Today's episode is a combination of 3 birth stories and then a chat with a fellow birth worker named Meagan Heaton, co-founder of The VBAC Link. She shares a bit about her three births, which include two cesareans and one vaginal birth after two cesareans. Then Meagan & Lisa chat about vaginal birth after cesarean. This episode should be interesting and educational even if you're expecting your first baby and haven’t ever had a cesarean. The strategies and information in this episode could help you ensure you’re hiring a medical care provider who's only going to intervene and do a cesarean if absolutely necessary. It’ll also help you think about questions you might want to ask as you’re hiring a care provider whether it’s your first time or you’ve had a cesarean and would like to VBAC. A lot of expectant or new parents have said, after having a cesarean, they thought it’s “once a cesarean always a cesarean” for any subsequent births. But if someone has a cesarean, it’s evidence-based in the majority of cases to give that person a chance to give birth vaginally if they’d like to. So we’ll do some mythbusting on this today. Lisa & Meagan also discuss some of the reasons why they don’t believe 39-week inductions that’ve been all the rage since 2018 due to the ARRIVE Trial are leading to fewer cesareans.
Resources:
VBAC Link Group on Facebook (anyone can join)
CBAC Link Community Group on Facebook (for folks who’ve had more than one cesarean)
The VBAC Link Course: - 20% off - promo code BIRTH20
Deciding Between a VBAC and a Repeat Cesarean: 7 Questions to Ask (ACOG)
Sponsor links:
Free “Pack for Your Best Birth” Packing List (with free mini-course option)
East River Doula Collective (find a doula, attend our free “Meet the Doulas” event)
Birth Matters NYC Childbirth Education Classes (Astoria, Queens and virtual)
*Disclosure: Links on this page to products are affiliate links; I will receive a small commission on any products you purchase at no additional cost to you.
Episode Topics:
Meagan's Personal Birth Journey
The Impact of Language in Birth Experiences
The Role of Intuition and Support in Birth Choices
Becoming a Doula: A New Calling
The Birth of The VBAC Link
Finding the Right Provider for VBAC
The Importance of Patience in Labor
Navigating Posterior Babies
Deciding Between VBAC and Scheduled Cesarean
Assessing VBAC Candidacy
Supporting a Partner Through VBAC
The Impact of Inductions on Cesarean Rates
Believing in Your Body's Ability to Birth
Resources and Support for VBAC
Interview Transcript
Lisa: Welcome to the Birth Matters Podcast. Today our guest is Meagan Heaton. Meagan co founded the VBAC link with Julie Francum in 2018. Although she always felt called to the baby world, she really found her love for birth in 2014 after her second C section. Through these two birth experiences, her love and passion grew around VBAC.
She wanted to help people feel supported and loved. I love that. She had two C-sections and then went on to have A-V-B-A two C, a VBAC after two cesareans, and has now supported over 300 families through her birthing journeys as a doula. Welcome, Meagan. I'm so glad to have you here.
Meagan: Thank you so much.
It's such a joy to be here chatting with you. We had so much fun even just before we started recording, so I'm so excited for today's episode.
Meagan's Personal Birth Journey
Lisa: Ditto. Well, so can you just start out sharing a little bit about your own personal journey and what brought you to the work you're doing now?
Meagan: Yes, so just like you had said, I had two cesareans.
And my first was It's like a lot of people's firsts, unexpected, and for me it was undesired. I wanted to have a vaginal birth, but I didn't really do a lot to prepare myself. So I found out I was pregnant, downloaded an app, and that's about as far as it went. I waited for that app to tell me every week what I should expect and how big my baby was Just assumed that I would have a baby just like everybody else in the world is having babies.
And I was definitely not expecting my water to break before contractions really started. And I went right into the hospital because that's what I was told to do. And they immediately wanted to induce me. My contractions weren't really going. I wasn't really dilated at that point. So they immediately put me on Pitocin and then the cascade kind of went from there.
Pitocin, epidural, Fetal heart tone drops after the epidural, which doesn't always happen, but it did with my baby. She recovered, but then I didn't really progress even with them upping Pitocin. And so after 12 hours of my water, after my water broke, which is very little, I was told my body didn't know how to do it and that I needed to have a cesarean.
And I really just didn't know, I knew I didn't want that, but I didn't really know my options then and I didn't really have anyone in my corner to help advocate for me or even remind me of my options and so I was wheeled down, uh, to the OR. And I had my baby and of course I was happy that everyone was good, but I just remember feeling so groggy and out of it and Disconnected.
And I know that not every cesarean people don't feel, you know, disconnected, but I really did. I remember laying there thinking, Hagen, aren't you supposed to cry? Like, your baby's crying in the corner. You, you shouldn't be crying. It was the weirdest battle in my head. And I just knew that after that, like I got home and I was like, I don't want to do that again.
And so I got pregnant again, a couple of years later. And,
The Impact of Language in Birth Experiences
Lisa: Before you move on, can I just ask a quick question?
Meagan: Yeah.
Lisa: Something really stood out to me when you said something along the lines of, they told me my body couldn't do it. Did they, did they make you feel that way?
Meagan: Yes, they did. They did make me feel that way. They're like, your body just doesn't know how, it's not progressing like it should.
Lisa: That's such disempowering language. I'm so sorry.
Meagan: I know, and language is so big, and that's something I've learned so much through being a doula, and then of course, a mom, going through the birth journey, but they also, of course, said the word failure, and I, I absolutely hate that word.
Lisa: Terrible clinical term, right?
Meagan: It really is, and I understand that it is a clinical term, and it's the same thing with TOLAC, trial of labor after cesarean. It was really hard to hear, oh, she's a TOLAC. No, I'm not trying to do anything. I am going to have a vaginal birth. I had to like, at the time, I wasn't able to kind of separate those and like, that's their medical word.
That's the way they use it. I don't have to let their word affect me. So when I would hear failure and when I hear failure now, it's not failure in my mind, even though I hear it, I don't compute it into my brain as failure. And I think that that is so important because a lot of people every day having babies are being told things that Like, and have words impact them.
Lisa: And like, incompetent cervix is another one that comes to mind, is like, are you kidding me? Like, stop! Stop it!
Meagan: Or a, yes, or a non proven pelvis.
Lisa: Yes! Yeah.
Meagan: My pelvis is great, guys! Like, I don't have to prove anything to prove anything!
Lisa: Right? Totally! Yes! Yes!
