VBAC Despite Thrombocytopenia: The Birth of Elodie

The birth of sweet little Elodie really begins with the birth of our son Huck. I had a normal and, dare I say, easy pregnancy with our first. Nothing was out of normal and I had no doubt I would be able to deliver this baby naturally until about 32 weeks when I was diagnosed with severe gestational thrombocytopenia. Basically my blood platelet levels were dropping rapidly, putting both me and the baby at risk for hemorrhaging during the delivery. At this time, we were living in Africa in a city where health care was limited and our doctor became so worried about my severe thrombocytopenia that she demanded a C-section at 36 weeks and 2 days. I ended up having a C-section under general anesthesia and didn’t even get to see my son until he was 3 hours old which left me feeling so removed from the whole birthing process. The whole experience was very traumatic for me and recovery from this C-section, which I never thought would happen, was harder than I ever thought possible. I almost didn’t want another baby until I started reading about VBACs.

When we found out we were pregnant with our second, I knew without a doubt that I wanted the opportunity to try for a VBAC. During this pregnancy we were living in another country overseas which was not the best place to try for a VBAC. After many conversations with my husband, we agreed we would temporarily move back to the States at the end of the pregnancy so I would have the best chance possible of delivering naturally. We emailed an OB/GYN who was a family friend and he was immediately on board and excited about helping me go for a VBAC.

Our pregnancy was pretty routine and easy like my first one but the whole time we questioned whether the thrombocytopenia would come back and what it would mean for my chances of a VBAC. Around my 30th week of pregnancy, we flew the long transatlantic flight back to America and settled into my in-laws’ house with our almost two year old to wait for baby girl’s arrival.

About the same time that we got to America, my platelets started dropping again which meant the thrombocytopenia of my first pregnancy had returned. Our OB/GYN was amazing and had many a long conversation with us about how my low platelets could lead to different outcomes including steroids, induction, and the inability to get an epidural in case of an emergency C-section. The whole time he never mentioned a repeat caesarian as an option for me and made us feel in control of our decisions which was such a different experience from our first pregnancy.

We were fortunate enough to be able to transfer our care to the midwives of his office while he still helped us navigate the thrombocytopenia. Still we were forced to wait to see what my platelets would do. Every week I had blood draws to check my platelet count and each week, from 30-35 weeks, they dropped more and more until they were around 90,000. At this number they are considered too low for epidural and were coming closer and closer to the number our doctor wanted to induce me at. I had many good cries about my platelets and about the idea of having to go on steroids and then have an induction as I had really wanted an intervention-free birth where I could labor at home as much as possible. There were moments I was convinced my dream of a VBAC was slipping away. I wanted so badly to avoid interventions or an induction. I had this overriding desire to see what my body could do because I felt like I was robbed of the chance of experiencing labor with my first. I knew my body could do it if only it was giving the chance but with the thrombocytopenia I was so scared I would not be given the opportunity to naturally labor. All this time, my husband was always there to encourage me to trust my body and believe that we could have the birth I wanted.

We asked all our friends to start praying for my platelets to miraculously go up, even though we were prepared for them to start drastically dropping as they did in my first pregnancy. We went in for my 36 week blood draw full of trepidation to see where my platelets had fallen to. My husband called for the results a few hours later and found out they had gone up to 105,000. That was the first time ever in either of my pregnancies that my platelets had gone up! Over the next two weeks they kept going up until they were at a really good level (121,000) when I entered my 38th week.

At this point I started knowing in my heart that this was the ideal time for baby girl to come as we didn’t know if and when my platelets would drop again. On Thursday we went to our chiropractor for an adjustment and then spent Friday, Saturday and Sunday walking a ton. Each night I told baby girl that then was a good time for her to come. Sunday night I went to bed asking God to bring baby girl in his timing but asking Him to allow me the natural VBAC we had worked so hard for.

Around 1:00am Monday morning (I was 38 weeks 4 days), I woke up for my nightly pee and noticed bloody show in the toilet. I got really excited and knew that this at least meant my body was getting ready. Almost immediately after that I started getting my first ever contractions (I never had one with my first pregnancy). My husband was sleeping in our two year old’s room because our son was sick with a cold and ear infection so I laid in bed timing my contractions. I ended up having contractions all night long every 5-7 minutes apart. In the morning they spread way out and my husband and I were both disappointed. I had contractions off and on all Monday then throughout the night again which left me exhausted by Tuesday. Tuesday we spent the day relaxing and napping as contractions came and went. I eventually told my husband I did not think I could do another night of these contractions and I really hoped active labor would start soon. My husband ran out Tuesday evening to get me some of my favorite soup for dinner while I bounced on my birthing ball and watched our two-year-old.

