Small women can't birth big babies? Now that my dears is a big fat LIE. Just read this story. How better to introduce this than with this powerful mamas own words. "I think I will start with my 10 lb 2 oz VBAC. I'm a very short woman who was declared 'lucky' to have had a cesarean with my 9 lb first baby. Eyeroll. I showed them."
My oldest son was born by cesarean section in 2003 for breech presentation.
My second son was adopted in 2006.
My second son was adopted in 2006.
I was very pregnant with my third baby, and due on August 17th 2008. In the afternoon on August 12th I had a burst of nesting energy~I cleaned the downstairs bathroom including scrubbing the floor, and swept and tidied the rest of the downstairs. I wasn’t sure if this was nesting or not, but suspected it was because of the strength of my drive to clean, particularly compared to my preceding two months of all encompassing inertia with regards to cleaning my house. I wanted to ensure my midwife would see an adequately clean bathroom and an adequately tidy house.
Labouring in dirt sounded awful, too.
At 8:30 a.m. on August 13th, I got out of bed to help my older children set up a DVD to watch. While in their bedroom I felt a trickle of fluid run down each leg. Not a gush, but enough to get some on the carpet. I went to the washroom and on the toilet paper was a pink stained something~not mucousy, but definitely pink. So I waited an hour until 9:30 so as not to be rude or wake her up, and paged my midwife. J. was on pager that week. I wasn’t sure if my water had broken, or if I had lost my mucous plug. What I saw was a bit of both descriptions! I looked it up on the internet to be sure.
My husband Brent was sleeping off his final night shift so I didn’t tell him until he woke up at around 10:00 or 10:30. By then my mom, sister, and cousin knew. I tried to stay calm and keep my mind off of labour or babies in order to conserve energy for the task ahead. We went out to do a few errands. I had some mild, prelabour contractions but nothing regular or encompassing more than my front, lower abdomen, similar to the Braxton-Hicks contractions I had been having for months.
We bought my mother in law a Betta fish at PetSmart, dropped it off, went to London Drugs, and ate lunch at the Pita Pit. By that time the contractions were stronger and I was feeling a strong urge to be in a hands and knees position and for some privacy, so we went home. Brent took the boys out again, and I walked around, tried to lie down and relax, and listened to some music.
When Brent came back, at about 5 p.m., the contractions came more frequently and moved around my back as well as my front, down low. It became impossible for me to talk during the contractions quite early on. Then I knew it was true labour and not simply ‘false,’ or prelabour.
When true labour started, I needed to stand during contractions rather than be on my hands and knees. I got Brent to page J. again, and to call my mom and sister to come, and I called my best friend to come and pick up Matthew as preplanned. Brent packed Matthew a suitcase and got his car seat ready.
I tried to walk around because movement is good to keep labour progressing, but I was feeling confined to the bedroom and bathroom because with every contraction I started to leak more fluid so I tried to be in the bathroom when they came to protect my new carpet! I turned on my hypnobirthing CD. It was helpful for creating a positive head space for me, and for helping me relax even more than I already was. With each contraction I tried to relax my jaw, neck, shoulders, chest, abdominal, and perineum muscles. I breathed deeply and slowly to keep my uterine muscle and baby well oxygenated.
More oxygen means less pain for me and greater labour tolerance for baby. At the end of each contraction I took a deep, cleansing breath. I took it one contraction at a time and tried to move into a creative, intuitive frame of mind where I could lose track of time passing. One contraction at a time, I got closer to my baby.
J. arrived. I was in the shower. When I heard her arrive I tried to get out of the shower but got so cold that the next contraction was really painful, so I just got back in and figured she could see me naked! I’d not yet lost my sense of modesty.
J. was amazing. She talked to us, watched me labour a bit, and listened to the baby’s heartbeat with the Doppler. His heartbeat was strong, regular, and rapid. J. had an intuitive sense of what would be helpful touch: four fingernails at pressure points on my lower back, light back rubs, light pressure touch to my forehead and the back of my neck. She just knew what to do and when to do it. She administered via IV my first dose of antibiotics to treat Group B Strep. I gave her some tips on starting IVs that I have learned from my job (I'm a paramedic), since she indicated that she doesn’t get to start many IVs. I wanted minimal poking, so I gave her some tips!
In the shower I had a stool to sit on between contractions, and by the bed I had my exercise ball but it didn’t help. I really preferred to stand, though this was VERY tiring! At 10:00 p.m. my midwife asked to check internally to see if I was in early or active labour. If it was early, she would go to the home of my other midwife, J’s work partner and nap: active, she would stay with me. I was four to five centimeters, which surprised her because she said I was very relaxed and calm for someone in active labour.
Also, because my contractions were two to three minutes apart and only 45 to 50 seconds long. She commented that they were short but intense. She told me that the reason why I was progressing at the speed I was, was because I was so relaxed. It was good to know that I was doing well and progressing. It made me feel empowered and positive about succeeding with my plan to have an unmedicated, natural, vaginal delivery.
