Pam's VBAC of Mateo

This week on the Blog, I thought it would be good to feature several birth stories from a mom who has had multiple VBACs.  I know when I was preparing for my VBA2C, I spent a lot of time thinking about my HBAC to CBAC birth and expecting my VBA2C to be just like that labor, and I was surprised to find that they were worlds apart!!  Pam had 3 VBACs and 3 different labors, and I think it’s important for mamas who may have labored before to really understand that, even in a woman who has had a VBAC, her labors and deliveries may be different each time. Today we have her first VBAC story, Wednesday I will post her second VBAC and Friday her third.  Pam is an at home mom living in Colorado with her husband and four kids. Her birth experiences helped her become passionate about the rights of birthing women everywhere, and she has moderated BabyCenter’s VBAC Support Board for over five years. She strongly believes that birth is beautiful and empowering no matter where it happens!

Mateo’s VBAC Birth Story

Brief background: My cesarean was for failure to dilate at 9 cm following 27 hours of induced labor at 41 weeks 1 day.  It wasn’t a terrible experience but it wasn’t one I cared to repeat, and VBAC was very important to me. I was fortunate to have supportive providers, but I did have some hurdles to overcome. I had 2 miscarriages between my first and second sons, and then when I conceived my second child I had a lot of early bleeding that culminated in a diagnosis of complete placenta previa after I passed a huge gush of blood, fluid, and clots at 14 weeks. Fortunately the rest of my pregnancy was uneventful! This is the story of my first VBAC:

At 40 weeks I was 1 cm dilated, 25% effaced, and the baby was still floating above my pelvis.  I had scheduled an NST and AFI for 41 weeks and my OB agreed we could continue monitoring the baby and go to 42 weeks if we needed to. My OB told me not to get discouraged about having no progress because it could happen in a matter of hours.

My due date came and went, as I suspected it would. The following Monday I was 3 days late, and right before bed I lost my mucous plug. I was really excited because that hadn’t happened with my first son- and it was my first sign of something related to labor. All day Tuesday I had painless, wimpy braxton hicks contractions, but that was even more exciting because they had all but stopped after 36 weeks. Tuesday evening at dinner I told my husband, Tomas, that I’d lost my plug and was having contractions, and his face just lit up. I tried to temper the excitement by telling him it could still be days, but I think both of us had a sense that it would be much sooner.

At 1:30 Wednesday morning I woke up with contractions that felt like bad menstrual cramps. I knew if labor was starting I’d need the energy to get through it, so I took a couple Tylenol and went back to bed.

By 2:30 a.m. I gave up the pretense of being able to sleep or doze between contractions. They were coming every 3-5 minutes and increasing in intensity, and I was much more comfortable on my birth ball or pacing my kitchen. I still thought it could be false labor, and every half hour or so I’d time 3-4 contractions to make sure they were still coming regularly.

By 4:30 a.m. I knew “today’s the day.” Although the contractions weren’t nearly as painful as my induced labor with Vince, I was having to breathe through the peaks and my most comfortable spot was my rocking chair. When my husband’s alarm went off at 6, I went in and told him he’d need to call in to work.

We called my mother-in-law around 8:30 to have her watch our son while we went to the hospital. I did my best to give Vince a little extra attention and love but it was hard. He knew something was up, and he wasn’t too happy about it. Tomas took him to Grandma’s house a little after 9, and we left for the hospital around 9:45. I asked Tomas to not make fun of me if I wasn’t really in labor and we weren’t admitted. He said it was okay, because we’d be having the baby by tonight for sure. I laughed and said noon sounded better to me- but what were the chances of that?

On the way to the hospital I joked that we should flag down a police officer for an escort, and we chatted between contractions. Contractions were getting much more intense, and hitting a pothole during one was brutal. The drive wasn’t as bad as I thought it’d be, but it wasn’t exactly fun.

As we checked in to the hospital, a strong contraction came and I put my arms around Tomas and stood there rocking, tears streaming down my face, and said, “I feel like such a wuss.”  In the background I heard the check-in receptionist calling a nurse to take me triage right away. “She’s really uncomfortable.”  The doors opened, and we went through.

If you’ve given birth in a hospital, you know the routine: gown, monitors, pee in a cup, lie here in bed, OB will be in to check you. I told the nurse I was VBAC and GBS positive, that at 40 weeks I was 1 cm, 25%, and that I hoped when I was checked that I wasn’t still at 2 cm. I was checked at roughly 10:30 and was 4 cm, 100%. This was it!!

