CAM Birth Story #42: Kristen'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)!

Sometimes even I can’t believe that I really had a non-medicated, in-hospital, water birth VBAC. This experience had been a dream of mine for so long that I often have to remind myself that the actual experience was not a dream. But it was real, and it was empowering, and it was a dream-come-true.

My hopes for a VBAC (let alone for natural childbirth) were nearly dashed at my 36-week appointment with Dr. B, the obstetrician who performed my c-section for my first son. During this appointment, Dr. B informed me that I would not be able to attempt a vaginal birth since my lower uterine segment was measuring “too thin,” thus increasing the risk of uterine rupture at my cesarean incision site.

To make a very long story short, I had done my research, and I knew that Dr. B was either wildly misinformed about the studies on lower uterine segment and/or misinforming me about these studies. My lower uterine segment was not “too thin,” even according to the most cautious studies. Furthermore, the researchers who performed these studies specifically concluded that lower uterine segment thickness is better at predicting who will not rupture rather than who will rupture.

Although Dr. B wanted me to schedule my “convenient,” “urinary incontinence-preventing” 39-week cesarean at this appointment, I knew that I needed to seek a new plan for my child’s birth. So my husband, Tim, and I came up with an excuse about how we “needed to check our calendars,” and we immediately left the office building.[1]

I was devastated. Through my sobs, I told Tim that we needed to call our doula, Chris, and we needed her advice on transferring to another obstetrician or midwife. Tim made the phone call—I was so upset that I could barely speak—and Chris recommended that we call Dr. N. In fact, with Chris’s help (she spoke to Dr. N personally), we were able to schedule an appointment with our new obstetrician for the following Monday.

Despite the uncertainty and near-chaos of this ordeal, I was surprisingly hopeful about my appointment with Dr. N. After first meeting with the midwives in his practice, we met with Dr. N in his office’s conference room. We were already grateful enough that he had taken us on as patients so late in my pregnancy. (At this point, I was only one day shy of being 37 weeks pregnant.) But we were even more grateful to hear that his cesarean rate was only 8%; that he had attended not only VBACs but also VBACs after two and even three cesareans; that he encouraged women to be mobile during their labor and did not recommend that they labor flat on their backs in a hospital bed; that he thought that trying to talk me into a repeat cesarean would be akin to talking my husband into an appendectomy because of the slight risk that his appendix could rupture at some point in the future. And I thought to myself, “Here is a man—and an obstetrician, no less—who respects women’s bodies, women’s autonomy, and women’s ability to give birth normally and naturally.”

After this conversation, Tim and I both felt as if we were right where we should have been all along. In fact, as we left the office, instead of feeling defeated and hopeless, I felt exhilarated and confident about this birth.

My membranes ruptured around 10 p.m. on Saturday, May 24. I was sitting at the dining room table with my mom and my two friends, cursing the intense “Braxton-Hicks” contractions that I had been having for the past hour and complaining that I wasn’t even going to time them anymore. (In my words, “They haven’t started labor for the past two weeks, and they aren’t going to start labor tonight!” Famous last words…) Then, I made the remark that I actually hoped that I wouldn’t go into labor that night because I had just finished one of the largest meals of my entire pregnancy and topped it off with homemade blueberry pie and Williams-Sonoma hot chocolate.

Of course, not twenty minutes later, I shifted in my seat, felt that tell-tale trickle, and said what many a woman before me has said: “Either I just peed my pants, or my water is breaking.”

Everyone jumped up and cheered as I waddled and leaked my way up the stairs. Since we had planned to stay home as long as possible, my mom went out to get some Depends. (For the time being, I was “making do” with a couple of pads and an old towel.)

While she was at the store, I crept into the room of my two-year-old, M. I curled up next to him and rubbed his back and whispered to him how much I loved him. I knew that soon, my little boy would not be my only child—and, I must admit, this fact made me somewhat sad and even prematurely nostalgic for M’s short reign as our only child. Soaking in those last few moments, I remained for a while in his bedroom, cradling my first baby boy, waiting for and wondering about the next baby boy’s arrival.

After my mom returned from the store, our friends took M home to stay the night with them. (We had always planned on him staying with them anyway—how convenient that they were already there with us!) On their way out the door, they asked Tim how he was doing. Not one to hide his fatherly nerves, Tim informed them that he “felt as if his life was flashing before his eyes.” Thankfully, I was able to find the humor in this statement.

