I wanted to write this story down because it is one I can’t forget.

I was walking back to my car after a late night downtown meeting and I was accompanied by Peter and Molly, old friends. Molly was someone I really admired and she had two young children. As we were walking along together, Molly said: “Gloria, I don’t think I’ve ever told you what an incredible difference you made to me.” My ears perked right up, I love to be acknowledged, but I couldn’t remember anything special that I had done for Molly.

She said, “Remember that day we bumped into each other on the street when I was hugely pregnant with Caroline, my second daughter? We hadn’t seen much of each other during my pregnancy and I was working with two registered midwives and planning a homebirth.End of Pregnancy

My mother had come out from Eastern Canada to help the family at the end of my pregnancy and it seemed to be taking forever for the baby to come. I was worried that my mom might be really scared to see me birthing and I had a feeling she didn’t like the idea that, this time, I would have the baby at home. I didn’t even want to talk to her about the idea I had of having a waterbirth. Everything else about the birth was going smoothly but I had this nagging fear about my mom’s reactions. Well, Gloria, you listened to everything I said and then you said “Oh, do you know what? I have the most amazing video of waterbirth that you just have to watch. Everyone who sees it has a lovely smooth birth, you’re going to love it”. (The video was Barbara Harper’s “Birth Into Being”). You went to your car trunk and presented me with the vhs tape. I took it home and we watched it that evening. My mom watched it with us and said at the end “Why don’t you get one of those water tubs and do it that way, Molly!” All my worries were gone and the next morning my birth process started. The birth was everything we wanted. Afterwards my Mom said “Honey, that is the most beautiful thing that has ever happened in my whole life. I’m so glad I came out to Vancouver and got here on time to be present to the miracle.”
My Mom returned home to Eastern Canada. She was a widow and she liked to live in her own home alone. A few months after Caroline was born, we got the terrible news that my mother had taken a fall down a flight of stairs and she died. The grief was terrible. Amidst all the grieving I had this sense of peace that my Mom had been present to a miracle and that we had shared a profound experience. I don’t know if it would have unfolded that way if you hadn’t run to your car and lent us that video.”

 Only two remain undilated.

Only two remain undilated.

Molly (not her real name) only told me this story when the baby in this story was about 12 years old. You never know what the ripples in the pond of your actions might be. Love Gloria

A Doula’s Experience with Breech

After a birth, it helps to get a perspective on what could have/ should have/ might have been different in order to learn and grow. Every birth story is different. Gloria

The family had a super healthy (first) pregnancy, with opportunities
galore; access to acupuncture, chiropractics, yoga, watsu, massage,
walking, biking, good rest and healthy food (they are both vegan and
eat really well). They chose not to have any ultra sounds and had
her first internal exam at 40 weeks, at her request. She was quite
anxious about having internal exams, learned that it is possible to go
through pregnancy and birth without any fingers up her vagina and
decided that would be best for her. She asked for the exam at 40 weeks
because she felt it would be better to have a ‘practice’ exam in a non
labour situation to see what it would be like just in case she wanted
to have one in labour.

Throughout her pregnancy her various health care professionals
palpated her belly and were sure the head was down. I don’t touch
bellies, I just pay attention to how women are carrying and moving and
what they are saying, and it seemed like a vertex presentation to me
as well. At 39 weeks, her chiropractor and her midwives noticed a
difference, but figured maybe the head was engaged. On her due date
she had an appointment with one of her midwives, who is quite new to
midwifery and she basically freaked out from feeling what she thought
were hands presenting and told the family they must go for an ultra
sound the following morning at 8am. The family was left quite worried.
I asked what she felt about the baby’s position. She said she had been
feeling flutters down below, and figured it was simply mild
contractions. I also asked if she was feeling pressure up in her ribs,
or if she was pushing down on her belly in discomfort, and she said
she had been feeling that way all week. I told her not to worry and
offered to join her for the ultra sound in the am.

Later that night I received a call that labour had started, she had
been contracting since her midwife appointment, but thought it was due
to the internal exam. The contractions were building, so she called
the midwives and they told her to go straight to the hospital for an
ultra sound and one of the midwives would meet them there. The ultra
sound indicated baby was breech and the OB on call was one of the only
in the city who was open to vaginal breech births, although he clearly
stated he was not interested in any marathons and she would have 6
hours to labour (no pressure!) The midwife assured them he was good at
what he does, but he was known to have no bedside manner. That was
pretty clear, but they didn’t care.