Meagan: Yes. And so, yeah, yeah. I was made to feel that way. I remember on the way down, I was feeling really nauseated because they had come in and given me more like epidural and medicine and all these things.
And I just got really overwhelmed and nauseous. And I just remember laying there thinking, I really failed. I really failed. You know, this sucks. And I didn't fail. I didn't fail. I was failed. I was failed. I did not fail. And I just, I. I didn't know that then, right? And so when I became pregnant with my second, as I was learning more and growing more, I realized that it was more failure to wait.
My body was doing great. I had made it to 3 centimeters in 12 hours with premature rupture of membranes, meaning my water broke before contractions began. And I feel like I was doing really well. I wasn't even an active labor at that point and I was progressing so they shouldn't have been able to legally deem me failure to progress because I had progressed and it, you know, even though my water had broken, I had still progressed.
So anyway, I learned a lot and was still learning along the whole pregnancy. But there wasn't a ton out there. I went to some ICAN meetings and, you know, stuff online.
The Role of Intuition and Support in Birth Choices
Lisa: And for those not familiar with ICAN, can you explain?
Meagan: Yeah, International Cesarean Awareness Network. So they are a great place and they have chapters all over.
So we would have, we had a couple chapters nearby. There was one within 45 minutes of me and one within 10. And so they would have meetings where they would come together and they would discuss feedback and discuss supportive providers and even have supportive providers come to these meetings, which was amazing.
And actually where I met the doctor that will come into play in my third pregnancy. So, anyway, yeah, I was going to ICANN meetings, being filled with love, but also still had just Not a lot of information. I learned about doulas later on in my third trimester. And I also had my intuition tell me you should switch doctors.
Now this is something I talk about on my podcast all the time is intuition. And I'm sure you, you talk about this and preach this and hear this within your clients, you know, your clientele and your courses and everything. Intuition is so big; It's so powerful. It's one of the most powerful tools we have. And I ignored it.
I just let it sit there. And I didn't switch providers because I had this weird feeling of, Oh, he's given me care this whole time. He said I could VBAC. And I felt like I was going to cheat on him or something if I left. It was the weirdest feeling. But as I've learned and, you know, heard hundreds of stories, this is actually a very normal feeling.
It's very daunting to switch providers. So I didn't switch providers, which was my number one mistake in my opinion. Didn't hire a doula. Husband was not on board. It's funny because I listened to a story that you recorded and I sort of like the husband was more like, let's do homebirth. Let's do this. And then the wife had to get on board.
You know, and it was opposite with me where I was like, I want to do these things. And my husband's like, no, he was offended. Anyway, needless to say, yeah, he was offended that I wanted to quote unquote replace him, which was totally not the case, but yeah, we got into a big fight at dinner one time. It was very memorable.
but yeah, I had my water break again. Lucky me, just, PROM every time. They say 10 percent of women have their water break before labor begins, and I'm two for two at this point, and my husband was in Texas. He was far away, so we're in Utah, he was in Texas, so I had all the time this time to wait for him to come home, and I really had learned a lot that you didn't need to rush in, water was clear, I was good, no temperatures or anything like that.
So I was just laboring, and when I say laboring, Contracting every 20 to 25 minutes, probably. and when he got home, my mom and him just were like, dying. They're like, you have to go, you have to go, because That's what we are shown in videos and movies and TV shows, right? Your water breaks, baby must be coming.
And I fought back for a little bit then finally just so that, okay, that's fine. Went in and my nurse was a doula, which was amazing. My husband fell asleep after the rush of getting home and we worked together. And then her shift changed and everything changed. I was pretty much told it wasn't going to happen for me.
Yeah. You know, my pelvis was now, you know, too small. We were talking about that again. We were talking about my body not knowing how to do it. I was one centimeter. I was begging for Pitocin. I was literally begging. I was like, put me on Pitocin. They're like, no, can't do that. That's a contraindication, which I had learned is not a contraindication for VBAC.
Does it increase risk slightly? Yes, it does. Gives us like a 1.1 percent chance of uterine rupture, which I was, that was acceptable for me. I felt very comfortable with that. But. No Pitocin, no Foley, no nothing, just nothing. And, needless to say, I walked down to have my second cesarean. And I was frustrated.
I was really frustrated. But my husband was like, Hey, she wants to watch it and be involved this time. Which I loved so much that even though he, in my mind, wasn't caring or paying attention to what I wanted, he was. And so I did. I watched my second Cesarean in the mirror. So I was able to see my baby come up and they were talking to me this time instead of just to each other about the weather.
And my anesthesiologist was playing music and checking in on me. And it was just so amazing. And then they put my baby on my chest, skin to skin in the OR, which Yeah, it was, it was what made it healing, being involved in my birth, even though that's not the birth I wanted, not the outcome, it was so healing for me.
So I've had a cesarean that was undesired and left frustration, another cesarean that was undesired but left healing, which I think is so powerful. And I tell people on the podcast all the time, cesareans don't always have to be traumatic. They can be healing. And I was so grateful that mine was.
Becoming a Doula: A New Calling
And so, yeah, I got into the post op room, holding my baby in the dark, my eyes kind of swollen and puffy. And I got my phone and started Googling how to become a doula. Which is totally silly because I should be bonding. I should be bonding with my baby in this moment.
But I was like, no, I want to help people feel what I felt in the first part of this labor. This love, this support, the compassion, the education, the guidance, just everything that she provided was it. It was it for me. And I was like, I want to do that for people. I want that. I want that. So yeah, I decided to become a doula right out of the OR.
Lisa: That is so amazing. I just want to chime in real quick just to mention for listeners that I love that you just shared some, a little bit of gentle cesarean techniques that were incorporated into your second belly birth. I don't know if you're okay with that use of that term.
Meagan: You can call it whatever.
Lisa: Yeah. Everybody calls it something different. It's comfortable with it, right? Yeah, I just feel like that de-stigmatizes some of it and helps it feel more like a birth, but everybody's different, of course. Um, so, uh, two episodes ago, on episode 120, we just had a couple of OBs who incorporate gentle cesarean techniques, which are not readily available in our city.
And so for listeners who haven't listened to that, you can go over and listen to some of those things you could discuss with your provider in the event that a cesarean Is needed or might be needed. So I'm glad that they were able to incorporate some of that for you.
Meagan: Me too. Me too. Because having my baby placed on my chest and touching my face made me feel that connection that I didn't feel with my first, I was kind of shown my baby.
