172 Carlee's VBAC + Cholestasis

The VBAC Link

After her first labor stalled and ended in a C-section, Carlee remembers leaving the hospital so grateful for her healthy newborn, but also confused, exhausted, and longing for a “birth redo.” When she became pregnant again, Carlee planned mentally, physically, and emotionally for a dreamy HBAC. She also prepared thoroughly with a super supportive team at a nearby hospital if needed. At the end of her pregnancy, Carlee presented a severe case of cholestasis and her plans suddenly changed.

Carlee began her low and slow induction at 37 weeks with no signs of labor and an unfavorable cervix. But the patience of her birth team, the support of her doula, and her ability to make decisions regarding her care all set her up for a nice, healthy VBAC. When plans changed, Carlee’s preparation still set her up for success and empowerment.

Carlee is proof that a medically necessary induction doesn’t mean you have to go right to a C-section. When working with an early induction, patience is the key. With the right mindset and a patient birth team, you have a good chance of having a great birth experience and an even better chance of having a VBAC.

Additional links

The VBAC Link on Apple Podcasts

How to VBAC: The Ultimate Prep Course for Parents

Full transcript

Note: All transcripts are edited to correct grammar, false starts, and filler words.

Meagan: Happy Women of Strength Wednesday. You are listening to The VBAC Link and this is Meagan and Julie and our friend Carlee. She is from Arizona and she is going to be sharing her VBAC story today. There’s something interesting about her VBAC story. If you have never heard of cholestasis, then you want to listen up because we’re going to talk a little bit about it, and what it is, and why it’s important to actually get the baby here sooner rather than later when it is present. We are going to dive into her story. As always though, we have a Review of the Week and Julie will be sharing that with us.

Review of the Week

Julie: Yeah. I’m going to share a review. But before I share a review, I’m going to congratulate Meagan for saying “cholestasis” right.

Meagan: I know. I always call, in my head, I’m like, “Choleo--”

Julie: Cholestasis.

Meagan: Yes. And I just, it says it all the time. I’m like, “Choleostasis.”

Julie: You didn’t even stutter. It was just nice and smooth off the tongue, so I was very proud of you. I had to let you know.

Meagan: Perfect. I am growing up.

Julie: The things we mature on by running a podcast. All right, so this review is from Apple Podcasts and it was left by “natashahoff”. This is one we can Facebook stalk, except it was just left a couple of weeks ago. But I am going to read it.

The title is, “So empowering.” She said, “I found this podcast after I had a Cesarean birth with my daughter almost two years ago. I knew I wanted a VBAC and I wanted to hear birth stories from women who have had ‘success’. Little did I know all of the incredible, evidence-based information that Julie and Meagan share on each episode and on their blog! I now feel like I have a wealth of information to help me achieve my goal of a VBAC, from choosing supportive providers to preparing my body for birth, all the way to what to do if my plans don’t go the way I would like. I’m so excited now that I am pregnant with my second baby to be able to put these plans into action and begin my journey to a beautiful VBAC in October 2021!

Meagan: That’s coming up.

Julie: First trimester. I know.

“Thank you, Julie and Meagan, and all of the wonderful moms who have shared their stories!

Sincerely, Natasha Hoffstater”

I love that she signed her name. Gosh, we should have waited to read this until October so we could go to Facebook stalk her and see if she had her VBAC. Oh well, we will come back to you Natasha. I promise.

Meagan: Yes, I was going to say. Natasha, keep us posted along the journey because we love hearing. We love it. We truly love when we get the messages and we are like, “Oh wait, you were the one we talked to way back when.”

Julie: We are getting old enough now, and I mean mature, not old, although we are old as well. Well, not Meagan. I’m just the old one. But where we are coming full circle with a lot of the stories and it’s really, really fun. It’s really cool because I love when people share that the podcast educated them and helped them have lots of information. Can I do a little shameless plug-in here for our VBAC prep course?

Meagan: Yeah.

Julie: Because the podcasts are definitely lots and lots of information, but you have to listen to-- what are we at now? 170-something episodes in? That’s 170 hours of information that you have to listen to. That’s why we created our VBAC prep course because it is condensed. It’s just the nitty-gritty, need to know, absolutely everything covered that you need for your VBAC, but hyper-focused in this six-hour course in easily digestible video segments with corresponding text and set up all really nice and easy, so you don’t have to listen to all 170 podcasts. You can just go and instead watch a six-hour course.

It’s set up so you can stop and go, and stop and go, and stop and go. It can take you a while or you can do it all in one day. That way, you don’t have to sit and listen through every single podcast. It’s just a nice sweet, Saturday afternoon with your husband and your little toddler running around, and then you can get empowered and educated in one day.

