09/02/2011 - Successful, but almost not, VBAC birth of Marley Diamond. Reflective.

[LimeSlice]

SO! Finally thought I should post my birth story for Miss Marley!

I am using it for an assignment for my Doula course, hence the breakdown, but TBH I can't be bothered writing it all out again 'normally' so am posting the assignment. Plus, I think that the reflection might be helpful for others, it is very honest and open, as it was originally not written for public consumption.

Enjoy!


INTRODUCTION:
This paper will be a reflective account of the birth of my second child, Marley. My “Estimated Due Date” was February 2nd, 2011 and she was born on Wednesday, February 9th, weighing 7lbs 7oz.
Marley is my second live child, my second daughter, and my third pregnancy.

DESCRIBE:
My membranes ruptured at 6.30am on Tuesday morning. There was no gush, but a steady stream of fluid. It was clear, odourless, no cause for concern.
I did not experience any contractions for another 3 hours, and was not in established labour until about 5pm that night.
The goal of this birth was a vaginal birth after the emergency caesarean I had to have with my first daughter. It was about proving to myself - and my obstetrician - that my body was capable of doing what it was made to do. That the problems I experienced with Charlotte’s birth were not a product of my ‘inability to birth’ (as the Specialist Obstetrician labelled it) but simply her birth. I was prepared emotionally and physically to birth at home if necessary, but I wanted to wait to go into the hospital until the very last minute.

The hospital called me after speaking with my obstetrician. I had informed him I was in labour, but had not contacted the hospital. After speaking with a midwife, I was then phoned by the Head of Obstetrics and pressured to come in earlier than I wanted. I refused, and was then threatened with diminished care and told I would be sent to the emergency maternity hospital in Perth if I did not come in. I refused again.
After this my husband and I decided it would be best to go straight to the other hospital. It was 30 minutes away and my husband was not comfortable with me staying for a possible freebirth at home without the backup of our original local hospital 10 minutes away. I consented to this and we left for the hospital at 10pm.

When we arrived at the hospital, the surges were very close together, very regular and gaining in strength. I then had to go about renegotiating the terms of my VBAC attempt with the new obstetrician. I was not successful and was set up in a birthing suite with a large gauge IV in my wrist, restricting my movement severely and hooked up to a CTG monitoring machine, restricting movement further and preventing any use of the bath or showers.

My labour was long and arduous, and with very little support from the assigned midwife beyond her concern for the monitors. I asked for them to removed several times as per the conversation I had had with the admitting obstetrician, I was placated and as my labour continued, I could no longer walk or hold my own weight and found myself on the bed sitting up. I submitted to 4 hourly vaginal exams although I refused to be told my “progress”.
This continued all night, I was tired and had been in labour for 24 hours when the obstetrician did a final VE and told me I was only 6cm dilated and that she recommended I have a caesarean section while the baby was not in distress as I was not progressing.
I agreed to her advice. She said that my cervix was “floppy”, the baby not pressing on it and therefore it not dilating further.
The anesthesiologist was called for, I was helped off the bed to empty my bladder and I had 5 surges like nothing I had ever experienced before in the 10 minutes I was off the bed. The staff were too busy prepping for surgery to take much notice of how strong they were. I was taken to theatre and given an epidural and a spinal block, whilst still experiencing massively strong surges.
I passed out on the trolley 3 minutes after the epidural took effect and woke 5 minutes later with another obstetrician asking my consent to perform another VE to help gauge baby’s position for the surgery. Through the course of this VE, it was discovered that I had in fact just gone through transition and was fully dilated and baby was ready!

At this point I was given the choice to return to the delivery suite and birth, or remain in the theatre. Of course, I opted to give birth with the staff who had been the most supportive which was, oddly enough, the surgical team. This was largely due to the most amazing doctor I have ever had the privilege to be seen by, who was my anesthesiologist. So was taken into theatre and set up in the stirrups (as I was still under the full effects of surgical preparation) and I delivered my beautiful baby girl vaginally, with only 2nd degree internal tearing. Almost how nature intended!

FEELINGS:
When my waters broke I was excited. I wasn’t scared of labour or birth, I felt prepared, I felt as though I was confident and my husband and I were together ready for this birth.
I think I was a bit too excited - I was revved up and ready to go and I had no contractions yet!

