Accidental Unassisted VBAC after an Inverted T Incision

Our first child, Emelie, was born January 19, 2007. It was an amazing experience, the best experience of my life up to that point. It was fairly quick and easy for a first baby, lasting only about 5 hours, but it was pretty intense. In the end, though it was awesome, there were a few things I wasn’t completely happy with (yeah, I’m picky). My midwife hadn’t checked me when I reached the point of “I can’t do this anymore”, and assumed I still had several hours to go, so I opted for narcotics, which I hated, didn’t relieve any of the pain and just made me feel “stoned” and out of control. As a result, my baby was born sleepy without much respiratory effort, and was separated from me immediately to be assessed. She had low blood sugar and had a difficult time nursing over the next couple of days. But, overall, I was happy and felt a sense of accomplishment…. I loved giving birth, and was in love with my daughter.

Five months later, I was breastfeeding on demand, day and night, and hadn’t yet had a period, and because I was naive, assumed I couldn’t get pregnant. So I was shocked when I discovered that we were expecting our second baby so soon. My husband was just plain pissed off, and “pee sticks” were thrown. But we eventually warmed up to the idea of having children so close together. I continued to nurse my daughter through the pregnancy and continued working full time as an RN in our NICU, despite having several episodes of spotting at 4-5 week intervals. At 29 weeks, after having worked four 12-hour night shifts in a row, I went to pick Emelie up from her grandparents’ house. As I lifted her from her crib, I felt a gush. I rushed to the bathroom, where I passed a fist-sized clot. My mother in law phoned the neighbor to watch my daughter, and we drove to the hospital.

Ultrasounds showed the placenta peeling away from my uterus, but no one used the word “abruption”, though I knew that’s what was happening. I was put on hospital bedrest and we did daily non-stress tests. The baby always looked great. Then at 29 weeks and 5 days, on January 8th, 2008, I was given “bathroom privileges”. I was thrilled to be thinking about going home to my daughter and husband, Nick. But at 1pm, after getting up to use the bathroom, I started cramping. My heart dropped. I started watching the clock, and realized the cramps were coming in waves, about every 10 minutes, so I let my nurse know. My anxiety level was rising again. She notified the physician, but no one seemed too concerned. Shortly after the cramping began, I realized I was in true labour. I had done this before, and I knew what was happening, but no one seemed to believe me. I was told I was probably just dehydrated and was experiencing strong braxton hicks, but I had always had strong and frequent bh’s contractions starting around 12 weeks, and the difference was obvious. I explained this to the nurses and the ob who had gathered in my room as they watched the monitor. They told me the monitor wasn’t picking up any strong contractions, but, being only 29 weeks, they had placed the monitor too high up on my abdomen to pick them up. I moved it down, and they believed me….

I thought it was funny that they wouldn’t believe a mother who had been through labour once before and knew what was going on with her body. By that point, I was starting to have to breathe through the contractions… it was progressing quickly, and I was panicking. I had the nurse call into the NICU and have one of my co-workers come to support me. I had them phone Nick at work to let him know what was going on, and to tell him to get to the hospital asap. Everyone seemed to be moving so slowly, and still seemed so relaxed and not the least bit concerned (even my husband thought this was just another one of my over-reactions, of which I’d had several throughout this pregnancy), and in my mind I was losing it and wanted to scream, but I tried to remain calm and in control. Being an NICU nurse, I knew exactly what was in store for my baby and I over the next couple of months, and I did not want to face that.

I was put in a wheelchair and moved to the labour and delivery unit. While they were wheeling me back, I held my hands between my legs. I had an urge to try to hold my baby in, I could tell that things were moving quickly. One of the nurses said, “You know sweetie, you can’t hold the baby in. That’s not going to help.” For some reason, that really pissed me off… of course I *knew* I couldn’t “hold him in”… it was just an instinct. Once in l&d, the ob did an ultrasound which showed the baby to be in footling breech position… not an ideal position, especially for a premature baby whose heads are larger in proportion to their bodies than a full term baby. Then the doctor did a vaginal exam, and suddenly it was an emergency. He later explained that I was about 7 cm dilated and my bag of water was bulging. If my membranes had broken, my baby’s body would have slid through my partially opened cervix, and the head would likely have become stuck. Everything moved very quickly from that point on, it all kind of blurred by. I signed a paper and was rushed into the OR. IV’s and an epidural were placed, but it took ages for the epidural to take effect. I could still feel everything, and I could tell the ob was starting to get nervous.

