I just received the most delightful email from a Birth Sense reader. She had written to me some time ago asking for information about trying a vaginal birth after cesarean (VBAC). Like many women who’ve had cesarean births, she’d been told that it was unlikely she would ever be able to give birth vaginally. One of the things we talked about was how to work with a “prominent sacral promontory”. I have discussed this in two previous posts: one in which I related the story of a former client of mine who’d been told she would never give birth normally, and another which explored the potential benefits of chiropractic treatment for this problem.
This reader recently had an amazing birth experience, especially considering the size of her first and second babies. She reports having seen a chiropractor every 2 weeks during her second pregnancy, and maintaining a good posture for optimal fetal positioning. Here is her inspiring story:
Backstory: I was told at the end of my long, very dysfunctional labor with DS1 that ended in c-section that I would never birth a baby vaginally due to an extremely prominent sacral promontory. DS1 weighed a bit less than 5 lbs.
DS2’s VBAC: At 41+4 days, I found I had dilated from a 1.5 in my previous two appointments to 3 cm and was 80% effaced and baby had dropped down to a -1. The CNM did an “aggressive sweep” that produced the desired contractions a couple hours later. I labored at home all afternoon, calling my mom around 3 p.m. to tell her this “might” be it and asking her to come on to the city to take care of my toddler. She said she would, but then called back a few minutes later saying that my dad suggested she just come up and get my son and take him back to my parents’ because my dad didn’t think I was really in labor. I was not very nice and told her I SAID I wanted her now. She said she’d be there. I got in the bathtub to see if it would kill the contractions; it didn’t, but it sure did feel good. My husband arrived home sometime around 4, and I told him I’d been contracting all afternoon and that I’d called my mom because this might be it. I think it freaked him out a little—he worked on keeping my son away from me so I could concentrate on contractions and got his shower and packed up the car. I spent a couple hours laying in the dark bedroom listening to my Hypnobabies tracks. Breathing through the contractions was working fine, and I was trying to get mentally prepared. I alerted my doula that I’d been having pretty decent contractions since noon, and they seemed to be getting closer (they started about 5 mins apart). I noticed that I often had a smaller contraction immediately after a “major” contraction ended, which I was a bit confused about how to time. Little did I know that pattern was only going to get worse…. My doula wanted me to get up and walk if I could, but I didn’t like how intense the contractions got when I did that, so I mostly stayed in bed. Got back in the bath for a while thinking it might be the last time for a while. After I got out, the contractions were stronger and I started wanting to moan through them instead of just breathing. I decided that I was about to pass the point when I was going to be able to deal with the triage rigmarole at the hospital so made the call to go in—it was about 9:30 p.m. when we left. At triage (which was as much fun as I remembered from last time—I answered the question, “Has your water broken?” at least 4 times, twice to the same person), I found out I was 5 cm and 90% effaced with a bulging bag of waters (not that this fact being noted in my chart stopped them from asking if they’d broken a couple more times…). I was a little disappointed that I wasn’t further along, but glad to hear I was in active labor. It took less than 12 hours to get there this time, rather than 30 in my first labor! L&D was having a busy night, the midwife (Deb) particularly. She said Dawn, the CNM I’d seen in the morning, had called and told Deb that she thought she might have sent 3 of us into labor, to watch out. I guess she was right—I was the last of the three to show up. I was stuck in triage for almost 1.5 hrs. I finally started pitching a fit, demanding that they had to let me out of there because I was hurting too much to be stuck in the bed on the monitors. I was already getting pretty loud during contractions at this point. My doula team had shown up about 30 minutes after we got to triage, and I was so glad they were there—they were already a huge help.
