Walked the Baby Right Out {A VBAC Story}

(I requested my hospital records and added details in brackets to my story from those records) ~Goldie

My first born son, Rafi, was born via c section after 36 hours of back labor and 3 hours of pushing in August of 2009. Rafi was in the occiput transverse position (facing my hip) when they pulled him out, and the reasons for the c-section were given as cephalopelvic disproportion, failure to descend, and arrest of labor. In the months and years following his birth I wavered between feeling like the c-section was justified and being very disappointed. I was planning and hoping for a drug free, completely natural hospital birth with my highly recommended CNM, but things didn’t go as planned. The recovery was long and hard (a full 3 months!), and I never wanted to do be in the position of caring for a newborn while recovering from major abdominal surgery again.

With my second pregnancy I knew I was going to do everything in my power to try for a VBAC. I was also determined to have my pregnancy and birth be as intervention free as possible, including avoiding routine ultrasounds. From a financial standpoint, I preferred a hospital birth (covered by insurance), but I could not find a doctor or hospital midwife who I felt was fully supportive of what I was looking for in my birth. More so, I knew that if I wanted my VBAC, my best shot would be to “stay home as long as possible,” and it just seemed more secure to plan on giving birth at home and having a midwife labor with me at home throughout active labor, as opposed to being without a care provider until very close to birth.  The biggest fear doctors seem to scare VBAC moms with is uterine rupture, and after reviewing the numbers and considering the slim chance that rupture were to occur, it seemed more likely for uterine rupture to happen before I got to the hospital (since my plan was to go in during transition or later).

My local ICAN chapter meetings gradually helped me feel entirely comfortable with the concept home birth from a medical standpoint. But it took almost my entire pregnancy to really get comfortable with the financial cost of the home birth I envisioned (homebirth was not something we could really afford).

I met with several midwives, but I had a difficult time choosing one. Then one night, I had a dream that midwife, Davi, was with me when I delivered my baby (but oddly, I was not at home!). I took that as a sign to choose Davi as my provider. I trusted Davi from the start, and by the end of my pregnancy had full confidence in her. At my consultation appointment with Davi, I shared my last birth story and told her the doctor essentially told me I could not birth a baby vaginally and I shouldn’t  “bother with the trial of labor!” and that I didn’t have a chance! And as much as I wanted to try for a vaginal birth, after my first experience, I had my doubts that my pelvis was big enough (I’m 4’11”). Davi discussed my family history (my mother had 8 vaginal births), did an internal examination, said I had a great pelvis, and could birth a small pony, and she assured me that I was a great candidate for a natural home birth.

My second pregnancy was a lot like my first pregnancy, textbook and healthy, but very busy. From the outset I was going to a ton of extra appointments in search of a provider. Then, I spent the unusually hot summer working teaching a physics course at a local college, and in addition to my regular prenatal appointments and chasing around my almost-3-year-old son Rafi, I had a whole VBAC preparation regimen which included: yoga 2-3 times a week, stretching daily, 20 cat-cows before each meal, weekly chiropractic care from 20 weeks on, prenatal massage from 35 weeks on, reading hypnobirthing type books and listening tracks, a positive attitude, and a lot of walking – 3 miles a day. In attempt to keep the baby’s birth weight down (my son was 8 lbs, 9.5 oz), I also followed a strict diet which was primarily low-fat, lowish carb, high protein, and very little dairy and meat. I also drank 2-3 cups of red raspberry tea leaf each day, took daily probiotics, and towards the end of my pregnancy, ate dates (to promote an easy labor), and took a vitamin c supplement (in hope that my water wouldn’t break before labor…).

