VBAC~Vaginal Birth After a Cesarean

Vaginal birth after Cesarean birth (VBAC) What is a VBAC?

Vaginal Birth After Cesarean is what VBAC stands for. It is a vaginal birth after one or more cesareans. More than 80% of women will be able to have a VBAC.

According to Midwifery Today (most recent issue, Winter No 36 page 47) ACOG recently updated their opinion on VBAC and stated “VBAC is safer than repeat cesarean and VBAC with more than one previous cesarean does not pose any increased risk”. The Guidelines can be obtained from: ACOG, 409 12th St SW, Washington DC 20024.

Why would I want a vaginal birth?

There are many reasons that you may want a vaginal birth after a cesarean. Some may be medical and some may be emotional. Others may be financial or in terms of recovery. Here are some brief lists of the benefits to the mother and baby of a vaginal birth. Mother:

Prevention of Death from surgery
Prevention of lesser complications from surgery
Prevention of blood loss
Prevention of infection
Prevention of injury (bowel, urinary tract, etc.)
Prevention of blood clots in the legs
Prevention of feelings of guilt or inadequacy that surgery sometimes causes
Breastfeeding is generally easier after a vaginal birth
The cost of a vaginal birth is about $3,000 less

Baby:

Prevention of Iatrogenic Prematurity (meaning surgery was done, because of an error in guessing a due date)
Reduction in the cases of Persistent Pulmonary Hypertension
Labor prepares the baby for extrauterine life
Prevention of surgery related fetal injuries (lacerations, broken bones)
VBAC results in fewer fetal deaths than elective repeat cesareans

What about rupture of the uterus?

This is a common fear among women who have had a previous cesarean. Most of this fear dates back to when the incisions of the original cesarean were of the classical variety (vertical incisions), nowadays most incisions are the low transverse type. There are two types of uterine rupture: complete and incomplete.

Complete uterine rupture is very unlikely today, for a variety of reasons. One is that when we use Pitocin, if needed, during a labor, we regulate the amount that goes in. In other times it was given IV to a woman and allowed to flow freely. These have also decreased due to some obstetrical practices being abandoned, like high forceps, internal version, etc. And the final reason is because of the rarity of the classical incision. A complete rupture occurs in much less than 1% of women attempting VBAC.

Incomplete rupture occurs about 1-2% of the time. However, usually these women are asymptomatic, and neither mother or infant require any assistance.

Golan published a study in 1980, where there were 93 ruptures of the uterus. 61 of those ruptures occurred in a normal uterus (never had an incision), and 32 of them had had previous incisions. There were 9 maternal deaths from the ruptures, but they were all from the group that had not had previous cesareans.

Labor After a C-Section

The time has come. Labor has arrived! What will it hold for you? Many women are very emotional about the labor, and rightly so. Critical times may be the place where you got “stuck” at the last birth, when your water breaks, getting to the hospital, or any other time. Support is critical, turn to those around you. Here are some questions that many women have about laboring with a VBAC.

What if I had a cesarean because my pelvic bones were too small?

Most women do not truly have pelvic bones that are too small, unless you have suffered a pelvic fracture or had polio. Women with a pelvis to small to give birth vaginally are truly few and far between. Many women go ahead to deliver vaginally the next time, and have a bigger baby than the first!

What if the baby is large?

The pelvis and the baby’s head are not rigid structures. Both mold and change shape to allow the birth to occur. There are certain postures that you can assume to help your pelvis expand (For example: Squatting opens the outlet of the pelvis by 10%.) The American College of OB/GYNs (ACOG) has stated that the effects of labor with a baby of more than 4,000 grams (8 3/4 lbs) has not been substantiated. However, in one study, 67% of babies weighing more than 4,000 grams were born vaginally, even when over 50% of these mothers had had previous cesareans for failure to progress.

What if I have had more than one cesarean?

From the Guide to Effective Care in Pregnancy and Childbirth:”The available data on outcomes after a trial of labour in women who have had more than one previous caesarean section show that the overall vaginal delivery rate is little different from that seen in women who have had only one previous caesarean section.”… and also … “the available evidence does not suggest that a woman who has had more than one previous ceasarean section should be treated any differently for the woman who has had only one caesarean section”.

What if the other cesarean was for fetal distress?

