My journey to a vba3c (Vaginal birth after 3 c-sections):
I’m warning you now this is really, really, really long, is full of TMI and has birthing pictures.
I can’t really start this story out unless I back up and explain why I needed to go on this journey in the first place. It all started in May of 2003 when I had my first baby.
Baby #1: I was induced at almost 38 wks for suspected IUGR (I didn't have it as baby was 6 lbs 4 oz at delivery). I had a vacuum assisted, vaginal delivery that was absolutely horrible. I labored for 42 hrs, had an epidural, and was on magnesium sulfate. I became internally swollen from baby being stuck in the birth canal, due to a posterior position, that I was cut by the vacuum, all the way around, as they put it on the baby's head. Then the doctor also performed an episiotomy, which resulted in a 2nd degree “tear”. I had to be stitched up all the way around inside and for the episiotomy. Between the sleep deprivation and the magnesium, I honestly don't even remember her birth, I was so out of it. This was so devastating because I had looked forward to the experience of becoming a mom and had planned for a natural birth. Recovering from all the stitches was the worst and I was deeply sad that I didn’t get the birth I had planned for or envisioned.
Baby #2: I so badly hoped for a natural vaginal birth this time around. I was induced (@38wks) for severe itching on my hands and feet (Cholestasis of pregnancy). I labored on my back and side in bed for 9 hrs (had elevated blood pressure and nurses wouldn't let me get out of bed). I then “had” to have an emergency c-section because my liver enzymes were increasing too fast, blood pressure was elevated and delivery was too far away (nothing but lies that I didn't understand till years later when I got my hospital records). After the labor and c-section, I felt like I'd been hit by a semi-truck, I was beyond exhausted and my entire body hurt. The healing from my c-section (incision) was much easier than my first vaginal birth healing, after I came out of the pain-med fog. I again mourned the fact that I didn't get the birth I had planned for.
Baby #3: I desperately wanted a vbac and felt that I "tried" my best to find a supportive doctor (I was definitely not educated like I needed to be). I found someone who did vbac’s (I switched providers at 32wks) but he didn't feel I was a good candidate because I had "such a hard time" delivering my 1st and she was tiny. He said I would probably labor for 18 hours and end up with an emergency section because this was my third baby and she would be bigger than the one I delivered vaginally. I told him that I knew I could do it and that I needed to know my body wasn't broken. He tried to placate me by saying that, just because I couldn't deliver vaginally didn't mean there was anything wrong with me. Also that this delivery would be so nice because he’d do it on his lunch hour on Friday and take me two weeks early, "because who wants to be pregnant those last few weeks anyways". So I agreed to a RCS at 38 weeks. At that point it was the easiest delivery and recovery out of all my births. Took all of 5 minutes to get baby out and I was in recovery and nursing her 45 minutes later. But I ached deep down, feeling like I was being cheated of experiencing giving birth the way I was created to. My heart just ached.
Baby# 4: I had the thought (that ache in my heart was still there) that it would be wonderful to have a vbac (vaginal birth after c-section), but figured at this point it was out of the question having had 2 prior c-sections. The thinking at the time was “once a c-section, always a c-section". I was completely shocked when the Army doctor offered to let me try for a vba2c. After talking things over with Kev and evaluating our life circumstances at the time, I talked myself out of trying for a vbac. All the scare tactics that were used in my two other deliveries came rushing back, along with the horror of my first vaginal delivery. Plus, my husband was in the middle of PA school and he was nervous about the idea, as the way of thinking was that vbac’s after 2 c-sections was not safer. I pretty much scared myself out of it by comparing my 3 previous births. I knew I didn't want a vaginal birth like the first, and that I didn't want to labor forever and then have to have an emergency c-section, so the easiness of my 3rd delivery is what lead me to my decision to have my 3rd c-section, if I’d only known. Recovery from my 3rd c-section was really rough, it was way worse than my 1st or 2nd c-section. I almost passed out when they gave me the spinal due to BP issues, spent 2 hrs in recovery before I could even see my baby, and my body was in constant pain because the pain meds didn't quite work as well as with my other two c-sections. I felt cheated afterwards, like I had picked what I thought was going to be the "ideal" birth option at that time for me, and then it sucked, bad, just as bad as all the other options I had considered. Then there was the ache of it all, feeling like I was missing out on what I wanted with my first child and longing to allow my body to do what it was designed and created to do. I felt defeated and broken!
