Thursday, August 2, 2012

"I DID IT"- A Hospital VBAC Interview

Another amazing installment in our VBAC interview section.  There is so much good information in this mom's story- from the importance of community in finding a good care provider, to the help a doula and husband can provide, to the role of sheer determination.  This is a beautiful story.  Enjoy-


-So, I would love for you to first give a brief rundown of your first birth and what you feel like happened and why you had your c-section

To completely over-simplify it, my daughter was asynclitic. While that, in and of itself, wouldn’t necessarily lead to a c-section, it was her bad positioning from early in labor that led me to choose some interventions I may not have otherwise chosen, up to and including, a c-section.

I could write a book, but I’ll try to keep it as simple as possible. Her poor positioning led to incredibly intense, “backwards” labor (I’ll explain what I mean by that in a minute) for hours that just physically, mentally, and emotionally exhausted me. By “backwards” labor, I mean that my contraction pattern was the opposite of what would be “normal.” Instead of the typical 1-1.5 min contractions coming every 3-5 minutes during active labor, mine were lasting 2-3 minutes, coming every 30 seconds. This went on for roughly 12 hours, beginning about 10 hours into labor.

These ridiculously intense, painful, back labor contractions were excruciating, and yet my progress was slow. After about two hours of working through them at home with my doula, we went to the hospital (the hospital was a 3-minute drive from our house and I had one contraction as we headed out the door, one in the car on the way, one in the parking lot as we walked in, and at least one while we finished up the registration stuff), where I found out I was only at 2cm. I’d been in labor for 10 hours at that point, and hard, active labor for about 3 hours. I was crushed. They kept me at the hospital rather than sending me home, though, because the contractions were so close and so strong. Looking back, staying may have been a mistake, but I didn’t know what else to do at that point. I figured there was no way things would stay that slow with as intense as everything was.

Little did I know it would take me hours to progress, even with being slammed by contractions, and, when I finally got to 6cms, my doctor (not an OB, by the way, a family practice doctor) recommended AROM to help get things going better. While I had planned for no drugs and no interventions, I decided, after talking to my husband and doula, that AROM was probably the least of the evils at that point, so I went with it. Knowing what I know now, it was probably the worst of the evils. My poor, crooked baby no longer had her cushion to help her get herself turned into a better position, and my body just had to work that much harder to try to make it happen.

The pain, which was already more than I thought I could handle, just got worse. I labored in a tub, in the shower, on the bed, on a ball, sitting, laying down, on all fours, and in every other manner I could think to try to manage the pain. Nothing helped, and I just got more and more exhausted by the minute. Finally, 16 hours into labor, and with my cervix finally at a 10 (with a lip) but with baby still high, the doctor suggested an interthecal block to allow me some rest, along with a small dose of pitocin to keep my body working through the block. The block was projected to last about two hours, with the plan being that I would push through the block to at least try to move the baby down since I was at least complete by then.

This plan may have worked, except it took almost the full two hours of the block for the pitocin to get to my room. As the block was beginning to wear off, I talked with my doula about the pitocin and decided I no longer wanted it, but wanted to try other methods, like nipple stimulation, to get my contractions going again (the block had slowed them significantly). At this point, I looked right at the nurse and told her not to push the pitocin. She blatantly ignored me, and pushed it anyway.

From there, the contractions, which had been excruciating all day, ramped up beyond anything I could have ever imagined. I could no longer handle what was going on in my body and I asked what my options were. Because I was complete, and even though baby was still high, another block was not an option, a full epidural was not an option, and my doctor expressed some concern about what the stress of the contractions was doing to me and to the baby. I remember him saying something about both of us being ok then, and he just wanted to keep it that way. The next sentence was a recommendation for a c-section.

It took me 10 minutes to sign the consent form. I could not believe my natural birth had come to that, but I didn’t know what else to do anymore. I remember almost passing out from sheer exhaustion on the OR nurse’s shoulders as I waited for my spinal. And then my daughter was born by c-section at 11:54pm, just about 24 hours after my first contraction.

-What made you desire a VBAC? 

From the minute I got out of surgery and into recovery, I knew that I would VBAC my next baby. Having had such a strong desire for a med-free, intervention-free birth in the first place, there was no way I would purposefully choose to have major surgery again. As time went on after my daughter’s birth, and I had time to process what happened and why, it became even more clear to me that there would be no reason I couldn’t have a baby vaginally. Part of me, to this day, feels like I gave up on a vaginal birth with her, so I felt like I had to prove to myself that my body could do what it was made to do.

-How did you find a care provider who would support you? 
 
