HBAC with PROM, Fast Dilation, Long Pushing Stage {Previous Cesarean with Twins}

by Birth Without Fear on March 4, 2013

My water broke at 10pm on Saturday night. It was a distinct popping sensation, followed by a gush of fluid that left me in no doubt about what had just happened. It was the night before my due date, and one way or another, my third son would be earthside soon.

Now, maybe I should back up to clarify that this was the night before my earliest due date. I’d had three at this point. One based on the standard 40 weeks after last menstrual period. Then another, slightly sooner, accounting for a shorter-than-average cycle & meticulous record keeping. Then another even sooner based on baby’s bigger than average size at my 20-week sono.

Having that sonogram not only changed my due date, but filled my heart with so much reassurance. You see, this was my third son, but only my second pregnancy as last time, I’d had twin boys. I’d had my first sonogram with them at 11 weeks because something told me it was necessary. That day we’d discovered that I was both pregnant with twins, and that they had some developmental issues which would bear watching. I threw myself into research to combat the fear of that pregnancy. I learned about twin pregnancies. Twin infancies. Each of the health issues they had. I learned and learned and learned about everything but informed birth.

Ultimately, I had eleven more sonograms of varying types for my twins. And they were born prematurely, at 35 weeks, growth restricted and via cesarean section without a single contraction, let alone a trial of labor. A whopping three and four pounds respectively. Had I known then what I know now, different decisions may have been made, or may not, but ultimately what I regret most about that pregnancy & birth was that I made their birth decisions based on fear, not solid information combined with faith in God. Oh, regret.

So fast forward to my first, and only, sonogram with what I now knew was a sweet singleton boy. I watched the acronyms and abbreviations pop up on the screen and read them out to my husband through tears of joy. Average. Healthy. A few days big. This was a boon to my mama’s heart and seemed like nothing short of a miracle.

I’d been introduced to the beauty of natural birth about a year before that sono, when a dear friend asked me to photograph her out-of-hospital birth center birth. Friends, I dearly hope she shares that birth some day because watching it through my camera absolutely changed me. She gave me such a gift. And I began to learn and learn and learn again, but this time there was no going back to the old obstetrical model of care.

So when I discovered I was pregnant a second time, I found a great home birth midwife, and set out to make things different. I researched & prayed & waited. There were a million legal reasons I might have to transfer my care to an OB, but every time I prayed about that fear, the gentle answer I would receive was, “Then I’ll walk with you through that, too.” The last pregnancy had been about fear. This one was about learning to trust.

So my water broke on Saturday night. I text my midwife, doula and my sweet friend whose birth I’d photographed, who had agreed to be photographer for me. I told them I’d not had any contractions, but my water was definitely broken and I’d keep them informed. My husband and I straightened up a bit, gathered our birth supplies, and I went to bed envisioning my Sunday baby.

I had irregular, light contractions all that night. They were tough to sleep through, but that was anticipation talking more than pain. I finally gave up on sleep about 7 am & woke my husband so he could get the twins up & ready to spend the day with their grandparents. Contractions started to become regular around 9 or 9:30 am, mostly because my midwife suggested the use of castor oil & my body revolted against that plan. Or so I believe.

My wonderful doula arrived just before the big boys left, around 10, and the midwife arrived to check me out not long after that. Things were going beautifully, if slowly, so I continued to labor in peace while my midwife left to check on another mama. The day passed and I tried everything. Every trick in the bag. My midwife had returned, my doula never left, and I was bouncing in and out of labor land. My husband was a rock for me the entire time, holding my hand, holding me up physically and emotionally all day long. Finally, the midwife checked me about 8pm for the first time. 22 hours after my water had broken and I was dilated a whopping 4 centimeters. I’d read enough birth stories at this point not to be discouraged, though. I knew it could change rapidly at any point.