Finally, I was numb, and he began cutting. The tiles on the ceiling were like mirrors, and I watched everything… I remember wondering who the heck would choose those tiles for that room. My son was pulled from my uterus feet first. His little 3 lbs body came out easily, but his head was stuck inside the incision, just as it would have been stuck behind my cervix. The doctor was pulling on his body so hard that I had to be held down on the table. I was watching this in the ceiling tiles, and it looked horrific. The pulling continued for what felt like several minutes, though I’m sure it wasn’t that long. I could feel the anxiety level rising in the room. I yelled out to the ob “just cut me more!”, which he did, leaving me with my “inverted-t” scar. My son was finally delivered and passed over to my co-workers, the best nurses I could have asked for, and the pediatrician, who also happened to be my favorite ped. My boy got the best care those minutes and months following his birth. I’ll be forever thankful to my friends in the NICU for giving him such exceptional care. They truly treated him like one of their own.

That night, I cried uncontrollably. I was devastated, terrified for my son, who we later named Nathan, missing my daughter and husband, and mourning the loss of my pregnancy. I could not take care of either of my children, and it was breaking my heart.

The next morning, the ob who had performed the c-section came to my room, and flat out told me that *if* I chose to have more children, I could never deliver naturally and would need to have a section at 37 weeks. The risk of my uterus rupturing was far too high to attempt a vaginal delivery, or even to risk going into labour. The information registered, but I wasn’t overly concerned at the time. I was much too focused on my son in the NICU and my daughter at home, who also needed me.

The next two months, I spent at least eight to ten hours at the hospital, arriving by 7am, every single day, holding my boy against my skin. I missed just one day, my daughter’s first birthday. I’d return home to nurse and cuddle Emelie all night, knowing she needed me just as much as he did. I felt torn between my kids, but I felt I was doing the best I could dividing my time and love evenly between them… he had me all day, and she had me all evening and night. I ran on auto-pilot, not feeling any emotions, thinking I was staying optimistic and strong, but not realizing I was just numb, doing what I had to do to get through those months without falling apart. I’d wake in the middle of the night thinking I’d heard the phone ringing. I was just waiting for that inevitable phone call, letting me know my son was septic and had to be re-vented… I was in a state of constant anxiety.

Thankfully, that phone call never came. When Nathan finally came home from the NICU, I collapsed emotionally. I was burned out, and all the emotions I should have been feeling and dealing with all along, flooded me. I felt emotionally detached from my son, feeling like he was just another prem I had taken care of in the unit, but this time I had to take him home. I realized I resented him for all the time I had to spend at the hospital with him and away from my daughter. He had reflux, and when I brought him home I weaned him off all his meds, so it took a lot of energy and patience to keep him happy. He had to be carried upright constantly, slept inclined on my chest at night, needed very frequent feedings, nursing at least every hour day and night. I was irritated, frustrated and exhausted.

The health nurse who came to visit asked me how I was feeling, and I described feeling detached and irritated, and wishing someone would come and just take him away. I knew I was meeting all his physical needs, and that he was being very well taken care of, but I worried he could sense my emotional detachment. She said this was common in these situations, that it would eventually pass, and that I was doing everything “right” that would help me to bond with my son. I was co-sleeping and breastfeeding both my kids all night and day, I carried them in slings constantly, one on my front and the other on my back. I refused to use bottles or soothers, and I never left them. Looking back, I over-did it. I burned *myself* out. It wasn’t my son’s fault, but he was my outlet. That first year is a blur. In the week leading up to my son’s first birthday, I began having anxiety thinking about the day I went to the hospital, the bedrest and the five days leading up to his birth. On his birthday, I had a panic attack at the same moment my labour had started, and it didn’t end until 4:30 in the afternoon, the time Nathan was born. After that, I think I finally started to come out of that “fog” of post-partum depression and PTSD, but it’s been a slow healing process. I often wonder how much the actual c-section contributed to the depression, detachment, and resentment I felt following the birth.

