A Powerful HBAC

I cannot begin Bella’s birth story without first mentioning the birth of her big brother, Adam. You see the plan was for Bella to be born via home birth after cesarean section (HBAC). Adam was born in August of 2010 via c-section after a 3 day long induction due to high blood pressure at 39 weeks. The labor was said to be a failure to progress, which I must agree with considering I only made it to 6 cm in 3 days! Adam was obviously not ready to come out but needed to with the high numbers my blood pressure was hitting.

I was not upset by the c-section since I feel I was given quite a fair shot at getting him out but with a posterior baby that is asynclitic (head tilted to the side) I didn’t really have a prayer of getting him out since I was stuck in bed and couldn’t help him move. The devastating part of it all was that I thought our breastfeeding relationship was messed up from all the interventions I received during labor. My mature milk never came in fully and we had to start supplementing at 1 week old due to a loss of 11% body weight. I was never able to bring up my supply despite trying for a couple months. Our breastfeeding relationship ended at 3 months old because Adam would get so frustrated that he wasn’t getting much and my supply slowly dwindled to just about nothing.

I started researching how to have a more successful breastfeeding relationship with my next baby. I found that fewer interventions during labor would be a huge help, no c-section, no Pitocin, no epidural or other labor drugs, and allowing baby to come when baby is ready. This caused me to throw my idea of a repeat c-section out the window. I thought that I was broken and would always need a c-section to get my babies out; my doctor agreed that with my elevated pregnancy induced hypertension (PIH) I would probably not be a good candidate for a VBAC. But I moved on anyways to research VBAC’s since I had never even considered the idea before. I knew nothing of the stats behind it, all I knew was what doctors had told me in my career (I was a NICU nurse for a couple years, did some work in labor and delivery, and spent a little over a year in a pediatric clinic which is where I was working at the time).  What I found through my research surprised me! I found that VBACs held a much lower risk of a uterine rupture than I thought and c-sections held many risks that I never knew about. I also didn’t realize that with each subsequent c-section those risks went up for mom, baby, and future babies. My husband and I then decided that a VBAC would be the way to go for us during our next pregnancy.  Another aspect about birth that I learned about was the use of a Doula during labor and delivery. I had heard about them during my first pregnancy but thought that Pat and I would be fine on our own. Little did I know that the use of a doula shortens the length of labor, reduces the need for epidural or other pain killers, and reduces the chances of having a c-section.  I decided I was going to hire one for my next birth.

Anyways, I learned so much during my research that this could go on for pages and pages so I will spare you all the details and simply encourage everyone to educate themselves on birth options and don’t rule out anything until you have researched it!  Even as a nurse and a bit of a “know it all” I can openly admit that I knew nothing about how birth could/should be with Adam and it makes me sad that I didn’t recognize that before it was too late. I had too much faith in the medical system that ultimately let me down. (Disclaimer: I do believe that the medical system has its place and has saved more lives than I will ever know, but I do not believe that it is the only option for a low-risk mom to birth in.)

During this time I also learned a lot about breastfeeding. Specifically about low supply, how to avoid it and what to do when faced with it.  I learned a great deal from reading forums, books, and attending LLL meetings. My favorite books on the topic is “The Breastfeeding Mother’s Guide to Making More Milk” and of course “The Womanly Art of Breastfeeding”.  I started mentally compiling a list of things I would do differently this time and what I would do if the problem of low supply arose again.

Adam turned 1 and we decided to go ahead and try to get pregnant. I got pregnant right away and we were overjoyed! I started out seeing a family practice doctor instead of the OB that I saw throughout my first pregnancy because I knew I had a better shot at a VBAC with her and not having to rotate through doctors during the pregnancy. We had our first ultrasound to confirm pregnancy at 11 ½ weeks and were told that we were only 9 weeks along. This was fine with me since it did take longer than usual to get a positive pregnancy test and I knew I wasn’t going to be induced so the longer I had to go into labor on my own, the better!! I asked my new doctor TONS of questions about VBACs and her feelings about them and the hospitals policies regarding them. I felt comfortable enough with the answers she gave but still had a bit of an uneasy feeling.

