By Breana Garlick
In November of 2017, I was 19 years old and newly married when I got pregnant with my first baby. I was seeing midwives at a freestanding birth center for prenatal care and was planning to have an unmedicated birth at the center. I’d had a difficult pregnancy from the beginning. Severe morning sickness made it nearly impossible for me to keep anything down and I was frequently having excruciating migraines and feeling altogether unwell. Very early on in my pregnancy, I began having abnormal swelling in my face, hands, and feet. I tried communicating how I was feeling to the midwives, but my symptoms were dismissed as harmless, common side effects of pregnancy. They told me to take Tylenol with caffeinated coffee for the migraines, which were blamed on hormones. As I recall my first pregnancy, I wish I had been better cared for by those midwives and that they had given me guidance on proper nutrition. I now know that those symptoms arose because I was not adequately nourishing myself for the task of growing a whole new human being and accommodating my body’s expanding blood volume. I didn’t know it then, but my body was crying out for help. What should have been warning signs were overlooked and eventually progressed into severe preeclampsia.
In April, I had a prenatal visit and a scheduled glucose tolerance test for which I had been fasting all morning. At the visit, my blood pressure was found to be in the hypertensive crisis zone. I was told to go to the hospital for some additional “tests and monitoring.” I fully expected to be home that night and had no idea that when I got to the hospital a whirlwind of events would follow and radically alter life as I knew it.
Once I arrived at the hospital, I was diagnosed with severe preeclampsia and admitted into the ICU. I was told that I needed to be prepared for an emergency cesarean at any moment, but that they would attempt to control my high blood pressure through medication so that I could remain pregnant as long as possible in order to give my baby a better chance of survival. In preparation for the impending cesarean, I was confined to a bed and denied food and water for four days. This, as well as administering a diuretic through my IV, was the worst thing that the hospital could have done for me and actually accelerated the problem. I later learned that diuretics are contraindicated during pregnancy because they interfere with expansion of the mother’s plasma volume. In 1975, the FDA ruled against the use of diuretics in pregnancy due to their ability to exacerbate plasma volume depletion in preeclampsia. Why my doctors prescribed me a medication that is well known for exacerbating the very problem I had been admitted into intensive care for is a mystery. Consequently, my health rapidly declined over the following days. On the fourth day of being denied food and drink and within hours of receiving the diuretic, I was told that there was nothing more that could be done for us, that my baby and myself were dying, and that delivery was the only way to save our lives. I expressed my wish to give birth vaginally but was made to believe it was unlikely my baby would survive a vaginal birth, so I ultimately consented to a cesarean.
After the surgery, I was told that I had been given a classical cesarean, which meant that I could never have a vaginal birth. A classical cesarean is when a vertical incision is made on the upper contractile portion of the uterus. They explained that the decision to proceed with a classical cesarean had been made because the lower segment of my uterus was underdeveloped due to the extreme prematurity of my pregnancy. I was told that because they had been unable to give me a low transverse incision, I would now have a uterine rupture if I ever even contracted. All my future babies would need to be born by repeat cesarean at no later than 36 weeks.
I did not get better after the delivery like I had been told would happen. I actually remained on medication for months to come. Our beautiful daughter Aurora Ruby was born on April 20th, 2018 at about 24 weeks gestation, weighing only 1lb 8oz and measuring just 12 inches from head to heel. I was unable to see her for almost 12 hours and was not allowed to hold her for over 2 weeks. After 104 long days, we finally got to take her home. When we left the NICU, a respiratory therapist who had been there at the beginning told me he really hadn’t thought she would live for more than a few days. She was covered in prayer by loved ones and strangers alike and is a strong-willed fighter. It is by God’s providence that she is now a happy, healthy two year old with absolutely no health issues! We were told that she would need surgery for a problem that miraculously disappeared, that she may be dependent on oxygen and medications for life, and that she may have seriously impaired vision or even be blind; yet she is perfectly healthy. Her NICU journey is a story of it’s own, but I’ll save that for another time.
