#367 | Your VBAC Questions Answered by The First Woman to Have One, Nancy Wainer

In today’s episode, Cynthia and Trisha are joined once again by Nancy Wainer, award-winning author, longtime home birth midwife, and the woman who coined the term VBAC in her 1980s book Silent Knife. With decades of experience supporting women through vaginal birth after cesarean, Nancy brings clarity to a conversation that is shaped by fear, false information, and shifting medical standards.

This episode is part free-flowing conversation and part Q&A, where we take listener questions and explore them in depth. We cover topics including delayed postpartum hemorrhage after cesarean, uterine rupture, scar thickness, “uterine windows,” closely-spaced pregnancies, doulas in a home birth setting, and VBAC with twins or breech babies. We also look at the common reasons women are given for repeat C-sections and where those claims hold up and where they don’t. 

We wrap with Quickies and a personal question Nancy's never been asked.

#273 | Special Q&A Featuring Nancy Wainer on VBAC and More

#272 | Nancy Wainer, CPM and Pioneer of the VBAC, Shares Her Journey from Mother to Midwife

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Transcript

I'm Cynthia Overgard, birth educator, advocate for informed consent, and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Nancy Wainer, my wonderful dear friend and such a beloved person to Trisha and me on this podcast, thank you so much for taking the time out of your unbelievably busy life to be with us again.

You are lucky to be here. I'm delighted. This is what I do. This is what I was brought to the earth to do.

Well, you've done a hell of a job doing it, Nancy. You were last here for episodes 272 and 273 in summer of 2024, and we're excited to have you back today because we're going to do, we did this a couple years ago too, but we want to do a Q&A episode with you. We've had some women call in with questions for you. We do a monthly Q&A episode to begin with, and every couple of months we do a breastfeeding Q&A that Trisha basically answers, those questions about breastfeeding, but we'd love to really focus on VBAC. But how have you been? What's going on with you? And before we start, you may recall that what I generally like to do before I speak to anybody is to light a candle, and this candle represents all of the women who, during the time that we have this podcast, are being unnecessarily sectioned, unnecessarily induced, unnecessarily everything, ultrasounded, whatever it happens to be, just to kind of keep them in our hearts and in our thoughts.

The birth situation in this country, in the world, but in this country, is absolutely a flipping mess. Just before we signed on for this podcast, I had somebody come here, a therapist who came to help my husband with some swallow exercises, and she saw some birth equipment that I have out, and she said, “Oh, I really wanted to have my babies normally, but I ended up with two C-sections.” She's 5'10". She's a really good-sized woman. She's healthy. And I asked her what the circumstances were, and she said, “Well, in some respects, I'm glad that I ended up with the C-section because I had an almost eleven-pound baby, and I really wouldn't have wanted to have pushed out a baby that big.”

Of course, my heart sunk into my toes because one of my easiest VBAC births was a woman who had a twelve-pound, four-ounce baby, and it has nothing to do with anything except head position, head position, head position, and nutrition and a calm environment, and letting the woman's body go into labor when it's ready. I asked her what her shoe size was, and she wears a 10. What we know is that the pelvis and the feet grow at the same time during adolescence, and so we know she has a really good-sized pelvis. Now I wear size five-and-a-half shoes. I always tell people I have a big mouth, big hips, and tiny feet. But anyway, beyond that, the thing is that this woman could have birthed, but nobody paid attention to the head position of the baby ahead of time, and she ended up birthing both of her babies by C-section and feeling like it was necessary. And so that just happened about twenty minutes ago, and I'm still reeling, because it just makes me so intensely sad that this is what birth is about in much of this country. Thank goodness for people like the two of you.

Providers are really good at convincing a woman who had a C-section that her C-section was necessary. The first thing they'll say is, “Oh, thank goodness we did that,” for this, that, or the other reason, and plant the seed in the mother's mind that her pelvis is too small. In fact, just today I had a mom who had a very unwanted C-section, was planning a birth center birth, and after the C-section the surgeon said, “Well, you know what? Your sacrum just wasn't going to move out of the way for this one, so that's why you had a C-section. Thank goodness you did, because that sacrum was just not going to budge.” And then she's left with the belief that her sacrum doesn't work right and that her body isn't built for birth. And then, of course, because we're trying to find a way to come to peace with something that doesn't feel good to us or right to us, we believe it because we want something to turn to.

