Attention JannyLiz - re VBAC OB query

Thank you (I glossed over the forum rules as I had two small people bugging me! :redface:)

:

My "VBAC" story Anne
May 27, 2009

Anne birthed her second child in October 2008 via a successful VBAC. Baby Lauren was born weighing 5.76kgs! Anne shares her story with the * community, and those seeking information and inspiration about having a VBAC.

What was your experience?

I had a VBAC (wow, I still can't believe it!). My first child, Claire, was born by an Elective (how I hate that word!) Caesarean with the reason given being 'High Head' (her head was not engaged in my pelvis) at full term.

My obstetrician (OB) for that pregnancy definitely preferred caesars over vaginal deliveries, and looking back on the experience he began the long process of setting me up for a caesar at my very first appointment. By the time I reached full term I was an emotional wreck and although deep down I knew I didn't need a Caesarean (and I certainly didn't want one!) I had been so disempowered and left so self-doubting, emotionally eroded and vulnerable that I felt I had no other option.

The operation itself was straightforward and I was delighted to finally meet Claire, but the initially good start to the recovery was complicated by a severe urinary tract infection (UTI) which left me suffering alternate sweats and rigors within a few days of going home. I was supposed to be caring for my newborn daughter and I was the sickest I have ever been in my life.

Another overriding memory I have is from the surgery (I struggle to call it a birth) is from when I was in recovery. The foot of my bed faced the main thoroughfare through the ward, and there was a male patient in the bay next to mine. The OB came in to check on me and without closing the curtain around the bed, pulled the sheet down to my ankles and the hospital gown up to my neck in order to palpate my abdomen. There I was, basically naked, legs still wide apart and paralysed from the epidural, visible to anyone who cared to glance my way. I have never felt so degraded and humiliated in all my life. I was so stunned that I couldn't even say anything. The nurse apologised profusely and I remember trying to shrug it off. It wasn't until months later that I got angry. I got very angry.

Someone once commented to me "Your caesarean ate you alive" and I think that is the most accurate way I've ever heard it described. I was utterly consumed by the quest for how I could avoid another caesar unless absolutely necessary. I admit that I am envious and somewhat puzzled when I hear women say they enjoyed their Caesarean experience. Mine was not something I could say I enjoyed, and I feel sad and guilty that it tempered the joy of the arrival of my firstborn child to such an extent. It was also the major contributor to postnatal depression for a number of years afterwards. Indeed, I would go so far as to say that the depression lasted until after my second daughter, Lauren, was born by VBAC. The contrast of how I felt after the two births was amazing.

How did you feel about the process and outcome of having a VBAC?

Looking back, every aspect of my VBAC seemed exhausting and full of nervous energy. From the long task of finding the right caregivers, to learning to let myself trust them, learning to trust my own body, and then learning that to succeed I had to let go of my hard won control, to exercise that trust and just give myself over to labour and birth.

I was very nervous about the birth. Not only had I not experienced so much as one labour pain with Claire, but my previous OB destroyed a lot of the trust I had once had in my body and its ability to give birth. I had no idea how I would cope with the pain, and if I would have the mental, emotional, and physical stamina required to get through the birth process. I had to give it my best shot though, as my husband and I felt that this would be our last child and so my last chance to give birth.

The last trimester was very difficult. I had dreadful insomnia (getting 2-3 hours of broken sleep a night), retained an enormous amount of fluid, developed a huge and painful oedema at the bottom of my bump, and was plagued by restless legs. I was enormous, tired, emotional and often extremely miserable. I looked forward to meeting my baby, but felt my chances of a VBAC were slipping a little further away every day. Rachel, my doula, tried to bolster my confidence, lending me books and birth DVDs, but I struggled to motivate myself to delve into them. I think I was in a self-preservation mode, trying not to get my hopes up, and to reconcile myself to the possibility of another caesarean.

Despite my misgivings, I started l started losing my mucous plug very early in the morning on the estimated due date (EDD), with contractions starting a few hours later. I was so excited! But the contractions were irregular and I ended up with four days of intensely painful posterior pre-labour with about eight hours of sleep in total. On the morning of the fifth day, my father ended up in hospital with chest pains, and I actually decided that I would ask Dr D for a repeat Caesarean when I got to my appointment that afternoon.

Of course after making that decision, the contractions almost immediately became more regular, frequent and intense, and just before we left for the appointment, we learned that my father would be released from hospital that evening, which was an enormous relief. My husband and I made our way to Dr D's rooms, where his quick, painless internal yielded good news: I was five centimetres dilated, fully effaced with waters bulging. So from there we made our way across the road to the birth suite. The maternity receptionist asked if I was in labour and I laughed as I answered, "Yes. Finally!"

