“I Did It!” {An Active And Unmedicated Hospital VBAC}

It was 6 days past my due date, I was being taken over by a mild but itchy case of PUPPPS (Pruritic Urticarial Papules and Plaques of Pregnancy) when I was woken up by the distantly familiar feelings of labor at 3am on a Monday morning. I was having short and mild contractions but not so short or mild that I was able to go back to sleep again. I tried. After 30 minutes and several contractions later I accepted I would not be sleeping again without a baby next to me and got out of bed. It was the end of our current family dynamic and the beginning of something new, something better, the beginning of life. This planet was about to get a little more beautiful. I went into the living room, got some snacks, and began focusing through my contractions. I appreciated the time alone and was enjoying trying different positions that worked for me. I wasn’t having any difficulty getting through each contraction but was “practicing” for when things got harder.

Around 5am I was pleased to see the surprised face of my sweet husband. He had not even noticed I wasn’t in bed when he got up, so when he walked into the living room to find me kneeling over the couch he was caught off guard. I told him I had been having regular contractions for the last couple hours but that he should go ahead and go on his regularly scheduled morning bike ride, he just needed to keep it short. He refused, good man, and I was happy as this meant we could go for a walk together. We woke my mom up to let her know what was going on and also so we could put J into her bed. We didn’t want him to wake up alone in our family bed and wonder where we were. At this point my mom told me that before bed she had lit a candle and said a small prayer the night before encouraging my body to start the process of bringing life to our side of the world. It worked! So around 530 in the morning R and I went walking around our neighborhood together.

The morning air was a perfectly crisp temperature somewhere in the low 70s, there was a bright sliver of a moon in the sky that gently lit the sidewalk, and the birds were just beginning to chirp. It was just us with an occasional car leaving for an early morning shift. I already felt somewhat disconnected from life outside my body as I focused on the task at hand. We stayed close to home but walked around the block many times while R timed my contractions using a cell phone application made just for this. Sometimes I was able to keep walking through the contractions but sometimes I would have to stop and lean onto R for support while I waited for them to pass. After I was no longer comfortable walking around we went back home to labor some more there. I spent time leaning on R, leaning on the pony wall, leaning over the birth ball and even in the tub.

My mom and J eventually woke up and wonderful J was so quiet and so gentle through all of it. He did not worry about me; my mom made sure to inform him that I was working very hard to bring his baby sister here and that he needed to be calm and quiet for me. His thoughtful three year old mind could somehow understand the magnitude of bringing forth life as he did a great job at staying calm and quiet while I focused through each contraction. After several more hours my contractions were becoming ever more powerful and were accompanied by some spotting, something I never had while in labor with J. This gave me hope that I was making some progress, though fear still gripped me tight as I mulled over my previous birth. Beautiful as it was, I did not want another cesarean section.

We contacted our Doula and requested she come to our house but it was no more than a few minutes later when we decided we would meet her at the hospital after all as both R and I were getting anxious. I was feeling eager to settle into where my baby was going to be born and I really wanted the car ride over with. We left my mom and J behind so that they could make arrangements for J to be picked up. We headed for the U of U hospital around 10am but not before my very sweet son gently put my sandals on my feet as a lay over the birth ball.

 Before labor started I was petrified of the car ride but it wasn’t as bad as I thought even with bumper to bumper traffic down Foothill Blvd. I spent the entire car ride on my knees in the front seat leaning over the back of it. With each contraction I visualized the word “OPEN”. I was so afraid this would be just like my previous labor that the word “OPEN” seemed the most appropriate word to think of. My labor had, after all, started similar to J’s. Both started at 3 in the morning and both started with no dilation and little effacement. Not to mention baby was not in an anterior position, much like J, to only further discourage me, but I kept an open mind and tried to relax. I was working together with my baby girl; a new birth, a new baby.

