Little Ollie, our little man.
My first birth (to my daughter Stella who is now almost eight years old) ended in an emergency Caesarean Section after 29 hours of labor, an epidural, and Stella releasing meconium (poop) and inhaling it during my brief period of pushing. The water broke very early in my labor and I am now pretty sure Stella got stuck in the birth canal due to her posterior position and was unable to turn to a more conducive position for birthing due to the lack of padding usually provided by the amniotic sac. A posterior position means her back was against my spine, with her face up ("sunny side up"), which resulted in back labor and caused me some crazy, unbelievable pain. Stella was also two full weeks late and weighed ten pounds on. the. dot. at birth. Of course birthing a baby that large is entirely doable (even I did it the second time around), but it wasn't helpful.
After Stella was born, she spent the first few nights of her life in the N.I.C.U. getting respiratory therapy, while I started developing an infection. Not of my surgery scar, but from some injury during the surgery which caused the release of blood into my abdomen. I was in increasingly terrible pain, which required a second surgery to relieve AND a second week of hospital stay. To top it all off, Stella, who had been staying in the surgical recovery ward with David and I, caught a virus and was rushed across the city to another hospital for a spinal tap and treatment. All the while I was "pumping and dumping" to keep the milk flow going for the day when I wouldn't be full of Barium or morphine and could start breast feeding Stella again. The whole experience left us totally shellshocked and mortified to think of going through anything like that again.
I should note here that we all survived this experience just fine. We had the absolute opposite birth of anyone in our birthing class or my mommies' group or anyone I'd ever heard of. The nightmare story. And we came out totally fine. Stella went on to breastfeed for 34 months and is very healthy.
We also found a doula. An incredible woman named Sandra Lloyd, a doula who specializes in VBACs and is also well known and respected at the hospital where I gave birth. Her kindness, strength and involvement in the whole process was the reason I was able to get to the 40th week without a doctor forcing another C-section on me. Through her guidance we were able to keep positive and always in the frame of mind that there was no reason that I couldn't do this. Essential.
That's where the fun stuff ends. Because at my first OB/GYN appointment I was surprised to find my new doctor at this very forward-thinking hospital to be so very against me having a VBAC. He knew the size of my babies (big), he knew about my birthing history with Stella, and he was scared for my uterus. I understood his fears, but he was unflinching and we butted heads the entire pregnancy. He required me to have the baby monitored for size repeated times, even going so far as requiring me to schedule an appointment for a Caesarean section the day after my due date, which happens to be right before Labor Day and there were no doctors around to schedule with, which would mean going to an entirely different city to have the baby. As a hormonal and anxious and excited expectant mother, those last two weeks of the waiting game before my due date were filled with tears and fears. Sandra comforted me after every negative, contentious prenatal appointment, telling me over and over that the size of the baby couldn't be accurately measured and that it didn't really matter anyway. She had facilitated many births of "large" babies via VBAC. She had me focus on the one thing that totally did me in the first time: fetal position.
As I mentioned before, Stella had been stuck in the birth canal in a posterior position, her back to my back, her spine pushing on and trying to slide past mine. They say you forget the pain of labor, but I never forgot that. So with Oliver, I spent the last three months of my pregnancy doing literally 200-300 cat-cows a day. This kept the weight of Oliver's back flipped down and kept him facing my spine in the anterior position. Additionally, I never, EVER sat back in a chair. NEVER. I never gave that little guy a chance to pivot and lay back and rest on my spine, he was always slung forward in my belly.
Then I got lucky. The night BEFORE my due date, right after the Daily Show was over and I had finished 100 cat-cows, the contractions started. By seven o'clock the next morning we were at the hospital, with our beautiful diva doula in full make-up and hair (how we love that woman), and I was eight and a half centimeters dilated, psyched, and ready to rock the rest of the way.
Four hours later, I hadn't moved along at all. Sandra was doing everything she could to lessen the pain and keep me open, but my cervix had just stalled out. And then I got lucky again. The nurse on that shift had been a midwife in Australia and was able to get the staff to just let us be for hours and hours. She had a chart in her pocket which allowed her to see how much farther Oliver's head needed to turn to be in a perfect anterior position for pushing, based on the position of his fontanelles. This is when we enlisted the help of an epidural, which at about seventeen hours in I was happy to receive after a little coaxing from Sandra. An epidural can help relax your body just enough to let those small shifts happen with the baby and the cervix, and my main goal was to have Oliver come out the door, not the window, so I was all for it.
