It’s April and Cesarean Awareness Month! Check out this interview our president did with Science and Sensibility in recognition of CAM.
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.”
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”
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.
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.
9/22/08, 7:33 a.m.
8 pounds 10 ounces, 20.75” long, 14” head
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.
July 25th, 2006
7 pounds 13 ounces
14.5” head circumference
This week on the Blog, I thought it would be good to feature several birth stories from a mom who has had multiple VBACs. I know when I was preparing for my VBA2C, I spent a lot of time thinking about my HBAC to CBAC birth and expecting my VBA2C to be just like that labor, and I was surprised to find that they were worlds apart!! Pam had 3 VBACs and 3 different labors, and I think it’s important for mamas who may have labored before to really understand that, even in a woman who has had a VBAC, her labors and deliveries may be different each time. Today we have her first VBAC story, Wednesday I will post her second VBAC and Friday her third. Pam is an at home mom living in Colorado with her husband and four kids. Her birth experiences helped her become passionate about the rights of birthing women everywhere, and she has moderated BabyCenter’s VBAC Support Board for over five years. She strongly believes that birth is beautiful and empowering no matter where it happens!
Mateo’s VBAC Birth Story
Brief background: My cesarean was for failure to dilate at 9 cm following 27 hours of induced labor at 41 weeks 1 day. It wasn’t a terrible experience but it wasn’t one I cared to repeat, and VBAC was very important to me. I was fortunate to have supportive providers, but I did have some hurdles to overcome. I had 2 miscarriages between my first and second sons, and then when I conceived my second child I had a lot of early bleeding that culminated in a diagnosis of complete placenta previa after I passed a huge gush of blood, fluid, and clots at 14 weeks. Fortunately the rest of my pregnancy was uneventful! This is the story of my first VBAC:
At 40 weeks I was 1 cm dilated, 25% effaced, and the baby was still floating above my pelvis. I had scheduled an NST and AFI for 41 weeks and my OB agreed we could continue monitoring the baby and go to 42 weeks if we needed to. My OB told me not to get discouraged about having no progress because it could happen in a matter of hours.
My due date came and went, as I suspected it would. The following Monday I was 3 days late, and right before bed I lost my mucous plug. I was really excited because that hadn’t happened with my first son- and it was my first sign of something related to labor. All day Tuesday I had painless, wimpy braxton hicks contractions, but that was even more exciting because they had all but stopped after 36 weeks. Tuesday evening at dinner I told my husband, Tomas, that I’d lost my plug and was having contractions, and his face just lit up. I tried to temper the excitement by telling him it could still be days, but I think both of us had a sense that it would be much sooner.
At 1:30 Wednesday morning I woke up with contractions that felt like bad menstrual cramps. I knew if labor was starting I’d need the energy to get through it, so I took a couple Tylenol and went back to bed.
By 2:30 a.m. I gave up the pretense of being able to sleep or doze between contractions. They were coming every 3-5 minutes and increasing in intensity, and I was much more comfortable on my birth ball or pacing my kitchen. I still thought it could be false labor, and every half hour or so I’d time 3-4 contractions to make sure they were still coming regularly.
By 4:30 a.m. I knew “today’s the day.” Although the contractions weren’t nearly as painful as my induced labor with Vince, I was having to breathe through the peaks and my most comfortable spot was my rocking chair. When my husband’s alarm went off at 6, I went in and told him he’d need to call in to work.
We called my mother-in-law around 8:30 to have her watch our son while we went to the hospital. I did my best to give Vince a little extra attention and love but it was hard. He knew something was up, and he wasn’t too happy about it. Tomas took him to Grandma’s house a little after 9, and we left for the hospital around 9:45. I asked Tomas to not make fun of me if I wasn’t really in labor and we weren’t admitted. He said it was okay, because we’d be having the baby by tonight for sure. I laughed and said noon sounded better to me- but what were the chances of that?
On the way to the hospital I joked that we should flag down a police officer for an escort, and we chatted between contractions. Contractions were getting much more intense, and hitting a pothole during one was brutal. The drive wasn’t as bad as I thought it’d be, but it wasn’t exactly fun.
As we checked in to the hospital, a strong contraction came and I put my arms around Tomas and stood there rocking, tears streaming down my face, and said, “I feel like such a wuss.” In the background I heard the check-in receptionist calling a nurse to take me triage right away. “She’s really uncomfortable.” The doors opened, and we went through.
If you’ve given birth in a hospital, you know the routine: gown, monitors, pee in a cup, lie here in bed, OB will be in to check you. I told the nurse I was VBAC and GBS positive, that at 40 weeks I was 1 cm, 25%, and that I hoped when I was checked that I wasn’t still at 2 cm. I was checked at roughly 10:30 and was 4 cm, 100%. This was it!!
The rest of Mateo’s birth went so fast that it seems almost dreamlike to me. I stayed on the external monitors in triage while my nurse went to find a nurse anesthetist to do my IV (I’m tough to get an IV into, but needed it for the penicillin), and before they came back my water broke. It was a pretty weird sensation- a strong contraction followed by a POP and a gush. Very different from amniotomy. I had Tomas go find the nurse so I could get a towel under myself, and we discovered very heavy meconium in the fluid. Contractions immediately intensified to a level where I decided (in my exact words), “I wanted natural childbirth but I was an idiot.” I was checked again and had dilated from 4 to 6 in 40 minutes. The anesthetist got my IV in on the first try, and the nurse had called in the OB to 1) evaluate baby’s heart tracings and 2) discuss pain relief with me. Because of the heavy meconium and some apparent late decels we decided to place internal monitors- something I’d initially been against. Because I was progressing so quickly I wouldn’t be allowed to have narcotics, and I still didn’t really want an epidural (Tomas was in the background saying “we’ll see how it goes babe, you’re doing great). An LDR room was being prepared for me, and after I was transferred I’d have all the monitors placed and discuss an epidural again.
In the hall between the triage room and the LDR room, I went through transition. The sheer physical intensity of it was more than I was prepared for, and I honestly don’t really remember much more than little snatches of conversation- Tomas telling me I was doing great, me quite literally begging for an epidural and asking someone to make it stop, the nurse telling the OB that I was dilating like crazy, me having to pee but not able to, nurse saying if I felt like I had to have a BM it was probably the baby, contractions one on top of the other, the resident OB telling my delivering OB that she couldn’t place an IUPC because there was such a small lip of cervix left, me thinking “WHAT??? I was only at 6 a minute ago!”, the resident placing an internal monitor on the baby and announcing that I was complete, and then it was time to push.