And then she was gone. I mean, just gone. She was removed from the room. And, yeah, so clear drape, but you know the, like, big belly bands they hold monitors on? Like the toco and the baby? So they put that on as a tube top. And even if they don't have that, listeners, you can get one. Just have it in your bag.
But I had that and they stuffed my baby down in there. So she was really nice and secure because, you know, There is some restriction within a cesarean and then I also requested not to be tied down, because sometimes they can strap our arms down.
Lisa: Right.
Meagan: And so that, oh my gosh, just the world of difference.
So definitely suggest going back and listening to that episode of yours because it did make a huge difference.
Lisa: Thank you. So you became a doula and that's so exciting. That's just amazing. That it was right after the surgery.
Meagan: I know. I researched how to become one and then I registered before I left the hospital. My husband was like, Oh my gosh, he's like, you can't stop talking about this. And I was like, I know. I just felt so called to it. In fact, I literally felt this adrenaline, you know, when you almost get pulled over and you kind of get like all shaky and stuff.
But like, that's like a nervous shaky. I had that, but it was like excitement. And it was like, this is me. This is what I want to do. And so I did. So I registered and then my baby was, let's see, five months old. And I took the course and I loved it so much. And so I, I just really, I. took it off. I just took off.
The Birth of The VBAC Link
I was like, I'm going to do this. I feel so passionate and called to this. And so I dove in and I would be lying if I didn't say I dove extra head first, like I, you know, really fast in the VBAC world because I knew that I was going to VBAC one day and we did want another baby. And so I wanted to start my research really early.
I didn't want to be in that moment of, Oh, I'm pregnant now. I should start researching. I wanted to find my provider, I wanted to get the information, I wanted to know the stats, I wanted to know everything, because now I had two. So, there was even less information about two cesareans out there. So I started interviewing providers, and I'm not kidding, like, twelve providers, you guys.
Like, twelve. Yes, I wanted to make sure I had the right provider.
Lisa: Good for you!
Meagan: Yeah, I found the one. He was so awesome. And as soon as I got pregnant, I went to him and I was like, you're my guy. And he was like, great, I would love to. You can do this. He did use the calculator on me, which if anybody has never heard of that, there is this calculator that was created.
And I have a lot of feelings about it, we won't get on that soapbox today. But, it was created and providers look at it and type in a little bit of your history and then it gives you a percentage. Okay, this percentage, I just want to totally nix the myth. If they give you a percentage, that doesn't mean that is actually the chances of you birthing your baby vaginally.
So, I knew that at that point. I was like, okay, cool, do your calculator on me. And he was like, oh yeah, cool, this is, this is okay, I think you can do it. I'm like, great. He's like, I just think you never were given a chance. And I'm like, no, I don't think I was either. And so yeah, so I became pregnant and was obsessed and attending births and getting ready for my birth and just loving, loving everything about life in the birth world.
And 24 weeks came along. And I decided I should switch. So I switched, which was really weird. But I switched providers, I switched to a midwife out of hospital. And I had to keep this one a secret. I had to really kind of not tell people what my real plan was. Because I had to protect my space. And I think that is okay, so to all your listeners, It's okay to protect your space with your due date, it's okay to protect your space with your plan, as long as you feel confident, that's what matters, right?
You need to feel confident. You don't have to have other people that feel confident about your choice around you. And unfortunately, like, my mom didn't feel comfortable with my choice, my mother in law definitely did not feel comfortable with my choice, and so I just didn't talk about it. I was still going to the OB.
And for a little bit, I was. I was doing some dual care. Just, you know, in the off chance of needing to transfer, I wanted to have that established. So anyway, the day came and voila! My water broke again. Oh goodness.
Lisa: What is it about your (water breaking)
Meagan: I do not know. This time I took, I took, I did take vitamin C, but I did realize that I maybe didn't take enough.
So vitamin C can increase the durability of your bag and amniotic sac. So that's a tip. So anyway, it broke. Threw a little fit. That's okay. Had to get a little bit of my feelings out. And then my contractions started. And we labored and labored and labored. Had a posterior baby for a while. And 42 hours later, I was invited over to a birth stool where everybody surrounded me.
And my midwife said, you're gonna have your baby and I started pushing and I started pushing and was like, oh my gosh That's a lot of pressure and I knew it like I was like my baby's coming out vaginally I am doing this and then the next contraction I pushed my baby out and my midwife said, "Meagan, grab your baby. Reach out and grab your baby." And I did. I just grabbed him and I just reached up and I put him on my chest. And he didn't even cry. He was so calm. And all I could do was scream, I did it! I did it! I did it! Because I was so exhausted, but so excited. And everybody just was crying. I looked around, everyone's tears flowing down their faces.
And it, yeah, I would say that day transformed me. I, it was a transformation in me, a hundred percent. I knew I could do it before, but then it was like, holy cow, this is so possible and everyone needs to know it, you know? And so I was, yeah, I was asked. By a friend, Julie Francum, who called me one day and said, Hey, I want to do this. And then the VBAC link was born.
Lisa: Amazing. I'm just getting all the chills.
Meagan: It was incredible. And it's crazy to think like it was eight years ago. And I just, I still remember the feelings and the emotion and the faces and the tears and I just remember feeling everything. Birth is just amazing and it sticks with you, which is why the VBAC Link started because we want to make birth after cesarean better.
Lisa: Absolutely. I'm so, so grateful for the work that you're doing because it's such a needed resource. And yeah, just, Want to help you spread the word
Meagan: Well, thank you.
Lisa: I just wanted to mention I'm going to link to all of the different places that you can follow and where the courses are.
And maybe we can talk about that in a little bit after we chat more about all things VBAC. But they have a great podcast that has so many episodes. They're putting me to shame. They started the year before I did and have like triple the number of episodes. It's really, really impressive. And so, yeah, so many wonderful stories.
I've listened to several, but I just want to keep listening because it's really wonderful. And if you want to listen to Meagan's birth stories in more detail. It's wonderful. Highly recommend it. Toward the beginning was, I think, maybe episode two or so.
Meagan: Yeah, two or three. And then we rebroadcasted it later on.
But yeah, you can hear more detail. I was actually interviewed by Julie in detail about the birth story. So yeah, talking about what we did through labor and, and all those things. Yeah, it's a good one. And. Yeah, this, I think the podcast is one of the best places you can learn through other people's stories and other people's journeys.
And it's kind of funny because we focus on VBAC, which means people who have had cesareans, but I really think it's such a great resource for first time parents. Like really dive into why cesareans happen. What is the cascade that people talk about? How to avoid the cascade. And that's, you know, between the podcast and then our How to VBAC course, that is our goal to help you guys learn and feel more educated because me and so many other people in this world are having unexpected, unplanned, undesired cesareans.
