Category: VBAC Preparation

Birth Story: Ellie

Birth Story: Ellie

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!IMG_7489

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!

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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!

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Yes, it was so good I am glad I took a picture!

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.

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Distribution and or reproduction of the story or photos not permitted without the written consent of the author.  If you would like to share your VBAC story with our readers, please send it to combatbootmama@gmail.com

Packing our Bags

With only two weeks until our due date, I’ve finally gotten around to packing for our hospital VBAC!

I honestly can’t remember what I packed last time, and I’m not sure if I used a lot of it.  We were in the hospital for over a week then, and I know that hubby had to go home and get more clothes and things after a couple of days.

This time, I want to make sure that I’m not packing too much since I know the hospital really does provide almost everything we will need for the couple of days that we should be there.

Here’s my list that I’m starting from.

Small purse insert {what I transfer from purse to purse anyways}

  • Photo ID, debit card, etc.
  • Military ID (Insurance Card)
  • Chapstick
  • Lotion
  • Hair ties
  • Gum

Mama’s Bag

  • Labor essentials zip-top bag:  Essential oil bottles, energy gels, headband, chapstick.
  • Toiletries Zip Lock: Travel sized shampoo, conditioner, body wash, cold cream, toothpaste, toothbrush.
  • Labor gown
  • Robe
  • 2 Comfy outfits (yoga pants, nursing tank, T-Shirt, socks)
  • Nursing pajamas
  • Nook and charger
  • Slippers
  • Visual Birth Plan
  • Blessingway cards and necklace, prayer cards.

Grab and Go

  • Camera and charger
  • iPhone charger
  • Makeup bag
  • Hair needs – comb, curling gel, blow dryer & diffuser

Diaper Bag

  • Gender Neutral going home and picture outfit (long sleeve white onesie, overalls, socks, mittens)
  • Swaddle blanket
  • Name reveal hats {can hardly wait to show you!}
  • Diaper rash cream

Junk in the Trunk

  • Infant car seat and weather cover (since we have a small car and already have another car seat in there too, and I plan on sitting in the back seat on the way to the hospital we will install it on day two before we leave)
  • Warm baby blanket
  • Boppy/Nursing Pillow
  • Garbage bag and an old towel – just in case we need to cover the seat of the car if my water breaks at home.

So far, it’s all sitting there waiting.. well, most of it!  We will see if it’s enough or too much soon.  What are some things that you couldn’t live without in the hospital?

~Mama

CombatBootMama

Birth Plan Series: Fetal Monitoring

The next topic that I really wanted to dig into for our birth plan was Fetal Monitoring. It’s come up a few times this pregnancy at some of my appointments, and the policy at my hospital is that all VBAC patients have continuous Electronic Fetal Monitoring during their time at Labor and Delivery. As I started to look into the research about fetal monitoring, it became clear that this is a HUGE topic! So, if you have the time to get through this I think you’ll learn a lot and be able to make a great informed choice for your own birth plan too.

My main concerns regarding continuous fetal monitoring during labor includes the accuracy of the monitoring and the affect it may have on my ability to stay mobile during labor. In this post, I’m going to go through a few different topics including the types of monitoring used, the various heart rate patterns that they are watching for during monitoring, and how that relates to VBAC specifically.

Types of Monitoring

There are two types of fetal monitoring used: Electronic Fetal Monitoring (EFM) and also Manual Auscultation. EFM is much more common, and enables providers to measure the response of the baby to contractions. It does this using two receivers, one for the fetal heart rate and one for measuring the strength on contractions. EFM has become much more popular since the 1980s, with original hope being that they could decrease the incidence of Cerebral Palsy. Although EFM is used in over 85% of hospital births, the rate of CP has not changed since WWII.

Manual Auscultation is when providers use a handheld device to listed to the fetal heartbeat while feeling for contractions using their hands. This type of fetal monitoring is most commonly used during care provided by a midwife, and usually more common in home birth and birthing center situations. There is no continuous monitoring when this is the method used.