Meagan: Yay.

Julie: So, I love that. Either way, we’ve got your back. Something for everyone here at The VBAC Link.

Carlee’s story

Meagan and Julie: Alright.

Julie: Ope, jinx.

Meagan: Are you ready to get into this story? I know, right? We are so excited for Carlee’s story and oh my gosh. Okay, Carlee. We are not going to take any more time. This is your time. Let’s turn the time over to you.

Carlee: Okay, awesome. Thanks, ladies. I am super excited to share my story and hope that someone can learn something or take something away. Starting from the beginning I guess, growing up, I was never really afraid of birth. My mom had four natural births at the hospital, but nice, smooth, easy birth,s and both of my sisters had natural births at the hospital as well. So I just thought, you know, my grandma, everybody just all had easy, nice, easy, natural births, so I was like, “It’s going to be okay whatever happens to me when the time comes. I will read a couple of books and I will be good.”

It turns out it was a little trickier than that. I got pregnant about after seven months of trying. My husband and I started trying after a year and a half of marriage. I was diagnosed with PCOS when I was 16. Doctors always said, “You’ll get pregnant, but most likely with help, with Clomid,” or whatever types of fertility treatment.

So after seven months and getting pregnant naturally, I was super excited and super grateful. I remember that first call to the first doctor, “Um, I think I am pregnant. I got the positive on the pee stick. What do I do now?” I don’t know if anyone else has ever done that. But I was just like, “Oh, what do I do?”

With that doctor, I had an ultrasound with them, but I didn’t really vibe with the doctor and so I was like, “I think I’m going to switch to someone else,” which I’m super glad I did. I went to a group of midwives that deliver at a more natural hospital here in the area. My sister had used them for her first birth and so I was like, “Okay. They are going to be great.”

Throughout the pregnancy, I met all seven of the midwives. I found two that I enjoyed more and felt more connected to and so I had always hoped that they would be on-call when the time came. For the most part, pregnancy went really well. I went to all of the regular appointments. I turned out to be GBS positive, which I hadn’t really looked into, so I was like, “Okay. I guess antibiotics is my fate.”

Towards the end of my pregnancy, I was due in September and during the summer, we lived in Boston for my husband’s work. We left out of town and then came home in August to start student teaching at 36 weeks. It was my senior year of college and I didn’t drop out. I just decided to do it. So I student taught from 36 weeks up until I went into labor, and then the plan was to have four weeks off and go back into student teaching. So it was a hectic time of my life for sure. Birth wasn’t quite the forefront of my mind and I do think that definitely played a part.

When I was 40 weeks and 1 day, I made it all the way to the end. I started feeling period cramps around 4:00 p.m. and I was like, “What? Am I starting my period? This can’t be.” I don’t feel like anyone ever told me that period cramps are the start of contractions, so that was shocking to me.

Around 8:00 p.m., they kicked up again, so I was like, “I am going to go to bed.” At 11:30, I woke up and got in the tub. I was just like, “I am just going to try and relax through this.” 20 minutes later or so, my water broke and that was the craziest sensation. I just remember feeling this “pop” and then a gush of water. I was like, “Uh, I think my water broke.”

So, I got back in bed. I knew I shouldn’t rush anything, so I put the blanket down on the bed and laid down and tried to rest, but I was really just on the app counting contractions. Don’t do that, anyone, in the future. It’s not worth it. I just felt like I should have really--

Meagan: It’s like watching the pot boil.

Carlee: Yes.

Meagan: If you just sit and watch it, it never boils. The second you walk away, you’re like, “Oh. What’s that noise? Oh. It’s boiling.” I agree, “Rest. Just rest.”

Carlee: Right. So. I wasn’t. I was so giddy and excited. I called the midwife and it was one of my favorite ones. I was so excited and she said, “Take some time.” Contractions were 5-7 minutes apart, which I feel like is kind of close, but I think I was probably counting them wrong. I don’t know. I was all confused right then.

So she said, “Take some time, but we do you want to come in to get on the antibiotics so you can get your two doses,” and so, we got in. We went to the hospital around 3:00 a.m. and contractions were pretty good. They were coming. I got to triage, which I think is the worst place ever. I do not like triage. I got checked there and I was 1.5 centimeters. I was just like, “Oh, you have got to be kidding me.”

I got into a room. They took my blood. The guy came in to give me an IV and I asked them, I was like, “Hey, I really don’t like needles. Could you be nice to me?” And he was like, “Oh, deal with it,” basically. I was like, “Oh, okay.” So I think right from the get-go, I just did not feel comfortable in the hospital. I felt out of place. I don’t like hospitals to begin with. Just from the get-go, I was like, “Oh, I don’t like this. I don’t feel comfortable.” I think I shut down a little bit.

