Vaginal Birth After Cesarean Under General At 25 Weeks
I love sharing VBAC stories and I am constantly amazed by two things: 1) The amazing strength of women and their faith against all odds simply astounds me. And 2) How different each and every story is.
This VBAC story contains a heartbreaking loss after a pre-term birth followed shortly after by a home VBAC.
Here is my birth story, about 99% complete. Most of this story is from what I directly remember, but there are parts that I was told about afterwards, from my midwife and doula and a friend that was there, filling in the blanks when I was too out of it to fully realize what was going on. I don’t yet have my midwife’s written notes, but it’ll be a little while before I get those, and she and I have talked about the birth, so I’ve included those bits in here and am going to call it good for now.
I also mention my Christian faith a few times, so if that will offend you, just be aware that it is there and an important part of my life.
And the final disclaimer, this is my narrative story and should in no way be taken as medical advice.
The birth story of my fourth child starts with the birth of my third. Jonathan, my third baby, was an emergency c-section at 25 weeks because of complete placental abruption (which followed my premature rupture of membranes at 23 weeks). He was with us for 27 days before we lost him due to complications from an infection.
Even if Jonathan had lived, Tim (hubby) and I would not have felt that our family was complete at only three children, but now I was a complicated case. I was sneaking up on “advanced maternal age,” I was a hopeful VBAC, I had a history of a preterm birth (even though my first two births were nearly textbook). Tim and I consulted with several people to see when we could try to get pregnant again and still have a reasonably good chance at a VBAC. The delivering OB and another one both said we could try in three months (putting 12 months between the surgery and the next birth). Other opinions wanted us to wait 6 or 9 months. We decided to start trying at 4 months, never dreaming that we would get pregnant on the first try.
I have to admit that I was more than a little nervous at first. I’d read birth stories and talked to people who had a short time span between their c-section and their VBAC. I’d also talked to people who had a full-term VBAC after having a premature c-section. But all my searching came up mostly empty when I tried to find people who had both of these factors in the same pregnancy. I didn’t know what would happen.
I saw an OB for my whole pregnancy, taking P17 shots this time, and I saw an OB all the way up until the week before I delivered. I also saw my midwife for prenatal visits that last month (but had kept in contact with her throughout the pregnancy as well), unsure until the very end whether I wanted to go to the hospital or try for another homebirth. (My second child was a homebirth, and my third child was supposed to be a homebirth as well before my water broke so early and I had to transfer out of my midwife’s care.)
I was officially due on 12/27, and in the couple of weeks leading up to that, I'd been having fairly decent Braxton Hicks off and on for several weeks, very similar to the way it happened with Benjamin (my second baby, 3 years old at the time of this birth). My due date came and went. I was a VBAC this time, so I didn’t want to be induced. I just had to wait it out. I had an appointment scheduled for 1/2 for a NST and ultrasound since I would be turning 41 weeks the next day. Then if I made it to 42 weeks, the OB was recommending induction at that time (which I was agreeable to, but still praying that I wouldn't make it nearly that far).
With both of my other full-term labors, I had light bleeding throughout the whole active labor, so I kept waiting for that to show up to indicate that I was finally in real labor, but it never did. I also was waiting for a loose stool, which could indicate my body cleaning itself out in preparation for labor, but that never happened either. (I did, however, have two separate solid BMs during labor, once it finally started.)
On 12/28 and 12/29, I was losing teeny tiny pieces of my mucous plug, but nothing to make me say, "This is it!" I just kept monitoring it throughout the weekend, and it would come and go as the days passed. I had an appointment with my midwife on 12/28 and my blood pressure had spiked a little bit, and she said that it might be an indicator of labor starting soon. She estimated his size to be at about eight and a half pounds. She also made the comment that she likes doing baby-size estimates on women with my body type because it’s easy for her to be fairly accurate. The afternoon of that appointment, I made some eggplant Parmesan using a recipe that is "famous" for putting women into labor within 48 hours. A friend of mine had made it with one of her babies and had gone into labor that same night. I made the recipe, but it was deliciously ineffective for that first night and the second night.
On 12/30, I woke up having lost a lot more of my plug the night before. I was having contractions that could still be called BH, but they were coming close enough together for me to think that they could easily turn into something more later. I texted our doula to see what time she was going to be in church, and to give her a heads up about the plug and that something might be happening later on. Tim and the kids and I went to church as well, and were there from about 9:00 to 11:30, where I continued having contractions.
After church was done, I got Tim's attention and told him that he needed to get the kids in the car (i.e. don’t dawdle and visit with people) and that today was probably going to be the day. He grinned at me. :D One of our friends who was going to come to the birth to help with chores or whatever else we needed came up to me before I could get outside and asked if I was in labor, and said that when she saw me when we first got there that morning, that it looked like I was. I told her that I don't know but that she should come over after lunch. On the way home, I called our doula and our photographer and midwife and made plans to have them all come over at their various times that they could make it (from being out of town or whatever).