At this point their midwife said they could go home to grab their
stuff and take a pause. She was well aware that this was a total game
change from their water birth at home plan, so taking a moment at home
seemed an important part of their birth experience. They called to
let me know the baby was in fact in a breech presentation and that
they were heading home to get their stuff. I was pleasantly surprised
they were encouraged to go home, and told them to keep me posted and
take their time. I said I would meet them back at the hospital when
they returned.

We met at the hospital at 9:45. The midwife did a very gentle and slow
internal exam and found her cervix was 4 cm and stretchy. They had her
on the monitors after that. I asked if she could be on hands and
knees, but they couldn’t get the heart rate as clear, so that was
ruled out. She was laying on her side and after 10 minutes on the
monitor we heard major dips in the heart rate over and over, tried
getting her on her other side and baby was still dipping quite a bit.
The midwife was concerned of a cord prolapse, so the nurse came in and
did a very different internal exam, got right in there fast and
vigorously and felt bulging membranes and what she thought was a cord.
Suddenly two nurses had their hands inside of her, it was terrible.
They said they were trying to push the baby up off of the cord.
breech presentations

You can imagine how intense this was for the mother to be. The room
filled with nurses and it was announced that she would have an
emergency cesarean birth. They wouldn’t let her partner go with her,
this was also terrible. The midwife wouldn’t take no for an answer and
got her scrubs on to accompany her. I stayed with her partner. He was
a mess. We found the only nurse on the floor and asked if she could
keep us updated and I asked if there was any way her partner could go
in. They were waiting for the doctor to come (this whole time with the
nurses hands inside of her…) the doctor would do one more check to
make sure the cesarean was necessary. The nurse grabbed scrubs for the father
and he got changed, but just as he was going to go in the doctor

I later found out instead of determining whether a cesarean was
necessary, he yelled at the midwife for having let them go home. One
of the nurses spoke up and suggested they instead focus on the task
at hand and he determined the cord was not presenting, but a foot was,
and her cervix was 8cm dilated. They went ahead and gave her general
and she heard the OB yelling at her midwife as she went under. Her
partner and I waited in the hallway, he made a comment that being the
dad waiting in the hallway while his baby was born felt like we time
warped to the 1950’s.

Baby was born at 10:45pm and dad held him for the first time in the
hallway at 11:10 pm. Apgars 8 & 9, and he was 5lbs 11 oz.

Mom and baby were moved to the recovery room and dad right away took
off his shirt and gave baby skin to skin cuddles until mom was ready.
At 12:45am the nurse said baby’s sugar was low and suggested formula
or glucose water. I asked mom if she was ready to try breastfeeding or
if she wanted me to get on the phone and call her friend who had
offered expressed breast milk if they needed. The nurses were outraged at this
suggestion, said they couldn’t allow it and so she did her best to
try breastfeeding. An hour later they did the sugar test again and it
was way up. The midwife and nurse were both in disbelief (the sugar
level raised from 1.9 to 3.7 in one hour!) The midwife commented how
interesting it was that they had no trouble believing the low number.
I told them it must have been the skin to skin contact with mom and
some colostrum that did the trick. Once they were settled and resting, I
drove home with their placenta and made them some quick prints and a
smoothie. They were happy to have had some of their birth wishes

Today the family is doing quite well. They are breastfeeding, resting,
eating well, have lots of support and are processing their unexpected birth
experience a little bit each day.

– Could we have avoided those low decels if she could have been up on
her hands and knees?
– What happened when that nurse felt bulging membranes? Did she cause the membranes to release?
Or is it possible to feel a prolapsed cord through the bag?
– Could a baby with apgars 8 & 9 have been in such distress moments
before? (or was it that they were worried baby couldn’t handle two
more centimeters as well as pushing?)
– Was this the only way it could have happened? In general it felt to
me like everything happened as it had to, except those few questions
above that leave me feeling a bit curious.

I have never attended a cesarean birth (I have been a doula for four years).

Any way in which we can learn together from this story would be great.
Comments and feedback are very welcome.


Gloria’s thoughts

    Dear Ruby, It’s getting to be hopeless to have a primip give birth vaginally to a breech.
    You must be traumatized/grieving about all this. Thank goodness you were able to give them some measure of getting their wishes met.:

    When the adrenalin gets going at a breech birth, they basically find reasons to head to the surgical setting. The cord wasn’t causing problems so, in hindsight, the heart tones were fine.

