CAM Birth Story #5: Lily's VBAC

In honor of Cesarean Awareness Month 2010, we will be filling the blogosphere with stories from real women (and their families) who know first-hand the consequences of a 32% cesarean rate. Each day we will post at least one birth story submitted by these women. Prepare to be moved (hint: grab a box of Kleenex)!

From Lily…

My first son was born by cesarean for what they like to call to failure to progress. I had labored 20 hours when my doctor decided the surgery was in my best interest. I had been at 8 cm for about 4 hours after allowing my doctor to break my water. Ignorant of the risks and exhausted from labor, I agreed.

When I got pregnant with my second baby, I was torn between trying for a VBAC or scheduling a repeat cesarean. I wanted to experience a vaginal birth so much, but I wondered if it would be easier to just schedule the surgery. I did a lot of research, joined the International Cesarean Awareness Network (ICAN) and decided that the safest thing for my baby and me would be to plan a home birth, far from medical interventions.

As I tried to fall asleep around 1 am on Tuesday, January 30, I felt what I knew were labor contractions. I recognized them from my labor with Lucas, and I knew right away it was it. All of a sudden I was so nervous. I felt like I was about to take a final exam. I was SO nervous I started shivering. That’s what happens to me when I get nervous. Same feeling as when I’m about to get on a plane. (I’m terrified of flying.)

I timed the contractions and they were really short – about 30 seconds long and 11 minutes apart or so. Ok, so I figured it would be a while. I told Trey I thought it was really it this time and we should go to sleep to get as much rest as we can. I tried to sleep but couldn’t, so I got on the web cam with my mom. She, my dad, and youngest sister are living in Japan so that’s how we communicate. She was thrilled to be part of my labor, and timed my contractions while we talked.

The contractions were pretty irregular. Some were 6 minutes apart, some 18 minutes apart, and others in between. Some were 30 seconds long, others were 80 seconds long. Pretty soon it was 6 am and they spaced out to 20 min apart. My mom said it was probably a sign I should go back to sleep, so I did.

At one point in the middle of the night I had called my CP to let him know I was in labor and probably wouldn’t be in for my 11 am appointment! But, since the contractions stopped when the sun came up, I called back later to say I would be in after all.

Trey left for work around 8 am and I got Lucas and myself ready. Trey would come back at 10:30 and he would drive me to my CP’s office.

We got there at 11 am and while waiting, I got one contraction. Same labor-type contraction. Eventually I got called in. All the while I was still wondering how to refuse a vaginal exam, but it ended up not being a problem because my CP asked me if I wanted one at all and I was able to say, “No, not really… I’ll give myself an exercise in patience.” In reality, the one reason I didn’t want a VE was because I was GBS positive and didn’t want any bacteria being brought up to the cervix. I had already done three nights of garlic treatment and it didn’t make sense to possibly bring up more bacteria.

Anyhow, my CP said that start-stop labors happen and to call him if it started back up. Just keep him updated.

As soon as we left the office and got back into the car, I got another contraction. Soon after, another one, and that one was PAINFUL. It peaked just as we were making a sharp left turn, and sitting in a car the way I was, OUCH. I got a few more as we headed home, and Lucas was asleep when we arrived.

Trey had to go to the airport to pick up his grandma around 3:30, so he took Lucas with him. I was fine being left alone, as I was able to concentrate on the contractions opening my cervix to let the baby out. I listened to my Celtic Woman CD and focused on the baby. Eventually I decided to start timing the contractions again, and they were still very irregular despite being quite painful. They were between 6 and 14 minutes apart and 45-60 seconds long, although I got a couple that were only 2 minutes apart, lasting 75 seconds each.

Later, Trey got home with his grandma and I decided to cook some homemade pizzas for us since Trey had to go back to work for a couple of hours. As I got everything ready, the contractions kept coming in the same irregular pattern as before, but getting a lot…more…painful. Every time I felt one coming, I would leave the room for privacy and try to find a position that minimized the pain. At times it would be kneeling on the floor with my knees as far apart as possible. Other times it would be putting my arms up over my head, leaning back a bit and stretching my torso. It took a long time to get those pizzas ready for the oven.

