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This FAQ last updated: February 2006
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
BBW Birth Story Pages
BBW Birth Stories: Baby Malposition Stories
This particular FAQ is on baby malpositions in order to show the effect this has on labor and birth. Although there are many causes for cesareans, it is quite likely that many cesareans today are actually due to undiagnosed or unresolved baby malpositions. However, few OBs pay any real heed to the possibility of malposition influencing birth progress or causing cesareans for "Failure to Progress" or "Cephalo-Pelvic Disproportion" (CPD). Yet it has been Kmom's observation (and her own experience) that many women of all sizes are having more complicated, difficult labors (and often surgical births) because of this problem.
The purpose of this FAQ is to document these births so that women can begin to see the patterns involved and to learn more about malpositions in general. If you are interested in reading more about this, check out the Baby Malpositions FAQ on this website, click on the links within it, and/or read the books, Optimal Foetal Positioning or The Labor Progress Handbook (reference/purchasing information on the Malpositions FAQ).
Unless specifically requested, all identifying information has been removed or changed to protect the privacy of the participants. All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
More stories will be added over time, so keep checking back if you are interested in reading further stories. If you are interested in sharing your birth story, click here for more information, birth story format, and submission guidelines. New birth stories are always welcome; Kmom updates the birth stories FAQs about once or twice a year so be patient for your story to show up. If you do submit your story, please carefully follow the format and directions given in order to shorten the amount of work involved for Kmom. Kmom's family will thank you!
Information About Baby Position and Implications for Birth
There are two terms that are used to refer to how the baby is located in the mother's body, presentation and position. Although some resources use these terms inconsistently, presentation properly refers to which part of the baby 'presents' first at the vagina; in other words, whether the baby is butt-first (breech), head-first (vertex), or shoulder-first/sideways (transverse). Position usually refers to how the back of the baby's head is lying in reference to the mother's spine (towards her spine or away from it, etc.).
For more information on breech presentations, check out the Midwife Archives at www.gentlebirth.org, and also read the book, The Thinking Woman's Guide to a Better Birth by Henci Goer. This websection is NOT mainly about breech presentations, but mostly about subtle problems in baby position because this problem is largely ignored in the obstetric community. In other words, the baby is head-down and so assumed to be ready for vaginal delivery, but because of subtle variations of this normal head-down position, a longer and more difficult delivery occurs, often even necessitating a c-section, yet the obstetric community does not recognize the role positioning played.
It is Kmom's personal opinion (and experience) that many c-sections are performed unnecessarily because of subtle baby malposition problems, and few doctors or even midwives pay close enough attention to the influence of baby's position on the progress of labor. In Kmom's opinion, many c-sections (or long, hard labors) could be avoided with more careful attention to preventing baby malposition, a quicker diagnosis of malposition during labor, and by employing corrective measures during labor if malposition is a possibility.
There are excellent online resources about baby malposition. To see illustrations of various positions, visit www.cefcares.org/fetal/position.htm, read the article by Valerie El Halta on turning posterior babies at www.cefcares.org/doula/FetalPres.htm. Another great resource is the booklet, "Optimal Foetal Positioning" by Sutton and Scott, available from Cutting Edge Press at www.childbirth.org/CEP.html or by calling (802) 635-2142. A more technical but extremely valuable resource on how baby position can cause labor problems is The Labor Progress Handbook by Penny Simkin and Ruth Ancheta, available from www.amazon.com. Kmom highly recommends checking out these resources, especially if you may have had a malpositioned baby in the past.
The basic presentations are breech (head-up), vertex (head-down), or transverse (sideways). In most current obstetric practices, only vertex presentations are considered for vaginal delivery, although some providers trained in the old ways will consider vaginal delivery for some breeches or will try everything possible to turn a baby to vertex before resorting to a c-section. However, most OBs these days simply schedule a c/s if the baby is thought to be breech or transverse.
The following is a description of the most common presentations.
Vertex: Baby is head-down. Most OBs will not deliver the baby vaginally unless the baby is head-down. However, once the baby is head-down, they generally don't distinguish between the subtle variation in positions.
Transverse: Baby presenting with its shoulder or side first; high chance of cord prolapse. Baby either must be delivered by c/s, turn (or be turned) for birth. If baby does not turn and a c/s is needed, the incision may need to be low vertical or perhaps 'classical' (up-down) because of the baby's difficult position. Transverse can sometimes be prevented/fixed through maternal position or external 'version', but few doctors try.
Breech: Baby's head is up by mother's ribs; the baby's bottom or legs present first instead of its head. More risk to baby, either by c/s or vaginally. Most OBs today have not been trained in the art of vaginal breech birth and so routinely deliver by c/s (despite lack of evidence that it improves outcomes); a few midwives and OBs still know how to do breech births and will attempt it.
Position (All Head-Down)
Please note that position terminology refers to how the BACK of baby's head (occiput) relates to the mother's body; occiput anterior (OA) means the back of baby's head is toward the mother's front and occiput posterior (OP) means the back of baby's head is towards the mother's spine. However, most people find it easier to think in terms of where the baby's eyes are facing, and this is the referencing used here.
Common Complications Seen With Baby Malpositions
There are a host of problems often associated with subtle baby malpositions, most of which get attributed to other causes by most OBs. If you've been told your pelvis is "too small", your babies "too big", or that your cervix "just doesn't dilate well", you may well have had a problem with baby malposition instead.
When a baby is LOA (anterior and perfectly positioned), the pressure placed on the cervix is even and smooth, labor advances smoothly and usually fairly quickly, and the baby is usually able to proceed through the soft pelvic bones without problems or delays. The mother's pelvis stretches and expands at the ligaments to let the baby through, and the baby's soft head bones fold like a vegetable steamer at the fontanelles (called molding) to also facilitate easy passage. The labor curve generally follows the accepted 'averages', and the birth usually proceeds without any real difficulties.
When a baby is malpositioned, the pressure on the cervix is placed inconsistently, and it often dilates slowly, erratically, or stalls out altogether, even though the mother experiences sufficiently strong contractions and significant pain. The diameter of the baby's head that presents is usually bigger, which means that more molding of the baby's head must take place. If the baby is at the wrong angle, he may be forced against the pelvis uncomfortably (especially if pitocin is added to augment contractions), which may cause fetal distress.
Often the baby gets 'hung up' or stuck before getting past "0" station (entry to the pelvis proper). This also often causes the labor to be slow and inefficient ('uterine inertia' or 'uterine dystocia'), stop altogether ('failure to progress'/FTP), or keeps the baby from moving through the pelvis despite good contractions or even full dilation and pushing ('cephalo-pelvic disproportion'/CPD, or 'baby too big for mother's pelvis').
For example, although there is more than one possible cause for the following
problems, the occurrence of one or a cluster should raise a high suspicion for
Not all malposition situations follow the same scenario. A lot depends on how the baby begins labor and what happens thereafter. For example, some babies start labor malpositioned but rotate during labor. These babies usually have hard labors but things ease once the baby resolves its position. Most of these babies end up being born vaginally and all is well.
Some babies start labor well-positioned but rotate or shift to a less-optimal position during labor. This may be because of the mother's position (often on her back) or the lax musculature caused by an epidural. These babies often are born vaginally but not easily (and some end up being born by c/s as well). However, most of these babies tend to do pretty well.
The most difficult cases involve babies that start labor malpositioned and stay that way all through labor (i.e., a 'persistent posterior'). Studies show that between 60-90% of these babies are born via 'operative delivery' (i.e. forceps, vacuum, or cesarean). These tend to be very difficult, hard labors, and often the doctor breaks the waters or utilizes pitocin along the way; fetal distress, meconium, or even bruising is not unusual in these cases. Many persistent malpositions result in cesareans.
the years, physicians’ attitudes about malpositions have changed.
In the early part of the 20th century, many doctors were very
concerned at the problems associated with posterior and other malpositions.
Because a cesarean was
such a dangerous operation at that time, doctors developed a number of highly
interventive forceps maneuvers to help turn the baby. Although this was sometimes harmful to the baby, it was seen
as less risky than cesarean surgery or prolonged labor in a ‘stuck’
Over time, however, physicians began to become more and more troubled by the amount of risk posed by some of these forceps maneuvers. Soon, conservative and expectant management become the norm; forceps maneuvers were seen as too risky once cesareans became safer over the years. Since some posterior babies are indeed born vaginally anyhow (generally those that are smaller and whose chins are well-tucked under, or who did not start labor posterior), they reasoned that malpositions are not terribly relevant. In fact, even today, baby malpositions are often not charted at all, even when a cesarean occurs. The size of the baby or the mother’s pelvis (“CPD”) is considered to be the main problem, not the baby’s position.
No one knows for sure why baby malposition occurs. There are probably many causes, depending on the woman involved. They may include an anterior placenta, a woman's pelvic shape, a short-waisted or 'sway-backed' woman, a woman with a previous back or pelvic injury, a woman with chronic back pain, or a woman with a misaligned pelvis/sacrum.
In particular, women with pelvic pain in pregnancy (pain rolling over in bed, pain putting on pants or other clothes, sciatica, pubic pain, low back pain, hip pain, 'freezing' in place, clicking or popping sensation in pelvis, etc.) may actually be suffering from a misaligned pelvis, and may be able to prevent malpositions by getting chiropractic care to realign the pelvis (especially the pubic symphysis area) and balance the supporting ligaments of the uterus. More information on this can be found on this website on the FAQ on Pelvic Pain.
In addition, some midwives strongly believe that a woman's posture near the end of pregnancy (and in particular her posture and position shortly before or during labor) can cause fetal malpositions. Although this may sound ridiculous on the surface, more and more midwives and others are now beginning to pay heed to this, and are finding the utility of maternal position/posture in resolving baby malpositions.
Recently, attention has begun to return to the issue of baby malposition. Childbirth educator Pauline Scott and midwife Jean Sutton wrote perhaps the most valuable contribution on the subject, called Understanding and Teaching Optimal Foetal Positioning. This summarized their experience with diagnosing, preventing, and treating baby malpositions. They contend that greater attention to posture in the late stages of pregnancy can lower the number of cases of fetal malpositions, and that proactive use of certain maternal positions can often turn the malpositioned baby in labor, preventing the high rate of operative deliveries and difficult labors (“dystocia”) common to malpositions.
Childbirth educators and doulas Penny Simkin and Ruth Ancheta have
recently published a new book called The Labor Progress Handbook, which
addresses the same issues in even greater detail, along with other suggestions
for helping labor dystocia situations. A few nurses
and midwives have also written about the importance of maternal positioning for treating
malpositions in recent years, but mainstream journal literature largely ignores
the issue. Of the
doctors who have written about posterior positioning, most are European or
Chinese. Thus, because most of the
information about baby malposition, its influence on labor, and proactive
treatment for it has been written about in foreign journals, nursing journals,
or in midwifery journals and texts, most American OBs do not know this
information or largely dismiss it.
Can fetal malposition be changed during labor, or better yet, prevented ahead of time? The answer is that many midwives and doulas now believe that it can be, but this information is only now just beginning to catch on. For more information on how to prevent or turn a malposition, see Optimal Foetal Positioning, The Labor Progress Handbook. There is also some basic information on this website in the FAQ on Baby Malposition, as well as at the websites at www.cefcares.org/doula/FetalPres.html, www.horns.freeserve.co.uk/ofp.htm, and www.aims.org.uk/posterior.htm.
It's important to note that Kmom has a special interest in this subject because all 3 of her births involved malpositions. (You can read a brief summary of Kmom's births below.) 2 of the 3 births ended up in cesarean, but by being more proactive and educated about birth position, she was able to have a normal birth with her third child (a Vaginal Birth After Cesarean, or VBAC). She strongly recommends that women who have had past malpositions or cesareans for "CPD" or "FTP" read the FAQs on fetal positioning and pelvic pain, and get the books Optimal Foetal Positioning and The Labor Progress Handbook if at all possible.
Terms and Abbreviations
Most moms will recognize most of these terms, but women new to reading about childbirth may be puzzled by some of the terms and abbreviations used in these stories. This section briefly defines some of these in order to help women understand the stories better.
Posterior Birth Stories
Rachel's Story (homebirth, posterior)
Kmom's Notes: A wonderful homebirth, even with a posterior baby (facing towards mother's tummy instead of towards spine).
Can be found online at www.childbirth.org/articles/stories/HH.html
Summary: This mother, a lawyer in New York City, originally intended to have a hospital birth with midwives, but changed her mind after touring the hospital. Also, all her lawyer friends in the area had had c-sections, and she felt there might be a tendency to practice defensive medicine with her due to her occupation. She then considered a birthing center but felt their guidelines were too rigid about transfer to hospitals, causing a very high transfer rate (about 20%). So she found a licensed midwife in the area who delivered at home.
At 8 days overdue, she went into prodromal labor for 3 days (common with posterior presentations). She feels that at a hospital they would have forced the issue much earlier and added pitocin (which may well have caused a c/s if the baby did not turn). She finally went into regular labor on the 4th day, had painful back labor and progressed very slowly (other signs of a posterior baby). She finished dilating but had an 'anterior lip' left on the cervix (also common with posterior babies!); her midwife helped move the lip aside and get the baby through.
Pushing lasted only 40 minutes; she pushed in the semi-standing position. It's not clear if the baby turned before descent. She was born with only very minor tearing. Labor lasted about 15 hours, once it started up in earnest. In retrospect, she found labor hard (understandable with a posterior position!) but was very glad she had chosen a homebirth. If she had been in a hospital, it's quite possible she would have ended with a c/s for 'failure to progress' due to not dilating quickly enough.
Shawn's Story (c/s, posterior)
Kmom's Notes: The circumstances of the labor suggests that this baby might have been posterior and gotten 'stuck'. Note that she had lots of tiring 'false' labor ahead of time, her water broke ahead of time (although apparently not completely), the pitocin augmentation, the fetal distress, stalled dilation, etc.
The midwife felt that the fact that the baby's amniotic sac was apparently not fully ruptured was keeping the baby from moving down, but rupturing it did not improve the situation and probably caused the baby's position to really get 'stuck.' After the baby started having heart rate problems, they decided on a cesarean, which at that point was probably a good idea.
Shawn confirms that her baby was indeed 'sunny side up' but that this was not noted in her medical records. This is not unusual; many doctors don't see posterior position as relevant and fail to note it in records or mention it to parents, yet many other providers feel that it is the cause of many c-sections. Positioning often helps facilitate rotation, but Shawn was not able to try these. Note that having a nurse-midwife did not mean that any more attention was paid to the posterior positioning; although some nurse-midwives are beginning to pay attention to this more, not all are. No certain job title guarantees attention to baby position.
When I went to see my OB about fertility treatments, I remember one of her first comments being, "You really should try to lose some weight prior to beginning treatment...but I have had patients close to your size who have conceived." "Whatever," I thought, "just give me the prescription." After the first cycle of Clomid, we conceived and we were both surprised and elated. MY OB was skeptical, however, and ran at least 3 progesterone tests and two ultrasounds before she was convinced.
My physician had not been derogatory in our visits, but I was concerned about her pessimistic approach to my care. After my second U/S the technician was able to see the baby's heartbeat. What a sigh of relief! Prior to seeing the U/S the doctor kind of walked back and forth past me as though she was preparing to give me bad news. When the U/S Technician finally put the report in the doctor's box she appeared amazed that it turned out so well and then stuttered over the words "Have you rescheduled your OB appointment yet?" Of course I hadn't because a week prior, she had told my to wait to schedule the appointment until after the U/S (as if to say if it's bad there will be no NEED for an OB appointment) So much for positive thinking!
After a great 'start OB care' appointment the doctor commented "things look really good, but because of your low progesterone I don't want you to get your hopes up until after the first trimester." I thought I would never get the green light that my pregnancy was fine. Although the pregnancy had been progressing fine and all signs were good, she was treating me as though the pregnancy was a risky one. Her attitude when I visited her was usually apathetic. I remember feeling that she just couldn't believe that someone my size was having such a healthy pregnancy. Nine UNEVENTFUL months later...to the day (my original due date had been 11/20, but was changed to 11/13 after my third U/S), I began my birthing journey:
Wednesday: False labor pains begin at 2:00 AM and continue on and off throughout the morning and afternoon. About 3:00PM I lost the first of what would be several parts of my mucous plug followed by general crampiness for the rest of the day and evening.
Thursday, 12:00 AM: Contractions begin at 7-10 minutes apart. I figured it was more false labor pains since I had not had a bloody show (but ultimately learned that these were in fact the real thing). I called my midwife when the office opened at 9:00. She thought I may be right in assessing the pain as false labor. I had not slept all night from the pain and she prescribed a sleeping pill. She said, "If it's false labor, the pills will stop them and you'll sleep, but if it's the real thing, you won't be able to sleep through the contractions." I decided not to take the pill just in case. I didn't want to be in pain AND groggy! At 2:00 PM my water broke (although it wasn't as much water as I had expected) and the midwife asked me to come in to be checked. Once there, she confirmed that it in fact my water had broken and then informed me that the fluid was stained with meconium. She also stated that I was only 1 cm dilated and at this point I had been in labor for over 13 hours. She recommended pitocin to get things going. I'd learned that those moms induced with pitocin had very hard labor pains and my midwife confirmed that this may be the case. I told her that I wanted to try it without an epidural and knowing the c/s rate for overweight women, reminded her how important it was to me to wait as long as possible before a C-section was considered. We then left for the hospital.
4:30 PM Contractions still irregular and topping off between 70 and 80. I am confined to bed with external fetal monitor. I am told that I may be able to walk the length of the bed if the baby responds okay to the contractions. So far so good.
8:00 PM After 18 hours of labor, the pain is more than I can handle. I admit defeat and request the epidural.
10:00 PM According to the monitor, contractions are double and triple peaking at 100. I breath a sigh of relief that I can't feel anything but pressure. Midwife checks and I'm still only dilated 3 cm. She waits for a contraction and stretches the cervix another 3 cm to 6!
Friday,12:00 AM: Midwife tells me there have been a few drops in the baby's heartbeat and asks to insert an internal monitor for more accurate readings. Realizing this would confine me to the bed but wanting to do what was best for the baby, I reluctantly agreed. Midwife discovers that my bag of waters had not completely ruptured and may have been delaying the baby's drop into the pelvis. She breaks the sack and the baby moves to -1 station. (NOTE: looking back, I realize that if we had known this back at the office, I may have avoided using the pitocin altogether since the unruptured sack was preventing the baby from moving down into the pelvis, thus stimulating more productive contractions.)
3:00 AM Dilated 6-7 cm. I am exhausted and disappointed, but ask to be given more time before considering a C-section.
4:30 The midwife brings in the doctor-on-call to evaluate. The baby had several heartbeat decelerations after contractions and she was concerned. I am dilated 8 cm and he tells me to push although I have not yet felt the urge. It is unproductive and a C-section is recommended. I begin to cry from the exhaustion and disappointment, but after 28.5 hours, I agree.
5:10 AM Our darling daughter is born. We had chosen not to learn the sex of the baby and although we both wanted a girl, we felt very strongly it was a boy. When the doctor announced "IT'S A GIRL" I cried and cried and cried. She was suctioned well and the meconium had minimal effects on her. Apgars 8 and 9. My husband left to go video the baby for me and I was whisked off to recovery.
I invested a lot of time developing my birth plan and although this is the farthest from my dream birth, my daughter far surpasses any hopes I had for my baby. There were times during the months following her birth when I thought I could have done something differently to lessen the need for the c/s, but in time I have learned to focus less on the way she arrived, and more the sheer joy she brings me and my husband now that she is HERE! I wish all of you the best in your pregnancies and pray that each of you have an uneventful labor and delivery.
Monika's Story (pre-eclampsia, postdue, 2 homebirths, posterior/ compound position)
Kmom's Notes: Be sure to visit this site. Very interesting story, great photos!
This is the story of two homebirths despite some high blood pressure and postdue concerns. The story (with graphic photos) can be found at http://members.home.net/mcmahan/. Below, Kmom summarizes the gist of the stories.
"This mom is a mid-sized BBW. She is not self-conscious at all about being in the very graphic photos, and the photos of baby #2 coming out are just AWESOME. Not bad considering the photographer is the teenage babysitter! Details about the births:
-First baby: high b/p concerns at end of pregnancy; used herbs (their site contains details for those interested). Mom was also almost 3 weeks past her due date when she finally goes into labor. Despite all this, they had a homebirth, though the labor was not easy (the baby was posterior) and the baby passed meconium. After the birth, the midwife was concerned about possible meconium aspiration, so they transferred to a hospital and had a hard time negotiating the bureaucracy and hassle there, but in the end all turned out well.
-Second baby: similar concerns with high b/p but all lab tests are reassuring and the herbs again seem to help. Baby similarly overdue, posterior at first, but this time mom's hands/knees position flipped the baby to anterior shortly thereafter and back labor ceased. Baby was large (10 lbs. 6 oz, considered 'macrosomic' by OB standards; most OBs would have called for an early induction or elective c/s), and did birth in a compound position (hand by head), yet despite baby's size and position, baby was born without any damage or trauma to mom or baby because of the careful handling from the midwife. The baby's older sister (not quite 2 years old) is present for the birth; shortly after the birth she demands that the baby be nursed immediately and that socks be put on his cold feet. ;-) The sweetest photo is of the 2 children, tandem nursing (nursing one on each side) after the birth.
Please note that even very big babies can usually be born without problems *IF THE PROVIDER IS WELL-VERSED IN BIRTHING BIG BABIES*, if mom has full freedom of position for laboring and pushing, and if the provider is patient and doesn't force the issue. Baby size does NOT have to mean a ton of intervention.
The photos are very graphic but beautiful; if you are not sure how birth happens or if you have a hard time visualizing that happening with you, you should go to the site and check it out. You may not be choosing homebirth, which is fine, but reading a variety of birth stories while you're pregnant is very important. And the very graphic photos really help show what happens in birth."
Margie's Story (5 children; #4: c/s, insulin-dep. gd; #5: VBAC, insulin-dep. gd)
Kmom's Notes: Margie has 5 children; this is mostly the story of #5, her gd vbac. The fact that she'd had 3 vaginal births before her c/s increased her chances for a VBAC, as did her supportive staff and taking good care of herself. Her birth stories (all of them) can be found at:
http://pregnancy.miningco.com/health/pregnancy/library/stories/b13797.htm (1st 3 births)
http://pregnancy.miningco.com/health/pregnancy/library/stories/blcameron.htm (4th birth)
Baby #5: This story begins with pre-pregnancy. This was a much planned for baby for a few years before she was even a sparkle in her Mother and Father's eye. I have four children, one of which I had Insulin Dependent Gestational Diabetes with. I wanted to have more children and knew that I would have to deal with this again. We got pregnant on our first try with In Vitro. Our previous son was conceived through In Vitro also. I found out I was pregnant and was very overjoyed. I was prepared for the pregnancy and hoped to make it better than my last. Even with Insulin-Dep. GD.
Only thing I wasn't prepared for was the onset was much earlier than my previous pregnancy. I began insulin at 12 weeks. My previous baby was born via C-Section due to Macrosomia. He weighed 11 lbs and 3 oz. I knew that if I kept with the diet and insulin that I would not have a huge baby. So on with the diet and insulin. My goal was to keep the baby's size down and hopefully go into labor on my own. I wanted to know what it was like to go into labor and not have pitocin. My three previous babies were either induced or augmented with Pitocin. As we were approaching the due date, all tests were showing that she was fine and not at all huge. I had twice weekly NST's (Non Stress Tests) and AFI's (Amniotic Fluid Index) tests. All were great. One nurse did however say that I had a decrease of fluid and was concerned. More on that later.
My due date approached and I asked if I could go another week in hopes that I would go into labor on my own. OB agreed. I thought for sure that I would have contractions and so forth, but by the next week nothing was going on. I had JUST gotten to 1 cm. Insulin-Dependent GDM has many risks. One is the function of the placenta could stop, resulting in placenta failure and stillbirth. That was why all the NST's. When it came time to decide if I would consent to an induction I reluctantly agreed, feeling that this was what was best for my baby. So Induction Day rolls around. I'm instructed to report to L&D with my orders in my hand at 7:30am Monday morning. I'm really apprehensive since my last induction was during a span of four days and I had a c/s anyway.
We get settled into my room. We meaning my husband, my Doula, and myself. They are very nice and sensitive to my needs with the monitors. The L&D nurse made sure I wasn't on them any longer than I had to be. She found out that I'm a clock watcher!!! I had my first application of P-Gel and asked her about my status. I'm 1 cm, 0% effaced, my cervix isn't too soft, baby is head down, and cervix is almost in an Anterior position. At the 2nd application I continued to have contractions on my own for several hours. This brought me to 1+ cm, -2 station, 30% effaced. An hour later the 2nd dose of P-Gel is given. With this exam I am 2cm, -2 station, 30% effaced. We are encouraged to walk the halls. We do so leisurely and this results in some contractions. So after all that walking I progress another centimeter. Monday night at 10:20pm I get another dose of P-Gel and we all get some much needed sleep for the next day. The contractions just about stop.
I am impressed with my nurse's sensitivity to my needs. I had drawn up a birth plan, but did not give it to them. They seem to be just as committed to me having a VBAC as I am. They all have studied my previous birth and remind me often that this is so much more different. After she got past -2 station, I relax. Cameron never made it past -5. Things certainly do seem different. At 4:15am it's rise and shine. I get back on the monitors for a test strip and the endocrinologist orders hourly Blood Glucose Tests. I think this was the most annoying part. He also orders an IV push of insulin as needed. At 5:00am the IV is started and pitocin is started at the lowest dose.
5:35am my water breaks. Remember, one of the nurses said I had such low levels of fluid. I change positions and noticed my water had broken. There is water coming out that is clear. I soak 2 chux pads. The L&D nurse has to rush to get more, I soak 2 more pads. She puts a towel between my legs as the water keeps coming. Every time I laugh, there is more water!!! I soak through another set of chux pads and another towel. Seems like enough water to me. We all cheer that my water broke on its own. Something's happening. Pitocin is steadily increased and contractions are going nicely in a pattern.
At 7:30am the new crew comes in. Our nurse ended up being the same nurse I had the day I had my c/section with Cameron. At first this worried me, but she reminds me that we have gotten further than we ever did with him and this is all together different. This relaxes me and we get ready for the hard work ahead. It's 8am and she checks me. I'm at 3cm 50% effaced, -2 station and my cervix is soft. The monitors around me are really irritating me. We discuss internal fetal monitors. One thing that I was most afraid of was the internal catheter to measure contractions. The nurse shows me that they are much different than they used to be. I had one nearly 15 years ago and the memory was terrible. I realize that they cannot effectively monitor the strength of my contractions with the straps. I'm a big woman and the baby is small. So I agree to the internal monitor for contractions so I will not be over stimulated on pitocin. That alone makes me fear for a rupture. In the 20 minutes that we discuss this and they place the monitors, I progress to 4 cm, 70% effaced and still -2 station. Contractions are 2 1/2 minutes apart and bearable. I can't believe how much the effacing is happening since this usually is the slowest part for me. I also had went from 4cm and 70 to 90 percent effaced to delivery in a matter of minutes with my previous pregnancy. I warn them. The contractions are really bearable and not at all painful. Just a force, but not really painful. They peak quickly and resolve quickly. The atmosphere is still very upbeat and we are playing Hymns on the boom box. This creates a very peaceful and serene atmosphere in the room.
I get my next exam at 10:00am. I have already progressed to 5cm, 80% effaced and still at a negative -2 station. I'm amazed at how easily everything is going. It just seems to roll along. In 30 minutes I progress to 6 cm, 90% effaced and she drops down to -1 station. Still the contractions have not changed or even seem to be that hard. In the next 30 minutes I again progress even further to 8 cm, 90% effaced and 0 station. They tell me I'm in transition. I'm amazed at how easily everything is going and even being in transition, I'm not in that much pain. While I was at 4, I was getting a bit apprehensive that the contractions would get harder to deal with and was asking about an epidural. My previous births were horrendous with the over-stimulation of pitocin. Sue talks me out of it and I agree to forge on through. So I'm at 8 cm and it doesn't' seem to be that bad. It's 11:45am and the OB is called. I am 9 cm, 100% effaced and zero station. The OB gets there and things start to halt. The contractions are getting harder and she isn't coming. I'm getting really concerned that I am some how unconsciously holding her back. They tell me she is posterior and is pounding on my cervix causing it to swell from 9cm back down to 6cm. At this point I am standing trying to get her to come down. I tried going to the bathroom and she still isn't coming down. Her heart rate drops severely and the OB nurses rush into the room. We are really scared at this point because it isn't coming back up. I'm laying on my side with oxygen mask on praying that she is OK. All sorts of things rush in my mind. I ask my husband who is an Elder in our church to give me an emergency blessing. He does and her heart rate normalizes.
I then get an epidural. The epidural doesn't take on a strip going along my belly and I can feel the contractions in a localized area. The Anesthesiologist tells me that this is called a window caused by the position of her head. They turn off the pit drip and I lay on another side to get the medicine to hit that awful nagging spot. Things settle down and I snooze. During this time DH gives baby a blessing by laying his hands on my belly. I didn't find this out till later. It's 3:00 and I'm at 10cm, 100%, and +1 station. They ask me to push. I have to say that I would make fun of the ladies on "A Baby Story" pushing through their epidurals. I now know that it is so hard to push. I haven't pushed in 15 years. I didn't practice this part!!! It was difficult to coordinate the pushing. No one counted in my face and I was really glad about that.
It's 3:15 and we have put the Hymns back on. She is slowly moving up and her head is crowning. I'm not sure at which point they called the OB. Her head is slowly pushing it's way out. The entire time her head is exposed the OB nurse is gently stroking her head. She is treated gently from the beginning and the tone in the room is quiet and not tense. She decides that she has had enough of the womb and her head pops out. No pushing from me. Then the body just slips on out. She is born and my first look at her is in amazement at her size. All of my babies are over 8 lbs including my 11lbs 3oz boy. She is really long and skinny. The OB walks in fully expecting to deliver a baby. He missed it and gets to catch the placenta. She cries and is cleaned off and placed on my stomach. I get to cut the cord. I couldn't see it and Bill took pictures. They ask me if it is OK to take her to clean her off. They are very quiet and gentle with her care. She is cleaned off and they assess her. She is measured and weighed. 7lbs 9oz. 19 3/4 inches long. Her Apgars are 8 and 9.
One nurse said I was bleeding pretty bad. They call the OB back in and he finds clots in my uterus causing it not to contract. They take care of this and the bleeding slows down. I am sat up so I can nurse, but when I am moved up I nearly pass out. My BP is extremely low. 99/34. They call the Anesthesiologist back in and she puts some medicine in my IV to get my BP up. I continue to have low BP the remainder of my visit. I am able to nurse her and the colostrum is able to maintain her blood sugar. She looks great. As soon as my epidural wore off we were back in our room getting to know each other.
Despite these little mishaps and having to get the epidural, the birth was very positive. I was able to have a VBAC. I did not submit a birth plan to the floor. I wonder if my doula did since everything I asked for was honored. I nearly got everyone I asked for. It almost seem too good to be true. During the entire time of my labor, a friend of mine is calling and being called to update my lists on my progress. I have an enormous amount of support and prayers during this time. This birth is a triumph. Not only that I got the most beautiful baby in the world, but that being diabetic I was able to make it post dates, I had a small baby, and she had no side effects of my diabetes. Most important that she was born a VBAC. She was at one point a twin. Her brother or sister was 10.2 weeks before he/she died in utero. We will always hold that precious baby in our hearts. But we say Welcome to the World to this baby.
Postscript: Breastfeeding does not go well, due to the anemia from all the blood loss after the birth. Additional factors may also include low thyroid levels and abnormal nipple shape. This was very disappointing but the baby did get the benefits of colostrum and some early milk.
Franny's Stories (PCOS, induced vaginal birth, posterior, forceps; cesarean for breech baby; home VBAC)
Kmom's Notes: Another case where the baby's position makes the birth difficult until it is fixed. In this mom's first birth, it was probably the combination of the hands-knees maternal position and the doctor using forceps that helped the baby to turn and be born vaginally.
Franny's second baby was breech. This may reflect a tendency among women who have had prior malpositions to have future malpositions as well. This may reflect a pelvic misalignment more than anything else, and we speculated that regular chiropractic care could help prevent position problems in the future.
She got that chiropractic care in her 3rd pregnancy. Did that help her to a vbac? Hard to prove. It's notable that this was the only pregnancy of the three without a malposition, so the chiro care may well have helped. However, she might have had a VBAC even without that care. It's more like an extra step to take, just in case.
Another notable thing about Franny's story is that she was told that she had to sign up for an elective repeat cesarean because her hospital didn't offer VBAC anymore. Fortunately, there were other choices in her community, and rather than being forced into unnecessary surgery against her will, Franny gave birth at home with a good midwife. And then she had the strength of will to write about it for her local paper!! She put those local doctors on notice that women will NOT be forced into unnecessary surgery!
Baby #1: I gave birth at the hospital where I worked at the time. I am an RN; I was working OB at the time and delivered with my 2 best friends as my nurses.
My B/P was elevated at my 38 week appt. and being the beginning of July and very hot and busy on the hospital floor where I worked, my MD sent me home with bedrest. I was swelling, but not spilling any protein and my labs were ok. I got a Non-Stress Test (NST) and baby looked fine. The next week we scheduled my induction because B/P and swelling continued and my cervix was favorable (ripe).
I entered the hospital at 6 a.m., my IV was inserted and pitocin began. I was having contractions, but they weren't anything. I was 4 cm when I started out. I walked the halls and rocked in the rocking chair. My husband and his parents were there. I worked on OB at the time and a Radiant Warmer Representative was there to in-service the staff on a new Warmer. I stood in the hallway with my IV pump and listened to his in-service at 9 a.m. By 9:30, he was done and I was tired, feeling contractions, but they weren't uncomfortable. I thought, if this is going to last all day I'm going to try to get some rest.
I went back to bed, got hooked back up to the monitor and my contractions were every 2 minutes, palpating moderate, but not uncomfortable. I had been laying down for 15 minutes and just got my eyes closed when I had 3 strong contractions that I had to use my breathing techniques through (I had coached so many other labor patients that I felt like I could do it). Then my water broke. Talk about warm soup down your leg! The contractions got really strong then. I was 5 cm. Got up to the bathroom to get cleaned up and got some pain medicine, Nubain 10 mg. I got back in bed, turning side to side and in 2 hours I was 8 cm. The contractions hurt, but they ended and knowing there was an end to every pain was a relief in itself. Back rubs, ice chips, and a cool washcloth over my eyes helped tremendously.
At 1 o'clock in the afternoon I started pushing. I pushed sitting up, lying on each side, on the toilet, standing up, squatting, and regular old lithotomy. I just couldn't get him to budge and I had pretty bad back pain. He was posterior. After 2.5 hours of pushing, I got on my hands and knees and pushed every other contraction because his heart rate was dropping. Finally, my doctor came in and I got a spinal in case I would have to go for an emergency c-section. They got me all set up for delivery and the doctor used forceps. After 3-5 contractions with pushing and pulling, we got him turned face down and delivered at 4:35 p.m. He was a bit exhausted and got a little oxygen, but cried well and after an hour of stitching, mom got to feed him. He nursed for 20 minutes like a trooper.
Baby #2: I was due 4/7. We knew dates for sure because we got pregnant with the assistance of Clomid and Glucophage for PCOS. My pregnancy really went quickly and pretty smoothly. From about 28-34 weeks baby was breech except for one brief period. Around 34 weeks I started doing the routine to turn her---lying on the ironing board, used a moxibustion stick at home, homeopathic pulsatilla, prayer, relaxation, imagery, talking to the baby, flashlight, music, the whole nine yards. I was on the verge of a breakdown about 35 weeks...called my midwife crying, "What am I going to do?"
We had talked about delivering breech and they weren't really sure. I had an appointment on Friday 3/14 for a consult with the OB (he's probably in his mid-50s and still does some vaginal breech deliveries) who backs up my CNM and possible External Version. We had planned to deliver at a birth center. That was all I was planning. I was thinking positively, I was relaxing and working on the imagery I was planning to use for labor...this baby was going to have a peaceful delivery and I was going to have a healing, positive birth.
I am a RN and work as a prenatal care coordinator for a community health clinic. I do home visits, education and referral for pregnant moms on the Medicaid program. I have worked as a doula in the past, but don't have time for it at present. I teach childbirth classes and had a class on Tuesday 3/11 from 5-7. Talked with a couple for about 30 minutes after class, then drove home, picked up my son at church (my husband is a pastor). We came home, I [ate] and read my email. I had just got Ina May's new book via Fed Ex that day and while my son was winding down...I started reading in the recliner. I had been sitting there about 15 minutes when I felt warm and wet---I jumped up so I wouldn't get the recliner wet and freaked out, "OH NO, that can't be my water!" When I pulled down my pants in the bathroom there was a lot of blood. Now of course, I'd just worked about a 12 hour day, moving constantly, and not really noticing much movement from the baby. In class that night we talked about Cesareans and abruption was going through my mind. I'm absolutely losing it, my heart was pounding, I was shaking all over, I'm shaking now just remembering how I felt. I read Prenatal Parenting early in my pregnancy and I had worked really hard on remaining calm and talking to the baby, taking fetal love breaks, especially when I'd had a rough day---now when she decides to come, I'm a mess.
I called DH on his cell phone. "Come home now, I'm bleeding." It was about 10 p.m. My son could tell I was worried because he was right there. "Mommy, are you ok?" (Side note: The next evening at Bible Study he asked for prayer for Mommy because she "Pooped blood in the toilet and it looked like Koolaid." He's still talking about that night!) DH got home, helped me find my midwife's phone number and we called her. She was a voice of complete calm, "I'll meet you on OB. It's probably just your water." DH has never driven so fast in his life! Now I was nearly a month early, I had just gotten finished saying that night at class that I would probably go close to my due date, I was too busy to have the baby early, I had home visits scheduled through the end of March, blah blah blah. I had no bag packed, had no comfort items gathered, had only 2 outfits for baby clean...I didn't have the crib pained, had no mattress, didn't have a pediatrician picked out, had not pre-registered at the hospital, I was going to deliver at the birthing center for heaven's sake!!----I WAS NOT READY!!!!
We got to the hospital and up to OB. They wanted me to change my clothes, I wanted heart tones. 130s, but very little variability...My midwife cam in and did a quick ultrasound, the baby's head was under my right rib cage, her bottom was inside my right pelvis, and her feet were over my cervix. My midwife sat on the bed with me, held my hand, and said, "We are not comfortable with delivering her vaginally this way, you need to make some decisions." DH went down to sign me in. When he came back I bawled in his arms for a few minutes then collected myself. My midwife and I talked about VBAC and she said that the doctor still did VBACs and was very pro-VBAC and had a good rate....I think she said ~80% success rate for VBACs. I made it clear that if the baby was OK, she was to be with me at all times. If she was not with me, DH would be with her. My midwife said that the pedi on call was a stickler about the baby going to the nursery, but she would do what she could.