Fast forward another 3 years. My husband and I weren’t sure whether we wanted a third baby, worried we might get a repeat of our last pregnancy, and were just in the “discussion” phase when I started to have a feeling I might already be pregnant. It was April 2011, and I was excited to be my cousin’s maid of honour at her wedding in Texas in May. We had been planning and looking forward to it for months, and though a pregnancy wouldn’t necessarily mean I couldn’t go, it would certainly mean I wouldn’t have *as* good of a time. Having never been away from my two kids, this was to be my first “vacation” and I was more than looking forward to it. But, though I had no symptoms, I felt sure that I was already growing our third baby. I headed into town alone for Easter dinner at my aunt’s house, and stopped at the pharmacy on my way to pick up a home pregnancy test. I peed on the stick at the “Wasabi” restaurant where I went to pick up sushi for Easter dinner. Positive. I left the restaurant with sushi and pee stick in hand, enjoyed my Easter dinner, and cried hysterically the whole way home. I realized I couldn’t tell my husband just yet (I was still 5 days away from a missed period), and threw the stick out the window… I didn’t want him to know I’d been suspecting anything and had done a test on my own.

So, a week later when I was a few days “late”, I told him of my “suspicions”, and we did a test together. This time, he was much more accepting… after all, our kids were no longer babies, and we *were* at least considering trying for a third after the wedding, unlike with our other two, who were completely unplanned. I immediately weaned my kids, who were both still nursing for about a minute at bedtime. I have read everything out there about breastfeeding through pregnancy, and I know it’s not considered dangerous, but in my mind, nursing Emelie and Nathan’s premature birth were linked. I was also concerned about my progesterone level, and wanted to make sure it was okay as soon as possible so that something could be done to hopefully sustain this pregnancy to full term. I got in with my midwives right away, and all the blood work checked out fine. I was relieved about the blood work, but was wondering why I wasn’t feeling nauseous yet. (I was constantly coming up with something to be anxious about!) With my first two pregnancies I was nauseous before I had even missed a period, but it always stayed fairly mild and was over by the end of the first trimester. I was now about 5 weeks, so I thought I might luck out this time and sail through the first few months. Then at 6 weeks, the week before I was supposed to hop on a plane to Texas, it hit me hard. Suddenly I was severely nauseous all day and night, couldn’t hold any food or water down, and started to rapidly drop weight. For nearly a week I tried to get it under control, but I’d never experienced anything like it before. It got to the point where I’d just lie on the couch or in bed all day unable to do anything but sleep, and my 3.5 and 4.5 year olds would basically be fending for themselves.

One day my husband came home early from work to take me to the hospital where I was diagnosed with hyperemesis gravidarum. I spent 11 days in the hospital being hydrated and trying every type of IV medication to get it under control. I was beginning to feel hopeless, and was upset that I had to miss my cousin’s wedding. I figured I’d have to deal with hg the entire pregnancy, and I didn’t know if I could do it. Then one day I just started feeling a little better. The dietician told me to try to eat whatever sounded even remotely tolerable… I asked her for Lays chips, and slowly devoured the bag that day and throughout the night. And the next day I was able to have a few bites of my breakfast and lunch. Then I ate my entire supper, and never looked back. I’ll always have a special place in my heart for Lays chips 🙂 The nausea continued until about 15 weeks, but it was completely manageable, as long as I ate constantly, and I mean constantly, day and night. I had lost over ten pounds, which I couldn’t afford to do being only 110 to start, and I put it back on quickly. Suspecting that my insufficient diet with my last pregnancy had been a contributing factor to my son’s premature delivery (I always ate healthy foods, just not *enough* food), I researched pregnancy diets, and started following the Brewer Diet as much as I could tolerate.

