Maria's Successful VBAC Birth Story
Many of you may know that my passion for Labor and Delivery nursing came after a less than ideal birth experience. For a little background, I had always imagined having a vaginal delivery. However, my first little love ended up being delivered via an unwanted Cesarean section. To explain, my whomping 9 pound, 3 ounce baby was face up during delivery, which isn’t the ideal way for a baby of her size to come through the pelvis. At 7 cm dilated, my healthcare team notified me that it was safer to deliver via c-section. I was really disappointed, and further saddened and scared when my baby was immediately taken to the Neonatal ICU for breathing support after delivery. Justifiably, I felt I had missed out on so many of the important birth moments I had wanted.
By the time I decided to have a second child I had been working as a Labor and Delivery nurse for almost a year. I was still adamant about having a vaginal birth if possible. I knew my risks; I knew that I had, what is considered to be, a low Vaginal Birth After Cesarean (VBAC) success score, but I was committed to giving it a try. I followed every suggestion my healthcare colleagues, doctors and midwives gave me in order to increase the chance of a vaginal delivery.
As my due date approached, I knew we would start to talk about next steps if I didn't go into labor on my own. I did all the old wives' tales - I ate pineapple and I curb-walked. I didn't care if the evidence said they didn't work. I was going to try it anyway. A week before my due date my doctor suggested I schedule a repeat cesarean for my delivery. I asked him why and he shared that, in his experience, patients who go into labor on their own before their due date and have what we call a ‘spontaneous vaginal delivery’ are the happiest; The second happiest are those with a peaceful scheduled cesarean. However, the least satisfied are those who chose induction, and their induction ends in a repeat cesarean. He and I talked about the risk of being exceptionally tired if I labored for a long time and ended up with a cesarean again. No matter what option he presented, I knew that I didn't personally want to go the repeat cesarean route.*
(*I do want to add here that my sister-in-law made the opposite choice and has no regrets – there is no universal ‘right choice,’ as it’s really a personal choice!)
On my due date, I reported to my prenatal appointment with my mother in tow. I knew that if someone were going to try and talk me into an induction or cesarean, she would be the one to ask all the questions I couldn't find in my jumbled brain. Thankfully, my doctor told me he was comfortable waiting a few more days for spontaneous labor to start. This was great news because he wasn't offering the type of induction I was interested in at the time and I was still not at all dilated. I called my boss and got my name added to the schedule for the next two days and prayed that hustling around helping other people labor would help my own body take the hint.
Thankfully, when I was 40 weeks and 2 days, the contractions started. I was sure I would be able to support myself in early labor at home and even sent my husband to bed to get some sleep for the big event. Despite my time helping other people, I found it hard to support myself the way I support my patients. My nerves ultimately got the best of me, and we headed to the hospital. I was devastated to find that although I had contracted regularly at home for quite some time, I was only 1.5 cm dilated. Thankfully, I had a lovely nurse that reminded me that dilation meant nothing. She kept me calm and got me in the tub for some relaxing hydrotherapy. Quite a few hours later I decided to get an epidural. After my epidural, they checked my cervix again and I was 5 cm dilated. They also thought it was time for Pitocin; this was mildly triggering to me because it felt a lot like my previous labor, but this time I was ready to support myself. I agreed to the Pitocin, but I turned to my nurse and told her exactly what I needed. I needed a peanut ball and some position changes. She insisted that because I hadn't slept in 30 hours, I should nap first but I would hear none of it.
I could tell my husband and my mother were also feeling triggered, but we tried to keep things light. Now that I was comfortable, I reached out to some friends and realized many people in "my village" were rallying around me. This gave me strength. My doctor asked if I wanted my bag of water broken when I was 6 cm and I agreed. A few hours later I started to feel my contractions again. We considered asking anesthesia to come in and reassess to see if all my movement pulled my epidural out or if I just needed a little more medicine, but this wasn't needed as I was able to tolerate the contractions better and felt motivated by them. I was 8 cm dilated when my cervix was checked again. This was farther than I got in my first labor!
An hour or so later I was completely dilated and ready to start pushing. Three hours into pushing I started to worry again. I knew enough to realize most doctors and midwives don't want you to push too long and that most babies don't tolerate pushing for too long before showing signs of stress. When my doctor came back to assess my progress, he told me I wasn't pushing as well as I had been when I started. He told me he would go to his office across the street to do some charting and come back in 30 minutes.
"Thirty minutes?!?!" I said to my mom and husband. Thirty minutes meant he thought I was nowhere near delivery. Well, that was all I needed to hear to help gain control of things again. My nurse gave me a really good tip about how to push (she said to envision my son nose diving out and shooting up to her face - it sounds weird, but it worked). I told my mom and my husband to let go of my legs so I could have as much control as possible. The next thing I knew there was a lot of chaos. I had pushed my son out to about his eyebrows and they were not ready. I remember thinking how funny it was that after all this time they were still not ready, and I committed this moment to memory so as never to put my own patient in this position. After this, I didn't have to wait much longer before my doctor was back and I delivered my son. He was placed right on my chest just like I had dreamed.
Looking back, I am so happy I had the experience of a vaginal delivery. I am glad I trusted my gut and my body. I got to have that moment I had been dreaming of with my husband and mom in total jubilation as my son was born. This is the moment I had hoped for, and the moment I felt like I had lost with my cesarean. Yet, in hindsight I now see that both my c-section and vaginal birth experiences were equally full of shock and even a little fogginess as things happened so quickly.
My advice to my younger self would be to soak it all in and to advocate for the experience you want. At the end of the day, while each birth experience is unique, it’s important to feel empowered as you’re laboring and delivering your baby into this world!