Sunday, March 10, 2013

Vaginal Birth After Two Cesareans- YES, It Can Be Done

I am excited to share another VBAC interview and story from one of our amazing VBAC moms.  Yes VBAC can be done, even after mulptiple cesareans.
 
And yes, women are being robbed of the blessing of normal, vaginal birth.
This is how one woman made it happen.
 
Enjoy!
 
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.

I was due with my first son January 15th 2008. I woke up that morning and went to the bathroom. I thought after I got up that I felt a trickle of amniotic fluid. I honestly think I was so tired of being pregnant that I was looking for any reason to call the dr to try to get them to induce me (what an idiot I was!). I had my husband call my OB and she told us to make our way in. When we got there, they put me right into a room, not a triage room, which I found strange. They did the swab to check for amniotic fluid under the telescope, which was negative. She told me that if nothing was going on they would induce me 3 days later but before she let me go, she wanted to check an ultrasound to check my fluid levels. I had had some "issues" with "low fluid" from about 35 weeks on. Knowing what I know now, my fluid levels were fine, never measuring below 7cm! She did a bedside ultrasound and said she was only seeing 2 cm of fluid. 
 
I hadn't had anything to eat or drink since dinner the night before, which I definitely think contributed to that low number. If I had educated myself before his delivery, I should have asked for some IV fluid and to eat and drink something and have it rechecked....hindsight is 20/20. So, I was admitted and I was started on Pitocin. I don't remember what my cervix was doing at this point, but I tend to think it was very unfavorable. They started at the lowest dose and increased it every half hour. I had NO contractions. I could feel squeezing, but I had no pain whatsoever. 
 
They just kept jacking up the pit. After about 8 hours, maybe longer, with no cervical change, they stopped it. They inserted Cervadil that evening and I was told to get up as little as possible (Shouldn't they have tried that first? ). I was also given ambien and told to try to get some sleep. The next morning another dr from the group came in and said he was going to break my water. That's when things really went downhill. I was having some contractions on my own after the Cervadil, and they actually felt like something. He broke my water and there was thick meconium in it. Probably from the stress of the Pitocin the whole day before. 
 
They inserted an internal fetal monitor, screwing it into my baby's scalp ;( And a short time they were telling me that the baby was having late decelerations, the worst kind and that I immediately needed a c-section. Off we went. I had so much guilt after his birth. I blamed myself for everything. The only thing I was guilty of was being uninformed and trusting that my doctors had my and my baby's best interest at heart. I do think that the stress of him being squeezed all that time was the cause of the meconium and I also know now, after getting my records and the fetal heart rate strips, that he was NOT having late decels like they claimed. 
 
There was one period on the strip where it was all jagged and it was all jagged on the contraction monitor too, it was obviously artifact from me moving. After that period, his heart rate recovered and was perfect until they took the monitor off to wheel me to the OR. I got pregnant with my daughter when my son was 7 months old. I had an interest in VBAC, but I was still not fully educated. I had a fairly easy recovery from my c-section and I figured, why not just do that again. I asked my OB about VBAC and she said she did not recommend it because my babies would be less than 18 months apart (they would be 16). That settled it. At the end of my pregnancy, I started feeling more of a desire to have a normal delivery and brought the topic up again. I was told "well, if you go into labor on your own, before your scheduled c-section date, we'll allow you to have a TOL". My c-section was scheduled for 38 weeks 6 days. Needless go say, I had another section. In the surgical report which I obtained to take to my new doctor, I discovered that they stated "patient was offered vaginal birth after cesarean but refused". And also, with that surgery, they only used a single layer closure.

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

Honestly, this sounds silly, but a few months after my daughter was born I watched The Business of Being Born for the first time. I felt a whole new wave of regret over my two surgical births. It ignited a fire in me to have a normal delivery with my third child. I did a ton of research at that time and learned that VBA2C WAS possible, but I would need to find the right provider to support me in my decision.

