My baby girl Stella was born just over 24 hours ago and I have to get the story down now. I’m high on it and the details are running through my head and it needs to come out now! Stella’s birth story begins with her big brother Graham’s birth story. This is Stella’s story though so HERE is the link to Graham’s story.
After having a c/s with an inverted t cut, I was nervous to get pregnant again. I knew that I didn’t want another c/s but finding a doctor to attend me would be really hard. I did find the perfect team right here in Korea, which saved me from having to split up my family and going back to the States. My birth team was so much more than convenience though, each person was there for a specific reason and each person was there in their own perfect capacity. I truly did have the best birth team possible in Korea and most likely Stateside as well. I am very sure of this.
Graham and I were already in Seoul at my friend/doula’s apartment, where I planned to birth. We live two hours from Seoul and the nearest hospital is about 45 minutes away and my OB and I agreed that was too far away in the event of transfer since I was planning to have a(n) HBAC (home birth after cesarean). We came into the city on the 15th, my estimated due date to await baby Fuller’s arrival. My husband was out in the field for an exercise and waiting to get the call to join us. He was 2.5 hours away minimum which made me nervous. In hindsight that is really really funny.
On Thursday, July 22nd I began having prodromal labor: start and go labor, regular then irregular contractions, no contractions, ‘false’ labor, etc. I also began losing my mucous plug. I called Josh to let him know and he decided to go ahead and make the trip to Seoul. Even though we weren’t sure when labor would really kick in, we knew it would be soon, especially since I was 41+ weeks at that point. He got in that evening and Josh, Graham and I checked into the hotel on post to get some private time as our last few days of a family of three. The next two days were spent hanging out, playing with Graham and doing lots of walking. I continued to have the prodromal labor until Friday night.
Friday night at 1am, I was woken up by a contraction that was not like the prodromal ones. It was ‘real.’ I layed there thinking I should ignore it and go back to sleep. Three and a half minutes later, I had another one. Then another one the same interval. I went to the bathroom and realized they weren’t stopping. Graham and Josh were both sleeping so I got on Facebook and started what would end up being a live feed of the birth until the end. I never planned on doing that but it helped me cope for many hours of the labor and once I couldn’t do it anymore, my husband and Karen (friend/doula) took over.
For the next 2.5 hours, I had contractions 3.5 minutes apart. I started to get the shakes and decided to text Karen and let her know I was thinking about coming back to her apartment. I also woke Josh up. It took about an hour and a half to get ourselves back to Karen’s and thankfully, Graham went back to sleep for a few more hours. I continued to labor all morning. I also had bloody show and knew it was the real deal.
Around lunch time or so my labor seems to space out. The contractions went down to 7-8 minutes apart and I was mildly annoyed. I knew it was because the baby was trying to get into a better position and just went with it. I made sure to eat and drink and I took a nap between the contractions. After that, Karen did a maneuver on me called a hip lift that we learned from the Pink Kit and I had immediate results. When she did it, I felt my pelvis open and there was an obvious shift in the baby’s position. Karen felt the movement too and she was only touching bony pelvis. As soon as I stood up, my contractions kicked back in stronger than ever. They were very intense compared to my labor with Graham. I had no back or hip pain but had intense cervical and lower uterine pressure, so much so that it caught me off guard and I found it overwhelming at times. I listened to my Hypnobabies tracks the entire time and it really helped me focus if I began to struggle at all. A few hours later I was able to nap between contractions some more and it really helped since I had only had four hours of sleep the night before.
Karen and I had discussed when to call Dr. C and I just felt like that even though I was definitely in active labor, it wasn’t very progressive and I didn’t want to have the pressure of a bunch of people there just yet. Little did I know that my med team (Dr. C and MW1 and MW2) would be the least pressure I’d encounter! We did call them around 7pm to let them know we were ready for them but that they didn’t have to be in a hurry. They arrived around 9pm. They checked the baby with a portable contraction/fetal heart tone monitor for about a half and hour and she was doing perfectly. My vitals were great as well. Everyone retreated to the kitchen and living room and gave me my space to continue to labor. Karen and Josh alternated helping me and keeping me company. At some point before the med team arrived, Karen and Rachel (another doula friend of ours that came by to help out evening #1) got the pool filled and I got in. I love it.
Around midnight I decided that I wanted a vaginal exam. I am not a fan of routine exams and my team knew that if I wanted one that I’d ask so no one ever offered. Rosa (MW1) checked me and said I was complete, 10cm and 100% effaced. I was floored that I was complete and excited too because I just knew that I’d be pushing soon and would be done! Then Rosa said that the baby was still a -2 station which is high in the pelvis still.
Because of the work I did with the Pink Kit and and the time I had spent discussing my birth history and pelvic shape issues with Gail Tully, the midwife that runs www.spinningbabies.com , I knew that I had some things to contend with and work through. I knew the entire labor that these things were why the labor had been somewhat funky with the spacings and with the baby being high. I also knew that if I could get the baby to descend into my pelvis that there was a very strong possibility that I’d push her out. The trick to this would definitely be getting the baby to descend.
Rosa began working me in different positions to aid descension. The first was walking while doing abdominal lifting in between contractions. I did this for 30 minutes. The she had me swaying my hips between contractions for 30 minutes. Then she had my so a side lying position in the bed for an hour. This was nearly torture. The rest of the birth team slept except Karen and Josh. My contractions were at the strongest intensity that they had been the entire labor at this point and laying down in bed on my side but while also squishing the left side of my belly into the bed (to force the baby out of a left occiput transverse position) was torture. Karen and Josh had to talk me through every moment of it and the last 20 minutes made me want to scream at both of them. And I did along with many choice cuss words that would embarrass some people but I managed to do the hour because of those two and it did help the baby move so it was worth it in the long run.
