Friday, August 1, 2014

Eden's Birth Story, Part III: Naturally Inducing my VBAC Home Birth

Jadon fell asleep on the way home from the non-stress test at the Dr. W’s office. Jon decided to stay in the car and read until Jadon woke up so that he could get a good nap in that day. While they camped out in the car, I went inside to give castor oil a second chance.

When I tried ingesting castor oil the previous day, I threw it up. I think I had been too full from breakfast when I ate the entire castor oil smoothie in one sitting. So for my second attempt, after a small snack, I prepared the recommended four ounces of castor oil with just two ounces of orange juice.

I gulped it down at 3:15.

Around 4:00, I took my first trip to the toilet. The digestive effects of the castor oil seemed to be working. I was so thankful that the castor oil wasn’t making me feel sick. The next few hours of toilet stops just seemed to be clearing out my system (which I really didn’t mind, hoping that a baby would be the only thing I’d be pushing out in that birth tub later!).

By 4:30, I started experiencing mild contractions. They began just as they had the previous day: five or six minutes apart, about 30-60 seconds long, and very, very easy. I texted Pam, my midwife, with the update, and then decided to lie down and rest. I would need to save my energy if this was the beginning of real labor.

The contractions continued as steady, easy, and unchanging as ever…for hours. When Jon came in with a groggy Jadon, he was thrilled to hear that contractions had started on their own. I texted Alison, my doula, with an update. She was excited to hear about the contractions, too, and hoped that things would really take off so that she could justify pausing her family’s vacation plans. If active labor began soon, she could come to assist me, and even then she’d be running on little sleep the next day en route to California.

Around 6:30, Pam stopped by to see how things were progressing. I was still resting in bed, so she checked to see how dilated I was. She determined that I was about four centimeters dilated. Then, she wanted me to get up and walk around to see if the contractions changed in any way.

Sitting, standing, and pacing seemed to have no effect at all on the intensity or frequency of the contractions. They were so easy and effortless that I showed no outward signs of their occurrence. In fact, Pam and Jon asked me many times if I was still experiencing contractions.

By this time, it was about 8:00 pm. Since things seemed to be going very slowly, Pam decided to leave and let me labor on my own. She said that she would make sure to stay in the area because she believed that contractions could really ramp up at any time. She wanted me to call immediately if my water broke or if my contractions started coming less than three minutes apart.

Alison called me shortly after Pam left. She asked if labor seemed to be picking up. When I told her that there was virtually no change, she admitted that she was at the point of no return regarding her family’s vacation. Her voice choked with emotion as she apologized over and over for not being able to be there. I cried silent tears on the other end of the line, but reassured her that nothing was her fault. After all, no one thought this baby would take so long to come out. She promised that she’d be praying for us all night, as she wouldn’t be able to think of anything else.

After we hung up, I let Alison’s absence sink in. Then, I made another phone call.

“Hello, Maria? It’s Alison… yeah, I tried the castor oil again this afternoon and contractions started up on their own within a couple hours…listen, are you available if I need you later tonight? My friend Alison won’t be able to make it because her family is traveling to a wedding in California…oh, thank you! Things aren’t moving that fast yet. Contractions are actually are totally easy and not changing at all…yeah, I’m willing to try acupuncture again…maybe I will…well, I’ll call if I think I need you. Thank you so much, Maria…yup, I’ll text you my address…Bye.”

Peace washed over me, knowing Maria was willing to assist me with so little advanced notice. She had even offered to do another acupuncture session in order to help things along.

For the next two hours, I paced the apartment, trying to speed contractions up with the movement. I continued to time them, and waited for any sign of change. Occasionally, it felt like they were be getting more intense, but it was hard to tell if my mind was playing tricks on me. Eventually, they started coming about every three minutes, but remained incredibly easy to work through.

Around 11:00, Pam returned. We started filling up the birth tub since you have to empty your water heater several times before the tub is full. I still was waiting for contractions to become “real.”

Then, I decided to call Maria again. Since things were moving so slowly, I wanted to try acupuncture to push my body over the edge.

Maria arrived at our apartment around 1:00 am. After some quick introductions, Maria and I headed into the bedroom to start an acupuncture session. I reclined on my side and propped up several pillows to support myself while she prepared the tiny needles for specific pressure points that would (hopefully!) stimulate my labor.

First, she put two small needles in my hand. Then, she added one to my ear. The next needles were placed into my calves and ankles. Finally, she inserted the last needle on the outside edge of my right pinky toe, a uterine point. Immediately after the needle pricked my toe, I felt a gush of water.

“Uh, Maria…my water just broke!”

“Oh, well that was fast…do you want me to continue?”