Earlier, my CP had said that with irregular contractions like that, nothing was probably happening, and that I needed to get into a good pattern for the contractions to really mean anything. They had to at least be consistently 60 seconds long, he said. I kept thinking about that, but it frustrated me so much because the contractions were so painful. I thought he must be wrong. Eventually, I realized they were consistently 60 seconds long, so I called him back around 7:30 pm and let him know. Surely he must have thought things were happening now.

Turns out, he didn’t. And I was about to cry.

I hung up the phone and called my midwife friend who would be my labor support. I had been updating her throughout the day pretty calmly, but this time, as soon as she got on the phone, I started to sob.

“My CP says the contractions aren’t doing anything because they’re so irregular,” I cried, sobbing. “They hurt SO much, it just can’t be that they’re doing nothing! Oh… there’s another one… UGGHHHHHHH!”

“Well, do you want me to come over and check you?”

“YEAHHH…”

So we hung up and I tried to calm down. Soon after that, Trey got home and I just cried on his shoulder. He asked me what was wrong and I told him the contractions were incredibly painful but my CP had said they wouldn’t mean much being so irregular.

Eventually, Bea got there and I told her how frustrated I was at my CP for thinking the contractions weren’t doing anything. He didn’t get just how painful they were.

She asked me again if I was sure I wanted to be checked and I said yes, because nothing would discourage me more than I already was. She checked me while I held myself open so as minimize contact with the external area. I wanted to keep any bacteria away from my cervix.

Four centimeters! And an extremely stretchy cervix, stretchable to 6 or 7. YES! I knew it! My body, my contractions were working – I don’t care WHAT my CP had to say. I was right, I knew it, I knew it! I should have known better than to doubt my body and trust a doctor over my own instincts. I thought I had already learned that lesson as I processed my previous labor and cesarean birth throughout this pregnancy, but I guess I needed a quick refresher lesson.

Okay. Knowing that, I began to have more confidence in my body once more. I got a second wind, and was more than happy to take on those irregular contractions that would bring me my baby.

They were still really, really painful, especially when the interval between them was longer because they would come on even stronger, more painful, and they seemed to hit without warning.

But Bea reminded me of the wisdom of my birthing body. She said there was probably a good reason for my contractions being irregular like that. We may not know what it is right now, but we do know that nature knows best.

We talked a lot about birth, and about how perfect it is when left alone. She helped me through the contractions, and having her there made such a difference. I felt so safe in her presence.

I was still trying positions that minimized the pain of the contractions, but Bea told me that at a certain point I was going to have to start embracing the pain rather than try to run from it. So she helped me change my perspective a bit. I still tried the easiest positions, but worked internally on trying to stay with the pain. Soon I found out I was quite good at it, and it brought me a good bit of satisfaction to take on the pain like that.

At this point, time becomes a bit blurry and I have a hard time remembering what happened when.

Some time during the evening, Trey took Lucas out for a drive so he could fall asleep. He did, and after that we started filling the birth pool.

Since Trey was free to be with me now, I started using him to help me through the contractions. The only drawback was that it was extremely hard to let go of him from then on. His touch and his loving words were so comforting that I fell in love with him all over again. As I type this, I can’t help but think just how lucky I am to have him. He is such a wonderful husband and father, and really a great human being; so generous, so giving of himself.

Later, Trey’s grandma said she was going to bed. Bea asked her if she wanted to be woken up for the birth. I told her it was fine with me, but that I wouldn’t want her there if she didn’t want to BE there. If she did want to be there, then I did want her there. So it was settled. It was so weird – though exciting – to think that my baby would probably be here before the night was over!

I labored on, and soon Bea looked at me and said, “Lily, these contractions are really close together. I’d say 2-3 minutes apart, and they’re long. You might want to give doc a heads up so he has a chance to make it here on time.”

“Ok, but I really don’t want to talk to him. Can you do it? Or Trey could…”

I was in the birth pool by then, and it was nice until Lucas woke up. I thought Trey might be able to get him back to sleep, but after a few minutes I got out of the pool and decided to try to nurse him back to sleep. Bea said the contractions might get even more intense, but to breathe through them and focus. So I went in, and nursed him back to sleep. As soon as I got off his bed, though, he woke back up. Ugh, how frustrating! One contraction after another, they kept coming. I didn’t now what to do (Lucas was really congested so he was really uncomfortable. I totally get why he was so fussy.)