Finding the Right Provider for VBAC
Lisa: It's so true. And. One thing that one of the OBs on our gentle cesarean episode said when I asked them the question, I was just curious to see what they'd say on if someone were to ask, what rate of cesareans would you recommend in terms of being a good sign of a provider who's not doing too many unnecessary or preventable cesareans?
And I love that they gave me such a nuanced answer. But the thing I wanted to point out in their nuanced answer was one of the doctors, Dr. Mussalli said, ask them about their VBAC rate.
Meagan: Yeah.
Lisa: Before you're even there, because that can be very telling. And we were talking about asking open-ended questions and that also gets them talking and kind of gets a better sense of their vibe and a more nuanced answer rather than just. I mean, we can have a number in mind, but not making our decisions solely based on that. So, that really resonated as you were saying that all your resources, including your podcast, can be such a helpful resource for first timers.
Meagan: Yeah.
Lisa: To navigate all of this.
Meagan: Mm hmm.
And we have a list of supportive providers that people are giving us all over the world. Like, seriously, all over the world. Amazing. So, for first time parents, like, find a provider that doesn't do unnecessary cesareans, and that is pro VBAC and things like that. Like, start there. I think, yeah, there's so much to talk about with first time parents, but yes, we will move on to more VBAC.
Lisa: Yeah. So say someone has had one or more cesareans and they're seeking out a VBAC supportive provider, what are the secrets to really discerning that? Especially with your, I mean, you have so much experience, and my mind is going back to interviewing 12.
Meagan: 12, I know.
It was a little ridiculous maybe, but it was what I needed to do. And then everybody was like, you're changing providers? After I found the right provider, he was like the VBAC doctor in Utah. And I was like, yeah. My intuition is telling me I should go out of hospital, and I can't ignore it this time.
Lisa: You're gonna always listen this time, yeah.
Meagan: Yeah, so, okay, let's talk about questions. You kind of just mentioned that, is asking open ended questions. Anyone can say yes or no, and they can say it with a smile on their face. Confidently. Yes, No, you know, they can. And that doesn't give us the answer. So asking questions like, how do you feel like the VBAC percentage rate, but how do you feel about VBAC?
We'll get to know a lot about how someone feels about VBAC based off of what their face does originally and if they're like, Uh, uh, yeah, you know, or you know what? I absolutely love them and I encourage them. Sometimes it's not applicable, but it's really something I want to talk to about my clients or my patients and there's pros and cons for both sides.
Okay, okay. Then, what are your requirements for VBAC? Because, weirdly enough, there are requirements, and this is how we can kinda decide if your provider's maybe on the more, like, friendly, okay side versus, like, no, I do everything I can in my power. And answers like, yeah, VBAC is totally possible, but there are some restrictions, like you have to go into labor by 39 weeks spontaneously, because we won't induce.
You have to get a just-in-case epidural. There's no Pitocin, so your body has to continue going on. And if after four or five hours it's not doing it, then it's probably not going to happen. You know, all of these restrictions, or, we have to start growth, ultrasounds. To, you know, make sure the baby is not too big, starting at 38 weeks, like all of that, you guys, red flag, red flag, red flag, big, big, big red flag.
If a provider's like, You know what? There aren't a lot of things, there are some medicines like Cytotec that we can't use, but we can do slight Pitocin if that's necessary. We like to let your body go to about 42 weeks, and if not, you know, we want to discuss possible induction or what you'd like to do after that.
We would maybe do, not NSTs, starting at 41 weeks, doing things that are more along the lines of evidence based care. And not just putting, you can if you check these boxes, you know, those are really those things that are going to be good deciding factors if your provider is going to support you or not.
And just overall their feeling and attitude towards it. Like, uh, sure, you know, that's maybe not the provider you want to go with. So yeah, and I actually think finding a provider is one of the number one things you can do to help your chances of the VBAC.
Lisa: Yeah. Yeah. And listeners of this podcast, or people who've come to my birth class, hear me harp on this all the time.
Like your choice of birth setting and provider is everything. It's such, such a fundamental thing that is either positioning you to, to really have the best chances of having the healthiest, safest, most empowering birth possible. Or very much not, you know, and that it's never too late to switch, although, you know, options shrink, admittedly, the longer we wait, but yeah, so you're reinforcing this within this context.
So thank you. Yeah. What do you think about asking, how often do you have VBAC clients or how, I mean, do they keep track of their success rate?
Meagan: I mean, I think they do. If a provider dodges the question of how many cesareans do you do? How many VBACs do you support?
And they're like, I don't know, plenty. Like I think that they know they have to know they might, you know, that's my opinion, but, um, I think if they're like, I do VBACs all the time. In fact, I encourage them, like, okay,
Okay, you know? So yeah, I really think it's all within how they talk to you, how they, if they're questioning, well, how big was your baby last time?
That right there? Problem for me. Like that means that in the future they may be questioning our baby's size, right? So I really just think going in and having conversations. Now cesareansrate.org used to show provider's cesarean rates. They don't anymore. I don't know why they took that down. But I also think one of the reasons or questions to ask is: In the event of a cesarean, like, or what would be the event to have a cesarean?
The reason for a cesarean. Tell me the reasons why you would call a cesarean. Because if they're like, oh, because you've reached 41 weeks, or oh, your baby looks too big, or oh, it's within three hours, you're not progressing, these are things. So, ask why they would, and then ask, You know, what do you do to help your VBAC clients achieve their VBAC?
What do you do? What, because I think that's telling too. If they're like, oh, we just sit there and let you do it. If you don't do it, then no. Or if they're like, I'm going to do everything I can. I am going to support you and we're going to walk through this together. Because I want this for you just as bad as you do.
Okay, you know, can you see the different feelings there? And there are providers that do that are on both sides of that. Like, those are actual true things that have been said. So, I think really getting a feel and having that conversation, what will you do to help me get this VBAC? I think that's important
Lisa: And in terms of helping people decide their birth setting, whether it's in a hospital, a birthing center, or home birth, I would imagine that just really has more to do with their comfort level, as it would. In any birth situation, um, and their, you know, risk tolerance versus, you know, where they perceive risk versus not.
Yeah.
Meagan: Yes. And I really think that people need to get educated before they make a decision on anywhere. And I also know that finances can be a big impact with out of hospital versus in hospital. Because a lot of in hospitals insurance covered, right? And it's the same thing with midwives and OBs. I just, today in one of the Utah forums, the birth community, they were like, I really want a VBAC.