At 33 weeks, I went in for a prenatal appointment and Davi asked me to go get an ultrasound done to check the location of my placenta. I really wanted to avoid all ultrasounds this pregnancy, and asked her if I must. She said I must. So at 34 weeks, the OB said my placenta was anterior (in the front) and 2 cm or less from my cervix and that not only was there a huge risk that it was covering my c-section scar, but I was potentially at risk for placenta previa. They booked me for another ultrasound 2 days later with a  better machine. I immediately called Davi and asked her what this meant. She said, let’s stay positive, but if my placenta is really that close to the scar location, we would not be able to go through with the home birth. But she wanted me to come in for an extra appointment early the next week to discuss options…(This was one of the many times I came in for an extra visit just to talk – of course at no extra charge – this was just one way that the level of care with a home midwife far exceeded anything I could get from an OB or hospital midwife.)

I came back from my ultrasound a stressed out a mess. What would I do now? So close to the end of my pregnancy, my plans for a peaceful homebirth were falling apart. I turned to the internet (big mistake) and started reading about the risks of placenta growing on the scar, the odds of hysterectomy etc. At 12 am I found myself worrying 7% maternal mortality rate with placenta accreta and getting tearful about who would raise my son…I started from point A again, researching vbac friendly doctors who would give me the hospital birth I wanted… The next day, I hosted a prenatal pilates class in my apartment, and one of the women in the class mentioned that her OB, Dr. Paul, was amazing and she had a successful VBA2C with him (a few months later she birthed a breech VBA2C’s with him!). I started asking around, and everyone had only positive things to say about him (including Davi). So I booked a consultation appointment with him for early the next week….

On Friday, I went in for my follow up ultrasound, and lo and behold, the first ultrasound was a false alarm. The placenta was a good 9 cm from my cervix! But I went in for my consultation on Monday with Dr. Paul anyway. Like all doctors, he lectured me on the risks of an HBAC and strongly recommended I do a hospital birth and said if I chose to do my birth with him, he would allow me to do it mostly intervention free (the only intervention he would require is the continuous external monitoring).

The next day I went in to talk to Davi. Despite the false alarm, she was no longer completely at ease with my doing a home birth. And when I mentioned my consultation with Dr Paul, she raved about him, and offered to be my monitrice – laboring with me at home, and going in to the hospital at 7 cm or so  to have the baby there just in case…

In the following weeks, there were a lot of “complications” getting my birth support set up. I was having insurance issues and my birth location kept changing, etc. etc. I wasn’t sleeping well, and was afraid I would go into early labor before I had everything arranged…But finally at 38 and ½ weeks, I was all set to give birth in a hospital with Dr. Paul and Davi as my monitrice. All along,  Davi was an amazing support, and helped me regain my confidence and remain positive about having a successful VBAC. She stressed that I was doing everything right, and at this point, she had no doubt that I would have this baby vaginally! (I still had some sliver of a doubt.)

At my 39 week appointment with Dr. Paul, he wanted to do a cervical check. I refused without him first giving me a good reason. After some coaxing, he said that if I was dilated, he would like to do a membrane sweep. I absolutely refused. Not this week. And not until I was well overdue would I consent to a membrane sweep. He then asked when I would allow him to do an internal examination. I responded, when I’m in the hospital ready to push. He laughed it off, but told me that if I was not going to let him to anything, there was no reason for me to come in the next week, and I should make my next appointment for after thanksgiving (3 days after my EDD).

On November 20th, the Monday before my EDD, I was feeling especially restless, similar to how I feel the day or two before I get my period. I just wanted to laze around, relax in the bath for hours, and watch movies all day. I heard of people feeling this way for weeks at the end of their pregnancy, and was hoping I wasn’t in for a long haul of feeling restless…Though, I wasn’t actually tired of being pregnant…I still felt pretty good. And had no other signs of impending labor…

The next morning I got awakened at 6:15 by a mild contraction. I didn’t make much of it and stayed in bed. Throughout the morning, I kept getting these mild contractions at irregular intervals of 5 to 15 minutes apart. Knowing this could very well be prodromal labor, I went about my regular day, while keeping conscious that this may be the real thing. In the morning, I went for my usual walk around the park, and the contractions were still coming. I made an appointment to get a prenatal massage in the early afternoon, since in case the contractions picked up I wanted to get this one last “massage” in to loosen up my muscles before delivery. I  took my 3 year old out grocery shopping to pick up fresh produce and bread for the week. I also warned my husband that I *may* be in labor and told him if he has anything that needs to be done urgently, this was the time to take care of it, just in case…

After my massage, the contractions were still going strong, so at 2:43 pm, I decided to give Davi, a heads up, and texted her: Mild contractions since 6 am. 5-15 minutes apart. Pick up when walking…

Then updated her at 4:40 pm: Update: every 4-5 min for the last hour. ~30-45 seconds long. No blood.

