VBAC

I was recently asked to speak at a meeting of the Macomb Birth Network. A lovely midwife heard about my VBAC and asked if I would attend their next meeting to share my story with other ladies pursuing VBACs. I couldn't attend the meeting as I had a previous commitment, so she asked me to pen my story instead. It had been awhile since flexing my writing muscles, so I obliged. Here's the story I provided.

My name is Mrs. Amen and I had a VBAC in August 2012 at Crittenton Hospital Medical Center in Rochester, Michigan. Here’s the story on how I conquered a VBAC.

Did you ever charge something on your credit card and forget you spent that money until the bill arrived in your mailbox or inbox later? That’s how I think of my C-section. I delivered a baby, but instead of having paid the physical pain “bill” by the time I left the hospital, I paid it after delivery and am still paying the interest off is some ways.

My first pregnancy resulted in a C-section. Other than Gestational Diabetes the pregnancy was pretty easy. I had no morning sickness, one weekend of ridiculous belching and heartburn (ladylike, I know), and some hand and foot swelling at the very end. When the doctor discovered the baby was gaining 15 ounces a week, she decided to induce me just past 37 weeks in order to avoid a 10 and a half pound baby by the due date.

At my 36 week appointment, I was dilated a fingertip. One week later, I was already 5+ cm dilated having felt one contraction earlier in the week. My doctor was tempted to break my water and send me to the hospital, but she didn’t. Instead she stripped my membranes (not as fun as it sounds) and sent me for an amniocentesis to check lung maturity. Lung maturity was confirmed and I arrived at the hospital the next morning for an induction where I promptly freaked out, started crying and asked demanded my husband take me home because I didn’t want to have a baby anymore.

Truth be told, I still wanted the baby, I just didn’t want the labor. Am I really supposed to look forward to an experience described using phrases like “ring of fire”, “worst pain ever”, “prefer to tear naturally”, or “poop on the table”?

At 8:45 am, my water broke as I sat in the hospital bed waiting for the nurse to start the IV. It was just like every comedy movie you’ve ever seen, a veritable waterfall of amniotic fluid. My doctor was thrilled at not having to make a decision about when to break my water and assured us we’d have a baby before lunch at the rate I was going. In triage, I had been 6+ centimeters dilated. I got an epidural almost immediately and though my stomach looked really weird, as if the baby was lying with its back along my right side, I settled into the bed to labor comfortably unaware of any work being performed by my body. Nine hours later, after my blood sugar had plummeted into the 50s because they forgot I was gestationally diabetic and having convinced them to give me a popsicle and some anti-nausea medicine (that didn’t work), I started vomiting. My doctor checked my cervix and I was still at 6+ centimeters. They couldn’t turn up the Pitocin any higher. I half-jokingly asked my doctor when she might consider a C-section. She said, “Sure. I’ve just been waiting for you to ask.”

Half an hour later, at 6:58pm, while my body shook violently from the epidural and spinal block medications and I threw up into a pretty, mauve kidney shaped vomit bucket I delivered a perfectly healthy 8 lb., 4 oz. baby boy via C-section.

I was in a daze. I couldn’t sit up; I couldn’t hold my baby; I couldn’t breastfeed my baby. I saw my family admiring this perfect little man, but I couldn’t focus on his face. I was unable to attempt to hold him until the next morning, a full 12 hours after his birth because I was too out-of-it and weak to actually do so. I didn’t even consider getting out of the hospital bed for almost 2 days (just leave that catheter in place, thankyouverymuch). I didn’t shower until the third day when they were discharging me. The intense burning at the incision site lasted several weeks and took more than 4 months to fully heal externally (I still have numbness surrounding the incision site more than 4 years later). My abdominal muscles were very weak making it difficult to get out of bed, get up from a sitting position or walk. I didn’t even attempt to nurse the baby until 3 days after his birth due to the pain experienced when holding him and sitting in the proper position. I ended up pumping for a few weeks, never really establishing a good supply and by the 4 week post-partum mark, I had given up nursing and pumping entirely.

At my 8 week post-partum appointment with my OB/GYN, I expressed a desire for a VBAC with my next pregnancy. The doctor told me I would have to have at least 18 months between deliveries in order to be a candidate for a VBAC, but if I did, I would be allowed to experience a trial of labor.