True fetal distress is rare, and only a handful of cesareans are done for fetal distress. One study indicates that fetal distress only occurs in 1.5% of all VBAC attempts (Finley, Gibbs), while another showed that of mothers who had a primary cesarean for fetal distress, the second labor had 3% of those mothers with fetal distress (Paul, Phelan, Yeh).

Who is a candidate for VBAC?

The general guidelines for VBAC are:

Low transverse incisions on both the abdomen and uterus
Adequate pelvis (See Above)
Willingness to prepare for VBAC

Preparing for your VBAC

There are many things that you should do to prepare yourself for a VBAC. Some are mental, emotional, physical and general preparations for your VBAC.

Information. Get as much of it as you can. Obtain a copy of your medical records from the previous birth(s) for yourself. Ask your current careprovider to explain anything that you don’t understand. Talk to your careprovider, make plans with them . Talk to other people who have been there. Read a lot of books and journals.

Physically you need to prepare your body. Being in good physical condition can help your labor move more quickly as well as speed healing. Regular exercise and special birth exercises are good ways of doing this.

Emotions of VBAC

Emotions run high during pregnancy in general. Preparing for a VBAC can bring up plenty of extra emotions. Almost anything you feel is within the realm of normal.

Some women are very excited about the thought of a VBAC, while others are forced into having a VBAC by insurance or their care provider. You may be afraid of labor, especially if you had a long or frightening experience the first time, you fear that it will repeat. You have familiarity of the cesarean, and you don’t really know a lot about birth or labor.

You may encounter some resistance from people, either pro VBAC or con VBAC. Be prepared to stand your ground, and remember who makes the decisions and lives with the experiences.

Talk to people. Talk to ones who have experienced VBAC, talk to those who have never had a cesarean, talk to the professionals on your birth team. Deal with your emotions, do not sweep them under the rug and feel guilty for them.

Some women feel very upset over their first cesarean, although this is not true for everyone. They feel cheated, robbed, defective, or many other emotions. These are very real emotions, and you have every right to feel that way. However, you must deal with it, not dwell on it.

Women’s Experiences with VBAC

“I don’t know what I could add except that I had a VBAC and felt the experience very empowering…it changed my feelings about myself from one who was likened to “a defective typewriter” to a powerful, strong and capable woman who can give birth to a baby the way GOD intended us all to do.” -Renee

“My daughter was born by Cesarean in ’04 after a 36-hr labor (24 hrs induced); reason given was ‘transverse arrest’ (head trying to come down the birth canal sideways). My OB felt only lukewarm about my chances for a VBAC, so I sought out midwife care for my 2nd…my thinking was 1) if I didn’t at least try, I’d never know what might have happened, and 2) I didn’t want to have a medical caregiver who was only lukewarm about my chances. The midwives were great; they seemed to just assume that it all was going to work out fine. My 2nd & 3rd deliveries were successful VBAC’s, both midwife attended (both in hospitals)…the babies were 9lb, 3oz and 9lb, 14 oz (my daughter had been 8-6!) and the deliveries were 12 & 3 hrs, respectively. I do remember a point in my 2nd labor when I might have only been half-joking when I thought, why in the world did this sound like a good idea? But I don’t think I ever had any serious reservations.” -Sue

Can I have a homebirth VBAC?

Considerations for VBAC at Home

Many women with a history of previous cesarean section with no contraindications to VBAC will be comfortable having a subsequent vaginal birth in hospital with midwifery care. However, some VBAC women will come to midwives requesting home birth. The BC College of Midwives recommends that clients with the following conditions may be candidates for vaginal birth in hospital, but should be advised that they are not suitable candidates for a home birth:

History of cesarean section at or before 26 weeks
History of impaired uterine scar healing
Inter-pregnancy interval of less than 6 months
Ballotable head in active labour
Prolonged active phase of labour

Research and Books:

By Nancy Wainer Cohen and Lois J. Estner:
Silent Knife; Open Season; Birth Quake (Coming soon!)

By Bruce Flamm:
Birth After Cesarean

By Johanne C. Walters , Karis Crawford:
Natural Birth After Cesarean: A Practical Guide

By William and Martha Sears:
The Birth Book

By Penny Simkin:
The Birth Partner; Pregnancy, Childbirth and the Newborn (Simkin, Whalley and Keppler)

By Diana Korte and Roberta Scaer:
Good Birth, Safe Birth

By Sheila Kitzinger:
Your Baby, Your Way; Homebirth; Birth Over 35; Complete Book of Pregnancy

By Lynn Madsen:
Rebounding From Childbirth: Towards Emotional Recovery

More books for VBAC Journal Articles:

Flamm, BL, JR Goings, NJ Fuelberth, E Fischermann, C Jones, E Hersch. 1987. “Oxytocin During Labor after Previous Cesarean Section:Results of a Multicenter Study.” Obstet. Gynecol. 70:709-712.