J.suggested going to the hospital before contractions became more intense and the ride became very uncomfortable for me. We left around 10:30. The drive was awful because I couldn’t stand up during contractions or move around, and the force of the car speeding up and slowing down was painful. I swore at Brent for making a joke and not letting it go when I didn’t laugh. Ayden was with us, as he wanted to be present for the birth of his baby brother.
The hospital maternity ward was full, but J. had told the staff over the phone that she could bring another midwife so we would only need a room and not a nurse, so they allowed us to come. I’m very thankful that the original plan was able to happen, with regards to the hospital I chose. We arrived and the security guard offered to find me a wheelchair but I just wanted him to leave me alone. We were able to go straight to my room. I paced. I tried to pee. I tried to drink water and sports drink, but I felt nauseous so I didn’t drink much.
My other midwife, S., arrived not long after. It was reassuring to see her, and I felt like everything could happen now that she was there. She was kind and reassuring. J. and S. did a half hour fetal monitor strip to have a baseline to monitor the baby from, as we had agreed upon in my prenatal visits. Women who have Vaginal Birth After Cesarean (VBAC) are routinely put on the External Fetal Monitor for early detection of uterine rupture, but I had refused this intervention because of the statistical ambiguity regarding its usefulness, and the high rate of cesarean section associated with its continuous use.
Instead, I opted to have a baseline assessment and intermittent fetal heart rate checks with the Doppler. I also refused the routine application of a large bore IV saline lock for women who attempt VBAC, because I did not want to labour with a saline lock in my hand. I knew the risk of uterine rupture to be low (0.4%) and the time frame in an emergency to be one that allowed time for IV access to be gained. I even joked that I volunteered to start an IV on myself if no one else could do it! The half hour of lying in bed with the fetal monitor on my abdomen was the most painful and difficult period of time in my entire labour. It was extremely painful for me to lie down during contractions. S. held my hand and talked me through it.
My sister arrived. My mom arrived. When my mom came in I had a moment of childlike need: I curled into her hug and whimpered, “Oh mom! It hurts!” She said “Oh Melissa, I know…” and then I returned to the business of labouring. I got in and out of the shower, and in and out of the bed. Sitting was really getting uncomfortable, even in the shower between contractions, but I was also getting quite tired so I used the bed a lot to conserve energy between contractions. The baby was doing great, tolerated labour like a pro.
I purposefully did not ask the time, look at the clock, or ask for internal exams. My cognitive mind wanted to know, to mark progress, but I knew I couldn’t think my way through labour. I had to be intuitive and function very much in the present moment. At one point I was in the shower and S. asked me a time-related question but I truly couldn’t even guess at an answer. I told her, “I don’t know. I’ve lost all sense of the passage of time.” She replied that it was good that I was in that space. It was the perfect mind space for giving birth.
Early in my labour I had emailed my closest friends and asked them to pray for me. During the intense part of active labour and transition I kept thinking of them. And I prayed. I had wondered if I would pray to Mary while in labour because of her femininity and experience with labour, but I didn’t. I prayed only to Jesus. ‘Help me. Make me strong. Oh, this is hard. Help me.’ This, I think, reflects my relationship with Him, because I spoke to Him and felt it entirely appropriate, felt heard, empathized with, and powerfully held. Positive. Right. I felt Him giving me strength and peace. I felt my friends’ prayers, too.
Labour was the most intense, laborious, fascinating, creative, spiritual thing I’ve ever done. The final two contractions I had in Stage 1 labour were so painful and overwhelming that I actually hit my head against the wall of the shower. Suddenly, my whole belly shifted and pushed down with incredible force. This surprised me! I waited for the next contraction and this time the force was even greater, and I let out a quiet yell. Brent came in. “Tell them I need to push!” I told him. He couldn’t hear me.
“PUSH! I need to PUSH!” I was irritated to have to repeat myself. S. came in and asked me about it and then asked me to lie on the bed for a second internal exam to determine if I was fully dilated. I was. There had been a small bulge of membrane with fluid trapped between baby and cervix at my first internal exam and J. ruptured it now, with my permission. I had only those two internal exams for my entire labour, which I appreciated. My second round of IV antibiotics was given to me on the bed sometime during transition or pushing, I’m not sure which.
After determining I was fully dilated, I had a lull in my contractions. Everyone helped me lie down to rest, and this “rest and be thankful” phase lasted approximately twenty minutes, although to me it felt like only three or four minutes.
For a long time, once my body began contractions again, J. let me go with my body. Mostly I tried pushing on my hands and knees in the bed for the first hour, resting in between as best I could. I think I was running out of creative steam—you would think I would try something new! Then I asked for help, because I wasn't getting anywhere. J. and S. started suggesting ideas. I pushed for awhile on the birthing stool but my left leg fell asleep very soundly.
So we switched to the toilet. But, firstly, I was so afraid of giving birth INTO the germy hospital toilet, though I knew this to be irrational and unlikely, and secondly BOTH my legs fell asleep on the toilet. So I returned to the bed and pushed for awhile on my side. I was frustrated and tired. It felt like I was getting nowhere—I knew the goal was to get the baby to “turn the corner,” and he was NOT turning the corner! J. kept saying I was making progress but I was frustrated that it was taking so long. An hour and a half more passed with these trial and error techniques and slow progress. Finally S. suggested I roll onto my back “like a turtle on its shell,” hold my knees up “by your ears,” and push that way. I was sweating so hard I could hardly see.