I knew I’d have to have a repeat c-section at 37 weeks, but I was determined to at least make it that far. When I mentioned the repeat section to my doula friend Brittney, she sent me a link to the “Special Scars Special Women” group on facebook. It was the first I’d heard of women having VBAC’s with special scars. How on earth were they going into labour, and actually giving birth naturally, without having their uterus explode!? So, I kept researching VBAC, special scars, and reading birth stories obsessively. I learned just about everything there is to learn about pregnancy, VBAC, risks of c-section, natural birth, things that could possibly go wrong, and what to do about it. I read about unassisted birth, home birth, hospital birth, how to have a “baby-friendly” c-section. I wrote a birth plan both for the “trial of labour” and one for if the baby and I absolutely needed a section… and writing the “plans” made me realize how badly I wanted to avoid the hospital, and having to defend my decisions while in labour. Every time I imagined my baby being born, I envisioned an unassisted home birth. I’d start having contractions in the middle of the night, and labour on my own until morning, wake my husband up when it was “too late”, and we’d birth our baby together in our home, just the two of us. This was what I really wanted, what felt right, and I fantasized about it constantly. But I didn’t truly think it was realistic, so I continued to plan for our hospital VBAC. However, all the while, my top priority was really just to reach 37 weeks… and of COURSE, a healthy baby. (I can’t believe the number of times I heard someone tell me that the *only* thing that mattered was a healthy baby!)

I set mini goals for myself… those who have had a premature baby probably understand the need for these “mini goals”. First was to make it to viability, about 24 weeks. Then the big 29. The day I was 29 weeks, we took the kids swimming to celebrate. I enjoyed sitting in the hot tub for a few minutes and played with the kids in the pool. When we got home I saw a tiny bit of spotting. So tiny I wouldn’t have noticed if I hadn’t been looking for it the entire pregnancy. But it was enough to send me back in time nearly 4 years. I panicked and rushed myself to the hospital. Everything checked out perfectly fine with the baby, no signs of abruption, probably just a bit of old cervical blood. My midwife, Amy, managed to calm me down and sent me home. I don’t think I had even realized how uptight I had been throughout the pregnancy until I saw that tiny bit of pink. It really opened up the lines of communication with my midwife though, and got me talking about my fears, and how determined I was to do what was best for this baby… and my gut was telling me that a VBAC was what we both needed.

Once passed the 29 week mark, the pregnancy really flew by quite quickly. Every week felt like a bonus, and I was so proud of my body for proving that it could once again carry and grow a baby to full term. This baby was even cooperating with being in a great position. Even my daughter had been breech until 38 weeks when I had an external cephalic version to turn her head down. I loved and soaked up every minute of this pregnancy, knowing this would likely be my last. My kids loved play “midwife” everyday, checking my blood pressure, listening to the baby’s heart, rubbing my belly and talking to their tiny sibling, and thinking up creative names for their new brother or sister.

I continued to spend a lot of time researching birth, discussing things I’d read and gaining support from the group of amazing “special scars” women. Their stories were so inspiring and empowering and gave me so much hope to hang on to.

At 35 weeks I had a mandatory appointment with the most VBAC-friendly OB in our city. I went in to the appointment expecting the worst and ready to stand my ground, but was determined not to argue or become emotional. I knew the facts, and I felt so positive about my choices that I wasn’t even nervous about her bringing me down. She gave me a rupture rate of at least 10% (huh??), made sure I was very aware that I was risking my life and my baby’s life, handed me a pamphlet to read about VBAC’s (which made me laugh afterwards… did she not realize I’d spent the last 20 weeks reading the REAL facts on VBAC with an inverted-t, and everything else concerning birth?), gave me a c-section date of December 27 and told me to call if I changed my mind and wanted to book the section. I tossed her card as soon as I left the clinic… booking the section wasn’t even an option in my head by that point. I felt so great about my decision.

I didn’t tell many people about my VBAC plans though. My mom was nervous, despite my reassurance and fact-spewing, and I could sense that many other close family members were very unsure, though outwardly supportive, about my decision, which I understood, but I decided that I wouldn’t waste energy trying to convince them… I knew what was best for the baby and I, and I focused all my positive energy on the outcome I wanted.

A few weeks before my “due date”, I rented a doppler so that I could “stay home as long as possible”… looking back, I knew I wouldn’t likely be going anywhere, and wanted to be able to monitor my baby myself. Being a NICU nurse, I knew the basics of what to be watching for. I stock-piled old sheets and a plastic tarp in my bedroom closet “just in case” I delivered the baby on the bedroom floor and didn’t want to make a mess. I bought a tincture of shepard’s purse to have on hand in case of excessive bleeding, and I had read about using the placenta to stop hemorrhage. I stocked up on coconut water, granola bars, hard boiled eggs, and fruit smoothies to sustain my energy through the labour. I was ready, confident, and so anxious and excited to finally see how this birth would play out, and to finally meet this little person.