My contractions started around 11 p.m., and they started and stayed three to eight minutes apart. At this point, they felt like a dull burning deep in my lower abdomen, near my pelvis. But I was obviously in early labor because I was joking, dancing, and even insisting that my mom take a photo of me with a pair of Depends on my head!

Once the contractions became more intense—and once I became more “serious” (around 12:30 a.m.)—I started my Hypbirth hypnobirthing program and asked Tim to call our doula, Chris. I didn’t quite feel that I needed her yet, but I did want her to be with us for the transition from home to the hospital. Since my contractions were now getting closer to three to five minutes apart, I wasn’t sure when that transition was going to occur. (In addition to the dull, burning sensation, I was also feeling increasingly crampy during each contraction.)

Chris arrived around 1:45 a.m. and was fantastic. She encouraged me to try laboring in the bathtub, but I just did not feel like getting in the water then. (How that would change!) But all of her other suggestions were spot on. She knew when to suggest that I change positions—when to try the birthing ball, when to try laboring on the toilet, when to try and rest on the couch—changes that I thought would make things “worse” but ended up making me feel so much better.

Although Chris came fairly early in my labor, I think that her presence truly helped the entire “labor team” to forge the incredible bond that got us through the next exhilarating and exhausting ten hours. So, for the hours that I labored at home, we remained in the living room (for the most part), me listening to my hypnobirthing CDs, going “deeper” with each contraction, Chris offering advice and performing counter-pressure during my contractions, my mom giving me gentle encouragement, and my husband giving me a shoulder to lean on and a hand to hold. All three of them were taking care of me and, I think, also taking care of each other. (I do remember Tim brewing some lattes at one point!)

Around 4 a.m. (I’m guessing), I started feeling what I thought were signs of definite—perhaps even later—active labor. My contractions were certainly more intense, and I was no longer smiling or even talking in between them. Adding to this intensity, I felt as if I wanted to throw up, I was shaking in between contractions, and I was experiencing major hot and cold flashes. But although I was beginning to feel an increased sense of pressure, I wasn’t feeling terribly “pushy” yet, so we decided to wait at home a bit longer.

I finally asked that we call and alert the midwife-on-call at 6 a.m. I truly don’t know what made me want to make the phone call. I’ll chalk it up to this “inner voice” that I listened to all throughout my labor. And I must admit, I was about to have some serious doubts about this inner voice.

We arrived at the hospital around 6:45 a.m. I hadn’t even met this midwife before, but I am so thankful that she was the first medical person that I encountered in the hospital. Her calm and peaceful presence made my transition into the hospital as “un-dramatic” as possible. After introducing herself, she said, “So, I can check you, if you want.” (A woman is very vulnerable during labor, and simple statements like this one can really reaffirm her power—I had a choice about my cervical checks!) I told her that I wouldn’t be discouraged with whatever my “progress” was, and that, yes, I wanted to be checked. I was hoping to be five, six, or even seven centimeters dilated, but I was mentally preparing to be only three or four centimeters. (I took a quick poll days after my labor and discovered that Chris thought I would be around a five, my mom thought that I would be between six and eight, and Tim was entirely clueless but was hoping that my discomfort would soon end.)

But I never could have prepared myself to hear that I was only one to two centimeters dilated. The midwife was wonderful, however, saying with all of the optimism in the world, “But you’re almost 100% effaced!” Chris reminded me too, “100% effacement is great. Now all your cervix has to do is dilate.”

At this point, I turned entirely inward. I don’t think my mom, Tim, or Chris said more than thirty words to me for the next three hours. I knew that we were all disappointed. I even told Chris, “I wasn’t expecting that.” And even though the hospital was “willing” to let me go home—and even though Chris continued to remind me that I could go home—that little voice in my head told me to stay put. (Yes, I was still willing to listen to it!)

Looking back, I think I knew that the car ride home would be too much of an interruption in my labor. (I could hypnobirth my way through a blood draw and the million-and-one silly questions the nurse was asking me, but I couldn’t hypnobirth my way over the “thousands” of potholes on the road!) So I got the heplock, was strapped to the monitors, and stayed very quiet for the next three hours until Dr. N arrived.

