Monday, March 8, 2010
Eva's VBAC Birth Story One Year Later (The Long Version)
Eva’s Birth Story: When Half Way Around the World is Not Far Enough
I was living in Korea when I got pregnant with my second child. Even though I am eligible to use the US Army hospital, I started my prenatal care with a Korean doctor, because, I thought they HAD to have a better c-section rate and attitude towards natural birth than US doctors, right? Wrong. The c-section rate is higher than the US and my Korean doctor told me that Korean doctors do not allow Koreans to VBAC at all*, but two doctors in two hospitals—only one of which was good for foreigners—would allow foreigners to try. I didn’t want to be at the mercy of one doctor or one hospital’s policy so I decided to go back to the US to my parents’ house and do an HBAC.
The area where my parents live is a very medically conservative area, but there are some homebirth midwives and since there are three fairly large cities within a 2-hour radius, I figured I had plenty of options. I contacted the midwife who would do HBAC and set my plan in motion. I started the Hypnobabies program, was following the Brewer diet (more or less) and exercising. Everything was going well until my 20-week ultrasound where the radiologist told me,”Your baby is breech and the placenta is marginally low-lying, but don’t worry, you’ll just have to have a c-section if it doesn’t move up. And we have to make sure the placenta doesn’t implant in your scar”.
My “Bubble of Peace” (Hypnobabies term) was shattered. How could I have ANOTHER breech baby? How could I have ANOTHER issue that might force a c-section? While you can find providers who will attend a vaginal breech delivery, placenta previa requires a c-section. I calmed myself and researched a bit. I found that there was nothing I could do about the placenta’s location except wait. In most cases it moves up in relation to the cervix and since, in my case, it wasn’t on the cervix, just close to it, that was a positive sign. For my sanity, I set the placental issue aside and focused on the breech positioning.
My battle with breech commenced with chiropractic visits for Webster Technique from about 20 weeks on, daily treadmill walking and Spinning Babies exercises. I added the Hypnobabies,”Turn Your Breech Baby” script and did multiple “Fear Release” scripts. At 28 weeks, the baby was still breech and now in the exact same position as my son had been. I could feel her head and she was not making major movements.
I arrived in the US mid-December and met with the midwife after New Years. The baby was still breech, placental condition unknown. She didn’t seem very worried about it, but I was because the pregnancy seemed to be headed down the same path as my first, which ended in a scheduled cesarean due to breech I was not willing to sit around and hope the baby would turn. My complicating factors, an extremely snowy winter and her already packed schedule led the midwife to suggest I find a new provider. She was not comfortable attending a planned vaginal breech delivery at home and I was not comfortable with hoping for the best in labor and then finding myself out of options.
I started the search for a new provider. The OBs in town were absolutely out of the question for me. I did not believe that I would be truly supported by any of the OBs in town. I called the other well-known homebirth midwife in the area. She was scheduled to be on vacation around my due date so she could not take me on as a client but offered to help in any way she could by ordering ultrasounds or attempting to massage the baby around. I thought about what I could realistically manage with a 2.5 year old, working parents and a husband who was far away. How far would I be able to go? I decided that a 2 hour radius was reasonable: Pittsburgh, Cleveland, Buffalo. I chose Pittsburgh because I went to school there and was very familiar with the area. I also have friends and family there so I had places to stay while I waited to go into my birthing time. I called the Birth Center in Pittsburgh, but they were already full for March births. Then, I found Mr. Midwife, Patrick Thornton, a solo-practitioner midwife in Pittsburgh whose own wife’s homebirths of their children had inspired him to become a midwife. I think he felt sorry for me and agreed to see me and help schedule an ECV (External Cephalic Version) at Magee-Women’s Hospital. I also contacted the new homebirth midwife in town and set up a consultation with her.
In the meantime, the weeks continued to pass as I trudged through the snow with my son to the chiropractor ("firecracker" as my son called him), walked on the treadmill, cat-and-cow, breech tilt, hot pack/cold pack, flashlight, music, knee-chest, etc. Do you know how difficult it is to do moxibustion in winter? I tried it in the bathroom with the exhaust fan running and the window open and the house smelled like my stoner (college) neighbor’s ash tray for more than a week. Since I was staying with my parents, I couldn’t subject them to that. I was able to do it at a friend’s house, but it was a hassle to get over there to “smoke my toes” .
