Tuesday, September 25, 2012

A VBAC Victory- Post Partum Thoughts


Surprise! Your pregnant... again!

When I unexpected found myself pregnant with Annabelle, I didn't know what to do. We had spent so much time just taking care of Aiden, we had not given much thought to how to prevent another pregnancy. So when that pregnancy test came up positive at 3am after spending an entire night puking, I was at a loss. Let's just say the first words out of my word started with "F" and it wasn't "f for fun!". While we did eventually want to try for another kiddo, but the last year of our lives was complete chaos. Between the high risk pregnancy with Aiden, to his DS diagnosis, moving from Portland, OR back home to Santa Barbara, CA only 2 weeks after deciding to move, and all the chaos that had happened with our business over the last year, I didn't feel as though I was in any position to go through another pregnancy.

I had some time to sort my thoughts, as I lay on the bathroom floor for a few hours worshiping the porcelain throne. I knew that "options" existed, but I couldn't bring myself to even contemplate it. While I am not religious, I do believe things happen for a reason. I didn't know it yet, but there was a reason this baby came at this time.

But don't you WANT a c-section???

I met with the kaiser ob the following week and had the dating ultrasound. I was absolutely shocked to find out I was already 12 weeks along! I was already almost out of the first trimester before I really even knew I was pregnant! Then came the bad news.

Dr: "So, at our next appointment, we will go ahead and schedule your c-section date."

Me: "Huh? Can't I try for a vbac?"

Dr: "No, the hospital won't allow it."

Me: "Which hospital will allow it?"

Dr: "None. But you will really like a scheduled c-section. It makes it so easy. Im sure your first c-section was pretty rough but it is so much easier the second time around when it is scheduled. "

Me: "No I wont".

Dr: "All my patients have had great experiences with repeat c-sections."

Me:"I'm sure you mean well, but your not going to succeed in convincing me that a repeat c-section is exciting and great."

He spent the next 10 minutes repeating the same things over and over, trying to convince me that this is what I wanted and getting no where. We finally decided to end our appointment and head for home.

Once at home, I did some research on the internet and found that both Santa Barbara and Ventura banned vbacs (vaginal birth after cesarean). The closest place I could try was UCLA.  I figured I didn't have a choice but to have a repeat c-section, but I didn't have to be happy about it.

Does Birth Choice even exist?

A week or two later I made an appointment with a doctor at the sansum Santa Barbara OB clinic, once our insurance switch had gone through. I met with my new doctor, who seemed very nice and supportive and tried to convince myself that the repeat c-section wasn't so bad. I tried very hard to convince myself, but I felt as though my heart had been crushed. Ever since I watched the "Business of Being Born," I had developed a strong desire for a natural home birth. It just made sense to me. I had spent the the last 5 years of my life eating a healthy diet and relying on alternative medicine to bring me to a state of good health. I wanted to bring a child into the world the natural way, the way I wanted to, without unnecessary and harmful interventions.

I decided that it wouldn't hurt to make a few additional phone calls to see if anyone knew of any midwives who would do a vbac. I called about 6-7 midwives and each apologized profusely for not being able to help me (for fear they would lose their back up OB, insurance... career), but each recommended me to the same person, Dr. Fischbein. I called Dr. Fischbein's office and scheduled a consultation.

I felt very encouraged after appointment with Dr. Fischbein. He spent an hour going over my previous pregnancy and went over the risks and benefits of both a vbac and repeat c-section. He explained my options, and even though I was at a slightly higher risk of uterine rupture due to the short time between pregnancies, if I was interested, he would take me on as a client for a home vbac.

Adam and I took all the information we were given and discussed how we wanted to move forward on the drive home. Adam felt confident in Dr. Fischbein's skill and extensive knowledge and told me that he would support me if this is the choice I wanted to make.

Do you have a death wish?