DH's parents arrived to stay with my son during the birth. IV started (after 3 tries), into a gown, consent signed, we went to O.R. After the anesthesiologist got my fluids in (she about froze my arm off pushing about 700 cc in 10 minutes), she sat me up for my spinal (again, third time was the charm). The doctor was at my feet, my midwife at my side, and nurse on the other side. They were all awesome!---kept trying to recruit me, though. I laid back down and felt everything go to sleep, boy that is a funny sensation. With [my first child], the spinal took the pain away, so it didn't feel so weird. With no pain, it just feels like they put lead in and made it all go to sleep, kinda pins and needles sensation. They put my catheter in (gave me the option not to have it at all, but I figured I'd probably not want to get out of bed for a little bit once the spinal wore off and I knee it was also in place to make sure my bladder wasn't nicked during the surgery, so I got it).
I informed everyone that if my baby was ok, I wanted to keep her with me. I got this weird sense of humor and was defensive by joking about things, I was kinda strange. My BP bottomed out at 60/40 and my heartrate was going nuts in the 120s. She gave me something for my BP and I felt a little better. DH at my side, they started my baby's birth; tears rolling down my face, I asked him to pray with me. DH prayed from the moment he placed his hand on my face until we heard them say, "Here's baby." My heartrate came down to the 90s while he was praying and the anesthesiologist said, "Wish we could bottle that."
During prenatal ultrasounds, we had a brief peek to see girl parts, but never saw them again (breech), so I was not getting my hopes up. I knew that they would see sex before she was even out, but they weren't saying anything! After her birth, the doctor made the comment that he went in and felt limbs, he grabbed two and started to pull them out, but had an arm and a leg, had to go back and find a matching set. She cried quickly and after a peek at her, to the warmer. The pedi checked her over and I kept talking to her, "Keep crying," "Hello Amy," etc. I had tears streaming down my face and into my ears. They wrapped her up and handed her to DH; I got to touch her. The anesthesiologist held her face right next to mine so I could talk to and kiss her.
The doctor held a section of cord up for me to see. "See why she wouldn't turn around?" She had a true knot in the cord that was really pretty snug. He felt that she was lucky to be here and that she would have probably not tolerated the version we had planned for 2 days down the road. Now, I have seen true knots before, even after vaginal deliveries, and everything was okay, but I also assisted a twin delivery where one twin had a knot and was stillborn, the other was ok.
The anesthesiologist offered Demerol to help with cramping and I refused because I didn't really want to see my supper again. I asked to have my placenta and the anesthesiologist said, "Well, what on earth for?" I said, "Because it's mine!" I got my placenta in the freezer, going to plant it with a Magnolia tree outside Amy's bedroom window. (I had a Magnolia tree outside my window growing up.)
The pedi took her to the nursery. DH followed and picked up our son and my in-laws so they could see her and 10 minutes later when my surgery was over, the nurses and doctors took me to recovery, and my midwife went to get Amy. I got her to the breast within about 45 minutes after delivery. She was cuddled up with her head on my breast...My son came in and asked me, "Did you get your miracle, Mommy?" More tears. He got to see her, my in-laws were in the hallway looking in, and DH was walking around with my placenta in a bucket under his arm. Back up to the OB floor at 2 a.m., got my morphine [Patient-Controlled Analgesia] pump and slept off and on through the rest of the morning with Amy on my chest. [We] ended up skin to skin for quite a bit of that time. They checked me often, but basically left me alone, never asking to take her to the nursery for her admission bath, etc. I got out of bed for the first time around 10:30 a.m. the next day, got to oral pain meds and my IV out around noon. Kept Amy with me around the clock and nursing went well. Went home Thursday afternoon around 3:30 p.m. I refused her Newborn Screen on discharge and brought her back that Saturday.
OK, the last thing I wanted was a cesarean. But what I was praying for was an empowering, positive, healing birth and even though I didn't have the natural birthing center birth, that wasn't what I was praying for. Next time I will be more specific, but I did get control in my birth experience, I was hyperaware of what I was feeling emotionally, physically, and mentally, and I feel I was so prepared for coping with pain that it has made my recovery super rapid. As far as healing, in that I feel like I can delivery vaginally without the medical need for management. I have not had that yet, but our daughter is named for 3 very special women, 2 very dear to me. Amy's birth was healing to me in that way, a healing I didn't even know I needed, but God took care of nevertheless. Positive, a resounding yes, I have a beautiful baby girl with a perfect round head, she has dimples just like mommy and lots of dark hair.
Did I get what I wanted---no, but I did have control over what I did get. Did I get what I needed---definitely. I will no longer feel sorry inside for women who had to have a cesarean, but instead I will ask how they felt about their birth. That is so much more important. A cesarean is not fun, it's not natural, it can be unnecessary, but it does sometimes save lives, and it is a birth of a precious little one, and an event that is no less memorable or special...Sometimes we just need to be reminded of it.
Amy was 6 lbs., 14 oz., 20.5 inches. She is a good baby, nursing well. At three weeks of age she is 8 lbs. 5 oz., solely breastfed, and I have an additional feeding built in for pumping. I love the Lansinoh Ziplock bags for breastmilk storage, and the Avent pump is great. It's like "I can't believe it's not electric!"
Update: Franny went on to have a home VBAC too. This is her VBAC story.
10 days past my due date I was miserable and called my midwife for help (this pregnancy lasted more than 2 weeks longer than my first and 6 weeks longer than my second...I felt like I was pregnant forever, add to this that I took off work for maternity leave at 38 weeks and I felt a little like an elephant, in more ways that one). My midwife recommended that I see the Chiropractor and get a massage. I chose the latter and by evening (Wednesday) my contractions had started.
I went about my normal activities, fixed supper, went to church, bathed the kids, put kids to bed, went for a walk. Contractions were regular, but not very strong, more like annoying. Thursday AM we were to drive an hour away to see the midwife...I didn't think I could handle being in the car that long, so I told her to head our way. (She has 7 kids of her own, the youngest just turned 1 in November). I napped and felt like they were fading away and she said she'd just drop in to see how I was. I had gone into work for a bridal shower on Tuesday and one of my co-workers, an OBGYN Nurse Practitioner said I should just go to the hospital and have another cesarean since I was so far over my due date...had a lot of mental work to do to get over that.
Midwife arrived at 3 and I told her what I was thinking/feeling and she helped me get rid of it and by 3:30 my water broke. By 5, my doula and our friends that were going to watch our kids were present and I was starting to get uncomfortable. Around 7pm, I was 4cm (the first time my midwife ever had her hand in me). I got in the tub ( borrowed a spa in a box from a friend) and got hot, then had to get out to cool off. I had just attended a Michel Odent conference and had his words in my head. If a woman gets in the tub at 4 and makes no rapid progress after 2 hours, he recommended a cesarean. I kept thinking that I didn't have the urge to push, so had I made progress? After dark (9ish?) I got back in the tub and was very cold, my husband found a space heater and was holding it on me next to the tub and jokingly went "oops" faking dropping it into the tub and it took me over an hour to get back into a regular pattern. Had to get into the shower to get warmed back up and they encouraged me to drink some really salty hot broth.
By 11 I was loud and hurting, they also tried to cram a peanut butter and jelly sandwich and juice down my throat...PB is NOT easy to get down with 'labor mouth'. I was all over the place position-wise, remember enjoying a forward leaning position. I starting pushing around midnight, although my midwife said I wasn't *really pushing* until about 1 or so. Was in the tub when I started to push, but kept a rim of cervix and got out to the birth stool so the midwife could help hold it while I pushed. While on the birth stool I remember saying, "I give up. Take me to the hospital, Help me" and they gave me some homeopathy. When she was crowning I got back in the tub.
The midwife said I have 'a large perineum' and so it felt like crowning took FOREVER. I remembered what It was like with Daniel and I realized that I ever got to the point where I could push past the pain and make progress...I finally figured out the pushing thing this time...but the pushing into the pain to make progress, then the contraction ending and feeling the baby slide back up and knowing I'd have to push back through that pain again with the next contraction was nearly overwhelming. I was on my knees in the tub, resting my head on the side of the tub, Aryn put his arm along the back of the tub so I could rest my head and I accidentally bit him...didn't even realize I was doing it until he flinched.
I got to the point where I felt like my urethra was going to explode and I reached down to support my labia and felt her head...It didn't take long from that point...it was so empowering to realize how close I really was. Once her head was out, her body followed quickly, the midwife just allowed the water to catch her. Once she was out, I flipped over and reached for her. Within seconds, I was pulling her up so I could see her, unlooped 2 nuchal cords and brought her out of the water to my chest. She opened her eyes and looked at me and started to whimper. No lusty painful scream, but more like..."Wait a second, what just happened?"
I felt between her legs and discovered she was a girl, but waited until our son came into the room to lift her out of the water for him to see and announce. I was convinced I was having a boy because my pregnancy was so much like it was with Daniel...Instead I have a little girl that looks just like her big brother. I was out of the tub about 30 minutes after her birth and we left the cord attached for about 2 hours, at that point we were able to cut without clamping and it fell off when she was 4 days old. I had a small 'scuff', but nothing worth messing with suture-wise. My midwife had a herbal bath to soak in with Abby and it felt wonderful...had to learn the hard way to strain out the herbs though :-0 clogged the tub.
Abby nursed very well and my milk was in by 24 hours. She never lost weight. Was 8-5 at birth, 2:04am Friday, October 14th and was 8-9 on Monday evening. Abigail has been a joy, a wonderful baby. Sleeps through the night (started at about 1 month) and was smiling by 6 weeks. She does have some gassy spells, but they are brief. Will definitely do it again!!! But will wait until Abby is in preschool or Kindergarten...a newborn and a strong willed 2 1/2 year old is just way too much for me!
This was an editorial I sent to our local newspaper after my daughter's birth explaining my decision and outcome in relation to the release of 2004 C/S rates. Several of the OBs in our area were really ticked and found out that I was the Childbirth Educator at the local Medicaid clinic and were not happy. Our Medical director wanted me to assure him that I was not teaching or encouraging homebirth in my class. I replied that I simply told my story and that I did not believe that homebirth was an option for our clients for 2 reasons...they can't afford the out of pocket expense of homebirth and local docs refuse to provide back up.
The results are in and 2004 saw another increase in surgical birth rates -- 29.1 percent of women delivered their babies by cesarean last year, according to a National Center for Health Statistics report released last week.
I chose not to become a statistic
Some doctors cited the reason for the increase was that more women are having elective cesareans, but keep in mind that "elective" does not mean that it was the woman's choice.
Earlier this year when we discovered we were expecting our third baby, I visited my OB/GYN to begin prenatal care. I was informed that we would be forced to have a cesarean if our baby was born at their hospital simply because I had a cesarean with my second child.
The cesarean rate has increased astronomically in the past 30 years: 5.5 percent in 1970, 16.5 percent in 1980, and 22.7 percent in 2000. The World Health Organization states that the cesarean rate should be 10 percent to 15 percent. Our bodies have not changed in 30 years, but medical management has. Although some babies have been saved by surgical delivery, a look at maternal and infant mortality rates show that nearly 30 countries lose fewer moms and babies than the United States and most of those countries have lower cesarean rates.
Having a vaginal birth after cesarean (VBAC) carries nearly half the potential complications than repeat surgery. Due to a 0.5 percent to 1 percent risk of uterine rupture, The American College of Obstetricians and Gynecologists has put very strict guidelines on VBAC, stating that the doctor and operating team need to be immediately available.
American Academy of Family Physicians guidelines noted that there are other problems that occur more often, and they found no evidence suggesting better VBAC outcomes based on the availability of resources. American Academy of Family Physicians went on to state that policies for VBAC "appear to be based on malpractice concerns rather than on available statistical and scientific evidence."
So, how'd I do it? I hired a midwife and kept my OB/GYN as backup. I found a doula -- someone trained to provide emotional and physical support during labor... and obtained a portable hot tub for pain relief. I ate well and read to educate myself. When labor started, my midwife came to me, and my daughter was safely born at home in water.
I'll do it again with my next baby. As long as doctors and hospitals do not allow alternatives, such as midwives, birthing centers and natural options for pain relief, more informed women who want to be able to make their own decisions will join me.
Kimberly's Story (posterior, induced vaginal birth)
Kmom's Notes: Another 'typical posterior' story. Her bag of waters broke before labor (not unusual with posterior babies because they tend to put uneven pressure on the amniotic sac), she dilated but had an 'anterior lip' (9.5 cm) that was difficult to finish, and she 'got stuck' in the second stage (pushing), almost leading to a c-section. In the end, however, the baby came unstuck and was born face-up just as she was being wheeled in for a c/s. Although it's not easy for a baby to be born posterior, it can certainly happen, especially if the baby's head finally molded enough to go through, the head slipped into a better position, or the chin suddenly tucked down (which reduces the head diameter that has to go through). Whatever happened, something occurred that allowed the baby to be born suddenly.
As a follow-up note, Kimberly notes that her first baby was also posterior (turned after hands/knees position), and that her mother and maternal grandmother also had some posterior babies. This second baby had a touch of jaundice, but that is common afteraffect of induction with pitocin.
I guess you could say I am a classic example of how average and "normal" a pregnancy and birth can be for a larger woman. C was conceived easily, one month after we started 'trying'. My pregnancy was fairly uneventful, except my doctor actually got concerned that I was LOSING weight. I found that my heightened sense of smell, couple with all-day morning sickness made eating a less-than-wonderful chore. In the end I delivered at a weight of 269 and left the hospital at 249, almost 20 lbs. less than pre-pregnancy. All of my health-care providers (nurses, etc.) were fantastic throughout the pregnancy, and I only had to ask once for the large bp cuff (new nurse).
My labor was induced with iv pitocin because my water had broken without real contractions for more than 12 hours. The presentation was [posterior], which slowed things down considerably, and put me in misery with back labor. During the final hours of labor I spent at least 2-2.5 hours on my hands and knees with my husband and nurse applying pressure to my lower back to manage the pain. The nurse also talked me through a lot of visualization, who knows if that helped? It almost seems like I was keeping her stuck because I couldn't relax through the pain.
The baby "got stuck" trying to pass into the birth canal and the doctors had decided that a cesarean was in order, which was fine by me at that point (was stuck at 9.5 cm, fully effaced for over 2 hours). When they mentioned c-section I finally relaxed because I knew that I wouldn't have to do the impossible (push her out) and BOOM there she was. The baby had other plans!
As I was being wheeled across the hall to the shiny metal-filled delivery room, she decided she was coming "unstuck" and fast....I was crowning in the hall and I shrieked that the baby was coming NOW and a nurse reached down and held her in till we got to delivery. She shot out like a wriggling cannonball (as my husband put it) about 5 seconds later. She had a touch of jaundice but that didn't even require bili lights and we went home about 40 hours later.
Maddy's Story (2 c/s, 1 posterior VBAC, due soon with #4)
Kmom's Notes: Another posterior baby story. She used a combination of patience, homeopathic remedies, rocking the hips, and the 'all-fours' position to turn the baby, plus a tub to help cope with the pain in the meantime. Labor stalled at 6 cm, common with posteriors. But because they were willing to wait things out and not force the issue with pitocin, their proactive measures did turn the baby and resulted in a VBAC; in most hospitals this would have turned into another c/s.
Baby #1 was a 42-week planned c-section for breech. The doctor wasn't comfortable trying to deliver her, and couldn't turn her (the cord looked like it might be around her neck). No labor or cervical changes at all.
Baby #2 was also a 42-week baby, an attempted VBAC with "midwives." (Hah! I trusted in the "midwife" label, but they really knew next to nothing that could have helped me. Spontaneous labor began the day before I was to be induced, but I was "only" progressing 1 cm every few hours, which wasn't fast enough. By the time 30 hours had passed, I was "stuck" at 6.5 cm, and had a beta-strep infection, so I consented to a c-section.
The hospital was horrid, and I vowed never to go back there, no matter how far I had to travel. Later, I learned that not eating, and being tied to the bed to "get a good reading on the monitor" had probably significantly contributed to my "failed" VBAC effort.
With Baby #3, I searched everywhere for a caregiver that would give me the benefit of trusting my body to do its job. I needed to move, I needed to eat, I needed to progress at my own pace. I called everywhere, and visited two local practices. One doctor took a look at my chart and told me, "You're overweight, you're out of shape, you failed at labor twice before, you don't progress, and you're going to end up being sectioned anyway. This is a waste of your time and mine." I picked up my jaw from the floor, and moved on...
I was ready to drive almost two hours to a midwifery practice, but one more doc was recommended to me, just across the state line (about 15 miles away). He was wonderful! He calls himself "a midwife in a doc suit," and it's *so* true. He truly believed I could do a VBAC, and was willing to work with me.
Because the first two babies were 9 pounders at 42 weeks, I consented to using a prostaglandin gel to see if we could coax a smaller baby to come at 40 weeks. For three days, I had three gel treatments a day, doses of castor oil, herbal tinctures, homeopathic remedies (pulsatilla and Kali Carb 30) to turn a posterior baby... I had decent labor during the day, went home at night--not too bad, except that by the third day, I was still only about 6 cm dilated--the same place I got stuck last time.
I consented to having my water broke, even though it was a bit earlier than I would have liked. My contractions completely stopped for almost six hours! They suddenly returned though, hard and heavy, at which point, I used a tub (what a lifesaver, especially in getting my own weight off of my back!), and a lot of hot compresses on my back. After three hours of hard back labor, the baby rotated around from her posterior position. Another two hours, and I had dilated the final 3 cm, and she was born!
It was the most wonderful, exhilarating experience of my life. I did it! I actually conquered the beast within, and my body worked as it should, to birth my baby. Funny thing was, even at 40 weeks, she was right at nine pounds anyway! But I did it, with no pain medication, no pit drip, no c-section!
My doc said, "You had the most functional dysfunctional labor I've seen... way to go!" I know I would have been sectioned eight times over anywhere else. The staff was so supportive, and no one made any of those horrible comments like the one nasty doctor had made. (I did want to take my baby and hold her in his face and say, "How's THAT for a waste of time?!?!")
Here I am, almost three years later, with a midwife (new to my area, and absolutely terrific!) who "doesn't see any reason whatsoever why I can't have a home birth." I'm still the same size, but I'm a different woman... I'm confident, I know my body can do it, and I'm looking forward to a great home birth!
Update: Maddy had her home VBA2C just recently! She had another girl, and this baby was 9 lbs. 11 oz. Below is her short version of the birth story.
I had labor off and on all week, so my midwife came Wednesday afternoon to see what we could do to get long and strong and steady labor. I agreed for her to strip my membranes, and things kicked in quickly then. From 7 p.m. to 1 a.m., I dilated from 5 cm to 9-10 cm. I would contract well for an hour or more, then they would slow down and I'd sleep for 45 minutes of so, with contractions spreading out to 5-10 minutes apart. Then my friends would get me up and get me back to work again.
I started pushing about 2 a.m., in the bathroom on all fours, then with one leg half on the toilet seat and me sort of crouching over, then standing....you name it, I tried it!! She was moving down but would NOT crown! My perineum is like vinyl, they said. ;-) She was "right there" for over an hour, and in spite of hot compresses and massage, she just wouldn't crown completely. So my midwife snipped (her second episiotomy EVER!!!), a tiny, tiny little snip, and let me tear from there.
I pushed her out slowly---her head stopped AFTER crowning, but before it was out, and I got a great look in the mirror, and FELT her head finish delivering!!! It was SOOOO cool!!! Then the rest of her came out, again with me feeling her descent and move out---one shoulder at a time...and then it was DONE!!!.....She nurses like a pro, and we're doing well.
Becky's Story (posterior, fetal distress, c/s)
Kmom's Notes: Classic malposition story. The baby's posterior position was discovered only AFTER the mom was fully dilated and pushing and the baby was firmly stuck; a posterior is difficult to turn at that point. Baby displayed some fetal distress (another possible side effect of malposition) but her apgars were good.
I was scheduled for an induction on Mon. the 27th and it looked like I would get in sometime in the afternoon, but I hadn't felt any strong fetal movement since Saturday so they had me come in for a NST. The nurse said that baby's heartrate should spike up when I had a contraction or when she moved but it didn't, so they admitted me at 10:00am and by 11:00 I was hooked up to the Pitocin (I was already dilated to 4 and 80% effaced) and boy, did it work quick!!
The Doc. was in and out checking the heartrate and seemed concerned about it enough to tell me that if it didn't pick up when she moved we might need to do a c/s. So, he put me on an oxygen mask for the whole time (yuk) and attached the internal fetal monitors. [Kmom note: Internal monitors means they must have broken the waters at this point if they hadn't already, which may have fixed the baby's position.] I almost came off the table it hurt so bad...she was still at a -2. Finally [the heart rate] started to go up like it should (whew!). He was also concerned about my BP, it was very low...85/40 average.
When the contractions got too bad to handle (about 2:00pm) the Doc. said I could have an epidural, and then all was good for a while. By 5:00pm I was fully dilated and ready to push....we pushed for 2 hrs. and by the end I kept telling them that it hurt really bad on my right side, the Doc. came checked me and said that she was face up and stuck firmly in my pelvis....so a c/s was our only option. I was very scared and upset, my mom and DH were in there with me and I made them both cry (I was a baby), they had my husband change his clothes and whisked me off into an OR.
The Anesthesiologist pumped up my epidural and we were prepped and ready at about 7:15pm, it felt like my doctors were going to yank me off the table but she was wedged in there pretty tight...it took them 7 min. to get her out after they opened me up. She was born at 7:28pm she weighed 8lbs 1oz and was 21 in. long, and her apgars were 9 & 9.
She looks like I took her to a salon to have her hair highlighted, it's auburn and red with blonde highlights in it. Everyone at the hospital told me how beautiful she is (and she is!!). Well, it wasn't the most wonderful experience but I would do it all over again if I had to. G is so sweet! Nursing is going well too, she's a pro at it....and she even started in the nursery on bottles and pacifiers, so if anyone says that you can't nurse with big breasts (mine are G cup) tell them to take a hike!
Lisa L's Story (induction, c/s)
Kmom's Notes: Lisa shows classic signs of a malpositioned baby: prodromal labor for a long time (including going overdue), back labor, feeling an urge to push too early, no progress in pushing despite strong pushing for a long time. The baby was also big, which could also have been or added to the problem, but it's difficult to know for sure what happened. If the baby was indeed posterior, breaking her waters committed the baby to that position and basically ensured the c/s. In a follow-up, Kmom asked her if the baby might have been posterior. She wrote back and confirmed that "she turned during labor and was face-up which contributed to having the cesarean."
I was 42 weeks pregnant, very healthy, but baby did not want to come out. On the day that I went in to be induced I was 1 1/2 cm dilated and 40% effaced and had been in mild labor for two weeks. I went into the hospital on November 24 and had a cervical pill inserted to help soften my cervix which would hopefully help me dilate more. They inserted this pill 3 times at 4 hour intervals but labor got strong just an hour after the first insert (7:00pm on 11/24).
After a restless night and much back labor, accompanied by many showers and much walking, they broke my water at 7am on 11/25. By 11am I was only dilated to 2 cm and getting antsy as my contractions had been one on top of the other for 17 hours. Finally at noon I received an epidural with no complications at all. During this and throughout my pregnancy my weight was never an issue.
At 5:00 I felt the urge to have a bowel movement and when the midwife checked me I was 6 cm dilated and progressing quickly. By 6:00 I was a full 10 but only 90% effaced and I began pushing. After two hours of watching her head bob in and out with contractions and pushing they decided on a c-section because her head was too large.
D was born at 8:13 pm on 11/25/98 perfectly healthy at a whopping 10lbs 4oz. Mommy healed well and overall the birthing experience, though long, was well worth the end result. I am now due on 4/10/00 with a boy and hope to be writing back with a successful VBAC story!
Danie's Story (PROM, posterior, partial abruption, premature, group B strep, c/s)
The full story can be found at www.childbirth.org/articles/stories/aidan.html. A very difficult birth story; the baby and mother turned out fine in the long run, but getting there was very traumatic for them both. Below is a brief summary.
While visiting a dying aunt, Danie's water broke at about 35 weeks. She did not know it but she had group B strep (infections can cause the water to break prematurely). She had a terrific OB who was very Bradley-oriented and supportive of natural birth, but due to complications she eventually needed a c/s (a truly necessary one).
Her baby was posterior and so labor was painful and not very effective, and during labor her placenta began abrupting (pulling away from the uterine wall). The baby went into distress. When the baby was born, he got pneumonia from the group B strep, one lung was punctured by the suctioning they did, and he was eventually found to have a hole in his heart. However, they did manage to establish long-term breastfeeding despite all the barriers, and he is doing well now in the long-term.
Leah's Story (gallstones, posterior baby, vaginal birth, postpartum hemorrhage)
to be used in FAQ: “Leah” Age:
Pre-pregnancy Weight or Dress Size: 275 lbs.
Baby Info: 7 lb., 14oz. 20 inches GIRL!
Wt. Gain in Pregnancy: initially lost 30 pounds, gained that back plus maybe 10.
Infertility Problems? I got pregnant on our first try
Any Complications: Post Partum Hemorrhage, Strep B, OP Baby (back labor)
Type of Birth: Vaginal
Birthplace: hospital Provider: OB
Breastfeeding: I breastfed for 6 months
Special Notes on Pregnancy: I had gallbladder attacks during my pregnancy
Kmom's Notes: An induction is an induction, whether it's by "natural" means or by the artificial drugs used in the hospital. When you rush labor or try to strengthen it artificially, contractions tend to be harder and you risk the baby not being in an optimal position for birth. This is what happened here.
This mom did an an amazing job of lasting through a long hard labor with an OP (occiput posterior, "sunny side up," i.e., baby facing towards mom's tummy) baby. This is not an optimal position for labor and birth, and it can be extra painful too. Fortunately, it all worked out; although many posterior babies end up being born by cesarean, some (like this one) do end up coming up just fine despite being posterior.
My birth story can be found online at http://www.ordinary-girl.nu/princess/birth.html
After 3 months of marriage my husband and I decided to get pregnant. I ended up getting pregnant on the first try. Everything was textbook except for the gallbladder attacks that I was having (quite severe) which I had BEFORE I got pregnant also.
I was 6 days overdue when I drank CASTOR OIL to go into labor. I ended up having a very long labor (as my daughter was OP), and at 8cm a plateau for hours.
was threatened with either a c-section or an epidural. At that point I was so
exhausted and tired (it had been Sunday evening when I pushed myself into labor
and by then it was Tuesday Morning) I went ahead with the epidural and had my
daughter 2 hours later. I also had
a post partum hemorrhage.
In a way I felt like I had failed at my attempt to go naturally, but my instructor told me that I made the best choice with the options I was given. I left with a good feeling, and look forward to my next pregnancy and birth. The second time I hope I'll be wiser, more patient, and I'm definitely still going to go natural.
Sandy's Story (SROM, indctn, posterior vagnl birth; normal birth; SROM, Cytotec, posterior vagnl birth, possibly septic baby)
Kmom's Notes: This mother's stories are a good reminder that although more problems are associated with posterior positions, sometimes posterior babies ARE born vaginally anyhow! This mother had 2 babies (#1 and 3) who were posterior and were born vaginally. (It probably helped that both posterior babies were small.) Baby #2 (who was not posterior) was a 9 lber. and the only one who was born at 40 weeks. Note how much easier that birth was, despite the baby's larger size. A good position helps, especially in a big baby!
With both of the posterior babies, the water broke ahead of time (as it often does with posterior babies). As a result, both labors were induced. This practice is questionable. It's true that babies whose waters have broken ahead of labor are at higher risk of infection, but the strongest risk factor for infection in this situation is vaginal exams etc., which are more common during an induction. (Placing Cytotec in the vagina, for example, already exposes the baby to a higher risk for infection, which is what they are trying to prevent by inducing!)
Many midwives have found that if the mother's temperature is monitored carefully, careful hygiene is practiced, and no vaginal exams are done, infection risk is lower and it is possible to wait longer for spontaneous labor. So it is questionable whether this mother really needed to be induced after her water broke (if they had omitted vaginal exams). However, it is a common practice.
Using Cytotec at home, however, was a very questionable choice by the midwife, as it has a higher rate of uterine hyperstimulation and fetal distress associated with its use. One has to wonder if the two doses of Cytotec were associated with the baby's problems after the birth at all. It sounds from the description like the baby was feeling the affects of the drug, and as a result of being sleepy and "out of it" became dehydrated. However, there is no way to know for sure what the problem was with the baby, or why it occurred. It's possible Cytotec might have been part of the problem, but there could also be other explanations.
After baby #3 was born, they suspected the baby was either dehydrated or septic (from whatever cause) and took him to the hospital for further tests. They went through some very difficult times as they tried to find out whether he was septic or not. In the end, the tests seemed to indicate he was not, but of course they had to treat as if he might be, just in case, which was very hard on them all.
Breastfeeding in particular was very difficult to establish under those circumstances. It's an amazing tribute to the mom that she was able to preserve bfing in a situation as difficult as that! What a testament to her love and dedication. Happily, the baby is still nursing at 26 months.
Baby #1: I read all sorts of material while I was pregnant, but I really didn't understand how prepared I would need to be for the birth. I naively thought I could decide to have an unmedicated birth, trot off to the hospital and have just what I wanted. Wrong!
My water broke at 38 weeks. I had been to the OB's office that day and was told that the baby definitely wouldn't come for at least two weeks. Being a first-time mom, I got all excited and off we went to the hospital. Mistake #1!! The doctor said to go if it would make me feel better. I wish he had said, don't go until you're having contractions! I ended up spending a long night waiting for something to happen----and nothing did.
The next morning I was informed that it was time to induce and Pitocin was begun. In all my reading I hadn't come across "back labor" and was totally unprepared for the pain. I expected pain in the front, not the back! After several hours, I asked for pain relief and was given Stadol. This did nothing except make me feel woozy and unable to concentrate on the contractions. I didn't realize until after the birth that the baby was posterior.
When it came time to push 12 hours after the introduction of the pitocin, my OB (in solo practice) was unavailable and a doc I had never seen came to deliver the baby. I pushed just a few times, he performed an (unnecessary in my opinion) episiotomy, and I had a beautiful 6 lb. 13 oz. little girl. I required several stitches to close the episiotomy. I decided at that moment that I would do things differently next time.
Baby #2: Because of my first experience (which wasn't bad, just not what I wanted), I determined to remove myself from the hospital setting for this baby. I found a birth center and a midwife that I adored. This pregnancy was very different in that I was nauseous 24/7 for over 8 months. Because of that, I gained very little weight (15 lbs.).
I started having contractions on a Monday evening around 10 p.m. and went to the birth center shortly thereafter. My labor progressed more quickly and I had much more freedom to move about and find positions that were more comfortable. When it came time to push, I found that lying on my left side was most comfortable. My 9 lb. son was born around 3 a.m. without drugs, and I had a very small tear that required just one stitch. Three hours later, I was home in my own bed.
Baby #3: Baby #3 was conceived almost 10 years after my other children and I was 42 at the time. Had he arrived on his due date, I would have been 43 at his birth. Before we conceived this child, my husband and I had determined that we wanted a home birth.
I found a midwife practice in my area that did home births and made an appointment. At my first visit, I asked if they were bothered by either my age or my weight (around 295). They were very accepting of me as I was and I knew I'd found the caregivers for this birth.
I was very ill with this baby and spent a lot of time lying down to try and control my stomach. Several of my favorite foods made me really ill and I was unable to drink milk at all. When I could eat, I tried to eat healthfully (though I did have a thing for cinnamon sugar pop tarts...). Still, I lost 40 lbs. by the time I delivered. It was obvious that the baby was growing well, though, and so there wasn't concern about the weight loss.
Because of my age and weight, I had researched the possible problems associated with pregnancy. I was well aware of the risks and the higher probability of having a Down's or otherwise handicapped baby. Still, my husband and I decided against testing. I had one ultrasound, mainly because we wanted to know the sex of the baby and I took the GD test. We passed on all other tests.
When I was 37 weeks, on a Tuesday evening, my water broke. I settled in to wait for labor to begin. Early Wednesday morning I had regular contractions and thought we were on the way to the baby, but by mid-morning they stopped. I spent the afternoon taking some vile herbal from my midwife, hoping that labor would begin. I did NOT want to go to the pitocin route again. Still nothing happened. Around 5 in the afternoon, my midwife suggested Cytotec. I was leery, but did some research on the net and felt it was worth the risk--even with a homebirth.
At 7 p.m. the first dose of Cytotec was administered. In just a bit, a nice steady pattern of contractions began and I was pleased with my choice. I was having back labor again as this baby was also posterior but managed better this time with pressure and a heating pad. I had two friends with me as well as my two midwives, my husband, and my two older children. They all provided wonderful support.
A second dose of Cytotec (around 11 I think) sent me into instant transition. I had experienced transition before, but this was much different. The contractions were more intense and almost non-stop. Around midnight, I began pushing. Before I had felt relief at this point, but this time pushing was just as painful as the earlier contractions. I pushed for 37 minutes and birthed a second son weighing 7 lbs., 4 oz. I had no tears and felt wonderful once the baby was born. He was perfect in every way. It was very early Thanksgiving morning and I had much to be thankful for.
The baby seemed very sleepy and didn't nurse well, unlike my other babies. Looking back, that should have warned me, I think, but I was tired too and missed this clue. We went to sleep around 3. The baby woke around 5 but only nursed a few minutes before falling asleep again. Then he slept until almost noon----definitely not normal newborn behavior, at least not in my experience. He continued to sleep most of the day and nursed very little---only once or twice----and I never saw his eyes that day. By evening I was concerned as I couldn't rouse him to nurse and he still hadn't urinated. I tried all sorts of things to wake him with no results. Finally I called the pediatrician about 10:30 Thanksgiving night. He felt the baby was possibly septic or dehydrated and wanted him in the ER immediately.
Twenty-four hours after my wonderful home birth, I was at the ER with my little guy. He finally began to really cry and wake up as the doctor poked and prodded. He was admitted for testing and fluids. We went to the pediatric ward and the baby was whisked away for a spinal tap while I did the paperwork. I was in such shock that I couldn't do anything but cry as I listened to him scream during the procedure (they were two doors away). I decided that was the last time they would remove him for a procedure. After the spinal tap, the floor nurse tried to start an IV. Because he was so little and somewhat dehydrated, she made 12 attempts and was unable to get the IV in. (He was bruised on both feet, hands, elbows, etc. from this when I took him home. He looked like an abused baby.) Finally they got a nursery nurse to put the IV in his head.
It took me a long time to soothe him after all that and every time I put him down he screamed. So, I held him almost every minute of the 3 days we were in the hospital. To their credit, no one said anything when I slept with him---I was ready for a fight over it. Massive antibiotics were given through the IV just in case he was septic. The doctor had been less than thrilled that I had had a homebirth and even more unhappy when I told him my waters broke hours before labor began. Though he made me feel as if this problem had been all my fault, the nurses were quick to say nothing of the sort was true. They told me that they see lots of newborns who had been born in the hospital and who came back for just this same thing. In fact, one told me that she wished she had had the guts to have a home birth and wanted to know all the details. The nurses were absolutely wonderful.
After about a day and a half, his IV came out. I was not about to allow him to be poked another 12 times to get another IV in. They made one attempt and failed. After that, he got shots for the antibiotics. That was traumatic too, but at least I knew he wouldn't be stuck a zillion times. Of course, he developed severe diaper rash from the medicines on top of everything else.
During all this, he was not a good nurser and I was encouraged to give him supplemental formula. This I refused as I knew that it could wreck our breastfeeding relationship. I did try to give him glucose water, but he wouldn't take that either. It took several weeks for him to be a good nurser (and almost 4 weeks for him to regain to his birth weight) but it was worth the effort. We enjoyed an exclusive breastfeeding relationship for 8 months.
We stayed in the hospital for 3 days and he continued on strong antibiotics for 10 days (with several visits to the ped's office). All of the tests for infection came back negative so he probably was just dehydrated and we might have been able to avoid all that. Still, I wouldn't take the chance with my precious little one and I am thankful for the help. I am convinced that had we not gone to the hospital that night, he wouldn't have survived another 24 hours.
Twenty-six months later, our little guy is a healthy, happy nursing toddler. I have had the joy of watching my older children bond with their little brother and learn just what a baby is all about. (Nothing like seeing a birth to help a teenager decide not to have a baby just yet!) If hubby and I were a bit younger, we'd probably do it all again. I'm very blessed!
Laurie's Story (posterior and asynclitic, vaginal birth)
Kmom's Notes: This mom also 'measured ahead' (not unusual in bigger moms) and her docs tried to talk her into an early induction for 'big baby'. Her baby turned out to be just over 8 lbs., even after going to term. Not all babies predicted to be big really are!
Her baby was also malpositioned, probably posterior and asynclitic. She nearly had a c/s because her labor did not progress (typical with malpositions). However, with an epidural, the baby was able to turn at the last minute and she narrowly avoided the c/s. The baby was born with a misshapen head, a sure confirmation of a major malposition. Other signs included prodromal labor for a long time beforehand, lack of progress in dilation, a baby that stayed high and unengaged, and a long labor. Unfortunately, no one did anything about the baby's position; she was fortunate the baby turned on its own.
Because my labor was long, my story is long, so I'll try to do a 'greatest hits' version. I wanted an unmedicated birth. We took Bradley [childbirth education classes], I read insatiably, I armed myself with everything I could find. I hired a wonderful doula. My biggest problem was with my provider, a large group known for their high-risk care.
I was never considered high-risk. My pregnancy weight gain put me over 300 pounds and I had one or two episodes of high/normal b.p. readings but I had a wonderful pregnancy and felt fantastic until the very end.
At 38 weeks I started measuring ahead. Suddenly the doctors began talking about a big baby, shoulder dystocia, induction, etc. etc. One doc pushed me into scheduling an induction. I did, but kept pushing the date back with the support of a female doctor within the group that I really liked. To avoid the induction, I had my membranes stripped twice in my 40th week, too castor oil, did everything you can think of to naturally induce. On Sunday evening, labor began. By Monday morning, my doula was pretty sure my close contractions and vomiting were signs of true labor and suggested I go to the hospital. I did, they checked me, I was still the same 3-4 I'd been for the past 3 weeks. I wanted to go home. They said my b.p. was high (not really) and the baby was slightly non-reactive (not really) and insisted I stay. I did.