What are they looking for?

A normal fetal heartbeat varies between 110 and 160 beats per minute, and potential problems with the fetus can be signaled by a heart rate that doesn’t vary, is too high, or too low. According to ACOG, there are three levels of classification for the print-outs, or tracings, generated by the EFM. Category 1 FHR Tracings are normal and no specific action is required. Category 2 tracings are considered indeterminate and evaluation, surveillance and possibly other tests should be used to determine if there is a problem. Category 3 tracings are abnormal and this may require additional actions like providing oxygen, changing positions, discontinuing labor stimulation (Pitocin), or treating maternal hypotension. If the providers aren’t able to get the tracings to return to normal, ACOG recommends that the baby be delivered as soon as possible.

So, who determines what category the tracings are? Your providers. This opens the door to a large variety of interpretations. In fact, according to a press release from ACOG, “The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22% of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings.”1 ACOG recommends that women who have high-risk conditions such as preeclampsia, type 1 diabetes, or suspected fetal growth restriction (IUGR) be monitored continuously during labor.

Fetal Heart Rate during VBAC

I really want to focus more on how this impacts mothers who are going through a VBAC birth. Understanding how providers use these tracings to monitor VBAC patients can give us some insight into why they have policies in place that require continuous EFM for those patients. When speaking to my provider, they said that fetal distress is often the first sign of Uterine Rupture, and that is why they have their policy.

“In a larger study, Leung et al. analyzed the FHR and uterine contraction pattern immediately prior to 78 cases of uterine rupture. Prolonged deceleration was defined as a FHR less than 90 beats per minute that exceeded 1 minute without return to baseline. Prolonged deceleration (alone or proceeded by either severe late or variable decelerations) occurred in 71% (n = 55/78) of the cases of uterine rupture. In addition, prolonged deceleration occurred in 100% (n = 36/36) of the FHR tracings in which total fetal extrusion occurred. If more than one type of periodic deceleration, in addition to a prolonged deceleration was present, only the most ominous pattern was recorded. Late decelerations were considered most ominous, followed by variable and early deceleration. Although late decelerations were more common preceding the prolonged deceleration that heralded uterine rupture, this finding may be an artifact of the study methodology.”2

I know that a lot of that is some very technical language, so now lets explore what some of those heart rate patterns mean.

Fetal Heart Rate Patterns

  1. Fetal Tachycardia, defined as a baseline heart rate greater than 160 bpm and is considered a nonreassuring pattern. Between 160 and 180 bpm it is considered mild and over 180 bpm is considered severe. Over 100 bpm is usually due to fetal tachyarrhythmia or congenital anomalies. Some causes of fetal tachycardia include maternal fever, hyperthyroidism, maternal or fetal anemia, Chorioamnionitis, and prematurity. Fetal tachycardia may be a sign of increased fetal stress when it persists for 10 minutes or longer, but it is usually not associated with severe fetal distress unless decreased variability or another abnormality is present.3
  2. Fetal Bradycardia is defined as a baseline heart rate less than 120 bpm with 100-120 bpm range not associated with fetal acidosis. It is common in post-date gestations and in fetuses with occiput posterior or transverse presentations. A FHR below 100 bpm is usually associated with babies with congenital heart abnormalities. Moderate bradycardia of 80 to 100 bpm is a nonreassuring pattern. Severe prolonged bradycardia of less than 80 bpm that lasts for three minutes or longer is an ominous finding indicating severe hypoxia and is often a terminal event. Causes of severe bradycardia include prolonged cord compression, cord prolapse, tetanic uterine contractions, paracervical block, epidural and spinal anesthesia, maternal seizures, rapid descent, and vigorous vaginal examination.

Both Tachycardia and Bradycardia are considered longer term patterns to watch for. There are some short term or periodic FHR changes that should also be noted.

