Saturday, August 02, 2008

a vbac story

Prodromal labour started at 37ish wks. I was 2cm dialated and everyone (Dr, doula, family, myself) figured baby would come pretty darn quick. It didn't. July 11th we sent Hana to her grandparents and Ben started his parental leave - again thinking things would start soon. We figured this would be the best way for me to be able to relax and prepare myself for labour. I also wanted to labour at home as long as possible, so having Hana underfoot would have been difficult.

And so things remained until my 40wk appointment. At this point I was getting regular strong ctx every night from about 11-2, and also through the day depending on my activity. I was missing Hana like crazy, but it didn't make sense to bring her home as MIL and FIL live 3 hours away, and labour could still start at any time. It was getting frustrating. To top it off, at that appointment the Dr (one in the group I hadn't seen yet) informed me my cervix was still very long. She wanted to induce me that Friday (25th), but said instead I could just go for a NST and u/s and talk with the gyno and go from there.

So thats what we did. I wasn't happy with the thought of induction for a VBAC, but at least they hadn't scheduled me for a section. I spent the days between appointments doing all I could to encourage labour to start.

Friday morning before my appointment I was woken up at 6 by the ctx. These were really strong and unprovoked - that was a really good sign. I put off calling the hospital until the afternoon, just to give as much time as I could for things to pick up on their own.

At 10 the hospital called me and asked I come in at 1:30. We called our doula and let her know - she decided to come with us, just incase they decided to induce. The appointment went really well - the gyno said baby had lots of fluid, the placenta was still working (tho had started to calcify) and that she'd rather have me go on my own than induce me. Still, an induction was scheduled for Monday, just in case. She said I was nice and soft and less than 50% length, so she stripped me and said she hoped I went on my own over the weekend.

After that, I came home and slept, then went for a walk. In the early evening things started picking up again, and at one point (don't remember the time) we decided to call the doula again. I was having trouble focussing through the ctx on my own and thought I could use the help. Around 3 (I think) things started slowing down again and we all slept. By 8 they were back to the ctx I had been having for weeks and we were all tired and exhausted. The doula went home, Ben and I went back to bed.

We woke up at 12, and as soon as I sat up things were much different. Ctx were more intense (not really more pain at that point, just deeper) and coming ever 7 minutes. I laboured on my own between the birth ball, the bed and the shower until 6 - ctx were 5 minutes appart by then so we called the doula back. After she arrived we walked, focussed, massaged and walked more until the ctx were 2 minutes appart - showtime!

We got to the hossy (less than 5 minutes away). I had a ctx in the car when we arrived. I had another in the parking lot and another inside the door of emerg (it was past 8 so thats how we had to go in). Another on the way to the birthing unit and one more when I got settled in the labour room - it was roughly 9 pm. The nurse checked me and I was a "streachy" 3. I had so been looking forward to the whirlpool tub, but had to wait until I was at least 4.

So we walked. And showered. And went on the birth ball. And walked. They checked me at 11 - no change. More walking, more birth ball, meditation, massage. My hips and back had been killing me for weeks (sciatia and an old muscle injury), and each ctx made the pain in those areas more annoying. Pressure on my back and hips during the ctxs helped, but I was really looking forward to that tub. Ctx had slowed to almost 3 minutes, which didn't surprise us. I had to get a hep-lock (hossy policy to have a line available for a VBAC) and two blood draws, and I'm really nervous about needles. Still, we figured slow progress was still progress, so we had the nurse check me again at 1.

And there was no change. I was slightly more effaced, but I honestly think she just said that because I looked like I was going to cry. She suggested we all try to get some sleep.

Yeah, sleep. With ctx coming every 3 minutes. So we tried. Ben and our doula got a bit (they brought in a cot for Ben and there was a reclining chair in the room, it was nice), but I was having issues. Just when I thought I might drift off I had another ctx and felt something move in an odd way. A few minutes later I really had to pee. As I stood up, the room flooded.

Ok, not really flooded, but it was certainly more water than I had expected. After I felt that ctx before I waited for water, but none came, so the realization that yes, my water HAD broken kind of surprised me. So glad this didn't happen anywhere but at the hospital!

So from that point sleeping was out. We had the nurse check me, I was now 3 and a half. Well, at least there was progress. I laboured on the toilet for a while, then the tub, then the shower, then walking, then the ball. My doula kept commenting how great I was doing and how if I could see myself in a video later I'd think it was so beautiful. I told her I didn't think it was very beautiful. The ctx were coming HARD and at this point seemed like there was barely a minute between them. I was having a very hard time staying on top of them and nothing seemed to work.

At 7 I asked for gas and air. I needed something to take the edge off and nothing was working. The gas was nice, helped me relax through the ctx instead of fighting them. I really thought I was making progress. At 9 I was checked - no change. 12 hours of intense labour and I had gone about half a cm. I was not ok with that. There was no way I could keep going at that pace - first of all it was a VBAC and they wouldn't let me. Secondly, my water had broken so I was on the clock (18 hours and baby needs a NICU stay, 24 hours and it's a c/s). Thirdly, I couldn't handle it emotionally.

After the prodromal labour, the lack of progress and how badly I felt I was dealing with the pain, I felt my body was going to fail me and I would end up with another c/s. I was given two options - pit and an epi, or a c/s.

I took the first option - I was wanting a drug free birth, but more than that I was wanting to avoid a c/s (unless medically necessary, of course), so I chose the epi. Ben and the doula were a little surprised and tried to encourage me to keep going, but I knew that just wasn't going to work. 6 hours with no change, even with the gas and working hard to accapt the pain didn't give me much hope against the clock. I have no regrets about my decision.