They started pit, reasoning that I was scheduled for an induction the next day anyway. I was on the pit the first day for almost 12 hours with no change. I was having contractions (boy, was I!) without any dilation. I had to fend off the doctor on call from breaking my water (he was reaching for the hook without even asking! I wasn't ready for a time limit yet). The baby wasn't dropping past his -2 station. They turned the pit off and agreed to restart it the next morning. I was convinced the baby was posterior and I was terrified after another day they would decide to do a section. I did everything I could (hands-knees, pelvic rocks) to try and turn the baby.
The next morning at 5 a.m. they started the pit---put me on the highest dose and by this time nothing was happening. Nada. My favorite doctor was on call. She agreed to unhook me from all the crap I was tied to (b.p. cuff, monitors, IVs) and let me walk to see what I could do. Two hours later I returned and I was slightly more dilated and the baby was down to a good -1. We discussed breaking the water; by now I knew I needed to make some changes or I was heading for the O.R. After the amniotomy, things began picking up. The contractions became intense but I was till dilating very slowly. A uterine catheter was administered (one more thing tying me down to that bed) and showed I was having really, really strong contractions (I could have told them that) but the baby wasn't budging.
Every time I had a vaginal exam, the nurse/doctor would say with a sigh, "Still at six." I started to give up. After 4 hours of non-stop rushes, I started to lose my focus during contractions. I asked for a walking epidural (and intrathecal). It was nice because I could still walk and use the birth ball to try and move that baby out of his funky position, but the contractions were pushed far, far away. However, it lasted only an hour and a half and could not be re-administered. After it began to wear off and I was still only 6-7, I knew what was coming. My doctor called to talk to my husband. She told him after 52 hours we needed to do the section. By this time I agreed. I was so tired and frustrated and disillusioned.
The anesthesiologist came back and administered a dose of epidural. I was shaved, prepped, cath'ed (by now I had 6 things attached to different parts of my body) and the nurses were waiting to take me into the O.R. when the doctor came in. She said she'd check me one more time. When she did, she got a funny look on her face. Then she stood up and smiled. "Well," she said, "I'll tell you a secret. You're complete." I went from a six to a ten in 25 minutes.
The anesthesiologist looked crushed. I couldn't stop giggling. The epidural wore off in 15 minutes and the urge to push roared through me like I'd swallowed a train. I pushed for one hour and delivered a beautiful baby boy with a crazy-shaped head. That poor thing had been ramming against my pelvic bone for quite a while. In retrospect, I suspect that my baby was posterior and asynclitic and unable to turn himself until the epidural relaxed my deep pelvic muscles. Had I not been restricted to bed in early labor, I think he would have rotated then. I desperately and instinctively wanted to get into the tub and spend all my time on the birth ball---two things I was not allowed to do.
I love that I did almost all my birth unmedicated. Next time I'll complete the process. I knew that my OB group was skeptical about natural childbirth but I was determined to prove them wrong. Next time, I'll begin with someone who shares my views and I won't have to prove anything.
Danielle's Second Story (TOL c/s due to malposition)
This mom has 2 malposition stories in this FAQ. Her first baby was breech, and born by elective c/s. He was also premature because the doctors moved up his due date incorrectly, causing many breathing problems for him, and causing breastfeeding to fail. Her breech story is in the breech section.
In her second pregnancy, she wanted a VBAC. However, they induced her, which strongly reduces the chances for a VBAC. Plus her baby was large and posterior, which often makes a vaginal birth difficult. Once again, the mother is told that a 'small pelvis' is the problem when it really was a malposition problem.
Baby #2 (Zach): I had an uneventful pregnancy, except for a lot of stress due to my husband leaving me when I was 5 months pregnant. Up to that stage I had put on very little weight, but between 5 months and 9 months, I had put on over 45 pounds (yes, it can be done!)
I was induced 12 days past my due date. I was trying for a VBAC. My mother and I turned up at 8 a.m. We sat around for what seemed like ages, and eventually the gel was inserted at 10 a.m. At 8 p.m. that night, still nothing, not even one measly little centimeter. I had had a few contractions but nothing much. They didn't show up on the monitor so I was given more gel. At 10:30 p.m. still nothing showed up on the monitor, even though I was having a lot of pain in my stomach. They said it was not proper contractions; if they were not proper contractions, I don't want to know what real ones felt like! So I gave up and had some pethidine and slept the night at the hospital. The next morning I went back down to the labour ward, was given an internal, and I had dilated 4 cms while I was asleep. But my midwife felt something on the baby's head. The OB/specialist was not sure if it was the umbilical cord or a finger, so I was sent for a scan. By the time I got there everything was okay. No sign of any cord or finger. He was estimated at 9 pounds, 11 oz. (we already knew the sex).
At 9 a.m. the waters were broken and more gel was inserted. At 1 p.m. I was still only 4 cms dilated and in a great deal of pain. But these were not considered to be 'proper' contractions, as they hardly showed on the monitor. They were felt across my c/s scar. [Kmom: This automatically raises the possibility of rupture in people's minds, especially during an induction. Usually, this pain is simply from adhesions from the old scar, but of course it's impossible to confirm that, which is an uneasy thing. In this case, there was no rupture, so it probably was adhesions.]
My midwife and I were not happy with my progress (or lack thereof). So for many reasons we decided on a c/s. Those reasons included failure to dilate, large baby, pain felt across old scar, and baby's heart rate dropping with each contraction. [Kmom note: Here's suspicion of malposition again---stalled at 4 cm, painful labor, no progress, and fetal distress. Also, they felt something was strange about the baby's head---probably the fontanel/sutures being in the wrong place because baby was posterior!]
So I was prepped for surgery. We arrived (my mum went in with me) at the operating theatre at about 2 p.m. A spinal (but only one this time) was inserted and at 2:12 p.m. my beautiful baby son was delivered weighing 10 lbs. 11 oz. He was 65 cms long with red hair and dark blue eyes, with a huge head measuring 40.5 cms (16 inches).
It turns out he was posterior and his head was too large to fit through my pelvis (apparently, even with my huge 5 ft. 11 frame and large bone structure, I have a small tilted pelvis! Typical). [Kmom note: a 16 inch head is larger than usual, as is a 10 and a half pound baby, BUT that doesn't mean the baby couldn't fit. The key here is the fact that the baby was posterior; a posterior baby presents with a much larger head diameter than one who is anterior and correctly lined up. So if this baby had been turned correctly, it might well have fit through. It certainly does NOT mean she has a small pelvis, or even a 'tilted' one.]
After 4 days in the hospital I went home and put all my baby clothes into bags and put them in the garage. My little baby was nothing like a baby---he was the size my daughter was when she was 3 months old! I didn't get a baby, I got a 3-month-old! Zach is now 2.5. He's huge---the size of an average 4 year-old. He is over 100 cms tall. His big sister is even bigger, standing at a whopping 120 cms for a 4.5 year-old. I'm getting used to the fact that these two wonderful children of mine will always be bigger for their ages.
Kati's Story (unmedicated induction, vaginal birth)
Kmom's Notes: It is rare indeed to see a woman (esp. a first-time mom) who is able to do an induction completely unmedicated. Kati did a fantastic job, and was helped by her partner, her doula, being able to be mobile, and her Hypnobirthing instruction.
My husband and I wanted our birth to be as natural as
possible, but in a hospital setting. Before trying to conceive, I visited 4
separate OBs and had full annual gyno exams with each before I decided on my
doctor, even though insurance wouldn’t cover the cost of the extra exams,
because I wanted to be sure to find a doc who I was really comfortable with. I
found a wonderful practice of all women doctors and midwives that emphasized
natural birth. Although my doc suggested that it might be better to lose weight
before trying, it was more important to have a steady weight for at least three
months before trying, and since I was already in good health, doing it at my
present weight (at that point about 245) would be fine. With a little more
exercise, I was down to 234 or so when we started trying.
We conceived within 2 days of deciding to try. I had an easy pregnancy. My blood pressure was very good, and both the baby’s growth and my weight gain were so average my doctor called me “her most boring patient.” I didn’t gain any weight until my 24th week, and then around a pound a week. No GD, no anemia. My only real complaint during pregnancy was a strong lactose intolerance that made me throw up all dairy products, which probably helped curtail my weight gain! My husband and I started Hypnobirthing classes three and a half months before we were due, and practiced religiously together. We also took a breastfeeding class, which was invaluable. A month before we were due, we went over our birth plan with doctor, doula, and even one of the nurses at the hospital.
Celia arrived eight days past her due date. At 4 a.m. on Dec.6, I started having contractions 8 minutes apart, then seven. At a little after 8 o’clock the contractions faded to nothing. About 8:30 a little trickle down my leg made me think me my water had broken. After we determined with the doc at 10 am that it had, we asked if we could still attend an acupuncture appointment we had already set up for 10:45 to try to do that. We were afraid that the doc would make us go straight to the hospital, but to our surprise, when we told her the name of the acupuncturist, she told us to definitely go; she was friends with her, and in fact had had lunch with her the week before! The acupuncture really did start things at that office, although the contractions had faded by the time we reached the hospital.
We tried lots of non-pharmacological induction methods -- walking, using a breast pump, blue and black cohosh tinctures (and Evening Primrose Oil the night before)--but at 6:30 p.m. it became pretty clear that I wasn't going to start labor spontaneously. The baby had actually moved up in the pelvis, and my effacement seemed more like 25% rather than the 75% the doc had found the week before, so we really weren't in the best place for labor. So they suggested a tiny dose of Cytotec; I had a terror of it from the horror stories about high doses, but my OB convinced me that at a very low dose it would be safe. I started having small contractions, but it wasn't enough, so after discussion, we started Pitocin at a low dose just after 8 pm.
By then I had read them the riot act about the EFM, which was
not registering either the baby’s heartbeat or my contractions regularly
without being held in place, so we changed to intermittent monitoring, which
worked fine until pretty late in labor, when we decided to install an internal
monitor...again, another thing I was really afraid of, but it didn't cause any
extra grief and actually allowed me to move around more freely. I ended up on
"level 3" Pitocin, about half a normal dose. At one point, the OB
nurse said, "You know, I'm not seeing any contractions strong enough to
push out a baby; the doc wants me to up the Pitocin," and I whipped my head
up at her and stared at her like an insane person, since I knew these had to be
it. Eagle-eyed DH realized that when I had gone to the bathroom, the machine had
recalibrated to 30 points under zero - so my contractions were half again as
intense as they appeared on the graph. She apologized and left me alone!
Our doula, who had also been our Hypnobirthing instructor, arrived just as contractions started. She was FANTASTIC, and really helped me breathe and visualize through each contraction; we used every technique I learned in class, and then some, and many different positions, which helped a lot. She also corralled and put to use every member of my family in my care. I never did consider using the code word we’d decided on pain meds, nor did I really consider it, except for the moment I mentioned above. After that point I went from 4 to 6 centimeters in an hour, to eight in another hour, and then to ten in just three or four contractions. They put up a nice big mirror to help me see the crowning, which took what seemed forever because Celia had flipped posterior during labor; after 45 minutes of pushing, she suddenly flipped herself over in the birth canal, and it was just one more contraction for her head to emerge, and then one more push to get the rest of her out at 1:25 am on Dec 7. They plopped her on my belly, happy and wet and perky. I think the long pushing combined with our adamant perineal massage before and during birth to keep me from tearing...I just ended up with a little abrasion. I felt just fine after the birth since I didn’t have any meds or procedures to recover from – just the birth itself, about seven hours of active labor.
She weighed 6 pounds,13 ounces, and was 21 inches long at birth, which surprised everyone; because she was so long, they had all assumed she’d be more like 8½ lbs.
Because of the trust I felt in all my caregivers, even with all the interventions I had in the end, it still FELT in the end like a warm, cozy, minimal-intervention birth. And because I had screened them ahead of time to ensure positive attitudes about my size, it never entered into the birth event at all.
My only note to breastfeeding moms: stick to your guns about rooming in, no artificial nipples, and no supplementation unless absolutely necessary, and then only with a lactation aid instead of a bottle. The recovery nurses’ BF knowledge was spotty at best, and we finally gave in to one really difficult nurse’s demand that she give the baby a bottle, which hurt our baby’s good natural latch a lot and took weeks of work to overcome.
Tracywag's Story (posterior baby, induced vaginal birth; induction, cord prolapse, c/s, bfing problems)
Kmom's Notes: This mom had 2 rough labors. Not surprisingly, both were induced, which makes for harder labors. Although it is difficult to prove, many homebirth midwives feel that inducing before the baby is ready to be born increases the chances of the baby being in a poor position for birth, and thus having a rough time.
This mom's first baby was malpositioned for sure, born face-up. It is difficult to know from the story whether the second baby was malpositioned, although it seems likely. Another malpositioned baby could explain why the mother was "late" with her second pregnancy, "needed induction" and why the head had not engaged before labor. However, the baby also had knots in her umbilical cord and the cord around her neck, which might also have been an issue.
Ironically, the CNM in this case decided that labor should be induced in this mother because the baby hadn't engaged yet and the midwife was worried about the chance of cord prolapse. During the course of the induced labor, the water did break and the cord did prolapse, and a cesarean became truly necessary. The question is whether this would have been a problem if the midwife had not forced the issue by inducing labor, particularly with a baby that was probably malpositioned. Perhaps with more time, the baby's position would have resolved and cord prolapse would have been less likely. On the other hand, the knotted cord etc. might have caused a cesarean no matter what.
The mother notes that she had quite a bit of joint pain, sciatica, and round ligament pain. This suggests that she had Symphysis Pubis Dystocia (SPD), a misalignment of the pelvis that often seems to predispose women to malpositioned babies. It's unfortunate that no one suggested chiropractic care for her joint pain and SPD symptoms, as this might have made her more comfortable and might have prevented the malpositions. See the FAQ on SPD on this website for more information.
Baby #1: Induced Vaginal, Posterior Baby
My due date came and went. Baby was high, cervix was tightly closed and not effaced a bit. My CNM stripped my membranes, I drank tea, took evening primrose oil, had sex, walked, tried Castor Oil. Nothing. I got to know the night shift at Walmart well, it was air conditioned there and safe to walk. Ten days overdue, I went to the midwife again. Nothing. She said we need to talk about induction. I went to my husband's office and told him we were having the baby tonight.
We went home, packed, and went out to dinner at our favorite restaurant before checking into the hospital. They inserted Cervidil, and my husband went home to sleep. The chairs they said folded into a bed for the dad to sleep in were rickety old recliners, so I told him to just go home. At seven a.m. the next day, my midwife came in, saw little change in my cervix and asked if it was okay to break my bag of waters. I thought that wasn't supposed to hurt! In retrospect, I must have been tighter than a drum. Contractions started, 5-7 minutes, my mom came down. We talked, read, watched TV. I had lunch at noon and watched the clock as contractions became farther apart. The midwife came to check on me, the baby was still not moving down and labor had stalled. I agreed to Pitocin around 1 p.m.
Ack. Now I had monitors, an IV, and hard contractions. It was miserable. At 5 I couldn't take it anymore. The experts claim this is what you feel just before transition. I had them check me, 4 cm. That's it. [Kmom note: This is typical of posterior labors----transition like contractions at around 4-6 cm or so.] I started crying. I asked for some help, they gave me a shot of Stadol. It helped me relax between contractions, but did nothing during them. By 7 p.m. I was beside myself. I said forget it, I need an epidural. The guy checked my back, then the midwife checked my bottom. 10 cm with a lip. I beat the epidural, I could push.
I never felt the urge to push. They were yelling for me, my husband had one leg and the nurse had the other. I tried but didn't have any idea what I was supposed to do. It helped when the midwife put her fingers in a place and told me to push there.
My delivery nurse's shift ended at eight. She stayed till the end. The baby was face up and my midwife went in and tried to turn her. They were talking interventions and I heard them. Then my midwife said, "Reach down here, that's your baby's head. You can feel it." I touched her little forehead. I managed to push her out, face up, at 10:48 p.m.
My mom yelled, "It's a girl" and they gave her to me. Her eyes were wide open, she was mad. But when they handed her to me she just looked. My husband spoke and she turned to look at him. People started coming into the room. I held her for an hour, nursing her and just marveling. She was so intense and ignored everyone except mommy and daddy.
Suddenly they whipped the drape closed, and took the baby and my husband to the nursery. I was hemorrhaging. It took them nearly 1.5 hours to get it to stop. The nurses kept pressing my belly, it felt worse than labor. I finally told them to stop. Everything was slowing down, then this nurse starts giving me a sponge bath. I kept getting colder and colder and she wouldn't stop. It was making me nauseous. I told her I had to go to the bathroom just so she would let me up. I promptly fainted. They yelled for help, they got me on a gurney, and I was whooshed by my confused husband. I was pretty anemic.
I woke the next day to my beautiful baby, she looked like a Gerber baby---no marks, no squishiness, no cone head. I walked down the hall for coffee. I felt fine. Tired, but fine. I had a little skid mark, no tears, and no stitches. I put on my street clothes and started asking when we could go home.
Breastfeeding was less than intuitive. Everyone and the janitor got a look at my breasts in my short hospital stay. I don't think they knew what to do with larger than an "A" cup, not perky boobs. A friend who is about the same build as I am came to my house with her baby and did a show and tell session that was more helpful than anything else.
One thing that surprised me after the birth was the bleeding. It lasted nearly five weeks, finally petering down to nothing, then just after my six week appointment I started bleeding profusely, passed fist-sized clots and was scared to death. I called the midwife and she said it may be my period returning (fully breastfed and period didn't return until 7 months) and told me if it was more than a pad an hour to come in. I don't know from pads, I had a whole towel rolled up! I don't know what caused it but two other friends had the same thing so I guess it's in the realm of normal.
Although I wasn't super careful about eating when I was pregnant, I was 5 lbs. below my pre-pregnancy weight by my 6 week postpartum appointment.
Baby #2: Induced, malpositioned, emergency cesarean
During the last month of pregnancy, napping and bathing were my only forms of relief from the rash on my body, and this was how I was forced to spend my days. My CNM and my dermatologist could not agree on a medication that was acceptable to both of them.
Joint pain, sciatic pain, and round ligament pain helped complete my discomfort. When I was a week past due, my midwife suggested inducing labor. She noted increasing fluid retention, coupled with the fact that the baby hadn't engaged yet, as troubling at that late date and felt that inducing would give me the best chance against cord prolapse. (!)
I checked into the hospital on Monday evening. As with my first child, the process began with Cervidil insertion. I was set up for a period of external fetal monitoring, and my request for rest, food, and liquids was agreed to. Unfortunately, my heart rate and the baby's were a little too fast for the nurses' comfort. Instead of allowing me to sleep, I was kept on the monitors in an uncomfortable position on my back through the night. They came in once or twice an hour to look at the monitor and take blood pressure and temperature readings. Around 3 a.m. I was given IV antibiotics and a GBS test was done. The nurses on duty were convinced I would end up with a surgical birth and denied requests for food and water. When morning finally came, my midwife came to check me. I had not progressed at all, and she was reluctant to break my bags of water because the baby was still too high. I agreed to Pitocin, and requested an epidural be placed when the contractions became stronger.
I never really felt labor. When I started feeling discomfort, it was more from being strapped in one place. I rolled slightly to my side and the nurse rushed in and admonished me. I explained why I moved and she said the pain was an indication that the medication was working. When I refuted that, she became upset with me. She suggested I get the epidural right then, as the anesthesiologist may not be available later. I knew that was untrue but I gave in anyway. I gave up at that point; I didn't have the strength to fight anymore. I was tied to a bed with tubes, monitors and wires in every part of my body. I sobbed uncontrollably when they placed the epidural; the poor anesthesiologist thought she had injured me. I was just giving up any hope of a normal birth.
As the day progressed, people wandered in and out, and I knew labor was going nowhere. I threatened to rip off the damned BP cuff that inflated and HURT every two minutes (I was told it didn't really hurt). Mid-afternoon my midwife checked me again, there was no progression and couldn't find the head. Since my daughter had been breech until very late, she ordered an ultrasound to see if her head was still down. It was down, it just wasn't where it should be. She had me labor in a belly binder for a while, but I was still strapped in bed so it didn't do much. At nearly 5:30 p.m. my midwife came in to check me again. She couldn't feel the head in the pelvis and was concerned about the lack of progression. Within minutes I felt my water break. The midwife said very calmly, "I've got a cord," as one nurse said, "We've got green" and the other indicated they lost the heartbeat. "Somebody call Tony, stat."
The cord had prolapsed, cutting off all circulation to the baby. The "green" meant that there was meconium staining, an indication of fetal distress. My midwife ordered the surgeon paged and the theater prepared. The midwife calmly explained that she was sorry, but a surgical delivery was the only option right now. The other nurse found the heartbeat and I finally breathed again. At that point I didn't care if they took her out with a fork. My midwife prepped me while the nurse took my husband to dress for surgery.
The surgical theater was buzzing with people and machines. I was strapped onto a board, crucifixion style. I had a very hard time breathing in that position and said so. The new anesthesiologist upped my epidural, and I felt the numbness creep up and up. I no longer could move my arms, then I couldn't feel myself breathe. My midwife unstrapped my right arm and draped it across my face so that I could feel my breath on my hand. The anesthesia crept even higher, I was panicking, and the anesthesiologist told them not to let my husband in. I lost consciousness for a little while, but remember them removing my baby. Her umbilical cord had a true knot in it, and it was wound tightly around her neck. They all commented on how big she was. I listened for what seemed like an eternity. Finally, after the longest minutes of my life, I heard her cry. It was 6 p.m.
They finally let my husband in, and after a few more moments brought the baby over for me to see. I immediately became ill, and they took her away. I was in recovery for several hours, a little room that doubled as a janitor's closet. I kept asking to go to my room, to see my baby. My family had all left. I was told the baby's blood sugars were low, and they had given her a bottle of formula. When I finally got to hold her, it was after ten p.m. She had no interest in nursing, no interest in anything. I felt like I was holding someone else's baby.
I tried to clear away some of the mental fog I was in. I made myself get up, walk, and shower. I wanted my baby with me (I was supposed to be rooming in), and retrieved her from the nurses on more than one occasion. She wasn't eating well, so I requested the lactation consultant. "Breastfeed Only" was all over her charts, as was "rooming in with mom." Despite this, they consistently took her at 11 p.m. to the nursery for ped. checks, and didn't return her. I was told they'd return her when she woke to eat, her chart said she woke and they fed her a bottle. I mentioned this to the lactation consultant; she smiled and said they would never give a breastfed baby a bottle. I handed her photographs.
The hospital provided me with a breast pump, but not a convenient place to plug it in. Meanwhile, I had acquired a roommate---a loud mother of three with lots of local relatives who was happily bottle-feeding her vaginally-born son. There were never less than 5 people in this 8x10 room with two hospital beds and two chairs. I was bleeding from many places simultaneously, trying to maintain some sort of dignity while sorting out my emotions over the birth, all with a perpetual audience and Jerry Springer shouting obscenities in the background. The nurse took the pump away for a lady next door to use and never returned it. I gave up trying to nurse until I got home.
Once we were released things went much more smoothly. I still had the impression that this was someone else's child. Once a day, then twice, she'd manage to nurse. Every two to three hours I pumped. I was moving around fairly well, and even went on a few walks. My toddler seemed to be adjusting okay, and the baby slept like a dream. Eight days after the birth, my incision burst open, dramatically, in public. Since I wasn't feeling ill or running a fever, the midwife said I could wait until morning to come in. They cultured the incision, pried it open and forced some more fluid out. The student nurse was in shock at the amount. The culture tested positive for Strep, e. coli, and another bacteria I had never heard of. They put me on very strong antibiotics (Cipro). Then the real fun began.
The baby started to fuss about nursing, about taking bottles and about taking her pacifier. She also started having very loose, strong-smelling stools. I began a gastrointestinal episode that lasted 11 weeks. I took the baby to the doctor, and expressed concern about her eating. I discovered that no only hadn't she gained any weight, she'd lost it. I was advised to stop all breastmilk. The antibiotic I was taking was causing her problems. I alternated taking her in for weight checks with going in myself for wound irrigation, every day for a month. Every time I went out in public, the fluid would burst again. It didn't take much to convince me to stay home.
After a week on formula, the baby still wasn't gaining. She now had thrush, again from the antibiotics, that caused her mouth to be so painful she stopped eating. The first two rounds of anti-fungal didn't help her, so we went to another, stronger medicine that worked, but gave her diarrhea again. After five weeks, she was finally back at her birth weight. I continued to have weeping from my incision, as it hadn't healed yet, and the midwife ordered me home from work for another 3 weeks. My own gastrointestinal distress progressed to the point of painful bleeding. Vaginal bleeding problems weren't relieved until I was put on hormone therapy 12 weeks after the birth. I would hide in the bathroom and cry as often as I could.
I spoke with the midwife on several occasions about postpartum depression. She gave me the name of some resources, but didn't feel I needed medication at this time. She felt my depression was a normal response to the circumstances.
Mina's Story (posterior baby, vaginal birth)
Kmom's Notes: Doctors predicted a big baby and ordered extra ultrasounds to estimate the baby's size. The ultrasound she had the Monday before the baby was born estimated the baby at 9 lbs. The baby was born a few days later at 7 and a half pounds. Shows how reliable estimated fetal weight usually is! Off by nearly 2 pounds in this case.
This story also illustrates the importance of recognizing the signs of a fetal malposition; in this case, she had the classic signs of prodromal labor and a stall in dilation around 5 cm despite strong contractions. When the OB broke the bag of water to 'get things going,' the baby's position became more difficult to resolve and fetal distress eventually became an issue. The mom also needed an epidural for the pain after that, which is quite common in these situations.
The baby was never able to turn, and the mom had difficulty pushing him out in the traditional semi-sitting position. Fortunately, when turned onto her side for fetal distress, this position allowed her pelvis to open enough to let the baby out, even in the more difficult posterior position. Unfortunately, an episiotomy and vacuum extraction went along with this in her OB's management.
Another effect that seems to be more common with posterior babies is difficulty nursing afterwards. Often this can be helped with chiropractic treatment or Cranial Sacral Therapy to "free up" the nerves that are used as part of suckling, but few people know of this potential resource. Although it is difficult to know if this baby's difficulties in nursing were caused by this problem or something else, nursing difficulties do seem to be more prevalent in babies who were malpositioned or manipulated strongly during birth.
Update: Mina went on to have a much easier birth with her next baby.
On Tuesday, I went for my 41 week visit with my OB. Things were looking good, and I was almost completely effaced and 4 cm dilated at that point. I was told that I probably would go sometime that day or the next, which was very exciting...I'd been waiting for the baby to arrive for almost a week past my due date! My doctor stretched my cervix out and told me to go walk around the mall or something, because she was sure it would bring on labor any minute. My parents were down visiting from New Hampshire, so we decided to go home and drop off my Dad, and then Mom and I would go out to lunch and then go shopping to help bring on labor.
During lunch I started having contractions lasting about 45 seconds that were 3 minutes apart! I didn't think it was "real" labor though, because the contractions didn't really hurt, but Mom was concerned that it could be the real thing because she had very fast and easy labors. So I called my OB's office and was told [to go get checked out]...Of course, once I got to the hospital and got hooked up to the monitors the contractions stopped, so I was sent home to wait for the real thing....I had a feeling that I was going to have the baby the next day---turns out I was right!
I woke at around 2 a.m. the following morning with what I knew was a REAL contraction. It wasn't unbearable for me, but I could just tell that this wasn't just a Braxton-Hicks. I got up and played around on the computer for about an hour and a half while I timed the contractions, which were about 10 minutes apart at that point and were lasting for a minute. I knew that waking up DH at this point wouldn't be a good idea...my mom had volunteered to ride out the early contractions with me if they started at night, so I woke her up. We sat and timed contractions in the living room for about half an hour before she fell asleep on me...So I just sat and relaxed in the living room while keeping track of my contractions myself.
At 5 a.m. DH woke up and I let him know I was having significantly painful contractions that were still about 10 minutes apart, but that I thought he should just stay home rather than get ready and go to work. I sent Mom back to bed and DH went to lay down to try to rest while we timed the contractions...[The contractions stayed far apart] so I went downstairs and cleaned my kitchen while I was waiting, [and visited with my father].
That morning we were scheduled for another Non-Stress Test at L&D around 10 a.m. Because I was having significant contractions, I kind of figured that they would end up keeping me, so DH came with me to the appointment. We got there and they did the NST but also saw that I was having good contractions, so they called my OB to come and see me. Fortunately for me, the OB in my practice that I liked the best was on call that day and so she came to check me out. At that point she said I was 5 cm dilated and completely effaced, but that because my contractions weren't coming closer together that she could either let me leave and come back later in the day or she could break my water. Although I hadn't wanted my water broken artificially, I was also READY to have the baby, so I opted to be admitted and have my water broken.
Once we were admitted we were given the option of walking around for a while to see if my water would break on its own because my bag was bulging at that point. We walked the corridors for about an hour before we had to go back in to be monitored for 15 minutes...I was still at 5 cm dilated. We decided to wait a while and labor longer without having my water broken, so I got up and sat on the birth ball for an hour. The contractions were really strong and I had to concentrate and breathe to get through them....After an hour...my internal check revealed that I wasn't progressing at all, even with strong contractions that were about 3 minutes apart. My doctor asked about breaking my water again, and this time I decided to go ahead with it, hoping that it would speed up my labor and help me dilate more. [Kmom note: This decision probably cemented the baby's malposition and kept him from turning, and led to many more interventions from there.]
Of course, once my water was broken I was confined to the bed and put on the monitors all the time, so my freedom of movement was limited and my contractions became MUCH more painful. After a couple of contractions I was so tired and worn out that I decided I wanted an epidural, which I was hoping to go without but that I had decided I would consider if I felt I needed it. And I definitely needed it---I had labored from 2 a.m. to 5 p.m. without any pain relief and virtually NO rest, and knew that I still had a long way to go. I was also hopeful that the epidural would relax me enough to help me dilate.
At 5:30 p.m...I got my epidural. [The nurse] explained that it could take a while to get my epidural in because I was heavy and there was more flesh around my backbone. (She was heavy herself and had had problems getting an epidural with her previous labors.) The anesthesiologist came in and they got me up on the side of the bed hugging a pillow to my body to help me curve my back out. My contractions were really hard at that point, but I worked to stay still for the epidural. But the anesthesiologist kept hurting me when trying to get the catheter inserted in my back. I was in a lot of pain with the combination of the contractions and the pain of the needle from the epidural. He kept injecting more lidocaine [Kmom note: a local anesthetic] into my back, but the insertion of the needle was still very painful. He tried about 5 times and then called in another anesthesiologist to try. This new anesthesiologist also kept trying (about 5 times) and also couldn't get it in, so yet another anesthesiologist cmae in to try---and I was told that if he couldn't get it in, then they would have to give up. Fortunately, after a couple of tired and going in from a different angle, the last doctor got the epidural in, and the pain all went away within a few minutes. He was my hero!
Once my epidural was in and I was comfortable, DH and my family came back in to keep my company...I had been check right before my epidural and had still been at 5 cm---after half an hour of the epidural my doctor checked me again and I'd dilated to 7 cm, which was VERY exciting as I'd felt that I'd be stuck at 5 cm forever. [The epidural was placed] at around 6:30 p.m. and by 8:30 p.m. I was checked and told that it was time to push. Pushing is somewhat of a blur for me, although it was a LONG time---about 2 hours. After a while of pushing in a semi-sitting position the baby wasn't recovering from the heart decelerations and my doctor thought he had his cord around his neck. Before going to an emergency c-section, she decided to try having me push on my side. We tried me on my left side and the baby still wasn't recovering, so we flipped over to my right side. Thank God we tried the right side, because he began to recover from the contractions and pushing, and I was able to work at moving him down through the birth canal on my own.
After about 1.5 hours of pushing he was down far enough so that they could see his head well when I pushed but I was getting really tired and my doctor was concerned about the baby getting too worn out as well from the heart decelerations, so my doctor suggested using the vacuum extractor to help me push him out. At that point I had basically given up on my birth plan, and the only thing that I still wanted to avoid was a c-section, so I agreed.
It seems that once she started to "help" with the vacuum that things went fast, but I know it was still a half an hour or so before he was actually born. once they brought his head down lower in the birth canal I started to tear, so my doctor performed an episiotomy, which I also hadn't wanted, but like I said, at that point the birth plan was totally out the window. Finally his head was out, and they had me stop pushing so they could take the cord from around his neck. Then another push and he was out!!!
They whisked him over to the warmer so the pediatrician could check him out...and my doctor began to repair me, because my son came out posterior (sunny-side up) and I ended up with a 4th degree tear. So I didn't get to see my son until after they finished with me, which was about half an hour or so. But his daddy got some good pictures of him during that time, so I at least got to see what he looked like right away.
Once I got to hold him I started to try to breastfeed him, but he just wasn't interested, and didn't get interested at all the whole time I was in the hospital. We tried syringe feeding him and having me pump, but that was so time consuming that I couldn't deal with it, so I ended up switching to formula. I'm a bit disappointed that I couldn't get him to breastfeed, but I also know that my sanity is as important to my son, and that he will be healthy on formula as well. I ended up coming home but [the baby] had developed jaundice because of the bruising he sustained from the birth and from not taking in enough food to help clear the bilirubin...so he ended up having to stay in the special care nursery in the bili bed until Sunday evening, when he was allowed to come home. It was hard not being there with him, but I wasn't sleeping in the hospital at all and those two nights of sleep in my own bed were actually a good thing, as I felt better prepared to deal with taking care of the baby once he did come home.
Now that the baby is home I'm exhausted and was quite weepy at first, especially when my parents had to leave just a couple days after he got home...But overall he is a VERY good baby who doesn't fuss or cry very much, is very alert when he's awake, and who usually sleeps for about 3-4 hours at a stretch at night, so it really hasn't been too bad. I'm starting to feel more confident in my ability to care for him, and DH is being a VERY good daddy. It's amazing, but DH went from someone who couldn't be coerced into holding any baby to one who will do just about anything that the baby needs. He loves to hold him and cuddle him and has been helping with the feedings and with changing him...It's really nice for me, as I was concerned that DH wouldn't bond as quickly with the baby as I did, but he seems to have really fallen in love with him.....
In any case, things are going really well, although I'm still healing up from my nasty tear, and I'm tired and a little weepy at times...Right now I'm still getting used to being a full time mommy.
Update: Mina went on to have a much easier labor and birth with another baby. It may have helped that she had a fair amount of chiropractic care between births.
On May 13th I woke up around 2:30am to go help my 19 month old get back to sleep. By around 3:20am he was back in bed and quiet, so I headed up the stairs to go back to bed myself. As I walked up the stairs I had my first "real" contraction, and I was pretty sure that this was going to turn into labor. But, I went ahead to bed anyway, figuring that I'd try to go back to sleep in case it wasn't the real thing. I continued to have 3 contractions about 10 minutes apart, and then they jumped up to 5 minutes apart at around 4am. By 4:30am I'd been having good hard contractions continuing at 5 minutes apart, so I woke up my husband and told him I was in labor for sure. We called my MIL to come and stay with my toddler (she lives about 40 minutes away) and called my parents to let them know we were going to be heading to the hospital. I then called my OB to let her know, and she told me to wait another half hour and then if they continued to head out to the hospital.
Almost as soon as I got off the phone with my doctor my contractions jumped to 2-3 minutes apart! As my mother has a history of fast labors (her last labor was only 2 hours total!), being 2-3 minutes apart made both myself and DH a little nervous. I was in a bit of denial though, and went in to take a shower, figuring that my contractions wouldn't stay that close together...I still figured this was going to be a long labor like I had with my first child, especially because I was pretty sure that the baby wasn't optimally positioned. While I showered my husband timed my contractions, and they were still coming about 2 minutes apart. Chris then decided that he didn't want to risk waiting for my MIL to arrive and try to drive me to the hospital himself, which is 30 minutes away, so he called 911 to get an ambulance to come and get me. We both figured it would be better to have the baby born in the ambulance than in our car!
It took about 15 minutes for the ambulance to get to our house, and at that point my MIL hadn't arrived to watch my son yet. So, DH sent me off in the ambulance and stayed at home until his mother got there. I had him call my friend, who was my other support person for labor, to have her meet me at the hospital, as well.
My contractions stayed fairly consistent while in the ambulance, and they were painful but bearable. When I got to the hospital they moved me into the L&D triage area to see if I was ready to be admitted to an L&D room. They put me on the monitor and pretty much left me there without checking my dilation or anything, even though at that point I'd been having contractions at 2 minutes apart for an hour or more. My friend got to the hospital and kept me company in triage until my husband got there. After being in triage for at least half an hour I finally began complaining because I was having a MAJOR urge to push with contractions, and I knew that I was most likely in transition or close to it, and no one had bothered to check me yet, let alone get me into a room for delivery! Finally, after much complaining they had the house OB check me...and I was at 8cm dilated. So, they got me ready and moved me into a room and got me admitted.
Once I was in the room and in bed my OB came in to check me...and after that short time (maybe about 10 minutes) I was complete and ready to push. They got the bed ready for delivery and then I started pushing. I pushed through 3 contractions (my husband says it was 3, although I only remember pushing through 2...but I'll take his word for it), and while it was an intense experience, it was also quite amazing. Mitchell Frederick was born at 7:29am at 19.5 inches long and 7 lbs., 3 oz. It was so wonderful to not be medicated, to be able to feel everything, and to be able to see my little boy right after he was born, instead of having him whisked away to be checked over, which is what happened with my previous birth. After I held him for a bit and looked at him he was taken to the warmer and the doctor stitched up the episiotomy that he'd made, although I doubt that I really needed it! But, everything happened so fast that I didn't really have time to talk to him about that issue.
So...I ended up having FOUR HOUR labor total, which just seems amazing to me, after having a 20.5 hour labor with my first child. And, what is totally amazing to me is that it seems that the baby wasn't in a LOA position...I was told that when he came out (according to my husband and best friend) he was facing up toward my right leg...and it was STILL a fast and easy labor! I hate to think how fast things might have gone had he been LOA! This labor and delivery was just about perfect in every way, whereas it seemed like everything with my previous labor went "wrong". I will say that this experience more than makes up for my feelings of disappointment from my first labor. This was a wonderful experience in every way, and hopefully future labors will go as smoothly if we choose to have more children!
Dee B's Story (induction, malposition, c/s)
My beautiful daughter was a total and utter surprise to me. It was 1996, I was working at an early ISP, and I was surrounded by 19-year-old male co-workers. My cycles had been irregular since college: skipping six months had happened before and resulted in no more than a heavy bleed. We were using two forms of birth control.
