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Maternal Death and the United States {Birth Without Fear}

Maternal Death and the United States {Birth Without Fear}

Maternal Death – the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. (WHO)

This is a subject no one really wants to talk about. Mothers die. Mothers die in pregnancy and childbirth and just after birth. The weight of that reality is just so heavy and heart breaking. In our current birth culture, fear reigns. However, fear reigns without reason or knowledge of what really needs fear. And of course – all of us hope to Birth Without Fear. And so, I approach this subject with a heavy heart but hope as well.

Samantha's Birth

Where Does It Happen?

In short, it happens everywhere. However, some areas are more prone than others. This can be due to lack of care – think of sub-Saharan Africa or rural villages in some undeveloped countries. Maternal death in those areas is an unfortunate fact of life (though organizations are striving to change this).

But apart from the “obvious” places, where do you suppose it happens? Perhaps war-stricken places, or those places without advanced medical facilities? Would it surprise you to know that the United States has one of the highest maternal mortality rates in the developed world?

Yes – you read that right. Our current maternal mortality rate is 21 deaths per 100,000 live births as of 2010 (WHO). This rate went up from 2005 (18/100,000). The 2010 “Healthy People” Goal for the United States was set at 4.3/100,000 – we grievously missed that by a large margin. The 2020 goal is 11.4/100,000, which would only be a 10% decrease from what the US considers to be its current statistic (the 12.7/100,000). I find it interesting that the government decided after they missed the 2010 goal that maybe they should try less to save mothers, since their efforts before had no effect and saw a rise in deaths.

The WHO number is adjusted from the number reported by the CDC (12.7/100,000) – this is because the United States does not have a universal system of reporting maternal deaths and the CDC admits that our numbers are drastically under reported due to this lack of uniformity in reporting (See this CDC publication, specifically page 20). Currently, only 25 states make it mandatory to state that a death was pregnancy related on the death certificate – and even this method is questionable due to lack of doctor training in filling out certificates and the great fear of litigation in the medical system. Ina May Gaskin writes about the lack of reporting here.

Other countries have much better standards of reporting. The “gold standard” is considered to the be reporting system in place in the United Kingdom. The UK ensures that not only is every death reported, but they also compile the deaths and reasons for them in a report every three years. This report is available to the public and the locations and names of the deaths remain confidential. This allows the nation and the nation’s health workers to look at the issues without fear of litigation – meaning they have no reason to hide maternal deaths.

To provide some perspective, here are the rates of some other countries:

  • Australia: 7/100,000
  • Brazil: 56/100,000
  • Denmark: 12/100,000
  • Germany: 7/100,000
  • Israel: 7/100,000
  • Japan: 5/100,000
  • Netherlands: 6/100,000 – note that about 30% of all births here are at home.
  • United Kingdom: 12/100,000

As you can see, we are rather behind many other countries – and don’t worry, I am going to come back to Brazil and why I included that statistic which is very high for an industrialized country (as is the USA’s number).

Why Are Mothers Dying?

This question is hard to answer since as mentioned above the reporting methods are varied and not always followed. We do know that some deaths are simply not preventable, this is just a fact of life. However, looking at the much lower numbers in other comparable nations we know that unpreventable deaths are not the reason for the very high numbers in the United States.

We know that it is not from lack of care in general – reports show that over 99% of all women in the United States receive prenatal care. However, we have to look at the level of care women are receiving. We have to ask, does a 5 minute rushed visit with your actual doctor count as adequate care? Does more diagnostic testing equal better care? Does spending more money equal quality care? (The numbers say no – we spend more than any other country in the world on birth).

We see a HUGE disparity in death rates in regards to ethnicity. An African-American woman is 3.3 times more likely to die in childbirth than a white woman. This is simply not acceptable in a country as advanced as ours, and one that is supposedly equal. Midwives such as Jennie Joseph are helping to implement ways to combat this disparity – her creation of The JJ Way is an example of how we can work to correct this travesty.

A big question that needs to be asked in the United States has to do with who is providing this care – care that is obviously not saving as many mothers as it should. In the United States women overwhelmingly see Obstetricians. While Obstetricians are amazing for complicated and high-risk pregnancies, they don’t have much training in plain old boring pregnancy and birth.

A majority of the time pregnancy will proceed in a normal fashion, and birth will follow in the normal fashion. When we use care providers who are trained to search for problems there tends to be a trend of finding problems whether they exist or not, or whether they are actually emergencies or not. As the saying goes, “Give a boy a hammer and he will find something which needs to be hammered.”

We can see that in countries were the majority of care is given by midwives (or that country’s equivalent care provider) the maternal mortality rate is lower (and the infant mortality rate is lower as well). The United Kingdom is a great example of this. They are comparable to us in many ways (general health and population structure), and yet consistently have better maternal outcomes. And they use the midwife model of care in which all women start with midwives and only transfer if problems arise. (Note that a woman can opt for an OB to start with, however most do not).

Now for the elephant in the room: the United States cesarean rate. Our current cesarean rate is 32.8% (CDC). Yes – basically 1/3 of all babies in the US are born through cesarean. So are 1/3 of all US women somehow “broken”? Unable to birth? Producing massive or stubborn babies? NO – of course not. If 1/3 of all women in the US were “broken” then those numbers would be reflected all over the world, and the statistics show this is not the case. In the same vein, we are not producing massive babies either – in fact the average birth weight has gone down as the cesarean rates have gone up (and is independent of that rise or that of induction).

Remember when I said I would come back to why I included Brazil? Brazil has a rather good medical system and is considered a developed country, so why the massive maternal death rate (56/100,000)? Take a look at their cesarean rate – 52.3%. Yes – over 50%. Brazil is an interesting case since most of these surgeries are elective, even for the first time mothers. The fear of childbirth is so deeply engrained in Brazilian culture that women jump at the opportunity to have a cesarean and avoid labor totally. A vaginal birth is seen, culturally, as something only poor women do because they can not afford a cesarean.

That mortality rate could be the United States’ future. We see a fear of birth in the US, and a huge cultural love of telling horror stories about labor and birth. We see more interest in elective cesareans (though elective first time cesareans are not significantly altering the rates). As VBACs are “allowed” in fewer and fewer places and malpractice issues continue to rise we see more and more women forced into surgeries they do not want or need. Our rates are heading right up to that of Brazil’s, and our maternal mortality rates will be sure to follow. A Cesarean increases the risk of death significantly in comparison to vaginal birth.

In comparison, the rate of cesarean in the UK is 25%, the Netherlands has a rate of 14%. As I stated before, the UK has 12/100,000 rate and the Netherlands 6/100,000 – rather interesting that as the rate of cesarean is almost half in the Netherlands and their rate of maternal death is also half that of the UK. While in some countries a higher cesarean rate does not correlate to a significantly higher mortality rate, those countries with very high rates of cesarean typically have higher (or rising) mortality rates.

We also cannot forget postnatal care. The postpartum period is one that needs care just as much as the prenatal time period. In the US, typically a woman is seen in the day or two after birth, at two weeks or so, and then at six weeks…and that is about it. This is simply not enough during this time of life when hormones are changing, the body is attempting to heal from creating another life, and things like retained placenta or clots can cause major issues. A much better plan of postpartum care must be put in place.

What Can We Do?

Be Educated. That is the number one thing you can do to not only help yourself have a safe pregnancy and birth, but also to help the women around you as well. When you learn, share the information. Break down the myths that pervade this culture – break down the assumption that VBACs are dangerous, or that “big babies” need surgical birth. Share the studies and articles you read.