  1. Accelerations are usually associated with fetal movement, vaginal exams, contractions, umbilical vein compression, fetal scalp stimulation or external acoustic stimulation. They are considered a sign of fetal well-being, and are the basis of the nonstress test (NST) that many providers recommend to women who are past their due date. The presence of at least two accelerations, each lasting for 15 or more seconds above baseline and peaking at 15 or more bpm, in a 20-minute period is considered a reactive NST, which is a good thing.
  2. Early Decelerations have a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction. Meaning that the heart rate will decrease at the start of the contraction, and then return to baseline after the contraction. Early decelerations are reassuring, and not an indication of fetal distress, but they need to be identified to avoid confusion with other nonreassuring decelerations.
  3. Late Decelerations are caused by uterine contractions and are associated with uteroplacental insufficiency, which means that there is a decrease in uterine blood flow or there is a placental dysfunction. Some causes include postdate gestation, preeclampsia, chorinic hypertension and diabetes mellitus. A late deceleration starts at or after the peak of a contraction and the heart rate doesn’t return to baseline until after the contraction ends. According to the Association of American Family Physicians (AAFP), all late decelerations are considered Category 3 situations and a pattern of them is nonreassuring.
  4. Variable Decelerations. These are shown on the FHR tracings in “U”, “V” or “W” pattern and may not have a constant relationship with the uterine contractions. They are common in patients who have experienced premature rupture of membranes (PROM) and decreased amniotic fluid volume. They are caused by compression of the umbilical cord. Variable Decelerations can be complicated, “Variable decelerations may be classified according to their depth and duration as mild, when the depth is above 80 bpm and the duration is less than 30 seconds; moderate, when the depth is between 70 and 80 bpm and the duration is between 30 and 60 seconds; and severe, when the depth is below 70 bpm and the duration is longer than 60 seconds. Variable decelerations are generally associated with a favorable outcome. However, a persistent variable deceleration pattern, if not corrected, may lead to acidosis and fetal distress and therefore is nonreassuring.”3
  5. Sinusoidal heart rate patterns are associated with high rates of fetal morbidity and mortality, and is considered a Category 3 FHR pattern. It indicates severe fetal anemia, which can happen in cases of Rh disease or severe hypoxia. On the FHR tracings it looks like a regular, smooth, undulating wave that happens two to five times per minute and has a range of 5-15 bpm. It is also characterized by a stable baseline heart rate between 120 to 160 bpm, and doesn’t have variability between the beats.

How to Decide

Now that I know more about the different types of heart rates that they can see using the EFM and what they can indicate, I understand more why my hospital would require this for VBAC patients. However, my main concerns with continuous fetal monitoring haven’t changed. How can I be sure that the providers are accurately reading the FHR tracings? I have to have trust in those that are there and that they have the experience and knowledge to interpret them. How can I preserve my ability to stay mobile during labor? I am going to request that they use a wireless model of the EFM so that I can be comfortable while being monitored.

During my 35 week appointment, I talked to my midwife about my concerns and we talked in detail about how they ensure that multiple people are looking over the tracings before initiating the decision to have a cesarean section and that they work hard to try other options before resorting to surgery. She also explained how they have installed wireless receptors for their monitors throughout the birth center so that whether I am in my room or walking the halls they will be able to find me if they need me and I will still be able to have the mobility that I really want.

Although it’s not ideal to me to have continuous monitoring, I think that it will be something that I can work with. If during my labor I change my mind, we will cross that bridge when we get there. Did you have continuous monitoring during your labor? Were you able to have a wireless version? What was your experience like? I’d love to hear from other mamas about their experience!