Sometime during April (I think) an egg cell drifted down the tube and met up with its destined partner. Still don't know quite how that happened, but hey. :) And the tiny ball of cells drifted to its new home and settled in, with me totally unaware.
Life went on for me in Silicon Valley. I had what I thought was a short period in May. My breasts hurt like never before, but I paid no attention. July, and I really hated the nausea that came with the office flu. Even though no one else in my department seemed to be affected... besides, we were busy moving, and I'd moved from grave shift to day shift. I was soooo tired from the whole thing. Who wouldn't be?
August, and I went home to NC to be with my family in anticipation of my 25th birthday. Everyone told me California agreed with me: my hair, my skin, I just... well... glowed! Then Hurricane Fran hit right before I went back to CA, and I thought the increased swelling around my middle was due to the humidity. I'd always been a big woman, so if the seat belt fit more tightly than a few weeks ago it was just more evidence for me to get off the train a couple of blocks earlier...
I was answering an email two weeks later when I felt... movement. Given the perspective of my current pregnancy, I am absolutely convinced that my placenta was anterior where this one is confirmed posterior, because the first movement I felt was rather dramatic. The placenta must have been blocking sensation. I instantly cast my mind back across the weeks to when I'd last bled and went pale. Yipe.
Two days later, I spotted. In a panic I went to a doc-in-the-box and was sternly informed that "This is no first-trimester baby." (Spotting turned out to be nothing.) I went to the first OB whose office didn't say "What do you mean, you think you're at least four months pregnant?" The ultrasound was scheduled for 10/1. If I was more than four months, I'd see the OB that day; otherwise we'd set an appointment. So far so good.
Even then I knew that US dates could be off by a lot... by the time I found out my "due date" was Christmas, I knew that meant sometime between the 11th of December and the 14th of January, really. We couldn't judge by LMP, because we weren't sure when that really *was,* so we went by the US date.
My doctor was polite, funny, and supportive. We loved her. I passed the GD test with flying (if sickened) colors. My blood pressure was fantastic, I rarely swelled, I continued to glow. I had a very short time to adjust to motherhood, but even though my father had been an adopted baby, I told people, "Anything I grow in my body for nine months is mine!"
I tried to find Bradley classes, but was told by all the local instructors there was simply no time. It wasn't twelve weeks until my due date, after all, so they could not take me. I ended up taking the hospital courses.
Christmas came and went. I was huge. I wasn't really uncomfortable, but I was concerned. How far along was I, really? What if the date was the 11th of December, not the 25th? What if the baby had an aging placenta? I was starting to thin and open, but nothing was really happening. She was moving a lot, reactive to outside noise, but fear started to creep in.
When the OB did an ultrasound on January 3 and told me my daughter was a minimum of 9.5 pounds, that did it. I didn't know of the variation from estimated weight to actual. I agreed to the induction. Even though I did know about pitocin and its effects, the thought that my daughter was so big meant she was surely overdue, to my mind. Furthermore, my wonderful doctor was on-call at the hospital that weekend. I'd have her there. It would be just fine.
No one told me that that ultrasound being able to see a tiny face, the minute-long back pain I was having with each 20-second BH surge, the being able to see hands and feet meant a posterior baby. No one told me what that meant.
January 4 we checked into the hospital at the time requested, only to be told there was no room for me. That was 7am. We waited until 11am to get a room. I went to the bathroom, only to find pieces of my mucous plug coming out. I knew I was one cm open. I took the plug dropping and light surges I was having as a good sign. Today, I'd have cancelled the induction and said "Ne'mind, we're wandering home. We'll call you when things kick in."
It took them two full hours to get a continuous 20-minute strip on that little minx. Much like her younger sibling today hates ultrasounds and doptones, my daughter *despised* the external monitor. She would not settle down at all. After six hours in the hospital, we finally had a 20-minute strip (and an exhausted kid). They put in the Cervidil and we watched the football game.
At least, we tried to. I've always reacted strongly to medications. The Cervidil put me into 90-second surges with about 45 seconds in between. Furthermore, there was a little hard head pressing against my back. I was in agony. I wanted to get on hands and knees, but the staff wanted me monitored. (My wonderful OB? Birthing other women's' babies and trying to grab sleep.) They told me they needed the Cervidil to get me to four cm. At 6pm, they gave me a second dose because my cervix wasn't opening. Thinning, yes, but not opening.
The only place I could relax at all was the bathtub. It was my refuge. I got a new nurse who was fine with me being in there for forty minutes out of each hour if I would wear the monitor for the rest. At 10pm, I was totally exhausted already from nine hours of transition-type labor and Not. One. Centimeter. to show for it. I was still at one.
The nurse came in and looked at me in the tub. She took a deep breath and said "Look... you're worn out. Let me do this for you. Let me give you a half-dose of fentanyl, and I want you to stay in that tub. I want you to have someone sit with you. And I want you to sleep. Can you do that?"
I had so very much not wanted drugs. I also knew I was fried. I agreed. I slept for an hour, barely aware of anyone else near. At 11pm they checked me... four cm. Time to get out of the tub and on the monitor for real. The IV was set with the anti-GBS meds and the pit... it's time to have this baby!
My compassionate nurse went off shift. I got a businesslike no-nonsense type. Fwoosh went my daughter's waters. In went the internal monitor, screwed into my baby's scalp. In went the internal contraction monitor. In went the tube to keep fluid around my baby girl. In went the pit. Out went my brain.
I am not a visual person. I'm very much a kinesthetic and auditory person. The pain in my back was excruciating, but I could handle it as long as I moaned. If I could just keep that moan on one note, I could cope. Three of those would get me through. Just close my eyes, squeeze the nearest hand, and moan. Three times. Yes. As long as I had breath. And keep it steady... because if it's steady, I'm coping.
I'm told the nurse came in and cranked up the pit four times between 11:30 and 4:00am. I have no idea. My eyes were closed, I laid on my left side, and sang birthsong to my daughter. I vaguely remember switching sides twice. I remember hearing her heartbeat.
At four, the nurse came in and said "Oh, honey. You sound terrible. Let us give you an epidural. You're just not coping. It's going to be at least six more hours." Now, in point of fact and 20-20 hindsight I was. I was starting to shake, though, and I completely forgot about what that might mean. I'd been awake the best part of 24 hours, and the length of the surges was still 90 seconds with almost no time between. I agreed.
They sat me up (without checking me) to give me the epidural at 4:30 or so. I immediately threw up twice. (Clear) fluid gushed from within. It took the anesthesiologist three tries to get the epidural in. I could still feel everything on my left side. The nurse refused to call him back: "Just keep laying on the left, honey." In other words, I still had to cope with every surge just as before.
Except... I had been feeling a change in the way my daughter was resting. She'd been moving from my right side down. I felt her stop moving. Then, half an hour after the anesthesiologist left, I felt her go DOWN and PRESSURE and SOMETHING IS WRONG, call the nurse!
She checked me. "You're good to go, honey!"
The OB finally came in and she was great with me wanting to squat. So I did... and my beautiful girl's heartrate dropped. And dropped. After 45 minutes, we tried the standard hospital delivery posture. Two and a half hours into pushing, the last hour with vacuum, I finally said "I can feel she's not happy. Get her out. She's not moving down."
The operating room was taken. The doctor sat with me for the twenty minutes it took to come free. The baby's heart rate recovered. I moaned through my urges to push. I could still feel everything.
In the operating theatre, the anesthesiologist was *mad* at the nurse. She had never alerted him that my epidural was spotty. He gave me a spinal and sensation finally went away. I am grateful for that, because it spared me some of the horrors some of you have experienced. I came very close, I think, to understanding all too well.
At 8:14am, my *7 pound 12 ounce* baby was born. [So much for the 9 lb. behemoth!! -kmom] From the vacuum extractor mark, she had come down into my pelvis at an angle which still makes my neck ache in sympathy... thanks to the epidural arresting her turn. (I knew something was wrong, darnit.) She showed no signs at all of post-maturity. As a matter of fact, she showed signs of possibly being as young as 38 weeks. We will never know. Blessedly, she breathed, was alert, and nursed like a champion (other than being drug-sleepy... for that, I literally sat her upright on my thigh to nurse until that phase ended). My own recovery was uneventful, except for the recurrent yeast infection at the incision site.
Now, almost eight years later, I know where the wheels fell off that bus. I can point to every decision I made that I would not make now.
At the same time... my body was ready to go into labor, which is different from many women. Cervidil was a horror, and I think my cervix was soft in the first place or I would not have opened to the pitocin the way I did----ahead of Friedman's curve. I was having light surges. I wanted to get into beneficial positions, but second-guessed myself. But the instincts were there.
I know, absolutely and without question, that had www.spinningbabies.com been around then, I would have had a totally different experience. My daughter had been posterior for at least a month. It took reading Sheila Kitzinger to understand that those 20-second surges followed by a minute of pain were, in fact, "posterior" surges. Her more dramatic post-epidural malposition was confirmed by the vacuum extractor mark on the back right of her head. Poor kid. She tried to do her part and turn.
I also know, without question, that my body can make and birth a baby. After all, it made her for almost six months without my awareness, much less help. It came close to birthing her despite the interference. I am a birthing woman. I just haven't actually done it yet.
Now her sibling is wiggling in my belly. I can feel little hands against my pelvis. I knew within a week of conception this time... my dates are absolutely solid. I have a HB planned with a great team. My husband is 100% behind me. Even my parents are on my side. (My 22-weeks pregnant sister, on the other hand, is not... and she will not talk to me about my experience.)
Sometime soon, the lessons we (both DH and I) learned from my daughter will be put into play. And my family cannot wait to meet the new baby... but we will, because we know the possible price of not waiting.
Misha's Stories (PIH, induction, c/s, then 3 VBACs despite malpositions)
Kmom's Notes: The OB blamed this mom's stalled first labor on the size of the baby (which he thought was over 9 lbs.), but the baby was just over 6 and a half pounds. Because big moms measure larger than smaller moms and can have bigger babies, many docs assume that all babes of big moms will be big and are quick to assume that any problems are due to this. Well, the joke was on the OB. After having a cesarean because her first baby 'was too big,' Misha went on to have 2 VBACs, one with a 9 lbs plus baby!
Although we cannot know for sure, the stalled labor Misha experienced with #1 raises the suspicion of a malpositioned baby, especially since baby #2 WAS indeed posterior. However, the doctor managed to turn #2 during pushing and although difficult (and baby was born somewhat distressed), she was able to have the second baby vaginally. With her third baby, there was no obvious malposition, and Misha discusses how different labor felt to her with no malposition.
Misha then went on to have a home waterbirth VBAC with her fourth baby.
Baby #1 (Alexandria Paige): At 22yo, I went into my first pregnancy very excited, but also very naive. I signed up with an OB, ' cuz isn't that what you're supposed to do when you're pregnant? I'd scarcely even heard of a midwife, and certainly not in any modern context. I looked forward every month to prenatal visits, and took every word from the doc's mouth as law. His office gave out copies of What To Expect When You're Expecting to every newly pregnant mama (how generous), so everything I knew about pregnancy and birth was learned from that. I skipped the c/s parts ' cuz of course that wasn't going to happen to me so why waste my time.
After a couple rocky incidents (suddenly getting asthma/being hospitalized for it in the 5th month., and a breast cyst in the 7th) things seemed to be fine and we were getting very excited to meet our baby. Just over a month before my "Estimated Due Date" I came down with symptoms of Pregnancy-Induced Hypertension. I was put on left-side bedrest, and became bored out of my mind watching the OJ trial. I went to twice-weekly BP checks at the doc and played the victim to a tee, loving all the extra fussing over and attention.
Eventually, after a few wks. of this, it was wearing thin. I thought I would "never" go into labor, and was begging the doc to do something. He agreed to try to induce w/ prostaglandin gel. I knew nothing about the risks of forcing a baby out too early, and certainly didn't have any good objective info on drug risks, etc. I figured everything would just happen, the doc would be there just in case something happened to me or the baby, and my body would simply give birth. Oh I would try to do it naturally, but wouldn't feel guilty if I didn't.
at 38 wks. I went in for an application of gel. It took 4 tries a few days
apart, and at 39 wks. it finally threw me into hard labor. 4 hours after the
application, I started contracting and it took only a few minutes for them to
become only a couple minutes apart and brutally painful. My doctor came in and
said, "I'm sending up the anesthesiologist to give you an epidural.
Otherwise you'll be too tired when it comes time to push." I was so happy!
The epidural was great (or so I thought at the time). I could lay there pain
free, sleeping, talking to hubby and family, and just wait for my baby to come.
The rest of the story is pretty simple. As soon as I had the epi, they started pumping me w/ pitocin (again I had no knowledge of any risk - all along the line, we had been encouraged to just sign whatever they gave us - "you don't need to read all that fine print"). About 12 hrs. after labor had started, and being stuck at 5cm for 5 hrs., my doctor came in and informed me I was having a c/s. I started crying, and the anesthesiologist., who was trying to get me to sign papers, said "What are you crying for? You need to stop that so I can get you to sign these." I was scared, and esp. frightened of being awake for the surgery.
I was wheeled into the OR, my husband was not allowed in till after he'd started
cutting (during which time I was freaking out - I NEEDED my husband w/ me), and
I laid there w/ my arms strapped out as on a crucifix, barfing through the birth
of my first child. I heard "It's a girl," and started crying
again. I caught a quick glimpse of a pale little face buried in a receiving
blanket as she was taken to the nursery. Back in my room after being stitched
and stapled, I shook violently despite all the warmed blankets piled on me, and
thought I was dying because the epidural had gone too high and numbed my chest,
causing me to feel like I couldn't breathe. I was finally able to hold and nurse
her 3 hrs. later. The recovery was miserable and painful. As a result of
the pain meds I was taking ( and no one telling us [ that it would make
our daughter so sleepy that she would sleep too long between nursings]) in
addition to my failure to seek breastfeeding help, she was supplemented by one
month and weaned by 3 months.
One side note - during the time when my dilation was "stuck", my OB told me the baby was over 9 lbs. and that was why she wasn't coming down. After they weighed her (all 6 lbs. 11 oz.) I heard him say "Boy, was I ever off!"
I have found one thing (besides my daughter) to be thankful for in having gone through this experience. If I hadn't, I may never have learned all I have about birth and the way it can and SHOULD be, and in turn never would have been able to help reach out to other women who start their pregnancies as I did.
Baby #2 (Samuel Nathan): Sammy was our 2nd term baby. I had had an unnecessary cesarean for my first, and that, along with a couple other things, shaped my decisions for his birth. We had been experiencing secondary infertility for 3 years when he was conceived, and had also lost 2 babies to miscarriage over those yrs. - one at 5 wks. and one at 11.5 wks.
that period of time, my sister-in-law (SIL) attempted a VBAC. She had a young,
inexperienced OB, and had had a terrible first birth experience in a military
hospital, with a very scary placenta abruptio, ending in an emergency c/s.
Sometime around term, she began experiencing some mild contractions and went to
the hospital. They tried to send her home but she and my brother refused to go
b/c that was what had happened w/ their first birth ( and she had begun
abrupting in the car on the way home), so this time they were too scared to
leave w/o a healthy baby in their arms. She eventually ended up with pitocin and
an epidural, and during a fetal scalp sampling, it was discovered that the baby
was low on oxygen, and an emergency c/s revealed a catastrophic uterine rupture.
Mom and baby both lived and are healthy, thank God (though no more babies for
I tell this story b/c it was a big part of my preparation for VBAC. For a long while after SIL's rupture, I was not at all sure I was going to go for a vaginal birth. I was very scared of rupturing, and as yet did not realize the full impact that the interventions have on the uterus. I started talking to birth savvy friends, and began to lean more towards VBAC. After becoming pregnant in fall '98, I joined the ICAN list and started to soak up info like a sponge. I began to feel more confidence, and less fear. Throughout my pregnancy, however, I was still hanging onto fear from the miscarriages. I was very afraid of losing this baby too.
As 40 wks. approached, I started really freaking out. My OB was a fairly decent, hands-off type, in practice by himself in a small town. He was very respectful of how educated I was on birth, and was fine w/ almost all of my birth plan requests. But the problem at this point wasn't him, it was me. I started envisioning a stillborn baby, this baby I'd been awaiting for 3.5 yrs. The night before my 41 wk. appt., he didn't move for an hour. I drank OJ, etc., nothing. I flipped out, and the next morning we decided to break my water the following day.
Ironically, contractions started during that night, and continued all the way up till I got to the hospital the next morning, so apparently he'd decided it was time as well! When I got to the hospital I was at 2cm. As my doc broke my water, he said "Feels like baby's posterior!" Alarm bells rung in my head, but it was too late. Contractions were very mild, but regular, for several hrs. As the afternoon wore on, they picked up, and at one check I was 4cm. B/c of his posterior position, labor became pretty excruciating - my lower back was in agony during contractions. I'd been coping by leaning on the birth ball on the edge of the bed, and dh putting heavy counterpressure on my lower spine, but it wasn't long before I had to just lay on my side on the bed, drifting in and out of awareness. I asked for something to take the edge off, and got Stadol every couple hrs. Around dinner time I was checked again and was heartsick to hear "4cm" again. About a half hr. later my doc came in and checked me himself and said "a good 5cm, stretchy to 6". Whew, that was more like it!
The next several hrs. are very hazy in my memory. The back labor was very painful and I think I sort of zoned out in order to deal w/ it. Finally at 2am I was complete, and began pushing. The back pain during the pushing was unbearable and I got a weak spinal at that point. It didn't help much, but eventually my doc was able to turn the baby in the birth canal. That helped a little, but the pushing was still going very slowly and painfully.
2 hrs. of pushing he was starting to crown, and at that point his heartrate
started to bottom out after contractions. Thanks to the ICAN list, I'd learned
that late decels can genuinely be dangerous, so I knew they weren't just using
this to justify more interventions. It was at this point that everyone started
to bustle around and I heard my doc say to me, "It's a c/s or forceps - we
gotta decide NOW." We chose forceps, and minutes later Sammy was out. He
was blue and limp, and it was very frightening. They whisked him over to the
isolette and gave him some O2 and massaged him, which got him going after a few
minutes. I kept hollering out, "Is he ok? Is he ok?" but no one
answered. Turned out his first apgar was 6. It was a scary few minutes, but once
they put him on my chest, I had time to sit back and realize, I did it! I cannot
even begin to describe that feeling. "On top of the world" is an
understatement. I felt like dancing around the room and shouting at the top of
my lungs - it was the most exhilarating feeling in my entire life!
In retrospect, I realize that my own fear led to me making choices that made for a very difficult labor and delivery w/ lots of intervention. I later read that Stadol can cause fetal and neonatal respiratory distress, and this caused me much guilt. After reading many birth stories, I feel that I was very lucky to have had a VBAC that time, mostly due to my doctor's patience and my own determination. But, on the positive side, it was a learning experience, and showed me how strong I (and any birthing woman!) could be!
#3 (Bridget Grace): When our 2nd child (VBAC #1) was 4 mths. old, we
moved from MI to NC. Since it had taken 3 yrs. to conceive him, we were shocked
to find ourselves expecting again when he was only 6 mths. old! In my heart I
wanted a home birth this time, but wasn't ready. I halfheartedly picked an OB
group on my insurance list, and went for one visit at 12 wks., mostly b/c I
wanted the u/s they use routinely at 12 wk. visits to date pregnancies, b/c I
wasn't exactly sure when this conception had taken place. It turned out that my
dates were accurate w/ my suspicions. Anyway, after the u/s as we were talking
to the OB, I pretty much came out and told him I knew a lot about birth and I
was not going to agree to many of the routine things they do, and that I
expected to be a partner in my care, not a patient. His response was basically,
well that's fine to a point, but as soon as you start talking things that don't
make sense, then we'll have a problem. I knew at that point that I would not be
coming back. As we drove out of the parking lot I cried and told dh, "I
can't do this. I can't fight my way through this pregnancy." His reply was,
well, we'll just do whatever it takes then.
After combing the phone book, I came to find out that my insurance would cover the CNM practice in 45 min. away. They have a freestanding BC, but due to hospital/doc politics (read: B.S.) they were not "allowed" to do VBACs there. We would have to birth at the hospital. Still, we were thrilled, and really enjoyed our visits there, getting along great w/ 4 out of the 5 midwives. What a world away from OB care!! The pregnancy continued fairly uneventfully.
Tuesday, Sept. 5th, I had a midwife appt. I'd had a little pink mucous that morning, so I had her give my membranes a sweep; I was 3cm, baby at -1 station. At 41w4d, I told her, in all seriousness, "This baby is never coming out." Through the afternoon continued to lose my plug but still figured it was just the exam and that I had days more to go. 9pm, while reading bedtime story to my daughter, noticed that I was having contractions that I had to stop and breathe a bit through. They were consistently about 10 min. apart, and continued that way till 2am when I laid down on the couch and managed to get a little sleep. They hadn't gotten any closer or harder to handle so I didn't want to call and wake up midwife; I was still in denial that this could be the "real thing". I had told dh to just go to bed and rest, if I needed him I'd let him know. Woke up during contractions a few times, then woke up for good at 4:40 w/ more show. Contractions were now 6-9 min. apart so I told dh, maybe you'd better call in to work "just in case." I was starting to think *maybe* this could be it.
6am I called mw on call and told her what was going on, she said call back when
they got to 5 min. apart. 7am I sent dh to McDonald's ' cuz all I could think
about was their pancakes and eggs. While he was gone, laid down to nurse my son
back to sleep. About 5 min. after he left, while I was still laying there w/
Sammy, I felt a pop and thought wow, what a weird baby movement! I unlatched him
and got up, and immediately felt my panties get soaked. Ok, I guess this really
IS it, haha. Called mw again - this time call was returned by our favorite, J.,
who was now on call. Told her contractions were 6-8 min. apart now, so we would
probably go to the birth center first to have her check us, to see if we needed
to walk around a while before going to the hospital. Dh got home, and after that
contractions got to about 3-6 min. apart, so we left as soon as my parents
arrived and called J. on the way to let her know we'd go straight to hospital
Get into 8am traffic between Raleigh and Chapel Hill, and contractions widen out again to 10+ min. By 9:45 we're all checked into our room, and contractions are few and far between. J. and I agree it is probably "fight or flight." We get hooked up for a 20 min. strip on the monitor, and get my saline lock set up (GBS+). Everything looks great, so J checks me, 5cm. Yay! But - gotta get those contractions going again. We walk, and walk, and walk some more. J. recommends nipple stimulation, so dh and I start trying that. A few tries between walking, over a couple hrs. time, starts working. J. asks if I want to get into shower, might help relax and keep things going, and will work as nipple stimulation as well. My room doesn't have a shower - there are only 2 rooms w/ showers, and they were taken when I got there. She goes to the desk and comes back w/ a triumphant look - got you a room w/ a shower! So we move - which was great b/c my first room was little and dingy and prob. wasn't helping matters. This room w/ private shower was much nicer. After we switched rooms contractions never slowed again except by a couple minutes each when I'd lay on the bed to be monitored a few min. every half hr.
By this time it was maybe 3pm and things were getting more intense. Contractions were about 4 min. apart, and starting to spread around the sides of my back. I started to realize what most women mean by "back labor" - my back labor w/ Sammy was due to him being posterior, and was sheer hell b/c his head was smashed against my lower spine w/ every contractions. This was more like a muscular pain on the sides. MUCH preferable and more bearable! But still, started needing counterpressure on back during peaks. J. would stand behind me and stroke my hair and face, then during the worst would push in on my hips. After each contraction ended would say you're doing so great, etc. Dh would take turns when J's hands got tired. I started saying I can't do this anymore, so J. suggested shower again. That helped immensely. Dh stood behind me for counterpressure on back, and the heat from the water made it easier to cope. Finally got too hot and felt closed in by shower, so I got out again. Contractions had gone to 3 min. and I was 7cm now. It was maybe 4:30ish. I do remember laying on the monitor between contractions and saying very calmly to J. and dh, "I'm going home now, you guys call me when the baby gets here." J. laughed and said, lots of women say that towards the end, so that's a good sign! I said, but I mean it. LOL. Leaned over birth ball for a few contractions, then tried - briefly - sitting on ball. NOT! Made the pressure on my bladder/cervix/rear end unbearable. I made them pull me off quick.
At this point the back pain was becoming extremely hard for me to relax through - using the term "relax" very loosely, as much as one can relax in hard labor. What I mean is that I was really having a hard time not totally fighting against the contractions now. I was saying during every one, I can't do this, I'm done, I don't want to do this anymore. J. was being very encouraging, yes, you can, you're so close! But I knew I had reached my limit. She said, well, you can have an epidural -I did NOT want epidural. We talked about a shot of Nubain and decided that was the most preferable to me. It was very difficult for me to accept that this was the right thing for me to do, but I was getting out of control and knew I couldn't push effectively w/ the back pain. I was whining b/c I really didn't want pain meds at all - and I had come SO far! J got in my face and said this is your decision to make - an adult decision - you need to make it, and be ok w/ it. Either way. I don't want to hear you regretting it after, if you're going to do it, you need to decide that's the end of it. Oddly enough, this was great - it gave me the presence of mind in the middle of the pain to just get the decision over with. She had to check me first, 8cm - yippee!! So my L&D nurse gave me the first part in my lock, and the 2nd under the skin. It immediately took the edge off the back pain while still allowing me to feel everything else during contractions.
This was about 6pm. J decided she had time to run and grab a bite for dinner. Dh and my nurse were there w/ me. W/in a couple min. I started feeling these spasms through my pelvis and was grunting w/ them. When they talk about "pushing urge", I always figured I'd feel the head in the canal and feel the need to push it out, or something similar (I had not had a pushing urge w/ my first VBAC). This was more like the dry heaves, but lower - waves of muscle spasms that I could not stop. Nurse turns to me and says why are you making those noises - what are you feeling? I tried to explain but it was difficult, so she said, " I've gotta check you." She got down there quick and said, "Oh, you're complete, we gotta get J. back here NOW." She flies to the phone and barks at someone to get J.
Before I know it, J. is flying through the door and yelling over my roaring noises to stop pushing - I told her I CAN'T!!! She's trying to get the oil so she can support/massage the perineum. She's hollering over my noises that I need to try to get a little control or else she won't have time to help keep me from tearing a lot, but Bridget had other ideas. Finally she got ready, and by then the baby was crowning - definitely learned the meaning of the term "ring of fire"! It stung pretty bad, and all I wanted was for that to be over, so I really started working hard w/ the urges - I think I was growling get out of there! or something like that. Luckily I didn't have to worry about pushing through the ring of fire b/c my body was giving me absolutely no choice in the matter! During crowning J. said reach down there, feel the head - so I did, and it was all crumpled from the molding, very odd feeling, but wonderful. Her head came out after a few huge pushes, and J. said ok now you HAVE to stop pushing - the baby had a nuchal cord, not really tight, thank God. Once she got it free she said ok, push the body out; that stung as much as her head. She flipped the baby around and straddled her against her body (we did not know the sex yet and J knew we wanted to discover it ourselves) and just worked w/ her a minute to make sure she was going to cry well and stuff, suctioned her, etc., then after a minute she laid her on me and we saw that she was a girl! That was such an awesome moment! After the cord stopped pulsating dh cut it, which he did not get to do w/ our first 2.
My parents brought the kids in right away, that was neat, but I was bleeding pretty bad and my dad got queasy (wimp <g>). J told me to try to push the placenta out, b/c baby wasn't nursing yet and I was starting to bleed worse, so I did, it was quick and painless. I had a 2nd degree tear, which was pretty uncomfortable being stitched up, but wasn't surprising - I'd been 8cm at 6pm, and she was out at 6:31. No one, including me, had thought the baby was going to be particularly big - I didn't measure large, and everyone who palpated said, oh this baby won't be really big. Nurse asked what my guess was, I said around 8 lbs. - she said 9 lbs. 5 oz. and dh and I almost fell over! She had NO coning whatsoever, beautiful round little head full of black hair. It was fun making the hospital staff's jaws fall when they heard she was 9,5 w/ a 15 min. 2nd stage.
Postscript: We really loved the compromise between good prenatal care and old-fashioned midwifery, but unfortunately our CNM practice is no longer taking VBACs (due to BC staffing constraints in having to go to the hospital to attend them). So we will be planning homebirths from now on, as I will no longer consider returning to an OB unless medically necessary. I look forward to birthing my next baby in my big bath tub! [Kmom note: And she did! See the home VBAC waterbirth below.]
Baby #4 (Carina Rose): After weeks of prodromal labor I was beginning to despair not only of ever getting any rest, but of not knowing when "real" labor began. The contractions were painful, in my cervix, and hard to distinguish from the kind which started real labor with my last child. I was joking all the time with the midwife that I would probably wait till late in labor to call her because I just couldn't tell and didn't want everyone sitting around for a false alarm.
On Wed, Nov. 13th, I woke up and had some bloody show...The day passed with more show, but no baby. During that night, I was woken a few times at the tail end of a contraction---maybe every couple of hours or so. The next morning, at 41 weeks and 2 days, more plug and show, and contractions that actually kept going every 10-15 minutes even after my kids were up and distracting me. They continued that way all morning. I took a nap and they continued every 15-20 minutes or so. Just mild enjoyable early labor type stuff. The intensity was not telling me this might be "it"---only the continued regularity, so I still had no idea if I'd have a baby that day. Just before 4 p.m. I asked DH if he could leave early and pick up the digital camera from my parents' on the way home. I told him I didn't know if it was real labor but I couldn't concentrate during contractions and needed him to be here just in case things got more intense soon...He finally got home close to 6 p.m.
At that point the contractions were about 5 minutes apart, maybe 30 second for a long one. I was thinking maybe this might be the real thing, so I sent him up to get a couple last-minute things on the supply list. After he got back it became apparent that maybe his nerves weren't doing so well, bless his heart...I wasn't really needing any labor support still at that point but decided to call the midwife and let her know what was happening...She both figured she'd have plenty of time to get there. I decided I could use a little moral support, so I called my doula/apprentice midwife. By the time she got there, I was in the bedroom, leaning over the bed with my knees on the floor, low-moaning through short contractions about 3 minutes apart. The doula said that was totally fine, and she didn't want to get my hopes up but sometimes moms who go into that kind of pattern go very fast once things speed up. I was like, yeah, whatever, thinking I've got hours more to go.
The doula asked if I wanted to check the baby's heartrate; afterward I immediately started to have another contraction so collapsed down on hands and knees in the bathroom doorway while she called the midwife to find out how far away she was. It was probably about 8 o'clock at this point and we all still thought there was plenty of time. During this contraction on the floor, just as I was prepared for it to start going down, I felt a pop and the contraction restarted....My water broke, just a small amount, not gushing like last time. In retrospect I think that might be because the baby was already so low that she was acting like a plug. We started the tub running.
Almost as soon as I got in, things really kicked up. I tried the birth ball in the tub but couldn't stand the pressure from the way my legs were squatted down in order to fit the ball in. So I laid on my side for a few contractions; towards the end of those I started saying I can't do this, I don't want to do this. All I could think was OMG, I will NEVER make it another hour or 2 like this. DH came in at some time and asked the doula how long she thought it might be---she said maybe an hour or so, hard to tell, then she turned to me and said, "A will be here in plenty of time, I won't be catching tonight!" We laughed about it, haha. Then she suggested a position change since I was starting to have trouble dealing with things on my side. I went up on hands and knees again and laid my head/arms on a towel on the back corner of the tub (my tub is large and almost triangular in shape so I had lots of room to lean). After a couple of contractions in that position I was really getting agitated and start saying, "There's so much pressure, the baby's moving down."
After that I started to freak out. I started yelling, make it stop, make it stop! I can't do this, Oh God help me, etc. The doula was great, she just rubbed me, kept telling me only a few more second til the contraction is over. The pressure in my cervix and down thru my hips/pelvis/thighs was unbelievable and I was really worried that I was going to be in this agony for who knew how much longer. After a few of those "just give me an epidural now" contractions, I flipped back onto my side instinctively, and started hollering, "I'm going to poop!" I also noticed that there was NO break between contractions any longer---they were just bam bam bam one non-stop contraction. I kept saying, "I have to poop, I'm going to go," etc. and S said, it's okay, you're fine, etc. I think she was hoping I could hold on just a few more minutes till the midwife got there, and at one point asked if I could get back to the bed (she thought if I was out of the tub things would slow down)---I said I can't move! No way! I didn't really think at this point that the baby was coming. For some odd reason, I was just really upset that I was being forced to go potty in the bathtub in the middle of all this pain.
As the baby moved down further, the contractions stopped (blessedly!), although the pushing urge did not lessen at all. I HAD to get that kid out of there, and she was making it very easy. I had no choice in the matter. My 7 year old had gone to the living room to get DH and my 2 year old, and when I saw him I somehow found the presence of mind to yell, "Take some pictures!" A few pushes later, accompanied by frightening primal screams, she was crowning and I reached down and touched her head and asked, "Is that the baby?" I couldn't believe she was already coming! The rest of her just whoooshed out all at once and S brought her up out of the water onto my belly. Her eyes were open, and she was very quiet and alert, but making no noise and I don't think breathing yet. Her color was fine, so S started massaging her with towels and telling me to keep rubbing her, etc. In just a minute she started crying and then S said get the cord, at which point I realized was looped down around her neck and front like an upside down "U". So we undid that from her neck and she was fine. I looked at S and said I can't believe it's over, that's the fastest easiest thing I've ever done! We finally remembered to look between her legs and see what we had----it was a girl! The funniest comment came from our 7 year old; after everything was over and I was still in the tub, she looked at us and said, "I'm never taking a bath again."
I was still in the tub when the midwife arrived a few minutes later. She came in and oohed over the baby, looked to see what she was, then asked DH if he wanted to cut the cord. He said no, I cut the last one. So the midwife cut it, S took the baby, and we got me up and to the bed. The placenta came within 15 minutes, it was in great shape, the bag was very strong, no calcium deposits, etc. I had about 1" first degree tear along my old episiotomy scar (darn thing). We put a couple of stitches in it. Eventually the baby got weighed and all of us were surprised that she was "only 8 lbs. My last baby was born only 2 days later gestation and was over 9 lbs (both dates were very accurate!) This little one seems like a peanut in comparison.
Update: Misha has had another baby recently, this one a much harder birth but still a VBAC. For his story, see the BBW VBAC FAQ.
Balek's Story (postdates induction, posterior baby, c/s; hospital VBAC with no interventions)
Kmom's Notes: Another classic story of a malpositioned baby, forced into labor before it could align itself properly, and so resulting in cesarean. Note that "Balek" was able to use Optimal Foetal Positioning (OFP) to help the next baby be more well-positioned. For more information about OFP, see the FAQ on this site on Malpositions, and also the book available from www.birthworks.org or www.midwiferytoday.com.
Balek also had a history of a DVT (Deep Vein Thrombosis), while on birth control pills as a younger woman. She was tested and has no known clotting risk factors. There didn't seem to be any reason for the DVT, so the birth control pills were blamed. (Birth control pills are known to increase the risk for blood clots.)
A past history of DVT does raise the risk somewhat for a blood clot during pregnancy and birth, especially one by cesarean. Her family doctor in pregnancy #1 chose to treat for DVT risk only when they had an induction (which limited movement, another risk factor for clots) and a c/s (which increases the risks for clots). Treatment was heparin shots (a blood thinner compatible with pregnancy); one following the failed induction, then 2x/day after the induction and c/s, then Coumadin (warfarin) for 6 weeks. Heparin is preferred for pregnancy; it is a very large molecule and does not cross the placenta. Coumadin is used post-partum because it can be taken orally (instead of getting shots). Both are compatible with breastfeeding, according to Balek.
In pregnancy #2, the CNMs lost track of the fact that she'd had a prior DVT, although it was in the medical record and they'd been informed at the first visit. She got a call from one of her CNMs around the 8th month saying, essentially, that she should have been on heparin all along. They met with the perinatologist who is the CNM's primary OB backup and discussed DVT risk, plus they found information elsewhere as well.
After talking with a close family friend who is a physician, they agreed to take 5000 units 2x/day of subcutaneous heparin, self-injected. Her providers told her to just stop taking it when she went into labor. She asked if there was ANYTHING they would do differently if she was on heparin [Kmom note: mothers on heparin are often induced], and they said no. According to them, heparin is cleared from the system pretty quickly (hence the 2 or even 3 doses per day people take) and according to the perinatologist, a study has shown it to be cleared more quickly from pregnant women than from the general populace. According to them, a woman on heparin with a normal delivery and no episiotomy loses more blood than a woman not taking heparin, but not enough to be anything like a problem. In the worst-case scenario of a uterine rupture, the difference is not significant, because so much blood is lost in either case.
Post-partum, she is still taking the heparin but will switch to Coumadin/warfarin until 4 weeks postpartum. She says that she is honestly not sure it's all worthwhile, but "nobody knows any reason why it would be hindering either, so I'm doing it, although...I'm of two minds about it!" She points out that if she had any risk factors (like clotting disorders), it would NOT be a gray area; it would clearly be necessary to use heparin during pregnancy and warfarin postnatally.
Baby #1 (Failed Induction, Induction with Labor, C/S)
We liked everything about our family doctor except that she wasn't comfortable going past 42 weeks of pregnancy. She told us up-front that she wasn't, and that if we wanted to go past 43 weeks we needed to find another care provider. But she was so great otherwise that we stuck with her.
So I was induced with some suppository (don't know what) at 41 weeks, 6 days, and Pitocin the next morning. There were lots of contractions but labor didn't start. Go figure----the baby was posterior and not engaged! Our doctor sent us home and scheduled another induction for 42 weeks, 2 days.
At that point, still posterior and not engaged. A different suppository was used that evening. My waters broke around 5 a.m. but the contractions stopped. Pitocin was started very early the next morning. This time I went into labor. I labored all day with the damn External Fetal Monitor [EFM] strapped on, and I stayed in bed the whole time (although the doc and nurse encouraged me to try sitting in the rocker).
The baby had scary decels at one point so I had an internal fetal monitor attached and then an amnio-infusion. The decels stopped, so the doc was right that it was from cord compression. I was given an okay to try pushing when I felt an urge to do so, around 9 cm dilated. My cervix didn't swell so I continued. I got to 9.5 cm with an anterior lip, but even with the doc helping to lift the cervix over the baby's head, nothing doing!
Basically, I got tired. Nothing was changing, I wasn't making progress, and I lost hope and just wanted to be done. Around 9 p.m. our wonderful doc offered me options: keep going, have an epidural to rest and try again in the morning, or a c/s, with the baby out within 15 minutes of the spinal. DH and I were left alone to choose. We chose the c/s because the baby would get the least medication that way, plus I was so tired.
