Long before I was pregnant with Major I knew I wanted to VBAC my second child. VBAC -- vaginal birth after cesarean section -- is a term that many are unfamiliar with, unless perhaps you’ve had a previous c-section. The notion that “once a cesarean, always a cesarean” is actually a myth; according to the Society of Obstetricians and Gynecologists of Canada, VBACs should be offered to women who prove to be good candidates (see here for more info). But for many women hoping to VBAC, the decision to do so isn’t an easy one -- usually there are a great deal of emotions and “unknowns” to process, such as re-living the circumstances leading to the the initial cesarean, weighing the risks of VBAC (in particular, the 1 in 200 risk of uterine rupture), and coming to terms with the real possibility of labouring, only to end in another cesarean. Plus, doctors vary in their support. Because of this, moms who desire a VBAC often flock to women who have had one, seeking information and ultimately encouragement--I am posting my VBAC story to do just this. I encourage you to share my story with other moms needing this encouragement.
But first, every VBAC story starts with an initial c-section.
Towards the end of my pregnancy with my first baby, Gemma, I had had some concerns--I didn’t feel her move often, I had begun to lose weight and my fundal height was small (up to four weeks behind!). Up until then my pregnancy had been “textbook” and I was in perfect health, and so despite his concern, the doctor was optimistic that all was well with the baby. When he sent me in for a biophysical profile (BPP) ultrasound at 38 weeks, we were hopeful all was well with the baby. At the ultrasound my daughter scored 2/8 (to provide some perspective: healthy babies score 8/8, babies you “watch” score 6/8), and when the radiologist met with us he told us we needed to go right away to the hospital to have her as she was in “fetal distress”. My innate mother's protective instinct took over -- I told Matt I just wanted the doctors to “cut her out” -- I needed my baby safe at any cost. After she was non-responsive to the non-stress test administered at the hospital, the nurses began to prep me for surgery, even before they had had time to consult with the doctors (who were tied up in another surgery) -- they knew the situation was bad and baby had to come out right away. Before long we met with the doctors and twenty minutes later (literally), I had my sweet Gemma. Thankfully she was born perfectly healthy. We found out later that she had had marginal cord insertion of the umbilical cord which was limiting blood flow to the placenta. From the moment I heard her healthy cry and she pooped all over the weigh scale, life would never be the same!
While I absolutely adored my little girl, I was in shock that I had had my baby so quickly, and I found the recovery from the c-section difficult physically and emotionally. I learned that day that giving birth rarely goes the way you expect. I was utterly disappointed by my birth experience. I felt gypped of the rite of passage of labouring to bring my baby into the world--I didn’t get to hold Gemma until she was an hour old and enjoy those serene first moments with my newborn baby, and as a result nursing was a challenge from the very start. I also hated the feeling of relying on everyone around me to care for my baby and myself. When moms who hadn’t had c-sections made comments like, “be thankful you didn’t labour”, somehow implying that a c-section was a breeze compared to a natural delivery, I felt incredibly alone in my pain.
I desperately wanted to VBAC my second.
After doing a lot of research about VBACs and then of course getting pregnant, my doctor refered me to one of the most experienced OBGYNs in Edmonton. At the initial consult I was insistent about my desire to VBAC this baby; he was cautiously supportive. I was the ideal candidate: I had had a “cold c-section” meaning that my c-section was not due to my physiology or failure to progress, I had waited a while between children and I had a tendency for smaller babies. However, he was clear that he did not want to induce me so baby would have to come on its own, close to its due date. I was glad he was being cautious, as I was still fearful of complications during the VBAC.
My pregnancy was “textbook” once again, until around 36 weeks when I was sent in for another BPP to confirm that the baby was doing well (we were being careful in light of what happened with Gemma). Since the baby was moving lots and I was steadily gaining weight (perhaps a little too steadily!), I was not worried in the least about this ultrasound--until the radiologist walked into the room. I had seen this story before. The tech had briefed the radiologist on my previous pregnancy, and so the radiologist began by saying that the good news was that my baby had scored 8/8 on the BPP, but that my amniotic fluid levels, also known as AFI, were too low. She sent me right away to the hospital for a non-stress test. Assuming the worst, I called my husband to join me at the hospital. Thankfully the baby did amazing on the non-stress test and the doctor on shift assured us the baby was fine, but that we did need to routinely monitor him for the final month. I was to go into the hospital every other day for non-stress tests until I could meet with my OBGYN (who was on holidays on the other side of the world, literally) to set up a game plan for the final four weeks.
Later that weekend I returned for another non-stress test and the baby did well again; however, the doctor on call really did not like my low fluid levels. She said if I were her patient in her practice, she wouldn’t wait long to deliver this baby. I insisted we wait until I hear from my doctor before we make any decisions (after all, we were talking about delivering a baby at 36 weeks gestation!), but she was clear that the next time I came in for a non-stress test, the doctor scheduled to be on duty was very conservative and would want to perform a c-section right away. We were to keep our hospital bags in the car. The evening we went in for the third non-stress test I totally expected to give birth by c-section; in fact I had begun to come to terms that a VBAC just wasn’t in the cards for me and our parents cleared their schedules to babysit Gemma for the four day hospital stay.
