Friday, August 10, 2012

Two VBA2C- A Hospital Birth With an Epidural and an Unassisted Home Birth

Oh my gosh!  You get four birth stories in one with this blog post and they are amazing.  All so different and so much to learn from each and every one of them!  Love IT!
Enjoy!
To preface, I'd like to say that I grew up surrounded by birth. My mom was a doula, and I have many memories of sitting around with groups of women discussing labor and breastfeeding and feeling completely comfortable. I never planned my perfect wedding like many young girls do, but I knew from the time I was 15 that I wanted to have natural births, in the water and possibly outside :) At 17 I took doula certification classes through a community college in Canada and had read the complete works of Sheila Kitzinger, among others :) I was considering midwifery school during my last year of high school, but that didn't work out. My mom also became a childbirth educator and certified lactation consultant. So this was my background.
-So, I would love for you to first give a brief rundown of your first birth/s and what you feel like happened and why you had a c-section.
My first baby was my much-anticipated child who would fulfill all my dreams! It took us almost a year to get pregnant and I was soooo thrilled when it finally happened. My husband was VERY against home birth - "that's how crazy people die" - and didn't see why you wouldn't be in a hospital "just in case." Since this was his baby and birth experience too, I decided to go with a group of CNMs who delivered at the hospital and felt fairly at peace with that.
At 36 weeks we discovered my baby was breech. For the next 3 weeks I went to my full-time job, came home, and spent the rest of my hours in my part-time job of getting my baby to turn! I did EVERY.THING and tried every little suggestion I came across - just name it, I did it. We had taken Hypnobirthing classes and I finally went in to my instructor for a hypnosis session. I remember at the very end he asked, "Is there anything else preventing you from turning?" and I knew in my heart the answer was yes but I also knew the session should be over so I ended it there.
Well, nothing worked. So at 39+1 weeks we went to the hospital to try an external version. The doctor (who I LOVE) got him to turn, but as soon as he let go, the baby slid back into breech. We tried several more attempts. I remember the doctor working so hard that he had sweat dripping down the sides of his face. And it HURT. He was pushing on the bruises he had already made and it was so painful. The baby would still not stay in a head-down position. We debated waiting another week to see if things changed, and the doctor was not completely opposed to still attempting labor but was hesitant. Eventually we decided to go ahead with a c-section that night. I cried! Me, of all people, with a c-section! The doctor did such a great job, talking me through the whole surgery and making me feel part of it, which I really wanted. I was watching in the mirror as they pulled my son out. It took some time. The poor thing was so tangled up in there - breech, one leg up, one down, the cord wrapped completely around him twice and criss-crossed on his chest like an infant car seat's straps. As he delivered the doctor remarked, "That would have been one crazy labor." He held the baby up, my husband announced, "It's a boy!" (we didn't find out beforehand) and our son promptly pooped all over the doctor's hands, which I was strangely proud of :) They cleaned him up and weighed and bundled him and I got the standard 3-minute, upside-down visit with him before they wisked him away to the nursery for the next 2 hours. My husband went with him but I was so bummed he was gone so long.
