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Kyan's VBAC

9/8/2013

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I suppose the story of a VBAC must begin with the c-section, and since that’s probably the most important part of my story, I’ll start there.

Shanti, July 6, 2006


I became pregnant after nearly 3 years of trying, hundreds of dollars worth of fertility treatments, and the third intrauterine insemination (3rd time’s the charm, right?). It was an awesome pregnant lady despite some pretty significant morning sickness, and I had no other trouble all the way through.  Having gained some weight on the fertility meds, I was happy that at 9 months pregnant, I weighed 5 lbs less than before getting pregnant.  
 
After spending the preceding 3 years reading all I could about improving my fertility, I didn’t want to jinx the pregnancy or stress myself out by reading about pregnancy and the problems that could occur, so to this day, I’ve never read a book on pregnancy or birth (or child rearing for that matter).  As I neared my due date, I did however, watch number of those stupid birth shows on TLC to prepare myself for the actual labor and delivery (ha!).  
 
I chose to give birth in a hospital assisted by a doctor.  Several people I knew at the time criticized this decision in favor of using midwives at home.  But to this day, I maintain that each woman must make the choice about her delivery that works for her and her alone.  I felt that since I had gone through such an ordeal to actually get pregnant, having the baby at the hospital with a doctor would be best if anything were to go wrong.  I wasn’t risking ANYTHING with this baby. 
I wrote an epic birth plan/manifesto outlining all of my desires for the birth and how I was going to try to do this drug free, use of forceps was not allowed, and how the baby should not be taken to the nursery but room-in with
me, etc, etc.

I had been at 1 cm for weeks before my 39 week appointment, but was not at all effaced.  At that appointment, my doctor told me that if we didn’t see labor in the next week, we would induce.  I trusted my doctor and saw nothing wrong with this assessment. I assumed this was common practice and the following week on my due date, I was admitted at 4:00 pm for the induction.  Upon reaching the hospital and getting all hooked up, it was determined that I was actually in labor and so I was not given pitocin.  At 8:00, I still didn’t feel any contractions and my cervix was still not effaced, so I was given cervadil, a cervical ripening agent.  My husband and I celebrated his (my husband’s) birthday with Indian food and then I was given some preemptive pain meds and some sleeping pills and we went to sleep.  

At about 3:00 am, I awoke in pain.  The nurse told me that I could have more pain meds, but that they may not work and I wouldn’t be able to take anymore until they wore off 4 hours later.  I threw my birth plan out the window and went with the pain meds hoping they’d work until I was dilated enough for an epidural. They didn’t work.  I spent the next 4 hours screaming in agony with each contraction, which came erratically every 2-5 minutes.  All of the techniques my husband and I learned in our 8 week birth class didn’t work to relieve my pain.  At that point I told the nurse I wasn’t down with this whole labor thing anymore and just wanted to go home.  Not an option, she told me (although she was way more shitty about it). My mom called around 6:00 in the morning, as she was about to get on the road for the 12 hour drive to see us, and heard me screaming.  She cried the whole drive in.

As soon as it was safe and I was dilated enough, I got an epidural.  And I slept.  A couple of hours later, the nurse woke me up and told me it was time to push.  Ok, cool.  Let’s do this!  I pushed for 3 hours.  The baby’s head would crown, and then slip back in.  Over and over again.  The doctor decided to try the vacuum extraction.  I distinctly remember her putting her foot against the bed for leverage and leaning way back to pull the baby out, and the baby still wouldn’t emerge (my husband does not remember that foot-leverage part at all).  At that point, I was informed that we’d try a few more pushes and then we’d have to think about a c-section because the labor was failing to progress.  That’s when shit got real and I started to get scared.  The pushing was ineffective and I was told the baby’s heart rate was dropping and that I’d need to get an emergency c-section.  I agreed immediately because I was scared and didn’t want anything to happen to my baby, so I was wheeled into the operating room while my husband was led away to get scrubbed in.  My
epidural was replaced with a spinal block, I was strapped down (medieval-style) and my pubic hair was shaved.  As the spinal began to take effect, I could not feel myself breathing and had a panic attack.  The nurses assured me that I was breathing fine otherwise I wouldn’t be able to talk, but I swore I couldn’t breathe.  They gave me oxygen.  Then, I couldn’t hear myself talking.  Unable to calm me down, the doctor asked if I wanted to “take a nap” during the “procedure.” And so I went nigh-night while my baby was born.  My husband was not allowed to be present since I was under general anesthesia.    
 
When I woke up, I was in a strange room that I wouldn’t have readily identified as a PACU.  I immediately asked “Where is my baby and where is my husband?”  They were brought in and I found out I had a beautiful, perfect baby girl.  She was 7lbs 12oz and some 20.5 inches long.  We named her Afuwaa Shanti, and my world was forever brightened.

