Saturday, November 17, 2012

An Australian VBAC Interview/ VBAC Story With Epidural

I am so excited to have another installment in our VBAC interview series here on the blog.  You can find more VBAC stories here.  I think all VBAC stoires are beautiful- and frankly pretty interesting.  I love that this mom had a birth that was wonderful and different for her and that she noticed that "birth high" after her VBAC.  You know what else- I love that she shared this VBAC with an epdural on this here natural birth blog.  VBAC takes so many different forms just like any other kind of birth.  It really is...well, just birth.
  
And I love birth. 
 
Photo donated by a reader.  Not the mom in the story. 
-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.

There were many reasons for my c-section with my first birth, but ultimately it came down to me not being educated on birth enough. I took the standard hospital birth classes which covered off only ‘intervention’, not actually ‘birth’, and I took my doctors words as gospel without asking questions, I just assumed he had our best interests at heart. I had gestational diabetes and was told he would induce early due to the risk of baby being very large, the induction was unsuccessful in the sense that my body and baby where not ready, he was not willing to wait and baby was not a happy camper (not at severe foetal distress, but certainly unhappy baby with me on back being bombarded with syntocin).

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

I decided that I wanted a VBAC for 2 reasons, mainly that we wanted a large family and I was not prepared to be told no more kids after 3 or so c-sections, I wanted control over our family size not the other way around. Secondly though, I knew immediately after the birth that something wasn’t right, I don’t think I knew what a VBAC was til I started researching but as soon as I did I realized how uneducated about birth I was and how much the ‘system’ controlled my first birth, and I was determined to go into a second birth in control of my own destiny.

-How did you find a care provider who would support you?

I spoke to our gp who referred me to a few and the first one we saw (we were definitely not going back to the original obstetrician) said he was fine with VBAC birth’s and I knew from our gp and some friends who had used him that he was ‘old school’ and didn’t automatically classify births as high risk and he had birthed twins and breech babies vaginally so I thought I would be in good hands.

-What was labor like for you?

the biggest thing I can say about my second labour was it just felt ‘right’ and ‘normal’. Yes it was intense and hard work, especially towards the end, and yes I had more intervention than was ideal however for me and my family the decisions I made during labour and delivery were what made the VBAC possible so I wouldn’t change a thing. I will go into my next birth even more empowered though and who knows, drug and intervention free might be on the cards.

-What helped you VBAC?

knowledge and my husband! His support and knowledge (he learned alongside me) were THE thing that got me through the pregnancy and naysayers and the labour and delivery, without fail.

-How did you prepare for your VBAC (was there anything you did differently)?

I educated myself on birth and labour so I knew exactly what my body was doing and what to expect. I took a hypno birthing class which helped immensely.


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

Apart from the obvious physical recovery differences (being able to get up right after the birth, being able to 100% care for my baby unrestricted, not having the drawn out recovery that comes with major surgery, being able to drive right away) the biggest difference for me was the euphoria and ‘glow’ I felt. I felt like an amazing woman and mother who just performed an amazing miracle by bringing a child into this world. I’m sure a little of that is my happiness at my VBAC but I’m sure that its normal to feel that way too, I just never felt it after my c-section. I didn’t get the baby blues this time though and my milk certainly came in quicker and without the engorgement, however I’ve been told that’s common with second babies regardless.

-Describe your VBAC birth story.  We would LOVE to hear about it!

Wednesday
Contractions started around 9am, after a few false starts in previous weeks and plenty of Braxton hicks the entire pregnancy, for some reason I just knew that this was it. Throughout the day they ranged from 3 minutes apart to 12 minutes apart and they were easily manageable. At around lunchtime I called Ian to come home from work as a few contractions ended up only a min or 2 apart for a while and lasting a full minute. Some contractions were now strong enough that I needed to hold Ian’s hands and sort of sway through them. They slowed not long after that so we headed up to the shops to do some walking and get some lunch. Was quite amusing having to stop every few minutes and grip onto Ian and breathe through them. For the rest of the day I just bounced on the fitball, used some heat packs and tried to relax as much as possible while keeping up my fluids and food. Ended up going for another walk around the block later in the day when things slowed again, the walking certainly made things pick up and become more intense. With each contraction I also visualized the baby coming down into my pelvis and my cervix opening. That night after a full days worth of contractions I decided to try to get some rest so took a hot shower and some panadol, took a heat pack to bed and hoped for the best. I managed about 4 hours sleep without being woken with contractions.

