Saturday, July 23, 2016

Samantha's VBA3C

Trigger warning as I do mention our three previous traumatic deliveries. You can do it ladies! :)

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VBA3C of Maverick 


Our first baby was a cs in 2007 for "failure to progress" after a completely unnecessary, 3 day long induction at just over 41 weeks. I was young, 21, and didn't know any better. My cervix was completely unfavourable, never got past 3cm. Babe was 8lbs, 2oz. Recovery was horrible and included a spinal headache lasting over ten days. 

Second baby, again, was induced (2010). Told by my OB that induction would increase chances of a successful vbac. This time, got to 7 cm before my OB "called it" as baby's heart rate was starting to rise and I had "stalled out". In the OR, my epidural stopped working and without any discussion, despite there not being any urgent need, I was given a general anesthetic (GA) without any consent or discussion. The last thing I remember is the anesthetist saying he'd rather "just do a GA so I can get out of here on time today". My husband was completely traumatized as well as they told him to go change into scrubs and then refused to let him in the OR or update him on myself or baby for over an hour. Recovery was again, horrible. 


Just before I became pregnant with babe #3 whom I had in 2013, I had graduated nursing school in 2011 and had started working in labour in delivery although I was still very much a newbie. When it came time to find an OB I chose an OB at the hospital where I was working and chose to deliver at the same hospital thinking that the best way to go about a vaginal birth after two caesareans was to have a supportive team. What more support could I get more than with the people I worked with? I assume since I was a well like staff member that I would get the loving support from my peers… I was very wrong. I refuse to schedule a section at 42 weeks, knowing that if I had that date looming over my head it would stress me out. I went into labour on my own at 41+5, progressed super quickly from 2-7, and then the shift changed. I was bullied, harassed, yelled at, hubby was taken into the hallway and berated by the on call OB about how I had a "30-50% chance of killing myself and baby" etc etc (though hubby still tried to support me throughout). Nurses sat outside my room talking about how foolish/stupid I was. Finally in tears I gave up, bawled on the way to the OR. During the surgery I started to feel everything and the anesthetist had to actually order the OB to stop while she topped up my epidural - the OB kept saying "we're almost done" when I was saying that I could feel the sharp/sutures and was begging her to stop. In postpartum nobody came to visit me from my unit, and the PP nurses were miserable and rough. I finally left against medical advise, under 24 hours postpartum, because I couldn't handle it there anymore. My OB phoned me 6 weeks postpartum to ask why I hadn't scheduled a follow up. I told her I was seeing my family doctor. She then told me it didn't matter that if had a cs, only that I'd had a healthy baby. I told her I was glad she felt that way and hung up. (I never did go back to the hospital where my last cs took place/where I'd worked - we moved out of the province). 


Fast forward to 2015, pregnant (surprise!) again. We had moved to our new province and I was working in L&D at a brand new hospital. I applied for care and even got interviews with a few midwifery practices; while they all believed I could birth vaginally, they couldn't take me for "insurance reasons". Another practice would only take me if I agreed to be seen/followed by an OB as well and it HAD to be at the hospital where I was currently working, as they were the most evidence based hospital in the city and were the best chance of success. I refused, as I had learned that I couldn't forcefully advocate for myself amongst coworkers when I knew I'd have to return to work there (had learned that with babe #3's birth). I knew I couldn't put myself through the trauma of an unsupported hospital vbac attempt so I decided to have an unassisted home birth. I got meds (I have hyperemesis with all of my pregnancies) and ultrasound requisitions from the walk in clinic. 

Finally at about 37 weeks I went in to triage at another hospital just to get checked out/reassurance as I had been feeling very faint and dizzy that day - baby and I were both fine, just very dehydrated. During that visit, the resident started giving me the lecture about home vbac. I cut him off mid sentence and told him I didn't care what he thought, and to keep his opinions to himself. The OB however, overheard and flat out told me he'd support me in a hospital vba3c, and that I wouldn't be the first patient who'd wanted to vbamc. He then stated that the rupture rate for a vba3c was "roughly the same as after one cesarean, about 1-2% give or take". I was impressed he actually knew the stats. However, I told him thanks, but no thanks, as it was unlikely he'd be working that day that I went into labour, and then I'd be stuck defending myself and my choices to whomever was on call. He gave me his home number on the spot, and told me he'd email (with my permission) the rest of the OBs and ensure they knew about me and were aware not to harass me in labour. He was very arrogant but I sensed he was honest, so I agreed to at least meet him in his office to discuss the possibility. At that visit, he agreed with everything I told him I'd need to consider a hospital birth, no induction, no scheduling of a cs, no IV, no continuous monitoring, and especially, no harassment. He wasn't happy about me wanting intermittent monitoring but agreed. I still didn't plan on going into the hospital unless needed, but I kept it to myself. 