“I think you better go tell Pam.”

Before Maria could return with Pam I experienced my next contraction – a real contraction. It took considerable effort to keep myself from tensing up. I knew in that moment that we had crossed a threshold; this baby was really on the way now!

Pam entered the room with a Doppler fetal monitor to check on the baby’s heartbeat. Jon looked on with beaming eyes. I think he understood that things would really be moving now.

My water had broken around 1:30, and we decided to let me lie on the bed with the needles still inserted as long as I could continue to remain still. It grew harder and harder to remain motionless with every passing contraction. Eventually, I called Maria back in to remove the needles; I simply had to get up and walk around.

Within a few minutes, I was pacing in the living room, leaning over the couch as contractions came. They were getting so hard to deal with on my own! Maria was great at jumping in to apply pressure on my hips and give me an encouraging word.

A little later, I decided to try sitting on the exercise ball that Alison had let me borrow. I tried sitting on the ball, bracing myself against the couch for several contractions. Pam, Jon, and Heather, Pam’s newly arrived assistant, looked on while Maria continued to apply pressure on my hips to help with the pain.

“Oh, I just want it to be over! Pam, am I almost done? When is this going to be over?” I sighed after coming out of a difficult contraction.

“Honey, if I knew when a labor would be over, I would be a millionaire,” she gently replied with a smile.

I glanced at the clock. 2:30. How long would I have to continue?

“I need someone to tell me that this is going to be over at 3:30!” I stammered after another contraction.

“Honey,” said Jon, “this will all be over at 3:30.”

“You don’t know that!” I moaned back, irritated that his words couldn’t be true.

Contractions were really getting hard to manage at that point. Pam suggested that I try getting into the birth tub, since many moms say that the water helps them deal with the pain. I debated whether or not to get in. I knew that I wanted to save the tub until I knew labor was approaching the pushing stage. I didn’t want to labor in the tub for hours and hours.

However, after the next contraction, I announced that I was getting in the tub. These contractions were horrible. It was 2:50.

As I slipped into the warm water in the birth tub, I felt my body relax. The water felt so good. However, that sense of tension release left as soon as the next contraction came on. I don’t know what I expected the water to do to the intensity of the contractions, but it didn’t seem to do anything!

The water was great for moving around, though; the new sensation of weightlessness allowed me to try several different laboring positions without much effort. I tried a few contractions on my hands and knees. I tried a few more with my legs outstretched and my arms draped over the edge of the tub. At one point, I remember practically doing laps around the perimeter of the birth tub, moaning, “I don’t know what I’m doing! I don’t know what position my body needs!” Pam reassured me that whatever I was doing was exactly what my body needed to get that baby in position for his or her entrance into the world.

Then, I started feeling the urge to push. I found out later that it was 3:10. Had I really only been in the water for twenty minutes before I started pushing?

As a VBAC (Vaginal Birth After C-Section) mom, this part of the labor was new to me; it was like I experienced another first labor. I never knew how hard a woman really has to push in order to get a baby out! I was pushing with everything I had. Pam encouraged me to push only when I felt a contraction; it would be like waiting to catch a wave as you are swimming back to shore. But it was actually hard to tell when I was feeling a contraction! How could a contraction, so unmistakably unbearable just minutes before, now be so hard to discern?

At this point, time seemed to disappear for me. I continued to ask when this would all be over, although I was speaking to God more than anyone in the room. Everyone else knew that I was near the end, but I felt like the pushing and waiting would never end.

Somehow, I had enough mental capacity to remember something I had read in several birth stories. Some women instinctually reach down to feel for their baby’s head during labor. Upon feeling it, they often report getting a surge of energy, knowing that their labor is not in vain. I remember consciously thinking, I am getting discouraged…maybe I should to reach for the head to get the boost that I need.

“Pam, can I reach for the head?”

“Absolutely. See if you can feel your baby.”

I reached my hand down and felt a head! Not only did I feel the head, but I felt hair. I was shocked to feel hair; it actually distracted me for a bit. I had assumed that Baby #2 would be as bald as Jadon.

I continued to push, but now I kept my fingertips on the baby’s head. I was practically addicted to the touch of my little one; it really did give me the encouragement I needed. Looking back, it was an incredible experience to actually feel the baby slowly descend the birth canal with every effort I gave.

At one point, as I stopped pushing, I felt the baby retreat up the birth canal quite a bit.

“The baby went backwards!” I lamented.

“Two steps forward, and one step back, Alison. Two steps forward, and one step back,” reassured Pam.

