Vaginal Birth After Cesarean Under General At 25 Weeks
I love sharing VBAC stories and I am constantly amazed by two things: 1) The amazing strength of women and their faith against all odds simply astounds me. And 2) How different each and every story is.
This VBAC story contains a heartbreaking loss after a pre-term birth followed shortly after by a home VBAC.
Here is my birth story, about 99% complete. Most of
this story is from what I directly remember, but there are parts that
I was told about afterwards, from my midwife and doula and a friend
that was there, filling in the blanks when I was too out of it to
fully realize what was going on. I don’t yet have my midwife’s
written notes, but it’ll be a little while before I get those, and
she and I have talked about the birth, so I’ve included those bits
in here and am going to call it good for now.
I also mention my Christian faith a few
times, so if that will offend you, just be aware that it is there and
an important part of my life.
And the final disclaimer, this is my
narrative story and should in no way be taken as medical advice.
The birth story of my fourth child
starts with the birth of my third. Jonathan, my third baby, was an
emergency c-section at 25 weeks because of complete placental
abruption (which followed my premature rupture of membranes at 23
weeks). He was with us for 27 days before we lost him due to
complications from an infection.
Even if Jonathan had lived, Tim (hubby)
and I would not have felt that our family was complete at only three
children, but now I was a complicated case. I was sneaking up on
“advanced maternal age,” I was a hopeful VBAC, I had a history of
a preterm birth (even though my first two births were nearly
textbook). Tim and I consulted with several people to see when we
could try to get pregnant again and still have a reasonably good
chance at a VBAC. The delivering OB and another one both said we
could try in three months (putting 12 months between the surgery and
the next birth). Other opinions wanted us to wait 6 or 9 months. We
decided to start trying at 4 months, never dreaming that we would get
pregnant on the first try.
I have to admit that I was more than a
little nervous at first. I’d read birth stories and talked to
people who had a short time span between their c-section and their
VBAC. I’d also talked to people who had a full-term VBAC after
having a premature c-section. But all my searching came up mostly
empty when I tried to find people who had both of these factors in
the same pregnancy. I didn’t know what would happen.
I saw an OB for my whole pregnancy,
taking P17 shots this time, and I saw an OB all the way up until the
week before I delivered. I also saw my midwife for prenatal visits
that last month (but had kept in contact with her throughout the
pregnancy as well), unsure until the very end whether I wanted to go
to the hospital or try for another homebirth. (My second child was a
homebirth, and my third child was supposed to be a homebirth as well
before my water broke so early and I had to transfer out of my
midwife’s care.)
I was officially due on 12/27, and in
the couple of weeks leading up to that, I'd been having fairly decent
Braxton Hicks off and on for several weeks, very similar to the way
it happened with Benjamin (my second baby, 3 years old at the time of
this birth). My due date came and went. I was a VBAC this time, so
I didn’t want to be induced. I just had to wait it out. I had an
appointment scheduled for 1/2 for a NST and ultrasound since I would
be turning 41 weeks the next day. Then if I made it to 42 weeks, the
OB was recommending induction at that time (which I was agreeable to,
but still praying that I wouldn't make it nearly that far).
With both of my other full-term labors,
I had light bleeding throughout the whole active labor, so I kept
waiting for that to show up to indicate that I was finally in real
labor, but it never did. I also was waiting for a loose stool, which
could indicate my body cleaning itself out in preparation for labor,
but that never happened either. (I did, however, have two separate
solid BMs during labor, once it finally started.)
On 12/28 and 12/29, I was losing teeny
tiny pieces of my mucous plug, but nothing to make me say, "This
is it!" I just kept monitoring it throughout the weekend, and
it would come and go as the days passed. I had an appointment with
my midwife on 12/28 and my blood pressure had spiked a little bit,
and she said that it might be an indicator of labor starting soon.
She estimated his size to be at about eight and a half pounds. She
also made the comment that she likes doing baby-size estimates on
women with my body type because it’s easy for her to be fairly
accurate. The afternoon of that appointment, I made some eggplant
Parmesan using a recipe that is "famous" for putting women
into labor within 48 hours. A friend of mine had made it with one of
her babies and had gone into labor that same night. I made the
recipe, but it was deliciously ineffective for that first night and
the second night.
