Birth Story: Successful Birth Center VBAC

I am thrilled to offer this unedited birth story on my blog.  Many thanks to the fearless mama for sharing it with me and anyone else reading.  I am thankful that my community, and in particular this CNM, is making strides to reacquaint themselves with natural, normal birth. ~ labortrials

History: 2 1/2 years ago I had a scheduled c-section with Naomi. I had something called “placenta previa,” which is a “chance” thing that can happen in a pregnancy where the placenta covers the cervix, thus making labor dangerous and a normal vaginal delivery impossible. Because placentas move during pregnancy as the uterus grows, the doctors weren’t sure until we moved back to the U.S. that I had placenta previa. I was put on bed rest to prevent labor at 34 weeks and then advised to plan our c-section for the beginning of my 37th week. Naomi’s birth wasn’t traumatic for me, but I longed to be able to experience a “normal” birth…or at least be given the chance! Even though my c-section was absolutely necessary, I soon learned that many c-sections are not truly necessary, and that many doctors nowadays are absolutely mortified to attend to vaginal births after caesarians (VBACs), due mostly to fear of lawsuits if something goes wrong (the big one being a uterine rupture at the c-section scar). As soon as I found out I was pregnant with Elijah, I began reading everything I could about VBACs so I could do my best to prepare my body for birth and minimize any risk (which, by the way, is only .5% for a uterine rupture – much less than many other “normal” complications women have in first births!). In my research, I was shocked how unnecessary many routine interventions are done in hospitals and how this might affect any woman’s labor. I was determined to not have to go to the hospital, where I would automatically tethered to an I.V. and continuous fetal monitor. So I went the other way and found a CNM (certified nurse midwife) who had just opened a birth center in town and was willing to let me experience labor. If anything were to go wrong, the birth center is only a 5 minute (or less) drive to the hospital, so we felt very secure in our decision and Jeanne’s (my midwife, pronounced “Jean-ie) experience and expertise.

My Birth Story

I was putting Naomi to bed at 7:30 on Saturday night May 8th when all of a sudden I felt a little “pop” inside me. Pregnancy brings about all kinds of weird feelings, so I wasn’t sure what this was at first, but then when it felt like I had just peed my pants, I had an idea.

I freaked out. My due date was May 21st, so this was 13 days before my due date. Of course I was saying I was “ready” for this baby to be due…but was I really READY to do it now?! I checked the fluid – clear. Good sign. It kept coming. I called Jon (who was getting off work at 8). I called my midwife to find out if the fluid could be anything else at all. Nope. My water had broken 13 days before my due date and I had 24 hours to safely have my baby (more than that after the bag of water breaks and you have to start worrying about infection). Wow. This is crazy.

I had not felt a single contraction until this point in my pregnancy. Here we go!

I was told I could start contractions right away or not until much later, even Sunday afternoon – since we didn’t know what to expect, we called my mother-in-law and asked her to take Naomi for the night, just in case. She came by, her and two of my sisters-in-law prayed for me and baby before leaving (I was still in a bit of disbelief at this point), and they took Naomi to sleep at their house.

Jon and I started to watch a movie and relax and rest. I had a meal so I could have some energy if labor started. Light contractions started at 9:00, about 5 minutes apart. I went to bed at 9:30 so we could try and get some rest. Jon slept. I tried but didn’t do a very good job. Contractions stayed at 5 minutes apart but gradually got stronger and stronger. We called our doula Ali (whom we had only met with once before! Our next meeting was to be the following monday!) and midwife Jeanne around 11:45 after they moved to 4 minutes apart and I knew I was going to have to come in within hours. Jeanne told me to call again when contractions became 2-3 minutes apart. Okay. Around 3 A.M. I asked Jon to call Ali over and we called Jeanne. Jeanne told us to meet her at the Birth Center at 3:45.

Ali arrived at our house around 3:15 and immediately started helping Jon and I through my contractions. By this time they had become strong enough for me to need to focus intently through each one. I had started moaning through them to help with  the pain, too. I had read in several books that this was a good thing to do during labor because of the relaxing, opening  effect that open, low tones have on the body. What I later found interesting was that I didn’t really think about doing this as I was doing it…it just seemed like something that was natural and that I should do! And I definitely believe it helped.

We left for the birth center around 3:45. We live a mile away from this so I was VERY grateful not to have to be in a car too long. I had one contraction in the car and did not find it very fun.  Anyway, we got settled in to the room in the Birth Center room. I was so worried that I would only be at 5 cm dilated or another low number and have quite a way to go. Jeanne checked me. 7 cm. dilated! YES! We’re getting close and I’m almost to transition! Okay, I can do this!