That said, that hour was so incredibly difficult that I lost my control and focus. Josh went to take a nap while Karen stayed with me. I got back into the birth pool and tried to refocus and get my control but I struggled. I told Karen I was done and I ready to go to the hospital and I didn’t care about a VBAC any more. I wanted an epidural and some sleep and if that didn’t work, fine. She looked at me as if to say ‘everyone else is asleep’ and I glared back ‘then go wake them up!’ But what I said out loud was “I’m so tired and I need to sleep” and she responded with “so sleep then.” She didn’t pity me or baby me which is what I wanted. She was blunt and she wouldn’t let me jump of the ledge I was so desperately trying to escape from. It pissed me off but I do mad way better than I do upset or pity so it worked and I went to sleep. For two and a half hours I slept in the pool. My contractions had spaced a bit, maybe 6-7 minutes apart and I did wake up to work through them and then I went back to sleep. Karen slept on the bed next to the pool.
When we woke up the sun was coming up and I puked and ate, in that order. Rosa did another exam and said that the baby was still at -2 but that her head had moved to an OA (occiput anterior, optimal for birth) position so we were all encouraged that things would start moving. My water had not broken either and the bag was bulging out in front of the baby’s head. I wondered then if they would want to break it and analyzed how I felt about it. I didn’t like the idea but felt like something needed to happen. No one said anything about it.
Because of the nap and the food, I felt much better. I was still worried that I didn’t have the stamina to continue when my labor kicked back into high gear but I was beginning to believe that maybe I could do it. I had more energy, now I just had to find a rhythm. Karen and Josh rewarmed the pool and I got back to work. I labored in positions that made my pelvis feel open. Mostly I stayed on my knees while holding onto the side of the pool. Around lunch time, Dr. C told me they were going to go eat in shifts and that when they were all back that we’d discuss rupturing my bag of water. I had been at 10cm for about 12 hours that we knew of at that point and since the baby still was’t descending it seemed like something worth exploring.
They (med team) were all back by 2pm. They discussed what they though amongst themselves then Dr. C came to talk to me about it. Since the head was in a better position he thought that if he broke my water that the more intense contractions that would create would push the baby down farther into my pelvis. He was blunt and honest and said that he didn’t know if it would work but if it did hopefully I’d have the baby soon (music to my ears since I was 36 hours into it at that point) or it wouldn’t work and we would go to the hospital to explore other options. I agreed with him and gave him the go ahead.
They wanted to do a half our of monitoring first so we did and baby looked great. It was about 4pm when we were all ready to rupture the membranes. He wanted to break the water during a contraction so that the force of the contraction would bring the baby’s head down and prevent cord prolapse since the baby was still high in my pelvis. Rosa did the job and wow did i ever have some water! It just poured out. The baby’s heart rate jumped up to 180-190 for a bit so they gave me oxygen and had me lay on my left side. I had a contraction and more water poured out and then I had another contraction and my body pushed with all it’s might in the most uncontrollable way that I have no words to describe it. I looked at Dr. C and said, “I pushed!” and he said “I see that!”. They had me side lie for about 20 minutes longer and continued monitoring and the baby looked great so I was given the go ahead to get back into the pool.
The pool made everything better. I was ready to do it. I pushed when my body said push. I was loud and I roared and grunted and made noises that I never imagined. I remember Karen saying to be a lion and thought it was funny even though I ignored her. I pushed spontaneously for about two hours before I asked Rosa to check the baby’s station. The baby was at zero which was improvement but I knew I still had a ways to go. Rosa made sure I was swaying my hips and changing pushing positions at interval. I also got very serious about pushing and began bearing down as hard as I could on top of what my body was doing. It just seemed like I should. I was exhausted and had been pushing forever and was so ready to be done with birthing! After a bit, I could feel the baby’s head just inside and that gave me a lot of strength. I was oblivious to the world around me. I knew Graham was in the room and he seemed ok with my roaring. Josh said that he said ‘ow mama’ a few times and ‘oh shit’ more than a few times as that was my cuss phrase of choice. After the three hour mark of pushing I knew the baby was really on it’s way out. I felt fierce and determined. Everyone was focused on me and I didn’t care, I was happy and loved every single person present and so grateful that each of them were there for that moment. I soon realized that the baby’s head was crowning and I yelled “OH ring of fire, that’s sucks!” and I thought about how many times I told a client that ‘you can do anything for a minute!” and it made me want to slap myself and hug myself at the same time! In the next push, Dr. Chung reach down to help slow down the baby’s head and I really felt the stretching then. The next push I bent over on hands and knees and Josh got prepared to catch the baby from behind from outside the pool (I didn’t want him to get in). Dr. C and Rosa moved to the backside with Josh and I pushed what felt like a huge rock. Dr. C told me when to push and when to breath through it and not push. He has a 70% no tear rate so I told him I would listen and do exactly as he said. In fact, when I realized the baby was crowning, I asked him if it was time to listen to him which got some laughs. The next push brought the head all the way out and that was the hardest thing I think I have ever done. I waited until the next contraction for push again and Josh said that she opened her eyes and mouth and moved her head under the water. The next push brought her shoulders out one at a time which I felt every bit of then her body just squished out which kind of felt like a reverse vomit or something equally strange. I looked over my should in that moment and saw Dr. C and Josh both with outstretched arms and the next thing I knew they were trying to pass the baby back under my legs to me. I sat back in the pool and was somewhere between “OH MY GOD I JUST HAD A VBAC” and “OH MY GOD, I’M DONE!”. The very first thing I did when they handed me the baby was lift her leg and then say “I knew you were a girl!” It was an amazing moment. Karen was crying and saying “you did it! you did it!” and Josh was tending to Graham because as soon as the baby popped out he lost it. I sat back in the pool and stared at my baby girl and just couldn’t believe what had just happened! I had a perineal tear that wasn’t bleeding so we decided not to bother with stitching and opted for resting with my legs closed for a week or so instead.