    Don’t know what the nurse doing the exam was intending but I would hope she was being careful NOT to rupture that membrane with a breech. Did she break the water bag? You would have seen amniotic fluid with clear poop coming out of the woman’s vulva after that exam if the membranes released.FOOTLING BREECH

    As far as diagnosing a prolapsed cord through the membranes with a footling breech, it might be possible because the bag is thin but it’s highly unlikely and, we know in this case (again, good hindsight), it wasn’t there.

    Apgars of 8 and 9 indicate a healthy, well grown term baby (again, golden hindsight). We do know that monitoring increases the risk of cesareans without any evidence that it is helpful in improving health.

    From what that dr with no bedside manner said, the woman wasn’t going to be given much of a chance to give birth vaginally. Since she hadn’t had previous uterine surgery, it would have been nice if someone with the skill to do a cephalic version had been there when she was first at the hospital. The baby presenting by the feet is the easiest to turn, especially if the baby is small and it’s early in the birth process. To be fair, a first birth with feet presenting is not a good vaginal birth risk to take. Luckily it is a rare situation to have so the numbers should be very low.

    If the caregiver is palpating bellies and listening with a fetoscope (instead of doppler) in the prenatal period, the caregiver should be picking up when it’s breech at 36 weeks gestation (if in doubt, the woman can have a one-swipe quickie ultrasound to double-check). At that point, if it’s discovered, there’s time/space to get baby turned to head down. As I said, a footling breech is easiest to get turned. Frank breech is a more optimal position for safe vaginal birth of breech but not for turning baby to cephalic. Querying rib pain, listening in the 4 quadrants with a regular fetoscope (and finding the true fetal heartbeat low in the pregnant belly) and observing the shape of the pregnant belly are your best tools for early diagnosis.
    Thanks for being there for this family. Gloria


Lisa Kusch Case in Saskatchewan, Canada

When a birth worker is charged with an offense in Canada, she receives legal advice not to discuss the case and not to speak with the clients involved. This makes things very difficult because she must raise funds to cover expensive legal bills and she can’t campaign on her own because of these restrictions.
I have asked for facts from different sources and submit the following information for those who are helping with the funding and care about my friend, Lisa Kusch.

Lisa in 2015

Lisa in 2015

In October 2016 Lisa was charged, as follows:
“It is alleged that between the 29th day of October 2014 and the 29th day of November, 2014 in Saskatoon Saskatchewan, Lisa Kusch “ DID ENGAGE IN THE BUSINESS OR PRACTICE OF MIDWIFERY, WHILE UNAUTHORIZED TO DO SO, CONTARY TO SECTION 23(2) OF THE MIDWIFERY ACT” (see below for the wording of that section of the Act).
That’s it. There are no specific details of what Lisa did or did not do. It seems to me that this is an overly broad and vague accusation. The document with the allegation was accompanied by emailed complaints filed by the birthing woman and the attendant at the birth (a doula/friend of the woman who accompanied her when she transported to the hospital).

Some of the information I have gathered which is to the best of my knowledge:
1. Lisa was not present when the baby was born.
2. Lisa is not a Registered Midwife and doesn’t represent herself as a Registered Midwife. That has been agreed upon by all parties and she is not accused or charged for this.
3. The woman was having her first baby and transferred to hospital for pain management. I am told that the baby was delivered by non-emergency c-section, at the mother’s request. The medical reason given was failure to progress.
4. Mother and baby were discharged from hospital on a normal schedule.
5. Lisa is accused in the complaints of causing poor outcomes and delayed recovery, due to excess blood loss during the surgery.

If Lisa is found guilty of a summary offense the result will be a fine of up to $4000. This is not a criminal case and it is not a civil case. The burden of proof is on the Crown to prove that the defendant practiced unauthorized practices according to the Midwifery Act of Saskatchewan. If one reads the applicable section of the act quoted in the charge above, it is vague in its definitions.
This case will set a precedent as it is the first in Saskatchewan and will have national implications.
The trial date is now set for October 24, 2017.

