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Posts Tagged ‘VBAC’

Michelle’s Birth Story!

May 18th, 2011

Michelle called the Get Babied! line at 12:40pm on April 25, 2011. She had been having early labor contractions all morning and they were starting to get a little closer together. She was calling to let us know that she was going in to the office of OBGYN North to get checked. She was expecting to go home, but during a non-stress test the strip measuring Baby Kate’s heart rate started going crazy (or the monitor was in the wrong spot). Michelle called me at 2:40pm to let me know that they were instructed to go to the hospital to be monitored. Things had also really started to pick up for Michelle.

I got to Michelle and Jim’s room at 3:00pm. Everything was fine. Whatever was or wasn’t happening with the baby in the office had calmed down. Michelle was breathing easy through contractions, and they were starting to get closer together. As the contractions got closer and stronger, Michelle continued to breath through them beautifully but you could tell they were getting more uncomfortable with each passing one. Michelle really wanted to get out of bed, but she had to be continuously monitored since she was attempting a VBAC. We were all relieved when Nurse Brittanie came in with the portable monitor!
Michelle labored for a long time on her ball leaning forward onto Jim who was sitting on the bed. I sat behind her, and Jim and I rubbed her back and shoulders. Jim was really calm and a great birth partner for Michelle who was also laboring so calmly. They made a great team.

Eventually Charge Nurse Betsy came in to fix the monitors, because they weren’t staying on Michelle’s belly very well. Since Michelle had to be monitored and they were having a hard time getting a reading in this position, Michelle switched to side lying in bed. Things were really intense at this point. This was a great position for Michelle to rest and zone out in between contractions. Jim stood behind her and stroked her back while I was in front holding her hand and reminding her that she, “had this”. Things were moving along very fast. Her contractions had gone from short six minute apart contractions to long 2 minute apart contractions in just over two hours! Michelle was considering an epidural if she wasn’t far dilated. Dr. Schmitz came in to check Michelle around 6pm (this was the first time she was to be checked since the week before) and she was a 9! Dr. Schmitz left us to continue doing just what we were doing.

Michelle continued to labor in her zone, and Jim and I continued to try to keep her calm and comfortable while nurses scurried around setting up the room for delivery. Michelle started to feel like pushing not long after she was checked. Dr. Schmitz felt like she wasn’t quite ready, so she left and said she would be back in about ten minutes. Twenty minutes came and went and Michelle was feeling really pushy. She wasn’t grunting like a lot of moms do. She was really breathing her baby down. I think that might be why the nurses weren’t convinced she was fully dilated. Finally, Dr. Schmitz came back around 6:40pm to check Michelle again. She was fully dilated and +2 station! Way to go mama!

Michelle started out pushing in side lying and continued to breath her baby down and push just to the point of comfort. Nurse Donna and Dr. Schmitz were really encouraging her to really bear down to move Baby Kate down faster, because her heart rate was getting a little high with the first few pushes. Michelle figured out how to find her push through the next few contractions. Nurse Donna kept trying to tell Michelle what to do, but she was figuring it out for herself. At one point, Michelle looked over at the nurse and said, “Would you PLEASE just BE QUIET!?”. I had to stop myself from laughing. Michelle was so polite! Michelle was also an amazing pusher. Jim and I were on either side of her cheering her on and giving her progress updates. She got to feel Kate’s head twice. Kate had so much hair! Michelle didn’t push for long, and after only 40 minutes Baby Kate was out at 7:19pm. Kate came out so calm and alert and went straight to mama’s chest. Talk about a successful VBAC!!

The Epidural Dance

Labor is getting intense.  You want a natural birth, but don’t know how much longer you can endure the pain.  What do I do as a doula when the big E starts looming?



