Kasha found the VBAC care she wanted at the UI Hospitals & Clinics Midwifery Clinic

Kasha Walpole and her family sitting outside
Kasha got the birth experience she wanted, including VBAC and having the whole family in the delivery room when Nona was born.

After having two healthy children born by cesarean section, Kasha Walpole wanted to have her third child by vaginal birth. Her doctor said that wasn’t an option after two cesareans.

Kasha, 31, an Ottumwa, Iowa, native living in Springfield, Missouri, sought a second opinion. She looked for a provider who could support her choice of vaginal birth after cesarean (VBAC) and a midwife to manage her pregnancy and delivery.

She chose the University of Iowa Hospitals & Clinics Midwifery Clinic. In August 2019, after 36 hours of labor, Kasha, her husband Keith, and their two children welcomed their new, healthy baby girl, Nona.

I found people in sync with my thinking at UI Hospitals & Clinics. Choosing them was the best decision we made.

— Kasha Walpole

Nationwide search for VBAC care leads to Iowa

Kasha knew from experience that recovery after cesarean was tough. But as a healthy, active person, she believed she remained capable of going through labor and childbirth, and she felt confident making decisions about her own body.

“There are certain things our bodies are meant to do,” she says. “Having babies is one of them.”

When she talked with providers in Missouri, Maine, Utah, Florida, and Des Moines, every conversation began with the reasons she couldn’t choose the type of childbirth she wanted.

During a trip home to visit family in Ottumwa, Kasha learned that the UI Hospitals & Clinics Midwifery Clinic offered support for a VBAC delivery and had a team of certified nurse-midwives and physician specialists prepared to provide complete care if complications developed.

She met with UI Health Care certified nurse-midwife Laura Dellos, ARNP, who assured her that VBAC was absolutely a realistic option for her.

“I was so happy,” Kasha says.

Midwife-physician partnership makes the difference

The American College of Obstetricians and Gynecologists supports offering mothers the right to have a VBAC, but many providers aren’t experienced in doing them and may not be prepared for the possible complications.

A VBAC has an increased risk of a uterine rupture, a serious complication that can happen when the incision scar on the uterus from a previous cesarean breaks open.

Ruptures are rare, says UI certified nurse-midwife Amber Goodrich, ARNP, but when they happen, the mother and baby are at risk, and surgery is usually needed.

You need experience doing an emergency cesarean, and not many hospitals have anesthesia and an OBGYN in the house all the time. We have a phenomenal facility with the technology, resources, support, and clinicians right at our fingertips. Somebody is always here.

The approximately 100 midwives in Iowa are required to have physician backup if they manage VBACs. That’s what makes the special partnership between midwives and physicians at UI Hospitals & Clinics ideal for women like Kasha.

“Our physicians are very supportive of midwifery care, and we function as a team,” Goodrich says. “They help take care of my patients, and if they’re in the operating room, I take care of theirs.”

UI midwifery approach enhances outcome

Kasha was also pleased with the UI Health Care midwifery model, which didn’t tie all of her care to one midwife. Instead, she saw different midwives at each prenatal appointment.

“We had time to get to know each other and build rapport,” Kasha says. “They encouraged my husband and me to ask as many questions as needed. They wanted to make sure we were all on the same page about the delivery so we could get the outcome we wanted.”

When Kasha was induced at 41 weeks, all of the midwives on duty throughout her 36-hour labor had already met her during her prenatal visits.

“I wasn’t a stranger walking in,” Kasha says. “We knew everyone. That’s what I wanted.”

The birth experience also included other things Kasha wanted: Her children were in the delivery room. She didn’t have an episiotomy. And delayed clamping of the umbilical cord allowed more time for the baby to get nutrients important to fighting bacteria and infection. 

Quicker recovery after successful VBAC

Two days after VBAC, Kasha and her family enjoyed a walk together.

“I wouldn’t have done that after a cesarean,” she says.

Now living in Gulf Shores, Alabama, the family is preparing to welcome a new baby. Because the few midwives in Alabama are only allowed to do home births, Kasha chose a VBAC-friendly obstetrician.

“Thanks to a successful VBAC with the midwives at UI Hospitals & Clinics, it gave me the chance to make future decisions about my body and birthing needs,” she says.

Your UI Health Care certified nurse-midwife provides prenatal care, delivers babies, and offers well-woman services.

Ottumwa, Iowa