Thursday
At around 4am I had to get out of bed as they were too intense to lie down through now. At 5am Ian got up with me and we had a quiet breakfast and hoped together that today would be the day. At around 7am I started to get a bit worried that things had gone on so long (even though it was mild and manageable) so we umm’d and ahh’d about calling our obstetrician’s office or hospital to get a check on bubs heart rate (he was moving fine). We had our 40 week obstetrician appointment later that afternoon but didn’t want to wait that long, and in the end decided to call the hospital as it was likely obstetrician would just tell me to go there anyway. As I was hoping to achieve a VBAC I knew it was also important to avoid the hospital as long as possible so this wasn’t an easy decision to make, however ultimately I wanted a healthy baby and felt that I needed reassurance he was doing fine. When we called the hospital I made sure they understood I just wanted to come in for monitoring and go home rather than being pressured to stay for either continual monitoring or intervention. The drive in wasn’t too bad, I’d just grip the door handle or Ian’s arm for the stronger contractions, they were around 3-4 mins apart and lasting up to a minute.

Once we got to the assessment unit around 8.30am a midwife hooked us up to the CTG and we could see bub was doing great and also see the contractions. We had 30 mins of monitoring and the middy then offered to do an internal and a stretch and sweep of the membranes and send us home. I was 2cm dilated at this stage and due to the trip into hospital the contractions had slowed right down to around 10-12 minutes apart which is normal with increased anxiety and adrenalin. My cervix was almost fully thinned and shortened. I consented to a stretch and sweep which was quite painful but it immediately kicked things up a notch with contractions back to around every 2-3 minutes lasting a minute long. We decided to head home and try to keep comfortable and away from hospital as long as possible given I was coping so well. The contractions continued on at the 2-3 mins lasting a minute to a minute and a half for quite a while. I was now having to grip onto Ian and sway through them with my breathing and was unable to talk during them. I found the best position or movement during a contraction was to grab onto both of Ian’s hands and arch my back, sticking my belly out, take a big breath in then I would try to slowly exhale as I stood up straight again. Most contractions would take 3-4 of these big deep breaths and the arching. Ian was wonderful during this phase, helping me time them so he knew when the peak would be and could help me to concentrate on my breathing then relax towards the end of each contraction. He was a source of positivity and just kept reminding me I was doing great, that I could do it and that my body knew what to do and we had to trust it. I kept up my visualizations of bub moving down and the cervix opening and this helped to give me focus and a purpose.

Around lunchtime I got out the TENS machine and it did give relief during contractions but by 2pm things were pretty intense and I was worried about leaving things too late and also potentially hitting peak hour traffic a bit later on the way to hospital so we decided to head back to hospital at this stage.
At around 2.30pm we had another assessment and were 3cm dilated and cervix fully thinned out and short. While we were deciding what to do I took off the TENS and jumped in the hot shower (one nozzle on my back and one I directed at my belly) and it was pure bliss. At 4.30pm they again offered if we wanted to go home or stay, and if we stayed it was the choice of staying in the assessment room or a maternity ward room. We decided to stay and chose the maternity ward so we could have some dinner and it felt more comfortable as we could turn off the lights and close the door properly for privacy. At this stage I was getting very sleepy and almost dozing off sitting up between contractions so I opted for a shot of pethidine before we went to the ward to try to get some rest. Within 10-15 mins I felt quite woozy and even sleepier and after not being able to stomach much dinner I managed to doze between contractions for a few hours.

It was around 8pm that the pethidine started to wear off, I was much more alert and focused now and got back to holding onto Ian and arching my back and breathing through contractions, however by now I was becoming quite vocal with a long steady ‘aaaaaaaahhhhh’ on each exhale. It wasn’t long that the ward midwife came to see us as she could hear me down the hall and was worried I was about to have a baby! We were then transferred downstairs to a birth suite.

At this stage we had an encounter with hospital policy. Its standard practice for VBAC’s to have continual CTG monitoring at this hospital, but I had previously discussed with our obstetrician and he was happy for us to have 20 mins upon admission and then another round towards delivery. The midwife huffed and puffed about policy but in the end admitted that she knew our obstetrician so she went along with it. I also didn’t want a cannula put in (again standard practice in case of emergency c-sect) but hadn’t had the conversation with my obstetrician about it, so this time round I told a white lie and said our obstetrician was happy if we didn’t have it, and they took our word for it. So after the short stint of CTG monitoring I jumped in the shower again but this time it didn’t really do much and I was finding myself fighting each contraction, not breathing properly and tensing up (along with a few choice swear words) – which I knew wouldn’t be helping me dilate. So I asked for another shot of pethidine and half an hour later it still hadn’t had any effect, so I asked to have an internal to see how far along I was as I wanted an epidural but didn’t want it too early in case it stalled things. At this stage I was 6cm (which was further than I dilated in my last labour) so we opted for the epidural after discussing with the midwife that considering I was 6cm and things had been going for quite some time at this intensity I felt it was unlikely that things would slow down. Only took about 20 minutes for the anesthetist to arrive and maybe 10 to put in the epidural. We also had the membranes ruptured at this stage, there was a very slight trace of meconium but nothing the midwife seemed overly concerned about.

