Today, I get to share with you my own VBAC birth story! It’s already been a few weeks since Ellie arrived, and I am finally able to sit down and write this and it still seems surreal to me! If you’ve been following my blog, you know that over the past three years I have been doing a lot to prepare for our second baby – even before we knew that they would be here!
My first baby arrived through a traumatic emergency cesarean section after a long labor in 2012. He presented in an asynclitic posterior position and despite the OB trying to manually turn him twice during the pushing phase – he would not budge. During the attempts to turn him, meconium stained fluid was released, his fetal heart rate plummeted and we were rushed to an operating room. I experienced a panic attack during the surgery and my son was rushed to the NICU due to inhaling the fluid and meconium. We were reunited again more than 7 hours later, an exhausted mama and baby. Recovery was very hard physical, emotionally and mentally.
The following days, weeks, months I started to heal. I started to realize that it was okay to not be okay with how my son was born. And once I acknowledged my own trauma of his birth I was able to truly start healing. I felt like my body had been broken and I needed to figure out how to fix it. I started to reach out to other mothers who had similar experiences to get more support for how I was feeling. And just as I had seen medical staff for my physical healing, I started working on my emotional and mental healing as well – combining PTSD counseling from the surgery with physical activity and took up running. Every mile that I ran started to prove to me that I was not broken – that I am strong and capable. I even ran my first full marathon in January of 2014!
In the Spring of 2014 my husband and I finally agreed that we were ready to expand our family, and that I had healed from our previous birth to try again. Little did we know that it wouldn’t take long to get a positive pregnancy test!
All things considered my second pregnancy was fairly uneventful. I didn’t have any pregnancy related complications. I was diagnosed with Thyroid Cancer during the first trimester however, and that did make it more interesting but it didn’t change a lot regarding our pregnancy. I really liked my providers and they have a great reputation for VBAC success with over 70% of TOLACs resulting in VBAC. I also hired a Monitrice as a labor assistant so that we would have someone with us throughout labor to assist with positions, pain management, and when the midwife couldn’t be in the room with us. I stayed active and healthy throughout the pregnancy; running until I was 34 weeks and continuing to walk until 38. I saw a chiropractor weekly to help get baby into a good position by using the Webster Technique. I think all of these factors combined really helped to get us ready!
My due date was 8 February 2015 and as the date came and went my anticipation built. Several friends due around the same time (and after me!) had their babies and I was eager to have our baby too! That last week we tried nearly every old wives tale out there to try and convince our little one that it was time to make their debut! Eggplant parmesan, fresh pineapple, sex, walking, acupressure massage, pedicures, evening primrose oil, pumping, spicy thai food and I’m sure there’s more that I tried and even tried twice. This kiddo was just not ready!
I had an appointment on Thursday when I was 40+4 and agreed to finally have a cervical check. I was already at 3 cm and 70% effaced! The midwife did a membrane sweep to see if we could maybe get labor going within the next 12 hours or so. Since I had already been experiencing contractions every night for over a week that didn’t stick around, I was willing to risk going into prodromal labor. I went home hopeful that it would be just what the baby needed, and waited. And waited. I texted my Monitrice around 9pm and she suggested I go to bed saying, “if it is going to work it will work! You’ll need your rest!” I woke up to go to the bathroom around 1:30 am on Friday and nothing was going on still. I chatted with my sister on Facebook, lamenting that the baby would apparently never emerge. and then went back to bed.
Contractions woke me around 5:30 am on Friday, just a few hours after complaining to my Sister. I started timing them and they were about 5 minutes apart already but only 30 seconds or so long. I sent a text to my Monitrice, Ellen, at 6:30 am and got in the shower. I woke up my husband after the shower and let him know that the contractions weren’t letting up and I was fairly sure that this was the real deal. I messaged Ellen again and let her know that I was going to eat some breakfast and keep her posted if they got more intense. By 8:00 am I was starting to think that maybe I should have Ellen here and I called her. She stayed on the phone with me for 15 minutes and at the end she said it might be a better idea to meet at the hospital rather than have her come to the house first – it was starting to snow out and it was the beginning of rush hour traffic on a Friday!
We headed towards the hospital and arrived there around 9 am. In triage they had me change, did some monitoring, took some blood, inserted my Hep-Lock and the Midwife on call, Meredith, came to check me. I was so thankful that she was the Midwife on duty! She had been so reassuring during our appointments and she immediately put me at ease. I was already at 5 cm and 80% effaced. By this time I think the contractions were 2-3 min apart and more than a minute long. I was starting to rely more on my Hypnobabies words and having counter pressure on my hips. Once a room opened up they wheeled me there – I didn’t think I could possibly walk through these contractions. On the way there I had to get the nurse to stop the wheelchair for one!
