My VBAC birthing experience
I’m not really sure where to begin in retelling my daughter’s birth. All I know is that there was a series of events and choices which led to an unfortunate experience - most of which could’ve surely been avoided with a bit more knowledge and/or assertion on my end. I own up to not having known enough beforehand, and having instead chosen to believe that the healthcare professionals involved in L’s birth (mostly women) had our best interest at heart. Which, to be honest, they probably did. It just wasn’t the best for me. And I believe that this is what the vast majority of women opt to do - trust - so I urge them through this humble platform to do their research, and stand their ground when it comes to this defining moment in their and their babies lives.
L was born on February 1st 2019, at 23:41h, in Starnberg, Germany. Weighing 2.780kg and with 51 cm, she was already the most perfect bundle of joy and we were immediately smitten. We decided to have her in Germany mainly because they’d allow me to try and have a VBAC, i.e. a vaginal birth after cesarean. Since there’s been less than 2 years since my son was born, there was a small chance of a uterine rupture - a chance they wouldn’t take in Brazil or France. In those countries, I would’ve had to have undergone another c-section, which I didn’t want. We don’t plan on having more children, so I truly wanted to experience vaginal birth. My heart was set on a VBAC as long as my daughter and I were healthy; so a VBAC is what I got.
Yet, here’s what I wish I’d known in advance.
Cervical exams are optional
A cervical exam during pregnancy is when the doctor inserts two fingers into the vagina to check manually whether the cervix is dilated, by how many centimeters, etc.
The day before L was born, exactly a week before her due date, I was feeling a lot of pressure on my c-section scar and, after calling my doctor, decided to go to the hospital and have it checked (with the risk of uterine rupture, I wasn’t taking any chances). At the hospital, the doctor performed the standard cervical exam, rather aggressively, but although it was uncomfortable I didn’t see any harm in it - until it was too late. As she removed her fingers, a small gush of water came out.
That night, my urine was a bit tainted with blood. The following morning I woke up to my PJs soaked. My water had broken. I am now rather certain that this cervical exam the night before somehow contributed to PROM (premature rupture of membrane, i.e. when the water breaks before labor starts). I wasn’t dilated at all, L hadn’t “dropped”, I didn’t have any contractions. Yet the time had come, and at 7am we headed to the hospital.
Choosing a hospital close to where you live has also to do with postpartum
The hospital we chose was 30-40 minutes away from our place, in a city southwest of Munich called Starnberg. It came with excellent recommendations (unanimously good experiences by all women I asked) and, since it wasn’t in Munich, we had a higher probability of getting a private family room for my recovery. On the day of her birth we had more than enough time to get there. In fact, I would go on to spend the day walking all around and climbing up and down the hospital stairs, hoping it would trigger labor naturally.
However, what no one told us was that the hospital’s proximity is just as important, or even more so, during the baby’s and mother’s postpartum recovery as it is during labor. I’ll write more about this on my post about the first weeks of the puerperal period.
GBS testing is not standard in Germany
In Brazil as in other countries such as the US, where most of my pregnancy reading material comes from, GBS (Group-B Streptococcus bacteria) testing is pretty much standard. This is an important test, as GBS bacterial infection can pass onto babies born vaginally and, in very rare occasions, cause meningitis, pneumonia or sepsis. If a woman tests positive for it, or if she isn’t tested, she will be routinely administered antibiotics during birth - which I really didn’t want, as it could affect my daughter’s gut health for months to come. I was thus shocked, and frankly pissed off, when my doctor told me the day before L’s birth that I hadn’t been tested because “I didn’t ask for it, and the health insurance wouldn’t cover it”. At no point throughout the pregnancy had he asked me whether I was interested in taking it, and I assumed it had been routinely done. Again, my mistake in trusting and assuming. Alas, I’d be given antibiotics.
If you live in Germany and would like to be tested for GBS, which I recommend, make sure to discuss with your doctor in advance. You may need to be tested a few times throughout the pregnancy, as the result can change, affected for instance by your diet (probiotics can help a lot). The results take generally about 48 hours to come out.
If you aren’t vocal and assertive about your wishes, executive decisions can be made on your behalf without consulting you first
I arrived at the hospital around 8am, and by 1pm I was still walking around trying to trigger labor naturally. It didn’t happen. The midwife decided to give me medicine to speed up the process, since my water having broken put L and me at a higher risk of infections. I had the right to refuse it, but I didn’t, which I take full responsibility for. To be entirely, 100% honest, I didn’t “feel like giving birth” at that moment. I didn’t feel empowered. I didn’t feel energized. I knew my daughter had to come out soonish by whatever means, and the only thing I was sure of then was that I wanted her to be healthy. I was fearful of a uterine rupture, and I was also fearful of stories I’d read about incontinence and ruined sex lives post vaginal birth. Yet, I didn’t want to have to recover from a c-section again (although my experience had been overall positive). All sorts of thoughts were going through my head and I didn’t know what to make of them, so I went on a trusting auto-pilot.