Nothing was working. Nothing was changing. Nothing was happening. I met with another homebirth midwife who was new to the area and while I liked her, she was not comfortable attending a planned breech delivery. She tried to massage the baby around a bit, but baby didn’t move. She told me that she would be willing to let me labor and if the baby didn’t turn in labor I could just head to the hospital for a c-section. While I really liked her as a person, I just did not have faith that the baby would turn in labor and didn’t want to leave it up to chance.
Then, I met with Patrick. He was very interested in what I wanted. I told him that I wanted to get the baby turned because I felt my options depended on whether she turned or not. He was very clear that he does not support homebirth for VBAC, but said that it was my choice and he would do what he could to support me by arranging the version and we would talk about the rest afterwards if I wanted him to attend me. He also said that one of his clients was going to have a vaginal breech delivery with his partner doctors at Magee and that he would arrange a consultation for me if the ECV did not work. The prior cesarean would be an issue, but if baby was the right type of breech and we passed the other criteria that they might be willing to take me on.
He scheduled an ultrasound for me at Magee on a Friday towards the end of 35 weeks. They did a full anatomy scan since they didn’t have any scans in their records from before and told me that the placenta was right where it should be. Everything looked great, except that she was breech. I drove home full of hope: Obama won the Presidency, the Steelers won the Superbowl, so the version had to work!
My version was the following Wednesday. My mother drove down with me so she could watch my son during the procedure and drive me back home. We checked into the hospital early in the morning. I was put on a monitor by friendly nurses. Then the doctor came in to talk to me. He was calm and relaxed. He had some other things to do before he got to me and apologized for the wait. My midwife had told me to be prepared to be there all day, so I was ready. Later the resident came in and explained the risks and had me sign the papers. I put on my Hypnobabies tracks and relaxed myself.
Finally, it was showtime. The doctor started to coach the resident through the process. I thought to myself,”This is the first time she has done this. I will not panic. He is teaching the next generation. If she can’t do it, I believe that he will. Relax. Peace.(Hypnobabies cues)”. They slathered up my belly with goo and pushed. They lost their grip and tried again. It was uncomfortable, but not the horrendously painful experience that so many people described it to be. And it was short. Within a minute or less, it was done. The doctor held the head down for another minute or so and the resident asked,”How long you do hold the head down for?”
He responded,”Ideally, the next three weeks!”
I was sweaty and faint from being on my back so the doctor got some cool wash cloths for me. I asked him if there was anything I could to make a difference in keeping her head down. He said, “Not really, but if they are going to turn back, they usually do it right away.”
He then said, “Everything looks good, but it is my policy to keep you on the monitor for 2 hours afterwards. Just to be sure.”
I spent the next two hours sitting up in the bed on the monitor and telling the baby, “Please stay down.” As soon as I stood up to leave, I felt the difference. She felt much heavier than before. I emerged into the waiting room to see my mother and son and said, “It worked! Let’s go to Primanti’s for lunch”.
I kept feeling her butt to reassure myself that she was still head down. Then it hit me: I am going to have a baby soon! She was head down so I could plan! I hadn’t packed my hospital bag or hired a doula or even chosen where to have the birth.
I decided to stay with Patrick and birth at Magee. Even when I was planning a homebirth, I had a dream that my baby was born very easily, but at the hospital. My gut told me to go with Magee. I went to school in Pittsburgh so the drive to both Patrick’s office and Magee-Women’s was autopilot for both my mother and me. Patrick agreed to use my first ultrasound date of March 9 instead of the LMP date of March 6 because I have long cycles. His plan was to let me go until 42 weeks and then induce. My induction date was March 24. I was just praying to go into labor on my own before the 20th so I didn’t panic.
As for the VBAC special requirements, Patrick wanted a heplock in the forearm and continuous EFM. I told him that I was concerned about the continuous EFM because it could limit mobility and I was worried people would be hovering to find something wrong and swoop down on me to take me into surgery. He said that his job was to monitor and mine was to labor and that he would make the adjustments to get the readings and I could do what I needed to do. I decided to trust him. He had a good reputation for VBACs among the Pittsburgh doulas and I felt that my options were very limited at this point in my pregnancy with a 2.5 year old son, working parents and a husband far away. I felt good about him and it felt right to birth in Pittsburgh, so I went with it.
Then, I hired a Pittsburgh-based doula. I loved my doula from my first pregnancy, but felt that asking someone to drive two hours to the hospital in winter would complicate things too much. I met with my new doula after my 38 and 39 week appointments. She was not a Hypno-doula, but I gave her the Hypnobabies Birth Partner guide to look over so she could support me.
