Most of this was written ~7 hrs after the birth (here I am typing it actually) but I've filled in some details and added some context. And I'm calling it "almost precipitous" since technically a precipitous labor is less than three hours and mine was four and a half hours. So, although I was dilating a cm every 15 minutes, it's not technically precipitous despite how it felt to me! 
This was my second hospital vbac and I'm still on cloud nine! My first child was born via cesarean after an extremely long labor. She was posterior and asynclitic, I had pSROM at 42+ weeks, and she was 9lbs6oz with a giant head. Despite everything, we just couldn't get her to budge and after roughly 32 hours of unmedicated back labor (the final 19 hours "stuck" at 7cm) I had a c/s. I healed well physically but was emotionally gutted and eventually diagnosed with PPD.
Two years later dd2 arrived via hospital vbac. I again had SROM prior to labor but this time my babe was lined up and ready to go at 40 weeks. Twelve hours after the first "was that a contraction?" I was holding my daughter in my arms! However, I did push (with urge and in many positions) for roughly four hours and dd2 developed a true shoulder dystocia. I was squatting when her shoulders stuck and the SD did not resolve with the Gaskin Maneuver or McRoberts. Eventually the OB "reached in" and manually freed the shoulders. I had a 4th degree tear and dd2 required resuscitation (on my chest with the cord still pulsing and me on oxygen). It was a dramatic few minutes but in the end we all healed and the joy of my unmedicated vbac carried me over much of the emotional/physical difficulties caused by the tear. She was 9lbs even.
Trying to find a care provider to attend a VBAC is tough. Finding one who will attend the vaginal birth of a mama with a prior shoulder dystocia and 4th degree tear is harder. And then you add in expense and insurance coverage? It took several tries and many months, but by the middle of the second trimester I had a provider I liked. It was a 45minute-1hour drive and they only delivered at a hospital I'd never used (and had heard less than baby friendly things about) but with my super supportive DH and doula I felt it was my best option.
Here's the story...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The hospital doesn't "support" vbac after 41 weeks so my care providers changed my due date to "give" me an extra week... I didn't think I'd need it after a bout of PTL and being a third time mom, but it turned out that a "second 40 week" visit really was helpful in the end. (My "guess date" was August 7th, they changed it to August 13th, and then he didn't arrive till August 22nd.)
DS was happily head down and LOA till 39 weeks. Then he moved posterior. A week later he was transverse and moving between head down and breech! I tried everything I could (moxa, OFP, acupressure, homeopathic pulsatilla, visualization, etc) and when I had my 41 week NST and quick u/s (marked as "40 weeks" on the form) he was once again head down and looking great. I had a membrane sweep since I'd been having serious prodromal labor almost 24/7 since 38 weeks but while there was a bit of an increase in contraction strength it eventually fizzled out.
I went back Friday the 21st for a 42 week NST and the results weren't "great". DS was still head down and fine, but he wasn't as fine as he had been. And with "41 weeks" marked on the paperwork, the midwife I saw was concerned about my vbac options. She did a thorough membrane sweep and asked us to stay in town. She wanted us to come back that afternoon for another check... if there was some cervical change she wanted us to consider going to the hospital for AROM and a hopeful vbac. And if there was no change she wanted us to go to the hospital for AROM and a possible c/s.
I was really upset but trying to stay calm. We found a hotel (we wanted my MIL to watch our girls at the hotel so they'd be nearby), updated our doula, and dh and I talked a lot about options. We considered not going for our afternoon check but eventually decided we'd do it. When we arrived at 2pm though there was a new midwife on call. She is the most hands off of the midwives at the practice and the most pro-vbac. She checked and while there was no change she suggested another sweep (she doesn't like them but thought it was worth the risk at this point) and then sent us to the hotel. She told us to page her directly if anything started and if I was pregnant in the morning to page her... she'd meet us at the (closed) office for a check and to discuss options.
I felt a HUGE relief... dh and I had both felt like we were being pushed into a "friday afternoon ftp" scenario and this totally removed that fear. We went to the hotel and took my MIL and the girls for a walk. Then grabbed supplies at Wegmans and had a yummy dinner in our hotel room.