I remained hopeful. Hopeful that I would get to the hospital and be at least a 6. If I was a 6 I would be happy, I thought. I should have known better from last time not to pick numbers and then place such importance on them that it could change the course of my birth. Once at the hospital the nurses immediately put me in the closest room and began asking a battery of questions to check me in. R answering all of them, of course. I was told to get undressed from the waist down before they could start checking baby’s heart rate but I was never asked to put on a hospital gown. No one cared that I remained in my own clothing, a black over-sized night gown that clung tightly to my pregnant belly. This was significant to me because I specifically did not want to have to deal with changing my clothes during labor.

They hooked me up to the monitor all the while letting me take the time and positions I needed to make it through each contractions. I knew this part was going to be a challenge and I knew I was going to get “extra attention” due to my previous cesarean birth, but all the while the nurses remained respectful and patient. “Good job, girl. You’re doing great” both nurses kept saying; quite a contrast from being held down by one of the nurses while laboring with J. Once they got a heartbeat on the monitor they had me lay down to check for dilation. This part was difficult and probably would have been better off not done at all, laying down was extremely uncomfortable and the result was just discouraging anyway. They told me I was a 4 1/2. I was hoping for so much more and all I could do was chuckle a bit. I wasn’t going to give up! I was determined! In response to my reaction the nurse said, “You must be happy about this given your smile”. I informed them it was a smile of disappointment. At this point I told myself I will wait to get settled in with my doula and my midwife before I make any decisions about pain medication. I tried to back track from my desire to be a 6 and continue to trust my body, to trust each powerful contraction, and to trust that my body, and my baby, were capable.

After they determined baby’s heart rate was fine and that I would be admitted, I was taken to the room I would actually be delivering in. I honestly have no memory of how I got to that room, probably walking, but once there I was able to lean over a birth ball (my most beloved position), and have my full support team there and available to me. My doula showed up, my mom showed up, and my midwife came in; the lovely midwife I had switched to from my OB when I was 30+ weeks pregnant. My midwife came quietly walking in while I was in the middle of a contraction, she gently but confidently walked up and did a hip squeeze maneuver that immediately helped relieve the intensity of the contraction. From then on out someone (sometimes two people at a time) applied the same pressure to my hips with every contraction. I was taking it one contraction at a time while everyone was encouraging me, rubbing my back, pressing in certain areas to decrease the pain and various other ways of keeping me going. All of it, every bit of it, was so very helpful. Every women in the room, as well as the one man (my husband), were doing everything perfect. Absolutely perfect. Every touch, every word of encouragement, everyone was working together to make this easier for me and it worked! When my midwife left the room I felt a sense of fear, I didn’t want her to leave, her presence was comforting. But it was brief, and it was to get some essential oils to spray around the room. I could feel the cool mist gently landing on my back and the smell was refreshing. Everything that everyone did was to support and encourage me so that I could let my body birth as it was meant to do.

At one point the nurse asked me, “you plan on going un-medicated, right?” I laughed and told her that was yet to be decided. It was certainly the goal but at this point I had my doubts. She responded with “well, if you want pain relief that is your choice but I will not bring it up again, so if you want it you can ask”. Perfect, I thought.

I continued to labor. My Doula reminding me to relax and to moan low, rubbing my back and helping me stay focused. My midwife rubbing my back and feet all the while monitoring my well being as well as my baby’s. My mom moaning with me to remind me to keep my sounds low and productive. It was perfect, I was comfortable making whatever noises I needed knowing my mom was right there doing it too! I guess a mother never loses touch with her daughter. My sweet husband gently whispering in my ear that I was doing a good job, helping with hip squeezes, and taking me to the bathroom whenever I needed. When I was checked again I was a 7 1/2. I had a bit of a negative attitude as I was sure my labor wouldn’t progress like last time. I complained that I was only a 7 1/2 but my doula gently reminded me that I was farther dilated than I ever did with my last labor. My midwife pointed out how fast I had gone from a 4 1/2 to over a 7. At this point they had to change the location of the fetal monitor from high up on my right side to down low on my left side; baby had rotated to a better position and was down low! I continued taking it one intense contraction at a time all the while thinking, if I want drugs I can get them. The truth is I didn’t want them, not any of them, I was not interested in them coming in and messing with me; making me lay down, making me get IV fluids etc. Some positions were so horribly painful I thought if I ask for an epidural and they make me lay down I will die, it just didn’t seem worth it. So I kept relying on my support team to make things bearable. I cannot emphasize enough that the tricks these ladies knew, and shared with my mom and R, were amazing. Absolutely amazing! The words each person said, the touch, the scents, it was all too much to even ask for yet I got it all. Everyone worked so well together it was just perfect!