My midwife got to the house first and we talked about what was possibly going on, and I went ahead and had her check me, and I was at a 3, 50% effaced, and very squishy. My bag of waters was intact but she could feel the baby's head through it. He was floating, though. Since I was still in very early labor, my midwife stepped out to grab lunch with her hubby and then run another errand.
Throughout the afternoon, the rest of my "birth team" arrived, and we were lighthearted and chatty since my labor was also lighthearted. :P The birth supplies were assembled, but I couldn’t find the little hats that I had crocheted, so I spent a little time in early labor making one more hat, just to be sure we’d have one. I also had some music on with a portable stereo, and Benjamin was laying down on the floor, directly facing the speakers, singing the familiar church songs on the CDs that I had picked out. It was so heartwarming to watch him do that. Lydia (my first baby, 6 years old at the time of this birth) played games on various electronic devices (like our photographer's iPad and my Kindle). We eventually let Benjamin take a long nap, but Lydia stayed up the whole day and all the way through to the birth. At some point, we blew up the birth pool (but didn't put any water in it yet) and the kids were enthralled with their new "toy" and kept playing over the edges of it. At one point, they managed to flip the pool on top of themselves, creating an air-filled cage. :D
I got checked early in the afternoon when my midwife first got there, and I was at a 3, 50%, and very squishy. Since labor was still so light, she went to eat lunch with her hubby and run another errand. I gradually dilated to a 5, and at that check, my midwife was able to stretch me to a 6, but then I never dilated past that because my bag of waters was keeping the baby's head from putting direct pressure onto my cervix. (My midwives called it "bag of water dystocia.") I did a round of nipple stimulation, which helped the contractions get stronger and closer together, but it still wasn't enough to move the baby onto my cervix and finish dilating. She suggested maybe breaking my water in an hour or so if there's been no progress (and if baby was not posterior).
I wanted to go ahead and fill up the pool first, though, so we started to do that. When Tim and I had made preparations for this birth, we got a hose and some fittings to fit it onto the shower head, because our washing machine spout wasn’t easily accessible. We hadn’t run any water through the hose, though, and instead had just seen if it would screw onto the shower head prior to birth day. Once it came time to actually fill the tub, Tim had a little trouble getting the fittings tightened properly, and it kept leaking, so we had a lot of stop-and-starts when trying to fill the pool. He finally got the fittings finished and then turned on the water. About a minute later, he called down the hallway, “Here comes some water!” to make sure that someone was holding the hose at the other end. It was a humorously delayed warning, but someone had been holding the hose anyway, so everything was good.
I was in the pool for an hour or so, but the contractions slowed down, so I continued the nipple stimulation. They picked up, but again, not enough to do what they needed to do, so I got out and agreed to have my water broken. It felt like a gallon came out of me (but was really only about two cups), and it kept coming out in several spurts as I continued laying there, but as soon as she broke it, I was at an 8.5. She said that since I was so soft, it would probably be only an hour or so after she breaks my water and then the baby would be born. My amniotic fluid was meconium-stained, so it was yet another thing to keep an eye on during this birth. My doula had had a “streak” going where all of her clients had started labor with their water breaking, so I was glad to break her streak and have my water intact for so long. It took her some effort to break my water since my sac was so strong this time, which was such a change from my third pregnancy.
My contractions picked up in intensity, but not frequency, after my water was broken. I was back in the pool but couldn't get comfortable. I started vocalizing and screaming through the contractions, and at one point, they suggested that I go to the bathroom to get my full bladder out of the way (everyone had been giving me sips of Recharge and water throughout the day). I did that, and had a few contractions on the toilet and felt pushy. I wanted to get to the bed so they could check me, but I had to time it just right because the contractions were finally coming pretty close together.
I felt the contractions so low that it felt like they were running down the side of my thighs as well. It was quite the odd sensation. While still in the water, I started needing some counter pressure applied to my low back/hip area, which Tim did for me. He was amazing through my whole labor, just doing what I said I needed instead of what he thought I needed. :p Overall, I’m glad that I gave water a try, but I don’t know if I’ll do it again. It didn’t really feel like it was the “magical pain relief” that people have made it out to be.
I got to the bed and was checked, and I just had a lip that moved back and forth as the baby tried to find his way down. I was complete, but my cervix kept slightly shrinking back with the contractions. My midwife checked the position of his head, and he was asynclitic (with sort of a front "corner" of his head trying to come out first instead of the back of his head). She spent a few contractions trying to push the lip over his head and at the same time get him to rotate. Even with no water, there was room for him to do all that. Both of those techniques were incredibly painful. Throughout my contractions and especially during the pushing phase, my midwife never stopped praying for us, out loud. I greatly appreciated this as it helped keep ME focused on who was in control of the situation as well. Since I was GBS positive this time, they also gave me a chlorhexidine rinse every so often, which was cold! Brrr!
