Angela's Vaginal Birth After Cesarean Section (VBAC) Story

I am writing my Vaginal Birth After Cesarean Section (VBAC) birth story before giving birth. If I wait until after the baby is born, I won’t remember what it is like to be on this side.

Background

My first pregnancy was easy and uneventful. I had a cesarean. I personally determined that my daughter was posterior. This, however, was never mentioned during prenatal visits, labor or in medical records. Instead, those records stated my cesarean was a result of “failure to progress,” and possible “CPD”.  I believe the reason was a poorly positioned baby and mother during labor (semi-reclined in bed with an epidural makes it difficult for a baby to maneuver the pelvis). It was not because my body failed to work. Fetal position was stated as Vertex. If properly diagnosed I could have been coached into proper positions and/or the baby could have been turned, resulting in a vaginal birth. It was simply an oversight.

I became pregnant with my second child in November 2003. The following month we moved to Yokosuka, Japan, where my husband was stationed with the United States Navy. This time I was determined not to have a cesarean. Prior to leaving Washington State (where my first baby was delivered) I was told I was an excellent candidate for a vaginal birth after cesarean (VBAC). I always had great experiences with military health care so I naively assumed everyone in Japan would be as excited about my vaginal birth after cesarean section  endeavors. That was not the case.

I soon realized I was not going to receive the same support and encouragement as I had stateside. That realization led me to consider flying back to the United States for a homebirth. Since that was out of the question (for a variety of reasons) I tried to obtain care in hospitals or clinics and with Japanese midwives. Much to my dismay the language barrier was too great and vaginal birth after cesarean section too controversial. So a doula from Los Angeles, California, was hired to fly in for the birth.

In spite of this setback, I refused to compromise my plans to have a vaginal birth after cesarean section . I was prepared to make my requests known to the hospital. I was willing to fight for my rights.

To become better informed I read about birth, vaginal birth after cesarean section, interventions, positioning and preparation. My reading included: The VBAC Companion by Korte; The Vaginal Birth after Cesarean Experience, compiled by Richards; Silent Knife by Cohen & Estner; Optimal Fetal Positioning by Scott & Sutton; part of Open Season by Cohen; and Sit Up and Take Notice by Scott. I also read labor and delivery articles from the ACOG Compendium 2004 and ACOG’s Evaluation of Cesarean Delivery.

The Professionals

I was excited to be pregnant again and to have another chance to have a “normal” birth! Unfortunately, my excitement was short-lived. A pelvic exam conducted during my first appointment showed I had an angular pelvis. According to the doctor, my chances of a successful vaginal birth after cesarean section was 50 percent.

I left sad and discouraged. Small pelvis? Complications? Lower chances? Not a positive or encouraging word had been said, except that vaginal births are safer.

I saw the certified nurse midwife for my next visit. By this time I had developed a negative attitude concerning how a hospital manages labor. Much to my embarrassment and disappointment that attitude reared itself during our meeting. I became defensive whenever the negative aspects about vaginal birth after cesarean section  or interventions were mentioned.

Before leaving I was told to have a private moment or ceremony to lay my cesarean to rest. To me, those words meant the midwife had given up. She was not going to fight for me. My defensiveness had been interpreted as being a result of an emotional attachment to my first cesarean. It was more than that. I pass out during blood draws. I react negatively to heavy medications. I want to hold my baby immediately after birth.

It was another sad day. Had I jeopardized my only hope? After apologizing I changed to a family practitioner. At our first meeting I informed my new doctor of my needs during pregnancy. Once more my words seemed to fall on deaf ears. He, too, felt the need to explain the risks involved with a vaginal birth after cesarean section.  I didn't say much rather I smiled and nodded in agreement. I left the hospital and cried for a week, vowing never to go back.

Next I contacted a pediatrician. Again, the conversation revolved around death, dying and complications. She was against my laboring at home until the last minute, fearing the baby would be born in the car or too soon upon arriving at the hospital. Consequently, if I hemorrhaged I would not be able to receive help fast enough and I could die.