At that point I decided I was done having babies because there was no third way of birthing a baby and I couldn't go through another c-section. I also figured a vba3c was simply impossible (the doctor had told me if I didn't try a vba2c then a vaginal birth would never happen).
Baby #5: 5 years later... My arms ached to have a baby in them and I felt we were missing someone in our family. I was so torn because I knew I couldn't go thru a 4th c-section and figured a vaginal birth was not an option. I turned to the internet to see if there was any chance that women were having vaginal births after more than two c-sections. I hoped that if I found a midwife group, I could possibly have a vaginal birth. All I could find though was the name of a doctor in Atlanta, Dr. Joseph Tate, and my heart sank. He was 6 hrs from where we were living at the time and I knew there was no way that could happen. It gave me hope though that if he was supportive then there had to be other doctors. After two miscarriages, and a move to Savannah, GA, I found myself pregnant.
Knowing the fight I may have in trying to get my vaginal birth, I started to educate myself about the research behind vbac’s and if there were any studies on vbac’s after multiple c-sections. I knew I needed the medical evidence to get Kev on board with a vbac and knew the knowledge would be handy in meeting with prospective providers.
At my very first appointment (7 weeks) I asked the Army OBGYN if I could have a vbac. He pretty much laughed at me and said that was not even an option because I’d had two many c-sections. In fact, he insisted I tie my tubes on this c-section because any more c-sections would be to big of a risk. Kind of ironic if you ask me. When I scheduled my next appointment I made sure it was with a different doctor, but he kindly explained that it was just to “risky” and not allowed. In between appointments, I had to see the midwife for routine testing, and hoped she’d be different. Same thing, she explained that although it would be nice, that it just wasn’t a possibility. Not one provider would listen to the medical evidence I’d found to support at least me having a TOLAC (trial of labor after c-section). I was desperately loosing hope that I would find a doctor who would allow me to have a vbac. One of my biggest annoyances and frustrations was that none of these doctors were practicing evidence based medicine.
Realizing I had no chance of a vbac at the military hospital, I started looking at the civilian OBGYN’s in Savannah. I called the local Birth Center, and two other recommended doctors (from my local ICAN chapter) who all told me no, they wouldn't even meet with me so I could explain the research I found to support it. The knowledge that Dr.Tate was now only 4 hours away was always in the back of my mind, but even that seemed like a crazy option.
My last chance was the Perinatologists office who specialized in high risk pregnancies. I saw the midwife my first visit, and although she listened to all I had to say, and agreed I should at least be allowed a chance to try, she informed me that it more than likely wouldn't happen (sadly all due to liability issues), but encouraged me to meet with the most vbac supportive doctor in the practice. When I met with him he also listened to all I had to say, told me his concerns (used plenty of scare tactics) and said that he can’t “force” me to have a c-section and said he would “allow” me to have a TOLAC, but put all these stipulations on it: I had to go into labor by 40 wks, couldn't be induced, no pitocin and any sign of distress would be an immediate c-section. I left feeling like I would have to fight my way to a vbac. So I called Dr. Tate’s office just to see if it was truly a possibility or if I needed to prepare for a 4th c-section.