When I finally got moved to a room around 12:30 a.m., the doulas asked what I wanted to do, which was get back in the bathtub if they didn’t think it would slow down contractions. They thought it should be fine, so in I got. I labored in the bathtub for about 3 hours in various positions—at first just reclined, but then my doula wanted to flip me over so I could move a bit more. The pain on hands and knees was horrid without extreme counterpressure on my hips, which was super hard on my knees in the bathtub. It was also really hard on my labor team, I’m sure, but they didn’t complain. It was at this point that I really began noticing the pain/pressure was strongest around my pubic bone—that’s where all my pain would be concentrated the rest of the labor. After about 3 hours in the bath, they needed to do some monitoring of baby, so I got out and got hooked to the telemetry unit. I guess everything looked great because they let me off 20 minutes later. During this time, we did various upright positions—leaning over the birthing ball (I didn’t like), and finally ending up hanging over the bed. I decided I wanted to know how far I was at some point and asked to be checked. I was at 7 cm and 90% effaced, baby still at a -1 with a very bulging bag of waters. I was a bit freaked out at that point because 7 cm is the furthest I ever made it in my first labor. I was afraid of being stuck there forever because I was already hurting so much and didn’t think I could last much longer. We went through a series of several more contractions, mostly with me hanging over the back of the bed (modified squat/hands & knees position) and the team applying counterpressure to my hips and shoulders. At this point contractions were coming so close together that I could barely get moved to try any new positions. Every once in a while I’d get a nice, long 2-3 minute break, which felt heavenly, but usually because I was double/triple peaking, I’d just have a bit of a letdown at the end of a big contraction and then head right into the next one. It was mentally exhausting, and I was doing a lot of yelling. I’m sure I was scaring passersby and the people next door! I told my doula I didn’t think I could hang on much longer—would breaking my water speed things up? She said it would put different pressure on the cervix, so it definitely could get things moving. I said I was scared of trapping baby in a bad position and that the pain would get worse but not speed up. Then I had another contraction and decided I was desperate enough to go for it! We called Deb in, and she broke my water, still with me hanging over the back of the bed. (She was REALLY great about figuring out how to work with whatever crazy position I was in.) She checked me after she broke my water, and said I was an 8-9 and that baby was at a +1. I asked if the baby had passed the sacral promontory yet, and she said he had. I cried then because I knew I’d passed the point of problem in my first labor. Breaking my water definitely increased the strength of the feeling and did not alleviate any of the pubic pain as I’d hoped. The CNM didn’t leave at this point, but just hung back through a couple of contractions, and then I think asked to check me again (this part’s a little fuzzy); I think I was trying to lay down so she could check me, when a contraction hit, and I landed at a crazy angle with one half of me angling off the half-broken down bed. She checked and said I was pretty much complete and that if I felt like pushing I could. I did not have an urge to push at that point, but I did want Deb to get her hand out of my cervix (I think she was pushing back a bit of cervical lip) and did a bit of yelling at her about that. A contraction or two later, I was getting the urge to push, and everyone was yelling at me to push, but I yelled back that I didn’t want to, and that I was afraid to push. It didn’t help that I had tried a push and really couldn’t tell what I was supposed to be doing. None of their directions were making sense to me, and I didn’t feel like there was any way for me to get a big breath like they were telling me to do. I was also remembering what Hypnobabies teaches about breathing your baby down, and I thought that sounded really nice at that point (not requiring any work from me!), but everyone was yelling at me that I *had* to push. Also at some point in here, I asked if the baby was far enough for me to touch his head, but when I did, it completely freaked me out because everything just felt so swollen and different. My lizard brain was definitely a bit traumatized by that (rationally, I know this has to happen…). The midwife offered me a mirror to see, and I pretty much shrieked “NOOOO.” It’s funny because I thought I would really like to see/feel what crowning looked like, but not at all when it came down to it! There was also a lot of yelling that I couldn’t do it at this point. Everyone was very reassuring and encouraging that I was doing it—it was almost done if I’d just give a couple of pushes. My doula got the idea of having me play tug of war with a towel; appealing to the aggressive side of my nature turned out to be a stroke of genius. Holding on to the towel, I finally figured out how/where I was supposed to be pushing, and moved him pretty effectively. This was all done in a modified lithotomy position (which was not chosen or directed, just how I happened to crash on the bed when Deb wanted to check me earlier), with one knee pushed way back (and not on the bed) and the other leg stretched out straight. One of the last contractions no one was ready for, and I yelled because no one was pushing my knee back (the counterpressure felt good to me) and my doula wasn’t there with the towel. Deb did some perineal massage/support that was not feeling good to me at all, and I yelled at her that she was ripping me apart (but my husband says she wasn’t even doing anything at that point, so I assume I was just feeling the baby). She held baby back through a push or two to try to get things stretched out a bit, and then when she let go, I pushed and he squirted out completely, head and all around 4:46 a.m.