You know, and everyone's like midwife, midwife, midwife, midwife. And she's like, I just can't do a midwife. They're not qualified. And there's just, that's just so not true. And so I think really diving into the education for yourself. So you can make that an educated decision. Like if you just think home birth is scary, but you haven't done the research, then you're probably not making the really smart, educated decision.
Now, if you've done the research and the risks are not acceptable to you, then there you go. But don't just like, I can't, I won't, unless you know. And that's how it was for me once I started realizing how my chances would possibly even increase to have a VBAC after two cesareans out of hospital with this midwife.
I was like, this seems like a no brainer. I had a backup plan all was well, but yeah, I think don't knock something until you really know what you're knocking.
The Importance of Patience in Labor
Lisa: Agreed. Yeah. Yeah. And the thing that stood out to me, Meagan, with your three stories was a huge difference --and we see this all the time in the different birth settings-- a huge difference in the amount of patience with a CE time, you know, that was given to you, didn't you say 40 something hours with your third? 42.
Meagan: Yeah. And it took a long time to really get into that active contraction pattern, which I think it did for all of my labors. I think I would have totally been able to deliver vaginally if we just sort of left me alone.
And that's why I was kind of talking about that in the beginning is failure to wait. Like no one just waited. And let me go, and I rushed into the hospital, so there was that, like, I knew that when they got there, they wanted to do something, but yeah, patience, patience is so, so key, because sometimes, I say this in our course, our bodies aren't robots.
We don't, we don't just push a button and get to move our arm one way or progress one way or whatever.
Lisa: Our bodies are like, what's a textbook? What is a textbook? I don't know if they behave according to a textbook.
Navigating Posterior Babies
Meagan: It's just, and we're all different and every baby's different. And what I had learned is my babies had to get into my pelvis posterior.
That's how they needed to get down to navigate their way all the way down. And so that means I had to navigate posterior babies. Yeah. And that's okay. I accepted that and learned that and worked through that, but I had a team. Yes, I had a team that was willing to give the time to me and support me along the way.
So yeah, time is so key and it's so hard because we have so many people. And trust me, I was one of them. You guys, I took castor oil running up State Street, downtown, trying to get a baby, jumping on trampolines, trying to get a baby out. Cause I was done. It's hard to not be done, but try your hardest listeners to embrace those last moments with your baby inside of you.
Love them. Even if you're miserable. I know it will come to an end. It will end, but trust your body. It knows what to do.
Deciding Between VBAC and Scheduled Cesarean
Lisa: Love it. So now what if someone who's had a cesarean is having a really hard time deciding, like, they've heard that they might be able to have a VBAC, but they're really having a very hard time choosing, making a decision between scheduling, you know, their provider is saying, hey, we can do either.
What do you want to do? How would you answer that? I always have a hard time. I often just try to do some reflective listening and, and ask them for more information. You know, what are the things you're thinking about? What are the things you're struggling with? But what would you say, Meagan?
Meagan: Yes. So I also, if I have a client that's unsure what they want to do. Or not even a client. If I have a friend or someone that has reached out to me, a consult within the VBAC link, it's very much listening. Why, why are you questioning? What is, is it fear? Is it past experience?
Is it doubt in your own ability because of what's been said. But I find that it always comes down to a lack of education. That is what I find every time. It's that we just don't know. And the world makes VBAC sound very, very scary. Very scary. Because when we hear the word uterine rupture.
That's terrifying. And so it's scary. And we know a cesarean, so it's hard to steer towards something we don't know from something that we do know.
Lisa: So true.
Meagan: I think that my tips would be educating yourself, and I mean really diving in. That's why we created the How to VBAC course. We are going over both the pros and the cons of cesarean and VBAC.
It is not a one sided course. It is not just How to VBAC because not everybody's going to choose it and they're undecided for a long time so know the pros and cons of both know the history of both know the Trying to think of the word right now the repercussions even long term. Okay, so cesareans have long term risks that people don't think about.
Things like bladder adhesions and, or even just dense adhesions in general. Things like infertility in future babies or placenta accreta and previa increasing. And so, it's so hard, but I think breaking it down and deciding what feels best. And that takes you learning.
Assessing VBAC Candidacy
Lisa: Right. So true. How does a provider assess whether someone's a good candidate for a VBAC?
Meagan: So I mentioned the VBAC calculator that they pull out sometimes and they will assess things like past birth, did you get to 10 centimeters? Did you push a baby out? Have you pushed a baby out in general? We talk about scar thickness sometimes. Now there is a whole episode that talks about scar thickness and qualifications of VBAC with Dr. Fox on our podcast. And I highly suggest going to that. Yep. Dr. Nathan Fox. Yeah. So, and we really kind of debunk that whole thickness thing where it's like, if you don't measure this thick, you can't do it, but that's not really necessarily the case. So, but they'll mention, you know, the thickness of the scar.
Duration, how close you conceived after your VBAC, which is another really burning question in the VBAC world. How soon can I conceive after, if I conceive before 18 months, am I doomed for another C section, uh, which is No, you're not. But yeah, so these are the things that they're looking at. They want to know if you've had that quote unquote proven pelvis, proven cervix, if your cesarean scar is a low transverse, you know, incision, or if it's a special scar.
And that's a whole topic in itself, special scars.
Lisa: Right? Yeah. In other countries, I've heard that They not necessarily, depending on where they came from, if they're coming to the U. S. It can sometimes be two different incisions through different layers. Like, one vertical, one horizontal, which I did not know that until recently.
Meagan: Yes, and we've even seen two transverse, one low, one high. And sometimes that can be based off of if it was a preemie baby or if it was a really stuck baby. Sometimes if a baby is in a weird transverse position or something it can tear a little bit more and it's happening here in the U. S. as well, special scars, but, and, and there are some increased risks, right?
With different types of scars, but people still VBAC and do it safely, but they're going to look at all of these things to see if you are a quote unquote, good candidate. Now, I was a mom that never made it past three centimeters, never got a baby out of my pelvis. So I was maybe a lower candidate, right?
And then the second time never made it past a one. So a lot of providers may be like, No, she doesn't, her body doesn't dilate, it doesn't work. But then, obviously it did. So even know that if someone is rating you and your ability, whether it be on a calculator or not, based off of facts that you've had, there are likely other situations that stacked up that caused a cesarean a lot of the time.
