International Cesarean Awareness Network

Northern Virginia Chapter

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Jacob's VBA2C

Jacob's birth was supposed to be my easy one. I was having a nice normal pregnancy and planned to deliver at home with my midwife, C. It took me a long time to feel comfortable with homebirth and it only happened because I had come to know so many women who had done it successfully and had wonderful healthy births. The agreement I had come to with my husband John was that if my pregnancy continued to be uneventful and healthy, I would deliver at home. If any problems arose, I would deliver in the hospital under Dr. T's care. I had established a relationship with him early in the pregnancy and felt comfortable with his approach and VBAC-friendliness.

The weekend after Thanksgiving, I decided it was time to start getting serious about preparing for the birth since the baby was due in the beginning of January. I had yet to gather all the supplies that would be needed, still needed to cook and freeze a supply of meals, and also needed to do Christmas shopping. On Tuesday, November 30, I had a marathon afternoon of baking lasagnas. I made seven of them. The next day, my mother-in-law was going to babysit my 2 sons so I could start and finish Christmas shopping. After I got the boys to bed, my sister-in-law called to chat. And as I was sitting on the couch, talking on the phone, I felt a warm gush come out of me.

I knew instantly that my water had broken. There was no confusion. I was mid-sentence when it happened and struggled to finish my thought, but my head was spinning with confusion. How could this happen? I was only a little more than 35 weeks pregnant. I had taken alfalfa religiously during the pregnancy hoping to fortify my sac, since I had an early (term) rupture with my second son. I was not ready for this baby. The house hadn't been organized and we still needed to pull out all our baby "stuff."

I told my sister in law about my rupture, but asked her to keep the news to herself. I didn't want anyone in the family panicking and I also wanted to decide for myself what my options were and what I wanted to do before I started getting input from the rest of the family. I hung up the phone and immediately called my midwife. She said she'd come over within the next hour or so. When she arrived, she checked to make sure it was amniotic fluid. It was. And then the news got worse. She palpated my belly and said that something felt funny. She palpated some more (very gently since each push meant another gush of fluid) and said "I think this baby is breech." Her partner and mentor, M. happened to be in the area, so she came by my house too, and confirmed that the baby was indeed breech. Now I was really reeling with this double-whammy of bad news.

We talked over options. I wanted to try a version. We discussed the risks...cord compression or a nuchal cord being tightened. We discussed proceeding with the homebirth plans. At 35 1/2 weeks, I was very close to the midwives' cut-off for attending homebirths. I called my OB, Dr. T. I asked about a version. He said it wouldn't work without intact membranes and that it would be too risky. He said that I should wait for a few hours for labor to start and if it didn't I would have to come in and be induced. I told him that I wasn't sure about the baby's position (I couldn't tell him that I'd gotten a diagnosis of breech from my midwives) and he said that I would have to have a cesarean if the baby was breech.

I was devastated. I couldn't believe that I was on the road to a cesarean delivery. All my hopes that this would be an easy birth, proof that my body knows what to do if given the right support, evaporated. I couldn't believe this was happening to me. It was such bad luck. So bad that it couldn't be just bad luck. I was jinxed or God was smiting me. I crumpled into sobs and my husband worked keep me focused...what's the goal honey? What's the goal? A healthy baby and a healthy mother, honey. I told him I couldn't go through another cesarean. He told me I would, if it was what I had to do. I just couldn't believe that my normal healthy pregnancy had been turned upside down and now I was being cornered into the surgery I had worked so hard to avoid.

I felt like I needed more information. Why was my son breech? Could we consider a breech vaginal delivery? I kept coming back to the cord. What was going on with the cord? What if it is wrapped around the baby's neck and that's why he flipped breech? We decided the only way to know was to get an ultrasound. I felt like we were up against the clock and couldn't wait for an office visit the next morning, so we decided to go to L&D. Just for a quick peek at the baby and the cord, then we would come back home and decide what to do with additional information.

We didn't get to the hospital until nearly 1 or 1:30 a.m.. What greeted us was an obstetric cliche. Her name was Dr. TA and she was the chief resident. She was cold and curt and she gave me her own version of the "have a cesarean or have a dead baby" speech. She was emphatic that anything other than an immediate section would put me and my baby at terrible risk. She went on and on about the dangers of an emergency cesarean versus a planned cesarean. She said she was glad that "you ALL are here to hear this" meaning that she was trying to scare not just me, but my husband and my midwives as well. (We didn't tell her they were midwives, we called them my "doulas.") She never discussed the risk of delivering the baby so early, and compounding the potential breathing problems associated with prematurity with the respiratory distress common in cesarean babies. She didn't discuss any cesarean risks in fact.

