VBAC AT FORTY
I finally became pregnant almost three years after the emergency
c/sec birth of my first child, and two months before I turned 40.
I had debriefed to the nth degree with my husband, my doctor, and
friends who had similar and dissimilar experiences, and read everything
I could. My posterior baby had failed to rotate at second stage following
prostaglandin induction at 10 days overdue, and failed to descend
low enough even for forceps. I was chalked up as a failure to progress
after one and a half hours of pushing, resulting in a healthy child
but a very unhappy and unwell mother.
Having made it clear to my OB that I was unhappy with aspects of
the first experience, and after negotiating conditions of VBAC before
and during my pregnancy, I changed to another private hospital but
stayed with the same doctor. My pregnancy had some problems in the
first 16 weeks, but once this was over and I had the all clear from
all my "40 y.o." tests, I began seeing an independent midwife
(IM) to attend hospital as a support person. She said to me from the
start, "You WILL have a vaginal birth". It was so good to
have someone there who had so much confidence in my body.
Throughout my pregnancy I practised optimal foetal positioning -
something I knew nothing about during my first. With this pregnancy,
the baby was posterior only at the 32 week visit- after that it was
anterior or occipital transverse every time.
I tried to keep positive and not get stressed about what would happen
and whether I would go overdue again. I worked full-time until about
32 weeks, and planned things to do in the 38th to 42nd week to keep
me occupied. My H. and I told no-one the exact due date to keep the
enquiries at bay.
I went to see my IM on a Monday, with 10 days to go. The baby was
fully engaged according to her and LOA - perfect! This was great news
as my first baby had never engaged - not even in labour. We made an
appointment for the next Thursday, which was my due date on the scan.
That Friday - 39.1 weeks - I saw my OB. When she palpated, she got
a huge smile on her face and declared that the baby would not get
any lower before labour, and was ROA and looking good. As the relationship
had been a little fraught, this was the most positive feedback I'd
had. I'd been having a lot of braxton hicks and a few genuine contractions,
and I left with her telling me to keep up my evening walks.
I had a very poor night's sleep that night, feeling very uncomfortable
and with a very active baby. The next day I took my daughter to a
birthday party, still feeling shocking and putting it down to fatigue
- everyone told me how well I looked! I decided to have an early night,
planning to sort through some baby things the next day.
I went to bed early to read. At about ten o'clock I started having
mild contractions, but they were low and definitely not braxton hicks.
I ignored them and kept reading. At 11.00 I got up to go to the toilet
and discovered copious fresh blood. I hadn't had a show with my first
labour, and this didn't look like a blob of mucous with a little blood
to me. Alarmed, I rang the hospital. After some discussion they told
me to come in, but as the call progressed I had calmed down and didn't
want to go in. I talked them out of it, hung up and rang my IM who
assured me it was a show, congratulated me and told me to get some
rest. I went back to bed and tried unsuccessfully to sleep.
The contractions were coming irregularly all night - in five to fifteen
minute intervals. At 4am I got up again to go to the toilet and discovered
some mucous. I rang the hospital, confirmed it was indeed a show,
and was told to ring again when the contractions were seven minutes
apart."Sure," I replied, not intending to. I had a long
shower but the pains were worse while I was under the water. I went
back to bed, with the contractions closer together and stronger but
still not regular.
At six the pains were about five minutely, although I was not strictly
timing them, and 60-90 seconds long. I had another shower - this increased
the pain again, but when I got out and sat on the birthing ball, they
stopped for a while. My husband got up, and I told him we would need
to ring my mother soon, as she was 2 hours away and was to mind our
daughter. "I think I'm going to have the baby today," I
said. "Really?" he said, laughing.
Shortly after this the contractions returned in earnest, and he
rang my mother who said she'd be there around nine. I tried unsuccessfully
to eat a piece of toast, knowing I would not be fed at the hospital.
The pains were longer, stronger and closer, and I began to wish I
had a TENS machine at home. Around eight o'clock it was full on with
the contractions three minutely. I started to lose the plot. I had
pain between contractions - was it my scar? The baby wasn't moving
much - was it in distress? I felt pain in my back - had it turned
posterior? My husband was calm, telling me my body was doing its job,
and we could do nothing till my mother arrived. At this stage I really
felt I needed to be in hospital as my confidence was leaving me.
