My VBAC - Leo arrives

Grab a cuppa! This is long - as it should be heh?

The birth of Leo Ezra

14 September 2009, 5.08pm

Sarah - my sister and mother of four

Corrine - hospital midwife

Melissa - our private OB

Ed - my husband

Roman (Rommy) - our first son born by c-section and very sick at same hospt

The prelude
When does labour actually start? I could give you a few answers to that question for Leo’s birth. It might have been six days before his birth – the Tuesday night (39+1wks) when the first of the irregular “pre-labour” started. I thought I was going into labour and so timed and noticed each “contraction”. Only they built to 10 minutes apart and then faded off again after a few hours. They were still there during the night and so I got up to monitor them but there were too erratic to do anything about. I txted with Sarah who thought I was in early labour and by 4am she had decided not to go into work for the day.

The next day Ed and I met Sarah for brunch at Market 190. Everything had stopped until we were eating when it started up again. This would be the pattern for the next 5 days. Nothing until 9 or 10am then 10-20 minutes apart for a few hours building in strength until the early evening when they were down to around 8 minutes apart and strongest. Then by late evening they would fade off to one per hour overnight. Each day I would get a call from Maggie, Melissa’s midwife to see how things were going. We had discussed going in for CTG and VE if the contractions were down to 5 minutes and really strong.

By the Saturday I was getting tired and a bit worried about what all this activity might be doing to our baby. After shopping with Sarah and Alice for a few hours Sarah thought we should go into Women’s Assessment to see if things would progress and how far along my cervix might be. She had seen first hand what the contractions were like and on that day they were down to around 5 minutes apart for most of the day. Ed and I arrived at WAS around 7pm and were taken through to be hooked up to the CTG. I was monitored for around 40 minutes and had contractions between 8-13 minutes apart but not strong.

It was very odd to have Ed seeing the contractions while I was experiencing them. It was like I couldn’t hide and involuntary body function from him and it gave me the giggles. The midwife came back in and said that I would know when I was in labour as I would loose my sense of humour! She did a VE and had trouble finding my cervix – apparently it was high and behind the birth canal. She announced “only 1 cm if that” dilated but fully effaced. She called Melissa and we were sent home. I was a bit deflated, as I was sure I was further along than this.

It also confirmed to me that VE’s were not going to help me as I would indeed get caught up in expectations of progress and that my birth plan of not having VE’s was the way to go for me.

The plan now was to wait until things kicked off more or to get to the Monday which was my due date and if my cervix was favourable Melissa would do a Stretch and Sweep.

Sunday was uneventful and indeed probably my most restful day contraction and activity wise. The calm before the storm…

Monday was my due date and so Ed and I went in to see Melissa and she found that I was 2-3 cm and fully effaced so proceeded with the S&S at 10.30 am. That was painful and felt like bad period cramping. However she didn’t have trouble finding my cervix and said that she was surprised that the midwife measured only 1cm and she was surprised to have not seen me in labour on the Sunday.

Contractions that morning were already started around 10minutes apart so after the S&S I thought Ed and I should go for a walk around Ashford before going back home – just to see how I was feeling. I had a couple of contractions within minutes of leaving Melissa’s which felt decidedly different than all the preceding ones. Deeper and more painful. (This is probably when actual labour started for me.) So we decided to go to Glenelg for a walk on the beach and an early lunch rather than head straight back home to Sellicks. Mum had Rommy so he was ok.

By the time we got to Glenelg the contractions were around 5 minutes apart and taking a fair bit of my attention to get through. We found a good fish and chip shop and had takeaway sitting in the shop – contractions now needing me to breath through and coming 4 minutes apart. We went for another stroll and I found that I had to lean against Ed or the shop fronts to breath through the contractions and they were regular at 4 minutes lasting around 1 minute. No point going all the way home so I called Melissa’s rooms and the WCH and Sarah and Mum to update all that we were heading in to WCH.

The contractions in the car were very hard to cope with as sitting down was not an ideal position (good thing we weren’t driving up from Sellicks!). Ed dropped me off at the entrance to WAS just as another contraction came and so I leant up against a pylon and moaned while it lasted. It was now 12.30. A woman came out and asked if I was OK and if I needed her help – very sweet but I was nearly at WAS. I had to wait for a few minutes with other women – I seemed to be the only one in labour and I had three contractions while waiting to be called in. I was taken through to an assessment room where a MW and student started doing my obs. They put the CTG on and left Ed and I to it but the trace was hopeless and so didn’t show all the contractions I was obviously having. The student asked permission to do a VE, which took ages – she pronounced me 2cms and mostly effaced. A contraction started while she was still examining me so I asked her to stop. I had quite a bright red show after the exam.