Don’t get me wrong—I heard lots of negative things “in my head.” “You got a c-section for fetal distress last time and now you’re going to end up with a failure to progress c-section.” “If it is this tough to get to one to two centimeters, there’s no way in hell I’m making it to ten.” And so on. I don’t know if it was my incredible labor team or my incredible hypnobirthing program, but I was able to move past those negative thoughts and reach even deeper inside of myself, drawing on some sort of unknown well of inner strength. In fact, I wasn’t even explicitly practicing my hypnobirthing program anymore. I was under some sort of self-hypnosis, giving myself little pep-talks and just forging on with each contraction. (And sometimes, “forging on” just meant clinging desperately to the railing of the hospital bed as each contraction surged throughout my body.)

Right before Dr. N arrived, I was able to use the telemetry monitor and labor on the toilet for a few minutes. Tim showed me some pictures of M at this point. And, just as I had practiced with my hypnobirthing program, these pictures reaffirmed for me the unconditional love that was surrounding me during my labor. I was completely taken care of, and my body knew exactly what it was doing.

Dr. N arrived around 10 a.m. and offered to check me. I was four centimeters dilated! I was making progress!

And this is where things get good. I mean really good.

Dr. N and/or Chris suggested that I try laboring in the tub. (I think that it was a “joint” suggestion.) He praised the water’s ability to “make the mom buoyant” during contractions and really thought that I would benefit from it. Unlike earlier in my labor, I was rather excited to get in the water, and I hastily agreed to give it a try. And then Chris asked the question of all questions: “Dr. N, I heard at the panel discussion that you have done water births before. Do you think that Kristen could try giving birth in the tub?” (The panel discussion in question followed a recent local screening of The Business of Being Born.) And Dr. N agreed! In fact, he added that I would be the first mom in the history of the hospital to have a water birth!

Of course, the hospital did not “officially” do water births, so we had to keep it quiet. But it was thrilling.

I made it into the tub around 10:30 a.m., and as my body sunk into the warm water, I smiled for the first time in what seemed like years. I still felt my contractions—admittedly, at times I felt as if my lower back was on fire and as if my hips were about to explode out of their sockets—but the water eased the intensity of each contraction…somehow. In fact, everyone later pointed out to me that it was quite difficult to tell when I was having a contraction since my body and face were so relaxed.

I continued to labor very quietly in the tub, with my mom, Chris, and Tim performing what I have come to call the “cool washcloth and Gatorade assembly line.” (Don’t worry—the cool washcloths weren’t soaked in Gatorade. I drank the Gatorade, wore the washcloths on my forehead.)

In addition to feeling exhilaration over the simple fact that I was laboring in the tub (and possibly on the road to a waterbirth), I was also thrilled that Dr. N was choosing to use as little intervention as possible for my labor. First, we weren’t using continuous fetal monitoring: our nurse just checked me with the Doptone every five to ten minutes. Then my heplock fell out in the tub, and Dr. N wasn’t about to force me out of the water so that the nurse could restart the line. All the while, she kept insisting that she needed to get me out before delivery, and Dr. N kept reassuring her, “Okay, okay, whatever you need.” Of course, he knew that we had different plans! And, since my mom and Chris also knew that we had different plans, they made sure that my nurse was distracted at the “right” moments. In fact, at one point my mom dumped out our full bucket of ice chips, handed it to my nurse, and asked her kindly to refill it—all to keep my nurse from ushering me out of the tub!

At 11:15 a.m., I did start to feel a bit “pushy.” (Attempting to describe the sensations of labor is nearly impossible, but by “pushy” I mean that I could feel my uterus bearing down on its own—almost quivering or “tremoring”—during each contraction.) I initially asked my mom to get Dr. N to check me, but then I quickly said, “No, no, never mind,” thinking that I could not possibly be ready to push. But my mom knew better—and she knew me better—so she left to get Chris.

When Chris arrived in the room, I told her, “During the past contractions, my uterus kind of did this ***making sound like a washing machine*** thing. Do you think Dr. N should check me?” Granted, this was only about one hour after he told me I was four centimeters. And although I was twelve hours into my labor, I also knew that I was a first-time laborer who only four hours ago had been one to two centimeters dilated. I don’t know what I was expecting. In fact, I don’t think that I was expecting anything: I was just paying attention to “that little voice.”

