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Pam’s VBAC of Luis

This is Pam’s 3rd and final VBAC story.  Her first two VBAC stories were featured earlier this week on the Blog.

I was 41 weeks pregnant with our fourth child and had been having irregular contractions all day when I decided I needed to go birthday shopping for my husband, whose birthday was the next day. So I took our oldest son out to get his dad a gift. We were shopping in Target when I realized I was having to stop and wait for contractions more and more often, so we went back home with just a birthday card and a few last-minute items I’d picked up for my soon-to-be-postpartum self: Tucks wipes, hemorrhoid cream, and lanolin for my nipples. Great job I did birthday shopping for my husband!!

Once we got back home, my contractions spaced back out to the 10-15 minute range, and I told Tomas maybe I should go back to Target to see if real labor would kick in. He laughed and asked me to wait since he wanted to watch the Bronco and Cowboy games that afternoon and evening. I was feeling restless and discouraged because this long period of latent labor reminded me a lot of how my labor started with our third child, and I had been hoping for a much shorter labor and delivery. My temper was shortening as I realized I was facing a long night of contractions too painful to sleep through, but too far apart and not intense enough to be really doing anything.  I took a long hot shower and that made contractions bearable for a while, but soon enough I was back to the same pattern of terrible pain over my pubic bone without any accompanying intensity to suggest real labor was going to begin any time soon. Around 10:00 we went to bed, and though I was up and down quite a bit I found that lying on my left side with my right leg jackknifed up over a pillow made the contractions bearable and I was able to get a couple hours’ much-needed sleep.

Right around 4 a.m. I woke up with contractions again and this time they felt different. The pain over my pubic bone was gone, but the contractions were much more intense and I could feel a lot of downward pressure into my perineal area. They also seemed to be coming close, in the 5-minute range, so I timed a couple and sure enough they were about 5 minutes apart. I decided to check my cervix and it felt to me like I was about 3 cm dilated, almost completely effaced, and baby’s head was fairly low. At 4:15 I went and woke up Tomas and told him we needed to get ready to head to the hospital. He went out and called his mom to watch the kids while I got dressed and called Kaiser to let them know we were on our way. We were on the road by about 5:00, and contractions were still coming hot and heavy. My fear that they would stop was unfounded. Walking to our van, I told Tomas that I was scared, I just wanted to go back inside the house and wait for it to stop. He put his arms around me and reassured me, and after waiting through another contraction we got into the van and were on our way to the hospital.

The drive to the hospital reminded me a lot of the drive with our second child, meaning having contractions in a moving vehicle sucks. Though we needed to get to the hospital, I considered it best when we hit red lights that coincided with contractions. The drive took about 20 minutes and L&D has a dedicated parking lot, so we were soon inside heading to the L&D Triage area. I was having contractions seemingly on top of each other as we checked in, so the receptionist had me go back to a triage room and said we’d do paperwork later. The triage nurse had me change into a gown and said she’d check me before hooking up monitors. Based on how I was feeling I expected to be about 4-5 cm, but a quick check between contractions and the nurse announced that I was 8 centimeters, 90% effaced, and baby was at -1. I was shocked and asked her if she was kidding, but she said no- I would be going directly to an LDR room, there was no time to do monitoring in triage. She offered a wheelchair but I wanted to walk- I didn’t feel like an invalid!!- and as we walked to the L&D unit she said “Okay, if your water breaks you are going to see everyone panic.” That didn’t happen, but it still makes me laugh to think about the chaos I might have caused. We also discussed my wish to labor in the tub or shower and avoid an epidural. And then we were at L&D.

I was immediately put on the monitors to get a strip on the baby, and as we were doing that I discussed my wish for NCB and laboring in the water with the L&D nurse. She said that even though I’d discussed my birth plan in detail with my OB, it was going to be up to the OB on-call whether or not I’d be allowed off the monitors as a VBAC mom. The OB on duty was Dr. Gottesfeld, who delivered my last baby and had seemed pretty reasonable during that labor, so I was surprised when the nurse came back and told me NO, I would not be allowed off the monitors. I said “Okay, then I want an epidural NOW.” The nurse went to check on anesthesia availability, and came back with Dr. Gottesfeld, who said she wanted to check me again. I said “You delivered my last baby!” and she looked at the L&D nurse and said “See! I told you I remembered her!” I was 9.5 cm with just an anterior lip, 100% effaced, and baby at +2. Doctor Gottesfeld said that was too far along for me to get in the Jacuzzi, and also too far along for an anesthesiologist to get an epidural placed in time.  She said, “I think this is just how it’s going to be, okay?” And I thought to myself, “Okay, here we go.”  I also had the presence of mind to think to myself- huh. I guess the doctor would have let me in the tub after all. Wonder why the nurse just said no?

I continued to labor, with contractions now double-peaked. Dr. G. called to have the room set up for delivery, and the nurse said to let her know if I started feeling pushy. But I had absolutely no urge to push. I withdrew into myself. My husband stood behind me with his hands on my shoulders, not rubbing, not stroking, just standing there being my rock of strength and that’s exactly what I needed. I rested my head on his hand, all my consciousness focused on getting through each contraction. I gripped my thighs and was keenly aware of the sweat slicking out of every pore, the feel of each breath, the continuing tension in my body during the brief break between contractions. I remember thinking this must be the calm before the storm because while it was intense it wasn’t excruciatingly painful; I remember thinking my body must have been resting, preparing for the one final push to get the baby out.

