tough and tight. And apparently it's rare and apparently that's what was going on with me. And so he had to stretch this thing out before he could come down all the way. I know. And so it was, it really hurt. And so my midwife like, kind of like said, "Okay, let's have you on the couch on your back and I'm going to help you stretch it."

So she had to help me do that. And then meanwhile, I'm like pushing with all my might. And later I was like, how long was I pushing? Cause it felt like hours and hours and she's like, "Oh it was like an hour and a half." And I'm like, "No way it was way longer than that." She's like, "No, it was an hour and a half." But oh my God, it felt so much longer.

And so she stepped away to go to the bathroom at some point. And then when she came back, I was still on the couch on my back and she's like, "Okay, let's get you on all fours on the floor," because he was like about to come. And I was like, "Okay, hold on I'm having a contraction. After this one." So I start contracting and he just like flies out. On the couch on my back and like, and not just like head and then body, like he flew out in one lurch.

Lisa: So interesting. Cause that's, yeah, it doesn't usually quite happen that way.

Sophia: No and like my poor husband did not want to like see him coming out because-- he just didn't and like he saw it, and afterwards I was like, "I'm sorry." But nobody thought he was going to come out like that fast. And like the midwife was like, "Oh my God." And they had had resuscitation stuff for him on hand because there had been some meconium in the water, but he didn't need it; he was fine. And he went right on me and we did skin to skin right away, which was great.

And they kept my placenta, which was awesome. So that was my first baby, I had really wanted to keep my placenta and bury it. And when we went to the hospital, I hadn't even packed a hospital bag. So I had nothing ready. And I had no birth plan for the hospital and they had asked me when I was having the cesarean, "Do you want to keep your placenta?"

But I didn't have a cooler, I didn't have Ziploc bags. And I was so tired and I was just like, "No." I just didn't have the emotional capacity to deal with it. So I said, no. And later, of course, I regretted it cause I was like, I wanted to see my placenta. So this time I got to keep the placenta and it's in my freezer.

Lisa: In a Tupperware probably or something along those lines?

Sophia: In a Ziploc bag.

Lisa: I know when I had a home birth, they had me get a large Tupperware container for it.

Sophia: Yeah. So, I mean, it was really cool. I got to see that and I got to see if my son had any vernix on him, which for people who don't know, vernix is this, like lotiony kind of oily substance that's sometimes on babies and it's like white and kind of looks cheesy, but it's just super protective. It protects them from the amniotic fluid and it's like antibacterial and like really moisturizing. So it's good to just leave it on them and kind of rub it in. Well, like with my first, they wiped him off as soon as he came out. So I didn't even see if he had vernix on him. So in this one, I got to like really see it.

I took a picture of him. I didn't think if someone else took it because I asked them to, but he had all this really nice vernix, which we kept some of it, so I could put it on him again after his first bath. Yeah, so it was such a different experience and I don't know if it was because I was swollen or because I was pushing so hard or because he came out so fast, but I ended up having third degree tears, which is also super rare.

So afterwards I said to my home birth midwife, like why, first I had a breech, which is like 3% of all the full term babies. Then I had a home birth transfer, which is like also a super small percent. And then I had third degree tearing, which is also like 4% of the vaginal births and so she's like, you're special.

I'm still recovering from these tears. It's been three weeks, but it's a different kind of recovery than the C-section. I really thought the C-section was harder than a vaginal birth, just like overall. And now I don't feel that way. They were just both really difficult in different ways, really painful in different ways. Reconciling one with the other, like my home birth wasn't magical. It was healing in terms of like, it's what I wanted and that's what I planned, but it wasn't this dreamy like ethereal birth that I kind of had imagined in my mind. I don't know if that actually exists; some people say that theirs were like that, but mine wasn't, it was just, it was a birth and it was still really special because it was our birth and so that will always be special.

 I would say before I had my cesarean and I had this high horse about like, "Oh people who have cesareans it's only because they're not educated enough and usually, it's not indicated that they need a cesarean. But I needed one and my kid wasn't coming; I gave him lots of time to come and he wasn't coming.

And so after that, I felt like I was really humbled about, oh, okay birth does all these different things and it's good to be educated, but it's also really good to be open-minded about, okay, maybe I'm going to need this, maybe I'm going to need that about the different interventions. And even with this home birth, like as soon as it was over, I was like, wow, I understand now why people plan repeat cesareans. Before that I would have totally judged someone for doing that. And I'm like, I get it because in a lot of ways that's easier, if the goal is just having a healthy baby then cesareans are great way to attain that. So each of my experiences has really humbled me and taught me a lot and taught me to be a lot more open-minded and loving about other people's decisions. And as a doula, I just feel like people should be educated about their decisions, and as long as they know what they're deciding that that's their decision and they should should go forward with it in an empowered way and feel proud to do it and not feel any kind of shame or guilt or anything around their birth choices.