Christmas came and went. My sister in law and her husband were in town for the holidays and were catching their flight home in the afternoon on New Year’s day. We all gathered at my in-law’s house for New Year’s eve dinner. My husband and I had taken the kids sledding that afternoon, and I had made sure to run a few laps up and down the long, steep hill. By the time we left our house that evening I was feeling kind of crampy and “heavy”, but I’d felt that way off and on for about a week and didn’t think too much of it. We all joked that it would surely be a new year’s baby… I was, after-all, two days past my due date, and it was snowing pretty heavily outside. My sister in law had been hoping to see the baby before she had to leave, and time was running out! We joked about all the “natural” ways to get labour rolling. I had read that wine could do the trick, so I had a small glass.

We all headed outside into the snow, and I walked quickly up and down the drive-way while everyone else played hockey with the kids. We had a relaxing evening and headed home well before midnight. By 11:00, I was lying in bed, still feeling very mildly crampy and hopeful, but not convinced that the baby would be coming soon. As I layed in bed waiting for sleep, I thought about the conversation I’d had with my sister in law, and how we’d joked about nipple stimulation, and remembered that my midwife had given me the go-ahead to try it as a safe way to get labour rolling, and that it would only work if my body and the baby were both ready. I figured I’d give it a shot. Literally, within about two minutes of trying it, at midnight on new year’s eve, I felt a wave… nothing too intense, but a definite contraction. So, I did a little more “stimulating” after that wave had subsided. Sure enough, another contraction. I still wasn’t convinced that this was the beginning of true labour. I spent a couple of hours in bed, drifting in and out of sleep, waking about every 15-20 minutes when I’d feel another contraction. By about 2am, they were getting slightly uncomfortable, and were coming about ever 10 minutes.

I was convinced. This was it!! And so far, it was happening exactly how I’d spent months imagining and hoping it would. I got up and brought my computer and exercise ball (now re-named “birthing ball”) to my room. I posted on a couple of my favorite facebook groups that I was in labour, and to my surprise a couple of my friends were there to encourage and support me. I read a few inspiring birth stories, and did a bit more reassuring reading. I drank my coconut water and fruit smoothies, had some yogurt, and boiled water for my red raspberry leaf tea. I felt SO relaxed and comfortable, and not the least bit nervous or afraid. I listened to my baby’s heartbeat a few times, both between and during contractions, and it was always perfect. I checked my blood pressure, which was also great.

I was half-heartedly timing the contractions, and they were still 10 minutes apart, and would space out further when I got up to use the bathroom or walked to the kitchen for tea, but they were definitely becoming more intense, though still completely tolerable. I tried to lie down to catch a little sleep between contractions, but it was horribly uncomfortable to lie flat. I tried hands and knees, and that made the contractions quite painful. I settled on the ball as the most comfortable position and stayed there for several hours. I finally reached the point of having to breathe through each contraction a little, though they remained ten minutes apart. I was getting a bit frustrated, thinking that this was going to be a long labour… it had been a good 8 hours, and the contractions were still relatively far apart and fairly mild. Nowhere near as intense as I’d remembered them being in my first labour with my daughter. By about 8:45am, I could hear my husband and kids waking up in the other room, and I decided to finally let them know how I’d spent the night! I walked into the room and asked my husband if he was ready to have a baby today. I was so excited, but I knew he had been a bit anxious about the birth and the VBAC, and it showed on his face a little when I told him that it was time. He and the kids got up and got dressed, and I reassured him that I thought we had plenty of time and didn’t need to rush to the hospital right away.

At 9:00 I phoned my midwife to let her know I was in labour, and that the contractions were uncomfortable but tolerable, and coming about every 10 minutes. She asked if I wanted to head to the hospital or wait until contractions were 5 minutes apart, and I told her we’d start getting ready to head in because we live about 25 minutes from the hospital, but that we wouldn’t rush and would be there within the hour. We continued getting things together, I called my mom to let her know what was happening and for her to let my dad know. We called my in laws to let them know we’d be dropping the kids off at their house shortly on our way to the hospital. I was still pretty relaxed and comfortable. The contractions were intensifying, but remained pretty far apart.