So they look at these things. I think it's important to take them into consideration, hear what they have to say. But know that it's not be all end all, if they're like, you're just not a good candidate. APA actually says that like 90 percent of people are candidates for VBAC. Which is a very large chunk of people.
Lisa: Who said that?
Meagan: The American Pregnancy Association. .
Lisa: Got it. Thank you.
Meagan: Yeah. And you know, and really the success is like 60 to 80, but we know that VBAC rates are low. I mean like in the 12%, yet the cesarean rate is 32.1 as of 2023, I mean, we've got, we've got a problem here, which is also another reason why we talked to first time moms.
Let's learn how to avoid these. But I really believe that if you want to VBAC, if you put the work into it, it is definitely possible. Does it always work out? No, it doesn't always work out, but it's very, very possible.
Supporting a Partner Through VBAC
Lisa: I love that, thank you. How can a support partner support someone who's wanting a VBAC? I'm thinking more prenatally.
Meagan: Yeah. This is a really good question. My husband flat out said, I do not get it. He said the words, I don't understand why we don't just go unzip you. Those are the words that he said to me. He literally didn't get it that much. And I said, come learn with me, learn with me. And he didn't want to learn. Now I love him.
I love him so much, but he didn't care to learn with me. But partners learn with your partner. Learn and understand the reason why, and it's okay if they never understand the real, real reason why, but understand the reason why they want to VBAC. Right. And understand the real risk in VBAC, understand what your partner has to go through to get this VBAC.
You guys, it's not easy all the time, and that is frustrating, but the more support your partner has. As birthing women or birthing people, we need all the support we can get. And if our partners don't really support it or don't understand and don't have the education, it's harder to support them.
Right? So really diving in, taking classes together, listening to her. My husband listened to me. I didn't think he was listening to me, but he listened to me. Right? So when push came to shove and I was on the operating table again, he knew exactly what I said. If this happens, these things are important. And he heard me.
So listen, sometimes you don't even have to say anything. Just listen, just take a mental note, right? But really understanding the fear and then also helping protect your space. I think it's really important to protect your space. So if you know that Sally Jane, who's next door, doesn't like the idea of what you guys are choosing, it's maybe not something to talk to them about.
Right. Right? So know who, yeah, know who's in your space. I think that's really important because my husband definitely wanted to talk to people, but he didn't. He really didn't. And I said, I was as important to me that your family and my family doesn't know and it wasn't like lies and secrets. It wasn't, you know, it wasn't bad.
I wasn't doing it for ill intent. It was just, I was protecting my space. So yeah, really help, help understand, learn their desires and Yeah, be there. Just be there. Hire a doula. Don't hate doulas. Right. Because doulas are there for you, too. Absolutely. And that is something that my husband didn't understand.
And then with my third, I had multiple doulas, and he was like, I would never do without a doula, and he apologized later. Like, I'm sorry that we didn't do that. Um, so yeah.
Lisa: Yeah. I mean, I wanted to hire a doula because it was going to stress me out knowing how much was on my husband's shoulders.
I was like, no, that's too much. Like we need a helper. We need someone to support not just me, but him too. Yeah. Yeah, absolutely.
Meagan: Yeah.
The Impact of Inductions on Cesarean Rates
Lisa: Can we talk a little bit about, before we hit record, I was mentioning the term inductisection to you that our doula community, our doula collective, has coined that term or I'm, I'm sure we're not the first, but we just see far too many inductions go to a C section ultimately.
And, and it's heartbreaking for those folks who really, really didn't want that kind of birth, you know, and, and it's also a really rough, that's a rough road to go down potentially to be induced and to have all of those medications and all of that really, like often like forced labor that is harder to cope with for most people, I would dare say, and then going into a belly birth, major abdominal surgery on the heels of that.
And the ARRIVE trial that many of us think is leading to a lot of this. What are your thoughts on any of that you'd like to comment on?
Meagan: Yes, the ARRIVE trial. This could be a very long conversation, so I'll just start with saying that I do not like it. And I know that they tried to show that, you know, that it reduced cesareans and reduced preeclampsia and all these things.
And, okay, maybe a little, I mean, 19 to 22 percent, it's just really not valid enough for me. For me it's not. And like you I have seen so many Inductions being pushed and I mean pushed hard and it really did start Yeah, I would say induction was very much a thing before COVID in 2020, but since 2020 Really skyrocketed and and you know 2018 2019 Arrive trial was like heavily being looked at, but then 2020, it was like, wait.
We can control what we're doing, and that is what I feel like I have seen, is people wanting control.
Lisa: That's exactly my thought, too. Yes. Yes. When in a world that felt out of control, we were looking for any semblance of control, and so everyone was like, let's just induce, because that gives us some sense of control.
You're the first person, other person, who has said that. Yeah. Yeah,
I think so, too.
Meagan: That is where I'm finding, and I'm seeing it. I mean, you're seeing it in your group of doulas. We're seeing it on our group of doulas in our community here. The overwhelming push of induction is insane. And the overwhelming push of induction when someone is not even one centimeter dilated, 50 percent effaced, and has a hard closed cervix to the back in the posterior position is mind blowing to me. Why are we walking in? I mean, we know, we should score all that, whatever, but like, really, like, let's just let people do their thing. And so, yes, induction. You guys, I'm seeing it all the time. We're going in, we're starting with a little bit of low dose pit, we're getting a Foley, or in my opinion, even worse, which is so funny.
People are like, wait, you think breaking water is worse than starting Pitocin? This is my thing. Once water is broken, you cannot just patch that back up. You can't just put a little bit of Modge Podge and put paper over it, right?
Lisa: We're intentionally increasing our risk of infection and now we're more on a clock. Yeah.
Meagan: Yes, and if we have a higher baby and we break water and baby comes down in a weird asymmetrical, you know, asynclitic position or maybe facial, or maybe their hand was right by their head. And so now we've got a nuchal hand. We are increasing our chances of cesarean. Now, pitocin is not my favorite.
It's a synthetic form of oxytocin, but it can be shut off and it can go away from our body within time. So if an induction is taking place, I usually do say start a low dose pit over breaking your water at two centimeters, because you can stop it, right? You can stop it. So, yeah, we're seeing the push around 39 weeks.
So it's like they're going off ARRIVE trial and we are seeing providers say, Oh yeah, we'll support you if you go into labor by 39 weeks. And it's so funny because doctors all over the world are like, we will induce, we won't induce. You have to induce. We can't induce. You have to get an epidural. You can't get an epidural.