They had tubs there though, in the hospital, that you could labor in, not deliver, but labor. And so, I spent a lot of time in the tub. I didn’t have a doula, so it was just me, and my husband, and the information I had read from Ina May. I just tried to work with what I knew to do, so I would be in the tub, try different positions, change around. The nurses would come in and check baby’s heart rate. The midwife would come in and see how I was doing, but then contractions really just spaced out and after about 15 hours of my waters being ruptured, they suggested Pitocin. I just really wanted to do natural and so I was like, “Maybe not yet.”

They decided to give me half of a pill. I don’t remember what it was called.

Meagan: Probably Cytotec?

Carlee: Yeah, something to help the contractions, I think. Is that what it is?

Meagan: Cytotec, yeah. It’s like your cervix wasn’t super primed and ready. It’s, yeah. Something that can help effacement and dilation. The contractions usually kick in a little bit with that as well.

Carlee: Okay. I took it orally. Is that the same thing?

Meagan: Uh-huh, yeah. They do it vaginally and orally.

Carlee: Okay, because I have heard of the vaginal one. But, okay. So that got contractions a little bit closer together, but they still weren’t-- they were 7 to 10 minutes apart. Just not ideal. And then, they checked me and I was 4 centimeters. So still, not really-- progress, but not as much as they wanted, you know? And so, we decided to go ahead and start the Pitocin. Oh my goodness. Wow. Those really amped up. And so, I wanted something, I needed something to help me relax, but I was so against the epidural. So they gave me something. They said, “It will last two hours. It may make you hallucinate. I don’t know what it was called, but it did exactly that.”

Meagan: Maybe fentanyl?

Julie: Fentanyl?

Carlee: Yeah, probably. Okay.

Meagan: It makes you feel, a lot of people are like, “I feel high.” And like, “Whoa.” Like out-of-body and sometimes nauseous.

Julie: Loopy or drunk.

Carlee: Yeah. I was definitely, at one point, I was running down the street in The Lego Movie. I have never seen The Lego Movie, but I was a Lego person running. It was so weird.

Julie: Oh my gosh, that’s awesome.

Meagan: That’s the cutest.

Carlee: It was crazy. So it was the middle of the night. My husband was trying to sleep and I’m trying to get some rest, but you could still feel the contractions. And so, I was getting out of bed every seven minutes and asking my husband, “Come hold my hips. Squeeze them.” So, making him get out of bed and just a rollercoaster of just-- it was awful. Once I woke up out of that hallucination, weird, daydream stuff, the nurse came in and said, “Baby’s heart rate kept dropping while you were on that, so we had to stop the Pitocin, but we want to try it again.”

So we tried it again and then baby’s heart rate dropped again. You know, that whole stop and go, stop and go. At this point, I am 7 centimeters. I had stalled at 7 centimeters for a while. I think this was hour 30 and so, that was the first time I really considered a C-section and realizing that this was probably what might get my baby here. I still wanted to wait and they did let me wait. My midwife, I just have this vivid memory of her standing, like leaning against these cupboards, her arms crossed around her chest, her feet, ankles crossed over. She is standing up, leaning against this, and just so leaned back and not even caring. Just kind of like, “Yeah. I mean, we can do this, or we can do this.”

Right? I’m just sitting in this bed like, “Oh my gosh, help me.” You know? I’m trying everything I possibly can, but I just don’t know what to do. Me and my husband are just confused, not sure what to do. She was just like, “Yeah.” I was like, “Well, should we try the epidural before a C-section?” She was like, “Yeah, you could, but you’ll probably just end up in a C-section.” I am like, “What? You guys are these natural-minded midwives. What?” I don’t know.

So that’s why I was just like, “I guess the epidural won’t really work.” And then, they started saying like, “What if something is wrong with your baby? What if something is stopping your baby from coming like the cord or something like that?” And so at that point, I was like, “Well, I probably shouldn’t keep going. Maybe it just would be better to get her or baby, here safely.” We didn’t know she was a girl yet. Get baby here safely rather than potentially having a crash Cesarean and maybe NICU time or whatever.

So we did. We decided to call around 5:30 in the morning and it ended up being about 35 hours from my water breaking to go into the OR. Everything in the OR was great. Everyone was really kind and understanding. The anesthesiologist was super nice and the nurse held me while I got the needle in my back, which I was terrified of. I think probably the lowest point though, was lying naked on that table with the lights. For sure. Like, awful. But my husband came up and he got to be there. The surgeon let us know when baby was coming.