Eventually I decided to let him get up, get a snack, and play. I also called Laura, our babysitter, who had agreed to be “on call” for us in case we needed her. And now we did. She arrived about 30-45 min later and took over with Lucas. Everything was good again.

Meanwhile, I was holed up in our bedroom, all dark, trying to get through the contractions. They were on top of each other and getting pretty unbearable. But I tried to concentrate on the prize at the end, with Trey and Bea’s help.

Then I remembered about calling my CP and had Trey make the call. By this time it was about 1 am, I think. He asked him question after question, and Trey tried to answer as best he could but eventually told him he really didn’t know much about childbirth, and that all he knew was what I had told him to say. It seemed like my CP really needed some convincing. Finally, Trey hung up and said my CP would be over.

Back in the bedroom, I was starting to get really discouraged again, especially after that phone call to my CP. The pain was so bad that I was moaning through the contractions and starting to get desperate. I asked Bea to check me again. She did, and I was 9+ with an anterior lip.

YES!!!! My body was STILL working, no matter how much convincing my CP needed.

Then, my contractions started to really space out. I thought, “Uh oh… what’s going on…” Maybe this was the break between full dilation and pushing that some people talk about. The only thing was, for the next two hours or so, very little happened. Not very many contractions, and certainly not a shift to pushing. I was wondering what was going on, and also where my CP was. At 1 am he had said he’d be over, and now it was almost 3 and no sign of him. It made me feel like he didn’t really believe in my labor. I felt abandoned.

Right before he got to our house around 3:30 am, the contractions started to pick back up, and as painful as ever. I moaned and moaned and moaned…

“I can’t do it… It huuuurts!!!!”

Bea: “Lily, you can. Your body is working to bring you your baby. Open yourself up to this pain.”

“AAAUUUGGHHHH…” In whispers: “Ok, baby, sweetie, work with mama here, come down, come down, come down… I want so see youuaaAAUUUUGHHH…”

Finally we heard my CP arrive and I told Trey not to let him into the room; I didn’t want to see him. Then I changed my mind. I did want to see him, I wanted him to see for himself that this labor was happening and my body was working.

He checked me. 7-8 cm.

What? Bea said 9+ before! Well, according to my CP she probably didn’t do it right.

Riiiiight. I didn’t say anything, but I figured I had reverse dilation – the type caused by emotional stuff or whatever. It made sense to me since I really had no trust in my CP anymore and didn’t really want him there anyway. I had been almost expecting that to happen.

Another contraction come on and I started to cry helplessly. I sobbed and sobbed, and everyone was quiet. My CP asked what was wrong with me and Bea told him I was really discouraged now.

“Well,” he said, “She wanted natural childbirth, and this is what it is. She said she doesn’t want her water broken artificially, so there’s nothing left to do now but wait until it breaks on its own. It’s just going to keep on like this until that happens.”

Still sobbing, I yelled at him. “So really you don’t think I can do it like this!!”

“No, I never said that, what makes you think that I think that.”

“Well, you just SAID it’s just going to keep on indefinitely and my body isn’t going to do anything until my water breaks. You think we need to break my water now, and I don’t want to do that because that is exactly what caused my c-section last time. My baby’s head got stuck in a bad position and I DON’T WANT TO BE CUT OPEN AGAIN!!!!” I was screaming at him.

“Last time you were only 2 cm when they broke you water, right?”

“NO – I was eight centimeters, just like now, and that STUPID DOCTOR wanted to break my water, just like now!!!!” I sobbed.

“Well, I’m sorry but I am not a stupid doctor in a hospital. I’m me, I’m not him.”

“I know, I know you’re not him…”

More sobbing.

Then my CP stepped out and Bea came over to me.

“Lily, you WERE 9 cm when I checked you. He just doesn’t think it’s possible to close back up. You’re doing great – you’re going to do this.”

I never got a single word of encouragement from my CP. I reckon that’s not what he was there for.

Again, the contractions spaced out. I was so exhausted, so I decided it was probably my body telling me to rest and I did. But when another one came on, it was so much more excruciating than the previous one.

