Drug free VBAC of a 12lb 11oz (5.76kg) baby girl
Hi all,
It was suggested that I post my birth story here for others to read. I wish everyone the very best on their VBAC journey:
This version of the birth story of my second daughter was published in the Maternity Coalition's magazine 'Birth Matters' in June 2009. While it is long, I have left a lot out and it is not the final 'perfect' version that I wanted to post here on *. But I think the final version is too personal, so I have decided to post this one in the hope that other women aiming for a VBAC might find it useful.
Tuesday’s Child - The Epic Tale of a Triumphant VBAC
My darling child,
Looking back, our VBAC journey began even before your sister Claire was born by elective (how I hate that term!) caesarean. I remember thinking (naïvely) as I tearfully signed the consent form, “Oh well, next time I’ll just have a VBAC.” Ha!
That obstetrician definitely preferred caesars, and really began setting me up for one at the very first appointment. I myself had been born by (emergency) caesarean, which just gave him ammunition, despite my mother’s first pregnancy ending in a perfect natural birth.
The emotional fallout of Claire’s delivery had me feeling like my own birthing circumstances would predetermine Claire’s, and wondering whether all my future descendants were doomed to caesarean deliveries. I later found a cartoon that summed this up perfectly. It depicted an obstetrician performing a caesarean on a Russian Matryoshka doll, only to find another smaller doll nested inside. So he performs another caesarean, and another, and another …
I desperately wanted a VBAC, not only to experience it myself, but to prove to Claire that the female body is designed to give birth and that her body wasn’t any exception.
I feverishly trawled the Web, attended Birthrites meetings, and read voraciously. 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, and compulsory epidurals. So, when your Dad got work in Canberra, I gladly switched focus.
There, my VBAC options also seemed quite limited, until I posted a query on an internet parenting forum. 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 (Claire was 10lb 2oz). 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.
You were conceived the following month, and your due date was 23 October 2008. Your Dad and I were excited but nervous. I wanted a VBAC, but would my resolve last through the pregnancy, let alone the birth itself? Your Dad was supportive but had some reservations. After witnessing my depression and self-blame after Claire’s birth, he was understandably worried about the potential fallout if I had to have another caesar. But at six weeks gestation I attended a screening of Ricki Lake’s documentary The Business of Being Born, hosted by the Maternity Coalition, and I knew I had to give VBAC a shot.
I spent most of the first trimester in a haze of constant nausea and utter exhaustion, along with my usual hormone-related migraines. We decided not to find out your gender as I felt I needed some element of surprise, just in case I had to have another caesarean. Above all, I hoped for a perfect euphoric moment where I clutched a gloriously gooey naked baby to my chest, and found out your gender for myself.
Towards the end of the second trimester, I convinced your Dad that we should hire a doula to support us through the remainder of the pregnancy and the birth. Rachel was recommended, and from the first meeting I was confident she was right for us. Rachel never seemed intimidated by Claire’s birth size; instead she told me that my body obviously grew lovely healthy babies. It was a huge confidence boost, and the first of many lessons in viewing my body positively, instead of feeling that it had failed me by growing babies that were too big and needed to be cut out.
Dr D and I discussed my hopes and plans for your 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 most of 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.
The last trimester was very difficult. I had dreadful insomnia, 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 you, but felt my chances of a VBAC were slipping away. Rachel 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.
At 37 weeks, I was dismayed to find that Dr D would not be working the weekend after your Thursday due date. So when I started losing my mucous plug and having contractions early Thursday morning, I was relieved to think you might arrive before the weekend. How naïve I was!
I was in posterior pre-labour for four very long days – a blur of painful back contractions, heat packs, a trusty TENS machine, homeopathy, a frustrating inability to urinate and about eight hours sleep in total. Several times it felt like a progression to real labour, and Rachel would come around, only for the contractions to peter out again. Then, I felt like the boy who cried wolf; now, I wonder if I somehow held myself back, knowing that I needed to make it through Dr D’s weekend off.
My parents had joined us on Friday from Sydney, and did a wonderful job looking after Claire, but their apprehension about my VBAC attempt permeated the house, and after two long days we were all feeling the strain.
