Only weeks before giving birth in August 2021, Emily Rayhons decided to change health care providers. She knew the timing wasn’t great—few providers would be likely to work with her so late in her pregnancy—but she was not satisfied with the care she was receiving.

Emily, 37, of Des Moines, also hadn’t been satisfied with her care during her two previous pregnancies, both of which had deliveries by cesarean section, and now she felt like her wishes for a vaginal delivery were being ignored.

As a registered nurse, Emily knew that most providers consider vaginal birth after cesarean (VBAC) to be too risky. Still, Emily wanted to feel like a participant, not a bystander, in her own childbirth experience.

She switched her pregnancy care to University of Iowa Health Care, where certified nurse-midwives and obstetrician-gynecologists are committed to working together to provide the safe, expert VBAC care that few hospitals are equipped to offer.

A few weeks later, Emily’s daughter Eleanor arrived by vaginal birth at UI Hospitals & Clinics.

“It wound up being the easiest medical process I’ve ever gone through,” Emily says. “It was, hands down, just a wonderful experience.”

‘Like I was visiting friends’

The UI Health Care Midwifery Clinic was the only place where Emily felt fully supported in her choice of vaginal delivery.

“I think a lot of places will just say, ‘We’ll see how your pregnancy goes,’” she says.

UI midwives made her feel welcome and appreciated in a way that earned her trust.

“It’s easy for clinics to go through the motions, especially when there are so many patients,” Emily says. “But I truly felt like they knew me on a personal level. They asked about my kids, how work was going. You never felt like you were taking up their valuable time. I felt like I was visiting friends.”

Eleanor arrived healthy and safe after 32 hours of labor. “It’s how I wanted everything to go,” says her mom, Emily.

Instead of receiving care exclusively from one certified nurse-midwife, patients in the UI Health Care Midwifery Clinic see multiple midwives during their prenatal appointments. This means that the patient will likely see familiar faces on delivery day.

In Emily’s case, three midwives cared for her during 32 hours of labor.

Expert VBAC care empowers patients

Uterine rupture during VBAC is rare, but it is a risk, which is why midwives in Iowa must have physician backup ready during the procedure. UI Health Care midwives collaborate closely with obstetrician-gynecologists to provide that crucial backup.

When minor complications arose during Emily’s delivery, labor was induced using Pitocin, a hormone that stimulates contractions. This had the potential to further increase Emily’s risk of a ruptured uterus.

But Jaclyn Roman, ARNP, CNM, one of the midwives who cared for Emily during delivery, says Emily tolerated the induction well and was able to continue to deliver Eleanor naturally.

“We were able to work with her and her wishes to have a vaginal delivery in spite of some of the medical needs she had,” Roman says. “Childbirth is a very natural process. A lot of times if we just sit back and let things happen, that can be beneficial. But it’s also a matter of knowing when to intervene.”

That attention to her safety and to the safety of her baby allowed Emily to make her own decisions with confidence. Rather than agreeing to a C-section she didn’t want, she had the birth experience she preferred, with no regrets.

“The labor was long but totally worth it,” Emily says. “There was a lot of trauma associated with my other two pregnancies, but this was a very healing process to go through. It’s how I wanted everything to go.”