I soon began getting the urge to push. With each contraction my moans changed from pain coping sounds to short grunting sounds. “I think she’s pushing” I heard someone say. “I think I’m pushing” I said in response. It was almost over I thought but really it was only beginning! I was standing and could not for the life of me lay down. My midwife checked me while I stood but did mention it was a hard position to check in. She told me if I had the urge I could push if I wanted. So I pushed just as I had been. Little nudges and not much more. My midwife requested I lay on my side on the bed so that she could check me better as she felt a little unsure about her last check.

She gave me the news that I was still an 8. “AN 8!” I exclaimed. “I can’t do this, I can’t do this” I began saying. I was an 8 twenty minute ago, which isn’t long, but at the time it felt like an eternity. “I want an epidural.” Although I had crawled deep within myself hours earlier I had now lost focus and was losing control. The pain and intensity was taking over and I wanted to give up. I think they call this transition! My doula mentioned breaking my water as one option to speed things up, I declined as I was terrified things might get more intense than I felt I would be able to handle. My midwife agreed and supported my decision so we left them intact. Everyone reminded me that an 8 was really good. My midwife, sensing fear spilling over from my last birthing experience, got eye level with me and gently but sternly said, “Meghan, this is not like your last. This is different”.

My doula encouraged me to go 3 or 4 more contractions and then re-evaluate. I agreed to go 2 more but it would be many more before I brought up pain medication again, mainly because I slipped so far into a different place there really wasn’t much room to think about anything other than getting through it. The contractions were so intense, more than my mind could handle, they were flooding over my entire body; from every hair on my head to the tips of my toes I could feel the intensity and power of each contraction. My mind had shut off, submitting fully to my body as my body took over and labor continued. It was around this time R and my mom started offering me some personal items I had brought with me intended to give me strength. I chose a charm R had given me at the conclusion of our birth class and focused on it in my hand. With each contraction I dragged my fingernail over each raised line of the symbol that represented a labyrinth.

After a few more contractions my doula and midwife suggested I change positions, I chose to stand at the edge of the bed again. Another contraction! Another slight urge to push and immediately I felt like I had been hit by a freight train. My water broke, the pressure changed, the sensation changed, and I collapsed. My knees buckled and I completely collapsed into a squat as my arms reached up holding onto the edge of the bed. My mom was holding tight to my arms from across the other side of the bed, my doula, midwife and R all holding me up from behind. I screamed; no, moaned. I never screamed, I was never scared. I had no control of my body, none, every single muscle pushed without asking for permission and pushed with a fierce strength I never knew I had. My body had completely taken over. Imagine standing on a train track and suddenly, without warning, a train comes and slams into you from behind, you never saw it coming. That is the best way I can explain the sudden intensity of having that urge to push. Finally the pressure, the train, it stopped. I stood up, I breathed, I relaxed. I almost felt like I could fall asleep but not enough time; another contraction, another chance for my muscles to take over. I collapsed again, being held up by my team, I moaned, I felt pain and pressure so severe, so strong, so intense I had checked out of my body… but I wasn’t scared.

If before my mind “shut off submitting fully to my body”, it had now walked off, left the room, left the planet. I trusted my team and they continuously reassured me I was doing good. I knew if anything went wrong I was taken care of, I was safe. I could focus solely on getting my baby out. My midwife began instructing the nurses to get the squat bar. In between contractions I climbed up onto the bed and was told how to effectively use the squat bar. It was a great place to be at that time in my labor; brilliant was my Midwife to recognize the need for it. More contractions, more pushing, more freight train, more giving into my body.