I did not like pushing. I felt very exposed, totally overwhelmed, and it HURT. After the first couple contractions the OB told me that I’d dilated really fast because my cervix had done that before, but that since I hadn’t delivered vaginally I might be pushing for a while. He said I’d probably have the baby within the hour- and I thought there was no way I could push for an hour. A couple contractions later and everyone realized the baby was coming fast. It was a mad rush to get the special care nursery folks in the room (they would pay extra attention to baby because of all the meconium) and get everything set up for delivery. The OB, my L&D nurse, and my husband stood at the foot of my bed holding my legs, cheering me on as I pushed.
Once the baby started crowning I was overwhelmed by the bestiality of it all. I felt wild, feral- almost like some part of me had sprouted fangs and claws and sprung free from an inner corner of my spirit. I roared with each push, panted between contractions, my mind and body seemed to be in two completely different places, and still I can’t quite fathom that it was ME harboring that raw animal instinct. At one point the OB told me to reach down and feel the baby’s head- it was so soft, and so foreign, and so strange, and just what I needed to find the strength to push the baby OUT. Feeling his body slide out after delivering his shoulders was amazing. It was one final push and a swift flow of baby and fluid, and there was our perfect son! He weighed 8 pounds 5.6 ounces, and was 19.5 inches long. Later I asked the nurse how long I had pushed and she laughed and said, “You could count it in contractions instead of minutes- let’s see, you pushed for 9 contractions.” Roughly 15 minutes. Amazing.
Because of all the meconium (and I’m telling you, it was a LOT), Tomas didn’t cut the cord and Mateo was immediately handed off to the nursery team. They suctioned him and cleaned him up there in my room, and then gave him to Tomas. His apgars were 9,9,9 which they said is “perfect” for a high-altitude baby, so the meconium was a bit of a mystery. After a little while he started having trouble breathing and was taken down to the nursery for oxygen. Meanwhile I had delivered the placenta (the OB later showed it and all its parts to me, which was pretty cool) and was being stitched for a 2nd degree perineal tear and 2 anterior/urethral tears. It seemed like it took forever, and I lost track of how many times the OB and the resident turned around for more sutures. I got the post-delivery shakes while they were stitching, and it seemed like every time I saw their hands the blood was further up their arms. But, finally, they were done and I was able to lie in bed and be amazed at what I had just done.
Overall this was as close to my ideal birth as I could have experienced. I have absolutely no regrets about any of it, and I would take 100 deliveries like this over another cesarean. I feel amazingly blessed to have had such an easy and fast labor. Given all the hurdles I had during the pregnancy and the “anti-VBAC” indicators I had in my history, experiencing this birth has been amazingly empowering. I am strong, I am capable, and I was not ever wrong to believe in the creative feminine power of my body.
This is Andrea’s story of her CBAC birth of baby Johnathan. Andrea exerienced a complete uterine rupture, which both she and Johnathan survived. When commenting, please keep in mind the incredible strength and courage it took for her to share her story so publicly.
When we found out that we were expecting another baby, our emotions were all over the place. Of course, we were happy.. but at the same time, we were very scared. Scared that we might not be able to care for two children. Scared that Alex might not respond well to a new baby. Scared that we wouldn’t be able to love them equally since Alex was our whole world. It was really hard trying to wrap our heads around it all. Alex was only 9 months old, still a baby himself. But as time went on, we saw this new baby as a gift, especially to Alex, that was coming our way. The idea of having two small kids was growing on us, but we were still scared. I guess that’s normal though. We had no idea how the transition from one kid to two kids would go. All we knew was that they were going to be close. Really close. And we really liked that idea.
I was a lot sicker with this pregnancy than with my first. I was always so tired and I never wanted to do anything. Everyone told me that I was going to have a girl because my pregnancies were so different. But I think everyone just thought that because I already had a boy, I had to be having a girl now. From the very start, I knew that I wanted a VBAC. I knew that I did not want to go through what I went through with Alex again. There was no way I was going to get cut open again. Thankfully, my midwives supported me 100%. There were no questions asked, and there was nothing in their eyes that would prevent me from birthing this baby naturally, which was awesome. I didn’t know at that point that some women had to fight for a VBAC–I thought all providers we this great. I know the truth now, and I see how lucky I really was.
Time kept going by, and I kept getting bigger. The fatigue started to hit hard and I started to realize that it was not easy to chase after a toddler while being pregnant. Alex’s crazy amount of energy never failed to wear me out. Still, I had to keep it together for him and be the best mommy I could be…because he needed me.
We went for our 20 week anatomy scan and found out that we were having another BOY! Exciting but very unexpected. I had a feeling that I was going to have a girl this time. I guess not! Also, the perinatologist explained to us that during the ultrasound, they found a bright spot on his heart and a cyst on his brain. Those signs together could indicate Down’s Syndrome. My odds almost doubled after that scan and we were offered an amniocentesis to see if he had it for sure. We declined and chose to wait to find out. They wanted to see me again in about a month to see if the markers went away and I was told not to worry. Not to worry? Seriously? I worried for a long time. I tried to mentally prepare myself for taking care of a special needs child. I knew I was capable, it was just all so new to me. I just wanted my baby to be healthy, just like every parent out there. I will admit that deep down, I knew everything was going to be fine. I would try to prepare myself, but it was like my mind was telling me that there was no need to. M was a lot more worried than I was though. I had to constantly remind him that everything was going to be okay. As life got busier, we let those worries slip from our minds. Until the next ultrasound, of course. And that scan showed us that our boy was perfectly healthy. Both markers disappeared. We were overjoyed!
Throughout my pregnancy, Johnathan was going back and forth between being head down and being oblique (head at my hip) and I was always so good at telling where he was. After many attempts at trying to get a midwife to feel him oblique, we finally caught him. I was told to get a belly band and wear it tightly all day to try to get him to stay head down and engage. I also spent a lot of time on the yoga ball, trying to get him in a better position. I do wish I would have done more about it though. I know now how important positioning is, and I didn’t know that before. The midwives told me that I could still try for my VBAC, but since he was malpositioned, they were not going to push my body too hard. And they wanted me in ASAP if my water was to break, since the chance of cord prolapse was greater.