For me, the first time you ask I usually suggest changing something up – either finding a new position, heading for the shower, doing a different comfort technique – often we can find something more manageable just in a position change.  The second time you ask I’ll have you set a goal – like – lets go for 1 more hour and if there is no progress or the pain is worse then we can request the epidural or something like that.  Goals can also be stuff like lets get to Xcm dilation, let’s get to shift change, let’s get to the next cervical exam, let’s do three more positions, etc etc).  The third time you ask for an epidural I usually help you get it, because we’ve tried various position changes, we’ve made it to various milestones, etc.  I’m also a good judge of when I think you can go the whole way, or when you’re exhausted and an epidural might actually help you relax and get rest to get energy for pushing ahead.



For VBAC mamas though, and other mamas at a higher risk for cesarean (obesity, short stature, advanced maternal age, gestational hypertension or other complications, etc), the longer you put off that epidural, the better your chances for a vaginal birth, so I’m going to push you to your limit if I can, because I know that’s an end goal.  Some new research is also coming out on pushing technique.  It turns out that mamas who push while holding their breath actually tire a lot faster than mamas who push while slowly exhaling.  Mamas who hold their breath are taking in less oxygen and this leads to fatigue sooner.  So as doulas we remind you of that when you’re pushing.  It’s much easier to do this “spontaneous” type of pushing if you are feeling the urge to push (ie no epidural) so that’s another reason to stave off the epidural, you’ll conquer that exhaustion by being able to push more effectively.  Another area of research on pushing exhaustion is knowing when to start each push.  The clinical standard often observed are nurses that watch your contractions on the monitor, and tell you to push when a contraction starts.  But a new body of evidence is coming out that says if you wait and start pushing until after the contraction has built up momentum – starting pushing in the middle or at the height of a contraction is actually better – you’re pushing for a shorter time, but using the momentum of your uterus to bring your baby down.  It takes a little longer from start of pushing to delivery of baby to use this delayed pushing technique, but it has a 61% reduction in pushing fatigue.  Often pushing fatigue is a reason for C-section (failure to progress etc) so you might as well use every ace in the deck to your advantage.

Signs I missed That My Practitioner Would Not Support A Natural Birth

A good reflective article blog post from Julia at the Connect Mom.  Thought I would share with you mamas to encourage you to stay empowered!

http://www.theconnectedmom.com/2010/09/signs-i-missed-that-my-practitioner.html

It’s been eleven months and two and a half weeks since I gave birth to my son Oliver. Almost a year now and I am still not able to talk about my birthing experience in any detail. To say I was disappointed with my birthing experience is a gross understatement, and as the months go by and I start to open up about that experience more and more I am coming to realize that I am not the only one.

I have read a lot in the past year about the business of birth; about the rising cesarean rate, about women being refused their right to informed consent, doctors and nurses who do not take a woman’s autonomy seriously, women who have their children taken from them for refusing to allow that autonomy to be ignored. and about women who’s birth experiences go far beyond disappointment and trauma. It seems to me that what should be one of the greatest days of a woman’s life is too often a nightmare. I was vaguely aware that stories like these existed before I had Oliver, but I am realizing that I was not really as equipped as I could have been to prevent it happening to me.

I am still not ready to talk about my birthing experience in detail. But nearly a year later I have begun to look back at the months leading up to that experience. Hind sight being 20/20 I have come to realize that there are quite a few signs I missed that my OBGYN and I were not on the same page, or even reading the same book, when it came to my labour and birth. I am sharing these flags in no particular order, and hope that it may help others to accurately gage whether the practitioner they are choosing is right for them.

1) When I stated my intention to breastfeed and informed my practitioner that I would like to forgo an epidural to ensure my child and I were alert and healthy enough to do so immediately following birth I was told by my practitioner that an epidural, or even the type of birth I had would not have any effect on breastfeeding.

Despite all of the reading I had done about breastfeeding from a number of valid sources that said otherwise, I believed what my doctor said to be true. After all, he was a doctor right? What I did not realize at the time was that my practitioner was either ignorant to or lying about the risks and side effects of the epidural and other interventions.

2) At one point, I asked my practitioner what his cesarean rate was in an effort to gage the likelihood that he would intervene unnecessarily in my labour and birth. Looking back I now realize that he never did give me a straight forward answer, but instead told me: “I don’t want you to have a C-Section, because then I wouldn’t get to deliver your next baby.” This answer was comforting to me then, it made me trust him, made me think that he and I were on the same team and that we wanted the same things.

