A husband’s experience with VBAC and lessons learned
“I have just seen so many women who have husbands who aren’t supportive because they don’t understand. My husband would love to help more men understand.”
A couple recently shared their VBA2C (vaginal birth after two cesareans) journey with me. It touched my heart. By the time I was done reading it, I had tears in my eyes.
So many women do not feel that VBAC is an option for them because their partner isn’t on board.
Now I know there are women who will birth how they please regardless of their partner’s feelings or thoughts, but there are many women who wish to bring their baby into the world while preserving their relationship. And, what typically happens in these scenarios, is that the woman puts the desires of her partner above her own and she schedules a repeat cesarean.
Often, the challenge of educating and convincing their partner is just too great in the face of the conventional wisdom that states VBACs are just plain dangerous.
Just the other day, I was talking to a couple in their 40s who didn’t have children. Yet despite the fact that they were not in the “world of childbearing,” they thought “once a cesarean, always a cesarean.” This falsehood is so ingrained in our society that even those without children know it by heart and believe it to be true.
The absence or presence of social support is a huge factor in whether a woman plans a VBAC or a repeat cesarean. This is why it is so important for partners and people of non-childbearing age, such as the birthing parent’s parents, grandparents, and extended family, to know that the American College of OBGYNs and the National Institutes of Health say that VBAC is a safe, reasonable, and appropriate choice for most women with one prior cesarean and for some women with two prior cesareans.
When friends and family members are undereducated about VBAC, it negatively impacts the birthing mom. Many women are simply not willing to create family drama in order to plan a VBAC. And the seeds of resentment are planted.
And then there are spouses that want to support their partner, but don’t know how. They feel trapped between a growing mistrust of their doctor and the desire for a good outcome for their partner and baby.
Today I spoke with a father who said that he “felt powerless” as his wife was bullied into a cesarean. He really believed that he should be able to completely trust his wife’s OB, but as her labor progressed, he did so less and less. And yet, he didn’t know what to do.
Men need to hear the experiences of other men as partners are such a critical part of the birthing woman’s support team. For many women, when their partners are on board, they have the emotional sustenance required to plan a VBAC in a country where over 90% of women have a repeat cesarean and women planning VBACs are often bombarded with stories of “VBACs gone wrong.”
I hope you enjoy the words of this engineer, this military man, this caring father, as he graciously articulates his VBAC journey.
One of the most important life choices is the freedom to choose what one wants for their own health and their body. For my wife, it was the choice to have a VBAC after two c-sections and the need for her husband’s support to make it happen. This is a short story about a husband’s lesson learned and incredible experience of sharing a VBAC birth with his wife.
Our first child together was a cesarean because the labor would not progress and ultra sound pictures indicated a large head. The doctor feared complications due to the large head and the concern over my wife’s first vaginal birth 9 years earlier that resulted in a 4th degree tear. Our going in game plan was always as natural as possible.
Before we decided to start a family, my wife relayed her desire to have a natural birth when the time came. She described the challenges in her first birth that resulted in a painful 4th degree tear. She relayed that in retrospect, the 4th degree tear could have been prevented had the atmosphere of the delivery room been more supportive, more relaxed and the doctor vetted more carefully prior to delivery.
All doctors are not created equal. A medical degree does not guarantee that two doctors will have equal outcomes. And with my wife’s first child years before I was in the picture, there was good evidence to support her claim that both support structure and doctor helped lead to a painful labor.
“I could not understand the true emotional implications”
When our son was born cesarean, there was a disappointment that only she could truly understand. I was simply happy to have a healthy son. I remember her making a comment about cheating me out of the experience to have a natural birth, as if her body had failed what it was made to do.
I reminded her that natural or cesarean, it was all the same to me as I just wanted wife and baby to be healthy. How this was accomplished was not important to me. But, to my wife the cesarean felt like a violation of her choice and cheated her out of the way nature created the female physiology to behave after 9 months of baby development.
I admittedly could not understand the true emotional implications that having a cesarean had on my wife until she went through her second cesarean. When we decided to have baby number two together, my wife’s third, our doctor immediately said that since our son was born cesarean that our next child would have to be delivered cesarean too.