The amazing thing about my birth is that Dr. C was so incredibly comfortable and confident. He was confident but not cocky. He listened to Rosa, who is more experienced than he is but he still made the call when it came down to what he felt was best. He discussed everything with both me and my husband and Karen and I ultimately had the final say in every aspect. There were no time limits, no unwanted interventions, lots of privacy. They did monitor regularly but were not over bearing and were unintrusive. Rosa is probably one of the most experienced home birth midwives in Korea. She is a CNM who worked in a hospital for 10 years before doing home birth. She also runs a birthing center. Dr. C respects her and listened to her and she did exactly what I wanted her to do when I asked her to join the birth team which was help me deal with positioning issues. I knew going into my birth that I have pelvic shape issues that would made birth more difficult and that lended a hand in what was Graham’s c/s birth. I wanted the best and she brought it. Dr C told me later that adding her to the team was the perfect choice.
I was 10cm dilated with an intact water bag for 20 hours or so before any intervention. Dr. C told me today that he didn’t feel intuitively about doing anything earlier than what we did. There was a chance it could have cause more harm than good and by waiting we were able to increase the chance for best case scenario. I agree wholeheartedly and adore him for his patience and do not know of another care provider that would have been comfortable doing that. He said that the baby was fine and I was ok so waiting was what was needed. When we did break the water, it worked exactly as it should have. I am in awe.
After the birth, I had some heavy bleeding. It wasn’t to the point of hemorrhage but it was concerning. The placenta did not detach either. Afte two hours and still bleeding and still no placenta birth, Dr. C told me he wanted to take me to the hospital. He felt like everything was ok but he wanted me monitored over night and wanted blood work done. Josh and Karen got us together and Karen took the baby. I was weak and needed a lot of assistance getting out so Dr. C and Danica (MW2 who was also great but more of a Dr. C/Rosa support person than so much for me). We got checked in to the hospital and I ate some food that Karen packed up for me and Josh took care of baby Stella. Once settled in, i was able to sleep for about 5 hours until Stella was ready to nurse. She nursed like a champ and slept all morning on my chest. Josh go to sleep for 5-6 hours in the morning.
Once morning came, Dr. C dropped by and checked me out. The bleeding was at a normal level and my labs were fine and other than being weak I was ok. The placenta was still attached but in the absense of any indication to do so (such as infection or bleeding), Dr. C is comfortable with waiting to see if it will come out on it’s own. He doesn’t want to have to do a manual or surgical extraction. So orders are bed rest and daily check ups and blood work and infection monitoring and we will reevaluate the situation daily until either it comes out or he takes it out.
None of the after birth stuff has affected my birth though. It was exactly the birth I was supposed to have and I would do it again five times over if it meant not having to recover from another c/s. I am still in shock and awe and amazement and I can’t believe I did it! It was the hardest thing I have ever done and I’m so grateful to my team, they were perfect. I know I’ve left out important details and that this hasn’t been proofread but I had to get it out. Enjoy! I’ll edit later.
EDIT: The placenta came out a few hours after I posted this birth story. I went to the bathroom and couldn’t pee much but could tell my bladder was full. I stood up and felt a very heavy weight on my bottom and I looked in the mirror and saw the placenta bulging out. I didn’t push but when I spread my legs it plopped out onto the floor all at once. My bladder immediately released and for a second I couldn’t tell what was going on and was afraid that I was bleeding. I realized what happened and calmed myself before yelling for Josh. I told him what happened and he was super excited then I told him how bad it smelled. It was TERRIBLE and like meat that had been left out for a few days. He peaked in to look at it on the floor. I had him go wake up Karen (who of course, took a picture) and she called Dr. C. Since I wasn’t bleeding he decided to wait until our planned check up for the next morning. My bleeding has been a bit heavy but still normal, so I’m not concerned and I’m sure he won’t be either.
I feel SO much better physically. I immediately felt different when it came out. I did get weak and woozy and had hot flashed but the pain I was having in my bottom was gone. I’m still sore but i can actually move around with little assistance now. My body knew that the placenta didn’t belong in there any more but I guess it just needed time to release it. I’m so glad Dr. C was patient and didn’t force manual extraction. Again, everything about this birth was exactly as it should be and I’m so happy there was not a surgical ending to my beautiful VBAC. The placenta was born 29.5 hours after my baby was. Dr. C told Karen “Time. She needs more time. With Amy, everything takes more time.” He knows me so well!
Our baby girl’s name is Stella Rose. I didn’t know Stella meant “Star” when we chose it but it’s so appropriate because for our VBAC the stars had to align on so many levels. We chose Rose as her middle name to honor our Korean birth team. MW1’s Korean name is Kim Oak Jin (Oak Jin is her first name) and there is no English translation for that name so she chose Rosa as her English name. We thought that by choosing Rose for Stella’s middle name that we were acknowledging our medical attendants and their dedication, hard work, patience and confidence in our birth. Plus, Hwan Wook (Dr. C’s first name) didn’t flow very well with Stella!
9lbs 2 oz
15 inch head
Dr. Tate is the doc I would have used if I were going back to the States to VBAC. Instead I found Dr. Chung here in Korea who is, in my opinion, even better than Dr. Tate but both men are amazing docs with a calling to really provide care and options to birthing women in all scenarios.