I pondered how I was going to have a successful VBAC with all of these stipulations the hospital would place on me.  I had seen The Business of Being Born and loved the idea of a home birth but didn’t quite know enough about it. I also didn’t think that I would be able to since I had such issues with my BP during my first pregnancy. So now I needed to do my homework on how to keep my BP stable and home births after c-section (HBAC). I already knew that research suggested that a home birth for a low risk woman was just as safe if not safer than a hospital birth but was unsure of the HBAC issue. I found that if I didn’t keep my BP under control I was too high risk for a home birth but having 1 prior c-section did not make me high risk! I had heard about Brewer’s Diet through a family friend and started reading about it. I decided that it couldn’t hurt to give it a shot and see if it helped. From their website it looked like it had helped many women keep their BP down but I couldn’t really find much research on it. I committed to following that diet through the pregnancy as long as it was helping me keep my BP down.

Pat and I decided to start meeting with the local midwives just to see what we thought of them and if they thought our situation was ideal for a home birth or not. The first midwife we met with, Noel, was awesome. Pat couldn’t be there for the appointment so I had a long list of questions to ask her for the both of us. My main reservation with a home birth was all the things I had seen go wrong with birth while working as a nurse. When Noel informed me of all the emergency equipment that a licensed midwife in the state of Idaho would bring with to a birth it instantly made me feel better. Noel also told me that I was going to have to work through my fears for my VBAC to work no matter if I was in the hospital or at home.  That was just what I needed to hear.

Next I had a phone interview with Nancy, I asked her the same questions I asked Noel and got many of the same answers. Pat and I had decided by that point that we were indeed going to have a home birth! At this point we were about 16 weeks along. Now we just had to pick a midwife! I really enjoyed both of them but ultimately we decided to have Nancy be our Primary midwife and Noel would assist her at the birth. The medical side of me was really drawn to Nancy because she is also an EMT which gave her a few more medical skills that put my mind at ease (she also bills insurance, which is a plus)! Another fantastic thing about the midwives is that they did not just lead me to believe that there was nothing that could be done about my BP which the OB’s had done. They encouraged Brewer’s Diet, exercise, mag/cal, and herbal teas! Nancy also checked on those things at each visit, she cared about me as a whole person and I was not just another pregnant woman to see that day.  With her help I was able to keep my BP under control, eat a healthy diet during pregnancy and progress with no problems at all!

We had a 20 week ultrasound that revealed we were having a little girl! Everything went great! Starting at 34 weeks I began pumping colostrum everyday and saving it just in case we needed it. I ended up with about 4 ounces in my freezer.

Anyways, on to the birth story! May 28th I decided to shampoo the carpet, I was 38 weeks exactly. I had some bloody show and couldn’t sit down all day because I was uncomfortable. That is when contractions started happening every night and then fizzling out when I went to bed or took a bath.

June 11th my due date, rolled around with no further signs of baby. We took Adam to the water park with my mom and I started having constant back pain. My mom decided to stay the night just in case this was the start of labor. I woke up in the morning still pregnant and without back pain.

June 14th I am feeling really foggy and emotional. I started crying coming home from the grocery store for no reason at all. I had Pat come home early from work because I thought this might be the start of something and I didn’t feel like I could handle life at that time.

June 16th I met with Nancy to discuss natural induction options.  We set up a plan to try and get this baby out before 42 weeks since I cannot have a homebirth past 42 weeks in my state. The local hospitals were also in the middle of setting up VBAC bans which meant minimal support from them. By now I am very annoyed when people ask if I have had the baby yet. Don’t really want to talk to anyone on the phone anymore so I ignore most of my calls and most of the time Pat takes my phone away to keep me off of Facebook since it only made me worse!

June 19th Nancy came and stripped my membranes. Of course I had contractions 3-6 minutes apart lasting 30-60 seconds for the whole evening (5 hours). Went to sleep, woke up without contractions the next morning.

