(Nona is an MD who specializes in Family Medicine)
What was the reason for your initial Cesarean birth?
I went past my due date. At 41w5d, my OB recommended that I undergo an induction of labor. Once my contractions started, my doctor ruptured my membranes. She said there was "some meconium" but she was confident everything would be fine. I still wanted to forego the epidural, but Pitocin can really intensify the pain. I was only dilated to 3 centimeters when the contractions were stronger than I could bear. For 10 hours I labored, blissfully ignorant of the pain. I fell asleep for about an hour. When I woke up, I felt rather warm and I could hear the fetal monitor beeping at what seemed to be a rapid rate. I asked my husband to read the monitor and he told me it was reading in the 170's. The nurse took my temperature and told me that I had a "low grade fever." By then I was 7 cm. The doctor came in and told me that she was going to give me another hour, but if I wasn't fully dilated by then, I may need a C-section. Unfortunately, I only dilated another cm over the next hour, to 8 cm. The baby's heart rate persisted in the 170-180's. My doctor returned and told me that we could wait a little longer, but she was concerned that if the baby continued to be tachycardic that she may have to do a crash C-section. She reminded me about the meconium she had seen earlier. Frightened and emotionally exhausted, I consented to the surgery. My 9 pound baby boy was occiput posterior. He was pink and healthy and latched on to nurse as soon as they brought him to me (an hour later). The official reason for my C-section was fetal distress.
Why did you choose a VBAC?
Even with my first pregnancy, I had wanted the most natural experience possible. I came to motherhood as a medical profession in my late 30s. As a medical student and resident, I had personally delivered over 100 babies. I was curious about what the experience must be like as the patient and wanted to have the least medical intervention possible. Having my first baby by C-section sent me into a bit of an emotional tailspin. When I found out I was pregnant with my second son, I was really confused about what to do. My OB told me she would support me if I wanted to try for a VBAC, but on a subsequent visit, I saw one of her partners who told me a "story" about the last VBAC she had attended. In summary, she told me that the woman had suffered a uterine rupture, but the doctor had found it in time and the baby was fine, the woman "just had to have a hysterectomy, that's all". I left the office that day very unhappy. At that point, I was already 29 weeks pregnant and didn't even know if I had any options. By chance, I ran into my friend that night who is a doula, Annely Allen. She became my doula and was so encouraging. It was through her recommendation that I found Dr. Cobb. I had to jump through some hoops with the insurance company to change providers so late in my pregnancy, but we made it happen.
What were your fears and concerns (if any)?
My biggest fear was one I think many health care providers that attend VBACs have--the possibility of uterine rupture leading to fetal and/or maternal death. Of course, childbirth can be dangerous under the most ideal circumstances, but the added risk of allowing a scarred uterus to labor is something to consider. My other concern was regarding damage to my genitourinary system. Having already suffered surgery and a scar on my abdomen, it seemed almost silly to also risk the urinary incontinence and chronic pain with intercourse I had heard some women complaining about after a vaginal delivery.
What was the biggest challenge during pregnancy?
Not to give in to the fear that I was making the wrong decision. Personally, I'm a Christian, so I found a lot of peace in prayer. Every time I was fearful, I asked God to care for me and my unborn baby. He brought me a lot of peace during that time as I trusted Him and learned to let go of something that I had no control over. I also was careful to only read things that would encourage and uplift me. I read Ina May Gaskin's Guide to Childbirth--I would highly recommend this book just before delivery. It's like a giant pep rally right before a big game. It contains the birth stories of dozens of women, written from a very positive perspective.
What was the biggest challenge during labor and birth?
I went into labor at about 11pm. The pains became very intense rather quickly. As soon as my doula arrived (about 90 minutes after the contractions had started), she took one look at me and told me it was time to go to the hospital. When I got to my hospital room about an hour later, I was already at 8 cm… where I remained for the next 5 hours. Five hours without progression, still getting intense pains every 2 to 3 minutes was the most discouraging part of the process. I gave in and asked for the epidural--I even used my "panic word." My doula looked at my doctor and they both told me I didn't need it. Dr. Cobb offered me a shot of Fentanyl, which I accepted. It helped me to relax which allowed Gabriel to finally descend into the birth canal. It would be nice to say I had an entirely "unmedicated" delivery, but I did the best I could. I had hated the feeling of the epidural with the first delivery and was happy not to have to deal with that.
How did you prepare for your VBAC?
I did a lot of research. I talked to a lot of moms-- including some of my patients! I tried to keep in shape and not to gain too much weight. I did a lot of stretching to keep my hips and pelvis flexible. I spent a lot of time in prayer. I prayed for the safety of my child and myself, I prayed for peace and calm. I did a lot of reading about different methods for dealing with the pain. In the end, it was the face of my doula that kept me calm. Her moment to moment encouragement and support made the labor bearable.
How did you find your care provider and were they VBAC supportive?
Yes and at the recommendation of a friend/ my doula, Annely.
If your VBAC became a repeat Cesarean birth, how did this feel?Fortunately it didn't. I certainly considered how I might have felt if my delivery had gone in that direction. For me, I felt that I had done everything possible to have the VBAC. I was prepared to take it easy on myself and let it go if I was unsuccessful. That's how I try to deal with most of the challenges in my life. I think that is the encouragement I would leave with any woman considering a VBAC. I believe that a vaginal delivery is really the best way to have a child. Do what you can to try. If it doesn't work out, it's okay. I'm sure we will all agree that having a healthy baby is the most important outcome when the day of our delivery comes.
How was your experience different with the VBAC compared to the Cesarean?
(Nona asked that I include this additional question and answer)I had both of my children later in life (ages 37 and 40), so that may have affected my healing time, but I recovered so much more quickly from the VBAC. After my C-section, it took me more that 6 weeks to feel like I could even go for a walk without being in pain. After my VBAC, I sat on an ice pack and sprayed numbing solutions on my vulva for a week and that was it. I had recovered. I could lift my baby and my toddler. I could do chores (although I didn't have to-- thanks to my husband, Robert). It was a big difference. My body healed so quickly when I had my baby the way I was created to have him.
Also, even though labor and delivery hurts, I really "enjoyed" the sensation of Gabriel being pushed out of my body. It was a cathartic experience. I had a real sense of accomplishment when it was over, that I lacked with the C-section. I was able to hold and nurse my baby immediately after delivery (as I mentioned above, I had to wait for an hour to see my first son). I was definitely left with a sense of empowerment, a feeling that this is how it's supposed to be, and the idea that what had been taken from me with my first delivery had been returned to me unblemished. It's almost as if, without the C-section, the gift of the vaginal delivery would not have been as poignant…