That was more of a challenge than I thought it would be. Between my two pregnancies, we moved from Alaska to Alabama. I knew that I would’ve had no choice but to have a repeat c-section had we stayed in Alaska (the hospital had a de-facto ban due to staffing issues and lack of emergency services; there were no OBs in town and a surgeon had to be called in for emergency c-sections); but I figured that it would be no problem to have one at all now that we lived in “civilization.” Imagine my surprise when I showed up for my first OB appointment and the doctor said, “We’ll schedule you for your repeat section at 39 weeks,” as if it were a foregone conclusion. I shook my head and said, “No, I want to try for a VBAC,” and she answered, “No.” At this point, she had no idea what I had a c-section with my first (she did NOT have my old chart), and she just decided that I was not a candidate. Even after discussing it with her, she told me I would’ve only been a candidate if my first baby had been breech. 
 
I left the appointment in tears, but with a recommendation from the doctor to try to find a provider who worked at the University hospital in town for the best chance at being able to “try” to VBAC.

I went home and looked at the hospital’s website, where I found out there was a CNM on staff. I had NO idea there was one in town, mistakenly believing they weren’t allowed to practice in the state at all (homebirths attended by CPMs are illegal in AL, so I assumed all midwives were illegal here). I delayed making a call to set up an appointment with her until a conversation in passing at my MOPS meeting sometime in the next few weeks led me to find out that two of my fellow MOPS moms had used the one midwife in town, and that she was THE person to see if you wanted a VBAC.

Armed with that information, I made an appointment for a consultation with her to see if she would support me in my VBAC plans. At our meeting, she asked me, “Ok, explain why you’re here again,” and I said, “To find out if I’m a good candidate for a VBAC.” This time, without knowing my history or why I’d had a c-section, instead of saying no, she said, “Why wouldn’t you be?” I knew I’d found my provider and switched my care to her that afternoon.

-What was labor like for you (with your VBAC)? 
 
It was such a different experience this time around. With my first, there were no real signs of labor in advance of my first real contraction except a slow loss of mucous over a couple weeks and then bloody show about 15 minutes before that first contraction. This time around, I had irregular and unpredictable contractions for about two weeks before really going into labor. At times, they were barely different from Braxton-Hicks, and at other times, I wondered if I was starting real labor. Once active labor started, it was far more manageable than I ever expected, and it was more peaceful than last time around. I labored for the majority of the time in my dark living room, alone, until my husband stopped trying to sleep and came out to talk to me about calling our doula to come over! Instead of feeling like I was fighting pain, though, I pictured each contraction as a wave. I would gear up to make it through the peak, moaning or moving, rocking or swaying through the peak, and then calmly coming back down to rest. 

Transition was difficult for me because I spent 30 minutes of it in the car on the way to the hospital, but it was still manageable. Just like so many others, it was in the heart of transition, when it was so intense, and I was starting to feel like I needed to push, that I started to doubt my ability to get through this. My biggest fear was pushing – the only thing I didn’t get to do with my first - and I think that made the pain worse for me. I had a hard time just going with my body and not fighting the urge to push and move my baby down. My doula was amazing in getting me to let go and I credit her with my pushing stage being pretty brief. Looking back, two weeks later, I’m still surprised at how “easy” my labor was in comparison to my first. From the time I moved into active labor until the time my daughter came into the world was only about 8.5 hrs, and only the last two felt difficult and even slightly unmanageable. Such a different experience from my first!!

-What helped you VBAC?

 I don’t know if it’s so much “what” as “who.” I mean, I read every last VBAC story I could find, I read books about VBACing, I read studies and statistics to ease my own fears of uterine rupture since the plan was to stay home and labor as long as possible out of the hospital and away from what I felt was my “safety net.” 

But more importantly than all that were there people who supported me. From my midwife saying, “Why wouldn’t you be able to VBAC?” to my husband listening to my neurotic ramblings every night at bedtime, to my doula who really saw what was going on in my brain during transition to get me to let that baby come down…. I wouldn’t have been able to do it without them. And I almost forgot my L&D nurse, who wisely and logically talked me out of an epidural because, “by the time it actually takes effect, you could just have a baby!” 

If I’m being totally honest, too, I think my straight-up stubbornness also helped me. I had decided I would have a VBAC if I ever had a second baby 3 years ago, almost immediately after having my first baby. I wasn’t going to let anyone think that I couldn’t do it, least of all myself. I did the work to find a provider, got through the break-down when she all of sudden became unavailable to attend my birth at 37 weeks (my midwife broke her arm in 5 places right before my 37-wk appointment, so instead of delivering with her, I was stuck with the on-call staff, none of whom are particularly VBAC friendly), made it beautifully through active labor… there was no way it was going to end with anything but a vaginal delivery!

-How did you prepare for your VBAC?