We argued the point and our doctor, whom we loved and took care of all the children and my wife, finally gave us the option to find another doctor because the hospital “protocol” required that under the circumstances (quoted as saying the 4th degree and then a cesarean) dictated a second cesarean regardless of how the pregnancy was to progress. This catch-22 complicated several factors for us.
“Our doctor, whom we loved, gave us zero options”
First, our doctor, whom we loved, gave us zero options. She was a great person, wonderful doctor, but she was strapped to the protocol of the local hospital or their medical group that tells patients what they will do as opposed to giving the patient real options and choices on their health care. I mentioned to my wife that we could switch doctors for this pregnancy but found that it may complicate our life because we were getting good care just miles from our house with the current doctor. In the end, we stuck with the doctor we liked.
The lesson learned was that I should have told the good doctor to either grow a pair and stand up to the hospital’s myopic protocol and allow us the opportunity to do it our way or we should have just cut ties and got a new doctor who supported our VBAC wishes. In the end, my wife’s freedom to decide should have been more important than our comfort zone with the local doctor.
I reluctantly supported our doctor and their protocol for a second cesarean. I could tell my wife was disappointed, but she did not fight me. This is one of those critical marriage lessons that go both ways. Since there was little objection, just subtle and maybe even lingering apprehension to not make the decision to switch, we stayed with the plan.
Looking back, my wife’s apprehension to switch doctors was due to lack of VBAC education and lack of support from any of her caregivers, including me. She just couldn’t understand why she was being forced into major surgery.
Later, after our daughter was born, I realized how much the inability to have the option of a natural birth meant to my wife. The night before the scheduled cesarean, it appeared my wife was going into natural labor. In retrospect, considering the labor signs and the small size of the baby, there is little doubt that she could have delivered vaginally.
My wife mentioned this to me the night before the c-section when she was having contractions and said, “I can do this naturally.” My response was, “No, we already have this scheduled for a cesarean in the morning and the doctor said that they would not do it.” This response was naive and void of any empathy or realization of what that lack of support meant to my wife.
We went into surgery and it wasn’t until she was pregnant with our third that I realized how much the second cesarean had left her with some lasting emotional stress and even low grade secret resentment toward me for not supporting her or understanding her feelings on the topic better.
Whether she’ll admit it publicly, she harbored feelings against me for not supporting her, for the medical community’s lack of birthing choices, and to the doctor who we loved but had a hard time saying no to.
“I realized I let my wife down”
When I finally realized how critically important it was to have the freedom and choice to labor naturally, without absolutes dictated by the medical community or their “legal directives,” did I realize that I let my wife down.
When the clue light came on I was set on supporting her on a VBAC, but it didn’t start that way. My awakening did not come immediately when we found out we were having a third baby.
The pregnancy of our last child coincided with the pop up surprise news that I had to leave on a one year deployment to Afghanistan. In January 2012, I found out I was leaving the first week in April for a one year deployment and days later my wife announced she was pregnant. What great timing. Now my wife had to be a pregnant single mom to 3 children for an entire year.
Fortunately, we found out that due to the length of the deployment I was allowed 15 days of leave any time after 90 days in theater and therefore we started planning on my arrival for leave to coincide with the birth of our new baby.
“A selfish desire to try”
My wife quickly relayed her wishes about how this pregnancy would go. She said to me bluntly that we’re doing this naturally. I quickly shot back with absolutely not.
My engineering brain quickly argued with her that we had three data points that indicated this was not a good idea: a 4th degree tear from forceps and 2 cesareans. I told her that I did not want to take the chance of having my wife or baby put at risk because of a selfish desire to try and prove something to me or the world that she could do this naturally. I had read medical reports of women’s uterus rupturing and dying from bleeding after attempted VBACs. I feared what could happen.
But, I never knew the more thorough and recent facts of what my wife wanted to do.
She knew that I was a man who required facts to make critical decisions so she turned away from this conversation and re-engaged me at a later time with literature that showed a VBAC after 2 cesareans is not as dangerous or risky as I originally thought.
She showed me numerous medical associations that supported VBACs of all types. I did a little more research and realized that from a technical perspective; it was possible assuming the pregnancy progressed normally without anomalies.