I went into split brain because we didn't have a whole lot of time, and I didn't want to take her out of her belief, on the one hand, that it was a good thing that she had a C-section, that she wouldn't have wanted to push that big baby out, and at the same time I was thinking, we need to keep educating. So I made one comment to her, and I said, “If you ever want to speak about it, here I am, but you made the best decisions you could in the moment with the information that you had.”

One of the most effective things I've ever heard you say, Nancy, because you've shaped and educated and informed me and inspired me far more than anyone in my nineteen years doing this work, and one of the most effective things that you ever said, and it was when you were speaking live, I believe it was at my, it might have been at my grand opening. I saw you in Westchester, I saw you in Boston, and then at my own live opening. I don't remember which one, but I think one of the biggest problems we're up against, it's hard to say what the biggest one is, but the how easy it is to scare women. And the concept of a big baby is very frightening, and you put it all away so quickly. You said, “Look, fat is squishy. We're not concerned about a baby's weight. Head positioning is everything. But when a head is out and a shoulder is out, that baby is coming out, no matter how chunky or big.” I mean, I was over ten pounds. My mom is as slender as can be. It's nothing about the weight of the baby.

I just met with a woman last week who had a traumatic birth, and they induced her completely unnecessarily. She was willing, so it's hard to reach someone who's totally willing. They suggested it, and she was willing. Her own family didn't want her to do it, and she was pretty determined, so she went along with it, and they put her on Pitocin all the way to the max because she endured it so well that they actually put it to the max, and her baby, of course, experienced fetal distress. Heart rate went down to the 40s. They brought her into a C-section, and she's left to feel guilty about it, confused, upset. Well, guess what? The famous line is that her providers said to her afterwards, by the way, they told her her baby weight was about eight and a half pounds. The baby was 5'10". That was the good work of an ultrasound. Guess what the line is that they gave her after the birth. They said, “Thank God you didn't have a home birth. This baby would have died.” The nerve. She had Pitocin cranked, and she was in a bed on her back. The nerve of them to summarize that story with, “Thank God we were here.”

Yeah. So we hear that all the time.

So it's a systemic problem, but it's also the fact that women are so easy to manipulate. We're so easy because we do just want a healthy baby in the end. You tell us anything and we're going to agree. “Oh, thank God. Thank God.”

We're wired. We're wired to put ourselves after our children. So this is like the first example in life where you're becoming a mother, where a woman is going to self-sacrifice her body, her soul, her spirit, whatever, for the sake of her baby, if that is what she's led to believe is necessary.

Yeah, and she had no anger toward them at all, which was very different from how I was feeling. She just felt her body failed. And I said, “Sounds like your body did pretty amazing to me, given what it went through.” So we had completely different perspectives on her birth experience.

I always tell people, as you know, that if their great-great-grandmas and their great-great-grandmas and their great-great-great-great-great-great grandmothers all had babies, then you come from really good stock. So there's no reason why you shouldn't have a baby.

I have a friend who's about to become a grandmother for the first time, and her daughter-in-law is thirty-two weeks pregnant, and the baby happens to be breech at the moment, and the obstetrician said to her, “We're going to schedule you for a C-section. Maybe the baby will turn,” but gave her no information or suggestions about what to do to help the baby to turn. The baby then did turn transverse. I think the baby's on its way head down. I have suggestions that I can certainly give, and so do you. And then the doctor said, “Well, you also have a fibroid, so we're going to keep that C-section date because there are a number of things going on here.” My friend is very frustrated, but it's her daughter-in-law. It's very hard for her to say too much, and when she did sort of broach the subject, her son said, “Mama, hold off. This is my wife. We like our obstetrician. We feel like we're fully informed.” And I said, “She's a sitting duck. She's going to get a C-section for one reason or another, even if those reasons are completely invalid.”

One other thing is going back to having a big baby. You can have a big baby who has a small head, and you can have a smaller baby who has a larger head. So I just want to repeat: head, head position, head position, head position. And we always say that the penis changes shape to get the baby in, and the vagina, the pelvis changes shape to get the baby out.

And the head changes shape.

That's true. The head changes shape. I have shared this on the podcast before, but I'll share it again because it's so phenomenal to me. I attended a home birth once where the woman was fully dilated, and until the time the baby was born, eighteen hours passed. Eighteen hours from complete dilation to the baby being born. And this baby's head, the shape of the baby's head, was unbelievably misshapen. I mean, it was the biggest cone head I've ever seen. Within two days, the baby's head was perfect. But there is no way that baby was ever going to be born vaginally unless she was at home with a midwife who was cool, calm, and collected and trusted the process, and the baby was fine through the whole thing. The pelvis changes shape. The baby's head changes shape to fit whatever the circumstances are that it needs to fit through. But yes, head position is very, very important. We know that the baby's head fits best when it is in the optimal specific position.

