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Who can benefit from ICAN?

After a recent discussion with a group of women, I had two of them tell me that they didn’t think they would benefit from anything that had to do with ICAN. One believed ICAN was only for those who had a cesarean due to crazy circumstances and were upset about it and the other thought it was only for women who wanted a VBAC. Although ICAN is the only organization in the world that is dedicated to working towards lowering the cesarean rate and advocating for the increase of VBACs, I don’t want anyone thinking that if they don’t fit into these two categories that ICAN has nothing to offer them.

In fact, ICAN provides Mother-to-Mother support –through our website, blog, Facebook group, web seminars, speaker series, and local chapter meetings—for a variety of circumstances including:

  • The woman who is thinking about becoming pregnant or who is pregnant and wanting to know how to decrease her chances of having a cesarean section.

  • The family who knows they need a cesarean and want their birth experience to be as special and personal as possible.

  • Any woman who has had a cesarean and wants to learn about things she and her partner/support system can do to help her physical and emotional recovery.

  • The family who had a difficult birth experience and needs the support of others who have also been through it and understands their feelings.

  • The family who is looking into their birth options and wanting to know the risks and benefits associated with cesareans, trails of labor, and vaginal births after cesarean.

ICAN also strives to reach out to those in the community:

  • The medical professionals who want to gain deeper insights into how birth shapes families and what they can do to make sure every experience is a positive one.

  • Those who care about public health and want to reduce the number of unnecessary medical procedures, lower the maternal and infant mortality rate, and help bring health care costs down.

As one of the new blog writers for ICAN, I look forward to writing about a broad range of issues and circumstances that have brought you all here. We will be posting breaking research news, informational articles, opinion pieces, and birth stories of all kinds. If you have any topics you would like to see discussed, please post them in the comments below. I would also like to thank Melek Speros for doing a wonderful job over the past few years as blog writer; you have left big shoes to fill! I am very excited to do my part to spread ICAN’s mission and sincerely hope I can help you by posting the information you need to help you in your birthing decisions, let you know you are supported in your feelings, and make you realize you have an advocate in your corner.

-Tara Gilmore

ICAN blog writer

Lexi & Christa’s Birth Story – HBA2C

3 years ago today I gave birth to my 3rd daughter via HBA2C.  It was the most amazing experience ever.  I would not be the person I am today had I not experienced her birth.  Her birth taught me more than anything in life about the person I am and the strength that I have.  It gave me the courage to step up and join ICAN on the national level so I could help so many other mothers out there fighting the fight to give birth on their own terms.  As I began my journey to vba2c I was faced with no choice other than to birth at home (at the time).  For me it was the journey I wanted to choose, but so many mothers don’t have birth options, so they choose to birth at home because they have to, not because they want to.  I will be forever thankful to ICAN for educating me and supporting me in all my fears, happiness, anger etc. along the way as I planned and processed my cesarean, CBAC & HBA2C births.  My first cesarean was for a breech baby. My second cesarean was a planned hospital VBAC that ended in a CBAC.  In honor of my HBA2C baby’s 3rd birthday today I thought I’d share the birth story of my HBA2C.

Lexi & Christa’s Birth Story – HBA2C

I did it!

On Wednesday July 14th I went to bed feeling very crampy. On Thursday July 15th I woke up at 4am feeling crampy still. I drifted back off to sleep. I woke about 10 minutes later from having a dream that I was in labor. I still felt some cramps. I again drifted back in and out of sleep every 10 minutes or so. I finally woke up at 5am realizing it wasn’t a dream. I really was in labor (but I wasn’t convinced yet). I stayed in bed for another 10 minutes thinking the cramps would die down. I had been having prodromal labor for 5 weeks & it always fizzled out before. The cramps weren’t dying down so I decided to get up & get ready for the day thinking they’d fade out once I got in the shower. Once I was in the shower they changed into feeling like contractions, not just cramps anymore. I thought they were getting closer, but I hadn’t timed them yet. Brock came into the bathroom at 5:45am when he heard my hair dryer. He asked if my water broke, since that is how my 2 previous labors started. I told him no, my water did not break, but you’re not going to work today. This is it! Fifteen minutes (6am) later my youngest daughter woke up for the day. We decided to get the girls ready for daycare like it was any other day. There was no reason to call grandma to come get them if we could just drop them off at daycare. We figured she’d just pick them up later.