The rest of Mateo’s birth went so fast that it seems almost dreamlike to me. I stayed on the external monitors in triage while my nurse went to find a nurse anesthetist to do my IV (I’m tough to get an IV into, but needed it for the penicillin), and before they came back my water broke. It was a pretty weird sensation- a strong contraction followed by a POP and a gush. Very different from amniotomy. I had Tomas go find the nurse so I could get a towel under myself, and we discovered very heavy meconium in the fluid. Contractions immediately intensified to a level where I decided (in my exact words), “I wanted natural childbirth but I was an idiot.” I was checked again and had dilated from 4 to 6 in 40 minutes. The anesthetist got my IV in on the first try, and the nurse had called in the OB to 1) evaluate baby’s heart tracings and 2) discuss pain relief with me. Because of the heavy meconium and some apparent late decels we decided to place internal monitors- something I’d initially been against. Because I was progressing so quickly I wouldn’t be allowed to have narcotics, and I still didn’t really want an epidural (Tomas was in the background saying “we’ll see how it goes babe, you’re doing great). An LDR room was being prepared for me, and after I was transferred I’d have all the monitors placed and discuss an epidural again.

In the hall between the triage room and the LDR room, I went through transition. The sheer physical intensity of it was more than I was prepared for, and I honestly don’t really remember much more than little snatches of conversation- Tomas telling me I was doing great, me quite literally begging for an epidural and asking someone to make it stop, the nurse telling the OB that I was dilating like crazy, me having to pee but not able to, nurse saying if I felt like I had to have a BM it was probably the baby, contractions one on top of the other, the resident OB telling my delivering OB that she couldn’t place an IUPC because there was such a small lip of cervix left, me thinking “WHAT??? I was only at 6 a minute ago!”, the resident placing an internal monitor on the baby and announcing that I was complete, and then it was time to push.

I did not like pushing. I felt very exposed, totally overwhelmed, and it HURT. After the first couple contractions the OB told me that I’d dilated really fast because my cervix had done that before, but that since I hadn’t delivered vaginally I might be pushing for a while. He said I’d probably have the baby within the hour- and I thought there was no way I could push for an hour. A couple contractions later and everyone realized the baby was coming fast. It was a mad rush to get the special care nursery folks in the room (they would pay extra attention to baby because of all the meconium) and get everything set up for delivery. The OB, my L&D nurse, and my husband stood at the foot of my bed holding my legs, cheering me on as I pushed.

Once the baby started crowning I was overwhelmed by the bestiality of it all. I felt wild, feral- almost like some part of me had sprouted fangs and claws and sprung free from an inner corner of my spirit. I roared with each push, panted between contractions, my mind and body seemed to be in two completely different places, and still I can’t quite fathom that it was ME harboring that raw animal instinct. At one point the OB told me to reach down and feel the baby’s head- it was so soft, and so foreign, and so strange, and just what I needed to find the strength to push the baby OUT. Feeling his body slide out after delivering his shoulders was amazing. It was one final push and a swift flow of baby and fluid, and there was our perfect son! He weighed 8 pounds 5.6 ounces, and was 19.5 inches long. Later I asked the nurse how long I had pushed and she laughed and said, “You could count it in contractions instead of minutes- let’s see, you pushed for 9 contractions.”  Roughly 15 minutes. Amazing.

Because of all the meconium (and I’m telling you, it was a LOT), Tomas didn’t cut the cord and Mateo was immediately handed off to the nursery team. They suctioned him and cleaned him up there in my room, and then gave him to Tomas. His apgars were 9,9,9 which they said is “perfect” for a high-altitude baby, so the meconium was a bit of a mystery. After a little while he started having trouble breathing and was taken down to the nursery for oxygen. Meanwhile I had delivered the placenta (the OB later showed it and all its parts to me, which was pretty cool) and was being stitched for a 2nd degree perineal tear and 2 anterior/urethral tears. It seemed like it took forever, and I lost track of how many times the OB and the resident turned around for more sutures. I got the post-delivery shakes while they were stitching, and it seemed like every time I saw their hands the blood was further up their arms. But, finally, they were done and I was able to lie in bed and be amazed at what I had just done.

Overall this was as close to my ideal birth as I could have experienced. I have absolutely no regrets about any of it, and I would take 100 deliveries like this over another cesarean. I feel amazingly blessed to have had such an easy and fast labor. Given all the hurdles I had during the pregnancy and the “anti-VBAC” indicators I had in my history, experiencing this birth has been amazingly empowering. I am strong, I am capable, and I was not ever wrong to believe in the creative feminine power of my body.

Pam

Vincente 8/17/02

Mateo 9/8/04