“It was at this moment that guilt set in”
When my wife dropped this data in my lap and looked at me with a long, deep stare that pierced right through me, my awakening had begun. I realized that she wanted to have the choice to deliver this baby naturally without anyone in the medical profession telling her no unless there was a clear smoking gun for why it wasn’t possible, like high probability of death to baby or mom.
I knew she needed my support to make this work. I decided at that moment that I would support her wish to have our baby without surgery. I knew if anyone could do it, she could. And I knew that there was no reason why we shouldn’t try to do it naturally.
It was at this moment that guilt set in for not doing something about my wife’s desire to try and have our daughter (second c-section) naturally. I could have pulled my alpha male tricks and told the hospital to pack sand and that we were going to labor naturally and they’d have to follow our wishes or put us in the parking lot.
But, I didn’t do that and I was determined to redeem myself for not understanding how she truly felt.
“The only doctor we could find was a 2.5 hour drive without traffic”
The plan was complicated. The only doctor we could find that took our military insurance and would entertain our idea of a VBAC with my wife’s past birthing history was in Los Angeles, a 2.5 hour drive without traffic from our desert home. The doctor seemed too good to be true.
Our doctor, Dr. W, was personable, professional, and most importantly very supportive. There was no talking down or psychological political play to try and convince us that our decision was not wise. I told him that if there was no real reason why the baby couldn’t come into this world naturally, then we wanted his support for a VBAC.
He said he’d support our wishes as long as mom and baby were healthy, and the American College of Obstetricians and Gynecologists (ACOG) supported VBAC.
This seemed too good to be true because our impression was that California was much more litigious than Washington State from where we had our last two children and the previous c-sections. We assumed we would have fewer choices in California because California is a highly regulated state.
In our case, it took a very experienced doctor with the courage and trust to allow us to proceed with our desire to have a natural baby. He was under pressure from both the hospital and his own reputation if things went badly, but he took a chance and gave us the benefit of the doubt to respect our right to choose.
“I wasn’t worried about the rocket attacks from insurgent forces, I was worried about my wife.”
While in Afghanistan, I wasn’t worried about the every 8 to 10 day rocket attacks from insurgent forces, I was worried about pregnancy issues and my active wife. She was now a pregnant single mom, raising a teenager and two children, running 3 houses (we own two in WA State) and maintaining an aircraft.
With our son, my wife was put on bed rest at 29 weeks due to pre-term labor and in the end because the labor did not progress she had the first cesarean. The surgery was an experience she did not ever want to repeat but ended up repeating with our daughter.
While I received the daily reports via emails, skype sessions and pictures, I prayed for her and the kids’ safety and health. I was slated to fly home on or around the 5th of October and be present for the birth, due date October 11th.
There is no doubt that the 15% increase in grey and white hair while deployed was due to the reports of life at home. While pregnant, my wife traveled to Florida, Georgia, and Colorado, traveled and hiked the forest on the Pacific coast with all the kids.
And at 8 months pregnant I would get pictures of her painting various rooms in the house and even using a chain saw to do yard work. I pleaded with her to hire the labor and help as I was scared something was going to happen.
She was simply not a sit on the couch woman. She was on the go all the time.
With our second daughter, my wife fell out of the car 10 days before the scheduled C-section and shattered her left 5th metatarsal. Ten days after breaking her foot, she had the c-section, then 2 weeks later she was in a car and we were moving from Washington State to California and into temporary housing, headed to our next California duty station. She had a cast on her foot for 4 months. This experience was painful both emotionally and physically.
Now, 8000 miles away, I was afraid something similar might happen but even worse since I would not be there to help.
“Preparing her mind and body for a successful VBAC”
Simultaneously while my wife traveled with the kids, painted, and did yard work with chain saws, she took numerous steps to ensure that the VBAC would succeed.
Of her many objectives, one was to ensure that the baby would not be occiput posterior as her first and only vaginal birth yielded a decade earlier and a contributor to the 4th degree tear. She also contacted and connected with various people who gave her more information on how to best prepare for a VBAC.
She had chiropractic appointments to help loosen up her hips and to prepare her body for natural labor. She read more medical data, communicated and worked with people like our doula, who volunteered her services free to military members. The doula could be instrumental in helping many women and seems to be an underutilized service. Our doula volunteered with Operation Special Delivery for families of deployed military members, free of charge.
