The Redeeming Birth (VBAC)
Lee and Jason sent me this birth ages ago... And it sat in my to do list for ages, sorry guys, cause this birth was amazing and I am so sorry I haven't shared it until now. This birth has all the highs and lows and Lee was a total superstar throughout the whole thing. Enjoy this one... N x
Prior to discussing my most recent birth experience, it is important to understand the difficulty I had with the labour and birth of my first-born. To begin, at the outset of my first pregnancy, I formulated a divine plan for a peaceful homebirth; however, it all changed when I discovered that my baby was in a breech position. So, with my mind set on achieving some degree of tranquillity in labour, versus the cold defeat of a caesarean section, I set my mind on attempting a vaginal breech birth. Nonetheless, after enduring a 48-hour crescendo of anti-climactic labour, I found myself in the midst of an emergency caesarean section as my labour failed to progress. Making matters worse, after my bright-eyed baby was born, my uterus laid floppy and deflated, resulting in the loss of a litre and a half of blood. Where I was once filled with vigour and enthusiasm for the experience of labour and birth, I could barely keep my eyes open to take in the anticipated delights of motherhood. Furthermore, I was deeply wounded with disappointment at my body’s inability to birth naturally, especially being a midwife who had seen first-hand how splendid a birth could be. Consequently, entering into pregnancy this time, I set my intentions towards a desire for the birth I missed out on. I was not going to let this happen to me again.
Well before this current pregnancy was conceived, I meticulously examined the risks and benefits of having a vaginal birth after a caesarean section (VBAC). The primary concern identified with VBAC is the uterine scar from the previous caesarean section rupturing during labour. While the probability of this occurring is low-risk, due in fact that this pregnancy is IVF, there is a heightened risk that the embryo could implant over, or in close proximity to, the previous caesarean scar. Furthermore, with the rate of post-partum haemorrhage in VBAC’s being two-fold of a normal vaginal delivery, having had a previously large bleed, I am increasingly at risk of it occurring again. Nonetheless, as I proceeded through my pregnancy, I remained optimistic, especially as the morphology scan confirmed that the placenta was on the rear portion of my uterus. In any case, this delight was short-lived as I was diagnosed with diet-controlled gestational diabetes. Due in fact that babies of mothers with this diagnosis can be substantially larger due to the increased influx of sugar, the prognosis of uterine rupture increases. While a growth scan at 36-weeks identified that my baby was of a normal size, which put my mind at ease, the hospital policy did not see it this way, and continued to recommend that I be induced into labour as early at 39 weeks. Being well-informed of the risk I was placing on my unborn child and myself, I made the decision to endeavour towards having a spontaneous labour.
Knowing that I laboured spontaneously in my prior pregnancy, I trusted that my body would be able to do it again. At 34-weeks’ gestation, I felt that an early labour was auspiciously approaching, especially as I started getting intermittent pelvic cramping’s and tightening’s. However, as days came and weeks past beyond my due date, I could see my intervention-free labour and birth dissolve as attributes of my previous pregnancy revealed themself. My sanity faded, and I began to lose faith in my body’s ability to labour and birth naturally. I was in two minds about what to do. I understood that the risk of complications increased as days passed, but I was still reluctant to relinquish my plans for a spontaneous and natural labour. To compromise, I set a date for induction at 42 weeks, with the plan for a stretch a sweep two days prior, and cervical ripening the night before the infusion began.
For the remainder of the week, my mind was imprisoned in the succession of anger, resentment, depression, and optimism, as early labour pains emerged and then vanished just as I would begin to get my hopes up. However, on the day before my stretch and sweep was planned, this all would change. Today, like all the other days previous, my regular pains developed just after noon. Begrudgingly I waited for them to dwindle, however, rather than fizzling out, they surprisingly began magnifying in intensity. Still yet, I downplayed their advancement until they literally took my breath away. Becoming complacent with the development of previous non-eventful labour-pains, I was stunned and overwhelmed that the moment had arrived. Further intensifying my bewilderment, the contractions quickly amplified in strength and duration; and with it, my breathing changed from deep controlled in and outs’, to a vocal animalistic moaning. My 2-year-old son instinctively sensed the change in my demeanour, becoming increasingly temperamental and demanding of my attention. Seeing the impact that my son had on my mind-set, my husband was eager to take me to the hospital, leaving our son in the capable hands of a close friend.