At 9:15, I felt one come on and I leaned over the kitchen table to prepare to breathe through it, and I felt an intense pressure and a gush as my water broke. Suddenly, it was on. It was no longer “waves” of contractions, it was a steady, heavy, deep down, intense pressure, like my baby was going to fall out. I reached for my husband and clung to him, telling him to bring me to the bathroom so I could sit on the toilet… for some reason the toilet sounded like the most comfortable place to be.

I sat and tried to find a way to ease the pressure, but there was nothing I could do to lighten it. I was beginning to vocalize *loudly*, and was glad the kids were already in the car waiting to go. I told Nick to call Amy back to let her know we weren’t going anywhere. I spoke with her briefly, though I don’t remember exactly what was said, just to tell her that the baby was coming *now.*

I remember being amazed at how quickly this labour had gone from mild and comfortable to BAM! baby’s coming. Nick phoned 911 at some point, then headed out to the car, which was still running, and brought our kids inside. He asked them if they wanted to come watch me have the baby, and they said no, so they went into their bedroom. Nick called Amy back and she tried to have him help me lie down, but there was no possible way I was going to move from the toilet at that point… I yelled at him, between my “moaning” that I “am not lying down!!” I felt an intense pressure and urge to have a bowel movement, reached down and felt the head starting to emerge… I still had not felt any urge to push, just an urge to try to slow things down. I held my hand over the baby’s head to provide support to my perineum because I felt like it was coming too quickly and I’d surely tear from one end to the other.

I felt my body give a tiny little push and suddenly the head was out. The pressure subsided greatly at that point and I was able to stand. Nick and I both waited with our hands between my legs. I kept feeling like he was pushing the baby up by its head, and I asked him several times if he was touching the head, which he never was… of course he wasn’t… he was terrified to touch it! I know now that the baby was pushing against me from within with its feet! I stood with the head out, waiting for another contraction, for what felt like a good minute or so, though I have no idea how long it really was. It was like my body was just taking a little breather before the final hoorah. I felt like it had been long enough though, and I gave a little push, which was all it took for the rest of my baby’s body to slide right out, into our hands. The little purple body was quiet and not moving, but I knew everything was fine and I quietly and gently dried it off… and in the process happened to notice we had a boy. I took huge comfort in knowing that his umbilical cord was pulsating and that he had time to start breathing for himself. I just kept him warm and waited for him to come around.

A few minutes after he was born the paramedics showed up… one of whom was Nick’s brother! They both seemed slightly panicked, asking me what I needed and what they should do (it was their first time attending a birth). I asked them to calm down first, and give me some blow-by oxygen for the baby, though I’m sure he didn’t really need it. He started to pink up, and we moved from the bathroom to the bedroom to wait for the placenta. I nursed my son, and waited. Everyone was getting a bit anxious for the placenta to make its appearance and transfer to the hospital was suggested, but an hour after the birth, it finally delivered with very little bleeding. I was glad I refused to head to the hospital. Shortly after that, Amy arrived and examined the baby and I, and everyone looked great.

I lounged in bed with my new son and chatted with Amy, with my two kids cuddled up beside me. Nick had called our parents earlier, and was now serving coffee in our living room. My sister in law and her hubby got to meet the baby before they left. I had breakfast and tea in bed. It was wonderful, and once everyone left, it felt like it had just been a part of a normal day, that left me feeling like I was on cloud nine for the next week. The physical recovery was pretty much a breeze compared to my c-section, and was even much easier than after my 6 lbs 10 oz daughter’s birth. Emotionally, I haven’t had a “low”… other than the time my husband mentioned that this would be our last baby. It’s been one month and four days since my amazing, empowering, healing, unassisted VBAC with an inverted-t incision, and I’m so in love with my little turkey.

Cullen Patrick Henny weighed 8lbs 1oz, was 20″ long, with a 38.5cm head… by far my biggest baby yet, and absolute BEST birth.

“There are many people who will tell you that you can’t. What you’ve got to do is turn around and say ‘watch me!!’”