So Brock took the girls to daycare and I had time to start timing my contractions. I didn’t want to call my midwives till I had timed the contractions. They were coming about every 4 minutes and lasting around 45 seconds. So I called my midwife around 7:30am. She said she would call her apprentices & they would be here in about an hour. She told me to call back if the contractions got stronger. I was breathing through the contractions which were painful, but not too bad yet. Brock finally came home & kept asking me if there was anything he could do. I told him he didn’t need to do anything except to stop asking me questions during my contractions. Around 8:30am I called my midwife back to tell her the contractions were getting stronger & lasting longer. She said she was on her way and one of the apprentices should be here any minute, since they left first. All of sudden I started having some back pain. My first thought was no, not horrible back labor again. I had Brock apply counter pressure to my back for a few contractions. I decided I wanted to go get some relief for the back pain. I headed upstairs & started to fill our tub in the bathroom. I didn’t fill it too much since I was going to use the midwives tub for labor. I just told Brock to wait for the midwives to get their tub set up the rest of the way. I never got around to putting the liner in their tub before now. I got in to our tub and the water really was natures epidural, like I had heard. One of the midwives showed up a few minutes later. She checked our vitals & we both looked good. I just decided to stay in our tub while Brock and the midwives put the liner in there tub & started filling it. During all this the other 2 midwives showed up. Our vitals were checked again by my main midwife when she arrived. We both looked good. I decided to get out of the tub because I thought the water was slowing my contractions some. Around 9:40am my contractions had picked up to 3 minutes apart. I labored for a while leaning against my dresser breathing through the contractions as they got stronger. I was chatting with my midwife between contractions at this point. At 10:17am I went to the bathroom. I went to go wash my hands and all of sudden I felt a huge gush. I yelled my water just broke & ran back to the toilet anticipating it to keep leaking. I felt Alexis drop and hit my pelvic floor when my water broke. Her head ended up plugging up the leaking water. I never understood what people meant when they described the feeling a baby dropping and hitting the pelvic floor, but now I do. I had high hopes that she would come down easily. My last daughter never dropped into my pelvis since she was posterior. I tried to labor out of the tub to keep things progressing, but my contractions were getting really strong now that my water had broken, so I decided to get into the tub now that it was ready. I wasn’t in the tub for long when I started feeling nauseous. At 10:32am I threw up & then I said I feel so much pressure. I kept trying to work through it. I had no idea how far along I was as we were not doing cervical checks, or at least that was the plan. I thought there is no way I am very far along because the pain wasn’t nearly as bad as it was with my previous labor. I remember at some point saying to my midwives “I know I can do this, but I am starting to feel like I can’t, but I know I can.” The pain was just started to get intense all of sudden. I felt like my body was starting to involuntarily push a little. I decided I did want to be checked after all, because I didn’t want to start pushing if I wasn’t complete. My midwife checked me at 10:50am & I was 9 ½ centimeters with just a lip. She thought I could push right past it. She told me to go ahead & start pushing if my body was pretty much doing it already. So I started pushing at 10:58am. I remember at one point saying I feel like I am going to rip in half. I felt like I wasn’t getting anywhere, but my midwife assured me that I was. I felt like she was sliding back up every time the contractions were over & I’d take a break from pushing. The words of encouragement from my midwives really got me through the pushing & made me realize I was going to push this baby out. I remember asking at one point how long have I been pushing. It had been 45 minutes, but it felt like hours to me. It was still a relief to be pushing against the pain vs. just breathing the contractions. I tried laboring in a few different positions in the tub, but untimely they ended up having to pull my legs ups just like I was lying in bed on my back, only I was in the water. Finally her head was out. I didn’t even realize her head was out until they told me & I reached down to feel her head. I was having a little trouble pushing her the rest of the way out. She was stuck a little. Not quite a shoulder dystocia though. With a little easing by my midwife she was out with one final push at 12:14pm. They lifted her up & on to my chest. I remember saying “I did it!” I never doubted myself, but didn’t really believe it either until she was there lying on my chest. She was so beautiful. I instantly felt the bond with her. I really missed that with my previous births. Brock was just so amazed from it all, that he said “you can name her whatever you want”. We were waiting to name her till she was born. We had it narrowed down to 2 names, but we both favored one. I guess he felt after all I went through to get her here, he’d let me have my name choice. I did have a tiny second degree tear. My midwives probably wouldn’t have bothered with stitches, but with 2 toddlers & stairs in the house they did stitch me up just to be on the safe side. I couldn’t feel the tear at all though. My baby girl was 8 lbs 12oz. A full pound plus bigger than her sisters.

I am so amazed at the recovery of my VBAC! I never realized just how bad I had it with my cesarean section recoveries. I would never for a second trade my homebirth experience for anything. I can’t imagine ever giving birth in a hospital again. We however are done having children, so that’s not an issue. I just wished I had educated myself with my first pregnancy & maybe avoided the cesarean sections in the first place. Although then I would have never had this beautiful homebirth that I am so thankful for. It was a beautiful, peaceful, fast birth! If nothing else my births have taught me a lot about myself & helped me grow huge amounts as a person. They have brought me some great friends too. I’ll continue to help educate others on birth now that I am done having children, so that hopefully other women can avoid the things I went through.

Christa Billings

ICAN President

www.ican-online.org

Meeting baby

Ina May Gaskin is coming to ICAN next Tuesday!

The International Cesarean Awareness Network’s Speaker Series Event

Join this Online Event July 9th, 2013 at 3pm PST/5pm CT. You’ll need to register with the speaker series host first. Please email Thais at speakerhost (at) ican-online (dot) org with your first and last name to receive the password and link to enter the meeting.

The speaker series is FREE for members. If you aren’t a member, please join ICAN to hear Ina May Gaskin speak and support a great organization all year long for just $30. You can become a member HERE and support ICAN’s mission to improve maternal and child health.

Ina May Gaskin, MA, CPM, PhD(Hon.) is founder and director of the Farm Midwifery Center, located near Summertown, Tennessee. Last month, ICAN hosted Sara Lamm and talked about her film, Birth Story, a documentary that examines Ina May Gaskin and her work as a midwife on The Farm.

Looking forward to seeing you there!

Remember to email Thais at speakerhost (at) ican-online (dot) org to register with your first and last name. Registration closes at 10am the day of the event, July 9th.

Interview with Sara Lamm, Co-Director with Mary Wigmore of Birth Story: Ina May Gaskin and the Farm Midwives

Behind the Scenes of Birth Story with Sara Lamm, Co-Director with Mary Wigmore

by

Thais Derich

On May 14, 2013, Thais Derich from the International Cesarean Awareness Network (ICAN) speaks with Sara Lamm about her recently released film Birth Story. The interview took place online with voice and video for ICAN members.

ICAN: How did you make a film with small children?

Sara Lamm: It was grueling to the degree that I’ve never experienced in my life. I’m answering this honestly because I feel like the question was asked very honestly. The key is to be working together. Because I have a directing partner who is also a mom. We understand each other and we give each other a lot of room. Like today I’m going to do twice the amount of work because tomorrow I’m going to the school play. The schedule is so much more flexible and it’s rooted in the fact that we have each other’s backs. That’s been a big part of it. Emails get sent at 9, 10, 11, 12 o’clock at night. I wouldn’t trade the experience.

ICAN: Can you comment on Ina May’s comment about her husband in your film? She said that his support freed her to be a fierce woman.