It's like, There's so many different opinions, just depending on your location, and it's like, can we just follow what is evidence based, and just get back to physiological birth, because our bodies are incredible. So, yeah, the induction led to cesarean. It's, it's almost, okay, I'm gonna say this, and it's gonna sound really bad, you guys.
But it's almost something that we can have a client come and say, okay, we, in the beginning, they didn't want to be induced. They wanted to go unmedicated, all this stuff. Now they're getting all this pressure. Now they're choosing to be induced because they've got a lot of pressure. So already their entire plan and desires have changed.
So they go get induced. And based off of where they're at, we can almost call a cesarean. And I don't try to will a cesarean to anyone's life, but it's like. What's happening is likely going to lead to a cesarean, and nine times out of ten, it does. We can see it. And, we try as doulas, really hard to like, educate you and help you learn what you're choosing, but I will say, in the end, we can't make the decision for you guys.
So, again, it comes back to that educated you know, self to make these educated decisions and know that even if you're in a really pressured spot, you do not have to say, yes, you can say, Hey, thank you so much for bringing that up. I will think about it. I'll get back to you. Or you know what? I am not saying no right now, but, but maybe later, or thank you so much.
But no, thank you. You know, I think some validation on their end softens them a little bit and doesn't put up their wall. But at the same time, standing your ground and saying no. Or maybe later, and that's only if you may want that later.
Don't say maybe later, because they'll keep coming. If you don't want it, say no. If you're really gonna entertain the idea of them breaking your water later, then say maybe later. Or just say no.
Lisa: And even if we schedule it, a lot of people think, oh no, we're scheduled for an induction, that means I have to show up.
No, you don't. Like, you can schedule it. You don't have to show up. I, although I, I wonder if they would bill you. I don't know. Actually, financially, you would want to find out what, what the repercussions might be.
Meagan: They don't, they don't. They will sometimes harass you. Why didn't you show up? Why didn't you come? You can also schedule a c section if that's something that you're wanting, but no, you don't have to go. You do not have to go. But don't schedule an induction or a cesarean if you don't have it in you, because trust me, I know it's really hard to not go. Don't schedule it if you're gonna feel pressured to go if you don't feel, it doesn't feel right.
So it always comes back down to that intuition too, like, what is your intuition telling you? But yeah, this, the induction, the induction into cesarean we're seeing it so much, so much.
Lisa: And I know there are researchers trying to disprove some of the conclusions of the ARRIVE trial. And I just want to mention, I heard from one of my clients, who just happens to be a doctor herself, but she told me that her hospital said they are not doing 39 week inductions, based on internal data and I'm like, yeah, show us this internal data because we're seeing it anecdotally as doulas, but we don't have the, the tracking mechanism to, you know, get those numbers to prove that.
Meagan: Yeah, that would be really interesting because I would like to see more of the internal facts of the ARRIVE trial to like the deep, deep parts of the ARRIVE trial, but I feel like we're probably not seeing.
Lisa: Yeah. I took a class with the OBs who did the gentle cesarean episode. I may have them back on to talk about the ARRIVE trial because they taught a great class when it first came out for doulas in Manhattan on just all the details of why they are not going to be routinely abiding by this 39 week induction thing. And they're trying to spread the word to their local fellow practitioners. Let's not, we're not going to be able to replicate these same outcomes, at least here in New York City. We can't speak for other areas of the country, but we have such busy hospitals. They just don't, they don't have the time, the luxury of giving people the amount of time that they gave people in that trial.
Meagan: And I love that you just brought that up. I love that you just brought that up because in the ARRIVE trial, they purposely tried to allow as much time, like 50 hour labors, you guys, not even kidding.
To allow it to have to avoid the cesarean, but that's not real life. It's not real life. We don't see 50 hour labors. Yeah, it's just not happening. I mean, especially those hospitals that require, yeah, require the OB and anesthesiologist to be on the whole time. You're telling me that they're going to be willing to stay there for 50 hours. No, they're not. They're not. Mm hmm. So, yeah. I love that you brought that up. Big thing.
Lisa: Yeah. It's a huge one. And, you know, another thing I point out is that they started a lot of those labors at home with a Foley.
Meagan: Uh huh. Which is not happening a lot.
Lisa: We hardly ever see that here in our local hospitals. Very, very rarely.
And so that alone is another factor whereby they were able to give people more time. And then also like the demographics, at least here, our birthing population skew way older than, um, Somewhere like in Utah were pretty young hair, right? Yeah, I grew up in Texas. So I grew up in a similar.
Yeah. Yeah. I know where people have babies much younger. Um, yeah. And those are just a few of the many reasons that's not going to translate. But yeah, that readiness is one of the biggest reasons I believe earlier inductions are leading to a lot of cesareans, because, you know, we're much less likely to be in a state of readiness.
The cervix, our whole body at 39 weeks, then we might've been at 41, you know, yeah, exactly.
Meagan: Something else too, that I am finding is that we, as individuals who are birthing, are being made to feel like if we weren't in the hospital, things have would have gone really bad because these inductions are leading to some more emergence or quicker need for a cesarean.
So then we have this distrust that anywhere else would be safe when in reality, it was caused. Thank you for saying that. That emergency was caused and pushed on us when it actually probably wouldn't have even gone that way. And maybe it could have gone to a cesarean or an emergent situation, but it likely wouldn't have if we didn't have ABCDEFG before, you know what I mean?
Lisa: So, so, so true.
Meagan: And I think that that is a big thing into why there's such a negative out of hospital or even midwifery supported providers because we are being made to think. that they are the big saving grace when they're not. They're the cause a lot of the time.
And we also recognize there's emergent real true need for induction, medical reasons. There's real medical reasons for cesarean, but what we are talking about today is not that. That we're, we're not waiting. We're not trusting the body. We're pushing on. So we're pushing something onto our body when it's not ready. And then we're stressing out our body and our baby. Yeah.
Lisa: Yeah. Thank you for having the ARRIVE trial chat with me.
Meagan: Yeah. Sorry. I know.
Lisa: You don't need to apologize; I was so glad to get to chat. And I think, I feel like we're very aligned in a lot of our areas of thinking, opinions on that.
Believing in Your Body's Ability to Birth
All right. Well, I would love for you to share more with us about the work that you do and your offerings. But is there anything else besides those things that you haven't gotten to share that you wanted to share?
Meagan: I just want to kind of reiterate, like, believe in yourself, believe in your ability to birth your baby. Try not to let the outside world convince you that your body can't do it, that your pelvis is too small.