But you had said something right at the beginning about making sure that the baby's head is in the right position. Can you talk a little bit about how you help women understand that? Because we don't want women worried that they have to do something in particular to change their baby's head position before labor.

Well, we would always check starting at about, well, first of all, we would give suggestions for diet because nutrition makes a difference. Secondly, we also talk about the woman's bathroom habits because those make a difference in terms of how the woman is impacted. For example, the baby will be in a particular position, and if the woman is using the bathroom frequently and everything is fine, that will also help. She can't wear certain shoes. She should sleep on different sides of the bed, rotating sides of the bed. There's so many things that women can do that are really easy that help the baby to get into position.

At about thirty-four, thirty-five weeks, when we are palpating the woman from the outside with her permission and talking to the baby as we do so, we check to see where the baby's back is. So if the baby's back is on the mother's left, we don't do anything at all, because babies whose backs are on the mother's left-hand side have a tendency to put their head in the correct position. But if the baby's back is on the mother's right, then we get active in giving some suggestions and doing some things so that we can help the baby to rotate, so that the baby will be in a good position going into labor. Things that we can do, such as a rebozo, having her lean over the bed, do certain things that are easy and relaxing that can help the baby. So we do everything we can beforehand to get the baby into position.

If, when the woman goes into labor, the baby's head is not in position, and by the way, I don't do a lot of vaginal exams, but we were given directional signals because there are fontanelles, and there are all kinds of lines and indentations. So when you do an exam, it's not just the dilation, which is what they do in the hospital where you're three centimeters, you're only five centimeters. It also has to do with the head position, because if you feel the fontanelles that you want to feel, and you don't feel the fontanelles you don't want to feel, you know the baby's head is in the right position, and all of the adjacent lines. So if the baby's head is lined up, then we're all set. But if the baby's head is not lined up, we immediately become active in getting her into positions, climbing stairs, doing whatever. Because in the hospitals, what they do is they just wait and wait and wait, and as you've heard me say, the longer the woman labors with the baby's head in an unfavorable position, the more committed the baby's head becomes to that position, and the more likely there's going to be an issue later on.

I just want to clarify what you meant about the fontanelles, that the front one is shaped like a diamond and the one in the back is shaped like a triangle. And I want women to understand that if a woman is at least a few centimeters dilated, you as the skilled midwife could go in and feel and say, “Oh, there's a fontanelle. Let's see which one this is. Okay, that's the front one. Now I know the position of the baby.” And you can help to potentially adjust the head using the fontanelle. So I just wanted to explain that because it's very cool.

I do have to ask you about the shoes, because I know women out there are going to be wondering, what shoes can't I wear? Are we talking sandals, high heels?

Shoes with really good support and not a lot of heel, where the foot is not squished into a funky position. Really good, nice support. Walking barefoot on the grass or in the sand is also wonderful.

Heels wreak havoc on a woman's posture. They really do.

So good.

Well, too, if the woman, without realizing it, is sort of holding her toes together to keep the sandal on, if it doesn't have a back, that also wreaks havoc with her system.

Because tight toes, tight pelvis, tight body, tight hips.

All right. Nancy, is it okay with you if we jump into the listener questions? Some women called in on our voicemail, and then we have quickies at the end, which we always do.

Okay.

Let's play the first one and see what you say to this.

“Hi. I saw a post on Instagram saying you were taking VBAC questions, and I had a question about going for a VBAC after having a delayed postpartum hemorrhage. I ended up with a C-section because they told me my baby was asynclitic. I was in active labor for like forty-five hours, I think, pushed for four, got a C-section, and then a month later, four weeks to the day, I hemorrhaged because I had retained products. But the doctors couldn't really explain why I hemorrhaged with that small an amount, because they were saying, you know, some people retain much more than this and just pass it naturally. And I'm just curious, is a postpartum hemorrhage a signal you're more likely to hemorrhage, and does that make VBAC or attempting a VBAC a bad idea? Thank you so much for everything you do. I love your show so, so much.”

Thank you. Well, one of the first questions I have is, how come they left something inside of her? I have women who've had all kinds of instruments and bandages left inside. But that's number one.

When a woman has a vaginal delivery, there's a lot of contractions afterwards, which help to expel much of what's left, if anything. But with a cesarean section, they're cutting everything out of your body, and I don't think the body works the same way that it does. Her diet needs to be really excellent. She needs to make sure her iron count is really high.