Be Fearless. Help to eradicate fear of birth. Can birth end in tragedy? Yes. Unfortunately is does happen. But with proper and evidence-based care we give ourselves and our babies the best chance. Share the positive birth stories you hear. Share your positive birth. How does this help? It helps women to not fall into a fear based decision that increases her risks of complications – namely induction and cesarean. When a woman can start her pregnancy and birth journey from a positive place it gives her more space for growth and research. Absence of fear is not ignorance of risks – it is not being beholden to the fear of risk.

Those two things hand-in-hand – education and fearlessness – can go a long way towards helping this mortality rate go down. An educated woman is better able to avoid situations or care providers that increase her risks, and a fearless woman is better able to stand up for herself and decipher what is really in need of intervention and what is not without cultural fears clouding her view. Lets do our part to save mothers.

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VBAC: What ACOG Really Says {Birth Without Fear}

VBAC: What ACOG Really Says {Birth Without Fear}

VBAC – Vaginal Birth After Cesarean.

The term and action is wrought with political and emotional meaning in the birth world. Can  you have a VBAC? Does your doctor or hospital “allow” a VBAC? Under what conditions can you have a VBAC? Should it be called a TOLAC (trial of labor after cesarean)? What sort of prior birth history is preferred? Once I have one successful VBAC, will I still have to jump through hoops in subsequent pregnancies?

All these questions and more come up when we start to discuss the mine field that is VBAC in today’s world. But I wanted to know what ACOG really says. I am not talking about the public statements – which you can read HERE. I want to know what ACOG is saying to the doctors, what they put out in their practice guidelines.

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The document I found is HERE. I encourage you to not only look at the document for yourself, but to also follow the many links I have scattered throughout this article.

At the opening of the document, ACOG has this to say:

Trial of labor after previous cesarean delivery (TOLAC)* provides women who desire a vaginal delivery with the possibility of achieving that goal––a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient’s preference for vaginal delivery, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. At a population level, VBAC also is associated with a decrease in the overall cesarean delivery rate (1, 2). Although TOLAC is appropriate for many women with a history of a cesarean delivery, several factors increase the likelihood of a failed trial of labor, which compared with VBAC, is associated with increased maternal and perinatal morbidity (3–5). Assessment of individual risks and the likelihood of VBAC is, therefore, important in determining who are appropriate candidates for TOLAC. The purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and provide practical guidelines for managing and counseling patients who will give birth after a previous cesarean delivery.

Lets start with noticing that ACOG automatically terms all VBACs as TOLACs first. If you complete the trial with a vaginal birth, then it is a VBAC. The issue with this sort of wording (and thought process) is that it sets women up with doubt and it sets the doctor on the defense against the failure of the trial. I will use the term interchangeably only because the document that I am citing uses the term so often. But moving past this unfortunate wording we do see that they know VBACs are beneficial. They state that VBACs lower the maternal morbidity rate and risk of complications in future pregnancies and that as a whole they lower the cesarean rate. They do also point out that there are certain factors that make a TOLAC less likely to succeed, and that when they do “fail” you are more likely to have morbidity (which makes sense, as a major surgery is considered a morbidity to begin with).

In the “Background” section at the start of the Practice Bulletin we see several points that seem to be denied in the general obstetric community. First they state that the cesarean rate has increased rapidly since the 1970s, from 5% to more than 31% in 2007. They blame this increase on the introduction of electronic fetal monitoring, and the decrease in breech births and forceps births. I put emphasis on the EFM use, since we are often told that it is needed for a safe birth, even though research proves that it does not lower fetal morbidity or mortality. Again and again, research also shows that it increases the chances of a cesarean, which in turn increases the risks to mother and baby. Yet, ACOG still insists on the use of EFM as standard care.

They also state in this section that after the 1970’s VBACs gained popularity. By the mid 1990’s the rates of VBAC (28.3%) were such that it was actually reversing the cesarean rates. However, this increase in VBACs seemed to come with an increase in uterine rupture – though the literature does not state what sort of uterine scars were common (since certain types are known to have more risk, such as classical), whether induction was used, or what type of rupture occurred (most ruptures are not catastrophic but are instead considered a “dehiscence”). Due to this increase in ruptures, the case for VBACs was again set back to “once a cesarean, always a cesarean” in many practices. They finish this section by stating that it is known that liability is a large part of why VBAC is not offered to many women who are actually good candidates.

Now we get into the nitty-gritty of what they say about VBAC. I am going to take questions and statements from the document to break this down. All noted pages are from the Practice Bulletin unless otherwise stated or linked.