About a week after my appointment with Dr. Fischbein, I had another appointment with my sansum ob. After waiting for a full hour for my appointment, the doctor rushed in without much of a hello. He quickly shot of questions about I hadn't done any further genetic testing in this pregnancy and why did I refuse to get a blood panel done or the 20 week ultrasound. I politely responded that I had made it clear my last appointment that I didn't want to do any further genetic test, and that I had completed the blood work and the ultrasound, which he should have the paper work for. He briskly attempted to find fetal heart tones with the doppler, using far too much pressure and got frustrated after a couple of seconds when he couldn't find it. Once he found it, he said everything is great and asked if I had any questions. I told him I was more than likely going to have a home vbac. He turned beet red, elevated his voice and asked if I "had a death wish for myself and the baby." He then rambled on for about 10 minutes about how dangerous it was using false facts and stated how the American College of Obstetrics and Gynecology (ACOG) was highly against vbacs (which they aren't). I knew for sure at that point I wanted to go with Dr. Fischbein.


The births of Aiden and Annabelle are two very special moments in my life. Aiden, for being my first baby, and the hardships we overcame. He was never expected to make it past 34 weeks gestation, only to make it to 38, and then to come through his medical problems as quickly as he did. Annabelle, for the victory of finally having the birth experience I didn't know I was capable of. I am proud of myself for conquering my fears and the pain of both experiences.

I am forever grateful for my home birth OB, Dr. Fischbein, for his willingness to take on "high risk" cases (VBAC, twin, breech, etc), such as myself. If it wasn't for him, I would have never been able to know that a birth experience can be a positive one. Going through Annabelle's birth was very therapeutic after what I had been through with Aiden; an experience I will never forget.

Birth Choice

For me, going through a natural home birth, surrounded by supportive professionals and my wonderful husband, was the most empowering moment of my life. While a home vbac, home birth, or hospital vbac, may not be the right choice for every woman who has gone through a c-section, it should be a choice.

Some women who have gone through traumatic labors or deliveries, only to end up with a c-section, and may find it more healing to have a scheduled repeat c-section. For me, going through Annabelle's birth, managing and experiencing contractions, labor, and pushing and then to actually see my baby being born, is an experience every woman should have access to.  The point is, there should be a choice. Her choice.

Tuesday, September 11, 2012

The Home VBAC of Baby Annabelle

Note: to read the story of my c-section with my son, click here

Baby Annabelle’s HBAC (Home Birth After Cesarian) Birth Story

The weekend had started out a bit rough. After feeling run down all week, I came down with a cold (runny nose, sore throat, fever, achy, completely exhausted) on Friday, September 7th. This also happened to be Adam and my dad's birthday. I felt terrible! At this point I was 40.5 weeks along and I was terrified that I would go into labor while I was sick. My biggest worry was that I would not have the strength to get through labor and end up with a c-section. 

On Sunday, September 9th, I felt a little bit better. We decided to take a trip to Sears to get some bigger clothes for Aiden. I felt very exhausted and dazed, but walking around made me feel a bit better. We got home about 4pm and I started to feel a little crampy, so I drank some water and rested a bit on the couch. By 6 pm, the cramping felt a little more serious and regular.  I had been having a lot of false labor the past few weeks, so I didn’t put much thought into it. Just in case, I did all the laundry, packed my emergency hospital bag, and did some last minute preparations for the home birth. While doing all this, I did notice a few things:

  • Ann, my MIL, told me the day before she gave birth she had a surge of cleaning energy… this sure felt like a surge of energy I didn’t have before and it did go into cleaning.
  • The Annabelle-y was REALLY REALLY low. I actually took a photo on Saturday, one of the few preggy belly photos I allowed myself to be in. After being pregnant for 2 years, I felt huge, out of shape, and less-than-glowing. 
 Taken on 9-8-12, Saturday, the day before labor started.
  • I just had that “feeling” something was different.