Nobody should be in labor, according to my mentor midwife, for forty-five hours. We've talked about this before because what that does is it tires out the body and makes it much more difficult for the body to do the things that it's supposed to do. She said that we are mammals, you've heard me say this before, and that all other mammals birth their babies relatively quickly, and they need to because they're out in the jungle or in the wild and there may be predators around. They also have to be in good enough shape to be able to take care of their babies because they don't have postpartum doulas. I hate the word doula, but they don't have postpartum help. As a result, they have to be in relatively good shape to be able to take care of their babies afterwards, even to be able to pick up their babies and move them if necessary, if there's danger close by. And as mammals, my mentor midwife used to tell me, our mothers should be in relatively decent shape or in good shape afterwards in order to be able to take care of their babies and to do what needs to be done afterwards.

So a forty-five-hour labor almost always signifies that the baby's head is not in position, and the dilation is taking a lot longer, and the pushing is taking a lot longer. And when you push with an asynclitic head, you're pushing against skin and muscle and tone that is going to make it more difficult. And the more you push, the more difficult it gets, as I said a few minutes ago. So no, I don't think that she necessarily has to have another C-section. I wouldn't do that. But she needs to take really good care of herself, and she needs to be with people who understand head position and in a calm environment, and that if she's not moving along, this isn't like pushing a woman to have her baby really quickly, like on the Friedman curve, but that with a baby whose head is in good position, the woman will dilate rather quickly, and she will have her baby in a lot less than forty-five hours with four hours of pushing.

Just a quick thing before we play the next one. Nancy, what about all the women listening who did in fact have forty-hour labors vaginally, and they hear you say it's not supposed to happen? What explains why it did happen? What do you say to the fact that it does still happen for women?

Forty-five-hour labors and they have a vaginal birth, there are so many factors that are involved. Nutrition is certainly one of them. Partner support is another. General support is another. Environment is one of them. Fear. Most mammals do not birth their babies if there is danger nearby or if they perceive that this is not safe or right, because they would be prone to all kinds of attacks and they would be killed. So as mammals, women also, on some intuitive level, on some really deep level, are checking out their environment to make sure. And then also, I wonder how many of those women who had forty-some-odd-hour labors were induced, because if the body is not ready to have a baby and the baby's not ready to be born, it's going to take a heck of a lot longer. So I would have to know the circumstances under which the labor took such a long, long time.

Even something like a membrane sweep that they may have had two days prior and they were sort of in and out of prodromal latent labor could be the reason for that. Most women are not experiencing a forty-five-hour active labor. That's true.

“Hi, Cynthia, Trisha, and Nancy. I'm thirty-two weeks pregnant and preparing for a VBAC in July. I was wondering if you feel that there are any reliable warning signs of an impending uterine rupture. My understanding is that changes in the fetal heart rate is the best way to detect it, so continuous fetal monitoring has been recommended to me, but I would love to hear if you agree with this or what your experience has been. Thank you for all you do. Bye.”

Bye. Well, I'm sort of laughing with a little bit of tears, because no, I wouldn't do continuous fetal monitoring. That makes everybody really nervous, and baby's heart tones change dramatically at various times in labor if the woman is hungry, if the baby is hungry, if the woman is in a particular position, if she is exhausted, whatever it happens to be, if the baby's changing position. Although I know that there are some people who find that continuous beep, beep, beep, beep, beep comforting, it makes me crazy. So no, I would not want to be with people who insist or recommend that you continuously monitor because you will have a C-section for some deceleration or some whatever. No, I would be with people who are really calm and listen.

On occasion, I must say that there have been a few births where I was really glad that we were listening. But we listen, and then for those women, we continue to listen more often because the baby did give us a little bit of a warning sign. But in most of my VBAC births, and there were hundreds of them, we would listen every now and again. There were some women who just didn't want us to listen. We had them sign a consent form. And there were some times when we would arrive at a birth and the women were pretty much ready to have their babies, and we just didn't have any time to listen.

So I don't think we fully understand babies' heart rates internally. They can give us some clues, but we have babies where they say, “Oh my goodness, the baby's heart tones were just horrible.” They did an emergency C-section, and the baby was absolutely fine. And other situations where the baby didn't give any indications there was a problem and that we really did need to give the baby a little bit of help when the baby was born. But that's why you have competent, experienced people with you. Calm, competent, experienced people who believe in natural birth for the most part, for everyone. And I wonder how many doctors and nurses in the hospital have ever seen a truly natural birth.

