WOMEN AND BIRTH: WE HAVE A VOICE! By Jamie Stacey
My VBA2C - By Jamie Stacey from Canada
What ever happened to the good ole days when a pregnant woman would go into spontaneous labour and have a natural birth, fully supported by medical staff?
When did we really start hearing about so many of these unfortunate stories of women ending up with unplanned caesarean sections?
Why are so many inductions turning into emergency surgeries?
Why are doctors encouraging repeat caesareans instead of encouraging the natural process?
Over my journey of fighting for a vaginal birth after 2 caesareans (a.k.a. VBA2C) with my third baby, I have found a passion for helping women find their voice while navigating the not-so-supportive medical community and helping to inspire them to write their own history without unwanted pressure and fear from external forces. During my third pregnancy, I had to deal with past trauma surrounding my birth stories in order to really figure out what I wanted and most importantly, WHY.
I am going to go into some detail around my first 2 c-sections because during the process of diving into my past experiences, I listened to a lot of podcasts and had a lot of conversations with other women, and I always found that the ones I really resonated with, and that truly inspired me, were the ones who also dove into their previous experiences.
Even if our stories are somewhat different in the details, there still seems to be SO many similarities!
Listening to others retell stores also helped me to unpack some emotions around my own birth experiences that I did not realize I had and more importantly, some memories that I must have subconsciously blocked out. The process of educating myself on VBA2C has been a great source of therapy. However, if you wish to dive right into my VBAC story, jump down to “THIRD BABY”.
MY FIRST BORN:
I was young, 21 going on 22, when my now husband and I found out I was pregnant with my daughter. It was completely unplanned, (I was on the pill!) but we were high school sweethearts and had already been together for 5 years at that time so jumped into it with two feet. I was under the care of midwives, and ultimately had a pretty uneventful and normal pregnancy. At 38 weeks we started stretch and sweeps and I started losing my mucus plug a little bit at a time for about a week. We discussed induction when I was around 40 weeks and at this time, I was already 2cm dilated. My only request was to book it around a certain OB and her schedule. I wanted to avoid having her a part of my birth. She was a gynecologist that I had horrible experiences with as a teenager and if anything were to go wrong during my labour, I did NOT want her to be on-call. So, we scheduled it for 41 + 4 days.
November 29th, 2010: My husband and I went in at 6:00 am that morning and by 8:00 am I was hooked up to Pitocin and had my waters broken. The medical staff continuously turned up the Pitocin to get things moving, and my labour became extremely intense, very quickly. I was having strong contractions on top of one another. I was unable to get comfortable and I had no breaks in between them. I had the monitor around my belly which kept slipping any time I tried to do things to get through the pain.
At some point my care got transferred to the OB as the Pitocin was causing distress for the baby and her vitals were becoming increasingly difficult to monitor. In walked the doctor I specifically tried to avoid. (It turned out she was covering for the on-call OB that day… great.) My mood and my emotional and mental state, it all changed immediately. She had me on my back so that the monitor would not move around, and it made my labour extremely difficult to get through. She would not let me walk around, change positions, nothing. Everything my husband and I had discussed to help me through my labour and everything we planned was no longer an option. I was checked many times (probably too many) and progressing very well. I went from 2-9cm in what I think was about 3 or 4 hours.
The OB told me that because the baby’s vitals were so inconsistent, she was concerned the baby was in distress or the cord could potentially be an issue, so she strongly encouraged an emergency caesarean. She left the room and my husband, my mom and I cried and talked it out very quickly and decided if the doctor was concerned, then we should be too. I gave my consent, (yup, I was asked to sign paperwork in a moment of fight or flight while I was in mom-survival mode) and I was wheeled into the operating room for my spinal.
While laying on the table with only the anesthesiologist in the room, in walked my mom wearing scrubs. I asked her where the HELL my husband was, and she reports to me that he did not feel comfortable coming in. Side note: my husband THINKS he does not do well in hospital settings or with blood. I looked her dead in the eye and demanded she get Zack in here right away (may have used more aggressive language). Sure enough, he came in soon after.
During the time my husband and mom were swapping outfits, the OB told me I was 9.5cm dilated while I was laying on this hard surface with bright white lights shining on me. I remember feeling stressed out, scared, cold and alone. I was in tears the entire time. When she said I was 9.5cm I had a split second where I questioned why I was even laying where I was. I was so close! She asked me if I wanted to try pushing, I excitedly said yes, despite my husband not even being in the room, and she guided me through one push. I think because I was so frozen and I had no idea what I was doing, I could not feel my contractions, nothing. Then she just said, lets just get this baby out. She just gave up on me.
I do not know what the time span was between when I was told an emergency caesarean was necessary and when it actually got started; but it was enough time to sign paperwork, get a spinal done, try for a push, for my mom to change in, then out of the scrubs, and then my husband to get dressed in them after and finally join me in the operating room.
When my sweet Rachel was finally out, she swallowed some meconium (super common), so they rushed her to the table to aspirate it out of her lungs, wiped her down, wrapped her up, brought her over to us to get a look at her, and then took her away to have a pediatric respiratory therapist monitor her. She was breathing fine, and she was okay, yet I did not get to hold her, I did not get an opportunity for any skin to skin, I did not even get more than maybe 15 seconds to look at her.