Sara Lamm: In the 70s, there was some issue at the Farm around marijuana and Steven (Ina May’s husband) said this is a community and if you’re going to arrest somebody, you’re going to arrest me. Steven went off to jail and Ina May really stepped in and did a lot of leading at that period of time. That’s a really interesting chapter of her growth as a leader. We weren’t able to include that in the film. But when I asked him about it he said it’s like stepping out of the way of a moving bus.  There’s no choice. They all worked really hard to create a culture that respected women, respected women’s bodies, and acknowledged women’s power. At the time, maybe he would talk about the Divine feminine and honoring that in men and in women. It really informed the whole way that they structured their society. The midwives were a treasured, treasured part of their community, as I would hope that they would be in all communities.

ICAN: Were there vaginal births after a cesarean (VBAC) on the Farm?

Sara Lamm: People across the country have different access to VBAC. Even in places where there are practitioners who are willing to do them, a woman has to know what she’s asking for or she’s likely to be discourage from even trying. We only filmed two births at the Farm but we got to meet a lot of pre and post partum clients.  We filmed a prenatal visit and she was having a VBAC and then visited her after her birth. She had a really powerful experience. I know that they definitely do VBACs at the farm. They’re careful with the way that they do VBACs. They trust the body. They trust woman’s ability to birth. They don’t start from a negative place. They start from a positive place. You can do this and we’re going to make sure that we take care of you and keep you safe.

ICAN: I was wondering if you could talk about the choice to include a breech birth in the film?

Sara Lamm: My directing partner, Mary, would have a lot to say about that because she had scheduled cesarean breech for her first baby. The shame is that there is not often a choice presented. And it’s quite difficult now a days to find practitioners who have breech skills. Our motivation in showing it was to support the movement that’s out there that’s saying let’s not lose these skills. Ina May was just at a breech conference. As soon as you start saying that a breech is automatically a C-section than the C-section rate goes up automatically. Then you’re saying VBACs aren’t allowed and now we’re at a 33% C-section rate. Ina May points to the shift in breech culture as contributing to the increase in the C-section rate. If we can show a breech birth, it can become a little more tangible. It starts to feel doable. The hope is that the breech scene opens the idea a little bit more. On a care provider level, if you’ve never seen anyone do it you’re going to feel a lot more afraid of it than if you do see someone perform a breech birth.

ICAN: Ricki Lake praised your film. Has she given you any advice or help with your film? What has that been like?

Sara Lamm: She has been really lovely. We had a party for Ina May at my house. We showed Ina May a rough cut of the film. We invited Ricki who we knew through our doula Ana Paula. We’ve been in touch with Abby Epstein the director of Business of Being Born. They’ve been so lovely. Talk about women who get the idea that we have to support women. Abby has tweeted about it and put stuff on facebook. They gave us that beautiful press quote. She’s come to see the film twice already. Ricki brought over a huge gorgeous bottle of pink champagne to my house to share with Ina May and that was really so touching. We saved it and drank it after the premiere of the movie. They really paved the way in helping to create media that really is reaching a lot, a lot of women. Almost everyone who gets pregnant seems to find their way to The Business of Being Born. Because of that film and the information covered in that film we were able to make a film, a different film.

ICAN: Your film doesn’t do that back and forth with statistics like Born in the USA. How would you respond to the critics?

Sara Lamm: We talked a lot about that in the edit room. We really felt like there’s a lot of that out there. It’s not the style of filmmaking that interests us and it’s not the style of filmmaking that we think ultimately connects with people’s hearts. We wanted to show the birth culture as we found it when we went to the Farm. So, we took our cameras and that’s what we saw. There wasn’t anyone showing up at the Farm saying that this is really not safe. We don’t believe in this. Or, here’s the statistics of why this isn’t a good idea. We didn’t find that. These women lived in comfort and in security knowing that what they do is the right thing for them and the women that they’re caring for. That particular conflict we would have had to manufacture. And, we didn’t want to. That didn’t feel authentic to what the experience is like in being there. That said, we make sure that the Farm outcomes are in our press kit and on our web site. We had to recognize that we think birth is totally normal but there is the rest of the world where people think it’s incredibility dangerous and needs a particular style of care, and so we had to open up the dialog around the film to help speak that.

(end)

The next speaker series event will be July 9, 2013 at 5pm Pacific with Ina May Gaskin. A registration link will be posted on the ICAN website on July 1st (ican-online.org).

ICAN Speaker Series!

ICAN is excited to announce the kickoff of its Speaker Series.  Please
join us as our Speaker Series Host, Thais Derich, interviews Sara
Lamm, Director (with Mary Wigmore) and co-producer of Birth Story on
Tuesday, May 14th 5:00 pm PST.  Birth Story has been screened in over
200 locations worldwide including several locations hosted by local
ICAN chapters. Birth Story is a documentary that examines Ina May
Gaskin and her work as a midwife on The Farm.

The speaker series is FREE for members. Membership is $30 a year. The
cost for non-members is $20 per event.  To support ICAN’s mission by
becoming a member, visit our homepage at ican-online.org.  To register
for the event go to
https://ican.webex.com/ican/onstage/g.php?d=663697212&t=a

The vision of ICAN is to make the Speaker Series a bimonthly event.
Our host will be examining current issues around maternity care in a
fresh thought-provoking format by interviewing a variety of childbirth
experts.  The next event is scheduled for July 2013.

Sara Lamm is a Los Angeles-based writer, director, and performer whose
documentary film, DR. BRONNER’S MAGIC SOAPBOX was released
theatrically in 2007 and had its television premiere on The Sundance
Channel. Her work has also appeared at MASS-MOCA, The American
Visionary Art Museum, on Public Radio, and in performance venues
throughout New York City. In 2010, she was one of 25 emerging artists
recognized by AOL’s 25 for 25 grant. For five years she produced and
performed in Dog & Pony, a live NYC variety show featuring sketch
comedy and multi-media performance. She has two children, birthed with
the help of an extraordinary midwife.

ICAN President Christa Billings Talks to Science & Sensibility!

It’s April and Cesarean Awareness Month! Check out this interview our president did with Science and Sensibility in recognition of CAM.