So fast forward to the day I went into labor. It was March 3rd, 2012. A Saturday. M had just gotten off of work and we were having dinner–it was around 6:30 PM. I can’t quite remember what we were having though. I remember a gross feeling “down there.” I went to the restroom and peed, and as I got up, I discovered bloody show!! I literally screamed “OMG!” and went to go tell M what had happened. I was shocked, but since I was just a bit over 37 weeks when I had Alex, I knew I was going to go early again. And I did! I was told that they found I had a bicornuate uterus during my c-section, so the babies literally run out of room to grow anymore in there, making me go into labor a bit early. Contractions started at around 10:00 PM, pretty mild at first. M offered to put Alex to sleep that night since I was “in labor.” I was still in denial, as always. M started playing StarCraft since things were still pretty easy for me. I sat at the kitchen table, feeling my contractions get stronger and stronger. I started feeling this intense scar painp–I’ve never felt pain at my scar so it was pretty alarming. It was very strong while I was standing up, and never really went away, even between contractions. It was a sharp pain that went through my entire incision site. It burned.. a lot. But when I sat down, I didn’t feel anything. I guess that was the weird part for me. I was really having a hard time straightening my midsection out. Something was not right, and I was starting to get nervous. I actually tried to avoid sitting down because I didn’t want my contractions to slow down or stop. At this point I told M that I needed to go in and get checked. He then told his game buddies that we were off to have a baby. I filled him in on the pain I was having and how I felt about it. I decided to go ahead and call the midwives. It took me so long to get in touch with someone, which was really odd because I’ve never had to call them more than once. M had fallen asleep on the couch and I was pacing back in forth in the living room trying to get a hold of someone. After a few pages, I got a call back. She said for some reason her pager was not working properly. My contractions were not consistent, but I still felt like I needed to go in. I explained everything to her and she said that I was probably in early labor and that the scar pain sounded normal. I sure didn’t feel normal. She heard me breathe through a contraction and gave me the option to either come in or wait it out. But she was sure that I was fine. I opted to go in and get checked anyway. I woke M up and told him we had to go. His mom was “on call” for us since they live down the street. It was around 3 AM. He tried to call his parents multiple times, and no answer! He ended up having to go to their house and jump the fence to get her to wake up. While he was gone, I got all of my toiletries and bags ready. Finally, M’s mom was here, I kissed Alex and we were on our way.
On the car ride there, my contractions were starting to fizzle out. I had maybe a couple the entire drive there. I kept making sure M knew that I just needed to be checked, and that we are better safe than sorry. I didn’t want him to be disappointed if we got sent home, since I was sure we wouldn’t be admitted. We got to the parking structure and started walking towards the hospital. I didn’t have ANY contractions on the way up. I was still very sore though, so we had to take it easy. We got to L&D and it was pretty empty, so we got into our room right away. The nurse gave me my robe and said she was going to set everything up while I was changing. As soon as I walked in to the restroom and started changing.. bam!! Contractions hit again. And they hit hard. I walked out of there in a lot of pain and for once I thought that this could actually be it. I got all set up on the monitors and his heart rate looked perfect….what a relief. They confirmed that I was having contractions every minute and a half, and they were lasting long. Really right on top of each other. The nurse said that we had to get a few minutes of the contractions on paper and that she was going to call the midwife down. It was hell laying on that bed, I was not getting any breaks from the pain. Finally the midwife came down. She said she was going to check me so I took my underwear off. I had a pad on and I felt embarrassed so I explained that things felt very “weird” down there and it felt like my water was going to break any second. She waited untilI was not having a contraction and then proceeded to check me. She said “oh yeah, you are preeeetty dilated”. I was so expecting her to say I was 2 cm, maybe 3 cm dilated. But no, I was a whole 8 cm dilated!!! I was thin and soft with a really big bulging bag of water. I guess that’s when it really hit me, I was going to give birth in just a couple short hours. I couldn’t believe it, M and I were in shock. It had taken me SO long to dilate last time that I just couldn’t believe it. It was literally a dream come true because I always said that I wanted to show up super progressed to the hospital this time. And it happened! All without me even knowing I was in labor to begin with. I guess I probably hit transition as I arrived to the hospital.
So this part still kills me. The midwife was starting to walk away and she said she was going to make some phone calls and get all of my paperwork set up. I asked her if she thought it was a good idea for me to get the epidural. She said “Yes! that is a good idea” and walked out of the room to call anesthesia. I have no idea what brought me to ask her that. I was set on a natural birth and everything was going so perfectly. I blame it on fear. But on fear of what? I have no idea.. and I still regret it to this day. I guess I needed someone to tell me that I didn’t need it and that I was fine without it. I can’t even begin to explain what was going though my mind at that point. I think that has to be the moment I most regret. But I do know I needed relief form those piggyback contractions. They seriously never stopped. At this point, two nurses come in to place my IV. I was so not in the mood for these idiots. I could tell from the momentthey walked in that something weird was going to happen. They start talking about I don’t even know what.. maybe how their weekend went? Something like that. One starts my IV, oh so slowly. And I’m over here in transition, in bed, and just not comfortable. As she goes to put the tube in, she does it too slowly and blood gushes ALL over. Mostly all over her though. Her clothes, her hair, her arm. And they start cracking up. Still, I was not in the mood and really wanted them out of my face. The other one tells me that I have to forgive them, it was 4 am and they were just exhausted. I sat there as she finished up with tears rolling down my cheeks because I was just that annoyed and in pain.
So the anesthesiologist gets in, and he’s basically god to me at that point because the pain was excruciating and just was not going away, even in between contractions. I have two new (awesome) nurses at this point and one was holding me as I leaned over the side of the bed to get my epidural placed. She helped me breathe through all of the pain and helped me stay still enough to get the needle in. Everything wasplaced and I was a happy camper. My new nurses went ahead and put my catheter in and M went to go get the bags out of the car.. because we were staying!!
One of my nurses wasnamed Gloria and she was just the best. The epidural was nice for awhile but eventually started fading. They had to call the anesthesiologist back in over and over again to keep uping my dose. It just kept wearing off. Even the little button they gave me to push (for more medication) was not working. The anesthesiologist’s name was Johnathan, pretty cool since that was the name we had picked out for our baby. He didn’t have a problem with coming in so much to help me. We were all pretty confused as to what was going on, since he was confident that it was placed right. After awhile, it felt like I didn’t have any pain relief at all. And of course, the contractions never let up. I was checked again and I was at a 9. One more cm to go, I was so excited. So I continued to labor and I continued to get medicine placed in my IV for the pain. During the check, I was also told that baby’s head was still very high, and kind of off to the side. People were starting to get concerned about my contractions. I guess it was weird to see NO breaks at all in between them. My uterus was working extra hard to try to get that baby in the right position. Everything went by so quickly to me, so I don’t remember exactly when I got checked.. but I know that I was stuck at a 9 for awhile. The new midwife whose shift had just begun was scared to break my water because she didn’t want the cord to come out. She called in an OB to do it for her. They were hoping that would help me dilate that last cm. I was told that was supposed to be the easiest dilation, and that I was not supposed to get stuck at that point. The OB checked me before she was going to break my water, and during the check, my water broke on its own. She kept her hand in there for awhile just to make sure none of the cord came out. Of course I was still at a 9 and he wasn’t engaged. I was told that there was A LOT of fluid. M said he saw, and it was basically a waterfall!! The fluid was nice and clear.
