A Hospital VBAC, Dedicated Mama-

Recently I shared a birth story from on of our readers- a VBAC with a big baby and a little mama.  This is the story of her FIRST VBAC.  I thought you might enjoy it too.  

Enjoy- and GO VBAC!

~

This birth was a gift. It was beautiful, and peaceful, and so filled with love I could hardly contain it.

A short time before my due date, my friend Dana emailed me that she was praying that I would hear a specific word from God regarding this birth. Immediately afterwards, my friend Jen emailed me with several Bible verses filled with words of peace. Several of them stood out for me and were comforting for me during labour, and remarkably descriptive of the emotional and physical space of this birth.

Peace I leave with you; my peace I give to you; not as the world gives, do I give to you.

Let not your heart be troubled, nor let it be fearful.

~John 14:27

Blessed is the one who trusts in the Lord and whose trust is the Lord.

For (s)he will be like a tree planted by the water,

that extends its roots by a stream

And will not fear when the heat comes,

But its leaves will be green,

And it will not be anxious in a year of drought

Nor cease to yield fruit.

~Jeremiah 17:7-8

Shortly before I went to bed on Sunday evening, February 27th, I had some mild contractions. I ignored them, figuring they would disappear once I went to bed, as usual. I was able to sleep soundly and peacefully, but the contractions continued all night. By six a.m. they kept me awake and were steadily ten minutes apart, so at seven as the household woke up for the day I told my husband Brent and tried to distract myself between contractions.

I let my labour support team know so they could plan their day, and paged my midwife. I knew it was early but I wanted to give everyone lots of notice. My midwife lives closer to me than to her office, so she came by to see me around eight in order to assess whether she should cancel her clinic appointments, or continue her day until I kicked into active labour. I knew it was too early to cancel clinics and expend a bunch of energy focusing on contractions, but she wanted to be sure so she came by. The baby was well engaged and my cervix was very soft and very thin, but too posterior to feel dilation, which means early labour.

She went to her clinic, and I had breakfast and helped scoot the older boys off to school. As I moved around and distracted myself, I noticed the surges were spacing out. Fifteen minutes, twenty minutes, half an hour...

I pulled out my breast pump to add to my stash of expressed breast milk to take with me to the hospital in case my gestational diabetes caused blood sugar regulation problems in the baby and the hospital staff wanted to feed her. A bottle of formula can help regulate a newborn with low blood sugars, but for long term health formula puts an infant at increased risk of developing type II diabetes later in life.

A baby who develops in the womb of a woman with gestational diabetes is already at increased risk for diabetes, so I was determined my baby would be fed only human milk to decrease its overall risk. I had asked a friend to donate me three ounces of her milk, and added what I could of my colostrum, just in case. The pumping helped bring things back to ten minutes apart, and regular again.

My photographer friend Louise came over to take some photos at about 9:30 or so, and stayed for over an hour chatting and taking gorgeous photos of my kids and my clock and me on the phone...I love her kids, and they play well with my kids, so we had an impromptu playdate! The surges were spacing out again so as she left, I went for a walk.

I was continuing to watch the clock to time contractions and to time my food intake, since good glycemic control is important during the last few weeks of pregnancy and during the birth process for women with diabetes. I ate every three hours and took my insulin as usual.

Riley wanted to have a nap, so I lay down with him and nursed him to sleep. Breastfeeding him made my contractions jump from every ten minutes and moderately strong to every two to three minutes and stronger. Breastfeeding releases oxytocin, which is also the hormone that stimulates contractions. It was handy to have this tool to help keep things moving along during this long prodromal stage!

I had expected this labour to go quickly, but the early phase was long and relaxed. I felt a bit impatient, but mostly relaxed and peaceful. I phoned my midwife and let her know that things had picked up a bit. She came over to assess me, and I was 2-3 centimeters dilated and the baby had progressed to +1 station, cervix very soft and very thin, and no longer posterior.

This was all good information to have, but I knew I wasn't in active labour yet. It just didn't feel quite like my productive labour had been with Riley yet; that feeling that I was riding a river current that was deep, fast, powerful, and unrelenting. My midwife went home, but told me she expected to be back within an hour.