Well, around 9pm Friday I started having some show (but after three weeks of 24/7 prodromal labor contractions and TWO membrane sweeps in the previous 12 hours it didn't feel like it "counted" you know?). We started timing contractions around 10pm. They were 5 minutes apart at 10-ish, 3 minutes apart at 11-ish so we called the midwife and met her at the hospital. Contractions still weren't really uncomfortable and they were easy to tune out using the hypnobabies techniques. In the car I kept telling dh that it was probably a false alarm/hopeful thinking since the contractions still felt like the prodromal labor (and we'd had one 8-9 hour stretch of contractions 3-5 minutes apart at 40 weeks where we'd gotten a hotel and were good to go only to have it fizzle).
At the hospital I was still 3-4cm (where I'd been for weeks) and we agreed to let the midwife break my waters since i both of my previous births I'd had SROM prior to contractions and maybe my body just needed that "sign" to realize it was supposed to be doing something! The water was clear and our midwife ok'd the jacuzzi tub, heplock, and hand held doppler monitoring. Our doula arrived around 11:30 and I was still totally on top of contractions, walking and swaying and listening to my hypnobabies scripts.
Then the tsunami hit. The contractions got stronger and harder all at once. I couldn't walk or move during them since all mu muscles contracted, and they were all double peaked... there didn't seem to be enough time to catch my breathe and release the muscle tension between contractions. The contractions "hurt", but it was the ongoing muscle pain between contractions that scared me... like those horrible pregnancy leg cramps, but covering my whole midsection. I worried that this birth was following the shape of dd1's birth.
We filled the tub and I got in. It did help a bit and I managed to vocalize through the contractions staring at the reflection of my open mouth in the tub spout (of all things!
). I remember the midwife coming in to ask how it was going and not being able to talk... I knew she was there but I just didn't have time/energy to focus on her. DH and the doula explained that I seemed to be going really fast and that the contractions were extremely long/double peaked with very short breaks. When the midwife left my doula suggested I try hands and knees and when the next contraction hit I almost lost it. It was so much more intense and painful I actually started screaming. It was horrible. I wanted out of the tub and I wanted drugs!
The contractions were intense and I couldn't walk to the bed... DH half carried me and once I was lying down there is no way I could have moved. The hospital could have been on fire, it wouldn't have mattered! I needed the doula and dh to help me roll from one side to the other since every movement caused a contraction, and it seriously felt like my contractions were having contractions.
They hooked up the monitor belts (I couldn't feel them) to keep an eye on the babe and gave me a shot of Stadol. It did almost nothing as far as I could tell... it made my vision blurry through two contractions but that was it. DH said that it seemed to even out some of the double peaks... that instead of two individual peaks I was sort of hitting a plateau and staying there. But from the "inside" all I noticed was the brief "double vision" and that was it.
I started begging for an epidural even though I'm dead set against them. DH worried that it would slow the labor and I couldn't find a way to explain that I WANTED to slow the labor! I felt like I needed more time to adapt and needed space between the contractions in order to just survive. My doula and dh kept reminding me about my birth goals and offering support but eventually the nurse did hook up the iv to give me pre-epidural fluids. DH told me we had a conversation where he said he hoped the fluid alone would help space out the contractions (by increasing hydration and changing my electrolyte balance) and I called him an idiot and explained the fluid was to prevent a blood pressure crash once the epidural was in place.
Anyway, the drug guy showed up (I didn't notice him) and dh asked me to reconsider one last time. The nurse pointed out I'd need to sit up for the epidural and there was no way I could do that... I asked to be checked and I was at 9-10cm. I decided I didn't need the epidural after all despite screaming my head off with each contraction. Everyone was telling me how fast things were going and I felt like I could hold on a bit longer.
I pushed on my side with my doula holding my leg. I mangled dh's hands and buried my face in his belly. I found that pushing felt great but the "rest" between pushing contractions was really painful. My left sciatic nerve was being crushed and while I couldn't feel it when pushing, between pushing my leg was on fire and my pelvis felt like it was splitting. I ended up being almost completely silent while pushing but crying/vocalizing between contractions (unlike with dd2's birth where I felt totally fine between pushing contractions and even told jokes and stuff).
In the end, I had one hand on the babe's head, one hand wrapped in dh's shirt, the midwife was supporting my perineum, the doula was holding my leg, and the nurse was monitoring the babe with a hand held doppler. And then Torin Salvatore was in my arms at 3:23am Saturday August 22...
all 9lbs 8oz, 21.5 inches, and 14.25 inch head of him! I went from 3-4cm/long/posterior cervix to babe in arms in 4.5 hours. No wonder it was overwhelming and intense! He was a bit "sticky" but it wasn't a dystocia... just a big baby and a lot of scar tissue.