After resting for a while, I got up and started to think. Ok, what haven’t we tried? Pelvic rocks, I haven’t tried pelvic rocks. So I did them. The contractions came back for a while and then slowed back down.

Ok, what else. I tried various other weird positions I can’t even describe, that made my pelvis feel open.

Soon I started to cry again. “I don’t know what else to doooo!!! I can’t… I can’t…”

Then I went to the bathroom. This time I turned the light on and sat on the toilet. I cried and cried. Contractions came and came as I sobbed, in so much pain. Then it hit me. I had to use my last resort. I yelled at Trey to get me the cell phone. He asked what for and I told him I was going to call Bonnie. YES, she’ll get me through this.

I dialed her cell number. No answer. I dialed her house number and sobbed into her answering machine for her to wake up. “Bonnie, it’s Lily, I need you. Bonnnieeee, I need youuuuu… wake uuuuup… Bonnie…” I hung up. I called back like she told me to. “Bonniieee please answer the phone… I need you, I can’t do this anymore…” I Hung up again. I called back and her husband answered. Oh. Ok, he put her on the phone. Ohh, how glad was I to hear her. She was always so wise on the ICAN list, I know she can get me through this, I thought.

She asked me what was up and I told her I was stuck, stuck again. Told her about my dilation, about how discouraged I was. I went through a few contractions with her on the phone and she said they sounded like they were really close together. She told me to get in the shower and really relax between contractions because I have all this adrenaline going and I need to relax. She said to be by myself in the shower.

So I got in the shower and the water felt so good. I focused on relaxing between contractions, and that brought them on even stronger, on top of each other. I was thinking everyone else probably thought my contractions had stopped again because I wasn’t making any noise, but they were coming fast and furious, and I was coping with the water. I remember saying to myself over and over again, “This pain is not going to kill me, this pain is not going to kill me,” and that made it easier to cope.

After about half an hour of doing that, the hot water was running out. I started to panic. I thought, “What am I going to do now?”

I started thinking of going to the hospital. I wanted an epidural so bad. I didn’t want another c-section. Then I remembered one of our local ICAN members, who had her VBAC at the hospital near my house (my transfer plan). She had a light epidural, labored for days at the hospital and didn’t get sectioned for failure to progress. Ok. I had options, and having gone on like this for hours and hours, something had to change.

Something had to change.

So I decided I was going to the hospital. But I still had to get out of the bathroom and tell Bea and my CP. I told Bea and she said she would try to get him to check me again and see where I was. She went to the kitchen where he was and talked to him for a few moments. Eventually he came over to me ready to check me but I had made up my mind. I didn’t want him checking me, it wouldn’t make a bit of a difference, and I was going to the hospital. I told Trey to wake up his grandma and tell her we were leaving. I gathered my clothes trying to deal with the pain, but knowing now that the end of the pain, even if not of my labor, was in sight. I was prepared to labor for another few days if I could just get a partial dose of an epidural.

Soon we were in the car. I couldn’t sit, so I held on to the back of the seat. We drove the mile and finally made it to the ER parking lot. I was in so much pain I wanted to die. Now, instead of moaning during contractions, I was yelling “No, no, no, no, please not another oneeeee!!!” That turned into “God, please no, please take this pain away, please…” I went back and forth like this.

Soon I was in a wheelchair, screaming in agony. I thought I must have looked just like those women in the movies. Screaming their lungs out and begging for an epidural the moment they’re wheeled in.

I went in to triage and the nurse seemed to treat me like I was just another laboring woman in pain. It was like she didn’t get the kind of pain I was in! I told her I’d been laboring for hours and that I needed an epidural right away. “Ok, sweetie, but first we have to get you admitted, get some blood work…” UGH.

It went on forever. First this, then that. I was in so much pain, and now that I was lying down, I could really feel that it was mostly on my left side. I didn’t want to get up, though, because I knew if I did, the contractions would come stronger and longer. I was so afraid of being yet in more pain.

Even with all that pain, though, I knew I wanted them hospital folks to know they had an informed patient on their hands. So, when they brought me the blanket consent forms, I actually took the time to read them and alter them here and there. I think the nurse was shocked. I altered as I deemed appropriate and signed. When I handed the form back to the lady that brought them in, I told her I had made some changes and to read them before signing the form as a witness.

