When Plans Change: Baby Born Vaginally Before Cesarean

Sadie’s story starts a few weeks before her birth. At 34 weeks I started to have the same symptoms of labor as I had with my first daughter, Peyton. I called my midwife and she told me to immediately go home from work and put me on bed rest temporarily for three days.

Once I was home the contractions subsided and everything seemed back to normal. I saw the midwife after those three days and after a lengthy discussion she recommended that I start my Maternity leave early. She also wanted me to have another ultrasound. I had only gained 17lbs so far and was measuring 2 weeks behind. She wasn’t that concerned as I measured small with Peyton and eventually gained 30lbs. She just wanted to make sure nothing was amiss.

I went to the ultrasound the next day. They measured Sadie at 33 weeks and weight around 4 lbs. I wasn’t concerned; I knew ultrasounds can be off quite a bit. It did show that she was Frank Breech, though. My midwife is not allowed to deliver breech here, but it was still early and she could turn. I was trying not to worry. After Peyton’s birth at a hospital, with an OBGYN and being very unhappy with how I was treated then, I felt very strongly about having an all-natural birth. At the birth center, with a midwife.

I gained 3lbs that first week at home. I was thinking that’s great, obviously a good choice to start early. Then I stopped gaining completely. It was very frustrating. I was watching what I ate and I was eating anywhere from 3000-4000 calories a day in an attempt to gain anything. It was hard mentally. I didn’t know what else I could do and I didn’t appreciate the remarks I would get about how lucky I was for being so tiny; I didn’t feel lucky.

The midwife had me go for another ultrasound at 38 weeks to confirm that Sadie had turned. Success, she had! I left the ultrasound feeling great. Then I got a call from the tech asking if I could come back for a few more scans. The doctor writing up the report was concerned about some measurements and wanted to confirm them before sending the report to my midwife. I headed back there and got the extra scan, then called my midwife. She could tell I was worried and assured me she would call me right when she got the results. That was at 2pm, she called me at 6 pm. She explained that they were worried I had an intrauterine growth restriction and was sending me to the perinatal clinic at the hospital for a BPP ultrasound. My appointment was scheduled for the am the day I was at 39 weeks and then I would see the midwife in the afternoon.

The BPP ultrasound went well she scored 8/8 on it. But she was measuring asymmetrically. At 39 weeks her head was measuring at 35 weeks and her body at 33 weeks. The OBGYN performing the ultrasound said even though she scored great because of her growth pattern, he was still recommending I be induced within 48 hours. He just “felt” that the placenta would fail me.

I was angry; this wasn’t how it should go. I felt forced into delivering at the hospital, with an OBGYN I had never met. I don’t know how to describe it. I just felt with everything in me that my baby would be fine. I am usually a very anxious person that takes the ‘ better safe, then sorry approach’.

I talked with my midwife that afternoon. We talked about what interventions I was ok with, what I wasn’t, and what methods of induction I was willing to try, etc. She tried to give me a stretch and sweep, in the hopes that may put me into labor. But she could not reach my cervix. It was very high and posterior. What she could feel she said was thick and hard; so as unfavorable as it gets. She explained that cervidil may take 2 rounds before it works, as it generally works slowly, and each one can be inserted 24hrs apart. She also said that she would be there to help me through labor and advocate for me. Even though she was not legally allowed to deliver me and had to transfer my care, she would be there. That helped calm me.

We agreed to call her when/if things started to pick up during the induction. The next day I had scheduled an acupuncture appointment, also hoping it would help. I got a call that AM from the OBGYN, my first time talking to him. He agreed to admit me to the smaller hospital he works out of. The other one he works out of was the hospital I delivered Peyton at and had horrible memories of. He also wanted to use Pitocin and a gel prostaglandin. I refused and said I was only comfortable with cervidil. I could have it removed if it got to be too much and from my understanding it was a localized prostaglandin. Meaning it would help me to dilate, but the contractions would be my own.

I was admitted to the hospital at 3:30pm on March 2^nd, 2012. Derrick and I brought games, cards, movies, etc., expecting it to take a while. Now the doctor was at the other hospital at the time doing a C-section and hadn’t ordered my cervidil yet. So we were just waiting. In the mean time I told the nurse that I may be a difficult patient. She said with a smile that was fine. I told her I was refusing an IV line, the antibiotics for GBS (I was GBS positive), I didn’t want any pain meds, I was ok with oxygen if I needed it, we wanted delay cord clamping, I wanted to walk and use the shower during labor. I was determined to have as natural as a birth as possible.