So I was still in a lot of pain and the anesthesiologist kept giving me more pain relief. It was just an ongoing cycle. The closeness of my contractions was starting to get everyone concerned. I remember a test being done, I’m just not sure what it was called or what was done. My mind is not remembering it for some reason, but I think it had to do with checking to see if there was a mixture between maternal and fetal blood. I’m not sure if that was it exactly, or why they did it, but it came back normal. The midwife said that she wanted to put internal monitors in me and check to see if the problems were because my contractions were not strong enough. I didn’t feel so good about that, so I declined. I changed my position as much as I could being somewhat numb in the legs. Then the midwife offered pitocin. Really? Was this lady really trying to give me pitocin, when my contractions were already coming at a dangerous rate?? Of course I said no thanks. Even Gloria thought she was crazy, she told me that she was NOT going to let her give me any of that. I have no idea why that was even suggested. I think it was around this time that I had a break down. I cried about the fact that I couldn’t progress, I cried because I was in so much pain. I was ready to give up. I did not want this to end up like Alexander’s birth, my main goal was a healthy baby. I didn’t care at this point how he got here, I just didn’t want to go through that trauma again. Everyone in the room tried to convince me that everything was okay. Gloria said that we were going to have a VBAC in that room, and soon.
At around 11:40 AM, on Sunday March 4th, I made the decision to go in for a repeat c-section. I was just not comfortable laboring anymore. I was a mess, I just wanted my baby out and in my arms. It was a hard pill to swallow. I talked it over with M, who really wanted me to have my VBAC, and we agreed that it was time. Neither of us were happy about it though. I told the midwife and she said she would have me into surgery soon and the anesthesiologist gave me another dose of medicine. Before the midwife walked out of the room, she had my lay in a position on my side, with one leg up, in a last effort attempt to get me dilated.
Almost as soon as she left the room, Gloria and a few others rushed in. They seemed so calm, I didn’t think anything of it. They told me that they needed to adjust the monitors. I turned all of the way on my side, and then to my back, as they searched. I started to feel a bit scared. More people came in and someone threw an oxygen mask on me. They told me that I needed to breath deeply. I was checked one more time (I was called COMPLETE and +2!!!) and an internal monitor was placed on baby’s head. The midwife yelled “Well baby just made up his mind for you!”, which was not true because I had asked for the c-section right before that. Anyway, they started getting my bed ready to go and I was freaking out. I thought I had lost my baby. I thought he was dead. No one was telling me anything, and chaos was happening all around me. Right before they wheeled me out, I grabbed M’s hand. He told me everything was going to be okay. As they are rushing me down the hallway, I’m bawling. I felt so sick to my stomach and scared. I was hoping that it was all a dream, it felt like a dream. The doctor was going over the risks with me, as her and a handful of other people flew me to the OR. When we got there, they stopped my bed right next to the operating table. They told me that I really needed to get on it. So without even knowing how I did it, I jumped with numb legs onto the table. I just knew that I needed to be fast and there was no time to waste. They did a quick ultrasound and said his heart rate was in the 30’s. That was the first thing I heard the whole time about the situation. I knew he was still alive, but for how long? I was checked to make sure I was numb enough, and I was. So the surgery started. It was literally a few seconds till I heard “baby is out” and I heard the sweetest little whimper. He was okay. I breathed a sigh of relief but was quickly brought back to fear as I hear “complete uterine rupture!” Really? You have to be kidding me. The only thing that I was told over and over was so rare actually happened to me? The doctor was yelling as she was operating “what is this?!,” “is this cervix?” and even “where does this go?” Everyone was just in awe. I begged them to save me. I had two little boys who needed their mom. I had to live for them. I continued to beg, and to cry. I started to pray. I needed strength, I needed to live. I was getting IVs put in both wrists, on the bottom sides of them. It was extremely painful, but my arms were being held down by other people so all I was able to do was cry some more. It was then that the anesthesiologist took off my oxygen mask and put another one on. I asked him if that one was oxygen as well, he said yes. I was then put to sleep.
I woke up at around 3 pm to people all around me. I was confused, but soon remembered what happened. Before I even said anything, they reassured me that my baby was okay. That he was fine, but he was in the NICU. I can’t even begin to explain how much joy and relief I felt at that moment. I was freezing and as soon as I was able to talk again, I asked for a whole bunch of blankets. My throat was so sore from the breathing tube they put in, and my voice was so raspy. I wasn’t in the regular recovery room, I was in a big empty room with empty beds along the walls. One of the nurses went to get Michael. He told me about our baby. He showed me pictures, and I cried some more. They had him in the NICU for monitoring, because he was shocked at birth and wasn’t breathing. Johnathan Samuel was born at 11:52 am, weighing 7lbs 7oz and 20.5 inches long. I found out that his heart rate dropped to the 40s out of nowhere. The heart monitors saved his life. And when the doctors cut me open, they didn’t have to cut my uterus to deliver him. There was a huge hole in my uterus. His arm, cord and body were hanging outside of my uterus in my abdominal cavity. My entire previous c-section scar had opened and the rupture extended down all of the way through my cervix and into my vagina. The surgery took almost 3 hours, but they were able to save my uterus. I had an in-surgery consult with urology, because there was suspected injury to my bladder. Everything turned out fine with that though. I experienced uterine atony on the table and lost a lot of blood. I was injected with a shot of pitocin directly into my uterus, which caused my uterus to contract and stop bleeding. I received two blood transfusions and one bag of plasma while asleep.
After I spent awhile in recovery, I was taken back to my L&D room for about an hour. My dad was in there waiting for us. M had called him while I was in surgery. He stayed for a bit, but didn’t go see Johnathan because he was getting over a cold. At around 6:30, I was finally wheeled down to the NICU. A place that I never thought I’d see again. I had promised myself that I’d do everything possible to prevent another birth like Alex’s, but it happened anyway. I saw my sweet little baby asleep in his bassinet. He needed help breathing for a few hours, but by the time I got to see him, he was fine. He did have an IV in because I was running a teeny tiny fever during my labor, and they wanted to treat him just in case. His cultures all came back negative though. The nurse handed him to me and I started crying. I couldn’t believe he had pulled through. My true miracle baby. Everyone was looking at me with a sad look in their eyes. I’m assuming everyone had heard that I had a UR, because all the nurses in the NICU took time out to tell me congrats. I was so in love with him. He looked a lot like his big brother, just perfect.
I tried to start skin to skin contact as soon as I could, even though he was already almost 7 hours old. I offered him my breast and he actually latched on. I cried again as he nursed like he was starving, like he was so happy to have me holding him. After having breastfeeding fail with Alex, I really wanted to make it work this time. Even after all we had just gone through, it was a very magical moment.