They called Melissa and she suggested I be admitted to Antenal-Gyney ward as I was only just in labour and as it was my first this could take quite a while. The MW went to arrange this and by the time she came back my contractions were far stronger. Her words were “Jeez you are cracking along aren’t you? Lets get you up to the delivery ward.” So up we went. By this stage I had chatted to Sarah again who had left work early and was now in North Adelaide. She hadn’t wanted to invade our privacy but I wanted her there now.

We got up to delivery and I ran into our neonatal physiotherapist Bec. Had a lovely chat between contractions and then in we went. I waited at the nurses’ desk for the MW to decide on rooms as another contraction took my attention – just as Sarah walked in (in uniform).

The room we were assigned was the same room that we had with Roman’s birth. I recognised it straight away and said – the MW’s offered to change rooms for us but I was really ok with birthing in the same room that Rommy had nearly been born in.

It didn’t really matter to me when we got in that there was no bath. I was never fully wedded to the idea of a bath as long as I could use the shower.

The main event
Our MW was Corrine.
By now it was 2pm. Ed, Sarah and I got settled into the room and Corrine looked over our birth plan and chatted with us for a bit. She then did a palpitation and a CTG trace and I agreed to wear the portable unit for a while.

I sat at the window and used the stress balls against each other and on the windowsill while looking out at the big palm tree in the parklands. Corrine asked me to describe how much of the pain was coming from the front and how much from the back – at that stage it was 50/50 but it soon changed to being all at the front, when I told Corrine she seemed comfortable with that and commented that it was cervix pain.

There was no bath in the room so we decided to try the shower. Sarah set up some towels for my knees and a chair for me to lean against and Ed tried to work out the temp which was being problematic. I moved into the shower with my elbows on the seat of the chair and my knees on the towels. Ed aimed the water over my back and I also tried the fit ball with the water on my tummy and back. A Dr came in and put in the Jelco, which was FOUL, and hurt. We had to stop once or twice for contractions. Poor Dr, I think it was as bad for her as it was for me, but it needed to be done. She also needed to draw blood to do cross matching and was not sure that she had enough and was talking about putting in another needle to get more blood when she caught my expression and decided that actually she did have enough.

I was reminded by Sarah to have a wee and so sat on the toilet and had a contraction there – I can see why women want to labour on the loo, the height and freedom of letting it all go while on the loo was great. Sarah was great in reminding me to make my sound go down into my belly rather than up high into my throat. It helped me focus and not get panicked by the strength or frequency of the contractions. There were by now lasting around a minute and coming every 3 minutes. Not much of a break between which surprised me. It was good though because it meant that I couldn’t spend too much time in my head – my attention was all consumed by moaning out the pain.

Apparently I spent around an hour in the shower, but it certainly didn’t feel that long. Unfortunately I also vomited in the shower – lost all my lunch and the fluid that I had been drinking. It hurt my throat, which made the moaning harder for a while.

The contractions got very strong in the shower and Sarah has said since that she thinks I was in transition in the shower. I was quite cold and so Corrine suggested hot blankets and Sarah suggested laying down on the bed for a bit. I held onto Ed and lay under hot towels while being hooked up to the CTG but it was soon very clear that laying down or sitting was not how my body wanted to labour. The hot towels were heaven though and I remembered Birth Skills enough at that point to rub one leg up against the other to offer a distraction to the contraction.

When I came out of the shower I couldn’t find a comfortable position and was quite restless, this made me feel a bit panicked that I wasn’t going to find my groove or get into a position that I could hold.

Ed had shown me all my affirmations one by one and I had nodded or shaken my head to indicate weather or not they were going to help me. Then he arranged them on the floor near the birthing bar and bean bag. I did glance at them but basically I kept repeating “open” to myself during contractions and that seemed enough. I didn’t have time to think about other props or strategies as the contractions were taking all my effort to moan through and then I instinctively rested between them.