At about 14 weeks post-partum I had a return to fertility. As Natural Family Planning users and instructors, we had started charting again at 3 weeks post-partum and we continued on with pregnancy avoiding/delaying behavior (also known as “following the rules to avoid a pregnancy”). When our son was 15 months old we switched to pregnancy achieving behaviors (also known as “trying to conceive”) again. It took more than 6 months to conceive our second child, who we lost in a miscarriage at about 7 weeks. We tried again for 7 months, including doing four unsuccessful rounds of Clomid, before achieving another pregnancy which also ended in miscarriage at 8 weeks. Three months later, we conceived our fourth child, and 9 weeks later we said goodbye yet again.

It has not been suggested by my OB/GYN that the C-Section has in any way harmed my fertility. It is suspected that the recurrent pregnancy loss is due to an unidentified clotting disorder, but no definitive diagnosis has been reached. In order to sustain a pregnancy, I take a baby aspirin daily (before achieving pregnancy through week 36) and use a prescription vaginal progesterone supplement during the first trimester.

When I was able to sustain our fifth pregnancy, we knew that we wanted to pursue a VBAC. In fact, prior to getting pregnant, I had already discussed it with my new OB/GYN, Dr. Daniel Greene at Crittenton, and he was very supportive (because he’s the best!).

I knew the benefits of having a doula’s support during labor based on conversations with my wonderful sister-in-law who is a doula. My husband, Mr. Amen, especially liked the idea of having another person who was experienced in childbirth attend our labor. He really felt that he needed the support as much as I did. At about 15 weeks pregnant, Mr. Amen and I were speaking about Natural Family Planning at a medical conference held at a local hospital and we were introduced to a doula. Her approach and philosophy were very comforting and her strong personality convinced me she was the right doula for us. Though I adore my SIL and she is a fabulous doula, I am way too close to her to have her be my doula. We hired our doula, Bonnie, and never looked back.

With my fifth pregnancy, I was diagnosed with Gestational Diabetes again. My sugars were diet controlled at first, but I did end up requiring the medication glyburide to control fasting/waking sugar levels and for the last few weeks to help control sugars after meals. This time around I was considered “Advanced Maternal Age” (over 35 years old) and I was not at a healthy weight. I also have hypothyroidsim, though it is well controlled with medication. All of these factors together along with my desire for a VBAC pushed me into a high risk category, so I was monitored by a Maternal Fetal Medicine Doctor at Crittenton in addition to my regular OB/GYN.

While my doctor was very supportive of a VBAC, one of his partners expressed displeasure with my choice. He tried to scare me into a repeat cesarean based on my “high risk factors” and he indicated that he would be happy to just schedule a C-section for me. I refused. I insisted I be given a trial of labor.

Prior to giving birth, we went through some childbirth classes with our doula. We had forgotten nearly everything from my prior labor classes except all the scary parts, so having the refresher class was helpful. We did many of the relaxation exercises at home and I took some homeopathic remedies to get labor going as I had a hard deadline. My doctor had an induction scheduled for the day after my due date because of the high risk nature of my pregnancy. The prior C-section would make the induction tricky. Only a very low dose of Pitocin could be used to encourage contractions to start if my cervix was showing some signs of readiness for labor (effacement and dilation).

 In consultation with Bonnie, our doula, our birth plan was pretty simple. Here are the highlights:

Goal: I want to show up pregnant and go home with a baby.
Labor: I want as few interventions as possible. I am willing to have continual fetal monitoring. I am willing to have an IV placed (my veins are very tiny and a hep-lock was not the best choice because of my gestational diabetes). I will labor naturally, until I don’t want to labor naturally anymore. You’ll know when that time arrives. I want to be able to move about freely if I want. I would prefer to tear instead of have an episiotomy.
After birth: I want delayed cord clamping/cutting. I want to nurse my baby as soon as possible. 

These items were not in my official birth plan, but were part of my plan:

• I’ll eat and drink whatever I want, whenever I want (I did this when they weren’t around and in the case of an emergency Mr. Amen would’ve told them I had been eating and drinking).

• I’ll pray during contractions offering up my pain for my friends suffering from sub-fertility. 

• I’ll also listen to Eminem and/or Metallica to help me focus (odd choices perhaps, but there’s just no explaining my musical preferences). 

The hospital staff was OK with my plan, in that they didn’t laugh out loud or tell me absolutely no to anything in it. I think this was because I wasn’t very specific with a lot of dos and don’ts. I did what I wanted when they left the room. I was vocal about what I wanted when they were in the room. I can’t emphasize enough how helpful having Bonnie was for that piece of it. She was there for us, to make sure we had the birth we wanted (or as close as possible).