The labour and birth were long and hard (I pushed for over three hours) but thanks to the attentive support of my caregivers and being able to have an active labour, it never even occurred to me to ask for pain relief.

The outcome of having a VBAC was hugely positive and in my opinion was worth every step of the long journey to get there. Despite having 2nd degree tearing, I was in minimal discomfit and was able to move around freely to care for myself, my baby and my three-year-old. And the hormone rush was just amazing - I'm not sure I will ever come down from that high! How I felt after the VBAC seems like light years away from the recovery from the caesarean, the difference was immeasurable.

How difficult was it to find medical support?
My quest for the right caregiver for my VBAC started a few weeks after Claire's arrival and lasted for nearly two years. I feverishly trawled the web, attended Birthrites meetings, and read voraciously. I think I have Australia's largest VBAC library! I was frustrated that my caesarean precluded me from so many birth options in Perth, including the Birth Centre at King Edward Memorial Hospital and the wonderful Community Midwifery Program. Some obstetricians were rumoured to support VBAC, but only with myriad conditions imposed, including continuous monitoring, not going past the due date, compulsory epidurals, and no 'big' 8 lb babies. This last one was particularly pertinent, given that Claire was 4608g (or 10lb 2oz) at birth. So, when my husband got work in Canberra, I gladly switched focus.

There, my VBAC options also seemed quite limited, until I posted a query on ** forums. A fellow member, Emma, recommended her obstetrician with glowing praise for his attitude towards VBAC and birth in general. Emma answered my many questions and I couldn't believe my luck; Dr D sounded too good to be true! Shortly after arriving in Canberra I booked a pre-conception appointment with Dr D and began preparing pages of notes and questions. Never again was I going to place myself under the care of an obstetrician who lacked faith in the natural birth process.

I was well prepared for the appointment, but the conversation unfolded so easily and naturally, I never consulted my notes. Dr D seemed genuinely aghast at how I had been treated by my obstetrician during Claire's pregnancy and birth, and was extremely optimistic about my chances of a successful VBAC, even with another big baby. I felt like a massive weight had been lifted from my shoulders. Having an obstetrician view my caesarean the same way I did was a huge vindication of how I felt about it.

During the pregnancy, Dr D and I discussed my hopes and plans for the birth. Much of it did not meet Dr D's "Gold Standard" of VBAC care, but he respected my educated decisions, and was willing to accommodate my deviations. I desperately wanted to believe I would have Dr D's full support, but my experience with my previous obstetrician had left me scarred and sceptical, and I wondered how we would go on the day.

Dr D didn't disappoint. At all times I was treated with the utmost compassion, courtesy and respect, and I am so pleased and thankful that I chose him to be my caregiver. When the first midwife I encountered in the Birth Suite refused to budge from the strict VBAC policy of continuous monitoring and being restricted to labouring on the the bed, Dr D's support meant I had the intermittent monitoring and active labour I had worked so hard to achieve, and best of all I was able to make full use of the shower and the bath.

A change of shift brought an amazingly supportive midwife, Judith, who even offered me a waterbirth! For a VBAC! In a private hospital! Unheard of! Then of course there was Rachel, my fantastic doula, who seemed to know just what I wanted without me having to say anything, and my wonderful husband with his endless jugs of water and just plain being there for me. The journey to find the right caregivers was long and full of twists and turns, but with lots of research, a lot of trust and a stroke of luck, it ended perfectly. I definitely had the right people there with me when it mattered the most.

What would be your advice or suggestions to women considering a VBAC?
A lot of this advice is applicable to all women, not just those considering a VBAC. Do your research and choose your caregiver carefully. No matter what your decisions are, make them informed ones. Don't be afraid to interview caregivers to find out who will suit you best before committing yourself to someone's care.

Not only do you have to have confidence and trust in your caregivers, but you have to have faith in yourself too. Having a caesarean can scar more than your uterus, often there are mental and emotional hurdles to overcome in gaining the confidence you will need to see you through your VBAC journey. Hire a copy of Rikki Lake's documentary The Business of Being Born. Watch DVDs of actual births and read birth stories, get a basic understanding of the 'mechanics' of birth. Identify what will help you learn to trust your body, to believe, no, to know that given the right circumstances and support you are capable of giving birth to your baby. Educate yourself and avoid interventions wherever possible. The dreaded 'Cascade of Intervention' can so easily lead to a(nother) caesarean, so educate yourself about alternatives and discuss these with your support people.