I got in the jacuzzi tub next and this felt SO GOOD! With Ali on one side and Jon behind me, I spent an hour in there, where things really became intense. Jeanne had been quietly preparing this whole time, candles were lit, the room was so calm and peaceful. Jeanne also checked the baby’s heart rate every 10 or 15 minutes to make sure baby was doing well (a sudden drop could mean a uterine rupture or other complication). Heart rate was perfect every time. Awesome. I had brought a bag of snacks and drinks to eat/sip during labor and then, ironically, all I wanted was ice cubes throughout the hardest part of this labor! They were heaven in my mouth – truly. After about an hour, Ali suggested I get out for a little bit to change positions again. At the same time I felt it was a good idea, I went through another contraction and OH! TIME TO PUSH! I had spent my entire transition (dilating from 8-10 cm) in the tub. Perfect! We slowly made it over to the bed, Jeanne checked me to confirm we were there (at least I think she did…things kind of got fuzzy around now). Okay, it’s go time.

Pushing was hard, and since this was my first birth, it was definitely 2 steps forward one step back. I was holding on to Ali and Jon’s hands really hard. Pushing was the most intuitive thing I have probably ever experienced. My body was working, doing what it needed to do, and it didn’t seem as if there was any other option than to just let it push. It wasn’t my decision – it was simply time to push! No stopping this train!

I’m not exactly sure how long I pushed – 45 minutes to an hour, possibly. I had no concept of time at this point. At times Jenny the nurse would put a mirror down so we could see Elijah’s head as he slowly emerged. I didn’t want to look at first but it ended up really helping me focus. My baby was coming, and I was ready to meet him! Elijah David King was born at 6:29 in the morning. Jeanne immediately put him on my chest; he started crying and it was the most amazing feeling in the world. We had done it! I had had no drugs whatsoever, felt every sensation, and was constantly in the moment, aware of my baby and the sheer power of my body doing what God intended it to do. Elijah was messy, beautiful and alert. Just amazing! I can’t describe it. Nothing had gone wrong and I feel so extremely blessed. I got my VBAC! I trusted my body and our first son was born without complication with him or me (or Jonathan’s hand…poor guy, I was gripping so hard there at the end).

I pushed out the placenta (piece of cake!) then Jeanne spent some time stitching me up (I had a 2nd degree tear…not too bad. Still a little sore as I write this, though). Jonathan, Elijah, and I laid there in the bed for quite a while, bonding and admiring each other (me still in a little bit of disbelief that I had pushed that head out of me…so amazing what the human body can do!). At least 30 minutes later, we were ready for them to clean up Elijah, so Jenny took him and weighed him (8 lbs even!) and cleaned him off and gave him back to us. We tried nursing and he immediately latched on – I had so many problems nursing Naomi so this was such a relief. I got some ibuprofen to help with my sore bottom and the strong uterine contractions (still having those a few days later as it takes 2 weeks for the uterus to return to normal size). My mother-in-law, Naomi, and a few of my sisters-in-law came and visited us a little later, bringing blueberry pancakes, eggs, bacon, and fruit. It was wonderful. Jon took a nap (figures…wimp!) but I couldn’t sleep yet. Jonathan and Ali were amazing – they supported me and cheered me on through the entire labor, moaning with me, breathing with me, telling me I was doing a good job, etc. It seems so simple, but helps so incredibly much. Who knows how much longer my labor might have been without the wonderful positive support!

We left the Birth Center around 11:45 in the morning to go home, only five hours after Elijah was born. I walked to my car, feeling sore but wonderful, still on a natural high from giving birth naturally! Elijah’s birth was the very first VBAC at this birth center!

Now, two days later, I’m still getting reacquainted with nursing, still a little sore and tired, but feeling great. Elijah’s doing so well, too, and we are completely in love with our new baby. Naomi seems to be taking well to baby brother too! She likes to come kiss him and gets concerned when he cries or she thinks he doesn’t have enough blankets. I love our little family and we feel so blessed to welcome our new, incredible miracle.


Undue Burden and Access to Evidence-Based Maternity Care

I’ve been reading Jennifer Block’s Pushed and really enjoying what a journalist can bring to childbirth advocacy.  I’ve learned many new things – what a nice surprise.  It’s not that I’ve learned everything there is to know about childbirth, but I think I got “stuck” in reading books that basically said the same thing but in different ways.