We didn’t know the gender, and so we wanted my husband to call out the gender. The surgeon held up the baby and he was like, “It’s a boy, I think.” Everyone just laughed and helped him out. It had been a really long time, so we had to give him some slack. He was exhausted. But it was a girl and my heart was just bursting. I just wanted to hold her so bad. I was like, “That baby needs to be over here right now. They did once they did all their stuff over at the baby station.”

They brought her to me and I got to hold her in the OR, and then they got me back to our room pretty quick and I got to breastfeed. Everything honestly did turn out pretty good. I still have happy feelings driving by that hospital. It’s not an awful place or anything, just kind of disappointing. I remember asking my midwife before the C-section began, I was like, “Can I have a VBAC? I know my body can do this and I want to do this. I want more children.” I wasn’t sure if C-sections for life were going to be my fate.

But she did say, “Yes. You totally can.” I just remember driving away from that hospital with my little baby right next to me in her car seat and just thinking, “What just happened? I want a re-do. I need a redemption on this birth.” That’s what propelled me into trying for a VBAC. I had all of the thoughts of, “Why is it so easy for other women? I thought I had done everything. I didn’t get an epidural. Usually, it’s an epidural, right, that causes a C-section? But, no.” This experience just had taught me a lot.

After I had graduated from college and once my baby was a year old, we started trying for another one. I just wanted to make sure I had reached that 18 months of like, “You want your babies to be 18 months apart for an ideal VBAC chance.” I started reading books and listening to podcasts. I found this podcast which I absolutely loved. At the end of my pregnancy, I would just listen to it every night. My husband knows your guys’ voices and all of that.

I started to envision what I really wanted and that was ultimately no interventions. I just wanted a natural birth and I realized that the first intervention really is leaving your house, and so I really wanted an HBAC. I wanted to have a home birth. I got pregnant about four months after we started trying and I started interviewing some midwives here in the area. I interviewed one-- I just knew I needed a supportive provider.

If The VBAC Link has taught me anything, it’s that a supportive provider is key. And so, I interviewed one and got super excited at how supportive she was with her VBAC, or with HBAC, and thought, “Oh my goodness. This can actually happen. People actually do this.” But we didn’t super connect and my husband-- we got out of the interview and he was like, “Well, that was kind of weird, but if you feel comfortable, I am comfortable.”

And so, I decided to interview with another midwife here. We were playing phone tag and she called me back and said, the first thing she said when she answered the phone was like, “I cannot wait for you to push your baby out.” I don’t think she could’ve said anything better to me at that point. I was just like, “Oh my goodness. That is exactly what I want.” That was the support that I needed and wanted.

And so, we built a relationship super quick. I just felt so loved by her and trusting of her. Pregnancy went really well. Nothing too crazy, except COVID. At 20 weeks, everything shut down. It was pretty crazy, but everything was mostly at my home. She did home visits with me and then her office. Nothing had really shut down for my care, except the 20-week ultrasound kept getting pushed back. I had it at 24 weeks.

But everything looked good and I was just preparing for my home birth. I made a birth goal sheet in case I did end up having to transfer. I tried to envision all different types of scenarios. I think the biggest scenario that I was envisioning of having to transfer was if I was just stalling out, labor was taking forever again, and that I would go to the hospital and get an epidural. That was fine with me. I was like, “I will do the epidural this time. No big deal if I need to. I am fine with that.”

So I had all of these, just prepping for this home birth. My midwife actually works with an OB in Phoenix and transfers to him. They have a really good connection. She had suggested, “Maybe do a phone consultation with him just to get to know him and just in case you have to transfer that you will have a record with him. He will know you and you will know him.” So I did. I did that and I loved him right away. He was for super informed consent. He told me, right at the first phone call, he said, “I will never check you. I will never tell you that you need to be checked because that’s assault. I will only check you if you want me to check you.” I was like, “Wow.” So that made me feel really comfortable.

Meagan: That’s awesome. Yeah.

Carlee: Yeah. Isn’t it awesome?

Meagan: It is awesome. Yeah.

Carlee: And so, I was just like, “Oh yes. I can vibe with him and if I do have to transfer, I will feel comfortable going to him.” Pregnancy went good. At 36 weeks, I started to feel really nauseous, especially at night, and just no appetite. You know, you’re growing a baby, so there’s no room. That’s what I chalked it up to be. I was really achy and really tired, like, super tired. But you know, I am 36 weeks pregnant and that’s pretty typical. And so, I just chalked it up to be the end of pregnancy.

It turns out that those are all symptoms of cholestasis that I didn’t connect until the end. So 36+6, I was laying down relaxing at the end of the night and I asked my husband, I was like, “Is there a mosquito in here?” Because whenever there is a mosquito, I always get eaten alive and he doesn’t get bit at all. And so, I am like, “There’s got to be a mosquito in here because I am just itchy all over.” And just frustrated. I was like, “Ugh, I hate being itchy.” You know? And so, I go to bed and I am just itching like crazy. This is no mosquito. This is more than any mosquito could ever do. I’m not sleeping at all.