During an incredibly painful contraction, I asked if I could push, and they told me I could. Because of his presentation, I never did get the uncontrollable, “my body’s going to push whether I want it to or not” urge like I’d had with my other vaginal births. My midwife was inside me trying to show me where to push (but I had thought she was holding my lip out of the way), which was also pretty painful. She also was still trying to turn his head in between contractions to a better presentation, but then before the next contraction hit, he would turn right back. I couldn’t feel it, but Tim kept seeing the baby flip back over as he watched my belly. She told one of my friends later that I had a pelvis that could birth a 10-pound baby and that the baby just had too much room in there since he kept flipping back.
I was getting tired and weak by this point and kept saying and thinking, "I can't do it, I can't do it," over and over. But I was also aware enough to realize that his heart rate had gone down into the 90s and stayed there, so they were getting nervous about a possible cord problem. I gave it my all. They didn’t know what was causing the drop in heart rate, but my midwife knew from my previous birth records that I could push a baby out fast, so she wasn’t as worried as she might have been if I were a first-time mom or having my first vaginal birth. We didn’t have the luxury of taking an hour or more to push with that declining heart rate. Tim was trying to help me push better/faster/harder by yelling, “PUSH!” several times at me, with increasing volume, but that wasn’t helping and before it started to bother me too much, the midwives told him to stop.
At some point, I was on my hands and knees trying to get the baby to a better position, but that wasn’t working, so I ended up on my back. I have NEVER had a pushing phase hurt like this one did. I had various people giving counter pressure on all four limbs to give me traction. I wanted to scream from the pain, but I knew if I did, it would make my pushing less effective, so I tried to be quiet and just let all the energy go into my push. From Tim's point of view, there was one point where a big portion of the head was visible, but then when I stopped pushing, it slipped back. At one point, they invited me to feel his head, and based on the pain I’d been feeling, I thought I was going to feel a huge portion of it, but it ended up feeling only like a half-dollar-sized amount of head. The video is a little blurry because of the low lighting, but it ended up actually being a significant portion of head that I was feeling and not just a tiny little bit.
When the head finally came out all the way, he was looking down towards my left leg. Before the shoulders came out, he rotated clockwise, looking directly at my left leg, then up to the ceiling, then finally straight over at my right leg, and THEN the shoulders came out.
He was neither breathing nor trying to (but did still have a pulse, which my midwife monitored with her fingers on his chest while they worked on him to get him breathing). They kept him right at my feet where he had come out while they worked on him, leaving the cord intact. They suctioned him (getting a lot of watery blood out when they did this) and gave him oxygen. His one-minute APGAR score was only a 6 (but his five-minute one was 9). My friend told me that my midwife was crying at one point. After quite a bit of suctioning and some oxygen, he got a tiny spot of pink on his head which nearly immediately spread to his whole body, replacing the purple that he had been upon first arriving. He started crying and they put him on my chest. His cord (which was two feet long) ended up being wrapped around one of his feet, but that was the only place it was wrapped. And remember that 8.5-pound estimate from a couple days prior? The first thing I noticed when they laid him on me was how dense and heavy he felt. This baby was not an 8.5-pound baby. When we finally got around to weighing him, he was 9 pounds and 6 ounces, my heaviest baby so far.
Another thing I noticed about him was that he had absolutely NO vernix on him, not even in his little neck folds or anything. He was a very well-cooked baby. :D I cut the cord this time, and was surprised that I had the strength to do that since I didn’t even have the strength left to fully lift my head to see where to cut, and had to rely on others to move my hand into the proper position. And 36 or so hours after the birth, I had a sudden realization, “Oh, yeah, I cut the cord this time,” like I’d forgotten that I did it. The assistant midwife and my friend were looking at the placenta later, and that midwife pointed out the few calcification spots in there and said that it wasn’t a “bad” placenta, but it was definitely done and time for the baby to have been born.
One more thing I noticed was a “scratch” on his abdomen that looked like there had been a cat inside me with him that gave him a good clawing. It ended up being just a weird arrangement of dried blood, though, and came off in the bath, revealing smooth and unblemished baby skin.
Sometime earlier while I was still in the birth pool, I was nauseous, and threw up all the fluids I'd taken in in the previous hour or so. They wanted me to keep taking more fluids, so I kept trying, but the nausea never went away, and I also threw up all those additional fluids along with the few bites of eggs that I'd tried to eat as my first postpartum meal. This loss of fluids combined with the loss of blood made me incredibly weak and lightheaded, and I came very close to passing out many times, and actually did pass out once, later, after my herbal bath. Baby was born at about 2:24 a.m. and it wasn't until noon that I finally felt able to walk a few steps by myself and got my appetite back. I didn't even try to carry the baby before then, either, because I felt that bad, and instead just kept him near me in the bed and had Tim change all the diapers. And even after feeling better, I still had another few sporadic incidents of lightheadedness where I had to stop and bend over, and these incidents reminded me even apart from bleeding intensity that I needed to get back into bed or into a semi-reclining position.