I truly felt that this c-section was necessary, seeing the twisted condition of my son and how there was no cord to spare. The doctor agreed that in another time both the baby and I could have died in delivery. Previously I had felt pity for all women who I heard had c-sections, feeling like they didn't have a true "birth experience." But I felt no shame in this case and was able to increase my empathy and understanding for other moms who have gone through this, which I was very grateful for. My recovery was quite smooth. My mom immediately got me lots of information on VBAC (which was a term I had never even heard of before) and I knew I'd definitely try that.
Twenty-two months later it was time for our second to be born! At the insistance of my sister-in-law, I chose another doctor as my primary care physician (because he was SO AWESOME! which I later decided just meant she thought he was handsome). I wish I had just stuck with the first, but I didn't realize it would be a big deal. Well, doctor #2 was great and very supportive of a VBAC attempt ... until I was overdue. At 40+4 weeks I went for a non-stress test at the hospital and everything was fine, though I was told my baby would be over 9 pounds. I purposely missed an OB appointment at 41 weeks because I knew I would face a lot of pressure, and I was sure this baby would come soon. I remember someone asking me, "When are you due?" and sighing, "Ten days ago." 
I finally went for another doctor visit, unfortunately, and it was like they had forgotten about me and were like, "What?? You're 11 days overdue??" I thought, thanks for looking out for me! He immediately wanted to schedule an induction, and I reluctantly consented because I really wanted my baby, too, though I hoped to go into labor that night. I knew the risks of induction and pitocin after c/s and was nervous. The next morning we checked in for our induction. They hooked me up to all my tubes and monitors and after a few hours I felt some mild menstral cramps but nothing much. They decided they needed to do an internal monitor to make sure my contractions weren't too hard, and that was MISERY!! Each contraction was so painful with that cord aggravating the cervix ... duh! How could that possibly be beneficial to labor? 
After about 7 hours I had progressed from finger-tip dilation to 4 cm and 90% effaced, but at that point the doctor finally showed up, checked me, and informed me that things were moving too slowly and we needed a c-section. I was just barely starting to get the intense contractions expected, compounded by the stupid internal monitor, and I wanted something to take the edge off. There was not much fight in me left. I said, "Give me an epidural and then we'll talk." But he said no, he'd rather do a spinal with the c/s, it is more effective. C-section it was. 
They even made me walk to the operating room! Our baby girl was born weighing 7 lbs 3 oz. As the doctor did the surgery he chatted with the other nurses and said nothing to me at all, except to state, "Oh yes, your uterus is very thin," implying it would have ruptured had we continued. My daughter had what they called inverted breathing where her chest collapsed a bit as she took in a breath, so I only got to see her for a moment before they took her away. The spinal drugs made me very ill, throwing up, itchy, sensitive to light, and finally feeling like the whole room was tipping and spinning as my blood pressure dropped. I stabilized within a few hours and then kept begging everyone who came in to find out where my baby was and bring her to me! 
My husband came back into the room because he was too bored in the nursery, saying she was just laying under the lights but she was "too cold" for a bath, so they had to warm her, then when she was warm they bathed her, and then she was too cold again! I was really ticked. They finally brought her to me after 5 hours. Luckily we didn't have any nursing difficulty. But I was determined that would never happen again!
Oh, and my own doctor never did come by to check on my for the 3 days we were in the hospital. Chicken. Recovery was a lot more difficult and emotional this time. I thought it was because it was hard to juggle 2 children, especially not being able to pick up my son or take care of him, but I realize now it's also because I knew this c-section was not necessary and I was deprived of the birth experience I wanted.