It was at this point that the contractions changed from being mildly annoying to being painful. I started having to concentrate on breathing more and really focus during them. My husband at this point didn’t realize that things were changing so he was going about doing dishes and laundry…at some point I snapped at him to stop leaving me alone because I needed him. He said it was at this moment he realized things were picking up. We sat together and watched Wheel of Fortune and Jeopardy as contractions came every 7-10 minutes or so. It wasn’t until around 9pm that I think I really entered active labor. I moved into the shower and labored there as contractions started coming every 5 minutes or so. Eventually we ran out of hot water for the shower so I went into the bedroom. It was at this point the contractions became really intensely painful. My husband called our doula and she came by the house to check on us. It was about 11:15pm and she guessed I was probably 4.5-6 centimeters and said I should try to sleep between contractions as I was now on my third night without much sleep. She left around 11:45pm asking us to call her when we headed to the hospital, which she thought would be in about 2 or 3 hours. As soon as she left contractions picked up in both intensity and frequency. They started coming almost every 2 to 3 minutes and lasting almost a minute. I was a little shocked by how intense they got in such a short amount of time. I told my husband that we needed to head to the hospital then. He was hesitant to go to the hospital as the contractions had not been that consistent for a whole hour yet. After a few more minutes of me yelling about going to the hospital, he decided it was indeed time to go and we headed out. The drive to the hospital was only about 10 minutes but I was contracting every 2 to 3 minutes so it seemed much longer.

We got to the hospital around 12:20am and were checked around 12:30. The nurse said I was a stretchy 6.5 centimeters so I was immediately brought to a labor and delivery room. At this point I was exhausted and demanded some IV pain killers. I knew I didn’t want an epidural but I was beginning to panic between contractions and knew I needed something to calm down. The painkillers helped me relax and sleep a bit between contractions with me still waking up every 3 to 4 minutes to breathe, scream, and occasionally cuss through so wildly intense and painful contractions. All this time the nurses were struggling with monitors for fetal heart beat and contractions. I did not know what they were talking about but I kept hearing them say “the contractions aren’t being read on the monitor” which in my tired mind meant that they weren’t strong enough to be picked up yet. That totally freaked me out as I thought I must just be at the beginning of labor. I kept asking our doula and husband if all of this was just false labor, to which they kept assuring me that this was really labor and a baby was coming soon.

By around 1:45am the painkillers had worn off and I started asking (demanding) for an epidural during every contraction. Our doula knew in that moment that I would really regret that decision so she lovingly but strongly told me no. Our nurses were awesome in honoring our request that they not suggest or bring up epidural either. Our doula did suggest I get checked at 2:00am as a way to give me a goal. At 2:00am our midwife checked me and I was at 9cm and the baby was at a 0 station. It was then suggested by our doula, that our midwife should break my water to help speed things along. At 2:15am she broke my water and I immediately began to feel the baby moving down. After about 2 contractions where I felt baby moving down, I told everyone in the room that I was going to start pushing. Our midwife, thinking I was still at 9cm, told me to try not to push. I told her again I was pushing and pushed with the next contraction. She had me flip over onto my back (I had been on my knees up over the top of the bed the whole time) to check and saw that the baby was close. At that point she called the nurses in and told me that since pushing was working I should just keep going. At that point all I wanted in the world was to get that baby out. I started pushing at around 2:25am and baby was crowning after only 2 or 3 contractions. Even as the baby was crowning I was scared of messing up somehow and needing a repeat C-section. I think almost everyone in the room laughed as baby was crowning and I was asking if there was any way that I was still going to have a C-section and if I was really in labor. It all just happened so fast that I was in shock!

The moment I pushed my baby girl out was literally one of the best and most empowering moments of my life. Her head came out and the rest of her body followed immediately. Our midwife placed her right on my chest and that is where she stayed for over an hour. After having a general anesthesia C-section with our son, getting to spend the first hour of my daughter’s life just holding her was a gift that I could not possibly be more thankful for. It was only after my daughter’s arrival that our midwife told me that my platelets had indeed dropped again and were under the threshold for an epidural. My husband and I are both so thankful we did not know that going into the hospital as the fear of a general anesthesia C-section would have caused me to panic. We are just so thankful baby girl came right when she needed to and exactly how she needed to.

Overall, I felt like my husband and I really fought for this VBAC and it was so worth it. We felt educated, informed, and empowered during the whole pregnancy. Even when dealing with thrombocytopenia and the complications that came with that, we felt like all our providers were fighting alongside us for our VBAC. All I wanted was to give my body a chance to do what I knew it could do and what it was made for. Our amazing team never pushed any interventions on me and allowed me to labor how I wanted. Our midwife was absolutely amazing in completely following my lead and allowing me and my body to control the pace and feel of labor. One of my recovery nurses, while reading the notes on my labor and how fast it went, said, “It is just sad you ever had to have a C-section in the first place. It’s clear that your body was just made for this.” It was such a redemptive moment for me to once again believe in my body’s ability to birth.

Overall, God gifted us with a birth we only could have dreamed about with only 2 hours in the hospital from check-in to baby. We now are thrilled to have a beautiful, healthy baby girl that came into this world naturally, surrounded by a loving and supportive team.

Story and photographs submitted by Julia Van Scott.