I start googling. You know, the worst idea to do in the middle of the night. I start googling everything, itchiness at the end of pregnancy and it comes up with cholestasis of pregnancy. I am just like, “Oh no,” seeing that I would have to be induced potentially or all of these different things. I just started having really negative thoughts and I tried to get some sleep but I cannot. So once it was more of a decent time in the morning, which, I guess there is no decent time for a midwife or a doula, I called my midwife.

Oh, and I had a doula as well, I forgot to mention, but I did hire an amazing doula who was super great during my pregnancy. So, I called my midwife and doula and just let them know, “I am itching really bad. What should I do? I read that it could be cholestasis.” My midwife was like, “Yes. It could be cholestasis. You’d better get it checked out. Why don’t you go to the hospital where the OB is? I will let him know that you are coming. Let’s just get it checked out just to make sure. Let’s do it for baby. Let’s make sure that we get keep baby safe.” And so, I was like, “Okay, let’s do that.” She was confident, “You’re probably just going to get the test results and come back home, but maybe text us just in case you do stay and do get induced,” because that morning, I was 37 weeks. That’s the day that typically they induce moms with cholestasis.

So, I was just a basket full of emotions, but my midwife and doula were so reassuring and just kept saying that, “This is the best thing for your baby,” and that’s what I wanted was, I wanted my baby to be safe and be healthy. I knew I could do this for baby. We decided to go to the hospital where the OB was. It was about 30 minutes away and with COVID and everything, I decided to pack up everything just in case we did stay. I wanted my baby to be in a cute outfit when he or she was born. We didn’t know the gender again.

We said goodbye to my daughter as if we were going to have a baby which was so weird and so hard. I was not prepared for that. Everything just seemed so rushed and so quick, that I really had to start shifting my mentality to not focusing on how the hospital was the last place I wanted to go right now and I do not want to have my baby in a hospital, but you know what? God is in control. He led me and He taught me so much with my first birth, that He can teach me so much right now and He will lead me now. And so, I just tried to give it over to God and just trust. I was so, so nervous though especially knowing that induction with VBAC is just not ideal.

Meagan: Less ideal, but not impossible.

Carlee: Right. Right.

Meagan: Yes.

Carlee: Exactly. That’s what my doula and my midwife-- they were so encouraging. Like, “You can still do this. You can still have your VBAC. This is not a one-and-done, end-all, be-all. And so, I was just trying to say very positive. So, I got to triage and it was just me allowed. Husbands weren’t allowed because of COVID. I got there around 11:00 a.m. I just thought it would be an NST and blood draw.

The OB came in and explained to me my options, and what could happen once I got the results, and just very much informed consent. I got my numbers back and they were some of the highest he had seen. He would have let me leave. He would have let me go home and try to get labor going on my own, but I just felt like it was best to stay and to get induced because I wasn’t sure what this was, you know? And because it can be scary with losing your baby. I definitely did not want that. And so, I just felt like it would be best to stay.

I was there basically all day. They were really busy that day. I was just in triage and the little curtain you can’t go around because of COVID, so I’m just staying there trying to stay up. I was doing squats in the little curtained area. I’m trying to do all these positions. It was very weird. But my nurse in triage was so comforting when I told her I was trying for a VBAC. She got so excited and said, “Oh my goodness. The hospital has a 95% VBAC rate.” All this great stuff. I was like, “What? Oh my goodness.” Super exciting.

She actually ended up visiting me every night in the hospital after that. After her shift, she would come by and say, “How are you doing? Where are you at? How’s the day been?” Because I was there for multiple days. She was really comforting at a time that I was so, so confused and unsure and just scared, you know? That was very nice.

I didn’t get back to my room until 7-7:30 because they were so busy with cases more severe in mine and so they were like, “Oh she gets the next room. Sorry. She gets the next room,” which I was grateful for, but it was also just like, “I am so sick of being here and my husband couldn’t be with me.” Anyway, trying to remain positive and grateful, but I finally got back to my room.

My nurse, her name was Beth. I still remember her. She came back to my room. She was an old lady and she looked a little like, I don’t know, a little scared. I am like, “Okay, this is not going to go well,” but she ended up being the most confident in my induced VBAC. She was like, “Oh honey, you’ve got this. You’re going to be so great.” I was trying to go natural. She was all for me trying nipple stimulation first. We got a little breast pump set up and she was like, “Do you want a show? You guys just enjoy your time here.” Super sweet. Super nice.