We are so beyond thankful to have our little blessing with us today, because I know he was so close to death, and a lot of other moms didn’t have the outcome I did with such a large rupture. I just can’t wrap my head around how lucky we were. There was a lot of survivors guilt there in the beginning, when I was in contact with other UR moms whose babies passed away. Why did Johnathan survive? I’m 100% sure he had an angel watching over him that day. The whole thing brought a lot of emotional pain, trauma and questions. Why did this all happen to us? What did we do to deserve that? I grieved over the fact that I was told not to have anymore children. That was very hard to hear. Not only did my VBAC fail, but I was never allowed to try again, when all I ever wanted was a positive birth experience. It was a ton to process at one time. That one thing that is so rare happened to us. It was unbelievable. I’m very very very thankful for the staff who were on-call that day. He was born 12 minutes after the first sign of rupture, and that was almost not even fast enough. The longest 12 minutes of my life.They all worked so fast, with minimal “decision to incision” time. I couldn’t have asked for better doctors or nurses. I have realized that even though my baby survived, UR is not something you can just get over. The scars are not only physical, but emotional as well.. if not more emotional than physical.
Now Johnathan is a happy and healthy 10 month old baby. He is such a joy to be around and a complete mama’s boy. We have a wonderful breastfeeding relationship still and I am so thankful for that. I can’t imagine life without him. His big brother Alex just adores him. I have had the best time watching them grow in to being best friends and I’m excited for our future together as a family. I thank God everyday that he’s here with us. As for me, I’m still working through the pain. I still think about it all every day and often replay my story in my head, trying to figure out where I went wrong. I wasn’t as prepared as I should have been. There are so many things I would have gone back and changed. BUT, there is no use thinking about all of that now–I’m still in the process of learning how to make all of that stop.
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Dr. Joseph Tate of Atlanta, Georgia, a professional subscriber to ICAN, has been awarded the inaugural REAL Award in the field of Newborn and Mother Care. Dr. Tate is a wonderful supporter and advocate for women, and has attended VbAmC, vaginal breech birth and even a VBA2C of triplets! He is active in the Atlanta chapter of ICAN, and we are so glad he received this award! To read more, check out this article, authored by ICAN of Atlanta co-leader Christine Strain.
Marci’s New Year’s Day Blessing: The HBAC of Cayla Ariel
This is the story of the HBAC of Cayla. In many ways, it begins with the birth of her older sister, Annalise, so I’ll start there. Forty-nine hours into labor, I was transferred to the hospital, and after fifty-six hours of pain-med free labor, Annalise was surgically delivered via caesarean section. I had the classic occiput posterior labor with Annalise: back labor, painful contractions that inhibited rest, very little dilation for all the laboring done. I was fortunate that labor started soon after PROM with a gentle nudge from homeopathy and acupuncture, but since her amniotic sac was gone, once she turned from ROT to OP position she had a really difficult time turning into either the OA or LOA positions that are ideal for vaginal birth. Although I only had maybe three vaginal exams during my labor with her, my temperature started to creep up at home, at which point we abandoned our plans for a homebirth and heeded our midwives’ advice to transfer to the hospital. By the time I got to the hospital, I had a full-blown fever, and both my heartrate and Annalise’s were tachychardic. They managed to get my heartrate down after administering antibiotics and fluids, but her heartrate remained high. The OB on call recommended pitocin to expedite delivery, because there was only so long I could go on laboring now that Annalise’s heartrate was tachycardic. She also wondered if the tachycardia might be due to Annalise being in a sleep cycle, but as labor progressed, it became clear that this wasn’t the case.
I did all the things that generally increase the chances of successful, non-traumatic vaginal birth: I remained pain med free until they wheeled me into the OR and gave me a spinal for the c-section; I was active during my whole labor, trying to use various positions to help Annalise move out of her malposition into optimal birthing position, and I only accepted interventions as they became truly medically indicated. Despite this, Annalise was born with an APGAR of 2, was a “Code pink” baby and had to be resuscitated for a long time after birth. I’ll never forget what it was like to hear the terror in the pediatrician’s voice. He hadn’t intubated Annalise, thinking she’d be okay. (The OB was going to go ahead to surgery without the pediatrician present; my midwife intervened and insisted that the pediatrician be there specifically because Annalise’s heartrate was so high and she thought he might well need to intubate her at birth. [sigh]) Turned out she had thick meconium and mucous blocking her airways and the suction device got clogged and stopped working. A back up suction device wasn’t handy, and he started to shout to the staff “I need suction! I need stimulation! Code Pink! Within seconds, people were pouring into the room from all doors, and working on Annalise. After all that, her breathing still wasn’t okay, and she was in the NICU for 48 hours.
I figure I did my best, and in life, there really are no guarantees. Most times, what you accomplish will reflect your efforts. But sometimes, what you accomplish won’t be what you envisioned. I tried to give Annalise a good birth and that didn’t really happen, but I really did try my best….so I leave it at that. Despite the fact that the birth didn’t go as planned, I am so thankful for those in my immediate and church family who prayed for me during the birth. I truly do still feel that God protected Annalise and helped her to be born just in time.
When I returned home five days after my c-section, the waterbirth tub we’d rented was still full of toasty warm water….and I’d never gotten in because of the hospital transfer. Ouch.
When I got pregnant with Cayla, I knew I was going to try for a VBAC. I had done research into the risks and benefits of VBAC versus RCS, and knew I wanted to at least try.
What I didn’t know was whether or not I was going to attempt VBAC at home or in the hospital.
[Well, I knew what I wanted....]
I live in Ontario, Canada, and here, we have one of the best midwifery systems in the world. So I could choose to have my birth at home or in hospital, and because midwives here must attend both hospital and homebirths, I knew that if there were signs I needed to be transferred, the midwives would recommend transfer because – unlike some other places in the world – transferring to the hospital setting would not prevent them from continuing all my care and would allow them access to any necessary interventions. Still, the question of birth location is one I discussed at length with my husband Orett, my doula Jo-Ann, and my midwives, Kara and Edie.