My father felt it most of all. He had chest pains on Monday morning, and went to hospital in an ambulance, with my mother in attendance. I was utterly despondent. There we were, still at home with Claire just as we had been four days earlier, and now with my father in hospital as well. I took a deep breath, looked at your Dad, and said the words I thought I’d never say: “At this afternoon’s appointment I’m going to ask Dr D for a Caesarean.” Surprise, relief and then sadness showed in his face before he nodded silently. We hugged and cried for our lost dream.
Of course, 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. Your Dad 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, at 4 pm, 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!”
We were taken to our birth suite, and the midwife organised the initial monitoring. I asked if I could sit on a birth ball while the monitoring was done and was told in no uncertain terms that I had to be on my back on the bed.
The midwife asked what my birth plan was. Damn, I’d forgotten to print it out! I said I wanted intermittent monitoring, active labour, and use of the shower and bath. She snorted audibly and told us if we thought we could do that, we had come to the wrong hospital, and that we should have brought an independent midwife with us. I knew that wouldn’t have made any difference – an independent midwife remains subject to hospital policy – and my heart sank, but I’d come too far to back down now, so I suggested she ring Dr D for confirmation. As we had planned for only two children, this was my last chance to give birth, and I refused to be disempowered again. She left, and your Dad rang Rachel. She was surprised to hear we were at the hospital, and said I had better get used to the constant monitoring, as the hospital would insist on it. I was shocked, and suddenly understood why Rachel kept saying that we should stay home until I was pushing. I clung to the hope that Dr D would be true to his word and let me have intermittent monitoring.
After 20 minutes of monitoring, I told your Dad through gritted teeth, mid-contraction, to get the midwife to remove the monitor before I did it myself. He went, and I wondered how on earth I could get through labour with constant monitoring.
The midwife finally returned and removed the various straps. We mentioned our doula and the midwife asked, rather coldly, where she was. Your Dad replied that Rachel was waiting for us to decide whether we were going to stay at the hospital or return home. It was a bit of a bluff – we were strongly inclined to stay – but the midwife suddenly became much more helpful, and went to phone Dr D.
When she returned, she said I’d have to have 20 minutes of monitoring every hour. I glumly nodded and asked if I could use the shower. The midwife threw a clipped “Yes” over her shoulder as she left, so I quickly got in, leaning on the shower chair and enjoying the warm sensation of the water.
It seemed no time at all until Dr D arrived at 7 pm. An internal revealed that I was now seven centimetres dilated and that my waters had gone. I thought he meant they had broken in the shower but no, as he said it I felt a tiny ‘twang’, followed by the audible sound of running water as a huge volume cascaded onto the bed. I told Dr D I wanted to get in the bath, and he said to go ahead, and that he’d see me later. No monitoring! Ha!
I was in the bath, on all fours with my eyes closed and heading to Labourland, when Rachel arrived at around 7.30 pm. She was delighted that we had managed to bend the rules. “You go girl!” she said, and set about creating the ‘birth cave’ environment we had previously discussed, turning out the bathroom light and burning my favourite essential oil.
With Rachel there, I got right into Labourland, dealing with each contraction as it came, and relaxing into the peaceful void in between. Unfortunately, this peace was routinely interrupted by the midwife wanting to use the Doppler, seemingly always during a contraction. She made me kneel up and lift my oedema for best contact, but she never remembered where your heartbeat was from one session to the next, and we all tensed up when she entered the room. She eventually tried using the Doppler underwater, but each time she moved it through the water there was a pterodactyl-like screech. I found this very distressing, and imagined how awful it must have been for you, tucked away inside me with your cushion of fluid gone.
At about 9 pm, Rachel gently asked me if I felt ‘pushy’. Then, with what seemed like the next contraction, I felt the most overwhelming urge to push! The contraction ended and Rachel quietly suggested that I not tell the midwife just yet, to avoid the imposition of a time limit on my pushing.