This was around two o'clock in the afternoon. I let Louise and my friend Rowenna know, so they could prepare to leave for the hospital once things picked up (Rowenna's role was to look after my kids, who wanted to be present for the birth). However, things slowed down again!

I had been trying to balance distracting myself so as not to waste my focus or energy on early labour, with being able to cope with contractions I couldn't ignore, and paying attention so I would know when my body made the shift to active labour. I got in the bathtub for an hour or so to relax, which made things slower again but warmed up my feet and helped me to get a regenerative rest.

At six thirty I pulled out my breast pump again and pumped a few ounces to add to my hospital stash, and within fifteen minutes, my body shifted and I knew I was finally in that fast, powerful river of active labour with little chance of slowing down again. I ate dinner, and then we all headed to the hospital shortly after seven p.m.

When we walked onto the Family Birthing Unit, it was shift change and a large number of nurses were at the desk. We walked past with our entourage of photographer, midwife, Brent, my mom, three little boys, birth ball, pillows, food, and a rather full suitcase: an unusual sight on a maternity ward! It was a homebirth in the hospital, just like I wanted! Riley had his baby doll in his arms and two pigtails in his hair "jus' like mommy" and his favourite spiderman pajamas on, and the nurses all thought he was SO cute.

When we arrived and got to our room there was paperwork for my midwife, and several routine things for the hospital with regards to women who are delivering VBAC. Here's where there is the most potential for conflict with hospitals in my part of Canada, when it comes to me. I tend to be a pain as a patient, because I have some weird preferences that go against standard policies.

My nurse came in. Lets call her Amber. She was very businesslike and 'efficient'~which is a nice way of saying brisk and detached. She had the external fetal monitor with her, and my midwife turned around and said, "Actually she has refused the external fetal monitor. She won't be going on the monitor." Amber was stumped, "Oh, I don't know about that," she said, indignant.

"Both myself and Dr. Drake (my OB, not his real name) have discussed it with Melissa, and she knows the risks and has chosen to refuse it. All you need is the refusal form, and she won't be going on the monitor."

First of all, if Dr. Drake was in the room telling Nurse Amber I wouldn't be going on the external fetal monitor, she wouldn't be saying 'I don't know about that,' and second of all how fantastic is it for me to have a midwife to advocate for my wishes, which we had discussed at length for the previous eight months, while I focused on labouring. I knew this conversation was happening, but I didn't need to contribute to it. My midwife also said, "It's in her birth plan. You really need to read her birth plan, which is in her chart."

I wasn't aware of what happened next, but my midwife and Amber wound up at the nurse's station talking to the head nurse. Of course, the head nurse knew that a woman can refuse anything she doesn't want in Canadian health care, so she settled the matter in my favour and nothing more was said.

A similar thing happened with my I.V. Women who are VBACs in hospital are always given a large bore I.V. saline lock in case they require surgery and/or a blood transfusion. I choose not to consider myself a potential obstetrical emergency and dislike extra discomfort or apparatus while giving birth, so I refuse this I.V. However,

I have tested group B strep positive for both my natural births and decided in both cases to accept I.V. antibiotics to treat it, which are administered every four hours during labour. Most women would choose to have a saline lock in place so they only need to be poked once with a needle, but I prefer repeated pokes and no saline lock.

Amber bustled up with a eighteen gauge needle and the longest saline lock I’ve ever seen with about a billion ports.

“Why are you using an eighteen gauge for an in and out I.V?” I asked, eying the huge needle with a green port (green is eighteen gauge).

“Oh, this is the standard size in obstetrics,” Amber assures me.

“Yes, I know it is, but it’s not staying in so can you get a smaller one?”

“No, this is all we have.” POKE, fiddle, tape, op site, more tape…I rolled my eyes. Then my midwife Cathy noticed what was going on and reiterated that Amber really needed to read my birth plan, because that I.V. would be coming out as soon as the antibiotics finished running. Amber's eyes widened in surprise:

“You would rather be poked more than once?” I laughed.

“YES! I know I’m weird, but that’s what I want!”