A new term for me is “undue burden.”  Wikipedia’s definition falls short, in my opinion, but between Block’s discussion of it and other internet sources, I’ve come to understand it better (at least from a layperson’s perspective) and how it might apply to a LOT of women in the childbearing years.

I’ve learned that undue burden has been applied to reproductive rights issues, specifically abortion.  However, I don’t think we advocates have worked this “angle” enough in terms of childbirth choices.  Abortion rights activists have advocated for “morally agnostic undue burden standard[s]” [1]  Likewise, I would call for an “agnostic” undue burden standard applied to childbirth.

The undue burden standard is utilized in American constitutional law and historically has been applied in such areas as abortion rights, affirmative action, tax laws, and more.  The Supreme Court applied this concept to abortion, ruling that a state can’t put up so many obstacles to abortion procedures that a woman’s individual rights are violated.  [2] An undue burden is created when obstacles are severe and/or not justified.

Do you see where I’m going with this?  I feel like I am a victim of undue burden.  I have no reason to believe that I can’t successfully birth my twins naturally.  But the state has deemed that my preference of birth venue is not valid – women with breech babies or multiples are not allowed to birth at home with a licensed midwife.  My choices are to (1) birth unassisted at home, (2) go to the hospital against my will, or (3) enlist the services of an illegal midwife.  Additionally, the only services that would be covered by my insurance are hospital services.

In most states women with breech babies have no choice but to go to the hospital for a cesarean section even though breech presentation has traditionally been referred to as a version of normal.  We’ve lost access to vaginal breech birth.

In most locations women with multiples are pressured to succumb to cesarean surgery.  A number of folks have voiced their concern for my choice to birth these babies vaginally.  They simply don’t know any better.  Luckily I have found an obstetrician who is not afraid of normal birth.  However, I realize now that he may not be there for me when it comes time to go to the hospital.  He takes a week of vacation each month of the summer and is out of town twice next month, my birth month.  I found this out accidentally from his reception staff.

It is possible that I will show up at the hospital and some OB whom I’ve never met will show up and start pressuring me into surgery or ignore (or at least be unaware) of my birth preferences.  So because the state has deemed that twins should not be birthed at home, and because my insurance company won’t cover home birth anyway, I can either “choose” to go to a hospital that doesn’t practice evidence-based obstetrics or go eff myself, I guess.

Isn’t this an example of undue burden?  Lack of access to the care of my choice?  Paying for health care that doesn’t support evidence-based maternity care and forces me to go to a specific hospital in my town with a high cesarean rate and low VBAC rate?  Unjustifiably restricting scope of practice for midwives?  Not offering alternatives/access to the type of care I require?

I don’t want to be a patient.  I don’t see any need to expose myself or my newborns to the hospital environment.  Even my 4 year old doesn’t understand why I would go to the hospital to have babies.  “Mommy, are you sick?”

Don’t get me wrong, if I or the twins needed emergency medical services, you bet we’d go to the hospital.  I’m thankful to have access to obstetrics when necessary, but I resent being forced to utilize services that go against common sense, research, and are expensive and wasteful as applied to the great majority of laboring women.

I hope natural birth advocates, women’s studies researchers and writers, and lawyers will work together to expand application of the undue burden standard to the women who don’t have access to ethical, evidence-based care in childbirth, and are forced instead to incur great expenses to access the care they desire, to hire “illegal” or “under the radar” practitioners, to utilize unwanted services and support the over-payment of those services, or to go at it alone.

Please, give me back my right to birth.  Give me back my body.

1 – “Destacking the cards…,” Gender & Sexuality Law Blog, accessed 7/18/09.
2 – Jennifer Block.  Pushed. p.262.

Things Do Change or Welcome to Waffling

I had my most recent ultrasound a couple of weeks ago.  I was pleased to find out that both babies are guestimated to be roughly the same gestational age and size.  In fact, at 28-29 weeks pregnant, they were measuring 2lbs15oz!  They’re keeping up and even slightly ahead of the average singleton of the same age!

The other piece of great news is that they are both head down . . . or at least they were during that ultrasound.  This means the likelihood of a natural birth in the hospital is more likely.  It means that hospital birth is back on the table.

A midwife told me that I’d have to pay for the birth experience that would be best for me and my family.  It’s true – if I want an optimal experience, it’ll be a huge out of pocket expense with the possibility of additional hospital expenses should 1-3 of us need additional care.  I wish I were made of money and could afford the birth experience of my dreams.  I’m not so fortunate.  This is not how healthcare or maternity care works in the US.  No, I can’t put a price on the health and well-being of our triad, but that doesn’t mean that I can afford alternative health care or maternity care at this time.  And I’m not going to feel guilty about that either, ya know?!