  • What are the risks and benefits associated with TOLAC? (p2)
    • Neither an Elective Repeat Cesarean (ERC) or a TOLAC are without risks.
    • Most maternal morbidity that occurs during TOLAC is related to a failed attempt when a cesarean becomes necessary.
    • VBAC is associated with fewer complications than an ERC.
    • Thus, the risk of a VBAC really comes down to whether it is achieved. If it is a “failed” TOLAC it has more risk than an ERC, but if it succeeds, it has lower risk than a ERC.
    • The main risk of TOLAC/VBAC is a uterine rupture. However, as stated in the background, some studies do not give background information about what type of ruptures are occurring nor on what type of prior incision or induction methods.
    • They include a chart of maternal risk in this section and it is interesting to note that maternal death risk can be almost double (0.2%-0.4%) with a ERC compared to a TOLAC after one prior cesarean (0.2%), and that TOLAC with more than one prior cesarean had no death risk within those studies. It is also noted that a ERC also comes with the risk of uterine rupture (0.4%-0.5%).
    • It is noted that for families wanting several children a successful VBAC takes away the risks of multiple surgeries which includes hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as previa and accreta.
    • They include a chart of neonatal risk factors when comparing ERC to TOLAC. It should be noted that there is no significant increase in neonatal death or neonatal admission (NICU admission). We see a much higher rate of respiratory distress (1%-5% vs. 0.1%-1.8%), transient tachypnea (too much fluid in the lungs which causes breathing issues) (6.2% vs. 3.5%) and hyperbillirubinemia (jaundice) (5.8% vs. 2.2%) in babies who go through an ERC.
  • What is the vaginal delivery rate of women who have a TOLAC? (p3)
    • Most studies show a 60-80% success rate.
    • Studies show a decrease in success if the same circumstances happen again, such as stalled labor, which lead to the first cesarean  (however, I will note that the definition of “stalled labor” is more likely the issue than anything else).
    • The chances of success are increased if the mother has spontaneous labor with no augmentation.
    • One VERY interesting note is that being “non-white ethnicity” lowers your chances of success. This speaks to the huge disparity in maternity care in ethnic groups in this country. Simply taking one look at the maternal mortality rate in non-whites gives a clear and horrible picture of this undercurrent in our maternity care system.
  • Who is a candidate for VBAC? (p4)
    • The best candidate is one in whom the risks and benefits balance out in a way acceptable to the client and care provider, this may be different for each woman and there is no specific “formula” to come to this answer.
    • Decisions about the first VBAC should be considered with future pregnancies in mind. This is due to each subsequent cesarean increasing the risk for future pregnancies, and the inability in some areas to find care providers to attend a VBAC after multiple cesareans.
    • For most women with one prior cesarean and a low transverse incision VBAC is a good option and they should be counseled and offered a TOLAC. Women with other incisions (T-incision or classical) or with prior ruptures and surgeries of other sorts to the uterus should be evaluated more.
    • Individual factors should be considered in all cases (i.e. – no hard and fast decisions to ruling mothers out of VBAC), and in the case of women presenting in labor, VBAC should be strongly considered as spontaneous labor increases the success rate of a TOLAC.
    • More than One Prior Cesarean:
      • Studies addressing TOLAC in women with more than one prior cesarean find rupture rates ranging from o.9% to 3.7% – again, without specifying the type of prior incision or level of rupture. They also have not consistently compared these findings directly to women with only one prior cesarean.
      • One large study in particular found no significant increase in rupture between VBAC and VBAMC (vaginal birth after multiple cesarean) – o.7% vs. 0.9%. A second large study only found a slight increase – 0.9% vs. 1.8%. They also found no significant increase in morbidity.
      • The chances of success are similar to that of a VBAC after only one cesarean.
    • Macrosomia (Big Baby):
      • Some studies show a decreased chance of success with a baby larger than 4,000g, and posibily higher rupture rates. However, these studies are based on actual birth weights, and not the estimates given before birth. This is significant given the inability to accurately predict birth weight before the birth.
      • Suspected macrosomia alone should not rule out TOLAC.
    • Gestation of more than 40 weeks, according to the largest study done which looked at this factor, does not increase risk. There is evidence that after 40 weeks chances of success decrease but we must consider that induction of some sort may be common at that point (given current practice trends) and that lowers the chance of VBAC in general. Gestation of more than 40 weeks should not rule out TOLAC.
    • Previous Low Vertical Incision:
      • Studies show similar rates of success compared to low transverse incisions (the most common).
      • Studies do not show increased risk of rupture or morbidity for mother or baby.
      • Studies are limited, but a low vertical incision should not rule out VBAC given the current information.
    • “Unknown” previous uterine incision should not rule out VBAC. The two large studies done at large tertiary hospitals show that there is no increase in rupture rates or morbidity, and success rates are similar. Unless there is a high clinical suspicion of a complicated previous uterine incision TOLAC should not be ruled out.
    • Twins Gestation:
      • In all studies available it is shown that in women with a previous low transverse incision there is no increase in risk to VBAC a twin gestation.
      • Success rates are similar to those of singleton mothers. Twin gestation should not rule out TOLAC.
  • How does management of labor differ in a VBAC? (p5)
    • Induction of labor for maternal or fetal factors remains an option for TOLAC. However, the increased risk of rupture that comes with any induction and the decrease in success rates should be discussed.
    • One large study of over 20,000 women found that rupture rates increased slightly with induction. Spontaneous labor had a 0.52% rupture rate, non-prostaglandins induction with a 0.77% rate, and with prostaglandins a rate of 2.24%. However, again the types of rupture were not specified and the context of the inductions are not known (unfavorable cervix, need for multiple induction methods, etc).
    • Another study of over 33,000 women found a slight increase in rupture (o.4% for spontaneous labor, 0.9% for augmented labor, 1.1% for oxytocin alone, and 1.4% with the use of prostaglandins). An analysis of this same study noted an increase in rupture rates when the highest levels of pitocin were reached, however no upper level of dosing has been decided for VBACs.
    • Studies done on the risks of misoprostol (cytotec) show an increase risk of rupture and should not be used for TOLAC. (Actually, it increases risk of rupture in ANY mother so it should not be used for induction, period.)
    • Due to the small absolute risk found in several studies, ACOG notes that use of pitocin for labor augmentation is not ruled out for VBAC.
    • Mechanical cervical ripening (such as the foley bulb) are also considered acceptable for labor augmentation/induction in VBAC.
    • ECV (External Cephalic Version), such as to turn a breech baby, are not contraindicated in a woman who wishes to VBAC.
    • Epidural/Analgesia use is not contraindicated and studies show it does not effect success rates. However, epidural use in general is shown to increase the chances of cesarean in all mothers. (to view that study, right click and select “copy link location” and input into google)
    • Electronic Fetal Monitoring is suggested since the main sign of uterine rupture is abnormal fetal heart rate (up to 70% of cases). It is noted that internal monitoring does not help in diagnosing ruptures.
  • How should future pregnancies be managed after uterine ruptures? (p7)
    • If the rupture is in the lower segment of the uterus, the chance of another rupture is 6%. In the upper sections of the uterus it is around 32%.
    • ACOG suggests an elective cesarean for births after a rupture.
  • How should women be counseled about TOLAC/VBAC?
    • Each woman will weight the risks and benefits differently. Therefore, the options should be discussed at length and documented.
    • Counseling should always consider the future plans for more children and discuss the risks of multiple uterine surgeries. Women should also consider that family plans can change or there may be unexpected pregnancies.
    • After counseling the ultimate decision should be made by the client. Global mandates (aka – hospital wide) should not be made as they do not consider the individual factors and wishes of each client.
  • What resources should be available at a facility where a woman will VBAC?
    • The previous suggestion of ACOG was that VBAC should only be offered in facilities with “immediate” access to surgical facilities and staff. However, this severely limits the locations where women could VBAC.
    • ACOG now suggests that care providers and clients consider the facilities available, their individual risk factors, and the availability of other locations where more resources are available.
    • Health care providers and insurance companies should do all they can to facilitate women in achieving VBAC through transfer of care or co-management of care.
    • If there is no way to transfer care, a woman’s autonomy should be respected. If a woman wishes to VBAC in a hospital without immediate access to surgical facilities steps should be taken early in care to develop a plan of action in case of rupture.
    • It should be noted that coercion into a repeat cesarean is not appropriate. A policy of not allowing TOLAC at a facility should not be used to deny care or force a woman into a repeat cesarean. If appropriate, transfer of care should be arranged to a facility and care provider who is better able to support TOLAC.

Now I would like to take a moment to talk about the notion of only “allowing” VBACs in facilities with immediate access to surgical teams and facilities. Lets compare the risk of rupture, 0.7% in most studies, which is not always catastrophic, to the risk of other obstetric emergencies. Cord prolapse, a very dangerous situation in which the cord proceeds the baby down the birth canal and gets pinched, occurs in about 0.28% of births. This situation requires immediate access to a cesarean in most cases. Placental abruption, another very serious complication, occurs in about 0.7% of pregnancies. This also requires immediate access to cesarean in almost all cases. Notice that the risk of abruption and the risk of rupture are the same. The rate of shoulder dystocia, which is considered an emergency that may necessitate a cesarean (or an instrumental birth) is around 1.29% though some studies report it at higher rates in the current birth climate.

Now looking at the rates of these complications, which are on par with the risk level of rupture, we have to wonder why ALL hospitals offering birth services are not required to have immediate access to a cesarean. After all, placental abruption happens with the same frequency and can happen in any pregnancy and ACOG does not seem to be concerned that EVERY pregnant mother does not have access to immediate surgical care. At the end of the day, the risk/benefit analysis needs to be decided by the mother and what she feels comfortable with since the rate of rupture is comparable to the risks of any pregnancy and birth.

The point of this article is not to suggest any particular course of action for every mother. This is about giving you the facts to make your own decision. This is about looking at what ACOG really says about VBAC/TOLAC and not just what your doctor tells you they suggest. Arm yourself with information and consider your own personal factors and Birth Without Fear, no matter how you choose to birth.

