My Third Baby- The Birth of Elia Quinn: HBA2C

I had my first two sons via cesarean. My recovery from both of the cesareans was physically easy.  I did have adhesions that I felt over the next few years.  It was emotionally rough to hear about perfect vaginal births that other women experienced but I just said to myself and others “My body needs to have babies cut out and it is so much easier anyway.”  I became a nurse after I had my second son.  I worked on many c-sections and vaginal deliveries.  I always cried with the c-sections.  I thought it was the “miracle of life” affecting me until one day I realized I never cried during the vaginal births- I think it was hitting a chord that I still wasn’t fully aware of.  I ended up being an ICU nurse and leaving the labor and delivery realm.  In the ICU, we see the worst case scenario quite a bit and my perception of reality became somewhat skewed.  During a lecture in nursing school, we had a lactation consultant come and talk to us about random birth topics.  Somehow, I ended up staying after and asking about VBAC and if it was even possible after two cesareans.  She directed me towards ICAN and suggested I start learning more about this topic that is not usually covered in school.

I signed up for the ICAN yahoo group and watched as other people posted…for years.  I never posted anything.  I was sometimes put off by what I thought was an obsession with having the perfect birth without regard for the baby.  It took me a long time to process my own thoughts and feelings regarding this perception that so many people share.  I guess I might still be processing it.  In December of 2012, a member posted her birth story of a homebirth after two cesareans.  I read it, I connected with her voice, I cried, and I kept it to myself.  I started talking about another baby with my husband.  I was finishing my MSN and would graduate in December of 2013.  The earliest we could get pregnant would be March 2013.  We went back and forth with whether we should have another.  We always knew we wanted another baby, we just weren’t sure we could handle everything.  Our boys are so good but they are typical boys and a bit of a handful.  We decided in February after some soul searching that we were ready and excited to have another baby.  I had already decided that I would be having a girl and I started doing everything in my power to make sure when we started trying that my body would be primed for XX creation.  We used the Shettles method and every other wives tale on the internet.

Pregnancy

I had a positive pregnancy test at the end of March.  We scheduled an appointment with an OBGYN that I had heard was an amazing surgeon as well as open to the idea of a VBA2C.  At our first appointment, he confirmed the pregnancy and we had a very quick meeting. I didn’t bring up the VBAC, I didn’t want to be shot down.  At the 10 week ultrasound, he spotted a medium-sized fibroid in my uterus that I didn’t know about.  I was devastated.  I started crying and was convinced that I was going to have a miscarriage.  I didn’t hear much after he told me about the fibroid, the baby looked healthy, would I like to go ahead and tie my tubes when we are in there doing the repeat cesarean? I just nodded and sat there, dazed, sad, overwhelmed.  My husband looked at me when the doctor left the room like I was crazy.  He said the fibroid wasn’t a big deal, according to the doctor, everything would be fine.  Turns out the fibroid was totally not a big deal- despite what some textbooks will tell you about that type of fibroid I had/have.  I was left with the issue of the repeat cesarean.  No, I did not want to tie my tubes- that was presumptuous and unprofessional- and no, I don’t think I want to schedule a repeat section either.

At 14 weeks, I took my family for an elective ultrasound and found out that we were definitely having a little girl!  I cried so much with happiness.  If this was going to be my last pregnancy, I would get my little girl. We had decided that if this was going to be a cesarean that it would be my last pregnancy, we didn’t want to deal with the increased risk of everything bad that happens after three cesareans.   Around this time, I went to my first ICAN meeting.  I was obsessed with talking about rupture.  There was another mother there attempting a HBA2C that I wanted so badly to help me figure out how to overcome the thought of rupture.  She was so calm and confident in her body and her decision.  I needed answers, I need a play-by-play for how I was going to get where she was.  I wanted to be calm- dammit! She said that you have to be confident in your decision even if that decision were to lead to something undesirable. She was so sweet and helpful but the message was definitely not what I was looking for.  Another mother there was also in my exact situation- we were both the same week in our pregnancy even.  Her husband was not supportive of a homebirth, neither was mine, and she was trying to find an option for her VBA2C.  I ended up randomly meeting her sister in my prenatal yoga class and she told me months later that she had ended up having a successful VBA2C in a hospital.  It was good news.