My personal out of pocket max from 7/1-6/30 is $2300.  My family out of pocket max is $4600.  An out of hospital birth will cost at least $3500 (if I travel) or closer to $7000 if I stay home.  I can’t ignore the math – not on my salary.

I am so glad that I have explored my options.  I am still considering these options but am back to planning my “best birth” at the local hospital with an OB and a fantastic doula (who just happens to be a wonderful homebirth midwife).

* Check back soon for my review of Your Best Birth and a book giveaway.

Absurdity of the End Game with Hospital Birth

I don’t know how else to title it.  Perhaps “Being Left at the Altar”  Or “Some OBs Value Weekends More Than Moms & Babies.”  Or “Left to the Tribe: Who Will Catch or Cut?”  Yeah, those are good ones, apt titles.  But I’ll stick with my initial title.

I’m not an OB hater, really I’m not.  There are some awesome docs out there who do wonderful things for women and their babies.  When pregnancies are truly complicated, OBs and perinatologists may be necessary.  When natural birth goes awry and babies need to be delivered by cesarean, OBs are necessary.  Most of the time, though, it’s overkill.

And then there’s someone like me who needs RE assistance for pre-conception (or an OB who’s willing to test progesterone and treat low progesterone) and regular monitoring in early pregnancy to be sure that the babies have a chance at life.  But just because I need interventions in pre-conception and pregnancy does not justify the need for interventions at birth.  I’m deemed high risk for many reasons this time – I’m old, my scarred uterus, twins.

My OB and I have agreed . . . no induction, no augmentation.  That increases my risk of uterine rupture.  My OB and I do not agree . . . I don’t believe that having twins puts my scar at greater risk during labor, mostly because I haven’t found any evidence that supports the claim.  If the risk is there in labor then it’s there just being pregnant.  I reminded him that the composition of the lower uterine segment (mostly fibrous, less contraction) is different from the contracting portions of the uterus.  He had to agree.

But most simply stated: I don’t feel high risk.

So why the title of this blog.  Yes, perhaps I digressed.

I am not assured of getting my OB after hours or especially on weekends.  The call group in this town is large and shared among many practices.  Excuse me . . . but I chose my OB specifically for his track record with lower-interventive birth and “natural” delivery of twins.  I didn’t choose him and the rest of the tribe here in town.

Additionally, if it were to turn surgical . . . I may not know who my surgeon is?  What???  In any other medical specialty this is NOT how it’s done.  This is what is absurd – you spend 30 or so weeks cultivating a relationship with a particular provider only to be left at the altar at week 40?  Only to be cut open by a complete stranger?  Only to be cut open by a complete stranger whose surgical skills are completely unknown to you?  Whereas if you need hand surgery you meet with a surgeon a couple of times, be sure that this is the right surgeon for you, and that surgeon does the surgery!

Why is this acceptable?  How do we put pressure on the tribe to be accountable to their patients.  How do we convince docs to break up into smaller call groups of similar-minded similarly-practicing docs and be sure that women know and have interfaced with these docs at least once during pregnancy?

Tribal obstetrics is selfish.  It’s lazy.  It’s unjustifiable.  Docs, if you didn’t want to serve your patients, you should have chosen another field.

Vague Musings

It feels like an eternity since I wrote anything authentic and of substance, but I’m fighting my way back.  I’ve been in survival mode, in a way, since finding out I was pregnant in December.  I was excited and terrified, and it was all I could do to stay sane and work my job and meet my family’s needs.  Now that I am 24 weeks pregnant and doing well, the semester is nearly over, and family life will be more simple with me in town, it’s time to direct my attention to me and these babies!

I have had a lot of ultrasounds with this pregnancy.  As much as I have read about the controversy regarding the safety of ultrasound (search for Sarah Buckley’s articles on the subject, for instance), they were absolutely necessary for me and my husband.  I’ve also noticed things . . . like Baby A seems to be a pretty “chill” baby and insists on snuggling down on top of the birth canal.  Baby B, on the other hand, appears to be a terror.  Heartrate is usually about 10 points higher than her sibling’s, and this baby is always in motion.

I’m concerned about my pelvis and sacrum – they’ve already been giving me grief.  Thankfully my visits to the chiropractor help with this immensely.  My chiropractor also helps release excess tension in my round ligaments.  But the babies seem to prefer breech and transverse positions.  Rats!  I’m only 24 weeks, so there’s time, I know this, but again, the pattern they have established has been marked by malposition.