At 40+3, just after supper, had my first contraction. After three more, very painful, 5-7 minutes apart, I knew it was labour! I sat and rocked on a yoga ball while hubby packed the kids' bags in case they had to go to the neighbour's house (which we'd pre-arranged just in case). He also packed a hospital bag for me at my request just in case. After the first half hour, contractions ramped up to 30-60 seconds apart and lasting a full minute. I wasn't getting much of a break - so into our huge oversized tub I went! There I laboured for another hour and a half, only getting 20-30 second breaks most of the time between contractions. I knew the lack of breaks between contractions would likely stress baby out, and I just had a feeling there'd be meconium whenever my water broke... So I told hubby I needed some gas and we should head into the hospital. He dropped off the kiddos at the neighbour's and we headed in, 30 minutes away. I was now feeling major pressure, but all in the front, and had a feeling it was the bulging amniotic sac. 


At the hospital in triage, to my surprise, I was treated respectfully when I refused continuous monitoring and also to lie on the stretcher (had to be standing for contractions!) The OB on call was the partner of my OB, and she was very calm and welcoming. The resident on call was amazing. Nobody got frustrated, even when I couldn't finish a sentence or answer questions as I was still only getting 20-30 seconds between contractions, which where now lasting 60-90 seconds. I allowed a cervical check after ensuring the resident knew I did not want my water broken. I was a very stretchy 4cm with bulging membranes. 


Within another 20 minutes, in our labour room I was using gas for relief, and suddenly had an uncontrollable urge to push, I was 6 cm now so tried hands and knees position to relieve the pressure. Immediately, my water broke with an audible pop and soaked the bed. There was thin meconium, as I'd guessed, but baby's heart rate (still using intermittent monitoring) was fine. I literally pushed and pushed for over an hour (couldn't stop!) and was still 6-7 cm. over the next few hours I tried gas, then IV Fentanyl, then finally asked for an epidural as I still couldn't stop pushing and was STILL only getting 20-30 second breaks between contractions. I told the nurse I wanted an epidural. 


The anesthetist was great, I couldn't sit so he inserted the epidural with me lying down at my request. It only took on one side, but it relieved the pressure/urge to push. I continued to use gas with the epidural. I insisted on trying hands and knees, sitting, etc and trying to get up to the bathroom, and our nurse was supportive of it all. Finally we were 8 cm, then 10 and +3 station. I wanted to wait for an urge to push, and everyone was agreeable. I never did get much of an urge but did start feeling some pressure. As baby was crowning, his heart rate plummeted and wasn't recovering. I figured he had his cord around his neck (normal occurrence) but after quite a few minutes went by I agreed to let the OB help him out with a vacuum. She barely pulled once and he came flying out with a tight nuchal cord and a good sized gush of blood - OB wonders if placenta had concealed/partially abrupted at some point. We got delayed cord clamping (hubby got to cut the cord for the first time!) and skin to skin. I got a small second degree tear. I got 90 minutes of Skin to skin and breastfeeding time uninterrupted at my request before babe was weighed and measured etc. He was 8lbs, 4oz, my biggest baby yet! So much for CPD. ;)

 
It was the single most amazing and empowering experience of my life! My husband never doubted me throughout pregnancy or the birthing experience, he was my rock. I also knew all along that I could do it and believe it or not I can't wait to do it again! Someday, that is, when we're ready for baby number five LOL. It's three weeks after the birth today and I'm still on a complete high! I feel great. So many people told me that I couldn't do it that I wasn't meant to birth my babies vaginally – and I proved them all wrong! Validation feels so good and my sweet baby was so worth it. Keep fighting for your birth experiences ladies! They really do matter and they really do have an impact on your life whether positive or negative.