Loving My Body {One Scar at a Time}

Loving My Body {One Scar at a Time}

c-section

My fourth baby, an attempted VBA2C, left  me with my final scar of childbirth. After 3 premature deliveries, progesterone shots allowed me to carry to 38 weeks 6 days. Labour began on its own and after a stalled labour, forehead presentation and Bandels Ring I delivered by a calm and quiet c-section, the final chapter in my family’s growth.

I didn’t fail having a VBA2C, I tried and that’s all that I can ask for. Two emergency c-sections and one successful VBAC with premature babies were stressful. This babe was big enough to come home with us and we are breastfeeding exclusively 7 weeks in. That in my eyes is success.

Loving my body, one scar at a time. Your blog gave me hope and confidence… and for that I thank you!

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A Cesarean for Breech Birth with Video

A Cesarean for Breech Birth with Video

In the early days of my pregnancy, back when I was an un-crunchy as could be, my husband told me I wasn’t going to get an epidural. Told me. He was on the other side of the world serving the last couple months of his tour in Iraq and I was in sunny Hawaii, where we were stationed at the time, stunned at his words. My friends scoffed at the idea, “Forget him, you’ll get an epidural if you want one! They’re heavenly!” I believed them.

When he came home I was 15 weeks pregnant. Around that time, I watched a show where the woman giving birth was doing so at home using techniques she learned in a Bradley Method class. The idea of natural birth always intrigued me. My mom had done it several times and when I looked up what the Bradley Method had to offer, I started to change my mind. Maybe I wouldn’t get an epidural after all. Maybe I wanted an all-natural birth.

Fast forward a few months and we were taking our Bradley class. By that time I was fully convinced I was going to have a drug-free, low-intervention, hospital birth. I wrote out a beautiful birth plan. We were ready to tackle everything. Except one thing: A breech baby.

My family has a history of breech births. My mom and aunt were both breech. I was breech until the very end; my little sister was the same. But my baby was head down, at least at my 36 week appointment, so when I walked in for my 38 week appointment ready to be checked to see how far I was dilated (I wanted to know if I should start any natural measures to get things going), I wasn’t ready for the midwife to find something wrong. She brought the ultrasound machine over, waved it over my belly, and showed us. She was butt down, her head wedged in my right rib.

From there, began the most frantic and stressful two weeks of my life. They sent me upstairs for a non-stress test, which I passed fine, and a chat with an OB about scheduling a cesarean or doing an external version. No way, we said, we aren’t scheduling anything. We would think about the version, if it came to that. They sent us home with instructions to return in a couple days for another NST.

At home, we decided we weren’t comfortable with doing an external version, but we were try everything else to flip that baby around. Chiropractor, acupuncture, inversion table, music, hot & cold packs, music & recordings of our voices, handstands in the pool… everything. Nothing. She wasn’t moving.

At my 39 week appointment, the kind OB and midwife sat us down to talk about our wishes. We told them we didn’t want to schedule anything, that I wanted to go into labor naturally to give her every chance she had. They accepted it. And then again, at my 40 week appointment, we said the same thing.

That ultrasound, though, showed that she had one foot up and one foot down. The OB warned that if my water broke, there was a high chance the cord could prolapse and cause an emergency situation. He still was fine with me going into labor naturally, but urged me to consider scheduling a cesarean by 41 weeks if she hadn’t showed. He said it was up to me, of course.

The next day, while dealing with some awesome Braxton Hicks, I decided if she had showed up by the next day (a Friday) I would schedule something for the next Wednesday, 41 weeks. However, as the day progressed I noticed my BH coming regularly, about 6-10 minutes apart. By dinner time, I knew something was up, and even though I had wanted to labor at home for as long as possible, I was worried about the risk of cord prolapse. The hospital had us come in that night.

Our daughter was born via cesarean at 1:05am on December 16, 2011. She was 6 lbs 12 oz and 18 inches long. We named her Penelope “Penny” Ann.

The cesarean was an interesting experience, but so unlike what I was expecting. I received a spinal and requested anxiety medication as well, because I was feeling a panic attack coming. I didn’t feel a thing except some rocking, like I was on a boat. After the baby was born, my husband went to recovery to do skin-to-skin and I chatted with the anesthesiologist for 45 min while they stitched me up. In recovery, after nursing our desperately hungry baby, I vomited from the medicine. The next few days in the hospital were painful, and the recovery took several weeks before I could walk normal or feel an ounce like myself. I never wish a cesarean on anyone who doesn’t absolutely need it.

I don’t feel guilty about doing it, though. There were no doctors or midwives on the island who would deliver a breech baby. Giving her position, I wasn’t going to risk doing it by myself. In the head, we weighed our options and felt fairly in control of the whole process. Still, I feel some disappointment in missing out of the experience that I was envisioning, though I hope with our next baby we can have a home birth after cesarean.

You can find the video here through this link:  http://youtu.be/Ouf4BywpbRA

breech c-section

breech c-section

VBAC Plan Turns into a Healing Repeat C-Section

VBAC Plan Turns into a Healing Repeat C-Section

I had a very traumatic cesarean section birth with my first son. He was induced at 39 weeks because of my rising blood pressure and labor progressed uneventfully. I had an epidural and got to the pushing stage, but he got stuck in my pelvis after pushing for 3 hours. I was terrified of the surgery but the doctors assured me I wouldn’t feel a thing. They were wrong. After my son was out and my uterus was being repaired and closed, the epidural began to fail and I could feel everything that was being done. I felt such intense pain and began to curl up on the operating table with my hands and legs tied down, screaming that it hurt and for them to stop. It took what seemed like forever for the OB to realize I really was feeling everything before she stopped and they ordered more drugs. They drugged me heavily, and though the pain was gone I too doped to stay awake very long to enjoy meeting my newborn son Gabriel. We were unable to breastfeed that night and I had troubles feeding him for the next several weeks, so eventually I had to switch to formula.

At 4 months post partum I was diagnosed with Post Partum Depression and PTSD after my traumatic experience. I re-lived the birth every night and couldn’t stop obsessing over what happened. It took two years for me to come to terms with it and how abandoned I felt by the doctors. It was a rough road, and when I got pregnant again two years later I was so very scared of having the same experience all over again. I began having flashbacks when seeing C-sections on TV and movies.

But I was determined to make this second experience a positive one, despite my fears. I worked with a midwife group to plan a VBAC, and even though my second baby was measuring large at 37 weeks they still were willing to give me time to go into labor on my own. My goal was a medication-free birth, so I read up on Hypnobabies and crafted a detailed birthing plan that would help me in case of any eventuality. I also hired a doula-in-training to assist me in making the decisions I wanted in the thick of things. I was open to the possibility of drugs, but after doing extensive research I was sure that in case I needed a repeat C-section, I wanted to get spinal anesthesia and not another epidural.

I woke up at 7:30am two days before my dute date on October 29th, the day Hurricane Sandy came to town, expecting a quiet hurricane-day off of work. My husband Mike was already up with Gabe and they were watching TV. I got up to use the bathroom and tried to climb back into bed, but the second I put my leg up I felt the POP of my water breaking. I ran back to the bathroom and yelled to Mike that it was time! He immediately got into gear and started running around getting all of Gabe’s stuff ready to go to daycare and then my parents’ house. We finally got ready, and I sat on my trash bag and towel in the car while we drove Gabe to daycare. I began having mild contractions just as we dropped him off. We got to the hospital around 8:30am and got triaged in. The nurse checked my pad to make sure it was actually amniotic fluid and there was already meconium in it, so they began admitting me.