After just a few more contractions, I felt the head emerge. I paused, following Pam’s guidance. She positioned Jon’s hands to catch the baby. With the next push, the baby slipped into my husband’s hands. Pam told him to keep the baby under the water while she freed a tiny foot from an umbilical cord tangle. The baby was under the water for a total of about ten seconds. As long as the water is warmer than the mother’s body temperature, the baby will not experience the reflex to take a breath.

Then Pam helped guide Jon’s hands to hand the baby to me. A few seconds after lifting the head above the water line, the baby let out a cry.

I realized that no one had checked the baby’s sex yet. With my baby draped across my chest, I lifted one of the legs to discover that we had a daughter.

“It’s a girl!” I announced. “Hello, Eden! It’s your mama!”

“Look at all that hair,” Jon remarked. I smiled to myself, knowing that I discovered the hair before anyone else.

Our little girl arrived at 3:34, ironically close to the 3:30 cut-off time I had demanded earlier in my labor. Jon and I gazed at our amazing creation while Pam, Heather, and Maria got to work preparing the bed, towels, sterilizing equipment, and more. I found myself muttering phrases like, “She’s finally here,” and “I can’t believe it’s finished,” over and over again.

The aftermath of our home birth was a welcome change from our hospital stay after Jadon’s c-section. I was immediately offered food and drink from my own kitchen. I rested in my own bed, wrapped in my own soft towels and blankets. My toddler was still asleep, just a room away, unaware that he was now a big brother. Best of all, I knew that I would soon be able to sleep without hourly interruptions from hospital staff performing required checkups throughout the night.

As I reflect on Eden’s birth, I can clearly see God’s provision for all the little details. I’m grateful that the castor oil actually worked without making me sick so that I could avoid a hospital induction. I’m amazed at His plan in having Maria be present in Alison’s place; I credit her acupuncture expertise for pushing my body into active labor! I’m relieved that the labor happened overnight so that we didn’t have to send Jadon away with friends or family; I liked knowing that he was safe and nearby. I am thrilled that God granted me a successful home birth VBAC with no complications or scary surprises. Above all, I’m smitten with my darling little girl, whom I have the privilege to raise and cherish in the years to come. 

Monday, June 16, 2014

Eden's Birth Story, Part II: Scheduling a Hospital Induction

[Missed Part I? Click here!]

I woke up Tuesday morning refreshed from deep sleep. The emotional end to the previous day felt like a distant dream now that the sun was up. Yet, I was still a little nervous about the non-stress test ahead of me. I followed my midwife's advice to eat or drink something with a good amount of caffeine or sugar, as monitoring the baby while he or she moved was the main purpose of the test. I enjoyed a large iced coffee in the car on the way to the clinic for our 10:00 appointment.

41 weeks and 6 days pregnant, the day of our non-stress test
We didn’t have to wait long to be seen. The nurse led us back to a small examination room where she hooked me up to a fetal monitor. We immediately saw several bouncing lines start scrolling across a computer screen. Pointing, the nurse explained that a particular line recorded the baby’s heartbeat. She handed me a small wand with a button on the end. When I felt the baby move, I was supposed to punch the button. The frequency of the baby’s heartbeat was supposed to increase immediately following movement.
And then the nurse left, saying she’d check up on us in about five minutes. Jon kept Jadon occupied with snacks and an app on his phone. I waited for the baby to move, but felt nothing. Five minutes passed.

The nurse returned, took one look at the screen, and said, “Baby must be sleeping, huh?”

“Yeah, looks like it,” I replied.

Then the nurse offered to get me a glass of apple juice, as that usually gives a sugary burst of energy to the baby. I accepted the offer.

When she returned with the cup of juice, I asked how long this test usually takes. “Well, it takes as long as it takes for your baby to move,” she answered.

I downed the juice. “And what if the baby doesn’t happen to move?”

“Then we may have to send you over to the hospital for some closer monitoring.”

Great. Exactly what I was afraid of. More tests. I knew that my baby was fine, and that he or she had been moving plenty that morning already. However, if the baby wasn’t moving during this test, I was out of luck. I literally couldn’t make this baby move, and I couldn’t leave until he or she did.

Thankfully, just minutes after drinking the juice, I felt a nice hard kick. I immediately pressed the button, joyfully telling Jon that the baby moved. I saw relief fall over his face. The heartbeat line on the screen steadily climbed, and then gently fell back to the normal frequency. Then the baby moved again. And again. And again! The heartbeat peaked after each movement, and always returned to that healthy, steady rhythm.

When the nurse reentered, she looked at the screen, smiled, and remarked that the juice seemed to be working. Since there was plenty of data to see, she left again, this time to get Dr. W.

“Wow, your baby’s a rock star!” remarked Dr. W as he glanced at the screen. “But, I thought I wasn’t supposed to be seeing you folks again! I guess your baby’s pretty comfortable in there, huh, Alison?”