Press Release: Threats to Rights of Pregnant Women

For Immediate Release Contact: Cristen Pascucci
March 13, 2013 Phone: (443) 622-2892
ImprovingBirth.org and International Cesarean Awareness Network Address
Threats to Rights of Pregnant Women
With protections for mothers under threat, advocacy groups call for solutions
San Diego, CA–Maternity care advocacy groups speak out on the heels of last week’s public cases of a Florida mother threatened with law enforcement to compel a quicker Cesarean and of “Mother A” in Ireland, the woman taken to court by her hospital to force birth by surgery.
“We’re concerned that we’re hearing from more and more pregnant women about what seems to be a growing disregard for their rights; commonly, this means denials of informed consent and refusal, but we’re seeing more extreme cases of legal coercion.  In the last few months, women in Pennsylvania, New York, Oregon, Maine, and Washington have reached out to us with pleas for help against threats of police involvement and court-ordered surgery,” said Dawn Thompson, president of ImprovingBirth.org.
Christa Billings, president of International Cesarean Awareness Network, urged, “It’s a dangerous situation for moms and babies when a cooperative, trusting relationship between patients and providers is undermined.  It gives doctors the power to decide when and how you give birth—not necessarily based on your circumstances, but on things like practice preferences, opinion, scheduling, convenience, and legal liability concerns.
Legal protections for women in pregnancy and birth are the same as for non-pregnant people—including constitutionally based rights to privacy, physical integrity, autonomy, informed consent, and the rights to refuse treatment and surgery.  These rights are foundational in constitutional democracies, including the United States.  The fundamental human right of a woman to decide how, where, and with whom she gives birth was affirmed in the landmark 2010 Ternovszky vs. Hungary decision by the European Court of Human Rights.
“Healthcare decisions are for the individual to make.  When we contract with our providers for their expert advice and skill, we do not trade in our basic rights to informed consent and refusal of treatment and surgery,” said Cristen Pascucci, ImprovingBirth.org Vice President.  “Then, when our medical and legal systems join forces against women and their autonomy, what follows is the systematic undermining of women’s ability to protect themselves and the babies they carry. Allowing policy that removes mothers as the representatives of their babies, based on a broad assumption that anyone but the mother is more invested in her and her baby’s safety and well-being, is troubling.”
Ms. Billings added, “Hospital Cesarean rates in the U.S. range from 7% to 70%–a variance largely due to provider preference, not patient diagnosis.  It’s frightening to think that a doctor who performs surgery has the ultimate authority to decide whether a woman receives surgery or not.  While Cesarean surgery can be life-saving for mother and baby, it is major abdominal surgery which is not without significant health risks for both the woman and her child.  These choices should be discussed and decided on together by both the mother and health care provider, not via coercion by the care provider.  Women truly care for their babies and want to make the best evidence-based choices for their care.”
According to Dr. Nick Rubashkin, staff obstetrician and chair of the Perinatal Quality Committee at St. Luke’s Hospital in San Francisco: “The American Congress of Obstetricians and Gynecologists (ACOG) Committee on Ethics clearly states that using the law to punish maternal decisions … has no place in prenatal care.  Now is an opportunity for departments of obstetrics and gynecology across the country to take a good look at whether their policies and procedures need improvements to be consistent with ethical guidelines.”
“We call on ACOG and other organizations to reiterate their ethical guidelines concerning patients’ rights—especially in maternity care,” said Ms. Thompson.  “And then, it’s time for mothers to be brought to the table as stakeholders in this discussion.  We can’t wait any longer for solutions.”
About:
ImprovingBirth.org is a national nonprofit run by and for mothers, to advocate for evidence-based maternity care and humanity in childbirth.  Last year, its first annual Labor Day rally to raise awareness around these issues brought out almost 10,000 women and their families in 46 states in the U.S.; this year’s rally is on track for twice as many locations and participation in other countries around the world.
The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).  ICAN is the only international mother-to-mother support organization with chapters in over 200 locations worldwide, where we hold educational and support meetings for people interested in cesarean prevention and recovery.
For more information on Cesarean section, see Childbirth Connection’s comprehensive “Cesarean Section: What you need to know about C-

For Immediate Release

Contact: Cristen Pascucci

March 13, 2013

Phone: (443) 622-2892

ImprovingBirth.org and International Cesarean Awareness Network Address

Threats to Rights of Pregnant Women

With protections for mothers under threat, advocacy groups call for solutions

San Diego, CA–Maternity care advocacy groups speak out on the heels of last week’s public cases of a Florida mother threatened with law enforcement to compel a quicker Cesarean and of “Mother A” in Ireland, the woman taken to court by her hospital to force birth by surgery.

“We’re concerned that we’re hearing from more and more pregnant women about what seems to be a growing disregard for their rights; commonly, this means denials of informed consent and refusal, but we’re seeing more extreme cases of legal coercion.  In the last few months, women in Pennsylvania, New York, Oregon, Maine, and Washington have reached out to us with pleas for help against threats of police involvement and court-ordered surgery,” said Dawn Thompson, president of ImprovingBirth.org.

Christa Billings, president of International Cesarean Awareness Network, urged, “It’s a dangerous situation for moms and babies when a cooperative, trusting relationship between patients and providers is undermined.  It gives doctors the power to decide when and how you give birth—not necessarily based on your circumstances, but on things like practice preferences, opinion, scheduling, convenience, and legal liability concerns.

Legal protections for women in pregnancy and birth are the same as for non-pregnant people—including constitutionally based rights to privacy, physical integrity, autonomy, informed consent, and the rights to refuse treatment and surgery.  These rights are foundational in constitutional democracies, including the United States.  The fundamental human right of a woman to decide how, where, and with whom she gives birth was affirmed in the landmark 2010 Ternovszky vs. Hungary decision by the European Court of Human Rights.

“Healthcare decisions are for the individual to make.  When we contract with our providers for their expert advice and skill, we do not trade in our basic rights to informed consent and refusal of treatment and surgery,” said Cristen Pascucci, ImprovingBirth.org Vice President.  “Then, when our medical and legal systems join forces against women and their autonomy, what follows is the systematic undermining of women’s ability to protect themselves and the babies they carry. Allowing policy that removes mothers as the representatives of their babies, based on a broad assumption that anyone but the mother is more invested in her and her baby’s safety and well-being, is troubling.”