I still had no urge to push. I felt more pressure, but as with my previous labors, pushing wasn’t remotely on my mind. I asked Dr. Gottesfeld if she thought I could get a light epidural before I started pushing- though I planned a fully natural birth, I also remembered how much I disliked pushing unmedicated and how much better I thought second stage was with an epidural. Dr. G. went out and found the anesthesiologist who was coming on shift, and I discussed my wishes with her. I said I wanted a very light epidural that wouldn’t diminish my ability to move or push, but would take away the pain of contractions. She listened and was confident she could do it, so I went ahead and had her place the epi. Once it was done I remember not feeling a change in the contractions and thinking “oh my God, I made a huge mistake, this isn’t going to work!” The anesthesiologist asked me to lie on my right side so the epidural could work its way across my back and provide complete coverage. The instant I got into the side-lying position I was overcome by the urge to push.

I have heard women say the urge to push is overwhelming. I’ve heard it described as undeniable. But after experiencing it, I can honestly say I don’t think I have ever in my life had a more compelling physical urge. I shouted “Oh my God!” and pushed for all I was worth, and with that one push I felt the baby’s head move down the birth canal and hit my perineum. Someone was telling me to try not to push, “I know your body is doing this anyway, but try to blow it out” and the nurse was saying she needed to check me to make sure the anterior lip of cervix was gone. She got about a knuckle in before feeling the baby’s head, and she quickly hit the intercom and yelled “We need doctors in here NOW!”

The doctors came in as I was simultaneously trying to figure out why in God’s name the epidural hadn’t worked, and trying not to push. Dr. Gottesfeld asked me to scoot down so she could break down the bed for delivery, and almost immediately after I got into position the epidural took effect. It was sort of surreal. Dr. G. looked at me and said “Okay, whenever your next contraction starts and you want to push, you go ahead and push.” I felt a tightening in my belly but it wasn’t the rock-hard massive force I’d been feeling for the past half hour or so. I looked at the doc and said “Is that a contraction?” and when she said yes I felt the relief flood my body. I could still feel contractions, my body was not numb at all, I had complete control of my legs, complete sensation in my bottom, but the edge was off and I had a moment to regroup and regain my sense that I was actually going to remain an active part of this birth instead of feeling like I was an observer as some unseen power made the birth happen. The urge to push came again and it was every bit as intense as it had been. I pushed with everything I had, and felt the baby descending and starting to crown. My water broke at this point and there was light meconium. No one coached me, no one told me when or how long to push, no one complained that I wasn’t holding my breath, no one asked me to be quiet.

Once the baby crowned Dr Gottesfeld did coach me to stop pushing, pant, and push slowly so that I would have less chance of tearing. She was doing perineal support and massage and suddenly I felt it: the ring of fire. Oh. My. God. It is aptly named. Delivering the head hurt this time and I was almost certain I’d torn where my anterior tear was previously- it was unfathomable that anything could hurt that much without doing damage. Once the head was delivered I felt the shoulders drop into my pelvis and they felt huge. Dr. G. was encouraging me to push hard, and for a brief moment I thought maybe it would be dystocia, but no. The baby dropped just a tiny bit lower and once again I was overwhelmed by a vital need to push.  Almost before I was aware I’d pushed enough to deliver, the baby was out and I heard Tomas say it was another boy! Baby was taken for immediate suctioning due to the meconium, but within minutes the suctioning was complete and the nurse pulled down the top of my gown, placed the baby on my chest, and covered us with warm blankets.  There he was, my perfect new baby son, lying on my chest where I could smell him and touch him and kiss him and look into his eyes- we had even delayed the application of the ointment so his eyes would be clear for our first time together. While I was falling in love with him, the placenta delivered and Dr. Gottesfeld showed it to us. It was large and healthy. She also checked me for tears, and once again I had delivered intact.

After a short time I decided I wanted to nurse the baby, so the nurses took him to the scale while the L&D nurse helped me get comfortable- and cleaned up, since Luis had marked me as his mom by pooping on me. He was a little confused about latching at first but quickly got the hang of it, and he has been nursing like a champ ever since.

Whenever I have talked about my previous births, I have said that in an ideal world I would have a labor like I did with my 2nd child and a delivery like I did with my 3rd. I always planned on having a natural birth, but I also always felt that choosing to labor drug-free meant I would also have to live with pushing drug-free. Having Luis the way I did was nothing like I thought it would be- and I still did not get to labor in one of my hospital’s awesome Jacuzzis!! Yet I am left with the knowledge that everything came together in perfect synchrony for me to have the kind of birth I would have written for myself, if I could have. Oh, I’d tweak some things here or there- the latent labor could’ve been shorter, and I might not have used quite so much profanity while trying not to push (lol), but overall this was an amazing birth that showed me once again exactly how much I am capable of. And now I have this beautiful little boy with the future in his eyes and my heart in his tiny hands.

And in the end, I think I gave my husband a pretty good gift for his birthday, too.

Luis Pedro

9/22/08, 7:33 a.m.

8 pounds 10 ounces, 20.75” long, 14” head