Then a resident came in to do the VBAC informed consent. He said there was a minimal risk of uterine rupture, about 0.7%, and that I just needed to sign the form saying I was aware of all that. I read, signed, and in an almost delirious state from the pain I told him I was very impressed he used the 0.7% figure (my former OB used 1%) and said the risk was “minimal.” Very impressive, and I thanked him for portraying the risk of uterine rupture in adequate perspective. Later, I overheard him telling someone across the curtain about the Landon study. He said that a recent study had come out that hadn’t found a significant difference in uterine ruptures between vaginal birth after one and multiple cesareans. WOW! When he came back in, I told him I was extremely impressed at how up to date he was on his research.

When I was admitted to the hospital, the resident and staff were trying to decide whether to label me low or high risk. My blood pressure was slightly elevated and I had a scarred uterus. In accordance with the low risk of uterine rupture, which is even lower in an uninduced, unaugmented labor (some studies have found a uterine rupture rate of 0.4%, and one as low as 0.22%), I was labeled “low risk.”

Somewhere in between all this, I felt I really needed to empty my bladder. They had started an IV and I hadn’t used the bathroom in a while. They brought me a bedpan because I wouldn’t get up, but I told them I couldn’t go, and that I wanted a catheter. The nurse said they don’t like to do those because of the risk of urinary tract infections and that I would have to get up and go to the bathroom.

I said, “No, I want the catheter – can you quote me the actual statistics on UTIs and catheterization?”

There was a LONG silence and in my pain I still found it in me to smile at the fact that she didn’t know. Heh. I didn’t know either, but it just proved my point that you can’t talk me out of something just by calling it “risky.”

The resident came back in and said most people find the catheter very uncomfortable. I told him I knew that, but I’d had them before and I was fine with it. He said I was probably feeling the urge because the baby’s head was pressing on my bladder, and I repeated that I’d had the IV on for a while, I needed to pee and to get me a catheter.

Finally, another nurse came in to do the catheter, which they’d decided to make it the type you keep in since I was going to have the epidural anyway. (I had previously suggested they just do an in & out or whatever it’s called, but they didn’t want to since I was going to need another one after getting the epidural.) Once it was in, it drained and drained and drained my bladder. I felt such relief, and it seemed to take the edge off the contractions for a while.

After what seemed like an eternity, they FINALLY wheeled me into L&D. It had probably been about an hour and 45 min. I got to the room, ran to the bed and instinctively got on my right side. Most of the pain was on my left side.

They brought the epidural consent form, and I was about to sign it when another contraction hit. I was in such agony, and about 2 contractions later, my body started pushing. Ohhh and it hurt so much. I thought for a moment that it might take the pain away, but it didn’t. It multiplied it. What was most unbearable was that my body was starting to push really, really, really hard and there was nothing I could do about it.

My body pushed and made me scream what I could only describe as the most primal scream. Ohhh, I wanted that epidural so bad. Someone asked if I had signed the form, and I hadn’t, so in between pushing contractions I scribbled my name on the paper. Someone mentioned something about it being a race between the baby and the epidural. I said, “EPIDURAL!!!!!!!”

Another contraction was about to hit, and I begged for it to stop. “Please, please, no, no, I don’t want toooooAAAAUUUUGGGHHHHHHH!!!!!” I roared.

People were starting to rush in, getting stuff set up, and all I wanted was that epidural. Someone asked if I had been checked for completeness and I yelled, “I don’t want to be checked, I’M PUSHING!!!” Ok, so no check.

The resident then instructed me to get on my back so they could put my legs up in stirrups. I said I didn’t want to, that I wanted to push on my side. He said it would make it easier.

“YEAH… easier for YOU!”

“Well,” he replied calmly, “it helps to open up the pelvic outlet…”

I fired back: “Actually, no, that’s wrong. It constricts the sacrum and collapses the pubic bone…AAAUUUGHHHHH!!!!!” I stayed on my side.

At the third pushing contraction my water broke. All clear.

“Good, the fluid is clear.”

“Of COURSE my fluid is clear!! ALL my babies have clear fluid!!!”

Someone else mentioned the heart tones were good. Again, I told them all my babies had good heart tones. (There were never any heart rate issues when I was in labor with Lucas.)

