Thursday, August 11, 2011

a couple thoughts on vbacs

My opinion is that in nearly every case of a physically healthy and mentally prepared pregnant woman, a vaginal birth is completely achievable after a previous cesarean section.  If you don't believe that, then you probably shouldn't try it.  It might be too stressful to be a good experience for anyone.

The one thing I hear people are worried about when attempting a VBAC is that their incision will burst.  There was a time when this did happen to multiple women; and it can be deadly for both the baby and the mother.  But according to my doula instructor (who is also a nurse ... among countless other things), this happened because doctors began trying out cytotec.

Cytotec is a drug that was made for a completely different purpose, but someone noticed that it caused horrifically strong contractions in pregnant women.  Stronger contraction will get the baby out quicker, right?  Well, whether or not that is true, your body can only handle so much.  A weight lifter can only lift so much before they will tear something.  A runner can only run so hard before they will collapse.  And your uterus was built to handle a certain amount of stress.  Drugs can do all sorts of crazy things to make your body change and/or simply ignore the limits that exist to protect it.  While this can be quite useful, it can also be deadly ... as in this case.  This drug caused contractions so strong that the incision burst in laboring women, and also wreaked some serious havoc on those without an incision.

Cytotec now has "Not for Pregnant Women" all over it's labeling, as was shown to me by a midwife recently.  She told me she keeps it on hand in case a woman is bleeding uncontrollably after the birth ... the contractions will close up the uterus and hopefully help stop the bleeding.  "It's something we would do as we were calling 911 at the same time ... I never use it otherwise."

Another newer trend that is contributing to the VBAC fear is that some doctors are favoring a single row of stitches in the uterus, instead of the previously required a double row.  The reasoning is that it is much faster; less time bleeding and having your insides on the outside.  Is it really better?  I don't know, but from what I've been told it's not widely accepted.

Whatever method your doctor may have used in the past, you can't do much about it now.  But there is a lot you can do.  Stay healthy.  Walk, walk, walk.  And learn everything you can.  Read "Understanding the Dangers of Cesarean Birth: Making Informed Decisions".  Scour these websites:

Take control.  Nothing contributes to a successful VBAC more than a prepared, positive mother.

Saturday, August 6, 2011

another wonderful VBAC

My sweet friend Chelsea called me a few times throughout her pregnancy to discuss a VBAC.  She was excited, terrified, and seriously wanting one.  Though she did wait till the end to make her final decision, once her doctor expressed some real support, she was gung-ho.  She had a beautiful experience and said I could share her family blog post about it here:
"I want to hurry and type my whole story out before I forget all of the little details. I like details. In fact, expect this to be way too long, full of things that no one really needs to know but that I can't help to include.

So a week ago, I was sitting in my doctor's office and told that it would probably be another week or so, but that I would most likely deliver Nolan before his August 13th due date. I was super excited until I did a little research and found that most women stay dilated 3 to 4 cm for weeks and that I shouldn't get my hopes up to be any different. 

36.3 weeks, the day I went into labor
I stubbornly stuck to my work-outs, hoping that it'd help further some cervical change. On Sunday, I *ahem* had some alone time with my hubby. Sometime later, I had the strangest sensation as my mucus plug worked it's way out. That did not happen with Boston and even though it was kind of exciting, it was mostly really gross. I noticed some strong pressure and what I thought could be contractions almost immediately afterward. Again, some scouting around on the internet and asking my trusted doula friend told me that it was common to lose your plug and it could mean labor within the next 24 hours or not for another month.

I debated whether I was just having false labor or if I should go get things checked out. My doc told me that once I started having contractions, I shouldn't sit around at home but go right in. He made it sound like things would happen pretty fast. We had dinner plans with my family that evening and I decided that if these pains continued for a couple of hours, we'd hit up L&D afterward for a quick check. 
So to dinner we went, where I told everyone what was going on and got lots of cheers that "a baby was coming tonight!" No pressure. Haha. I still wasn't convinced that it was true labor until the night wore on and when I couldn't stand without fidgeting in pain, it was time to go and pay a visit to labor and delivery.

We went home and got my bag packed, just in case. It was something I put off doing because I was only 36 weeks (and 3 days) along. I still had plenty of time, I thought! We live like a block away from the hospital and thought that since they were going to send us home anyway, we might as well just walk over. In fact, my mother in law joked that we should leave my bag...being unprepared meant they would keep me. Sage advice. :) So we kissed Boston good-night and told everyone we'd see them soon.