Free expert doula care is something that does not exist and therefore we were fortunate to be in the right part of the country at the right time when a humble, caring and experienced woman was offering her doula services free to military spouses. This too was a unique windfall and something that feels more like a blessing than pure luck.
Through my wife’s various connections, proactive appointments, nightly stretching rituals, she was preparing her mind and body for a successful VBAC. People such as our doula volunteered hours talking about the game plan for VBAC day.
There was a real possibility that my leave period could have been canceled or late, because anything in the military is possible. Therefore, our doula was necessary to coach and represent my wife’s interest in the event that I couldn’t get home. With both me and our doula in the room with my wife we were able to support her and time share in helping her along.
Fortunately, we both shared the same objectives and wanted the birthing room to be sterile of negativity and only wanted supportive hospital staff to interface with my wife. This was a critical aspect of the successful VBAC. The doula’s warrior like spirit and endurance meant that I had help and an advocate by my side the entire time.
By the time the baby arrived, all three of us, the doula, my wife and I had been up for almost 36 hours since we never got to sleep the night contractions started. My wife text messaged our doula when the contractions got bad and she stayed up on standby until my wife told her that we were headed into the hospital. Our doula arrived shortly after we arrived at the hospital and stayed through the entire experience.
“What was important was her health and the baby’s, not my convenience of being home”
Thankfully, my wife’s pregnancy was just about as perfect as one could hope for. She had terrible heart burn, the normal stuffy nose and difficulty sleeping at night, due to the physiological challenge of having a baby grow against the bladder, making nightly trips to the bathroom routine. All this was normal and when I finally arrived in Los Angeles on October 7, we were ready to have a baby.
There were no indications that the pregnancy could not continue into normal labor. Now, the next step was simply getting my wife into labor. She tried acupuncture, lots of walks and when I arrived, we tried the husband-wife techniques that usually help stimulate labor. But, after a few days home, there were no signs of labor and my wife was getting frustrated. She so desperately wanted me to experience this with her and my window home was short.
I told her what was important was her health and the baby’s, not my convenience of being home.
The strict military protocol didn’t have flexibility in the return schedule: unless it was a major medical emergency, I was slated to leave on the 16th day after I arrived home. So if the baby came late, then I would have very little time with the baby. If the baby had to be delivered via yet another c-section, my wife would be in dire need of help because she’d be hard down with NO family scheduled to be around after I left.
This iteration of the various scenarios had me the most concerned. I was sick to my stomach thinking about this situation; leaving my wife days after a c-section with a house full of kids was unthinkable. I knew I’d have to come up with some creative way to get her immediate help at home.
Another scenario that had me concerned was the baby being 7-9 days late, as was the case with a friend during the same period. The reality of me coming home and then leaving with no baby was a possibility and then having to deliver just hours or days after I left to return to Afghanistan was a horrible thought too.
In this scenario, the probability of complications increased because the possibility of the baby growing too big and then again requiring a c-section increased significantly. When my wife began to panic a little about having no signs of labor, I tried my best to reassure her that everything would work out. In my statistically oriented mind, I knew the odds were against us.
“Contractions were coming about 4-5 minutes apart and they were getting stronger”
Lying in bed on the 8th of October, my wife was upset at the possibility of our grand plan not working out and I assured her that this baby was coming and it would come on the due date. Early in the afternoon on October 10, my wife started to have small contractions.
By around 10 pm they were getting more significant. Just after midnight on October 11, the baby’s due date, the contractions were coming about 4-5 minutes apart and they were getting stronger.
Then with the first real sign of labor, the bloody show, we decided to leave for the hospital, which was about a half hour drive from our hotel.
My father had flown into town a few days before I arrived from Afghanistan. He was the cat herder; he took care of our 4 and 2 yr old. My father at 68 years old has the amazing stamina to handle two energetic kids.
We left at around 0130 in the morning on October 11 and left my father to pack up the entire little cottage we were renting at a local air force base in LA. When we got to the hospital, my wife’s contractions became very strong and painful.
I remember my wife saying labor will be hard for me because I’ve never seen her in real pain and I’m not good with seeing her in pain. I didn’t know what she meant until she started to go into active labor. Our doula met us at the hospital. Between the doula and me, we helped coach my wife through 17 hours of painfully slow labor.