Lisa: Absolutely. Yeah, I love that. I think when I was watching some of your sharing on social did you mention that the baby was in an ; position a little bit during your second labor?

Sophia: Yeah. So when he came out, his head was coned like on the corner of his head instead of right on the crown. So that's how we knew he was asynclitic. Yeah. So I was surprised by that because I'd had all that chiropractic. I was like, what are you doing, kid?

Lisa: And thus far, have you seen at all any signs of pain from that, with your baby when you're breastfeeding or anything?

Sophia: The only thing that I've noticed and we're actually going to craniosacral therapy next week.

Lisa: Yay I was just about to ask that.

Sophia: So we did it with my first because he was breech and I labored for 50 hours before we found that out so his head was all mushed on one side from being under my ribs and the poor kid. And he had ties as well so when we got his tongue and lip ties released bodywork is really important. So we took him to the craniosacral therapist and it worked wonders. And so we're planning on doing that with this guy too; it can't hurt right. And so.

Lisa: Absolutely.

Sophia: Cause he was asynclitic, and also I've noticed that he has a little bit of a harder time nursing on the right breast.

Lisa: One side. Yep. That's that key sign.

Sophia: Exactly. So he still manages to do it and like we figured it out and his nursing is great. He's a champ. But I want to just make sure everything is going well for him. Honestly, I believe that every baby should have cranial sacral therapy.

Lisa: I do too. If we all had the resources and the time and energy to do that, I totally agree with you.

Sophia: Absolutely. Cause I feel like a lot of adults have physical issues that could have been resolved when we were kids.

Lisa: Oh, you're so right. Yeah, yeah. Like what you were just talking about tongue tie or lip tie that can have lifelong ramifications that we don't always necessarily connect back to that. But we know that there are connections between sleep issues and all kinds of different issues. Yeah. So I love that. And cranial sacral therapy can often help resolve a tongue tie or a lip tie. Not always, but it can sometimes rather than immediately going to an oral adjustment.

Sophia: Right, right. So, yeah, I'm with my first son, we had issues nursing, which is why we got the ties clipped. Cause especially his lip tie was very tight, so he couldn't like flange out his lips to nurse. But this guy is like a champion nurser, so I'm planning to go, like you said, to see if the craniosacral therapy by itself is going to be, I don't even know if he's tied but I do want to have him at least evaluated and then adjusted a little bit to make sure that he's all good because he was asynclitic and he's having a little bit of an issue on the right breast like I said.

Lisa: Now, just to have a little clarity back on your labor. So like around how many hours was your labor?

Sophia: So the midwife said that from like the beginning of my contractions to delivery was like 24 hours. So, I mean, that's pretty normal for like a first vaginal birth, which it was. And I think, like I said, that the end part got delayed because of this hymenal ring situation, which I Googled it; it's real.

Lisa: I'm going to research this now. Cause I want to learn more. I do feel like at some point I just barely heard about it, but not enough to dive into researching it and learning more. Is it scar tissue at all?

Sophia: I guess. Yeah. It's like remnants of your hymen. And I guess for some people it becomes like scar tissue and that's why it's not stretching right.

Lisa: It's harder to stretch. Yeah. That makes sense.

Sophia: It's rare. Yeah.

Lisa: Yeah. Interesting. And since scar tissue just came up, going back to your recovery from your first birth did you do any scar tissue massage where the incision had been?

Sophia: So I did do scar tissue massage on my own. And then I ended up going to a pelvic floor therapist because I was having itchiness on my scar every time I had my period or ovulated -- I think it was like a year and a half out from the birth. So I was obviously all healed. So I was like, what is this? You know, itchiness? And I thought it was normal. And then in one of my C-section groups, someone was like, "Yeah, that's not normal." Or like, "I don't have that or whatever," so I was like, oh, I better go see someone about this.

So I went to a pelvic floor therapist who was recommended in one of my mom groups and she evaluated me and she said I had scar tissue on the right ligament that holds up your uterus. And like also just between the fascia of my layers of skin. And so I saw her for maybe like six sessions and she worked internally and externally to break it all up and she gave me some stretches and things I could do at home. And it made a huge difference. Like even after just a few sessions, I noticed that it wasn't itchy anymore. And didn't have any issues with my scar during pregnancy, which I was worried that, oh my gosh, I had all this scar tissue; it's going to be really uncomfortable for my uterus to expand again. But it wasn't, and I completely attribute that to the pelvic floor therapy. And again, this is something that every person who gives birth should have like covered by insurance.

Lisa: Someday, we're going to be like France and have that built into our care, please.

Sophia: I consider myself really lucky that I've been able to see the chiropractor, the pelvic floor therapy, the craniosacral therapist, the tongue tie release, all these things I've had access to because of who I am, but a lot of people don't, and it's really unfortunate because these things are necessary.

