This birth story really begins as far back as December 2004 as the birth of my first child ended in cesarean. Since then I’ve struggled with the knowledge that choices can be quite limited for families desiring vaginal births after a cesarean (or two or more). I endured pregnancy loss due in part to the build-up of adenomyosis on the anterior (front) side of my uterus, another cesarean with the twins in August 2009, and difficulty finding the right care provider who would honor my wishes for a vaginal birth after 2 cesareans (VBA2C).
I planned for a homebirth. Thank goodness that VBA2C is not out of the scope of practice for homebirth midwifery. It often (always?) is for our local CNMs, and most of our doctors in town will NOT attend VBAmC. Just before Christmas I was ready to be done with OB care. However, my midwife encouraged me to consider maintaining what we call “shadow care” (when you see an OB and don’t tell him/her that you’re not planning on birthing with them at the hospital).
I knew my current OB was not the right one for my situation. I believe that at my first prenatal appointment with him he said, “You know you’re really not a candidate for vaginal birth.” Additionally, I knew from the previous pregnancy that he takes a week off every month in the summers and does not usually come in for births when he’s not on call. This is important information to know especially when you’re planning a hospital VBAC!
Several friends used one particular doctor here in town. I was impressed with how he handled my close friend’s complicated pregnancy and even got to see him in action at her baby’s birth. However, at my first appointment with him, when I mentioned that I was very motivated for a VBA2C, he interrupted me to say . . . “Don’t do it. Don’t do it,” shaking his head and speaking in a patronizing tone. Of course I cried. The rest of the appointment was like fencing . . . but with words. He did his best to dissuade me, and a less informed (with regard to the rights of childbearing women and the appropriateness of my request/choice) woman probably would have given up at that point. Some of my appointments with this doc were easy and others were quite upsetting.
At my 40 week appointment he told me that 41.5 weeks was his limit on my pregnancy. He had his office schedule me for a cesarean for Monday, July 11 at 1:30pm. To his credit he would have done Tuesday but the surgical schedule was already full (creepy, eh?). I wasn’t sure I agreed with his expert opinion on the risks associated with post dates pregnancies, but I knew that I didn’t consider 41.5 weeks to actually be post term! It was easy enough (not that I didn’t cry afterwards) to agree to the surgery date because I never thought I’d need to challenge it.
That Tuesday turned into Wednesday which all of a sudden was pushing into the weekend. I started seeing an acupuncturist. I increased my walking. I started pumping some. Friday we decided it was time for castor oil and another ‘cervical massage’ with my midwife. The castor oil took effect an hour after consumption, and then the worst of it was over about 45 minutes later. Unfortunately, the baby had backed out of my pelvis that week. So whereas I was 50%/1cm/-2 station the previous Friday, this week I was more effaced, but the cervix was harder to reach, and the baby was now up around -4. I was contracting and tried to encourage the baby into a more favorable position, but ultimately we decided to stop and go to bed.
I was very concerned by one of the suggestions made by my midwife. She thought that perhaps if we could get a good labor pattern going, that I should go to the hospital so that in case the contractions slowed or stopped that I could be augmented with pitocin. I read more into that comment than did my DH. It just really threw me off. Didn’t she realize that although vaginal birth was the goal; that I wanted to do this at home? Didn’t she realize that I saw going to the hospital as a last resort!!! Furthermore, I felt like this meant she didn’t think I could do this – at home, perhaps at all. It really threw me off.
I contracted some throughout the night, and after another bout of sickness the next morning, I had some pretty good contractions until midday on Saturday. We decided to take the rest of the day off from actively trying to put me into labor. It was tough for me to stay focused on anything else since Monday was coming. I went to church on Sunday with my oldest and wept through the entire service. God was talking to me – telling me to trust the intelligent design of his creation and cautioning me against the ‘wisdom’ of science. I couldn’t possibly be more specific than that, but the readings and the sermon all affirmed what I felt with every inch of my being – that the scheduled cesarean was simply WRONG.
I asked my midwife to come over Sunday evening to check me. I was hoping that the position changes, and ball sitting, and bouncing, and jiggling would get the baby into a better position. However, it hadn’t. My DH and I told our midwife that we were canceling the cesarean for the next day anyway, and were just going to have to hope that labor would start before she’d need to risk us out of her care (42 weeks).
Monday came, and I felt great. No contracting or anything – I felt like a normal pregnant lady. I called the hospital and cancelled the surgery. My husband called the doctor’s office and let them know. The doctor called my DH’s cell phone soon after and was pretty upset. He wanted to talk to me, unfortunately, and finally around noon I called him back. He tried to make me feel like I had broken some ‘deal.’ I explained to him that me canceling the surgery was no different than his insistence on scheduling it in the first place. That too was done without both parties really agreeing on it. He didn’t see it that way. He didn’t appreciate that I was on the one hand asking for his expert opinion and other the other hand rejecting his expertise. I can see how he feels that way, but I think he’s not used to women exercising their right to participate in their own care.
Why did I cancel the cesarean?
- After doing my own research (including Web of Science searches for scientific studies), I did not believe that a 41.5 week cesarean was necessary.
- The BPP performed days earlier was perfect; the placenta was hardly showing any age.
- My baby was not “late;” she was gestating.
- I did not want to endure another surgery unless absolutely necessary.
- I believed that I could birth my baby normally.
- I felt supported by my midwife and knew that I wouldn’t need to be risked out of a midwife’s care until at least 42 weeks.
Or so I thought . . .
I spoke with my midwife on Monday morning, and she was still recommending trying to get labor started and then going to the hospital. This way I’d meet the terms set down by the OB. (He told me that I needed to check into the hospital that day or I’d be AMA.) I thought that made sense, somehow, and I reported back to my husband. DH did not understand why she was still suggesting the hospital. He knew that going to the hospital before labor was well-established was risky. He decided to call our midwife.