Start of Section 23 (2) No person shall engage in the business or practice of performing any of the authorizedpractices described in subsection (1) with respect to another individual unless:
(a) the person is a member who is authorized by his or her license to perform
that practice;
(b) the person is authorized pursuant to another Act to perform that practice;
(c) the activity is one of daily living and is performed by the individual or by
a person on the individual’s behalf. (end of section)

I submit the above to help people see the bones of this complaint and action against Lisa Kusch. Thanks for reading. I will update/edit as more info comes to light. Gloria Lemay, July 12, 2017

Some people have asked if they can send money for Lisa’s fund by bank transfer so I’ve set up a separate email and bank account for that purpose. The email address is I’ll post periodic messages on the GoFundMe page about the total that comes in via bank transfer.
Lisa Kusch

The GoFundMe page to donate to the legal fund is at

Grand Multipara Birth



This is an online conversation that I had with a grand multip (woman who has given birth more than 5 times). There are special things about birth after the fifth baby. . . for instance, sometimes the process can be stop and start for days and, then, suddenly. . . here’s the baby. There is nothing wrong with that way of birthing but, because large families are relatively rare, many practitioners lose faith and patience and brand the woman as “failure to progress”.

Another unique thing about women carrying a fifth or more baby is that they are prone to what midwives call the “blue right leg syndrome”. It can be alarming to see how blue the right leg becomes in pregnancy but, then, the baby is out and the woman’s right leg looks just fine again. I like to read things by the midwives in the USA who serve religious groups with big families. Lots of little anecdotes like that.


Hi Gloria,
I am wondering if you could answer a couple things for me.
I was reading your post about the 30 Minute Third Stage, and saw your comment about the anti-bleed tea. I’m curious to know more about this.
I understood that shepherd’s purse was not to be used until after the placenta was delivered, and that it was dangerous to use it before.
I see that one of the ingredients for your anti-bleed tea is shepherd’s purse. Can you share with me how it differs in the tea, as opposed to using the tincture? Also, is this safe to use as a grand multip? This is my 10th baby, 14th pregnancy.
I tend to bleed a fair bit with my births, and I am trying to be prepared this time, (due in August) and read and research things that I could/should try to have on hand, especially in case my attendant doesn’t make it here on time. I tend to go quickly, and feel a strong need to be prepared this time.
Thank you for any input you are willing to share (smile emoticon). Caroline

TUES 22:35
Hi Caroline, One of the things with grand multips that really helps prevent bleeding is going for a 1/2 hour brisk walk. One of my clients found some research on it and it really seems to work. I don’t know why. As far as the shepherd’s purse, no one can really do studies on these herbs and their use after a birth. We worry more about after pains with grand multips. Therefore we give a cramp bark /cinnamon tea. A couple of things that I’ve seen lately that interest me for the after pains are 1. Increasing magnesium supplementation after the birth. 2. Emptying the bladder more often than you think you need to. Just get up and pee if it’s been a while and don’t wait till you feel like pee’ing. Apparently these 2 things are very helpful for cramps. Thank you for writing. I’d love you to have a smooth, relaxed birth. Gloria

Thank you so very much for your time!!
These are some very interesting points.

I’m curious for a little more information on the brisk walk. Is this something your recommend in labor? Or for the days leading up to birth?

I feel so much peace about our upcoming birth. Much more so than I’ve felt with any of the others. But I also am loving to learn as much as I can about birth as a whole, and things that could be useful for my own as well.
Thank you again. Caroline

You’re very welcome, Caroline. I mean a walking program starting NOW. I never ask women to walk when they are in the birth process. I’m afraid they will hit me! ha ha. You’ll know what you want to do when having the baby, it’s the preparation that’s important. By a walk I mean a brisk walk with no kids, no purse, flat shoes and really walking as fast as you can. Gloria

Gloria, Thank you! I will start doing that today. ?

I am soaking up as much information as I can.

I also have to say that I love following your page and reading on your site. So much information that has been so useful.
Thank you for everything you do!!
Makes me wish I was in Canada and could meet you! Caroline

That’s very sweet of you. You are exactly the woman I am writing for, so many people just can’t “get” what I’m trying to communicate.

I am loving the learning! I have been trying to dig as deep as I can, and find as many different ideas and perspectives as I can. I’m always thrilled when I find new perspective that makes sense!
Will you be offering your online class again in the future? I would be very interested in taking part, if you do.