 

~Mama

CombatBootMama

 

  1. American College of Obstetricians and Gynecologists, June 22, 2009. (31 December 2014) (http://www.acog.org/About-ACOG/News-Room/News-Releases/2009/ACOG-Refines-Fetal-Heart-Rate-Monitoring-Guidelines
  2. O’Brien-Abel, Nancy, RNC, MN. “Uterine Rupture During VBAC Trial of Labor: Risk Factors and Fetal Response” (31 December 2014) http://www.medscape.com/viewarticle/458963_5
  3. Sweha, Hacker and Nuovo. Association of American Family Physicians. “Interpretation of the Electronic Fetal Heart Rate During Labor” (31 December 2014) http://www.aafp.org/afp/1999/0501/p2487.html

Hiring our Monitrice

I have talked about the process for hiring a doula or monitrice in another post, and as the end of the first trimester came upon us we knew that we needed to get moving and hire ours! We decided that a Monitrice would work best for us for several reasons. First, I wanted to be sure that I could labor at home for as long as possible before going to the hospital. Second, my husband wanted to make sure that whomever we hired had medical knowledge to be able to identify any red flags that could indicate an emergency while I’m laboring. Third, I wanted a trained person to be able to stay with us throughout my labor at the hospital, instead of the flitting back and forth of the busy midwives at the hospital.

Over the past few months, I had been collecting the names and recomendations for several home birth midwives in my area. I was able to find five or six that area mothers had used and had stories about.  I tracked down their Facebook pages, websites and anything else I could find about them to narrow it down.  Based on all of that information there were really only two that I knew could work for us and our family dynamic.  I emailed one and recieved a reply, she was no longer taking any clients at all – homebirth or monitrice.  I then contacted the other and she replied back quickly wanting to know more and to talk.

We spoke over the phone for about an hour, talking about my previous birth experience and what we are looking for in a Monitrice.  Then we set up an appointment to meet. She warned me that she had two homebirth clients due that week so it may change.  And change it did! The day our meeting was planned she was called to a homebirth and we had to adjust to the following weekend.

My husband and I drove to her house for the meeting, and we could immediately tell that our worries of winter weather could be valid. Her road was up the side of a steep hill, and was all gravel so cannot be plowed.  We started praying for a mild winter! Her home was on the side of the mountain, and was a log cabin style.  Her husband met us at the door and talked with us while we waited for her to be ready (we were nearly 20 minutes early having over estimated the drive time).  Our families are similar with several service members, and he even showed us a picture of his daughter with General Franks from her deployment.

Once she was ready, we got settled into the conversation easily.  We talked about my previous cesarean section and what I liked and didn’t like about my labor experience during that time. We went over our expectations and what we are hoping for by hiring a monitrice as well as some concerns that we have.  We were curious about how the dynamic would be between her and the hospital staff, as she is well known as a home birth midwife in the area and she has transfered patients there in the past.  She assured us that as a monitrice they will probably love that she is there as it makes their job very easy.  The hospital where we are going is very busy – more than 10,000 births per year.  So the providers are constantly going between patients and don’t get to spend a lot of time with the laboring mothers.  By having the Monitrice with us we will have a fully trained midwife with us throughout the entire birth and that is something that I really look forward to.

We also discussed nutrition, and staying healthy throughout the pregnancy. She also was able to give me ideas on how to avoid having so much water weight at the end of the pregnancy which I hope to follow including decreasing my carbohydrates and balancing the ones I do eat with plenty of protien.  Many of the things we talked about are right on track with how we view healthcare in general.  In our family we try to avoid artificial or synthetic medications, instead trying our best to find natural replacements or whole foods.  She was of the same mind on many of these things and it put our minds at ease that she is the right choice for us.

She also checked to see if I have any seperation of the abdonminal muscles, or diastasis recti, and I do have a one finger width gap. So she showed me some ways that I can keep excercising and keep my abdominal muscles strong without causing any further separation.

We ended up speaking for more than two hours and at the end both my husband and I were definitely sure of our decision.  She is also affordable and works with us on a payment plan, so that definitely helps!  We are very excited to have another supportive provider on our team as we work towards our VBAC!

~Mama

CombatBootMama

Second Prenatal Visit: 13 Weeks

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?

~Mama

CombatBootMama{written on 7 July 2014, delayed publishing until after our announcement!}

First Trimester Genetic Screening

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.

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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.

CombatBootMama

First VBAC Prenatal Visit

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?

~Mama

CombatBootMama