A review of my daughter's birth in 2003: My water broke at 5:30 a.m., contractions started 30 minutes later, and within six hours I was at 10 cm and pushing (whoosh!). This was a planned hospital birth. I pushed using the squat bar, hands and knees, and birthing stool, as well as (finally) the traditional reclined position that the doctors prefer. After 7 hours, it became clear to me that no progress was being made even though my daughter was reaching +2 with each contraction--after which she would slide back up. They refused to try vacuum extraction because they were convinced she was large and they were concerned about shoulder dystocia. I realized that the contractions/pushes/movement had been identical for at least two hours when my husband and I finally decided that a c-section was probably necessary. An hour later I was in the OR and my daughter was born at 8:20. She was 7 lbs 6 oz and had a moderate-sized (though not molded whatsoever) head. The doctor wrote down "CPD" as the diagnosis, which I was sure was bull.
After much review I had decided that she was probably asynclintic, though because she had a teeny anterior fontanelle, and they pushed her back up before the surgery, they couldn't tell the position of her head during the pushing phase.
This time, we decided that my best chance for a VBAC (since our hospital doesn't allow them) was a homebirth. We hired a midwife and she and I set out a plan of attack against malpresentation: I used an ergonomic chair for the last two months of pregnancy; I was manipulated by my osteopath at least once per month to keep my alignment good; I exercised and ate well and did all the things I was supposed to do. I researched extensively to find out what positions and techniques could be tried during labor if the baby still was not positioned correctly. I was ready.
Then came 3:00 a.m. on Thursday, March 16--I started having real contractions (definitely not BH and probably not prodromal, though I wasn't yet sure). They were coming every 7-8 minutes, so I didn't wake my husband. I even slept some between 5:00 and 6:00, although the contractions were starting to get more painful. As soon as he was awake, I told my husband what was going on. We waited another 30 minutes or so to time them, by which time they were three minutes apart. I put in the calls to my doula and midwife.
Luckily, our three-year-old daughter slept soundly and late that day; by the time my doula arrived I was nearly in transition, and by the time my midwife came I was pushing (completely without any effort on my part). This labor was STRONG. Again, I had dilated in pretty much six hours, though the pushing started before the transition contrax had stopped. It was intense and much more painful that my first labor. Sometime during the haze my husband got our daughter up and took her to daycare and was back before I had really missed him. She never had a clue what was going on (which is as we wanted it--she's very empathetic and couldn't handle seeing me in that situation).
I was kneeling by the bed when my water broke. I found out later there was meconium in it, though it was light-colored. I pushed in that position; I pushed on a wooden, Amish-made birth stool that my midwife brought; I pushed while my husband held me in a supported squat; I pushed with one leg up on something; there were probably other positions. Like before, I could feel his head coming down a little with each push, but unlike my daughter, he was not sliding back up. My mw checked and said his head was molding. This was a positive note, since my daughter's hadn't.
However, after a while it became apparent that he wasn't descending any further. The most dramatic moment was when my midwife actually tried to help spread my pelvic opening during a contraction--I thought this was going to increase the pain a lot, but it really didn't, since the pain was already so intense. Even this didn't encourage his head to come down any further.
At the 2.5-hour mark, my midwife gently suggested that this might not be working (and she was right). I insisted on trying hands and knees, and we did that for another 1/2 hour, and my midwife reiterated that he wasn't descending and we should, in her opinion, transport. She was very kind and not pushy about this; she has had both a VBAC and a CBAC with a uterine rupture, so she was trying to be very careful with me and not let me go too far in my zeal for an HBAC.
My husband and I made the decision to transport. Our hospital would allow nothing but a C-section, and we knew this.
While we transported, my midwife helped me blow/huff through contractions so that the baby wouldn't be stressed any more than he had to be by the waves of squeezing (which were really beyond my control to a great extent, but the breathing helped). Unfortunately, by the time we got to the hospital and they had me in the initial exam room, there was thick meconium and his heart rate was showing late decelerations. (It was recovering in between, but nobody seemed to care about that.) My "unwitting backup doctor" was p*ssed as heck at both me and my midwife, but to his credit he got me into surgery in about 20 minutes, which is probably an all-time record for our sluggish little hospital. (We had called ahead and requested/talked to a different doctor, but I knew that this one would be there--he's the head of the practice, and he took a liking to me as a patient and felt very paternal toward me during my pregnancy.)