-What made you desire a VBAC when they seem so hard to come by in the current obstetric climate?

A little research was all it took to understand the risks of repeated c-sections vs. the risks of VBAC. Uterine rupture rates, the thing they use to scare you, are very low. In fact, they were just coming out with studies showing the risk of rupture after 2 c-sections was only 1-2% greater than in women who'd never had a c/s. Really not bad odds. Also, I still had a strong desire to experience natural birth!

-How did you find a care provider who would support you?
I was so lucky. For baby #3, I went back to doctor #1 and told him of my VBAC desires. He was very supportive and said he was the only doctor in the region willing to let you attempt after 2 c/s. He said he had patients coming in from neighboring states because no one would was willing to let them try. He didn't gloss anything over but knew the current research, and was willing to take risks despite the insurance companies and potential lawsuits. He told me a great story about a patient of his who attempted VBAC 7 times and was finally successful on her 9th baby!! I was highly encouraged.

-What was labor like for you?

With baby #3, I was all kinds of nervous! I told everyone (including my doctor) that I was actually a week less than I really was, so they wouldn't pressure me into an early induction. I started having contractions the night of my real due date. They tapered off towards morning and I was able to sleep some. This continued for the next three nights. I was TIRED. That day (3 days after my real due date) I had contractions on and off throughout the day, starting to pick up at night. I was disgusted because my husband decided to clean out his part of the closet that day, which effectually kept him as far from his laboring wife as possible! He had a lot of fears as well. Luckily my mom was supporting me through it all. Things started to get really hard and I remember saying, "I can't imagine it getting much worse!" and my mom saying, "Oh, just wait." I had such sharp pain in my cervix during each contraction and there was nothing I could do to get more comfortable. 
I tried taking a shower and was mad that all it did was give my crazy hair for those first baby pictures; it didn't help at all. We finally headed to the hospital and that 5-minute car ride was AGONY. I could not sit during contractions and had to kneel on the seat backwards. We got to triage and the nurse checking me said, "I'm so sorry, I know I have short fingers." Her check sent me crawling up the bed. I was like, you are in the wrong line of work lady! She said I was 2-3 cm. That was terrible news. I had to stay in triage with a monitor to see if I would progress in the next half hour or I would have to go home. I knew there was no way I could go home. I was in so much pain! 
Finally another nurse came in and checked me, and I think she was being merciful when she said, "Um, I think you're a 4." So I got checked into my room, and they asked me if I needed anything for pain and I said, "Epidural. NOW!!" My mom was shocked as that was not a part of my birth plan, but I knew I had had enough and my fears were preventing me from relaxing the way I needed to. That epidural was beautiful. I could still feel every contraction, they just didn't hurt any more! I could move my legs and even felt like I could walk, though they thought it necessary to tell me not to try :) 
About 6 hours later I was completely dilated, but the doctor (who ended up being my doctor's partner on call that day - disappointing, but at least he didn't say anything about the double VBAC) was called out to do an emergency c-section, so they told me to just hang out until he could get back. I figured pushing would probably take a while so I started doing little practice pushes during contractions, just to get things stretched out and hopefully prepared. A couple hours later the team was assembled and I started pushing. Everyone seemed pretty impressed with how effective my pushes were, so I was proud. 
After about an hour I said, "OK, here he comes!" and everyone was like, "No, wait!!!" I was pretty indignant that they didn't realize how close I was and were just standing around chatting while I'm actually trying to get work done. They still hadn't broken down the bed, doctor wasn't geared up, etc. They told me to lift my bottom so they could get a new chux pad underneath me, and I was like, "Ha, yeah right!" I was a little busy trying to hold baby's head in because they didn't do their job right! So they just shoved it under my butt - youch. Finally they're all assembled, and the next push brings his head out, and one more and he's all the way here. The doctor said, "Are you sure you've never done this before? You're a pro!" 
I reached down as my baby was born and he grabbed my finger and held on. It was so sweet. I finally got to hold a baby on my chest while he was still messy and totally brand new, and I was thrilled. I did have a decent tear that was not properly sewn and caused me pain for 6 weeks, which I felt was comparable to the pain of a c-section, so that was disappointing. But everything else was nice and smooth!I was much more stable post-partum this time.
Baby #4 I was sure would be overdue like the others. On Labor Day, five days before my due date, I had terrible gas pains throughout the day. Around dinner time I started wondering if they were actually contractions. Around 9 pm my mother-in-law (who was supposed to be on call to take my older kids when I went to the hospital) came over for some computer help and brought my nieces with her, whom I was surprised to learn she was still watching because their parents had extended their trip. She also told me they were sick. I said, "Well, I suppose this isn't a good time to tell you I've been having contractions all day." She laughed but I was ticked! No one consulted me about whether or not I needed her and if other arrangements needed to be made. I didn't want my kids to get sick right as a new baby came into our home. So I sat there helping her on the computer through contractions and steaming. 
They finally left and I sat down to fold laundry for an hour, and didn't have any contractions, so I thought maybe this was just early labor. I went to bed. At 2 am I got up because the contractions would no longer let me sleep or lay down. They were coming very erratically - 8 minutes, 15 minutes, 20 minutes apart. The longer the time between, the stronger the contraction was, but they were never less than 6 minutes apart, and they only lasted 30-45 seconds. I labored on the toilet, in my rocking chair and in the living room while my husband slept (he briefly woke up at 3 am so I could complain that it looked like this would be another long labor). I figured it was better to let him sleep until I really needed him. 