June 20th I went and met with on call doctor at the hospital in case of transfer on Monday (42 weeks). She said that she would not suggest an automatic c-section (the VBAC ban would be instituted 6 days later) but would try either augmenting any contractions I may be having at the time with Pitocin or break my water and see if labor kicked in on its own. She also said that if nothing was happening by the end of that day she would highly suggest a c-section. I was at peace with this knowing that I would have tried everything to get her out safely before this happens.

June 21st I took nasty, nasty Castor Oil and did lots of pumping. Lots of contractions increasing in intensity on and off for 7 hours. Adam went to Lewiston to be with my mom as I felt I couldn’t run around after him anymore. Contractions stopped whenever people would come over. I hardly had any contractions while my mom was here. Later in the evening my Doula stopped by to give me some homeopathics that might help keep the contractions consistent and I stopped contracting when she got here and started up again when she left. This led me to think that I was going to have to labor completely by myself which didn’t sound pleasant to me. Before bed Pat set up the birth pool just in case we needed to fill it up that night. Of course when I went to bed the contractions stopped again.

June 22nd Today was the 2nd round of membrane stripping. I was 3 cm dilated and easily stretching to 5cm, 50% effaced and she was at a +1 station. Nancy inserted a Foley Catheter to dilate me to a solid 5 cm. It fell out about 2 hours after she put it in. It was very interesting because my body just pushed it out and I had no control over it! That night I was very emotional and had hit my limit. I had a craniosacral therapist come over and do a body works session with me. I was very crampy through the whole thing but enjoyed laying on my bed by myself listening to the storm outside afterwards. She really helped me work through many of the thoughts I was having about the whole situation.  Fear that I wouldn’t succeed or would flake out and want to go to the hospital for a c-section.

June 23rd We decided not to do anything to try and get baby out! We just relaxed and spent time together. Adam was still with my parents and it was stressing me out not having him with me. I would cry every time I thought of him! So, Pat decided to drive and go get him that afternoon. I was in much better spirits when he got home!! I had my normal contractions that night and decided to take a bath when Adam went to bed. My contractions didn’t stop this time!! They last through my bath and I questioned a possible slow leak in my amniotic sac. I call my midwife and give her a heads up for like the 4th time in the past 2 weeks! We go to bed at about 10 and by midnight I cannot lay in bed anymore when I am contacting!! This is it! I can hardly believe it!

June 24th (41 weeks 6 days) my contractions were quite frequent (2-3 minutes apart) lasting about 1 minute. We called Nancy and she came over around 1 AM. All of us figured it wouldn’t take too long for the baby to come out since I was already 5 cm dilated at the start of consistent contractions and she was at least as low as a +1 station. Nancy started setting up all of her supplies and Pat started filling the birth tub.  Having Nancy come over was a test to see if my labor would continue when someone was over and it did! So Pat went ahead and gave my doula, Stacy, a call to come over.  I walked around and couldn’t stand still between contractions but they were manageable. When a contraction would start I would hang on either my hubby or Stacy.  I was starting to get pretty vocal through the contractions. Around 5 AM Nancy said I could get in the birthing tub if I wanted as I was getting quite uncomfortable.  It was so warm and so wonderful! I was able to relax between contractions and that was huge.

I figured if it was time for the birthing pool then we should call the remainder of our birthing team. Brittany (photographer), Kelly (hostess/videographer) and Noel (2nd Midwife) all showed up. I don’t remember when anyone got there but I know they showed up! Pretty soon the sun came up and my contractions spaced way out.  We thought it was the tub so I got out and started walking around. They were about 8 minutes apart but lasting around 1 ½-2 minutes. At 7 AM we decided to do a cervical check to see where we were at. 7 cm dilated, 90% effaced and baby was at a +1 station. Progress!

It was around this time that my contractions changed from a painful tightening in the front to a horrid pain in my back.  Adam woke up around now and didn’t seem to care at all that I was making noise. He was just excited that so many people were at the house hanging out. He got to be the center of attention and got to watch Cars twice that day!  Pat started feeling sick about now and we realized he had a fever so he went to sleep in Adam’s room. Shortly after this my brother in law’s sister stopped by with my niece and nephew to pick up the portable DVD player. I totally forgot they were stopping by and they didn’t know I was in labor. I was in my room at that point and nobody else in the house knew them. It was awkward at the time but funny now. I was really hoping they wouldn’t say anything to my family since I hadn’t called to let anyone know I was in labor! Hindsight, I don’t even think she realized what was going on!