Public Citizen Health Research Group. 1989. “Unnecessary Cesarean Sections: How to Cure a National Epidemic.” Washington, DC

Asakura H & Myers SA. More than one previous cesarean delivery: a 5-year experience with 435 patients. Obstet Gynecol 1995;85:924-9.
Flamm, BL, OW Lim, C. Jones, D. Fallon, LA Newman, and JK Mantis. 1988. “Vaginal Birth After Cesarean Section: Results of a Multicenter Study.” Am. J. Obstet. Gynecol. 158:1079-1084.

Finley, BE, and CE Gibbs. 1986. “Emergent Cesarean Delivery in Patients Undergoing a Trial of Labor with a Transverse Lower-segment Scar.” Am. J. Obstet. Gynecol. 155;936-939.

Hertitage, CK, MD Cunningham. 1985. “Association of Elective Repeat Cesarean Delivery and Persistent Pulmonary Hypertension of the Newborn.” Am. J. Obstet. Gynecol. 152:627-639.

Schreiner, RL, et al. 1982. “Respiratory Distress Following Elective Repeat Cesarean Section.” Am. J. Obstet. Gynecol. 143:689-692.

Bowers, SK, et al. 1982. Prevention of Iatrogenic Neonatal Respiratory Distress Syndrome: Elective Repeat Cesarean Section and Spontaneous Labor.” Am. J. Obstet. Gynecol. 143:186-189.

Paul, RH, JP Phelan, S Yeh. 1985. Trial os Labor in the Patient with a Prior Cesarean Birth. Am. J. Obstet. Gynecol. 151:297-303. Support and Counseling:

VBAC, by Gloria Lemay

The Day of the Birth

The female uterus is a very strong organ that maintains its integrity and resiliency through the birth process AS LONG AS IT HAS NEVER BEEN CUT. One obstetrician explained it to me, thus: ” The nulliparous (first time birther) uterus is as strong as a rugby ball. You could kick it all over a field and it would never break. However, if you cut a rugby ball and repair it, it will still be quite strong and may work all right in most games but one day someone will land a kick on it that breaks it open again because the integrity is never quite perfect again with a repair.” This is the source of the obstetrical concern about VBAC births. Most women attempting a VBAC will do absolutely fine and the scar where they were cut will hold strong.

It is 1 woman in 200 VBACs who will have a rupture of the scar. It is essential that VBAC births are not induced or augmented IN ANY WAY. If the physician/midwife were to give a VBAC woman misoprostol (Cytotec), oxytocin, castor oil, strip the membranes or use any other form of induction then that would triple her chance of having a uterine rupture. I believe that VBAC women have longer, gentler births because nature is compensating for the scar. There must be no hurrying. Many midwives would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally.

What are the signs of rupture? Stabbing pain, unusual bleeding, decelerations of the baby’s heart, or a peculiar shape of the abdomen. In most cases, the mother is the first to know that “something’s wrong”, “something’s tearing”. IF she is unmedicated. For this reason, the VBAC woman must be having her birth with all her senses active (no epidural). Very rarely, it is possible to have a uterine rupture without the mother feeling it.

Third stage

The doctor/midwife must be especially careful with the birth of the placenta in a VBAC because there is a slightly increased chance that the placenta might be adhered to the scar, and cord traction (pulling on the cord) could cause the uterus to prolapse. A physiologic third stage (no routine oxytocin and no pulling) is something that should be included in the birth plan.

After the birth

After the birth, VBAC women need to be told that they can walk upright. They can’t believe that they can straighten at the waist right after giving birth. Then, they can’t believe they can do sit-ups and leg raises on day one. Usually by day three, you’ll find the VBAC woman working out at the gym! With VBAC women, the complaints are very few in the postpartum period because they are comparing to post-surgery pain and any minor scrapes and bruises seem like nothing.

A VBAC is an amazing experience for everyone involved. Very Beautiful And Courageous (VBAC).