So we turned on The Office and watched a couple of shows or whatever and got some contractions going, but nothing serious and nothing to write home about. We decided at that time to start Pitocin. And at that point, I hadn’t had an IV yet. I hadn’t gotten checked. So the OB came in and he checked me. I was 0 centimeters and 0% effaced and very high up which, I mean--

Julie: Oh my gosh. How frustrating. If you’re 37 weeks, you kind of expect that, but when you’re trying to have a baby now, it’s just gotta be hard.

Carlee: I was like, “Wait. My baby needs to come.” But yeah. My doula was like, “Carlee, you are 37 weeks. That’s exactly what you should be.” I was like, “Oh yeah.” No one was concerned about that. They were like, “Yep, that’s fine.”

Meagan: That’s such a good point. Such a good point right there. That’s exactly what you should be. I love that.

Carlee: Right.

Meagan: Because you wouldn’t expect to be 4 centimeters at that point, right?

Carlee: Right. I didn’t want to be.

Meagan: Like, you’re really early. Yeah.

Carlee: And so, it was a good-- like, “You’re exactly where you should be.” And I was like, “You know what? That’s right. That’s good.” So, I got the IV in, which I hated again, but it was better and started at the lowest low of Pitocin which I made sure, because of what I have learned here, that you start at a 2 and move up 2 every 30 minutes, right? On Pitocin?

Julie: Yeah, or longer. You know, 45 minutes to an hour. Yeah.

Meagan: I like to say an hour. I like to suggest to my clients, to encourage an hour because it really takes 30 minutes for the uterine receptors to receive it and start acting. And so, it’s hard to know what it’s actually going to do at 30 minutes because we haven’t given it time to actually do it. Does that make sense?

Julie: Yeah, it actually starts responding within minutes, but it takes 45 minutes for the full strength to hit the uterus. So you’re not contracting to the level you adjusted it to until it has been 45 minutes. So if you’re adjusting every 30 minutes, you’re contracting based on the dose you got two times ago instead of the last dose. I don’t know if that makes a lot of sense.

Carlee: Yeah. I think they were doing every hour. I can’t remember. I was like, you know, and it hurts. I’m pretty sure they said every hour because they were very VBAC friendly and everything. So I think they were doing that, but I am not sure. But it ended up working out. So that night, on and off throughout the night, and then at the shift change the next morning, the OB checked me and said that I was 2 centimeters and 50% effaced, which, I was bummed because that just seemed like my fate in birth is just going so slow.

But everybody else was so excited about that. They were like, “You made so much progress over the night.” I was like, “What? Okay. I guess so.”

They were just so happy because, at that point, we could try and get the Cook’s catheter in, which, I have always heard about the Foley bulb, but my OB wanted to do the Cook’s catheter. I don’t know if you want to try and explain that.

Meagan: I mean, it’s pretty similar. Cook’s catheter actually has better results. But I mean, it’s similar. It’s a catheter that goes into the cervix and is inflated like a balloon on the other side with the saline. It puts pressure on the cervix which is like a manual dilation, then it eventually, once the cervix is open, it just falls out. So people all around the world, you know, it just depends. It’s honestly a doctor’s preference and sometimes it’s what the hospital has. It’s either a Foley or a Cook. But essentially they are the same.

Julie: Yeah. The Cook’s just puts pressure on both ends of the cervix and the Foley bulb just pulls from the outside, or from the inside, towards the out.

Meagan: It pushes pressure down. Yes. It pushes down.

Julie: From the inside of the cervix to the outwards, yes. It pushes down on the cervix. That’s right.

Carlee: Gotcha. Okay. So, yes. So he tried to get that in twice and it was not working. I was like, “No, no, no. I have to do this. This is the only way.” You know? I am just having all these negative thoughts, but he was like, “You know what? Try and relax. We’re going to take a break.” And then his wife who is actually a certified nurse-midwife, they own a practice together and work in the hospital together and everything. He was like, “I will have my wife come in and try. She’s got smaller hands,” or something.

And so, she came in two hours later and she got it in the first try which was exciting. So she took over my care from then on. I don’t know, but it was great because I loved her too. So we continued with Pitocin, moving around. We would go up to the full amount of Pitocin and then take an hour break, then get back on. Eventually, so the catheter was put in at 9:30 and then the catheter fell out at 9:15 when I was on the toilet. It was the most exciting moment ever because my body was actually working and I just couldn’t believe it. I thought they were going to have to deflate the fluid and take it out manually or something.

So my body was working and they checked me that night at 7:00 and said I was a 6. So I was just super excited. I was a 6. Contractions honestly, were pretty consistent, but I was able to breathe through them, no big deal. And through the night again, I labored with Pitocin. Lots and lots of Pitocin trying to give birth.