I kept laboring and laboring but was starting to lose hope. My back hurt so bad I wasn’t sure I would be able to continue. I kept thinking that I should go get a c-section but then I would think about how much work that would be. Going all the way to the hospital (4 minutes away max), getting an IV and an epidural. It just seemed so impossible (love the way a laboring mind works!).  I was trying hard to get my contractions closer together. I was squatting between contractions and lunging. Nothing was working to bring them closer together.

I got in and out of the pool and the shower a few times. I spent a good chunk of time in the pool listening to music while Stacy gave me sips of Gatorade and fed me food. I wanted to throw up but nothing would come out, but I knew I would feel better if I could get everything out of my stomach. I was starting to make a few grunty sounds and wanted to be checked. Around 11AM there was no change at all. I was really beginning to doubt that I could do this and wished that I wouldn’t have gone into labor and I would have had a repeat c-section. Around 1PM Pat got up for awhile and I told him how I was thinking of giving up.  He did the right thing and spread the word to my doula and my midwives.

They of course came and gave me a pep talk and challenged me to wait one more hour.  They suggested we try some different positions and some herbs and homeopathics to get my contractions closer together. So we worked hard for that hour and had my chiropractor come over. He adjusted me often and said my sacrum kept popping out of place which was contributing to my excruciating back pain. After each adjustment I would have HUGE contractions that must have been pretty productive. Now it was time for the big check. At 2:30 I was 8cm about 90-100% effaced. We all cried and were so excited for some change! It gave all of us the hope that I WAS GOING TO DO THIS!

Pat and I kicked everyone out of our room and had a little dance party between contractions to help wiggle baby down more.  I was feeling really good about things and was in good spirits between contractions. I got in the pool for a bit to try and reduce the back pain. I don’t remember much of this as I was entering transition and getting deep into labor land. I know I started hating my chiropractic adjustments as they made everything SOOOO intense! My chiropractor would walk around with me and hold my sacrum in place and that caused frequent contractions that were making baby surge down. When he wasn’t doing that Stacy and Pat were working together to push on my hips but it got to the point that even if they were both pushing with all their might it was not making any difference. I wasn’t sure if I needed to start pushing at this point but thought I might and asked to be checked.

No change in dilation but baby was at a +3 station. Contractions were now back to back and long. At 6 PM I was 9 cm in the back and 8 cm in the front. I was getting SO tired and not handling things very well at this time. I was easily stretching to complete so Nancy held back cervix during contractions while I sat on the birthing stool because I was getting ready to give up. I soon moved to the bed and lay on my back while Nancy continued to hold back the cervix. At 6:40 I started throwing up and at 6:45 I was complete with a small cervical lip. I got one more adjustment and then started trying to pushing past the lip. It wasn’t going away so I panted through some contractions while Nancy continued to hold the lip back. Nearly 2 hours of trying to get my super stubborn cervix to dilate took everything out of me. I felt like there was NO way I had the energy in me to push this baby out.  During all of this time my birth team worked so hard to help me relax and not get overworked.  It was hard to stay in control of myself.

FINALLY at 8:45 I was complete and actively pushing. During pregnancy you think and plan about how you will push and labor and it’s amazing how much that can change in the moment. I planned and prepared for a water birth, but where did I end up pushing at? Flat on my back on my bed! That’s just what was working for me. Honestly I couldn’t even think about where I wanted to push. Nancy asked me if I wanted to get into a different position and I don’t think I was even capable of answering her. I really don’t remember much about pushing, but I felt completely out of control! My doula was on my left side holding up my leg and when I was losing it she said “Shawna, look at my face” and I scream/cried “I can’t look at your face”. Everyone in the room started laughing. I just felt like I had zero control over my whole body.