The doc who did the c/s had just had a c/s herself 6 months before. She tried to keep the cuts small. As she was sewing me up, she assured me that I would have no trouble with a VBAC next time. Our baby girl came out of me crying and pink, at 42 weeks, 3 days. My DH never left her side, and he brought her to me in the recovery room. She was nursing 70 minutes after her birth, as soon as I was back in the LDR room. I went home with my family 3 days later, as soon as they would let me go.
Baby #2 (VBAC, zero interventions)
At 38 weeks, our fetus turned transverse. After all my work on optimal fetal positioning, this was hard to take! We kept it up and by 39 weeks the baby was anterior and LOA, thank goodness! The baby began to engage around this time---at least, I felt all kinds of interesting stretching sensations deep and low inside me.
By 40 weeks, the baby was engaged enough that the CNM could only feel its chin. I was so happy because this was already farther than I had gotten with my previous birth. We knew exactly what we wanted and what we would and would not agree to, and we stood firm that we would not do any NSTs or other tests until 42 weeks (and not the standard 41 weeks). We also continued to refuse induction or even to discuss it. I strongly feel that induction is dangerous in general, and especially for a VBAC. I did agree to do kick counts to keep the CNMs happy.
At 40 weeks, 6 days, I had contractions that built up gradually all day. I thought it might be early labor, but then they stopped in the evening, so I figured it was Braxton Hicks contractions. Nothing happened the next 2 days. At 41 weeks on the nose, I had a nice few BH contractions in the evening, and some bloody show. But no "real" contractions and no labor.
At 41 weeks, 1 day, with more bloody show in the a.m. but no contractions, we decided to try castor oil. We knew the baby was LOA [Kmom: Left Occiput Anterior, or perfectly positioned for birth], vertex (head-down), and engaged, or we never would have done this! But while the castor oil made me visit the bathroom 3 times that morning, it didn't seem to do anything else. Oh well, I thought. My DH went off to school.
That same day, I was online around 2 p.m. while nursing my daughter down for her nap. We both slept until around 3:20 p.m. Then she was fussing so I woke up and brought her to bed with me to nurse so I could rest, since I was having some BH contractions---which got more intense pretty quickly. By 3:30 I couldn't stand having my daughter nurse because she kept moving during the contractions. I went back to the computer to see if changing my position did anything, and I starting timing the contractions. At about 3:45 the contractions were 45-60 seconds long and 2-4 minutes apart.
At 4:15 my DH was home, at 4:30 the doula arrived. Still no breaks longer than 4 minutes. At 5:00 our babysitter for our daughter arrived. With the help of the doula and my DH, I stayed on top of the contractions, feeling them as tremendous pressure but not directly as pain. I just lay on my couch, listening to Enya, relaxing through the contractions, and letting my uterus do its work.
About 7 p.m. we left for the 2-block trip to the hospital, hoping to get there before transition. When I was standing outside, I felt the beginning of a desire to push. I allowed myself to push gently, as the contractions seemed to want (but it wasn't breath-holding or bearing down). I was really pushing during the contractions as we walked down hospital corridors, starting to grunt and bear down. (I also peed all over myself!) Our doula saw a resident she knew and so we didn't go into triage; we went straight to a labor/delivery room. I was examined, I was complete, and the CNM gave the go-ahead for pushing (that I was already doing!). NO I.V., NO saline lock, NO fetal monitor, NO NOTHING!
I did hard pushing from about 7:30 until 8:49 p.m. Our son came into the world the way nature intended, with no drugs, no cutting, and no interventions at all. (Also without much head molding.) He had meconium in his amniotic fluid so he was deep-suctioned, but that was IT for interventions. We held and cuddled him for an hour, until the law required his Vit. K and eye stuff. Then we held and cuddled him some more. He wasn't even bathed until 4:30 a.m.
We left the hospital 24.5 hours after his arrival. We were (and remain!) very tired, but overjoyed with our boy and with his birth, too. I had a lot of tearing and bruising (I didn't ask what degree, but it took a long time to sew up) but he's worth every stitch and sore spot.
So much for the "CPD" [Kmom: Cephalo Pelvic Disproportion, baby 'too big' or mom's pelvis 'too small' for birth] written as the reason for the c/s with my daughter!!
Tami's Story (posterior baby born vaginally at home; postdates homebirth)
Kmom's Notes: Pregnancy #1: Tami worked up until her due date and had no complaints. They used a fetoscope only (no Dopplers). Did have a Glucose Tolerance Test, which was normal. No other testing.
Note that the first baby had difficult establishing bfing. Although many factors can be responsible, it is not unusual for many posterior babies to have more difficulty nursing at first, or to have long-term colic problems. Chiropractors theorize that this is due to cranial and neck trauma during the birth in a less-optimal position. Many women have found that Cranial Sacral Therapy or gentle chiropractic work (done by someone TRAINED in treating newborns) can often help in this situation.
In her second pregnancy, Tami had no testing at all during the pregnancy. Fetoscope only was used, except for using the Doppler while in the pool during active labor. Tami also notes that she nursed the first child through the second pregnancy.
Link to birth story #1: www.visi.com/~jlb/homebirth/micah.html
Link to birth story #2: www.visi.com/~jlb/homebirth/naomi.html
Kmom special note: Tami has great pregnancy/baby photos and even a short movie ("It's a girl!) on her website!
Asynclitic Birth Stories
Kathy1's Story (GD, baby's head tilted, vaginal birth)
Kmom's Notes: Kathy's long days of pre-labor ('false labor') and then stalling at 4 cm for a while was a good clue that something was wrong with the baby's position. It's hard to say whether this was an asynclitic position or another one of the various face/brow/oblique positions at first.
Unfortunately, breaking her waters may have forced her baby into instead of through her pelvic bones. Adding pitocin on top of that poor position to strengthen contractions pushing baby down may well have caused the damage and bruising she saw in her baby after birth, although of course it's difficult to know for sure. Getting up and shifting position probably corrected her baby's position and may well have saved her a c/s.
Kathy1's first child was delivered vaginally at about 40 weeks after being induced on a mostly unripe cervix. She found labor tolerable until the doctor broke her waters at about 3 cm, and then contractions became very intense and nearly continuous (very common occurrence). Eventually she opted for the epidural as a result, and did get some sleep. During transition, she desperately wanted to get up and move around, but was trapped in the bed by wires etc. and began to feel panicky. She began to feel the urge to push but was not allowed to until dilation finished, and had trouble keeping from hyperventilating. Eventually she began pushing, although it was not very effective due to the epidural. After an hour and 40 minutes of pushing, her son was born, weighing 8 lbs, 14 oz. However, the amniotic sac was not delivered with the placenta as it should have been and the doctor had to go get it, which was difficult, caused a lot of bleeding, and caused her to need a lot of pitocin afterwards.
With Kathy's second child, her father was diagnosed with type II diabetes during her pregnancy, and so she opted to be tested early for gd at 20 weeks. She did indeed have it, but was able to control it through diet only. Because of the gd and the fact that her previous baby had been almost 9 lbs. without any gd, her doctor wanted to induce her at 39 weeks. Fearing a pit induction again, she tried a castor oil induction at 38 weeks instead. The following is her story.
"After having mild, non-productive contractions for 3 days, I decided to try some castor oil in hopes of starting real labor. I drank 4 oz of castor oil with equal parts orange juice about 7 pm. After about 3 hours, I began having diarrhea, which lasted for maybe 2 hours. And then about an hour after it ended, the contractions began. By 1:00 am they were VERY strong and about 2-3 minutes apart, and by 2:00 am I was settling into my labor room at the hospital. I was at 2 cm and 50% effaced.
A friend joined us at the hospital and she and I giggled and talked through the early labor while my husband snoozed. I walked the halls, taking breaks to be monitored for about 15 minutes every hour. The contractions weren't bad at all, and I was having no problem dealing with them. About 9 am I was 75% effaced and 3 cm, so the doctor broke my water to speed things up. The contractions got much harder and faster, and I was really breathing through them, but we were all still in a good mood and laughing and talking between contractions. By about 1 pm I was totally effaced and 4 cm, but my labor had stopped. I was getting very tired by then and discouraged. So I tried to rest and see if things would pick back up. They didn't. After walking and trying various things, we started some pitocin about 4 pm. The contractions got much harder, and after about an hour I started to feel panicky, as it was getting more difficult to handle the contractions.. So they gave me a bit of Stadol to try to help me relax, but it wore off quickly.
Just when I thought I couldn't take anymore, my friend Amy arrived. Amy has been an OB nurse for many years, and is now a lactation consultant and childbirth educator. Needless to say, she knows how to handle a woman in labor! I was crying when she walked in, and I started begging her saying "Please...I want an epidural!!" She said "You don't need one. You need to calm down." She got very stern with me and made me breathe with her through a few contractions. When I got panicky, she'd just get stern again and tell me to look at her. Then a strange thing happened. I relaxed and I began to feel empowered. If I paid attention, my body was trying to tell me what positions helped the contractions along. It felt better to be standing and swaying, and pacing around. I did that for a while, and Amy was keeping me focused and helping me breathe through each contraction. I was handling it!! But I was also awfully tired.
Soon they checked me and announced I was at 7 cm, but my nurse and Amy also had begun to suspect that the baby's head was in my pelvis a little funny. Amy had me squat on the edge of the bed through several contraction to open my pelvis, and I felt his head shift down into the birth canal, and the pressure was incredible! I started to panic a little again. I kept saying "He wants to come out NOW!" And Amy would calm me and say, "not yet--breathe." I was breathing and having to focus so hard during contractions, but was dozing off in between. (My husband said I was even snoring!!) Resisting the urge to push was so hard! But thankfully I went from 7 to 10 in about 20 minutes, but when I pushed, he still wasn't moving down. Amy told me to lie on my side and draw one leg up to push. The doctor didn't argue with her although his preference was to use the stirrups! So I got on my left side and drew up my leg and I pushed through 3 contractions, and with every one they were saying they could see more...they could see hair, etc.
On the third I pushed with all I had, and I remember making some kind of growling sound. His head was partly out and Amy said, "If the contraction's over, rest." And I thought "Forget that!" His head was partway out and I had some kind of fear that if I stopped and rested then, he'd be hurt in some way, so I took a deep breath and PUSHED!! I felt something pop and he came flying out onto the bed all at once (not the usual "head then body" delivery). It sure was a good thing that I didn't have stirrups because I don't think the doctor would have been able to catch him!
David's head was very bruised and the bridge of his nose and left eye were extremely swollen--further evidence that his head had not originally gone into my pelvis correctly. I am SO GLAD that I made it through without the epidural. It was hard, and a lot of work, but if I hadn't been able to squat and roll on my side and such, I just might have had an emergency c-section. And I am SO thankful that Amy was there, because she helped me fight the urge to withdraw into myself during the pain of the contractions, which was the only time when the pain would overwhelm me. As long as I could remain focused on something outside of my own body, I was able to stay on top of the contraction and handle it. David nursed right away in the recovery room, and I was amazed that he latched on immediately. He was 7 lbs, 11 oz., 20 1/4 inches long, with apgars of 9 and 10."
Update: Kathy writes that "My son has recently seen a surgeon...and the surgeon was [able] to provide an explanation for his postpartum nasal swelling that kept him in the hospital until he was 5 days old. He suffered a broken nose due to the positioning of his head in my pelvis. This also explains the extreme swelling across the bridge of his nose and one of his eyes."
Heather's Story (baby malposition, 2 vaginal births)
Kmom's Notes: #1 is another baby malposition story! It's not clear, but it looks like this one was not truly turned around, just a little 'off', since it was easily corrected by a vacuum extractor. Baby was probably asynclitic or a tad transverse in the head only. Baby #2 came easily and quickly; see what a difference a properly positioned baby can make!
I had my first baby when I was 19. After a comfortable and uneventful pregnancy I went into labor 1 week shy of my due date. I knew I was already dilated 3 cm. and 90% effaced from a doctors appointment a few days earlier.
For the last three months I had told my doctor that the baby didn't move much, and he seemed okay with that, but when I went in to the hospital with contractions 4 minutes apart they were very concerned that I hadn't felt her move very much. They immediately put monitors on me and ordered an ultrasound, apparently I had little to no amniotic fluid. They tried to rupture my membranes, but nothing happened. I stayed in bed on my back with a rolled towel under my right side for 17 hours and I had three failed attempts at an epidural- so I was feeling everything.
I started to push at 9pm, she moved less than 1 cm in almost three hours of pushing. She started dropping her heart rate with each contraction. My OB walks in and announces without explanation he will try to vacuum-extract her and if doesn't work in the next ten minutes I will be having an emergency c-section. We found out her head was stuck because it was rotated the wrong direction and she came out within a few minutes with the vacuum. I was thinking "Why didn't you do that 2 hours ago?". She was born at 11:50 pm. She was quiet and needed a little stimulation to breathe. She went straight to the nursery and was on an oxygen hood for the night. She in now a perfectly healthy four year-old.
My second daughter was a completely different experience. My water broke at home. We went to the hospital; I was not having contractions I could feel. They started me on pitocin, I had an epidural and slept on and off for a few hours. I was stuck at 5 cm for about three hours and they called in my midwife. When she checked me I was 8cm. She said she'd be back in 30 minutes to see how dilated I was- fifteen minutes later I had to send my mother to get her because the baby was coming- NOW!
Two good pushes later K came into the world at 2:31am. I held her for three hours and got to nurse her. Her birth was a much more pleasant story. My second baby was a wonderful vaginal delivery, except for needing the pitocin.
Kristi2's Story (induction, back labor, malposition, forceps)
Kmom's Notes: All the classic signs of a malposition, probably the more 'minor' malposition of a crooked or 'asynclitic' head. An "overdue" baby, back labor and sciatica, slow labor progress, a very painful labor, an epidural that didn't take fully effectively and needed frequent redosing, slow progress during pushing, difficulty getting the baby under the pubic bone---all are classic signs of a malposition.
Inducing and breaking her waters early on like this could well have sent this mom to the O.R. for a cesarean, but fortunately, the baby was able to eventually move down, and with 'help' of forceps, be born vaginally. However, if it had been managed differently, this birth might well have been easier and the mother might not have torn so badly. Fortunately, all was well with the baby despite the difficult labor.
I wanted to have a baby for a couple of years but was terrified to get pregnant because of my weight. Thanks to [research], I saw that there are many other overweight women who get pregnant and have perfectly normal healthy pregnancies. So I went for it and got pregnant on the third month of trying.
I had a very easy pregnancy. I was a little nauseous for the first few weeks but that ended promptly around 12 weeks and had no other problems. My blood pressure was always perfect, the baby's heartbeat was always perfect, and I didn't gain too much weight. I was due on October 30th and naively convinced myself that I would have the baby on or before that date. Sure enough, my due date came and went with no signs of labor.
On November 5th, six days after my due date, I was scheduled to have a non-stress test. By this point, I had been dealing with sciatica pain for about a week which made it difficult to walk, but had no reason to complain as I was done working and my only responsibility was to relax and go into labor. My baby was never one of those kids who would kick on command. While I was pregnant, friends and family would ask me to make the baby kick so they could feel him move and I would poke my stomach, but my son would only kick when he wanted to kick so he did not rate well during that portion of the non-stress test because he was sleeping and I couldn't get him to kick. Even though the heartbeat was perfect, he would only move when she rung a buzzer on my belly and then would go right back to sleep so points were deducted. Then I went in for an ultrasound and he wasn't taking in fluid as much as he should have so we got points deducted for that also. For the whole test, we only scored a 6 out of 10. Considering I was six days past due, the baby was estimated as weighing almost nine pounds and I was showing no signs of going into labor, the doctor decided to induce me. She said it seemed silly to risk the health of a perfectly healthy baby. [Kmom opinion: It's inducing that presents the greater risk to the baby's health!]
I had always wanted to go into labor on my own because after reading countless birth stories...it seems that when women go into labor on their own, it simply goes easier because their bodies are ready. Not less painful, just easier. I wanted to do what was best for my baby so even though it would mean being induced, I agreed and DH and I were off to the hospital.
The labor room was very nice and welcoming. I was given a large gown without even having to ask for it and the equipment was made to fit a woman of any size. During my entire pregnancy and labor, I was never treated as an overweight pregnant woman. I was simply treated as a pregnant woman. All except for the anesthesiologist who did my epidural, but I'll get to her a bit later.
I was checked into the hospital at around 1 p.m. My water was broken about 15 minutes later and I was hooked up to the pitocin by 1:30 p.m. Contractions started about an hour later and at first they were manageable. By 4 p.m. the pitocin had been gradually turned up all afternoon so the contractions were coming hard and fast. I was only dilated 2 cm, which was only 1 more than I had been that morning so I told my nurse that I was going to want an epidural as soon as I could get it. They told me I had to get to 4 cm. All labor is painful, but back labor is supposed to be the worst and unfortunately that was what I had. By 8:30 p.m. I was still only 3 cm but in a lot of pain so I started begging for the epidural. Luckily, my OB said OK, even though it was a little early. She said maybe if I could relax, I would start dilating faster.
This was when, for the first time in my entire 9 months of pregnancy, I came across a fat-phobic person. The anesthesiologist walked into my room and proceeded to tell me that due to me being "morbidly obese" she wasn't sure if she would be able to stick me with the epidural catheter, but she would give it a shot (gee, thanks!). While explaining the procedure, she called me "morbidly obese" a few more times and then said again that she would give it a shot but I shouldn't be surprised if it doesn't work. I wanted to let her have it or tell her that I wanted someone else, because I had read that a good anesthesiologist should not have a problem inserting a catheter regardless of a person's size, but because I was in so much pain, I just wanted my epidural so I figured I would argue with her after I was no longer feeling contractions. My mom actually had to leave the room because I could tell she wanted to lay into [the anesthesiologist] too, but I shot her a look telling her not to and I think she understood why. I figured if she tried and it didn't work, which I doubted, that I would ask for someone more qualified. My husband was just scared because of all the things she was saying could go wrong due to my size, but we took Prepared Childbirth Education and all the things she was saying could happen to me because of my size were things that could happen to anyone--regardless of size--so I tried to reassure him not to worry.
The nurse or the anesthesiologist's assistant must have said something to her about the way she acted towards me because when she came back in the room to administer the epidural, she was like a completely different person! She was incredibly nice and friendly to me. We actually discovered that she lived right down the street from me. SO she must have felt bad for how she treated me, but I'm not sure if she realized it on her own or if someone pointed it out. Well, lo and behold, my epidural took on the first try. From start to finish, the whole process took about 15 minutes, which according to the nurse is pretty quick for administering one. The nurse also told me that it took the anesthesiologist 4 tries with the skinny woman down the hall. So much for her theory about fat people!!! I hope it taught her a lesson.
After I got my epidural, I felt great for a couple of hours. My OB told me to try and take a nap because since I was only 3 cm, I had hours to go and I needed my strength to push. I was able to sleep for about 2 hours and then work up because I started feeling the contractions on my right side. By this time my contractions were peaking at 9 or 10 so it was pretty painful. I had to get the epidural re-dosed, but that only held me over for another couple of hours. Keep in mind, this had nothing to do with my size. The catheter was installed properly. This just happens to some people. This happened to my sister's friend, who weighs 130 lbs. This kept going on throughout the night and my epidural was redosed about 4 times.
At 7 a.m. I was 6 cm. I wanted a vaginal birth, but I knew an end was in sight because my OB will only let a woman be in labor for 24 hours so I knew either way, it would be over by 1:30 p.m. Around 9 a.m., I was feeling the urge to push, but I was only 9 cm. My OB had me start pushing anyway since the baby was only at 0 station and figured it would be a long time pushing because I needed to get him down. By this point I was in labor for 20 hours and just wanted it over with. I started crying and told my DH I didn't think I could do it anymore. By this point, I was very tired and couldn't even hold my legs or head to push so in order to concentrate all my energy into pushing, we called in my sister. She held one leg, my DH held the other, and my Mom held my head. My OB had said that my baby was acting like a cork in a bottle. I wouldn't be able to get him all the way out without help, but if I got him past my pelvic bone, she would be able to use forceps and I could avoid a c-section. I pushed for 2.5 hours and got him past my pelvic bone. With that they got out the forceps. The forceps helped get his head out and then with one more push, out came my little boy at 11:26 a.m. on 11/6, 1.5 hours shy of my 24 hour cutoff. He was 8 lbs, 6.5 oz, a little smaller than predicted, but big enough that between him and the forceps, I tore inside and out and had to get several stitches. I kept asking my OB how many stitches and she would just say, "a lot."
When they broke my water the day before, they noticed I had a little meconium so they warned DH and I that the baby wouldn't cry immediately because they had to suction him out good before they would let him cry. He cried in less than a minute, but when you're waiting to hear your new baby cry, a minute can seem like an eternity. Also the cord was pretty tight around his neck so DH did not get to cut the cord. Through 20 hours of labor, 2.5 hours in the birth canal, and a tight cord around his neck, my son was a real trooper! His heartbeat only went down once for about 15 minutes shortly after the epidural, but only to around 110 so they were not scared, and after putting oxygen on me for about 30 minutes, it went back up and stayed there for the rest of labor.
I tried breastfeeding a few hours later, but didn't have much success because I was so tired and all the baby wanted to do was sleep. That evening around 8 p.m. the nurse came in and said the baby needed to eat and asked if I wanted help breastfeeding. She showed me the proper way to latch the baby on and he took to it like a pro. I breastfed pretty much exclusively while I was on maternity leave with just a bottle of formula here and there to get him used to the taste. I went back to work when he was 9.5 weeks old and we began weaning him over to formula. I wanted to continue breastfeeding but couldn't pump enough during the day to keep up with how much he was eating, and since I didn't have the opportunity to breastfeed during the day, my milk supply dwindled and he wasn't getting enough at night to satisfy him so it became a constant battle of him being hungry, me not satisfying him, and him screaming for more. I finally decided that since I had to be apart from him all day and didn't want our evenings to be so stressful, I would switch him to formula and we are both happier for it. I felt guilty about it, especially since we had no problems with breastfeeding, but you have to do what you have to do and if I would have been able to stay home with my son which would have been my ultimate dream, I definitely would have kept it up, but since that wasn't even an option, we had to come up with another alternative. Breastfeeding is best, but it is sometimes hard for working Moms to keep up with it and they shouldn't be made to feel guilty if they stop, which is exactly how some people tried to make me feel.
My son is now almost 5 months old and a complete angel!! If you want to have a baby and the fact that you are overweight is the only thing holding you back, don't let it! I am living proof that an overweight woman can have a perfectly normal, healthy, complication-free pregnancy. We are already talking about trying for number 2 this fall.
Compound Position Birth Stories
Note: See Monika's Story above, under 'posterior' stories (she had both). Also, see Kmom's 3rd birth story below.
Veronica M's Story (baby malpositions, fat-phobic treatment, 2 vaginal births)
Kmom's Notes: Veronica has classic symptoms of SPD (Symphysis Pubis Dystocia), a gap or misalignment of the pubic symphysis area (the joint in the front of the pelvis on the pubic bone). When the pelvis is out of alignment, chiropractors believe it can pull the uterine ligaments unevenly, causing the uterus to be unbalanced and the baby to often assume a malposition. Kmom believes that many cases of baby malpositions are actually related to SPD/misaligned pelvis, and may be able to be prevented in the future by chiropractic treatment that addresses misalignments in the back and pelvis (including the pubic symphysis joint, which is often overlooked), and release of the ligaments that support the uterus. Without this, malpositions are likely to recur, and difficult labors/cesareans are common (although not inevitable.)
In Veronica's second birth, the nurses saw that the baby's hand was by its head, so that put her on her back and pulled her legs forcefully back to her ears. This is called a McRobert's position. If the baby has trouble getting out this position can be useful, but in this case the baby's head was already crowning easily when the nurse did this. Unfortunately, the side effect of using the McRobert's position was that the gap/misalignment of her pubic symphysis joint got pulled apart too far and was damaged long-term. When this damage happens, it is called DSP (Diastasis Symphysis Pubis), and it can make it hard to walk or do normal activities for years. But because the diagnosis is not commonly known among doctors in the U.S., it was missed with her.
The other outrage in Veronica's birth is the fat-phobia exhibited by her doctors and nurses. Her treatment was inexcusable, from the doctors to the nurses to the anesthesiologist. As is common with large women, the doctors and nurses predicted a 'huge' baby and told her to expect a cesarean, but were surprised when the baby turned out to be only 6 lbs. Between their expectations, the induction, the lack of pain relief, and the position they made her deliver in (on her back, in stirrups), it's a miracle this baby was vaginally. This mother did an amazing job under very difficult circumstances.
Unfortunately, like many women, she found it hard to switch providers and went right back to the same people who had given such poor treatment the time before. Not surprisingly, she got burned again. She now knows not to return to these providers, and to stand up for herself and not tolerate sizist treatment. Hopefully, she will also get treatment for the pubic symphysis problems so she does not have to endure such pain and discomfort in any future pregnancies.
Despite my weight, I was easily able to conceive and was looking forward to my first baby. I never had problems with blood pressure or blood sugar. During the third trimester I started to have debilitating pain in my pubic region. I told my OB about my symptoms and she dismissed it as normal pregnancy aches and pains. Being my first pregnancy, I assumed she knew what she was talking about so I carried on best as I could. I couldn't roll over in bed or get out of the car or walk up the stairs without crying from the pain. My husband ended up pushing me around in a wheelchair the final weeks because he couldn't stand to see me suffer anymore.
My water broke before labor started and I dutifully did I as I was told and went ahead to the hospital. Once there, the hospital staff was very rude about my weight. The nurses rolled their eyes when I asked for a bigger gown. They got disgusted when the blood pressure cuff was too small. They assumed I would be having a huge baby and told me to be prepared for a cesarean since I am only 5"2. Pitocin was started right away, despite my protests that maybe I could start labor on my own by walking or nipple stimulation. I was hooked up to a monitor and IV and wasn't allowed to ever get up. I really wanted to walk but the nurses kept scaring me with talk of "cord prolapse" until I hushed. I now know that it would have been highly unlikely considering that my baby was well engaged and had been for weeks.
The monitor wasn't picking up anything substantial so the nurses kept increasing the pitocin every 20 minutes until I was writhing in pain. I was screaming that the contractions were too intense and it felt like my uterus was being torn in half, but they hushed me and pointed to the monitors that were showing nothing. Finally I convinced them that my padded tummy was causing the monitor to fail. They inserted an internal monitor and found my contractions were off the charts at only 4 cm. All I could do was scream. That breathing stuff was useless at this point. Finally, at 5 cm I was told I could have an epidural. I was so relieved at the mere thought of it. My pitocin had been turned down but it was too late at that point. The contractions stayed unnaturally strong the remainder of the time. Well, the epidural didn't take and the anesthesiologist refused to try again. I was hysterical since I was counting on it for a little relief and I knew I still had a long way to go.
Somehow I survived transition and I got ready to push. I wanted to be on my side because of the pelvic pain I knew was still there somewhere (couldn't tell where one pain ended and another began) but because they assumed I would have a large baby, they made me put my feet in the stirrups and told me to push with all my might. At this point my OB shows up and gives me an episiotomy which I had specifically requested not to have. It all turned out to be overkill as my 6 pound baby slipped easily out with 2 pushes.
The pelvic pain subsided after that but returned during my next pregnancy. I was considering finding a different OB and hospital for my next birth, but for some reason I didn't. I think because my OB is a plus size woman herself and we get along well, I was willing to overlook all her rules( bed-confinement, episiotomies, etc.) and the fact that she only delivers at this hospital that had been so rude. I should have had more sense but I was just hoping for a better outcome this time.
My second birth ended up exactly the same. The pelvic pain was terrible but still no one would listen. My water broke before labor again and again I dutifully went off to the hospital to be confined to the bed. Pitocin was started again and despite my telling the nurses what happened the last time, they still wanted to use the external belly monitor. Again I had violent contractions and the nurses were very rude and telling me to be quiet while I screamed. Again the epidural failed and wasn't tried again. I remember wailing to my husband that I couldn't believe all this was happening again. I felt like a caged animal, writhing in pain and strapped down to this bed. When I felt the urge to push, the nurse scoffed and told me I was at -2 so there was no need to call my OB yet. I pushed anyway and the nurse screamed for a doctor (turned out to be a med student) because she crowned in one push. She had her arm up by her face so the nurse grabbed my legs and pushed them to my ears while at the same time pushing me flat on my back. I gave another push and she easily slipped out. I don't think it was necessary for them to panic like that and my pelvis has never been the same since then. The doctor hurriedly yanked on the placenta and I was bleeding heavily for hours. The nurse refused to massage my uterus, saying that she wouldn't be able to find it. So I did it myself after I got to my room.
After her delivery I was barely able to walk. The pubic pain had gotten worse and I had no idea what the problem might be. I talked to my OB about it and she did a quick exam, said she couldn't find anything wrong, and sent me home. My family doctor said I was just imagining it and to get some rest. My internist had an x-ray done of my tailbone and when it looked fine, he was very annoyed that I had wasted his time. Everyone told me that it was just normal post-delivery pains or that I just needed to lose weight. I was so upset and angry. I could barely get around but no one believed there was anything wrong. Aarghh!!!! Finally after 2 years it has resolved itself, but I still feel clicking and weird sensations when I lay on my side.
Transverse Presentation Birth Stories
Ann's Story (transverse presentation, c/s)
Kmom's Notes: Ann experienced some size-phobia and hassle from a previous provider, and decided to switch mid-way through her pregnancy. Unfortunately, her baby settled into a transverse position (shoulder/side first) and her doctors' policy was not to attempt external version. Because the baby did not change position on her own, Ann needed an elective c/s.
Ann's story can be read on her website at www.adairmedia.com/ann/elizabeth.htm. She had a pretty ordinary pregnancy, but had a c/s when her baby was found to be transverse. Because it was an elective c/s (no labor beforehand because of the danger of cord prolapse in a transverse presentation), the baby had some troubles breathing at first and spent quite a bit of time in the NICU (neonatal intensive care unit). Ann also had to have an unusual vertical incision due to the baby's presentation. Recovery at first was tough but all is well now. Breastfeeding got off to a rough start, but they persevered and are now breastfeeding exclusively.
GAMom's Story (high blood pressure, PROM, transverse malpresentation, c/s)
Kmom's Notes: This mom has not been evaluated for either PCOS or thrombophilia but may have some autoimmune problems affecting her fertility; test results have been contradictory. Progesterone supplements in the beginning of pregnancy seem to have helped this pregnancy continue. She also took low-dose aspirin for part of the pregnancy.
In a follow-up question, she noted that the hospital did not tell her to have her staples out at 3-4 days; she waited until her 2 week postpartum checkup to have them out! Ouch.
My husband and I had 3 miscarriages (all between 8-10 weeks). We really wanted a baby. My OB-GYN was great. He immediately put me on progesterone suppositories due to prior miscarriages. We had our first ultrasound at 7 weeks. You could see the sac and heart forming. Our next ultrasound was at 15 weeks and you could see the babies heart beat. I was SOOO relieved. My husband was great. I still didn't want to get all my hopes up. We got pregnant when we weren't supposed to. It had only been 2.5 months since our last miscarriage and the doc wanted to run some tests. Oops! :-) We had our first round of tests and it came back with levels increased. Our doctor informed us that it was probably just a false positive but sent us to a perinatologist anyway. We saw him once a month for quite a few months. Boy, do we have great ultrasound pictures. Our baby girl developed quite rapidly over the time. All measurements were great and on target. Two amnios were attempted but the needle wasn't long enough. And MAN, did they hurt!!!! They monitored closely and took precise measurements to ensure the baby was okay.
We were finally released from him and seeing our doc every two weeks. Everything was fine. Our baby had been head down since January at every visit. My blood pressure starting to rise a little to about 140/80 and 150/90 toward the 33 week. My doc put me on bed rest and then it soared higher. He released me back to work and it was fine. At the next visit it was a little higher ( I was seeing him every week now) and it put me on home rest, not bed rest. It did much better. I went out to dinner with my husband on Friday night and that night my water broke. It was just leaking and I really couldn't tell much difference between that and going to the bathroom a good bit. By morning around 8,, we called the doctor and he sent us to the hospital. My water had definitely broke.
Because it had been broken for a while they wanted me on bed rest there. They hooked me up to all the monitors and the baby was fine, but I was not in labor. they did and ultrasound and she had turned transverse. All things considered, we opted for the c-section. The epidural was easy and I was awake for the entire thing. My beautiful baby girl was born that night at 8 thirty. She was healthy w/ apgars of 8/9. She roomed in w/ us for Sunday and Monday. Monday night I put her in the nursery because we were going home on Tuesday. She choked on them (they fed her a bottle!) and turned blue. As upset as I was, it ended up being good because she needed oxygen. Her O2 levels were in the mid 80's. They put her in NICU and gave her antibiotics, oxygen, and lots of tests. She also had to go under the bili lights after that test came back. I was in there as much as they would allow. She nursed well, but I never did have milk that came in. She got a lot of colostrum though.
Within three days she went to the intermediate nursery on an apnea monitor and oxygen. they couldn't wean her off the oxygen and she had a few apnea episodes. After it was finalized that her lungs just weren't completely developed because of her prematurity and high birth weight for her prematurity, we PITCHED a big fit. To make a long story short, she came home on oxygen and has been great ever since. She is now 8.5 months old and still on the monitor, but no oxygen since 1 1/2 months. She now weights 20 pounds, 29 inches tall and is a very HEALTHY baby girl.
I wish all the supersize moms had as great a doctor and experience as we did.
Amy Moiles' C/S Story (malposition, c/s, anesthesia problems; has other stories too)
Kmom's Notes: This was Amy's 6th baby. Her first baby was born vaginally but was stillborn. Her next 3 babies were born by cesarean. Her next baby was born vaginally, a homebirth VBA3C (this birth story can be found in the BBW VBAC Stories and the VBA2+C Stories FAQs). With the next pregnancy, however, the baby was malpositioned---probably oblique or transverse, with the baby's arm presenting first. Although Amy planned an unattended childbirth, she ended up in the hospital with a cesarean due to the baby's position.
Unfortunately, the cesarean did not go well. They used a general, and the level of anesthesia was not sufficient during the surgery. When a general is used for cesareans, the drugs used can severely depress a baby's respiratory system, so the doctors have to walk a fine line between light enough anesthesia to avoid affecting baby too strongly, and a strong enough anesthesia to keep the mother from feeling the surgery. Most of the time they find the right combo, but in this case, the mother was fully conscious of the pain, but was paralyzed from other drugs and so was not able to communicate that she was feeling the surgery.
I had woke up that Thursday morning with some contractions that REALLY caught my attention. I had cried wolf all week, had the usual prodromal stuff daily. I just KNEW this wasn't the fake crap, it was IT but I also somehow knew it wouldn't pick up until evening. I had only one natural labor and I guess I just assumed they would both go the same way. They did in many ways. I had lost my mucus plug several days before and had the prodromal stuff for a good week with both. Hubby and stepdaughter went to work when I assured them I was OK. I don't remember what I did during the day. I know I got my stuff ready, set the birth tub up and putzed around with the kids. At the time I had 3 at home---my then 2 year-old, my 4 year-old, and my 4 year-old granddaughter. My older two were at school. I took a nap but the contractions woke me up so it wasn't a good nap.
Around mid-day I kinda got scared as the contractions picked up and I was alone with the kids. Both my DH and my 21 year old stepdaughter were due home by 5. DH got home early, knowing I needed help. I tried to make dinner but the contractions were no requiring my full attention. They didn't HURT, just made me focus on them. I went to take a shower, hoping that would relax me. I got dressed in my labor nightgown (the one I wore when I labored with Joshua) and was in the bed on a hands and knees position, crying that this was happening too fast for me. I wasn't in PAIN (my back hurt like the dickens but not my belly!) but I wasn't ready---I wanted the house settled and my house was loud and the kids were distracting me. So here I am, butt in the air, crying to DH and I start to leak my water. I thought I peed at first but I realized I had just went potty and it was clear and I couldn't control it. Well, I knew things would get intense. I got a long break from contractions and emailed my online friends to let them know it REALLY was happening. The contractions came back but were spaced apart and VERY do-able after that. I felt better.
How the kids got to bed---I have no clue but they did! I sent DH and stepdaughter to bed---I wanted them fresh when I needed them and I was fine. So I watched TV, chatted online, and just labored alone. I found straddling the toilet backwards helped so much. I put candles in there and pillows on the back of the toilet and would head straight for the bathroom when they came. This was strange to me since the only thing that felt good during Joshua's labor was standing and rocking. I think it was close to 2 a.m. when I woke Rob up. He got the water in the pool and was trying to help me but what worked with Joshua wasn't working; I almost didn't want to be touched, VERY different from my last birth. I was TIRED at this point. I had not been sleeping well all week and it had caught up with me. I tried to lay on the couch and take a snooze before transition hit as it felt like it was VERY close. I did snooze for a few but got up, annoyed, that my contractions just seemed to kinda stay at one point. They never got closer or stronger and then transition symptoms that I didn't even have with Joshua came. I got sick, had the chills, and was hot at the same time. I got excited things were happening. To be honest I was scared of the pain at this point. I also was STILL so very tired!
Around 5 a.m. I started thinking something was wrong. I had this band of pain in the front of my belly---not where my section scars were. It was strange. I had it a few times during the pregnancy but never knew what it was. Well, it scared me. I wasn't thinking rupture--I didn't know WHAT it was. I tried walking around and squatting and hands and knees to get things going again----the contractions had not changed since about 2 a.m. no bloody show, no triple peak contractions, no thinking I can't do this---all the sings I KNEW as transition from Joshua. Just contractions that didn't change and even kinda slowed down at this point. I called my old MW from when I had Joshua and she gave me suggestions, even gave me a clue on what that band of pain might be (I can't remember what that was now though!). We continued and I called a friend from my childbirth list. Everyone said I was doing good but I just KNEW something wasn't right. I was in the tub when I decided I needed to transport. I was thinking I had stalled at 5 or 6 cm despite the fact that I could barely feel any of my cervix. My oldest woke up and got off to school knowing I was headed to the hospital.
I left for the hospital around 8:30 a.m. and knew what I was in for. When I got there they hooked me on the monitor and checked me----I was 8-9 cm!! At this point the doctor started being VERY rude to me and Rob. She talked about breaking my water as she also called the OR that I was coming in for surgery since I had 3 sections before. I thought about pain relief---funny since I think I had one contraction the whole time I was there. Again, the doctor came back---Rob and I had asked for some time alone. I told Rob maybe I should just get the section and he said nothing, just gave me a look. I knew he thought I could still do this so we left Against Medical Advice (AMA). This made them mad to say the least. They told me my baby could die (despite the fact that the monitor showed she was FINE!).
