Some thoughts on my VBAC

11 09 2013

After going through a successful VBAC (you can read about it here) my thoughts are these:

  • I worked hard in preparing myself for this. I do not think I could have gone through physiological birth otherwise.
  • It is very doable. In no moment I felt it was impossible or beyond me. I never thought or felt I needed pain relief. If you think you can live with the pain during the recovery after giving birth, you can totally cope with the contractions!
  • If you feel comfortable and safe, labor as much as possible at home, one doctor praised us for this saying it had been the key to a successful and fast labor. Heck, if you have a good knowledgeable team *and* you feel safe about it, have a home labor! I did not want to deal with it really, the risk of a uterine rupture, the cats, the cleaning up, etc.  It was tempting once I was in labor, but then, I had not prepared for it.
  • The doctors and nurses were impressed and all had words of praise about me not using drugs, so know that they will respect you for that. I just wish they were more outgoing and supportive of it before and during labor, though.
  • I did not feel pain during active labor, which is the longest stage. Even when I did feel pain later, there is pain at the peak of the contraction and then you have resting periods in between, the total time of pain is very little. I fell asleep several times between contractions, giving me much needed rest.
  • In fact, I loved active labor, it is kind of trippy and it was a wonderful bonding moment with my husband.
  • Marissa, my doula, says physiological labor is addictive. I wouldn’t say I am addicted to it, but surely enough I would love to experience it again!
  • I hated pushing, but you might like it, in fact many women have told me it was their favourite stage… go figure! They say it gives them relief.
My sweet little boy.

My sweet little boy.

  • If you think you can raise a toddler and a newborn, you can totally tackle a VBAC! It’s a piece of cake compared to what comes next!
  • You will hear mothers tell you “I was in labor for SIX hours!!!!” with a horror expression and as if that was super long. My labor was about 10 hours, and it is still below the average of 12 hours or so. It really did not feel long, let your body lead and you lose sense of time, and remember it is not 10 hours of sustained pain, most of labor is “time between contractions”, so it is very manageable.
  • The birth was not “all I ever envisioned”. I tried to keep my expectations reasonable, I tried not to focus too much in details and I tried to define what things were important for me. I wanted no drugs so my baby would be born with no drugs in his system. I wanted to be ready to go home to my oldest child as soon as possible, therefore I wanted to avoid a C-section at all costs. With these things in mind I was ready to stand my ground about some things, and to negotiate and even yield others.
  • I hold myself responsible for everything that did not go as I wanted, even that asshole resident doctor hurting me during his examination. After all, I could have always refused treatment and done it my way, but I didn’t. I was aware, I was in full possession of my faculties, but I did not refuse certain things, nobody forced me to do anything.

How is your perception of your labor? Did you enjoy it? Would you do anything different?





My VBAC experience. Part 1

22 08 2013

I have been asked several times by people to tell how my VBAC resulted, and since when I was pregnant I did feed my self confidence from other VBAC stories, I thought it would be a good idea to share mine for other women to read. It seems I am unable to write a short story 🙂 so I will divide this very long post in a couple of shorter (still long, though) posts.

The days before
I started experiencing contractions that would wake me up at night months before Santiago was born. My doula reassured me that my body was doing its job, getting everything ready for the big event. Contractions continued to progress slowly and steadily and the baby positioned himself head down by week 30-32. As I mentioned before, I was doing yoga and keeping very active with all the running after a 20 months old and going up and down three flights of stairs daily.
Because I knew labor was going to likely be an endurance test, I prepared for it as if I was preparing for a long distance race. As I felt birth was coming close, I started to eat larger meals and load up in carbs. You can read about many things I did to prepare here.
My sister was arriving on February 16th and each day that we got closer I could feel the baby really wanting to be out sooner than his due date on February 24th.

Getting ready for having a baby! Only a few weeks to go!

Getting ready for having a baby! Only a few weeks to go!

Pre-labor
On the 20th, after dinner, I started to have contractions that felt like menstrual cramps but I paid no attention to them because I’ve had been having mild cramp-like contractions for a few days, they would last one or two hours and go away. By the time I put Ignacio to bed, though the contractions were actually regular and I told my husband and sister about them. We decided to go to bead early just so we could get some rest if I would go into labor the next day.

Contractions were coming every ten minutes. I was not tired enough to sleep but I wanted to catch some rest. I started to hear some gurgling and asked my husband if it was him, he said that it was me “What do you mean it is me? If it was my guts I would feel them! Could it be the cat?”, and then I heard a “pop!” and with the next contraction I heard a louder “POP!” and a gush of amniotic fluid came out of me. I had broken waters! It was 10:15 PM.

