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Home Birth VBAC Helps Mom Come Full Circle

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With my first child, I planned to have an out-of-hospital birth at a birth center. At 41w 5d, the midwives decided that my blood pressure was too high (160s/90s) to be out of hospital and referred me to a practice of midwives in a hospital for an induction that night.  Cervadil was followed by magnesium sulfate (given to prevent siezures if I developed eclampsia - but also used to stop preterm labor) and then pitocin.  Though I was treated well by the midwives and nurses, I ended up with virtually every intervention, including a c-section 36 hours after they started the cervadil after being stalled at 7 cm for 6 hours.  My baby was healthy, though suctioned a lot and I didn't hold him during that "magic" first hour as I was waiting to regain enough feeling in my breasts to feed him.  He was 8lbs 4oz with a 95th percentile head that showed signs that he was asynclitic and posterior.

My second was a planned VBAC. I needed a change, and ended up with new everything - new doula, new hospital, new midwives.  There was a lot of monitoring of my blood pressure and after one very high reading (which I lowered with the help of hypnosis) I ended up having 3 biophyiscal profiles.  Going to my appointments was no longer fun as was always worried that they'd find some reason to tell me that I needed to go in for a repeat c-section.  But this baby came on his own, either 2 days after his due date or on his due date, starting with my water breaking.  My response was to go downstairs to bake a birthday cake for the baby, and then sleep for a few hours.  After about 5 hours, we arrived at the hospital to find I was 5 cm - so exciting since I was only …

 1 cm when I arrived for the induction of my first.

Hypnobabies was great for me and helped me to be present during my birthing time, even as I contemplated the fact that it seemed like it would have been easier if I'd scheduled a repeat c-section.  During pushing (guided, not mother directed), there were concerns about decels, and the midwife administered a pudendal block because she'd called her ob backup believing that they'd perform an episiotomy and then use the vacuum.  The ob asked why she was called, looked at the monitor and said, "Looks fine now.  Keep going."  I was so grateful that she just sat at the end of the bed and adjusted the mirror, so I could see my son emerge - it was the most helpful thing as seeing that little head get larger let me know that I was really "doing it right."

My second was born in a room full of doctors and pediatricians - we believe he wanted the audience as he is a social little bug.  He was immediately placed on my stomach and stayed with me for at least the next 90 minutes.  (My husband was incredibly patient, allowing me this time to hold the baby.)  He nursed well after 40 minutes (and then continued to nurse for an hour) and weighed 9lb and had a 50th percentile head.

I'd always wanted a girl...so we went for number 3.  The midwife I saw for my VBAC had moved to a different office with stricter policies (such as showing up late for your appointment could result in losing the privilege of scheduling an appointment for the next 6 months during which time you'd have to be a walk in patient and have to wait up to 3 hours to be seen.)  They were also often running late - by 30 to 60 minutes.  I also asked if the hospital rules would be different (I was "required" to have a heplock, continuous monitoring - they did have wireless monitors - and could not birth in the tub.)  I was told that the rules would be the same, but they'd be "more relaxed."

I started to look at my options. No birth center would take me because of my previous c-section.  So, I contacted my doula from my VBAC , also a 3rd year midwifery student, and asked her about home birth.  (I knew I she'd had a home birth VBA2C.)  She told me about two midwives she was working with, one who'd attended her during her home birth.  My husband and I clicked with this midwife and so I made the switch.  I got to go back to what I loved about midwifery care - the time you spend with your care provider talking about things that are important, just getting to know her and trust her, establishing a relationship and being with her during your whole appointment.  We also found out the gender, something we hadn't done with the boys and learned we'd be having a girl.  (I must admit that I wasn't totally convinced until she was born and I could see for myself.)

I was more able to stop worrying about my blood pressure being too high, and though it did rise as I progressed through the weeks, it didn't get as high as before.  I had a "practice" run just before my birthing time (39w 5d by my original midwife's dating, 39w 3d by mine), where I had waves from 7:40 pm to 11:30 am, but then the waves stopped.  I listened to "Come OUT, Baby."  I went back to my usual activities and worked hard to finish the baby blanket I'd started 5 weeks before.  I was down to the final casting off when I went to bed on Sunday night.

On Monday morning (40w by my dating), I woke up with stronger waves.  I laid in bed and wondered if I'd take my boys to the craft at the mall or not.  After 40 minutes, I called my husband and told him I thought I needed him to come home.  I called the midwife and told her that things seemed to be happening again and she asked me to time them.  I called my friend to come and take my boys.  As I tried to get the boys fed and dressed and ready to go, the waves came more frequently.  My husband got a ride with a co-worker (he'd carpooled that morning) and got home just before my friend arrived for the boys.  At one point we were talking in the driveway and I kind of nodded in answer to her question, probably looking a bit faraway as well.  She asked if I was having a wave then and I just nodded.  They were off a few minutes later.