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

Fast forward two and a half years, I found myself unexpectedly pregnant. Unfortunately, that pregnancy ended in miscarriage and with a D&C. I got pregnant again right away. I was still with the same doctor I used for my other two deliveries, out of convenience. I knew in the back of my mind I wanted a vbac. The discussion never came up. In fact she said to me at an early appointment "do you want us to do a tubal while we're in there"? I started looking for my new doctor that night. I searched google, read Facebook pages of my local ICAN and went to a meeting. There was talk of an OB in our general area who was supportive of VBA2C and had assisted many mothers in achieving their goal of a natural delivery. I called and scheduled a consultation with him. He was AMAZING at that first appointment. I went in with a list of questions and things I wanted for my delivery and he basically agreed that it was all reasonable! He encouraged us to hire a doula, said I could labor in the tub if I desired, agreed to no continuous fetal monitoring, just periodic handheld monitoring and a 10 minute strip every hour, hep lock only, I could eat and drink during labor, etc. He confirmed for me that what I read and interpreted in my surgical report from my daughters birth that I indeed had a single layer closure. He said that while it was not ideal, it didn't change anything and he would still allow me to labor. I was beyond excited! I had one more appointment with my old OB and I told her I was leaving to go to a provider who supported my decision to have a VBAC. She said something about it being too risky, and quoted me a 5% rupture rate, which I knew was incorrect. I left there knowing I was making the right decision.

-What was labor like for you? 

Long and fairly easy in the beginning, and fast and intense at the end! All told my labor was 18.5 hours. The first 16 hours were nothing. I could walk around, talk and joke in between contractions and manage the discomfort with no problem. Active labor and pushing lasted 2.5 hours and it was tough. Pushing was the most intense thing I've ever experienced.

-What helped you VBAC?

I couldn't have done any of it without the support of my husband and doula. They both were there for me in so many ways. My doula was fantastic. She walked with me in the hall for two hours before I got admitted and my husband was able to sleep some because he had been working in the city the whole day before and got almost NO sleep that night. It was great having her there and I really don't think my experience would have been anywhere near as good without her. Also, we rented a birth pool which really helped me get through active labor and transition. 

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

I did everything different! I read and read and read. Research articles about VBAC, stories of other mamas success (many of them right on mamabirth!). I read everything I could get my hands on about natural childbirth including Ina 
May Gaskins guide to childbirth and spiritual midwifery. I watched the business of being born a few more times while I was pregnant, and also More Business of Being Born series, twice. I went to the chiropractor weekly, sometimes twice a week too.

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

Right from the very beginning of my pregnancy I said I was going to go to 42 weeks. I did this, not because I really believed it, but so I wouldn't be discouraged or disappointed if it actually happened. In fact, I was prepared to go past 42 weeks if necessary to go into labor on my own. I was going to be patient. I had a few episodes of contractions that I thought were the real thing, but always went away after some time, which was frustrating. I had never been in labor, so I had no idea what "real" contractions felt like. 
 
Now that I know, what I was experiencing were not "real" but just BH contractions that were actually timeable and consistent. 40 weeks came and went. Everything was looking good with me and baby. At my 41 week appt. we discussed what the plan was if I went to 42 weeks. I said I really wanted to wait for labor to start on its own but I would agree to a foley bulb induction at 42 weeks if there appeared to be any health concerns. My OB was totally okay with letting me go beyond 42 weeks as long as there were no red flags. 
 
He said at that appointment that he couldn't even strip my membranes because my cervix was too posterior and it would hurt like crazy if he tried. At 41 weeks 3 days, my doula suggested going for a massage. She had a friend who she said has put 5 of her mothers into labor within 24 hours of having a prenatal massage. I figured, why not, a massage sounded lovely. I made an appointment for the next day. I went at 2 pm and I had the MOST AMAZING massage I think I've ever had in my life. I left there feeling so relaxed. My husband was working in the city that whole day and had a dinner thing after work and would be home late. 
 
I put my other kids to bed and relaxed on the couch. I fell asleep for a bit and then went up to bed around 10pm. At 11 pm I heard his car pull up. I swear that I had my first real contraction as his car was sitting out in front of the house! It was like my body was waiting for him to be home. Right from the start my contractions were 5 minutes apart and lasting 1 minute. I laid in bed trying to fall asleep for a few hours. I finally got up and tried taking a shower, thinking that might slow things down so I could get some sleep. It did the opposite. When I got out of the shower, they were 3 minutes apart. I called my doula. I think she was expecting me to call! 
 
She said since they were so close together that I should call my OB and see what he wanted me to do. He told me to make my way in. We called my MIL to come stay with the kids and started the 45 minute drive to the hospital. We got there around 4 am. They put me in a triage room and hooked me up to the monitor to run a strip on my contractions and the baby's heart rate. They checked me...I was 1 cm and 90% effaced and my cervix was anterior. They let the dr know and he said for me to go walk for 2 hours and if there was a good change in that period of time they would admit me. 
 