Following my surgery, I was wheeled into a dark recovery room, wrapped in warm blankets and left alone for what felt like many hours. My freezing was taking a long time to ease up, my arms and chest were super heavy and my vitals were all very low so they wanted to monitor me. My daughter was in the NICU as this was the protocol at that time when a baby swallows meconium. My husband was allowed to go in there and be beside her so he kept coming back and forth as much as they would allow him to and show me pictures, and I would just cry. I was devastated and so very eager to hold my baby girl. (Side note: this should not have happened, and would not happen today)
I should have been resting at this time, but I was a basket case of emotions. I could not stop crying, I wanted to see my daughter and no one was bringing her to me. I felt like I was in jail! Eventually I got brought into my room where my mom and in-laws came to see me then I finally got some rest.
I still at this point had not seen or held my daughter. When I woke up, my freezing in my legs still had not completely alleviated and I was extremely sore from surgery, so my husband had to wheel me into the NICU to see and finally hold Rachel.
My daughter was born 8 pounds, 2 ounces, yet to this day I have no idea if she was measured for length or what time she was born at. We estimate it was around noon that day, but no one wrote it down. I also still don’t know whether the cord was around her neck or not as this had been brought up as a potential issue they were concerned about when I was labouring.
What really kills me was the fact that I didn’t get to hold my newborn baby ALL day. I am not quite sure what time it was that I finally got to be wheeled into the NICU and hold her for the first time, but I know it was dark outside, and that we no longer had any visitors. So, to me that indicates the earliest it could have been was 6 or 7pm, possibly even later. She stayed in the NICU over night to be monitored even though she was perfectly healthy. Luckily, I was able to spend as much time as I wanted sitting beside her, holding her hand from my wheelchair, holding her in my arms here and there, and that I did. She was discharged from the NICU at 7am the next morning and stayed with us in our private room while I recovered from my surgery for 4 days.
Again, my daughter was not given the opportunity for skin to skin, she was not being held by her own mother and to top it off they were giving her formula without my consent.
December 4th, 2010: RECOVERY…
If you think this experience wasn’t traumatic enough, I was trying to heal from an abdominal surgery and really struggling. My midwives came to our house the day after we got home to check in on me and baby but I had a horrible fever and a lot of pain; I did not seem to be healing. She suggested I go to the office of the OB that delivered Rachel and get checked out. I did so immediately and when she took one look at my incision, I saw sheer panic on her face. She attempted to contain it, but I knew something wasn’t right. She asked me to meet her at the hospital. I ended up being re-admitted due to a haematoma (pool of blood between the uterine wall and bladder) which resulted in an infection and the uterine incision not closing. Staples, glue and stiches would not take. They decided to freeze me up, open up the exterior incision and reattempt to close my uterine incision. I was re-admitted at the hospital for a few days and my husband was caring for our baby from home on his own. He would bring her to the hospital in the morning and they’d stay the day so I could try feeding and I was constantly pumping. Because I was unable to care for her on my own, and she was no longer a patient, she was not allowed to stay over night with me.
When I finally got home, I was hopeful that I was on the mend and I could just focus on being a new mom. Unfortunately, the fevers did not subside. I was on antibiotics and naproxen and it was not helping. I saw the OB again and she said that my while my uterine incision was starting to close, it was not holding properly, and it seemed my body was rejecting the cesarian section; the staples and ultimately the outside incision was not closing either. She had me meet her at the hospital once again to have a wound care specialist come take a look at me. It was suggested by the specialist that I not attempt to seal the incision and instead allow it to close naturally on its own. So they arranged for nurses to come to my house daily, then eventually weekly to clean my incision and pack it with an antibacterial seaweed material and cover it up. This went on for 2 ½ months postpartum. I did not have a proper shower that entire time because I couldn’t get it wet and I was hardly able to stand up completely straight for several months. Worst of all my body was fighting an infection so hard that it was unable to produce enough breastmilk to exclusively breastfeed my baby. We struggled a lot, feeding her was extremely difficult as I had to be in the perfect position with the right amount of pillows in order to hover over her without pain. This incision consumed my days and nights along with the usual stresses of having a newborn baby come into your world. I gave up on the breastfeeding by 4 months and just continued with the formula.
What happened????? I don’t know! I do not know what happened during that c-section, but something wasn’t right, and it was evident in how this OB went from being a cold, nasty, over-confident woman to providing me with her personal cell phone number to reach her at any time. She knew she did something wrong, but I will never know what. And as I looked into it further, this was not her first time botching a surgery.
I strongly feel an unnecessary cesarian was pushed on me and it robbed me of enjoying my first few months as a new mom. Recently, while pregnant with my third, I had the opportunity to review my medical records from this labour and delivery and have learned a lot of interesting things, the biggest one being that the Pitocin dose was started way too high and increased way too frequently, which after some research would be reason enough to cause distress for me and for baby.
My husband and I were only 22! It was a lot to go through. But the positive of it was that Rachel was healthy, and it was so incredible seeing how my husband stepped up to the plate and managed so well as a partner and a new dad.
BABY NUMBER TWO:
We got pregnant with our son Lucas when our daughter was 21 months. I considered both midwives and an OB early on and met with both. As you can imagine, my scar from the incisions and the trauma following the caesarean was a mess. I had a keloid scar that appeared like 2 or 3 incisions happened in and around the same area. I also had that pouch above my incision that no matter how in shape I was, it would not go away. It was about an inch thick and completely numb. It was especially hard on me from a confidence perspective but also it never felt right. I spoke to many women who had caesareans and did not have a scar like me and did not have the same puffiness or numbness.