But it was nice. That night, the nurse was there. She was amazing and she was talking sports with my husband which, I think, super helped for him. He had just been in this birth world for going on 24+ hours, and so just having the sports talk with her was super exciting and super nice for him. It gave him a nice big mental shift and excitement.

The next morning, Ellie came back to check me. I was still a 6, but kind of 7 centimeters and 80% effaced. So again, it was easy to feel discouraged. That was a whole other night of laboring and Pitocin. My doula decided to make her way over because she couldn’t leave once she got there. And she had four other births going on at the same time, so I felt really bad, but she was a saint and came in. She and my nurse gave me some new positions to try to help baby labor down and it was a huge help. The positions just helped me a ton. Hands and knees, ball, toilet, side-lying, all of the things. I couldn’t walk the halls but was just trying to stay active.

Also, trying to remind myself to rest because it had been so long and just to be okay with slow because sometimes that is okay and my baby was, her heart rate was amazing. Sorry, it was a girl again. I blew it again. But it was a surprise for us. So she was amazing and probably what let me keep going this long.

At the end of the night, Ellie, the nurse-midwife, was in the office all day and she didn’t like having other people check me or do anything. And so, we waited until she got back to do anything else. But around 4:20 that afternoon, I was laboring on the toilet and trying to stay positive knowing that 7 centimeters was where I got stuck with my daughter. I knew that there is usually a wall when most women are trying to VBAC and was trying to get over that. As I’m sitting on the toilet, I feel my baby drop. I had never experienced that before, and so to feel her drop down and get into my pelvis, I broke down. I lost it.

I started crying and saying, “I can do this. My body isn’t broken. I can get past the 7-centimeter hump.” And just the biggest motivation for me. My doula actually got a picture of me on the toilet and it’s one that I will cherish forever. It’s amazing just seeing the confidence in me that knowing that I could do this.

I got checked again and I was 7 centimeters still, but 90% effaced and at 0 station. I made some big progress. We decided to have my water broken, which I thought a lot about but decided we need to get this going and it will be the next best step. And so, I got my water broken and then contractions amped up a ton. I asked to turn off the Pitocin. I was doing it on my own now.

I got in the shower, but I had to get out of the shower because they wanted to keep checking with the monitors. Those portable ones weren’t staying on. I just really wanted the birth tub like I had envisioned during transition to be totally in the tub, and relaxing there, and breathing through, but I was not there. I was in a hospital where I did not want to be. I came to realize that I should probably get the epidural to give me the biggest shot at this. It was around 7:30 at night. I got the epidural and it worked pretty good. Yeah, it worked pretty good. That’s about it.

We were able to rest until about 11:30 and I got checked. So, four hours later, and I was complete and at +2 station. We were all so, so, so excited. I got to labor baby down for about another hour and then I started pushing. And pushing with the epidural was not my dream. I couldn’t really feel what I was doing. I felt pretty ineffective, but soon I got to reach down and feel my baby which was super cool. Even at this point I still was like, “I could have a C-section at any point.” Like, they could still wheel me back. I was not positive. Although, I guess when I touched the baby’s head, I was pretty close. I don’t know if-- I doubt you can have a C-section at that point.

I don’t know, but it was really exciting. And so, towards the very end, I started feeling really nauseous and as I was pushing, I started to throw up. It was really glorious having my husband hold a throw-up bag as I am pushing. Everyone was coaching me, like, “Come on. You can do it. Push harder.” And I am puking my guts out. I think that happened through four contractions. I definitely-- I threw up pushed my baby up which was so weird, but pretty cool I guess. I guess that’s pretty common, being nauseous and throwing up at the end.

Julie: Yeah.

Meagan: It definitely is because a lot of things are shifting, too. As baby is moving down, our organs and all those things that have been pressed up and jumbled around to make room, they’re moving and shifting, and so sometimes it can make us nauseous.

Julie: They are starting to let loose.

Meagan: Plus, we are holding our breath during pushing and that in itself can make us nauseous, and then we get hot and that can make us nauseous. So it’s all just--

Julie: A hot mess.

Meagan: Yeah.

Carlee: That was me. That was me at the end. Yeah. I threw up and she came out, but I got to pull her up on my chest which was the most amazing moment ever. Something that I wished with my first baby I could have done. But it was amazing. So I got to pull her up, do skin-to-skin with her for two hours or whatever, and then, yeah. That was my birth, basically.

Julie: That’s exciting.

Meagan: Aww. Congratulations.

Carlee: Thank you.

Meagan: I know. It is such an awesome feeling. So, question. After you had your baby, did you feel much better and feel less like you had cholestasis? Did you feel better?