Recovery from the c-section was not easy.  On top of that, 3 weeks after Shanti’s birth, I began to have painful symptoms that 5 weeks later were diagnosed as rheumatoid arthritis (likely brought on by the pregnancy).  I spent much of the first weeks of my daughter’s life bedridden and in extreme pain, and over the next year while I struggled to manage my illness, I missed out on a good portion of her babyhood.

I always knew I wanted to have 2 children.  It is what my husband and I had planned.  I wanted Shanti to have a sibling.  But in order for me to get pregnant again, I would have to get off nearly all my arthritis medications.  I had already suffered significant joint damage and had 3 surgeries by the time Shanti was 2. And then there was that pesky fertility business too.  Ugh! We shelved the idea of having another child for a few years and my husband even made peace with having an only child.  But I kept an attic full of baby stuff, and a hope that someday we’d become pregnant again.

Ellis, December 15, 2011

Baby Fever had consumed me by the fall of 2010.  I was GOING to have another baby one way or the other.  My husband was much more hesitant.  Holding onto the hope that my disease would go into remission during pregnancy (as is common), I had my IUD removed, I went off my meds, drank this horrible slurry 5 times a day for 2 weeks to flush the meds out of my system, and got our ducks in a row for IVF since we didn’t have the luxury of trying for 3 years again.  But, it turned out we didn’t need fertility treatments this time around.  When I showed up to the doctor to start the meds, I was pregnant.

And I rocked it out again.  Another awesome pregnancy with no problems and weight gain of only 10lbs.  My rheumatoid arthritis did go into remission while I was pregnant, returning with a vengeance a short time after baby was born.  At this point, we lived in a different state and so I found a new doctor.  Due to my “advanced maternal age” (I was 36) and my disease, the pregnancy was classified as “high risk” and I had about a billion ultrasounds.  This time we decided
to find out the baby’s sex ahead of time, and learned I was having a boy.  
 
I asked my doctor about a VBAC.  She said sure, we could try it.  But after reviewing my chart from my first delivery, she placed my chances of a successful VBAC at about 18%.  So I scheduled a c-section for December 16, 2011 - the Friday before my due date.

My plan was to work through December 15th, until my mother convinced me to take off the 15th to give myself time to prepare for surgery the following day.  I picked my mom up from the airport on December 14th at 8:00 pm.  She brought me spicy tamales from my friend’s restaurant and I ate several before going to bed (because I guess I hadn’t learned my lesson eating the Indian food the night before Shanti was born).

At 12:30 am, I was awoken by some strange contractions.  I got up to go pee.  I continued having these weird contractions that made me pee several times in the next half hour.  These contractions weren’t like the Braxton-Hicks ones, so my husband called the doctor while I threw my stuff into a bag and woke my mother to tell her we were heading to the hospital.  We sort of sped, and by the time we reached the hospital about 15 minutes later, I was seriously uncomfortable.  They put me in a holding tank where they hooked me up to monitors and gave me a choice: they could prep me for the c-section, or since my labor started spontaneously, I may have a better chance at the VBAC if I wanted to try it.  I figured that if I was going to end up with the C anyway, I might as well give the VBAC at try.

So I did.  At that point, I was 6 cm dilated and begging for an epidural.  Anesthesia was called, and a short time later, I was hooked up.  There was so much peeing and pooping going on with my contractions (damned tamales) that I wasn’t sure when my water broke, but eventually it did and I took a little nap while my labor progressed.  Soon, it was time to push.  I pushed for 40 minutes and my son, Ellis Addae came into the world at 5:02 am, a short 4 ½ hours after my labor started.  He was 7lbs 11oz and around 20.5 inches long.  He was then, and continues to be the most beautiful boy I’ve ever seen.  And such an old soul; I’m completely sure we knew each other in a past life. 

Overall, I’m not bitter about the c-section.  If I have to be cut open for my baby to be born healthy and safe, then I would do it again in a heartbeat.  My only regrets are that my husband couldn’t be present, cut the cord, and hear the doctor say “It’s a girl!”  I regret that I panicked and had to be put out and as a result neither of us experienced those first few moments with our first child.  We can’t get those things back.  So I felt redeemed when Ellis was born.  When he was a week old, I was walking around outside in pre-pregnancy jeans feeling so good, I actually had the thought - “Huh, I feel well enough to go back to work already!” 
And then I kicked myself for that. 
;-)    
 
***This picture is of us a week or so after Ellis’ birth at his Outdooring.  My husband is from Ghana and in this ceremony the child is given his name and presented to the community.

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Hawa's VBAC

9/6/2013

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I live in London, UK and birthed in an NHS hospital. My first baby was a planned all natural water birth at a birthing center that ended up in an emergency cesarean for failure to progress. I had spontaneous labour, followed by nearly 3 days of exhausting prodromal labour which resulted in me requesting an epidural as soon as I was 4cm and 'officially' in labour. Things went down hill from there.