I'd already experienced the "dead baby" speech a hundred times through hearing the stories of other ICAN women, but going through it myself, pregnant, tired and scared, at 2 a.m. nearly 6 weeks before my due date was another experience altogether. But all my experiences with ICAN and my own birth research held me firm that night. I knew I didn't want a cesarean unless it was a true necessity, not because there was a nervous resident hovering over me. So when Dr. TA told me I needed a cesarean, I refused. When she told me that she wanted to do a vaginal exam to see if I was dilating, Henci's words from "The Thinking Woman's Guide to Better Birth" came back to me, and I refused that too. A little while later, one of the other residents came in to chit-chat and then asked, very by-the-way'ish, if I had been planning a homebirth. I lied and said no, but they had clearly decided that I was some natural birth wacko who needed to be well-managed so that I wouldn't kill my baby. Because they care about the baby so much more than I do. Right.

A few hours after I arrived, Dr. T came to visit me. He walked into the room, and the fog of crisis lifted immediately. He offered options and hope. The man is a rare gem of an OB. He believes in vaginal birth. He believes in VBAC. Most importantly, he believes in a pregnant woman's right to be informed of her options and to allow her to make the ultimate decision about her care.

We discussed my situation. Much to my relief, he said he would be willing to attend a vaginal breech birth as long as the baby was either complete or frank breech. A footling breech would be a deal-breaker and would mean cesarean. He routinely does breech deliveries and didn't see my VBAC status as a hindrance to a breech delivery. I was so relieved. But the catch was that he wanted me to stay in the hospital until I delivered. He was concerned about the risk of infection and cord prolapse. I didn't agree with him at all on this front. First, if I'm going to catch an infection, a hospital is a very scary place to catch one. It seemed much safer to go home. As for the risk of prolapse, they were only monitoring the baby twice a day for an hour at a time. So if I prolapsed at any point in those other 22 hours of the day, being in the hospital would not have done anything to keep my baby safe. Plus, I was afraid that the stress of being in the hospital would hinder labor.

But I trusted Dr. T to truly support my VBAC and I was concerned that leaving the hospital against his advice would cause him to pull back his support and cause hospital administration to further scrutinize how he was handling my case. Either of those things would have diminished my chances of having a supportive environment in the hospital. If things had turned very sour in the hospital, I would have left the hospital and continued with my homebirth plans, since I had plenty of support from my midwives. But it was not truly where I was comfortable birthing a breech baby.

So the next morning, I went to Dr. Mc's office for a sonogram. The test showed that the baby was in a complete breech position. Finally, some good news. So the next step was to wait for labor. For most women with rupture of membranes, labor kicks in within 24-72 hours. So I was optimistic that I would be holding my baby soon. Because my water was broken, infection was a risk. To reduce my risk of infection, Dr. T put me on a course of IV antibiotics. On the advice of my midwife, and I did my own course of Vitamin C, Echinacea, garlic, and a special peri bottle protocol in the bathroom.

With the help of my midwife C, I spent the next few days working on preparing myself for a breech birth, since I had never considered it a viable option. But in reading about it and learning from my midwives' experiences, my comfort level grew considerably. I was inspired by Dr. T's extensive experience with breech delivery and felt that he would be able to help me have a healthy, uneventful birth. Dr. T and I wrangled a bit over his standard protocol of using forceps and cutting an episiotomy. We discussed both approaches at length, and finally came to a middle ground. He would not cut an episiotomy unless there were definitive signs of fetal distress and he could gently use some forceps to ease the baby out and flex the baby's head. He said it was either the slim metal of the forcep or his big fat fingers.

I was admitted on a Wednesday night and by the weekend I was starting to feel very antsy. I was concerned about my absence from my sons and how it was affecting them. I also felt that simply being in the hospital and the accompanying stress was keeping me from going into labor. By Monday morning, I was on the path to a total breakdown. I felt that I was just sitting there, in that hospital bed, a target for infection. If infection set in, it would be the beginning of the end. If I could just go home, perhaps I could relax enough to go into labor. I spent much of that Monday in tears. I called John, angry about my predicament, and yelled at him, as if it were his fault. I told him I couldn't stay any longer and that I wanted to leave, "against medical advice" or AMA. He wasn't comfortable with that idea, if for no other reason that it would make both our sets of parents very concerned and stressed. But he said he would support me in my decision.

So I called my nurse and told her that I wanted whatever form I needed to sign so that I could leave. I wanted to talk to Dr. T before I left, and I was told that he would be around as soon as he got a chance. I waited and waited.

Dr. T didn't manage to get to my room until late in the evening. At that point, I had given up on leaving that day. I was still considering leaving the next morning. But Dr. T managed to "talk me off the ledge" and reassured me that he would support me in my efforts for a vaginal birth. We discussed waiting for labor versus induction and he seemed to understand my reticence about induction. He also addressed my emotional distress too. He really listened to me, and we talked about faith and God's plan. His visit reassured me. This visit, combined with snowy weather forecast, cemented my decision to stay in the hospital for the time being.

I decided that I needed to take a more positive and proactive attitude. I tried to take advantage of the hospital's massage services for some relaxation, hoping it would help me go into labor. But I wasn't allowed to leave my room and they weren't allowed to come to me. So I called around and managed to find the most wonderful massage therapist who could give me an "induction massage." The following evening I brought in an acupuncturist to try to stimulate labor. I brought in my breast pump and started pumping regularly to stimulate labor as well.