Once we settled at home after months of living in the NICU, I began researching vaginal birth after cesarean (VBAC). I had always been fascinated by natural childbirth. So much so, that I had considered a career in midwifery before marrying my husband and deciding to start a family and be a stay at home mom. I aspired to experience natural birth and knew that it is far superior for both mother and baby. I just couldn’t accept that I was restricted to repeat cesareans for the rest of my life. But everywhere I turned, I was met with closed doors. Everything I could find on the topic said that I was the exception, I was not a “candidate,” and that VBAC with a classical scar was just not a possibility.
Finally, after almost a year of searching for answers, I stumbled upon the excellent book titled Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean (VBAC) by Nancy Wainer Cohen and Lois J. Estner. On a whim, I decided to try contacting one of the authors. She is a wonderful person and was willing to speak to me over the phone. I found out that she is actually the midwife who coined the term “VBAC.” (I felt as if I had met a celebrity!) She told me that many women with my type of scar went on to have “lovely, normal, natural births.” I was so thrilled that I immediately burst into tears. That was a pivotal moment in my journey because I finally felt like my dream could actually one day be a reality. It was around that time that I discovered the Special Scars, Special Hope organization. I finally felt as if I’d found my “tribe.” Suddenly, I was able to converse online with many other women who had all kinds of unique uterine scars (not just classicals). To my astonishment, many of these women went on to have vaginal births! I would spend hours just reading their stories. I spent hours more by reading any studies I could get my hands on that talked about anything pertaining to the subject of VBAC. I couldn’t get enough.
The studies on vaginal birth after special scar cesarean are very limited. However, one of the most influential studies of national policies on VBAC, Landon et al. (2004), found that of the 105 women who attempted VBAC with a special scar, 2 experienced uterine rupture (1.9%). For perspective, a low transverse incision is typically said to bear a 0.5% chance of uterine rupture. I couldn’t believe that all this time I’d been made to think I had a 100% chance of rupturing, when that simply wasn’t the case. The way I looked at it, a 1.9% chance of uterine rupture meant that I had a 98.1% chance of being successful. In any other area, a 98.1% chance would be considered fantastic odds! To paraphrase from the afore-mentioned book, Silent Knife, if someone told you that you have a 98.1% chance of winning the lottery, you probably would go for it and not be held back by someone pointing out the 1.9% chance you have of not winning.
Uterine rupture can happen, and it should be taken seriously. However, so should the risks of cesareans. What many people do not understand is that when considering the option of VBAC versus an elective repeat cesarean, one is not choosing between a risky option and a safe option. Cesareans are major abdominal surgeries that carry a multitude of risks and only increase the risks in future pregnancies with each repetitive surgery. Why had I been drilled by my doctors about this 1.9% chance of uterine rupture, while the many risks associated with repeat cesarean had not even been mentioned to me? By whose standard is the risk of uterine rupture “too great”? Shouldn’t the level of risk I’m willing to take be up to me, and not a decision for my doctor to make for me?
According to ACOG’s VBAC Practice Bulletin, the rate of cesarean deliveries has increased from 5% in 1970 to 31.9% in 2016. Interestingly, the maternal mortality rate has also increased. In fact, it has more than doubled during that time frame. The United States has one of the highest maternal and infant mortality rates in the developed world. Our nation’s overwhelming majority also happen to seek mainstream obstetrical care and have medically managed hospital births, while other countries tend to seek midwifery care and have higher rates of home births.
An acronym I learned from The VBAC Link Podcast (another outstanding source that was hugely influential to me), is B.R.A.I.N. This stands for Benefits, Risks, Alternatives, Intuition, and Nothing. When I closely evaluated the benefits, risks, and alternatives to having a VBAC and reflected on what my intuition was leading me towards, I deduced that doing “nothing” was the best option for me. In other words, I felt that due to the significant risks involved in cesareans, I could only consent to another one as last resort. If I did nothing and let nature take its course, my body would deliver my baby the usual way. Personally, it just didn’t make sense to me to intervene by scheduling such a major surgery purely for the sake of preventing something with such a small likelihood of happening. The benefits of natural birth far outweigh the small chance of uterine rupture.