Added: Another tip I will give to grand multips. When you have lots of older children, they ALL want to hold the new baby. This gets to be a competition and a struggle and it could be a reason why the mother might bleed too much. Explain to the entire family like this: “It’s very important that Mommy has the baby on her skin for the first day of the baby’s life. That helps Mommy’s body to change over from being pregnant to being a nursing mother. If we want Mommy to stay at home and be healthy, we are ALL going to wait until the baby is 24 hours old before we take turns holding the baby.” In most families, the kids really understand this and they don’t mind so much not holding the baby as long as no one else is either.

Pregnancy Induced Hypertension, Woman Heal Thyself

I have had this article from the New Statesman (a British magazine) in my files for decades. I’ve given it to many women to underline the importance of daily quality protein in pregnancy. I can’t find any reference to it on the internet and I publish it here in order to have this history preserved. Remember when reading it that no one had home computers in 1984 and there were no search engines. We had to rely on TV, magazines, newspapers and medical libraries back then. There was no email so the British postal service was the way these women contacted each other. For this young woman to undertake this project in those days is truly amazing.

The terms toxemia (spelled toxaemia by the British), and pre eclampsia have both been retired and now all these words are under the umbrella term of “Pregnancy Induced Hypertension” (PIH). Enjoy the read and leave comments. Thanks Gloria

New Statesman 6 January 1984



John Hargreaves on a new approach to toxaemia

FEW PROFESSIONALS care to be lectured in their own field by their clients. But when Dawn James faithfully followed her doctor’s advice during pregnancy and succumbed nevertheless to a disease which kills an average twelve women and hundreds of fetuses every year in Britain, no one could tell her why. This 27 year old woman, living in a council flat in Hackney—‘shy, and not a speaker type at all. . . from a working class background and a secondary modern school’ –determined to find out for herself.

Two years later, she was invited back by the Senior Nursing Officer to the hospital where her baby was born, to explain to the midwifery staff what she believes are the causes of toxaemia of pregnancy and how it can be prevented.

Pre-eclamptic toxaemia (a misnomer because it is now recognized that no ‘toxin in the blood’ is involved) is a condition unique to pregnancy, generally diagnosed upon appearance of two of a triad of symptoms—high blood pressure, swelling, and protein in the urine. Abdominal pains, headaches and blinding flashes of light may alert a pregnant woman that something is seriously wrong. At its extreme, the condition becomes eclampsia, the epileptic-like convulsions that can be fatal to mother and baby.

Diagnosis of pre-eclampsia is confused by the fact that all three of its cardinal symptoms may arise from other causes, many of which are entirely benign. This is often not recognized by doctors, who may begin treatment of healthy pregnant women, sometimes causing problems where none in fact existed. Even in genuine cases, standard medical treatment with bedrest, sedatives, drugs to control blood pressure, and early induction of labour does little to ameliorate the condition. Many doctors believe that the only effective treatment is to end the pregnancy.

Pre-eclampsia is still hailed as ‘the ancient enigma’ in obstetric journals, and a consultant dealing with a reader’s problem for ‘Woman’ magazine wrote recently ‘the cause of pre-eclampsia is not known. . . Because of this it is not possible to give advice on how to avoid it.’ While midwives have taken Dawn James’s findings seriously, the obstetric profession remains obdurate and aloof.

It was in the women’s magazines that Dawn James began her own search, with a request that others who had suffered pre-eclampsia write to her. She had 200 replies. She sent them a questionnaire, and compared her findings with what she had learned from the textbooks. Pre-eclampsia was supposed to be more common in twin pregnancies, overweight women and diabetics, and to run in families. None of these categories fitted Dawn James, and none was common among her correspondents. These women, anxious about their future, had invariably been reassured by their doctors that pre-eclampsia was a disease of first pregnancies only. Yet out of the 32 respondents who had undertaken another pregnancy, 23 had suffered pre-eclampsia again! With the support of many of these women, Dawn established P.E.T.S., the Pre-Eclamptic Toxaemia Society.

DAWN BEGAN a massive educational effort involving correspondence with the experts’ across the three continents and delving through the medical journals reaching back over a hundred years. But alongside continuous reportage of this work in the quarterly P.E.T.S. newsletter, Dawn kept publishing the personal experiences of her members – tragic accounts of unsuspecting women meticulously following their doctors’ orders and yet succumbing quite suddenly to convulsions and coma and having either a premature, low weight baby (with a much higher risk of mental or physical disability) or a stillbirth.