The midwives were confident I was a candidate for a VBAC, but when I interviewed this highly recommended OB, we discussed that she could actually reduce the amount of scar tissue that had built up. I agreed to another caesarean section as I liked the sound of not only cleaning up my scar tissue from the outside, but on the inside too which, according to her, would ultimately give me a better chance to be a potential candidate for VBA2C if we decided to have a 3rd baby.
My pregnancy was easy and was going by very quickly between moving and having a toddler to chase around. At around 6 months the doctor showed some concern about the baby’s size. I started going for growth ultrasounds biweekly at about 7 months. His size remained small, growth was minimal and they ultimately declared him to have IUGR (Intrauteral Growth Restriction) and decided I should have him early. It was suspected that for whatever reason, likely a lack of blood flow to the placenta, that he was not being fed enough, so they felt he’d be better outside eating than inside not knowing why he wasn’t getting bigger. We scheduled the c-section for 35 weeks. I started going for regular NSTs (non-stress tests) and monitoring at the hospital, I received steroid injections to increase development of his lungs and heart and we prepared for an early birth.
He was born at 4 pounds, 1 ounce. I did not have the opportunity for immediate skin to skin this time around either because he was premature and fragile. I was prepared for this. They started him on breathing and feeding tubes but he was a champ! He pulled them out himself and did just fine on his own. He even did pretty good with latching right off the bat! Like all babies, he lost a bit of weight after birth and we stayed at the hospital with him in the NICU for 9 days until he was 5 pounds and passed his car seat test. There were no major concerns, but it was important for him to continue gaining weight, so he spent the majority of his time inside the incubator to stay warm and grow. I’d say about 80% of the time he was bottle fed with both formula and whatever breastmilk or colostrum I could get, through little arm holes in the incubator. At night I would bundle him and hold him to feed, and we’d do some skin to skin and latching practice here and there too. We got him home the day of my pre-planned baby shower!
He excelled as a baby and is now 8 years old. I healed from that caesarean with no problems. It was just a few days before I was standing up pretty well and completely independent. It was night and day from my first experience in that sense. Breast feeding went okay; he was so tiny that in order to properly feed from my breast, we had to use a nipple shield and it became clear pretty quickly that he preferred the bottle over that. We continued the formula and I continued pumping, so he had both but my milk production went downhill pretty quickly and by about 3 or 4 months, I stopped.
Although I sometimes regret not attempting the VBAC then, I do not have the same negative feelings attached to his c-section because I knew in advance that he was going to be whisked away afterwards and I had months to mentally prepare for it. Perhaps I’d feel differently if I was planning for a VBAC and got told he was growth restricted and needed to be born surgically, but that wasn’t the case, so I try not to dwell on it.
THIRD BABY: Challenges of my pregnancy, labour and delivery…
I thought my husband and I were done having children. Fast forward 6 ½ years, New Years Day 2020 and we decided that we both wanted more, so made a plan to start trying in the summer after I ran my first half marathon in May. Covid happened, so the race got cancelled, and we started trying earlier!
I got pregnant in July of 2020 and I immediately knew I wanted to have a chance at a VBAC. I didn’t even think twice. Here is why…
Over the years I found myself jealous of women and their birth stories and ashamed of my own. While I do not agree, I knew there was so much stigma around c-sections being the easy way out, and not considered “real birth”. I always felt this need to justify to other women “yah I had 2 c-sections but the first was an emergency after a full labour and the 2nd was because he had IUGR”. And then I felt yucky about feeling ashamed.
I have always wanted that experience of a vaginal birth, not just for myself, but with my husband. I have realized over the course of this 3rd pregnancy how much trauma I really had from the first experience and how much regret I have not going for a VBAC with my son. And I had to work through that this time around.
I was only a few weeks pregnant, if that, when I called our local midwives and got assigned a team. For the majority of the pregnancy, I only saw my primary midwife. (Note: here we have a primary, and two secondary midwives) My midwife reviewed at all of my medical history and birth records and knew from the beginning I wanted to have a VBA2C. I was upfront that I did not want to be encouraged into a c-section unless there was a very clear-cut medical reason why.
I did not even consider for a second that my decisions for a VBA2C would become a problem down the road;
why would a woman be penalized for wanting the natural choice?
A small scare… I had my first ultrasound at 12 weeks and waited patiently until I was to meet with my midwife for the first time. I received a phone call from the ultrasound clinic on a Sunday morning asking me to schedule an ultrasound. When I had gone to my initial one the week before, there were some administrative confusions and they did not have my requisition, so I showed them the one I had on my phone. So, when they were asking me to book another ultrasound so quickly, I assumed they were simply confused. She ended up calling me back moments later and said that my family doctor had actually requested a second ultrasound based off of the results of the initial one. I attempted to get more information but all she could say was that the doctor’s notes indicated a need to follow up on the previous results. I booked it, hung up, and fell into my husband’s arms in tears. I was terrified. It was Sunday, my family doctor’s office is closed so I cannot call them to find out why she requested it and the woman I spoke to at the ultrasound office doesn’t have answers or isn’t allowed to say more. Who does this to a pregnant woman??? I called them back, I asked if I could come and get a copy of the requisition request so I could check it out myself. I wanted to compare it to the copy I had, to see if it were in fact the same requisition so I could rule out the need to re-book. I drove down and got it, I opened it up as soon as I got in the truck and read subchorionic hematoma. I immediately Google it of course, and it sounds scary. I read chance of miscarriage and just break down. At this point I had not actually met my midwife in person or spoken to her on the phone yet. I did not want to page her as it didn’t feel like an emergency. My sister-in-law encouraged me to, and I am so glad I did. My midwife was able to explain what it was and how common it is, and she completely calmed me down. Regardless, this was going to continue to be something I feared every day, every time I went to the washroom and every time I went to another ultrasound. Finally, by my anatomy scan it was gone.