Prenatal Care

Contrary to what doctors claim, prenatal care for a vaginal birth after cesarean section mother is different than for other mothers. It is more complicated, more emotional and calls for special care. Sadly, the only prenatal care I received was hearing my baby’s heartbeat and having my fundal height measured. Instead of discussing my pregnancy, my time with the doctor was spent fighting about my birth.

I must confess I neglected this pregnancy somewhat. I took care of myself, but I was not as open or trusting of doctors. With my first pregnancy I had a wonderful relationship with my doctor. I was honest, open and never hesitated. Not so this time! If I sensed something might be wrong I remained silent, believing that any negativity would be reflected unfavorably in my records. If that occurred, hospital staff could intervene with my labor, be hasty to perform a cesarean or deny me a trial of labor.

The Fight

I was determined to have a home-birth experience in a hospital without interventions, IV’s, continuous EFM and imposed fasting. I would, however, be open to such things if necessary. However, due to poor communication, hospital staff was under the false impression that I would refuse all treatment. I portrayed myself that way.

After three months of negativity I obtained a copy of the Patient’s Rights and Responsibilities to determine which procedures could and could not be refused. According to the director of OB/GYN my rights were limited. In my case the disparity centered on augmenting labor with Oxytocin. If I did not dilate 1-2 cm per 1-2 hours during the active phase, my labor would have to be augmented. Because I was considered a high-risk patient I could not refuse this procedure.

The next two weeks were emotionally difficult. I felt trapped. I was worried, upset and fatigued, unable to function in daily life. The situation appeared hopeless, causing me to combat bouts of depression. My daughter also suffered. I ignored her, pushed her away and spoke harshly to her. At one point she started screaming and crying uncontrollably, flailing her arms and shaking her head. Her uncharacteristic behavior caught my attention. I attempted to comfort her but it was too late.

My breakdown occurred a few days later while my daughter was napping. I stopped breathing for seconds at a time. I pressed against the wall, slid to the floor and panicked! In desperation I called my husband at work, begging him to come home. Unable to leave, his comforting words stabilized me temporarily. That evening he told me to drop the subject of vaginal birth after cesarean until he returned from a four-day leave.

I obliged.

It was like a weight had been lifted. For the first time in months I felt good! I was happy being the mother I needed to be for my daughter. I also was able to view the situation from a different perspective. That is when I realized this fight had gone too far.

It was time to place things in God’s hands.

Public relations continued contacting us. They were concerned about why my next routine appointment had not been scheduled and wondering if I would be returning to the States for the birth. A lawyer we knew contacted us informally about our “case.” He would be representing the hospital in their quest to determine if a patient could be refused treatment. How disappointing! They had missed the point! I had no intention of making this a legal matter. I simply wanted more control over my baby’s birth.

Shortly after being contacted by my husband, the director of OB/GYN called to say I would have full autonomy of my labor and delivery. They [hospital] would make assessments and suggestions but the decision would be mine. I needed to prepare a birth plan and bring it to my next appointment.  What a total switch!

It had been six weeks since seeing my doctor. I sat nervously as he reviewed my plan. He was pleased. He had been prepared to lecture me about interventions but that proved to be unnecessary. Several days later my husband and I met with the XO of the hospital. He fully supported our proactive approach to have more control over our birth experience. He also admitted that patient communication could be improved with regards to vaginal birth after cesarean. That was a major victory. Until now, doctors’ ideas for managing vaginal birth after cesarean section  labor were conflicting and hospital policies were unclear. At our recommendation, the idea to present parents with such information in writing at their first appointment is being considered.

In subsequent weeks hospital staff wanted to discuss my birth plan and I switched doctors—for the final time—back to the midwife. She was precious to me, providing emotional support and encouragement. During the last three weeks of my pregnancy I became frightened. My midwife would reassure me and validate my feelings, allowing me to maintain my focus.

The last trimester was nearly stress-free. Everyone was helpful, agreeable and encouraging. Whenever I was tempted by fear or anxiety I turned to God. I knew He was willing and able to help me. “Offer unto God thanksgiving; and pay thy vows unto the most High: and call upon Me in the day of trouble: I will deliver thee, and though shalt glorify Me.” (Psalm 50:14,15); “I can do all things through Christ which strengtheneth me”. (Philippians 4:13).