We got to the delivery room around 10am and that is when it all starts to blend together. I remember them bringing the birthing ball and using it to lean over the bed while Jeremiah, my husband, and Ellen did counter pressure on my hips. Then I was kneeling on the bed facing the wall. Jeremiah says that worked great because they could adjust the head of the bed for me and still give me counter pressure during contractions. Ellen and my husband were great at reminding me to keep my voice low during contractions, and that helped to make me feel more in control of the pain.
I started to transition around 11am and they checked me again; sure enough I was at 8 cm! The intensity of this time surprised me, and having Jeremiah by my side encouraging me was priceless. He even told me that they were starting to prepare the infant warming table – I was going to do this!! He even prayed with me for strength and comfort. Not long after this I started to have the urge to push, but Meredith and Ellen let me know how important it was to wait until I was at 10 so that I wouldn’t swell and make it harder to push when the time came. They had me blow my breath out like blowing out a candle through contractions to help resist pushing, it took a lot of focus and encouragement. They were having a hard time getting a heart beat from the baby, so they had me turn around on the bed so that I was laying on my left side. They found a great heart rate and checked me again.. and said I could push!! I was so relieved! It was 11:20 am.
I hooked my arm through one knee and Ellen helped to brace the other. Jeremiah held my hand and helped coach me through pushing, relaying to me what Ellen and Meredith were saying about slowing down, tucking my chin, staying focused and what was happening. We prayed together again, thanking God for everything and asking for more strength. The nurses brought a mirror out so that I could see what was going on – I took one look and was done with that! Ha! The need to push was so intense that it was hard to resist and slow down so that the baby didn’t come too fast. It wasn’t long until our precious baby emerged and as they helped me bring her to my chest, my husband announced that our little girl was here at last! 11:37 am! Only 17 minutes of pushing!
She was beautiful. I could hardly believe it was real! I had done it! She was here! The three of us reveled in the moment, soaking in the moment that we got to meet each other. She latched right away and we got to spend some time doing skin to skin as Meredith repaired a small tear and helped with delivering the placenta. After an hour of family time, the nurse took Ellie’s measurements while I started to get a bit cleaned up. Meredith and Ellen joked about us being able to leave the next day since everything went so smoothly!
I started to notice some bleeding as we were getting ready to go to the recovery wing. I told the nurse and she checked me before we left the delivery room and then called ahead to have an OB meet us at the recovery room to double check the bleeding. I was still feeling a lot of pressure and pain, which surprised me, but I had a hard time describing it to anyone so I wasn’t sure if it was normal or not. When the OB came to our room he was also followed by a small swarm of nurses with different carts and trays. He said that they needed to check me for a hemorrhage and not to worry. Lets just say that even though he was calm and collected, the influx of staff and the uptick of concern in the room made me anxious. Thankfully, Ellie was sleeping peacefully after her eventful morning.
Before the OB started to check for the hemorrhage, they gave me pain medication through the hep-lock that was placed while I had been in triage earlier that morning. I was so thankful that I hadn’t fought back on the hospital policy that required them for VBAC patients! Jeremiah took my hand and comforted me as the OB checked and found more than 800 mL of blood and tissue that had to be removed. It was a very painful procedure, but the OB was able to remove everything that needed to be and ensured that there was no active bleeding. Thankfully I did not need a blood transfusion, but they were going to keep a close eye on me for 48 hours to make sure that there was no more bleeding. They also double checked with an ultrasound machine that there was no additional tissue or anything remaining.
After a roller coaster of a day, we were finally able to relax as a family! We started calling our families and letting them know that Ellie Grace had arrived safely and that we were doing well. And I finally got to eat! Pancakes, bacon, eggs and a big glass of orange juice delivered right to my room for an afternoon snack. It was already after 4:00pm!
I am so thankful and blessed from this journey. Ellie is amazing, and Noah is a great big brother to her already. I know that many VBAC moms say that their births are healing and in many ways it was. During my pregnancy there were so many moments when I still doubted myself, my body, and God’s plan for us. When I crossed the finish line of my marathon last year I had finally had a moment where I felt like my body could handle anything and that I wasn’t broken anymore. Ellie’s arrival was the reaffirmation of that moment, and that as long as I trusted God I could do anything.