Lisa: Yeah, it's very unjust. Yeah. That's so funny that you just brought up pelvic floor therapy because then my next question was going to be, coming back to this second time around, and given that you had third degree tears, which is considered severe tearing, what are your plans for pelvic floor therapy?

Sophia: As soon as I'm healed, I'm going back. My midwife actually has everybody that she has as a client at least have a consultation with a pelvic floor therapist. That's really important. So I think once I'm like six weeks out, then I should be healed enough and she'll have me just go have a consultation.

Which I was planning to do, even if I didn't have tearing, just because I know how important it is to be looked at and make sure everything's okay after a vaginal delivery. And even just after pregnancy because obviously with my first I didn't have a vaginal delivery, but I still needed pelvic floor therapy. So again, yeah, something that's super important and not everyone has access to, which is unfortunate.

Lisa: Are you planning to go back to the same therapist?

Sophia: Yeah so if for anyone who's curious, I saw Dr. Nidhi Sharma with FuncPhysio Pelvic Floor Therapy.

Lisa: Yes. I know her. She's wonderful.

Sophia: Oh my gosh. She's awesome. And I think she's back from her maternity leave because I saw someone recently who said they saw her. She was wonderful. She's so brilliant and super just like gentle and supportive and really did a good job, like explaining to me what was going on. And giving me stuff to do at home and to follow up with. So she was really wonderful and I don't have enough good things to say about

Lisa: That's so great. She actually took my birth class in her pregnancy. Yeah.

Sophia: She told me right at the beginning. She was like, "Nobody in the office knows yet, but I'm pregnant."

Lisa: It's a secret. Well, as we start to wrap things up, are there any other things that you haven't gotten to share that you wanted to share and, or are there any final kind of insights or tips you'd like to give to people who are listening, who are mostly pregnant folks, but also maybe on the fertility journey trying to conceive?

Sophia: Yeah, I mean, I would just say firstly hire a doula because it doesn't matter what kind of birth you're having doulas are super valuable. And the statistics say that having a doula contributes like in a massive way to your overall birth experience satisfaction. So regardless of what kind of birth you're having having a doula can just help you enjoy it more and go into it in a more empowered way like you have the knowledge and information and you feel like you're supported in every way that you need to be. And they also help you plan for the postpartum phase, which none of us thinks about enough beforehand. Yeah. So hire a doula. Plan out your postpartum period, get lots of help if someone offers help, accept it don't say no.

Lisa: And for folks who are hoping to have a VBAC, what would you say to them?

Sophia: Yeah, I would say know your stuff. So first of all, get a supportive provider and not someone who's tolerant, not someone who's like, "Okay, you can have a VBAC if you go into labor by 39 weeks, or if you aren't over a certain weight." Okay. Like these are not evidence-based reasons to not have a VBAC. So you want to make sure your provider is the VBAC supportive. Which I have a really good post about it on my Instagram, whether your provider feedback supportive or tolerant.

Lisa: Yeah. Because a lot of people don't know how it will. How do I figure that out? What are the questions to ask? And so I was just about to ask where they should look for that-- your Instagram, let's do that. I'll make sure to post that.

Sophia: Any of the VBAC Facebook groups, like the VBAC Link, you can ask around for different areas for VBAC supportive providers. So it's hard to just find one, you can't just call up your doctor and be like, are you VBAC supportive? Because a lot of the time they'll say, "Yeah, we do VBACs." But then when you go in, they start pressuring you and asking you questions and you're like, "Wait, this doesn't feel supportive." So VBAC supportive provider is really important and knowing your stuff so that if anyone-- doctors or even your regular friends, family try to dissuade you from having a VBAC, you can say, "Oh, no, the risk of uterine rupture is actually less than 1%," or, "Oh, the risk of repeat cesarean are XYZ." Because a lot of people don't know these facts and when you know it you can confidently say, "Yes, this is why I'm doing this, and it's actually way safer for me and my baby and you should do some research yourself if you're interested." And that way you feel, I feel like, okay, I'm making the right decision for myself. And if you decide to have an epidural or to be in the hospital or to do a repeat cesarean, if you have that knowledge, then you know, you're going in armed with that. And you can be confident in your decision without having to second guess yourself. And you're more likely to have a much more enjoyable birth experience regardless of how it goes.

Lisa: Thank you so much, Sophia. This has been wonderful chatting and particularly with your doula perspective and all the knowledge. I just love that you really did your research, really sought out good care in so many ways and really had a great birth this time. Like you said, it's hard, no matter how you give birth, it's challenging. But you were totally able to do it, and you positioned yourself in such a way to optimize things.

Sophia: Absolutely. Yeah. And I definitely felt more prepared this time for any outcome. So that, that helped a lot. Yeah. Yeah. Thank you so much for having me. This was fun. I really love talking birth.