The Birth

My sister stayed with me for two months to help with my daughter. My EDD was July 28. On July 20, the midwife determined my cervix to be 3cm dilated and 75% effaced. My doula arrived on July 22.nd My husband returned on the morning of July 24th after being away for 2 weeks. That evening, while at the movies, I felt a portion of my mucous plug coming out (I had been losing it piece by piece for days!). After several trips to the restroom I suspected that it was amniotic fluid.

Upon arriving home I felt something “give” and a small burst of liquid came out. I only told my doula about my suspicions. She was already in bed, still suffering from jetlag. I put myself to bed as well, knowing that labor would soon be at hand.

I had 15 minutes of rest before contractions started. My husband and sister—unaware that “it was time”—were entertaining themselves while I braved contractions in 8-minute intervals. After noting each contraction for about one hour, I informed my husband and doula and moved into the tub. Labor accelerated quickly so I decided to leave for the hospital.

The car ride was not as difficult as I had anticipated. I knelt on the back seat and hung my body over the backrest, facing out the back window. The nurse greeted me at the hospital. I was not very cooperative that first hour. When asked to get into bed I declined. I preferred to remain standing. When asked to change into a gown, I begged to stay in my own clothing. After several strong contractions I sweat through my own clothing and welcomed a cotton hospital gown. By then I was in bed. I could no longer stand up through contractions and a baseline EFM reading was needed.

A saline lock was placed in my hand. Initially, I was not allowed to have natural hydration or nourishment. Everything had to be taken via I.V. in case an emergency cesarean was needed. I protested about this prior to labor and was subsequently granted the lock. Thankfully, the saline lock was never used. However, having that lock instead of artificial hydration was another victory in my fight for a more natural birth.

I was 5cm and fully effaced upon admission. I moved to a labor room where I was instructed to lay on the bed, semi-reclined, so the EFM readings could be obtained. I was well enough in labor by now that the fight wasn’t worth it.

The nurse panicked several times when the baby’s heartbeat dropped into the 80’s and 90’s. The EFM machine was confusing my heartbeat with the baby’s. After two hours my back began to hurt from laying on my tailbone. My request to move was declined. An adequate baseline reading had yet to be acquired.

As an alternative an internal fetal scalp monitor was suggested. I was hesitant. I was against piercing my newborn’s scalp with a wire and risking infection but a choice had to be made—an IFM or the OR. Intermittent monitoring was not a viable option and the scalp monitor would get me off my back, so I opted for the IFM.

With the monitor in place I was free to change positions. It felt wonderful to get off my back. On my back/sitting I used my arms to push my bottom off the bed for every contraction, unable to tolerate pressure. Although I had planned for months to change positions frequently and stay out of the bed, each movement triggered painful and intense contractions. I endured two or three of these before adjusting to the new position. I tried the left side-lying position. That allowed me to give my tired arms a break, although I gripped the bedrail for every contraction.

I also hung over the back of the bed. That permitted me to be off my bottom and somewhat suspended, even though it was not the most comfortable position to maintain. Sitting semi-reclined, the worst position, seemed most comfortable and I held that position for the majority of my labor.

I employed several methods to work through contractions. When it was still “easy” I used distraction. During each contraction I described my father’s property in the Catskill, NY, mountains. Whenever I lost my train of thought the nurse or doula would question me to bring me back around.

I rested quietly in between contractions. When talking became too tiring I started counting. Counting helped me to maintain steady breathing and remain in control. I counted the snowflake patterns in my hospital gown and visualized them on a dice.

When I counted I was loud and my voice was low. The harder the contraction, the louder and deeper my voice became. I did it for hours! My vocal chords were exhausted by the time I was finished!  Looking back I find it quite funny.  I sounded just like Dory speaking whale in “Finding Nemo”.

I maintained control for most of the labor but there were times when I wanted to give up. I wanted someone to rescue me. I considered that elective cesarean just to have it end. It was that hard! I also wanted Demerol, a spinal, any relief. I was exhausted. I had been up almost 24 hours with little food. I was so tired. I just wanted to sleep.

