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In this episode, I am joined by Sabrina Tran of Alabama, who recently had a daughter, and took the Evidence Based Birth Childbirth Class with Instructor Traci Weafer. Sabrina, a therapist, is now a stay at home mom.

Sabrina had a precipitous – or, extremely fast labor and delivery. She describes it as exciting! Hear her tell her story of how her baby was born before the midwife could make it to her home. I also share the evidence on perineal tearing,  and the relationships between tearing, provider experience, and home birth.

Resources

Click here for great images explaining perineal tears on the Mayo Clinic website.
More references:

Click here to access the EBB Signature Article, The Evidence on: Waterbirth.

View the transcript

Rebecca Dekker:  Hi everyone. On today’s podcast we’re going to talk with Sabrina Tran about her planned home birth that was accidentally unassisted.

        Welcome to the Evidence-Based Birth Podcast. My name is Rebecca Dekker and I’m a nurse with my PhD and the founder of Evidence-Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See EBbirth.com/disclaimer for more details.

        Hi everyone today. I’m so excited to welcome Sabrina Tran to the Evidence-Based Birth Podcast. Sabrina lives in Alabama and she took the evidence-based birth childbirth class with EBB instructor Tracy Weaver. Sabrina was pregnant with her first child, a girl. She is a therapist and she’s now a stay at home mom to her daughter who is now five weeks old and Sabrina is here to share her birth story with us. Welcome Sabrina to the Evidence-Based Birth Podcast.

Sabrina Tran:  Thank you. I’m so excited to be here.

Rebecca Dekker:  So tell us a little bit: How did you find out about the evidence-based birth childbirth class that Tracy was teaching in Alabama?

Sabrina Tran:  Well, I just Googled some childbirth classes and I really wanted a class that would be supportive of natural birth and there wasn’t really a lot of options in my area or I didn’t feel like there was. So when I did a Google search, the evidence-based birth class popped up with Tracy Weaver and that sounded like what I was looking for. That’s how I found out about it. Then once I went to the evidence-based birth website, I realized that my midwife had been sending me articles from the website, so that was even more familiar.

Rebecca Dekker:  So it wasn’t your first time really hearing about evidence-based birth, but it was the first time you realized there was a class you could take?

Sabrina Tran:  Yes, exactly.

Rebecca Dekker:  So tell us what your experience was like taking the class with Tracy.

Sabrina Tran:  It was really awesome. I’m really glad that I took it. I took it with my husband and it was really nice to be around other people who had the same ideas or same perspective, same mindset. In the class there were two other couples and we all wanted a natural birth and one of the other couples was also doing home birth, so that was just nice to know other people like that and I was really, really happy that my husband was able to learn about the birth process. That made me feel a lot more comfortable, I think both of us a lot more comfortable, especially with what ended up happening during my birth.

Rebecca Dekker:  What were some of the things you learned that were new to you that you weren’t aware of beforehand?

Sabrina Tran:  I think learning in a lot more detail about the stages of labor. I had a basic idea, but really knowing how to tell what stage you’re in, that ended up being very valuable for me and my husband. There was a lot, there was a lot that we learned. Learning just about all of the interventions that can happen, like whether it’s a hospital or a home birth and the evidence of those interventions. Then my husband really, really valued the advocacy part where he had to, you know, the partner’s the one that deals with advocating for your partner when they’re in labor.

Rebecca Dekker:  You raised a good point in that some midwives and people who work at birth centers and places like that ask us if the class prepares you to have a natural childbirth, and we don’t necessarily advertise this as a class that… It’s not a natural birth class, it’s a class for anyone to take, but if you want to have a natural birth, we give you the tools you have to be able to do that. Did you feel like you got gained some tools to be able to cope with an unmedicated birth?

Sabrina Tran:  Yes, definitely.

Rebecca Dekker:  What kinds of tools did you learn? What kinds of comfort measures were you excited about?

Sabrina Tran:  I was really excited about the acupressure, learning about those, and then just the whole self-talk part. But yeah, I think those were my two favorite things, was just the self-talk, the affirmations and learning the acupressure points.

Rebecca Dekker:  Okay. Cool. All right so take us to the end of your pregnancy. What kind of birth were you planning? You mentioned you were planning a home birth, what were your visions? What were you expecting?