I’m not sure if it was the joke about me being weird, or if she figured my birth plan really deserved a read, but she was no more trouble after that. We didn’t need her much, so she was only in the room for a few more minutes and then for the birth itself, several hours later. This whole interaction took only about fifteen minutes but was an interesting example of the intersection between a medical approach and a humanistic or midwifery approach.

The kids all grouped around the room, eating timbits and looking around with wide eyes at the hospital room. Matthew was curious about all the machines, my I.V., the fetal monitor, the cupboards, the bathroom…

Ayden settled back in the soft chair and watched like a pro~he was present for Riley’s birth process and remembers it well. Riley was establishing territory with Matthew and settling his doll on the windowsill, waiting for the “baby come out.” All three soon settled in reading stories.

Brent was perfect labour support, he was very in tune with me and applied counter pressure to my back during contractions and rubbed my back in between whenever I asked him to. He was never far away. If he was occupied with one of the kids my mom filled in with counter pressure on my back.

It was interesting to me the amount of pressure I felt in my back during each contraction this time~my labour with Riley was almost all in the front. I didn’t have ‘back labour,’ because the pain was absent between contractions, and Amarys was in a good position (not posterior), but with every contraction my sacrum felt pulled with such force that it flexed in the middle. A few times I commented that it felt like my back was going to break in two pieces!

Brent’s mom and sister arrived and came into my room to say hello. Everyone was quiet and peaceful, but I like to have a number of supportive, loving family and friends around when I give birth so it was nice to feel like we filled the room and that there were a number of conversations going on at once.

When the I.V. antibiotics were started, I moved to my exercise ball on the floor by the bed. Early evening was generally the baby’s most active time of day, and so it wasn’t surprising that she started doing some major gymnastics at this point, causing her heart rate to increase to the 170s and 180s. Cathy recommended some time on the fetal monitor and I agreed. The monitor paddle kept being kicked by a very active baby and the sound made me giggle;

“thwockathwockathwockaTHUMPBUMPthwockathwockaKKKKKTHUMPBUMP!”

The movements were very visible. It was remarkable how everyone’s focus, even my own, moved from my body to the readout and noise coming from the monitor. We are a fairly low tech bunch of people who believe in physiological birth and a woman’s body knowing best and yet that machine is quite captivating! Once she settled down her heart rate returned to the mid 140s and stayed there, and Cathy removed the monitor.

For me, as long as I stayed vertical, either sitting or standing, and I had counter pressure, my contractions were very manageable. The antibiotics finished and the ridiculous eighteen gauge gadget was removed from my hand. I was free! The kids went to a waiting area next to our room to watch a movie, and I emptied my bladder and then climbed in the enormous bathtub.

WOW the tub was awesome! I loved the tub, I praised the tub, I determined I wanted to MARRY THE TUB! It was obviously designed for labouring women because it was enormous and deep. (Water births are not officially “allowed” at this hospital as yet, but this tub will be perfect once they are). The water really soothed me and helped me to maximize my hypnobirthing techniques to really get deeply relaxed during surges. It was still more comfortable for me to be upright so I mostly sat in the tub rather than lay down.

The best techniques that worked for me this time were counting backwards from ten, silently, and relaxing twice as much with each number. Usually by the count of six or seven, the height of that surge was finished and a few more breaths and it faded away. Sometimes the counting didn’t work so I would repeat, silently, “Relax, relax, relax,” or “Peace, peace, peace,” or if it was really intense, “Jesus, Jesus, Jesus!”

A few times I visualized my cervix melting away into the thinnest ribbon and lifting up and disappearing, and a few times I pictured that tree planted by the water in Jeremiah 17. Whenever I remembered that my friends and family were praying for me, I smiled, and a few times I laughed even during contractions if someone said something funny. Ina May mentions the dilating power of being positive in labour, so I tried to be as positive as I could.

This really helped me, as did the Birthing From Within concept of non focused awareness, because last time noises really bothered me, but this time full conversations didn’t bother me, nor did the Doppler, nor did the camera. There were floaties in my tub, but they didn’t freak me out. My strong fear of germ contamination was totally absent. It really was incredible how peaceful it all was, and how calm and capable I felt.