Once we had eaten dinner, I decided to take it easy so I can hopefully get some sleep. The contractions required me to stop and think about them, but I wouldn’t have called them painful at this point. I texted my awesome doula, Jennifer, and she suggested wine/bath/sleep. I hadn’t had a glass of wine in almost 2 years, so I happily obliged with a glass from the bottle I had in the pantry for just an occasion. I had a very small glass of wine, and settled down to watch tv with Adam and Aiden. I noticed the contractions getting stronger and more regular through the night, but didn’t want to contact Dr. Fischbein (my home birth OB) yet as I had been having a lot of what felt like real contractions (prodromal labor) over the last few weeks and didn’t want to give false alarm until I figured out if it was real labor this time. Around 10 pm, I went to bed to try to get what sleep I could, as I had a feeling  I wasn’t going to pregnant much longer.

I didn’t get much sleep that night. I was able to rest between contractions and stay laying down, but definitely didn’t sleep through them. I got up and walked around the house a couple times. Starting at around 4am the contractions started to get strong enough where I had to get up on all fours and vocalize through them. I got up and made a small snack and waiting until a decent hour to call Dr. Fischbein. At 6:30 am, I called him and let him know I had been having contractions through the night. A this point, the contractions were still 7-10 minutes apart, but were getting stronger. At 8 am our nanny, Adrianne, showed up and took over little dude for a few hours. He was one cranky little dude! He had been battling a cold and getting 3 teeth simultaneously so it was a bit of a rough morning. While Adrianne was here, I decided the best thing for me to do was to keep busy and get a few things done around the house. I shipped about 7 Pretty Pony orders, cleaned the guinea pigs, fed the lizards, emptied the dishwasher, finished the laundry, and finished packing my emergency hospital bag. Dr. F checked in via text every 2 hours for the update. My contractions stayed at a steady 7-10 minutes apart through the morning.

At noon, Adrianne took off for a dr’s apt for the day, and Adam took over Aiden duties. Adam called his parents for some additional help, should I go into more active labor. Aiden had other plans in mind. He SCREAMED relentlessly with his grandparents and even Adam, and seemed to only want me. Adam kept bringing him in to see me, but I think it did more harm than good. I know he is very sensitive to my emotions and he was picking up on my labor pain.

At about 4pm, after almost 24 hours with no change, I was starting to panic. I texted the doctor and doula and both said I needed to make sure I was keeping my mind clear. With that in mind, I thought it would be good for me to get out of the house and go for a walk. First attempt, Aiden was in his cool car my parents bought him for his birthday. EPIC FAIL! We didn’t even make it past the driveway before he screamed bloody murder. Second attempt was in the stroller and again, we didn’t make it past our sidewalk before he started screaming. At this point, I just wanted away from it all! I screamed, “Im going for a damn walk, if I have to go by myself." So, I left for a walk by myself for about a mile around my block.

I went for the best 45 minute walk, stopping or slowing to a waddle/sway each time I had a contraction. On my way, I met a nice family sitting on their front lawn who asked me when I was going to have the baby and I told them, “It better be tonight!” The mom got very excited and then I got a contraction and starting waddling on the sidewalk in front of their house. She got really excited and said, “Wait, are you in labor right now!?!?!?” and I nodded my head because it was hard to talk during contractions and they wished me good luck. When I was almost home, I met another woman, Lucy, who was out walking her cute older lab. The lab immediately went to my side and inched his head under my hand. The woman asked how far along I am, and I told her I was 41 weeks and in labor now. She told me she used to be an L&D nurse and was very interested to hear I was planning a home vbac. I ended up seeing her again 2 weeks later and was very excited to hear everything had gone well. 
By the time I got home, the contractions seemed to disappear altogether. I panicked at first, but thought I could maybe get some sleep. Eventually, I would have the baby. I locked myself into the formal living room, turned on “The Ellen Show” and bounced on my (pink) exercise ball. After about 30 minutes, I noticed the contractions seemed to return with a vengeance. I started timing them again using the app on my phone. They were 4 to 5 minutes apart. Another 10 minutes went by and I realized I had no idea what was happening on the Ellen Show and could not focus my attention on it. I was finally entering Labor Land!!!! I texted Dr. F and my doula and both said they would be there around 8-9pm.