With the exception of all of that, my pregnancy was very uneventful and very healthy. I stayed active working out 3-5 times a week until about 7 months, I ate healthy, and the baby and I passed all tests and scans with flying colours. Due to my son’s history of IUGR I was taking low dose aspirin throughout my pregnancy until 36 weeks to ensure extra blood flow to my placenta. And I started biweekly ultrasounds at 34 weeks to check on baby’s size. The 36-week ultrasound showed that baby was already approximately 6 ½ pounds so they ruled out any concerns of IUGR.
As per the college where I live, midwives must send their patients to consult with an OB if they are hoping for a VBAC after 2 or more caesareans. I booked with head of gynecology at the hospital I was to be delivering at for almost 32 weeks. Earlier that week I met with one of my secondary midwives. It was my first time meeting her and she hit me with some hard news;
the OB was most likely going to insist on a transfer of care from
midwifery to OB with a recommendation for a repeat caesarean
She was definitely a straight shooter, and I appreciated the heads up so I could prepare myself for my appointment with OB, but it left me with a big fear that if I pursued this VBA2C, despite his recommendation no to, that even my primary midwife wasn’t going to support me. It truly felt like I was in a lose-lose situation and no matter what, I was backed into a corner.
For those of you who don’t know me, I am not just going to sit back and be told without a fight… so here is what I did:
I hardly slept the few days leading up to my appointment with the OB and of course immediately began my research. This led me to a local VBAC support group on Facebook which was extremely helpful. I did learn the OB I was to be meeting with that Friday is known to be unsupportive of VBA2C. I connected with a woman who had her VBA2C baby delivered by this doctor in recent months, and she filled me in on her story, which was remarkably similar to mine. I also reached out to the VBAC Link (both the podcast and community Facebook group) and began immersing myself in each and every podcast, blog and discussion around VBA2C and uterine ruptures, and it was my saviour!
The appointment with the OB did not go as poorly as I had anticipated it would. To my surprise, and to the surprise of the midwives, he indicated in his notes that although he was not enthusiastic about VBA2Cs, he did not see a reason at this time to transfer care. This meant we could continue on as planned! What – a – relief!
NOTE: Uterine Rupture is the #1 reason doctors are uncomfortable with VBACs. If you want to better understand them, and the 3 types of uterine ruptures, this is a great summary. I also recommend you listen to their podcast episode where they discuss it further. https://www.thevbaclink.com/uterine-rupture/
It was time to start attending my growth ultrasounds. My secondary midwife had put in the requisition notes that the patient was interested to know about the myometrial thickness (uterine scar thickness). This was not necessarily true. I think my asking her about it resulted in a miscommunication because had I known this would turn into a giant obstacle, I would never have brought it up to her.
Now pay attention… The first ultrasound showed it to be at about 5.5mm. Within that report the OB on shift that day reviewed it and stated that she would recommend a repeat caesarean if it were to go thinner than 3.6mm. I did not get a chance to discuss these results with my midwife prior to my 2nd ultrasound which measured it at 3mm just 14 days later. My midwife brought it up to me just as a warning that if these results were to get in the hands of the OB I had my consult with, that it could trigger a recommendation for a transfer of care.
I unfortunately received a call from my midwife the day before I was to meet with her and she informed me that the OB had in fact recommended a transfer of care due to the previous 2 ultrasound results and therefore her role is now a support person and within that meant that she was no longer able to give me a stretch and sweep at our appointment the next day.
NOTE: In Ontario, and in the community I live in (it varies from city to city and at each hospital too) the College of Midwives indicates that if transfer of care is recommended by an Obstetrician, their hands are tied. So basically
“Recommendation = Enforcement”
I was devastated. I cried and talked it through with her for 40 minutes, just trying to digest it. I couldn’t understand how in this world we live in; we as pregnant women cannot choose our care providers and that the rights of a midwife with their own patients can be stripped from them without either parties’ consent. Mind-boggled. She assured me she still had my back and would be there through every step of the way, on delivery day and for post-care no matter what happens from here on out. She continued to repeat our plans, and constantly reminded me it is my right to say no to surgery.
I met with the OB later that week with a goal of requesting the transfer of care be reconsidered to a minimum of shared care. I was so nervous about this appointment, I even brought along some notes. As I was waiting for him in the room, I began having a small panic attack and felt faint. I kept telling myself to pull my shit together, if I pass out, I’ll be giving this man yet another reason to worry about me and my pregnancy. So, I closed my eyes and took deep breaths until it passed.