“I just left my OB/Midwife appointment and they told me that I’m gaining too much weight!”
This same or similar post has been posted in the birth month group that I am in on Facebook several times over the past few weeks. It seems that providers all over the US and around the world are reminding their patients not to overdo their weight gain during pregnancy.
In 2009, the Institute of Medicine (IOM) released new guidelines after nearly two decades since their initial release. The new guidelines are based upon the pre-pregnancy Body Mass Index (BMI) of the mother (Table 1). It indicates a range for the total amount of weight that the mother should gain, as well as a rate per week during the second and third trimesters. In addition, the IOM indicated in their report that maternal obesity increased the risk of “high blood pressure, gestational diabetes, and an increased chance of needing a Cesarean delivery.” But I wasn’t able to find how much your risk increases for those conditions. Whether it is a 1% increase or a 90% would make a big difference.
So where do all those pounds go? According to the Mayo Clinic, here’s the break down:
- Baby: 7 to 8 pounds (about 3 to 3.6 kilograms)
- Larger breasts: 2 pounds (about 1 kilogram)
- Larger uterus: 2 pounds (about 1 kilogram)
- Placenta: 1 1/2 pounds (about 0.7 kilogram)
- Amniotic fluid: 2 pounds (about 1 kilogram)
- Increased blood volume: 3 to 4 pounds (about 1.4 to 1.8 kilograms)
- Increased fluid volume: 3 to 4 pounds (about 1.4 to 1.8 kilograms)
- Fat stores: 6 to 8 pounds (about 2.7 to 3.6 kilograms)
By that count, there are 31.5 pounds total to be gained. And that is if your baby is not more than 8 pounds (My son was 10!). So is it realistic to expect women who are overweight or obese to gain less than that? These guidelines are important because providers want to ensure that women aren’t gaining too much weight – more than they can safely lose post-partum. But what do they mean for those of us that already struggle with our weight in the first place?
Before this pregnancy, I weighed 170 pounds and I am 5′ 4″ tall, giving me a BMI of 29.2. According to the IOM table, I should only gain 15-25 pounds during my pregnancy. So here I am, 25 weeks pregnant and I’ve already gained my allotted 25 pounds. Which makes me wonder: What is more important, gaining within the guidelines or maintaining a healthy lifestyle?
I have continued to run during this pregnancy, even participating and finishing in long distances races like the Army Ten Miler at 23 weeks pregnant. I usually run 2-3 times per week for 30 minutes at a time – the same as before pregnancy just at a slower pace. I have continued a healthy and balanced diet, and added several vitamins to my intake to ensure that I’m getting everything that I need to stay healthy. On average, I have been gaining one pound per week. I was unable to find well reviewed research regarding the direct effect of Thyroid Cancer on weight gain during pregnancy, but my assumption is that it would not help the situation.
During my first pregnancy, I gained more than 60 pounds. I did not monitor my diet at all and only took the prenatal vitamins given to me at the military treatment facility. I participated in the Army Pregnancy Physical Fitness Program, but it was largely a joke to me – mostly walking in slow circles around the small on post gym because they were so averse to us running on our own outside. As my due date approached, the pounds piled on. After my son was born, I lost all but five pounds of it within the first six months and lost another 20 by the time he turned one.
I think it is more important for women to maintain a healthy lifestyle than to chain themselves to a weight gain requirement. My goals for this pregnancy have included:
- Run two to three times per week until I must switch to walking, and then continue to walk.
- Decrease cravings based on deficiencies by adding vitamin and nutrient supplements with the goal of eliminating unneeded calories due to cravings.
- Gain less weight than I did during my first pregnancy (60 pounds).
So far, I’m doing well in sticking to these goals.
I think it is unrealistic for providers to expect every woman to stay within the boundaries of the IOM guidelines. I think it adds unnecessary stress for some women to worry about their weight when it may not necessarily be a dramatic risk factor in their pregnancy. And as these providers continue to tell most women that they are gaining too much weight, it starts to dull the effect of their concern. Like the boy who cried “Wolf!” they will be less effective at getting women who truly do need to be concerned to pay attention.
My second appointment during this pregnancy came in my 13th week. I have just cleared by my endocrinologist to start taking my Thyroid medication again and I am starting to feel better already. It is most likely a combination of both the medication and entering the 2nd trimester.
I went to my appointment in uniform, since I was going straight from work and my husband wasn’t coming with this time. I think I make the nurses chuckle a little by already having my weight measurement ready for them rather than stepping on the scale whilst in uniform. The boots alone add 4 pounds! If they weigh me themselves, the wont deduct pounds for clothing so I like to skip that part and I weigh myself that morning.