Jennifer, my doula, showed up around 8 pm. I was deep into labor land at this point. It felt like I was high or drunk. I could hear and sense everything going on around me, but had a hard time opening my eyes and focusing on it. Jennifer came and sat with me, turned the timer off on my phone. I told her I knew my labor was real when I started throwing up about an hour ago and she thought that was pretty hilarious. She got my water bottle, and massaged my back and legs during and between contractions. Adam at the time was busy trying to put a VERY cranky Aiden to bed, so I was thankful for the company and support. The contractions were not painful, just intense and powerful. I found the most comfortable position for me during contractions was leaning over the top of the couch and alternating bending my knees.

At about 10pm, Dr. Fischbein and his midwife, Karni, showed up. I was very spacy at this point and had a hard time opening my eyes up and didn’t want to stop bouncing on the birth ball between contractions. Dr. F checked my BP, the heartbeat on Annabelle, and then started an IV line to give me a dose of antibiotics, as I showed up Group Beta Strep positive a few weeks ago.  By the time they were done, my contractions spaced out a bit because of the distraction and they encouraged me to go for another walk.

At about 11pm, Adam, Jennifer and I went for another walk around the block. At the beginning, I was able to walk fairly briskly, determined to get labor moving. About 20 minutes in, contractions got really strong. I wouldn’t say painful yet, just really strong. I had to lean onto Adam’s back and moan and sway while my doula rubbed my back and timed the contractions. About a block away from my house, I felt like I couldn’t make it. I felt a lot of pressure which was making it hard to walk and could barely go 5 feet before another contraction would strike again. Im sure we made quite a sight moaning through the neighborhood.

We finally made it home (HOORAH!) and I immediately went to bathroom. I was happy to find out I had a little bloody show.  That had to indicate SOME sort of progress!  Dr. F listened to Annabelle’s HR and it all seemed well, so they let me do what I wanted for a while. Adam and I spent some time in the bedroom working through contractions while Jennifer took a break. The contractions continued to increase in intensity to the point where I started getting very vocal. I really wanted some relief so I started drawing a bath. Jennifer came bounding in and said I should probably get checked before I get in to make sure I progressed enough, otherwise the bath could slow labor down. Dr. F came in and I moved to the bed for my first cervical check. I was 6 between contractions, 7 during a contraction with my water bag still intact. I was told I was free to take a bath as needed, as I seemed to be moving along pretty quickly at this point.

Im guessing I spent about 2 hours in the bathtub. I made it to 8, 9 during contractions but seemed to stall out at this point. Dr. F offered to break my bag. I started panicking. I had felt stuck for the last bit of labor, like I was pushing against a bowling ball and not making any progress. I knew that by breaking my bag, things were going to get intense. I was scared. I knew that there was only one way to end labor, and by breaking my water, it would be coming much quicker. Until then, contractions were very strong, but manageable, and I worried how I would manage more intense contractions.

At about 2 or 3 am, Dr F broke my water and I had the MOST INTENSE CONTRACTION of the entire labor. I started screaming and arched my back off the bed. I rolled onto my side, unable to stand it on my back. Seriously how does ANYONE labor on their back in a hospital… I couldn’t stand it for even a few seconds during my entire labor process, even right from the beginning. Jennifer and Adam were in front of me, holding my hands and helping coach my breathing through the contraction (it felt like the longest ever!). Karni sat behind me whispered comforting words in my ears. After a few seconds I was able to finally relax and calm down once the contraction passed.I asked if the water was clear, and it was and I breathed a huge sigh of relief.

I was allowed to get back in the tub, were I stayed for the next hour… the final bit of transition. These were intense contractions. I would (finally) call them painful at this point. I vomited after many of them. I cried a bit, and told them I didn’t think I could do it. Typical reaction during transition, from what I've read. We talked about this afterward- whether they ever thought I couldn’t and needed to transfer. They said I wasn’t saying it with enough determination. Looking back, I knew I didn’t want to transfer. I was more scared of what was to come. I felt like I was stuck between a rock and a hard place. Jennifer and the whole team reminded me that there I needed to face the fear and give in to it and allow myself to move forward.