Not having pushed before and not knowing what I was feeling, I was terrified during the pushing phase because I kept remembering that average for a first-timer pushing is 2 hours, and I just didn’t see how I could possibly keep it up that long or longer. Little did I know it would only take 4 or 5 good pushes to get him out. Thankfully my evil multi-peak contraction pattern became more normal and lengthened out a bit during pushing so that I usually got a couple- minute break to catch my breath between them. I think it was only about 45 minutes from the time the midwife broke my water to the birth, so it all happened relatively quickly.
I got immediate skin-to-skin contact with my baby, delayed cord clamping, and even no pit for delivery of placenta! I realized later that my heplock was never used. I am a bit regretful of ending up in the lithotomy position (though you couldn’t have paid me to move at the time) because I ended up with a 2nd degree tear, and I wonder if it might have been at least partially avoided had I been in a better position. This baby was 8 lbs, 22 inches, head circ. 13.5 in. I told Deb she needed to tell Dr. ____ (who did my c/s with #1) that she was wrong about me never birthing a baby vaginally. I was elated and in a little bit of disbelief that I had done it and that everything had gone so perfectly. I am assuming since I didn’t hear otherwise that baby never had a remotely concerning heart pattern, a sharp contrast to my first labor where the monitor alerts went off almost continually during the last 12 hours.
All in all, it was a very good experience, though it was much more intense than I had imagined, and I will admit, when I was in transition, I definitely had thoughts of “why didn’t I just have a repeat c/s??” running through my head. It was worth it. I felt great as soon as the baby was out, and I didn’t go to sleep till 7 or 8 hours later (one of my big regrets with my first delivery is that I saw him for about 15 mins after he was born and then spent the next half-day sleeping). Baby was nursing within the first 5 minutes and was alert and looking around for about an hour after birth.
My doula team (doula and back-up/doula-in-training) and husband were fabulous. I required a LOT of physical work from them, and I can’t imagine trying to have done it without them. I know that I would have ended up with an epidural if I hadn’t had them to massage/apply pressure for me during contractions. Also of note was that I had a completely clueless nurse, who apparently had JUST started the job (considering she needed help putting on the monitoring systems, etc.). She clearly had never worked with a woman laboring without pain medication as she never seemed to have a clue that it was inappropriate to question me when I was yelling through a contraction. I don’t know why she kept doing it, since I never answered her till it was through! She also tried to put the monitor on me while I was in the middle of a contraction just before I had my water broken and didn’t have the sense to wait till it was over to try and put it on. I was yelling through the middle, and she started trying to buckle me in. I took a break from my contraction yelling and snarled at her to wait until the contraction was over. It was a good thing for her that I was physically incapacitated during the contractions or she might have gotten more than just yelled at. (Truly, I have never had so many fantasies of doing bodily harm to other people as I did that night with the triage nurses and my L&D nurse.) Recovery from this delivery isn’t even in the same ballpark as from the c/s. While I have perineal pain from the tearing and stitches, I was able to get up within an hour after birth, and I can get myself out of the bed without help, and I am not living in fear of my energetic toddler jumping on an incision in my belly. VBACing was definitely worth it!
I am so inspired to hear stories of strong women like this who believe in their ability to birth normally. I hope some woman reading this story will also be inspired to give normal birth a chance.