Contractions had picked up by that point, but they were still pretty mild. My doula Rene arrived while we were being admitted and we got everything straightened away and went off to a delivery room. I felt so confident and ecstatic that I had gone into labor on my own and it seemed like everything was falling into place for this VBAC to happen. My birthing room was gigantic, and included a shower, a rocking chair, a birth ball, and a peanut-shaped ball. I immediately changed into a hospital gown because my clothes were very wet, which was nice.

I met my midwife Julie who I had seen a few times before at the midwifery and we talked casually a bit about the weather and how busy it was getting already at the ward. Everyone’s water was breaking because of the storm front coming in! At this point contractions picked up a bit, but I worked through them with deep breathing and some moaning. I labored pretty well in various positions, mostly sitting on the birth ball leaning over the bed. Occasionally I would get up and try to walk but sitting with my butt out was my favorite way to be.

At 12:30pm I was checked and was 4cm and fully effaced. We were all hoping it would continue to progress quickly. Over the next few hours the contractions seriously intensified. The pain began to be less of a pressure wave and more of a sharp, crushing pain that felt like my entire abdomen was being torn into. The nurse tucked hot packs into my underwear to help with the pain, and it felt great but couldn’t dull the sharp stabs of the contractions.

I began trying every position the midwives and doula suggested: on the ball, on the bed on my knees with my arms up on the headboard, standing and swaying with Mike, leaning over the bed while it was raised, and leaning on the windowsill. I liked leaning over with my butt out and swaying my hips. My back was killing me, every contraction radiated back too, so Mike provided counter pressure and he and Rene were awesome at reminding me to breathe through each wave. The contractions came regularly but sometimes there would be two right after the other, then I’d have a few minutes break, then one, then maybe another two. So it was erratic and tough to find a rhythm.

I got checked again at 4:30pm and I was at 6cm. Baby Evan was also still very high up. I was both amazed that 4 hours had gone by and discouraged that it was so painful and yet I was only 6cm and he hadn’t dropped. I started asking for some drugs at this point.

To keep with my birth plan Rene suggested trying the Nubian in my IV. It seemed to take forever to get ordered and injected, but it did help cut the edge off. I progressed for another hour, but at that point I was lying down on the bed on my side, clutching Mike’s hand and the bedrail and shaking and moaning with each contraction. I was out of my mind with how much it hurt. After each one passed I broke down crying and sobbing at Mike and Rene and I remember feeling like I couldn’t do 4 more centimeters of that kind of pain.

The midwife offered to check me again and was at 7cm. At this point I let a few more contractions go by, each one just more painful than I could handle. When my head cleared at one point I looked at Mike and Rene and said I had made up my mind and wanted the epidural. I needed a break and I was no longer able to relax my hips and body. I was clenching everything in my body and shaking with each wave, completely unable to control my breathing at that point. They both agreed that I was serious about my decision and the epidural order went in.

That also seemed to take forever to arrive. I tried to remind myself that relief was on the way but the contractions were just too painful and I couldn’t manage it anymore. I had also vomited a couple times by that point. My body felt entirely out of my control. Finally anesthesia arrived and the epidural was placed. I was checked again once it went in and was at 8cm or so, Evan was still high up and hadn’t descended at all. At that point it was around 6pm.

I labored on lying each side for a while, getting checked intermittently and resting for the pushing stage. I made it to 9cm and was hoping the end was in sight.  He was still high, and I said I was worried and the midwife agreed that it was not a good sign. We had me laying almost on my stomach with my leg over a small ball on each side for the next few hours. This was pretty uneventful, and I was feeling a lot of low pressure, but another cervix check at 11pm showed that I was still 9cm and he was still high up.

The midwife started talking C-section. I had a moment of panic watching her use those words, but I had started feeling that this discussion was bound to happen, and so it wasn’t too much of a shock. We had gone 5 hours of no more progress or descent of the baby. He was way too high and I wasn’t able to get completely dilated. The midwife called in the OB on duty and she agreed with the decision to go for a cesarean section. I started crying, and admitted that I was terrified of another section. I explained again to them what happened with Gabe and they assured me that the epidural should be sufficient pain management for the surgery. But I just didn’t trust it. I wanted a spinal. I had them call in the anesthesiologist on duty to talk over my decision.

The anesthesiologist came in and I laid out my fears. He just shrugged, grinned at me, and said “Sure I’m cool putting in a spinal.” I almost hugged him! He said “I just want you to be comfortable.” I was still nervous but his attitude was so refreshing and reassuring. I really felt like the team listened to me and let me make the right decisions for me. So I signed the consents for surgery and we shut off the epidural to give it time to dissipate before putting in the spinal.

Once I got into the OR it went very quickly. I unfortunately vomited again on the table just before they put in the spinal. But Julie held my hands and reassured me that it was going to be fine. The anesthesiologist placed the spinal and I started going numb very quickly. By the time they had the drapes up and Mike was allowed in, I was numb up to my chest and felt it in my fingertips!

I felt absolutely NOTHING for the whole surgery! Roger, my nurse anesthetist, asked me who my favorite band was and put on a Pandora playlist. I was able to just enjoy some music and let myself relax and not panic, using some self-hypnosis techniques to calm my nerves. They pulled Evan out and he immediately started crying. I was so excited to hear him! Mike went to get pictures of them cleaning him off, and we learned he was 9lbs 4 oz and 23 inches long!

At this point I told Roger I was feeling like I was going to have a panic attack, because during the closing is when things went bad last time. He immediately ran some meds in my line and I felt awesome. Not too doped up, just less panicky. I heard them say Evan’s Apgar’s were 7 and 9 and the NICU team checked him out and made sure he had no issues with the meconium. They swaddled him and let Mike bring him back to me. I didn’t have to have my hands tied down, so they let Mike lay him on my shoulder and I could wrap my arms around him and touch him. It was amazing! Roger took some pictures of us all.

The OB came to see me off in recovery right away, and she informed me that when she opened me up I had begun to rupture along my scar. It was a small rupture, technically called a dehiscence, but amniotic fluid had begun to leak out. I just felt a huge wash of fear at that news. I’m so glad nothing happened and we made the choice to have the surgery! It made me wonder if all the sharp, tearing pains of my contractions weren’t normal after all and were in fact signs that I was beginning to rupture. It also made me wonder if this was the reason why Evan would not descend. I felt so grateful I didn’t try pushing him out with a rupture. It could have been disastrous!

So though I had been really hoping for a VBAC, I feel this was an incredibly positive birth experience. I felt true healing from my previous trauma for the first time. Everything went step by step according to my birth plan because I had been sure to cover every eventuality, and the entire team I worked with respected my feelings and tried to make me feel comfortable. This was the surgery experience I wish I had had the first time around. I felt in charge of every decision and listened to every step of the way. It wasn’t the birth of my dreams, but it was a powerful and moving birth that healed some very deep wounds for me.

{Holding Evan for the first time}

HoldingEvan (2)

{First family photo}

FirstFamilyPhoto (2)

{Skin to Skin}

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{Brothers}

brothers (2)

A Much-Desired VBAC with a Supportive ObGyn

A Much-Desired VBAC with a Supportive ObGyn

The stories of my children’s births are both my worst and best day ever.  My son was born February 26, 2011.  I had wanted a natural childbirth, unfortunately that did not come close to what I got.   I was called by my midwife on the 23rd, stating that she had concerns regarding some of my blood work and said that I would need to be induced that day.  This is a moment I think of often and wish so much I could have acted differently.  I was close to 42 weeks and was ready to be done, and so I said “okay”.  I knew I should have asked what other options were available, but I didn’t.  When we got to hospital my birth plan fell apart immediately.  They let me know that my platelets were low and I would be unable to have an epidural.  This wasn’t a big deal to me; I didn’t want an epidural anyway. I was dilated to a one and nothing seemed to help, my body and my baby were not ready.