On 12/30, I woke up having lost a lot
more of my plug the night before. I was having contractions that
could still be called BH, but they were coming close enough together
for me to think that they could easily turn into something more
later. I texted our doula to see what time she was going to be in
church, and to give her a heads up about the plug and that something
might be happening later on. Tim and the kids and I went to church
as well, and were there from about 9:00 to 11:30, where I continued
having contractions.
After church was done, I got Tim's
attention and told him that he needed to get the kids in the car
(i.e. don’t dawdle and visit with people) and that today was
probably going to be the day. He grinned at me. :D One of our
friends who was going to come to the birth to help with chores or
whatever else we needed came up to me before I could get outside and
asked if I was in labor, and said that when she saw me when we first
got there that morning, that it looked like I was. I told her that I
don't know but that she should come over after lunch. On the way
home, I called our doula and our photographer and midwife and made
plans to have them all come over at their various times that they
could make it (from being out of town or whatever).
My midwife got to the house first and
we talked about what was possibly going on, and I went ahead and had
her check me, and I was at a 3, 50% effaced, and very squishy. My
bag of waters was intact but she could feel the baby's head through
it. He was floating, though. Since I was still in very early labor,
my midwife stepped out to grab lunch with her hubby and then run
another errand.
Throughout the afternoon, the rest of
my "birth team" arrived, and we were lighthearted and
chatty since my labor was also lighthearted. :P The birth supplies
were assembled, but I couldn’t find the little hats that I had
crocheted, so I spent a little time in early labor making one more
hat, just to be sure we’d have one. I also had some music on with
a portable stereo, and Benjamin was laying down on the floor,
directly facing the speakers, singing the familiar church songs on
the CDs that I had picked out. It was so heartwarming to watch him
do that. Lydia (my first baby, 6 years old at the time of this
birth) played games on various electronic devices (like our
photographer's iPad and my Kindle). We eventually let Benjamin take
a long nap, but Lydia stayed up the whole day and all the way through
to the birth. At some point, we blew up the birth pool (but didn't
put any water in it yet) and the kids were enthralled with their new
"toy" and kept playing over the edges of it. At one point,
they managed to flip the pool on top of themselves, creating an
air-filled cage. :D
I got checked early in the afternoon
when my midwife first got there, and I was at a 3, 50%, and very
squishy. Since labor was still so light, she went to eat lunch with
her hubby and run another errand. I gradually dilated to a 5, and at
that check, my midwife was able to stretch me to a 6, but then I
never dilated past that because my bag of waters was keeping the
baby's head from putting direct pressure onto my cervix. (My
midwives called it "bag of water dystocia.") I did a round
of nipple stimulation, which helped the contractions get stronger and
closer together, but it still wasn't enough to move the baby onto my
cervix and finish dilating. She suggested maybe breaking my water in
an hour or so if there's been no progress (and if baby was not
posterior).
I wanted to go ahead and fill up the
pool first, though, so we started to do that. When Tim and I had
made preparations for this birth, we got a hose and some fittings to
fit it onto the shower head, because our washing machine spout wasn’t
easily accessible. We hadn’t run any water through the hose,
though, and instead had just seen if it would screw onto the shower
head prior to birth day. Once it came time to actually fill the tub,
Tim had a little trouble getting the fittings tightened properly, and
it kept leaking, so we had a lot of stop-and-starts when trying to
fill the pool. He finally got the fittings finished and then turned
on the water. About a minute later, he called down the hallway,
“Here comes some water!” to make sure that someone was holding
the hose at the other end. It was a humorously delayed warning, but
someone had been holding the hose anyway, so everything was good.
I was in the pool for an hour or so,
but the contractions slowed down, so I continued the nipple
stimulation. They picked up, but again, not enough to do what they
needed to do, so I got out and agreed to have my water broken. It
felt like a gallon came out of me (but was really only about two
cups), and it kept coming out in several spurts as I continued laying
there, but as soon as she broke it, I was at an 8.5. She said that
since I was so soft, it would probably be only an hour or so after
she breaks my water and then the baby would be born. My amniotic
fluid was meconium-stained, so it was yet another thing to keep an
eye on during this birth. My doula had had a “streak” going
where all of her clients had started labor with their water breaking,
so I was glad to break her streak and have my water intact for so
long. It took her some effort to break my water since my sac was so
strong this time, which was such a change from my third pregnancy.