Then there was a lot of waiting. Waiting for Oliver to get perfectly aligned, waiting for my cervix to finish widening. There was a period of time where we were all exhausted and I started to really lose my motivation. David slept for a minute, and Sandra sat in the corner, meditating and calling on what she calls The Great Mother to help give me the strength to finish birthing the baby.
Hours and hours later (another 19 hour labor and another ten pound baby if you can believe it) we were so happy to get the okay for pushing. I pushed and pushed. I wanted another epidural, because once you've had the relief of an epidural and it starts to wear off, the pain seems to hurt even more! I couldn't have another epidural because I would've lost the control I needed to push. I hung from a bar and faked it while everyone counted through the contractions. About a half hour into the pushing, the attending physician decided it was go time. She gave me only one half hour more to get the baby out.
I remember the only thing I could think about at that point was that I really didn't want to disappoint Sandra after all of the work she had put into this. There was a cast of thousands in the room at that time: doctors for the "oversized" baby, nurses to assist with the post-VBAC business, probably a couple of residents, David, Sandra, and me. So I just went ballistic and pushed like I had no feelings at all and I was only made for pushing. And then out came Oliver.
Here's where it gets a little ugly, and I got lucky a third time. Before I went into labor, I pictured myself holding and nursing my newborn baby right away, with the umbilical cord still attached and the great bond beginning immediately. This is what most Caesarean birth mothers miss out on. But right after Oliver popped out I became instantly freezing cold. I told David to take the baby. I didn't realize what was going on, and neither did David until about twenty minutes after the birth, when the attending doctor took a phone call from between my legs and said "I can't talk, I've got an emergency". I was losing a lot of blood, really fast. I had just pushed out what looked like the biggest placenta in the world (see for yourself down below) and my uterus just wouldn't close up. It took two hours to stop the bleeding.
Eventually they did stop the bleeding with much massaging of my uterus and shots of oxytocin to the leg. We were able to settle in with Oliver and start him nursing. I received so much saline after Oliver's birth that my body and face were swollen like a prize-fighter's for days. I ended up losing a liter or two of blood, and before I was released from the hospital I received a fairly large blood transfusion, which I protested against as long as I could, but ultimately realized I needed. The day after Oliver was born my OB/GYN was making the rounds and came by our room. We chatted a little about the birth (he wasn't the attending doctor at the birth), and the last thing he said to me was "I guess you are really into brinksmanship". A dick thing to say, but I guess I was.
In the end, I was so happy that I was able to squeeze Oliver out without having to undergo another major surgery like a C-section. At that time David was about to start a new job far out of town, Stella was starting preschool all the way across the city, and I needed to be able to strap Oliver to my chest and make my way around the city to get Stella where she needed to be on public transit. So, along with it making me feel like a pretty strong lady, having a VBAC made my life so much easier than someone recovering from having their stomach and uterus cut open again.
I do feel like for someone with my previous birthing history that a VBAC was a little risky, and I can't totally endorse a VBAC in every case. But here is a recap of some of the things that I think led to my successful VBAC:
1. Find a hospital that is pro-VBAC.
We are so lucky that here in San Francisco there is a major health care provider (Kaiser Permanente) with such a great VBAC track record. I have a dear friend in upstate New York who was never given the choice as none of the hospitals in her insurance plan were prepared to deal with VBACs.
2. Find a doula or other professional that will be there at the time of the birth, at the doctor's appointments if you need an advocate, and throughout the pregnancy.
Especially one who is very experienced with VBACs. And trust her, as she most likely has WAY more experience with all this jazz than you do. Our doula Sandra is the number one reason we were equipped for Oliver's birth, and she was so critical at the actual event.
3. Examine why you think you had a Caesarean section the first time.
In my case, I think it was the fetal position and my water breaking very early in labor. That can't necessarily be controlled, but David and I think we caused my water to break during my first labor by some swinging moves we were doing with a blanket to my belly to relieve the labor pains. Find ways to reduce the risk of the causes of your Caesarean happening the second time around.
4. Be lucky.
What can I say? My labor started naturally in the nick of time, and the right people were in the right places for us at the right times. I definitely did not have luck on my side when Stella was born.
I am really happy that mine was a successful VBAC. I had craved laboring again and am so thrilled to have experienced pushing out a baby. But as most people know, as much as you can get very wrapped up in all of that business while you are hopeful and pregnant, years later when your baby is a toddler or a preschooler and is sweeping you off your feet, it won't matter quite that much, if at all.
4.45 kilos = 9.81057 pounds = TEN POUNDS TO ME.
That's Sandra, our amazing doula. :)