The first day they tried Cervidil which did nothing.  The second day they tried Cytotec which gave me some mild contractions the entire day.  I was still excited at this point and couldn’t wait to meet my baby.  I was not scared of birth; I couldn’t wait to take part in this amazing journey.  Even though I was contracting, I wasn’t dilating.  The next morning they gave my Pitocin.  This is when my world fell around me.  Two hours after receiving the drug I was in agony.  I was unable to get through a contraction without vocalizing and I felt completely lost.  I was not prepared for this.  After hours of intense contractions with no relief my pain transitioned into suffering.  I was begging for help, but no one could do anything.  At one point I looked around the room and saw our midwife, nurse and my husband simply staring at me totally helpless.  No one could help me, I was entirely alone in this room full of people.  I continued this way for almost an entire day.  I got to nine centimeters dilated and stayed there for hours.  My hope was gone, I had done enough.  I was ready.  They took me in for a cesarean.  Every part of me that makes me “Meghann” was gone.  When I got up to go into the surgery room I didn’t say goodbye to my husband, the only thought running through my head was that the pain would be over soon.  I cried knowing I would not be awake at the birth of my child because of my platelet levels, but needed help.

When I woke from surgery the full impact of what just happened hit me.  I was stuck on the table and could not get up.  I did not know one person in the room.  Tears instantly began streaming down my face.  I felt like I couldn’t breathe.  All of my physical pain had turned into emotional pain.  One of the nurses came over when she saw I was crying and asked what hurt.  I told her I wanted my baby.  “In just a few minutes.”  I heard them tell me that for almost an hour while I waited to meet my son.  I asked “what color eyes he had?”, “what color was his hair?”, “how much does he weigh?”. They told me, “I don’t know”. How much longer until I could meet him?!  It was the worst time of my life, waiting and searching for my baby while I knew he was doing the same for me.

Finally they took me into our recovery room where my husband and my son were waiting for me.  I remember them wheeling me down the hall, still lying in a bed.  I could not stop crying.  I saw family of other women who were likely having beautiful births waiting to meet their newest family member.  They saw the look on my face and they no doubt knew that child birth did not always go that way.  Once I was in the room I hurriedly looked from side to side asking where he was.  My husband pointed to the bassinet in front of the bed.  It was strange, but I felt like I could not have him, like he wasn’t mine, as if it would be inappropriate to ask them to give him to me.  It was as if the hospital had more rights to him than I did at that moment.  My husband went over and picked him up and put him in my arms.  While I have read about difficulty attaching after a cesarean, this was not what happened.  I felt instantly bonded to him, and did not let him go.  I felt that I needed to protect him and make amends to him for what we had just experienced.

I can’t tell you how painful Jackson’s birth was.  He was our first child and I missed everything.  I missed his first breath, his first cry.  I missed my husband meeting his son for the first time.  I didn’t know if someone had bathed Jackson or not.  I couldn’t answer simple questions in our baby book such as “Dad’s first words to his son”.  Jackson was introduced to me by others, others who knew my son first.  I should have been the first.  This was never going to happen to me again.

When Jackson was 15 months old we learned I was pregnant with Audrey.  A dark shadow hung over my pregnancy as I was told that my platelets would likely drop again.  I went back to my midwife and she told me not to worry, that it would be different.  I wouldn’t have to labor, I would come in for a scheduled cesarean.  She gave me a concerned look when I said that I was going to VBAC.

My platelets were indeed dropping.  I did everything I could to keep them up.  Took an array of vitamins, ate huge amounts of organic fruits and vegetables.  I scoured the internet for anything I could find on lifting platelet levels.  I had to be awake for this birth. I knew that my success did not just depend on me, it also depended on the people I chose to support me.  My husband and I chose to birth in a hospital, which meant I would need to find an OB, which was a little concerning to me.  It was at this point that I realized how much women come together to help one another when needed.  There was hidden in society a network of women who understood the meaning of birth and would fight to help one another succeed in achieving their desired birth.  I spoke to doulas, midwives, women who had beautiful and horrific experiences.  Over and over the same names came up, doctors to definitely check out and doctors to definitely avoid.  I began interviewing those doctors and was feeling a bit hopeless.  Then I finally found a one that I intuitively felt I could trust.  He listened to me and seemed to understand in a way you would not think a man could, how much Jackson’s birth hurt.  He vowed to help me.  I also hired a wonderful doula that listened to Jackson’s birth story and knew my desire to witness my child’s birth.  She helped me establish a birth plan for every possibility and stood beside me throughout my pregnancy and birth.

I went into labor with Audrey the night before her due date.  My contractions began at just under four minutes apart, but were easily handled.  After about two hours of labor I woke my husband up to let him know.  He urged me to call the doctor’s office.  I got the doctor on call, not my doctor.  She said that I needed to come in and that I shouldn’t worry, if I’m not dilating she’ll just start me on Pitocin.  I got off the phone with her and felt like I could not leave my house.  Was this battle starting already?  I called my doula.  I felt grounded when I heard her voice.  I remembered that I have the right to refuse any procedure, but that I would need to be strong.

We drove the hour drive on ice covered roads.  When I got into my room the doctor came to check on me.  She immediately said that she wanted to feel my stomach so she could measure the baby.  She said that if the baby was too big she would know later not to use a vacuum.  What?  Why were we already discussing vacuums and babies that are too big?  I knew I had to tell her no.  I then had a contraction and it hurt.  I thought to myself, if I’m strong enough to get through this contraction then I can tell a doctor no, and I did.

I asked about my platelet levels right away, they were high enough that no matter cesarean or vaginal, I was going to be awake!  They told me this, but it didn’t really sink in.  I could only concentrate on the contractions, nothing else.  I began vocalizing like I did when Jackson was born and I was ready for relief.  I opted for an epidural.  Once it began to work was when my doula looked at me and said “You’re going to be awake”.  Tears fell, happy tears.  I had worked so hard and everything I had worked for was being realized.

My doctor came on a few hours later.  His first words to me I’ll never forget, “Goal one met, you’re going to be awake”.  I had been clear with him that while I desperately wanted a vaginal birth, it was more important that I was awake, it was of primary importance.

He checked me about an hour after he came in and I was fully dilated!  I began to push but wasn’t making a lot of progress.  He told me that my little girl was sunny side up.  I worked and worked, and the pain was excruciating.  Even though I had an epidural, I could feel my doctor attempting to stretch me to make room for my baby to change positions.  I screamed through many of the contractions.  I worked for over three hours and then consented to allow a vacuum to help her out.  Looking back, this wasn’t what I planned, but I trusted my doctor and felt that he would not recommend anything that was not necessary.

An intense and indescribable pain, the hardest push I could muster, and then I heard the words, “Meghann, reach down and grab your baby”, and I did.  I pulled her onto my chest.  I heard her cry, saw her first breath.  I was the first to hold her.  I kissed her and told her I loved her.  I saw my husband meet her.  Nothing happened to her without my consent.  She did not leave my arms unless it was to go into my husband’s.

