"Parents are like shuttles on a loom. They join the threads of the past with threads of the future and leave their own bright patterns as they go."
-Fred Rogers

Thursday, July 23, 2009

Another Beautiful VBAC

Here is the birth story of Addie through her mom's eyes:

On Monday, July 6th, I went to my 41 week doctor’s appointment (his gestational 41 weeks based on my last menstrual period, whereas mine gestational 41 weeks was Wednesday the 8th based on ovulation day). I was silly enough to let him start checking my dilation and effacement (out of sheer curiosity) a few weeks before and was disappointed that, at 41 weeks, I still had not dilated at all, though my cervix seem soft and thin (no way to tell if you can’t get inside the inner cervical os to check)-he estimated 30% effaced, baby at -3 station. I called my doula with the bad news and she reassured me that most first time vaginal births do not start dilating before labor begins. That afternoon I went to an acupuncturist and had some electro-stim to try to help labor come on, and went for a 3.5 mile walk to Evanston on Tuesday. The walk seemed to make the baby feel like she lowered a bit more, and I enjoyed listening to my self-hypnosis scripts on the walk, with no distractions. I listened to them every night as I went to sleep for several months, as I used Hypnobirthing as my coping mechanism in labor.
I woke up at about 4 in the morning on Wednesday July 8th with a recurring menstrual cramp sensation…I realized that these must be the notorious contractions that I wasn’t sure I would know when they happened. Sean and I got up and walked up to the beach and through the park and home to encourage things to move along. The contractions were 7-9 minutes apart all day, and didn’t seem to be getting any closer together or strong (though they were lasting 60+ second each). At about 3:30, my fantastic doula, Tricia, advised me that they might be prelabor and not the real thing and suggested I take a bath and have a glass of wine and go to sleep. Before that, I took Gillian to ballet class and walk a mile and a half home to see if it might help move things along. The times I woke up through the night, I noted that I was still contracting, but not with enough discomfort to keep me awake.
Thursday morning, the 9th, I woke up at 6am to a shiny happy Gillian who abandoned us shortly after waking us up (so much that we couldn’t go to sleep to go play with her Nonni-who, thankfully, was willing to stay with us for several weeks to help us out). Around 6:20, I noted stronger contractions that were now 5 minutes apart. I got up and noticed that when I was up and about, the contractions were 3-5 minutes apart. I excitedly texted Tricia with the news and she told me to let her know when they were consistently (for 1 hour) 3-5 minutes apart and lasting more than a minute. I texted her back and told her we would start timing them after breakfast and a walk to the beach. We started timing them at 9:02 am and over the next hour they were all 5 minutes apart or less and all were 60 seconds or longer. We called Tricia at 10:15 and told her we thought this was it. She thought it was a good idea to still go to my biweekly post date doctor visit and get my dilation checked to see where we were in labor (I had one scheduled for early afternoon); she guessed by my behavior and the length and intensity of the contractions that I was ~3cm dilated. We called ahead to the doctor’s office and they were expecting us. My doctor checked me and found I was 2-3 cm dilated and 80% effaced, a huge difference from Monday. I was a little disappointed, but Tricia thought we were going to progress quickly and we went back to our house to labor. We labored on the birth ball for an hour on our return home, listening to the hypnobirthing scripts.
Around 4pm, my labor got increasingly intense after an hour-long shower (which Tricia said could help push me into active labor-and it did) and I continued to breathe and focus on my hypnobirthing scripts. Sean set up a surround sound system in the bedroom with old computer speakers to really support my immersion in them. I managed very well, breathing calmly through contractions as my body continued to open up. Sean helped me labor in bed and on the birth ball, while Tricia reminded me to breathe deeply and helped me labor with encouragement and also added aromatherapy oils to help things progress. At 5 pm, I started having cold and hot flashes and became nauseous. At around 6pm I lost my mucous plug (I had been waiting for that for weeks, and it happened during labor!) and had a lot of bloody show. At about 6:15 pm I got in the bathtub, and it was there that I labored for an hour and began vocalizing. My version of vocalizing (which was completely instinctual and involuntary) was a low “Ommmmmm” sound, which I accidentally discovered released a lot of tension with each contraction. Tricia added oils to the bath and dumped the hot water on my stomach with each contraction, gently reminding me to breathe in deeply, to breathe in and out with long soft breaths. She told me she thought I was at or near transition. My contractions were very intense at that point, some had two peaks, contorting my belly into tight mounds, sometimes for more than two minutes at a time (I now wonder if the red raspberry leaf tea three times a day from week 36 made the contractions super-efficient and intense).