At about 5 pm, my contractions started to really pick up. Tending to my 3 year old was beginning to be a struggle, and making a simple dinner took a LOT longer than expected. I told my husband that things were picking up, and he mentioned that he was hoping to go the gym at 6 for the spinning class…I firmly let him know that  if he wanted to fit the gym in today, he’d better go now just in case this continued to get more intense…

A bit after 6 pm, Davi came around to check on me. For the 20-30 minutes she was over, my labor slowed down a lot – my contractions became irregular for the first time in hours, and I hardly had any strong ones… Davi asked to check my cervix, but I was very resistant. Last time, my labor took a nasty turn after my first cervical check. Davi took this as a sign to sit down with my husband and I to discuss the fears I seemed to have lingering. My main fear was that my labor would be long and hard and would end up the same way my son’s did, with 3 hours of pushing and a head that wouldn’t pass my tail bone…I don’t remember what Davi said to me, or if it was just verbally releasing the fear, but after this discussion I felt a lot more confident…And I finally allowed her to check my cervix: 1 cm, and still long and hard. Davi told me I was still in VERY early labor and I should stop timing my contractions. She stressed, don’t pay any attention to them at all! She told me to take a bath, drink a glass of wine, and go to SLEEP. BUT, she stressed, I should call her whenever I felt like I wanted her to come back.

After Davi left, I was going to walk with my husband and son, Rafi, to the library (less than a ten minute walk) to pick up some DVD’s for Rafi to watch while I was in labor and/or in the hospital. But my contractions picked up again, and I just wanted to go for the bath. So I sent them off the library, and got into the bath. At first the water felt really nice, and I just relaxed, but within a few minutes, I started getting hit by much stronger contractions, and the bathtub felt very confining and uncomfortable. And I couldn’t figure out how to ignore these contractions as Davi instructed…

With some difficulty, I got out of the bath and got semi dressed and got into bed. I was shivering/shaking and having a lot of trouble relaxing. The time in between when Davi left and when she came back to support me was the only portion of my labor that I would describe painful….

When my son got back from the library at about 7:30/8 pm (I lost track of time after Davi told me to stop timing my contractions), and he came to talk to me, I really couldn’t give him the attention he was looking for, and I really wanted some labor support. I asked my husband to keep Rafi busy and to please call Davi and ask her to come back.

When Davi arrived, she checked me again, and I was 2 cm. “Early labor,” she said, “Goldie, we’re going for a walk.”

I was feeling pretty nauseated (I had thrown up once after my husband and son got back from the library), and asked Davi if I should bring along a bag or something in case I had to throw up again. She laughed, and said no, you’ll be fine, or you’ll throw up on the side of the road. (!!)

Once out walking, Davi took over timing my contractions, and coached me to embrace each one of them. She would lash out anything I would say that was even slightly negative (I could not even exclaim “oh gosh” without getting lectured). She explained that I have to stop fighting the contractions, and that these contractions were good, and they were my body and the baby working to get the baby out. With each contraction, she had me repeat different affirmations, along the lines of, “Yes, I want this.” “Yes to the pressure.” “Pressure is good.” And she made sure I was not stiffening up ANY part of my body during a contraction. She had me relax my shoulders, my legs, and hips, etc, through each contraction. And often, she would tell me to walk faster…She also talked me out of my nausea explaining that it was fear, my fighting the contractions, and my stiffening up, that was making me nauseous. I threw up once on the walk, and after that, I learned to relax through the contractions that I didn’t need to throw up again (until I got home…). Once I got into the swing of it, the contractions became the pressure waves I read about in hypnobirthing books. (This was somewhat surprising to me, because, I was planning for and expecting a painful labor since I had what I considered a VERY painful labor the first time, and it was amazing to see the difference that walking and having someone coach me through the contractions made!)