My wife’s labor pains came strong and painful. She was right; I’d never seen her in that much pain before. She had painful contractions for hours and hours. Her first cervical check revealed she was only 1-2 centimeters. She became frustrated again – after all that work and pain we assumed she would have been considerably further along.
Since my wife had two c-sections previously, the staff was trigger happy to react to any anomalies seen in my wife or the baby. Their threshold for pregnancy challenges was low. If the monitors weren’t on at all times, they’d come into the room quickly and impatiently.
Our doula and I had to tell the staff to stop over-reacting. They settled down a bit, but they reminded me that there wasn’t much wiggle room for the monitor rules. The previous night, a woman’s uterus ruptured just after birth and she almost died in a room next to ours. So the staff was even more on edge than usual.
Therefore, we had additional pressure to ensure my wife was relaxed but yet progressing. After 13 hours of labor, she was exhausted and the pain was beginning to take its toll. Her dilating slowed at around 6 centimeters.
The anesthesiologist recommended an epidural in case my wife needed a c-section. They could put one in without administering medicine.
We did not want an epidural to prevent my wife from being able to position on all fours or sitting on the port-a-potty they brought in for her to labor on. But, the pain was so bad, that it was preventing her from relaxing and she was simply running out of energy.
At 8 cm the epidural was in, we made the decision to administer a very low amount of pain relief, just enough to take the edge off. This technique worked and the small amount of pain relief helped my wife regain some confidence as it reduced her pain level. They put in enough pain meds for 1 hour of relief. The doctor said the water bag needed to be broken to further progress.
Several hours after the water broke the doctor came in and checked her. She was 10 centimeters now, the magic number to begin the delivery.
After 15 hours of labor, the baby had to be delivered now. The doctor recognized how tired my wife was and he ensured no more epidural medicine was administered because he needed her strength to push the baby out if we were to do this naturally.
He pulled me aside and told me the baby’s threshold heart rate was down 30%, something I had observed and was concerned about. Dr. W told me that it was time to get the baby out and it was coming out one of two ways. He said when he comes back, we’re having the baby.
He couldn’t let the heart rate deteriorate any further and said the baby is plus 1 and not happy about being stuck in that position.
“The natural urge to push wasn’t happening”
I went immediately to my wife, who was exhausted and told her when Dr. W comes back in, it’s time to push. I calmly gave my wife a pep talk, but she was too tired to respond and her lack of response had me worried. But, she listened. Both our doula and I could tell that my wife was having a hard time pushing.
The pain was difficult to push through and for some reason the natural urge to push wasn’t happening like my wife envisioned it would happen. Her body made it to 10cm, slowly, but wasn’t sure what to do now. The natural urge to push wasn’t occurring. But, it was time to push anyway.
I didn’t want to seem panicked, but I told my wife several times when the good doctor comes back, he’s either taking you to the OR or you’re going to have to push this baby out.
A delivery nurse came in first and she wanted to observe my wife push and immediately gave her some corrective technique.
Then Dr. W came in and did the same assessment and recognized some technique issues and then he turned into an assertive drill instructor, telling my wife to push. Both the labor nurse and the doctor’s quick technique advice were key.
“Is that the baby’s head?”
After one of my wife’s strong pushes and while I was holding her right leg back I noticed something unusual looking next to the doctors finger that was positioned about a half inch inside my wife’s vagina. I couldn’t make out the object initially but once my tired brain thought of all the possibilities I realized that it looked like a mat of wet hair.
I asked the doctor, “Is that the baby’s head?” He said yes it is.
I was filled with energy and excitement that I hoped would jump to my wife when I told her the news of what I had just witnessed.
I couldn’t believe I was staring at the top of our child’s head. We made it I thought! I told my wife I could see the baby’s head. She pushed harder and after about 3-4 good pushes, our baby came right out. It was the most amazing thing I’ve ever witnessed.
Once the baby was out, they placed her on my wife’s bare chest. After several minutes we realized that we never checked to see what the sex was.
My wife lifted her up, moved the umbilical cord and I think we were both surprised to see a little girl part. We did not want to know the sex of the baby until he or she was born.
We assumed we were having a boy because of how strong the baby was during the pregnancy and how much the baby looked like our son from the 3-d ultra sounds.