When he walked in, the first thing he said to me was “okay so today we are going to be scheduling in a c-section and reviewing your last 3 ultrasound results.” I immediately got angry. I couldn’t control it. I never consented to surgery, and I had no intentions on booking one in. The OB began showing me images from my ultrasound, which were impossible for me to understand, but did show me that in my 38-week ultrasound my scar measured at 4.0mm.
I didn’t mention this before, but in our 1st consult 2 months prior, I inquired about getting my scar ultrasounded and in summary he felt it was not necessary as there was not enough concrete evidence to support that myometrial thickness correlates with scar strength.
Quick review:
-
34 weeks: scar thickness was said to be 5.5mm
-
36 weeks: scar thickness was said to be 3.0mm
-
37 weeks: recommendation for transfer of care
-
38 weeks: scar thickness was said to be 4.0mm
All I could think was; my scar got thicker??? How can that be? Well it can’t and this aligned with all of the research I had done around this topic and the inaccuracy of using ultrasound technology to measure uterine scar thickness to begin with.
I began asking questions and reciting my own research, and it quickly became clear to me that he was not entertained by what I had to say. I put my notes down and my angry mama bear side came out.
“You clearly don’t seem to give a shit about what I am saying or feeling right now so I am just going to give it to you straight” just shot out of my mouth! Like word vomit!
I continued to express that while I do not question his abilities as a doctor and I am confident that he is extremely intelligent, he is not a woman. He has never been pregnant, given birth, had a c-section, recovered from a c-section, experienced the trauma of a terrible recovery from said c-section and then found out it was an unnecessary surgery. I accused him of never being able to understand the emotional and mental harm he has caused me these past couple of weeks, or the effect he has had by telling a woman at 38 weeks that he is taking away the rights of her care providers and transferring it not only to a stranger, but a stranger who evidently does not support her, or her birth plan. I stated that if I were a first-time mother, this would be extremely traumatizing. I may even have name dropped past patients of his who had successful VBA2Cs. His eyes just widened and stared at me. (He may think I am crazy at this point, but I am perfectly fine with that! Lol)
So I continued… I explained to him that since our last consult, I…
-
Reviewed my medical history notes and revisited my birth stories with my other 2 kids to unleash some trauma I had blocked out, and really dealt with those feelings
-
I listened to 30+ hours of podcasts
-
I read everything ACOG (American College of Obstetricians and Gynecologists) and SOCG (The Society of Obstetricians and Gynecologists) have to say about VBACs and VBAC 2+
-
I exhausted many avenues of research, some of which provided by the hospital
-
I had conversations with and read blogs by nurses, midwives, doulas, ultrasound technicians and many, many women who have had successful VBA2Cs, have had traumatic birth experiences like I did, and even some people who have had a uterine rupture.
I expressed to him that I am not ignorant or naïve to the risks associated with VBA2Cs and that I have even been clear since day one that I am not opposed to a c-section if medically necessary. I know that:
-
Uterine rupture risk is only 0.1%, even if it was double the risk with a VBAC after 1, it is still only 0.2%. And that the risk of a catastrophic uterine rupture is even lower than that. I am taking bigger risks every day just by leaving my house in the morning! **Note: a catastrophic rupture would be an outcome such as a need for a hysterectomy or a blood transfusion, trauma to the baby, or worst-case mom or baby do not make it.
-
I learned all about how there are 3 levels of uterine ruptures and 2 of which are nearly impossible to have clear cut research on because women aren’t delivering vaginally and then being wheeled into an ultrasound to have their scars measured. Research really only can count the ones that fully rupture because those cases end up going into emergency surgery. [More about this in the link provided earlier]
-
I read research articles on the inaccuracy of measuring uterine scar thickness via ultrasound and that many women have had scars thinner than 2.0mm and did not rupture. Not to mention all uteruses get thin during pregnancy and all women, previous CS or not, are at risk of a uterine rupture. In fact, it is said to be unethical to use scar thickness as a risk assessment tool in these cases.
-
I mentioned some of the basic risks of repeat caesareans and of getting spinals and epidurals and questioned why none of this is ever addressed with patients prior to making a decision. [Please research this!!!]
-
I listed off the various reasons why I am not a high-risk pregnancy and reminded him that both baby and I have consistently been healthy. My current health and age and my medical history do not indicate any added risks.
-
I am not 22 and unaware or uneducated this time; I have done endless amounts of reading and preparing, I made my decision based on research not on a selfish want to have this experience. I trust my body and the natural birth process. I trust my instincts and ability to make good decisions in stressful or emergency situations.
What I noticed in that appointment was that he was unable to provide me straight answers to any of my questions or clarify how his line of thinking changed so drastically since I saw him 2 months prior. I requested that rather than enforcing this transfer of care, that he at the very least make it shared care so my midwife can have a role of more than just a support person on labour day. He agreed to this like we were making some sort of negotiation, but he was still in charge. I advised him that my birth plan had changed, and my midwife would be sending it to him in the coming days. We booked our next appointment for 40+5 and I left his office.
After a few edits and some long discussions with my midwife around her own comfort levels and skill sets, we came up with the following birth plan:
Note: I opted NOT to have an epidural or any form of pain management medication. Reason being is with all of the research I did around uterine ruptures, I learned that the actual pain and feeling of the rupture happening is very different from that of a contraction. And if you know a uterine rupture is likely happening, intervention (such as a c-section or immediate surgery following your birth) will decrease your chances of a catastrophic outcome and ultimately keep mom and baby safe. So I wanted to FEEL everything happening. You can learn more about it and make your own choice by doing your own research!
