We are honored to have Ana Paula Markel, ICCE, CD (DONA) on our site to answer any birth related questions this week. Ana Paula Markel is a mother of 4, birth doula, birth doula trainer and childbirth educator. Ana has supported hundreds of families to transition into parenthood. In Ana's view there is no right or wrong way to give birth or parent but there is informed decision and conscious and awareness in choice. Women deserve support and to be heard in their life changing transition into motherhood.
Feel free to ask Ana anything about taking birth education classes, a doula's role during labor and delivery, home birth, hospital birth and anything else related to having the birth experience you desire and she will reply here throughout the week.

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Hi Michelle, wow, congratulations on the birth of your 2 babies. I am sorry to hear the births were not what you had hoped for and that breastfeeding was a challenge. Allow for the healing to happen as you are trying to conceive again. We can't control the past, only learn from it. And it sounds you have done a great deal of that.

Yes, you can definitely have a vaginal birth after 2 cesareans, I did :-), twice. You will definetely need to find a careprovider that is more than comfortable with that but that has supported women with VBA2C! A lot of caution will happen to make this a safe birth. Making sure you eat amazingly well to make a strong and healthy uterine tissue, you will need to be monitored in labor, especially after active labor and no drugs to augment labor.
find a lot of support in your community from internet lists, facebook, etc. there are plenty of VBAC moms out there who will support you. Look for ICAN which is an amazing organization. And hire careproviders that believe in you. I would recommend a doula too.

Good Luck and Keep me posted, also if you would like to hear about my stories I would be happy to share,
AP Markel

Michelle Hewitt said:
Hello! I am a mother of two beautiful children both born via c-section. After 20 hours of 'labor' induced by the hospital and no sleep or food, they allowed me to push for what they say was about 2 hours, I feel it was closer to the 30 mins. Regardless, I ended up w/ a CS due to my daughter being 'stuck'. I remember seeing her head, and her hair, but they forced me in my drug induced state to have a C. With my 2nd child I just did what the doctors said and scheduled my second C-Section. The day of, I went into labor naturally, but they insisted that I have the C section. After attending my friends home water birth, and reading and attending conferences, I feel that had I had the knowledge and support I do now, that I could have sucessfully vaginally birthed both my children. So we are hoping to get pregnant with #3 this summer, and I would love to have a vaginal birth. I have had issues with breastfeeding (to the loss of why to many lactation specialists) and I feel that I can do this. With having 2 prior C-Sections, do you feel it's safe enough (in a hospital setting) to attempt a vaginal birth? My children were 8lbs 1oz and 9lbs 4oz. Thank you! !

Sacramento, CA
Hi Serena, absolutely.
I completely hear you, the price of doulas in Los Angeles can go as high as $ 2700 and of course that depends on their level of experience and if they hold other certifications such as acupuncture, massage therapist, etc.

Both options you mentioned are valid. I do not believe everybody needs a doula, a lot of partners or friends can be extremely helpful if that is what the mother wants. I recommend he or she reads The Birth Partner by Penny Simkin and definetely Your Best Birth has some great stories to illustrate different comfort techniques.

Option 2 is extremely valid and easy to find. Doulas that have been trained are often very affordable because they need 3 births for certification and even if you want someone who is certified with less experience you can find that too.
In Los Angeles, you can definitely contact me at Binibirth.com and I can assist you in finding one or DASC ( DOULAS ASSOC of SO CA)

I am a DONA Doula and Approved DONA Doula Trainer and we believe : A doula for every woman that wants one.
It is our commitment and doulas are often willing to reduce their fees or make payment plans.
It is a work that comes from the heart.

all the best,
AP Markel

Serena said:
Doulas come at a premium here in Los Angeles (some cost as much as the OBGYN), and according to my insurance company (Blue Cross PPO) they are not covered. Can you tell me ways to help my husband take on this role during our hospital birth? Are there networks of Doulas in training that I may find?
I agree with Sonya.
The decision to when to go to the hospital is a team decision. We take into consideration careproviders preferences, mother's preferences, traffic hours, GBS Status ( if the mother needs antibiotic in labor). Most of the time it is clear to everyone. Some careproviders that are more conservative use the 5-1-1 rule, meaning contractions 5 minutes apart that last 1 minute for 1 hours. The 4-1-1 that you mention is common too and I know of some doctors that encourage women to stay home to 3-1-1, which would be a much more active labor.
But remember, WOMEN BIRTH BETTER WHEN AND WHERE THEY FEEL SAFE!!! A lot of times women feel safer in the hospital and I know that in such case labor will progress better there, especially if there is a supportive team that would allow mobility , shower, etc. or other women feel safer at home, for those the 3-1-1 may be a good idea, so when you arrive in the hospital labor is well established and much less likely to slow down or stop due to adrenaline levels.

AP Markel

Sonya said:
'I am considering a doula because I'd like to labor at home as much as possible. What I want to know is what does this usually mean?'
A: I myself considered a doula but decided to take it on with my husband. We took a hypnobirthing course and we decided to go to the hospital when i felt ready. I was in labor for four hours before I got to the hospital.

Who makes the call as to when mom should go to the hospital?
A: I would discuss this with your Dr. My Drs. advice was to go to the hospital if my water broke or if my contractions were 4mins apart for an hour. After getting to the hospital if I was less than 4cm then I could go home (I was 5cm when they checked me at the hospital). You can also ask to be checked at the Drs. office instead of going to the hospital (during office hours). With the hospitals in my area there's a 24hour time clock from the time a woman's water breaks to the time a woman needs to have the baby delivered. - Something to consider if your in the hospital and they want to break your water (the baby looses cushioning and cause stress on the baby).