I even joked “is it too late for an epidural?” I asked in between pushing. I was told by many natural birthing mamas the pain stops when the pushing starts. To that I say bull. I was looking forward to pushing the entire time in hopes of finding some relief. My doula put it best when I met her before labor “you welcome the change in sensation” this is true but that “change in sensation” came with other things that were not necessarily welcomed. Regardless I was happy to be getting close. At his point my midwife noticed I still had a “lip” left on my cervix, pretty bad news to me but turns out it was as simple as her going “let me see if I can just push this out of the way” and away it went, no biggie.

“Meghan, do you want to feel her head?”. I said no. Not sure why I wasn’t interested in such an amazing opportunity but my Midwife knew it was one I wouldn’t want to miss. “Meghan, reach down here and feel her head”. I did it. My response, “that is it? That is hardly out”. I was such a downer. I had spent the entire labor concerned of not progressing like last time. It seemed no matter how much progress I made I was convinced it wasn’t enough. So my amazing birth team, yet again, reminded me of my great progress.

I kept pushing when I had the urge and relaxing when I didn’t. My midwife patiently watched and waited and simply supported me. Then her demeanor changed a bit. She began telling me I needed to push and push hard, even instructing me to push in between contractions. She looked at me, she was serious. “I need to do an episiotomy. I haven’t done one in 4 or 5 years, I’m so sorry”. I remember talking about episiotomies at the clinic. The Midwives were against them unless they were absolutely necessary. I didn’t fully understand the seriousness of the situation but I knew something had to be going on. I wasn’t scared, I trusted my team.

At this point my husband said things got kind of crazy in the birthing room. My daughter’s heart rate had dropped, and dropped low into the 60s only recovering into the 90s. This pattern was remaining despite my teams best efforts. I was changing positions and given oxygen to try and help baby girl get more but it wasn’t working. There was the potential that she would need to be resuscitated upon coming out. I never felt scared. My midwife was never panicked, she never made me feel fearful, she acted quick, she made good decisions, and I trusted her fully.

“Will you numb it?”

“There is no need, the baby’s head on the perineum is a natural anesthesia, you won’t feel it.” and she was right, I didn’t feel a thing.

I kept pushing until I felt her head slide out! The burning and pain decreased immediately and it felt as though the rest of her slid right out. I later learned, due to a tight cord wrapped around my baby’s neck, my midwife did some cool midwife trick to help get her out quickly without having to prematurely cut the tight cord. A quick check by the midwife to make sure all was okay and just like that she was on my chest. She was damp but easy to hold onto, not slippery like I thought she would be. Her smell, it was ‘earthy’. It was pleasant, it was the scent of life, of hard work, of strength beyond comprehension, it was of me and her. I will never forget her smell. So distinct but completely hard to describe.

She was perfectly healthy and I believe my midwife’s quick decisions and cool manoeuvres were a huge part of my baby’s health! Her cord was wrapped tightly around her neck, her arm and her body. In most situations the cord around the neck is not a big deal, however in my baby’s situation it was very tight. My amazing midwife did some cool midwife trick where you keep baby’s head close to mom’s thigh and flip her around doing some somersault thingy, apparently it’s something to do when the cord is too tight. R got to watch and said it was pretty cool. I hardly knew any of this was going on, I never felt scared. I trusted my team.

“Can someone get the resident?” My midwife asked. She had begun stitching me. I looked at her face and she was focused. She kept inspecting me, stitching me, cleaning me but the resident never came. No one got him, no one listened to her. “I need someone to get Jacob right now” she sternly repeated. I had lost 500mls of blood. Anything over 500mls is a hemorrhage but I never felt scared.

The resident came in and I was offered an epidural by the resident while they did repairs. Apparently some areas were deep enough inside and bad enough it was difficult to get numb. I declined the epidural. I was not about to go through what I just went through only to have an epidural for some stitches. They numbed me up as best they could, which wasn’t good enough and what seemed like over an hour (and probably was) I had a clean bill of health!

Baby girl born VBAC July 25, 2011 8 lbs 4.5 oz at 2:05 PM.

I DID IT!