There isn’t a lot of research on HBAC, but my main question was whether or not, in event of emergency such as uterine rupture, I would actually get access to lifesaving surgery any faster by being in a hospital. Because of how close I lived to the hospital, and the hospital’s “decision to incision” time of 20 minutes according to my midwives (the OB I consulted with at the local hospital was reluctant to guarantee a “decision to incision” time of sooner than 30 minutes, but the midwives use 20 minutes to err on the side of caution when advising a client about whether or not HBAC is generally a safe option in her specific case), I actually wouldn’t receive lifesaving surgery any faster by being in hospital. Of course, people have become accustomed to believing in the inherent safety of all things hospital and most folks actually think that, should there be an emergency, lifesaving surgery is performed immediately. Even when the call for surgery is made and given priority status, real life just isn’t like it is on many medical TV shows: rescue efforts still take time. My distance from the hospital meant that should my uterus rupture, the midwives would make the call in immediately so the hospital could get everything ready for surgery and they would run all my IV lines and prep me for surgery in the ambulance: I would arrive at the hospital BEFORE the hospital was even ready to make an incision. Once the hospital was ready, they’d give me general anesthesia and surgery would commence. If I lived further away, or lived close to one of those rare but awesome hospitals that had a “decision to incision” time of five or ten minutes, the hospital would’ve been a safer place for my birth; however, my proximity to the hospital and its “decision to incision” time opened up HBAC as a safe option for me.
I hoped, though, to avoid needing surgery and interventions in general. So from July 2011 till I gave birth, I faithfully went to chiropractic care to get my spine and pelvis in optimal condition for birthing (I was in a car accident just before I got pregnant with Annalise, and – despite four months of physiotherapy – still had problems with my pelvis and spine). I ate healthy, tried to remain active, took lots of vitamin D (to lower chances of c-section birth), and vitamin C (to prevent repeat PROM scenario and increase my body’s natural oxytocin levels). I took Gentle Birth Formula, a tincture to promote uterine tone and prepare the body for labor. I prayed and asked others to pray for me when I felt overwhelmed by the idea that achieving a vaginal birth after caesarean is often harder than getting a vaginal birth as a first-time mom. (My immediate family and church family were AWESOME about praying whenever I asked!). I connected with VBAC support boards that could help me navigate the emotional and physical politics of achieving VBAC. I hired a doula who specialized in birth trauma and had worked with VBAC moms before to help me do the necessary emotional work before and during labor to have a successful outcome. And I had three sessions of craniosacral therapy, since spinningbabies.com suggested that body work like this could increase the chances of malpositioned babies turning to optimal positions either prior to or before labor. In my case, every time the craniosacral therapist did a session, my baby would shift from ROT to LOT/LOA, which are better birthing positions. So even though Cayla did shift back to ROT at the beginning of labor, she did finally shift to LOA partway through labor, and I do credit this to all the extensive chiropractic care and craniosacral therapy I received helping to balance my body for birth.
I had hoped for a shorter birth. It was shorter – 44 hours instead of 56 – but not as short as I’d hoped for. We don’t always get what we want, yet, as my story demonstrates, sometimes it’s still all for the best.
At my 37 week appointment, I asked my midwife for a vaginal exam, and I was not effaced or dilated at all. I wasn’t surprised, but because there are things in my medical history that make me more likely to need an induction, I did want my cervix to be at least ripe. Part way through the 37th week, I started using three capsules of Borage Oil and one capsule of zinc orally at night to ripen the cervix.
Around 5pm December 30th, 2012, I felt really nauseous. I didn’t throw up, but just wasn’t feeling very good. An hour later, I went to the toilet and had a serious bout of the runs. TMI, I know, but I was wondering at the time what on earth I’d eaten to have my system so upset: I was only 38 weeks pregnant, so I just didn’t quite connect it all to labor quite yet. In any case, I felt pooped and decided I would go to bed really early. I woke up at 12:30 am on December 31st to use the bathroom and noticed bloody show. Within 30 minutes, contractions 8-10 minutes apart commenced. They were long and strong right away, so that put an end to my attempts to fall asleep. Three hours later, the contractions were still strong, so I got out of bed and decided it was time to wash up the dishes I’d left in the sink the night before and do light cleaning. I made eggs and bacon, ate some, and then decided I would return to bed to try to sleep. After 20 minutes, my contractions finally stopped altogether, and I slept for about two hours, only to again wake to strong contractions, 8-10 minutes apart.
By this time, Annalise was stirring, so I got up and set about getting her fed and ready, etc. I sent my doula, Jo-Ann, an email letting her know that I had bloody show and had contractions 8-10 minutes apart. She wasn’t supposed to be “on call” for my birth for another 3 days, but she emailed me right back and said to consider her on call for my birth now. Contractions continued, and I closed my eyes and breathed through them. My husband Orett got home from working a night shift in the ER (he’s a Registered Nurse) and played with Annalise for awhile. I told him I was having strong contractions and that he needed to get the proper connector to attach the hose to the faucet, as I would never let him hear the end of it if I didn’t get a waterbirth this time round because he hadn’t got the connector in time! Realizing I was serious, he hustled out to purchase the right connecting piece. Contractions continued 8-10 minutes apart. I was tired because I hadn’t had much sleep, and was a bit concerned that this labor pattern might just indicate that baby was again ROT or some other malposition. The contractions stopped at 12 noon and I immediately went to lay down and sleep, only to awake to more too-strong-to-sleep-through contractions at 1:30pm.
I got up and got more things ready for the baby’s arrival. Contractions were still 8-10 minutes apart and I continued most of the afternoon the same way. At around 6:30pm I spoke to my doula about the labor pattern and the fact that I was a bit concerned about how this was playing out. She suggested taking a warm bath and then taking homeopathic pullsatilla to see what effect this would have on my labor. I did this, and an hour after taking the bath and homeopathic, my contractions stopped. So at 8pm, I dashed into bed….only to – you guessed it! – awake at 10 pm to contractions 8-10 minutes apart.
I had told Orett it was okay to go to work before I went to sleep because, at this point, the homeopathic and bath had seemed to stop my labor, so I actually thought I was going to be the very lucky lady who got a whole night of sleep before labor resumed: I thought this would be just the ticket to waking up with contractions 5-1-1. Orett promised to notify his work as soon as I was clear about the birth being imminent and return home. So I was really concerned when I awoke at 10pm with strong contractions 8-10 minutes apart. I was hoping for a whole night of sleep, not just a couple hours!
Finally, at midnight, I sent a text message to my doula and told her I was really concerned about the lack of sleep, yet I couldn’t sleep because the contractions were just too strong and I had to breath through them. She recommended Gravol, and then asked me if I’d contacted my midwives to let them know I was in labor. I said no – I’d kept waiting for labor to get to 5-1-1, and it hadn’t. She said that while she would recommend Gravol, I should really call the midwives and let them know what was happening and find out their recommendation. So I did, and my midwife, Edie, was concerned about the lack of sleep and how that might impede labor. She supported using Gravol…but we had none. Which isn’t surprising, because I rarely ever take so much as an Advil or Tylenol; I’m more of a ‘natural remedies’ type of gal. So I dug around in our First Aid kit, found and took Tylenol (which did nothing to make me sleep) and then called Orett to come home at 3:31 am, asking him to bring Gravol. Orett got home and gave me Gravol. No change – contractions still 8-10 minutes apart and incredibly intense.