In my imagined labor, I saw myself emailing friends and family in the early stages “Hey, contractions coming every 10 minutes. Oh, they are now 8 minutes apart, this is happening!” but my water breaking made the next one came too fast “That was not ten minutes!” I said, “No, it was seven” Greg answered. Right after that “That was not seven minutes!!” I was a little panicky. No, it was four. My contractions started to come consistently every four minutes, and they were so much more intense! I then remembered a trick I had read about in some books, and went to the ground in knee to chest position, that puts gravity working against your contractions and slows them down. In my imagined labor I would not have wanted to do that, but in reality I needed some time to adjust to what was going on. Each time a contraction would peak I would kneel up and let it go through me. I was not in pain, but they were very intense.

Contractions every four minutes. We took advantage of the time

Contractions every four minutes. We took advantage of the time in between to give birthday presents to my sister!

Active labor
I kept laboring, moaning with each contraction. I never imagined I was going to be the vocal type, I am rather quiet in my life, so I thought I would just breathe and be silent. But I was moaning with each of them, I was able to talk between contractions and even when they were coming every 6-4 minutes I still didn’t feel in active labor. After a couple of hours though I felt I needed to get my doula, Marissa, with me, I thought I was in active labor now and I really wanted her home. My nose started to bleed copiously (scaring my sister!) while I was talking to Marissa, I was still feeling very well, but I was having a hard time keeping my thoughts coherent for a long time, couldn’t quite keep track of what I wanted to say. She heard me moan through a couple of contractions and then I told her I really would feel better if she was with me, she agreed to come soon.

I went to the bathroom and checked for blood (if your uterus breaks along the C-section scar you will bleed copiously) but there was only a bit of pinkish tinged fluid, so I felt at ease. After that I headed to the bedroom to keep laboring there.
My moans turned into chanting sometime during active labor, I can’t pinpoint when, but it was actually quite powerful. I found a low pitch that helped a lot to ride each contraction, making it bearable. From outside the bedroom, my sister says that it sounded like Greg and I were having a great marital time (!) but that it later turned into “Oh, dear, she is dying there!” Truth to be told, I felt really well and relaxed all the time, and there was no real pain so far, just a very intense feeling taking over my whole body.
At about one O’clock Marissa arrived. When she entered the room she smelled so good! It was lavender and other herbs, it really was wonderful… I should mention that the chemicals being released in your body during physiological birth make your senses wild. The light in the room was golden and our dull green speckled carpet was bright green in my eyes. It really is trippy! Marissa encouraged me to keep going saying I looked great and that I seemed to be handling things nicely. I remember riding the contractions, tucking my pelvis under my body each peak and doing cat-cow sometimes.
There still was no pain except in my sacrum area, my lower back really hurt, but it was not back labor. My sacral bone was risen because of the baby passing so Marissa suggested counterpressure, but it was really painful when they would even just slightly touch me. At some moment she brought in the exercise ball, which I always imagined I would like, but as soon as my belly grazed the surface of it made me hurt, so I pushed it away.
Marissa suggested to stop doing knee to chest, and to actually put my pelvis lower than my shoulders to keep labor advancing. I did so, using the bed to recline my body against something and rest. Greg climbed on the bed and I used him as my anchor, holding his arms and raising up and back each time a contraction would come and peak. He says I looked serene and beautiful, very goddess like (God bless good husbands! How sweet of him!) I just know that at the peak of the contractions, gazing into his eyes helped me feel calm and collected.
At some moment I felt the baby dropping. It was amazing to feel the sound and the actual shock of him falling against my bones. I told Marissa and Greg, I was so excited about having felt it! Many times I fell asleep between contractions, which helped me feel rested during the whole time.

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Second part here!





Preparing for a VBAC

1 08 2013

My first child was born via C-section. When talking with the doctors about future children I expressed my wish of having vaginal births if possible, they did give me an incision that would allow this. Thirteen months after Ignacio was born we became pregnant again, and after I found out that everything looked great to give birth vaginally I started to get ready. A friend of mine wanted to know what and how I made it, since she is getting ready for a VBAC too, and I thought I’d share with  you all what I told her.

Know your possibilities and limitations.
Having a VBAC implies a bit more risk than a vaginal birth without a previous C-section. There is a 0.5-0.7%  risk of uterine rupture along the C-section scar, which can lead to excess bleeding, posing a risk for the mother and the baby, and it would require an emergency C-section to get the baby out as soon as possible before there is brain damage, plus mom might need a transfusion and surgery to repair the uterus. This is why some hospitals would not allow a water birth for a VBAC. Some hospitals may even refuse to do a VBAC because they are not ready for the emergency C-section that it might require. Know what the rules are in your area before attempting a VBAC in the wrong place.
Know too that this risk is lower if your labor is not induced or augmented with pitocin, and that you  do have after all, 99.5 chances of not having a uterine rupture. The probability of a successful VBAC will also depend on your age, if you had previous vaginal births, and your attitude, but these are not about uterine rupture but about the same factors that would count for a woman with no prior C-sections.
Going for a repeat C-section implies higher risks than a VBAC, such as higher chance of perinatal death for the mother and child (it is a low number, but much higher than with natural birth), respiratory complications for the baby, etc. You can read about this in any medical website.