I laughed, glad that he seemed to be laid back about going later than we expected. He explained to us that the non-stress test looked excellent, but he also wanted to get a quick look at the baby on the ultrasound screen to make sure the fluid levels were appropriate, and that the placenta looked healthy. Even though we prefer having only one ultrasound performed at twenty weeks, we agreed that a quick ultrasound was wise and would give us peace of mind as we continued to wait.

Our entire crew shuffled to another examination room with the ultrasound equipment. It took less than five minutes for Dr. W to see what he was looking for.

“Okay, let’s see…well, baby is head down…now I'm looking for a fluid pocket…fluid pocket…here’s one…but the cord is present in the shot, so I’m not allowed to do a reading on that one…another fluid pocket…it's a nice size, excellent size…okay, now for the placenta…it’s still nice and high, away from the cervix and your scar tissue…wow, it’s really in excellent shape, only slight traces of calcification near the edges, which is wonderful at the 42 week mark…well, that’s all I need to see…everything looks great!”

As I cleaned the goop off my belly, Dr. W reasoned with us about the days ahead. He explained that there was no reason to induce simply because I had reached the 42-week mark, especially when the baby and I were both in such good health. However, he continued to say that the probability of unexplained stillbirth rises exponentially between 42 and 43 weeks, and that he really wasn’t comfortable letting the pregnancy continue past the weekend. He proposed that we come in for an induction on Thursday, only two days away, and one day past 42 weeks.

At this, my husband piped up. “Doesn’t it make more sense to come in for another non-stress test on Thursday, and then consider an induction on Friday, especially if the non-stress test isn’t as favorable as the one we had today?”

Dr. W paused, but agreed to scheduling an induction for Friday. I had a lot of questions about what would be allowed if I was to labor in the hospital. I found out that I would be allowed to walk the halls and move around the room during my contractions, and that I would not have to push laying down on a bed. However, I would have to have a wireless fetal monitor on me at all times, and an IV saline lock in my arm in case they needed to administer fluids or medications. He saw in my face that I didn’t like the idea of continuous monitoring, or the IV. Then he said, “I know how much you want to have a home birth, Alison, but how important would you say it is for you to have a vaginal birth?”

“Having a VBAC this time around is probably my top priority, even if it has to be done in a hospital.”

“I am committed to giving you a VBAC, Alison,” Dr. W said earnestly. “This means that I won’t be giving you any kind of timeline if you are laboring in the hospital. If you arrive on Friday morning, I know that you may be here all day Friday, and Saturday, and maybe even Sunday. As long as you and the baby continue to look healthy, I want you to have as much time as you need to have the VBAC.”

So, we scheduled the hospital induction for Friday morning at 7:30 am. My heart was heavy, but I was grateful at the same time. I knew that not every doctor would be as gracious as Dr. W in allowing the pregnancy to continue at all! Furthermore, doctors are notorious for putting time constraints on labor, especially if a woman’s water has already broken. Yet, as generous as his “no time limits” offer was, I knew that chemically inducing my labor complicated my hopes for a VBAC. Pitocin-generated contractions are a lot harder on the uterus, and scar tissue, than contractions stimulated by the body’s own natural oxytocin. Continuous monitoring could show “distress” or other issues that were actually caused by the induction itself. 

The more I thought about a hospital birth, the more resolved I became to have this baby before Friday morning.

On the drive home, I texted Pam (my midwife) and Alison (my doula) to share the good results of the non-stress test, and the ultrasound. I also told them that we had scheduled an induction, but that I would be taking some more castor oil when I got home. This baby needed to come out.

Stay tuned for the final Part III, coming soon!

Saturday, June 7, 2014

Eden's Birth Story, Part I: Waiting for Labor

I was pretty confident that I would be “late” with my second child. My mom carried all of her children well past their due dates: all three girls were a full two weeks late, and the two boys were exactly ten days late. My own firstborn also took his time in making an appearance; Jadon’s birth occurred twelve days past his due date. I was sure that I would be late with Baby #2, but I didn’t know how late.

While I wasn’t worried about being “overdue,” I was very aware that being late with my VBAC (Vaginal Birth After C-Section) status could make doctors, friends, and family more nervous, even more so because I intended to birth at home. I knew that I wanted the freedom to go into labor on my own; however, I also knew that I was willing to help things along “naturally” in order to avoid a hospital induction.