After that meeting, I decided to push my doctor about the VBA2C and make a plan.  My husband was supportive about trying for the VBA2C because of all of the research I had given him about outcomes.  He encouraged me to be strong with my doctor.  I went to my 16 week appointment in my scrubs because I had taught a class at my hospital earlier that day.   I told my doctor that I am completely educated on the issue, I am realistic about my expectations, I want more children, I would like to try for a VBA2C with him, and I would like to go over 40 weeks if necessary.  I felt like he really listened to me and took me seriously.  He said he would try to talk to his partners and the hospital and see if it would be possible for me to labor there and TOLA2C.  I left feeling good but I knew how these things went.  He would be supportive while he was with me but then be easily talked out of it by his colleagues, insurance, and the hospital. 

I started thinking about alternatives.  I could get a monitrice to watch over my labor at home until 8 cm then show up at the hospital in transition and ready to push.  I could hire a midwife and labor in a hotel across the street from the hospital in case I ruptured.  I could labor at my friend’s house who lives blocks from the hospital.  I made an appointment with a midwife that I had heard about through ICAN and brought these issues to her.  My husband went with me.  She listened to all of my ideas and asked about where I live. She told me that it would take just as long for them to set up the OR if I were at home and she called them in advance as it would if I were in the hospital and they decided to do the C-section emergently. She also reassured me that she would be monitoring me and watching for signs of anything bad- not just rupture and would likely catch something way before it would be emergent and catastrophic.  She listened to my fears, my hopes, and my history without judgment and without interrupting.  I had so much time!  It was nothing like being at the OB!  I told her I was planning on keeping the OB and her as my providers.  She said that keeping one foot in each world would make it very tough for me, especially if I were to go past 40 weeks.  The scare tactics would come at every appointment.  We decided that I would break up with my OBGYN at my next appointment after the anatomical scan.

My husband was initially not on board with homebirth.   After we spoke to the midwife and we did more of our own research about the success of a VBAC at home compared to the hospital, he became fully convinced and supportive of the HBA2C.  He kept saying, “We are looking at the research, our options, and our current situation.  We are making the safest decision for our family at every step of the way.  If that decision means we go to the hospital during labor, then that is what we’ll do but we can’t worry about things that haven’t happened yet.  We just have to make the safest decision for our current situation- right now, that decision is homebirth.”  He was my rock.  I went back and forth SO many times. What if the baby dies?  What if I die?  What will you guys do without me?  What will I do without my baby?  Will you hate me?  When I asked him this last question during one of my moments of fear/doubt, he said, “You and I made this decision together and we will deal with whatever happens together.  You are amazing and I have no doubt you can do this.”  I cried with relief.  I could do anything with his support.  I just needed to have that kind of faith in myself.

My OBGYN was frustrated when I told him about my plans.  He said he knew I could probably birth this baby but he had talked to his insurance provider and they would not support him if he let me labor.  He suggested I contact a midwife.  I told him I already had and that I would be transferring to her service.  He ranted a little while about how doctors are being replaced by advanced practice nurses.  He said he had no autonomy, no decision-making power, and thus- no respect.  It was an interesting meeting.  After that, I continued care with my midwife.  I LOVED our appointments.  They were so laid back and comfortable. She gave me belly massages and felt where my baby was every time.  She insisted that this was not a big baby and that I had so much amniotic fluid (but not TOO much).  I grew well, I stayed in shape and went to yoga three times a week.  I had a very healthy diet and gained only 30 pounds in my whole pregnancy.  I was feeling really good. 

At week 36 I started getting serious about my pre-birth preparation.  I started taking evening primrose oil orally and vaginally.  I took a gentle birth tincture that gave me strong Braxton hicks contractions.  I drank loads of raspberry leaf tea.  I did squats, I did the stair stepper at the gym daily starting at 38 weeks.  I walked MILES.  I was determined to go into labor.  I was so afraid my body was broken and I that I was incapable of going into labor on my own.  I was due December 9 but I was afraid I wouldn’t have a baby until Christmas and that would probably be by cesarean.  I WORRIED so much but also tried to stay Zen doing hypnobabies, meditating, chiropractor, acupuncture, and doing yoga.  Oh and sex, of course.  Everyone tells you to have sex 50 times a day.

By 40 weeks, I was feeling discouraged.  I tried castor oil.  Twice. I had good contractions the first time but they tapered off.  The second time I just had the worst diarrhea of my life.  I read more birth stories than I thought was possible.  I read blogs about people being over 40 weeks- Jackie Chan’s mom went to 12 months before delivering him by cesarean.  That was going to be me.  I cried, I watched HBO go, I complained, I ate hot wings.   I had a biophysical profile every few days starting at 40 weeks.  I insisted on being checked at all of my appointments with the midwife starting at 36 weeks.  I never got past 1 cm, 70% effaced, -2 station.