Ed was always there on my left side during any contraction and I held/squeezed his hand very hard to get through contractions. Sarah was also important for me to be able to hold onto.

The Birthing Bar had been set up for me and so; in my black and white leopard print knickers and Sarah’s birthing top I got on the bar and leant over it. We adjusted the hight after a few contractions and I was able to use the bar for quite a while. I circled my hips with each contraction and moaned and yelled out the pain.

At some point while on the birthing bar I asked Sarah for some gas to help with the pain; she said that I didn’t need it(!). That was actually what I needed to hear. Apparently I asked Sarah for the gas twice and when she told Corrine that I had asked a second time Corrine said “we will know when she is serious”.

Sarah got me some Rescue Remedy to put under my tongue. I had been sipping on it in my water and it felt good to have something to calm me down. Sarah also got the face washer with the oil on it. That was nice but not a strong enough distraction.

At this point I was really wondering what “stage” I was at and was tempted to ask for an internal or just to ask Sarah or Corrine if they thought I was at or near transition as I didnt have a clue and wanted to know if I was progressing as quickly as it felt like. Sarah read me well and just encouraged me gently. I was so tempted to ask for a reading of where I was up to – but I knew that that would mean that I would open the gates of my thinking mind and then need more and more information from others rather than allowing my body to lead me.

Contractions were pretty intense by now and then suddenly I felt an amazing pressure in my bum. I responded by yelling really loudly through the contraction. I yelled out “PRESSURE” and Ed thought I meant that he needed to increase the pressure he was using on my lower back! Apparently this is where Sarah went to seek out Corrine who was making a cup of tea and when Corinne saw Sarah she said “was that her?” and then they both came back in and Sarah suggested a position change.

Through each contraction Ed had held my hand and rubbed my lower back. While on the birthing bar things changed which I now realise it was the baby moving down into my birth canal. I responded by starting to grunt a little at the end of the contractions and also to bite! I have left my teeth marks in the top of the birthing bar (I had the presence of mind not to rip it too badly) and poor Ed nearly lost his thumb. With one of these contractions I remember thinking that it was really big and exclaiming “Far Out!” after it – that raised a giggle from Sarah and Corrine.

Sarah suggested we take off my knickers and that I move onto the bean bag. She thought I should let my bum and hips/pelvis relax and open. I had felt myself tense my bum and legs with each contraction while using the birthing bar and Sarah had noticed the same thing and thought I needed to relax that area to facilitate birth.

Getting onto the bean bag wasn’t easy! And laying my head and chest onto the bag and relaxing my pelvis with my legs drawn up and under me felt very exposed but I made a conscious effort to go with it as I knew I needed to relax all those muscles.

I can’t remember deciding to get onto the bed for delivery – I think Sarah suggested it. The beanbag wasn’t overly comfortable and I was definitely getting the urge to push. Corrine checked with me a couple of times about did I feel like pushing and I told her when I did. Corrine also offered to do an internal to see how I was going if that is what I wanted, I think it was when I was on the birthing bar. I really was tempted too but kept with my plan of no VE’s and felt very pleased with myself that I had made that decision.

Corrine also checked the baby regularly with the Doppler and at one stage asked me to wear the portable unit but she made it clear that if I didn’t want to I didn’t have to. But I wore it for a while. I can’t remember taking it off but it did come off at some stage. Corrine was very unobtrusive in using the portable Doppler to check on baby’s heart rate. I hardly noticed but apparently towards the end (after the waters had broken) she used it nearly continuously.

Sarah and Corrine had set up the bed for me. I hadn’t been involved in deciding on the birth position but as I had been upright and leaning over for the later stages of the labour this is how they set up the bed. They had dropped the bottom of the bed away and brought the head of the bed up past 45 degrees to nearly upright. I then kneeled on the bed facing the back wall with my chest leaning into the top of the bed and my arms over the end of the bed. I also had a pillow under my arms. The end of the bed had great handholds on it so with each contraction (now pushing contractions) I pulled back on the right hand side (near Sarah) and held on to Ed on the Left.

Sarah suggested I take off my t-shirt at this stage as the birth was close and I would need to be naked to have skin to skin. I think she asked my a couple of times which I needed as I was in labour-land and it was hard to get motivated to do anything else.