So despite taking the Tylenol and Gravol that were supposed to make me sleep, I actually didn’t get a wink more.
I called Edie around 8am in the morning explaining that I still couldn’t sleep – contractions were just too strong. She offered to come do a home visit and assess me, to which I agreed. She also mentioned that if this situation continued, she might have to take me to the hospital to get morphine, as that would knock me right out and then I could sleep. But she explained that that was sticky, because an OB would need to prescribe the morphine and depending on what happened with my cervix, this could create a “transfer of care” situation. Even though she’d be able to stay on in a supportive role during my birth if a transfer of care took place, we both agreed that this option should be a last resort.
By 9am, both Edie and Jo-Ann arrived to see what we could do about my labor. Edie watched me during a few contractions and confirmed that I was, indeed, having really strong contractions. Edie did a vaginal exam, and confirmed that I was now 5 cms dilated and very soft, so there was no doubt I was laboring. She did a stretch and sweep to see if this would launch my contractions into 5-1-1 pattern sooner rather than later. She then checked the baby’s position, and baby was just as I’d suspected: ROT. ROT fetal positioning tends to result in protracted labor, and until the baby’s head is more firmly applied to the cervix and the baby rotates to a position like LOA or OA, labor and progress are slow. But I took comfort in the fact that my cervix had dilated to 5cms, because with Annalise, after all that labor, I’d only dilated to 2cms: she just got wedged into a bad position early in labor and couldn’t get out.
Edie had me pee on a stick to check for keytones, which I had, so I then ate some more and she and Orett ran an IV line into my arm with fluids because the dehydration was so severe. She also gave me more Gravol, hoping it would knock me out and I’d sleep. No luck – the contractions were just too strong and I couldn’t even sleep between them. She brought in some things for the homebirth and I stayed in bed laying on my left side for hours, trying to ride out the contractions and wishing I could sleep. Because we didn’t want baby to descend before rotating to an ideal birthing position, lying down was a good option at this point in my labor. Edie would come in at intervals to monitor the baby’s heartrate. I kept hoping and praying that things were going to progress.
Edie didn’t want me to feel like a watched pot, so she and the doula left for a bit. Before Edie arrived in the morning I’d called Kitty, my naturopathic doctor who does acupuncture, to find out if she could use acupuncture to change the course of my labor. It was New Years Day and I KNEW she might not come, as it was a holiday. But she knew my story and that I really wanted a VBAC, and I called, hoping that she just might help me out. She called me back and said she would come to my home, but was concerned about using acupuncture for labor augmentation if I was already running on such little sleep. She suggested instead giving me herbs to reduce the contractions so I could sleep, and then – after a good sleep – seeing about bringing things on more strongly using acupuncture.
Now, by this point I was becoming skeptical of the notion that my labor could be quelled enough for me to sleep – after all, I had ardently been trying to sleep through contractions to no avail. But I recognized that if sleep could be had, it would be fantastic. So I agreed. While I waited for her to come, I got out of bed and labored on the toilet. It felt really good to do that and I started to feel rectal pressure. I labored there for an hour and then switched to the birth ball beside my bed to labor more. Kitty arrived after 2pm and did a full history on my current situation. She gave me a homeopathic remedy and then gave me some Crampbark tincture to help labor subside. She said that if the tincture were going to work, it would work within an hour, and said that I should take a ½ tsp dose every 10 minutes for an hour then wait a bit. She also mentioned that getting in the tub might also help to dissipate contractions. She asked my permission to speak to my midwife, and I granted it. She relayed her recommendations but asked what my midwife felt and left it up to her. My midwife agreed that if I could sleep, that would be best. But if I couldn’t, it was what it was. Kitty stayed with me for about half an hour, softly helping me breathe through contractions, then left.
I waited over an hour for the tincture to do its work.
And then I came to my senses.
Now faith is the substance of things hoped for, the evidence of things not seen
~ Hebrews 11:1 KJV~
Contractions were just getting stronger. I realized that our baby had decided to be born today, and it was time to get about the business of birthing my baby before severe maternal exhaustion set in and I would be unable to have a vaginal delivery without some variety of hospital drugs to assist me. I spoke to Orett about my feelings and he agreed 100%. I called my doula Jo-Ann around 4pm and told her that I felt sure that the baby wanted to come tonight, and that I was sure that if I could just birth my baby in the next four to eight hours, I would get my HBAC and all would be well. And I accepted the fact that if I couldn’t do it in that timeframe, I was probably looking at having to transfer to the hospital for drugs so I could sleep and then deliver vaginally. This was hard to say, as I really believe in not using drugs during childbirth unless truly medically indicated. But I know all interventions under the sun have their time and place, and if it was truly needed because I was exhausted, I would accept interventions. I also acknowledged that there was the chance of a repeat c-section if some complication cropped up if I transferred, but for right now I just had to focus on birthing Cayla. Jo-Ann mentioned that she loved the determination she heard in my voice and that I should continue to focus on welcoming labor now.
I called Edie and told her that the tincture didn’t work and I was still in labor. I asked if she would come to my house and check my cervix to see if I had progressed since the 5cms I was at 9am that morning. I knew that she had recommended me calling her when contractions were five minutes apart, and even though they weren’t, I was completely going on my gut instinct now and asking her to trust my sense that this was going to happen. Most careproviders ask women to follow the 5-1-1 rule for their first planned vaginal delivery, as a woman is usually consider in “active labor” if her contractions are 5-1-1 and her dilation seems to confirm this diagnosis. It was ultimately because I was not experiencing contractions five minutes apart when Edie checked me in the morning that we were all still waiting for this signal of “active labor.” But by this point in my labor, I knew that although my labor was not conforming to standard medical definitions of active labor, there was no doubt that I was laboring hard.
I also told Edie I wanted to know if the baby had shifted positions, because I’d been feeling a lot of flailing around in there. And I told her that after she checked, I intended to get into the birthing pool for at least an hour to see if the natural oxytocin increase that water labor creates would send us full steam ahead; or alternately, if this wasn’t “it”, stop labor. I was not going to transport to the hospital until I’d at least gotten into the water this time round!
[By this point, I really doubted that anything would stop labor....but I wanted to sound rational, because I knew my labor was not fitting textbook parameters and definitions]
I suggested that after doing all these things, we could all decide on the best course of action. Edie agreed.
I walked up and down our house, trying to focus as I listened to my birthing tracks, and feeling the labor intensity soar.
I had Orett call my parents and ask them to pick up Annalise, as I was in my birthing time and felt I needed less distractions now. They came, combed Annalise’s hair and got her ready, said a prayer for me that that Cayla would get into the right position for birthing, that my labor would progress, and that she would be born vaginally. They also prayed for wisdom in all our decision making as we went through labor. They asked us to keep them posted and then they left.