This picture that you see is not simply me meeting my daughter; it’s a moment I knew I could miss.  It’s a moment I missed with her brother.  It was the most precious moment of my life.  It was something that is entirely indescribable.  Since her birth I still feel as though oxytocin is cursing through my body.  I feel so empowered, so strong.  I am capable of anything!  To be a woman is truly an unbelievable gift.

Meghann's much-desired VBAC

Birth of Twins {Baby B-Birth in OR before CS}

Birth of Twins {Baby B-Birth in OR before CS}

A few days after finding out I was having twins, I began mourning the loss of my birth experience. Dramatic? Probably. But as a Doula and at the time, prospective, Childbirth Educator, and someone who’s frankly quite terrified of needles, I knew that medication, needles, scalpels and augmentation were not for me.

Coming to terms with the possibility that my birth was most likely going to be filled with things I didn’t want was very difficult. I agonized, cried and had panic attacks over it for weeks. After seeking the advice of other doulas and doing some serious soul searching, I finally started to feel peace about the possible ways I would birth these babies. However, I was very prepared to make informed decisions and fight for what I wanted and needed during my birth experience.

I knew that in order to have a birth that somewhat resembled the ideal I had envisioned, I would need to have a doctor who was ok and on board with at least some of my desires. Home birth was not an option for me so I chose a practice I was familiar with through both personal experience, and experience as a doula, who I knew would give me the best chance at a vaginal birth of twins in the area. That being said, out of the four doctors in the practice, only two were ok with the fact that I didn’t want an epidural or even want the catheter placed but only one of those two was ok with doing a breech extraction if needed, should baby B turn breech after baby A was born. While I knew I could make the decision to refuse any procedure, I also knew it was probably going to be an uphill journey and one I wasn’t sure I was strong enough to climb.

34 Weeks with twins

On the day I went into labor (around 34/35 weeks gestation), the doctor who didn’t mind if I refused the epidural but wouldn’t deliver a breech baby B was on call, but I felt at ease. We arrived at the hospital when I was 5 cm and 100% effaced. Within an hour, I had progressed to 6 cm and was hardly uncomfortable, despite the air conditioner in L&D being broken, and it being 82 degrees in my room. The rest of the labor progressed quickly, with minimal discomfort, and without any mention of pain meds, or epidurals from the nurses and the doctor.

At 9cm I was not feeling the typical transition-like contractions I had felt with my previous 2 labors and wasn’t quite sure what was happening with my body. I had prepared for something so much more intense! I had also prepared to defend my choices with the medical staff every step of the way, but none of that was necessary as they were in awe that I was completely in control of my contractions and pain management, and was willing to listen to and think about the choices I was presented with and decisions I had to make.

There were a few things I did agree to and ask for after making conscious and educated decisions, but they were MY decisions. I did ask for a bag of fluids when I arrived at the hospital, so I had an IV and I did ask for pitocin to be turned on during pushing if it was needed. Staying in the labor room to birth my babies was not an option because of hospital policy, but I was ok with that and we did move to the operating room at 9cm. Though it wasn’t a climate controlled, dimmed room, I was able to maintain my focus and feel at peace with being there.

Immediately after being checked and found “complete” I felt the urge to push, and 5 pound 13 ounce Baby A was born after a few pushes, 5 hours after arriving at the hospital.  Not one nurse counted or yelled or told me how to push, which was exactly what I had asked for.

When Baby A was born I remember thinking she was tiny and had a great cry, but I didn’t get to actually see her face. She was passed to my nurse who started checking her over, who then had to passed her to the NICU nurses because the doctor needed her help. Baby B had flipped transverse as soon as her sister was born and she did it fast too.

Everything I had read about twin births said that the worst pain you would ever feel would take place if you had to have a version during labor without an epidural. And there I was, facing a version without an epidural. When I made the decision not to have an epidural I was very much aware of the possibility of the pain but I figured I would rather endure 5-10 minutes of intense pain than all of the risks and side effects associated with an epidural through a labor.

Somewhere between both the doctor and me “talking” to Baby B and begging her to turn and the doctor and nurses beginning the version, I went into a trance like state. I didn’t feel pain, just a lot of pressure. I spent the last minutes of labor fully aware of everything that was happening, but It felt like  it was happening to someone else and I was just watching.

During the version there were about 5 hands on my belly, some holding the space where baby A had been, others turning baby B. They were able to turn her to be head down, but she then turned transverse again and her heart rate became rocky.  The doctor decided it was best to do an internal version to try to get her into position to be born. He was holding the ultrasound transducer with one hand and internally moving the baby while trying to keep her cord from prolapsing with the other. He was able to move baby B into position to be born but then she moved her hands above her head. So we sat, and waited. Waited for her to move, waited for something, anything that would allow me to push for her birth. And we waited while the doctor still was holding her cord and her in place, internally.

After roughly 13 minutes of waiting, her heart rate plummeted and wasn’t showing any signs of recovering. She needed to be born right then, but that wasn’t going to be possible to do vaginally. I will never forget the look in the doctor’s eyes when he looked at me and told me he had to do a c-section. He knew how much I didn’t want one and how hard I had fought for this birth. I knew that he didn’t want to do a cesarean and had tried everything possible to get Baby B to be born vaginally. There just weren’t any other options.

Because I had chosen not to get an epidural I was going to go under general anesthesia, which I had never been under before. The anesthesiologist who was standing by quickly started preparing the anesthesia while the nurses were racing to put sensors on my chest. The pitocin was turned off, and the room was switched from a birthing room to a fully functioning operating room in less than 45 seconds.

Right before I was put under general anesthesia, the doctor saw on the ultrasound screen that Baby B had moved her hands, and yelled for me to push. And in the confusion and haste of the OR, I pushed twice and our feisty 5 pound 8 ounce Baby B while the doctor guided her into the world, just 17 minutes after her sister was born.

I will forever be grateful to my doctor for trying so hard to give me the birth I wanted and what I needed. He respected me and my knowledge and trusted me and my body to do what it needed to do to birth these babies. Never once did he look down on or question my choices, he never made me feel like naive or pressured into anything. He went well outside his comfort zone and fought for me and fought for birth and in those 17 minutes, admittingly learned a lot.

Edited To Add:

Even though it’s been nearly seven years, the story of the birth of my twins will sometimes hit me and cause me to pause. I’ve never shared this picture before- I wasn’t ready to. I was honestly scared to. This picture captured and froze a moment so personal, and intense. The intensity and emotion are still fresh, even after all this time.

My sweet Baby B, being born into the hands of our extremely patient and incredible doctor. Her umbilical cord coming before her, after a nearly 15 minute internal version (without pain meds), seconds before I was going to be put under for a crash c-section. This moment, with our baby girl halfway between my womb, and the beginning of her life outside, before she’d even taken her first breath, was captured by my husband as he stood next to me, praying desperately for his wife and baby. He will tell you this moment defined and shaped him more than any single moment before, or since. And I don’t doubt that because it did for me too. But I can only imagine what he felt watching our baby’s birth unfold from his vantage point: the unknowns, the joy, the confusion in the chaos. Truly needing to trust, have faith, and let go.

Seven years later my perspective is changing. Instead of the uncertainty and a moment hanging in the balance, I am starting to see a joyous beginning, a triumphant entrance into the world and the perfect start to the life of our feisty Baby B.

twin vaginal birth

The birth of my twins serves as a reminder of strength and courage that I hold within. If I can get through a nearly 15 minute internal version without pain medication, I can handle almost anything. I look back on that day with peace and a sound mind, knowing it went exactly the way it was supposed to go, with nothing to regret.