By the time we arrived at the hospital, my contractions were unbearably strong and occurring every minute. With this onslaught of labour, I was barely able to revive myself before the next contraction took my breath away. With anticipation and apprehension, I begged for my midwife Deb, and my student midwife Claire, to assess my progress. My cervix was 3cm and fully effaced, and the baby was well-applied and in a good left lateral occipital position. Despite the promising news for the advancement of my labour, the thought of being in early labour and in this much discomfort, brought back agonizing memories of my previous labour. Deb, an experienced midwife whom I trust and know well, reassured me that she thought that I was going to birth quickly. Despite this, I was struggling both in mind and body. I endlessly attempted to hypnobirth, as I had finessed with my previous labour, but I could not get a break to reset my thoughts. As a result, rather than hypnobirthing, I ended up hypno-screaming out my frustrations.
Morphine was then offered and administered as an intermediary analgesia to help me relax and transition into the next stage of labour; but this made no difference to the intensity of my contractions. Standing at the side of the bed I withered and contorted myself in an epileptic dance of agony, in which I impulsively changed from standing, squatting, and swaying around. Furthermore, in a clear representation of a split personality, I went from having an inconsolable distant stare amidst the contractions, to having a sound mind within seconds of them easing. My husband later told me that he drew a comparison of my mindset and actions at that time to that of my toddler in the midst of a temper-tantrum. “I’ve had enough, I can’t do this!” I muttered in a low tone to myself amongst my shrieking demand for an epidural. Thankfully, my husband and midwife knew my true thoughts about having an epidural and used the period of calm between the contractions to reason with me. I was told that if I held off from having the epidural, and give the morphine time to work, I would be reassessed in an hour and we would go from there. It was 7:30 pm, I was now one hour into the ordeal of active labour.
For the next hour, I found that absolutely nothing could make me comfortable; this was, until I was reassessed and found to be at 8cm. Amidst my agony, I was given hope. Further to this news, my midwife suggested that I have my membranes artificially ruptured to help advance the baby’s head. After doing so, my contractions became easier to deal with, and I felt like I was back in control of my labour. I got off the bed, leaned over it, swayed back and forth, and breathed with my contractions. Within an hour I began to feel like I was pooping and was involuntarily pushing. I got back into bed and leaned over the back rest in an all-fours position. Whilst I felt comfortable with this position, the CTG monitor began to show my baby was becoming increasingly in distress as he progressed through the outlet of the birth-canal. Unbeknownst to me, the baby’s umbilical cord was over his shoulder and was being compressed against my pelvis with each of the contractions. I changed to a McRoberts position on my back with high knees to open my pelvis and alleviate the distress. I continued in this position, using every ounce of breath I had to bear-down and push for the extent of the contraction . . . . Within 25 minutes, I birthed a rigorous and screaming healthy baby boy into the arms of my student midwife. In a moment of both relief and disbelief I proclaimed, “I did it!?” With a total of 3 ½ hours of labour, Julian Jason was born at 9:39pm.
After the birth, both my care, and that of Julian, was seamless and uneventful. Firstly, to facilitate the delivery of the placenta, it is common for oxytocin to be administered to accelerate the contraction of the uterus. For me, I opted to try a physiological delivery, in which no medication is administered, to allow more time for oxygenated blood to pulse from the placenta to the baby. Even with a history of post-partum haemorrhage, I successfully birthed my placenta in less than half-an-hour, and with a limited amount of blood loss (450ml). To aid in the process of contracting my uterus, Julian’s immediate breastfeeding helped to release natural oxytocin. While I did suffer from a small second-degree tear, which required cosmetic suturing, my recovery thus far has been substantially easier than the recovery from the major abdominal surgery of my previous caesarean section. As an added benefit of a successful VBAC, 4 hours after Julian was born, I was discharged home. I was absolutely delighted to have gone home so early, and have my son wake up and meet his new brother the next morning.