I think another big one from me is not to feel a misguided sense of loyalty to your previous caregiver. If you feel your caesarean was unavoidable and your OB genuinely supports a VBAC attempt then by all means stay with that model of care if you feel it is best for you. But please do your research. If a VBAC is really important to you and you feel switching from the Obstetrical to Midwifery/public mode of care will give you the better chance of success then don't be afraid to change. So many times I hear stories of women remaining with a less than supportive caregiver or being reluctant to give up their private room, even when they know that this means their chance of a VBAC is seriously compromised. Few turn out to achieve their dream of a VBAC. The expression 'Better the devil you know' does not always hold true.

I think based on my own experience, one of the biggest recommendations I would give to someone considering a VBAC (or just aiming for a vaginal birth) would be to hire a doula. A doula is someone who provides various forms of non-medical support (physical, emotional and informed choice) to a woman and her partner before, during and after childbirth.

My husband was initially reluctant to hire a doula. I think he thought that he alone should be able to support me through the labour and birth; that having a doula would be like having some paid stranger at the birth. It didn't take him long to realise just what a wealth of information, support and friendship our doula, Rachel, would provide for us on our VBAC journey. We got to know Rachel, and she us, over several long and leisurely pre-natal meetings. I give Rachel a lot of the credit for my VBAC being such a success. I had a very long and painful pre-labour, and without Rachel's support over that time, I have no doubt that I would have turned up to the hospital too soon and ended up with another Caesarean.

I often hear people say "Oh, I can't afford to have a doula." My response to that is that if you really want the best chance at giving birth vaginally (VBAC or not), with minimal intervention and reduced need for pain relief; to have a positive, empowering birth on your terms, then you can't afford not to have a doula.

What were your partner's reactions/feelings to you having a VBAC?
My husband, Simon, was supportive but had some reservations. After witnessing my depression and self-blame after Claire�s birth, Simon was understandably worried about the potential fallout if I had to have another caesar. I think part of him would have preferred the predictability of a repeat caesarean. There would be security in knowing there would be no middle-of-the-night drive to the hospital, what day and time to turn up, and that there would be that ubiquitous green sheet separating him from the messy 'business end' of birth. But despite that, he was my rock. He fully supported every decision I made throughout the pregnancy and the birth, provided me with a regular rotation of wheat packs, expert application of TENS machine pads and boundless emotional support throughout my four days of prelabour, and poured countless jugs of warm water over my back when in labour. He supported me physically while I pushed our second daughter out into the world, and bless him, he even watched her emerge, despite having looked decidedly pale at that thought when we talked about it prior to the birth and declaring he would stay up 'the other end'! He even cut Lauren's umbilical cord, something he vowed he would not and could not do (he declined to cut Claire's). Simon definitely rode the VBAC roller coaster with me; he saw me at my absolute lowest and at my highest and was there for me through it all. I love him even more because of that; I could not have done it without him. I think the VBAC journey was just as challenging for him as it was for me really, but in a different way, and he is very pleased with the outcome.

Were you absolutely thrilled? Did you regret it? Etc.
Absolutely thrilled doesn't even come close! It was the most amazing experience of my life to date. I still can't believe I did it! (Did I mention that already?)

Some would think Lauren's birth very traumatic, and in some ways it was. After her head was born, it became apparent that Lauren had severe Shoulder Dystocia and it took some serious effort from my OB and from me to get her out. For an absolute eternity of a few minutes, I wondered if I would regret trying a VBAC for the rest of my life if my baby was injured (or worse) as a result of the birth. This had been my biggest fear with attempting a VBAC; that something would happen to the baby. But it ended well, and I gave birth to my second daughter, all 5760 grams of her (at (12lb 11oz, she was the biggest baby born at that hospital last year!) by drug free VBAC. I was, and still am, absolutely thrilled, ecstatic, euphoric, awed, amazed, vindicated, and triumphant! There are definitely no regrets.

The flow-on effects of such a positive and empowered birth experience this time around cannot be overestimated. I feel like I have rediscovered myself; reclaiming confidence, optimism and enthusiasm for life, and I'm even making plans to study again. It has made a huge difference to my family as well; no longer surrounded by the fog of PND I am parenting with much more confidence and I'm even seriously considering having a third child.

Somewhat surprisingly, the VBAC didn't heal the emotional scars of my caesarean experience. In some ways it was like rubbing salt into the wound. I still occasionally grieve for what could have, and should have, been the birth experience with my first daughter. And yet if I hadn't had the caesarean, would I have truly appreciated the everyday miracle of birth, or met the wonderful people I have, or learned so much about myself?

Birth story to follow ...