Sabrina Tran:  Well, I was expecting a long labor, because I’m a first time mom and yeah, it was a planned home birth and ended up being unassisted. I’ll get to that maybe later. I was thinking it was going to be really long, we had made a music playlist, I had all these affirmations that I printed out that I was going to hang up around all the rooms. I had little Christmas lights and we did a water birth.

Rebecca Dekker:  So you were planning a water birth?

Sabrina Tran:  Yeah. Mm-hmm(affirmative). We had the birthing pool set up in our nursery and I was just expecting it to be just long and slow and calm and I would have all these different comfort measure things and my birth ball and all of that and didn’t really end up that way. I did have my water birth, it was at home, but I would call it more of an exciting birth rather than a calm birth.

Rebecca Dekker:  What was your mindset like before you went into labor?

Sabrina Tran:  I was a little nervous, but I was very eager. I was like, I’m ready to like get my baby out. I was actually really scared about going over my due date, like too long, which that didn’t happen. I was really eager. I wasn’t really scared, I was just a little nervous. Yeah, that was kind of my mindset.

Rebecca Dekker:  What was the support team lined up? You said you had your husband with you and you were planning on having a midwife. Was there going to be anybody else there?

Sabrina Tran:  No. I wasn’t planning on having anyone else. Well my midwife had an assistant that was going to be there also, but I really wanted the least amount of people as possible. That was just my preference. I wanted as much privacy as possible, which I ended up getting a lot.

Rebecca Dekker:  Yeah. So let’s here this birth story, how did it begin? How far along were you?

Sabrina Tran:  I ended up giving birth two days before my due date. I was due October 27th and I gave birth October 25th and it was like 9:40 that night and I was just sitting on the couch reading a book and just out of nowhere I got this really strong, stronger than than I had ever had before, contraction, that made me jump up and it was just so sudden and I’m just like, “Oh that was a little intense.” Then four or five minutes later I had another one that was just as strong and I was like, “Okay, this is different.”

        I just kept having them four minutes apart and then I started getting a little worried like, are they supposed to be lasting? They were lasting like a minute long and I was like, I think I remember that they’re not supposed to last that long until active labor and be so close together. So I was texting my midwife and I was letting her know what was going on and I was asking her like, “Can I take a bath?” Because the cramping was really bothering me. She was like, “Yeah, take a bath, use some Epsom salt and let’s just see what happens. Maybe it’ll stop or it’ll slow down.” I was thinking maybe false labor or something.

Rebecca Dekker:  How were you coping with the contractions? Did you have to stop and focus and breathe through them or were you talking through them or how intense were they?

Sabrina Tran:  At first I could talk through them, but what I really wanted to do was stop and just focus on deep breathing and swaying. I did a lot of swaying and deep breathing. Again that I know when you have to stop and focus and deep breathe, I knew that was another thing that was later on.

Rebecca Dekker:  But labor had just started for you.

Sabrina Tran:  Yeah, it didn’t make any sense. I was confused. The first 20 minutes of these contractions, I kept having to use the bathroom and then I saw I had the bloody show, is that what you call it? I let my midwife know and then I’m not sure, but I think that might have been when she started getting ready to leave to head towards me and she about two hours away. Yeah, I was just having those contractions and they started getting more intense to where now it was past just the deep breathing thing and now I was vocalizing, like I was moaning and it wasn’t even on purpose. It’s just strange how that happens. Like my body, I was just automatically vocalizing. Then I remember feeling this pressure, like a ball between my legs.

Rebecca Dekker:  How far along were you then into this labor when you started moaning and feeling pressure?

Sabrina Tran:  That was probably like 30 minutes.

Rebecca Dekker:  Whoa. So your contractions started, they were going every four minutes, one minute apart and you’d learned in the class that that was probably active labor, especially if you were having to stop and focus and 30 minutes into this, your midwife was already on her way because you’d had the bloody show, but she’s a two hour drive from you?

Sabrina Tran:  Yes, yes.

Rebecca Dekker:  You start feeling pressure. So what happens next?

