A VBAC Odyssey

by Jill A. Kuhn
Web Exclusive

pregnant in hammock My birth saga starts at around 34 weeks of pregnancy when the midwife I had been seeing informed me that because of her own liability she had to refer me to an OB and could no longer see me. This was because I had a C-section with my 1st daughter and was now unnecessarily marked as “high risk.” She referred me to a physician who was supposed to be “VBAC friendly” but I quickly found out this was not the case. Thus, my whirlwind education into the hostile world of VBACs began. I called numerous hospitals and OBs and not one of them would allow me to deliver as a VBAC. I quickly learned that only 14.5% of women had VBACs in the whole state of California even though 80%-90% of women can be successful at it if given the opportunity. Liability was only a small part of the reason that OB’s did not want to do VBAC’s. Rather, they often put their own needs and wants above their patient. I entered a world of smoke screens, fabrications and lack of respect for the Hippocratic oath. I was stunned to realize that the right of women to choose the birth that is safest for themselves and their babies was severely limited.

I discovered, after reviewing numerous medical journals, ACOG statements and policy, and midwifery journals that the feared liability of a “uterine rupture” was highly exaggerated. In fact, a baby is more likely to die as the result of an amniocentesis than for a C-section scar to rupture. Ironically, I was encouraged to have an amnio (which I declined), but was completely disallowed from having a VBAC. I was not told that there is a greater likelihood of something going wrong for ANY woman in labor than for a C-section scar to rupture. When a uterine scar does “rupture,” (less than 1% of the time) it is rarely fatal to the mother or the baby. In fact, with most ruptures or “dehiscences” baby and mom are just fine. Conversely, elective C-section has a higher risk of maternal and fetal death, of anesthesia complications, of injury to other organs, of infection, and of respiratory distress in the infant when compared to VBAC. Even in the best of circumstances the recovery from a C-section is arduous and fraught with pain and difficulty caring for a baby and other children. After all, it is major abdominal surgery! Unfortunately, women are rarely fully informed of the risks of C-section. As a result, too many women have initial C-sections and are then forced to consent to elective C-section in subsequent births, because they cannot find someone who will “allow” them to have a vaginal birth.

I saw the obstetrician to whom I had been referred at 35 weeks. She insisted that she would not allow me to labor, before even examining me or reviewing my chart. She wanted me to schedule a C-section for the 38th week of my pregnancy to fit neatly into her 9-5 schedule. She also told me, “I don’t do VBAC’s, because I don’t want to spend all day in court.” As there had been some question whether my baby was breech, my husband, Steve, and I decided not to burn any bridges with this physician…just yet. We politely left her office with another appointment in two weeks. We never returned. I was stunned! At 35 weeks of pregnancy I did not have a healthcare provider to deliver my baby.

By the next day my shock had turned into anger. I decided that I needed to get moving if I was to find someone who would see me prenatally and deliver my baby vaginally. I searched the Internet for hours trying to find a VBAC friendly birth center in California. I wanted a midwife to deliver my baby, since midwives are trained to see birth as normal and healthy in the vast majority of cases. Conversely, many obstetricians see birth as abnormal and thus see every normal turn of labor as a potential problem. Furthermore, obstetricians are surgeons. So, surgery is often the solution to conjured up dilemmas. Twenty-six percent of pregnant women are sectioned in the United States, with some hospitals cutting as many as half of their pregnant patients. Yet, our infant and maternal morbidity rates are no better than countries that have much lower section rates. Physicians are quick to intervene with machinery or surgery for fear that something may go wrong and unwittingly create a self-fulfilling prophecy. I did not want to labor or give birth in this environment.