A Butcher’s Dozen, by Nancy Wainer

A Butcher’s Dozen
by Nancy Wainer
© 2001 Midwifery Today, Inc. All Rights Reserved.[Editor’s note: This article first appeared in Midwifery Today Issue 57, Spring 2001.]

I’m so tired! Exhausted. It’s the wee hours of the night and it’s dark and freezing cold. I am driving home slowly-darn, the roads are icy-from back-to-back births. I realize that both of the women whom I have just attended would have had cesareans had they been with typical American obstetrical care providers. Two more women who weren’t cut, who birthed their babies powerfully and naturally. Two more babies who were born into calm and joy. I’m not quite so tired anymore. In fact, I begin to feel exhilarated. The roads aren’t icy, they’re sparkling, and I’m going to build a (pregnant, of course) snowwoman before I go inside!
I have been asked to write on VBAC-vaginal birth after cesarean. Good. I’ll use this invitation to share some stories, pass along some information, give a quick retrospective history on the subject, and, OK, yes, to vent a little steam.

VBAC. A victory and a relief for most of the women who have one. A deep and generous healing for many of them. And still, very much a sham, because most of the women never really needed to be cut in the first place, so they didn’t really need to be VBACs after all. In that respect the whole concept of VBAC is actually, unfortunately, pathetic. In this country the subject of whether or not VBAC is “safe” is also subject to the obstetrical fashion of the hour.

I receive thousands of inquiries about VBAC every year. This week I have gotten several calls from midwives throughout the United States who tell me that the hospitals they work for no longer want to do VBACs, or that doctors who have been backing VBAC are getting a lot of heat. Today I received a letter from the coordinator of a cesarean education and support group in Australia.

She writes that South Australia has a section rate of 25 percent-so I guess we in the United States aren’t the only ones who are ignorant and knife-happy. She writes that “the vast [majority] of doctors are scared of VBAC. Current hospital policies do not support VBAC women’s needs. …[T]he general statement [from the heads of all hospital birth units] is that they do not need to address the issues of VBAC because there is no issue! . . . I would like to ask you for your advice on how to make ‘them’ listen to us ‘mere women'”

Mere women. Without us, my dear new Australian sister, they wouldn’t be here, cutting women. We must remember that cesareans are just one more reminder that we live in a misogynistic world-they are a form of violence and abuse and they are symptoms of fear, hatred, greed, misuse of power, and sexual dysfunction.

For the moment, let’s just arbitrarily begin with the last 12 women who have used me as their midwife. They all had homebirths, and let’s get one thing straight: I did not deliver their babies-they delivered their babies. I did not do their births-they did their births. But I did assist, and I did work hard, and I did influence, and I did suggest, and I did listen, and I did trust, and I did support, and oh-dear-God/dess yes, I did love.

Dawn had had two previous sections. She was two weeks past dates. She had prodromal labor for several days, during which time we made many suggestions to keep her relaxed and trusting and to help line up the baby (see addendum); then, when she went into labor, she birthed her baby in two-and-a-half hours with a big smile on her face. She said people thought she was crazy having a homebirth at all; after learning she’d had two sections, they thought she was stupid. But they were really convinced that her wiring was crossed, she says, when she told them she loved being in labor and wants to do it again! She’d have been sectioned.

Deb, sweet and tiny, five feet tall, had had a section for cephalopelvic disproportion (CPD). This time she had a five-and-a-half hour labor. She went into labor two weeks prior to her due date, on the day her three-year-old was having his birthday party. There were 20 guests, and an entertainer who brought animals to her child’s party. Deb had her baby with a ferret, a boa constrictor, a tarantula, and some bunnies very (very!) close by. She had the exact same difficulty during pushing that she’d had last time. But we do things differently and she had a nine-pound baby. She would have been sectioned, sans ferrets.

Laura, small in stature as well, had been sectioned for CPD the last time. That baby was nine pounds, 14 ounces; so, of course, with such a big baby-sarcasm dripping here-that section must certainly have been “necessary.” This time, she had a four-hour labor, an 11-pound baby with a huge head circumference, and no stitches.

Jean had a nine-pound, seven-ounce VBAC baby last month; in fact, many of our mothers have babies that are nine pounds or more and have them in less than five hours-love that HypnoBirthingTM! I am so glad that I learned early on from one of my wonderful mentors (thanks, Val) that larger babies come through very easily when their heads are lined up-and how to help them line up!