The details are just coming out about this VBAC but apparently the woman had her triplets in a hospital attended by Dr. Tate. I am assuming she went natural, as in unmedicated, as that’s generally the way with a VBAC with Dr. Tate. From what I am reading so far, the first two babies were head down and the third was footling breech. Here are the babies stats according to the ICAN of Atlanta chapter posting.
3 girls, all vaginal, all Apgar 8/9.
A= 4# 6oz, 18.25in @ 10:24pm, vertex.
B= 6# 4oz, 18.25in @ 10:37pm, vertex.
c= 3# 11oz, 16.5in @ 10:39pm, double footling breech extraction.
All three babies are successfully breastfeeding as well.
What an amazing day for this mother, her family, Dr. Tate and the VBAC world as a whole!
***EDIT: I was first informed by a commenter that the mother had an epidural and delivered in the OR. I have since been informed by Dr. Tate that the mother did have an epidural in the event that baby C got into some trouble and he had to reach up and get it out quickly, which is in fact what happened.
I found this study done on the safety of triplet vaginal delivery. One woman in the study was also a successful VBAC of triplets.
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 Preliminary experience with a prospective protocol for planned vaginal delivery of triplet gestations.
AUTHORS: Alamia V Jr; Royek AB; Jaekle RK; Meyer BA
AUTHOR AFFILIATION: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, State University of New York at Stony Brook, New York, USA.
SOURCE: Am J Obstet Gynecol 1998 Nov;179(5):1133-5
CITATION IDS: PMID: 9822488 UI: 99039941
ABSTRACT: OBJECTIVE: The objective of the study was to evaluate a protocol for vaginal delivery of triplet gestations.
STUDY DESIGN: All women with triplet gestations managed between January 1, 1995, and December 31, 1997, by University Medical Center’s perinatal practice were offered enrollment in our vaginal delivery protocol. Our protocol offered attempt of vaginal delivery if triplet A was in vertex presentation, fetal monitoring was possible, and there were no other obstetric contraindications. Twenty-three triplet gestations were identified; 8 achieved vaginal delivery. Outcome parameters investigated included neonatal mortality, Apgar scores, neonatal intracranial hemorrhage, arterial cord pH, neonatal weight, and length of postpartum hospital stays of mother and neonates. All parameters were analyzed with analysis of variance and the Student t test as appropriate with the JMP 3.1 statistics program (Cary, NC).
RESULTS: Twenty-three sets of triplets were enrolled. Eight sets were delivered vaginally. Eight of 9 patients (88.9%) who attempted trial of labor were delivered vaginally, 1 of which was a vaginal birth after cesarean section. The remaining triplet gestation failed to progress at 4-cm dilation. Twelve sets of triplets had a nonvertex-presenting triplet and were delivered by the cesarean route. The remaining 2 triplet gestations were delivered by the cesarean route because of inadequate fetal monitoring. Neonatal survivals were 100% for both groups. No significant differences in neonatal mortality, Apgar scores, intracranial hemorrhage, arterial cord blood pH, hospital or neonatal intensive care unit stay of neonate, neonatal weight, and change in maternal or neonatal blood cell count were noted. There were no cases of grade III or IV intraventricular hemorrhage in either group. A significant reduction in postpartum hospital stay of mother was noted in the vaginal delivery group (2.8 vs 4.5 days, P <.001). The mean gestational age at delivery was significantly lower for the vaginal delivery group (31.3 vs 34.0 weeks, P <.02). The mean neonatal weight for the vaginal delivery group was significantly lower (1758 +/- 473 vs 2022 +/- 407 g, P <.02). There were no significant differences in outcome parameters for the first, second, and third triplets within each group when compared with each other or with the other study group. One patient who underwent vaginal delivery had retained products of conception and required curettage. A single fetal death occurred at 22 weeks’ gestation from twin-twin transfusion, with the remaining triplets being delivered vaginally at 35 weeks’ gestation. Cesarean hysterectomy was required in 1 case for uncontrollable bleeding at the time of cesarean delivery. Perinatal complications occurred in a large number of patients, with the incidence of premature labor 47. 8% (n = 11), that of preterm premature rupture of membranes 26.1% (n = 6), and that of preeclampsia 34.8% (n = 8).
CONCLUSION: In selected cases vaginal delivery of triplet gestations can be accomplished without increased maternal or neonatal morbidity and mortality and may significantly decrease maternal hospital stay and postoperative morbidity.
I had a c section with Graham because he was left mentum transverse. This means he put his face into my pelvis first, sideways, with his chin on my left hip and his forehead on the right hip. This is considered a vaginally impossible delivery. I can pretty much attest to that as I had 52 hours of contractions without pain medication of any kind. I was upright and active the entire labor. I didn’t even go to the hospital until my water broke with particulate and thick meonium and even then I was 7cm. Because of all of this, it as very difficult to deliver him once the docs were inside so my uterus was cut a second time. The first cut was the standard bikini incision on the lower segment of the uterus and the second cut was perpendicular to that. It was a vertical cut extended into the contractile portion of the uterus. The result is an inverted T incision style scar on my uterus. This type of cut is reserved for emergency or very difficult deliveries. Only about .4% of c section end in this type cut.
American OBs quote the rate of rupture during a trial of labor in a subsequent pregnancy as 10%, 15% or even higher. It was originally recommended that any future babies were delivered by c section at 36 weeks after an amniocentesis to check for lung maturity. This was very disturbing to me on so many levels. First, I would be purposefully delivering a preterm baby. Graham gestated until 41 weeks and 1 day. By that reasoning, he would have been 5 weeks early. It was also concerning because if the rate of rupture was truly that high then was it even sensible to carry another baby at all?