An underlying theme did begin to emerge from Dawn’s reading, and that was the supreme relevance of the mother’s diet. John Lever at Guy’s in 1843 was probably the first obstetric physician to take a dietary history, noting a single daily meal of bread and tea from a woman with puerperal convulsions. The work of Hamlin in Australia, Strauss in North Carolina and, especially, Brewer in California made a strong impression. Here was an account of the aetiology of pre-eclampsia – from inadequate nutrition, through liver dysfunction, low blood albumin and reduced blood volume—which made sense and was supported by the evidence amongst the severely undernourished subjects involved. But how could this apply in Britain in the 1980s?

By the time the next newsletter was compiled, Dawn had made the most significant step of all, by simply asking herself, as so few obstetricians have asked of their patients since John Lever, ‘what exactly had I been eating?’ ‘During the first twelve weeks of my pregnancy, I was constantly vomiting day and night and survived a few weeks mostly on bottles of lucozade. . . then, at about 5 months, I was told I had gained ‘too much’ and that I should cut down on my food. I felt really hungry all the time and would sneak a potato or some bread until my husband would remind me of the expert advice and I would go back to mostly salads. . . . When I was in hospital. . . I hardly ate at all during those two weeks prior to my induction.’

Underweight and premature

Underweight and premature

Again and again, the personal experiences indicated maternal under-nutrition, sometimes instigated by doctors setting artificial weight limits. And more scientific studies, conducted by dieticians and public health physicians rather than obstetricians were given a new prominence in P.E.T.S. They showed that pre-eclampsia could be effectively prevented by thorough nutrition counselling or diet supplementation.

The obstetric profession doesn’t like this idea. ‘I would counsel that you drop any reference to Brewer’s work,’ wrote Professor Ian MacGillivray about the California champion of the nutritional thesis, ‘if you wish to have any support from research workers into this problem in the United Kingdom or for that matter, any part of the world.’

Nancy Stewart, another P.E.T.S. member and recent editor for the Association for Improvements in the Maternity Services, believes that this is inevitable given the training and role of obstetricians. ‘Prevention through good nutrition is a woman-centred approach, which means being in touch with women’s daily lives. And it has to do with health, rather than disease. This is the approach of midwives, as the guardians of normality. Obstetrics is not about health, but about diagnosing and treating disease. It is a male science, and within the political structure of maternity care it is these men, trained to approach pregnancy as a medical event, who have the power to define health care.’

Pre-eclampsia is more prevalent among unskilled working class people and teenaged, Asian and single mothers—those statistically least likely to meet the extra nutritional demands of pregnancy. How can a few informed women hope to change the system of maternity care to benefit these in greatest need? Midwives may learn eagerly from P. E. T. S., and may even recall the days when their duties included baking and delivering egg custards to get concentrated protein into poor pregnant women, but their role as independent practitioners is being rapidly diminished into one of obstetric nurses.

Perhaps P.E.T.S. can work its approach into the health care system through the back door, women taking the lead. But in the meantime as many as 15 per cent of women in pregnancy are diagnosed as pre-eclamptic, and very few of them discover in time the protective effects of sufficient high quality foods. Instead, they are categorized immediately as high risk and referred to the obstetric clinic, where sophisticated, expensive diagnostic procedures chart with scientific precision the worsening and irreversible damage to their babies.

(Transcribed by Gloria Lemay, Vancouver BC Canada from the original magazine article)

Podcast available for download

I had a great time being interviewed by Alain Desaulniers, DC, recently. Enjoy this podcast. Love, Gloria

Thanks so much for sharing about your AWESOME birth story and for your willingness to share so openly and authentically. I hope that millions are transformed through your words and message! I look forward to connecting with you soon! You rock!
I would be honoured if you would share with your circle of influence!

Your Show’s link:
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Thank you for giving back,

Dr. Alain Desaulniers

Family Chiropractor, Everyday Revolutions Podcast Host, Educator, Keynote Speaker everydayrevs

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Midwifery Care for the VBAC Woman
by Gloria Lemay
© 2001 Midwifery Today, Inc. All rights reserved.
[This article first appeared in Midwifery Today Issue 57, Spring 2001.]

Someone asked me recently what things are done differently with vaginal births after cesarean (VBAC) as opposed to a first baby. Midwives usually reply to this question with a reassuring, “Oh, we treat you normally,” but there are differences in the two situations that can be distinguished in midwifery practice.