I had a 2nd degree tear along my prior scar line and the midwife put in a few stitches. Since the L&D unit was pretty empty and the postpartum unit was really busy that night we had a HUGE lucky break. Instead of being moved to pp (with all sorts of crazy interventions we'd psyched ourselves up to challenge) we were allowed to "transition" in the L&D suite. Our labor nurse called the nursery to get a list of their protocols, but since it wasn't her unit she didn't feel strongly about doing the things on the list. So she'd say "OK, we need to get a blood sample since he is a big baby" and we'd say "Thanks, but our other big babes didn't have blood sugar issues so we'd rather wait and see." and she'd say "ok" and move to the next thing on the list.
She brought us some food (buttered toast, and I grbbed some coconut water from my birth bag) and they left us alone for a few hours. My doula emptied the tub and chatted a while, then headed out. The nurse returned and helped dh give Torin a bath while I jumped back into the shower to wash... dr Bronner peppermint soap and some yummy shampoo, hair braided, and clean clothing on I felt fine! We all walked over to our postpartum room and settled in. It was around 6:30 am and the pp nurses were all really surprised at how active/ok I felt. I sat on the bed nursing and chatting and writing my birth story and eating breakfast and basically feeling fine with my adorable babe... and almost every person who came into the room did a double take. Several actually asked "Are you the mom?" and commented on how most of the moms didn't get up and about until discharge.
My throat was in shreds (the midwife added throat lozenges to my available medications) and I did take a few of the "big" advil over the next two days. My left sciatic nerve hurt like heck for about 24 hours. The midwife suggested chiropractic for both Torin and I (she had worried about a broken clavical at first and felt he was probably in need of an adjustment given the sticky shoulders). We went home Monday morning and while the swelling/stitches aren't super comfy, I feel really good! Of course, my prior births involved a c/s recovery and a 4th degree tear/repair recovery so my pp pain experiences have been a bit extreme.
Tor's a bit jaundiced but he's a breastfeeding champ (went home Monday at 8lbs13oz and regained his birth weight by Wed), very chatty, and his big sibs have declared him "very cute". Thanks for the energy, wishes, and birth vibes! It's been an amazing adventure so far.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
pictures up on flickr http://www.flickr.com/photos/wombatclay/
This was my second hospital vbac and I'm still on cloud nine! My first child was born via cesarean after an extremely long labor. She was posterior and asynclitic, I had pSROM at 42+ weeks, and she was 9lbs6oz with a giant head. Despite everything, we just couldn't get her to budge and after roughly 32 hours of unmedicated back labor (the final 19 hours "stuck" at 7cm) I had a c/s. I healed well physically but was emotionally gutted and eventually diagnosed with PPD.
Two years later dd2 arrived via hospital vbac. I again had SROM prior to labor but this time my babe was lined up and ready to go at 40 weeks. Twelve hours after the first "was that a contraction?" I was holding my daughter in my arms! However, I did push (with urge and in many positions) for roughly four hours and dd2 developed a true shoulder dystocia. I was squatting when her shoulders stuck and the SD did not resolve with the Gaskin Maneuver or McRoberts. Eventually the OB "reached in" and manually freed the shoulders. I had a 4th degree tear and dd2 required resuscitation (on my chest with the cord still pulsing and me on oxygen). It was a dramatic few minutes but in the end we all healed and the joy of my unmedicated vbac carried me over much of the emotional/physical difficulties caused by the tear. She was 9lbs even.
Trying to find a care provider to attend a VBAC is tough. Finding one who will attend the vaginal birth of a mama with a prior shoulder dystocia and 4th degree tear is harder. And then you add in expense and insurance coverage? It took several tries and many months, but by the middle of the second trimester I had a provider I liked. It was a 45minute-1hour drive and they only delivered at a hospital I'd never used (and had heard less than baby friendly things about) but with my super supportive DH and doula I felt it was my best option.
Here's the story...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The hospital doesn't "support" vbac after 41 weeks so my care providers changed my due date to "give" me an extra week... I didn't think I'd need it after a bout of PTL and being a third time mom, but it turned out that a "second 40 week" visit really was helpful in the end. (My "guess date" was August 7th, they changed it to August 13th, and then he didn't arrive till August 22nd.)