The kids were in and out of the bathroom during the several hours I was in the tub. I lost all track of time on purpose, and didn’t want cervical checks because I try to get away from my left brained, measuring, logical brain during birth, particularly the active phase. It's better in my experience to get deeply engrossed in the present moment, it makes things easier to cope with.

Counter pressure would have been helpful~before I got in the tub it brought my back pain from 7/10 down to 3/10 or less! But the tub was so large and deep that without his bathing suit it would have been awkward and pretty wet, and we forgot to pack Brent’s shorts. It wasn’t as bad in the tub, or I didn’t care as much, because I was managing well without the counter pressure.

I ate my evening snack in the tub, a pear and some cashews. When we arrived, and later when I got out of the tub, Cathy had me test my blood sugar. It was high after that snack so she had me give myself four units of short acting insulin to bring it down a bit.

I was also working to stay hydrated, but at one point in the tub my water bottle was too cold and each time I drank some of it, it gave me painful contractions. I asked for it to be warmed up and Cathy poured most of her peppermint tea into my water bottle: there’s a true example of midwifery care going above and beyond! I had expected warm tap water, but peppermint tea was infinitely better!

Suddenly, I hit an emotional wall, and I said, “Okay I’ve changed my mind, I don’t want to do this anymore.” Part of this was deadpan humour, but the other part was dead serious. I knew I was near the end, I didn’t want to face greater intensity, and I did not want to push. Cathy reassured me that because I didn’t want to continue, it meant I was almost finished, and that I was doing really well.

It was what I needed to hear. I told her I was afraid to push, and that I thought my vagina was too small to push out a baby, but she reassured me there, too, saying vaginas are built like accordions and designed to stretch. My mom reminded me of another analogy, where a tiny bud seems far too small to become a flower without violence or damage to the bud, but nature knows that full bloom is not only possible, but beautiful and natural.

After expressing not wanting to do this anymore, I felt bad for being negative and apologized for being whiny. Both Cathy and my mom laughed, because in general I was so quiet and peaceful, it didn't seem to them that I was being whiny at all. Cathy wanted me to get out of the tub for my second round of antibiotics and I kept saying, “Uh-huh,” but not actually doing it!

I had been feeling pressure but not a strong urge to push, and I had a feeling the decreased gravity in the tub was keeping me from really feeling a strong urge to push. I didn’t want to get out of my nice, warm tub oasis, and I figured that once I got out I wouldn’t be able to get back in. I didn’t mind too much the idea of pushing outside the tub, although I had hoped to break hospital policy and just ‘accidentally’ give birth in the tub.

This idea wasn’t something I felt strongly about but I couldn’t figure out why I wouldn’t get out of the tub until it occurred to me that I was afraid to be cold. I remember the transitions in and out of the shower with Riley’s birth being quite uncomfortable. So I asked for some warm blankets to wrap around me when I climbed out, and they worked wonderfully.

I went over to sit on the bed for the second round of antibiotics but realized I should empty my bladder again. While I was on the toilet I got really pushy, and I thought, “Well, lots of babies are born on the toilet!” Cathy didn’t want me to give birth while she was fiddling with an I.V, especially on the toilet, so she abandoned the I.V. and asked me to move to the bed.

I did NOT want to be relegated to pushing on that darn bed like a beetle so I asked for the birth stool so I could be vertical while I was pushing. Both Cathy and myself anticipated this second stage to go quickly, so the second round of antibiotics was set aside as something we didn’t have time for. Ironically, I pushed for an hour!

I spent about half that time on the birth stool, and it was very nice and peaceful with the lights low, my mom on one side of me, Brent on the other side, Cathy waiting watchfully and encouraging me, and Louise taking photos very unobtrusively and occasionally encouraging me also. Eventually my tailbone got tired of being compressed on the chair during each push and I felt that lying down would be better because I could rest more completely between pushes, so I requested to lie on my side on the bed.

It was remarkable to experience the difference between a first and second delivery with regards to pushing; it took me a long time and a lot of help and coaching to push Riley out, but this time my body transitioned into the second stage seamlessly, and I breathed through contractions until the urge to push was too strong to resist, and my body did it for me. Cathy said this is normal, to need coaching for pushing the first time but be able to follow your body in subsequent labours.