I e-mailed several midwives and the next day called several more. I also posted messages on the website for Mothering magazine and joined the International Cesarean Awareness Network (ICAN) listserv asking for help. Some of the birth centers I contacted would not accept me because I was a VBAC or because it was too late in my pregnancy. Then an angel replied to my post on the Mothering boards and gave me the name of Marcia McCulley, a nurse practitioner and licensed nurse midwife, in Simi Valley, CA, 130 miles from our home. She indicated that Marcia “loves doing VBACs.” Marcia sounded too good to be true. Early that evening I called her and she answered her cell phone. We chatted for about 20 minutes. She was trying to get her 3 boys into the car so they could meet their dad at a restaurant for dinner. Even when I asked her if I had called at a bad time she seemed eager to talk to me and completely unruffled with herding them out the door. When my husband came home that night I told him, “I found someone to deliver our baby!” I was ecstatic! I had a really good feeling about her. The next day, I called to schedule an introductory appointment. For the next few days before we met, I was afraid that Marcia would disappear, would reject me as a patient, or was just too good to be true. I continued to be afraid that my scar marked me as a patient that no one would touch.

That Saturday Steve, Hannah and I drove 2 ½ hours to Marcia’s office and spent several hours with her. She answered our numerous questions and did an initial exam. I was impressed with her vast knowledge of birth and VBACs, her incredible organization, and her calm and caring demeanor. We toured the birth center, which was absolutely gorgeous and immaculately clean. Both of the birthing rooms had hardwood floors and a queen size bed with numerous overstuffed pillows and gorgeous floral linens. Each room also had a deep tub with water jets and lit candles around the edges and a homey baby table for the initial exam to keep baby from being separated from mom. When we left, I just knew that I would deliver my baby with Marcia!

In spite of the peace I was feeling at having found Marcia, I also combated surprising reactions to my decision to give birth to my daughter in a freestanding birth center. I am not sure what these people thought my midwife did during a birth, but it clearly had nothing to do with the reality that she practiced excellent midwifery. The baby growing inside of me was not a tumor or disease that needed to be managed and eventually cut out of me. She was vigorous and strong, and my pregnancy was healthy and normal.

There was no need to see my pregnancy as an illness. My body would give birth to my child and deliver her without some physician over-medicalizing each step of my labor, without inducing, constantly monitoring, and keeping my labor on a clock. There were people in my life who wished I would just schedule the Cesarean and be done with it. For them there was comfort in knowing I would be “safe” in a hospital under the care of the “all-knowing” OB’s. I think some even secretly hoped my baby was breech, so that I would have to acquiesce to a C-section. One woman, who had no children, told me a C-section would not hurt, and others told me that a vaginal birth was, “no cake walk” as if to convince me to have a “pain free” Cesarean. I was actually called selfish for wanting to make the best and most informed decision for my baby and myself.

The next few weeks were uneventful as far as my pregnancy went. I dutifully trekked to Simi Valley each week to see Marcia. We talked about ways to cope during a natural childbirth, and I tearfully shared how negative some people had been towards my decision to deliver at a birthing center and have a VBAC. I also poured over my 100+ e-mails a day from the ICAN listserv and read numerous research articles from peer reviewed medical journals, ACOG, and midwifery journals. I annotated, underlined and pondered non-stop all the information I was reading. I dreamed about it at night and thought about it all day. Each article convinced me further that I had made the right decision by planning for a VBAC. I also received the most amazing support and encouragement from many women on the ICAN listserv, from a couple close friends, and from my surgeon brother. Within a few short weeks, I felt prepared and empowered to birth my baby on my terms. As it turned out, this crisis was just what I needed to plan the best birth for my baby. If I had found an OB to allow me a “trial of labor,” I now know that I would have eventually been coerced into a C-section for “failure to progress” or “cephalic proportion disorder.” In retrospect, I was fortunate that in spite of all my legwork I had been unable to find an OB.

The evening of Friday, February 27, 2004 I went to bed about 11 pm. At around 1am on Saturday, February 28, my due date, I was awakened by a painful contraction, but continued to lie there to see if I would have anymore. Sure enough, they continued every 2-3 minutes. I got up, went to the living room, and the contractions continued another 45 minutes while I watched late night TV. Finally, I got my husband up and asked him to time contractions for me. They were still occurring every 2-3 minutes and lasting for 45-60 seconds. Because we were having a lot of snow off and on in the town we lived in, in the mountains of southern California, we had agreed to call Marcia to decide when we needed to leave to drive the 130 miles to Simi Valley. So, at 3:30 am we called and she agreed that we should head down the hill. She did not think I was ready to deliver, but that because of the drive we should give ourselves as much room as possible. So, Steve quickly packed up some snacks, got our 4-year old Hannah up and we left the house by 4 am. Our bags, packed weeks earlier, were already in the car.

