Akasha came to me for support in helping her have the VBAC that she was wanted. I’ve supported a lot of VBACs, but Akasha’s story was different. For the birth of her daughter, she had planned a peaceful home birth, but after a long labor, with a baby that was not positioned well and would not descend after a lengthy pushing period, she and her midwife decided it was time to go to the hospital. At the hospital it was discovered that she had a Bandl’s ring and needed a Cesarean birth. A Bandl’s ring is a rare birth complication (.02% incidence rate) in which a constricting ring forms from thickened muscle tissue between the upper and lower segments of the uterus. The baby becomes trapped by the ring and cannot descend. It creates a risk of uterine rupture as well as significant trauma to the baby if the ring is not diagnosed and a Cesarean performed to deliver the baby. When Akasha became pregnant again, she discussed her options with her midwife and did a lot of research into the recurrence of Bandl’s rings. Unfortunately, there is very little information out there, only a handful of documented cases of recurrence, and no evidence, even anecodotal, on the success rate of vaginal birth after a Bandl’s ring, likely because most birthing people who experience a Bandl’s ring automatically undergo a repeat Cesarean. But she and her midwife, Laurie Fremgen, decided to trust her body and give labor a chance, while preparing for the possibility of a Cesarean if necessary. Because a Bandl’s ring typically forms during a long, obstructed labor, Akasha focused on optimal fetal positioning to give her baby the best chance of being born vaginally. And this time around labor progressed smoothly and quickly, and there were no difficulties with the baby’s position. Her son, Elio, was born into her arms at home with a successful VBAC. She wants to share her story so that others who have experienced a Bandl’s ring know that there are options, and that it is possible to have a successful VBAC after a Bandle’s ring. She describes her birth story below in her own words.
“Birthing a baby naturally at home is an experience I've hoped for and imagined most of my life, and I'm so glad I got to experience it with you, my love.
“The morning of your birth, I woke up at around 8 or 9 am with fairly frequent contractions, which I intentionally slept through until about 10:30. You were only 38 weeks and a day, so I thought maybe it wasn't really labor. Once I got up, I told your dad, who had fallen asleep in the other room, that I'd had more contractions than normal and could be in labor but probably wasn't. I remember he shot up with surprise and excitement. I was excited, too, but I told him it was probably nothing. I also texted our midwife Laurie and our doula/photographer Jamie. Laurie said maybe I was having a light warm-up.
“I'd been feeling woefully unprepared for your arrival, having anxious dreams about your coming early, and here you were, possibly two weeks in advance! I still had so much to do. I spent the whole day preparing — mostly doing laundry, but also reorganizing the bedroom and downstairs. Your dad needed to clean out the guest room so the birthing attendants would have a place to be while I labored alone — which didn't really happen, but was my intention. We decided not to say anything to Aurora yet in case it was false labor or we were still a long way out.
“At around 5:30, I lost what's called my "mucus plug," but still didn't know if it was the real thing. I downloaded the Freya hypnobirthing app to help me breathe through contractions, which was enormously helpful, as was sitting on a birthing ball. By around 8 pm, my contractions were 5-6 minutes apart. The app told me I was in active labor. I let Laurie know, and found out she was at another birth in Wimberley and might need to send Leena until she could make it over. Your dad was still prepping the room, so I didn't ask anyone to come just yet. Eventually the contractions were so close together that I only had 90 seconds to prep laundry between each one. At around 9:15, Jamie arrived, and I told Laurie to please send Leena. We finally told Aurora I was in labor and that you were coming; she was hyper and excited.
“I decided to eat something before labor progressed much further, so Aurora and I shared a bowl of soup. The contractions were getting stronger, and I remember Jamie telling me to drop my shoulders when they came, which did help me to center. I asked Jamie if she could tell which position you were in. She wasn't sure, but thought you were in front facing my back; this was great news, since you had been on my right side at 36 weeks, and your dad and I had done a course of Spinning Babies exercises to encourage you to rotate.
“Leena arrived just before midnight. The contractions were becoming more difficult, and I remember she checked me on the bed. I asked her not to tell me how dilated I was, but she did tell me "Baby is very low." (I found out later that I'd been at about 7 cm at that point.) Pretty soon after, I started to feel shaky, which I knew was probably transition. I remember your dad came in, and I told him it was really hard and I was freaking out, but I was okay. My mom also came around that time, and the first thing I said to her was, "This sucks balls, Mom."
“I felt the urge to get in the tub, but eventually went back to the bed, which was where it got pretty heinous. This was the most painful part of labor, and I remember thinking that if I'd been in the hospital, I'd have gladly accepted a C-section (I'm so glad I wasn't and didn't). The contractions had become unbearable. I tried not to resist them but couldn't; I hated and fought them. At this point, my water broke, and shortly after — at around 1 am — my body pushed involuntarily during a contraction. Soon I wanted to get in the tub again, and once I was pushing in the water, I knew I wouldn't move again before your birth.
“I was now making a lot of noise with the contractions — loud and sometimes high screaming. Jamie suggested I go low, and I began chanting “O-o-o-o-o-open.” It helped to add a visual. I started experimenting with making no sound, which was calmer; I put all the sensation into the pushing. Soon I started to feel the “ring of fire.” I mistakenly thought this meant you'd be out after only a few more pushes and, in retrospect, probably began pushing too hard from excitement (and impatience).
“Laurie and Janixa arrived at 1:50 am, and a few minutes later I pushed your head out! Leena told me to stay in the water. Two minutes later, on the next contraction and at 1:55 am, I pushed out your body as Laurie pulled you out and onto my chest. Someone wrapped you in an orange towel and we stayed there in the water. I remember looking at you and thinking how big you were! The umbilical cord was still pulsing.
“Even though it was rough, the labor was fairly quick and straightforward. There were no complications, and you had been in the perfect position (which had been a worry of mine). Your Apgar scores were 9 and 10 — so very healthy. Thirteen minutes later l birthed your placenta (which I ate in smoothies over the next two weeks!).
“Before long my teeth started to chatter, so they wrapped us in towels and we moved to the bed. Aurora awoke from the commotion and came up to meet you while I enjoyed a post-labor snack of frozen mango chunks.
“At 3 am your dad cut your umbilical cord. You weighed 8 lbs. 1 oz. and measured 19.75 inches long. I had second-degree tearing, but received no stitches, on Laurie's recommendation. I believe we nursed once, and then we both slept. I was exhausted. You probably were, too.
“Thank you, Little Boy, for coming into our home and our lives. You are my beautiful boy.”
