Kimberly's VBA2C

Kimberly of Labor Trials is sharing the story of her VBA2C baby, born just last month, in a planned HBA2C turned VBA2C.  Her story is an amazing tale of a VBA2C against all odds, and I am so happy to be able to share it with you today.

VBA2C: Doing It ‘All Wrong’

I am no stranger to the ICAN list hosted by Yahoo Groups.  I have been varying levels of active since July 2007 when I found out I was pregnant with my second child.  I have questioned, ranted, cried, uproared, despaired, cheered, and supported these past few years but never has ICAN, and I do mean ICAN as an organization and network, been more important to my birthing process than this past year as I hoped, dreamed, and prepared for a HBA2C.

The decision to birth at home did not come quickly or easily to my husband or me.  When I was pregnant with my first child, I attended independent childbirth education classes.  Some of the parents were doing ‘home birth,’ but I had no ability at the time to comprehend what that really was.  Shortly after joining ICAN in 2007, I started to realize that my best bet for achieving a normal physiologic birth was birthing at home.  My husband wasn’t so sure until we watched The Business of Being Born later that year.

I was unable to plan for a homebirth until this last pregnancy.  I was planning my first vaginal birth, my first home birth, my first everything, it seemed.  Prenatal appointments with a homebirth midwife were so different from prenatal appointments with an obstetrician.  No alarm bells.  No pissing and moaning about my pelvis or my scars or about the possibility of an anal fissure.

However, this pregnancy was not lacking in stress or fearmongering.  My midwife encouraged me to maintain ‘shadow care’ with an OB that would support a hospital VBAC after two cesareans . . . just in case.  The last trimester was fairly stressful as I sparred nearly every week with the OB who agreed to take me on at 31 weeks.  The last few weeks of the pregnancy were abnoxiously stressful – big baby card, uterine rupture card, dead baby card, post dates card, blah-dee blah-dee blah.

I was scheduled for a 41.5 week cesarean – the absolute deadline given to me by the OB.  At the time I wasn’t terribly worried as I didn’t expect to still be pregnant by then.  However, as 40 weeks easily skirted by and 41 weeks passed, I started to wonder what was wrong with me.  Evidently, I looked too good to be going into labor any time soon, and the OB said I probably just gestate longer than usual.  Even though everything was fine, and I looked so good @@, he was not willing to postpone the cesarean.  As a result, I lost faith in the wisdom of my body.  I began feeling pressed to make birth happen, and that was probably the worst thing for me emotionally that last week of pregnancy.

The Friday before the Monday scheduled cesarean, my midwife recommended that I take some castor oil.  She would then come over and massage my cervix.  (No, it’s not nearly as pleasant as it sounds.)  She was dismayed to discover that I was no more dilated than I had been the week prior and that the baby had backed out of the pelvis and was hanging out around -4 station.  After several hours of sickness, contracting, and bouncing to try and get the baby into a better position, she recommended that I get some sleep.

I continued to contract throughout the night, but the contractions didn’t keep me awake.  I was still contracting the next day and was starting to think that my body was going to take over and continue the contractions.  However, as soon as I started to acknowledge what was happening, the contractions evaporated.  Sunday, the day before the scheduled cesarean, was just as uneventful.  The midwife checked me and found that nothing had changed.  She didn’t think I should bother with more castor oil.

I was resolved to cancel the cesarean.  The next morning, Monday morning, I called the hospital and my husband called the OB’s office to cancel the 1:30pm surgery.  Needless to say, the OB was quite perturbed, and by the time I spoke with him, he was insisting that I go to the hospital for monitoring since I was claiming to have labor signs.  I told him that I’d speak with my husband and decide what I was going to do.  The OB made it clear that he wanted to hear from me that day.

Ultimately, I didn’t call the OB back.  I took more castor oil and then tried to take a nap.  I was too wired to sleep.  I was waiting – waiting for labor, waiting for castor-induced illness, just waiting . . . and nothing happened – no labor, no illness, nothing.  I spoke with ICAN friends.  I cried to the ICAN list.