Carlee: Yeah. It was interesting. Once I got to the hospital and started the whole labor process, I really didn’t feel itchy again which was weird, but I don’t know. I guess I just needed to get to the hospital and then my body could relax. I don’t know. Yeah. I didn’t really have any more itching after getting there and then after having the baby, yeah. My nausea went down. My achiness, you know, all of those things. So yeah, it left right away, which, I know sometimes it can stay on for a couple of days or so, but--

Cholestasis

Julie: Yeah, usually it resolves pretty quickly after the baby is born. It is so interesting. I just want to talk a little bit about cholestasis. It’s actually not that complicated of a thing to understand. But it is something that you usually don’t really hear about until you have it. Right?

So cholestasis is actually a problem with the liver. It affects the liver. It either slows down or stops the normal flow of bile from the gallbladder. So it can cause itching, which is the first symptom of cholestasis, and then it can turn into jaundice-type symptoms like the yellowing of your skin, eyes, and mucous membranes. Essentially, it starts deteriorating your liver.

And then, if you have problems with your liver, then it can also cause problems for your baby which is why they recommend inducing cholestasis around 37 weeks if things aren’t looking too bad. Sometimes they even recommend it at 36 weeks. Usually, it develops later on pregnancy, but sometimes it can show up in early pregnancy, which would mean you would need to transfer to a maternal-fetal medicine or a high-risk provider pretty quickly in order to manage that.

So, pretty simple right? It affects the liver and it affects its ability, it stops the normal flow of bile, which kind of sounds really disgusting, but it is just a normal body function. Yeah. And the cool thing is, I really love this story because we were talking about cholestasis, which, I don’t know that we have had somebody with cholestasis on, have we?

Carlee: You had one.

Julie: Did we?

Carlee: I listened to it, yeah.

Julie: Oh, so we did have one. But it has been 170 episodes. You guys, I can’t even remember. I wish I could remember every single topic that we have talked about. But also, with the cholestasis, and then you had an induction at 36 weeks with a cervix that was not showing any signs of being favorable and a nice, patient birth team that let her go low and slow on the induction, and she had a long labor, which is kind of expected when you are 37 weeks pregnant. But with the patience of her birth team, and the support of her doula, and her ability to make decisions regarding her care, all set her up for a nice healthy VBAC. Now, I’m not saying that every time you have this scenario, sometimes it is not going to go that way, and sometimes a repeat Cesarean will be needed because if your body is not responding to labor, it’s just that a whole bunch of things come into play.

But I really like hearing stories of an early induction or preterm induction. I guess you were right on the brink of the early term category at 37 weeks. But I love hearing those stories of success because it gives people hope when they do have things that are mesically-- I just combined medically and necessary into one word. Medically necessary for the baby to come out, you don’t have to go right to a C-section, although in some circumstances it might be the best choice.

But where induction is an option still, you can have that induction and be patient, and be prepared for the long-haul because honestly, a 37-week induction is probably not one of those ones that is going to take two hours, and then you have a baby. It is probably going to take a couple of days. As long as you are set up with the right mindset for that and you have a patient team, then you are going to have a really good chance of having a good birth experience and an even better chance of having a VBAC because patience is the key when we are working with earlier inductions.

Meagan: We said earlier that obviously, induction is not the most ideal. It is just not, but it’s not impossible. When you have providers like Carlee did, it is so possible. It is extra possible because they have got patience, they understand the physics of birth, and what the cervix does, and what the cervix needs. A lot of the time, it just needs time, like Julie said.

Usually, you don’t go in, unless you’ve totally had a baby before, I wouldn’t say that it is impossible to have a baby within 24 hours. A lot of the times, you go in in the morning and have a baby by 3:00 p.m., but when you haven’t had a baby vaginally before and your cervix hasn’t gotten all the way there yet and things are different, it just takes time. It takes a lot of time and the biggest thing, one of the biggest things that we talk about in our VBAC course a lot is finding a good provider that you trust and that trusts you because if your provider doesn’t trust you, that could be a problem.

Julie: Yeah. You need trust both ways.

Meagan: Because that means your opinion, yeah. Your opinion won’t matter as much because they don’t trust you, right? So you need to trust them. They need to trust you. And all of us need to trust birth. We need to trust birth. We need to trust our bodies, that our bodies can do it. It just needs time. You know, from my birth, I likely would have ended in a C-section if I were in a different place because it was 42 hours and I was stuck. I was a certain centimeter for a really long time and I was exhausted. It was rough. And it’s just, yeah. I can’t stress a good provider enough. So, so proud of you, love and congratulations again. Thank you so much for sharing your story.

Carlee: Thank you guys so much.

Closing

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