My contractions were so back to back that there was hardly any time that I wasn’t pushing. I did not enjoy pushing one bit! I kept feeling like I was going to pass out and I remember wondering how Bella would come out of me if I was passed out. I never did, just had a few times where everything started going black (I think I was pushing too hard). Nancy said as baby was coming down the birth canal she was wiggling her head back and forth. I am not at all surprised since she was flipping from ROA and LOA all throughout my pregnancy and labor.  Baby was crowning at 9:53 and Nancy talked me through pushing slow and easy to prevent tearing.

When her head was about half way out they had me reach down and feel. It was so amazing to feel her little head for the first time but my mind did not comprehend that I was almost done and I started crying that she was NEVER going to come out! Everyone laughed and said that she was almost all the way out. At 9:58 her head was out with a nuchal cord X1. I don’t remember anything for the next couple minutes and then all of a sudden everyone is helping me flip over onto my hands and knees. Bella was stuck with her head out for 3 minutes before her body came out at 10:01 PM, 1 hr and 59 minutes before I was 42 weeks. I rolled over onto my back and FINALLY got to hold my precious little baby! She was very out of it (Apgar of 3) but came back quickly.  Bella weighed 8# 4 oz and was 20 inches long.  Mr. Adam slept through all of the pushing and the delivery!

As far as I can remember my first words were “Am I really done?!”  Of course I quickly turned my attention to my new little bundle of joy! Unfortunately I started hemorrhaging. My midwife asked me if it was ok that she gives me a shot of Pitocin. I said “I don’t care. I just don’t want to die after all that hard work!”  I ended up getting 2 shots of Pitocin, yarrow, placenta put in my cheek, and a few other things. My bleeding slowed some and my midwife was able to put in 2 stitches where I had a TINY tear from the shoulders being stuck. During this time I kept telling everyone to not ever let me have another baby! I was saying that I know I will forget about how much it hurts but please remind me that I do not want to do this again! Haha!  Bella started to search around for something to suck on and she nursed 35 minutes after she was born. She latched on like a champ and was swallowing right away! After that my bleeding picked up some and Nancy did a straight catheter to empty my bladder. That worked and my bleeding slowed to a normal amount.

We hadn’t told anyone that I was in labor so I called my mom and I said “guess what” she said “Oh are you in labor now!” and I said “nope do you hear that?” On cue Bella cried and my mom couldn’t believe I had already done it! She lives about 45 minutes away and left with my dad to come meet Bella and take Adam with her.  They got to bond with Bella while I was busy getting stitched and cleaned up.  It was about 1 AM when we were done getting all of us settled and stable. Bella had nursed a couple times and we were all ready for bed! Nancy tucked us in and went and slept in the guest room for a few hours. She checked on us before she left to make sure my bleeding was under control still and finally went home. Sleep has never been so needed or so wonderful! Bella and I were skin to skin and loving life! I won’t lie and say that I felt amazing, I was in rough shape. It took me at least 24 hours to be able to stand up without the room starting to get black due to the blood loss, but it was many times better than recovering from a c-section!  I am still trying to wrap my mind around the fact that I actually had a vaginal birth after a previous c-section at home without a drop of pain killers!

As I mentioned above Bella latched on quickly after birth and was wonderful at nursing. I let her eat whenever she wanted which was pretty frequently. We also spent most of the first week skin to skin in bed or on the couch. At 1 week old she was 1 oz shy of birth weight which was amazing to hear! The following week she started nursing more frequently and only gained 3 oz. We decided to give it a week and see how she did after that since she was already above birth weight at 2 weeks old. That was a very hard week. She basically nursed the whole week. Every night from dinner time until 2AM she did not stop nursing (not exaggerating at all). I was losing my mind, but wanted to give my supply every chance to increase. At the 3 week mark Nancy came back over to weigh Bella. She did not gain a single ounce that week. I cried and cried! I couldn’t believe it was happening again, I wasn’t producing enough milk.  Her latch was great, she sucked well, and no tongue tie or lip tie could be seen.  I had encapsulated my placenta because I knew it helped bring the milk in and I had high hopes that it would help. I was also drinking a special lactation tea that was made for me. Right away I got out my pumped colostrum and gave her a bottle. We then went and rented a hospital grade pump and bought an SNS in a town an hour away.  I went and got fenugreek (4 pills 4X/day) and ordered Motherlove More Milk Special blend.