At 7pm I was on the phone when suddenly strong, scarily strong, contractions began and were coming every 2 to 3 minutes.  I also felt a ‘pop’ down low and was concerned when I realized that it was not my water breaking.  This labor seemed abnormal, and I didn’t feel right about things.  My husband and I quickly gathered our things and headed to the hospital.  I actually wanted to get on a fetal monitor and make sure my baby was ok.  Since home birth was no longer an option, I had no other way of checking to see if the baby and I were fine.  The hospital was our only choice.

I titled this post “Doing it all ‘wrong’” because hardly anything that follows is natural or physiologic.  Instead of writing an epic novel, I will outline several things that could have led me right to a repeat cesarean.

1. I went to the hospital.  Honestly, I felt like going to the hospital when I was in labor with my first child was the wrong choice at the wrong time.  I could not believe that I was choosing to go to a hospital this time.  I would have to assume that women who desire a VBAC are more likely to achieve that end in an out-of-hospital venue than in the hospital.
2. I consented to continuous monitoring.  Information on the problems of continuous fetal monitoring is easy to find on the internet.  The best evidence shows that continuous monitoring does not improve outcomes – it increases the risk of operative delivery!  I should also add that since I was planning a home birth, I was not prepared to interpret what the monitor was telling my care providers.  Instead, I was completely reliant on them for information, and what they were telling me was that my baby wasn’t tolerating labor well.  She was having “late decels.”
3. NPO.  I wasn’t allowed to drink water or eat ice chips or anything.  I did have IV fluids, but that doesn’t mean that I was immune to hunger and especially thirst!
4. I was restricted to laboring on my side.  Because of the late decelerations, the OB would not allow me to move freely during labor.  I was told that I needed to relax my lower body so that my cervix would dilate, but there was no way for me to relax with contractions that strong while laboring on my side in bed.
5. I was stuck at 2 cm for hours.  In addition to “late decels” and restricted movement, my body was resisting dilation.  The baby was not descending and putting pressure on my cervix even though contractions were plenty strong.  No progress is usually a recipe for getting rolled down the hall to the surgical suite.
6. I begged for and received an epidural.  There was no way I could handle hours of slow dilation and restricted movement, so I began asking for an epidural.  (Never thought I’d do that.)  I was first given an intrathecal, and then when it wore off, I was switched to an epidural.  The intrathecal was good, but the epidural was fairly ineffective (which made me incredibly nervous as I thought ahead to a potential cesarean).  The anesthesiologist gave me a bolus of something, and then upon request, another bolus of something as nothing seemed to be working.  I will say that I quickly dilated from 4 to 8 cm in about an hour-and-a-half.
7. I was stuck at 8 cm for hours.  I was given an ultimatum around 3am that if the baby’s head didn’t move, we’d have to consider our options.  I knew this meant cesarean.  The OB told my nurse that I needed to change positions 3 times every half an hour.  This was quite interesting with an epidural.  However, I did my best – moving from tailor sitting to straddling the hospital bed to finding asymmetrical sitting positions to labor in.  (By this time my baby’s heartrate was stable.)  When my OB checked me, I could tell that my baby still hadn’t descended, but he was somewhat encouraged by the fact that she was no longer asynclitic.
8. After a couple of pushes at 8cm, my baby did descend, and well . . . all of a sudden I was completely dilated and it was time to push.  Because of the heavy epidural, I was at the mercy of the doctor and his nurse.  I was terrified because I was pushing in a semi-supine position.  I was terrified because I was being coached to push, but what else was I supposed to do . . . I had no idea where anything below my navel was located.  My OB was an amazing labor coach, and he took me through every contraction and every push.  Despite being on my back having my sacrum compressed, my 8lb 14oz baby girl came out vaginally after a mere 30 minutes in the birth canal.  Her 15.5 inch head hardly had any molding.

I am not proud that I had such an interventive birth.  I am proud that I had a vaginal birth despite the numerous interventions that should have led (at any point) to another cesarean.  I have shared this both as a warning and as encouragement to women who may find themselves facing similar obstacles.