So my midwife suggested I get into the birth tub, a true miracle of the modern age, and gave me the go ahead to try some “grunty pushing.” That was an hour of bliss. It felt so, so good to take some action. I was horrible at letting labor just happen, awful at relaxing through the contractions. Pushing. Was. GOOD. And by the end of that hour in the tub I was fully dilated and ready to push for real. It was 9pm on Sunday.

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Again, we tried everything. Every position. EVERY position. I pushed and pushed and talked and grunted and moaned. People kept telling me to stop sending all my power out through my voice and start sending it down through my body, and I knew that was good advice but try as I may I couldn’t make that happen. I was pushing to a mental count of 15, but my body was only effectively pushing for a couple seconds of that time. I just couldn’t figure out how to make my body do what I wanted it to. I was frustrated, exhausted and so disappointed in myself. Why couldn’t I make it work?

Finally, around 3am on Monday, my midwife began to talk about transfer to a hospital. She was well past the limit of what she was technically allowed to let me do while she attended me. This was true, but at the time I didn’t realize she was making a play to see if I could kick it into high gear. I cried and begged her not to give up on me. I prayed aloud. My husband went through the house hurriedly packing us a hospital bag. I pushed with all I could muster, but at this point I’d lost three nights of sleep and my tank was empty. Not just mine, but my whole birth team as well. My friend and photographer told me later that she was wondering if she’d even be able to drive a car to the hospital through the haze of exhaustion and tropical storm Isaac, which had set in hours before. There were buckets and buckets of rain and heavy wind howling around outside going unnoticed by me.

My midwife eventually relented, and made a deal with me. If I could lie down in my bed for an hour, stop pushing and relax as much as possible through the contractions to help recharge my battery, then she’d agree to help me push a while more before we decided to transfer. I agreed; I would have agreed to almost anything to keep me out of the hospital. Everyone lay down, including me, and for about 2 contractions I really tried my best to resist pushing. But that was really, truly the only part of the birth that was genuinely awful. I’d reached the point when my body just couldn’t be ignored. I tried to sleep between contractions, and push as gently as I could when a contraction came on. I just couldn’t NOT push, though.

I have no idea how long I lasted that way, it could have been 5 minutes or an hour, before the midwife’s assistant came in to check on me & take the baby’s vitals. She never ended up leaving because it was clear to both of us that I was fighting a losing battle. She knelt next to the bed, encouraged me, soothed me & did everything she could to help. I’m not sure how it happened, but everyone was eventually back in the room and we were working in earnest again.

My doula was pressing on my belly with the contractions, which felt wonderful, and getting me to drink, and then chew ice. My bladder had become painfully full while I lay down, but the baby was pressing too hard on it even for a catheter to be inserted (we did try!), so it simply had to be lived with. The midwife & her assistant were applying warm compresses, anointing me with what seemed like buckets of warm olive oil, checking heart tones and encouraging me. Everyone present was holding a leg or a hand, working incredibly hard right alongside me. I never learned to make my body work exactly the way I wanted it to, but my pushes became somewhat more effective than they had been earlier in the evening, and after several more hours, my sweet baby boy finally made his way out.

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Fist up against one side of his face, cord looped up against the other, he still managed to cope with the long labor and pushing beautifully. He made his big debut at 8:06am on Monday; 34 hours after my water broke, 11 hours after I started pushing in earnest. My doula asked me, as I was sitting up in bed holding my brand new son what I’d thought: I admitted it was much, much harder than I thought it would be. But also that I’d never do it any other way. This was the complete opposite of how I’d felt after my section. That day I’d felt that the pain was never as bad as it had been advertised, but also that I never, ever wanted to go through that again. This, THIS day was the day I had wanted all along. This was me getting the desire of my heart, and also learning just how much work I’d put in to get it. And, above all, knowing that God had walked with me every single step of the way. It was the hardest, and also the best, thing I’ve ever done.

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Birth photos by Tara Rojas at Tara Lynn Photography

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