I had a stretch and sweep with my midwife at 40+2 where she indicated I was 1cm dilated on the outside, but not quite on the inside yet.
I met with the OB again at 40+6. He advised he received my birth plan, was comfortable with it, with the exception of using Pitocin as a means of induction and that he had sent it off to Labour & Delivery so that they had a copy on file.
We booked an induction for 41+4… NOTE: I chose this day. He would have preferred earlier, and I was willing to go as late as 42 weeks. However, for various personal reasons, I wanted to ensure my primary midwife would be there for me when I was induced. She would be going off-call the following day in the evening and would be off-call until 42+2 so I did not want to risk her not being by my side. I do not necessarily recommend planning the birth of your baby this way, but in some cases, it makes sense. For me, this felt like the only option and given there were no red flags, baby and I were still healthy, 41+4 seemed like a safe choice.
The OB advised that when we come to the hospital he would have the midwives start the induction and monitor my labour and he would only be there to intervene if necessary. This was a glimmer of hope that he was finally succumbing to my plans and getting on board. He gave me a stretch and sweep and indicated I was not even 1cm yet. With that he warned me that if I came to my induction appointment and I was not dilated enough, I would not be able to have the foley catheter (sometimes called a foley ball) put in, or have my waters broken, and since he is not comfortable with administering Pitocin to induce labour for VBA2Cs, “we would have to have a conversation I would not like”. Which meant he would suggest I go in for a RCS (repeat caesarean section). He added in there that even if I was able to get the foley and AROM, that if there was not enough progression, the outcome would be the same, no Pitocin, and a RCS. I nodded my head and said okay but knew I was not in agreement to that.
I left there feeling much better than the last 2 times but still had quite a bit of anxiety about not being dilated enough for my induction plan to be put into place. I thought it through repetitively and came to the following conclusions:
-
If I showed up for induction and was not dilated enough for a foley or AROM, I could just go home and give it a couple more days (as long as baby was okay and fluid levels were safe)
-
If I got the foley, and AROM but there was no progress, at that point my waters would be broken and therefore chance of infection increases, so they’d have to administer Pitocin if I am refusing surgery (I am happy to sign an AMA [against medical advice])
-
He has made it clear that not using Pitocin for VBA2Cs is a personal preference, but he is only on call that day until 6pm, so I was just hopeful the doctor who takes over is fine with it
I saw my midwife once again at 41+2 (3 days after I saw the OB) and she was very happy with where things were at. She said that I was most definitely at least 1cm dilated all the way through, which although wasn’t a huge change since the last time she checked, my cervix was very soft and shortening and she was able to touch baby. Keep in mind that how dilated or not you are, is NOT an indication of when you are going to go into labour so do not get defeated! She was content with the note from the OB and was excited for induction day. She advised that even where I am at now was enough for a foley and/or AROM so not to worry. I left there that day with such a sense of relief, I finally let go of my anxieties, I was in such an incredible head space. I did tons of walking that day and enjoyed the first warm day of Spring.
The following evening, I felt some pressure and some “cramping” as I call it. I could not get comfortable on the couch with the kids and was sore, but I didn’t think much of it because at this point my body had tricked me so many times that I was positive it was not pre-labour. I took Gravol and Tylenol and went to bed.
March 24, 2021: Induction Day…
At 5:00 AM on induction day I woke up feeling the same pressure and cramping I had the night before. I was convinced it was constipation pains as I could not recall being regular that week, so I made a big pot of coffee in hopes to get things moving, sat on my ball and watched a show. I had a loose stool and got in the bath because the cramping was not going away, and I wanted to have some relaxation before we went to the hospital. We still did not know what time we would be going in as the hospital said they’d call us the morning of and let us know, so we had planned to have a big breakfast, get showered and hang with the kids until it was time to go.
While in the bath, I decided to start timing my contractions and they were only 30-41 seconds long and 2-3 minutes apart. You always hear “5-1-1 means go to the hospital” so I didn’t consider these contractions real labour so kept ignoring them. I finally messaged my husband from the bath at 6:30 AM to tell him I was extremely uncomfortable and asked him to get up and start breakfast. I went upstairs to get dressed and its then that I realized something was happening because I was now breathing through contractions hunched over my bed and pillows trying to find comfort with each one and I wasn’t able to eat the breakfast he brought me. I called my midwife and she advised that the hospital usually calls around 7:30 AM so we would have a better idea of how soon I could get in. I told her I could wait half an hour for that call. But it turns out that I couldn’t. I had my husband call her back 15 minutes later and he told her we were going to head to the hospital. We packed up and were out the door by 7:30 AM.
The drive was awful to say the least! My husband even said “You never really realize how bumpy Hamilton streets are until you have a labouring wife in the truck!” We arrived, he wheeled me across the hospital to L&D while I was in immense pain and felt every bump in the floors along the way. My midwife showed up shortly after and advised that since I was shared care, my OB would want to check me when he comes out of surgery, so she suggested I wait rather than doing it twice given how uncomfortable I was.