Sabrina Tran:  My husband was sitting on the couch in front of me and I was standing in front of him and I think I was about to explain to him like, “Oh, I feel this weird pressure,” but as I was saying it, I reached my hand down to feel and I barely touched I guess my water sack and it just exploded all over the floor.

Rebecca Dekker:  You were out of the bath tub at this point?

Sabrina Tran:  Yeah, I was out of the bathtub.

Rebecca Dekker:  Did you ever get into the tub or no?

Sabrina Tran:  Well not really. I got in the tub, but then because I kept having to use the bathroom, I kept having to get out.

Rebecca Dekker:  Okay.

Sabrina Tran:  I ended up just staying out and I had been out for a few contractions and yes I felt that pressure and then it just burst all over the floor.

Rebecca Dekker:  Were you in the bathroom at this point?

Sabrina Tran:  I was in our den.

Rebecca Dekker:  Okay.

Sabrina Tran:  I was standing in front of the couch and my jaw just dropped and I was like, “My water just broke,” obviously, and he was like, “Yeah.” He then called the midwife because we had just been texting and he was like, “Yeah, her water just broke.” He’s so calm. He’s just calm through the whole thing, really impressive. She was like, “okay, well I’m on my way.” That first contraction after my water broke I think was the only time where for a second I had a bit of panic just because it was suddenly so much more intense and I like wasn’t prepared for that, I guess. It caught me by surprise and I remember having like a thought for a split second of like, maybe I can’t handle this. For just that split second I could feel the cortisol, the stress, the panic and it felt more painful in that instant.

        Then I realized, I cannot think like that. I can’t think like that because it really is going to make this experience worse. So I changed my thinking. I was like, “No, I can either calmly just deal with this or I can feel like it’s overwhelming and be stressed out.” I just decided that I was going to handle it and it was going to be fine and from then on it was, it was fine. I mean it was intense, it was very intense, but I didn’t feel scared or panicky.

Rebecca Dekker:  And your husband wasn’t scared?

Sabrina Tran:  No. No.

Rebecca Dekker:  Or he didn’t give off that feeling to you?

Sabrina Tran:  Yeah, I mean he seemed a little frantic because everything was happening so fast and the birthing pool wasn’t filled with water, so he was running around while trying to comfort me, but he didn’t seem scared. He was very calm, spoke very calmly the whole time. I did ask him afterwards if he was scared at any point and he said, “Not really.” So yeah, I think the class really helped him too. I think it really prepared us. I guess after my water broke, I think maybe an hour had passed and then my body was immediately pushing and I felt like I could not control it at all. I was like, “Oh no, this is way too fast. Am I supposed to be pushing already?” I felt like I couldn’t control it. So I just focused on trying to like breathe through the contractions, which is what I learned, to breathe through it and I remember not to scream but to keep your noises low.

        I was doing that and then I remember my husband on the phone with the midwife and he was like, “Yeah, I can see the baby’s head.” And I was like, “Oh my God,” and I still wasn’t in the pool yet. And he was like, “Well the pool’s ready if you want to get in the pool.” I was like, “I’ll try.” So I waddled with her head right there, got into the pool and then it was probably maybe three contractions and then I think she was born. Yeah. I felt like the stinging of her head coming through and then her head popped out and I was like, “Oh my gosh, that feels so much better.” And my husband was like, “Her head’s out.” Then the next contraction, her body just came out very easily. The midwife was just on the phone talking us through, but my body, it just did it on its own. It just knew what to do.

        No one caught her. Which is kind of funny because people always ask me, “Well who delivered her?” I’m like, “No one delivered her, she was just born. The water caught her.” My husband was like, “Her body’s in the water.” I turned around and I picked her up out of the water and she popped her eyes open, looked around a little bit and then immediately started crying. We didn’t even have to rub her or anything and yeah. And it was over. Well almost over I guess.

Rebecca Dekker:  How did you feel when she came out and you were all the sudden holding her?

Sabrina Tran:  It was very surreal. I was in shock but as soon as she cried, then it’s like everything had been leading up to that moment. All the nine months and everything had been leading up to just hearing that first little cry. That’s when like all of my emotions just flooded me and it was just, it was beautiful.

Rebecca Dekker:  What about your husband? Was he crying or how is he handling this super fast experience?