Walking up to the nurses, I felt so dumb. I explained that while I was probably just having false labor, I wanted to get checked and be assured so that I could try and get some sleep that night. They were totally obliging and led us back to none other than the room I labored in with Boston. Deja vu! Or bad luck, I can't decide.

One uncomfortable exam later and the nurse declares I'm at 5 cm. So wait, I'm really in labor?? Now what? Then she lays the bad news on me: Dr. W is unreachable until Monday afternoon. The on-call OB, Dr. P, doesn't do VBACS. Ever. Are you bleepin' kidding me?! Since I'm pretty far dilated, I'm not quite allowed to leave yet. She says Dr. P. wants me to hang out for two hours to see if I progress. If no change, I could go home but if I dilated further, then we would be completely at the mercy of Dr. P and what he wanted to do.

While my original plan was to walk and move for as long as I could, now I was determined to make labor stop! I sat in a bath for 40 minutes, willing my baby not to come until Dr. W was back. Then I laid on the bed in an almost comatose state for the rest of the time. Thinking I had succeeded, the nurse comes back and tells me (almost grimly) that I'm now a 7! Wow, doing nothing moved me that far along?! Pretty cool, but then dreadful as I realize this means I'm stuck with Dr P. I beg and plead for her to call Dr. W, pretend I'm a four and let me go, tell her I refuse to sign a c-section waver. She nods at me empathetically and says we just have to wait and see what Dr. P wants to do.

I can't remember how long we waited for the answer, but I divided the time between crying in despair to Shane (I'd worked so hard for this labor!) and contemplating an escape plan. Shane comforted me and gave me such a wonderful blessing. I could feel his faith in Heavenly Father and in me as he blessed things to go well.

Profound relief and even excitement came when the nurse said Dr. P would allow me a trial of labor (I later found out that it was the nurses who championed my cause and talked Dr. P into giving me a shot, bless their souls!!) I can so do this! was the mantra in my head. It was probably close to midnight when I was officially admitted, tethered to an i.v. and roaming up and down the halls. I was amazed at how little my pain was. Part of me was nervous that things were too easy and something bad was approaching, the everlasting cynic in me I guess.

At one a.m. I reached 8 cm and decided that it was probably a good time for the epidural. I was required to have one, but wanted to wait as long as I could before getting it. I wasn't in a whole lot of pain but wanted a restful sleep before all the action began.

The epidural was a little more painful than I remember. So many strange sensations. My back is still aching from it. But I did start to feel tired and heavy. The annoying thing was every time I'd drift into sleep, my evil angst-ridden side would nag me awake with worries that my contractions weren't strong enough and that I'd get stuck at a 9 again. That I'd end up back in the OR. This went on for hours.

At 4 a.m. I'd reached a 9 but still wasn't all the way effaced and baby was still at 0 station. My contractions were a little bit weak since he wasn't putting much pressure on my cervix. My bag of waters was still in tact and I kept wondering when they would break it since I was so far dilated.

Two, three, seven hours change. I was in a bit of a state of weepiness and despair as I felt the all-too-familiar stall of labor. I cursed that stupid room where the same thing happened two years ago, I cursed the doctor for not being my doctor (he hadn't been in to see me once!), I felt my fantasy of pushing my baby out and holding him on my chest slipping rapidly away.

Well, my second most-amazing nurse of the day refused to let me get discouraged. Coincidentally, she had had a VBAC herself and reassured me that we weren't out of options yet. Finally, at 11 a.m., Dr. P came and ruptured my membranes. Contractions and pressure increased but not quite enough and an hour later I was given a low-dose of Pitocen. OH MAMA those contractions picked right up. When I was given the epidural, I requested it low enough that I could move my legs and feel the contractions while my nether region stayed nice and numb, but when those transition contractions started coming every minute or so, I began pushing my epi button like there was no tomorrow. Eventually the anisthesiologist came in after hearing my animalistic cries of labor down the hall and gave me not one, but two more doses! I remember my mind being divided between trying to focus on the baby moving down the birth canal and doubting myself that I could go through with this as each contraction peaked. I had Shane on one side trying to rub my arm, my leg, my head to calm me and my mom on the other trying to get me to "Ommm" the right way. Haha, bless her heart, she thought that if I got my vibrations just right there'd be no pain. I almost chucked the tennis ball I was clutching at her.