At about 9:00 AM he came in, checked my progress and I was already 9cm! I could not believe it! He even said “It looks like you’re getting exactly what you wanted!” He had to go into another cesarian section but suggested I continue labouring and if my midwife felt it was necessary, we’d break my waters if they don’t break on their own. I laboured the entire time on my side, facing the fetal monitor and holding my husband. I was experiencing a bit of back labour, so my midwife would massage my lower back and hips while my husband held my hand, iced my upper back and had a cold compress on my forehead. I swear he grew another arm during all of that, I don’t know how else he did it so seamlessly. The contractions were becoming so unbearable and so close to one another that we decided to try a different position and so I moved onto my knees and leaned over the back of the hospital bed. One contraction and I knew that position wasn’t better. I felt something between my legs so reached down and felt my bloody show.
As I was moving to get back on my side, the baby’s heart rate dropped extremely low. I recall seeing it as low as 60 from its consistent 128-132 bpm on the monitor but could not actually hear it. Shit! I got terrified! Remember too that I am thinking about uterine ruptures the entire time. With every single contraction I am thinking about the pain and whether it feels different from the others. I am paying attention to mine and the baby’s vitals because distress for either of us is an indicator. So now I am panicking and was franticly asking if the baby was alive while the nurses tried to reassure me it was okay and anxiously attempted to find the heartbeat by moving the monitor all around. The OB got an emergency page and all of a sudden there were like 8 nurses and doctors in the room.
He broke my waters and ton of meconium came out. (Great, another scary thing) As he and everyone else in the room, including my husband, guided me through some pushes, he was asking the nurses how long the heart rate was that low and asked for the pediatric respirologist and team to get ready to suction meconium from baby’s lungs. I worked hard at pushing but was also learning as I went; don’t blow your breath out of your nose or mouth, don’t let out your scream, cry or moan, push like you are taking the biggest poo of your life!! He told me he needed to speed things up so he would have to give me a small cut and use the vacuum. He looked me straight in the eye and demanded I get this baby out in 2 pushes or he’d be wheeling me into the surgical room. I could tell he was concerned. I was too.
A third-degree tear, an episiotomy, a vacuum and two pushes later, my beautiful BOY was born at 10:18 AM. My husband cut the cord, baby went on my chest while they delivered my placenta and stitched me up.
I looked up at the OB and jokingly asked “how much do you hate me right now??” and he laughed and said “I don’t hate you, but you had me a little scared there, but now you can say ‘I told you so’. You did amazing, congratulations.”
So, it was quick, and a bit traumatic. But let me be clear; this could happen during ANY delivery! None of what happened in this birth story was due to the fact that I had 2 previous c-sections. It was just the way things went! If his heart rate had not dropped so dramatically, they’d have let me push for hours until the baby came out when he was ready to. I probably wouldn’t have tears and a he would not have a bruised head from the force of the vacuum. But he is healthy and I am okay with everything that went down because (excuse my language)
I GOT MY MOTHER FUCKIN’ VBA2C!!!!!
And that is my story. But if you are hoping for more, I am happy to give you more…
Comparing Recoveries:
I have now had 3 different labour, birth recovery and breastfeeding experiences. If you are someone who chooses to have c-sections whether it is because you are fearful of the pain, the effects on your body, or whatever else – that is okay! It is STILL A BIRTH!!!! I do not shame you or judge you, but I do wish you knew how different your experience can be recovering from a natural birth versus a very serious abdominal surgery; and not just for you, but for baby too. I recommend you do your research, but I can tell you all this from my own experience…
For anything related to recovery, especially bum related, you MUST check out my doula friend / sister-in-law Natalie on her website/Instagram! www.natalb.com. She is also a monthly guest-host on the In Relation Podcast (we did one together and she has a bunch of other guests that she interviews with all things pregnancy, labour, delivery and postpartum!)
I think this is long enough, so to start closing…
I first want to say that a truly supportive and amazing provider takes time and can be difficult to find, but when you do, they will be impossible to forget. I technically had 3 midwives and an OB on my “team” during this third pregnancy, but it really did feel as though my primary was the only one who had my back. She was honest about her skillset and her comfort level throughout every appointment, and the fact that her experience working in the field was only one year, but she also listened, was sympathetic and kind from day one. Although she could not promise that I would get what I wanted in the end, she did everything she could so that I at least was given the chance. She consistently reminded me that she would be there for me and for baby right until the end and advocate for me throughout the process and most importantly reiterated that no matter the outcome or how the baby came into the world, she assured me that she would do anything in her power to make sure that my overall experience would be much better than my previous two births because she recognized the trauma. So, figure out what that is for you and what you want in your birth experience. Whether it is something small such as having a hot or cold compress, a warm bath or being able to move around when labouring, or ensuring that you have skin to skin or alone time with your partner and baby immediately following the birth. Whatever it is, do not be afraid to ask! Write it down! Which brings me to that…
Have a birth plan but be flexible. We all know that things do not always go as planned in life, especially when it comes to bringing a baby into the world. So think of it more as a wish list. Have a few birth plans within one and structure it as “if this, then that”. For example, “IF the foley catheter does not help progress dilation after 4 hours, THEN I would like to break my waters” and “IF labour does not progress after breaking my waters, THEN begin Pitocin”. And of course “If the need for a RCS arises THEN….” and lay that out as well.
Going back to my 2nd appointment with the OB and how the first thing he said to me was that we were going to be booking a c-section… he was not entirely wrong about that. I did talk with my midwife about my initial birth plan and had agreed to book one to avoid the need for a medically induced induction and of course to avoid a potential emergency surgery, so we loosely threw out 40-41 weeks as a potential. But I was not happy with that plan.