Sabrina Tran:  I think he was maybe still in shock too, because I don’t remember him crying. I just remember him just like looking at her with this calm expression. I was surprised that he didn’t cry, but I think he was just in shock.

Rebecca Dekker:  What’d you do next? Your midwife was talking you through this on the phone. What do you do at an unassisted home birth when you weren’t planning that? Did you just leave the baby on your chest until your midwife got there? What did you do next?

Sabrina Tran:  Well, so yeah, she had told us, “Put the baby on your chest, rub her feet and her back to get her to cry,” but we didn’t need to do that she cried immediately. Then the midwife was like, “Has your placenta come out yet?” I said, “No,” and she was like, “Okay.” She didn’t want us sitting in the water for too long, so she said if we could get up and go ahead and make our way to the bed, which had been set up at some point, I don’t know when my husband set up the bed with all the mats because I guess I was out of it, but he did at some point. I stood up with the baby to go to the bed and then as soon as I stood up my placenta just like plopped out into the water and I was like, “Oh, my placenta just came out.” She was like, “Oh, okay.” Then she told my husband to wrap it up in some towels and then he had to carry the placenta and I carried the baby and we walked over to the bed and got on the bed.

        Then she was just asking about how much blood there was and it was probably about 30 minutes after the baby was born that she got there. I always joke that we had wanted delayed cord clamping. Well it was delayed for like an hour, so we definitely got it. So yeah, once she got there she checked me and everything. Everything was good. Checked the baby, the cord. Then I had teared in like three places, but only two needed stitches. She was able to stitch me up and helped me get a shower and all of that. I didn’t realize how much midwives did to just help out with cleaning and that was really awesome. She helped me just cleaning up everything and with the laundry and the trash and just everything. That was really nice. I think it was like 3:00 AM before she left.

Rebecca Dekker:  You went into labor, was it 9:40 PM?

Sabrina Tran:  Yeah, around 9:40 and then the baby was born at 11:52.

Rebecca Dekker:  Wow. Just a little over two hours of labor.

Sabrina Tran:  Yeah, very fast. Yep.

Rebecca Dekker:  Looking back, I mean, are you surprised you had such a fast birth, which we call precipitous birth? Does that run in your family?

Sabrina Tran:  I was very surprised. I didn’t expect it. My midwife was very surprised. None of us expected it, but looking at my family, I have two older sisters, so yeah, my mom and my older sisters, I think maybe I should have prepared more for a fast birth. Because my mom, I don’t her first two pregnancies were really fast, but with me I know it was super fast and sudden and my sisters both have had like really fast births and they have [inaudible 00:20:53] children each, so not all of their births were fast, but some of them were. I just didn’t expect my first one to be fast, but I guess I should have.

Rebecca Dekker:  Now that your baby is five weeks old, how is the fourth trimester going for you? How are you recovering physically and emotionally?

Sabrina Tran:  Really good. Yeah. I think I’m almost fully healed from the tearing, so there’s no pain there. Emotionally I only had some wacky hormones I think the second week there I was just very emotional suddenly about random stuff, but that’s kind of subsided. It’s been really good, she’s a pretty easy baby luckily. So it’s really nice.

Rebecca Dekker:  After going through such a whirlwind experience, do you have any advice for people who are listening who are planning on entering birth or parenthood soon?

Sabrina Tran:  Yeah, I think definitely first and foremost just educate yourself on what’s normal, what’s healthy, what’s evidence-based. Just educate yourself and your husband too, or your partner, whoever your partner support person is going to be. I think it’s definitely very valuable they’re as educated as you are because I think that really helps. Like I mentioned before, your self talk, the way that you’re going to be thinking about your birth is really going to impact your birth experience. I experienced that firsthand when I had even just that split second of doubting if I could do it or not. I really felt the difference.

Rebecca Dekker:  Yeah. We talk about that in the evidence-based birth childbirth class about the fear, tension, pain cycle. When you get afraid you tense up and the pain intensifies. You felt that in that moment and then you felt that change when you changed your thinking. I know you change your thoughts to, “I can do this, I can handle this,” but what were some of your favorite affirmations that you said to yourself during pregnancy?