Ms. Billings added, “Hospital Cesarean rates in the U.S. range from 7% to 70%–a variance largely due to provider preference, not patient diagnosis.  While Cesarean surgery can be life-saving for mother and baby, it is major abdominal surgery which is not without significant health risks for both the woman and her child.  These choices should be discussed and decided on together by both the mother and health care provider, not via coercion by the care provider.  Women truly care for their babies and want to make the best evidence-based choices for their care.”

According to Dr. Nick Rubashkin, staff obstetrician and chair of the Perinatal Quality Committee at St. Luke’s Hospital in San Francisco: “The American Congress of Obstetricians and Gynecologists (ACOG) Committee on Ethics clearly states that using the law to punish maternal decisions … has no place in prenatal care.  Now is an opportunity for departments of obstetrics and gynecology across the country to take a good look at whether their policies and procedures need improvements to be consistent with ethical guidelines.”

“We call on ACOG and other organizations to reiterate their ethical guidelines concerning patients’ rights—especially in maternity care,” said Ms. Thompson.  “And then, it’s time for mothers to be brought to the table as stakeholders in this discussion.  We can’t wait any longer for solutions.”

About:

ImprovingBirth.org is a national nonprofit run by and for mothers, to advocate for evidence-based maternity care and humanity in childbirth. Last year, its first annual Labor Day rally to raise awareness around these issues brought out almost 10,000 women and their families in 46 states in the U.S.; this year’s rally is on track for twice as many locations and participation in other countries around the world.

The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).  ICAN is the only international mother-to-mother support organization with chapters in over 200 locations worldwide, where we hold educational and support meetings for people interested in cesarean prevention and recovery.

For more information on Cesarean section, see Childbirth Connection’s comprehensive “Cesarean Section: What you need to know about C-section

###

Lauren’s Birth–Beginning the Process

Let me start by saying that when I got pregnant, a c-section was the furthest thing from my mind. My husband and I were living in Hattiesburg, MS when we found out and I was bemoaning the lack of birthing centers. There were was a group of midwives in a city 2 hours away, but after consideration my husband and I opted for natural birth classes instead and to go ahead and go with one of the two OB practices in Hattiesburg. We found a Bradley class taught by a local doula. At 26 weeks my husband’s job moved him to Tampa, FL, and I had to discontinue Bradley classes (half-way through the course) and transfer to a new OB. Still, I educated myself in the Bradley school of thought, used the Dr. Brewer diet, and filled my husband and in on what should happen at the hospital every chance I could get him to listen.

When I went to the doctor for my 39 week check up, the doctor told me she thought this would be my week — but my daughter had dropped 3 times, so they’d been saying this for a while. Everyone was surprised I’d made it as long as I had. The next evening immediately after dinner I began to have contractions. I’d been plagued by Braxton Hicks contractions since 18 weeks, so to be honest I ignored it for about two hours. I’d been timing things for weeks and they’d always fizzled out, so what was the point? I had two diarrhea bowel movements around 9pm and figured I might be starting the laboring process. But I knew from Bradley class that early labor could take hours — even DAYS. I told my husband I thought I was in early labor and was going to take a shower. I guessed they were 15 minutes apart — so by all accounts we still had a long, long road ahead of us. But I didn’t walk out of the shower — I crawled. My contractions became incredibly intense and very, very close together during my shower. My husband helped me onto our bed, naked and soaking wet. He put the covers over me and helped me time my contractions which were now 3-5 minutes apart. I called the doctor when this was the pattern they held for an hour and we were sent to triage. The doctor told me we’d likely be sent home or sent to walk the ward since I’d only been in labor for about 3 hours at this point.

On the way to triage I began to experience back labor — my daughter was posterior (”sunny-side up”) — and my contractions got closer together (1-1.5 minutes apart by the time we made it to triage). I was in the worst pain I’d ever felt in my life. I walked, I rocked, I breathed, I relaxed — everything Bradley told me to do — and nothing worked. I was only 3cm and they were going to send me home at midnight when my water broke. Because it broke at the hospital, there was no way for me to hide it. We were stuck, and now there was a count-down on top of it.

By the time we got to labor and delivery my back labor was too intense for me to walk, so I let the nurse put the stationary monitors on my belly. Because my water had broken, the nurse wanted minimal vaginal exams to decrease the risk of infection — which I knew, and expected to have to fight them off of me, but the night nurse “got it.” She was an angel. The abdominal contractions were intense but nothing I couldn’t handle — it was the back labor that got me. It didn’t let up. At all. And it triggered a panic response. I couldn’t control my breathing, and stopped making sense. My husband quietly said “Lauren, the epidural will let you relax enough to finish dilating so we can meet our little girl.” So I agreed to it. The problem: there had been a problem with my platelets early in pregnancy that I wasn’t told about, and the nurse hadn’t gotten enough blood to come out of my hand. She stuck me in my arm, and then in my other hand, trying to get enough blood to send off to get new test results done. If my platelets were down, I couldn’t get the epidural and if I needed a section they’d have to put me under — scary stuff. I remember I was mad because the doctor hadn’t told me anything was wrong with my blood results when they found out. But the blood test came back fine and I was in so much pain I didn’t even feel the epidural go in. I literally told the doctor to “git’er done.” I had been in labor for 8 hours at that point, water broken for 4 or 5, and was 6cm dilated.

