Hooray — it’s local birth story time again!
Here, mama Lauren shares the story of her journey to a VBAC (vaginal birth after cesarean) for the birth of her second child.
Lauren’s story is a lovely example of the great things that can come when a mother does her research, follows her instincts, and has the courage to place herself in a birth environment where she and her care providers share the same birth philosophy — even if it means switching providers mid-pregnancy!
Lauren, thank you so very much for sharing your wonderful story with us all! Congratulations on your beautiful baby girl!
THE BIRTH OF LAYLA
My journey to a VBAC actually started during my C-section for my first baby, who was breech. Our son just couldn’t be convinced to turn head down. While examining me after the surgery my doctor told me that I was a good candidate for a VBAC. Unfortunately, my practice stopped delivering babies when I became pregnant the second time and so I started seeing the OBs at another practice in Williamsburg.
At first the new practice seemed reasonably amenable to the VBAC idea. I think this was in part because I had already done research on VBACs, but also because my husband and I would like to have three or four children. However, as I went to more appointments and did more research (including joining Birth Matters Williamsburg) I came to realize that some of the things I needed to increase my odds of success were not going to be available to me in Williamsburg. They told me I would need to have an epidural so that the anesthesiologist would be present in case my uterus ruptured. I was also told that I would have constant fetal monitoring — and it wouldn’t be remote. The most concerning discussion was when they told me that they only had two VBACs in the previous year. Both were successful, but they apparently discouraged everyone who they didn’t think would be successful from attempting a VBAC. “You should be glad, we think you will be successful” is what the doctor said, but instead I was concerned about the material they were providing women about the chance of uterine rupture (which was a little out-of-date), the restrictions on my labor and their open discouragement of trials of labor after cesareans.
After thinking it over and worrying about the practice’s attitudes towards VBACs for four months, I pulled the plug and switched to the midwives at MCV. MCV had one of the highest VBAC success rates in the state and the midwives were extremely supportive of VBACs. I felt guilty changing doctors but then I thought – “why?!” They were providing me with a service and I was not happy with what I was receiving. After I ditched the guilt and switched care providers the stress around my VBAC dissipated, and I was really glad that I trusted my instincts.
I was very happy with the care I received at MCV. The midwives were absolutely wonderful. We went along without any serious issues, other than a slightly oblique and sunny-side up positioning phase. When the baby was somewhat oblique I became very upset, worried that there was something wrong with my body as it appeared my babies didn’t like being vertex. I was worried that all of the changes I had made to increase my odds of a successful VBAC were for naught and I would end up with another C-section. However, I was diligent about my body positioning and doing pelvic rocks and was able to encourage the baby into a better position. This involved a lot of walking, standing and kneeling at my computer while at work, for anyone who is curious.
Finally, March arrived and I was so anxious to meet our baby! My son came two weeks early, which is why I was able to go into labor on my own and discovered that my labors were relatively fast. On one hand, I wanted this baby to make it to at least 39 weeks. On the other hand, as any heavily pregnant woman can tell you, the end of pregnancy can be somewhat tedious. My water “finally” broke at 39 weeks just as I was getting ready to go to bed at 10:30pm. My contractions were pretty mild and irregular, but fairly close at 5-10 minutes apart. I took the dog for a walk to see if I was really in labor, or if I had just had some sort of humiliating 3rd trimester experience. Returning to the house after a very brief walk, my water had definitely broken and I was definitely in labor. When we got to the house the dog raced back to our bedroom and sat down in front of my husband, who was putting up shelving in our closet, as if to say “this is no time for house projects!” (side note: my husband nests more than I do.) So we puttered for about an hour and a half, but I was anxious because my labor moved quickly with Tony and I heard that second labors went faster. We had a 40 minute drive ahead of us, and fortunately the midwife was already at the hospital when we called. She invited us to come up whenever we wanted, so we went ahead and drove to the hospital, while my Mom stayed with our sleeping son and anxious dog.
Not only did I not give birth on the highway, but once I got to the hospital I was barely 3 cm and the baby was still high in my pelvis. I was bummed, but we stayed because by the time we would have gotten home, we probably would have had to return to the hospital. After we were settled in the midwife offered us the option as to whether she stayed in the room with us or not. We said we were fine, and after I was hooked up to the monitors they left. One of the big reasons I went to VCU was to have the remote electronic fetal monitoring so I would have a great deal of freedom to move – including getting in the shower or tub.
[A note from Williamsburg Mothering: At midwife-attended births at VCU, VBAC mothers receive continuous electronic fetal monitoring (EFM), but the monitoring is done with a remote unit that allows the mother freedom of movement. Continuous EFM is not used during routine labors; instead, the midwives monitor every 30 minutes rather than continuously. Additionally, IVs are only administered in cases of GBS or dehydration; they are not routine for every mother. With the VCU midwives, there is no restriction on eating or drinking, and mothers can labor in any position they would like.]