The midwife I met with today was great. She’s spunky, down to earth and isn’t sugar coating anything. We talked about pain management a bit during this appointment. I had heard that the family doctors can administer gas and air during labor at this hospital, but she indicated that I would have to switch to them as my providers if that is what I wanted to use. Since this group of midwives has a stellar reputation for VBAC success, I am hesitant to do so.
We also talked about epidurals. During my last labor, the epidural did stall my labor for more than five hours so I would like avoid getting one so that my labor progresses. I feel that I would have been less exhausted when I had reached the pushing stage if I had foregone that intervention (since it had worn off anyways). She indicated that that was fine, but to understand that if there was an emergency and a CS was neccessary that they would use general anesthia. I am very claustrophobic, and the inablity to feel my body or move was traumatizing for me during my son’s delivery. I have through a lot about what she said since we spoke, and based on my emotional and mental reaction to the spinal block during my sons delivery, I think that general anesthisia may actually be the better solution for me if there was a true emergency.
I also talked with her about what the group of midwives expects regarding a timeline at the end of the pregnancy. She said that they allow VBAC patients to go until 42 weeks as long as the baby is healthy and there are no complications. Upon 42 weeks, if the cervix has ripened they will opt for an induction using membrane sweeps, foley bulb, and pitocin. They absolutely will not use cervadil or other chemical dialators. If the cervix has not ripened they will schedule a repeat cesarean for 42 weeks 1 day.
I also got to hear the baby’s heartbeat and it was coming in strong at 158 bpm. What a beautiful sound!
As I continue through my pregnancy, I will be seeing a different midwife in the practice at each appointment. I hope to start formulating a list of questions to ask each one so that I can get to know each of them better. This way when I am in labor they are all familiar and I can know what to expect from each of them. If you were seen by a different provider each appointment, what questions would you ask?
During your first trimester of pregnancy, you may be offered a genetic screening test. A screening test is used to show if a patient’s risk is high or low for a specific disease or condition. If the risk is high, then further diagnostic testing can be done. The most common screening tests for pregnant women estimate the risk of the baby having either Down syndrome or spina bifida.
A blood test and an ultrasound are used for these screening tests. Human choriaonic gonadotrophin (hCG) and pregnancy associated plasma protein PAPP-A are measured using a blood test. Women are more likely to have a baby with Down syndrome if hCG is high and PAPP-A is low.
An ultrasound is also used to indicate the risk of Down syndrome. The nuchal translucency, or the amount of space between the spine and the baby’s neck, is measured. During my screening, the tech indicated that they like to see a space of less than 3mm at my gestational age (12w 5d).
Both the blood test and ultrasound results are used in conjunction with other risk factors like the mother’s age to determine the risk. The combined accuracy rate for the screen to detect the chromosomal abnormalities mentioned above is approximately 85% with a false positive rate of 5%. If the risk is higher than normal, many providers will arrange for you to meet with a genetic counselor to talk about what these results mean and decide if further diagnostic testing is right for you and your family.
It is important to remember that Ultrasound technology, while useful for medical screening when necessary, should not be over used. According to the American Pregnancy Association, “The ultrasound is a noninvasive procedure that, when used properly, has not demonstrated fetal harm. The long term effects of repeated ultrasound exposures on the fetus are not fully known.”
Genetic screenings are not required, and you can of course decide that it isn’t right for you. It is important to make an informed decision before consenting to any testing or procedure during pregnancy. For more information about genetic screening tests visit the American Pregnancy Association page.
We were very excited for our first pre-natal visit this pregnancy. I actually had a mixture of excitement and nervousness. I had researched area providers with the help of my local ICAN Chapter, so I knew that the midwife group I chose was not only VBAC Friendly but had a good success rate and reputation. My husband came to this appointment so that both of us could talk to them about our hopes for this pregnancy.
The appointment was actually broken into two parts, the first being a sit down with a nurse. We went over my medical history including going over my previous labor and cesarean section. Family medical history was also taken thoroughly. She gave us a welcome packet that included suggestions for safe medications for common pregnancy related maladies, a list of pre- and post-natal classes that they offer, a list of symptoms that they want me to call or come in if the occur, as well as some information about the labor and delivery department.
The nurse was very encouraging, and she put some of our other more general concerns to rest. Namely that the facility is across town from us- through a tunnel and two bridges away! So if we needed to go during rush hour it could potentially be a very uncomfortable 30-40 minute drive. She said our plan to have a doula or monitrice would help with knowing how urgently we would need to get to the hospital, and whether we could wait for traffic to ease.