Like I said above, I read VBAC stories, I studied the research to feel more confident in my choice, I unleashed all my hopes and fears on my husband, my midwife, my doula. I ate right (ie didn’t overindulge on the sugar and carbs!) to try not to grow too big a baby this time (my first was 8lbs, 13oz). I used the spinning babies techniques to try to keep baby positioned right. Mostly I just tried to get in my own head and make myself believe that I WOULD birth my baby vaginally this time.

-Describe your VBAC birth story. We would LOVE to hear about it!
I feel like I’ve already written a book… this is going to be long!
As I said, I had contractions on and off for a couple weeks before I had my baby. They started the weekend my midwife was away on a trip, and I got panicky, thinking I would have to deliver without her! Little did I know, she would break her arm on vacation and, although she’d be back in town in time for my daughter’s arrival, she wouldn’t be able to attend her birth after-all! After finding that out, I went from hoping for an early baby to hoping the baby would stay in until 42 weeks – at least!! Baby had other plans, though, and early it was. However, I swear I kept the kid in the last two days by shear will…. I HAD to stay pregnant until after my first daughter’s birthday (on a Monday) and her party (on a Tuesday). Sunday and Monday nights, I lay awake in bed overnight, breathing through contractions, just saying, “Please, not yet! Let the kids have different birthdays! Let Michaela (my older daughter) have her party!”

Finally, the day after my older daughter’s birthday, and minutes after the last guests had left her party, my contractions started to get more regular. They weren’t intense, but they were timeable – every 15 minutes or so. As the day went on, they faded away, only to pick up again after sunset – keeping with my doula’s prediction! For most of the early evening, I just breathed through each wave, not really paying attention to how long they lasted or how often they were coming. When bedtime rolled around, I sent my husband off to bed and decided to stay in the living room in order to not keep him awake. Little did I know that things would pick up shortly and that, even in a different room, he was not sleeping. From about 11pm until about 3am, I labored in the dark in my living room, by myself. I felt like each contraction was a wave…. I would feel one coming on and would breathe and moan deeply as the intensity picked up. I pictured myself riding up to the crest of the wave and then riding it back down as the contraction faded away again. Between each one, I laid on my side on the couch and rested comfortably. Eventually, without me realizing it, they started to come much closer, and I had to start getting up to move through them instead of laying down and moaning through them. I spent a lot of time on all fours, rocking, or kneeling in front of the couch, leaned over, and swaying my hips.

Beginning at about 2 in the morning, I decided to time the contractions with an app on my phone. I guess sometime around 3am I got a little more vocal than I’d been, and my husband came out to the living room. I told him they’d been about 5 minutes apart and lasting a minute each for the last hour. We discussed when we should call our doula, because I honestly did not realize how long I’d been working through active labor, and she had almost an hour drive to get to us. My husband told me that my contractions had actually been 5 minutes apart, and lasting a minute, since just before midnight. He’d been timing them from the bedroom! I let him make the call to our doula when he felt like it was time (which was almost immediately), and she got to the house sometime around 4 in the morning. She just watched and waited for a while, seeing how I was working through things, and then she finally asked if she could check me (she’s able to provide montrice services as well, something that was key for me in order to be able to stay away from the hospital). She first listened to the baby for a while and through a contraction or two. And then, the moment I’d been dreading arrived - getting checked. It was a necessary evil for me – I wanted to be sure we didn’t wait TOO long to leave for the hospital since it was a bit of a drive, but I also couldn’t face the possible disappointment of laboring for a while and having no change.

After a quick check, my doula pronounced…. 7cm! I had only been in active labor for about 5 hours at that point, and I was a 7!! I cried in relief and JOY that these contractions, which hadn’t been all that bad in my mind, were getting the job done so much better than the horrific ones in my first labor had done! The only problem was that we weren’t at all ready to head out to the hospital yet (bag wasn’t done being packed, friend hadn’t been called to come stay with our daughter)! So now, instead of just laboring, I was laboring AND trying to wrap up what I needed to in order to be ready to go, including doing things like brushing my teeth!

We finally left for the hospital around 5:30 in the morning, and arrived just before 6. Intake was a blur as I worked through contractions bent over a chair. They tried to tell me they wouldn’t let my husband or doula go into the triage exam room with me and I just said, “I’m not going alone.” Copies of my birth plan were handed out and somewhere along the line, I heard my doula say, “We’re a VBAC.” I’m sure my doula must have told them that she’d checked me an hour earlier and I had been a 7, and that she’d listened to the baby and all was well, because no one even tried to check me or hook me up to any monitors. We were quickly brought to an L&D room after I changed into a gown and vocalized pretty loudly through a few contractions in the triage room!

It was then we met my awesome L&D nurse… one who was VERY pro-natural birth, an anomaly at the hospital. She went about the business of getting the room all set, and let me labor with my husband and my doula. At one point, apparently, she commented on our team, and how well we all worked together.