Looking at my 10.5 week old baby girl Aisha sound asleep, I am struck by a sense of familiarity. It is like she has always been here, always been mine and we were merely introduced again through the process of birth.  It's hard to believe I carried her for one day shy of 43 weeks.  She almost didn't want to come out.

When I fell pregnant 8 months after my son's emergency cesarean, there was no doubt in my head that I wouldn't or couldn't have her vaginally.  I plunged myself into research, I read birth stories and scientific publications.  Most of all, I supplicated to the Almighty to guide me towards what was best for both of us.

My pregnancy was uneventful.  By that, I mean I was besieged with the typical pregnancy niggles but nothing so bad as to make me never to want to become pregnant ever again.  Nevertheless, I was put under consultant care because of my previous cesarean - I was considered high risk.

At my 24 week appointment, my consultant was understanding of my intention for a VBAC.  She explained the pros and cons of a VBAC vs repeat cesarean all the same. However, when I saw her again at 36 weeks, she mentioned that a VBAC was too risky and that she attended one recently where a rupture occurred and the baby died.

I was too shaken by her revelation and left the hospital deflated.  It was not at all what I expected to hear 4 weeks to my due date.  I chucked it down to her being still shaken by the awful experience of witnessing a baby dying.  In hindsight, I realise if it had been a mother who had died from a cesarean under her watch, she would not have used it as justification for encouraging me to have a VBAC!

I know ruptures are rare. Statistically they occur in roughly 1 out of every 200 spontaneous, unaugmented VBAC births.  So I was not under any illusion that I was 100% safe.  It was around this time when I was researching the rights of birthing mothers under the NHS that I came across the statistic stating black women were less likely to be successful at a VBAC than white women.  I thought to myself, hell no, this baby is coming out of my vagina and that was that!

I saw my consultant again at 38 weeks.  She checked my cervix and declared I was just 1cm, barely effaced and labour was, to use her words, "not imminent."  Again she tried to coax me into a RCS but I reiterated that the only time I will consider a cesarean is if it was an emergency.  I then whipped out a giant notepad with questions and it shut her down immediately.

Well, by 40 weeks my due date came and went with nothing significant happening.  My midwife gave me a membrane  sweep and signed me off her care.  Besides Braxton Hicks which were irregular and unpredictable, I was just your garden variety pregnant woman waddling from point A to B, thoroughly fed up with being pregnant and eager to meet her baby.

I checked into hospital around noon at 40+12 weeks for an induction.  My plan was to wait for spontaneous labour, but hubby and I decided the anxiety of waiting and possible stress of daily fetal monitoring with a 17 month old toddler in tow would be too much to handle.

In triage I was strapped unto the monitor which showed baby was moving but not as much as it was expected to.  By 8pm I was taken to the delivery suite.  I went through my Birth Plan with the midwife which was to be minimal interventions, delayed cord clamping, skin to skin, no offer of pain relief unless requested and most importantly we did not want to be told the gender; we wanted to find out ourselves.

Around 9.30pm my membranes were ruptured, baby had passed meconium but they weren't too concerned.  I was about 2cm, my cervix had thinned out but baby's head was still a bit high.  I was allowed to walk around for 1 hour to get things moving.  Hubby and I went to pray and afterwards headed downstairs to grab something to eat.  We had to hurry back to my room because I underestimated how much fluid leaks post waters breaking.

At 11.30pm, syntocinon (pitocin) was administered starting from the lowest dose and an increments every half hour.  I was contracting every 10 minutes on my own prior to this and still strapped to the monitor but was sat on the exercise ball.  I was able to bounce up and down and wiggle around to help baby descend.

I remained mobile and upright for most of my labour, either rocking gently on the ball or leaning against the edge of the bed.  Every 30 minutes the dose was increased and my contractions got more intense.  I was coping well with gas and air.  It made me so high I was giggling in between contractions yet it did absolutely nothing for the pain itself.  Contractions were coming hard and fast, I was having one every 3 to 4 minutes.

5 hours later I had had enough, cue screaming for an epidural.  Nothing helped with the pain, plus I had a weird pushy feeling at the end of each contraction.  I would scream at the beginning and then grunt against my will towards the end.  I can't remember telling the midwife I had an urge to push, but if I did, nobody took me seriously.

The anaesthetist took forever to arrive and forever to insert the epidural, all the while threatening me with paralysis if I didn't keep very still.  As soon as it was in, I heaved violently and nearly passed out from low blood pressure.  When the epidural kicked in, hubby and the nurse piled my numb legs unto the bed.  Just at that moment, the Dr was doing her rounds. She wanted to check my progress only to see a head of hair peeking out.

She says to the midwife, "deliver her." Those were the most beautiful words I had heard all day. I was ecstatic.  I couldn't believe it was finally happening.