My contractions picked up in intensity,
but not frequency, after my water was broken. I was back in the pool
but couldn't get comfortable. I started vocalizing and screaming
through the contractions, and at one point, they suggested that I go
to the bathroom to get my full bladder out of the way (everyone had
been giving me sips of Recharge and water throughout the day). I did
that, and had a few contractions on the toilet and felt pushy. I
wanted to get to the bed so they could check me, but I had to time it
just right because the contractions were finally coming pretty close
together.
I felt the contractions so low that it
felt like they were running down the side of my thighs as well. It
was quite the odd sensation. While still in the water, I started
needing some counter pressure applied to my low back/hip area, which
Tim did for me. He was amazing through my whole labor, just doing
what I said I needed instead of what he thought I needed. :p
Overall, I’m glad that I gave water a try, but I don’t know if
I’ll do it again. It didn’t really feel like it was the “magical
pain relief” that people have made it out to be.
I got to the bed and was checked, and I
just had a lip that moved back and forth as the baby tried to find
his way down. I was complete, but my cervix kept slightly shrinking
back with the contractions. My midwife checked the position of his
head, and he was asynclitic (with sort of a front "corner"
of his head trying to come out first instead of the back of his
head). She spent a few contractions trying to push the lip over his
head and at the same time get him to rotate. Even with no water,
there was room for him to do all that. Both of those techniques were
incredibly painful. Throughout my contractions and especially during
the pushing phase, my midwife never stopped praying for us, out loud.
I greatly appreciated this as it helped keep ME focused on who was
in control of the situation as well. Since I was GBS positive this
time, they also gave me a chlorhexidine rinse every so often, which
was cold! Brrr!
During an incredibly painful
contraction, I asked if I could push, and they told me I could.
Because of his presentation, I never did get the uncontrollable, “my
body’s going to push whether I want it to or not” urge like I’d
had with my other vaginal births. My midwife was inside me trying to
show me where to push (but I had thought she was holding my lip out
of the way), which was also pretty painful. She also was still
trying to turn his head in between contractions to a better
presentation, but then before the next contraction hit, he would turn
right back. I couldn’t feel it, but Tim kept seeing the baby flip
back over as he watched my belly. She told one of my friends later
that I had a pelvis that could birth a 10-pound baby and that the
baby just had too much room in there since he kept flipping back.
I was getting tired and weak by this
point and kept saying and thinking, "I can't do it, I can't do
it," over and over. But I was also aware enough to realize that
his heart rate had gone down into the 90s and stayed there, so they
were getting nervous about a possible cord problem. I gave it my
all. They didn’t know what was causing the drop in heart rate, but
my midwife knew from my previous birth records that I could push a
baby out fast, so she wasn’t as worried as she might have been if I
were a first-time mom or having my first vaginal birth. We didn’t
have the luxury of taking an hour or more to push with that declining
heart rate. Tim was trying to help me push better/faster/harder by
yelling, “PUSH!” several times at me, with increasing volume, but
that wasn’t helping and before it started to bother me too much,
the midwives told him to stop.
At some point, I was on my hands and
knees trying to get the baby to a better position, but that wasn’t
working, so I ended up on my back. I have NEVER had a pushing phase
hurt like this one did. I had various people giving counter pressure
on all four limbs to give me traction. I wanted to scream from the
pain, but I knew if I did, it would make my pushing less effective,
so I tried to be quiet and just let all the energy go into my push.
From Tim's point of view, there was one point where a big portion of
the head was visible, but then when I stopped pushing, it slipped
back. At one point, they invited me to feel his head, and based on
the pain I’d been feeling, I thought I was going to feel a huge
portion of it, but it ended up feeling only like a half-dollar-sized
amount of head. The video is a little blurry because of the low
lighting, but it ended up actually being a significant portion of
head that I was feeling and not just a tiny little bit.