My last chance was the Perinatologists office who specialized in high risk pregnancies. I saw the midwife my first visit, and although she listened to all I had to say, and agreed I should at least be allowed a chance to try, she informed me that it more than likely wouldn't happen (sadly all due to liability issues), but encouraged me to meet with the most vbac supportive doctor in the practice. When I met with him he also listened to all I had to say, told me his concerns (used plenty of scare tactics) and said that he can’t “force” me to have a c-section and said he would “allow” me to have a TOLAC, but put all these stipulations on it: I had to go into labor by 40 wks, couldn't be induced, no pitocin and any sign of distress would be an immediate c-section. I left feeling like I would have to fight my way to a vbac. So I called Dr. Tate’s office just to see if it was truly a possibility or if I needed to prepare for a 4th c-section.
Not knowing the logistics and knowing it was crazy to drive 4 hrs one way to see a doctor, I switched to Dr. Tate at 32 wks and never looked back. It was the best choice I could make, having a provider that supports you 110% is priceless and it took so many worries off the table for me. It allowed me to just embrace birth and prepare myself to do what I knew deep down I could do. Don’t get me wrong though, this plan was difficult to execute and there were a lot of things I had to sacrifice, but it was all so worth it.
My VBA3C
The plan was for me to go to Atlanta and stay there after my 39 week appointment. I figured my luck, I would be one of those women that goes to 42 weeks. Since I’d never been allowed to go into labor on my own, I had no idea when it would happen.
I headed to Atlanta, by myself, for my 38 week appointment (Thursday). I had not packed a hospital bag yet and decided the night before that I should at least put a few things in a bag so as not to jinx myself. My appointment went well, lasted about 15 minutes, and I was on my way. After I got lunch and stopped at Ikea, I noticed I wasn't feeling so well. I stopped to take a quick nap and decided I’d start to head home. Kev had tried to convince me that I should just stay the night but I assured him it was probably just because I had been up since 4:30am and was tired. An hour and a half later I had to pull over because I started throwing up. My 7 yr old had been home sick earlier in the week for vomiting at school and I figured I gotten what she had. I stopped for water and gatorade because I knew I didn't need, or want to get dehydrated. I continued on the 4 hour drive home and had to pull over three more times. About half way home I started having contractions about 10 minutes apart and figuring it was because I had been throwing up. I got home late, showered and went to bed.
About an hour and a half later I woke up to pretty intense contractions that I couldn't sleep through. I got up and timed them for an hour and then decided to wake Kev up since they were 3 to 5 minutes apart. He freaked out for a minute when he saw how close they were and was upset I waited so long. But then I explained that I woke up to them that close together. I called Dr. Tate and he asked if I thought they were real contractions. I said definitely but explained I’d been sick all day long. He said I needed to head back to Atlanta just to be sure or go into the local labor and delivery, and then kind of scolded me for leaving in the first place. He said he hoped I knew where the hospitals were at along the way. I knew if I went into the hospital in Savannah I’d end up with interventions I didn't want and a c-section. So we loaded all the kids in the car (this was the one weekend I didn’t have someone to take the kids, Kev’s mom was set to arrive Monday) and we drove back to Atlanta at 3am. I had contractions 5 minutes apart the entire 4 hr drive. Once we got to the hospital (7am, Friday) they went to 10 to 15 minutes apart. They checked me at labor and delivery and said I was 1cm and 50% effaced. They suspected I was just dehydrated and exhausted and sent me home to rest and drink lots of fluids. We checked into a hotel and slept most of the day. I continued to have irregular contractions and we decided to stay the night in Atlanta.
Saturday morning I felt so much better and was only having random contractions. I was trying to convince Kevin that I could just go back to Savannah and I’d be fine to come back up the following week (I had so much I “needed” to get done). Kevin was worried about delivering a baby on the side of the road the entire drive up, and was determined to not do that drive again with me in labor. I almost had him convinced until I lost my mucous plug that morning. It was then we decided I’d be staying in Atlanta until the baby arrived. Kev and the kids headed home late Saturday afternoon after they helped me get settled into a hotel. I had a melt down shortly after because so many things were out of my control, nothing was going as planned and I was just sitting there waiting. I woke up Sunday morning and my feet and hands were slightly itchy. I just shook it off and figured I’d ask about it at my appointment that upcoming Thursday. I finally went to sleep, at midnight but woke up at 2:45am Monday morning, uncontrollably itching, everywhere. It was the worst on my hands, feet and belly. I took a cold shower, ate something, did a kick count and then tried to get some more sleep. I just knew this was Cholestasis of Pregnacy, which is what I had with my second baby, and it ended with my 1st c-section. I knew I had the best doctor possible to handle this situation and figured I’d call around 6am. I felt bad waking Dr.Tate up at 3:30 am two days earlier and I also wanted Kev to get some decent rest before he had to drive back to Atlanta. I was using excuses, because I was so afraid this meant I was headed in for my 4th c-section.