Oh, we talk about that all the time. They don't even have to see that before they get their degree, which is just unacceptable. But Nancy, the question was around signs of uterine rupture. Are there signs of it?

Well, I will tell you that in my many decades, I never had a woman with a uterine rupture. We did have a woman who had a dehiscence, which is an opening, which they called a rupture. But it may not have been a rupture. I only heard from, I think, two or three women in thirty or forty years who had uterine ruptures, and there was no warning. There was no warning. So what can I tell you? I think baby's heart tones were fine, and one was in Colorado. I can't remember what the other one was, and it really doesn't matter. In one of those situations, the woman did have a hysterectomy, although I always wonder whether or not they were punishing the woman for attempting a VBAC. And in the other case, they repaired her uterus and she did go on to have another baby.

I think one of the signs to really watch for is the woman sensing something is significantly off in her labor. Wonderful point. I have definitely heard numerous stories of women who have said something doesn't feel right, something doesn't feel right with my baby, something doesn't feel right with my body. This is a different kind of sensation, a different kind of pain, and they have actually had a rupture right around that time or shortly after. So listening to women. Obviously we're always listening to women, but that is one indicator. But otherwise, there really are no physiologic markers of that happening.

Well, I've had so few people who have had ruptures, but you'd have to ask a lot of questions. Again, you'd have to ask, how long was the labor? Who did the suturing? Is it a student or not a student? Sometimes students are better than the actual doctors. Was the woman induced, so maybe her body wasn't ready? There's so many different questions. How long had it been since she had anything to eat? But also, the body heals. The body heals. And so for the hundreds and thousands and thousands of women who I have been in touch with who have had previous cesareans, some of them two, three, and four cesareans, there's a midwife out on the West Coast who just attended a woman a couple of years ago who had had nine cesareans. I think they healed. They did fine. Their bodies were okay. They had their babies.

So she had a vaginal birth after nine cesareans, is that what?

Yes.

Wow, at home. Is there an interval of time that you believe is the minimum that a woman should wait between having another baby after having had a cesarean?

Well, I have had women who have become unexpectedly pregnant and had a VBAC within eleven months, twelve months, thirteen months, and they have been fine, absolutely fine. But I think when you read the literature, they say that to have the baby nursing and to take care of that particular baby for a period of time, you should wait eighteen months to two years. Under most circumstances, natural family planning is that the woman would get pregnant, she should get her period back sometime after the first year. But I've had women, and also a couple women who were in their late thirties or early forties, who said, “I can't wait two or three years to have another baby. I may not be able to conceive.” And so they had their babies very close together. Good nutrition, lots of loving.

Well, you would not say, Nancy, that those women who conceive again very quickly should have a C-section. That's really the ultimate question.

That's for sure.

Okay, either way you're planning a VBAC. That's really the key question that women like to ask, right? Once they ask, “When is my body ready?” then they get scared. Does it mean I can't have a VBAC?

Well, and also women who have had disappointing or upsetting or traumatic birth experiences, unfortunately there are many of those, and I was one of these, I wanted to get pregnant right away so that I could do it again and do it this time. I wanted to be able to do it right this time.

If there is any listener who hasn't heard episode 272 and heard your life story, they just have got to pause this and go back and listen to that episode because it is unbelievable, and because of the trauma you suffered, what you did with that ended up changing the world. So it has no exaggeration at all. That is a very incredible story. All right, let's continue with our questions.

“Hi. I'm currently twenty-nine weeks pregnant with my second baby after having an unnecessary C-section the first time around due to a failed induction. We have planned to home birth and love our midwife, and up until now I was confident in my support team being my husband and best friend. My husband has recently started to become more anxious around his capability to be fully supportive through the labor and birthing process and has expressed his concern that we might need a doula who can be fully present for me in labor. For context, during our last birth in the hospital he passed out multiple times, but I believe this was due to the setting and fear that medical professionals were putting on him. My question is really, how much do you think having a doula impacts a successful home birth VBAC? I'm trying not to let this affect me too much because I fully trust in myself and my baby to be able to do this together, but also know that having confident birthing support will be very helpful to me. Thank you, Nancy, Trisha, and Cynthia, for all of the work that you've done and continue to do. It's truly life changing, and I have so much more joy, confidence, and excitement surrounding my pregnancy and upcoming birth.”

Thanks to you. Well, first of all, the husbands are having a baby too, so I'm glad when they're there, and I'm glad when they do what they can to be supportive, but I don't see the husband necessarily as one of the support people. He's having a baby. He's becoming a father again. So I wonder what your midwife says. When people said to me, “Should we get a doula?” my response to them was, “We're going to doula you. We don't need to have another person unless there's somebody that you care about or somebody who cares about you, who's experienced, who helps you to feel much more relaxed and calm.”