When the head finally came out all the
way, he was looking down towards my left leg. Before the shoulders
came out, he rotated clockwise, looking directly at my left leg, then
up to the ceiling, then finally straight over at my right leg, and
THEN the shoulders came out.
He was neither breathing nor trying to
(but did still have a pulse, which my midwife monitored with her
fingers on his chest while they worked on him to get him breathing).
They kept him right at my feet where he had come out while they
worked on him, leaving the cord intact. They suctioned him (getting
a lot of watery blood out when they did this) and gave him oxygen.
His one-minute APGAR score was only a 6 (but his five-minute one was
9). My friend told me that my midwife was crying at one point.
After quite a bit of suctioning and some oxygen, he got a tiny spot
of pink on his head which nearly immediately spread to his whole
body, replacing the purple that he had been upon first arriving. He
started crying and they put him on my chest. His cord (which was two
feet long) ended up being wrapped around one of his feet, but that
was the only place it was wrapped. And remember that 8.5-pound
estimate from a couple days prior? The first thing I noticed when
they laid him on me was how dense and heavy he felt. This baby was
not an 8.5-pound baby. When we finally got around to weighing him,
he was 9 pounds and 6 ounces, my heaviest baby so far.
Another thing I noticed about him was
that he had absolutely NO vernix on him, not even in his little neck
folds or anything. He was a very well-cooked baby. :D I cut the
cord this time, and was surprised that I had the strength to do that
since I didn’t even have the strength left to fully lift my head to
see where to cut, and had to rely on others to move my hand into the
proper position. And 36 or so hours after the birth, I had a sudden
realization, “Oh, yeah, I cut the cord this time,” like I’d
forgotten that I did it. The assistant midwife and my friend were
looking at the placenta later, and that midwife pointed out the few
calcification spots in there and said that it wasn’t a “bad”
placenta, but it was definitely done and time for the baby to have
been born.
One more thing I noticed was a
“scratch” on his abdomen that looked like there had been a cat
inside me with him that gave him a good clawing. It ended up being
just a weird arrangement of dried blood, though, and came off in the
bath, revealing smooth and unblemished baby skin.
Sometime earlier while I was still in
the birth pool, I was nauseous, and threw up all the fluids I'd taken
in in the previous hour or so. They wanted me to keep taking more
fluids, so I kept trying, but the nausea never went away, and I also
threw up all those additional fluids along with the few bites of eggs
that I'd tried to eat as my first postpartum meal. This loss of
fluids combined with the loss of blood made me incredibly weak and
lightheaded, and I came very close to passing out many times, and
actually did pass out once, later, after my herbal bath. Baby was
born at about 2:24 a.m. and it wasn't until noon that I finally felt
able to walk a few steps by myself and got my appetite back. I
didn't even try to carry the baby before then, either, because I felt
that bad, and instead just kept him near me in the bed and had Tim
change all the diapers. And even after feeling better, I still had
another few sporadic incidents of lightheadedness where I had to stop
and bend over, and these incidents reminded me even apart from
bleeding intensity that I needed to get back into bed or into a
semi-reclining position.
It was a little while before I
delivered the placenta. They kept checking to see if it was ready to
come out or where it was. I had lost a lot of blood beforehand and
they were wanting to make sure I didn’t have a bunch behind the
placenta as well. When it was finally ready to come out, I didn’t
want to push it out since the baby had been such an effort. But
everyone reminded me that the placenta had no bones, lol, and I
pushed it out and that was that.
He nursed very well, once we finally
got around to it. It ended up being about an hour and a half after
the birth before we were able to successfully latch. From the loss
of blood and fluid, I was too weak to do it lying down (though I did
try with what little strength I had) and too weak to sit up without
help. I was also too out of it mentally to ask for help sitting up
and to realize how much time was actually passing.
When we finally did sit up, my midwife
asked us if we were going to circumcise him, and we said no. She
said “Yay,” but I didn’t quite understand what she said, and
she had a weird look on her face and said it in a weird tone of
voice. I thought that she was upset at our decision until I asked
her to repeat herself. Tim and I had had that discussion while
pregnant with Benjamin and had left him intact as well.