Dr. Tate said I needed to head into the hospital and that they more than likely were going to induce me. I called Kevin so he could get the kids situated and make the trip up. I took a taxi to the hospital and headed into triage. Dr. Tate had called and they were expecting me, they decided to induce me because of my symptoms and previous history. They ran the necessary blood work to verify the Cholestasis but the main lab work takes 3 to 4 days to come back. They moved me over to an L&D room, once the blood work came back showing my liver enzymes were elevated and that we were moving on with the induction. I was trying to keep my cool but in my head I was freaking out. I had been down this road before and I didn’t like how it ended.
I hadn’t changed any from my exam on Friday so they used a foley bulb to help dilate my cervix. It was placed around 11:45am. It fell out just after 2pm, they checked me and I was now dilated to 4cm and 60% effaced. They started the pitocin at a 1 and decided to increase it by 1 every 30 to 45 min. Kev finally made it to the hospital around 3pm and things were starting to pick up. I started having consistent contractions that were manageable at the moment, so my doula (Christine) headed into the hospital. She arrived around 4:30pm and the pitocin was at 4 and I was contracting 3 to 5 minutes apart. Dr. Tate made his way in to say hello and stayed and visited for a bit.
My goal for this delivery was to have as few medical interventions as possible, with the hope of avoiding a c-section. Some of the interventions I couldn't avoid, due to the induction and my history of the 3 c-sections, and I was okay with that. I had the i.v. because of the pitocin and antibiotic (I was GBS+) and was hooked up to the fetal monitor. I went in hoping for a non-medicated birth as well, again trying to avoid the c-section. The one thing I told my nurse right off was that I was not getting in that bed unless I needed to be checked. I feared that I’d get stuck laboring in bed and then the cascade of interventions would come (that was the place I labored for 42 hrs with my 1st and the 9 hrs with my 2nd, and it was unbearable). She was totally cool with that, so I hung out at the side of the bed on my birthing ball or just standing.
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| Just swaying back and forth |
Before long things picked up and I was having to concentrate through contractions (pitocin was at 6), but I could still start up a conversation once the contraction was over. Kev and my doula were getting hungry so they ordered food. I was starving but nothing sounded good. I decided I’d just eat some of Kev’s dinner when it arrived.
Around 7pm, the dinner got there and as soon as I smelled it, I decided I was no longer hungry. Both Kev and my doula offered to eat it out in the lobby but I was okay enough that they stayed. It was at this point that the labor was getting pretty intense and I really had to concentrate through the contractions and recovery of the contraction. I also stopped being able to talk between them. I lost all sense of time and awareness of what was going on around me and just tried to internalize what was happening. The contractions were a lot closer and longer at this point. My doula tried counter pressure a few times but it didn’t help with the contractions. All my labor pain was in the lower part of my abdomen. I don’t recall any back labor, but maybe the pain up front was just worse :) We tried soothing music and that became so annoying. I just needed it silent and to be left alone. It was kind of funny because after I came out of a few contractions I realized my husband and my doula were just hanging out watching me.
Things started to get unbearable and I started saying I couldn’t do it anymore. I got nauseous and either Kev or my doula quickly asked the nurse for some Zofran in my iv (that stuff is heaven sent). My doula also used some essential oils to help till she got back with the meds. At this point I had just been leaning over the side of the bed and swaying and moaning through the contractions. I’d been on my feet a few hours because sitting down was to painful. I was getting tired and discouraged. I thought I was going to be at this for 12 more hours and I was just done. I started saying out loud, “I can’t do this, I can’t do this!” I was on the verge of freaking out. Both Kev and my doula had been very supportive and reassuring, but I was loosing it.