But I'm wondering what your midwife says. Does she say, “Yeah, go get one, because we're not going to doula you”? Which, by the way, some midwives do say. But you want somebody who's experienced, somebody who's had a baby naturally, hopefully. I'm sure there are some good doulas who have never had babies before, but to my way of thinking, all over the world, in various tribes, the women who support the women are the women who are older, who have had babies, who really understand the process from the inside out. And how will it feel to have another body in the room? I don't know if that's an adequate answer, but we always said, “Oh, if you want to have a doula, that's completely up to you. But we're going to doula you. We're going to love you up so much. You're just not even going to believe it.”

Yeah, it's really an interesting thought because when you're having a home birth with a home birth midwife, they really do function as the doula. When I was a home birth midwife, there were almost never doulas at the births, although I see it more now today because I think doulas have become so popular. But doula became really important for hospital births. Doulas have always just been, as you said, the women supporting women in birth. Historically, they weren't called doulas. They didn't go through a special training. They were just women who understood birth and came to support the woman in birth. But now a doula is almost a requirement. I think for women it feels like it's almost a requirement to ensure that they're going to have a physiologic birth. I think that's the pressure many women feel, to have a doula.

Well, I want to paint a picture that goes into this conversation and may represent Nancy better than she can represent herself in this next moment. Years ago, I had a client, it was a VBAC after two C-sections, a client who had nowhere else to turn, as most women who've had two C-sections or more find they have nowhere else to turn. She took my class, wanted a natural vaginal birth more than ever, and had no one at all to support her. Long story short, she had a Westchester doula, a really outstanding doula, and Nancy agreed to travel all the way down, hours and hours, to be at that birth.

I will never forget when the doula, who was phenomenally experienced, really outstanding at her job, called me. She said, “Cynthia, I never saw a midwife in my life like this. We heard Nancy was parking. We heard she was on her way up. We were getting the mother ready. The mother was starting to have doubts about whether she could do it. We were expecting Nancy to come in and lie her back and check her dilation. Nancy came in, peeled off her coat and dropped it on the floor on the way toward the mother, heard the mother expressing doubt. Nancy fell to her knees, took the mother's hands and said to the mother, ‘Now you look at me. You look at me. This is what's going on, and your baby is doing this, and these are the women who've done this before you.’ And you looked at her, and you loved her, and you talked to her.” And that doula said to me, “She never put her hands inside of her.” Nancy, I just don't even know if you can understand and appreciate how rare you are, even as a home birth midwife.

You're going to make me cry. You're really going to make me cry. I had to stop attending births two years ago because my husband needed a full-time caregiver, and that was me. I don't miss getting up in the middle of the nights, and I do not miss going out in snowstorms, I will tell you that. But I miss the mothers and the babies. Anyway, I just thought I'd throw that out. I really miss the mamas and the babies.

“Hey, Trisha, Cynthia, and Nancy. My name is Amanda. I'm a doula in Middle Tennessee, and we are seeing this new trend in VBAC where providers are talking about uterine windows, a place where the uterus is very thin, as well as measuring the C-section scar to see if the mother is a good candidate for VBAC. I would love to know if there's any validity behind this, or if it's just another moving the goalpost down the line. Thank you so much. Bye.”

It's total bullcrap. Total bullcrap. Total bullcrap. Did I make myself clear?

Say it again one more time.

You can have, for example, a certain fabric like silk that's very thin to the touch, but it's very strong. And you can have Styrofoam that's really thick, but you can just break it apart really easy. The amount of thinness or thickness doesn't necessarily give you any indication as to the strength of the uterus. And if the uterus has held up to thirty-nine, forty, I should say forty weeks because thirty-nine is still not time for birth, and if it's held up to that point, most likely it's shown its integrity. Because if there was anything wrong, there might have been an issue before then, such as what Trisha said, that the mother says something doesn't feel right, or whatever it happens to be.

But also the openings are what's called a dehiscence, which I think I mentioned a little bit ago. They're openings, but they don't necessarily cause a problem. In fact, they may even give a little bit more stretch, so I would not. And ultrasounds, we haven't even talked about those yet. The more I read about them, I think there's a new book that just came out about the dangers of ultrasound. Thank goodness. Somebody is finally writing the book. We've been talking about how dangerous and inaccurate they are. The size of the baby, the weight of the baby, the position of the baby, because babies change position when the mother is being sonicated, when she's being exposed. The baby can turn thirty seconds later, but they based their decision on that particular moment in time.