To make myself feel like I was doing something productive, I repeated some of the "natural induction" tricks I used at the end of Jadon’s pregnancy: eating pineapple, going on daily walks, and doing “pelvic rocks” on all fours, etc. To be honest, I don’t think any of these methods had any effect on the timing of Jadon’s birth. At the end of this pregnancy, I also tried a few new tricks, like eating Eggplant Parmesan (with three days of leftovers!), and doing hula hoop motions while sitting on an exercise ball. If nothing else, I knew that the physical exercises would at least help this baby stay in an optimal birthing position. No surprise breech babies allowed this time around!

Mmmmm...Eggplant Parmesan...tasty, but didn't induce my labor
I knew that if my body had not gone into labor on its own within a week of my due date, I would be willing to consider some more – shall we say – drastic measures. Even so, I continued to hope and pray that Baby #2 would come when he or she was ready.

My midwife, Pam, and doula, Alison, both recommend acupuncture and acupressure as a means for readying the mother’s body for labor. Alison credits acupuncture for getting labor started for her second child. I’d never done acupuncture before, and was a little apprehensive about having a bunch of needles stuck in me. However, an acupuncturist/doula/massage therapist friend of mine, Maria, privately messaged me on my due date to offer her services if I was interested in using them. She shared that she has had a lot of success with acupuncture for VBACs in particular. The idea of meeting with someone I knew put acupuncture in the “maybe I could do that” category. I told Maria that I would let her know.

41 weeks pregnant, passing the time with another trip to the playground!
One week later, at 41 weeks pregnant, and with no signs of imminent labor, I finally decided to give acupuncture a try. It was a new experience for me, having needles stuck into particular points on my body for uterine and cervical stimulation. I can’t remember what all these points were for, but I know that I had needles in my lower back, ear, hand, ankle, and on the outside corner of my pinky toe (that one really stings going in!). I learned a little about the practice of acupuncture from Maria, and enjoyed the chance to relax, but really didn’t know if it was doing anything. Two days later, a Friday, I went back for another session, this time at the recommendation of my husband, Jon. We hoped it would give my body the push it needed to take off on its own, hopefully over the weekend.

Saturday arrived, with no signs of labor. Alison texted me that morning to ask if I wanted her to make me a castor oil smoothie.

Castor oil…the powerful laxative that not only empties the bowels, but irritates the uterus, often resulting in the routine tightening of the uterine muscles called contractions. I had read several birth stories where castor oil successfully jump-started labor. However, castor oil also makes many women sick. Vomiting or diarrhea while laboring? No thanks!

Yet, theoretically, I knew that I was willing to try it. The 42-week mark was only four days away. On that day, Pam would be legally required to consult with Dr. W about the condition of my pregnancy. Most doctors would not allow a pregnancy to last that long in the first place. That day, I could lose a lot of freedom and decision making power over how and where I would give birth. I knew I was willing to try castor oil before then, but when?

I decided to text Pam about trying castor oil. She said that it was completely up to me if I wanted to try it, but that she would definitely want advanced notice before I take it. She also mentioned that she has a specific protocol to follow for best results, if I chose to go that route. First, she said that castor oil plain or in a smoothie would be best taken earlier in the day so that I wouldn’t be up all night on the toilet, which would probably leave me exhausted at the delivery. Second, she told me that nothing less than four ounces of castor oil is worth the drink. Any less could potentially not be enough to produce the desired result of contractions. Third, Pam reported that castor oil works best when coupled with some time on a breast pump, as nipple stimulation also can produce contractions. Finally, she said that it’s most important to stay hydrated before and after taking the castor oil.

I spent the rest of the night debating whether or not I should take the smoothie. I stayed up late, reading dozens of online forums where women reported their experiences with castor oil. The most common story went something like this: “I made myself a smoothie…a couple hours later I had diarrhea…a couple hours after that I had a baby.” However, some women reported getting really sick, even having diarrhea during labor (ugh!). Even more reported that the castor oil had no effect on them at all. Of course, some of these women were attempting to induce themselves at 38 weeks pregnant, or less. And I had no idea how much their dosage was.

Sunday morning, I privately messaged Maria to ask if she had any advice concerning castor oil. She informed me that her sister used castor oil to coax her fourth baby out, but that it made her feel pretty sick during labor. She reassured me that it has no negative effects on the baby whatsoever. Then, she volunteered herself to help me in my labor in any way that she could be of use. "Please don't hesitate to call!" she wrote. "I am just passionate about babies being born healthy!" I was so touched by her sincerity, and told her that I just might take her up on the offer if I felt like I needed her.

Sunday night, I found myself in Alison’s back yard, celebrating her husband’s birthday with food from his new birthday grill. We enjoyed the beautiful weather, watched our kids play in a water table, and talked about my midwife’s castor oil recommendations. Together, we decided that I should make a castor oil smoothie the next morning after having a good breakfast. Alison would come up to my apartment with her kids around midday, hopefully while I was starting to see the effects of the castor oil. If labor really got started, she’d be there to watch Jadon, call Pam, and assist me while we waited for the rest of the birth team to arrive.