We got home and I called another friend from my list. She talked to me and I cried but I had a new strength to keep going---I was almost there after all! 8-9 cm without transition! I tried a bath, tried different positions--you name it. Nothing was changing. I was so tired I was getting weak. I tried to eat and was drinking but I was just SO TIRED. The kids were in the bedroom, keeping busy. It must have been 2 p.m. when I gave up. I was having a hard time walking, I was so weak. NOTHING had changed---no bloody show, nothing. I did get transition type contractions but they spaced out so much at this point. I called the hospital to see if the yucky doctor was still there and she was gone. The nurse begged me to come in --she remembered me and sounded so concerned but not in a mean way. I was crying but yet I was okay with leaving.
We got there and the nurse checks me and says 8-9 cm still. My bad of water was still intact and HUGE. Doctor came in, same thing, and he left to get ready for surgery. When he left the nurse came over to me and told me my baby was SO LOW and if my water broke, baby would just fly out before they cut me. She told me to pretend it broke on its own as she broke my water. After she did this she checked me again and said, "Get the doctor, this is no head, it's an ARM." He comes in and confirms my daughter's hand in there. He tries to move it, although I am not sure why since they were planning to cut me. No luck---her arm would not move. I have never cried so hard. I begged the nurses to keep my baby safe. I was so heartbroken that I had done EVERYTHING right, did it all the way I should and it failed me.
They decided to use a general and I am not sure why. I was so tired and after my last epidural (8 tries with horrible pain) and most of my labor was in my back----I was okay with this. As I laid on that cold, sterile table---so far from how I planned to greet my baby---I prayed not to wake up (as happened during a general several years ago during my ear surgery), to not feel it and for my husband to get my daughter so she could know someone loved her. I did not fear for her, never did---somehow I knew she was OK but I also somehow knew I had some problems coming.
They put the mask on me and I hear, "She's out" and they start to cut me. I AM AWAKE!!! I feel like I cannot breathe, I can hear them talking and can feel everything. I have never felt such pain in my life. I prayed not to die from the pain. I felt like I was doubling over from pain but I knew I wasn't moving. When they stopped cutting I was so glad it was over. I felt like I sighed but I don't know if I did. It was over but I didn't hear my duaghter or them talking about her. This is when I felt the pain again. Oh my God---they are cutting me AGAIN!! I try to scream, I try to kick, I try to blink my eyes hoping SOMEONE will help me.
Then I hear my daughter's cry! I was so happy to hear her cry. Then I was asleep finally. I woke up in the recovery room asking where my daughter was. She was with my husband. That made me feel better but I wanted to see her. A few minutes later I see my husband and my daughter. She was so beautiful! She was asleep. I cry that I missed it and my husband tries to comfort me and tells me how he handled her in the nursery. He told her about our family and how many brothers she had. She was awake for him. I was never so jealous in my life. I was glad she had him to comfort her but I wanted to be the one holding her!
The next few months of healing (physical and emotional) were rough, to say the least. I ended up breaking my tailbone from her bad position and that took months to heal. The doctor also told me I had SEVERE adhesions and that took longer to "clean up" than the section itself. Turns out that was that band of pain I was feeling in later pregnancy and labor. He told me I was headed toward a bowel obstruction if he hadn't fixed it. Funny how that was my 4th section and I never heard that before.
I have since viewed my records and it does seem she was VERY malpositioned. It is unclear but it reads to me like she may have been oblique or even transverse. Her arm was what was coming first---no head at all.
Breech Presentation Stories
Note: There are many women who have breech babies; there are too many to include here. A few representational stories only are presented. For more breech stories, see other online birth story collections, and also see the c-section birth story FAQ here on this website.
Liz's Story (breech, failed external version, c/s)
Kmom's Notes: External Version is not the only option for turning a breech baby, but it's the only one most OBs will even try (and some OBs won't even try this either). Moxibustion/acupressure, position changes (knee/chest or ironing board tilt position), special use of lights and music, cold stimulation, hypnosis, homeopathy, and a chiropractic technique called the "Webster In-Utero Constraint Technique" all have succeeded in turning breech babies, often even when External Version fails. Furthermore, the skill of the provider doing the Version is key; some doctors have extremely low success rates and cause the mother great discomfort in this procedure, while other doctors (and some midwives) have much better success rates and much more gentle approaches.
No one person or method is 100% successful in turning all breech babies, and sometimes there are physical reasons why a baby is stubbornly breech. However, it's too bad Liz did not get the opportunity to try any of the other methods that often work. Kmom has personally known the ironing board tilt to turn the breech baby of a very late-term mom similar to Liz. Also, it is Kmom's anecdotal observation that moms with strong sciatica pains often end up with malpositioned babies, and the Webster Technique can often help with both of these things. There are no guarantees that any of these things would have turned Liz's baby, but it's too bad she didn't get to try.
About two weeks before my due date, an ultrasound revealed that my once "heads-down and ready-to-go" baby had turned breech. The doctor told me my untested birth canal combined with the particular breech position of my baby made it especially dangerous to attempt vaginal delivery. However he was also leery of performing a c/s because of my age and physical condition, and he felt a vaginal birth would be easier for me.
He strongly urged me to have an External Version. This is a procedure where they try to manually turn the baby. He reminded me that a c/s was major surgery and he felt I should do everything possible to have the baby vaginally. So a week before my due date, my DH and I headed off to the hospital to try and turn our little dear. Once at the hospital, they hooked me up to monitor the baby's heartrate and my contractions, if any. A steady stream of nurses and residents came in to ask me questions, start an IV, explain the procedure to me, detail the risks associated with a version, and ask if I had any questions. They told me in the slim chance something went wrong, they could have me in the O.R. and the baby delivered within two minutes. When the doctor performing the procedure arrived, he did an extensive ultrasound and then he announced that he didn't think the version would work. He said there were several factors working against success:
He said it was unusual to try a version so late in pregnancy, but even with all these things working against us, we decided to give it a try. The doctor and two residents proceeded to push, pull, and push some more. But the baby just wasn't going to turn. After 3 tries, they gave up and sent me home with instructions to call my doctor as soon as possible if I should happen to go into labor over the weekend. The c/s would be scheduled for the next week.
It was a very long weekend---waiting for the surgery to be scheduled. I was scared of having surgery. I was scared of not having surgery. I was scared something would go wrong. I was scared of becoming a mommy. I was just downright scared! Monday afternoon my OB called and told me I should go to the hospital that night for blood work and my c/s would be in the morning. A sudden rush of adrenaline, excitement, and fear coursed through my veins. In 24 hours, I would be a mommy!
Tuesday morning, I got up, showered, packed my last couple of things, and we headed off to the hospital. DH and I were pretty quiet in the car. It felt like the air was very heavy and I didn't know what to say. Once at the hospital, I had a mini-panic. I had some bills that needed to be paid and I had forgotten to mail them. Overcome with a mixture of the fear, adrenalin, and excitement, I wouldn't let myself be checked into the hospital until I found a mailbox. I was a mad woman---running around the hospital looking for a mailbox.
Once checked in, they hooked me up to the monitors. The baby's heartbeat was strong and steady but there were no contractions. I was asked all the same questions they asked me on Friday. Another IV was hooked up. One last ultrasound was done to confirm the baby was still breech. Finally my OB and the anesthesiologist came in. They asked if I had any final questions, gave my chart the once-over and told DH to put on his scrubs. It was show time!
They had me walk from the intake/observation unit to the OB surgical suite. This was one of the longest walks of my life. The closer we got to the door that said "Authorized Personnel Only", the more my heart raced in my chest. There was no turning back. This was it! DH was told to wait outside the operating room while they started my spinal. I was taken into the cold operating room and told to hop up on the operating table. I needed some help for this maneuver because a short heavy pregnant lady doesn't hop anywhere. The spinal was the worst part of the whole thing. The anesthesiologist said I didn't have good landmarks (not something I wanted to hear), so it took him a few minutes to do the job. But once that was done, everything started to move really fast.
I was shaved and given a catheter and the incision was made. I asked when they would allow my husband to come in. With that, the doctor summoned him. I felt a little woozy from the tranquilizer they put in my IV but I was still present for the whole thing. The surgical lights were set up in such a way that I could watch the whole operation, if I wanted. It was a trip! There I was, lying there watching this surgery like I was watching the Discovery Channel and all of a sudden it hit me---"Hey, that's me up there!" So I stopped watching.
Dh was a little overwhelmed by the blood. He said it was a good thing I stopped watching. He was making jokes and taking pictures to keep busy. The next thing I know the doctor says, "Here she comes. Here's you baby!" I look up to see him holding the most beautiful blonde baby girl. My OB gave her to the neonatologist to clean her up. He suctioned her out and the nurse took her footprint. They put ID tags on DH, the baby, and me. We all had bands with identical numbers and you had to show your band in order to get the baby once you left surgery.
While they were stitching me up, I couldn't take my eyes off of my little girl. The nurse wrapped her up in a blanket and brought her over to me. They put her across my chest and I just kept staring at her and crying. I had a little girl. My baby was here and I loved her more than I dreamed possible. All the fear, pain, and 9 months of petty annoyances were well worth it. I would have walked across hot coals for that moment with my beautiful baby.
Danielle's First Story (breech, premature, elective c/s)
Kmom's Notes: This mom had her hospital dispute her due date. They changed it to 3 weeks earlier than it was supposed to be. The mother and her husband are both tall, so the baby probably was bigger than average. But because ultrasound dating is based on averages, her baby's larger size made it look like the baby 'should have' been due earlier.
This had strong consequences for the mother and the baby; baby was still breech (as some still are at that point) but might have turned on its own before the due date (as many do). However, because they thought the pregnancy was farther along, they did an elective c/s for 'breech', and it turned out that it was done almost a month early. Elective c/s on its own is a risk factor for breathing problems; elective c/s plus prematurity is an even stronger risk for breathing problems. It also often impacts a baby's ability to suck effectively; it is not easy to preserve breastfeeding in the face of prematurity. Between the elective c/s, prematurity, and uncooperative nurses who kept giving the baby bottles, they were not able to preserve breastfeeding. Moral of the story: Don't allow a change of due date based on a late pregnancy ultrasound. They tend to be quite inaccurate for the purpose of either dating or estimating the baby's size.
Danielle's second birth story (c/s due to posterior presentation) is in the 'posterior' section of this FAQ.
Baby #1 (Alyssa): I was 7.5 months pregnant when I arrived from overseas to have our baby at home in New Zealand. Seeing as it was so late in my pregnancy it was hard to find a midwife, but we ended up finding one, who went halves in our care along with a local hospital. The hospital decided to do their own testing, and after yet another ultrasound they came to the conclusion that our baby was due on the 23rd of November even though my last menstrual cycle and doctors in Australia told us our baby was due around the 16th of December. Being our first pregnancy, we decided the hospital must be right and we continued with our near perfect pregnancy.
At 8.5 months it turned out our daughter was still breech; in fact the specialist said he could not turn her manually because she had descended down feet-first into my pelvis. I had an x-ray of my pelvis and another ultrasound which all concluded that she should be able to fit through (after 6 ultrasounds showing a girl, we figured that she would be a girl!). My husband (boyfriend at the time) and I talked about what we thought was best. We decided to do what we thought would be best for the baby, and having a breech vaginal birth worried me. I was scared that I would go into labour, my waters would break, and her feet would pop out. We decided the only way to ensure our baby was out safely was to have a cesarean. To me, having our baby safely was the most important thing; the caesarean itself was not a problem. I don't believe a baby has to be delivered vaginally to be a 'perfect' baby. At our next antenatal visit we told the nurse of our decision.
Wednesday the 13th of November at 8 a.m. was the date of our little baby's birth. It was a weird feeling knowing what day and at what time your baby's birthday will be. Wednesday came around slowly, each day counting down to the day our lives would change forever. Finally, we could meet our little daughter. We got up early, had a shower, took a quick photo of me outside, and walked to the hospital. A most unusual labour.
We arrived early, we were taken to a waiting room where we waited for our midwife to arrive; she arrived on time. We all waited and waited and waited. Finally a nurse came and asked me to lie on the bed in the lovely gown, where I had my temperature taken, and had my blood pressure recorded. I then had 2 nurses and a doctor attempt to insert an IV drip in my wrist. When all else failed a specialist finally managed to insert it in my hand. My husband put on the green scrubs. Then I was wheeled into the operating room. We were told before how everything worked, and were told again. So we left ourselves in the hands of the unlimited amounts of people present for our baby's birth. There were doctors, nurses, nurse's nurses, specialists, students, and somewhere in the middle was our midwife, me, my boyfriend, and my bulging belly.
I was moved onto a thin table, assured I was not going to fall off, rolled onto my side, and the spinal block was inserted into my spine. I was rolled onto my back to wait for the fluid to spread. After 10 minutes I could still feel my left hand side, so another spinal block was given. After another 5 minutes I was numb up to armpits, a catheter was inserted, a mast was put over my face to ensure the baby got enough oxygen. 5 minutes later, our beautiful baby was born at 10.15 a.m., weighing 3400g (7 lbs, 8 oz). The first thing I remember thinking the first time I saw her was, "She's not ugly, she is beautiful." I had an impression that all newborns were scrawny little shrivelled up half-prunes, half-alien-looking things with funny-shaped heads. But she was far from ugly.
We were wheeled off into a room to await our hospital stay. Things were going really well until that night. She had problems breastfeeding. And the night nurses had problems hearing me say no. She stopped breathing and nurses rushed in and told me she had mucus on her lungs. they informed me the only way they could get rid of the mucus was "to give her a bottle of formula." This I could not understand. I asked them if they could put my breastmilk in a bottle and they said no. I then protested, saying I didn't want them to give her a bottle of formula, and they said in the most degrading and horrible way, "If you want to kill her, it is up to you." I could not understand how giving her my breastmilk would kill her. I let them feed her formula, and the nurse sat in the corner of the room feeding her her first decent meal since her birth (of formula) without saying a word to me or letting me feed her the formula myself.
My husband arrived later that morning to find me crying. I felt like a failure because I could not feed our baby. I told him what the nurse had said and he ran off and rung our midwife. She arrived at the hospital less than half an hour later and blew up the nurses. She told them that this was supposed to be a baby-friendly hospital and that they are not meant to be so eager to feed babies formula unless the mum and dad want them to.
Later that night, the baby woke hungry. I tried for more than hour to feed her by myself, but she just would not latch on. I rang the bell finally but no one came, so I rang it again---still no answer. Finally after 2 more rings, the same nurse as the night before appeared and asked me what I wanted. I asked her to help me latch her on, and she said (and I quote), "Oh no, I can't do that. I'll have to call your midwife." I said, "No, I don't need my midwife. I just need some help latching her on." She replied, "Your midwife has stated quite clearly that I am to ring her if there are any problems at all." (My midwife had written at the top of my page, 'No formula or bottle, please call me if needed." So the nurse went off and called my midwife at 2 in the morning.
I went home the next day, after 2 nights in the hospital (4 nights early). That's very early after a c/s. The stress of having one more night in that hospital with that nurse was overpowering. Things did improve at home, but our daughter never breastfed. After trying for 9 weeks of pumps, syringes, bottles, sterilizing, breast shells, shields, and crying, we decided to give up and the postnatal depression I'd had disappeared when I saw her weight go up.
Oh yes, it turned out we were right---she was 3 weeks early at birth [Kmom note: At least!]. Because my husband is 6 ft. 4 and I am 5 ft. 11 all the ultrasounds showed her to be bigger and taller than she was. I don't regret the c/s but I do regret having her early because I now can't help thinking if we waited, she would probably have turned, and I would have had a 'normal' birth and not had such troubles breastfeeding.
It turns out now that nurse has been fired; I was not the first or the last person she degraded. She was rude to all first mums, especially those under 20 years old and unmarried (as we were---I was 18), and those overweight (thought I'd love to weigh that again!). It is sad to think just one person can make what should be such an exciting time into a stressful, demoralizing experience.
I hope this helps other people to stand up for what they believe and realize that just because someone has a piece of paper it does not make them right.
Unknown Position Stories
Lori's Story (insulin-dep. gd, rising b/p, induction, vaginal birth)
Kmom's Notes: This is an interesting story of a mom who had to have some interventions but fought off others, and with the support of her midwife (acting as a doula), was able to have a vaginal birth because of her hard work and careful choices. Because of her rising blood pressure, she needed to induce, but they essentially used 'serial induction' (where you delay breaking the waters and if the pitocin etc. does not have much effect at first, you stop and try again another day). They induced over 3 days, and she fended off many OBs who wanted to break her waters earlier. Amazingly, she did the induction without an epidural.
Although it's impossible to be sure, it sounds quite likely that her baby was malpositioned somehow. Intense pain without progress, back labor, labor stalling at 4 cm---these are common with malpositions. Her midwife put her on her side, and it looks like this might have turned the baby somehow into a more favorable position, for labor progressed after that. There is research that shows that side-lying (or all-fours) can help turn most malpositioned babies; it seems to have worked here. However, if they had broken her waters earlier, this may have put the baby into 'deep transverse arrest'---where the baby is gets so stuck in its malposition it cannot turn fully.
The baby's small size (just over 5 lbs. at 38 weeks!) could be from simple genetics, or a side effect of poor placental function due to high blood pressure. It could also be from too-aggressive insulin treatment. Some research has questioned extremely aggressive insulin treatment, noting an increase in small-for-gestational-age babies in this group. However, there's no way to tell for sure why this baby was smaller.
The midwife acting as doula probably also strongly increased her chances at vaginal birth too. Although small, one doula study found that women who had medically-necessary inductions with the support of a doula had a MUCH lower chance for a cesarean compared to those induced without the support of a doula. Moms who must be induced might want to strongly consider hiring professional labor support like a doula.
When I was thinking about getting pregnant, I considered dieting, but much of what I had read (including on this website) convinced me that crash dieting before being pregnant would not be good. Instead I concentrated on keeping my weight stable and eating well. I got pregnant the second month of trying, and the first part of the pregnancy was uneventful.
My husband and I took a Bradley class which scared me about drugs and some hospital practices, and I developed a desire for a natural birth although I did want it to happen in a hospital. I was concerned about unnecessary c-sections, because I am the kind of person who questions everything. If I had to have a c-section, I wanted to come away from it feeling that it had to happen. Because of all this, I was in the process of switching from my OB practice to a midwife I liked. However, that is when I got diagnosed with GD, and it did not respond to diet. The fasting numbers stayed high, so I started insulin.
I was very depressed---I was not going to be able to have my midwife in charge of the birth, and I was probably going to have to be induced, have an IV, the whole nine yards! The people at the high risk clinic I now had to go to said I had greater than a 50% chance of having a c-section, so I tried to mentally prepare myself.
[Kmom note: The c/s rate in insulin-dependent gd moms IS higher (unacceptably and probably unnecessarily so), but this rate of 50% they quoted her is excessively high. Most studies don't show c/s rates this high for GD moms, even those on insulin--it's usually between 25-40% or thereabouts, with a few studies on either side of these ranges. True diabetics (type I or II) do tend to have a c/s rate of about 50%, but it's not usually quite so high in gd moms. However, perhaps it was true that in THAT clinic, the rate was 50%---which says a lot about that clinic's practice!---but readers should not infer that the c/s rate is 50% for all insulin-dependent gd moms.
This is also an ironic comment on the purported benefits of insulin treatment, one of which is supposed to be a lower c/s rate due to a smaller baby. Although some studies have found a lower c/s rate in the insulin-treated group, most have found that the c/s rate is actually much HIGHER in this group, often even when macrosomia is reduced. This is probably due to the 'high-risk' mentality and interventions applied when insulin is used.]
In fairness, I have to say that I didn't get a lot of comments on my weight from the doctors and such. I mostly heard about it in the context of my risk of Type II diabetes later; that I should diet and exercise. When I was in the hospital it was never mentioned except that they were looking for the large gowns, but it was all matter-of-fact.
My midwife offered to be with me anyway---run interference with the hospital staff, etc., like a consultant. I gratefully accepted. During the last ten weeks I had two non-stress tests weekly, went to the clinic once a week, and had acupuncture to try to control my BP which had started to rise. The midwife and I were planning to try to get my cervix ready for labor with Evening Primrose Oil (EPO) and try to induce labor with acupuncture/castor oil just before my scheduled medical induction.
But we didn't get the chance---when I went in for my routine 38 week visit, my b/p had shot up and they wanted to induce starting that night. After some discussion we agreed. My midwife was a realist; she didn't try to hide the fact that we were going into a situation with the odds stacked against us. My cervix was not dilated or ripe at all, and with my high b/p the medical staff would be very eager to section me at the first sign of distress. We'd just do our best.
We checked into the hospital Friday evening and I got the Cervidil (a prostaglandin insert). Saturday morning they started the Pitocin and ran it all day---nothing happened. Saturday night I got Cervidil again and fended off an OB who wanted to break my water. Sunday morning I got the Pitocin again and fended off another OB who wanted to break my water. (The general OBs on call were trying to do things contrary to the perinatologist's ideas.) Early Sunday afternoon I finally began to have contractions and my water broke! I now had 5 bags on my IV: saline, glucose, insulin, Pitocin, and Magnesium Sulfate (for the b/p).
The contractions got intense and I started to vocalize through them--I had my husband in front of me and a doula behind me applying counterpressure (back labor, ick). At some point during all of this I had an internal monitor placed. I hadn't wanted it, but those belts just did not work on me once I was having contractions.
I was at about 4 cm, and a couple of hours later I was still at 4 cm. I was very discouraged---for some time it had taken all of my skill to get through it, and I was losing confidence. I said to the midwife, "Oh God, if I am going to have to get an epidural I'd just as soon get it over with..." She helped me stay in the present and reminded me how fast things can change. She suggested a small shot of Fentanyl to help my back and wanted me to change positions. I agreed to try her plan. The Fentanyl didn't seem to do anything for the contractions, and the position change (she suggested I lie on my side) seemed to intensify things. I think the baby may have been turning. I went from vocalizing to downright screaming during the contractions---forget Lamaze and Bradley and all those other MEN! This went on for about half an hour (kudos to my husband who was a rock---love but no pity) and she checked me again---I was ready to push! "Well, no wonder!" everyone said, and we got ready to push.
Pushing was hell for me; some people said it feels better at that point but not for me. I screamed during every push (what a sore throat I had the next day!). [Kmom note: Perhaps there was some malposition left, as this can make pushing slow and extra painful.] I pushed her out in about an hour. At the very end she started to show a little distress, and the midwife urged me to push harder and harder. She later told me that the distress wasn't bad yet, but she didn't want the baby to be born with depressed breathing because they would take her away.
So at last she came out---what a feeling! The midwife actually ended up delivering my baby because the perinatologist was called away to a c-section. She was much smaller than we thought at 5 lbs. 4 oz. The ultrasounds were wrong; they said she was average. She had to have lots of glucose tests but she was very healthy. She and I were both a little spacey from the magnesium sulfate but other than that I felt pretty good. I got up in half an hour and went to the bathroom. I had one small tear, smaller than the episiotomy, from having to push her out fast at the end.
Despite the days in the hospital and the stress, the birth is a very positive memory for me. I feel lucky to have the outcome as good as it was given the circumstances. I believe that the midwife and not letting them break my water too early were instrumental in saving me from a c-section. The other factor was just luck. I'm also glad I didn't get the epidural because I would never have been able to push her out so well, and they would have needed to use vacuum or forceps when she was distressed. I hope to have another baby in a few years, and I know I might not get so lucky the second time, but I'll never forget the experience of feeling the baby come out. I'm glad I got to do it at least once.
Jen C's Story (induction, unknown malposition, c/s)
Kmom's Notes: Again, classic signs of malposition that the OB missed. Days of 'false labor', very intense labor pains, uneven dilation, feeling pressure despite an epidural, early need to push, fetal distress, etc. Unfortunately, the doctor blamed the problem on the 'layers of fat' keeping the baby from going through the pelvis (what nonsense!) instead of recognizing the baby's obvious malposition. She then told the mom that if she lost weight, she 'might' be able to have a baby vaginally. Although the doctor is almost certainly meaning well, it is yet another form of underlying fat-phobic attitudes. Although a doctor may not show any overt fat prejudice, there still may be underlying assumptions that reflect unconscious size bias. Assuming that layers of fat can keep a baby from coming through is indeed size-phobic. Women much larger than this mom have had vaginal births!
My original due date was March 6th. My OB was supposedly the best where I am from; my family doctor referred me to her. I kept having false labor and the doctor kept and eye on the baby's guessed weight (she thought the baby was between 7-8 lbs). She decided not to induce as I had no prior problems in my pregnancy. I had no PIH, no GD, no edema, nothing. But I did have horrible morning sickness, which caused me to lose about 15-20 lbs in my first trimester. I had anemia, which I was put on iron pills for, and I had low cholesterol. In the end I had acid reflux so bad it would keep me up at night (I never had it before my daughter, and to this day there are certain foods I cannot eat without taking an antacid prior to eating it). Generally I was very lucky, a very uncomplicated pregnancy. My hope was to have this baby vaginally. Not once did it cross my mind that I would have to have a cesarean----boy was I wrong!
I had 'false labor' on March 13th and went for the hospital for the 4th time, only to be told it was seriously trapped gas, which I was given some nasty liquid for. They asked me if I wanted to stay overnight or come back in the morning for a Non-Stress Test. I decided to go home and tried to sleep with it on my mind. I got to the hospital the next day, had the NST which proved the baby wasn't doing so good in her environment, so my doctor called back the nurses and told them she wanted to have an induction that day (the original induction was supposed to be the next day). Around 11:30 a.m. she came in and asked how everything was going. I told her I was miserable and just wanted to have the baby already, so she broke the bag of waters and started me on pitocin and had the antibiotics for Group B started as well. [Kmom note: Breaking the bag of waters probably set the baby's malposition for good and made it very hard to resolve.]
The major contractions didn't kick in until 1:30 p.m., although right when she broke the bag of waters I had a major contraction. She joked and told me that was what a REAL contraction felt like (my doc was kind of cold, so this little joke was a surprise to me and even made me smile). I decided on Fentanyl for the pain; I had already gone over the birthing plan with my doctor and told her NO EPIDURAL! The pain became too intense for me and I remembered what one of my friends had told me---that you cannot get the epidural after you're dilated so many cms. I was about 4 or 5 and I told them I wanted the epidural, which shocked my OB but she got the anesthesiologist in there and I had no more pain. UNTIL the baby started descending later on and I kept telling my absolutely wonderful and caring nurses that I felt like I was 'going to pee'. They checked the catheter and were puzzled. The anesthesiologist upped my dosage of epidural but it did no good. By this time I was shaking, my BP was extremely low, and I was so cold the nurse brought in 4 warmed blankets and covered me and turned the heater on ('transition!').
I kept complaining about having to go pee, the nurses were still puzzled and still checking my catheter when I finally shouted, "You don't understand, I have to PUSH!" They checked me once again and said that I was dilating strangely (had been at 6.5 cm for a couple of hours), more so on the left side than the right side. Apparently the left side was completely effaced but the right side wasn't. One nurse thought I was dilated 8 cm--I was overjoyed to hear that, thinking only 2 more cm to go! But another nurse came in and told them I was still only 6.5 cm. I was tired and frustrated when the baby's heartbeat started dropping and my OB said to me, "We're going to have to do a cesarean, the baby's in distress." I asked her why the baby wasn't progressing and she told me that the baby's head wasn't going through my pelvis, and told me that layers of fat were (possibly) stopping her from descending. Being in labor and tired, I totally misread/misinterpreted what my OB was saying and started crying, saying I didn't want a cesarean.
I was prepped for a cesarean and taken to the OR across the hall from my room. It seemed like forever that they were prepping me and I kept asking where my fiancé was because he wasn't by my side. When he got in there, the OB asked me, "Can you feel us cutting into you?" and I told her no. By 9:22 p.m. my daughter was born. She wasn't breathing at first so they had to give her oxygen. Her Apgars were 4 and 7. I got to see a glimpse of her for about 3 minutes (this really upsets me to this day) and then she was whisked away to the NICU, and I was sewn up and wheeled to recovery. In recovery, I was so drugged up I had no clue what was going on. My nurses were constantly checking on me due to the high fever I had (105 degrees). [Kmom note: A fever is very common after an epidural.] Luckily it went away pretty quickly and I recovered with a 'score' of 100%. The nurse attending told me she had never seen anyone get a perfect score on their recovery and was quite impressed. All I wanted was to see my baby! Four hours later I got my wish, but the memory is non-existent since I was on antibiotics, pitocin and morphine.
Getting up the next morning to walk wasn't too easy. I hunched over and protected my stomach, thinking my guts were going to fall out. But my doctor did a wonderful job. Both of us were allowed to leave the hospital 3 days after her birth. I tried breastfeeding her in the hospital but I was nervous as my mother (who didn't really breastfeed either myself or my younger sister) kept telling me 'how to' breastfeed my daughter, not to mention my daughter wasn't too happy that it wasn't coming out fast enough for her. So when I got home, I reluctantly gave her a bottle of formula, my fiance next to me, my father and his girlfriend watching. She was so happy that she was getting something and seemed content. It really relieved me. I pumped for 2 weeks thereafter, and eventually couldn't make a schedule and my milk dried up. She is not 1 year old and not quite walking yet, but very active and very squirmy.
I have plans to have another child. When I saw my OB I asked her what the possibility of having a VBAC was. She told me that it was fine, as long as the baby isn't over 7 lbs. [Kmom: Baloney! The critical issue is not the baby's size, but getting it positioned well!] She also told me (not naggingly, I might add) that if I lost the weight before having my next one, I may be able to go through a VBAC with a bigger baby. Although I thought she was the best possible doctor for my cesarean situation, I didn't care too much for her bedside manner and I hope to find a more suitable doctor. I don't know if she was fat-phobic; she never really commented on my weight, but that comment she made right before the cesarean still unsettles me a bit. I am just hoping that I can find someone who is very fat-friendly and willing to work with me. [Kmom: She should try a midwife first. Although there are bad apples in any barrel, midwives are much more likely to be size-friendly, and research shows that she would have a greater chance for a VBAC with a midwife.]
Anna's Story (PCOS, PIH, induction, malposition, TOL c/s)
Kmom's Notes: Anna feels that her doctor wrongly attributed her blood pressure in pregnancy to "chronic hypertension" because of her size. In fact, her blood pressure was normal before pregnancy, was normal in the first several visits, and then started to rise. However, when she asked about pre-eclampsia, he told her she had chronic hypertension and she felt that this assumption was based on her size and not on the facts. After her pregnancy, her follow-up visits record very normal blood pressure readings. Obviously, she did not have chronic hypertension, and the higher BP was due to pregnancy.
This was Anna's second child. Her first had been born by cesarean, and she was hoping for a Vaginal Birth After Cesarean this time. Because of her rising BP, Anna's labor had to be induced, which strongly lowers the chance for VBAC in most cases. However, women *do* have VBACs with induction; unfortunately, her baby was slightly malpositioned, which made it difficult to be born vaginally. Because the doctor did not know how to help the baby re-position, a repeat cesarean became the wisest choice at that point.
Anna showed great strength of character by demanding that the anesthesiologist re-do her anesthesia for the cesarean! All along, they were not taking her seriously when she told them she was not getting good relief with the epidural. They also did not take her seriously because their monitors showed her contractions weren't very strong. (Many large women report that contraction monitors do not accurately measure the strength of their contractions.) When the anesthesiologist tried to tell her that her epidural was sufficiently strong for a cesarean, she fought back and PROVED that she still had feeling and needed more. Reluctantly (because doing a spinal after an epidural does have risks), he did a spinal, and she was able to have a 'good' cesarean experience. If she had not been so assertive, she probably would have been one of the unfortunate few (like Kmom) to feel their cesarean surgery. Standing up for herself like this in the face of their disbelief was amazing.
Having experienced secondary infertility due to PCOS and three miscarriages, we were delighted and frightened to find we were expecting again. I had pre-eclampsia in my first pregnancy, so they monitored me closely as a result.
About 4 weeks prior to the due date, having seen my blood pressure increase slowly with each visit, my
perinatologist wanted me admitted for possible delivery. My ob/gyn, who seemed
convinced ( despite the fact that my first couple of BP readings with this pregnancy were
normal) that I was chronically hypertensive, disagreed. He sent me for observation to the maternity floor of the hospital, but
told the nurses that if my BP stabilized, I was to be sent home. After six
hours on my left side, I did see a bit of a decrease in BP, so they sent me home to follow up the next Tuesday with the ob/gyn.
On Tuesday, I went to my appointment, and my BP was 175/110. That was the highest it had been, and I argued with my ob that I was ready to deliver. He begrudgingly sent me to the hospital, again for "observation". After several hours without a change in my BP, he decided to go ahead and induce labor. Cervidil was inserted and a pitocin drip started, and just a couple of hours later, my labor began.
The nurses were wonderful. They monitored me closely, and tried very hard to encourage my plan of a natural, drug free labor and delivery. After twelve hours of no sleep, they finally convinced me to do something for the pain. My cervix had only dilated to 3, I was progressing very slowly, and I was already exhausted. I hadn't eaten since 6 AM the day prior, since once I was admitted to the hospital, I wasn't allowed anything but ice chips. I agreed to some narcotic relief, the doctor decided to break my water, and I finally slept fitfully for about two hours. The pain seemed to be getting worse, and upon inspection, I had progressed to 5 cm.
The nurse asked about an epidural, and even though I had strongly desired a natural birth, I felt
totally wiped out and needed some relief. Finally, with the epidural, the pain subsided, and I was able to get some bit of sleep. It seemed to me
that the epidural wore off quickly, and twice, the nurse called to bring someone in to give me a little more medication. The third time, with the
pain seeming to me to be very intense, a new anesthesiologist came in and told me that based on my 'strip', the contractions weren't that bad and I
should be fine with what I had. He also noted that I hadn't progressed past the 5 - 6 cm point in quite some time, and said that if the pain did
continue, I could call back. After about 45 minutes, the nurse who was taking care of me stood up for me and demanded that someone come and give me
more meds for the pain. The anesthesiologist came back, and another round of drugs was administered.
About 5 that evening, February 14th, after having been in labor about 21 hours, I felt like there was something passing - there was no pain, but I felt for sure something was coming out of me. Seconds later, the feeling passed, and the nurse checked under my gown. She became quite frantic, scooped up the waterproof pad that I was laying on, placed it on a table out of my view, and ran to get another nurse. I became extremely concerned, and my husband didn't seem to know what was going on, and when the other nurse came in, they both agreed that my doctor needed to be called immediately. Apparently, I passed an extremely large blood clot, and after the doctor came, he deemed me okay to continue with the labor.
After several more bouts of trying to convince people that my epidural wasn't working, and the pain was really bad, the nurse confirmed that my labor seemed to have stalled. I had been at the 6 - 7 cm point for a long time, so the doctor was called in. At 2 AM on February 15th, the decision was made by the doctor, myself and my husband to go ahead with the c-section. The baby's head wasn't in position, and I was so exhausted that I felt if the time to push came, I'd be in a terrible predicament. The anesthesiologist tried to convince me that my epidural was just fine, but I proved to him that my feet and legs were totally feeling, and the contractions were absolutely being felt. I refused to go into surgery until something else could be done, so he agreed to a spinal. I am certain that had I not demanded something else, I would have felt the scalpel make the cut.
At 2:34 AM, on Thursday, February 15th, after 31 hours of labor, our second daughter was born via c-section. She had APGARS of 9 and 9, and after a few minutes of introductions, she was taken to the nursery. She remained there for a few hours. I insisted on stitches instead of staples, so I didn't have to have the staples removed, which I found uncomfortable after my first c-section. She and I went home four days after surgery, and except some minor drainage from the incision, I healed well.
I believe that the ob/gyn made a call regarding my increasing BP based on my weight. I kept close track of my BP, and I know it was normal up until about 4 months into my pregnancy. I learned during this labor and delivery that if you don't speak up, you won't get what you want. I hope I remember the lesson in other areas of my life!
Teresa's Story (2 prior cesareans due to malpositions, VBA2C)
Kmom's Notes: A story of malpositions! Her first probably had a malposition (postdates, distressed baby, water broke, terrible back labor, no descent of baby), and her second was stubbornly breech.
Her third probably also initially had a malposition (went overdue, water broke, back labor, labor too painful lying down, transition-like labor but stuck in early to mid-labor, baby not engaged, sudden change in labor probably indicating that baby had resolved its position, quick dilation and birth after that, baby had bruised forehead from where it was probably stuck for a while). Since this malposition was able to resolve on its own, she went on to have a lovely VBAC.
Baby #1 (cesarean): Water broke at 42 weeks with meconium, went to the hospital, shaved practically from the neck down, pitocin to start labor, HORRIBLE back labor, got the epidural that I swore I wouldn't get, could feel absolutely nothing, got to 10 cm and tried pushing for a couple of hours but couldn't feel anything so I'm sure it wasn't very effective. After 2 hours of pushing had a c/s for 'failure to progress,' 'CPD,' and distressed baby. (I was 20 and very naive--the doctor and hospital staff scared me into thinking the baby was in grave danger.) Baby was perfect, 7 & 9 apgars, no complications with the surgery. Had mild to moderate post partum depression for about a month. I'm now convinced that she was probably malpositioned. [Kmom note: She notes that she was not heavy for this pregnancy.]
Baby #2 (cesarean): I had divorced and remarried. Baby was breech from 32 weeks. Tried everything including version and standing on my head to get her to turn, had c/s at 39 weeks. Baby was perfect, 8 & 9 apgars. Still stubborn as a mule!
Baby #3 (VBAC): Even though my daughters' births were joyous occasions and resulted in two healthy and beautiful babies, I felt like I had missed something. I had always wanted natural childbirth and for my third (and most likely last) birth, I wanted it desperately. As crazy as it may sound, I longed to feel the pains of labor, to feel my baby emerge from my body, and to hold my baby while he was still warm and slippery with amniotic fluid, instead of hours later after a dozen or so people had laid hands on him. So I did everything I could to attain that goal. I read every book ever written on VBAC, scoured the internet for information and statistics on the safety of VBAC, went to Yoga class, made my husband read about natural childbirth, hired a doula, and generally drove everyone close to me a little crazy, including my wonderful and VERY patient husband.
The last and probably most important step I took to ensure that I got the birth that I wanted was to change doctors at 34 weeks. I didn't feel I was getting the support I needed from the doctor/midwife team I was seeing. My office visits were with the midwives, but since I had had 2 cesareans I was considered 'high risk' and so the doctor (whom I never actually met) became involved in my care. The 'rules and requirements' of my labor changed from visit to visit and became more and more conservative the farther I got along. There seemed to be too many conflicting opinions on VBAC. I felt that whoever ended up on call when I went into labor would determine the fate of my child's birth. The emotional burden of that was too much for me to handle. I needed to know that everyone around me wanted the same thing that I did and BELIEVED that I could get it.