At the next contraction, someone said something about hair. I couldn’t believe it. There was no way I was pushing this baby out without an epidural. It felt like my insides were going to rip apart.

Next contraction and the head was almost there. I had been holding my left butt cheek open for the pain, and I reached down to touch the head. Yup, there it was. I still wanted that epidural, but realizing it would be way more horrible to get the epidural put in than to just push her out right then and there, I ordered: “Ok, you said heart tones are good and the fluid was clear, so I want her ON MY CHEST as SOON as she’s out!”

“Well, we’ll have to make sure she’s ok first,” said the nurse.

“NO, she’ll be fine – I want her on my chest!”

I also told them to remove the catheter since I obviously wasn’t going to get the epidural.

Since I knew she would crown with the next contraction, I finally decided to help my body do its thing. I felt the contraction come and pushed with my body. I heard Bea’s beautiful voice whisper, “Lily, push through the pain.” So I did. I knew I didn’t want the head stuck there for another contraction just because I didn’t push hard enough during this one, so I pushed, pushed, pushed and POP! the head was out. They checked for the cord. I thought the rest of the body would just slide out, but it didn’t. I actually had to push again. Push, push, push, and then AAHHHH, out slid her body.

(I remember thinking I didn’t want her shoulders to be stuck for more than a few seconds, because then they’d cry shoulder dystocia, and that’s another label I don’t need.)

I lifted myself up from the side-lying position I was in and saw her lying on the bed, just over two hours after getting to the hospital.

“Oh my God, oh my God, oh my God, oh my God! I can’t believe it, I can’t believe it, I can’t believe it! That’s my baby, that’s my baby!”

They cut the cord just as I started to say “No, don’t clamp—oh well…”

I picked her up all gooey and bloody and held her tight to my chest. “Oh baby, my beautiful baby!” The first thing she did while in my arms was grab my medallions. I wear two medallions, one of the Virgin Mary of Guadalupe, which my grandparents gave me for my First Communion, and one with the Sacred Heart of Jesus on one side and the Virgin Mary and Child on the other. It was perfect. I told her that her brother liked to play with my necklace, too!

I never let her go for at least an hour and a half while being stitched up. She had been posterior (seen by ultrasound when I was admitted), turned transverse (which is how she came out), AND with her hand by her face. “Compound presentation,” the doctor said. Wow.

I had a 2nd degree tear in the vaginal wall, a small midline perineal tear, a small one on my labia, and a couple of “skid marks” which weren’t bleeding, on the urethral wall, I think they said.

I talked to her a lot in the hour and a half I held her while being stitched, cleaned up, etc. Then they told me to just let them know when I was ready for them to weigh her. She weighed 8 lbs even. Several hours later they did her measurements and she was 20 ½ inches long. Head circumference, 13 ¼ inches.

By the way, our L&D nurse was someone I’d met at an LLL enrichment group a few months before. Her name was Lisa, and when I saw her come in I had looked up at her and said “OH! I know you!” She was wonderful.

While they admitted Elisa, I started to feel very sad, thinking I never ever wanted to do this again. I felt traumatized. It was horrible. It felt like I was being tortured.

I spent the next two days in the hospital recovering emotionally from the birth. The day of her birth, I was shocked at the experience. The next day, my former doula came to see me and encouraged me to see the positives. That started me on the road to recovery, and my thoughts that day were of “Wow, I can’t believe it actually happened.” I couldn’t believe I had my VBAC. I thought it only happened to other people, to the luckier ones, and I never considered myself particularly lucky. Still, when people told me what I great job I’d done, I said I didn’t do it. “Don’t tell me I did a great job, because I didn’t.” My body did it, not me.

I spent that day thinking a lot about what I had done and what my body had done. My mom pointed out that I had made every single decision before the birth to put me in a position that would maximize my chances of having a VBAC. She said that just by making those decisions, I did it.

So the next day, I thought, “I did it!”

I did it.

Today, I give thanks to God for knowing my body strong enough to allow me to go through that pain even though my mind gave up, and for somehow allowing my baby to come before the epidural.

I’ve had body image issues my entire life, but after going through what I did with this birth, I’m in awe at what my body can do even without my consent!

For the first time in my life, I love my body.

Originally posted on ICAN of St. Louis’ website.