About 9.45 pm and another mid-contraction Doppler session was due. But I was over it, and refused to move into position. The midwife was insistent and finally I summoned up the energy to voice a very firm “NO!” Rachel suggested she note down that I had declined this time, but the midwife stayed until it became clear that I wasn’t going to change my mind, whereupon she rather petulantly announced her departure and the end of her shift. “Good riddance!” I said, after the door closed behind her. Rachel and your Dad burst out laughing, which cleared the air and helped us reclaim our space as we waited for the new midwife to arrive.
I laboured on, and in the middle of a contraction I sensed the presence of a third person crouched on the floor between Rachel and your Dad. The contraction ended, and a gentle touch was accompanied by a quiet voice: “Hello Anne, my name is Judith. How do you feel about having this baby in the water?”
I thought I was hallucinating. Was I just offered a waterbirth? For a VBAC? In a private hospital? I was stunned, and I could sense Rachel fairly buzzing with excitement at this opportunity. What an amazing contrast from the previous midwife! A million thoughts were running through my head. “Dr D,” I managed to say. Judith agreed to run the idea past him, and I retreated to Labourland to consider my options.
I’d have loved a waterbirth, but I was worried about another big baby, and the added difficulty if something like a complicated shoulder dystocia happened in a waterbirth. I’d bent some rules, but didn’t want to push my luck. Judith reported that Dr D would support me if I decided to waterbirth but he had some reservations. So did I. Judith explained waterbirth procedure, but as much as I wanted it, I decided I couldn’t risk complications in the water. I knew I had to get out to give birth, and I reluctantly said so, before returning to Labourland.
The contractions intensified, but Judith was confident with the Doppler in the water and I was grateful for not having to move. Judith asked if I could reach inside and feel your head, but I felt as though I couldn’t try. I needed to get out of the bath for an internal, but it was very quick. She verified that I was 10 centimetres dilated and returned me to the bath before the next contraction hit.
Sometime after 11 pm, I knew it was time to leave the bath, and Rachel suggested I labour on the toilet. I was apprehensive about the pain, but it was fantastic – why didn’t I move there earlier? Sitting there, between contractions, all was silent. I opened an eye to find your Dad, Judith and Rachel sitting in a semi-circle around me on the bathroom floor, with Judith shining a torch at my nether regions. “Well, this is a sight I never expected to see!” I exclaimed, making them all jump. “I’m never going to be able to use the bathroom at night again without thinking of this moment.”
Another contraction. Judith told me to push through the burning and stinging, but I wasn’t feeling any. It wasn’t nearly as painful as I thought it would be. So much about birth surprised me.
It became uncomfortable on the toilet. It was too high for my short legs, which kept cramping. Did I want to try the birthing stool? Yes. Your Dad sat on the edge of the bed and I settled between his knees on the stool. The room was bright and cold: out of my cave-like sanctuary, I closed my eyes and inhaled deeply, enjoying the aroma from the oil burner.
11.30 pm. Dr D arrived, and the energy shifted. He was jovial, encouraging and energetic, but I was so very tired that I couldn’t respond verbally to him at all. He joined Judith in front of the birth stool and I felt like I had my own personal cheer squad as I gave my all to each contraction. Now it began to sting! I heard the whir of Rachel’s camera. I wondered if I would ever want to look at the photos.
Suddenly, your head was out! It was actually going to happen – I was about to give birth!
The next contraction came and I gave it everything, but nothing happened.
Judith used the Doppler. Oh sh*t. I heard it straight away; your heart rate had plummeted. My poor baby, what had I done to you?
Dr D told me I needed to get up on the bed, so I immediately stood up and tried to work out how, while your Dad got out of the way. “Don’t sit on the head, don’t sit on the head!” I was frantically told. “Well, help me!” I thought but could not say. Such urgency and yet no one seemed to know what to do. (I learned later that they were all completely stunned that I just stood up and moved, with your head already out between my legs). Frog-legged, I backed up to the bed, felt the metal bar against my buttocks and somehow threw myself back so I was lying across the foot of the bed. The emergency button was pressed: I was vaguely aware of the alarm and the fact it was for me. For us.
It seemed like everyone was holding their breath. I understand now what people mean when they say their life flashed before their eyes.