That's another one we didn't really touch on, but big, big thing that we're being told is our pelvises are too small or our babies are too big to fit outside of us. And it's just. It's just not true. Our bodies make beautiful, perfect sized babies. And guess what, guys? I call, we call our audience women of strength.
So I will say, women of strength, your pelvis is perfect. Love your pelvis and believe in your pelvis. But yeah, just overall, believe, believe, believe, believe, because the world doesn't want us to believe in our body's ability. And if we lose that, you guys, if we lose our faith and our belief in our own body, I mean, we're going to have some issues in this birth world, right?
We really are. Because you are strong, listeners. You are so strong.
So, I just want to leave that like, you're strong
Lisa: And it affects how we parent too, right? Like just the whole birthing, this rite of passage, this very sacred rite of passage, how it goes. It just has everything to do with how we feel on every level and protecting our mental health going into parenthood.
Meagan: Oh my goodness, yes. And that's actually a really big tip. I think mentally and physically prepping before you even have your baby, prepping and processing your past birth is so big. So if you just had a cesarean, And you're like, okay, maybe I can't even get there because I can't even process what happened.
I encourage you to start there. Start with processing. It is so important, and our mental health is important, and we talked about it a little bit, but you guys, you're not a failure. If you have had a cesarean, or if you needed a cesarean, or whatever it may be, you're You're not a failure. And if you chose a cesarean, you didn't choose the easy way out.
A lot of people say that and it's really annoying to me. Cesarean is not the easy way out. So just know you are amazing no matter what. You did not fail. Your body did not fail you. And most likely someone else failed us along the way, if I'm being super honest.
Lisa: It's so true. And that's something I preemptively say in birth class is you're a warrior however you give birth. No birth is easy. And you need to have heard me say there's no such thing as failure ever.
Meagan: No such thing. Yeah. Even if it says it on a document, don't believe it. Oh, that's a final tip. Get your op reports, get your op reports, read them, go over them. It will help you process and work through and find another provider.
Lisa: You haven't gotten to hear the VBAC story that's airing right before your episode, this episode, but as you were talking about, processing your previous birth, Seanna is going to be sharing or did share how, she went to therapy, like she really had a very traumatic experience that required seeing a therapist and doing some EMDR therapy and how healing and helpful that was and then coming to birth class and while she was coming to birth class, seeing a therapist so that because there would be triggers that she didn't even expect. And I even asked her before she started class knowing a little bit of her history. I said, I want to just be sensitive as much as I can. Are there any things that are going to be particularly sensitive that you know of? And she was like, I appreciate that, but no, and I'm working with the therapist. So I have that space held for me, you know, anytime I need that. And some things did surprise her that came up in birth class. But I was so grateful to know she had someone to talk to and hold that space.
Meagan: Yeah. No, I really, really suggest it. And, and sometimes we don't register the past experience as traumatic, but our body responds to things as they were traumatic.
Like our, our body's responding as trauma, even though our mind might not describe them as trauma. So sometimes, yeah. Sometimes you really don't realize until you're in labor, so I think no matter, no matter what, even if you don't think it was traumatic, talking about it with a specialist, I think is so important. So, yeah, yeah.
Resources and Support for VBAC
Okay, so where can you find us? You can find us anywhere at the VBAC link, and it's V B A C, everybody. VBAC, V B A C, Vaginal Birth After Cesarean. So, the VBAC link, and then we want to offer your listeners 20 percent off our VBAC course and any VBAC course. We have a couple. We have an online self paced course.
And then we have one that is online, but we also have a manual to kind of follow along with it. And they can use BIRTH20. So B-I-R-T-H 20 to get 20 percent off our courses and doulas, if any birth workers are here, we have a doula directory because we believe that doulas are changing the VBAC world. We truly do.
They can help change the VBAC world. There's actual statistics showing that doulas reduce the chances of cesareans, shorten labor, lower interventions, I mean, actual evidence. And so we train doulas and certify doulas, and that 20 percent off would also apply for any birth worker who wants to be on the directory and help our community find you because they need you. They need you. We push doulas real hard. So yeah, that's where you can find us. And if you have any questions or follow up questions with any of this, you can email us at info at thevbaclink.com.
Lisa: Wonderful. Thank you. And the Facebook group, can people, did someone need to have had a prior cesarean to be able to join that or what are the terms for that?
Meagan: How could I possibly forget? We have a couple of Facebook groups. So on Facebook, the VBAC Link community, you can find that there are questions that you will have to answer to get in. So you do not have to be expecting. You do not have to have had a cesarean either. Like if you just want to go in and come learn, because this is such a great place to learn as well.
And then we also have a CBAC community. Now, we have thrown a lot of terms at you. VBAC, VBA2C, TOLEC, HBAC, home birth, which is what that other story. So we have CBAC, cesarean birth after cesarean, and it's called the CBAC community, CBAC link community, and it's a space where if you can't be in a vaginal group right now because it didn't end in a vaginal birth like you had wanted or you're wanting to know more about those gentle cesarean tips, or you're wanting to learn how to implement things like our amazing page, our VBAC link team member.
She just had the first maternal assisted cesarean in Korea, actually pulled her baby out of her belly and brought her little boy up on her chest in her cesarean. So amazing game changer. And she'll be sharing her story. We'll have her story on the podcast as well, but yeah, if you, if you're looking for more support for CBAC, the CBAC link community.
Lisa: Oh, that's so fantastic. Thank you. Yes. And we'll link to all these things in the show notes. Awesome. Thank you so much. Thank you, Meagan. And I already went on to our doula collective, uh, WhatsApp group and asked if anyone had taken your course. No one had, but now I'm going to send them the promo code and I want to take the course. So you'll probably see me in there.
Meagan: We would love it. And as updates come, you'll always have access. So there are updates that are coming. Hence why I'm having some special things happening on the podcast. So as updates come, you'll always have access to that, which I love because in the birth world, things change.
Lisa: Yep. Yeah, yeah, it's what keeps it interesting for us birth workers, right? Always taking new classes and seeing the new studies and all those things so that we can keep improving the state of birth. Absolutely. Lots of room for improvement.
Meagan: Yes.
Lisa: Well, thank you, Meagan, it's been such a joy to meet with you, and I cannot wait to share all of our chat with listeners, and thanks for the wonderful, important work you're doing.
Meagan: Yes, oh, thank you so much, it really has been a pleasure, and I can't wait to even go back and listen and send it to all of our VBAC people.