He also wanted me to get general anaesthesia, but I balked at that. The anesthesiologist stood up to the OB and talked to my husband, who explained why I didn't want general, and he agreed to give me "one chance" to get the needle in, after which I would have to have general. I thought to myself that I would hold still for that needle if it was the last thing I did--I would NOT be asleep for my baby's arrival!
In the OR, they got the spinal in quickly (YAY!) and got to work so fast I actually felt the first of the cutting (but did I care?? No--if I complained I was sure they'd knock me out). They wouldn't allow my husband to go back because it was an "emergency" (sheesh). But the anesthesiologist was so nice, kept checking on me, talking to me, telling me what was going on over the sheet. Not exactly a spouse or doula, but at least there was someone there treating me as a human being. They got the baby out--he was crying as soon as his head came out and I was crying, too, for joy--I found out later my husband had sneaked up to the doors and could hear him, too, so we all must have been crying together.
: At this point, I should note, my husband and midwife thought I'd been knocked out--in retrospect I should have said "Can my husband come in now?" once they got the spinal in, but I was overwhelmed by everything that had happened and was happening.
At any rate, they took my son out and whisked him to the corner to vacuum him--he'd swallowed a lot of meconium, and he cried over there while they patched me back up. At some point I hear the OB say, "Look how thin that is," and the assisting surgeon say, "Is that a rupture?" The OB distinctly said "No" at this point, but by the tongue-lashing he gave me later, he clearly wanted me to think that it was a rupture. (I fired off my highly-researched knowledge of dehiscience, but he wasn't impressed.)
The other weird thing about this surgery is that the sew-up was very rough--I could feel myself being jerked around a lot, and my bottom even sliding on the table. The first time was very gentle and easy--was the manhandling necessary? Or was my OB still just angry and being a drama queen? I tend to believe the latter--he has a very emotional temperment, much too much so for his profession, IMO.
At any rate, they finally brought my very grumpy-looking son over to me to touch and coo over, I got a chance to refuse all the usual crap (eye drops, VitK shot, etc.), and they had him in an incubator when I was wheeled to my room after surgery. I didn't see him for at least two hours, but my husband stayed with him to make sure he was treated right. My midwife was still there and came to stay with me during this time. When they brought him to me the nurse helped me get into a semi-side-lying position and he latched right on. Thankfully we have had no trouble with bonding or nursing. He's a sweetie pie!
As to why he wouldn't come out? My midwife told me afterward that while she was trying to spread my pelvis, the baby was aligned correctly, but that she felt all my pelvic joints and there just wasn't much, if any, flexibility or movement in any of them. My bones simply weren't spreading. It's a strange thing--I have never heard anyone else name this as their birthing problem, but it seems to be my big obstacle. I have a splendid uterus, a brilliant cervix, and a stiff pelvis. Go figure.
So what have I learned from this experience?
First, don't let one OB in the practice "adopt" you while pregnant. I thought for a long time it was a coincidence that I saw this one doctor more often than the others, and by the time I had figured out that he had chosen to make me his "pet patient," it was kind of too late to establish a close relationship with one of the others. This made it more difficult to deal with the situation when we transported and he found out that we hadn't gone to Columbus for a VBAC after all...
Second, that we really did try everything
in order to help a vaginal birth happen. I have no doubts about that now--so that has dispelled a lot of the lingering doubts from my first birth. Even though I know I will have a lot to deal with emotionally from the loss of a natural birth, at least I know that it simply wasn't possible, and I can't have any regrets about any of my own choices now.
Third, and most importantly, that everything I thought about my first labor was true, that my instincts were far better than anyone else's. I remember thinking as I bore down on the labor stool that my daughter's head was just hitting the bones--that they wouldn't open for her. I remember telling people this. But of course no one really expected that was the reason she wasn't coming out--myself included. Now I know that my body was telling me everything I needed to know. I am so glad to have had two natural labors (even if the second was quite difficult--I can't think how much more horrible it would have been in a hospital) so that I can one day tell my daughter that her body is her best ally when it comes to childbearing.
If you read all this, thanks, and thanks also to anyone who has offered both congrats and condolences. As for me, I'm enjoying the babymoon right now--the grief will wait.