DS was happily head down and LOA till 39 weeks. Then he moved posterior. A week later he was transverse and moving between head down and breech! I tried everything I could (moxa, OFP, acupressure, homeopathic pulsatilla, visualization, etc) and when I had my 41 week NST and quick u/s (marked as "40 weeks" on the form) he was once again head down and looking great. I had a membrane sweep since I'd been having serious prodromal labor almost 24/7 since 38 weeks but while there was a bit of an increase in contraction strength it eventually fizzled out.
I went back Friday the 21st for a 42 week NST and the results weren't "great". DS was still head down and fine, but he wasn't as fine as he had been. And with "41 weeks" marked on the paperwork, the midwife I saw was concerned about my vbac options. She did a thorough membrane sweep and asked us to stay in town. She wanted us to come back that afternoon for another check... if there was some cervical change she wanted us to consider going to the hospital for AROM and a hopeful vbac. And if there was no change she wanted us to go to the hospital for AROM and a possible c/s.
I was really upset but trying to stay calm. We found a hotel (we wanted my MIL to watch our girls at the hotel so they'd be nearby), updated our doula, and dh and I talked a lot about options. We considered not going for our afternoon check but eventually decided we'd do it. When we arrived at 2pm though there was a new midwife on call. She is the most hands off of the midwives at the practice and the most pro-vbac. She checked and while there was no change she suggested another sweep (she doesn't like them but thought it was worth the risk at this point) and then sent us to the hotel. She told us to page her directly if anything started and if I was pregnant in the morning to page her... she'd meet us at the (closed) office for a check and to discuss options.
I felt a HUGE relief... dh and I had both felt like we were being pushed into a "friday afternoon ftp" scenario and this totally removed that fear. We went to the hotel and took my MIL and the girls for a walk. Then grabbed supplies at Wegmans and had a yummy dinner in our hotel room.
Well, around 9pm Friday I started having some show (but after three weeks of 24/7 prodromal labor contractions and TWO membrane sweeps in the previous 12 hours it didn't feel like it "counted" you know?). We started timing contractions around 10pm. They were 5 minutes apart at 10-ish, 3 minutes apart at 11-ish so we called the midwife and met her at the hospital. Contractions still weren't really uncomfortable and they were easy to tune out using the hypnobabies techniques. In the car I kept telling dh that it was probably a false alarm/hopeful thinking since the contractions still felt like the prodromal labor (and we'd had one 8-9 hour stretch of contractions 3-5 minutes apart at 40 weeks where we'd gotten a hotel and were good to go only to have it fizzle).
At the hospital I was still 3-4cm (where I'd been for weeks) and we agreed to let the midwife break my waters since i both of my previous births I'd had SROM prior to contractions and maybe my body just needed that "sign" to realize it was supposed to be doing something! The water was clear and our midwife ok'd the jacuzzi tub, heplock, and hand held doppler monitoring. Our doula arrived around 11:30 and I was still totally on top of contractions, walking and swaying and listening to my hypnobabies scripts.
Then the tsunami hit. The contractions got stronger and harder all at once. I couldn't walk or move during them since all mu muscles contracted, and they were all double peaked... there didn't seem to be enough time to catch my breathe and release the muscle tension between contractions. The contractions "hurt", but it was the ongoing muscle pain between contractions that scared me... like those horrible pregnancy leg cramps, but covering my whole midsection. I worried that this birth was following the shape of dd1's birth.
We filled the tub and I got in. It did help a bit and I managed to vocalize through the contractions staring at the reflection of my open mouth in the tub spout (of all things!
). I remember the midwife coming in to ask how it was going and not being able to talk... I knew she was there but I just didn't have time/energy to focus on her. DH and the doula explained that I seemed to be going really fast and that the contractions were extremely long/double peaked with very short breaks. When the midwife left my doula suggested I try hands and knees and when the next contraction hit I almost lost it. It was so much more intense and painful I actually started screaming. It was horrible. I wanted out of the tub and I wanted drugs!The contractions were intense and I couldn't walk to the bed... DH half carried me and once I was lying down there is no way I could have moved. The hospital could have been on fire, it wouldn't have mattered! I needed the doula and dh to help me roll from one side to the other since every movement caused a contraction, and it seriously felt like my contractions were having contractions.