I believe that I am fearfully and wonderfully made by the God of the Bible, the Creator of the universe and everything in it. He intelligently designed all the inner-workings of the female body – everything from the dance of hormones that spark the first contractions to the moment of birth itself. Natural childbirth is unique and special in the way that it was the mode God chose to bring His one and only Son into the world to be our Savior. God reminded me not to put my trust in man, but instead to put my trust in the One who made my body to give birth the way He designed it to.
I began to work on looking at myself as healed and not broken. I stopped thinking of myself as a “VBAC” and started thinking of myself simply as a woman with all the working parts who was going to use my body the way it was designed to function. So what if I had a scar on my uterus? Bodies heal, and I really began to embrace and believe that.
Although I now had an arsenal of information surrounding VBAC, I still needed to understand what happened within my body to cause severe preeclampsia during my first pregnancy. I had been told by my doctors that no one knows what causes preeclampsia, that the only “cure” is delivery, and that it was likely to happen again in my future pregnancies. But similarly to when I was told vaginal birth was not possible for me, I just wasn’t satisfied with that. Somewhere along the way, I came across the Brewer Diet. The principle of the diet, which is backed by years of research from an array of doctors, is that metabolic toxemia of late pregnancy, or MTLP (an umbrella term for toxemia, preeclampsia, eclampsia, and HELLP Syndrome), is a disease of malnutrition. During pregnancy, the mother’s plasma volume must increase to a significant extent in order to meet the greater circulatory needs of pregnancy. To briefly summarise, a lack of sufficient nutrition triggers a preeclamptic response when the mother’s body isn’t well nourished enough to accomplish the task of plasma volume expansion.
In the late 1960’s and early 1970’s, an American obstetrician, Dr. Tom Brewer, formulated a diet outline that covered the basic nutritional needs of a pregnant body. His outline consists of consuming a minimum of 2300-2600 calories daily, 80-120 grams of protein daily, and salt to taste. This is best accomplished through the consumption of healthy, whole foods and frequent, small meals. By having his patients focus on proper nutrition, he successfully eradicated preeclampsia in populations where the cases had previously been upwards of 40%. Although this is really remarkable, his work was ignored by mainstream medicine because he refused to conduct a placebo study, believing it unethical to treat some patients while leaving the others malnourished and at risk for complications. I strongly recommend that anyone searching for answers about preeclampsia research the Brewer Diet. There is a website and Facebook group titled Dr. Brewer Pregnancy Nutrition that was very helpful to me in understanding the diet and receiving support during my second pregnancy.
Preeclampsia is the most common complication of pregnancy. It is long past time for modern obstetrics to acknowledge that proper nutrition has the ability to prevent and reverse these complications, instead of continuing in a fruitless search for a “magic pill” while countless mothers and babies are harmed or die in the process.
In November of 2019, I got pregnant for the second time. It’s funny, because conception occurred immediately after my husband and I agreed to stop living in fear regarding a future pregnancy and to trust God with our family planning. I felt convicted to relinquish my fears to God and trust Him, which was something I had to learn to do daily during the course of my pregnancy. I believe that even childbearing is an act of worship and that children are a reward from the Lord (Psalm 127:3-5). God really blessed me in the way that my second pregnancy actually followed the same time frame as my first. (I got pregnant in November both times, so the due dates were within days of each other.) Being able to carry my second pregnancy to term and having the natural physiological birth that I so longed for was very healing for me, and almost a way of “righting the wrongs” that happened to us the first time.