Eventually the second round of antibiotics was given to me by a nurse that I loved because (a) she used a smaller needle without hesitation, and (b) she was quick, thoughtful, and worked hard to ensure it went in my vein between contractions despite them being very close together at this point.

I breathed and moaned and Cathy said a few times that my still intact waters were bulging and that once they broke, the baby’s head would be right behind them. I felt them once with my hand, and it was like a balloon filled with water, but with seams in the balloon. Eventually I said, “Can you please break them [my membranes]? I’m a strong believer in letting them break on their own, but this is ridiculous!”

Everyone laughed and Cathy tried to break them with her finger, but they were very strong so she needed an amnio hook. Right behind the waters, there was the head. When the baby’s head was crowning I swore, because the fullness was so intense and everything was stretched to its maximum. I think I was surprised that it stayed that way between contractions, and that is why I had such a strong reaction.

I tend to be quiet in labour and turn inward very deeply, so it was funny that I laboured so silently and then hollered at the end! The experience of pushing this second time was far more coordinated and natural than the first time, and I just followed my body.

The baby’s head emerged slowly and without tearing, with one loose loop of cord around the neck, but when her shoulders came out it was more difficult to control and I had a second degree tear. I had extensive tearing with Riley and scar tissue is not as strong as intact tissue so I wasn’t surprised, although Cathy was frustrated; we had worked together so well to ease the baby’s head out without trauma, and then the shoulders caused a tear!

I was so relieved that the baby was out! I reached down and Cathy passed her warm, slippery body to me, and I lifted it towards my chest. The cord was not long enough to come all the way up to my chest or for me to check if it was a boy or a girl, so we stayed cuddled up with her on my tummy while she was rubbed dry. She opened her eyes and let out a cry, and I was overcome with emotion and repeated, “You’re awake! You’re awake!”

This moment made me realize that a small part of me was still emotionally wounded from Riley being born unconscious and needing resuscitation and immediate separation. This birth helped to heal that memory for me. My mom couldn’t wait any longer and checked~she jumped up and down and shouted “YES!!” so we knew it must be a girl!!

Once the cord stopped pulsing Cathy clamped the cord and I cut it~our first time separated. I lifted her up to my chest and we stayed skin to skin for two hours, nursing and cuddling. It was perfect. I had knit her a hat, and she wore only the hat for two hours, and stayed on my skin under a towel and blanket acclimatizing to life on the outside.

The placenta took awhile to come, and although it had detached it was large and having difficulty coming out, so about half an hour after the birth Cathy proposed the idea of a shot of oxytocin to help expel it. We had been trying more natural methods, breastfeeding and being patient. I agreed to the shot and that did the trick; out came a large, healthy placenta.

Shortly after she was born, Brent went to tell the kids and grandma and auntie in the waiting room that we had a girl! The plan had been for the kids to be in the room when she was born, but it didn’t happen that way. They were very excited to have a sister though! And they had been a big part of the whole experience, so it was okay in the end. Brent gave them the choice to come in now, while there was still a lot of blood and the placenta yet to come out and suturing to do, or to wait until that was done.

They opted to wait. By the time we were ready to call them in, Matthew and Riley had fallen asleep and they were so exhausted that we couldn’t wake them up for more than a quick peek, but Ayden was enraptured. We all were! It was a wonderful, joyful, peaceful birth and I am so grateful to have experienced it. And we are all grateful for our baby girl!

Peace I leave with you; my peace I give to you; not as the world gives, do I give to you.

~John 14:27

(Amarys was totally healthy with no blood sugar problems.  We went home less than eight hours after she was born.  She weighed 9 lbs 1 oz.) 

Bio from the mom-

I am the editor of Mothers of Change www.mothersofchange.com

and I also have a blog, White Noise www.vosefamily.blogspot.com

Short bio: I am an artist, writer, women's advocate, doula, and kid-wrangler. I live in Western Canada with my wonderful husband and our four noisy, crazy kids.  I blog at White Noise, and am the Editor of Mothers of Change, a birth advocacy organization working to improve maternity care services in Canada. I am passionate about breastfeeding, attachment parenting, ecological living, advocacy work, art, social justice, traveling, and raising awareness regarding mental illness.