Sabrina Tran:  Some of my favorite? I think just the affirmations that were like, “Your body knows what it’s doing.” Those kinds that were like your body knows what it’s doing, the baby knows what it’s doing. Those were my favorite. That women are made to give birth, your body is made for this. Those ones were my favorite, which I ended up not being able to put my affirmations up because I was planning to do that during early labor to distract myself, so I didn’t really get to actually hang up my affirmations, but luckily reading them over and over again, they were in my head so that was good.

Rebecca Dekker:  That’s awesome they were in your head.

Sabrina Tran:  Yeah, there’s a lot of comfort measures that we didn’t get to use that we had planned just because everything happened so fast. We didn’t even get a chance to put the music on.

Rebecca Dekker:  It sounds like you were able to use the deep abdominal breathing that we teach and you used the affirmations in your head and you also said you used vocalization, you used the low moaning sounds.

Sabrina Tran:  Yeah and swaying a lot of swaying.

Rebecca Dekker:  And movement. Yeah. And water. You used water.

Sabrina Tran:  Yeah, my husband did do some acupressure when he had the chance when he wasn’t running around.

Rebecca Dekker:  Getting everything ready.

Sabrina Tran:  Yeah.

Rebecca Dekker:  Awesome. Well thank you so much Sabrina for sharing your story. Do you have any questions for me such as anything about birth that you’re curious about?

Sabrina Tran:  Yeah, I have one pretty random question. I mentioned I had some tearing and the worst of my tears was second degree, and I knew there was a third degree, but I learned recently that there’s a fourth degree tear, which sounds terrible. What is a fourth degree tear?

Rebecca Dekker:  So yeah, that’s a great question about perineal tears and we talked in your childbirth class about protecting perinea, but we don’t go into a ton of detail about the different kinds of tears, that’s a great question.

        A first degree tear is the least severe kind of tear of the perineum. It involves the skin around the vaginal opening. Second degree tear involves the muscles between the vagina and the anus, and it typically requires stitches, although there’s some research on whether or not stitches are always necessary. There’s some ongoing research on. That third degree tear impacts the muscles around the anus and it sometimes requires repair in an operating room. Fourth degree tear is the most severe and it reaches the tissue that lines the rectum. Both the third and the fourth degree tears are also known as obstetric anal sphincter injuries or OASI or OASI.

        The acronym is O-A-S-I. I know there’s lots of support groups online for parents who’ve experienced an OASI injury. I’ll link to that in the show notes, the support group for people with the most severe kinds of tears. But we talk about tears and preventing tears a lot in the evidence-based birth childbirth class because it is something that parents are afraid of. When I teach college students for example, when I teach a class about childbirth to them, a lot of them have this fear of tearing down there, right? I think it’s sometimes helpful to know the rates of tearing and know that it doesn’t necessarily happen to everyone and there are ways to lower your risk. In the United States, the research on this as found that depending on the population, anywhere from 31% to 93% of mothers experience tears, which are also sometimes called lacerations, that’s the medical term for it. But the rate of severe tears is usually pretty much lower. The ones, third or fourth degree can range from 0.4% of 15%.

        Now the reason the rates vary so widely is because it really depends on what the providers are doing in those locations. It can vary geographically and the individual provider, who your healthcare provider is, is a strong predictor of whether or not you’re going to leave birth with an intact perineum with no tears. Because really it has to do with the provider expertise. Giving birth at home, you have the highest chance of having an intact perineum. About half of all moms who give birth at home, give birth without any tears at all. About 41% have a first or second degree tear and about 1.2% have a third or fourth degree tear. There is a large review article published in the journal of Midwifery and Women’s Health by [COPIS 00:27:43] in 2014 and they found that overall the rates of perineal tears are lower at birth centers and home births than in hospitals, but that there is no difference in the rate of third and fourth degree tears between settings.

        It’s really hard to find statistics on how often perineal tears happen in US hospitals, but it is tracked regularly in the studies on home birth and birth centers. So one thing that could potentially increase your risk of having a second degree tear, which is not severe, it’s not a third or fourth degree tear, is being a first time mother having also a precipitous birth, a fast birth. Then they’ve done a lot of research on care providers who have very low tear rates, whose clients are more likely to have an intact perineum. It’s just so provider dependent, it’s really interesting. So they’ve actually gone and interviewed in depth. They’ve done research studies where they interviewed these people where most of their clients don’t tear at all and they found some common patterns.