Sometime shortly after we arrived, the on-call resident showed up in the room. It became very clear in her brusque manner and attitude that she was not ok with me showing up that far into labor and wanting to VBAC! With the worst beside manner ever, she came back to the room with the consent forms – first the standard form that said, “I________ consent to treatment for a vaginal or caesarean delivery,” on the first line. I wrote “per informed consent” next to the caesarean part and circled it, to make it clear they’d have to talk to me about that again. The second form was the VBAC consent form. I’d seen it already, thanks to my midwife giving it to me at my second appointment, so I ignored what the doctor said as she explained the risks associated with a VBAC…. Yada, yada, yada. Oddly enough, in signing the form that mentioned a c-section, there were no discussions of
those risks. With her forms signed, she left. And we didn’t see her again!

By now, I was in full transition. My husband, whose arms were sore for the next day or two, squeezed my hips with every contraction. And my doula provided counter-pressure in the small of my back. I labored on my knees, arms hanging onto/over the back of the fully-raised head of the bed. My water was still intact at this point, and my doula was already starting to see that I was not letting go with these very pushy contractions. She brought me to the bathroom and made me sit on the toilet for a few contractions, not only to empty my bladder, but to try to get me push without fear of what might come out!! Finally, just after 7am, on the toilet, my water broke on its own. I moved back to the bed, where my nurse asked if she could check me again. This was the second and final time anyone did a cervical exam, and they told me I was a 9+, and the baby was pretty much right there.

It was at this point that I started in with the “I need something for the pain,” and the “I can’t do this anymore!” talk. This was when the nurse explained how long it would take to get an epi ordered, in, and working, and that I could just have a baby by then. She was right. I continued to labor on my knees, hanging over the back of the bed until I’d feel the need to push, and then I’d sink down and try to push through the bed at the height of each contraction. There was sweat. There was fluid. There was... poop… And there was the constant, steadying, pain-relieving pressure of my husband squeezing my hips.

Although I wanted to stay on my knees, both the nurse and my doula were seeing that nothing was changing with me in that position. Against everything I thought I would have to do, they both urged me to lay on my back and try to push that way, legs tucked up to my chest. I thought they were insane – that is NOT how you work with gravity to get a baby out!! – but it was exactly what I needed. The other thing I needed, to get me over that last hump, was to feel my baby’s head just before it was ready to come into the world. If that’s not motivation to keep going, I don’t know what else is!!

The doctor was called (a different resident came in, thank goodness… one who apparently didn’t have a problem with a VBAC!), and the nurse held my baby in for a few extra minutes while the doctor got her gloves and glasses on to catch my baby. At 8:17 in the morning, just over 2 hours after getting to the hospital, and about 9 hours into labor, I pushed my baby into the world after only about 15 minutes of pushing on my back, and with only 2 pushes to get her head out and one for the rest of her. She was immediately handed up to me, and I put her on my chest. My husband, on my right side up by my head, told me we had a girl (we didn’t know until then), and I just held my new baby girl, with a sense of relief, joy, amazement, excitement, and accomplishment. I had done it…. I had birthed this baby with no drugs, no interventions, and NO SURGERY. I did it.

Things got a little crazy after that because I tore pretty significantly so the attending had to be called in to tend to that. But even with the craziness going on around me, my girl was just on my chest. We let her cord stop pulsing and then my husband cut it. I brought her to my breast and she found a nipple and latched on. I worked with her to get nursing so I wouldn’t need a pitocin shot to stop any bleeding. Unfortunately, I didn’t get to deliver the placenta on my own time because of the tear (it was causing excess bleeding so they wanted to get going on sewing me up), but a little help in delivering that was the ONLY intervention I had. As the doctor sewed up my 3
rd degree Y-shaped tear, my only thought, which I voiced, was that I’d rather be sewn up from one of those than have another c-section scar to deal with! Two weeks later, that still holds true!


- Has the postpartum experience been different than your other birth? What about it surprised you? 

I don’t think there’s any way for the postpartum experience to not be different between a c-section and a VBAC. I had a rough time at the hospital, having lost a significant amount of blood from the tear and needing a transfusion, but since getting home, this period has been like night and day from my post-c-section recovery. I can get in and out of bed. I can sit up to feed my baby. I’ve been able to get out and walk around without feeling like my insides were coming out! Even with the tear, I’m FAR more comfortable and mobile than I was at 2-wks postpartum after my c-section. I knew it would be easier, but I never dreamed it would be this much easier! With the exception of building back my iron stores and trying to kick a cold, I don’t feel like an invalid this time…. I definitely felt that way the last time.

The other benefit this time around is that I am not second-guessing myself or my decisions in labor. I’m not mourning the loss of the birth I wanted. I’m celebrating how my second daughter came into the world and spending less time dwelling on what didn’t go right with my first daughter.

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