Monday morning, Memorial Day, I woke up full of anticipation. What if today’s the day? Will it be a boy or a girl!? I couldn’t wait to meet my baby.

Jon was sitting out in the living room with Jadon when I emerged from the bedroom. I set myself to making breakfast. We finished eating shortly after 9:00. As Pam recommended, I waited over an hour to allow my food to digest before I took the castor oil smoothie.

At 10:40, despite still feeling pretty full from breakfast, I did my best to finish the smoothie in one quick sitting. Then I waited. In one hour’s time, I was supposed to use an electric breast pump to get some contractions going, switching sides every five minutes for a full hour. I sat on the exercise ball, watching some Curious George with Jadon. I over-analyzed every little feeling in my body. Was that my stomach churning, or the baby? I felt like a ticking time bomb.

Alison arrived with her two kids while I waited for the hour to pass. It was nice to be distracted from what was going on in my body while we talked.

Around 11:45, I started the breast pump. My insides still churned while I spent my first five minutes on the right side. A few seconds into the left side, my mouth started watering like crazy. “I’m going to throw up,” I announced to Jon and Alison. Luckily, I made it to a garbage bin in time. With every heave of my stomach, the awful churning feeling went away. On the one hand, I felt relief, since the castor oil was out of my system. On the other hand, I felt defeated because “operation castor oil” no longer seemed feasible.

I texted Pam to see what she’d have to say. She suggested that I still complete the hour on the pump since we weren’t sure how much castor oil my body had taken in. Even if I hadn’t been able to digest much, some women successfully jump-start labors with a breast pump alone.

Sure enough, within ten more minutes of using the breast pump, I started experiencing mild contractions. They were extremely easy to handle, but definitely had a peak in strength before they resolved. They soon fell into a regular pattern of three minute intervals, usually lasting about a minute. My hopes revived as the pattern continued for the entire hour, and seemed to maintain itself even when I went off the pump for a break.

My dresser, standing ready with my home birth kit and lots of clean towels...for weeks!
Thirty minutes off the pump, the contractions slowed to four or five minutes apart, but quickly resumed their three minute intervals when I started my second hour on the pump. All the while, they required no concentration or effort on my part.

At the end of the second hour, Alison and I decided to take a walk, hopefully to ramp up the contractions. With rain clouds looming overhead, we thought it best to simply do laps around the dead-end street where my apartment is located. Contractions continued as steady as ever, but with no increase in intensity. Some of our neighbors were sitting in their open garage while we walked. After our third loop around the street, it was clear that we had become a topic of conversation. 

As we passed them a fourth time, I called out, “You must be wondering why we’re walking in circles!”

“Oh, we know why…you want that baby out!” yelled one of the guys, as they all laughed.

“But I have to ask,” chimed one lady, “How far along are you?”

“Twelve days late,” I replied with a smile.

“Twelve days late!” several of the neighbors repeated, in disbelief.

“Wow, you look great for being twelve days late!” the lady remarked. “Good luck!”

When it finally started to rain, Alison and I returned to the apartment. I called Pam as we headed inside. Pam thought it best for me to take a break. If things really were going to get started on their own, I would need energy for labor. If the contractions tapered off and stopped, then it just wasn’t meant to be. She encouraged me to eat a good dinner and to get a good night’s rest either way.

I thought this was good advice, even though I really was hoping for labor to take off at any moment. After all, this day was the perfect day for my baby to be born. Jadon would be going to bed soon, and he could just sleep through the birth and meet his baby brother or sister in the morning. Alison and her family were already at our apartment; they were planning to leave for vacation late the next day. How could I have this baby without my doula and close friend? I also really wanted to avoid the non-stress test at the doctor’s office we had scheduled for the next morning. I knew that my pregnancy was healthy and normal; what if the test didn’t satisfy Dr. W and his staff and they’d want to keep me there for further monitoring or something?

My bedroom, rearranged to fit the birth tub. Also a constant reminder that my baby still wasn't here! 
I decided to take a cool shower and lay down for a bit while Alison prepared dinner for both of our families (seriously, what would I do without this woman?!). As my body settled into rest, the contractions spaced out to nine or ten minutes apart. I joined everyone at the table and realized at the end of the meal that the contractions had stopped completely. I was disappointed, but I tried not to show it.

Alison and I went for another quick walk after dinner, just to see if contractions would start up again. They didn’t.