At 41 weeks and 4 days, I had given up on ever going into labor.  My husband and I decided that we would wait until New Year’s Eve (43 w 1 d) and if nothing had happened by that morning, we would go to the hospital for a cesarean.  My biophysical profiles looked really good and baby was moving around really well but we knew that 43 weeks was our limit. That day, Adam’s parents came in town.  His mom is a labor and delivery nurse and we had told her about the VBAC but not about the homebirth.  She was already concerned that we were going so far past our due date.  We had a wonderful dinner out and took the kids to a park in the evening.  The trees in the arboretum were decorated with Christmas lights and there were a few people enjoying the unseasonably warm weather.  I started having my nightly contractions and even timed a few at 4-5 minutes about 45 seconds long for thirty minutes.  It was a really nice night but the contractions went away as I went to bed. 

Labor

The next day (41 weeks 5 days) we went to lunch and a movie with Adam’s parents and I started feeling sick to my stomach.  When we got home, I threw up.  I assumed I had caught the stomach bug my oldest had the previous Wednesday.  His parents went to their hotel and we planned to meet them in the morning for breakfast on their way out of town.   Around 9 pm I went to bed and tried to get some sleep.  I woke up around 11 with awful diarrhea.  Every single thing in my body came out.  I tried to sip water to keep from getting dehydrated.  I walked around the dark house while everyone slept from about 11 to 1 am.  I was having contractions regularly that were beginning to be uncomfortable.  At around 1, I woke my husband.  The contractions had turned painful and I needed him with me to talk and breathe through them.  I knew I was just dehydrated and the contractions were a product of that. I knew it was false labor.  It felt just like the contractions I had when I took castor oil.

I texted the midwife about the contractions at 4 am.  The contractions were close together and painful.  I had thrown up everything again and had no fluid in my body.  I am also a hypochondriac and slightly dramatic so I was trying to remain realistic and calm.  My husband and I worked through a few contractions and called the midwife at 6 am.  She came over and gave me two bags of lactated ringers through an IV.  I felt much better and SO tired.  She checked me and I was only a 1.5 cm, 70% effaced, -2 station.  She and the other midwife left so I could sleep and see if the contractions stopped.  I slept for about 30 minutes between contractions that never stopped.  They slowed briefly to every 7 minutes but picked right back up to every three to four minutes.

My husband and I wandered around our room for the next 12 hours laboring.  My mother watched my two older sons all day while we worked.  I leaned over my birthing ball and used it to put downward pressure on the top of my uterus while I used my hands to push in on my lower uterus (scar).  I have NO idea what compelled me to do this. I have never seen anyone do it or heard of anyone providing counter pressure on the front but this is what made me feel better.  I have read that it was unsafe but that is what my body told me to do.  My husband also provided counter pressure on my back at the base of my spine.  I felt every contraction so strongly in my back.  I tried to stay fed and hydrated but food disgusted me.  I drank emergen-C and coconut water and a few bites of dried mango.

The midwife texted us to check in around 1 pm.  She said she would be by that evening to check on us.  I still didn’t think I was in labor.  I was in a strange denial.  With every contraction, I was thinking “Is this really labor?  Is anything even happening?  Am I dilating?”  Negative Nancy.  I spent a lot of time in the bathtub, on the side of my bed, and on the ball.  My poor husband and I were exhausted.  We hadn’t slept in so long by the time the midwives got there that evening.  I told him that if I hadn’t progressed (I was convinced I hadn’t) that I wanted to just go to the hospital and get the c-section.  It was too much and I was too tired.   Before they came, he looked at me and said “Even if this is it and this is all we get from ‘labor’, I have had such a great experience with you.  This has been great, I am so proud of you.”  So many times in my pregnancy and labor, my husband was the voice of confidence that I did not have for some reason.  He is the most amazing man in the world and thinks so highly of me.  I was so happy to have that day of laboring, even if it was going to end up in c-section.

As soon as the midwife got there with her assistant at 7 pm, they checked me.  I was 4 cm, 90% effaced, and -1 station.  Baby sounded great.  I was relieved that something had changed but still worried about how long it was taking.  The midwife told me to relax during a contraction and let her try to stretch my cervix during a contraction to move things along.  HOLY MOLY.  Pain.  I couldn’t do it, I bucked and she pulled her hand out.  I apologized and told her it was too much.  The midwife later told me that she was also worried that I hadn’t progressed during the day.  She said that long hard labor with no progression is sometimes a precursor to rupture.  Eesh.  I am so glad she did not have that talk with me while I was in labor.  About rupture, although I had been obsessed with it for a large portion of my pregnancy, I did not think about it very much at all while in labor.  I just knew everything was okay.