The first thought I had with this suggestion was, “that’s the least effective pushing position!!” But I trusted my midwife, so over I went. It worked!! Mom, J., and S. all cheered when the baby turned the corner in the next few pushes. I pushed for awhile in that position, until the baby’s heart rate dropped just a bit, to the low 90s. They had me roll onto my side again and his heart rate returned to normal. At one point I was holding my midwife's hand, at another Brent’s, and another my mom’s. I often reached out for a hand without looking up, so, once when I reached towards Brent and he didn’t take my hand I looked up and was grimly aware that he was asleep in the rocking chair beside my bed, sitting straight up. You know, because he was working so hard. Eyeroll.
Again I rolled to my back. Many times I felt the baby’s head push up over my pelvic bones during the contraction, and then slip back when it was done. Crowning was definitely a nerve-wracking sensation, but not very painful as I was numb from three hours of pushing. I truly didn’t fear or dislike the sensation because I knew the whole experience was very close to being finished when I felt it. My midwife got a mirror for me so I could see the baby’s head—but then I needed my glasses. They rolled me back onto my side and off came the glasses. On. Off.
When the baby’s head was just reachable I was able to touch it—very cool! And later when it was almost fully out I touched it, too. Soft, warm, and pretty wet! Then I felt his arms move inside the birth canal, just below my pelvic bones. I didn’t like that at all! More trauma to the tissues! But in retrospect it was a good signal that the baby was still doing well. I did small pushes when directed. I could feel small tearing at the top as he eased out, but nothing terrible nor more painful than the sensation of extensive stretching.
Pushing felt different once his head was out~I couldn’t really feel contractions anymore and it was harder to effectively push with less baby inside me. The baby’s head and body turned with some help from J., but another push and they could tell (a) he wasn’t doing well, and (b) he was stuck. I heard S. say, “Do you want her on her hands and knees?” and I thought 'shoulder dystocia!' J. reached in with the fingers of her left hand, hooked one under his armpit, and pulled as I pushed. She pulled him down and his top shoulder popped out, then up and his bottom shoulder popped out. She put him on my chest and the first thing I thought was, “Wow! He’s huge!” He was bluish grey, covered in amniotic fluid and blood, and I didn’t care at all. I laughed with total relief and joy.
S. very quickly rubbed him with a towel and then said, “He’s very limp!” in a firm, emergent tone. “Cut the cord!” she directed. The she directed Brent to pull the emergency call cord on the wall and shouted, “Limp baby!” over the intercom. The code team was called. Meanwhile I tried to talk to the baby, touched his head, and gave him one kiss before he was taken to the baby warmer for resuscitation.
A team of people came into the room. They assessed him. S. had started positive pressure ventilation with the infant bag-valve-mask, and the team continued. Someone said “Heart rate less than one hundred, start compressions!” and S. started compressions. [note: the heart rate for starting compressions on a neonate is less than 60.
Either he didn’t need compressions or the nurse misstated in the flurry of activity surrounding his resuscitation]. Approximately 30 seconds of compressions and 90 seconds of positive pressure ventilation, and Riley pinked up, started to breath on his own, and made a small cry. He was still on the limp side, but he was pink. The team suctioned his mouth, took blood samples, dried him off, and watched him for a few minutes.
During all this activity I was torn between euphoria that he was born and that I did it, and concern for him. I know some babies need resuscitation, and that the vast majority of those babies are just fine. I’m also very calm in emergencies. As a paramedic I have a lot of experience with them! I don’t ask, “what if” so I didn’t panic. But I was worried! Especially when it took some time for him to cry. We all breathed an enormous sigh of relief when he did. He was perfectly healthy and his 5 minute APGAR was 9/10, totally recovered from what happened in those final 2 minutes before birth. J. said his cord was compressed behind his shoulder when passing my pelvic bone during those final two minutes.
He crowned at 5:05 with a strong heartbeat, his head was delivered at 5:07, and his body was delivered at 5:09. By 5:24 he was back in my arms. I delivered the placenta before the team gave him back to me but after he was vigorously crying. The placenta was very cool to see and touch. It was strong and warm. Riley’s home and lifeline for nine months!
I was grateful to have the natural delivery that I had hoped for, and euphorically happy to meet my 10 pound, 2 ounce baby boy! I put him skin to skin on my chest and settled in for a cuddle. After about half an hour he wanted to breastfeed, and he stayed on my breast for the next hour. It was the most rewarding hour I’ve ever spent, getting to know Riley after having worked so hard all night to deliver him. It was a wonderful VBAC! I feel very proud of myself for pushing a 10 pounder out of my small, 5'1" frame! This was by far one of the coolest experiences I have ever had, and one I will cherish forever.
I included two photos of the moments right after the birth, and one photo of Riley at 3 years old, taken the day before yesterday. =)
I am editor of Mothers of Change but also have a personal blog http://www.vosefamily.blogspot.com