We walked for about an hour or hour and half, and then stopped by my  apartment for a nausea remedy, a pee break (I was feeling so much bladder pressure, but couldn’t pee!), and to pick up some money to buy a heating pad (for the back labor I was feeling with some of the contractions) from CVS. The contractions intensified at home, and I had 5 or 6 in the short amount of time we were in the apartment (and I threw up again). I was more than happy to go back out in the fresh air and continue walking. We walked to CVS (normally about a 20-25 minute walk). I was dreading going indoors, and I had a couple of  really intense contractions while we were in CVS. We bought the heating pad and some benedryl, and we headed home. On the walk home, I was having difficulty repeating the affirmations through my contractions, and had to slow my walking down quite a bit through some of them. I assumed I was getting really tired. Davi was rushing me home. She kept telling me to walk faster, and that we would go home and rest. But I really wasn’t looking forward to going home…My contractions seemed a lot more manageable out in the fresh air…

It was about 11:30 pm when we got home, and I remember feeling exhausted. Davi unpacked the heating pad, and insisted I take 4 benadryl, take a bath, and go to sleep. I was very skeptical. 4 benadryl??? And sleep through these contractions??? But she insisted. And I was really in no condition to argue. So I took the benedryl. But I really didn’t feel up to getting into the tub – I dreaded dealing with getting undressed, and then redressed after coming out, the shivering, etc…Davi was pressuring me to get into the water, but I was pretty firm on declining…And I went to lie down instead….Or I attempted to lie down…But I couldn’t…I told Davi I was feeling too much pressure. So she said she better check me. She checked me and said, “Goldie, you’re 9cm.” I really wasn’t sure I heard right. But Davi was as surprised as I was that I dilated 7 cm in less than 3 hours…

I was expecting to go through a transitional stage of feeling like I couldn’t do this anymore or I was going to split open…But this was completely manageable… I was completely shocked and thrilled that I was 9 cm already!

Davi called the doctor (incidentally for the first time, since she was under the impression that I was in early labor all this time…), and we headed toward the hospital, normally a 10 minute drive. I only had 2 contractions on the drive there, so I’m guessing we got there a lot sooner than 10 minutes….

In the hospital parking lot, the benedryl hit me…I could barely keep my eyes open, and was leaning on Davi, practically sleep walking…I think she kept telling me to open my eyes when we were walking through the hospital halls….And either my contractions got more mild, or I was just too tired to notice, but it seemed like I was getting a bit of a break compared to the last couple hours.

At the check in desk, the nurses wanted to send us to triage, but Davi kept insisting that I needed a room NOW, and that I was 9 cm…They asked for my insurance card and ID and I was lucid enough to direct Davi to the front pocket of my suitcase (but I doubt I could have gotten them out myself!). Finally, for some reason, they agreed to skip triage and set me up in a room. [My records indicated that I was admitted at 12:20 am].  They had me get up on the bed, and kept asking for my arm to take my blood and set up the heplock (the one intervention I had agreed to), but this whole process took a while, in between contractions, and I didn’t realize until after I had the baby that they popped my vein and never did manage to get that heplock on (I’m not sure they even drew blood – I think they ended up drawing it after I had the baby…).