I was allowed to rest and labor down without the use of pitocin until just before the nurse/doctor shift change. My contractions became erratic, but they were still causing cervical change and that was good enough for the doctor on call — who I adored, she was one of my favorites from the practice. I was 9cm for three or so hours, so they gave me a “wif” of pitocin to get the last bit dilated. I had an anterior lip, but the baby’s head was molding. I’d only had 4 vaginal exams in 9-10 hours because my water had broken. They were hopeful I’d be pushing soon. — And then the shifts changed. I was examined every hour. My pitocin drip was increased without my knowledge. I began to show signs of a fever and was refused ice chips. I had never even met the doctor who was on call, and the new L&D nurse didn’t seem to get where I was coming from. Finally, I started to push around 12pm — water broken for 12 hours. I pushed. And pushed. And pushed on my left side. And pushed on my right side. And pushed on my hands and knees. And pushed. For over 2 hours. She hadn’t budged. The doctor came in and examined me, and sat with me while I pushed through a few contractions. Sometimes we waited 10 minutes for another contraction. My temperature kept inching upward. The doctor said my daughter was likely not tucking her chin downward — babies who are anterior tuck their chins down presenting the smallest part of the noggin to pass through the pelvis, but babies who are posterior tend to keep their heads up, leaving a larger part of the head to pass through the pelvis. She said that she had to leave to do a c-section, and she would let me push while she was in surgery. If I had progressed at all when she came back, she would let me continue to labor. However, she told me that in her experience when women pushed effectively for as long as I had and no progress was made that something else was going on and a section was the best option. My temp was 100.7. The baby’s heart rate had spiked: these were signs of infection. I had been in labor for 20 hours, water broken for 14-15.

I don’t know if something in me knew she wasn’t going to come out vaginally, or if I gave up out of dehydration and exhaustion. I really don’t. My husband told me quietly he thought I had done everything I could, and that I should have the c-section. I bawled. I consented to the surgery thinking surely the doctor had several she had to attend to, and that it might be a few hours before it would be my turn. I thought I’d have time to process it. Maybe in that time I could push with just my husband (without telling the nurses). But a fleet of nurses came in to prep me for the OR immediately. I cried. And cried. And cried. I told my mother and sisters who were in the waiting room to go home. I didn’t want to see anyone. I had to have the surgery. I was a failure. I cried. and cried. And within 20 minutes I was in the OR.

I could hear the nurses talking about what they were going to do that weekend — one was angry with her boyfriend. I was just the disembodied head on the table. No one spoke to me. Finally my husband came in. The surgery began. And then, 5 little words I’ll never get out of my head: “I can’t get her out.” Maybe I forgot to mention — though I could not feel pain, I never, never, EVER lost feeling in my legs. I probably could have walked to the OR. So I felt them when they pulled my legs apart, and felt searing pain as someone had to go in vaginally to push my daughter back into my uterus. I screamed out. They wouldn’t tell me if she was ok. The doctor asked if I felt pressure or sharp pain. It was beyond sharp. She pushed a stronger epidural down my line and morphine in my drip. I kept asking if the baby was ok. Everything was quiet. It took forever for her to cry. Absolutely forever. But when I heard her cry, I cried. It was the best sound I’d ever heard. Her apgar was 8/9. They brought her over to my husband and I. I got to hold her first. She cried until she heard my voice. She was allowed to go with me to recovery. They kept me there for two hours. I was so tired. So thirsty but they couldn’t give me anything. Not even ice chips. I was higher than a kite, and instead of enjoying my baby I kept apologizing to her. For not being able to birth her myself.

Once we got to the maternity ward I asked for ice chips, but the nurse saw how dehydrated I was and cleared me to have liquids. My mother hadn’t left. My husband’s mother had arrived (though we told her what we’d told my mom). And they descended upon us. My mother-in-law came in first. She hardly looked at me, which I was grateful for. She loved on her first grandchild, talked to my husband. I was allowed to sit in stoned silence and drink juice. My mother came in a short while later and stopped dead in her tracks when she saw me. I’ll admit that seeing the pictures I looked awful. No one in my family had ever had a c-section before. So my mother, who can handle anything, was shaken. Did I mention I looked awful? I later found out I’d lost enough blood to make me a borderline candidate for a transfusion. And I was allowed to leave the hospital after 2.5 days severely anemic, without having had a bowel movement (my daughter was born 3:27pm Friday, I was discharged Monday morning).

My daughter is 7 weeks and 2 days old. She is perfect, and healthy, and happy. She is the joy of my life. We have a successful breastfeeding relationship. If my mother had had my birth, there would not be late-night research, or VBAC websites, or tears over the traumatic birth experience I had. If someone else had my birth, this email wouldn’t exist. But I had my birth. I was open to a lot of things. But a c-section was the ONE thing I always said I didn’t want. I’m blessed to have a very patient husband and very excellent friends who are willing to listen to me say the same things over, and over. I’ve been told I’m an excellent candidate for VBAC, but everyone in my family — including my husband — is against another trial of labor. In Tampa there are only 2 OB practices that take VBACs. If they won’t take you, you’re left with the midwives who will do VBAC homebirths. In 2010, Florida took VBACs out of birth centers. I wanted a large family. Now I think my daughter might be an only child. I’m having complications with my healing, and I’m not sure I want to do this again. On top of that, I’m not sure if the double disappointment of a repeat section after another trial of labor wouldn’t be even harder than the first. My emotional healing isn’t over — not by a long shot. I’ve begun making jokes to cover up the pain. This is an improvement from crying everytime I talk about it. My hope is once my physical healing is over — or I’m at least not in so much pain — the emotional healing can really start.

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

Pam’s VBAC of Raquel

This is Pam’s 2nd VBAC.  The story of her first VBAC was published earlier this week on the Blog.

Raquel’s birth once again proved the old adage: Expect the unexpected.

My pregnancy was nearly perfect, so while I expected to pass my due date, I was somewhat surprised to find myself still pregnant after 41 weeks. Though my doctors all supported me in waiting until 42 weeks to decide about forcing the issue, I recall sending an email to a friend, lamenting the fact that I “no longer look forward to this birth with a sense of anticipation and excitement, but with a sense of Good God, can we just get it the f— over with?”

I did try to stay positive, and we started walking, having sex, talking to the baby asking her to come out. I had a few episodes of false labor, but they all petered out after a couple hours of regular contractions. I was going for NSTs every other day, and the baby was doing really well, so we continued to wait. On July 24, at 41 weeks 5 days, I had finally made some positive progress toward labor! I had lost my mucous plug the morning before, and after my once again perfect NST I was found to be 3.5 cm dilated and about 80% effaced. Based on that progress, I asked to have my membranes stripped and scheduled an induction by artificial rupture of membranes (AROM) for two days later- 42 weeks pregnant. The end was in sight!!