I realized that I was not being transparent with my midwife about my wish to NOT book an induction as I feared her being scared off by me, that she would ultimately withdrawal from being my support person. I was going to agree to book a c-section to avoid the OB transferring care. I found that I was constantly making a plan that would satisfy everyone else, but in the end, I was not happy. I was still at home anxious, upset and losing sleep over it all and just PRAYING I would go into spontaneous labour so that I could avoid all of the external pressures.
I finally broke down crying and was extremely vulnerable and honest with my midwife about how I was feeling, and as she promised, she still supported me. She encouraged me to be clear with the OB when I saw him next, to bring notes to our meeting, to write down my birth plan and provide her a copy so she could provide it to him in advance. This was the best thing I could have done for my own mental and emotional well-being and
I strongly encourage every woman to feel the freedom to do the same;
be vulnerable, be honest, and be clear
on what you want and don’t stand down to anyone
who says you cannot have it!
Okay, I am pretty much done, but before I go…
I am so thankful for the VBAC Link, their podcast and community group on Facebook. I would not have had the strength to fight for what I wanted, and not give in to what doctors, or any non-supportive care provider, family member or friend thought my plan should be. Listening to all the women tell their stories empowered me to find my voice, advocate my ass off for myself and encouraged me to not be afraid. I can only hope you will do the same in your pregnancy journey too.
And lastly, for informative purposes and just for…
INDUCING LABOUR & WHAT I LEARNED:
First things first: You can’t induce labour, it does not work. Baby will come when your body is ready. When I was pregnant, especially overdue, I hated when people said that to me. However, with that said, you CAN do things to help to get your body ready… I tried every medical recommendation and old wives’ tale out there. Here is a list of what I did.
-
Sex: The key here is that the sperm is a natural oxytocin. Toward the end, we had sex every other day or so, especially those ones where I was extra crampy, and 100% after a stretch and sweep. I tried keeping the sperm inside of me as long as possible. The issue here is that you need to have a real orgasm for the sperm to really do what it is needed to do and that is tough when you are super pregnant and uncomfortable and sex position options are limited. It is extra hard to accomplish if you have not been having sex regularly over the last few months and your partner can’t last long enough to help you out. Worth a try though!
-
Exercise: I was active my entire pregnancy. When I could no longer work out daily, I started going for long walks & hikes, stretching, birth ball exercises and curb walking. I always just felt like my pelvis and groin were sore after, and did not notice it to do more than that but I am sure it was keeping my ligaments limber which is beneficial.
-
Guided Meditations: They are said to work, there are tons out there to try and many people swear by it. This is not for me, but if you are into meditating, or even yoga, worth a try for sure.
-
Nipple stimulation: This is said to create natural oxytocin so I pumped every morning 15 minutes per side. It obviously did not induce me, but I did start a collection of colostrum and stored it in syringes in the freezer for later use.
-
Food: Three foods that historically help induce labour are spicey food, majool dates and pineapple. I got heart burn from eating Thai and Indian cuisine, canker sours from the fruit and fell in love with my new favourite (and healthy) snack: dates with almond butter. BUT none induced labour.
-
Acupuncture: This treatment can alleviate pelvic and abdominal pain, assists in blood circulation reducing swelling and is incredible if you are experiencing sciatic nerve pain. However, once you are 37+ weeks, applying the acupuncture needles into your pregnancy related pressure points (ankles, hands, lower back) sends a signal to your uterus that Mom is relaxed and ready. I did it 3 times (after each stretch and sweep) and whether it helped me or not, it was calming and I got an adjustment at the same time so it was a win-win in my books.
-
Chiropractor: Your ligaments get so loose during pregnancy that things get misaligned very easily and can cause discomfort. Regular adjustments throughout your pregnancy is going to alleviate any pain you may have but also helps keep your posture and pelvis aligned. Toward the end of your pregnancy the right chiropractor (one experienced in prenatal care) can help open your pelvis to allow the baby space to descend. Some are even trained to turn breeched or sunny side up babies!
-
Castro Oil/Midwives Brew: I did this twice. The first time I was nauseous and on the verge of throwing up, all day long! The second time, all it did was cause bowel cramping and had me on the toilet all day. It did not induce labour at all. I honestly think the women who say it worked for them, it was a fluke.
-
Raspberry Leaf Tea: This is said to help strengthen the uterine walls. Although this is not going to induce labour, I strongly believe that it assists with decreasing labour time. I drank 1 - 3 cups a day from 38 weeks but it is safe to start at 37.
-
Evening Primrose Oil: At 38 weeks I started taking 1000mg in the morning with my breakfast. At 39 weeks I upped it to 3 x 1000mg a day with food. You can also take it vaginally but putting things in there freaks me out so I opted not to. The beautiful thing about evening primrose oil is it is supposed to thin your cervix. At each of my stretch and sweeps, although I was not dilated, I was always complimented on how soft it was and how it was progressively getting shorter. I truly believe taking these supplements assisted with my progress and ultimately played a role in how quick my labour was.
Thank you for taking the time to read my blog, I know it was long, but it was important! And if I can help even just one woman, I am HAPPY! PLEASE COMMENT, GET THE DISCUSSION GOING AND SHARE, SHARE, SHARE!!!