Prepare.
I cannot emphasize enough how important it is to prepare both mentally and physically for birth, especially for a VBAC.
Read, educate yourself about birth. No matter what you choose, drugs, no drugs, epidural, water birth, home birth, etc. make sure you know how labor works. I did a lot of reading during both pregnancies, I tried to put aside the strong opinions from both doctors and midwives, and keep the facts of birthing. The best way of not being afraid is to know as much as you can, do not let other people decide for you because you did not learn enough, you have nine months to get ready, use them well.

Do talk to your doctor about what you want, he is there to help you birth a healthy baby but also to help you achieve what you want.
As soon as I knew a VBAC was possible I started a long conversation with my OB, I told him I wanted to have a drug-free birth, I asked lots of questions, he expressed concern about me not wanting an epidural or IV and we basically talked about this for five months. Having an epidural in place during labor would make things easier if a repeat C-section was needed, but I wanted to have the freedom to move around and change positions if needed, besides there was no way I wanted to have a needle stuck in my spine again! Each time we had a visit and a talk I would go home, think about the conversation and write down more questions. After a while it was clear that if there was a uterine rupture they would put me under total anesthesia to take the baby out as soon as possible, so for me there was no point in having an epidural in place.
Be ready to compromise. If your doctor will be too nervous about what you want to do it is not a good situation. Ask where you can find a solution? I wanted no IV, but I compromised to have a port in my arm in case an IV was needed.

One month to go!!!!

One month to go!!!!

Do hire a doula!
If there is one thing that I think was crucial for my successful VBAC was the presence of a doula. A doula is a labor assistant, basically she has more experience than you in births, she is knowledgeable about the stages of birth and what to expect at each moment, and she can be a great support for your partner too. Bonus points if your doula has experience in VBACs. We hired a great doula: Marissa Evarts, if you are in the Pittsburgh area I cannot think of anybody better to coach you.

Keep a positive attitude.
One thing I had a hard time with during the intense reading I did was dealing with the negativity in many books and websites. I am of the idea (maybe naïve?) that most people are doing their best, nobody is out there to get you, so reading books and blogs with strong opinions against doctors or midwives was exasperating. I mentioned this to Marissa and she helped me to find very positive videos of mothers giving birth beautifully, this was great for me because it helped me to keep centered and focused on the good things and not in the negative.
There are a bunch of videos on youtube that you can watch.
I also read a lot of VBAC birth stories and focused on positive affirmations. One of the most significant ones I read was “your contractions cannot be more powerful than you, because they are coming from you” which was a real eye opener, our bodies are made to do this, it cannot be beyond us women to do it.

Be active during pregnancy.
If your doctor allows exercise do your body a favor and exercise, the more you move the better chances you have that your baby will go head down and that labor will go smoothly. Plus you will need strength and flexibility for the endurance test you h ave ahead of you! Do listen to your body and don’t do anything that does not feel right, though. Walking and prenatal yoga are two things I can recommend a lot. I blame climbing up and down three flights of stairs daily for my baby being positioned right and low from the 30th week.

IMG_9080

Nothing like running after a toddler to keep active and fit!

 

Learn breathing and meditation techniques.
You will realize how much it helps you to keep calm during labor. When you feel you might lose it, breath and come back to your center, you will be ready to ride the next contraction. You might want to learn different techniques as Hypnobabies or Hypnobirthing, these are not so much hypnosis, as the name suggests, but tools to learn to relax. Yoga can help achieve a good relaxed state too.

Do give yourself a pep talk!
You are a strong woman, there are a lot of things you’ve been through successfully. I know that for sure, after all you did go through a C-section: you were cut open, stitched closed, and were taking care of a newborn before you could recover. This is just one more challenging thing to go through.
My husband, if at any moment I started thinking I could not go through with it, was in charge of reminding me of a bunch of things I tackled that were very hard and I didn’t know if I could go through them. One of my motivations was that I did run a 5K having gotten shin splints a few days before the event. Running the whole thing was excruciating, but I made it and I did enjoy the beautiful landscape. Labor was not as bad 🙂

Attend a local ICAN meeting.
I did not get to, my schedule did not allow, but it is a good idea. You will meet like minded people and learn from their experiences.

Acknowledge your fears.
Do not let fear take over you, but acknowledge what you feel, talk about it with your partner, doula, doctor or a good friend, keeping things inside will only make it worse. Many times we just need to say things out loud.
I was of the idea that I could deal with the contractions just fine, but I was terrified of pushing and passing a baby through my vagina. After all, I’ve cried during pap smears in the past. Talking about it made me realize that by the time the baby would be about to come out there is no way any doctor would accept to give me an epidural. The epidural would take longer to catch than the baby to come out, so knowing that I was doomed made me feel at ease that I was not going to cave out.

And remember, labor and delivery will be a few hours of your life. You are in for a much more challenging experience, which is mothering two (or more) children for years to come…. labor is a piece of cake compared to that!