Prenatal Preparation

The full history of the events leading to the cesarean is very important. With a VBAC client, ask her to get her operative record, nurse’s notes, anesthetist’s report, pediatric report—get all the records and go over them thoroughly. Often the couple did not get full or accurate information about what was going on. Sometimes there’s a little “clue” as to what went wrong that could help to prevent a cesarean from recurring. Sometimes there is a big chunk of information that didn’t get communicated. I saw one set of records where the only indication for the cesarean was the note from the obstetrician that “this woman is a natural childbirth fanatic.” Another set of cesarean records had no indicator whatsoever of why the woman received abdominal surgery when she had given birth at l9 years old. When she told her parents that the midwife was perplexed and could see no reason for the surgery, her father admitted to her that he had stayed in the visitor’s lounge all day and had been verbally threatening to the doctor: “If anything happens to my daughter, I’ll sue you!” This helped the daughter to understand what had happened to her and also helped her to be firm with her father that he was to be nowhere near her VBAC birth.

With VBAC births it is important for the midwife to work with the dad prenatally. A VBAC father is in a horrible position because, despite the fact that his wife had an operation and a long recovery, he still got a live wife and baby at the end of it all. VBAC dads are often “fantasy bonded” to the medical system and terrified of childbirth in general.

The good thing is that they listen very carefully and really know when the care is better and more thorough and when the practitioner is authentically on their team. I find that if the midwife talks to them very honestly, they can trust and be fully supportive when the birth time arrives.

If the woman has dilated past five centimeters in the first birth, I plan for it to be fairly fast—like any second baby. If the woman has not gone into the birth process or not dilated past five the first time, that’s all right, she’ll still give birth vaginally, but we have extra midwives on call to bring fresh energy if the others get discouraged or tired. We plan for it to be like going to two births in a row. The point that the woman reached in her first birth is often a psychological hurdle for her. If she dilated to six centimeters the first time, the news that she is seven or eight will be a relief and a breakthrough. One of our clients, a minister’s wife, said over and over again in her pregnancy: “I just want to feel what pushing is. If I only get to push, I’ll be happy. I just want to know what other women mean when they say they had to push.” She’d had a Bandl’s ring in the first birth process and the cesarean was done at five centimeters. We were praying that the complication wouldn’t repeat. She dilated smoothly and began to push. With each push she would exclaim “Thank you Jesus, thank you Jesus!” What a wonder it was to watch her push out the baby, a girl whom she named Faith.

All humans have a certain propensity to self-sabotage, and the VBAC woman must be on guard against her own defeating patterns. The midwife must be bold in pointing out ways that the woman is repeating dumb moves—there’s no place for us being “nice” if it will mean another cesarean. An example of this: If the woman had a cesarean with five support people, she will be cautioned to keep her VBAC private.
Privacy and quiet are a must, and we will be very forceful about setting up logistics before the birth so that the woman can birth in peace. In short, the VBAC is high priority because this woman’s whole obstetrical future rides on its success.

Keeping a VBAC normal

Keeping a VBAC normal

We show the couple lots of videos of beautiful VBAC births because one video is worth a thousand words. If you don’t have your own, purchase a copy of my dvd “Birth with Gloria Lemay” which shows a beautiful VBAC waterbirth. Art therapy is helpful in creating the environment before the birth day. I place a big sheet of drawing paper in front of the father and mother with lots of colored pencils and instruct them to, “Draw your birth cave” or, “Color your birth.” When they are finished, I write the date on the two drawings and put them away in my files. After the birth, we take them out and are amazed at the details that were drawn weeks before and later manifested in the actual birth.

I schedule longer appointments with VBAC women because they seem to need to obsess. I don’t have solutions to many of their fears but it seems to help to just be able to talk to someone who cares and understands. I usually also ask them to, “Tell me how you know that this time you’re going to have a vaginal birth?” The answers always amaze me. One woman said, “Because this time I’m not depending on my doctor or my midwives—me and my husband are going to have this baby.” I suggested that she give up depending on her husband, too. She looked terrified at that idea but I could see that she understood; she looked me in the eye and said, “Right!” That was the moment I knew she would do it. She’s had three water homebirth VBACs since then, and after each birth her first words were, “I did it.”

VBAC women are so grateful for the opportunity to birth normally that they are often shy to ask for the extra things that make a birth beautiful, such as a Blessingway ceremony or a waterbirth. The midwife must remember to offer and encourage the mother to think “really beautiful birth” rather than “bare minimum birth.” I find it helpful to ask, “This is the only second baby you will ever have—what would make it really special?”