By early that afternoon I was having regular contractions and thought I might be in latent labor. Around 3:30 p.m. my mother-in-law came over and said she’d take the boys for us so we could go to the hospital whenever we needed to. Tomas and I went out for a walk to see if my labor would intensify, and though I did have to stop for a few contractions, I eventually decided that it was going nowhere and we should just get the boys back and have dinner. Once the boys were home and I started cooking, contractions immediately intensified and starting coming every 3-5 minutes instead of every 10-15. That continued through dinner, and by around 7:30 we decided to ask Maria to come back and watch the boys again. She got here a bit after 8, at which point contractions went back to a 7-10 minute interval but stayed very strong. Some of them were extremely difficult for me to manage, so I called Kaiser’s after-hours service and told them what was going on; they agreed I should head in to the hospital.

We got checked in to the hospital uneventfully. I was hooked up to the monitors for the initial 20-minute strip and my cervix was checked. I was extremely disappointed when I was told I’d made no progress since that morning. All those contractions for nothing. After talking with the on-call OB (whose name was Dr. Payne, if you can believe it), we decided I’d stay for 2 hours of observation to see if the still-regular but still 7 minutes apart contractions were doing anything as far as progress. If not, it would be my call whether I’d go home with a sleeping pill or stay and do the AROM induction a day and a half early.

After a couple more hours of contractions, there was still no change! I was incredibly discouraged. I really wanted another natural labor and delivery, but also had to admit that a sleeping pill was not going to get me any rest because the contractions were just too strong. The baby was also having pretty steep heart rate decelerations during contractions (dipping into the 80’s and low 90’s), and while that is normal it was also a little disturbing since I’d been contracting for so long and making so little progress. Tomas and I decided to stay at the hospital, and I was admitted around 1 a.m. I hoped to be having my baby soon!

Before I continue with Raquel’s story, I need to take a second to acknowledge how critical Tomas was to me during this labor. Though he doesn’t appear consistently in my narrative, he was always there discussing our options, talking with me about my feelings, encouraging me to say no to intervention and continue laboring to see what would happen, reassuring me that we were making the right decisions.  Looking back, if it hadn’t been for him I would probably have allowed the doctors to intervene more and earlier than they did. I give him full credit for helping me be comfortable with all the intervention I had, and confident that the decisions we made were the best ones we could make.

Once we were admitted to the hospital, my birth plan was out the window. I wasn’t coping with contractions well and kept telling Tomas how much more this labor hurt than my last one did. It was very different, and I knew I wouldn’t be able to cope post-AROM so I discussed pain relief options with the OB (I should mention I talked with a number of different OBs at this point and am making no effort to keep them straight). I asked if I could get an epidural and still not consent to pitocin, and if doing that would reduce my chances of a successful labor. To my surprise, the answer was a definitive yes, I could still refuse pit and my chances of delivering vaginally would still be at least 75%. As I signed the consent form for the epi, I made a comment to my L&D nurse about wussing out. She sort of laughed and said something about how although my contractions were far apart, they were lasting 2.5 minutes, and I wasn’t wussing out. I also signed consent forms for a trial of labor and a repeat cesarean, and I specifically requested double layer sutures if I ended up in the operating room again. Everyone was very positive and supportive, and our plan at that point was to start an IV and have me get up out of bed while I was receiving fluids. If I’d made progress by the time I had enough fluid for the epidural, I would stay up and mobile and epi-free; if I hadn’t made progress I would get the epidural and go ahead with AROM. I got on a birth ball and Tomas stood behind me, supporting me through each contraction for about an hour. No progress of course, and though the OB wanted to break my bag right away I refused and insisted I get the epidural first. My L&D nurse (Lee, who had a VBAC with her 3rd baby) seemed pretty pleased that I wasn’t being intimidated by the doctors- she gave me a big smile and a thumbs-up when I refused immediate AROM.

The anesthesiologist had a couple other women before me, and I have to say that knowing relief was on the way made it more difficult to cope with contractions that were increasingly difficult anyway. I had a particularly painful contraction while the epi was being placed, and I was glad it was the last one I had to feel! The anesthesiologist gave me a huge bolus, and within minutes the worst part of my labor began. I was completely numb from the waist down and had absolutely no ability to move my legs- decidedly not what I wanted. The anesthesiologist apologized profusely and said she should have asked before she gave me such a large dose, and said that the numbness should wear off within an hour or so (which sounded like an eternity to me). When the OB came back to break my water I was at 5 cm with a bulging bag. It was about 5:30 a.m.

Immediately following AROM, contractions intensified quite a bit but still didn’t get any closer together. Raquel’s decelerations also intensified. When one particularly powerful contraction hit, I heard Raquel’s heart rate dip and when I turned to look at the monitor I was terrified to see it had dropped into the low 60’s and not recovered. I turned toward the door, knowing that at any moment someone would be running into the room, and there was Lee, holding an oxygen mask out to me. “That was really ugly,” she said, and I quickly grabbed the mask, willing the oxygen to my baby. Her heart rate recovered fine, but the pattern of huge contractions and huge decelerations continued. I sat there so numb I was nauseated, praying I wouldn’t puke into the oxygen mask, afraid things were really going to go downhill fast. Internal monitors were mentioned at that point, but never ended up being placed. I’m not sure why.

Shift change came. Juanita was our new L&D nurse and she was amazing, very supportive and reassuring that we would do everything possible to have a vaginal delivery. She checked me and I was at 8 cm, 90% effaced, baby at –1. Progress, anyway, slow but steady. The resident OB was Dr. Weatherwax, who had done my NST and AFI the previous Saturday.  The Kaiser OB was Dr. G. The anesthesiologist came in to check on me and I asked to have the epidural turned down as I was still too numb for my liking. He didn’t seem too excited about doing it, but went ahead and turned it down. Within an hour I could move my legs on my own, feel each contraction, even feel amniotic fluid leaking from me with each contraction, but I had no pain at all. That was the epidural I wanted.