I continued to walk around our house, stopping for focused breathing when contractions would hit, and felt renewed faith that the Lord would hear the prayers of myself, Orett, our families, and the community of faith (huge shout out to The Campus Church – our home church in Aurora, Ontario!) we knew had been praying about this birth for so long.
At 6pm, Edie and Jo-Ann arrived. Contractions were still 8 minutes apart. Edie checked my cervix – I was 7cms dilated and Cayla had now shifted from ROT to LOA: the optimal position for vaginal birth. The energy in the room was just amazing and Orett still talks about how my countenance registered complete relief when I heard that Cayla was FINALLY in the optimal position for birthing. We all knew that her newly-altered position dramatically increased the odds that I was going to have a vaginal delivery, and I was so excited.
Jo-Ann gave me some homeopathic remedies to gently encourage labor on. I hopped into the birth pool. For an hour, my contractions didn’t get any closer together. Edie thought I should stay in the pool longer and felt things were going well. She even suggested she could break my waters. Since I had PROM with Annalise, I really didn’t want to get rid of my waters just yet, because AROM can cause a baby to get into a bad position and be unable to maneuver enough to get out….but decided I would do it before transport to the hospital if it came to that. For now, I would just labor with my amniotic sac intact.
Around 7pm, my contractions suddenly dropped to 2 minutes apart. I instinctively shifted to hands and knees during each contraction in the water. Jo-Ann and Orett talked me through visualizations with each contraction. Before I knew it, I was in transition, and contractions were double-peaking. I felt my body bear down and water from my amniotic sac shooting out of me like a rocket. Finally, Edie said she wanted to check me. I asked her if she could just check me in the water. She chuckled and said she could, but it would be more accurate if I got out of the tub.
So feeling quite grumpy about having to leave the birth pool, I got out and lay on the couch. A contraction hit and I sat up to ride it. When it was done, I lay back down. She assessed me and said, “Well Marci, you are 9 ¾ dilated with an anterior lip.” I was so excited and asked if I could just get back in the pool. Everyone laughed and said that I could.
The urge to bear down just took over. When Edie realized that I wasn’t trying to push, my body was just ejecting the baby, she walked over to the phone. I heard her say “client has the uncontrollable urge to push, come right now.” With this, midwife #2, Amanda, was on her way.
(She didn’t make it before Cayla came out)
Once my body started pushing on its own, I remember trying to scheme in my head how I could get this baby out of me in no more than 10 minutes. A mom in one of my VBAC support groups had recently pushed for only eight minutes and that sounded like a pretty sweet deal to me…except I really had no control over the pushing; my body was just chugging her out and the pressure was incredible. Orett sat by the pool and held my hands and told me I was doing it, that our baby was coming to us just like we’d prayed for, that the pressure meant she was almost here, that my uterus was strong, that he knew I could do it. Almost thirty minutes after I started pushing, I felt the ring of fire. I gasped “I’m splitting!” as I felt her head crown. Edie asked me to flip from hands and knees to my bum after Cayla’d crowned and push through the burning.
And at 8:07 pm on New Year’s Day, Cayla Ariel Brown was born, a mere two hours and seven minutes after Edie had returned to check me at home and found me to be 7 cms dilated with contractions still eight minutes apart; an expeditious one hour and seven minutes after my contractions had finally dropped from every eight minutes to every two minutes. Her APGAR’s were 8 and 9, and she was seven pounds, six ounces – six ounces heavier than Annalise had been at birth. It was so surreal when Edie lifted her out of the pool and placed Cayla on my chest, and Orett cut Cayla’s cord. I couldn’t believe I’d done it; I’d pushed a baby out the old fashioned way! I was so overwhelmed with emotion and felt so incredibly happy and lucky to have helped her have a gentle entry into this world through waterbirth, with the hormones of birth the Lord designed uninterrupted by labor drugs, and with lots of hugs and cuddles and skin-to-skin. Birthing Cayla in a pool of warm water – in my living room, beside my fireplace and the twinkling lights from my Christmas tree – was such a blissful, peaceful experience, and I am truly thankful for this blessing.
Once Cayla was born, we figured out why – besides her pesky ROT positioning – it’d taken so long for her to come: she had a long cord, and somehow managed to get the cord not only around her neck, but knotted at the base. My midwives are sure that the cord was a significant part of why the labor took so long: with the cord knotted at her neck, she needed time to rotate and descend through my pelvis. We’d planned for delayed cord clamping, but at this point, removing the knotted cord from around her neck was the priority. Her cord was clamped and then cut off her neck, and she took her first breath. In a lot of ways, I am fortunate that I had an amazing birth team at home. Were I admitted to the hospital at 7 cms dilation with contractions 8 minutes apart, it would’ve been typical for the on-call OB to recommend pitocin augmentation to “establish contractions and labor.” But with the cord so tightly knotted at her neck, the oxygen deprivation that pitocin regularly causes could’ve easily produced another distressed baby, caesarean birth, and NICU stay. I am thankful for all the people who prayed for our VBAC birth, as I know the Lord protected us, guiding our decision making, so that we would chose the path most likely to result in the healthy birth of Cayla.
I hemorrhaged and was hypotensive after the birth, and my midwives were recommending that I be transported to the hospital. Despite the shot of pitocin and running pitocin through my IV line after birth, I was still bleeding. There are other PPH drugs they carry to births, but my uterus had already clamped down, so some of them were no longer medically indicated. But Orett asked if they could run one more bag of IV fluids, administer more meds, and monitor my bleeding and blood pressure for a further 30-60 minutes. Once the bleeding stopped, they agreed to let me stay home because Orett had the nursing skills to continue to monitor me through the night. (When Edie came for her home visit the day after Cayla’s birth, she told me that had Orett not been a Registered Nurse who worked in an ER, she would’ve insisted on transport. I’m such a lucky gal!!!). Once it was under control, they applied some anesthesia and sewed up my second degree tear. (No, I wasn’t even TRYIN’ to get stitched up sans anesthesia lol!) It was so nice to have Cayla on my chest while they worked on me, as after my c-section with Annalise, they whisked her off to the NICU because of her breathing and I never got to see her till 6pm the next day. It’s so wonderful to be able to bask in skin-to-skin bonding time after birth.
Even though my first day and a half were challenging because I was a bit lightheaded from blood loss, baby Cayla and I have both been doing well since delivery. Orett and I are so thrilled with Cayla’s HBAC birth and hope to do this again for any other children with which we are blessed.
MY BODY IS NOT BROKEN!!!!
I will praise thee; for I am fearfully and wonderfully made: marvellous are thy works; and that my soul knoweth right well
~Psalms 139:14 KJV~