I once saw a Frontline documentary on blood banks, and they took the same blood from the same human being the same hour and sent it to three different laboratories. And what happened? They got three different results, but each of the doctors was basing their decision on that particular result that that particular laboratory got at that particular moment. So we have to be very, very careful, very cautious.

Well, that's it for the voicemails, Nancy, but we always end our Q&As with a round of quickies, as we call them. And this is a pretty hard one, actually. Biggest piece of advice for a woman looking to have a VBAC?

Stay at home with a good, qualified, loving midwife.

And eat well. The next two are similar. How to trust my body again after C-section, and what's the best way to rebuild my confidence while preparing for a VBAC?

Other mothers who have had VBACs.

What do you want to say to the woman who's scared to have a VBAC?

If I did it, anybody can do it. Nobody was as scared as I was, but I wasn't going to let them cut me open again unless it was absolutely necessary.

At what point in labor do I go to the hospital for a VBAC after two C-sections? I'm afraid of going too soon.

It's difficult for me to understand that you even found somebody who is willing to attend you, and I think it's probably lip service. So I wouldn't go until you can see the baby crowning, and they have no, and by the way, there are a few people who have done that. We had a woman who lived in a motel across from the hospital, and she had support at the motel room, and they didn't go to the hospital until you could see the baby's head, and that was it. I don't know why they didn't even just stay where they were, but I guess she wanted to be in the hospital at the very last minute. And don't let them cut the cord, not for at least an hour after the baby's born.

What's the number one position you'd recommend for giving birth?

Oh, it depends. There isn't number one.

The position you choose. The position your body chooses.

Exactly right.

Thank you, Trisha.

Okay. This woman, Lindsay, says, “My baby was born sunny side up,” that's posterior, “for the first birth, resulting in a failure-to-progress C-section. How likely is that to happen again?” I guess I wonder if she means the sunny-side-up birth resulted in the C-section, which was a result of the provider, not the baby's position.

We talked about the fact that you can assess the baby's head position ahead of time, so that's really important. That's going to be really important, to get the baby on the left-hand side and to be with calm people and to eat well. No milk. I don't have any of my mothers drink milk during pregnancy. We're the only mammals who drink another mammal's milk, and so we're not growing a baby cow. We're growing a baby.

And the reason you say that is that you've studied journals and births for many years, and you've noticed that those women who've had an inordinate amount of dairy have, in fact, apparently made babies with far denser and less yielding bones for the birth.

That's exactly right. That's exactly right.

She just wrote a phrase because she only had a little box to write this in. “First birth was due to arrest of descent,” another term for failure to progress. They have a whole list of these terms. These women doubt themselves. Do you see this? They're saying, “What are my odds for having the next baby?” They have to understand this was such a function of where they gave birth and with whom they gave birth. They really think it's their bodies, right?

Absolutely, they do. And I did too.

Where did the idea come from that one cesarean birth means you have to always have them?

The reason for that is that years ago they used different techniques for cutting, and they used different techniques for suturing, and different types of, call it yarn. Many of the uteruses did rupture at thirty-five or thirty-six weeks. So they started taking women earlier and earlier and earlier, and then it was once a C-section, always a cesarean. But that is absolutely not necessary for the last decades. Absolutely not.

What can I do right after my C-section to best prepare for a VBAC?

Eat well, choose wisely, stay at home, all of the things that we've been talking about.

I think the top thing I would say is hire the right provider this time around, and certainly not the one who gave you a C-section for whatever reason, even if your body feels the familiarity unconsciously.

Continue to hire people from the hospital. Those people went to the same medical schools, they studied the same things, they have to work together, and so they bond together. Even though she thinks she's getting a different personality or somebody with a different kind of way of looking at things, it usually doesn't end up really well.

You almost always have to choose to have a VBAC at home if you want to ensure a successful VBAC. Not to say that women don't have VBACs in the hospital. It happens, but you're statistically much less likely to have your VBAC if it's in the hospital.

That's absolutely true.

I saw that in my own work as well with my own clientele. Why would a provider refuse to induce a VBAC mom at forty-two weeks and instead go right to C-section? That part surprised me.

Oh my goodness. I was about to say, “Well, it's an informed provider who doesn't want to risk your VBAC and doesn't want to cause uterine rupture.” No, wants to go straight to C-section. Okay. No big mystery there for me.