It took almost two hours to get the epi. There was a miscommunication between the anestatist and the Dr (wonder what would have happened had I needed an emergency c/s....). In the mean time, I kept on labouring, sometimes with the air, sometimes not. Right before they gave me the epi they checked again - 4 plus! We all found it kind of ironic (and sad in a funny way), but I didn't care, I was so looking forward to some relief!

Remember my fear of needles? Yeah, that includes tubes being inserted in my spine. I didn't cry tho, I was just too excited to get a break from the constant pain. It took no time at all to get it in, and it took effect just as another ctx was coming. Bliss.

It was odd being able to move my legs but not having any real control over how far I moved them - different from the spinal for my c/s where I couldn't move at all. I profusely thanked the epidural man - he was my new best friend. Then they got the synthetic oxytocen going along with an IV line. At this point I was happy to have the hep-lock already in, it just made it one step faster and I didn't have to think about it.

Because of my previous c-section I had to be constantly monitoured, so I had a nurse in the room the whole time and was hooked up to the machine. Didn't really bother me at all seeing as I couldn't move anyway. The only problem was the contractions weren't registering on the monitor very well - I could feel them happening (the pressure) but they just weren't showing up right. No big deal tho - I could still feel enough to know if something went wrong and the nurse was there to watch for signs of rupture or if my uterus couldn't handle the drug.

Once that was all done, I fell asleep. Sleep was good. I'd half wake up every now and then and adjust, but mostly it was just sleep for two and a half hours. When I woke up, I was shivering and felt very nauseous. They figured the nausea was because of the drugs, but couldn't figure out why I was so cold. I got a couple warm blankets, they checked my temp, everything seemed normal. Out of curiosity I mentioned transition (remember I wasn't even 5 cm (after being there for 14 hours!) 3 hours earlier), and the nurse said she'd check me.

So she checks me, and gets this odd look on her face, and I'm thinking "great, still no change, how long will they let me go like this?" and she gets a big smile and says "you're 10cm, you can push with the next contraction".

At first I didn't believe her. There was just no way I could be ready to push already, pushing was still far away as far as I was concerned. I asked her if she was sure, I was excited and a little scared. This was at 2 pm. She started taking the bed apart, let the Dr. know I was ready and at 2:30 I started pushing.

That part was odd. I couldn't feel it at all. My left leg/abdomen was completely numb, my right side had a bit of sensation around my hip and inner pelvis, but that was it. So I did what I thought was a push and everyone said "Great job" so I figured I got it right and kept on going.

The spot on the inner pelvis that still had feeling hurt a lot while I was pushing (found out later there was a loop of cord beside Eli's face on that side, so I'm guessing that's what was causing the problem), as was my hip, but otherwise there was no pain at all. It was a very slow descent - he'd come forward, slide back, over and over again. Ben did so great here - he'd hold my leg while I pushed, feed me ice in between and let me know baby was still coming. I kept asking if there was progress and if baby was tolerating it alright - I wanted to go nice and slow, but knew a lack of progress would be a bad thing. It was so exciting every time he came forward just a bit, and when his head finally didn't slip back there were cheers.

During the pushing there were a couple of bleeds - vaginal tears, nothing serious, but the Dr. still had to check them out. He was wonderful - very patient, laid back, never made me worried about rupture or anything else. Once he was sure the bleed wasn't serious he'd step back and let the nurse take over again. I was really glad of that - so long as he wasn't worried no one else needed to be.

Once we got to the point where he was below my pubic bone I had already been pushing for two hours. They started pushing me to pick up the pace a bit and get him out. I pushed as hard as I could (at least I think that's what I did, I still couldn't feel anything) and then all of a sudden there were more people in the room, there was a warm towel on my chest and the Drs (there was a resident there as well) were getting ready. I was in shock, it seemed so surreal. Then someone said he was crowning, and someone else said there's an ear, and I felt him turn inside me and then slide out.

And I cried and there was this little perfect person on my chest. And he was whimpering and coughing and breathing and turning pink. He didn't cry right away (but was breathing, so not a problem) and I just couldn't believe it. And then I lifted his leg and saw it was a boy and started crying. It was the most beautiful moment. I didn't care that I was naked and splayed, that there were tons of people in the room, it was just me and this perfect little person I had just brought into the world.

Ben cut the cord and after 10 minutes or so they wiped him down and measured him. While I was getting stitched up (which btw seemed to take FOREVER!) he nursed for the first time. They were a little concerned about my bleeding and so had to massage my uterus for a while and start another drip to keep me contracting, but it wasn't too horrible.

I had a second degree tear and a few minor tears that didn't need stitches. Eli had a little trouble regulating his body heat for the first day, but lots of skin to skin time helped with that - he didn't need to spend any time away from me at all. We were discharged on Tuesday and have been doing great since. There was a little trouble with nursing, but a trip to a wonderful LC helped with that and now things are just perfect.


Mommy Rader said...

Oh, Steph thanks for the beautiful birth story!!! Congratulations on the newest member of your family. Great job, mamma!!!

Dena said...

Yes, thanks for telling your newest birth story-I always enjoy a good one. I'm so glad you had a successful vbac and the hospital didn't get too worried about the clock. SO so so glad nursing is going well! What an amazing triumph! That has been my biggest prayer for you two, that no matter how the birth happened, bonding and nursing would not be an issue this time around. Congrats, yet again!

Maria Purviance said...

sweet story

Kristi said...

what an awesome recount of his arrival! So glad it was a success for you and you were able to push through and have him the way you had hoped to!
Congrats on his arrival! I know you will thoroughly enjoy him!!!