VBAC: How one mom found the support she needed

Medical City Healthcare - November 10, 2021

During her first pregnancy, the only thing Tatyana Rozenberg Bloom wanted more than a healthy baby was a natural labor and delivery experience. For her, that meant a vaginal birth with no pain medication. Baby Jacob was born healthy and strong, but due to complications of his breech position and her low amniotic fluid, Tatyana had to have a C-section. With her second pregnancy, she was even more determined to have a natural labor and delivery. Called a “VBAC” — vaginal birth after cesarean — here’s how Tatyana found the support she needed to have her dream delivery.

Choosing the right labor and delivery care team.

Tatyana discussed her options with Dr. Maria Reyes, the OB-GYN who delivered Jacob at Medical City Dallas in 2020. She also worked with Caroline Marrs, MD, a maternal-fetal medicine (MFM) specialist. In addition to the complications with her first pregnancy, her age put her in the high-risk category.

“I worked with an MFM this time around because at 35, I’m considered high risk,” Tatyana says. “I saw her every other week for a sonogram and monitoring. She was really reassuring and made sure I was comfortable and calm. In addition, I saw my OB every week toward the end.”

During her first pregnancy, which took place during the height of the COVID-19 pandemic, Tatyana felt it was important to have a doctor and care team who really try to help moms achieve their desired births without sacrificing the safety of mom and baby. Despite the change in her birth plan, she trusted Dr. Reyes and the team at Medical City Dallas to deliver her second baby.

“I really wanted to deliver at Medical City,” Tatyana says. “ I already knew what to expect from the room, the service, the food. I was thrilled last time and it exceeded my expectations again.”

Is VBAC an option?

In deciding whether a VBAC was the best delivery method for her second child, there were several factors for Tatyana and Dr. Reyes to consider.

According to the American College of Obstetricians and Gynecologists (ACOG), one rare but serious risk with VBAC is rupture of the cesarean scar on the uterus. There are several types of uterine incisions and some types are more prone to rupture than others.

You won’t be able to tell what type of incision was made to your uterus by looking at the scar on your stomach, which is why it’s vital that your physician has your records. ACOG notes that VBAC should take place in a hospital that can manage life-threatening situations for both mom and baby. It’s important to make sure the hospital you choose offers VBAC and has specialized labor and delivery services available should you need them.

Dr. Reyes gave Tatyana the green light for her VBAC at Medical City Dallas. With her care team and No. 1 choice of hospital in place, Tatyana went in search of a doula.

How a doula can help moms during pregnancy and childbirth.

While a hospital is the safest place to give birth, according to ACOG, many moms would like to have a more natural experience. Hiring a doula is just one of the many ways to have a natural childbirth environment in a hospital. If this appeals to you, check to make sure that your hospital supports this option.

“I hired Melissa Espey-Mueller at North Dallas Doula Associates on the recommendation of my OB to make sure I had the best chance possible to handle any situation,” Tatyana says. “A doula will walk you through your pregnancy, talk through your options, show up to the birth, make sure you understand everything that’s being asked and provide postpartum support. They empower you to advocate for yourself.”

“They can also tell you what they’ve seen in their experience and help you navigate the medical language,” she says. “If the doctor’s explaining something to you and you don’t have a medical degree, it can be really hard to unpack. However, by no means do they step in the way of the doctor. They will defer to your doctor in all medical circumstances.”

Special VBAC delivery thanks to a special nurse.

Although Tatyana was about to become a mom for the second time, she hadn’t gotten this far in her first pregnancy or carried a baby that wasn’t breech (backward, in a feet-first position). She had no idea what labor would feel like.

“I called my doctor’s office and then my doula because I wasn’t sure if that’s what I was feeling,” Tatyana says. “I thought I would progress like a first birth since I had never experienced labor, but I progressed really quickly. I was going to try for no epidural to increase chances of a VBAC, but I was in a lot of pain. I almost wanted to have another C-section because the pain was so bad, even though I knew how hard the recovery is after a C-section.”

Tatyana credits the staff at Medical City — and one nurse in particular — with fulfilling her dream of having a VBAC. As she progressed through the stages of labor, Tatyana nearly threw in the towel.

“Nurse Rachel made a huge difference and is a big reason I had a VBAC,” Tatyana says. “I said I need an epidural or I need a C-section; I just need this to stop. Rachel was calming and reassuring and kept me on track. She told me that the pain wouldn’t last and that I didn’t have to decide right then. She made me feel like I had more than two options: a C-section or tolerate the pain. I think at that point there was a good chance I would have had a C-section if she hadn’t reassured me.”

But Tatyana hung in there and soon gave birth to Jacqueline Isabella vaginally — and exactly on her due date. (Note: Only about 5% of babies are born on their due dates — including Tatyana!)

“My baby girl’s birth was amazing and the staff in labor and delivery took great care of us in helping me accomplish the VBAC,” says Tatyana. “The nurses were extremely supportive and helpful of my decision. It’s so important to have the proper support. I’m someone who can fight for myself, advocate for myself, but that’s not the case when you’re in the middle of labor.”

“Having the VBAC allowed me to be able to lift my toddler when I got home,” Tatyana says. “The recovery was so much better and I felt so much more like myself. I want to give a big thank you to everyone at Medical City.”