The feelings in my body were extraordinary and clear at this stage. I definitely felt the undeniable urge to push – more like my body was pushing I just had to go with it. I felt the baby move through my pelvis. That was amazing the most unreal feeling of a large, hard object moving down through me.

I was pushing when my waters broke, I had completely forgotten about them! There was a “pop” and a big gush of fluid out of me. It was quite dark with meconium and so Corrine had to ring Melissa to advise her. That was just before 5pm and Melissa was already on her way – but so was the baby! As I had forgotten about the waters when they went I was a bit surprised and so Sarah told me what had happened. I looked down and saw a huge puddle on the bed between my legs and also saw that it was a green-brown colour. This freaked me out of bit but I kept focussed. From this point Corrine used the Doppler continually but only between contractions. Sarah asked me if I felt some release with the waters breaking or a reduction in pressure but I didn’t.

I have heard people describe the “urge to push” and also talking about “how to push”. For me it was my body pushing him down and I had no choice about whether or not I wanted to assist my body with extra pushing effort as my body was already pushing as a reflex action. It wasn’t as if I had a choice in whether or not my body would push – it was doing it already. My body started the push and I was overwhelmed and carried into the pushing effort. It was odd to feel the first pushing sensation as my body started to push the baby out. It was a very familiar feeling and I remember being struck with a sense of knowing what to do. I had anticipated needing to be taught and coached in how to push the baby out (coffee plunger) but it was like a deeply buried memory that was resurfacing.

When I was pushing I felt the baby moving down into and through my vagina, I also felt him slip back a bit with each push, but not much. Suddenly there was a change to the feeling and it went from deep, grunty contraction to a sharp external pain and I called out “OWW”, this was crowning and I knew it. Sarah asked if I wanted to reach down and touch the baby as he crowned but I didn’t. Corrine and Sarah (who had been shifting between head and tail) both told me to pant. I did but couldn’t hold back and pushed his head out. Then there was a really odd moment when his head was born but I needed to wait for the next contraction to birth his body. I remember being very alert for this and asked Sarah “so now I just wait for the next contraction?”. It just seemed so odd to be kneeling with a babies head out of me and the rest inside just waiting. It seemed to take minutes but Sarah thinks it was about 30 seconds for the next contraction to hit and for him to be born.

I picked him up from between my legs and turned around to lay back and cuddle him. We left the cord to stop pulsating. I delivered the placenta without any assistance.

About five minutes after birth Melissa arrived having been stuck in traffic and not expecting me to progress so quickly. She was very sorry to have missed the birth but got right to work in stitching me up.

The stats
Active labour - 4 hours
Second stage - 10-15 minutes
Time of birth - 5.08 pm
Weight - 4.1 kg, 9lb 1oz
Head circumference - 36 cm plus his fist
Length - 51 cm
Apgars - 8 & 9 (breathing and colour at birth)
Damage - Second degree tear requiring lengthy stitching

Reflections

Ed was my rock and Sarah was my guide.

Ed’s steadfast support and his ability to be there for each contraction and quietly respond to my physical needs was just what I needed. He was gentle in his presence and did not bombard me with questions or assertions.

Sarah was my guide. She gently guided me into new positions as my body needed them and before I realised I did. She also set up all my props and even determined my birth position without overloading me with options and questions. Sarahs gentle reminders to keep my sound low in my belly were both effective and helped me avoid a more panicked tone – something that crept into my voice and my head a couple of times.

Sarah also took photos and some short videos of me in labour and after the birth. These are priceless mementos of our birth. I wasn’t really aware of her doing this during the labour or birth but was directly after.

Not having vigorous or loud coaching or encouragement worked for me. My birth team let me labour and worked around me to facilitate the most useful positions and props.

Not having numbers in my head measuring my “progress” was hard to resit during the labour but I believe it assisted me in focussing on my sensations and keeping in my body and not going into my head. During the labour I wanted very badly to ask for measures of the strength of the contractions as measured by the CTG, dilation from VE’s, time of contraction, length of contractions and the time we had spent in the delivery suite so far and how long Sarah and Corrine thought we would be there for, what stage of labour I was at (was this transition yet) etc etc. It took quite some self-control to not ask for this information and I am very glad I didn’t. The only time I came close was asking for gas – Sarah very correctly read this as a request for reassurance and told me I didn’t need it as I was doing so well.

It was the most amazing experience of my life and I am forever grateful to my wonderful husband and sister.