“She felt so good that we requested to leave the hospital at the absolute minimum stay period.”
Lucy Rose was born at 7:47pm on October 11, 2012. She was 7 pounds 1 ounce. My wife had no tearing and her uterus showed no signs of trauma from the VBAC. She felt so good that we requested to leave the hospital at the absolute minimum stay period.
The baby was born at 7:47 pm and we told the hospital we’d stay exactly the required 24 hour monitoring period. By 8pm, 24 hours later, we were loading up the car and heading back to our desert home, 2.5 hours from the hospital. We arrived at our home around 11:30pm.
This was the first time I had been home since April 7th and it was so nice to be back. No hospital nurses checking vitals every 2 hours and the comfort of our own nest. The next 10 days at home with the baby, my wife and kids were absolutely wonderful.
Due to the natural birth, my wife was immediately mobile. Unlike the previous two births, it was great seeing my wife smile, happy and glowing and able to move without pain.
She loathed the c-section and dreaded the possibility of having to go through that again, especially without the help of her husband. Thankfully, we were able to have a successful VBAC preventing my wife from having to relive another c-section.
“She came in and began lecturing us on the dangers of a VBAC.”
When we arrived at the hospital, the birthing process started out badly. The first nurse we dealt with was what I would consider bluntly, an idiot. She came in and began lecturing us on the dangers of a VBAC.
I quickly told her to stop and leave. This same nurse came in again and tried to make more negative commentaries and this time our doula rolled in and told her to essentially shut up and do her job.
I pulled this nurse out and told her that we weren’t going to have any negativity in the room. I told her that we weren’t 16 year old idiots; we were well informed and educated people who most likely knew more about the risks than she did.
I had thoughts of leaving the hospital due to the initial behavior of the nurses. In all honesty the staff on duty when we arrived was absolutely horrible. They were unfriendly and unprofessional.
But at shift change, something wonderful occurred. The next shift yielded very competent, supportive and professional nurses who understood that our path through this experience was going to be nothing but positive and supportive. Two of our nurses were also doulas. We had great health care providers through the rest of the stay at the hospital.
No more myopic lectures about the risks but instead an all out effort to support my wife through this delivery. There is no way we could have made it through this experience without the help and support of true and knowledgeable nurses who understood compassion and realized that the patient is first and foremost.
“My initial thought was that this hospital was going to be a disaster but I was happy to be wrong.”
My initial thought was that this hospital was going to be a disaster but I was happy to be wrong. We fortunately experienced a well organized and supportive hospital where our experience was wonderful and our dream of a natural birth and of a successful VBAC was realized.
The ability to have a natural birth allowed my wife to function immediately after the birth, something that would be crucial when I left again for another 5 months. My 9 days at home after Lucy was born, allowed my wife to rest and regain her strength. Then when I left, she would be able to successfully handle the newly expanded family.
If she had had a c-section, our lives would have been even more complicated and challenging. Alleviating this variable was crucial and it was extremely important in allowing my wife the choice and freedom to labor as she desired.
“Having hospital protocol tell you what you can do with your body is a crime.”
Having hospital protocol tell you what you can do with your body is a crime. It was a crime with our second baby and one that I unfortunately did nothing to stop. I was guilty of not recognizing the deep and complicatedly emotional desire and need to have that choice. I was guilty for not carefully listening to my wife.
But, I was fortunate to have had a second opportunity to ensure she was able to have that choice. When I saw and finally understood my wife’s deep desire and passion to have a VBAC, something that I can’t really explain, but instead felt – I knew she could in fact do it and that I needed to help pave the way to ensuring it was possible.
That meant I needed to knock down the obstacles that got in our way, like doctors saying no or nurses trying to convince us that our decision was dangerous and risky. I listened to my wife, and we thank God that we found a doctor who trusted us.
Ultimately, faith, education and research, proper planning, incredible support that we received from people like Dr. W and our doula, and the great nurses who helped make this a success were critical to the successful VBAC.
We heard it before “you’ve had one, so now you need to have them all c-section.”
This we now know is myth and one myth that removes the woman’s choice to attempt a VBAC. Our hope is that other women and couples will have the same support and success as we experienced.
What do you think?
Leave a comment.
What do you think? Leave a comment.
Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.