My husband and I had talked about getting a doula, but he was adamant about doing it himself. I wouldn’t recommend it for everyone, and we did quite a bit of preparation before I felt comfortable with him serving in that role. (This included watching birth videos, reading The Birth Partner by Penny Simkin aloud to each other while discussing each section as we went and writing a birth plan together.)
When we were preparing for labor we packed snacks and made a labor playlist. As it turned out, none of this was necessary because I became pretty nauseous and only wanted to listen to a classical music CD. Definitely no Cee-Lo! Before labor started, I thought I was going to want counter-pressure from my husband, but I found that I didn’t like that at all. Instead we walked and did a lot of slow dancing during contractions, even while I had an hour long IV of antibiotics. I also drank a lot of apple juice, which I normally hate but I wanted to have some sugar since I didn’t feel like I could eat.
After the IV was finished we got in the shower and stayed for a couple of hours. My husband kept the shower nozzle on my lower back. I started feeling more pelvic pressure and thought maybe I was in transition (ha!). So because I was feeling the pressure, which made me feel a little “pushy,” they checked me. Only 6 cm and 0 station. I was very disappointed. That’s when I really thought, “Lord, I don’t know if I can do this.” My husband said he could see all my emotions across my face – first disappointment, then self-doubt, and then determination. In my mind I felt all of the same things, what it really came down to at that point was “how badly do you want to be a participant in this birth?” My desire for a VBAC with as much freedom as possible during labor outweighed my doubt around my ability to handle the pain. I’m sure there was a little assistance from the Divine as well, a little shot of confidence to keep going.
At that point the nurse (who was assigned to the midwives and was also a natural birth advocate) and the midwife reminded me of my birth plan and desire to labor in the tub. I immediately agreed (and was grateful that they actually read my birth plan and referred to it) and so we got into the tub. The tub was VERY intense. I was feeling frequent urges to push and having double peak contractions with essentially no break in between. I think the tub sped up my labor because the warm water had a relaxing effect on me. It took a lot of focus not to bear down and I kept saying “I’m pushing I’m pushing!” The midwife, nurse and my husband kept calmly telling me that it was just my body moving the baby down the birth canal and to stay focused on my husband’s face, tilt my chin up and breathe. Apparently you can’t really push if your chin is up, and if you really want to push you should put your chin down. It was an odd sensation as when I had my son I only spent a little bit of time in transition and I had an epidural to prepare for surgery shortly thereafter. I was having difficulty focusing and making a lot of…primal noise during contractions. I alternated between worrying about inadvertently pushing on the one hand and on the other hand having an almost out of body experience where my mind was nearly blank. I could hear Chris and the nurse quietly telling me that I was doing well and I could sense that they were totally present in the moment with me but it was like hearing them through a fog. I appreciated their support and focus.
Out of the corner of my eye I noticed the nurse look up at the midwife and they asked me to come to the side of the tub. I knew they had lost the baby’s heartbeat. Although I couldn’t piece much of a cohesive thought together at that point and if I could it probably would have been something you would hear on a naval ship and not suitable for print. The midwife moved with purpose and they were able to find the baby’s heartbeat very low in my abdomen. After watching me for a few more contractions the midwife asked if she could check me again.
I was terrified that I wouldn’t have made much progress at all but at the same time felt I must be close because of where they found the baby’s heartbeat. Fortunately, I was at 10 cm! In 45 minutes I went from 6 cm and a 0 station to 10 cm and ready to push! Relieved, I hobbled back to the room (which was 20 ft away) and the nurse and midwife started quickly preparing the room as I started to push standing up. Pushing standing up was so wonderful. Standing up and I could use my whole body. I was literally pulling on my husband’s arms for about 20 minutes and we made such quick progress that the nurse and midwife asked me to get on the bed. Pushing in bed semi-reclined was much harder than standing and pushing. They asked me if I wanted to see my progress but I had left my glasses in the bathroom so I was nearly blind. Instead I reached down and felt the baby’s warm and squishy head. The only coaching I received during pushing was when the baby crowned — the midwife and my husband both encouraged me to not push as strongly and let the baby ease out. With the midwife guiding his hands, my husband caught our baby, excitedly told me that she was a girl and placed her on my chest. We marveled at this little life entrusted to us. After the cord stopped pulsing my husband cut the cord and we enjoyed uninterrupted bonding time with our beautiful baby girl.
I was somewhat dirty and exhausted but felt that the birth was what I hoped it would be. I didn’t want people hovering around me, I wanted to avoid an epidural so I could have total freedom of movement, I wanted to labor in the tub, I wanted to push in a way that felt good to me following my body’s natural urges to push and I wanted to be surrounded by caregivers who believed in birth as a natural process! The midwife commented on how nice it was to see a couple work so well as a team together. It was a powerful experience for us as a couple and as parents.
Facility: Midwifery Program at MCV/VCU Medical Center
Midwives: CNMs seen during pregnancy – Kathryn Beaton, Amber Price, Brenda Brickhouse; delivering midwife – Brenda Brickhouse