By the way, Laura was past dates with this very big baby-like most other VBAC hopefuls in this situation, she most likely would have been induced, Pitocin’d, and well, you know the rest of the story. But most of the people who are involved in birthing in this culture don’t know. They don’t understand that when you induce a woman, her body isn’t ready to give birth-if it was, it would be in labor!-and so you are, in effect, trying/hoping to blast a square peg through a round hole. And at what cost? At cost to the woman’s insurance company (ah, but that is a major subject for a different day . . .) as well as to her physical and-if she is a conscious individual-emotional health. And at cost to the baby as well.

Pam birthed last night. Another tiny woman, she and her husband and 20-month-old son moved all the way across the country so she could birth with me. I wanted desperately for her, as I want for all of my couples, a wonderful and healing birth. I knew they must have had a very traumatic birth last time for them to sell everything so they could move here.

Last time, she had a posterior baby and had pushed for hours and hours with absolutely no progress and was cut. This time she also had a posterior baby; however, we continually tweaked this baby’s head position. She pushed 45 minutes and had an eight-and-a-half pound baby. The only song that Pam’s toddler, Oliver, knew was “The Wheels on the Bus,” so to that tune, we were all-including Pam-singing “The mommy in the bed goes push push push” as she was birthing. Pam was laughing as Mack’s head, and then his body, was born. When we came back the next day for the first postpartum visit, Oliver started laughing and singing again. What joy. A healing for him, as well. An hour after the birth she commented that her baby hadn’t cried, and I repeated what I had learned: “Why would he cry? He hasn’t left your side, his cord has not been cut, he feels the love and joy in this room, and no one’s been mean to him!”

Amy had a section for fetal distress the last time. This baby was as happy as a pig in mud all throughout the labor. This baby was fed during the entire labor-at six centimeters his mom was eating a sandwich and scrambled eggs. This baby had no drugs to contend with and had no one disturbing/distressing his mother. We see almost no fetal distress at any of our births. But Amy would most likely have been sectioned because she had high blood pressure for much of the pregnancy. She would have been induced for sure. She said to me, “If you think my blood pressure is high now, take me into a hospital and you’ll really see it soar.” We (my apprentice midwife and my assistant) spent gobs of time with her and worked diligently with nutrition (Much love to you, Dr. Tom Brewer!), herbs, relaxation, homeopathics, chiropractic and other natural means to keep her blood pressure at a manageable level. She birthed at home.

The other women would also have been sectioned for a variety of reasons. One had her water leaking for several days. We waited until she went into labor on the third day and had a homebirth. We have never had an infection, even last summer when one woman’s water released at 32 weeks and she waited and had her baby at home at 36. One woman had very poor muscle tone-the doctor told her that her uterus did not have the tone to birth and scheduled her for a section-she birthed at home and had a four-hour labor. One woman’s waters contained meconium. We do not necessarily transport for this-it depends on a variety of factors. Our suggestions often work, and within a short time the meconium is cleared. She had a lovely homebirth.

One woman was 42 years old. She didn’t think she was a good candidate for a homebirth. I told her that some people aren’t good candidates for the presidency, but that doesn’t stop them! (OK, so I’m not a political humorist, so shoot me.) She had her VBAC baby (last child was born 17 years ago!) in under five hours. She lives in one of the oldest houses in Massachusetts-it is 275 years old, and very beautiful. There was a borning room!!! as well as the original beam floors in much of the house. We thought about all the babies that had been born in that house-and there were plenty of them-and all the midwives who came to attend the mothers there over the centuries. What a travesty it would have been for her to have been in a chrome and plastic hospital bed with the “potluck (or un-luck) OB of the day” who had to look at a chart to see what her name was.

Here’s one: Mary came to see me two days before Christmas. Because her baby was breech, her doctor insisted on a cesarean and had scheduled her for one. She wanted suggestions from me as to how to turn the baby and asked if I recommended she go in for an external version. My first suggestion, of course, was to not have the version done at a hospital! They do it all wrong and it hurts like the dickens and it’s rarely successful, and they give drugs that are actually counterproductive to the turning, but who cares, the docs get hundreds of dollars whether or not the baby turns anyway. She came to see me for a consult, and I palpated her and told her that her baby was not breech. She was surprised. To make a long story short, every time she went to see her doctor the baby was breech or transverse; she would come to me and the baby was head down. This happened three times. I made several suggestions, including chiropractic, homeopathy and so on and sent her on her way with good wishes. She called five days ago, and asked to come and see me again. She said she was considering a homebirth (she was “overdue” at this point). I told her to go home and think about it. The next morning she called and said they had just made the decision to stay at home. I told her that I had already fallen in love with them and they would be fine. I apologized and said that we would not get to know them as well as we know most of our clients. She said, “Are you kidding? In the first hour [we had spent four altogether] you spent with us, you had already spent more time with us than our OB has spent with us in the nine months of this pregnancy!” She went into labor two hours after she called, and had a two-and- a-half hour labor!