I started pumping after as many breastfeeding sessions as I could. Some days it was only 5-6 times because Bella didn’t seem to stop nursing and some days it was 10 times. We used the SNS for supplementing with donor milk once my stored milk ran out.  I had a few friends lined up with milk to donate if we ended up needing it. They are so amazing and a HUGE blessing! I got out my handy dandy book “The Breastfeeding Mother’s Guide to Making More Milk” to read for the third time and started implementing as many ideas from the book as possible. I tried going to the chiropractor to increase my milk but it did nothing for my supply. I started getting acupuncture and went 3 times. Each time the following day Bella would not need much if any supplements. But the day after we were back where we started. Once the More Milk Special blend kicked in we were able to get down to about 5 oz a day for supplementing. My doctor prescribed Reglan and ran tests on my thyroid levels as well as checking for PCOS.  Both tests came back normal. We also discovered we had Thrush at that time. The Reglan had no effect on my supply. I went and saw a craniosacral therapist for a session. No change in supply. I stopped pumping because it was getting overwhelming and I was not seeing an increase in supply with it.  I was drinking 100+oz of water a day, taking cod liver oil and eating oatmeal. I was waking Bella up every 2 hours at night.  I even tried drinking a beer (which I HATE) but nothing seemed to be helping much.  The SNS was starting to become a lot of work and adding quite a bit of stress; because of this I started adding bottles into the mix. She was ok with the bottles for a couple weeks but one day stopped taking them and we went back to SNS. I started taking Black Cohosh and Red Raspberry Leaf tincture to help with letdown in case there were issues with that.  I also started taking Lecithin just in case my milk was forming tiny clots that could be affecting my supply.  I started making lactation cookies with Brewer’s Yeast, Flaxseed Meal, and oatmeal. They didn’t help but they were good!  I decided to ask my doctor for a prescription of Domperidone but was unable to get a high enough dosage prescribed so I ordered it online.  Once I got up to a high enough dose at about 9 weeks old Bella started refusing supplements!!  She would eat every 45 minutes during the day but we were doing it all on our own!  Every now and then she would want more and we would go a week with supplementing and then wean off again. Soon I added in lemon balm, blessed thistle, and malunggay, because my IBCLC learned about them at a conference. They did not seem to affect the amount of milk I was making though.  At my highest I was taking 80 pills per day to try and increase my supply. I had been weighing Bella with a scale my IBCLC lent me and it was right on with the scale at our doctor’s office.  I weighed her at 3.5 months and then I returned the scale as I needed to stop obsessing over it.

At her 4 month checkup she hadn’t gained any weight in those 2.5 weeks. I decided we needed to go back to supplementing again. Bella would no longer take the SNS so we worked on bottles since breastfeeding was very well established. After 2 days of trying 4 times each day with the bottle she took it and we haven’t looked back since! She is doing great taking a bottle and breastfeeding.  I unfortunately decided to wean off of the Domperidone. It has this nasty side effect of weight gain and let’s just say that after losing 20 pounds of pregnancy weight it was not fun to gain it all back because of the Domperidone.  At 4.5 months old we have found our rhythm of breastfeeding and bottle feeding about 8 oz of donated breast milk. We have had 8 different women donate breast milk to sweet Bella and she has not had to have a drop of formula! I can’t even explain in words how amazing that has been. Not many things can make low supply easier but having donated milk is certainly one of them.  The first few months of this all, I cried many times a day because my body couldn’t produce what my baby needed and that made me feel like such a failure as a mom for the 2nd time.  I have truly learned that breastfeeding does not have to be an all or nothing thing, and I am just grateful for the milk that I do make. We plan on continuing breastfeeding until at least 2 years of age and hopefully until Bella decides to wean on her own. I hope that my journey through births and breastfeeding gives someone else hope and the courage to try their absolute hardest to give their children the absolute best.