They began and I still felt fine. I was excited, I had a fabulous day and was in a great mood. My 3 year old daughter went of to day care for the day and came home that night in a great mood and we were confident in my labour to tell her that her little sister would be with us by the next morning. I was sad that she would not be at the birth. I so wanted Charlotte to experience that, but unfortunately, my husband was not sure that she should. We weren’t sure how the birth was going to go and I think he was not wanting her to see me in pain if I would be, or if baby was distressed... The uncertainty was enough for him to favour her not being in the room with me. I was content with that, had she been a little older and able to understand better, then she could have been there. As it turned out, I was glad she wasn’t there - it was long and I was loud, I do not think she was quite old enough to process all that well.

It was all going well until I got the call from the hospital. My obstetrician had called them presumably to check my progress since he knew I was in labour and would be going in later on in the day as I had told him. However, I hadn’t called the hospital as I felt I had no need. The midwife seemed surprised when I told her I would not be in anytime soon to “be assessed”, but she was pleasant and made sure I knew I could call or go in when I was ready. It was about 20 minutes later that I answered a call from the Head of Obstetrics where I was bullied and essentially threatened with diminished care if I refused to supplicate myself to his wishes. I was seething on the inside, but determined to maintain my calm, peaceful and in control mood, I chose not to bite and thanked him, and hung up. Daryl and I both decided that we would ignore the next call he would make at 9.30pm if I had not gone in - his deadline. This would be a serious fault on my part. I carried that anger to the other hospital and never expressed it. I never fought for myself and I would continue on that path.

I tried to move on, labour was ramping up and I was feeling good. We put Charlotte to bed, she was so excited that she would be meeting her baby sister the following morning, I read her a story and tucked her in.
I was feeling really good. I was prepared mentally to freebirth, and was actually looking forward to labour. I wanted this rite of passage.
Then the phone rang again and I knew instantly it would be the hospital, and instantly I felt ill. I felt the massive surge of adrenalin and my anger growing large again. I didn’t want that, I didn’t want that emotion clouding my birth space, so I asked Daryl to take the call. I didn’t trust that I could speak to the Obstetrician without blowing my top at him, and I wanted to try and stay calm.
Turned out that the Obstetrician had gone home for the night and it was the midwife again. She repeated what the Ob had told her to, and Daryl politely told her that since they clearly couldn’t meet our needs, we would go to the other hospital directly. He was so angry, but he hid it well. I tried to focus, but it was hard. Not telling the doctor what I thought was grating on me.

When we made the decision to go into the other hospital and abandon all hope for a home labour, I was devastated. I felt weak and while I still had absolute confidence in myself to freebirth, I was disappointed that Daryl felt it too risky. I had a grand notion in my head that he would trust my confidence, but we never discussed it clearly. I had alluded to it but never wanted the negative response, so never broached it head on. This feeling of “not worth the argument” would turn out to be a symptom of the bigger communication issues in our marriage. I knew there would be a battle at the hospital - which deals with the high risk and emergency birth in Perth - over their VBAC policies. Policies I had already negotiated with my original hospital specialists and had planned for. I was dreading going into hospital. That is when things started getting painful with the surges of labour and I felt myself losing my focus.

The obstetrician and midwives at the hospital were all a bit outraged by the HOD at my hospital and his threats, and tried to be welcoming. It felt good to be heard. But they also had their own very strict policies that I just didn’t have the energy to battle in labour. The obstetrician appeared to hear me and compromise with me, but as soon as I agreed to the IV I had a panic attack and it took Daryl about 20 minutes to bring me back again. I did not want the IV, but let myself be talked into it and I felt really disappointed in myself afterwards because I feel this is where I really turned over my power.

During the labour at the hospital I felt very unsupported by the staff. The midwife was a lovely woman, my age and clearly inexperienced, but nice enough and young, which I liked. At first I felt I could relate to her and vice versa and that would be a good experience, but it seemed as the labour went on that she wasn’t there to support me as much as she was there to monitor the monitor strapped to my belly. There was little physical support of me, she kept fussing over the monitors and worrying what the staff at the nurses station would think when they kept losing the baby’s heart-rate. As the labour progressed I became more and more angry and frustrated with that. I could not support myself properly because of the placement of the large gauge IV in my left wrist, and so Daryl holding me up was simply not enough.