The doctor that was on-call from my practice for my delivery did not have the most pleasant bedside manner. She had actually sent me away from the hospital despite seeing that I was having regular contractions less than 7-8 minutes apart and knowing I was a VBAC and high risk. Less than two hours later her partner sent me back to the hospital because I was in active labor and should have been monitored the entire time. My delivering doctor tried to push for interventions that I didn’t want and we had to be firm with her to avoid them. As an example, as I draped my body over the birthing ball and swayed side to side during a contraction, she told us that when it stopped she would check my cervix and break my water. My doula reminded us that we didn’t want my water broken, so I was able to refuse this intervention, which did not endear us or our doula to the doctor. At that check, at 4pm, I was 6 cm dilated and 75% effaced. The doctor said, “I’ll come back to check you in two hours, but don’t get your hopes up because this is where your labor stalled out last time.” Gee, thanks for the encouragement.

After she and the nurses left the room, our doula encouraged us that I was doing great and that we were going to do everything we could to have a vaginal delivery. Bonnie had me doing lunges during my contractions to open up my pelvis and cervix. She and Mr. Amen supplied counter-pressure to my back and hips during every contraction. Bonnie massaged my neck and shoulders and used aromatherapy to help me relax.

One hour later, just after 5pm, my contractions were on top of each other. The pain was intense. My body felt loose and out of control and I couldn’t quite pull myself together. I asked for some pain medicine to take the edge off the contractions. I remember my thoughts were very clear during this part of labor. I kept thinking, “Wow! This must be transition. It’ll be over soon.” My doctor came to check me and found that I was 8cm dilated and about 85% effaced. She offered me an epidural, and I refused. They ordered an IV medication for me, but it wasn’t administered until just before I started pushing at 6pm.

 Mr. Amen asked Bonnie, “How will we know when she is ready to push?” Bonnie answered, “You’ll know because she’ll start singing a different song.” Just as she said that I felt the urge to push and I let out a low growl. He immediately recognized this as a “different song” from the incessant “no, no, no, no, no, no” whine chorus he had witnessed for the last hour. The nurse checked me and asked me not to push because I had a little lip of cervix left. She called the doctor who came right away and checked me. My water broke while being checked. I was completely dilated. There was meconium in the amniotic fluid though so they asked me not to push until the neonatologist arrived. Umm, is that even possible? When you have that urge to push, you just have to push. I liken the feeling to intestinal Armageddon: when you gotta go, you gotta go.

Twenty minutes later, after just a few pushes, I delivered a beautiful 7lb, 11oz. baby girl.

The doctor had given me an episiotomy to avoid a lateral tear, but I didn’t even feel it. The ring of fire? I didn’t notice one. Worst pain ever? Nah, I can imagine worse. Poop on the table? No one mentioned it if it happened.

I was able to nurse my daughter as soon as the neonatologist was done checking her out. I also showered on my own within 2 hours of giving birth and was otherwise up and walking around, albeit, slightly uncomfortably. I was feeling pretty good by the time I left the hospital.

The recovery from the vaginal delivery was so different from the C-section. I had a 2nd degree tear and episiotomy to heal from and that was not even comparable to anything I experienced with the C-section. The ability to get up and shower after my vaginal delivery, the ability to get up and get my baby out of the little bassinet in the hospital room, these are things that can’t compare to the limitations put on me by my C-section.

I can’t even imagine going through a C-section recovery when I am not allowed to lift more than 15 lbs. and I need to care for my newborn and my preschooler. The thought of needing to pick up my son to keep him safe or remove him from a situation (think tantrum at the grocery store where your 45 pound 3 year old refuses to come out from under the display table) and not being physically able to lift him without compromising my own health was unimaginable. Confronting the fear of the VBAC was worth it. I felt totally empowered delivering my daughter the way my body was supposed to do it. I will never forget the feeling of her body sliding out of mine. Never, never.

Within a few hours of giving birth, I was moving around easily. No difficulty getting up and down, no pain on sitting or standing. I would say that positioning for nursing was much easier without an incision to consider, though I was not able to continue nursing my daughter past the first month for reasons unrelated to the delivery.

My C-section delivery left me with physical pain, a scar, a sense of failure and a beautiful baby boy. My vaginal delivery left me with some physical discomfort, a sense of awe and accomplishment and a beautiful baby girl. In both instances, I was rewarded with incredible additions to our family, but I paid physically for each delivery in a different way.

I believe my exact words to my sweet husband in the post-partum room after my VBAC were, “I can’t wait to do that again!”

Best wishes for you as you go to the hospital prepared to pay the physical “bill” up front!