When we arrived at the hospital, fortunately, there are been some miscommunication and the doctor we had heard would be working wasn’t; in fact, the doctor who had reviewed the first non-stress test/ultrasound was the doctor on duty! She once again affirmed that she felt the fluid levels could have been miscalculated on the test depending on baby’s position, and considering how the baby looked on both the ultrasound and how he responded to the non-stress test, she wasn’t overly concerned. She even mentioned that a VBAC was very likely considering he was measuring small. In a matter of minutes I had gone from expecting a c-section (and trying to be okay with it) to hope once again that a VBAC was possible.
When we were able to meet with my OBGYN, he agreed we needed to watch baby carefully and that he wanted my fluid levels to go up, or else he would schedule an induction for later in the week. Despite originally telling me he didn’t want to induce, my cervix was favourable and so he was okay going forward with the VBAC. To improve my fluid levels I had to start drinking boost shakes (to increase nutrition to the baby) and we informed family and a few friends, asking them to pray that my AFI would normalize. I had an ultrasound immediately following that appointment and my fluid levels were already increasing! Before even drinking the shakes, a miracle was starting to happen in my body. The doctor was pleased by the higher levels and we decided to just wait and see, take it day by day, before we make any decisions about induction.
The final month of my pregnancy was an exhausting whirlwind of ultrasounds and non-stress tests at the hospital. The nurses at the Grey Nuns got to know me well and were rooting for me that all would turn out fine. Each week I went into the battery of tests terrified that my baby wasn’t doing well, only to hear from the doctor that all was measuring perfectly. At times I was an emotional wreck, calling my husband at work, afraid that I hadn’t felt the baby move recently and maybe things were going downhill with the baby. Emotionally I was reliving what had happened to Gemma.
Over the course of this pregnancy, and especially in those final months, I had prayed very specifically about the type of birth I wanted. I wanted the baby in the ideal position for a vaginal delivery, I wanted an epidural that worked well and didn’t slow down my labour, I didn’t want my labour to be augmented by pitocin, I wanted my doctor to deliver and I wanted minimal tearing. I even prayed that the delivery would be so smooth and uncomplicated, that the nurses would comment on it. I read passages of scripture about how we must ask for what we need/want and believe that God would provide it. This was all part of the process of preparing me mentally and emotionally for the big day.
At my 40 week appointment, the doctor and I had decided on making Tuesday, October 6, my induction date. I really wanted him to induce me on the Friday before, but he refused since there was no guarantee that I would deliver before he was off for the evening. I had been having all the pre-labour symptoms in the book, and was scared that I would go into labour on the weekend when he wasn’t on; but when he checked his schedule to see who was working, he realized that he was actually on most of the weekend! I was immediately put at ease knowing that if I went into labour, there would be a good chance he would deliver.
Then, two days later, on Friday, October 2, Matt and I decided to go out to dinner and a movie (The Martian with Matt Damon! So good!). In the afternoon that day I had had some cramping, but nothing super uncomfortable. When I dropped Gemma off at my mom’s I told her about my cramping and we decided together that they were most definitely contractions. At supper I started timing them and they appeared to have a pattern, but they were probably about 10-13 minutes apart, so there was no reason to head to the hospital. At the movie theatre I struck up a conversation with the woman sitting beside me, mentioning that I might be in labour. She thought it was hilarious that I would go to a movie while in labour and shared the birth stories of her children. It was all funny until the last 15-20 minutes of the movie when the cramping was really uncomfortable. I just wanted the movie to be over so that I could go home and rest. I told Matt we might have to go to the hospital that night, so we decided to stay over night at my mom and dad’s -- they live closer to the hospital and we wouldn’t have to disturb Gemma from her sleep.
For the next couple hours in bed the contractions were getting closer together, and increasingly more painful. I had a few that I just couldn’t handle any more, so we headed to the hospital. Of course, as we drove the the hospital things started to ease up. We ended up waiting in the hospital parking lot for an hour to see if the contractions would get worse. Around 4 am and still waiting in the parking lot, my mom texted me and told me to go in to get checked. When I got to labour and delivery the pain was bearable, but they gave me morphine and told me to walk around for an hour. If I progressed, they would consider it labour, if I didn’t, then it was just prodromal labour (pre-labour). Sure enough, after the hour passed, my body clearly wasn’t responding to the contractions and I was sent home to rest. Thankfully the morphine helped me to sleep in until noon the next day. I woke up pain free and figured my labour had stalled.