Once I discovered I was pregnant again, I began diligently following the Brewer Diet protocol and monitoring my health at home. The Brewer Diet worked excellently for me and enabled me to carry my pregnancy to term without any complications. Being able to take charge of my own health like that was so empowering, and I learned so much about my body and true health along the way. As far as prenatal care, I had come to realize that I was probably better off monitoring my health myself, since putting my trust in medical professionals obviously had not worked out very well for me the last time. Besides, the birth center would no longer take me as a patient and the hospital required me to schedule a repeat cesarean at 36 weeks. I considered driving several hours or out of state in hopes of finding a supportive provider, but I had a strong inclination to simply stay in the comfort of my own home and have a home birth. Even seemingly minor interventions that are routinely performed at medically managed births can negatively impact the course of labor. Studies have also shown that interventions and labor augmentation directly increase the risk of uterine rupture. After spending so much time intently studying the natural process of birth, I felt strongly that my body would function best in an undisturbed, private environment where I would feel safe in my surroundings. Many people have asked me how I could possibly feel safe giving birth at home. After everything I’ve learned, my reaction is to question how anyone could possibly feel safe giving birth in a hospital?
After strongly considering the idea of just having an unassisted birth, I decided to at least try finding a home birth midwife who wouldn’t turn me down. I ended up writing a letter to the Amish. I thought that whoever was assisting in Amish home births may be more willing to hear me out and give me a chance. I was right! A wonderful Amish family connected me to a non-Amish doula, who is also a midwife learning and working with the Amish community alongside a group of Amish midwives. She was willing to speak to me over the phone. I remember nervously listening to my phone dialing as I waited for her to answer and thinking to myself, “She’s going to hang up on me as soon as I tell her I have a classical scar. This is going to be a short phone call.” To my joy and shock, not only did she not hang up on me, but she and the Amish midwives were the perfect fit, a huge blessing in my life, and an answer to my prayers! They were extremely respectful and considerate of my wishes, not only for my birth but also throughout my pregnancy. I was very fortunate to have connected with midwives who truly respect the natural birth process and understand the importance of leaving it unhindered. For someone who desires a natural birth, I believe it makes most sense to choose a provider (such as a lay midwife) who has decades of experience in natural birth, instead of a surgeon who has been indoctrinated in the use of the very interventions that disrupt the natural birth process. Birth is a normal function of biology, not a medical emergency. I appreciate this quote I saw recently which says, “Sometimes the only thing that makes your pregnancy and birth high risk is your choice of care provider.”
On August 1st at about noon, I felt my first contraction. Contractions continued throughout the afternoon and evening, but I wasn’t sure it was real labor until nighttime when they got more intense and I started timing them. I updated my birth team but wanted to labor alone and undisturbed for as long as possible. I labored in my shower with the hot water running down my back, and also in my bed while my husband pressed a heating pad into my lower back. I focused on trying to relax my whole body during contractions and visualize my body working to bring my baby out. Eventually, the contractions were getting much more intense and very close together with little break in between, so I updated my birth team again and we agreed that it was a good time for them to come. They arrived at my house at about 5am, and we decided to do a cervical check to see how far dilated I was. I was so thrilled when she told me I was 9cm dilated and that my cervix was paper thin. I felt like all my hard work had already begun to pay off and I couldn’t believe I had made it that far all by myself! At 9:17am on August 2nd, 2020, our second daughter Athena Faie was born safely at home in our bed. She weighed 9lbs 4oz and was 20 1/4 inches long. I had no complications at all – not even so much as a tear! It was an amazing, transformative experience. Having such a family oriented birth was incredibly healing for us. I still get euphoric thinking back to that “birth high.” Words can’t explain how victorious I felt lying in my own bed with my newborn on my chest, still attached to the placenta, with my husband and older daughter by my side. After being told I couldn’t do it so many times, that moment was just so surreal.
By sharing my story, I hope to raise awareness to the significant discrimination that exists against women who wish to have a vaginal birth after a special scar cesarean. We deserve to be fully informed of the risks associated with repeat cesareans, and we should be respected enough to make well educated decisions for ourselves in how we want to bring our children into the world. The truth is that women with special scars can and do have vaginal births. I’ll close with a favorite saying of mine, “Those who say it cannot be done should not interrupt the ones doing it.”
The VBAC Link Podcast Episode 168: https://www.thevbaclink.com/podcast/
Natural Mother Network Podcast Episode 29: https://www.naturalmothernetwork.com/podcasts/