I started digging around and what I found was the most alarming thing of all. The true rupture rate found by the biggest study ever done on VBACs found a rupture rate of only 1.9%. How could it really be that low? How could I be told something so different previously? Where did the doctors that told me 10 and 15% get their info? I have no clue, I have never been able to find any reference or study reporting that high of a rupture rate. It kind of made me mad and when I get mad I get determined. I started reading everything I could find on this type of scar, why the cut is used, what doctors recommend and then I found that women did VBAC with this scar and they did it under the supervision of doctors and midwives that actually supported the idea. I knew I had to find out all of my options before I could consider getting pregnant again.
I learned through ICAN of Atlanta that there is a doctor in Atlanta that would be VBAC supportive after an inverted t incision. He also support VBAC after multiple cesareans, VBAC after classical incisions, twin VBAC, and does breech vaginal. His name is Dr. Tate. I emailed him and talked to him months ago and he was on board when the time came. He was willing to take me as a patient, meet me at the hospital at the onset of labor, only require a saline lock and fetal monitoring and he would stay as long as it took with no pressure how long it took. He was willing to let my body work and do it’s thing without interference. He, like me, believes that the body is capable of birthing without intervention and time constraints and in a higher risk VBAC it is safer to be as hands off as possible. The level of commitment that he was making touched me and motivated me and I knew that was the answer. I could go back to the States in my third trimester and live at Ft. Benning and go to Dr. Tate in Atlanta. I finally had some peace of mind.
Then I found out I was pregnant on November 4th.
Yep, that’s right for all of you that have been guessing, I am pregnant! Due July 15th. It is still very early, I am only 6 weeks along and I didn’t imagine announcing it so soon but I decided that I wanted to blog this experience and I was anxious to get started in case anyone else was going through something similar. So there it is 🙂
Once I found out I was pregnant my brain went in overdrive. I was already planning the move to Georgia in my mind and thinking of all the logistical aspects. I was bummed to have to separate my family for such a long period of time but willing to do it. I had decided that I would pretty much do whatever it took to make this trial of labor, my chance to VBAC happen. For me it is that important. I want my next baby to have a gentle peaceful birth. I want my body to experience labor and delivery the way it was meant to. I want to labor. I want to feel my contractions and my body work and my baby work in sync with it. I know it can do it. I am not afraid of labor, I had a very long labor with Graham, I know that I can labor. I am not afraid to birth. I am surrounded by birth, I attend births, I know that my body can birth. I want that moment of realization that I birthed my baby myself. I want to hold my baby the instant it’s born, preferable pulling it out myself. I have had 19 months to process Graham’s birth but I will always hurt that he didn’t get to be with me for the first three hours of his life. How terrifying and confusing it must have been for him to go to the arms of strangers and bright lights and to be force fed formula rather than nurse. I want to give this baby a more gentle entrance, it deserves that. I deserve that.
All that said, I am no fool. I know that I may have to have another c section. If the safety of my baby or my life is compromised, I get that. I have a lot of perspective and knowledge going into this next birth and I know that if we have another c section it is because it was truly necessary and I can live with that.
As all of this was coming out, my friend Karen, suggested that I talk to Dr. Chung. He is a Korean OB that has a solo practice and as the Korean’s say it he has gone the “natural way.” Women seek him out specifically for natural birth. Korea has a 45-50% c section rate and a 90%+ epidural rate for vaginal births. The “natural way” is small population in Korea. Dr. Chung also attends homebirths and has even attended homebirths on post at Yongsan Army Base. This is how Karen and I knew of him. It never occurred to me to ask him but I wasn’t aware that he attended VBACs. Once Karen told me this, I immediately emailed him. He got back in a couple days and said to come see him as soon as possible that he thought he could help me.
OH MY GOODNESS!!! I couldn’t believe it. I may have the option to stay in Korea and do this! I had a question list a mile long. Everything had to be on my terms and my way. I want to do this but it has to be as safely as possible. Here is the list of questions I used…
- Approximately how many VBACs have you attended?
- Of those patients in your practice who wanted a VBAC, how many were successful?
- What do you think my chances are of a VBAC success, given my childbirth history?
- What is your rate of cesarean sections and under what circumstances do you usually advise them?
- Who is your back-up? Is he/she VBAC friendly? Would he/she support my birth plan?
- What hospital(s) do you have privileges at? (Which would you recommend for a VBAC?) (Natural birth?)
- What prenatal tests/procedures do you usually require? Recommend?
- What do you think of Birth Plans/ Preferences?
- How do you usually manage a postdate pregnancy? Or a suspected Cephalopelvic Disproportion (CPD)?
- Do you have a vacation scheduled near my estimated due date?Labor & Delivery
- What’s a reasonable length of time for a VBAC labor if I’m healthy and my baby appears to be healthy?
- Do you know any kind of restriction I should expect from the hospital on a VBAC? (Who do I need to have policy exceptions approved through?)
- How many people can I have with me during the labor and birth?
- How do you feel about doulas?
- What is your usual recommendation for IVs? Pitocin? Confinement to bed?
- What’s your approach if the bag of waters has broken at full term but the mothers feels no contractions?
- In what percentage of your patients do you induce labor?
- Approximately how many of your patients have un-medicated births?
- If my baby is breech will you still consider me for a VBAC? ECV?
- At what point do you arrive at the hospital during labor/delivery?
- What labor positions do you recommend to your patients? Do you encourage movement during labor?