Well, again, if the uterus has held up to forty-two weeks, it's most likely proved its integrity. I wonder if it was the weekend and the doctor wanted to get onto the golf course or swim or whatever it happens to be. It makes no sense that at the stroke of midnight you were okay the day before. The longest we ever went was forty-four weeks and five days with a woman who knew her dates because her husband was a truck driver and came home on Valentine's Day to surprise her, so we knew when she conceived.

Wow. Forty-four weeks and five days is unbelievable.

I've been doing this a long time, and not only has it not changed nearly enough, but it's gotten worse. So we just have to keep doing this so it doesn't get even more worse.

All right, we have a few more. “I had a repeat C-section and was told my uterus is extremely thin.”

Less than two.

Doesn't matter, because if your nutrition is good and you're relaxed and you have the right care provider and your baby's in the right position, you can still have a baby.

Okay. Is a VBAC possible with twins?

Oh, absolutely. Absolutely. I was at a twin birth with VBAC.

One of my clients had a C-section due to a breech baby, and she was the first of anyone I worked with who refused to schedule the C-section. She insisted on going into labor on her own, and then did agree and consent to a C-section for her breech baby. She conceived twins the second time around, moved to Florida, had a home birth, and each of her two daughters weighed over eight pounds.

Oh wow, that's wonderful.

She was a six-foot-tall model, so her height, I have no idea if that makes things easier, but each baby weighed over eight pounds. That's unbelievable.

All right. Is pelvic rest at all effective for a low-lying placenta and hoping it'll move?

No, I don't think you should rest.

It's not going to help it move.

No, it's not going to help it move. And I want to know how many weeks pregnant the woman was, because all placentas are low-lying at the beginning of pregnancy because there's so little surface space on the uterus at that time.

Okay, I have two more. Should I change providers if they're not willing to deliver a breech baby?

Oh yes. I want to know when the woman was told that her baby was breech, because there are many things that can be done to turn a breech baby.

True. Let's just say theoretically, if a doctor says, “Oh no, no, no, I won't do that. It'll have to be a C-section,” because that is what most of them say.

Well, then I know some places where she can go to have a beautiful home breech birth.

Well, episode seven with Jessica in Amish country, Pennsylvania, was all thanks to you. She called me, I called you, and you did know about them, and she had an incredible footling breech birth, singleton footling breech birth, with them.

Who had a VBAC at that same place with a ten-and-a-half-pound breech baby.

Okay. Last question. I knew this day would come. I called this years ago. “The doctor has concerns about baby's head circumference.” I know years ago I said to my clients, mark my words, they're going to be talking about head circumference in a few years. And sure enough, sure enough.

What are you holding up there, Nancy?

That is my penis gauge. When a doctor tells somebody that he's worried about the woman's pelvic size, the baby's size, you show this, and you ask him to tell her what size his penis is now and what size it's going to be when he's turned on, and tell her she's going to be really turned on when she has her baby, and her pelvis is going to be just the right size for this little baby to come through or this bigger baby to come through.

That was everyone's cue to get over to YouTube and see what Nancy just held up. That was amazing. I love that you've done that.

All right. We always end with a personal question on a Q&A episode.

We're going to have to think of one for me to ask Nancy. A personal question. Nancy, I do have a difficult personal question. Difficult might be really hard to have an answer to. I don't know what you're going to say to this, and if you don't like it, we'll strike it. But let me ask it, because I am curious. Your C-section for your first birth was an absolutely devastating, heartbreaking, enraging experience for you. You cried every day for years. You have spent the rest of your life trying to heal from the rage, but you also took that and made an incredible life where you've touched thousands. You've personally touched thousands and thousands of families. This says nothing of the generations that will follow because we all influence our own children and how they will birth. So for generations and generations to come, you've changed the world. You are a very award-winning, renowned, revered author, and your books have changed God knows how many readers' lives.

I do want to ask you this question. It's very hard to answer, so forgive me, but if your first, you were a speech pathologist when you had your first baby, if you could have changed the course of your life, would you have had a dream first birth and remained a speech pathologist and not lived this life?

Was it worth it? That is some question.

I know. I knew it would be tough.

I was at a library a couple years ago, and there was a woman sitting with her arm just kind of like this, and I saw that she had some words written on her arm, tattooed. I went over to her and I said, “Do you mind if I see what you have tattooed on your arm?” And what it said was, “The two most important days of your life are the day you were born and the day you found out why.” And I found out why when they cut me open. So I wouldn't go back. As difficult and horrific and depressing and as upsetting and enraging as it was, I wouldn't go back.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.