By the time we returned the apartment, I was holding back tears. The unacknowledged emotions that had been building since my due date seemed to surface all at once. Today was twelve days past the due date! Don’t second babies normally come sooner than firsts? Jadon was born on day twelve; why hadn’t labor started on its own? I thought I wouldn’t be seeing Dr. W and his staff again; what if he’s not okay with allowing my pregnancy to go pass 42 weeks? Jon took off of work last week, and he can’t take off that many more days; who’s going to help me out if he has unavoidable commitments? If only I had been able to keep that castor oil down, then maybe I’d have a baby in my arms right now! What if I’m trying to force something my body, and baby, simply aren’t ready for? Why does 42 weeks have to be this magical cut off date? I just need more time!

The tears finally streamed down my face as Alison and her family packed up to go home. She reassured me that the hours of contractions that day certainly were priming my body for labor. Labor could even start on its own that night when I was sleeping. She told me that her phone was charged and ready for my call, and she’d be back as soon as things got going. She even mentioned that she was considering changing travel plans if need be, especially if there were sure signs that labor had begun.

After they left, Jon and I discussed our plans for the next day. He made a few phone calls and was able to reschedule his jobs for the next day so that he could come with me to the non-stress test. I went to bed thankful that Jon would be able to come with me, but still nervous about what Dr. W and his staff might ask of me, considering that I was so “late,” and a VBAC. 

With Jadon tucked into bed, we prayed for peace, patience, and trust in God’s plan and perfect timing. Then, emotionally and physically drained, I went to bed.

Part II coming soon!

Thursday, May 15, 2014

VBAC Preparation: The Consulting Doctor, the Ultrasound, and the Green Light

I don’t play the idle waiting game very well, so I've spent the last few weeks tackling a long "before baby comes" to-do list. Now yesterday's due date has come and gone, and we're still waiting! With my list practically finished, I decided to use the remaining pregnancy time to catch up on the blog posts I've meant to write throughout the pregnancy. In particular, I want to record the steps I've had to take to pursue the home birth VBAC (Vaginal Birth After C-section) that I’m hoping to experience in the very near future.

Passing the days with my energetic toddler!
If you want to plan a home birth with a Certified Professional Midwife in the state of Wisconsin, you essentially have to find a midwife who will take you on as a “low-risk” patient. While still being bound to their license and standards of practice, each midwife is allowed to determine her own level of expertise when it comes to judging what they consider “low risk.” In Wisconsin, VBAC, twin, and breech births are all allowed in a home setting. However, an individual midwife may not personally feel qualified to service a VBAC, twin, or breech pregnancy, and can decline a client who fits one or more of those categories.

My own midwife has never delivered a breech baby or twins. Though she has been trained in how to coach breech births, she has always been able to successfully turn a breech baby to the more optimal head-down position before labor has begun. When we discovered that Jadon had turned breech during labor, my midwife made it clear that she was willing to stay at home with me if I chose to do so, but stressed that breech deliveries were outside of her realm of expertise. I decided to transfer to the hospital for a likely c-section, rather than put my midwife, and myself, in a risky position that neither of us felt prepared for (check out Jadon's birth story here).

A year after Jadon’s birth, Jon and I were thrilled to discover that Baby #2 was on the way, and that my midwife was perfectly comfortable delivering the new baby in our home. However, in order to legally assist a VBAC, Certified Professional Midwives in Wisconson have to follow a few extra rules. First, the midwife must have a protocol for fully disclosing the risks of VBAC to their client. Second, the client must not have a vertical incision from the previous c-section, nor a low-lying placenta. Third, the midwife must consult with a physician to have confirmation that the client is a good candidate for a VBAC.

How did we find a doctor who was "home birth friendly?" Check out my previous post.

Meeting the Consulting Doctor 

I met with Dr. W for the first time when I was 12 weeks pregnant. He listened attentively as I recounted the details of Jadon’s c-section, reviewed what I had researched about VBAC births, and shared that I intended to birth at home. “However,” I continued, “I’m not a home birth nut who would avoid a hospital birth at all costs. I’m not seeing you just because I have to have a consulting doctor in order to get my home birth. I value your opinion as a medical professional, and I would really want to know if you considered my pregnancy unfit for a VBAC in any way.”

And then I held my breath for what he had to say.

He began by affirming what I had researched about VBAC’s, especially that I was an excellent candidate for one. Not only was Jadon birthed by c-section simply for being breech, but my incision was cut in a "low transverse" fashion, and my uterus was closed with a "double layer uterine closure." He said that I was especially likely to succeed because, before I got on the operating table, my cervix had completely dilated with Jadon's labor. He said that most VBAC patients are nervous about uterine rupture, but the odds of a rupture are still less than one percent of all VBAC births. Then, he complimented me on how informed my plans are. "You know, Alison," he went on to say, "If I were a betting man, I'd put down money on your successful home birth VBAC. I can't wait to congratulate you when you've accomplished your goal."