And last summer, VBAC-hopeful Bettina would have been re-sectioned because her baby was breech. We invited our expert breech midwife to come to Boston and teach us as she assisted Bettina. Bettina’s eight-and-a-half pound breech daughter slid out of her body. She was “lucky,” the doctors say? Lucky to have birthed safely outside the hospital? No, Bettina was lucky not to have been in the hospital getting cut. The same experienced midwife assisted Emma, who would have been sectioned as well-for twins; instead, she had them at home, gently and easily.

Ah, and Anna. She’d had two cesareans. At 39 weeks pregnant she decided to drive eight hours to have her baby here. The doctors in her area seemed itchy to cut her again. They had no faith in her ability to birth. Instead, this beautiful, large woman (over 300 pounds) had an eight-pound, 11-ounce VBAC baby four full days after her water released. She is so happy. Sooooooooo happy.

A while back, I had a true shoulder dystocia with one of our small (under five feet) VBAC moms. Her baby was large, 10 pounds, four ounces (although our three, over-11-pound babies have slid out). This is of course every midwife’s nightmare-I’m talkin’ real dystocia and not just sticky shoulders here. We did the Gaskin Maneuver-flipped her onto her hands and knees-and we were able to help the baby out; he is now an active, healthy three-year-old. During my training I was an observer at a hospital when there was a shoulder dystocia and the baby died. In hospitals, laboring women are usually medicated and epidural’d-they have monitor belts around them and are entwined in IV lines. IVs create a continually filling bladder (big deal, right, we’ll just catheterize) which compromises the amount of space for the baby. Women are often weak from lack of food. It is almost impossible to get them turned quickly and efficiently over onto their hands and knees-the position that often helps dislodge the shoulders.

Don’t we get it? Women have babies! Even when there are situations that arise! There are billions of people on the planet-they get here without being cut into the world! All our ancestresses had babies or we wouldn’t be here, and they all birthed outside of the hospital. I will say it again and again and again until I no longer have the breath: Hospitals are for sick people, and birth is not an illness. Every study that has ever been done has shown that planned homebirth is as safe (safer, I think safer) as hospital birth. Best kept secret in the country, wouldn’t you say?

Oops. I’m sorry. Please pardon the sarcasm-it just slipped out. Get me talkin’ about birth and VBAC and a whole lot of emotion comes up.
I have counseled thousands of VBAC mothers. They understand that they were robbed, and that birth is joy. They are exuberant-for years after their VBACs. Their bodies work, there is nothing wrong with them, they are normal. The “voices of VBAC” are profound and passionate. VBAC mom Megan proclaimed, ” I want to do this again!”-much to her husband’s shock, since only the head of this baby was out at this point. Brenda wrote, “When I met you, I had little faith in my ability to birth a baby. You gave me confidence and courage to let go and trust my body. Ryleigh’s birth was more powerful than I ever could have imagined. During Ryleigh’s birth, I found a strength within me that I did not know existed. I now find that strength extending into all areas of my life . . . Being surrounded by so much love and support was the key to my success. I wish I had the words to describe the impact your touch and encouraging words had on me during my labor. From that point I never doubted my ability to birth my baby . . . I am so grateful and I look forward to the day when all women can expect to receive the loving care I did throughout my pregnancy and birth.” Marcia said, “You have healed me of the trauma I experienced two years ago and given me back my birth rite. You granted my heart’s desire to push my baby out and feel it.” Rachel wrote: “I feel that you are the gardener who tended me while I blossomed. I’m sitting here with this bundle of flesh and bones, hands and feet, blood and smiles, eyes and ears, love and spirit on my lap. I stroke his head, and know that he is nothing less than a complete miracle. I know that it was the grace and power of my body and the creative force within it that carried him into the light. But I also know that you do whisper magic that makes miracles happen. And that your love and mothering nature tends to make things bloom. My experience of giving birth made me whole in a way I wasn’t aware of being broken.”

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