Just before nine the phone rang. It was our midwife saying she was
coming over. She spoke to me and assured me everything was as it should
be. My mother arrived soon after, followed by our IM at 9.20. I was
lying on my side on the bed by now at her suggestion, fighting the
contractions and not feeling very good at all. She did an internal
- the first one - and declared me 6-7cm and going well! Baby was fine
too. We could go to hospital now! She showed me how to groan effectively
through the contractions and had a coffee with the others once I'd
been to the toilet. While she drank her coffee I laboured in the baby's
room on all fours, trying to complete my packing!
The ride to hospital was interesting, with me across the seat divider
in the back, groaning loudly every three minutes. The walk into hospital
was just as eventful, with my eyes tightly shut and me leaning on
our IM and vocalising with every contraction. Finally we got to labour
ward. I heard her asking for the big room with its own shower - "you're
in there," the staff said, pointing to the only empty suite.
Apparently it had been a very busy night! By the time we arrived at
labour ward it was 10.45 am - more than 12 hours since the first contraction.
The midwife on duty when I first arrived did not seem very supportive.
She offered me a gown, which I refused, and asked me to have the belt
on for an "initial" monitor. I agreed, knowing I was 7cm
more than an hour before. Th CTG trace was fine. They only monitored
the baby's heartbeat, not my blood pressure or the contractions, so
it was just one belt. Although it was inconvenient it didn't bother
me too much - I was able to kneel on the bed and move around a little,
and I really only became conscious of it when the baby got really
low. I wasn't keen to use the shower as that had increased my pain
at home so that didn't matter too much. I had to lie on my back for
the hospital midwife to palpate. That was hell but only lasted a few
seconds. I didn't warm to the first hospital midwife (HM). I felt
she didn't like me having my own midwife and she was very determined
about the monitor. She wasn't particularly encouraging but I wasn't
too focussed on her, having my own support available.
Between contractions, groaning and with my eyes tight shut, I heard
the HM saying that Dr. B was on her way. Dr B?? My OB was Dr. A. I
knew Dr. B, who I'd seen for a couple of antenatal visits over the
Xmas break. I asked between contractions what was happening. It was
Sunday morning, and yes, confirmed the hospital staff, Dr. A was off
for the day and Dr. B was covering. Strangely, I didn't feel fazed.
She had been encouraging when I'd seen her, telling me her patients
with a prior c/sec at full dilation usually "got there"
the next time. In any event at that stage I was so focussed on the
pain and so amazed that I'd gone into labour spontaneously, that I
doubt I would have worried if they'd told me Mickey Mouse was coming
in!
While we were waiting for the OB the battle of the monitor was going
on. My IM kept saying how good the trace looked and offering the doppler;
the HM kept refusing. The baby was getting lower and it was harder
to get the belt on.
In the end it did come off and they checked after every contraction:
I still don't understand why they couldn't do that all the time. It
was obvious to me that the HM had a mindset about the monitor even
though the hospital purported not to have a policy. At one stage -
after the OB arrived - our IM persuaded them that I needed to go to
the toilet (I hadn't been since I was admitted) and the monitor came
off again. I sat on the loo for a few minutes trying to push and when
I went back into the room the monitor belt stayed off for a while.
As we waited for the OB I got more and more tired. I wondered how
long this was going to go on. I asked our IM and she told me it would
stop when I had the baby! I was hating the pain and complaining but
thankfully no-one offered me drugs. At one stage I heard our IM say
I had an anterior lip. Someone - I think it was her, not the HM -
inserted her finger and I think pushed my cervix out. I was crouching
on the bed, groaning hard, and I heard the HM say to our IM, "She's
pushing!" I don't know if I was or not, but our IM told me to
push if I felt like it. I can't say I really felt an urge. Around
this time she also whispered to me that when Dr. B came in she would
offer to rupture my membranes and I had to decide what to say. I was
about to ask what she thought when another major contraction hit and
I forgot about it.
Dr. B arrived at midday. She was very calm and very hands off. She
wanted to do an internal and I was begging her not to make me get
on my back - of course I had to. I was on the birthing ball, got onto
the bed for the VE and then straight back on the ball, trying to push.
I had no real urge to push although the midwives were encouraging
me to. When Dr. B examined me I was indeed fully dilated - 14 hours
after my first contraction.