They hooked up the monitor belts (I couldn't feel them) to keep an eye on the babe and gave me a shot of Stadol. It did almost nothing as far as I could tell... it made my vision blurry through two contractions but that was it. DH said that it seemed to even out some of the double peaks... that instead of two individual peaks I was sort of hitting a plateau and staying there. But from the "inside" all I noticed was the brief "double vision" and that was it.
I started begging for an epidural even though I'm dead set against them. DH worried that it would slow the labor and I couldn't find a way to explain that I WANTED to slow the labor! I felt like I needed more time to adapt and needed space between the contractions in order to just survive. My doula and dh kept reminding me about my birth goals and offering support but eventually the nurse did hook up the iv to give me pre-epidural fluids. DH told me we had a conversation where he said he hoped the fluid alone would help space out the contractions (by increasing hydration and changing my electrolyte balance) and I called him an idiot and explained the fluid was to prevent a blood pressure crash once the epidural was in place.
Anyway, the drug guy showed up (I didn't notice him) and dh asked me to reconsider one last time. The nurse pointed out I'd need to sit up for the epidural and there was no way I could do that... I asked to be checked and I was at 9-10cm. I decided I didn't need the epidural after all despite screaming my head off with each contraction. Everyone was telling me how fast things were going and I felt like I could hold on a bit longer.
I pushed on my side with my doula holding my leg. I mangled dh's hands and buried my face in his belly. I found that pushing felt great but the "rest" between pushing contractions was really painful. My left sciatic nerve was being crushed and while I couldn't feel it when pushing, between pushing my leg was on fire and my pelvis felt like it was splitting. I ended up being almost completely silent while pushing but crying/vocalizing between contractions (unlike with dd2's birth where I felt totally fine between pushing contractions and even told jokes and stuff).
In the end, I had one hand on the babe's head, one hand wrapped in dh's shirt, the midwife was supporting my perineum, the doula was holding my leg, and the nurse was monitoring the babe with a hand held doppler. And then Torin Salvatore was in my arms at 3:23am Saturday August 22...
all 9lbs 8oz, 21.5 inches, and 14.25 inch head of him! I went from 3-4cm/long/posterior cervix to babe in arms in 4.5 hours. No wonder it was overwhelming and intense! He was a bit "sticky" but it wasn't a dystocia... just a big baby and a lot of scar tissue.
I had a 2nd degree tear along my prior scar line and the midwife put in a few stitches. Since the L&D unit was pretty empty and the postpartum unit was really busy that night we had a HUGE lucky break. Instead of being moved to pp (with all sorts of crazy interventions we'd psyched ourselves up to challenge) we were allowed to "transition" in the L&D suite. Our labor nurse called the nursery to get a list of their protocols, but since it wasn't her unit she didn't feel strongly about doing the things on the list. So she'd say "OK, we need to get a blood sample since he is a big baby" and we'd say "Thanks, but our other big babes didn't have blood sugar issues so we'd rather wait and see." and she'd say "ok" and move to the next thing on the list.
She brought us some food (buttered toast, and I grbbed some coconut water from my birth bag) and they left us alone for a few hours. My doula emptied the tub and chatted a while, then headed out. The nurse returned and helped dh give Torin a bath while I jumped back into the shower to wash... dr Bronner peppermint soap and some yummy shampoo, hair braided, and clean clothing on I felt fine! We all walked over to our postpartum room and settled in. It was around 6:30 am and the pp nurses were all really surprised at how active/ok I felt. I sat on the bed nursing and chatting and writing my birth story and eating breakfast and basically feeling fine with my adorable babe... and almost every person who came into the room did a double take.
Several actually asked "Are you the mom?" and commented on how most of the moms didn't get up and about until discharge.My throat was in shreds (the midwife added throat lozenges to my available medications) and I did take a few of the "big" advil over the next two days. My left sciatic nerve hurt like heck for about 24 hours. The midwife suggested chiropractic for both Torin and I (she had worried about a broken clavical at first and felt he was probably in need of an adjustment given the sticky shoulders). We went home Monday morning and while the swelling/stitches aren't super comfy, I feel really good! Of course, my prior births involved a c/s recovery and a 4th degree tear/repair recovery so my pp pain experiences have been a bit extreme.
Tor's a bit jaundiced but he's a breastfeeding champ (went home Monday at 8lbs13oz and regained his birth weight by Wed), very chatty, and his big sibs have declared him "very cute". Thanks for the energy, wishes, and birth vibes! It's been an amazing adventure so far.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
pictures up on flickr http://www.flickr.com/photos/wombatclay/
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