The epidural was in place by 9.30pm and I was able to relax and rest. There were a few times when bubs heart-rate slowed after each contraction and the midwife started to get concerned, but a few changes in position from time to time helped, so thankfully we avoided her having to call the obstetrician in. During the times the heart-rate was dropping it was clear to me that although I dearly wanted a VBAC I was not prepared to take any chances so the minute things looked as if they weren’t picking up I knew I’d be the first one shouting for a c-section.

Friday
Somewhere around midnight I noticed a spot in my side that the epidural wasn’t working on and it was getting quite painful, especially considering I was laying down. So the midwife hit the button to top it up twice within an hour for me and eventually I got relief. It was not long after this that I got the vague pushing sensation (not the urge to myself, but like my body was just doing it) and midwife said it was a good sign and she’d do an internal at 1.30am to see how far along we were. (talking with her after delivery she said that she suspected when I started to get spots the epidural wouldn’t work that the baby was moving down and I was probably fully dilated then, but she wanted to give me long enough before an internal to make sure we didn’t hit the ‘failure to progress’ stigma, which I am grateful for, even though I would have preferred not to have the top up so I could have more sensation during delivery).
So at 1.30am we had an internal it was revealed I was fully dilated and ready to push. Woo hoo!!! I was over the moon at this stage, although quite surprised as even though it was far down in my subconscious I guess there was always a lingering doubt my dream of a VBAC wouldn’t eventuate but now I knew I was fully dilated I think I finally believed I might actually birth this baby the old fashioned way afterall. 

She said that my obstetrician only likes to have ladies push for a max of an hour or so and especially considering I was having a VBAC so she suggested we have a few practice pushes before she called him so that once he was here we were already going etc, especially considering I’d had the epidural and one leg was fully numb with the other almost numb. I actually found the pushing quite easy and she said I had it down pat. She offered me a mirror after a few pushes so I could see the beginning of bubs head and that really helped to keep me focused. At 2am she called him in and he arrived at 2.30am. There was a short discussion about whether to have a pead attend because of the meconium but as it was so minor it was decided it was unnecessary. It was at this stage that I started comparing in my mind my last experience with Benjamin and how many people were present at the birth, compared to this time, and how much more intimate, relaxed and natural it all felt. By the time he arrived even though I was on a high my body was pretty fatigued so he suggested a vacuum assisted delivery as if I tired too much and couldn’t push much at all it would be forceps or perhaps even c-section (he didn’t mention the c-section but it was in the back of my mind). Only took him a few minutes to set up for the vacuum, and after 2 contractions pushing with the vacuum our little boy’s head was out, then the contractions had a break so it was a few minutes before we pushed again to get his body out, and it took 2 contractions for his body to come out as his shoulders were quite wide. Because of the epidural I didn’t experience any of the burning sensation with crowning but I could definitely feel him moving down through the birth canal and coming out.

After he was out (born at 3.04am) he got a quick rub down then was placed on my chest and a few minutes after that Ian cut the cord. I opted for the injection to help the placenta and within the next 2 contractions it was delivered. There was a debate going on in the background between the obstetrician and the midwife as to his size, it hadn’t dawned on me that even though he looked tiny to me that he really was a big baby. Turned out he was just under 10 pound (4.498kg) and 57cms long. The midwife measured his length 3 times just to make sure! I was utterly dumbfounded at this stage that not only had I achieved my VBAC, I’d done it with a near 10 pound baby!! I just kept uttering ‘I did it’ and had the biggest smile on my face the whole time. I kept telling Ian I couldn’t have done it without him and I truly think this is the case, there was never a shred of doubt shown or mentioned and he was just full of positive words the whole time, in addition to getting me every little thing I need for the last few days. We had our first breastfeed while I was being stitched up (2 stitches needed for a minor 1st degree tear).. I asked to see the placenta and the middy showed it to me explaining how it all worked etc, she also said it was a great size, appx 2kgs in her opinion.

We were back up in the ward by about 5am and Ian passed out while I relaxed and stared at our little (hehehehe) bubba, on too much of a high to sleep.

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