It was my doula who brought me around during those times. I was reminded of how far I had come, how much I had prepared and why I was doing this naturally. I also was told that drugs would make me and the baby sluggish (no thanks!) and that a spinal or epidural would make me immobile (a double no thanks!). Interventions were like a one-way ticket to the O.R. I was not going to have another cesarean!

I had a nearly uncontrollable urge to push from about 8cm (the last 2 hours of my labor). The difficult part was breathing through that urge. Sometimes my body would override my will and push involuntarily. When the urge to push first started I wasn’t fully dilated. I was reminded that once I began to push there would only be a two-hour window to deliver before another cesarean would be necessary. That was enough to keep me from indulging myself by pushing.

I vaguely remember being so exhausted that I would fall asleep in between contractions (they were 2-3 minutes apart). I can’t remember the dreams but I remember having them. The room was dark and quiet. I used one break in contractions to pray. I spoke directly and aloud, asking the Lord to get this finished. I was tired. I reminded Him of the scriptures of promise He had given me. It was my final cry for help. I don’t remember much from that period of labor except that I was sleepy and the room was peaceful. No one talked to me or touched me. It was me and my body…me and my baby…me and God.

After eight hours of labor I was completely dilated. Getting to 10cm was a victory as I never made it past 9cm with my first. The only hurdle that remained was the baby’s position. Having a slightly android pelvis made me prone to having posterior babies. Knowing this, I had spent months prior to labor trying to prevent another posterior lie. I rarely reclined, kept my back straight, slept on my hands and knees, performed daily pelvic rocks and maintained knee-chest positions for hours.

Upon examination the baby was determined to be posterior. While a disappointment, it was not the end of the world. The baby had not descended into the pelvis so I was spared from back labor. The baby continued rotating. I knew that time spent in a knee-chest position was all that was needed. I turned over and stayed knee-chest for 30 minutes before I felt something change.

The doctor examined me while still on my hands and knees. In this position, large amounts of amniotic fluid were released. The baby had been floating in there, even at 10cm! Diagnosis? Anterior! That was music to my ears. I had the go-ahead to push. I had never pushed before and was afraid. After all, I had been trying not to push for so long!

Suddenly my husband, who had been sleeping, was at my side.

My doula did a wonderful job coaching me on how to push. I trusted her and listened intently to what she said. I had one or two ineffective pushes while learning. Then, after several productive ones, I felt the baby budge down into my pelvis.

Suddenly I was wide-awake. How exciting! I pushed several more times while on my hands and knees. Again I felt the baby move! How encouraging! I shifted to my left side with my right leg open into the air. However, the ideal position was on my side and my back. I refused to get all the way on my back so it was somewhat of a diagonal. My doula was in front of me, holding my legs in a position similar to a squat. She coached me, counted my pushes and reminded me to do certain things. She was awesome.

PUSH! I felt a budge. PUSH! I felt the infamous “burn.” PUSH! I felt the baby’s head pushing through. One big PUSH and the baby’s head popped out halfway. That’s when I had to stop and move on to my back.

The cord was wrapped around the baby’s neck. Once that was resolved I pushed one more time. I felt the baby’s entire body practically blast out of me. I was so relieved that it was over; shocked that I actually delivered my baby the “real way.” I was almost oblivious to the fact that my baby was born until I heard that first cry. I still didn’t know if I had a son or daughter!

It was a boy. Seth Abriel Sundaramurthy weighed in at 8lbs., 2.2 oz. and measured 20 inches.

Conclusion

It is amazing how powerful our bodies are when giving birth.

One of the many rewards my vaginal birth after cesarean section  afforded me was to be aware of everything my body was doing. It is difficult to imagine how some women can deliver a baby while on an epidural, unable to feel the tremendous internal force.

My vaginal birth after cesarean also reinforced the importance of having a doula or trained coaching partner. More wide spread use—especially for first-time mothers—would help to decrease the incidence of cesarean surgeries.

As a result of my birth experience I have grown immeasurably in faith, grace and manner. For once I am at a loss for words.

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Page Last Modified by Catherine Beier, MS, CBE