What followed after the internal was one hour and forty minutes
of pushing - ten minutes longer than I pushed for before my first
c/sec. I still felt no urge for some time but I was being coached
to push.. At 12.30, while I was still sitting on the ball, my membranes
ruptured. The expected question about ARM had never come. Dr. B. had
just stood back and let it happen. I was so grateful that I hadn't
had to make a decision.
At 12.45 the baby's heartbeat dipped a bit, and the HM put the monitor
back on. Our midwife assured us (and her) that this was normal. Not
long after this the shift changed. The first HM left and was replaced
by two lovely ladies - one for me and one for the baby. I was getting
close! The whole atmosphere changed. "You're a champion"
they told me, " You're doing so well!" All the pressure
lifted - they were happy to use our IM's doppler. I felt everyone
relax a little, even though I'd been pushing for quite a long time.
After about an hour of pushing the baby was still at the spines.
I had some urge to late in each contraction, but it was not overwhelming.
It was a relief to feel the urge as the pushing relieved the pain
a little. The baby was not turning the corner - the OB later described
her as occipital transverse, ie halfway between posterior and anterior.
We tried many positions to tilt my uterus but it just wasn't happening.
I was vaguely conscious of some tension in the room, and my H later
told me there was an exchange of looks between the HM and the OB that
reminded him of the critical moment in my first labour. Finally the
nice HM suggested I sit up on the bed and lift my knees to push with
each contraction. It took the pressure off my feet and it did the
trick. The baby passed the spines and rounded the corner! My first
baby never had. The OB, who had not long before told me to make the
most of these contractions as she didn't want me pushing too long,
announced that it was going to be a normal birth. Somehow I had known
that all along!
I kept pushing, eyes shut, urge late in the contraction, pain intense.
My husband whispered to me that they were getting ready. I opened
my eyes and one of the HM's was at the crib turning on the heater.
The doctor had a plastic pinafore and gloves on. I really was having
my VBAC! The baby was coming.
Around this time I heard my IM whispering. I knew she had a homebirth
in progress in another suburb and had arranged for a colleague to
go. I heard her whisper something about the shoulder and in my befuddled
state thought she was talking about getting my baby past the spines.
It was only in the last ten or fifteen minutes when one of the HM's
remarked that it was a shame she'd be missing out on the fun, that
I realised she'd gone! Again, I was calm. I just knew I was going
to do it.
I kept pushing, unsure how long I had to go. As I had not been to
the toilet enough - thanks to that silly monitor - my bladder was
full and the OB put in a catheter to empty it and make some more space.
Not long after that she said to pant when she told me so she could
move the cord. It was loosely around the baby's neck. She told me
to pant, then push. I couldn't detect any difference in the sensation
of crowning - like with the pushing contractions, the pain had been
so intense for so long I couldn't distinguish. But I opened my eyes
and saw my baby's head! So this was what birth was like! The OB told
me I'd have the baby on the next contraction. Another push and the
job was done. It was 1.38pm.
They handed me my baby. My husband and I were able to see that it
was another girl. No-one took her away. Her Dad cut the cord in situ,
not just the trim as he had with the c/sec. I had a small tear which
required four stitches. I didn't feel them going in, nor the injection
of oxytocin for the placenta - just a sting when the catheter came
out. Third stage was completed about ten minutes later, but I didn't
look. I only had eyes for our baby. I was very swollen and sore after
all that pushing, but I didn't care.
Within an hour, I had breastfed and had a shower. By about 4pm we
were all back in my room entertaining my mother, a very excited three
and a half year old big sister and our IM who had delivered a 5.1
kg girl with no stitches about half an hour after our daughter was
born. (Yes, 5.1 kg - that wasn't a misprint!) She told me later that
she'd left once she could see the baby's head and that, like me, she
trusted the two midwives who came on when the shift changed.
All the midwives back on the maternity ward kept congratulating me
- I don't think they see many VBACs. One agency nurse told me some
of the hospital midwives have lost their skills with the doppler which
may account for the enthusiasm for the monitor.
Both my labours were very similar in length from the first contraction
and pushing time, and the babies were almost identical in weight and
head size. The only real difference was the position and everything
that flowed from that. Our IM told me only position would stop me
from doing it myself, and she was right.
The birth was everything I could have hoped for. It was a blast.
I would like to thank everyone who helped: husband, mother, midwives,
doctors, all my girlfriends who listened to me, all the other women
who've shared their stories, and most of all my two beautiful daughters
for taking me on this journey.
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