Labor was very manageable using movement (including shaking my belly, which helped a lot) and visualization.  Things had been cake up to that point, and I kept telling myself, "I can handle this. It's going to get a lot harder." I called my mom about 5 am to complain and just talk to someone, and told her that this baby may not hold on for 2 more days until she flew in. I had 2 contractions while on the phone with her and was able to talk through them so I knew this was still early labor. She suggested I go back to bed and try to get some more sleep because I'd need it the next day, and to also try to find another babysitter in the morning.
I managed to fall asleep for a whole hour! Then I woke up to a doozy contraction, like the kind I had with baby #3 with a sharp pain in my cervix. I thought, 'Oh man, I'm not doing much more of that. Almost time to go to the hospital.' But I wanted to wait another hour or so because I had to figure out who I could call so early to take my older kids. I had a feeling that I needed to poop but I'd been on the toilet so much that night and I was still tired, so I laid down and went back to sleep for 15 minutes. Then I had another huge contraction that made me spring out of bed and gasp and moan as I leaned over the bed. Hubby woke up during that. 
Suddenly I knew I was about to mess my pants! I ran to the bathroom and sat on the toilet and started to strain, which felt amazing. I had this flash of memory from my doula class of a lady describing her births, saying the first was hours of torture, and the second just felt like a really good poop. I was jolted by the memory. I stopped straining and reached down to check myself. I felt something firm yet squishy a few inches inside my vagina, and I realized it was probably a head. I called to my husband in panic and stood up with one hand between my legs to hold that baby in! 
He came slowly to the bathroom and I said, "The baby is coming NOW!!" His eyes flew open and he said, "What should I do? Call the doctor? Call an ambulance?" I thought for a second and said, "Call an ambulance." He grabbed his phone and said, "Well, stand in the tub at least!" So I stood in the tub, still with a hand between my legs, trying to decide if I could make it to the hospital or not. I realized that I'd be toast as soon as another contraction hit, and I better sit down if I didn't want my baby to land on his head. I shoved away the bath toys from the kids' bath the night before (yep, they ALWAYS pick up their toys in the bath now) and sat down as my hubby spoke to the 911 operator. 
With the next contraction I involuntarily pushed, and the baby's head came out, followed by a gush of fluid as my water broke. I remember the neat sensation as I felt him spin sideways under my hand, and then one more quick contraction and he was born into my and my husband's hands, with the 911 operator on the phone. He took a few moments and then let out a good cry. I remember thinking he looked like a wrinkled little monkey. Hubby rushed around, grabbing the "nose sucker thing" and unlocking the door for the ambulance workers and pulling a shoe lace out of a boot (I know, I can't believe we did that - so gross. But that's what 911 said to do and it was kinda chaotic). 
He tied the cord, and a minute later the ambulance was there. I remember 4 men and 1 woman in the bathroom with me and feeling embarrassed that I was half-naked. One guy took charge and was very nice. He clamped the cord again and tried to cut it and take the baby, only he hadn't quite cut through all the cord and I got a good yank before he realized it. The female EMT took the baby and left the bathroom, and it's just me and the boys! They're wondering if I need oxygen and I'm like, "Nope, totally fine." They really wanted to use their oxygen though so I told them to give it to the baby. We waited a few minutes and I pushed out the placenta. 
Then we were just trying to figure out what to do, how to get me cleaned up. They had these little packets of wipes they offered, and I was like, "OK, second drawer down, get me a wash cloth and wet it so I can clean myself up." Then they wanted to carry me to the stretcher, which I was not going to let happen. I wanted something to cover me and someone ran to the ambulance to try to find a hospital gown, but when they didn't come back soon I was like, forget it. I just stood up and walked to the bed parked outside the bathroom door. I took a picture later of my bloody footprints on my bathroom floor :) (There was quite a bit of blood in the tub. We think that there may have been some separating of cord and placenta which created earlier internal bleeding, because there wasn't blood on the baby and I hadn't torn much.) 
We got an ambulance ride to the hospital with all the school traffic (and got to pay for it twice since there were 2 of us - lame!) and they took the baby and checked me. I had a little tear that the doctor wanted to stitch and I said "No thank you - it's not gushing and I feel great." He huffed a bit but left me alone. I took a shower and then they took me in a wheelchair to the nursery. That was the first time I got to go to the nursery so that was neat. My baby was laying there and as I looked around I realized how tiny he was compared to the other babies. 
He was only 5 lbs 12 oz. I noticed he had several pokes and asked why and found out they had run every kind of blood test to figure out what was wrong with this baby to dare to be born small and at home! He was completely fine in every way. We soon went to a recovery room. I felt great; I remember thinking, "OK, so what else are we doing today?" It took my husband 4 hours to get kids ready and over to another sitter, then call into work and reschedule meetings and appointments he had that day. (He had told me earlier that any day except THAT DAY would have been OK to have the baby :)) He finally showed up with my camera and phone so that I could call people and tell them the news! I was so thrilled with everything. It was the most amazing, easy birth and I felt empowered and ecstatic. The nurses still kept bugging us all night (and several came to hear my crazy home birth story) so the next morning we checked out and went home. I felt great. I didn't even have swelling, and baby was a great nurser. He was so cute and tiny, in his baby monkey way.
Baby #5 is due in 4 weeks! This time I am planning on an assisted homebirth with a wonderful midwife. I am hoping for a similar labor, the only difference being cutting out all the yucky hospital stuff and just staying home! I feel very blessed to have had so many different births! I have learned from each of them and treasure both the experiences and the children :)

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