At my 39 week appointment, Patrick asked me when I planned to start staying in Pittsburgh. I told him, “After my 40 week appointment.”
Then he instructed me to go home and choose an Erie hospital to go to as a back-up in case I didn’t think I could make it to Pittsburgh on time. I said,”OK, but do you really think it will be that quick? I’ve never had a real contraction before. This is my first labor.”
He replied,”Well, I always felt you’d go quickly, but I guess there really isn’t any basis for that. Still, it is better to be prepared.”
I drove home and started packing my bags and cleaning up. My mom said,”Oh no, she’s cleaning!” (True, it is a rare event).
On Wednesday, March 4, just days after my 39 week appointment, I took my son to preschool and went walking at the mall with other preschool moms. After our walk, I got a call from the school that my son had diarrhea and had to be picked up early. I took him home and then went to my last chiropractic appointment. My chiropractors were very supportive and very pro-natural birth. Even though the baby did not turn, I figured the adjustments had to be doing some good. We talked and I joked,”If there is anything you can press to get things going, feel free.”
He laughed and said,”If only…”
My son started to perk up towards the end of the day and then I started to feel sick. I had gas pains and loose stool all night, about on the hour. One of those late night potty trips I glanced at a brochure from my doula titled, Early Signs of Labor, and “loose stool” was listed. Still, I dismissed it as another round of the preschool plague where illnesses seemed to hit my son and then hit me.
The next day I just didn’t feel well. Ian was feeling better but still had diarrhea so I kept him home. We just lounged around the house. I talked to my husband on the phone throughout the day. He was working in DC to be closer to us for the birth (than Korea). He had been planning to drive up to Erie to stay after a job interview in Virginia in the morning of the 6th. I told him that I was beginning to think that something might be happening. Finally, at 4pm, he called to say that he had canceled the interview and was leaving for Erie.
My mom came home from school shortly after and I took my third shower of the day. I told her that Curt was coming home because I thought “something might be happening because I was having these weird gas pain-type things”. My mother instructed me to time them and after timing for an hour in between getting dinner ready for Ian, we could see the “weird feelings” were 3 minutes apart. So at 6:45, we left for the hospital in Pittsburgh with no way to contact my husband because his cell phone didn’t work in the US.
My dad and brother put the best of their military training use as we left them with a 2 year old with explosive diarrhea. I put my iPod on with my Hypnobabies tracks and laid down on the floor in the back of the van. The two hour ride passed very quickly thanks to Hypnobabies. I called my doula and told her to meet me at the hospital and that my plan was to check into one of the nearby hotels if I wasn’t that far along. I called my midwife and he did not call back. I called back later and a woman answered the phone. Apparently, he had forgotten his phone at the hospital but was on his way to get it. I told the nurse to tell him to stay at there because I was coming in. Then, I got a call from Patrick, after that, I just focused on Hypnobabies.
Kelly, my doula, met me in the waiting area of L&D. I had to check in which involved answering a lot of questions that I had already answered when I was there for the ECV, but no matter. I dropped to my hands and knees during my pressure waves. By this point, there was no doubt I was in labor. Still, the pressure waves were very manageable.
Finally, a triage room opened up and I went inside. It was 9pm. I threw off my clothes, gave a sample (I don’t know whether they needed one or not but when you are pregnant and see a pee cup it is a reflex to fill it). I got on the bed to be checked and Patrick started laughing,”You are at 8cm!” The on-call OB confirmed that the baby was still vertex by a quick ultrasound and we waited for a labor room to open up. Both Patrick and Kelly told me that they did not think I was going to be admitted. Hypnobabies. It works!
Once we got to our room, my mom went to get my stuff. I had packed for every contingency, but I did not pack for a fast labor. Most of the relevant items did not make it up to the room. (Next time, I will have an escape pod with the most important items).
I labored on my hands and knees and a bit on the birth ball. Kelly, Patrick, the baby and I were a well-oiled machine. Kelly pressed and massaged my lower back and although, I didn’t have pain there, her touch was very reassuring. The pressure waves were very manageable. There were just a few that made me yelp a bit, but Kelly and Patrick kept me focused. I definitely felt the difference when my Hypnobabies track ended and I didn’t restart it. I went to the bathroom a few times and the last time I wanted to take a shower. Patrick said that he wanted to do a cervical check then put me back on the monitor for a few minutes before I got into the shower. Well, when he checked me, my water broke all over the bathroom floor and I was complete! I ditched my plan for the shower and went back to the bed. I saw the clock as I went back towards the bed:11 pm.