It was a little while before I delivered the placenta. They kept checking to see if it was ready to come out or where it was. I had lost a lot of blood beforehand and they were wanting to make sure I didn’t have a bunch behind the placenta as well. When it was finally ready to come out, I didn’t want to push it out since the baby had been such an effort. But everyone reminded me that the placenta had no bones, lol, and I pushed it out and that was that.
He nursed very well, once we finally got around to it. It ended up being about an hour and a half after the birth before we were able to successfully latch. From the loss of blood and fluid, I was too weak to do it lying down (though I did try with what little strength I had) and too weak to sit up without help. I was also too out of it mentally to ask for help sitting up and to realize how much time was actually passing.
When we finally did sit up, my midwife asked us if we were going to circumcise him, and we said no. She said “Yay,” but I didn’t quite understand what she said, and she had a weird look on her face and said it in a weird tone of voice. I thought that she was upset at our decision until I asked her to repeat herself. Tim and I had had that discussion while pregnant with Benjamin and had left him intact as well.
I did not tear at all, but I had some bruising. It felt like I had been trying to climb out of an above-ground pool but that I was repeatedly dropped on the edge of the pool, with one leg in and one leg out. In addition, I was swollen so much that I couldn’t pee within the time that my midwives wanted me to (even with the assistance of some peppermint oil), so they did end up cath-ing me. After that, the assistant went home but my primary stayed and dozed on the couch and wanted me to try to pee again after an hour and a half or so. I was keeping fluids down again by then so I thought I might be able to go when it was time, and I did, and didn’t have any further issues in that regard.
They offered an herbal bath for me and the baby afterwards (and they also thought I might try to pee in the bath as well, but that didn’t work either), which I took, but I got increasingly lightheaded during that, and hindsight said that they probably should have skipped it. I had to have a ton of assistance walking just to the door of the bathroom, then they had me sit in our wheeled office chair to wheel me to the bed, and I think I might have passed out for half a second. I remember sitting down in the chair, then the next thing I know, they were calling my name and I realized I was leaning on the door jamb with my eyes closed. I woke up from whatever state I was in, and then they wheeled me across the hallway and to the side of the bed.
Baby is a champion nurser. He latches beautifully and just knows exactly what to do, as if he's been waiting his whole life for it. :) He had a bit of a "click" that first day or so, and after some investigating, I found out that he was turning in his bottom lip instead of turning it out, so I’m working to help him develop a better habit there. Other than that, he is a great nurser, easily handling my gigantic letdown. At three days postpartum, he was two ounces under his birth weight, but at five days old, he was two ounces over his birth weight.
Tim changed all the diapers that first day, including the first meconium diaper, which had a HUGE pile in it for him. Tim made the comment of "nothing wrong with that system," lol.
He smiled in his sleep within the first few hours, and then on Tuesday (I’m still wondering what happened to most of the rest of Monday), I saw him smile while he was awake and in a quiet alert phase. :)
One odd thing I noticed early postpartum with myself is that my uterus seemed almost cylindrical when it was freshly empty, instead of shrinking in a rounder fashion. My midwife mentioned this to me at my postpartum visit and said that she and the assistant midwife had noticed the odd shape even from when they broke my water. I don’t remember the shape of my postpartum uterus with my pre-c-section births being anything remarkable like that.
The kids just love him to bits. Benjamin was sleeping when Josiah was born, and when he woke up this morning, I was in the bed and I asked him where my baby is. He indicated my now-shrunken tummy and said, "In your tummy." I told him that he came out, and Tim helped him climb onto the bed so he could see the baby. Benjamin promptly squished him in a hug and said that "he's sleeping" and gently touched his tiny hands. :) Lydia was still awake for the birth, and when he came out, she said that he was "so cute." :D A good friend of ours took our kids for the first 36-ish hours after birth, so that was nice, since one of the things that first made me consider a hospital birth this time was the postpartum stay without having my big kids around. :)
We sort of have a “theme” going on with our names and our kids’ names – three-syllable names from the Bible. (My name is Andrea, which is the feminine form of Andrew, so I’m counting my name as a Bible name as well.) Then Tim is legally Timothy, and there’s Lydia, Benjamin and Jonathan. What WERE we going to name this baby, to keep with our theme? We chose the name Josiah Nathan, which means, “God has healed, God has given.” We couldn’t think of a more appropriate name and are just so happy that he is finally here. :)