Honestly, I was a little speechless at that point. He then proceeded to ask me questions about the role wanted him to play in this pregnancy. First, he asked how often I would like to see him since I am receiving dual care with my midwife. 
“Maybe every other month until the final weeks of pregnancy?” I posited.
“Done,” he replied.

Did I want his office or my midwife to do my blood work in the coming weeks?
“I’d prefer for my midwife to do my blood work.”
“No problem.”

How many ultrasounds did I want, when did I want them, and would like I to use the hospital ultrasound equipment, or use another provider?
“I would like one ultrasound at about 20 weeks, and I’d love to use your hospital technician.”
“So, we’ll be seeing you in about 8 weeks then!”

My spirit was practically soaring out of the examination room from the joy of making all these decisions for myself with no pressure to do anything differently! Who is this member of the “medical establishment” that was giving me all this decision-making power for my baby and pregnancy?!

The Ultrasound

Eight weeks later, Jon, Jadon and I returned to the hospital to see Baby #2 on the ultrasound screen. Jadon loved running down the wide, open hallways while Jon and I walked behind.

Like any expecting mother, I hoped that the ultrasound would confirm that the baby was measuring properly and had all of its organs developing normally. This ultrasound was especially important to me because we needed verify that the location of the placenta was a safe distance away from any c-section scar tissue. If the placenta were to be on top of my scar, I would be at a greater risk for a condition called placenta accreta, in which the placenta attaches too deeply into the uterine wall. If the placenta is attached too deeply, it may not separate from the uterine wall on its own after the baby is delivered, which can result in hemorrhaging and other dangerous complications. I certainly wouldn’t want to deliver at home if my placenta was in a “high-risk” location.

Finally, we were anxious to find out the sex of Baby #2…would Jadon be getting a baby brother or sister in May?

Once in the examination room, Jadon was very curious about the table on which I reclined, and all the fancy buttons and screens nearby. I was so thankful Jon was there to keep him from getting into trouble.

The technician soon started scanning Baby #2, pointing out all the organs and limbs as she measured and recorded. I was so relieved to hear that the baby appeared to be developing as it should be. I was especially thankful to know that the placenta was located high up on the uterine wall, safely away from the surgery scar and the opening of the cervix. Thank you, LORD!

I see a nice round head like Jadon's! 20 week ultrasound
When it was time to find out the sex of the baby, she kept scrolling the wand over my belly, trying to approach the baby from different points of view. While we waited for her to get a good angle, I asked what they do in order to identify the baby as a girl. Do they only look for the absence of male genitalia, or do they actually look for the presence of something? She explained that you can usually see "three white lines" in a girl's genital area. She continued to scan and pause, and then start scanning again. Finally, she admitted that the baby really wasn't giving her a good angle, and that the best she could tell us is that we have a 60% chance of having a girl, and a 40% chance of having a boy. Although we clearly couldn’t see male genitalia, she was not convinced that we had a clear enough view to confirm that it wasn't a boy.

Having scheduled my next appointment with Dr. W immediately following the ultrasound, we shared our initial disappointments with him. To our surprise, he offered to schedule another ultrasound free of charge so that we could find out what we’d be having! I was definitely tempted to take up the offer, but Jon gently reminded me that we really wanted to minimize our baby’s exposure to ultrasound technology. I agreed that having an ultrasound simply to confirm the sex was trivial. With no other medically necessary ultrasounds needed on the horizon, we resolved to wait until the delivery to see if we are having another boy, or our first girl.

The Green Light

As the long winter wore on, Baby #2, and my belly, steadily grew. I saw Dr. W again at 28 weeks. Our meeting, as always, was brief, pleasant, and completely respectful of my wishes.

Jadon, enjoying the view from Dr. W's waiting room
At the same time, I continued to see my midwife every month until the third trimester, when I started seeing her every other week. At each visit, I was pleased to hear that my blood pressure was excellent, weight gain was steady, urine samples were normal, and the uterus size was right on schedule. Baby #2 has even been keeping that head down!

When I reached 36 weeks, my midwife called Dr. W to have the official “consultation” required for her to oversee my labor at home. At my next appointment, she reported the good news that Dr. W considered me an excellent candidate for a VBAC.

I have the official green light to proceed with the home birth VBAC plans!

My last appointment with Dr. W was last week, at 39 weeks pregnant. Unless I develop “high risk” pregnancy complications, or go past 42 weeks, I won’t need to see him again. 

And now, the waiting game continues...where did I put that to-do list?