As I said before, I do take full responsibility for accepting other people’s suggestions rather than trusting my gut instinct. By 3pm I started feeling violent contractions triggered by the oxytocin, but they were then still far enough apart that I could rest a bit between them.
By 5pm though, I was already exhausted and miserable from the intensity and frequency of the contractions, and I was told I’d be given an epidural (which had always been part of my birth plan). For the following 3 hours I kept being told that the anesthesiologist “was coming”. When he finally showed up around 8pm, the hospital had somehow lost my paperwork - so he left while my mom, together with YY, filled it out all over again. I was truly miserable.
When the anesthesiologist finally came back, he told my mom and YY to leave the room. He didn’t speak a word of English and kept barking at me in German to not move - an instruction I tried to follow as best as I could despite the 1-minute-apart contractions. When the anesthesia caused a spasm on my right side, which obviously made me move, I was barked at again even louder, and this time by the midwife as well. I was so nervous and in so much pain that I started throwing up. Profusely. I have since learned that this “awful anesthesiologist” experience is somewhat common here. Once this whole ordeal was done and the pain had finally subsided, I was left in the room with YY and finally got to rest a little bit.
Asking you “not to scream” can be considered a form of psychological obstetric violence
Around 11pm, the doctor came to examine my cervix once again. At this point, thanks to the epidural, I finally was around 7cm dilated. I was overjoyed with the progress, and could at last envision the VBAC I’d hoped for. About 20 minutes later, however, I started feeling an overwhelming urge to push. I could feel L’s head putting a lot of pressure on my cervix, and quickly came to realize that I couldn’t “hold her in” any longer. I called for the doctor and the midwife, and as soon as they came in they told me to push. Continuously. It went against what I’d been told (to push slowly in order to avoid tear), but I was not about to contradict them. As I started pushing, screaming came naturally - at which point they told me not to. I was supposed to push, quietly.
I later learned that requesting women to be concerned about keeping things orderly during birth, when they’re at such a primal state, can be considered a form of psychological obstetric violence.
The “Kristeller maneuver” is not recommended worldwide, and is considered a form of obstetric violence
This is probably the part which shocked me the most during L’s birth, and one in which I felt like I had no control at all. The doctor performed the Kristeller maneuver (or “applied fundal pressure to facilitate childbirth”) in order to speed up the birth, since poor L was exhausted from labor and her heartbeat rate was dropping. I.e., she pushed L down the birth canal by aggressively pressuring my ribs with her arms and elbows. This maneuver is not recommended by the WHO, and hasn’t been routinely done worldwide for a while, including in Germany. The risks of this maneuver far outweigh the benefits. She could’ve broken my ribs. Worse yet, she could’ve broken L’s clavicle, or even caused brain hemorrhage - amongst many other tragic consequences which I don’t even want to consider.
With the additional aid of vacuum, L was out in about 5 minutes.
If you plan on giving birth in Germany, I urge you to include your preference for not having a Kristeller maneuver performed in your birth plan.
Suturing after a vaginal birth, no matter the degree of tear, takes longer than suturing after a c-section
Because the birth itself went by so quickly, and since I wasn’t dilated enough at that point, L came out ripping everything in her way. At first the midwife kindly reassured me that I had had “barely any tear”, but the doctor was quick to correct her. I had a third-degree tear, and suturing took longer than an hour. I thankfully had a healthy and hungry L on my chest for most of the time, but I couldn’t help but feel extremely fearful as the doctor called in other doctors to assist in stitching me up. Overhearing her say in German - twice, nonetheless - that it was a “catastrophe”, mustn’t have helped. She surely thought I was too “out of it” to hear, or assumed that I couldn’t understand German. Alas, I did hear her. And so did YY.
What I learned (much later, from another doctor, at another hospital) though is that suturing post-vaginal birth takes longer than a c-section, no matter the degree of tear. With my previous cesarean experience, S was out and I was stitched up in no more than 20 minutes. This time it took at least an hour and a half. Suturing a vaginal birth involves many unpredictable layers of skin and muscles, and doctors need to be particularly careful and attentive. Happily, I was reassured that they had done an “excellent job”, and I am ultimately thankful that they took the time they did.
By 3am, I was up in the recovery room.
To be fair, my experience wasn’t entirely negative, and I would like to end this report on a more positive note.
I had an angel of a nurse with me throughout most of the painful part of labor, who kept holding my hand and telling me that I was doing great (she also said YY was an excellent midwife as he encouraged me to do some of the breathing exercises we had learned in a great birthing class). Without her, I’m not sure I could’ve put up with the whole experience without begging for a c-section.
I’ll also never forget the moment in which I realized my daughter was being born vaginally, when we were past any possibility of a c-section, which was when the midwife exclaimed that she could see her head (and that there was so much hair!). That was exactly what I needed to hear in order to make the final push. Moments later they passed me my daughter. YY and I looked at each other, and he said “you did it”. L and I had indeed done it.
As we waited to be taken to the recovery ward, the midwife offered me tea and crackers. Time slowed down as I recovered a bit of my strength. L nursed immediately and instinctively, and I could at last enjoy the first rush of hormonal postpartum bliss.