I had been told I would be able to take the monitors off as I desired and sign the informed consent form to do so, but every time I asked, I was fobbed off. Every time Daryl tried, he was fobbed off. So I tried to work around it, which just made me even more cross. I never voiced it though, until much later in the labour when they became a huge hinderance physically. I felt I wasn’t being listened to, and I felt as though I wasn’t be supported the way I should have been - would have been, had I had a more VBAC friendly environment and an experienced midwife.

When the shift changed at 6am and I got a new midwife, I was so happy. She was fabulous. So supportive, she held my hand through contractions and tried to help me stand and encouraged me to move around. She reassured me when it was tough and had a beautiful smile. Veronica was her name and she was lovely, made me feel hopeful after a very long night of intense labour.
When the obstetrician told me she didn’t think I would progress further I was so disappointed. Disappointed in myself for being too tired and lacking confidence by this stage to fight on; disappointed that nobody offered any other solutions or tried to help me get off the bed and move around to give it another push; I was so so tried and the surges physically felt like someone was tearing my legs off. My hips were so sore, the sun was up again and I was feeling like a failure. That feeling of disappointment in myself deepened when after getting the epidural and VE in the OR they discovered that I had in fact been going through transition and I realised I had given up on my baby and my body when I should have keep going.

As soon as she was born, I was so proud of myself. I pushed her out with an epidural, but I managed to birth her vaginally regardless, and I was so proud of that achievement. It was such a bittersweet feeling. I had never considered that I would birth like that - I wanted a drug-free VBAC. I never considered a medicated VBAC as an option. I hadn’t been offered any pain relief at all during labour (at my request), it just never occurred to me. I was so relieved when I was able to hold her, have skin to skin contact immediately and try a breast crawl. She fed straight away, and again in recovery and the joy of not having another caesarean was amazing! Just the physical things like being able to shower that afternoon was awesome. She was born at 10.15am, 28 hours after my membranes ruptured, a successful VBAC and that made me feel a reserved pride.

ACTIONS:
Although I had many choices throughout the labour and birth, there are really four points at which I feel the crucial and course-altering decisions were made. They were the call to my obstetrician; the decision not to go to my original hospital when the obstetrician asked me to; the choice to allow the cannula and IV antibiotics to be put in place at the beginning of my my hospital labour; and when I made the choice to opt for the repeat caesarean.
These crucial decisions really changed the course of my labour significantly and looking back, really are the moments where my actions directly affected my ability to achieve the goals I had set for myself.
Feeling excited and a bit too happy with my body for having avoided the impending stretch and sweep and talk of repeat caesarean, by going into spontaneous labour, I made the decision to call my obstetrician and let him know where we were at. He did not work for the hospital, I felt comfortable with him and he always supported my VBAC wishes and shared my distaste for the specialist obstetrician at the hospital. For all these reason, I felt happy to call him without feeling there would be any obligation. I had no idea he would call the hospital, rather than me or my husband directly, for updates. I hadn’t wanted him to call the hospital and I was very disappointed that he had without my permission. After all though, this was my choice and logic states that of course he would call the hospital, another case of me not making myself clear enough.

I could have chosen to go into my original hospital. I had already negotiated the terms of my VBAC there and could easily have come home if I wasn’t in established labour, as we had already discussed and agreed to. The decision to go into the other hospital was made out of stubbornness and the mistaken belief that I was further dilated than I really was at the time. Had I gone to the hospital when the Obstetrician had requested, I would have had more control over my labour and staying on my birth plan, despite labouring in the hospital more than I would have liked.

When I did get to the other hospital, I chose to allow the IV antibiotics to be put in place. I had no problem with the IV cannula being put in place prior to labour - I was aware of the complications of not having one if I needed it and made the choice during my pregnancy that the “just in case IV” was a battle I could afford to avoid by agreeing and focusing on something else I felt more important to achieving my VBAC, like intermittent monitoring. I had no comprehension of how the large gauge needle they would use and the placement would effect my ability to use my wrist effectively. This seriously altered my ability to use varying birth positions that I had wanted to use to birth in, which lead to me having an inactive bed-prone labour, something directly in opposition my plan and goals.