I found a wonderful and much smaller doctor/midwife team. During our consultation visit the doctor explained all the risks of VBAC that I had heard many times before. He asked me how I wanted to proceed and, after that initial visit, cesarean section was never mentioned to me again. I was treated just like any other pregnant woman---not one who might expire at any moment. I think the changing of doctors changed the odds of success in my favor----both emotionally and physically.
For the first 6 months I developed severe allergies and asthma. I couldn't get out of bed without being out of breath. I coughed until I thought my eyes would pop out. I was on about 5 medications, which worried me a LOT. At about 7 months is just sort of went away relatively suddenly. Very weird.
My due date came and went. I was becoming more and more depressed because of the possibilities of inducement, the baby being too big, etc. Even though my providers hadn't mentioned these things yet, all the things that could sabotage my hopes for a natural birth were floating around in my mind. One evening 8 dates after my due date, about 10:30 p.m., I felt a little pop and thought my water had broken. About 10 minutes later came a little gush of fluid, but not even enough to wet the bed. I got up and went to the bathroom but there was only a little trickle and I felt a little contraction. I went to my husband and told him I thought my water had broken but I wasn't sure.
My DH got out his stop watch. We walked around and I was having small contractions but nothing I couldn't walk and talk through. I still had a slow trickle of fluid leaking so at around 11:30 we decided to call the midwife. She said to try and get some rest and see if things picked up, but to come to the hospital around 6 a.m. regardless of what was happening since my water had broken. We called the doula and the grandparents. I kept having contractions; they seemed to be close together but they weren't very strong so I sort of dismissed them. We tried to get a little sleep, but as soon as I laid down the contractions got harder and I had to start my yoga breathing. We timed contractions but they didn't really have a pattern at all. Around 1 a.m. I got too uncomfortable to lay down anymore so I got up and walked a little bit. Things seemed to me to be speeding up so we called the doula. She came and put us at ease right away. She thought I was still in early labor and should try to get some more rest. As soon as I lay down, I'd have to get back up---the theme of my labor. I decided to get in the bathtub to try and pass some time and relax. I told my DH to take a nap. I filled the tub with water as warm as I dared and turned on the jets----ahhhh heaven! I stayed in the tub for at least a couple of hours and just tried to control my breathing and relax, and I think I even dozed off at some point. By the time I got out of the tub I was using yoga sound to get through my contractions.
I waddled back to bed, had a contraction, and got back up. Things started getting more serious. A little while later we woke the doula. She had me sit on the birthing ball and helped me through some contractions. I was holding a lot of tension in my shoulders and she laid her hands on me there and was talking to me in her low, calm voice. She made me some toast and juice but I only managed to drink a few sips of juice. By this time it was around 5 a.m. I really felt like things were getting faster and felt an urgency to get to the hospital. I think my husband felt it too. My doula said she thought I was around 4 cm dilated and I was satisfied I'd done enough work at home. We prepared to go to the hospital, making all our phone calls, finishing packing our bag, etc. The grandparents took my younger daughter, and the older one went to the hospital with the doula. I expected the drive to be the worst part of my labor but it actually turned out to be one of the calmest moments I had during the entire labor. It was dawn and there was a thick, heavy fog. It felt like we were driving through a dream. I had my eyes closed most of the time and just concentrated on my breath, relaxation, and humming along with my contractions on an "O" sound, and also with a closed mouth hum.
We arrived at the hospital around 6:30 a.m. When I got there, the nurse told me I was fully effaced but only 2 cm dilated and the baby was at a -3 station. My first thought was, "Where are the drugs?" Needless to say, I didn't find the nurses' evaluation of my progress to be very encouraging. Fortunately, my mind didn't have time to dwell on that information because my body went into overdrive. Between the exam room and the L&D room, I had to stop for a half-dozen or so contractions and was making a considerable amount of noise. My nice controlled "O-O-O-O" ended up sounding like a very loud "O-O-OUCH."
We made it to the L&D room and the nurse wanted to hook me up for the 20 minute monitor strip and the heparin lock I had agreed to in case of emergency. At this point I was leaning with my contractions---on my DH, the wall, the bed, the birthing ball. It wasn't my intention to be difficult, but lying or sitting in bed was TOTALLY out of the question and the nurse was very anxious to get the monitor strip going. The doula suggested I sit on the birthing ball for the monitor strip. I tried that but couldn't really sit through the contractions. I ended up leaning against the cabinet the monitor was sitting on for about 10 minutes and making a lot of noise. I'm sure the nurse thought I was insane because I was only 2 cm dilated and all. DH was taking his job of birth advocate very seriously, going over the birth plan with everyone who walked in the room.
After about 10 minutes of ineffective monitoring and loud chanting of O-O-Os, I suddenly had an absolutely overwhelming urge to go to the bathroom. I expressed this to everyone. The nurse suggested I leave the monitor belt on and go use the bathroom. I said NO, take it off, I need to go NOW. The doula took my eldest daughter to the waiting room, as she wanted to be there but didn't want to see everything happen, and things were getting intense pretty quickly. DH asked me if I wanted to go to the bathroom by myself and I said yes so he left me there. Everything unnecessary for giving birth to a baby came out of my body.
My yoga sounds started changing. What started out as O-O-O was now ending up as a ferocious growl. I had a tremendous urge to push and the contractions were coming one right after another. I was still sitting on the toilet growling through my contractions, while DH was outside 'discussing' methods of IV insertion with the nurse. I didn't care. He checked on me to see if I was alright. I told him I didn't think I could do this anymore. He told me later that when I said this he was really happy because he knew that one of the signs of transition was self-doubt. (I just knew that Bradley book would come in handy!) He helped me back to the room where I ended up on the birthing ball again. I think more than one person was telling me to quit pushing, to blow through it. I couldn't have quit pushing if you had paid me a million dollars. At this point the nurse brought in release forms because I guess she was convinced she wasn't going to get her 20-minute monitor strip or an IV. I signed. My doula whispered to me that it was okay, I definitely wasn't at 2 cm anymore. Believe it or not, at this time we had only been at the hospital for about 1.5 hours.
My midwife arrived and said something like, "How are
things going?" I think I growled at her. She smiled and told me
I was doing fine. She wanted me to get on the bed so she could check my
progress. I asked her if I could stay on my hands and knees and she said
sure, we'll try it. I ended up on my knees, leaning up against the propped
back of the bed with my elbows. This is where I stayed for the rest of the
birth. I had
actually listened to a birth story in yoga class of a woman who used this
position, but never thought I would end up using it.
In retrospect though, I think it kept me focused and uninhibited because
I was totally oblivious to anyone else in the room besides Adam, Sabrina and
me and not only was I completely dilated, the baby was now at +2 station. It was really happening.
This registered with me and I think I said something like, “The
baby’s really coming?” I was
too busy growling to really be all that excited about it.
The doula was talking to
me even though I couldn’t tell you what she was saying.
DH was crying now and
told me my how good I was doing.
was growling and pushing and growling and pushing.
The doula was soothing me
and rubbing the top of my back. The
midwife was putting warm compresses and some sort of oil or gel on my
bottom and rubbing the lower part of my back.
DH rubbed my feet a
little and watched in amazement as the first glimpse of baby started to appear.
My midwife told me I was
going to hurt my throat if I kept growling like that.
(Unfortunately, it was already too late for my throat.
I could barely talk for about a week after the baby came.)
She told me to bring it down. Bring
it down to the baby. I tried to do
that and then suddenly I could feel the baby moving down.
I could actually feel it – it was the wildest thing – all the sound
went inward and I could feel the baby moving down.
When each contraction ended I would feel the baby move back up a little
and I would think, “No – go down, go down.”
Then, as things progressed the midwife told me the baby was crowning.
She didn’t really need to tell me because I felt the RING OF FIRE,
which you read about, but cannot truly appreciate until you have experienced it.
At that point I was thinking, “Go back up, go back up!”
But there was no turning back now, the baby was almost here.
All during this period the nurse was still trying to check the baby’s
heartbeat with the doppler. I
can’t even imagine what we would have done if she couldn’t have found it.
I wanted her to just leave
me alone, but I was having to concentrate too hard and couldn’t really convey
DH if he wanted to help deliver the baby. He
was the first to touch the baby. My
baby’s first experience with the outside world was his daddy touching his
little head. With the position I was in (upright but leaning over), the baby
came out with his face pointing up instead of down, and the first thing the baby
saw when he came out with his eyes wide open was the same person who was
touching him, his daddy. After the
head was delivered the rest of the baby came within one or two more pushes and
it was amazing. All the pain was
instantly and totally gone. My
midwife announced, “It’s a boy!” and at 8:43 a.m. my son officially
entered the world weighing in at 8 lbs 6 oz (bigger than either of my c-section
turned around so I could see and hold my new son. DH kissed me and told me
how beautiful we were. I was too
shocked to even cry. All I could do
was look at the beautiful, naked little being that was still attached to my body
and say, “We did it, little man. We
really did it.” I think I said
that to everyone.
held the baby and DH cut the cord. I
held my baby while they cleaned him up and checked him out.
His forehead was a little bruised from coming so fast, but otherwise he
was perfect. [Kmom note: The bruised
forehead probably indicates the malposition!] I tried to nurse
him. It didn’t take him long to
catch on and I nursed him for a little while.
They brought me a warm blanket for the baby and we lay skin to skin
covered in a nice warm blanket for a while.
My doula went to get my
oldest daughter and tell her the good news.
The midwife checked me
out and - can you believe it – NO tears, no stitches required.
She did think my cervix might have a little laceration, so she had the
doctor check me out. Luckily, it
was only swollen. Our nurse was
quite impressed with us, I think, and let us have extra time in the
labor/delivery room with the baby before they took him to weigh, measure and
bathe him. She was a good sport and was very happy and proud for us,
even though I’m sure we were her nightmare patients. Everyone, including us, was amazed that we had only been at
the hospital just a little over two hours.
We were still signing release forms after it was all over with.
The midwife told me later
that when she arrived at the hospital and heard me (I imagine the whole
maternity ward could hear me) and checked my chart she told the nurse, “This
is either really, really good – or it’s going to be a REALLY long day!”
It was really, really good.
had a natural and pure birth. No
drugs, no IV, no monitor, no cutting of anything.
It was the most amazing thing I have ever done.
Was it easier than having a cesarean?
No – absolutely not. But
it was completely satisfying, and perfect, and exactly as God designed it.
I was a participant – not a spectator.
I did it. With the help of
three loving and wonderful people, I did it.
The recovery period was easier than a cesarean, no contest.
The birth was powerful and intense and that’s exactly how I felt when
it was all over: powerful and energized. After
being awake all the previous night, it was almost 24 more hours before I slept.
I went home the next day to be with my family.
I had the most perfect birth I could have dreamed of. It meant more to me than I can even put into words. It was the difference between giving birth and having surgery. But it was more than that. I didn’t have a horrible experience with either of my c-sections, so it’s very difficult to explain the psychological impact that they had on me. My quest for a natural birth was about being whole, instead of cut in half. It was also as much about healing the scar on my belly as it was about bringing new life into the world. It was about trusting myself and my body - and even God.
Honestly, I had expected to have a huge emotional response when the baby was handed to me right after delivery. I fantasized about that moment almost daily while I was pregnant. As it turned out, all I could do right after delivery was stare in amazement and shock at my baby. The emotional response came a few weeks later when I got a note from my midwife thanking ME for letting HER be a part of the birth. I had also gotten a call from my doula telling me how wonderful the birth was for her. To know that the birth had touched other people made me realize just how amazing it truly was. As I read my midwife’s note, all the tears of hope, joy, fear, and relief that I had been wishing and praying for during the last nine months washed over me. I thanked God and I wept.
Katie2's Story (Group B strep, SROM, induction, epidural, big baby, occiput transverse?, vaginal birth)
Kmom's Notes: This mom planned a natural birth, but because she had group B strep and her water broke, she was pushed into an induction. (The value of this is debatable.) Intervention led to intervention, as they often do, but in the end, this mom was able to birth her baby vaginally.
This mother experienced pelvic pain and probably had a degree of Symphysis Pubis Dysfunction (SPD). Her baby was posterior for much of her late pregnancy but was able to turn more favorably (if not perfectly) for birth with use of Optimal Foetal Position techniques. The mother did experience many malposition symptoms during labor: the water breaking ahead of time, a long slow labor, a less-than-effective epidural, difficulty pushing the baby out once she was fully dilated, etc. However, because she had a nice roomy pelvis, she was eventually able to push out her 10 lb. baby vaginally, even in an occiput transverse position!
We decided to pass on the triple/quad screen. With the high rates of false positives for large women, we didn't need that kind of stress while going through additional testing just to find out everything was fine. Plus, we knew we wouldn't take any action against the pregnancy even if something did come out negative.
My fundal measurements always measured large because of the belly I started with before I even got pregnant. I had to ask my OB what I was measuring at because she never told me. By the time I thought to ask, I was measuring at 48 weeks (the day before I gave birth I was measuring at 50 weeks). No wonder no one ever said anything! I'm not sure why they continued measuring, though, maybe just as a source of comparison to my other measurements?
I had several ultrasounds during my pregnancy. Most of them were to reassure me because I wasn't able to feel much movement during the pregnancy. Turns out I just had a quiet baby (I often referred to her as "the sloth" for lack of movement). The ultrasound tech was fabulous. She was the one who explained to me that my inability to feel movement was partially my size but also because I had a front-lying placenta. It was sometimes difficult to see parts of the baby because of my size (particularly the genitals, which are more fleshy and thus harder to see). The ultrasounds never hurt, even when she had to put the wand-thingy deep into my belly button to get a good look.
At 32 weeks, my baby measured at 5 lb. 12 oz. Both the ultrasound tech and my OB said that I was going to have a big baby. This was expected, as both my husband and I were big babies. She was a big baby, too---she was born weighing 10 lbs. 3 oz.
I got through 7 months of pregnancy with very little complications, [just morning sickness through the 8th month.] Towards the end of my 7th month...probably as a complication of her malpositioning, I started experiencing very severe hip pain. When I'd stand up, it felt like I had to wait for my hips to come together again before I could walk. When I sat, it felt like my hips would spread. Because this was also associated with pain turning over in bed and the inability to bend over and lift my legs to put pants on, I suspected I may have been afflicted with symphysis pubis dysfunction [SPD], but I was never diagnosed by a professional. I was aware of the SPD, and would have gotten chiropractic care had I been able to afford it.
About the same time, I also swelled up like a balloon. Everything was swollen from the top of my head to my poor little toes. Because it is one of the symptoms for pre-eclampsia, I watched my blood pressure very carefully on each visit; however, my blood pressure never went up during the entire pregnancy. My OB, on the other hand, never seemed worried---just explained it was a side effect of pregnancy and everything would be back to normal after the birth.
Throughout my pregnancy, we consistently had trouble finding the heartbeat on doppler. However, my wonderful OB was persistent and always found it low on my right side. On the rare occasion we couldn't find it or couldn't hear it well enough, they got me on ultrasound to check. I think we all assumed the difficulty was due to my size, although nothing was ever stated outright. Come to find out, difficulty in hearing the heartbeat can be due to malposition, and this theory fits my situation. As it turns out, my baby was facing backwards---facing my front instead of my back. [Kmom note: Trouble finding the heartbeat is a classic sign of a posterior baby, esp. if they then find it low and on the right side. It can also be more difficult to find a heartbeat when the placenta is front-lying, as hers was.]
I started doing exercises to try and turn the baby. For the last two weeks of pregnancy, I watched my position carefully. No more leaning back and putting my feet up as I had been (due to excessive swelling). I sat upright at all times, Twice a day, I relaxed in the knee-chest position for 10 minutes, followed by a few minutes of pelvic rocks (however long my knees could stand it).
Something must have worked because the day before I gave birth, we found the heartbeat easily on the left side. She may not have been in the most optimal position (given my 25 hour labor) but it was better than what it had been. She was born facing my right leg, which I read is better than her facing my left leg (although facing down is optimal). [Kmom note: From her description it sounds like the baby was occiput transverse, meaning that the baby was head down but her head was facing sideways.]
Towards the end of my pregnancy...I wrote up this great birth plan. I wanted a completely natural birth. I'd read "Birthing From Within" and wanted a birth based on that idealism......then I was diagnosed positive for Group B Strep. As a result of this diagnosis, I was going to have to go to the hospital as soon as my water broke or shortly after contractions started in order to get IV antibiotics. Scratch two off my birth plan. When my water broke, I went to my OB's office, and hadn't had a contraction yet. They started me on pitocin to start contractions. At this point, the birth plan may as well have been never written--I didn't even bring it with me to the hospital.
I get admitted to the hospital at about 4 p.m., get the IV, the pitocin, and I'm dilated to 3 cm. I get an internal fetal monitor and an internal contraction monitor. I'm not wearing a hospital gown because I've opted to wear my own tank top, and I'm much more comfortable (emotionally and physically) this way. At 9 p.m., I'm in pain, tired, and still 3 cm. I ask for an epidural so I can sleep. It took way too many attempts to get the epidural in place. I couldn't get my spine arched enough to make it easier. My belly would only let me bend over so far. I finally realized that if I got my legs up onto the bed and sat with my feet together that I could get my belly down far enough to arch my back enough, and voila, the epidural line was in.
I don't sleep very well because the baby's heartrate kept dropping, so I have to wake up, rub my belly and talk to her, and her heartrate goes back up. I'm also uncomfortable with hip pain (so much for the epidural) so I have to keep switching sides; not easy to do when you have a gazillion wires hanging off your body and the lower half of said body is mostly numb.
Come morning, I'm only dilated to 6 or so, and they're worried about my amniotic fluid level. They start replacing the fluid artificially, so I have a third tube/wire going up there. At about 11 a.m. my contractions started becoming very painful. They tried retapping my epidural and it didn't work. The stupid anesthesiologist wouldn't let me get into the position that had worked the night before. [Kmom note: Another commonality among women with malpositions is an epidural that is not fully effective.]
Sometimes before noon I hit 10 cm. I started feeling like I had to poop. I kept telling my nurse I had to poop. She kept telling me that I didn't need to poop, that it was just the baby's head coming down. The contractions were coming one on top of the other and I couldn't stop bearing down, even had I wanted to. The nurse and I were fighting about my need to poop. When she left the room I told my husband to get me the bed pan. I'd been trying to poop on the bed, but wasn't able to; about a minute after getting arranged on the bed pan, I did it.
About this same time the doctor decided that I was going to need assistance from the vacuum to get the baby out. I'd essentially been pushing for two hours (I was just trying to poop!) and the baby wasn't coming down past the point she was at. The nurse told me to stop pushing and wait for the doctor, but I couldn't help it---my body was pushing by itself.
The doctor came back, set up the vacuum, helped me deliver the baby. At the time of her crowning, I definitely felt the "ring of fire" that a lot of women talk about. Then I felt a huge "swoosh" of movement and water. The doctor never told me to slow down or stop when the baby's head came out like they do on "A Baby Story," so I thought the huge swoosh came after the head. My husband later told me that her head was out and I was still pushing, and the huge swoosh was everything after the shoulders.
25 hours since my water broke, and after almost 3 hours of pushing, my daughter was born. My husband cut the cord and she was placed on my chest. It's a good thing the nurse asked if we had a camera, because both of us completely forgot about taking pictures. They took the baby over to the warming station while I delivered the afterbirth. Then the OB started stitching me up---I had a third degree tear. I'm so glad I didn't get an episiotomy, as I'm sure it would have been much worse!
The baby's blood sugar was low, so I had to breastfeed immediately. We were having trouble getting her latched, so we gave her a bottle. We also had to continue to bottle-feed because of blood oxygen level problems. Between the blood sugar and the blood oxygen levels, we really couldn't wait for my milk to come in. We ended up not breastfeeding because my nipples were too large and flat in order for her to get her little mouth around for a proper latch. We even saw a lactation consultant who reluctantly agreed it might be too difficult for her to breastfeed with a proper latch.
I never had any pain from my tear. I think I was too high on motherhood to notice. Nobody could believe I'd birthed such a big baby vaginally, without drugs (by that point everything had worn off) and wasn't in any pain afterwards. It's amazing what mommy hormones can do. I heard a lot about "big baby this" and "big baby that" particularly about eating and sleeping (my baby slept 4-5 hours at a time, 'round the clock, with about an hour in between sleeping sessions. By the time she was 2 weeks old she was sleeping 6 hours at night.)
Even though my birth plan was out the window from the word "go," I had a very satisfying birth, and have no regrets. I think the most important thing about a birth plan is to remember that sometimes it doesn't work out that way. Had I been rigid to my birth plan and things gone the way they did, I wouldn't be as satisfied with my birth experience as I am. I was talking about having another one before I even got out of the labor and delivery room into the recovery room.
It also helps that I'm head over heels in love with my baby.
Dawn2's Story (diet-only GD, herpes, PROM, preemie, vaginal birth)
Kmom's Notes: Dawn was able to ask a lot of informed questions of her providers, and was able to advocate for the kind of birth that she wanted. Having a doula can be especially helpful if you are facing complications and a more medically managed pregnancy, like GD pregnancies often are. Being co-managed and attended by a midwife at her birth probably also helped her avoid an unnecessary c-section.
Dawn's baby was probably malpositioned; she had strong back labor and a long pushing stage in which she seemed to make little progress for a long while. Then she felt the baby rotate internally and suddenly pushing became more effective, and the baby was born not too long after that. Once again, fetal position makes all the difference in the world for this mother.
I failed the 1-hour glucose screening test, but not by much as I recall. After the 4-hour test, I was diagnosed with gd because my fasting was high and my 2-hour level was high. I was placed on a 2100 calorie food plan, which I followed but had real emotional issues with because I hadn't dieted for many years (with a stable weight), and I really felt deprived not being able to eat the sweet things that I hadn't denied myself for years. I fell right into the emotional landmines that dieting brings, and it was really hard for me.
I tested 4 times a day--in the morning and 1 hour after each meal. I had done a ton of research on gd and so was in the position of asking questions of my provider (midwife) that she couldn't answer. I was co-managed by an OB, but he used Matria, a diabetes management provider, to which I was supposed to call in my numbers and talk with a counselor each day. I really felt like no one could give me a straight answer to my questions--it was a big deal because I asked whether the cutoffs they were telling me to have were supposed to be measured in blood or plasma, and what they told me didn't match the numbers I had seen -- I felt like they were asking me to have blood glucose numbers much lower than necessary, and the stress was causing my numbers to be higher. I was really concerned about insulin and the effects of altering my baby's metabolism before birth. If the OB had insisted on insulin, I was thinking that I would consider switching providers.
As far as the GD, I did get into something of a groove, but I found that fruit affected the numbers more than anything--I couldn't have an apple without my numbers jumping up, and that just seemed so counter-intuitive that fruit could be bad for me. But I was careful to be really active, maybe even more so than when I wasn't pregnant, and my after breakfast and after dinner walks really seemed to help.
One morning just after I was 34 weeks pregnant, I woke to a little moisture, kind of like when you've had a lot of discharge the night before. After my morning walk, I noticed a little bit of brownish discharge on my underwear. I didn't think anything of it, but later, as I was getting dressed, I felt some leakage. I thought it was just urine, as my sister had had a lot of urine leakage as she got to the last couple of months. But, combined with the discharge, I thought I'd call the midwife's office. They told me to come in, which I did later in the day. I wore a pad, because all day, as I walked around, I would occasionally feel some leakage, just a little here and there like I couldn't hold urine. I had been having occasionally tightening contractions, Braxton-Hicks, for the previous few weeks, and the frequency of those did not change.
When I got to the midwife's office, she started to do an internal exam, and as luck would have it, there was a little gush at the same time. She said, "That's not urine. It's coming from your cervix. I think you're going to have to go up to the hospital for a bit." I was really surprised, because I did not expect her to tell me that my water had broken. When the OB came in, the first thing I said was "I guess we don't have to worry about her getting too big!" and he was a total jerk, telling me that gd babies may be big, but they're not mature, etc, etc, etc. Just what a woman who has just been told she's going to have a premature baby wants to hear. I also thought I might have a herpes outbreak at the time, although I hadn't had any through my pregnancy, and was planning to go on suppressive therapy for the last 4 weeks of the pregnancy. (Vaginal births are now ok for moms with genital herpes if there is no outbreak at the time of birth.) The OB gave me these options: If I was having an outbreak, or if the baby was breech, I would be scheduled for a C-section right away. If the baby's lungs measured mature after they sampled the amniotic fluid, they would induce if I didn't go into labor soon, because I had estimated that my water had broken sometime in the morning, and they wanted the baby born within 24 hours. If her lungs didn't show maturity, they would let me hang out, and give me antibiotics to prevent infection, but they wouldn't stop labor if it started.
It turned out I wasn't having a herpes outbreak, so I was sent to the hospital with instructions that I would be admitted. Baby was head down, which was good, and I was put on a monitor, and I guess I was having occasional contractions, but I didn't really feel them. My doula and I waited for a while for the results of the amniotic fluid sample, and her lungs weren't as mature as they wanted, so they started me on IV antibiotics and I waited for a room in the high-risk antenatal unit.
The next morning I wore the monitor something like twice a shift. I was supposed to be on bedrest, but was able to go to the bathroom. As the day went on, the contractions got stronger and stronger and more and more frequent, and I seemed to be passing my mucus plug in the afternoon. I called my doula around 5 pm, because I wasn't able to handle the contractions on my own any more. I didn't really feel like eating, but managed to nibble a little. I think the contractions were about every 7 or 8 minutes at that time, but I could definitely breathe through them, and though I was supposed to be on bedrest, I would stand up and kind of rock my hips during contractions, to try and help gravity move her down. The nurses "caught" me, though, and I did have to wear a monitor part of the time.
By 8 pm or so, I was in "active labor" and was wearing the monitor. I could absolutely not lie flat--it was too painful, so I generally laid on my side. My back was also beginning to hurt constantly, so my doula rubbed it with an ice pack through contractions, which had gotten steadily closer and closer together. I had a couple of internal exams, and I guess I went from 3 cm dilated at 9 pm, to something like 8 cm at 10 or 11 pm. Fairly early on, I started asking for an epidural because I was having a hard time managing the contractions, but they didn't want to give me one because I was only at 3 cm, so they gave me some Nubain instead. That helped a lot, and I was able to relax. The next time they checked me, I got a second dose, which helped but not as much as the first one. When that wore off, I started to feel like I wanted to push. The decision had been made that the midwife could manage my labor since the baby was good-sized and looked good on all of the monitoring, so I was really thrilled because I had wanted a midwife, not an OB, all along.
The moved me from my antenatal room to an operating room because there were no labor and delivery rooms available--it was a full moon and the hospital was packed. My doula and my mom came in as my support persons, and I started pushing around 1 am. I tried several positions, on my back, on all fours, I stood and tried to squat, but it really took a long time to feel like the baby was getting anywhere. It was really, really discouraging to feel like I was doing this incredibly strenuous work and the baby wasn't coming down at all. We talked about an epidural, especially after I had pushed for something like an hour and nothing was happening. I wanted one, because the back pain and contractions were very difficult. But in all of the movement, my IV had come out, and they wouldn't give me an epidural without an IV in. The nurse tried to get another one started, but was not successful after poking me I don't know how many times. They had to call in an anesthesiologist to get an IV going, and he tried several times as well--I will say it was difficult for him, too, because I couldn't stay still for very long--it seemed like the contractions came every couple of minutes, and then I had to push, so he couldn't really search well for a vein. This took another hour or two, and I pushed all while they were trying to get an IV started again. Finally, they got one started, but the baby had finally made some progress downward, so I didn't get an epidural.
At one point in between contractions, I was resting with my doula and the nurse holding my legs up (because the pressure was so intense), and I felt the baby unmistakably rotate. At that point pushing seemed to have a point, and soon I started to be able to see her head in the mirror up in front and above me, and that really motivated me. It was still somewhat slow and agonizing, and right as she was crowning was really intense, but the moment her head came out (5:12 am--after 4 hours total of pushing) all of the pain and pressure was gone--almost instantaneously. It was really amazing how quickly the pain was just . ..gone.
She didn't cry immediately, and she was taken to the warming table, and she started mewing within a few minutes. Her apgars were something like 7 and 8, which I thought was great for a preemie, and she was 6 lbs 5 ounces! The midwife saw that there had been a knot in the cord, which could have been fatal if she had gotten bigger. I got to hold her after a couple of minutes, and my mom carried her up to the NICU for observation.
There was no episiotomy, no tears and I didn't require any stitching--the midwife said that was probably because I hung out with her crowning for a couple of contractions--she didn't come out in one push. In recovery, the most thrilling thing was that I got to drink some orange juice--which I hadn't been able to have for a while! I made sure that the nursing staff knew I wanted to breastfeed and got the information as to the baby's first feeding, which was scheduled a couple of hours after I got to my room. I went to the NICU, and was able to try to nurse with a lactation consultant's help right away. She didn't latch on for long, but she did latch for a bit, and then I followed with a bottle. She was on IV antibiotics (because she was born more than 24 hours after membrane rupture) but didn't need extra heat or oxygen.
I went down for almost all of her feedings, and attempted to get her to nurse first, before giving a bottle. I was quickly given a pump and instructed on how to do that, and I think I started getting little drops of milk on Friday night (she was born early Thursday morning) which I took down for the NICU to give her in a bottle. At one point, the NICU nurse called me about a half an hour before her scheduled feeding because she was crying and the nurse thought she was hungry--so I was able to continue to try to get her to nurse first when it would be most useful. I was released Saturday afternoon, but the NICU doctors wanted to keep the baby for another day, as she had started to get somewhat jaundiced. Sunday I checked on her right away, and because she hadn't really lost any weight and the bilirubin levels had peaked I was able to take her home then.
When we got home, our routine was every 3 hours to attempt to nurse, feed pumped milk, then feed formula if she was still hungry, and then pump if she hadn't latched on for at least 15 minutes. At her one week appointment, she was above her birth weight, and because the schedule was making me crazy, her pediatrician told me I could feed her on demand. After about 3 weeks, she was nursing much more consistently, and I dropped the pumping, and about once a day gave her some supplemental formula. By the time I went back to work when she was 12 weeks old, we only supplemented on occasion, but that changed as I didn't let down well to the pump and couldn't keep up with her demands by pumping. (Tried oatmeal, fenugreek/blessed thistle, breast compression while pumping, but my supply just got lower and lower as each month went by.)
At 11 months, she's 20 lbs, we're still nursing, although I've stopped pumping, and I hope to continue nursing as long as she wants to. She gets 2-3 bottles of formula daily at daycare, and 1-2 daily on the weekends when she nurses to sleep for her naps. I was thrilled that I got the kind of birth that I wanted, although there were so many things that almost derailed us in the process! What was important to me was that I had a healthy baby, born vaginally, and that I avoided an epidural and episiotomy, and I got all of that, although it was not easy! And breastfeeding was not easy at the beginning, but I feel that we have been successful at it and am not ashamed we had to supplement--I wish we didn't have to, but the circumstances were such that we have, and she's thrived.
I hope this story is useful for someone .. .the best advice that I can give you is to research, research, research--and don't be afraid to question your caregiver. Ask for their rationale for the decisions they are advising you to make and if it doesn't make sense, see if you can get another opinion and talk about it. Get as much support as you can--I had a wonderful experience with my doula and would highly recommend getting one, even if you have a partner because they offer a neutral perspective and are there to help you get the kind of birth you want.
Melissa's Story (pelvic pain, possible malposition, vaginal birth; pelvic pain, minor malposition, vaginal birth)
Kmom's Notes: This mom also had a lot of pubic symphysis pain during both pregnancies. Her first baby was probably malpositioned somehow (Kmom's guess would be that the baby's head was tilted to the side, since it resolved quickly when she swung her hips strongly from side to side, which is typical of an asynclitic baby). The mother's long labor and stall at about 7 cm, then quick resolution when the mother changed her position (with the mother feeling the change when it happened), then the quick birth afterwards all point to a malposition.
In her second pregnancy, the mother also had some pubic pain, but not nearly as strongly as in the first pregnancy. Her second baby was born after a long prodromal labor and then a quick labor once her midwife broke her waters. However, this baby came down sideways (probably occiput transverse) and the mother was on her back with her legs really pulled up strongly, which probably caused a strain and temporary damage in her pubic symphysis area (DSP).
After he was born, she experienced a lot of pubic pain. She notes she could hardly walk for a couple of weeks, and she also had tailbone pain for several months. This is typical of women with DSP. Fortunately for her, it eventually resolved on its own. Some women experience this pain long-term.
Again, for more information about this problem, see the FAQ on Pelvic Pain on this website.
Baby #1: My first labor lasted 23 hours. I started regular timetable contractions at 11:30 p.m. on January 30. We were up all night, timing them. About 4 a.m. we called the midwife and she said to go in. We got to the hospital at 5 a.m. or so and I was dilated to 7 cm when they checked me. My contractions were close together but not really very strong. I didn't even need to breathe through them at this point.
Then labor stalled. I walked and walked. Then we did nipple stimulation, and finally about 3 p.m. (I think!) we let my midwife break my water. After that, things got to really moving! OUCH! All of a sudden, those contractions HURT! So, I tried to get in the tub but I didn't know how to breathe right, and just couldn't stand the pain. So I had the walking epidural. BLISS! Except I was allergic to the morphine. ITCHIES! And then I started vomiting too!
Well, they gave me some Benadryl to combat the itchies, and my midwife got me up trying all sorts of position to get the baby to move down to the right place. She finally had me hold on to the counter and swing my hips back and forth. After a few minutes of this, I could FEEL something change down there. I got into bed, and in about 15 minutes, I had pushed my duaghter out, screaming and yelling (both of us!). No tears for me, but lots of bleeding. I breastfed her within minutes. I finally had to give her up because I was still getting sick from the morphine.
My daughter weighted 8 lbs. 13 oz and was 20 inches long. She was born at 10:38 p.m., almost a whole day after labor started. After the birth, the extreme pubic pain I had before having her disappeared. I do not remember having any trouble walking at all after her birth. I think in her case, just getting her out of there solved the pubic pain problems.
Baby #2: My due date came and went without any baby. His sister was born the day before her due date so I was a little disappointed that he was "late." I was so uncomfortable, so tired of being pregnant, and he'd permanently implanted his feet in my rib cage. It hurt. I was also getting VERY swollen up and my blood pressure was creeping up little by little. I was ready to get him born!
I had been having labor stops and starts for over a weeks and I was so darn sick of timing contractions. They'd get really close together and then just STOP. We walked and walked and walked. It was so aggravating when they'd just STOP! I went in for a midwife visit 2 days after my due date. I was only dilated to a 3. I'd been dilated to a 3 three weeks before my daughter was born so this was pretty discouraging. She massaged my cervix while she was checking. She also suggested that we take castor oil. She said it would probably start labor...
[DH and I discussed the castor oil business.] We came home and he fixed my "cocktail" for me. BLECH! We put it in Sunny Delight, which I can't even look at to this day. ACK! At least I didn't throw up though. A lot of women do, I guess. About 30 minutes later it started doing its job. A half hour after that I was ruined. I had "bottom problems" throughout my pregnancy, so all this diarrhea was NOT helpful. I was in so much pain!
My midwife called during this to check on me. She wanted to know if we'd decided to try the castor oil. I chewed her butt for it because I was hurting so bad. She was at the hospital with a first-time mom already, and suggested I just come into the hospital and take a Jacuzzi and let her check me, and possibly break my water.
I was a little leery of getting my water broken because I didn't think the baby was in an optimal position for it. She kept reassuring me though, that even if he wasn't, he'd get that way after my water was broken. So we calmly packed and took our time to go leisurely to the hospital. It was very nice just going like this, so calmly. We got there and they checked me in and then slapped me in bed to do some monitoring. Problem was, my BP was way up. I suggested they try a bigger cuff on me and see if that helped. It did. With the bigger cuff (a thigh cuff) my BP was what it had been in the office earlier that day. I'm still not sure if my BP was actually up and the bigger cuff was making it look lower or if my arms actually needed the big cuff to get a correct reading. I don't know. I am glad we went to the hospital, though.
After they were sufficiently appeased that I wasn't going to fall over because of the BP, they went away and let me get in the tub. Ahhhhh...it felt so nice. I still had to get out to go to the bathroom a couple time. I was also having contractions pretty regularly by this point, so I guess the castor oil did do its job? I'll never know, I suppose, if it was that or just that I was ready anyways.
After I got out of the tub, the midwife came in and asked me if I wanted my water broken. I decided at this point that I was ready to have the baby, so I let her. I had dilated to 4 since that afternoon, so I figured he was ready to come and we'd just be helping a bit. So she broke it and the bed FLOODED! I had SO much water. TONS of it! It went everywhere. I think it shocked the midwife and the labor nurse. I had not been diagnosed with "polyhydramnios." It had not even been suspected.
After this, things seemed to have moved very fast. DH called our families and told them to come. I labored through about an hour and dilated to 6 or 7 I think. The contractions were strong and hard and painful. They also spent FOREVER trying to get an IV in my arm because I was group b strep positive. They poked and poked and poked. I was bruised and bleeding on both hands. They finally called the anesthesiologist to come and try it. It even took HIM two tries to get one in, but the blessed man used Novocain on the places he was trying to put the needles in at, so I didn't even feel him poking. It helped, because I didn't jump when he poked me and he was able to get it in my little veins.
He went away. My labor nurse taught me how to breathe through contractions. I felt in control. I was staying on top of them. But it HURT so bad!! And then the thought went through my head that they wouldn't be passing out medals afterwards for going unmedicated. So I expressed this opinion out loud. They called the anesthesiologist back and he came and gave me my epidural, which was actually just a "walking" epidural. When I had this with my daughter, they used morphine, which I ended up being allergic to. By now though, they had stopped using morphine in them. It was a couple different drugs, but I don't remember what they said they were. They didn't make me sick, though. WOOHOOO! The relief was instant and wonderful. I could still feel things tightening up and I could feel all the areas under where my stomach stops, but it took away the terrible contraction pain.
Our families all showed up at some point. I hardly remember them getting there. They were having some trouble monitoring the baby so I was paying more attention to that. They decided I needed an internal monitor because he was having some heart dips. This scared me. They said they'd have nursery staff on hand, too, in case anything was wrong. She thought the cord was around his neck, but his [heart rate] was coming back up every time.