GGTwins Mom

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GG Twins sleeping

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Twins Born at 27 Weeks {A Mother’s Story of the NICU and Coping}

Twins Born at 27 Weeks {A Mother’s Story of the NICU and Coping}

My twin boys were due August 28, 2012. They were born June 1, 2012, 13 weeks early.

I had a doctor appointment that morning. I was so excited because it was an ultrasound appointment and I was going to get to see my little boogers. I met with the doctor after the appointment and he kept me a little longer because he was afraid that I had twin to twin transfusion. They tried to hook me up to heart rate monitors but said I wasn’t far enough along for them to work…. So he sent me on my way and made an appointment for the following week.

By now it was 10:30AM and I was supposed to be at work at 8:30AM. I grabbed my lunch on the way but I wasn’t able to eat on the way because I had to update my husband, my mom, and my mother-in-law. I worked the drive-thru so I was busy all day long and I ate in between customers. I didn’t get to sit down much, we were just really busy. I was lucky and got off at 5:00PM because I had to work Saturday. I went to the bathroom before I left and noticed something wasn’t right. I called my husband and he said that once I talked to the doctor to let him know and if he needed to he would be on his way.

My mom came because mother’s just worry too much. And we had to wait on the doctor. I couldn’t tell you what we were talking about but I just looked up at her and said my water broke. Her first comment was “Are you sure you didn’t pee your pants?” I laughed then and I still laugh now. I wasn’t able to call Jason because once I told the nurses my water broke all hell broke loose. So I text messaged Jason that my water broke. That’s not something that you want to text by the way, and he followed it with a phone call. I wouldn’t let him drive so I called his parents and I wouldn’t talk to his dad because I didn’t want anybody to be upset or rush or anything like that. So I told his mom to calmly go pick up Jason and we worked out arrangements for Jager (our dog) and that everything was okay.

The plan was to make it to Roanoke Memorial and stop labor. That didn’t happen. By the time we got there it was too late to stop it. We were prepped and I was taken in for an emergency cesarean. At 11:13PM Parker Lewis cried out. At 11:15 p.m. Jacoby Lee cried out as well. I didn’t get to see Jacoby but I was able to kiss Parker on his way out of the room. It wasn’t until the next day that I was actually able to see them both up close and touch them.

The next day everything was put into perspective. I received a call that Jacoby needed to be intubated. He was tired and wasn’t strong enough to breathe on his own. I finally was able to go see them and they were so small. Granted, they were big for 27 weekers, Parker was 2lbs 13oz and Jacoby was 3lbs 2oz, but still so tiny. It’s amazing that they were still able to function. We were informed that we may be qualified for the Ronald McDonald house, since we were an hour away from home. Which meant that Daddy would go back to work and I would stay. Here our new family was, and we were going to have to be separated for who knows how long. We had to take a class on how to handle and take care of our preemies. It was all so overwhelming at first. But with the right nurses, we started feeling like we could handle it. They showed us, comforted us, and became our friends. They took care of our boys, but they also took care of us.

Jacoby was able to come off the ventilator in less then 24 hours but any intubation causes damage to the lungs. He struggled with coming off his CPAP and ended up coming home on oxygen. Parker was able to come off his CPAP quickly only to go back on a few days later. He did this twice and the third time was able to stay off it. He developed an infection in his belly but with some antibiotics and stopping his food we were able to clear it up easily. They both had PDA’s (an artery in the heart that closes closer to 40 weeks) but with the proper medicines they closed on their own, not needing surgery.

 We were finally able to come home July 31, 2012, one day shy of 2 months in the hospital. Both boys came home on heart monitors and Jacoby came home on oxygen. I won’t lie, I won’t sugar coat it. It was hard. My mom stayed with me during the day for the first week and my mother-in-law stayed the second week. After that, I was on my own until after my husband or my mom got off from work. I breastfed at first, but I had to also had to supplement because they needed more calories.  It seemed like all I got done was feeding and changing diapers. So I would pump before time for them to eat and I just mixed it in with the formula. It made life a little easier but pumping for a year was hard. I kept with it though, I knew they needed the breast milk. In September, they both had to have hernia’s repaired. After that, they both were able to get rid of the heart monitors and Jacoby came off his oxygen! I finally didn’t have babies on a leash!

They have come a long way, and they have hit their milestones pretty close to when they should have. We had a developmental doctor’s appointment a couple weeks ago, and they said they were all caught up and advanced in some areas! It felt so good to hear something so positive!

It was a long 2 months but I actually enjoyed the experience. I knew when I went into labor that they were going to be fine. Call it mother’s intuition, but I just knew. I’m so glad for the experience because I wouldn’t know all the things that I know now without the in NICU.

Stacy's Twin Story

I’m so thankful for these two and I love them dearly. It is hard to believe but today is there due date. They should have been a year old, but they are almost 15 months! They are our miracle babies! We love our Parker Lewis and Jacoby Lee!

Stacy's 27 week Twins Story

Stacys Twin Story 2

*The first picture is Parker playing with bubbles. The second picture is Jacoby and the third picture is the first time I was able  to hold both of them. They were seven days old. Jacoby is on the left and Parker is on the right.

A Midwife-Assisted Cesarean for Breech Rainbow Twins Complete with Skin to Skin

A Midwife-Assisted Cesarean for Breech Rainbow Twins Complete with Skin to Skin

After a year of trying to conceive without success I saw a doctor and was diagnosed with PCOS. A year later I conceived with our first round of fertility injections and IUI. We were beyond excited…we ordered a crib the same day I got the call about my blood test! Sadly, I miscarried at 6 weeks. But our little one will never be forgotten and even has a name in our hearts even though we will never know the sex of the baby.

Two more rounds of injections and IUI brought us the delight of another pregnancy. This time it was twins! It was both a surprise and a wish come true. We had talked about how we would love to have twins if it were to happen. I had a rather uneventful pregnancy; no morning sickness or other early symptoms. In fact, the only discomforts were Braxton Hicks that started in my second trimester and lots of round ligament pain in my 3rd trimester.

We planned on an un-medicated natural birth in a hospital with a midwife, using the Bradley method. As time drew near it became apparent that my girls were still BOTH breech as they had been the entire pregnancy. I tried inversion techniques from SpinningBabies.com and saw a chiropractor for the Webster technique but nothing seemed to help. We scheduled a cesarean section. I was saddened to not be able to birth them naturally but decided there must be a reason and trusted God to keep us safe.

I couldn’t have asked for a better scenario. Our midwife accompanied us to the operating room and held my hand until my husband could be there. I was so grateful for her presence; she must have sensed my fear. She had gotten prior permission to let us do skin-to-skin in the operating room. Skin-to-skin was very important to me and seemed to ease the disappointment of not getting a natural birth. It’s one small thing I could do for my babies since it seemed so much was no longer an option.

I planned on nursing but couldn’t seem to get established so I decided to pump. Pumping was a constant struggle for me to maintain supply and I seemed to always have a blocked duct, but I persevered for 9 months.

In looking back, there are things I would change if I got to do it over again, but I realize that we did the best we could with where we were and the knowledge we had. I’m at peace with that.

Kristina's fraternal twin girls photo 1 Kristina's fraternal twin girls photo 2

Kristinas' fraternal twin girls photo 3

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