I haven’t talked to my OB about VBAC since our first appointment back in January.  He’s the most likely OB in town to support VBAC, natural birth of twins, and even twin VBAC.  However, my history has him a bit spooked.  Perhaps the babies’ presentations will take all of this out of the equasion, I don’t know, but it is getting close to time to talk with him about natural birth again.  Hopefully by now he can tell that I’m not some ill-informed, emotionally-driven crazy feminist or something.  I don’t know.  But I don’t look forward to revisiting the issue with him.

I haven’t been proactive about pregnancy exercise or further education.  I’m rereading sections of The Business of Being Born, and that’s helping me find my fire again, I think.  I also just e-mailed a doula/CBE in my community for advice.  I’m hoping to review My Best Birth sometime in the near future – I’m sure that’ll help.  I should probably read something by Michel Odent, Silent Knife (Wainer), or Pushed (Block).

I just feel very alone.  Sure on-line communities help . . . they’re awesome support, but they don’t substitute for face-to-face support.  The natural birth community here lost much momentum and power when Dr. Montgomery died.  He ran the only free-standing birth center and employed a handful of talented, caring CNMs.  We’re down to two CNMs in town who have hospital priviledges.  I’ve been risked out of homebirth because of the twins, so I’m forced to “choose” the hospital.  As I posted at another location today, “I’m at McDonalds trying to fashion a crappy meat-like patty into a steak.”

What drew me to childbirth advocacy

I received an excellent question from a Facebook friend the other day.  And even though my response is brief, I suppose this might be a question that a lot of folks have for people like me!

“So I’m curious… What led you to become involved with ICAN? Personal experience or passionate commitment to natural childbirth? Or both?”   “I am always interested in how people come to be involved in this kind of advocacy.”

My brief response:

I had a cesarean in 2004 and didn’t fully understand the impact of it until much later. I joined ICAN when it was time to try for another baby and have been involved ever since. So, now it’s personal experience as well as passionate commitment to evidence-based practices in obstetrics as well as spreading the word about the benefits of natural childbirth, VBAC, homebirth, birth plans, doulas, midwives, whatever! Also, I’m very concerned about the national cesarean rate and our local rate in Missoula. That’s it in a nutshell!!

And of course I suggested that she have a look at my blog!

Anatomy and Physiology of a VBAC Ban

I’m doing research for an upcoming presentation for Happy Mama regarding VBAC Bans.  We’re finally at the point in my community where this issue has to be addressed head on.  VBACs aren’t actually banned in Missoula at Community Medical Center, but they are rare because of the criteria in place discouraging women from having a vaginal birth after one or more cesareans.  This is NOT an evidence-based practice – to obstruct women’s access to natural birth.  What is more concerning regarding the medical climate in Missoula is that the cesarean rate is above 31% and therefore on par with the national average which is already twice the rate recommended by the World Health Organization.  According the the CMC website:

More babies are born at Community Medical Center than any other hospital in Montana. CMC is the hospital of choice for many families because family-centered care is accentuated in obstetric and newborn services.

All the more reason to ensure that CMC is providing the highest level of ethical, supportive, and evidence-based care.  First, I will contact Tracey Thompson, the Director of Women’s & Children’s Services at the hospital.  I’ve talked with her before, but when I called in a more formal capacity as an ICAN leader, she didn’t return my call.  If I do not receive what I need from her, I’ll call and talk with a labor & delivery nurse.  Depending on what I find out, I will contact the hospital’s Board of Directors and the President & CEO, Steve Carlson.

I am investigating discrepancies that have been reported regarding Community’s VBAC policy.  I have been told that the OB must be bed-side when overseeing a VBAC.  (Not great for mom; not great for the doc; not great for the doc’s other patients.)  I have been told that the OB must be on campus when a VBAC patient is in labor.  This has been particularly problematic for Dr. Lynn Montgomery’s practice, since his birth center is about 3 whole minutes from the hospital and therefore NOT on campus.  [Lynn Montgomery died from a massive heart attack at age 51.  I do need to write about him.  He is sorely missed in our community.]  Since Dr. Montgomery’s death, his CNMs have lost their privileges at the hospital.  Isn’t that horrible?  And it is my understanding that area OBs are more than happy to take business away from the birth center (sure we’ll take your clients) but won’t back up the CNMs at the hospital or donate their services temporarily to help keep the Birth Center in business.  More on that later.

Here are excellent resources to consult when you have questions about VBAC Bans:

VBAC Ban Stories & News

Google search: “VBAC ban” petition

Additional Resources

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