The next thing I knew, she checked and said I was complete. I couldn't believe it. It had only been 3 hours since she broke my waters! I was in labor with my daughter for 23 hours and it took 7 hours for her after she broke my water! So I said, OK, I'm ready to push! Someone got the video camera out and handed it to my sister. Our moms were down at the end of the bed waiting too. I remember my mom "getting in trouble" because she was learning on the sterile tray of birthing stuff. Leave it to Mom to get in trouble during my birth!
So they got me pushing. I was on my side for a few pushes, but decided it would work better if I could get on my back. I LOVE the pushing part. It seems like I finally have some control over something. I love the work of pushing my children into the world. It's satisfying in a way that nothing else has ever been to me. Certainly no physical work has ever been so rewarding. I'm GOOD at pushing. On the video I'm even joking between pushes. I was in a GOOD mood!
I think it only took 15 minutes or so of pushing for him to crown. I was dreading this part. I remember it being such a painful thing with my daughter. It was so shocking. No one warned me it was going to hurt like that when she crowned. I panicked with her and started screaming that I couldn't do it. I thought that pain was going to last the whole time. No one told me I'd go numb after that initial "ring of fire." So, as I was pushing with my son and I knew he was getting close to crowning, I was dreading this part, but wanted to get it over with too. So I just kept pushing and pushing and then, THERE HE WAS!!! And it didn't hurt anywhere like I thought it would. Maybe because he was not the first one? Maybe because the midwife had been stretching me the whole time I was pushing? I don't know, but it wasn't too bad. After his head was born, she told me not to push for a moment. I asked if the cord was around his neck and she said, "Not anymore."
With the next push he was out and handed to me. He wasn't crying. His sister was pretty mad at being born. She was carrying on like a little banshee. It scared me so bad that he wasn't crying. And he was just kind of limp too. And NOT crying! I said, "Is he OK?" And the midwife said, "He's fine!" At which he gave out a yell. I was SO relieved!!
His head was rather pointy. He was positioned semi-facing my right leg as I pushed him out, and it did terrible things to the shape of his head, not to mention to my pelvis. While his head was better by the next day, my pelvis still hurt two weeks later. Eventually it stopped hurting but I could hardly walk the first week or so.
Turns out the cord was around his neck twice, but he had a super long cord and it didn't hurt anything. He seemed to us to have kind of a LONG neck the first couple months, and maybe that's from that cord being around it. I thank God that it didn't hurt him. I had no tears and no stitches because my midwife is wonderful and knows what she's doing.
My son was 8 lbs. 9 oz. and 21 inches long. His dad, both grandmas, his aunt, and his sister were all there to witness his arrival. Even with a few problems, I loved my birth. It was a wonderful experience that had a very happy ending!
Liz2's Stories (induction, vaginal birth; occiput transverse/compound malposition, unassisted homebirth)
Kmom's Notes: Liz's first baby was induced early for suspected macrosomia. It was a very difficult labor, but she managed to do it virtually without medication, an amazing accomplishment! The baby was big was born normally and easily.
Liz's second baby was a planned unassisted homebirth. She had a nine-hour stall in her pushing phase because the baby was wedged in in a poor position for birth, but finally managed to find just the position that did the trick and turned the baby, and he was born shortly thereafter. He was also a big baby, but once he turned properly, he came out just fine.
Baby #1: My pregnancy with my first son was a complete surprise but a very pleasant one. My family is very mainstream when it comes to medical care. My grandfather is a family practice doctor (retired), my father was a medic in the army for a time. My mom had all 4 of her kids in the hospital, as did everyone I knew who had kids. Naturally when I found out I was pregnant I called up an OB in a nice part of town and made an appointment! Oh, if I only knew then what I know now (I'd never have thought to set foot in a hospital to have a baby, that's for sure!).
My pregnancy went along very uneventfully. I gained a LOT of weight, but my OB didn't really say anything about it. My BP stayed nice and low, all the myriad of tests came back normal. I got quite swollen towards the end of my pregnancy, but I think that was mostly due to me just sitting around and not doing much.
As my due date got closer, my OB informed me that due to the large size of my baby, he would induce me as soon as my due date passed if the baby had not arrived on its own. By this point I'd done my research (or so I thought) and knew I wanted a "natural" birth without drugs or interventions. My hubby and I had taken Bradley classes, I'd read books---my family thought I was being so progressive and so brave to try it "natural"!! I was crushed at the thought of an induction; I knew some of the risks----had I really known them all I would have refused. There was nothing wrong with me or my baby. There was NO medical reason at all to induce, but I wasn't strong enough to refuse based on my own gut feelings. My OB didn't feel inclined to wait around on us and told me so. He also used the lowest tactic in the book---he threatened me with the likelihood of a c-section if I waited "too long" and allowed my baby to get any bigger. *sigh* Next to a c-section, the induction was preferable.
Three days after my due-date, with hardly any signs of impending labor, I went in for my induction like a good little patient. My water was broken first thing, and I was allowed to walk the halls for an hour to see if contractions would kick in on their own. Of course they didn't, so the baby heart rate monitors, blood pressure cuff, and dreaded bag of IV fluids including pitocin were all attached to me. There went my mobility.
Hard labor hit with almost no warning. I went from no contractions to hard contractions every 5 minutes or so. The contractions got increasingly harder, longer, and more painful; the IV drip was religiously increased each hour by the nurse. I was determined to go epidural free, and I did. I did cave into the nurse's pressure and had a shot of Stadol during transition which did absolutely nothing for me. By that point, the contractions were almost back to back and were double and triple peaking. It was miserable. I remember looking up (with all the rigamarole attached to me I couldn't get off the bed, so I spent my labor laying on my left side) at my husband who held my hand through the whole thing and realizing he was crying just as hard as I was. Later he told me it was one of the worst things he'd ever been through, having to sit by and watch them torture me.
Transition passed very quickly. I went from 7 cm to complete and feeling the urge to push in less than an hour. It was amazing that change in sensation---the contractions went from almost completely unbearable to suddenly being very intense but focused and "productive"-feeling. I sat up and pushed unconsciously. I wanted to get up SO BAD. I told the nurse that I needed to go to the bathroom (she wouldn't let me), then I told her I just needed to GET UP. I wanted to get onto my hands and knees badly, but of course they rolled me into a semi-sitting position instead and told me to grab my knees and "try" to push.
In spite of everything, it felt WONDERFUL!! For the first time in my whole labor, I felt in control. It was extremely intense, but pushing with my contractions didn't hurt. I pushed, and the nurse suddenly realized the baby was coming. Now! There was a rush to get my OB in the room, and with just a few more pushes my son was born! Less than 15 minutes pushing time. He was born at 5:09 p.m. after a 9 hour induced labor.
He was absolutely perfect. He was placed on my chest immediately after birth and I just held him and marveled at what a wonder he was. He was extremely upset and screaming. He was dried off and his cord was cut (all while still on my chest, I wouldn't let them take him) and then I offered him a breast and he latched on and nursed like it was his sole lifeline to comfort. He roomed in with me our one night in the hospital---he never left mine or my husband's side and he slept in bed next to me. I had a very small tear that very likely would have been avoided if I'd been allowed to get up like I'd wanted to.
My son who was supposed to have been on the verge of being too large for me to deliver weighed in at 9 lbs. 13 oz. Yes, he was a big boy, but his actual birth was incredibly easy. I felt great as soon as he was born and wanted to grab him up and walk out the doors and go home. Boy, I wish I had!! I feel very lucky that both of us got off so easy, considering all the interventions.
Baby #2: After the OB-manipulated birth of my first son which resulted in a horrid induction, I knew I would NEVER have another baby in a hospital unless mine or the child's life depended on it.
When I got pregnant with my second child, I assumed I would find a midwife and have my baby at home. Long story short, between the runaround from my insurance company and my remote location out in the country, I just could not find a midwife I liked. I was so upset. I spent the first few months of my pregnancy feeling so miserable about my birth choices (or the lack thereof). I didn't want another hospital birth. I didn't want to see an OB. I felt so strongly compelled to have my baby at home that it was just overwhelming.
Feeling like I still had to have some sort of prenatal care, I decided to see a local OB who came recommended as being very hands-off while I continued hunting for a midwife. The first few appointments with the OB went OK, but it just felt so....well, wrong. All the poking, prodding, measuring and testing. It's so degrading and invasive. Pee in this cup, dear. Stand on this scale so I can raise my brows at your weight, dear. Grrrr---I didn't need that crap to have a healthy baby.
During this time I stumbled onto an option that my husband and I had been half-heartedly joking about---unassisted homebirth. Birth at home with just Mom, Dad, and loved ones present. No doctors, no midwives, no paid strangers with a bested interest in protecting their own hides at what may be the risk of the mother and child. It seemed so radical at first, and then it just seemed so right.
The straw that broke the camel's back came at my 5 month OB check-up. I declined the gestational diabetes test, and my OB just about fell over (don't women ever tell OBs, 'No'?). I pointed out that I have the right to decline any testing. She said it was mandatory. I left the office, fired her, and collected my file a few days later and never looked back.
After that I just stopped worrying. I felt WONDERFUL!!! No more OB appointments, no more stress over a midwife. Just loving being pregnant and living my life normally. After all, pregnancy IS normal. It's not an illness. I had such an incredibly easy pregnancy. I never got sore in late pregnancy, or tired, or huge and uncomfortable. Well, I got huge but never uncomfortable!
I woke up early in the wee dark hours of the morning 4 days after my 'due' date with light (but enough to wake me up) contractions spaced about every 15 minutes. I was so excited! Too excited to go back to sleep, which I really should have. My husband got up and left for work around 6 a.m. and I dozed a bit in-between contractions and eventually got up a couple hours later. And everything stopped. Blah! I felt really restless though. I cleaned the house, did laundry, and worked on finishing painting my son's playroom. I had light contractions throughout the day, but nothing major. Contractions on a ladder while painting are rather interesting, let me tell you!
My husband got home from work around 5 p.m. and like magic, labor really got going. Contractions started coming regularly about every 15 minutes. Nice moderate contractions that were about 20-30 seconds long. So, we did the natural thing---loaded up in the car with our son and drove into town to go to the grocery store and get last minute labor munchies and rent movies to keep my 3 year-old entertained. I found it so incredibly amusing to be walking around in public, in labor.
We got back home, and things were getting a bit more intense. I puttered around for a while (made a fruit salad), then wanted to go lay down and rest because I wasn't sure how long of a labor I'd be in for. Laying down on my left side felt really nice. I lit candles and just rested, breathing through contractions, thinking of my baby, sipping water and getting up to go potty regularly. This continued on until probably a bit after 11 p.m. My 3 year-old had finally fallen asleep, and the timing was great. I was just getting to a point where I wanted my husband with me (prior to that I liked the peace of laboring all alone). There was still no pain with contractions, just intensity. Contractions were about 5 minutes apart and still only about 30-40 seconds long.
My husband came in with me and I decided I wanted to get in the tub. The warm water felt wonderful, for a while, then I wanted up and out. Walked around a bit. Swayed with the contractions. Then wanted to lay back down again. I suddenly started feeling really nauseated and dispatched my hubby to go get me a bowl to puke in. He got back just in time, too! As I was throwing up, my water broke! Then it occurred to me that THIS was transition!! Holy cow!! Transition and my contractions were still about 5 minutes apart and almost completely painless. I was on cloud nine. It was about midnight or so and I just knew I'd be holding my baby in no time.
Then the first pushing-like contraction hit and it felt funny. It hurt. Pushing never hurt with my first son. It had been the only part of my entire labor that felt good. I went with my body. Pushed when it said push, didn't when the contractions rolled over me and didn't dictate any pushing. I decided to get up and move around. Tried different positions---any that were real upright put a horrible amount of pressure on my pubic bone and became very painful during contractions. I tried standing and leaning on my husband, kneeling on all fours, kneeling leaning over my bed, squatting, chest/knees, standing and leaning over a dresser and swaying my hips, everything I could think of that might offer some relief and nothing really did. I got back in the tub off and on through all this, the hot water helped a lot but then I'd start feeling claustrophobic and had to get out. I was drinking a lot, very thirsty and peeing a lot too. Made MANY potty trips through the whole labor. It was really nice to be able to drink when I felt like it.
After about an hour of this, I decided to call my best friend who---bless her----made the 40+ minute drive at 1 a.m. in the morning to come be with me (and she must have driven a hundred miles an hour because it didn't take her nearly 40 minutes to get to me!). She has no medical qualifications, just another mom and another shoulder to lean on. The support of another woman that I care a great deal about felt so nice. I knew she knew what I was going through, and she was there because she cared about me, not because I paid her to be. My husband was also so supportive. He never once doubted me and I can't even begin to describe how much his trust, love, and respect means to me.
To make a long story short, we went through 9 hours of this. At one point, my friend looked at me during a contraction and commented on the fact that my baby was completely and totally off to one side. I was getting so frustrated and discouraged by the end of that 9 hours. Pushing had taken less than 15 minutes with my first baby. I was complete, could feel my son's head inside of me RIGHT THERE and no matter what I did he would not budge. He was wedged tight, and with every contraction his head was being rammed into my pubic bones. It became more and more and more painful as time wore on and my energy ran out. I was getting so exhausted with laboring and the lack of sleep.
I was about at the point of transferring to the hospital when I got angry and decided I'd had it. Baby was coming OUT. I squatted at the foot of my bed, and with the next contraction I just hung there----and then he turned!! It was such an amazing feeling. He completely shifted position across my entire stomach. HUGE roll over!
With the next contraction he descended to completely crowning and the pain was overwhelming! The contractions were still spaced out and I felt like I squatted there forever with his head feeling like it was about to rip me in two. With the next contraction he was born completely into my husband's waiting hands and I joyfully collapsed to the floor and took him into my arms. It was about 9 a.m., 5 days after my due date.
He was a little slow to breathe, and as it turned out only my fore-waters had broken before. There was a huge gush of blood-tinged waters as he was born which really worried my hubby (he thought I was bleeding too much). The decision was made to call 911 (which in hindsight I wish we hadn't because they were not needed).
I gently worked on my son to encourage him to breathe. Turned him head down and rubbed him, talked to him, then gently sucked some mucus from his mouth and nose with my own mouth. As gross as it sounds, it was so instinctive at the time and also very effective and far more gentle than a plastic bulb syringe.
He was so calm; he literally just "woke up," opened his eyes, and started to breathe. He never cried. As soon as he was pink I offered him a breast and he nursed like a champ! Didn't let go for almost 2 hours! The EMTs showed up about 20 minutes after he was born, and by then we no longer needed them and got rid of them as fast as we could. The placenta delivered very easily, and we waited a couple hours before we cut the cord to allow it to completely stop pulsing so all the placental blood could transfer back to my son.
My "little guy" weighed 10 lbs., 8.5 oz., was 22 inches long, and had a 15 inch head circumference even with some pretty extensive moulding (OUCH!). I didn't have a single tear or skid mark from his birth. He was a wonderful, happy, completely healthy baby. I felt back to normal within a day or two of his birth. He's almost 3 now and is just such a bright, happy little guy.
After my labor was over and I was able to analyze it and put everything together, I realized he was left occipital transverse. He was head down, but curved sideways like a "c" facing left in my stomach. His spine was facing my right side and he was completely tucked over into the right side of my body. As a result, the broad side of his head was presenting (and ramming into my pelvic bones) and could not descend. I dilated very easily, but until he turned there was just no way to get him to budge, and he was VERY stubborn about turning around! He was in this position for at least the last few days of my pregnancy, I just didn't think anything of it at the time. I'm rather short-waisted, and he was so long I think that's just how he tucked himself in to get comfortable. He also had a hand up by the top of his head. He had scratch marks from his nails all down the side of his face after he was born. That may have been part of the issue as well.
I am *SO* thankful I was at home without medical intervention. Even midwives will only allow for so much deviation from the 'norm'. I've heard multiple stories from women who were forced to transfer and ended up with c-sections in cases like mine---and all of them were 'given' less time to make progress than it took for my son to be born. I am thankful I listened to my instincts. Through my whole labor I never felt like my son was in danger, and sure enough, it was obvious once he was born that although labor was rough on me the experience was very gentle for him. We joke now that he was asleep and woke up, stretched, rolled over and next thing he knew he was born! He had that exact expression on his face at birth, like he'd just woken up from a long, peaceful nap.
Kmom's Birth Stories (Summaries)
Note: A more complete version of these stories is available on other BBW Birth Stories FAQs. The notes here are simply about the malposition aspects of Kmom's births, since her 3 births represent a wide variation of position problems! They also explain Kmom's concern with malposition as an underacknowledged part of difficult births/c-sections, and the steps that can be taken to try to help alleviate this problem.
First Birth (unknown position, c/s)
Kmom's Notes: Oh, how many things I would change if I had this pregnancy to do over again!
This pregnancy was not an easy one. It was full of assumption of high risk, many medical tests and procedures, and ultimately became a self-fulfilling prophecy. I ended up with a difficult induction at term. I dilated completely eventually and pushed for 2 hours before we decided on the c/s. The c/s was a nightmare (not enough anesthesia), but the baby was born healthy and well and for that I was thankful.
In terms of malposition, I will never know what position my baby was in for this birth. The O.R. notes are difficult to read; it looks like they say she was "OA" (anterior) but the writing is ambiguous enough that it might say "OP" (posterior). The other possibility is that she was indeed OA but her head was tilted to the side or at an odd angle (asynclitic). Either would explain the many symptoms of malposition I had.
I had days of puttering prodromal labor ahead of time, but no progress was made. My cervix was long, hard, and closed before the induction. After prostaglandin gel and major doses of pitocin, I did dilate, but only very slooooowwwly. At 2 cm (and while the baby was still high up at a -2 station), the doctor broke my waters. This committed the baby to whatever poor position she was in and immediately the labor became excruciating. An epidural was an absolute necessity to finish that labor because of the pain level. (Terrible back labor is another sign of possible malposition.) Being stuck on my back and immobilized in bed kept me from being able to help the baby's position resolve. By the time we were pushing, I felt like I had a welding torch held to my back on one side, even through the epidural.
The baby never descended past a -2 station, despite effective contractions, a ton of pitocin, and 2 hours of 'purple pushing'. I wish the doctors would have documented her position so we would have proof that she was malpositioned, but the signs certainly seemed to point to it. They did note that they had difficulty getting her out during the c/s. But from the doctor's point of view, position was irrelevant, and she was just 'too big' to come through---"CPD".
This baby had 4 straight months of terrible colic. Probably her head bones were out of alignment after being 'stuck' so long during labor, plus they had difficulty manipulating her out during the c/s. A neighbor recommended Cranial Sacral Therapy (CST) but I thought it sounded too strange to try on a tiny baby, so I just endured the 4 months of colic. It was hell at times! But she was so sweet at other times I fell in love anyway. A chiropractor saw her as a preschooler and found a number of 'stuck' things that needed fixing.
In an interesting side note, I began having back problems in this pregnancy, which I did not have prior to pregnancy. I tried to get my doctors to pay attention because it did not seem to be normal, but they dismissed it as normal ("welcome to pregnancy!") and ignored my concerns. The pain did NOT go away after the pregnancy was over, but I still had great difficulty getting any doctor to take it seriously. It took 5 years before anyone finally took it seriously, and when it resolved, I was able to have a normal vaginal birth. This leads me to wonder if a misalignment in my pelvis/sacrum caused my back pain and also encouraged my babies to be malpositioned.
Second Birth (posterior position, c/s)
Kmom's Notes: This was a much better birth, although it was hard to have another c/s after a full trial of labor again. Still, I was glad to have labored, and the midwives made sure the staff was much better about honoring my birthing wishes during labor and during the c/s.
This pregnancy was a much easier one, despite me being 35. I read a lot between pregnancies and educated myself. I also was careful to start on a gd food plan before pregnancy, and that seemed to help me avoid testing positive for gd this time, which meant I could avoid being induced. Still, I had a lot of emotional baggage and fears left over to process from having gd the first time, from the difficult induction I experienced, and from the absolutely horrifying c/s I endured. Unfortunately, I had few places or resources to help me resolve some of these fears and they probably influenced my second birth more than I'd wished.
This pregnancy was also plagued by the lower back pain I'd had before, with the new addition of vicious sciatica pains peaking at 6-8 months. Still no one took it seriously, since so many pregnant women have back pain. I only got through because my husband would take his elbow and rub my lower back extremely hard, which somehow seemed to counteract the pain for a while. I didn't just need counterpressure during labor, I needed it for the entire pregnancy! My poor DH.
I switched from an OB to a midwife once I tested negative for gd (long story), and the midwives did not pressure me to induce earlier for a big baby. We decided on spontaneous labor to try for a VBAC (Vaginal Birth After Cesarean). However, my midwives did *not* tell me that my baby was probably posterior before we began, despite having troubles picking up the baby's heart tones, etc. I'm not sure if they suspected or were just ignorant of the clues.
My labor with #2 began with my water breaking, which is more common with posterior babies since the baby's position can put uneven pressure on the bag of waters. I happened to be sitting at the computer with my legs up above my hips at the time, which also tends to encourage posterior positioning. I wish I had known about the postures to avoid, but no one ever counseled me on these. So I slouched in chairs a lot, put my knees above my hips, and generally assumed positions that tend to encourage babies to be posterior. I also believe that my pelvis and sacro-iliac joints were out of alignment, which also probably encouraged a malposition.
Despite the posterior position, labor with #2 was much easier because it wasn't induced. It still hurt, of course, but this time the pain was bearable. I did still have back labor, but it wasn't excruciating this time. I also experienced transition-like symptoms at home, only to find I was only 4 cm when I got to the hospital! That was very discouraging, but that plus the back labor, waters breaking, and trouble finding the baby's heartbeat in the 'right spot' should have clued us in that position was a problem. It didn't.
This time I did dilate smoothly and pretty quickly once I was in the tub after 4 cm. I went from 4 cm to nearly complete in less than 2 hours and moved into a hospital bed (I wish I could have stayed in the tub but this was not allowed there ). However, the next clue something was wrong was the stubborn anterior lip I had. Pushing felt great once we started, but after a few hours, we made no progress and that welding-torch-to-the side-of-the-back feeling returned. At that point, labor became very painful indeed again, and I became very discouraged. After pushing for nearly 5 hours, I elected to have a repeat c/s. Inside the O.R., both my husband and I remember hearing them say, "Well, no wonder! He's posterior!", but that fact was never put down on my chart anywhere. They ascribed all the problems once again to the baby's size----another case of "CPD".
At least this time the c/s was a 'good' one, and there was no repeat of the trauma of the first c/s. But I certainly felt like my body had failed me in some ways, although I was still glad to have tried for a VBAC. All my midwives could suggest was to induce early next time, if I still wanted a vaginal birth. They never once mentioned to me anything about the baby being posterior or that this causes a high rate of c/s etc. I only realized how potentially significant that was later.
This baby did not experience colic and was generally a pretty mellow guy. However, we noticed a distinct ridge on his head for his first several months; it even showed up in photos. The chiropractor said that probably his head was molding significantly in an effort to get through the birth canal, and that one bone may have gotten 'stuck' underneath another bone. She said that this can lead to big problems if it does not spontaneously resolve; we were fortunate in that the ridge went away on its own in a few months. When the chiropractor checked him as a toddler, he did have a significant degree of 'stuckness' both in his head and all down his spine/neural tube area. She felt that if we had not caught and fixed it, there was a distinct possibility he might have ended up with scoliosis or other significant problem. Of course, there is *no* way to prove or disprove this, but it was an interesting comment.
Third Birth (probable compound presentation, vaginal birth after cesarean)
Kmom's Notes: Yahoo! I had a normal birth this time! It wasn't easy, but it was definitely worth it.
Pregnancy #3 went smoothly. Although I had very much wanted another child, I had a hard time committing to becoming pregnant because I was not happy with the choice of providers. The nurse-midwives from the second pregnancy were nice, but obviously didn't know enough about preventing/fixing posteriors, and my family doctor turned out to have a higher c/s rate than the OBs I'd seen previously. After several workshops on birthing issues, I began to process and heal the previous births, understand how very significant baby position is, and to trust in birth again. I also opened my mind to the possibility of home birth. After much research into safety issues, etc., I did end up deciding to hire a home-birth midwife and birth at home. Since I only live 5 minutes from a hospital, I felt this was a feasible choice for me, despite 2 previous cesareans. And I loved the idea of laboring at home, not having to fight 'the rules' for constant monitoring/interventions, not having to travel to the hospital while in labor, and not separating mom from baby or employing mandatory interventions unnecessarily.
Although the medical literature clearly shows that inducing early for 'big baby' decreases chances for a VBAC (it cuts VBAC success in half in some studies!), my new midwives felt strongly that my case might be the exception. Despite my reservations, as we came closer to the end of pregnancy this decision began to feel like my only chance so we proceeded to induce at 38 weeks. I also felt it was important to monitor my blood sugars daily and exercise religiously, which helped me to once again test negative for gd despite my age and previous gd history. I paid careful attention to my posture, did exercises to encourage the baby to be anterior, and studied up on ways to prevent a posterior baby. In general, I tried to be as proactive as possible in this pregnancy to maximize my chances.
At 36 weeks I also finally found a chiropractor that knew the "Webster Technique" and had this adjustment done. The idea behind the Webster is that in some women the pelvis/sacrum gets out of position, and this causes the soft tissues and ligaments that support the uterus to twisted, so that the uterus (and baby therein) tends to go out of optimal position as well. The Webster Technique adjusts and realigns all of these things, thus allowing the baby to get into optimal position too. It was originally intended for turning breech babies, but some practitioners have also found it useful for turning posterior (and other malpositioned) babies.
Once I had this procedure done on me, I lost most of the lower-back pain I'd been suffering with for the past 5 years, and for the first time, the baby turned "LOA" (Left Occiput Anterior), the most desirable position for birth! Up till that time, he had consistently been posterior; within an hour of the adjustment, he turned LOA for the very first time. I really feel like this was not coincidence and that the adjustment was what helped him turn.
The baby did stay anterior for labor, but probably had an added complication of having his arm up by his face (compound presentation). Labor started off strongly; the midwife induced me at 38 weeks, hoping to get a "smaller" baby for a VBAC. I was already 3+ cm dilated and partially effaced, and since I'd dilated previously without problem, we did not expect any trouble dilating this time. Wrong! Despite very strong contractions that steadily got more and more intense, I stalled at about 5-6 cm (very common with malpositions). We decided that perhaps breaking the waters would help bring his head down onto the cervix better, but that made the contractions excruciating without helping dilation any. [I would not choose to break the waters again! We probably just made his position worse!] Not even soaking in the tub helped the level of pain.
My head midwife wanted to stretch the cervix manually (from 5-10cm!), but this did not seem 'right' to me. I decided not to consent. Although she was a skilled midwife, she had a very brusque and forceful manner, and we had a strong disagreement over this. During the labor, she became progressively more verbally abusive and I felt like I could not stay in such a negative environment. I also was concerned at the lack of progress in the face of such strong contractions, and I was in great pain. Since I'd already done an all-natural labor (which was no big deal) with my previous baby, I knew that this did not feel like 'normal' levels of labor pain to me. Although I was disappointed and apprehensive, I decided that transferring to my local hospital was probably the best course. At first I was tempted to give up and have another cesarean, but then decided to chance an epidural and see if that could help relax me enough to finish dilating. I also wanted a bit more monitoring because of the lack of progress in dilation despite so much pain---I just felt it was common sense at that point.
The drive was short but very hard, let me tell you! We took along the second midwife who had been wonderfully supportive throughout. Although I had not had back pain for all of the labor, eventually the back pain became excruciating. I needed a great deal of counterpressure and support just to get to the room. We got set up and the anesthesiologist came in for the epidural. But as we were getting into position for the epidural, I had to move my hips on the bed, which was not quite even. Something in that hip shift helped the baby change his position, and all of a sudden I was pushing! The anesthesiologist told me I had to stay still and not push or he could not finish the epidural. Although it broke my heart to come so close to pain relief at that point, there was no way I could stop pushing. So we took out the epidural (no drugs had been injected yet) and did a vaginal exam. I was 8-9 cm but had a stubborn cervical lip all around. The nurse offered to manually move it over the baby's head. Somehow it seemed fine to do this now, so I agreed to it, and it was quickly out of the way. (I don't think it would have happened so easily earlier, however.)
I began pushing very hard. It didn't take long at all. At one point, the baby seemed to stop descending, and this is where my back-up midwife's expertise came in handy. The hospital nurses were great and handled an unexpected homebirth transfer very professionally, but they kept trying to insist on a rounded back, chin-to-chest position for pushing, which was apparently making the baby hit my pubic bone and stop. My midwife put down my bed, allowing me to lay back, arch my back, and support my pelvis off the bed, and that got the baby under and through my pubic bone. Apparently for some women, arching the back during labor/pushing can make a real difference in getting the baby down and through.
My midwife also insisted that I put my hand down to feel the baby's head as he crowned. It was a brief but TOTALLY AWESOME feeling. Then I put my hands back, arched my back again, and pushed the baby out. With a great "whoosh" and a very loud primal scream from me, my little guy was born! It was hard but great! I immediately sat up and they handed him to me, and I got to cuddle him right away. He didn't cry, but seemed very calm, considering! The cord was too short to nurse him right away, but I did get to cut the cord myself, and then we nursed him. It was so wonderful to be able to have him right away. I really missed that the most with my previous 2 c-sections. I did tear a small amount, but 3 small stitches were nothing compared to layers and layers of stitches from a c/s! And I got to snuggle him much more than I did my c/s babies.
From start to finish, my pushing phase once I was complete was about 12 minutes. That's a lot better than 5 hours of pushing!! An OB would argue that this baby was a VBAC because he was nearly 2 lbs. smaller than my other babies; while that might have helped, my midwives and I feel that the difference in the baby's position was the most critical issue. I feel I could have birthed a bigger baby, as long as it was well-aligned. We cannot confirm that this baby's position was compound, but all the clues fit. Compound labors tend to be VERY painful, if the arm/elbow is up by the face then intense back labor can happen even with the baby being anterior, moving the hips tends to help this position resolve, and once the arm moves the baby tends to be born very quickly. Since the birth, this baby constantly had his hands up by his face; sometimes it was a struggle to get him latched on because his hands got in the way so much. Although we will never know for sure that he was in a compound presentation of some kind, I really do think that the pieces fit and that is probably what happened.
Fourth Birth (arm behind the back, vaginal birth after cesarean)
Kmom's Notes: Yahoo! Another VBAC. This baby was 1 lb bigger than either of my "CPD" c/s babies, and 3 lbs. bigger than my previous VBAC baby.
This pregnancy was uncomplicated despite being in my 40s. There were a lot of stressful things going on in my life at the time so my exercise and nutrition was not quite as good as it had been previously (although not bad overall), yet I still managed to avoid BP problems or blood sugar problems. I found a pair of truly wonderful, lovely midwives for this pregnancy, saw a chiropractor all through the pregnancy, and also an acupuncturist who helped with minor pregnancy complaints.
Although I expected to go into labor a little early with this pregnancy, I ended up going "late" by conventional standards. By LMP I was almost 43 weeks when I gave birth. By ultrasound I was almost 42 weeks. However, by the Woods' Due Date calculator my midwives use, I was almost 41 weeks, and this turned out to be the most accurate of all. But imagine my surprise when I expected to birth before my due date and I ended up going way past it!!
However, after the induction nightmare of last pregnancy, I was not about to agree to induce labor, especially since we know now how very risky inducing a VBAC is. So we just waited for labor. I saw the chiropractor quite often towards the end, as I could tell baby shifted to OP at times when my pelvis was not well-aligned, and everything was so loose by the end that it was tough to stay in alignment. Despite this, the baby stayed LOA for most of the end of pregnancy. I really think seeing a chiropractor was a big part of the reason baby stayed LOA and why I was able to give birth to a 10 lb. baby easily.
I had several weeks of off-and-on prodromal labor. That was a drag, but I was glad I didn't give in and schedule an induction or a c-section. While waiting, I used the time to schedule some special fun times with my kids or special alone time for me. It was trying to wait, but in the end it was special to have that time with the family and for myself.
I finally went into serious, there's-no-going-back labor near the end of my "due month." I bundled off my kids to the grandparents' and called my doula (who was my acupuncturist too). Labor eased off a bit as I got the kids going, so I took the opportunity to do some last-minute nesting and cleaning. Labor spaced out even more, so we decided to eat lunch and take a nap. It was lovely to get this chance to rest up, because after the nap, labor kicked in with a vengeance.
My doula did some acupuncture points to help with pain, and we used a TENS machine on them to help distract me through transition contractions. DH filled the labor tub with hot water, my midwives arrived, and we decided to get into the pool. I roared through the heaviest transition contractions and tried not to bite the hands of my doula; I bit the side of the birth tub instead (hard plastic, fortunately). Not exactly the picture of serenity you see in some birth books, but it served me just fine. Pretty soon I was pushing.
Pushing hurt quite a bit. It felt like my pelvis was coming apart. That surprised me. But I figured that the harder I pushed, the sooner it would be over, so I worked at it really hard. Turns out the reason it was so painful and hard was because not only was she 10 lbs, but she had her arms behind her back, making her diameter extra wide to get through the pelvis. No wonder it hurt!
She started to crown but it went slowly. Before she finished crowning, she went back up a bit and started to restitute (turn her shoulders to get through). Normally this is done AFTER the baby's head is out fully, not before. That was our first clue that something was going on. Then I felt the strangest whomping on the inside of my pelvis, like someone was knocking on my insides!! That was very strange. Turns out it was the baby, trying to get her arms into the correct position so she could fit through better---but she was having a hard time doing it. My midwives waited patiently for a couple of contractions, but finally put a hand in to check and see what was going on. They found her arm, maneuvered it to the front, and then helped move it up and out. At that point, she shot out easily. She was born after 24 minutes of pushing total, and her heart tones and color remained excellent throughout. She was born into the water and then lifted onto my chest. It was sheer bliss to hold her for the first time, and I was content to just sit there for the longest time, holding my sweet little baby.
Things were not totally picture-perfect in the long run. I did hurt myself pushing so hard; I think I tore some ligaments or muscles. I was mighty sore afterwards, and that wasn't fun. But it was a heck of a lot easier than recovering from a c-section, and she transitioned so much better to the outside and to nursing than she would have after a c/s. I think if I'd been in the hospital I would have been forced into a c/s; they just can't tolerate long pregnancies or big babies very easily. I was glad to be at home, and glad I hired a good set of midwives this time that were trustworthy and knew how to help out with her arm. I really believe in the value of having a good midwife attending you, wherever you birth.
All in all her birth was very satisfying, but I was disappointed that once again we had an arm issue that caused some problems. I was so hoping for a birth without any problems whatsoever, just a sweet, easy and totally uncomplicated birth. But birth is like life, a bit messy at times, and you never know what will come up. I do believe that close attention to chiropractic care and optimal fetal positioning and all really helped me birth this 10 lb baby, who was a pound bigger than my "CPD" babies, and 3 lbs bigger than my previous VBAC baby. Obviously, size is not the real issue for me; positioning is. And for me, chiropractic care was crucial to optimal positioning.
Out of 4 births, I have had 4 malpositions----some major, some minor. One midwife feels that I may have a slightly different-shaped pelvis, and that this plus an exaggerated back arch may make my babies engage in weird positions. I don't know if I buy that, but who knows? Once I got chiropractic care, I didn't have OP babies anymore, but I did have babies with arm issues. So who knows WHY these things really happen.
Some midwives believe that fetal position is all about the mother's pelvic shape but I don't buy that. Pelvic shape may have some relevance in some cases, but alignment of the back and pelvis, posture, and the mother's mobility in labor all play critical roles in the labor and birth. Having previous malpositioned babies doesn't mean that you must have a poorly-shaped pelvis for birth; it is more likely an interaction of posture, alignment, and mobility along with pelvic shape. Many women with "bad pelvises" have given birth just fine----if they are allowed plenty of time to labor, get good chiropractic care, practice optimal fetal positioning, and are allowed to move freely for labor and birth.
In my first pregnancy I'd had a lot of back and pelvic pain, but this was ignored, as were clear signs of a baby malposition. I was almost totally immobilized in labor, my waters were broken when baby was in a poor position, and I was not able to try anything to change baby's position. Cesarean.
In the second birth, once again my back and pelvic pain were ignored as "normal" and clear signs of fetal malposition were shrugged off. We didn't find out the baby was posterior until the c/s. More education and some turning techniques might have helped prevent/fix the position, but my nurse-midwives didn't know these. So once again, I ended up with a cesarean.
With the third birth, we worked hard on posture and other preventative measures, but it was the chiropractic care more than anything that helped resolve an underlying misalignment problem that caused the previous malpositions. This time, despite less-than-optimal labor management, I was able to have a VBAC because the baby was LOA, even if had to wait for him to move his arm out of the way.
With the fourth baby, I had chiropractic care all through the pregnancy, and this enabled me to birth a baby 3 lbs. bigger than my other VBAC baby. She did have an arm behind her back which caused a brief problem, but at least this position was much easier to resolve! And once the arm was gone, she shot out with no problem whatsoever. So that makes me doubt that "pelvic shape" is the ultimate problem. It may be relevant once in a while, but for the most part, "pelvic shape" is just an excuse people resort to to explain why a c/s happens. It need not be a sentence to cesareans forever, nor malpositions forever either.
Because of my own experiences, I believe that subtle problems with a baby's position greatly influence the course of labor and birth, and cause many cases of cesareans due to "Failure To Progress" or "Cephalo-Pelvic Disproportion." In addition, I have seen so many cases of other moms who have had similar problems with malpositioned babies that I decided to highlight the problem by creating a section of birth stories about it. And through my VBAC support groups, I have come across many cases of c-sections that were attributed to 'too big' babies etc., but where the mother then went on to have a vaginal birth with an even larger baby. The difference between the two cases is often baby position.
Some cases of baby malposition can be born vaginally, and it's important to remember that a malposition doesn't have to mean surgery! But a very high percentage do end up needing a lot of intervention, and quite a few end in c/s. Other cases resolve themselves spontaneously (as in my 3rd birth) but make for a difficult, long, or very painful labor. So even though some malpositions are born vaginally without a problem, enough of them cause problems that they deserve more study and efforts at prevention.
Too many women are being made to suffer needlessly in labor, have cesareans, or come to believe that they are 'too small' to birth normally. The truth is that their bodies usually DO work, but our lack of understanding (and easy pat answers like 'too big' babies or the 'wrong pelvic shape') prevents us from helping them to work as efficiently as possible.
It is my belief that much more attention needs to be paid to the subtle variations of a baby's position before and during labor, and that much more attention needs to be paid to learning how to prevent and/or treat these malpositions as proactively as possible.
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