- I do not intend to push on my back. I may stand, kneel, squat or get on my hands and knees. How do you feel about this?
- I would like to push spontaneously and without coaching or counting. I would like help breathing my baby out to reduce tears. Will you do this?
- Do you require continual fetal monitoring for VBAC?
- Do you allow light eating/ drinking during labor?
- Are you OK with No IV – but a Saline Lock?
- I would like a for my labor room to be quiet and undisturbed unless medically necessary. How do you feel about this and can you advocate for me to the hospital staff?
- In the event that I need a c section and there is time, will I be able to have spinal anesthesia rather than general?
The conversation went even further than this list of questions. I spent well over an hour with Dr. Chung yesterday. I was very pleased to learn that he would be willing to show up at the hospital with me at the onset of labor and stay until about two hours after the birth. NO MATTER HOW LONG IT TAKES. There will be no time restrictions. He said that he envisioned his job in my labor and birth as a back up. He said that he felt like he should be there with me and if I need him he will be there. I will be laboring unmedicated so that I can feel any changes to my scar if there are any, and he can respond quickly because he will be in the room with me. He said that he understood the need to labor undisturbed and peacefully so he would be sure to keep staff out of the room unless medically necessary and that he would be an unobtrusive and quiet observer unless medically necessary. He has attended Hypnobirthing training and could certify as a Hypnobirthing practitioner if he wanted and that really got me excited. I am going to be using Hypnobabies and while the programs are different they are similar enough in that the laboring women requires peace and quiet and he totally gets that and is on board. He also said that his job was to let the staff know that my case is a special situation and while we do want little interruption that everyone should be on guard to respond to an emergency at any time. I will be doing this at a very large university hospital in Seoul that is also the most natural birth friendly hospital in the city. There will be pediatrics, NICU, anesthesiology, adequate nursing staff and a back up OB in case I get into trouble. I am also A+ which is great because that blood type is abundant in Korea.
I cannot think of a more perfect scenario given my circumstances.
I would normally be very wary of going to the hospital at the onset of labor and laboring with my doctor present the entire labor but I truly believe that Dr. Chung is going to give me adequate space and time. I don’t believe that his presence will pressure me. I think it will reassure me. Because I know that he isn’t going to put time restraints on me and he will not augment labor in any way, that I can relax. For me, because I have never had a vaginal birth, I need that security of immediate response and there are not many doctors in the world that commit to a patient the way he is committing to me. I know that if I have another c section it will be because it was necessary. I know that he believes that my body can do this and that my body can birth but that if there is trouble he is prepared to repsond accordingly. With that kind of support, I know that I can labor quietly and peacefully and without worry.
So, like my friend Karen said yesterday, I have all the pieces in place, now it is time to switch gears to “I CAN birth my baby” and leave behind the “what if something happens.” She is right. I am ready. I can trust that I am in good hands and in the best case scenario possible for a trial of labor.
For me and my family, this is the best decision and one that I have been working on for a long time. After Dr. Chung and I finished talking yesterday he did an ultrasound and I saw the little tadpole. It finally hit me that I was rally pregnant and not just planning any more 🙂Read Full Post | Make a Comment ( 31 so far )
I am on the email list for My Best Birth. The Business of Being Born did a really good job of bringing about a level of awareness of the crisis in US obstetrics and I think that it is fantastic that the follow up will be focusing on VBAC. I hope that they shed some light on VBACs for the mainstream community.
I received this email today…
A message from Ricki Lake & Abby Epstein to all members of VBAC Moms on My Best Birth!
As many of you know we have been working on a follow up film to The Business of Being Born, to be released this fall.
We are deep into the editing now and are hoping some of you might help us out by sharing
your personal birth footage and photos. Specifically, we are looking for:
1. Homebirth video footage
2. Birth video footage from anyone who had a VBAC.
3. Video of a sonogram
4. Photos of women recovering post-birth, looking especially unhappy or suffering.
5. Video footage of a free-standing birth center (exterior & interior)
If you have any of the below materials and would be willing to let us use them in the film, please fill out and sign the release form posted under forum discussions and mail us your footage by August 15, 2009 on DVD, mini DV, DVCam or any format you have, to the address below. Please do not send us your only copy as we will not be able to return the copy you send us. If you have photos (for item #4) or any questions you can email us at email@example.com.
Mail footage with a brief description and the release form to:
Business of Birth
15 W 11th St #3A
NY, NY 10011
Please note we will blur out faces of any doctors, birth attendants or people in the footage from whom we do not have approval.
Thanks for your help!
Warmly, Ricki & AbbyRead Full Post | Make a Comment ( 4 so far )
This is a very good article from vbacfacts.com.
“There is this idea that if you don’t VBAC and you schedule a repeat cesarean, that you will be safe from complications. This is because during a “VBAC counsel,” women are often told of the risks of VBAC, namely uterine rupture, but they are rarely told the risks of repeat cesareans in their current and future pregnancies.
Abnormal placental implantation is one risk of cesareans that only present themselves when you get pregnant again.
Women who expect to only have two children, and thus opt for a repeat cesarean, might think that not VBACing is the safer, and more controlled choice, for them.
But what happens if you get pregnant again? Now you have had two cesareans, your risk of placenta accreta (where the placenta grows through the uterus), placenta previa (where the placenta grows over the cerivx), and placental abruption (where the placenta prematurely separates from the uterine wall) all go up. And here women think they are making the SAFER choice by having a repeat cesarean.
This news article from Canada illustrates this point.
I’ve underlined parts for those who like to skim.”
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By Sharon Kirkey, Canwest News Service August 1, 2009
Dr. Jan Christilaw was in the operating room the day a routine incision was made into a young mother’s abdomen to deliver her baby.