I'll never forget the utter joy and shock I felt when my nurse annouced I was 10 cm and fully effaced! Tears literally ran down my face. The anisthesiologist said my pain shouldn't be making me cry after two doses of medicine, but I just laughed and told him I was so happy! I'd gotten past the dreaded 9! It worked, even though a big part of me doubted I'd ever see this point! And it was time to push.

Can I just say to ladies who are pregnant: exercise, especially yoga, works!!! I know that's what gave me the strength to be able to push effectively after being through such a long labor and being extremely exhausted. Ok, and it doesn't hurt if your baby is tiny. Once I got over my self-consciousness (I was convinced I'd be one of those mothers who poops all over, scarring and eternally turning off my husband), I pushed like an Amazon woman. The doc did end up giving me an episiotomy (ouuuuch!) but little Nolan's head crowned after about 20 minutes of pushing. Dr. P told me to stop and pretty much just lie there, which was SO hard! I didn't know at the time, but the cord was wrapped around his neck twice and he was a scary shade of blue. Luckily, Dr. P was quick to get it cut (sad for Shane that he once again missed out on cutting the cord) and to pull Nolan the rest of the way out. He went straight to the NICU nurses while I strained to look at him through the afterbirth and stitching up of tender areas.

Thankfully, baby was given a clean bill of health and I got to meet my teeny tiny bundle. A priceless moment, to say the least.

It was such an incredible experience that I'll cherish forever. I'm so thankful to have been able to have the delivery I dreamed about and that everything came together to make that possible. Our bodies are truly amazing, especially if we do all we can to help them out. And modern medicine is such a blessing. There is a fine balance between too much intervention and just enough to enable a successful delivery. The first time I believe I was on the wrong side of that balance whereas this time I wouldn't have been able to do a VBAC without it."

Wednesday, August 3, 2011

a friend's VBAC birth

A friend of mine recently had her second baby.  The birth of her firstborn son ended up being quite traumatic, and set a fire under her to make sure the birth of their next would be an enjoyable experience.  She took control of everything she could, and welcomed her second son into the world calmly and smoothly.

Because of her mindset and her preparation, she was able to have just the birth she wanted.  Here is an email she sent me with a few details about her VBAC:
"My first baby was an emergency c-section that I had to be put completely out for. I literally wasn't there for the birth of my first child and that event alone had a tremendous effect on how I bonded with my first baby. When I got pregnant the second time, I made up my mind then and there that I was going to try for a VBAC. Many O.B. docs won't even perform VBACs so I approached my doctor cautiously since I wasn't sure what his stance was on the matter. I told him what I wanted to do and he was on board from moment one. I was tremendously lucky getting a doctor who was behind my choice to try for a VBAC.
           I grilled him over and over again about exactly what I could do to increase my chances of having a successful VBAC. He said keeping the weight down and exercising were the only things that I could control. During my first pregnancy, I gained an extreme amount of weight and was fairly unhealthy to start out with. So for this pregnancy, I kept my weight gain down, only gaining about 30 pounds during the whole process. I walked at least 2 miles a day on top of that. At every appointment, I reminded him that I had my mind made up to do this VBAC.
My resolve faltered minutely when the nurse handed me the paperwork I had to sign that listed all of the repercussions that could come from my choice to deliver how I wanted to. It was two whole pages outlining the various and sundry ways I could die. I actually didn't even finish reading the forms. Childbirth is risky. It has been since childbirth started. I trusted my doctor. He said I was a good candidate because of my physical shape and mindset and I believed him. So I didn't even finish reading the forms.
           I started having labor pains on Sunday and spent Monday and Tuesday walking, walking, walking. I knew that the more I walked, the more the baby could drop into the right position for a natural birth. Even at the hospital, I put off getting the epidural so I could walk around more. Getting an epidural too soon ups the risk of needing a c-section. I walked until the pain was almost overwhelming and then got the epidural.
           The VBAC went great and I am so glad I did it. It was the birth experience that I wanted. Even now when I mention to anyone who knows a lot about childbirth - doctors, nurses, doulas, etc. - they always call me brave for trying it. It is risky and I truly wouldn't have put myself and my baby in danger if I hadn't been the absolute best candidate for a VBAC. My advice to anyone thinking about trying for a VBAC is to MAKE SURE your doctor is fully behind letting you try, be in good health, keep weight gain to a minimum, exercise as much as you can and wait for a good long time between pregnancies (I waited three years).
Good luck!!!"