At 7 am we went back and I was checked again, 2-3 cm and 100% effaced, I would be admitted. We got to the room around 8. My nurse, Jennifer started my hep lock and drew some blood. She said that Dr. G wanted a 10 minute strip on the baby's heart rate every 30 minutes and to listen with the dop tone every 15 minutes. It sounded like a lot. More than we had previously agreed upon. I decided that I would see how it was going and if I felt like it wasn't working for me, I would address it with the dr. It turned out to not be as bad as I originally thought and Jennifer was really cool about it. After a few hours of seeing that the baby was perfect, she let it stretch out a little longer in between checks. We walked, I bounced on the ball, I sat on the toilet, I squatted and lunged. I was doing it! Around 12:30, Jennifer asked if I wanted to be checked. I said yes. 
 
She had Dr. G come in to check me. I was 3-4 cm. I was so disappointed that I hadn't made more progress in all that time! He just said "okay, good! Keep doing what you're doing" and that was that! No talk of Pitocin or ANY sort of intervention at all. I laid in bed and rested some because I was feeling a little tired. My doula went and got lunch and my DH was resting in the chair. My contractions spaced out a ton, coming every 6 minutes or so, where they had been 2-3 minutes apart. My body knew just what it needed, rest, and it gave it to me. I was actually able to sleep some in between the contractions. 
 
When my doula came back, she wanted me to sit on the toilet for some contractions with my hips super wide apart. It hurt like crazy, but I think it's what pushed me over into active labor! After that, the contractions were really hurting. I started feeling this sort of stabbing pain going straight up my vagina. I think I was feeling my cervix opening! They filled the tub at this point and I got in. What a relief! I was in there for a while and they wanted me to eat something so I had a banana. I joked that I would eat the banana so that I would have something to throw up later. About 5 minutes later I had the most intense contraction thus far and i exclaimed "I'm going to puke!". They barely got the bag in my hands and it was all coming up. My doula was SO excited!! A minute later the nurse came in and she was ecstatic! Shortly after that I got out of the tub and asked Jennifer to check me. She got this really happy look on her face and told me I was 8 cm! I wanted to be 10 :). But I would take 8. 
 
That was at 4:40. That's when things really start to get blurry. I had to pee, so I went to the bathroom. I had this crazy contraction and yelled out "oh my god, I'm pushing, get me OFF this toilet!". I got up and had to sit right back down with another contraction. Jennifer was telling me not to push and to breathe or pant through the contractions....yeah, right! It was such an intense urge, there was nothing I could do and nothing anyone could say, to get me to stop pushing. She then told me that Dr. G was down the hall delivering another baby! She had me on my hands and knees and then laying on my side. 
 
Finally at about 10 after 5, he came in. They had me roll on my back. I really didn't want to push on my back, but I couldn't do anything else so I just asked them to raise the back of the bed as much as possible. Dr. G was giving me instructions to hold the back of my legs and push when I felt the urge. Another part of my birth plan that they honored, no directed pushing at all! I pushed again and he said to reach down and feel the baby's head. It felt all wrinkly and very hairy! The next push delivered the head and then slowly his shoulders and then he was out! Its a boy! We didn't find out the gender beforehand and my husband and I both thought it was a girl! We were shocked :). He went right to my chest and didn't leave until much later. They waited for his cord to stop pulsing and then my husband cut the cord. The placenta seemed to come out pretty quickly on its own. I had the tiniest tear that needed one stitch. I had said in my birth plan that I didn't want any Pitocin after the delivery, but I ended up needing it because I was bleeding pretty heavily. That's the only drug I had the whole time!

- Has the postpartum experience been different than your other birth/s? What about it surprised you? 
 
I was pretty sore down there for a few days after but on the whole I felt great. So much easier than my c-sections, and I had fairly easy recoveries with those as far as c-sections go. I was very weepy after both of my c-sections but this time I was nothing but elated. I know that my sadness before was in part because of the disappointment I felt at my birth experience. I am still surprised at how healing this has been for me. It wasn't a completely natural delivery but I think for a hospital birth after two c-sections it was a great, low intervention, drug free birth. Now, almost five months later I still feel like I am on that birth "high". I am so glad that I persisted in my desire for a normal delivery, the experience was worth every ounce of effort.

 

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