I did not tear at all, but I had some
bruising. It felt like I had been trying to climb out of an
above-ground pool but that I was repeatedly dropped on the edge of
the pool, with one leg in and one leg out. In addition, I was
swollen so much that I couldn’t pee within the time that my
midwives wanted me to (even with the assistance of some peppermint
oil), so they did end up cath-ing me. After that, the assistant went
home but my primary stayed and dozed on the couch and wanted me to
try to pee again after an hour and a half or so. I was keeping
fluids down again by then so I thought I might be able to go when it
was time, and I did, and didn’t have any further issues in that
regard.
They offered an herbal bath for me and
the baby afterwards (and they also thought I might try to pee in the
bath as well, but that didn’t work either), which I took, but I got
increasingly lightheaded during that, and hindsight said that they
probably should have skipped it. I had to have a ton of assistance
walking just to the door of the bathroom, then they had me sit in our
wheeled office chair to wheel me to the bed, and I think I might have
passed out for half a second. I remember sitting down in the chair,
then the next thing I know, they were calling my name and I realized
I was leaning on the door jamb with my eyes closed. I woke up from
whatever state I was in, and then they wheeled me across the hallway
and to the side of the bed.
Baby is a champion nurser. He latches
beautifully and just knows exactly what to do, as if he's been
waiting his whole life for it. :) He had a bit of a "click"
that first day or so, and after some investigating, I found out that
he was turning in his bottom lip instead of turning it out, so I’m
working to help him develop a better habit there. Other than that,
he is a great nurser, easily handling my gigantic letdown. At three
days postpartum, he was two ounces under his birth weight, but at
five days old, he was two ounces over his birth weight.
Tim changed all the diapers that first
day, including the first meconium diaper, which had a HUGE pile in it
for him. Tim made the comment of "nothing wrong with that
system," lol.
He smiled in his sleep within the first
few hours, and then on Tuesday (I’m still wondering what happened
to most of the rest of Monday), I saw him smile while he was awake
and in a quiet alert phase. :)
One odd thing I noticed early
postpartum with myself is that my uterus seemed almost cylindrical
when it was freshly empty, instead of shrinking in a rounder fashion.
My midwife mentioned this to me at my postpartum visit and said that
she and the assistant midwife had noticed the odd shape even from
when they broke my water. I don’t remember the shape of my
postpartum uterus with my pre-c-section births being anything
remarkable like that.
The kids just love him to bits.
Benjamin was sleeping when Josiah was born, and when he woke up this
morning, I was in the bed and I asked him where my baby is. He
indicated my now-shrunken tummy and said, "In your tummy."
I told him that he came out, and Tim helped him climb onto the bed so
he could see the baby. Benjamin promptly squished him in a hug and
said that "he's sleeping" and gently touched his tiny
hands. :) Lydia was still awake for the birth, and when he came
out, she said that he was "so cute." :D A good friend of
ours took our kids for the first 36-ish hours after birth, so that
was nice, since one of the things that first made me consider a
hospital birth this time was the postpartum stay without having my
big kids around. :)
We sort of have a “theme” going on
with our names and our kids’ names – three-syllable names from
the Bible. (My name is Andrea, which is the feminine form of Andrew,
so I’m counting my name as a Bible name as well.) Then Tim is
legally Timothy, and there’s Lydia, Benjamin and Jonathan. What
WERE we going to name this baby, to keep with our theme? We chose
the name Josiah Nathan, which means, “God has healed, God has
given.” We couldn’t think of a more appropriate name and are
just so happy that he is finally here. :)
Comments
What a moving piece. I lost a baby at 11 weeks of pregnancy and had a vaginal delivery. Most people look at me like I am nuts when I say that, because most people dont realise that my baby was intact and did not spontaneously deliver (I was induced). I am high risk and had to have my previous babies in hospital, but ironically I was told that this tiny baby would be ok to come at home. As it turned out she delivered in the labour suite. We are hoping for another baby, but so far have not been blessed.
Congratulations on the beautiful birthing of all your children.
Val
xxx