Get this. He finally gets the truth. She’s no longer comfortable with me birthing at home. She thinks my chances of birthing vaginally are higher at the hospital?? She didn’t like how my nervous system was responding to the castor oil induced sickness. (Basically, I can get pretty weak and faint when I’m that ill. I have passed out a couple of times in the past because of vaso vagal syncope.) DH had been regaling her with tales of me passing out after wisdom teeth surgery. Wish he had kept his big mouth shut. Wish she had told us THEN that she was concerned.
So . . . there we are . . . Monday morning. AMA. Without midwife too. Totally fu#&3d.
I took a long “fast” walk with my father-in-law. DH came home in the early afternoon. I took the rest of the castor oil and waited to get sick again. We decided to take a nap. I couldn’t sleep. I didn’t get sick. Nothing was happening. We packed for the hospital.
I was on the phone with an ICAN / Birth After Cesarean (BAC) friend, freaking out, not knowing what to do and when to do it. I think I was pumping too. Right at about 7pm I felt some wickedly strong contractions. My stomach was rock hard & distorted. It didn’t feel “normal.” Then I felt a ‘pop,’ but it wasn’t my water breaking. It felt like something in my pelvis. (I still have no idea what that could have been.) I was concerned, actually, about the strength and frequency of those contractions. We decided to get to the hospital quickly so I could get on a monitor and check on the baby.
The OB showed up for me. He wasn’t on call. Bless him – that’s a good good man. Of course, he was not happy with me . . . and he wasn’t happy with what the monitor was telling him either. My baby was having late decelerations from the contractions.
I was effaced but hardly dilated, and the baby wasn’t engaged in the pelvis. Things were not looking so good. Pretty soon I was restricted to the bed. That was agonizing – the only positions that felt good to me were upright. The only positions that gave us a chance at calming Gillian down were side to side. I was stuck in bed at 2cm for what seemed like an eternity. Pretty soon I was asking for an epidural. I knew that I was in so much pain, especially due to the bed restriction, that I’d never be able to endure it all. I assumed that dilation was going to take a long time.
Finally I hit 4cm and was given an intrathecal with an epidural. I went quickly from 4cm to 8cm. Gillian was doing better as well. However, she wasn’t descending. I got stuck at 8cm for what seemed like forever. The intrathecal wore off, and the epidural was turned on. However, the epidural wasn’t working well, and I had to be given a bolus. (All that was going through my mind was the fear that I’d feel them cutting when they did the eventual c-section.)
At one point the OB came back in, and since there had been no change, he gave me a deadline. He told us to try different positions (Gillian’s heart rate was just fine at this point) for the next hour or so. If there was still no change, we’d have to “talk.” Trying to change positions when you can’t feel your legs is quite an interesting challenge. But I did it. Lots of tailor sitting and some asymmetrical positions as well. I was terrified for the OB to return. DH & I were starting to plan our “defense” when he came back in.
Here’s where I admit that I haven’t touched this birth story since September 2011 and guess what . . . now it’s March 2015. My story stopped there above. How interesting. I know that a big part of that was how upset I was about my gap in care. I still feel anger – nearly 4 years later. It’s not anger for myself – it’s anger and fear for other mamas & babies.
So what happened next . . .
I called one of my best friends in the middle of the night and had her talk me through the darkness of stalled at 8cm. I kept trying strange asymmetrical positions even though I was completely numb in my lower body.
The doctor came back in at his next “check in” point, and did an exam. He was frustrated that I wasn’t fully dilated then . . . wait a minute . . . “Will you push?!” I’m thinking, “on an incomplete cervix are you crazy?!” but of course complied. After a few light pushes, my baby was ready to go. I was like instantly complete and we were ready to get the party started.
My doctor, my OB, my surgeon . . . my labor coach!
My doctor, my OB, my surgeon – he was the most amazing labor coach! I had no idea how talented he was until we were in the thick of it. He helped me birth a fairly sizeable baby vaginally after 2 cesareans, and my perineum did not even tear! I gave him a scare because I had an internal-ish hemorrhage (not uterine) that required immediate attention.
I have to tell you that I birthed my largest baby vaginally. My poor insufficient pelvis that couldn’t birth my smaller baby in 2004 (labeled CPD) was somehow miraculously (detect my sarcasm please) able to squeeze out a huge baby in 30 minutes. Just wanted to put that out there.
After that things went to hell in a handbasket because the epidural lowered my blood pressure, and I kept passing out. But at the end of the day, I was safe, my baby was safe, I hadn’t been cut up, and the birth had been a success. It wasn’t exactly what I had hoped for, but I was so happy. I just wish that I could have felt (internally felt) my baby being born. I had been so afraid of the epidural not working (in the likely event that I’d need a c/s), that I over-doped myself on the stuff.
I can’t help but think that my baby’s birth has a lot to do with the super strong bond we have. I am more tightly bonded to her than her 3 siblings. She is more well-adjusted than her surgically-born sisters. She is more compliant and joyful. I am more joyful with her. Maybe it’s because she’s the baby. Maybe I’m reading into it all. Or maybe not . . .
This is the end of birth for me. I still have moments of regret for not having the perfect birth, for not having an unmedicated birth, for not having a homebirth, etc. However, I realize that my last child’s birth was life changing: perhaps not only for me. Maybe my own daughters will have more faith in their own bodies since I finally had a vaginal birth? Maybe I broke the cycle of cesarean for the women of my family? Maybe I helped other women in my community (and the doctors as well) see that there are options (along with risks)?
This is the end. . .
This is the end of birth for me. I dedicate this story to you. May it help you find your path – as a mother, as a caregiver, as a supportive family member or friend. This story – this birth. She is for you.