I tried to push but felt nothing.  Darn epidural!  I was completely numb waist down.  I KNEW I was bearing down but the Dr said I wasn't.  Then baby's heart rate began to drop.  She told me baby was stuck and needed to come out ASAP and to push really hard.  I pushed and pushed but baby wouldn't budge.  So she said she was going to do an episiotomy and then use a ventouse to help baby out.  Two assisted pushes later with a lot of coaching and and encouragement from hubby, our precious baby slid out.  A screaming 3.589kg (7lb9oz) wriggling red lump of a baby.

She was immediately placed on my tummy, with her back to me,  while they waited for her cord to stop pulsating.  I was too giddy with emotions to check if it was a boy or a girl.  Then hubby told me and it was as if I had always known.

While stitching me up the Dr said she was born with a nuchal hand and I received a second degree tear.  If you ask me, it was all worth it.  I felt and still feel incredibly blessed.  It was my ideal birth, despite the pain from induction, despite it not being as intervention free as I has envisaged, despite getting an epidural 10 minutes before she was born, despite repeated warnings that I will be wheeled away for a cesarean if I didn't progress, I would do it over again in a heartbeat.  I thank Allah for His Mercy and Compassion and for the wonderful blessing He bestowed on us.

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Pauline's 2nd Home VBA2C

9/5/2013

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Pauline has six children.  Her first was an induced vaginal birth with vacuum extraction.  Her second was a spontaneous medicated vaginal birth.  Her third baby was an emergency cesarean due to placental abruption.  Her fourth baby was a planned repeat cesarean, which resulted in a NICU stay for her baby. Her fifth baby was a planned HBA2C with a midwife.  This is the story of her sixth and final baby, her second HBA2C, which she chose to deliver unassisted.


On February 27, 2009, at 41 weeks 6 days, I started having some contractions at around 4:00.  I’d been having them on and off for days so didn’t think too much of it.  At around 6, they hadn’t stopped and I noticed that I’d also developed a leak.  I went along as usual and the contractions started to pick up.  I had my husband fill the pool in the hope that I might have the baby faster than my last or at least have some pain relief as things got more difficult.   While in the pool at around 10, I got a big gush of fluid.  I had several more gushes over the next few hours, one of which caused my oldest to stay away, he thought I peed myself!  I labored all night and through the morning until about 11:00.  


At this point, my contractions slowly tapered off and spaced to about 20 minutes apart after a couple hours.  I stalled in my last labor at around this time, so I thought it was just normal for me. After about 4 hours with no progress I did ask my husband to have a quick feel to see if I had made any progress at all and I had.  I started to wonder after about 5 hours, so I called a couple friends and got online.  After a while, I realized I wasn’t sure I wanted transition to come.  I’d had some worries about how things happened in my last labor.  I was worried about the pain as well as the lack of an urge to push.  Although I thought I’d put these feelings aside, they were still there.  I asked my friend her opinion and she was blunt and honest, her words were what got me through the hardest part of my labor.  She told me I needed to decide now if I wanted another major surgery or if I could put my fears aside and allow my body to do what it needed to do.  My contractions were back before our conversation had ended.  I knew the hospital was not the place for me but if I didn’t allow my body to continue, that is exactly where I would end up. 


My labor was back in full force by 8:30.  I labored on-with a little help from Bob Marley‘s music- without too much problem until around 9 when I got this pain.  It wasn’t like any others and didn’t come with every contraction at first.  I knew I was well into transition because this was the exact way things happened when I had my last home birth.  I was still hoping to get the urge to push so I did what I could to get through them.  Soon it became apparent that I was losing control.  I screamed, begged and prayed for this pain to stop!  It’s odd, this kind of pain for me is almost like an urge to push.  Once I literally couldn’t get through them, I knew I had to push and my baby was born in less than 15 minutes at 10:32 PM on February 28th-his brother‘s birthday.  I pushed in my bed on all fours which is new for me.  I was able to guide his head out by using small pushes with no tearing and hardly any hint of the ring of fire but my husband caught.  I don’t think I’ve ever seen him more proud of himself. 


All in all, it was a great birth and I’m so happy that my little one is here now. My oldest son (10) cut the cord. He was a little nervous and worried about hurting the baby at first, but he did a great job!  My 7 year old daughter clamped it, my husband coached her through.  My 2 year old was the best little labor partner, he kept me happy and laughing during times when I didn’t think I could. My 8 year old slept through the birth she tried so hard to see.  She’s quite the little midwife already.  She was up with me half the first night doing anything I asked from pouring water on my tummy to passing me drinks without so much as a word.  


After things settled, we got him weighed and checked his length. He weighed 9 pounds 2 ounces and was 22 inches long--my largest baby! He nursed well and was quite a demanding little guy!
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