Next thing I knew, Rachel was on one side of me, Judith on the other and my knees were up around my ears. I recognised this as the McRoberts Manoeuvre. Oh crap. Shoulder dystocia, my biggest fear. Then a contraction. “Push, Anne! Push!” I felt like I was trying to push a grand piano up stairs, and nothing was happening. There were some sharp sensations around my vagina, and I saw Dr D had his hands there. I thought it must be an episiotomy, but it wasn’t – Dr D had inserted his fingers to try and turn you, and I was tearing. “Push, Anne, push! Keep pushing, don’t wait for a contraction! Again, again, again!”
I pushed with everything, but I couldn’t feel anything. “Oh God, please let my baby be OK,” I silently implored. I felt like I was being pulled apart, pushing all the while. Dr D had hold of you and was trying to turn you one way, and then the other. What had I been thinking? I should never have done this. Then it happened, I felt you turn and emerge. Immediately there was an enormous splash, as the rest of my waters fell to the floor.
I did it. I gave birth. But you weren’t crying. Placed on my chest, I marvelled at your weight and your thick dark hair, so much more hair than Claire had. But this was no time for quiet introductions and wonderment. You weren’t breathing, and I was frantically told: “Anne, talk to your baby, talk to your baby!” I touched your arm and opened my mouth to try to talk. You weren’t moving. “We have to take the baby, Anne”. “Yes, yes, GO!” I managed to say. Amid the chaos, Dr D remembered my wish for a physiological third stage, and apologised for having to cut the cord.
They whisked you away to the warming table on the other side of the room and began working on you. It seemed like an eternity, but Judith soon announced, “Everything is OK, pinking up nicely.”
“What is it?” I asked. No one heard me so I asked again. “Is it a boy or a girl?” A girl! “Oh Simon, another little girl!” Then you responded to the oxygen, and started crying. Hearing this wonderful sound, it felt like the whole room finally exhaled. You were going to be OK. The mood lightened considerably, and I was asked if you had a name. After a short hesitation I said, “Lauren. Her name is Lauren.”
At my request, I was not given the Syntocinon injection, but Dr D explained that he needed to help the placenta along. He gently pulled on the cord, and I felt the placenta move down. My breath caught as it emerged; it was enormous. Dr D immediately started explaining it to your Dad and me, as he checked that it came away whole.
“These are the membranes,” he said, holding them up, “and here is where they ruptured. Here is the umbilical cord. This is the side that was against the baby, and this side here was against your uterus …”. This simple act and explanation moved me to tears. It was such a stark contrast to the feeling that I could not even ask to see Claire’s placenta at her delivery.
There was a bustling near the door and Judith returned, pushing a set of scales in front of her. “I have to know!” she said excitedly, “Place your bets!” You had felt so heavy, lying on my chest, so my guess was 5.5 kg. “5760 grams! You win, Anne!” Oh yes, I certainly felt like a winner. A drug-free VBAC of a 12lb 11oz baby! Who on earth is going to believe that?!
Dr D congratulated me, and said “Not only have you got the biggest baby in Calvary Hospital, but you have the biggest pelvis in Canberra! You know, Claire would have just slipped out had she been given the chance.” In the midst of my euphoria, I felt a pang for what my birth experience could have been with Claire. But I refused to let that cloud our glorious day, your birth day.
My darling Lauren, you arrived at 11 minutes past midnight on Tuesday 28 October 2008. A lot of people would see it as a traumatic experience and, in some ways, it was. But it was our experience and it was beautiful. I will be forever grateful that I got to give birth. And maybe, just maybe, I will one day do it all again.
This VBAC didn’t magically erase the emotional pain surrounding Claire’s birth. But 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?
Acknowledgements:
I owe thanks beyond words to my husband Simon, doula Rachel *, midwife Judith *, and obstetrician Dr D for going above and beyond in providing what must truly be the ultimate in ‘Gold Standard’ care. My eternal gratitude also to Emma Davidson (ACT Branch President for Maternity Coalition) whose emails let me dare dream that this was all possible, and set me on the right path in recommending both Dr D and Rachel *.