I don’t remember being on the bed for more than one or two contractions before I felt this uncontrollable urge to push…I was leaning back on the semi reclined hospital bed until a contraction would hit, then I would grab one of the railings and pull myself upright and around, until I was kneeling on the hospital bed, pushing up against the back of the bed with my hands. (Maybe because of the benedryl, or because I was in a labor daze, but even shortly after giving birth, it was hard for me to remember exactly what the “pushing sensation” felt like.)  No one told me to push – I just couldn’t resist the urge to push along with my body. Though Davi did tell me not to make noise while I was pushing…After each contraction passed I would try and catch my breath, lean back with my eyes closed, and sleep – I think! It’s a bit of a blur…At some point,  the nurses, and the doctor, when he showed up, did ask me some basic questions, so I may not have been sleeping in between…

After a few more contractions,I felt more pressure than usual, then pop! The water broke, and it seemed like I heard a round of applause in the room [Spontaneous rupture of membranes noted as 12:41 am]…Someone commented that there was a whole lot of clear fluid…The nurse had me lift up one leg at a time to change the pad under me, and I guess I was resisting since I remember Davi telling me, “Goldie, you’re sitting in a puddle of water,  you need to let the nurses change it….”

The next bit of my birth story is even more of a blur…And even though I asked both the doctor and Davi at postpartum appointments to fill me in, they both kind of brushed over exactly what happened…The baby started showing signs of distress…Heart rate was down in the 90’s (and not picking up in between contractions??). They asked me to switch out of my kneeling position and lay on my side instead, I resisted, since it was really important for me to birth in an upright position, both to prevent tearing and to avoid having the baby get stuck behind my tail bone like my last birth…But Davi looked me in the eye, and said, “your baby does not like your position, you need to do this!” I was given an oxygen mask, and Davi was looking me in the eye and telling me to focus…I remember someone saying the side position was better…At some point the doctor said something about needing to check me during the next contraction. I remember being amused that the doctor was finally getting a chance to do his vaginal exam!

Somehow I ended up on my back, and at some point an episiotomy was cut (I’m not sure if I knew this at the time, or found it out after the birth). [Hospital records: There was fairly profound variable decelerations on the perineum; therefore, a midline episiotomy was done]. Soon after, Davi grabbed my hands and put them on my baby’s very blue shoulders as she was emerging, and before I knew it someone announced that the baby was a girl, she was immediately placed on my stomach. She was screaming, very red, and she promptly peed and pooped all over my newly deflated stomach…

I pushed for about 20-30 minutes total and gave birth a 7 lb 4 oz, 19.5 inch long baby girl. Her head circumference was 34 cm (so just about average! This is something I’m very proud of – no cephalopelvic disproportion here!). The doctor waited for the cord to stop pulsating  before asking me if I wanted to cut it. But I was too overwhelmed and felt unsteady with the baby in my arms, so I declined. And soon after, the doctor had me push the placenta out with no issues…[The placenta was spontaneous and intact 1:14 am]

Here’s a photo of Aura shortly after birth (I wish I had a photo with her. Would have loved to see the look on my face!)

It took the baby a while to settle down, but everyone else in the room was all smiles and congratulating me right after giving birth. The doctor was particularly congratulatory and he noted that although he liked my determination to have a VBAC, he thought my odds of being successful were quite low based on how my previous birth went…Then and there, he also gave me “permission” to have my home birth next time!

The doctor later told me that this was the fastest and easiest VBAC he’s seen and that I took everyone by surprise. And should I be blessed with more children, I should have no trouble birthing even a larger baby…After relating what the doctor said to some of my friends and family, it turned out that a lot of people had doubts that I could birth my baby vaginally (including my husband!), but thankfully, they all kept it to themselves, and I felt nothing but support for all of my VBAC efforts from my family and friends.

Overall, I was thrilled with my birth experience, and would do it again tomorrow if I could! The only major disappointment I had was the 2nd degree episiotomy/tear (the doctor at some point said something about feeling bad that I tore more after he cut…). I still wonder whether it was a necessary intervention…I also wish I didn’t take that benadryl. But that aside, almost 4 months later, I still feel empowered when I think of the birth experience!

I have to comment here that I could not have done this alone and I am very grateful to a lot of people. I am so thankful to my family and friends, to my midwife, chiropractors, doctors, to the birthwithoutfear facebook support group, etc. Additionally, I am so grateful to  ICAN of West Los Angeles for being a  fantastic resource and support during and before my pregnancy.

5 days old.