The second portion of the appointment was an exam with one of the midwives. There are eight different midwives in the practice and they try to have patients see everyone throughout the pregnancy. In this way, no matter who is on duty they are a familiar face. During the exam the midwife went over my current medications and medical history again. We talked more about the reasons for my previous cesarean section and my plan to have a vaginal birth with this pregnancy. Because my CS was due mostly to malposition,and I had completely dilated and effaced, she said I am a good candidate for VBAC. As a VBAC patient I would also have one appointment with the OB at the hospital to go over the hospital VBAC policy and ensure that I have the information about the risks of both reoeat cesarean and VBAC.
The midwife also did a very brief vaginal exam and although I was only 9 weeks at the time she was able to find the heartbeat with a doppler! A strong 170 bpm! She said it was very normal to have such a quick rate this early.
I felt much more at ease at the end of our appointment. I felt that the nurse and the Midwife both listened to our concerns and were understanding of our want for a VBAC. There are a few questions that I did come uowith after the fact that I want to remember for my next appointment:
– Do they have the capability to offer gas and air as a pain management method during labor?
– Do they have tubs for laboring and birth, and do they restrict their use for any reasons?
– What treatment plan do they usually follow when a VBAC mom goes past their due date?
I am excited for this journey and hope to keep all of you updated along the way. Have you had a VBAC? Was your first prenatal visit during that pregnancy similar to mine? What other questions do you think I should add to the list?
The two and a half years since the birth of my son have been a journey full of emotions. My recovery from Traumatic Birth has been cathartic. I am a stronger and more empowered Mother, Wife, Woman and Soldier than I ever thought I would be. Thank you all so much for coming with me on this journey!
I have been full of mixed emotions since finding out our exciting news. I feel so blessed to have our family grow, but I am also nervous about what the next few months will bring as I strive to have a vaginal birth. My doctors and midwives have already been so incredibly supportive!
So hang on to your hats as we embark upon our own VBAC journey! I’m going to keep you all updated along the way, with the goal of helping other Mama’s who are hoping for a VBAC know that they are not alone on this road.
A birth plan is a short document to take with you to Labor and Delivery that lets the providers there know what your preferences are during labor. It is important to keep your birth plan simple and easy to understand. Providing a copy to all those involved with your labor can eliminate miscommunication, help labor go smoother, and keep your wishes from being dismissed.
A visual birth plan is a great way to do this! By using simple icons to depict your wishes, you let those around you know what you’d like and not like during labor and for your child during recovery. A friend of mine introduced me to this idea, and when I asked how it worked out she said, “My husband had seen my plan and he and my doula spoke up for me since I came to the hospital already in transition and fought for the birth I had wanted. I really believe the super simple plan helped him understand my wishes better and because of him majorly sticking up for what he knew I wanted when I couldn’t, no one messed with me and I got the birth I wanted.”
Her Visual Birth Plan was an inspiration, and I have created my very own!
Pretty neat, right?
A Visual Birth Plan was a lot easier to do than I thought it would be! Here’s how I did it:
1. I found the icons for the plan on Imgur, and you can download all 57 of those images by clicking here. The icons include a wide variety of options and your plan will be completely customizable! They were originally made by Seanna for the BabyBumps group on Reddit! She did a great job making the icons easy to understand, and includes a lot of options. You can check out her page here.
2. I opened Microsoft Power Point on my desk top. I added my personalized message to my providers by using a text box positioned at the top of the slide.
3. I added each Icon that I wanted to the presentation by selecting “Insert Picture.” Then, I made sure that they were all the same size by formatting each picture to be 1.5″ wide and 1.5″ tall. You can do this by right clicking on each icon and select “Format Picture.” Then go to the “Size” page and change the Height and Width to 1.5″ each.
4. I then changed the colors of my icons to make it more fun and inviting. You can also leave them the red and green colors found in the original icons.
To change the colors of the icons, right click on the image you want to change and select Format Picture.
Then select “Recolor” from your Picture formatting tab in your Formatting Palette. You can choose a color from the list or select a custom color as well.
5. I saved my presentation to my computer. Once I need it, I can print it out and take it with me! Simply print the presentation with one slide per page and it will print beautifully!
Did you make a birth plan for your birth? What did it look like? Share your pictures with us at CombatBootMama@gmail.com we would love to feature them on our Facebook page!