Now the doctor ordered the cervidil at 5:30 and gave them instructions to call him when/if labor picked up. I still hadn’t met him. Only 2 nurses were trained to insert it and they were both in deliveries. It was finally inserted at 8:28 pm. Because my cervix was very unfavorable she ended up being very rough. My vagina was swollen, and I was uncomfortable sitting, and walking was next to impossible. I had to apply cold compresses to the area to get any type of relief. The nurse told me it could take a while to work and it will fall out when I am 3-4 cm on its own. I also had to stay lying down for 2hrs and be monitored. Of course that whole time I had to pee.

At 9PM, I could see the contractions on the machine, but couldn’t feel them. At 9:30PM, I started to feel them, but they were very light. At 10:30PM, I could take the monitor off and finally go pee. Sweet relief!

The contractions stayed the same. I quickly figured out I couldn’t walk or sit on the exercise ball; not from contraction pain but from my vagina being so swollen. So I sat in the shower and lay on my side. Between 10:30pm and 12:00am I don’t remember much besides being in a dark room and lying on my side on the bed and moaning and rocking through contractions, while Derrick pushed on my hips and lower back. Between 12-12:30AM they started to ramp up and I thought I should call my midwife. But the cervidil hadn’t fallen out so I figured I wasn’t far along and didn’t want to wake her. I should have known better, she never made it to the birth.

Around 12:30-1AM, I started sitting in the sitz bath/shower and that helped. I was on the toilet at one point in there and started bleeding a lot. The nurse just said it was the show and left. I knew it wasn’t the show. It was bright red blood and everywhere. It covered my legs, the bathroom floor, and the shower. I had Derrick go buzz the nurse. Ours was on break, so we had a different one. At this point, my contractions were back to back and I wasn’t getting a break. I asked her to remove the cervidil and call the doctor. The doctor was on his way for another lady delivering and said he would check in on me after. He missed that lady’s birth.

When she removed the cervidil at 1:15 am, she said I was 5 cm. The doctor came in at 1:20 and tried to introduce himself. I don’t remember what he said at all, I was in contraction after contraction. He then looked down concerned and asked the nurse when did this start (my bleeding), she didn’t know and the other nurse was on break so Derrick told him when. The doctor hooked me up to the monitor, and the baby’s heart rate was still good. He then said he wanted to break my water to see if there was blood in it, which would confirm my placenta was detaching. He broke it just after 1:35am and there was blood, but no meconium. The baby wasn’t under distress yet, but that could change quickly. He asked the nurse to start an IV and was saying we needed to do an emergency C-section. I could barely concentrate on the doc; I was in an immense amount of pain. Sadie had a different plan. Before they could put the needle in for an IV I remember saying, “I’m pushing,” everyone was yelling at me not to push. What I meant, but couldn’t articulate, was that my body was pushing on its own I wasn’t pushing, my body was. I had zero control over it. That was frustrating! But I managed to verbalize that my body is pushing.

From the moment he broke my water until she was out was 7 minutes. Sadie Paige Edie was born at 1:44AM on March 3^rd, 2012 at 6lbs 9oz. She came out screaming, pink, and healthy. I’m glad Derrick kept his head because he was able to remind the doctor we wanted delayed cord clamping, right before he did it. Then I delivered the placenta. I can’t remember how long that took. Then all eyes turned to me. My Uterus would not clamp down. I had the oxytocin shot in the leg, we got Sadie to latch hoping that would help, I had 5 pills of cytotec inserted rectally, the doctor massaged my uterus and he went up and cleaned me out making sure there was no placenta left over. It took my uterus 10 minutes to clamp down. What a relief when it did. I had no tearing. Sadie got the all clear from the NICU doctor (he was there cause of the IUGR Diagnosis). The doctor showed me her umbilical cord. It was 1/3 the size of a normal babies which probably was the reason for the asymmetrical growth. He also showed me the placenta and you could see where it was detaching from in the uterus.

It’s funny how the universe works. I was right Sadie was fine. But it was good we delivered at the hospital because we needed it. It easily could have turned into an emergency situation. I still got my mostly natural birth; I listened to the staff, and kept informed through the whole process.