Pushing did not feel like I thought it would. It felt like I was pooping. I put the Hypnobabies Pushing track on and pushed on my hands and knees. I did not felt the ring of fire. I didn’t really feel her come out, but Patrick said, “Reach down and pick up your baby.”
At 11:26 pm, I picked her up and was amazed that it had been so easy. I also double-checked to make sure she was a girl! I held her close to me and then I cut the cord myself. Her cord blood was collected for donation and she latched on right away. She fell asleep shortly after and Patrick was stitching up the 2nd degree tear. I handed her to the nurses so they could do their assessment (which they did in the room) so I could focus on staying relaxed for the stitches. She was 7lbs 11oz and 19 inches long (though I think they didn’t stretch her out all the way).
My husband arrived in Erie at 11pm. My dad turned him around and he made it to Pittsburgh at about 12:45am, just in time for everything to be cleaned up and beautiful. We stayed up all night just looking at her and watching her sleep. The lady came in with the paperwork for her birth certificate and social security card and so we finally decided on her name: Eva Mahassen. Mahassen is after a wonderful woman in Egypt who acted like a mother to us when we lived there.
After my son was born, I felt he was a beautiful little alien and that I didn’t really know him. It took a few days to process that he was mine. I was interested in him and happy, but I didn’t feel that strong attachment right away. I thought the delay was due to the c-section because I was detached from his birthing. However, I felt the same way about my daughter and I birthed her myself without drugs and really followed my body. It is not a bad thing since both times I seemed to have post-partum elation during what is often the “baby blues” or post-partum depression period.
The more time that passes, the more I treasure Eva’s birth. I was supported, not sabotaged. My body was able to do what it wanted to do. I was not rushed by AROM or Pitocin. I was not slowed down by an epidural or unnatural positioning. I just did it.
After hearing some horror stories at ICAN meetings after my first, non-traumatic, dare-I-say, easy scheduled c-section, I felt trapped. I wanted to avoid another c-section for my health and the baby’s health but I didn’t want to feel as badly as some of the women who shared their stories and who doubted themselves: If I had only switched providers, refused induction, refused AROM, refused pitocin, changed positions, held off from getting the epidural. I didn’t want to feel that way about myself or my baby’s birth and started to think a repeat scheduled c-section would be preferable. Still, I wanted to give birth so I decided to make a plan to give myself my best shot. Let’s face it, there is an element of luck involved that cannot be controlled. But there are things that you can control:
1. Choose a supportive provider. I mean, someone with pompoms that jumps up and down and says,”Go Girl, you VBAC!” OK, they don’t need pompoms, but check out their reputation, ask about their VBAC rate and VBAC success rate. Talk about birth plan elements EARLY. Most providers want to wait until the end, but it is much better to have the discussion in the beginning, especially for a VBAC. Don’t assume ANYTHING, no matter what kind of provider you have.
2. Prepare your mind and body. You prepare your mind by working through the issues and fears surrounding your previous births. Hypnobabies is great for this. It will also help you stay relaxed and focused which will reduce or eliminate pain. Read and watch positive birth stories/videos and avoid horror stories. For your body, read about Optimal Fetal Positioning and work towards it from the beginning. Exercise and eat healthy foods with adequate protein and salt (Brewer Diet)
3. Create a birth plan that covers everything from your ideal birth to a c-section. If you have a c-section there are still choices you can make and preferences that you can express.
4. Hire a doula. The best money you will spend. If your partner turns out to be a labor support genius, the doula can still add a lot of value to the experience by helping your partner help you, getting food, taking pictures, keeping the family informed and helping you advocate for yourself when things don’t go as planned.
For those of you who VBAC or have a wonderful natural birth experience, tell your story. Obnoxiously. Tell it. Tell it. Tell it. Many people will be bored by your story. Others will be annoyed. But among those pregnant strangers you tell in the grocery line, there will be someone who needs to hear your story. They need to hear stories like yours to combat all the horror stories that people seem to LOVE to share. They need to hear your story to know what is possible. They need to hear your story to know who can help them birth their babies in a calm, beautiful natural way.
And, you never know who is listening and how it will make a difference.
*I have since found out that this is not true and there are more VBAC options than I was told, but it is true that there is a very strong pressure towards repeat cesareans.