After a certain amount of time in the tub, I felt like I couldn’t cool down and the heat was making me dizzy and really nauseated, even with cool cloths on my head and cooling the water down. Jennifer suggested a position change and I didn’t think I could make it from our bath to the bedroom, so we compromised with making it to the toilet. Dr F came in and wanted to check my progress and was able to do so while I was sitting on the toilet. I was complete except for a small section that was swelling and stuck. Dr F helped inch the cervix up and over (not fun). After laboring on the toilet for a while, my butt and legs were starting to hurt from the hard toilet seat. We decided it would be best to get me to move to my bed for the "final push." It took a while to convince me to do so.

When I finally made it to the bed, it was time to get down to business. Dr. F, Karni, Jennifer, and Adam all coached me through the pushing contractions. At some point, I think Dr F told me it looked like she big, but totally birthable. This scared me but I felt encouraged when he told me that I could do it. I was warned ahead of time by the doula that because Im athletic and an equestrian, I would most likely tear because I have over developed musculature. He also said he wouldn’t do an episiotomy... Just the mention of the word made me determine to push this baby out asap so we wouldn’t have to come to an episiotomy or vacuum delivery. I trusted his opinion and it gave me the strength and determination to know that this really was something I could and WAS doing. Before I knew it, I got into a decent pushing rhythm. Some contractions seemed more intense than other. I think I yelled at everyone a few times when I felt a contraction starting, more out of fear than needing attention. After what felt like about a dozen pushing contractions and feeling like I was getting no where, Dr F gave me instructions that when her head came out, that I needed to stop pushing so he could rotate her and check for the cord around her neck. I was amazed! I couldn’t believe I was that close to being done! Once her head was out, I was able to grab Annabelle under her arms and pull her out the rest of the way. I pushed my baby girl out in 50 minutes from the time I was started pushing. Born on 9/11/12 at 4:10am. At the moment she was born, while I don't really remember much about that moment as I was so focused on getting the baby out, I was told that I screamed at the top of my lungs, “I did it! I did it! I did it! There is a baby on me!” She was so beautiful and I was soooo tired. 

5 Minutes after she was born- I swear I thought I was smiling but I guess I just didnt have the energy after 36 hours of labor, and not getting any sleep the 2 days before because I was sick.

After she was delivered I noticed, Dr. F and Karni looking concerned. Adam had gone to check on Aiden, who had woken up at some point and to let Ann and Bruce (who showed up to help with Aiden) know I had the baby. They seemed a little frantic in trying to get him to come in and cut the cord. I guess I was bleeding fairly heavily. While my plan was to wait until the cord stopped pulsing to cut it and to let the placenta deliver on its own, because of the bleeding, they needed to do it right away.

The next hour Adam and I were left alone to spend time with our new addition to our family. Jennifer brought us in some eggs and toast (best eggs and toast I've ever tasted). Afterwards, Dr F came in and stitched me up (REALLY NOT FUN!) and had to manually remove some clots (even worse!). Annabelle was weighed and checked. She was 8 lbs 15 ounces AFTER she had taken a giant poop (on me), so I count it as birthing a 9 lb baby. She had 9s on her APGARs. I was helped to take a shower and back into bed and put on strict bedrest for 2 days because of the blood loss. We all fell asleep shortly after that. 

Adam holding his daughter for the first time while I was put back together

Im so happy I finally got the birth experience I wanted. I am so thankful for the amazing support from Dr. Fischbein, Karni, and Jennifer. I can't believe the journey I have been on the last 2 years between going through such a difficult pregnancy with Aiden and then again to have such a positive birth experience with Annabelle. I am thankful for Dr. Fischbein, for his willingness to not be the only vbac provider in the area, but also to fight for a woman's ability to have a choice in how she chooses to birth.  It was long and intense, but I would do it again in a heartbeat. Maybe we will do it again, but let's wait a few years this time before we even think about it!

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