Another 2 hours passed and Dr. Weatherwax checked my cervix again. He said that not only had I made no progress, but he thought Juanita’s assessment might have been generous and 8 cm was optimistic. He suggested that we start pitocin to see if we could increase progress, but I didn’t want to do it. I truly felt that if I was not progressing with the huge contractions I was having, pitocin could only make the situation worse. I asked to wait a couple more hours since baby was still doing fine, and then if I’d still made no progress I’d go straight to a c-section. It was about 9:30 a.m.

Then came Dr. G. She talked with me about my anti-pit feelings, and I told her that during my first delivery everything was going okay until pitocin came into play. I hate the stuff, and especially knowing how much Raquel’s heart rate was decelerating with natural contractions, I didn’t want to do anything to increase her risk. I also explained my gut feeling was that if my body wasn’t progressing, there was a reason. I just couldn’t go against my instinct in this situation. Dr. G. re-checked my cervix and made a comment about “stingy interns.” She said she’s been an OB for 14 years, and for 14 years she would have called me a good 9 cm dilated- not 8, and certainly not 7. She also said baby was at about 0 station. Then she said she needed me to know her bias toward my situation: her first baby was a c-section and she scheduled two repeats, so if I was sure I wanted to go into the OR at that point, she would support me. However, she also said if I’d never had a c-section, we wouldn’t even be considering it when I was 9 cm dilated. She strongly recommended I consider using a tiny dose of pitocin to see if we could get contractions closer together and hopefully get the last bit of progress made. I was encouraged that I’d made it to 9 on my own, and asked everyone to leave so Tomas and I could discuss everything again. We talked it over and asked for a couple more hours without pitocin to try to make it to 10. It was agreed, and I continued to labor pit-free. Juanita seemed pleased that I hadn’t caved in to the OBs, and said she felt they were often just not patient enough.

Noon had been my arbitrary deadline to either give birth or go to the operating room. Around noon, I had just a very thin lip of cervix left and was 100% effaced. Contractions were still 7 minutes apart, and I finally agreed that I would have a low dose of pitocin to bring them closer together. I did a couple practice pushes to see if I might be able to push past the last little bit of cervix, and then we waited another hour to see if I would make it to complete. I was definitely starting to feel pressure with each contraction, and could feel the baby moving down into my pelvis. At the end of the hour, I still had a little rim of cervix left on my right side, but we decided to try to push past it. Juanita massaged the rim of cervix as I pushed, and I could feel the baby getting lower with each push. Dr. Weatherwax came back, and took over the cervical massage. After a few pushes, he asked if my other babies had been properly positioned, because this one was posterior.

In retrospect, I feel like I should have been able to put this together. Throughout my pregnancy, I’d said I wasn’t sure how big the baby was because, “it’s just in there different.”  I was having widely spaced intensely painful contractions, some of them extremely long, and I was making very slow progress. If I leaned way forward during a contraction, the pain was significantly easier to manage. The night before, I had told Tomas that as my pregnancy progressed toward 42 weeks, I was plagued by the feeling that something was wrong- I just couldn’t put my finger on what it was.  Had I known that Raquel was posterior, I don’t know how much would have been different- but at least I wouldn’t have spent so much time feeling discouraged and ready to throw in the towel on my VBAC!

Once we knew she was posterior, I set my mind to really pushing that baby out! I knew my second stage would end up being longer than it was with my last delivery, but I didn’t want to end up pushing for hours on end. I have to say that I loved having the epidural during second stage. I was able to focus all my energy on pushing and feeling the baby move down, instead of having a good deal of my focus taken away by the pain. Contractions were still spaced pretty far apart, so it was a little weird to have long periods of just sort of chatting with everyone, then feeling another contraction start and once again putting my all into pushing. I reached down to touch the baby’s hair once it was staying visible, and it was pretty amazing to know she was right there ready to come out. As I pushed, Raquel rotated 270 degrees so that by the time she was delivered, she was facing the right direction. I overheard Dr. Weatherwax saying he thought as soon as she was finished rotating, I’d have her out in one contraction, and that was such a great encouragement!! I pushed through a contraction and she was fully crowning, but instead of pushing again they asked me to wait and let everything stretch. During the next contraction, Dr. Weatherwax coached me to push slowly and used massage to get everything stretched around Raquel’s head; he then had me slowly push out her shoulders and she was delivered with no tearing at all!

Immediately once she was out, I looked down to see that she was a girl (we hadn’t found out beforehand) and when I saw her, I shouted “It’s a GIRL!” Tomas got to cut the cord this time, and then she was plopped on my chest all goopy and bloody, and it was absolutely amazing to finally hold one of my babies immediately after birth. The pediatric nurses took her shortly after because she wasn’t pinking up and needed some blowby oxygen, and as they were suctioning her it became apparent she’d swallowed a lot of blood on her way out. There was enough that they decided to pump her stomach- what a welcome to the world- and one of the nurses commented that she’d never seen a baby swallow that much blood before. As Raquel went through that, I delivered a “really big” placenta and started experiencing some heavy uterine bleeding.  The doctors checked to make sure I hadn’t torn my cervix pushing Raquel past that last lip, and then they cleared a bunch of clots from my uterus, started a full pitocin drip, and gave me a shot of methergine.  I was still gushing blood for a few minutes, but then it slowed and thanks to all the clots being cleared my postpartum bleeding has been pretty minimal.

Then all the drama was over. The nurse asked me which side I wanted to start nursing on, I pulled down that arm of my gown, and Raquel was placed on my breast. She latched on like a pro, and it was probably one of the most incredible moments of my life, holding my beautiful little daughter in my arms while she was still so new to the world. I remember looking at my husband while he was taking pictures of her, just being amazed that this tiny little girl was ours, and he helped me get her here.  I can’t remember another time in my life when I’ve felt so overwhelmed with love. All the hours of labor, all the moments of doubt, all of that faded away, and I am left once again amazed at doing this small part of God’s work. She is perfection.

Raquel Vivian

July 25th, 2006

7 pounds 13 ounces

20” long

14.5” head circumference