After a late breakfast at my parents’, we went home to spend our Saturday afternoon together as a family. I wanted to get a couple things done since I knew baby would be here, at the latest, on Tuesday at my induction. A few hours into the afternoon, the contractions came back. They were only a nuisance until around supper time, so I laboured on my own, hiding away in my room so that Gemma wouldn’t see me in pain. Around 6:00 pm I had had my bloody show and called the hospital to see if I should come in. They assured me that it was just my cervix dilating and since I was coping well at home, I should stay there. I mentioned that I was attempting a vbac, but that didn’t seem to matter--staying home was what I must do. I was getting pretty uncomfortable though, so I decided to have a bath -- that’s what all my friends said would make it feel better. But in the bath things got more and more uncomfortable. I told Matt to get Gemma to bed -- I couldn’t labour on my own any more. He got her to bed around 7:45, and at about 8:20 I had a contraction so terrible I thought my uterus was exploding. I was sure I had ruptured...I MIGHT have a tendency to think irrationally at times. I told Matt to call my mom to come over right away. She was there within half an hour and we were on the road to the hospital. This time the contractions didn’t slow down (except for one ten-minute break) and when I made it up to L&D I was writhing in pain. When the nurse checked me I was already at 4.5 cms (yay!) and she immediately got me a room and my epidural.
Unfortunately my doctor was not on shift until Sunday afternoon, and so I had to meet with a doctor I didn’t know at all. My first words to him were, “I’m trying for a vbac and I am terrified my uterus is going to rupture! Have you done many vbacs before?” He kind of chuckled and informed me the first and only time he had seen a uterus rupture was 18 years ago and that was the fault of the medical team, as back then they didn’t really know how to monitor vbacs properly. He mentioned that his happiest patients are his vbac patients and that I needed to just relax. His tone was totally sarcastic and condescending, but at the moment that was EXACTLY what I needed to be reassured. I told him that if I got my vbac “I would love him forever” haha, to which he quipped, “Dion, that’s just the epidural talking”. His sense of humour was perfect for me in the moment; his confidence was calming.
At 6 cm he broke my water, assuring me that this would make my uterus more efficient and less likely to rupture. Other than this augmentation, not once did I need pitocin or any other means to encourage contractions. My husband and I had become pros at reading the monitors (from all my previous NSTs), and he watched the tracings carefully the whole time -- Matt told me that not once during my labour did my contractions slow or become unevenly spaced, and baby’s heart rate never dropped below 130. I was having a textbook labour. I used this time to rest and meditate on some of the scriptures I had in my phone, reminding me that God was present and that he was answering my prayers. By 1:20 am Sunday morning, I was at 8 cm. By 3:00 am I was starting to feel the contractions more through the epidural. The nurse said that meant I was either transitioning to 10 cm or that I needed a top up. When she checked me I was already at 10 cm! Within 5 hours of getting to the hospital, I was ready to push. The doctor checked the baby and he was in the ideal position to deliver.
At this point I was not scared to push but excited! Everything so far had been a victory and I just knew that this time I was having my baby, my way.
Those of you who know me personally know that when I set my mind to something, I go hard. I asked the nurse how long the average first time mom pushes for. She said 1-2 hours. I was determined to push this baby out as fast as possible, so once I got the hang of pushing, I didn’t waste one second of each contraction. When the nurse told me 2-3 pushes a contraction was excellent, I decided to push four times per contraction, taking only enough time for a quick, deep breath in between. Not once during any contractions did I take a break. This was the most determined I had been about anything in my life. I kept asking the nurse how I was doing compared to other moms, and she always smiled coyly and told me that for a first timer, I was about as good as it gets -- I’ve always liked to be at the top of my class.
An hour and five minutes later, at 4:17 am, Major Matheson was born. Unlike my first delivery, this time I got to hold my baby the moment he was born, skin on skin, breathing in his scent, locking eyes with him. He naturally latched on and began nursing, something I never got to experience with Gemma. For 45 serene minutes, he and I cuddled in, soaking up the miracle that had just happened. The nurse was amazing, not once interrupting us from our moment together. My husband just watched us, happy that I had achieved something I had wanted so much.
Afterwards, while the doctor was stitching me up (another answered prayer, I had very minimal tearing), he told me in his condescending way that he had never had a patient mention uterine rupture to him when he first met them, that I worried too much and I needed to relax. He was totally right, and whenever I let my mommy nerves take over, I try to remember what he said. Although I didn’t get my doctor to deliver, I did get the doctor I needed in that moment.
On the way to my recovery room I chatted with the nurse about the delivery, and she told me that for a first-timer, that is about as smooth as a delivery can go -- another answered prayer.
I am so thankful for my VBAC and my healthy baby boy. I feel light years better, physically and emotionally, following my delivery than I did after my c-section. It was such a blessing to be able to walk right after delivery, lift the car seat and properly take care of my children, rather than being strapped in a bed for a painful four day hospital stay and much longer recovery. It also renewed my faith in my body -- that it can function properly -- and that I can trust it to work.
In the days following Major’s birth, Matt told me had never been so proud of me before. And to be honest, I have never been so proud of myself. Of all my life’s accomplishments, nothing took more commitment, determination, prayer, trust and faith, than giving birth to Major.
For mamas hoping to VBAC, as long as your doctor is on board, I say go with it! It is so worth every moment of doubt and fear.
To successful vbacs and mamas everywhere,
♥ Dion