After that check, the midwife suggested I go for vigorous walk around my neighborhood and try to really walk through the contractions.  I laughed at her.  I could barely SIT during the contractions, much less walk.  She said this was really the only way to get things to move along more quickly.  Oh God, okay.  So my husband and I went on a mile walk around our neighborhood.  The houses were all decorated for Christmas and everything was so beautiful.  I powered through each contraction- no stopping, just power-walking.  My husband was so encouraging and impressed with my burst of energy.  We were going to get this baby out!  Our walk was kind of romantic and definitely a once-in-a-lifetime occasion.

We got back from the walk and I started to have lots of bloody show.  This was very exciting for me.  I had been watching the toilet paper like a hawk for the past few weeks hoping for a clue about when I would go into labor. This felt like proof that my baby was moving towards her exit.  The midwife forced me to eat some yogurt and finish my drink.  I spent time on the ball and then got in the bath.  This was around 10 pm.  She checked me while I was in the tub.  6 cm, 100% effaced, -1 station.  My water broke while she was checking me.  Thin meconium but baby sounded great.  I totally expected the meconium since she was 42 weeks- it didn’t worry me, her heart tones sounded perfect.

I got up and sat on the toilet for a while.  My noises changed after my water broke.  I sounded more guttural.  A very few times, I lost it and went towards the “AHH! This hurts!” noise but I reigned myself back in.  I appreciated so much that our midwife just stayed in the corner of my room doing her own thing unless I needed her or asked for her.  Adam and I did everything on our own. It is such a special thing.  I sat on the bed and the amniotic fluid leaked a little bit with each contraction.  It looked darker each time.  There was also blood, frank blood.  Not a lot, but enough to make me question why I was bleeding so much.  I got back in the tub around midnight.  She checked me.  8 cm, 90% (cervical lip), -1.  Baby was in the perfect position, LOA. She told me the lip needed to be pulled back so that pushing could be triggered.  She would need to keep her fingers inside my cervix during a couple of contractions to try and push it between my pubic bone and the baby’s head so it could melt away like butter.  I knew what this felt like from earlier.  I was not excited about it.  I have no idea where I got the strength to let her do it.  This is the worst pain ever BUT it is such a good pain.  It is working towards something.

She encouraged me to then get out of tub and walk around.   I leaned on door posts and Adam pushed on my back.  It was intense. I breathed huge, deep, loud breaths and journeyed through each contraction.  As I stood in my bathroom entrance having a contraction I took time to thank God for this experience. I was actually in labor.  I was having a baby without someone doing it for me.  I was bringing her into the world in the best way for her health.  It felt really good.

I went and sat on the toilet.  I felt the cervical lip.  (I had been doing WAY too many cervical exams on myself for the weeks leading up to the birth and was very familiar with my stubborn cervix).   I decided to push the thing back myself.  The second I pushed it out of the way and thought “melt like butter”  I felt a deep instinct to push.  Instinct is the wrong word.  It felt like when you have e-coli poisoning and your body is trying to poop out your organs without your consent.  I had no control over the urge to push.  Also, no control over the growling noise it made me make.  The midwife heard me and moved me to the bed to check me and see if we were ready to go. This was at 1:30 am.

I got on the bed with my back flat, the midwife catching the baby, my husband pushing back one of my legs and the other midwife holding my other leg.  She said I was ready and could start pushing with the contractions.  It felt so right to push.  It felt like the last 100m of a triathlon.  I was a REALLY good pusher.  All of that yoga through 41 weeks of pregnancy paid off.  My husband got this crazy proud excited look on his face as he watched our baby crown.  It was totally worth it to watch him watch his baby girl come into the world.  The midwife told me that the baby was moving her little head back and forth at one point while she was crowning, like she was trying to help. So cute! I pushed for 45 minutes and she came out at 02:16 am- exactly 42 weeks.

She came right to my belly, the placenta came out 6 minutes later.  It looked amazing, also- like a 40 week placenta.   We cut the cord an hour later.  She nursed very quickly.  She was 8lb 14 oz.  My biggest baby.  20.5 inches. 13.5 head circumference.  She is a very big girl but she looks so tiny.  We took a very relaxing herbal bath, I ate some rice with broccoli and chicken while in the bath.  Our midwife cut up my placenta so I could make smoothies out of it.  I never tasted it but I definitely felt great.  I am IN LOVE with this perfect little angel.  Bonding had been a completely different process.  We are so much closer than I was with the boys at this age.  The hormones have been much gentler, also.  I have not experienced any postpartum blues as I write this on my baby’s six week birthday.  I just feel stable and calm.  This is how it is meant to be.