My husband and I returned and he put on a movie, "Airplane" which we'd both seen many times.  I decided that I wanted to finish the blanket, so instead of grabbing my iPod, I sat on the floor facing our futon (my back to the movie) listening as I worked to bind off the border.  Every ten minutes or so, I'd click the button on the online "contraction" timer, lean over the seat of the futon and breath, repeating "Open, open open" in my head.  (I was inspired by reading it in birth stories.)  My husband would put his hand on my back and I used it to help me relax (as if he'd given me the cue with just the touch.)  After 60 to 90 seconds, I'd click the timer again and go back to my knitting.  I could tell the baby was still posterior (she'd flipped nearly weekly, so I hadn't bothered to try to hard to keep her anywhere.)  At 1 pm after the movie ended, I called the midwife to give her a report.  She was torn because she wanted to check in with me, but had clinic appointments that afternoon which she didn't want to have to cancel if it was a false alrm.  She asked if I'd be up to coming in so she could check to see if it was really time.  So, we went in at 2 - I had 3 waves during the drive over - these were worse because I was sitting instead of being on my hands and knees.  She asked me where I was feeling pressure and I said that I was feeling some in my back and also a lot in front - I'd describe it as the "bikini area."  She told me that a lot of cervical dilation is felt there.

She found that baby was posterior I was 5 cm and fully effaced.  (I could tell things were different immediately by watching her face.  The two times she'd checked before - once to verify that the baby was head down - and once during the "practice," she'd felt around because the baby was high and my cervix would move around.  This time she kind of got a surprised look on her face as she found what she was looking for right away.)  She said that they'd finish their current appointment and then come over to our house.  On our way home, I had 3 more waves and told my husband that I thought he should inflate the birthing pool when we got home.  I got on the bed, and tried to lie on my side, but was very uncomfortable.  I ended up on my knees, leaning over a folded body pillow, listening to easy first stage.  I almost cried at the part about letting go of your baby.  My back started to hurt a bit from my head being so low, so I asked my husband to bring me my exercise ball.  I hugged the ball on my knees and that felt better.  The baby felt lower and I started to have little pushes along with my waves.  I told my husband that even though the midwives didn't want me to be in the pool until they got there, he should start filling it so it would be ready when they got there.  (When he wasn't off doing my bidding, he would put his hand on me.  Just that quiet presence really helped me feel supported and calm.)

The midwives arrived and asked where I was feeling pressure.  I said that it was low and sort of pointed to my back.  I'm not sure why I was avoiding saying that I thought the baby was low.  She asked if I wanted some counter pressure, and I said no.  After listening and watching the next wave as I kind of pushed a bit during it and was now vocal, she simply said, "Let's get you out of those pants."  Not too long after my former doula (as she was acting as a student midwife this time) told me that the water was a little cool, but I could get in if I wanted and they would put in some boiling water when it was ready.  I edged across my bed and into the pool, and submerged my belly while resting my arms and head on the side.  I was happy with the temperature as I was sweating anyway and was grateful that the hot water never materialized...because things went fairly quickly then.

Aside from occasional monitoring and the offer of a drink, it was just quiet.  My husband sat on the bed next to me and happily didn't touch.  (I was really annoyed by the touch of the doppler, but tolerated it because I knew they were just checking on the baby.  I think they only did so about 3 times.)  It was totally different to be the only one who knew when a wave was coming, and to just do what I felt I need to do without anyone suggesting I hold my breath or change positions.  At some point, I adjusted myself so that I was on hands and knees in the water.  (The only downside to this was that I had minor pregnancy induced carpal tunnel syndrome and my hands started to go numb as I pushed.)

It was amazing. I fought the concern about pooping, just reminding myself that it was totally normal and fine to feel that way and was no big deal if it happened.  At one point, I felt her head push down as I pushed and then pull back a bit as the wave and my effort dissapated.  And then I felt her head lower, felt the pressure as I kept trying to remind myself that my anesthesia was just ahead of her head.  I felt a pop, like the snapping of a rubber band (but unlike with my sons with whom this sensation was high in my belly) low down in my pelvis.  The midwives noticed the change in the water and surmised that my water had broken, which I confirmed.  I wondered if I could feel her head, and thought it was interesting that no one said anything.  I tried reaching back and felt her not very far in.  My husband asked if she had hair, and we (the midwives and I) said yes.

A few more pushes and the midwives coached me to go slow so I wouldn't tear.  As her head bulged, I reached down to feel it and had the amazing sense of having her hair float around my outstretched fingers.  I'd wanted to pull her out of the water, but I couldn't help guide her out, so I just tried to be very aware of what was happening and they handed the baby to me between my legs and I sat back and lifted her head out of the water at the same time.  My husband took a picture of me holding her and after that they draped her with a thin blanket to help keep her warm in the tub.

She was so mellow, that they ended up listening to her breath with a stethoscope to make sure she was okay.  The baby honestly appeared to go back to sleep for a few minutes.She was also coated with vernix.  (That first picture shows it in the water and coating her back.)  After a few minutes, I delivered the placenta and it was put in a bowl floating in the water.  She was left attached to her placenta until her cord stopped pulsing, which actually took a long time (around 10 or so minutes.)  In fact, it was decided that the water was too cold for her and so she was handed off to dad who was followed by the midwife carrying the placenta bowl. She rested on me and then nursed as we got to examine the placenta.  We were left alone to coo over her for a while before the midwives came back to do her newborn exam.  She was 8lbs 14.5oz, and had a 50th percentile head.

In some ways, I feel like I've come full circle, back to what I'd originally tried to have. And yes, she and this birth were worth the wait.

Carson

Daniel, 4

Riley, 2

Audrey, 8 days

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