        But one of the most important patterns they’ve seen when they’ve interviewed people, providers, and especially midwives with low tear rates is encouraging a slow birth of the head. It’s harder if you’re giving birth unassisted to slow yourself down, right? You are just going with what your body told you. It’s possible that if the midwife had been there, they might’ve been able to say, “Breathe your baby, slow down.” Trying to remind you and giving you those cues because it seems to be that slow birth of the head and shoulders is protective when the head’s actually emerging. Does that make sense?

Sabrina Tran:  Yeah, yeah it does. It reminds me of the example that you gave during one of your videos during the class, the online videos. You gave an example, what I think you’re talking about episiotomy and how when you’re cut, there’s a greater chance of tearing further.

Rebecca Dekker:  Exactly.

Sabrina Tran:  The research shows that, and you gave an example, like it’s a piece of fabric and if you were to cut a piece of fabric and then pull, it’s a lot easier to tear the fabric. Whereas if you made no cut and pull, it’s a lot harder. That really stuck with me.

Rebecca Dekker:  Yeah, and there’s a great randomized trial on this that was the first randomized trial and on episiotomies or cutting the vagina. It was done in 1992 by a family physician in Canada named Dr. Michael Klein. It was a famous randomized trial where they randomly assigned women to either having their doctors trying to avoid a episiotomy or using episiotomy liberally and frequently. They basically found that routinely using the episiotomy does not prevent severe tears and in fact it causes the opposite. In that study which had more than 700 women, 50 people had a severe tear, a third or fourth degree tear, and 49 of them had had a episiotomies. Only one of them had a severe tear without an episiotomy. Women whose providers used episiotomies were much, much more likely to have a severe tear.

        It is protective when you’re with a provider who doesn’t use episiotomies typically. But there’s a lot of other research on that and that’s something I would love to do a series on sometimes because there’s all kinds of research on not only episiotomies but using warm compresses or water birth and what are the pros and cons and does it increase your risk or decrease your risk. There’s other practices that providers use like massaging the perineum during labor or putting their hands on the head or not putting the hands on the head of the baby.

        There’s a ton to explore on that topic because I know a lot of parents want to lower their risk of having tears. It sounds like you did an amazing job though. You and your husband coping with such a fast labor, giving birth with just the two of you. I’m just amazed. I can picture your husband running around setting everything up and still managing to comfort you and help you stay calm. I’m so glad to hear that everything went well. If you had to sum it up in one word, how would you describe your birth? If you had to use one or three words that describe it.

Sabrina Tran:  Yeah. I don’t want to use chaotic because I think it was exciting. There was a lot of happiness, at the end when she came out. Yeah. Excited.

Rebecca Dekker:  Well thank you so much for sharing your story with all our listeners, Sabrina, and bringing a smile to our faces and hearing about your super fast, exciting birth story and we wish you all the best.

Sabrina Tran:  Thank you so much.

Rebecca Dekker:  All right everyone. That was a fantastic interview with Sabrina and I’m so thankful she shared her story of her super fast birth and I also really appreciated her question about perineal tears, so I hope you were able to learn something from that discussion. Thank you all and I’ll see you next week. Bye.

        This podcast episode was brought to you by the evidence-based birth childbirth class. This is Rebecca speaking, when I walked into the hospital to have my first baby, I had no idea what I was getting myself into. Since then, I’ve met countless parents who felt that they too were unprepared for the birth process and for dealing with a broken healthcare system. The next time I had a baby, I learned that in order to have the most empowering birth possible I needed to learn the evidence on child birth practices, find out how to stay comfortable during labor, and my partner needed to learn how to speak up for me.

        I’m excited to announce that we are now offering evidence-based birth childbirth class in about 50 communities in the United States and around the world. In your class, you will work online and in person with an evidence-based birth instructors who will skillfully mentor you and your partner in evidence-based care, comfort measures and advocacies that you can both embrace your birth and parenting experiences with courage and competence. Get empowered with a childbirth class you and your partner will love. Visit evidence-based birth.com/childbirthclass to find your class now.

 

 

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