But, as any woman who has ever had or planned to have a VBAC or HBAC knows, this answer was probably the worst one my practitioner could have given me. The fact that my practitioner was either unaware of or did not believe that vaginal birth after cesarean section was an option, despite mounting evidence and changing perceptions in the medical community, should have made it glaringly obvious to me that my practitioner would be making decisions based in myth and tradition and would not be providing me with evidence based care.

3) When I first heard of a Doula I had no idea what a Doula was for, so I asked my practitioner. “You don’t need one” he said “That’s what your husband is for”. I should have laughed in his face, instead what happened was my husband turned to me and said “I’ll be there for you honey, you can trust me to take care of you”.

I really do trust my husband to take care of me, and when it came time he did the absolute best that he knew how. But here’s the thing about relying on your partner to act as a doula: Not only does your partner likely have the exact same amount of knowledge and experience with labour and birth as you do, it’s also incredibly unfair. Chances are the birth of your child will be just as emotional, overwhelming, and life changing for your partner as it will be for you, you cannot expect them to give you calm and rational advise 100% of the time, and you cannot expect them to know how to help you in every situation that could arise, especially if anything goes wrong, they will not be capable of providing a calm, and rational opinion for you.

My practitioner was either relying on those facts to make sure he wasn’t questioned or stood up to in the delivery room, or he really didn’t understand the roll of a doula. Any practitioner who downplays or doesn’t understand the roll of a doula, or worse isn’t willing to work with one, is likely not interested in giving you the birth you want.

4) As my due date drew closer and closer and I started to get more and more nervous about giving birth I wrote myself a birth plan. It was a large print colour coordinated spreadsheet with very clear wording about what I did and did not consent to during my labour and birth. My practitioner never once used the word “birth plan”, he called it a “wish list” and told me to keep an open mind and be flexible just in case something went wrong.

I am sure now that he didn’t even look at let alone the laminated copy we gave him to put in my file. I know this because when the labour and delivery nurses called him to tell him that I was at the hospital and in active labour he told them to offer me an epidural, despite the fact that my birth plan stated in bold red letters on the very front page not to actively offer me pain relief and that I would ask for it if I wanted it.

A birth plan is so very much more than a wish list, and the fact that my practitioner was not interested in what *I* wanted or what *I* would or would not consent to should have been the biggest warning sign of them all. It should have been obvious to me from that moment that this man had no intention of respecting my autonomy when I went into labour.

I am not sure why I didn’t see these signs for what they were when I was pregnant and preparing for birth. It takes a great amount of effort not to blame myself for the way my birthing experience turned out because I didn’t notice these things.

Maybe I went into it a little over confident in my own strength without really appreciating what it would mean to give birth. I truly did believe that it didn’t matter what my doctor wanted, that I could just say ‘no’ to anything I didn’t want, even if I were scared, vulnerable and overwhelmed. Maybe I was unable to see these signs, or somehow chose not to see, or repressed them because of all the stress and anxiety I was already feeling.

At the very least I know now what I need to look for in a practitioner when we decide to have another baby. I will know next time that the practitioner you choose does have a very large part to play in the kind of experience you come away with, and that pure stubbornness isn’t enough to rely on.

I still struggle very much with how the birth of my son played out. I imagine it will take me a very long time to work through the self blame, and the anger, and the sadness and disappointment, but I do look forward to the next time. I feel as though I have learned a great many lessons from that experience. Not only about the kind of practitioners I want to help me the next time, but about the things I want to get out of my birthing experience and my own strengths and vulnerabilities. I cannot change the birth I have already had, but I feel very hopeful about the next one, whenever that may be. Posted by Julian@connectedmom

VBAC Video

March 7th, 2010

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

Watch how a baby is born by cesarean section and see the dramatic difference of what both the mother and baby experience in a home water birth after cesarean.

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