My friend Amanda is a family practice physician and told me she would check my dilation before I went to the hospital to ensure I didn’t get there too soon, and help me avoid medical interventions. She arrived at 7:45 pm and I was really actively withdrawn into myself and away from the world by that time. The seconds and minutes and hours were warped and fragmented and I had no concept of time (thankfully, I know when things happened because Tricia kept excellent notes). Amanda checked my dilation and told me I was 7cm dilated and 90% effaced, my bag of water was bulging, and that it was time to go to the hospital. We left for the hospital at 8:25 pm.
The ride to the hospital was rough, particularly with our post-winter-from-hell pothole ridden streets. I always hate potholes, but I hate them a whole lot more when I am in transition. We arrived after pulling over fairly frequently during strong contractions, and made it there a little before 9 pm. I would think the scene of us entering the ER would have been very Friends-episode-like, with the intensely laboring woman in the wheel chair entering and, upon realizing we were far into labor, the staff quickly abandoning protocol of asking 20 million questions to take us directly to OB triage. We went some crazy back way, all the while, I was “Ommmmm”ing loud and not giving much of a damn who heard me. Turns out Sean knew the registration guy wheeling us there from a playgroup in the neighborhood, which I now find ironic. We went to OB triage, where I gave them a urine sample and got a heplock and undressed. I had the hypnobirthing scripts on in my iPod, and was doing my best to dissolve into, despite the distractions. When the nurse asked me what I wanted to control pain, I said “nothing” as firmly as I could muster. No one mentioned pain medications again during my labor.
We went up to a labor and delivery room, and as I had asked, the lights were dimmed. At about 9:45 I resumed a more focused labor after another check where I was about 8 cm and 90% effaced, with a bulging bag. I labored on my birth ball, I labored leaning on Sean, and I labored on the toilet. At 10 I said “I don’t want to do this anymore” (which I later found out is a very different state of mind than saying “I can’t do this anymore”). At 11:35 I had a spontaneous push and ruptured my bag, and the amniotic fluid went everywhere. I know that rupturing the bag makes labor more intense, but I had already been officially in transition for 4 hours (counting when Amanda said I was 7 cm) and maybe longer, so I didn’t notice if it did get more intense. I find it amazing that some people can fight the urge to push, since my urge was so completely instinctual that I didn’t even feel it coming…it was like when you vomit or have a stomach cramp and diarrhea on the toilet-that kind of involuntary reflex. There was no holding back. When a contraction came, I pushed, HARD. I pushed on my side, on my hands and knees, and semi-sitting/squatting. The baby came fast, and I was surrounded by gentle encouragement…they told me they could see her head, and I reached down to feel it. It was hard and weird and warm, and not part of me. I kept pushing and she crowned and came out in one push at 12:50 am. She was on my chest, and perfect, and beautiful…8 lbs and 3 oz and everything I prayed for. She was pretty phlemy and a little blue, so they took her to suction her (she hadn’t “spent enough time in the birth canal to get that wrung out of her”) and Dr. C proceeded to manually help the placenta out (they did hook up the pit to my GBS antibiotic line to help), and then he began repairing my destroyed perineum. I had third degree tears, probably because of the power of and my inability to control my pushes. It took about 45 minutes for me to get sewn up, and I was shaking from the hormones. When Addie was done getting suctioned, she nursed for the better part of an hour, and she kept me from shaking during my repair. The mood in the room was celebratory-everyone on my birth team knew our first birth story, and every one of them wanted us to have what we wanted. Somewhere, our victory was also theirs, and it was exciting and energizing that we banded together and made it happen.