Also, I have questions about the role of the doula during labor. My whole concern is around not being informed and wanting to get info as things are suggested/ or about to be done to me by hospital staff. How can a doula help here?
A: I would have a great birth plan and discuss it with your Dr. and make sure your husband and doula are all on the same page. If your in a stage of labor where you can't 'talk' then you'll need your husband or doula for support in communicating.

I've heard that doulas shouldn't advocate for you but help you have better communication with your provider, but I would like a doula who will step in and give me information, is this beyond the scope of their work or is it dependent on each doula? A: I can't comment on having a doula but i can comment on having a rock solid birth plan and hashing out all the scenarios ahead of time with the Dr. My husband and I did that politely of course with our Dr. In our experiences there are several protocols on the nurse level, hospital level, insurance level and Dr. level - and they all compete with one another.

Most importantly keep a positive mind set and "don't take on others experiences as your own"

Have a Happy Birth!

PS - i'm a mom of two - one was induced and one was completely natural and the natural childbirth experience for me was awesome!
Hi Sara, how fantastic to prepare for this birth. It sounds like you have it covered. The midwife will bring an assistant to help with her equipment and professional needs. They will also clean up after the birth and cook something for you as you nurse your new baby.
Having a fridge stocked with great food, for you and the birth team helps. Midwives need to eat for energy if you have a longer labor. And you don't want to go out shopping or have your partner to, after the birth. Have some supplies for the first few days after the birth so you can focus on resting and bonding with your baby.
Friends can run errands for you and family can be helpful in any way you need. Do not be afraid to ask for support as people want to help.
All the best,
AP Markel

Sara Intonato said:
I am currently pregnant with my first baby and my husband and I are planning a home birth. In addition to my midwife and doula is it helpful to have anyone else there to assist? Or are those two attendants and a birth partner typically sufficient to help everyone feel cared for and comfortable? Thank you, Sara
Hi Nanette, it sounds like you have a great careprovider. I do not know a lot about the medical aspects of it. My experience with clients with fibroids 10 cm or bigger were to birth by cesarean. For this birth obviously it depends on the kind of incision you had and also if you had a double layer sutturing. If you had the same doctor of course she will know, if not it is in your records.
Good Luck to you. I believe babies to be very smart, and to work hard to find their fit, so let's envision that head going way around the fibroid.
All the best,
AP MArkel

Nanette Jula said:
Hi, I am hoping for a VBAC with my 2nd child. My son was born via C-section b/c I developed a fibroid (12-13 cm in diameter) low on my uterus. My previous ob said that b/c my son couldn't drop due to the location of the fibroid, I had to have a C. My new ob says that b/c the fibroid is a bit smaller (9cm) that I might be able to try for a VBAC. She says that as long as the baby can get her head around the fibroid, there shouldn't be a problem.

Do you have any experience with VBACs and fibroids? Are there any resources you can recommend? We plan on having a doula and delivering all natural (although my ob is strongly advising me to keep an open-mind as far as pain control considering my situation) but will have to deliver in a hospital. Luckily, my ob is very supportive and fully intends to deliver me via VBAC. Thanks!!!
After the birth of the baby, do you let the woman deliver the placenta on her own or do you "help" it along? That was the most painful part of birth for me when after I delivered my precious baby boy, my ob ripped the placenta out of me. I was totally unprepared for that and I would really like to not experience that part of child birth again.
Hello Marla, I am so sorry about your first experience. Doulas do not do anything with the placenta and quite honestly, most of the time nobody does. Placentas births are usually safer when mother and baby are loving each other and releasing oxytocin for a safe and fast birth of the placenta. You may ask that of careprovider for your next birth.
All the best,

Marla Ginter said:
After the birth of the baby, do you let the woman deliver the placenta on her own or do you "help" it along? That was the most painful part of birth for me when after I delivered my precious baby boy, my ob ripped the placenta out of me. I was totally unprepared for that and I would really like to not experience that part of child birth again.
I am planning a VBAC in my local hospital's birth center (the only hospital in 150 miles that allows VBAC). I have found a family practice doc that is very VBAC supportive whom I love. This hospital has an in house Doula program. I live about a 30 minute drive from the hospital.
My question is, should I hire my own doula to help me labor at home as long as possible or should we go it alone at home and wait for doula support once we arrive at the hospital? Most of the independent doulas here also work on-call at the hospital's birthing center and charge on a sliding scale anywhere between $500-$900 for 1 prenatal visit, labor support and 1 postpartum visit.
Hi there! I am 34 weeks and am actively searching for as much info as possible about natural birth. I went to the hospital's birth ed class and felt like their policies would be in line with what I want for my experience... as long as you don't want meds you don't have to have constant monitoring or an IV and can move around. The nurse who taught us a lot of natural pain relief methods, positions and I felt was shockingly honest about the negative effects of using medication, especially pitocin.
But I am starting to get concerned about my doctor's opinions. I'll say that my father is a doctor and for the most part I like and respect the medical community. However, I was really surprised at my last visit when he said I might have the have a C-section because of my short stature. I said "Well certainly I hope not!" but didn't continue the discussion further at that time. I'm 5'2'', in good shape and health and honestly don't really consider myself frail, puny, or otherwise unable to perform basic human functions in general. I was actually pretty offended.
I'm not even sure he actually knows how tall I am and I have not had an internal exam since Trimester 1.
So I want to ask someone like you who has looked at birth from a different angle than a surgeon. Could he be right? Is it common for women to just not be able to get the baby out safely b/c they are short? In my family this hasn't been the case but that is a very small sampling pool statistically! What do you think?



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