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Things started to get unbearable and I started saying I couldn’t do it anymore. I got nauseous and either Kev or my doula quickly asked the nurse for some Zofran in my iv (that stuff is heaven sent). My doula also used some essential oils to help till she got back with the meds. At this point I had just been leaning over the side of the bed and swaying and moaning through the contractions. I’d been on my feet a few hours because sitting down was to painful. I was getting tired and discouraged. I thought I was going to be at this for 12 more hours and I was just done. I started saying out loud, “I can’t do this, I can’t do this!” I was on the verge of freaking out. Both Kev and my doula had been very supportive and reassuring, but I was loosing it.
That’s when my doula looked me in the face and said, “You are doing this, and you CAN do this!”, and I needed her to say that. I needed her there. At that moment she was my rock. I adore Kev and he was soooo supportive and helpful throughout this whole adventure but at that moment I needed someone who had been through this, to tell me it was okay and help me realize that I wasn't going to die :) A few more contractions and I decided that I needed something, what, I wasn’t sure, but something.
Dr. Tate was called in just before 10pm and he asked if I wanted him to check me and to see about getting a PCB (pericervical block). He checked me and I was dilated to 6cm. I was devastated. I was at 4cm when the foley catheter had fallen out almost 8 hours earlier and I was frustrated I’d only gone 2cm. Dr. Tate suggested we do the PCB and brake my water. I really didn’t want to break my water. I had heard that once your water is broken the contractions intensify and I couldn’t imagine handling them. Plus, I was worried about being GBS+ and not knowing how much longer I had to go before baby would be born. After much discussion between Dr. Tate, Kev, me and my doula I agreed to the PCB and AROM (water being broken).
I got the PCB at 10:40pm and was 6cm/90% effaced/-1 station. Dr. Tate gave me 20min to “rest” before he broke my water. After he broke my water I was 7cm/ 90%/0. As much as I wanted to just lay in the bed, I got out of bed to move around ,per suggestion.
The contractions were so manageable with the PCB and I was feeling pretty good. After a few contractions I headed to the bathroom and as I came out I had a few painful contractions (the PCB was wearing off), then I lost it, I just started sobbing (say hi to transition). All of a sudden I had this intense amount of pressure. Dr. Tate was called back in and checked me at 11:40pm, I was 10cm and baby was at +2 station. Violet Claire Mayberry was born at 11:53pm.
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| Transition is no joke |
I can’t even begin to describe the feeling and pure joy I felt. I had done what I knew my body could do, I was on such a high. They placed her straight on my chest and I just loved on her. I was fully aware of what was going on, I wasn’t strapped to a bed, it was simply amazing. I had a 2nd degree tear that had to be stitched up so we just hung out. We eventually made it to our recovery room and I was exhausted. Recovery was 100 times better than any of my other 4 births and I really noticed it in the few weeks after. Things were drastically different than I’d ever experienced with the others.
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| proud Papa |
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| Dr. Tate- there are not enough words to describe how amazing this man is! |
This pregnancy and birth was life changing for me. I've learned so much stuff I wish someone would have told me I needed to know when I was pregnant with my first baby. This journey has impacted my life and will change how I teach my daughters and sons about birth and women hood.
Resources that helped me along this journey:
Ina May's Guide to Childbirth
Birthing From Within
The Business of Being Born
More Business of Being Born- Netflix
Medical Studies-
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02498.x/full
http://consensus.nih.gov/2010/vbacstatement.htm
https://innovations.ahrq.gov/qualitytools/vaginal-birth-after-cesarean-vbac-risk-calculator?id=3331
http://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Obstetrics/Vaginal-Birth-After-Previous-Cesarean-Delivery