There were moments of humor, some of which were funny (Dr. C raving about how youthful and good looking my placenta still was-he would have guessed it to be about three weeks younger than it was, or Sean eating a bag of goldfish while watching me get sewn up) and not so much (Sean telling me to “grind it, baby” when I was on my hands and knees pushing- NOTE: TRANSITION IS NOT THE TIME TO MAKE SEXUAL INNUENDOS TO YOUR LABORING WIFE).
After that I was starving (all day I had eaten 2 probiotic shakes, two pieces and two bites of toast, and two bites of banana- the two bites of toast and banana being all I ate after breakfast). Tricia got me a snack box and raided the vending machine for candy per my request, and we rested waiting for a recovery room. At 3, we arrived in our room, coming off our high. This time, my healthy baby slept next to me, and no one whisked her away from me to intubate her in the NICU. This time, it was as it should be. We left the hospital 36 hours later-all of us-me, Sean, and our healthy, beautiful, full term baby.
I did it. Vaginal birth after c-section. And I did it well. It was hard, but the experience is mine and I am proud to own it. I want to add another positive story to those that make a case that regardless of previous complications, our bodies are beautiful machines that know how to have babies. Every woman deserves to see what power she is capable of, VBAC or not.
Self-hypnosis was a very effective coping mechanism for my labor. I was able to control my state of mind and breathe into the surges until instinct took over completely. I never lost control of my labor. I never panicked. I stayed at the center. I thank my preparation and my doula for that.
Tricia ensured I got the birth I wanted. I would never birth another child without a doula. She was calm, reassuring, and is an expert on birthing…birthing is a woman thing, and women need to be with women when they are having a baby. The first time I met Tricia I felt like she was an old friend and I had known her forever, and I was completely comfortable with her. She will soon be off having her fourth baby, and I wish her the best :-). If we do this again, we’ll be calling her for a repeat service!
Dr. C is the best doctor on the planet. He calmly hung back, and let me do my thing. Tricia told me in the hall that he asked her about rupturing my membranes if things didn’t progress, but he didn’t push the issue. How many doctors can hold their desire to interfere and let nature take its course? He is funny, smart, empathetic, and talks to me like a peer, not a patient. It will be a very sad day when circumstances take him out of my life.
I found that I was more internal during my labor and didn’t really interact with the people around me. I didn’t do much leaning on Sean or looking into his eyes, though I was glad to feel his hands on my shoulders or him squeezing my hands during contractions. I went internal early on and stayed there. I suppose that is part of using hypnobirthing in labor.
Labor is surreal…waves of a fascinating kind of pain. You become instinctual. You can’t live in your head in labor or you will panic. You have to journey so far in. I found strength and a rock solid core I glimpsed before but didn’t know the breadth of. That is what is empowering about a natural labor and delivery. I feel like I joined some sisterhood of the ages or something, millions of years of women birthing a species as God intended…it is the proudest and hardest physical work I have ever done. Instead of saying “she was delivered” like I do with Gillian, I say “I delivered her”.
Sean was supportive, positive, and a rock for me during labor. He played the same role in our labor as he does in our life together-he creates space for me to exist and move in. He makes it safe, and he is a guardian. And I am grateful for that.
Suzi (my mother in law; Gillian’s “Nonni”) being here for Gillian was a Godsend. I labored here all day Thursday, and Gillian thought I was at work. We left for the hospital when she went to bed. I have so much gratitude for the help Suzi provided before and after Addie was born.
Lots of stars align to make a natural birth more likely. Addie allowed us a full night’s sleep before she kicked things into high gear. I worked well with my chosen relaxation technique and practiced it for months before the Day Of. I had a doula that was phenomenal. My bag of water stayed intact until I was pushing. My uterine contractions were regular and very effective (again- red raspberry leaf tea??). My baby was in the optimal position. I had people who could help me labor comfortably at home until it was time to go to the hospital, and a doctor who wanted this birth to be what I wanted. I know I am blessed, and I know that God was there.