What happened next, Christilaw says, “is something we never want to see.”
Normally, the placenta separates from the wall of the uterus after birth. It’s lacy almost, and not like solid tissue. “You can take your hands and sort of scoop it up, it’s like breaking cobwebs as you go,” says Christilaw, an obstetrician and president of B.C. Women’s Hospital and Health Centre in Vancouver.
But the placenta had eroded through the wall of the uterus, a condition known as placenta accreta. As soon as they stretched the opening of the uterus to deliver the baby, “the placenta started bleeding everywhere,” Christilaw says.
They couldn’t get the bleeding to stop. The woman was losing two cups of blood every 30 seconds.
The only way to stop the bleeding was an emergency hysterectomy. The woman was in the operating room for eight hours and lost 15 litres of blood.
It used to be that obstetricians might only ever see one or two cases of placenta accreta in their lifetime. Although still rare, obstetricians across Canada say one of the most feared complications of pregnancy is increasing as a direct consequence of the nation’s rising cesarean section rate.
Virtually all placenta accretas occur in women who have had a previous C-section, and the risk increases with each additional surgical delivery. The placenta attaches to the old C-section scar. Scars don’t have a proper blood supply to feed a placenta, so it keeps burrowing into the uterus until it finds one, sometimes pushing through the uterus completely and into the bladder or other organs.
The condition can be detected by ultrasound, but not always. “You almost never see it in a woman who has not had a C-section,” Christilaw says.
Today, about 28 per cent of babies born in Canada are delivered by caesarean. In 1969, Canada’s rate was five per cent.
More than 78,000 caesarean sections were performed in Canada last year, making it the single most frequently performed surgery on Canadian women.
“We don’t know what the ideal rate is,” says Dr. Mark Walker, a high-risk
obstetrician at the Ottawa Hospital and senior scientist with the Ottawa
Hospital Research Institute. “I think it’s fair to assume it’s lower than
where we are now.”
Walker says changing demographics — older first-time mothers, more multiple births from fertility treatments, more mothers with hypertension, diabetes, obesity and other health problems — are not enough to explain an almost doubling in the C-section rate since the early 1990s.
Neither is there evidence to support the idea that women are seeking
C-sections on demand. Studies from Ontario suggest less than one per cent of caesareans are for “maternal request.”
The Society of Obstetricians and Gynaecologists of Canada says the vast
majority of caesareans are done for medically valid reasons. But there are concerns that too many are being ordered because labour isn’t progressing quickly enough, and that thousands of “routine” interventions are now being done that increase the odds of a woman needing a surgical birth.
What’s more, the number of women who give birth vaginally after a previous C-section is dropping dramatically, meaning more and more women are having repeat C-sections.
Dr. Michael Klein calls it the industrialization of childbirth, where, in
today’s risk-averse society, women in labour are being treated “as an
accident waiting to happen” and where doing something is always better than doing nothing.
“Physicians and society have helped women basically believe that childbirth is no longer a natural phenomenon, but an opportunity for things to go wrong,” says Klein, emeritus professor in the departments of family practice and pediatrics at the University of British Columbia.
“But the fundamental issue is, we aren’t improving outcomes by doing more C-sections. For the first time in Canada, we are seeing the key indicators for mothers and babies going in the wrong direction.”
Risks to babies range from accidental lacerations when the surgeon cuts into the uterus, to neonatal respiratory distress. Research suggests two times as many babies born via C-section will end up in an incubator with water on their lungs, or with serious respiratory problems compared to babies delivered vaginally, because a C-section interferes with the normal hormonal and physiological changes associated with labour that prepare a baby to take its first breath.
Risks to women include higher risks of hemorrhage requiring a hysterectomy, major infections including blood infections, wound infections and bladder infections, and blood clots in the lungs — and every C-section increases the risk for another.
“If you have a caesarean section for the first birth, the probability of
having one the second time around is huge, because of the difficulty women have in getting a doctor to look after them once they have a uterine scar,” Klein says.
The worry is that the scar will pull apart during labour, causing a uterine
“If you have a catastrophic rupture, you can get into big trouble,”
Christilaw says. “You can have a negative outcome for mom or baby. In severe situations, the baby can die or become damaged — but that’s a very rare outcome.”
Her hospital is encouraging more VBACs — vaginal births after caesarean — in carefully selected women. “In those women who attempt a VBAC, our success rate is well over 80 per cent.”
But less than one in five women in Canada with a previous C-section
delivered vaginally in 2007-08. Eighty-two per cent had a subsequent
Christilaw says the only thing preventing Canada from seeing “horrific”
complication rates from C-sections is the fact women are not having as many babies as they once did.
“A C-section can be a life-saving manoeuvre for a mother or baby. Nobody is saying differently,” she says. “What we’re trying to say to people is, a C-section is not a benign thing. If you need one, that’s different. But you should not be doing this unless you absolutely have to.”
C-sections are frequently the end result of a cascade of interventions that
often starts with inductions.
Tens of thousands of women in Canada have their labours artificially induced every year, often via intravenous infusion of artificial oxytocin. Oxytocin is naturally produced by the human body. It’s what creates contractions in labour. Today in Canada, one in five women who gives birth in hospital is induced.
What doctors fear are stillbirths. But alarmed by the rising rates of
inductions, the Society of Obstetricians and Gynecologists of Canada
recently urged doctors not to consider an induction until a woman is at
least one week past her due date.
Claudia Villeneuve says that women are getting induced “if they’re two,
three, four days overdue.”