The final decision I took to bail out and take the offered caesarean section was in, again, direct opposition to my goals. I could have chosen to have an epidural, get some rest and attempt to continue labour, I could have turned it down altogether, but my inability to voice my feelings of wanting assistance to get into an active labour led me to choose the offered course rather than press for more options at the time.

LEARNING:
In the (almost) fifteen months since the birth of Marley I have learned several things about myself. If I am brutally honest, I realise there is nobody else to blame for the way my labour and birth came to pass. There were certainly obstacles thrown up by others, and their actions spurred me to have to make decisions, but I made some crucial decisions that were in direct opposition to my goals, and these are the decisions that only I could have made, and therefore I must own them.

I have learned that I am not as strong as I thought I was, that even with the strong physical support of my husband during my labour, I chose to isolate myself by not speaking up and demanding what I wanted. I tried to just ignore those things that were really hindering me and in doing so, became a passive participant in the process, rather than the active leader.

The decision to go to a ‘new’ hospital put me into a totally new environment, and immediately put me on the back foot. I can see that this was indeed a bad decision in terms of achieving my end goal of a successful, drug-free VBAC. It put me into a submissive position to new doctors and policies, and essentially made me scared to speak up in an effort not to seem like a demanding and know-it-all patient, given I felt very much like an unexpected nuisance on a busy night in a maternity ward.

I also learned that even trained midwives and obstetricians with years of experience can not recognise vital points in labour. My transition was completely missed by all the staff, despite their experience. Looking back on it, from all the accounts of this part of labour, it is plain as day to me that I was going through transition, and had it been recognised, I could have been supported better by the staff. So I have learned that we both failed in this.

My second birth has lead me to understand that there is no black and white, but many shades of grey when it comes to how we declare “success” in our birth goals. I had a “successful” VBAC, but failed in many of my labour goals. I made many decisions - by either direct choice or supplication and failure to assert myself - that led me to have the experience I did. I now understand that no matter how pressured or led we are by care givers, ultimately only we can own our birth choices and it was my own failing in this regard that compromised my birth plan.

APPLICATION:
It is through this experience that I had the realisation I want to help other women. It is a direct result of these lessons I have learned that I am training to become a Doula and Child Birth Educator.
Aside from the choices I made during labour, I wholeheartedly believe the choice I made that had the most profound effect on my labour was the choice I made not to have a Doula with me. This led directly to me not having anyone else there to help me speak up for myself and support me physically. My husband was a fantastic birth support, but I clearly needed another voice in the room to show me the space to use my own voice when I needed to. It is this voice I hope to help other women to access when they need it.
Using the lessons I have learned from both my birth experiences and my VBAC in particular, I hope to be able to help other women achieve their dream birth in its entirety, to ensure she has conviction in her own choices in the room when she needs it.

This reflection of my experience has really opened my eyes and allowed me to see with hindsight how my actions directly caused the birth experience I had, and realise that for its faults, I wouldn’t have it any other way as it has led me to where I am now.

SUMMARY:
The reflective process I have undertaken to write this paper has been a truly eye-opening experience. I am very glad I have done it.
The process has allowed me to clarify both my actions and my feelings, many of which were negative. I feel I am beginning to work on the feelings of failure in myself I have experienced since Marley’s birth, and through doing that I can reconcile the choices I made at the time and the very high level of expectation I put upon myself to achieve the birth I dreamed of.

The many lessons I learned will help me to be a better birth support for other women as it has shown me exactly where and how birthing women can feel helpless and when they can lack the confidence to speak up. It is clear how vital the role of a Doula is now that I have experienced a birth without one.

I now take full responsibility for my actions and choices in labour and my feelings since the birth and that is very liberating! My experience wasn’t the birth I wanted, but I experienced my birth, and now I can use that to help others.





ETA: For those interested, I gave birth at King Edward Memorial Hospital in Perth, the hospital I was blackmailed by was Rockingham General.