None of these efforts had immediate effects unfortunately. The visit with the massage therapist, who was accompanied also by my midwife's partner M. was truly uplifting. They really help me feel relaxed and more understanding of where I was, what I was doing and that I was making the best decisions I could given the circumstances. The acupuncturist visit was interesting and odd, since I'd never done acupuncture before. But it gave me the feeling that I was taking as much control as I could over the situation.

I also spoke with F. a birth counselor about where I was emotionally. It was while I was talking with her that I had a revelation for the first time...maybe my baby turned breech because I wasn't truly comfortable with the idea of homebirth. I realized that I was more of a "political homebirther" than a true homebirther. That was really a liberating revelation, because it allowed me to let go of my homebirth plans more completely.

On Monday, December 12, I ended up having another emotional breakdown. I was due for a biophysical profile and I was hoping that it would be timed well so that it would reveal a good amount of amniotic fluid. I would gush fluid every now and again, and I was hoping that I would have my BPP before I had a big gush. Unfortunately, luck was not on my side. While the baby tested well overall, my amniotic fluid was very low. Not surprising. The sonographer told me that Dr. T would definitely section me with such low fluid. I went back to my room and just cried. I didn't believe what she said, but I was starting to lose hope that I would be able to avoid a cesarean.

After my BPP, I got a visit from my dad. During his visit, I noticed I was having regular contractions. They weren't terribly painful...I could still talk through them, and was able to hide them from my dad. My instinct was to hide them because I was afraid to hope too much that labor would start soon.

After my dad left, I decided to take a nap. I turned off my phone, told the nurses to leave me alone, and hunkered down at about 3. I slept like a rock. Just before 6 p.m., I woke up to a painful contraction. It was significantly painful. I was so excited, but I still had yet to grasp that I might be in labor. I decided it would be wise, nonetheless, to get my husband to the hospital and I also called C, my midwife. Originally, my husband was not going to be able to come until 9 p.m., but he decided to call on a neighbor to sit with the kids so he could come sooner. My mom, knowing that I was contracting and alone, decided to come over while I was waiting for my husband. She arrived shortly before 7 p.m. and by that point I was contracting hard and regularly. I was at the point where I was moaning through my contractions. She took one look at me and asked me if I'd alerted the nurse. I told her no and she nearly panicked. I rang my nurse and told her I was in labor.

She decided to put me on the monitor to watch the baby's heart rate and my contractions. The monitored showed a happy baby, but no contractions at all. I couldn't understand it because I was definitely feeling them. My husband and C. arrived a little while later, and they both kicked into supporting my labor.

I decided that I needed to go to the bathroom. While I was in there, I heard Dr. TA come into my room to check me. I had a contraction while I was heading out of the bathroom, which she saw. She didn't say much and left.

A short while later, labor was really picking up. Still the monitor was showing little or no contractions. I knew the machine was wrong, but it was ok, because I think it helped minimize how many people were mucking with me at that point.

My doctor came to visit me, and even though the machine told him otherwise, he could see I was in labor and transferred me to L&D. The L&D nurse told me she wanted to do a vaginal exam to "see where the baby's head was." I yelled "the baby is BREECH!" and couldn't believe she didn't bother to glance at my chart. She reached in to do the exam and then, without a word, sprinted out of the room. I was in labor-land and didn't even notice.

Before we knew it, there were 14 new people in the room, doctors, nurses, neonatologists, and perhaps a few gawkers. None of these people included Dr. T. I was feeling a tremendous urge to push and I knew from my earlier conversations with my midwife that it was best to delay pushing on a breech baby until the baby had descended a bit. So I was trying to resist the urge to push, yelling for my doctor, and trying to figure out who the woman at my feet was. It turned out that she was a senior attending who had done her residency under Dr. T. And the reason the nurse who'd done my vaginal exam sprinted out of the room? When she reached in, she felt two feet.

Finally I was given the green light to push. During pushing, my midwife (supporting me as a doula at that point) nudged my husband to alert him that the doctor was getting ready to cut an episiotomy. I had discussed both episiotomy and forceps use with Dr. T. He agreed not to perform an episiotomy unless the baby started crashing, and I agreed to let him use forceps unless the baby decided to slip out very easily. It was a compromise that this doctor simply hadn't been in on. My husband piped up and said "No episiotomy...she doesn't want one." The doctor proceeded with her episiotomy set up. Finally, I clued in and hollered at her "I do not consent to an episiotomy!" I told her "I do not consent" a second time and she finally put the scissors down, but mostly because she had to get ready to catch my baby.

Moments later, I pushed out my son Jacob. He had great APGARs and nursed on the first try. I had no tearing. Dr. T missed the actual delivery, but his support was key to the success we had. My midwives and ICAN gave me the resources I needed to learn about breech birth, and an understanding of the power of well-informed consent and refusal. I took charge of my care, and with the support of so many people around me, my son and I had a safe and healthy delivery.

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