Dr. N arrived at my side a couple of minutes later, checked me, and then very calmly said, “Well, Kristen, you’re definitely fully dilated, so bear down whenever you get a contraction, just like you’ve been doing.” Oh. My. God. I choked up, grabbed his hand, and said through my sobs, “Dr. N, I have been waiting for so long to hear someone say that to me! Thank you, thank you, thank you!”

I had my mom take one of my favorite labor photos at this point: me, in the tub, grinning from ear to ear, holding up ten fingers.

Dr. N had everyone dim the lights so that I could push as peacefully as possible and even unscrewed some of the light bulbs that wouldn’t dim well enough. And then he turned to my nurse and said, “Well, I think that we should let her push in the tub for a little while!” (Since we had been “keeping the water birth quiet,” this information was somewhat surprising to her!)

Not thirty seconds after the lights were dimmed, my pushing contractions changed from “little tremors” to full-blown earthquakes. In fact, the sensations of these contractions resembled the video images one sees of bridges and buildings trembling like snakes during an earthquake.

As that first quake surged through my body, I began to make loud, low warbling groans. I must admit, it was a bit overwhelming to feel my body do something so powerful all on its own. But Chris reminded me that what I felt was normal, that I didn’t need to be afraid. So, trusting what my body was doing, I rode those quakes, allowing my body to do its normal, natural, yet truly incredible work.

After a couple of pushes, Dr. N and Chris helped me to get into a hands-and-knees position so that I could gain the assistance of gravity in my pushing. And then Dr. N turned to my nurse to tell her the following: “Look at how beautifully she’s doing. Look at how natural and normal this is. She’s pushing on her own, and no one is yelling ‘PUSH’ in her face, no one is counting for her.” And you know what? My nurse started to get excited about this birth. In fact, about twenty minutes into my active pushing, she came into the room to remind me of my birth plan and of my initial intention to push in a side-lying position. Although I told her that I felt much more comfortable pushing on my hands and knees, I was so grateful that she had taken my birth plan seriously enough to remind me when I wasn’t following it!

Pushing continued to be as intense as it was incredible. My body took over with each contraction, and I grunted and groaned like a wild animal as I felt A’s head moving through my pelvis. It was hard work. And, not surprisingly, Tim, my mom, and Chris continued to be amazing. Chris reminded me of what I was feeling: the molding of the head and the stretching of my pelvis (accompanied by my screechy, whimpering sounds), the delivery of the head (accompanied by my deep “ohhhhhs”). My mom made sure that each moment was captured on video and on camera. And Tim stayed right by my side, replacing my cold washcloths every couple of minutes and spoon-feeding me ice chips.

And then at 12:03 p.m. on May 25, 2008, A was born. Dr. N reached down to help me deliver the shoulders, but I pulled my baby up onto my chest (I did it instinctively—I don’t even remember intentionally doing it) and I massaged his back until he cried. And witnessing this miracle—one that has occurred billions of times over the centuries—everyone else in the room cried too.

A and I snuggled in the water for another ten minutes, and then we moved out to the main room. And my nurse—the one who wanted me the heck out of the tub—was nearly jumping up and down saying, “That was the most amazing thing I’ve ever seen! You are awesome!” And as she helped me out of the tub, she exclaimed, “You sure showed that Dr. B, didn’t you?!” (To this day, I don’t know how she found out about my experience with Dr. B.)

Later, I learned that about five other nurses rushed into the room to see the woman who had the hospital’s first water birth.

M showed up about two hours after A’s birth and stayed with us for a few hours. A was soon nursing like a champion. And I was on cloud nine.

So yes, I birthed my baby. I did it in the water, with intermittent fetal monitoring and no heplock. I did it in the hospital, with an obstetrician. I did it with the world’s best support team. But I did it, and it was an experience that I will treasure for the rest of my life.

[1] To his credit, Dr. B called me at home the following day. He informed me that he had gone home to “do some research” on lower uterine segment thickness and VBAC and had discovered that he had given me the wrong information at my appointment. In fact, he had reconsidered his recommendation for the repeat cesarean and was willing to “let me have a trial of labor.” Despite the fact that I chose to see a new care provider, I do respect Dr. B for doing this research, and I respect him for contacting me so quickly to inform me of his reconsideration.

Originally posted on Birthing Beautiful Ideas