“Inductions are rampant,” says Villeneuve, president of the International
Cesarean Awareness Network of Canada. “You have a perfectly normal mom who comes in with a perfectly normal baby, and now you put these powerful drugs into her system to force labour to start.”
The “humane” thing is to offer an epidural, she says. With an epidural, a
woman can’t feel pain in the lower half of her body. But epidurals slow
labour, sometimes so much that labour stops. “Now you have to get this baby out,” Villeneuve says. Two-thirds of first-time C-sections are done for “failure to progress.”
Klein says epidurals are too often given before active labour is
“The majority of women today get their epidurals in the parking lot.”
Kayla Soares had been in mild labour at home for 24 hours when her
contractions suddenly stopped. Doctors told the Edmonton mother she would have to be induced. She was three centimetres dilated when they started the oxytocin drip.
“It was the worst pain I’ve ever felt in the world,” she remembers. “I
wasn’t having contractions at all and then they put me on the oxytocin and every half-hour they would boost it up, so the contractions were coming every minute, pretty much. It was like going from nothing to being in crazy, absolute labour, and in so much pain.” Eleven hours later, she was still just three centimetres dilated. “That’s when they said it was enough, and they were doing a C-section.
“I didn’t want to do it. I was asking, could we just have more time?”
Three weeks later, she still couldn’t get out of bed without help. Her
incision had become infected. “It felt like I was ripping apart every time I
moved. It was a pretty brutal recovery.”
Soares had her second baby in June. “I was dead set on having a VBAC,” a vaginal delivery after cesarean. “It was a fight, an uphill battle the whole time with doctors.” One obstetrician asked her her shoe size. “She said that because I was a size five and smaller framed that I definitely was going to have another caesarean and that a VBAC wouldn’t happen. She said that because I was a ‘failure to progress’ the first time I’ll be a ‘failure to progress again.’”
Two weeks before her daughter was born, Soares started going in and out of labour. “They had me convinced it was causing stress to the baby even though the tests said everything was fine. They had me convinced it was enough, because I was overdue and they said my incision was going to rupture,” she says.
“They just kind of scared me into having another C-section.”
© Copyright (c) The Windsor Star
All North American women who have had breech pregnancies or births are invited participate in an essay-response survey, which takes approximately 15-30 minutes to complete. We are interested in participants who had breech pregnancies (breech babies who turned head-down before birth). We would also like to hear from women who have given birth to breech babies, whether vaginally or by cesarean section; with midwives, physicians, or unassisted; at home, in a birth center or in a hospital. We welcome input from both singleton and multiple (twin, triplet, etc) breech pregnancies and births.
How to Participate:
To take the survey, please visit the Breech Pregnancy and Birth Survey
.Read Full Post | Make a Comment ( 8 so far )
This blog post is about suspected macrosomia or ‘big baby.’ Very well said…Read Full Post | Make a Comment ( None so far )
I just realized that I am a doula and I write a blog about birth and I have never done a post on doulas!
A doula (doo-la) is a Greek word that means ‘woman who serves.’ A doula is a professionally trained woman who provides information, physical and emotional support before, during and immediately following birth. Women have attended birthing women for centuries in all cultures. Ancient hieroglyphics show women birthing with other women supporting them. It is only in modern times that we have begun to stray from this support with the medicalization of birth. The need for one on one support in labor is so crucial to the birthing woman’s perception of the birth experience and ability cope with birth. Women supported by a doula frequently report a significant decrease in the length of labor, the perception of pain and the need for anesthesia or analgesia as well as fewer cesarean sections.
I said this about doulas in a previous post…
I am a doula, I think every woman should have a doula. It’s not because I am trying to justify the profession or the cost or to promote myself, but I really believe that no woman should have to birth without someone who is trained to support a laboring woman. There is a big difference between a doula and a loving partner, a doula and a best friend who has had five kids and a doula and the grandma. While a doula does form a relationship with her clients, she doesn’t have that intimate relationship these other people do and can help the laboring woman without the emotions that are often involved with these family members. Doulas are also trained professionals who study birth and labor and ways to make labor easier and more comfortable with different positions and massage and other techniques that even someone who has had a few kids of their own may not know. Doctors, midwives and nurses often times have several patients at once and cannot stay with the laboring woman.
The research has shown that the presence of one-on-one support such as that of a doula a less likely to have:
have a cesarean section;
give birth with vacuum or forceps;
have regional analgesia (e.g., an epidural)
have any analgesia (pain medication)
report negative feelings about their childbirth experience
With a doula you can have up to*
• 50% reduction in the cesarean rate
• 25% shorter labor
• 60% reduction in epidural requests
• 40% reduction in oxytocin use
• 30% reduction in analgesia use
• 40% reduction in forceps delivery
*Information was obtained from Mothering the Mother: How a Doula Can Help You Have a Shorter Easier and Healthier Birth, Klaus, Kennell, and Klaus (1993).nc
Doulas can also help incorporate the partner into the labor experience. Often times partners are very inexperienced in childbirth and they are nervous and worried and are scared of labor pains. They are often scared and unsure of how to help their partner even though they very much want to. I have found that they are relieved to have the help of a doula, especially once labor kicks in to high gear and they do feel more of a part of the labor process when they are shown ways to help the mother. It gives them a greater sense of importance and usefulness that they very much appreciate. I love working with the partners as much as the moms because they are so willing and grateful by the end. Even the strongest, most loving and supportive dads benefit from having a doula around.
With every birth I attend, I believe more and more that no woman should birth without a doula and that every woman has the ability and probably should birth without drugs. I have not had a client get an epidural yet but I would completely support a woman if she chose to.Read Full Post | Make a Comment ( 5 so far )
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