The Day of the Birth

In my practice, no one gets induced in any way or gets pain medication. This policy is very important for all women but especially for VBAC women. If there is a small chance of uterine rupture, we must have everything on our side to prevent it (the rate of VBAC uterine rupture without induction is 0.4 percent or less than one in 200*). It is beyond my comprehension how anyone could give a VBAC woman misoprostol (Cytotec), oxytocin or castor oil or strip the membranes or use any other form of induction when 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 is no hurrying. I would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally. We keep it in the back of our heads that the signs of rupture are stabbing pain, unusual bleeding, decels of the baby’s heart, or a peculiar shape of the abdomen but we don’t look for problems if they don’t exist.

We are 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 we do not want to have a uterine prolapse caused by pulling.

Postpartum Differences

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 it when we ask them to do sit-ups and leg raises on day one. Usually by day three when we go to visit, their husbands say, “Oh, she’s gone to 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.

In the years following the birth, these women and men send us more clients than anyone else, and if we’re in legal trouble, they’ll be at all the rallies, raise money, stamp the envelopes, write letters to legislators, and be our true friends for life. A VBAC is an amazing experience for the birth attendants as well as the family. Very Beautiful And Courageous (VBAC).

    Q & A: VBAC

Two Types of Pelvises
by Gloria Lemay

Q: From a midwife: A great many Asian women are very small and small-footed, yet I hear that many of them birth vaginally. Would you comment on pelvic size?

A: When I get a VBAC client and she is endlessly self-psychoanalyzing and beating herself up for having a c-section, I usually say, “Look you made two big mistakes! First you were born in the wrong country, and second you were born in the wrong century—if you’d been born and raised l00 years ago in France, for instance, you would have given birth vaginally.” When I teach my workshops, I tell the students there are two types of pelvises in allopathic medicine: l) contracted, and 2) adequate. In midwifery, there are two types of pelvises as well: l) roomy, ample, and 2) you could get a pony through there!

Gloria Lemay is a Private Birth Attendant in Vancouver, British Columbia, Canada and a frequent contributor to Midwifery Today and The Birthkit.

DVD: “Birth with Gloria Lemay”

This is the kind of delightful feedback I receive about the DVD. Gloria

From Donna Reicks:
“Gloria, I just have to tell you…..I loaned out your DVD “Birth with Gloria Lemay” as I do to any “English” ladies I serve. These are 1st time parents (after 7 years of trying!) and she loved your DVD and commented her favorite part was the extra features on circumcision!! They were on the fence if they had a boy. Now, their decision is made. Thanks Gloria!! Keep up the good work! Much love to you!”

From Gloria Lemay: “When I made the DVD, it was easy to add a few “extras” besides the footage of 9 home water births. One of the “extras” is a Director’s Cut-type film with me explaining what is going on in the film. The strange thing for me is how many women say, “After watching the version with you explaining what’s going on, my husband is now comfortable with the idea of birthing at home and he feels confident.” The conclusion I’ve come to is that I must have been talking to the back of the sound technician (a man) and that’s why the words seem to affect men. Completely inadvertent but I like it.

Then, there were 2 really good videos that really taught me a lot about the importance of the male foreskin so I requested the use of them from the owners. They were both thrilled to give me their material. Again, so much of the feedback that I get is that those two features have such an impact on people. Both of those intact penis features are available for anyone to watch online but, it seems, a couple sitting on their couch watching a DVD will keep going right to the end of the DVD and THAT has put the information in a lot of people’s hands. It’s so gratifying to know that those DVDs are all over the world. If you have one, don’t leave it on your shelf—get it out and show it or lend it to pregnant families!”

“Birth with Gloria Lemay”

To order the DVD, send $35 via Paypal or Interac to birthdvd(at)

Placenta Bowl, a family tradition

Lightened photo shows detail on the underside of the bowl.

Lightened photo shows detail on the underside of the bowl.

Copyright Gloria Lemay 2014

The birth of a baby is a time to really consider what family traditions should be kept and what family traditions should be discarded. It can be a time to get creative and design rituals that truly nourish the heart. This wooden placenta bowl was commissioned by a family and carved by a B.C. artist. It is now being used at the second generation of homeborn babies in the family and will be passed on for years to come.

Shared with the kind permission of the family.