A Positive VBAC Experience!
A Client Success Story!
This week, I want to highlight one of my birth prep clients who came to me at 36 weeks pregnant with the goal of a VBAC (vaginal birth after Cesarean). During the labor and delivery of her first two children, the position of the baby was suboptimal and ultimately led to a failure to progress with pushing, leading to two C-sections. For her third child, she was determined to learn and prepare her body as much as possible in hopes of a vaginal delivery.
Over the course of our 1x/week sessions for 4 weeks, we worked to improve the mobility of her hips, pelvis, and lumbosacral spine with gentle joint mobilizations, PNF stretching, cupping, scraping and myofascial release techniques. We addressed tightness of the adductors, hamstrings, quadratus lumborum, lumbar paraspinals, diaphragm, piriformis and gluteals that were contributing to lumbopelvic pain and mobility restrictions. The sidelying release technique from Spinning Babies was one of her favorites each session, as it was hard to find time with her partner to recreate the effective stretch at home. Her stretching program focused on improving pelvic inlet, mid pelvis, and pelvic outlet mobility combined with diaphragmatic breathing to optimize baby’s position in the weeks leading up to and throughout labor.
When we started push practice, her initial strategy was to hold her breath, engage the core and tighten the pelvic floor. During the internal pelvic floor assessment, there was notable tightness and pain limiting the ability to effectively coordinate pelvic floor muscle lengthening and expansion, which are crucial for a vaginal delivery. After manual release techniques and teaching her how to use a pelvic wand for self-release at home, the tenderness and pain of her pelvic floor resolved, allowing her to improve her ability to lengthen and relax the pelvic outlet.
After working together, we were able to improve her coordination to where she could exhale, engage the abdominals and expand the pelvic floor in a variety of delivery positions suitable for with or without an epidural.
She had a calm confidence at her last visit and told me how prepared she felt this time compared to her first two deliveries. Whatever happened, she knew that she had done everything possible to optimize her outcome because she invested in her knowledge and physical preparation. Ultimately, she went into spontaneous labor and was able to achieve the vaginal delivery after two Cesareans that she had hoped for! Mom & baby are both healthy and we are looking forward to seeing them back in the clinic to start postpartum rehab.
Bringing babies from the womb to the world is a wild experience that is largely out of our control, but we know that knowledge and preparation empower outcomes. Even if things don’t go exactly as we hope, increasing our awareness in advance improves advocacy and can change the trajectory of our responses, leading to less birth trauma carried into the future.
Dr. Rebecca Acevedo, PT, DPT
Evolve Physical Therapy