At about 4:30 am I called my brother-in-law Andy (Steve’s twin brother) and told him I was in labor. Early in my pregnancy he agreed to shadow Hannah as needed during my delivery. He and Hannah are great pals and have always had am amazingly close relationship. He plays anything she wants and generally gives her his all. So we knew he would be the best one to help her during the unknown nature and timing of my delivery. Having my daughter near me was another reason to deliver in a birthing center. She would not be sent to a “waiting room” and could choose her level of involvement at various stages of my labor. Because she is a mommy’s girl, I was very concerned about the impact of a prolonged separation from me.

We got to the birthing center at about 6:30 am. I was relieved to be with someone who could support me and believed in my ability to deliver my baby vaginally, scar or no scar. Marcia checked me and I was only 1cm dilated, but was almost entirely effaced. I was hoping to be dilated further, but was glad to finally be in labor. I was ready to meet my daughter! Marcia suggested we check into a hotel, go eat, shop, walk around for a while and to call her when my contractions were lasting at least 1 minute and had this pattern for over an hour. She let me know to call whenever I needed her. By this time Andy had arrived and Hannah was thrilled to see him.

We were able to get a room at a hotel only 1-½ miles from the birthing center at 7:30 am without having to wait until the 3 pm check-in. I immediately headed towards the tub and took a bath. I felt quite nauseated but tried to eat and drink a little. I started with a single grape and right away threw it up. I eventually got out of the bath and rested on the bed for a while. My contractions slowed a bit, so I walked around the room some more. I knew I was not up for going on an outdoor stroll, but pacing the room seemed to get things going again. At around 11 am Steve, Andy and Hannah went to get lunch and I slept for about 30 minutes. After I woke up to more painful contractions my close friend Cori called and we chatted for a while. She wondered if I would have a leap day baby. I really hoped that would not be the case because I did not want to still be in labor the next day. I would be just fine with a February 28 baby. My mom had also predicted several weeks prior that I was going to have a leap day baby.

Steve, Andy and Hannah returned from their meal. My contractions continued to increase in length and at about 3 pm we called Marcia and told her we would like to come to the birthing center. She agreed that this was a good idea. Hannah decided to go with Andy to the park and they would meet us later. After Steve and I arrived at the birthing center my contractions slowed a bit. Marcia suggested I try the homeopathic remedy Caulophyllum (blue cohosh). After 3 doses of it and 20 minute periods of walking around outside, we decided to try a breast pump to get the contractions going a bit stronger.
This was a funny transition for me because suddenly the decorum of undressing behind a closed door and draping with a sheet was gone. I was topless, sitting on one of the beds in what would be our birthing room, with Marcia, and her assistant Kari, getting the pumps properly attached to me. All modesty was gone for the rest of my labor. I walked naked to get to the tub, moaned and groaned and was generally exposed a great deal of the time. In retrospect there was something amazing about being able to be this raw with other women and feel as if it was the most natural thing in the world. Within about 15 minutes of pumping I had hard, strong contractions again. I labored in numerous positions both in and out of the tub. In between contractions we had wonderful conversations about how we met our husbands, Kari’s upcoming wedding and our children’s births.

Because I was so nauseated and had thrown up several times, I was not well hydrated or nourished. Marcia was able to give me several liter bags intravenously, throughout my labor, of lactated ringers and Dextrose 5% in lactated ringers. Around 11 pm, and about 7cm dilated, I was lying on the bed and my tired little Hannah, who had been up since 4 am that morning, lay down next to me and went to sleep. This was a touching moment for me and reminded me that I was doing the right thing by being in a birthing center. No hospital would have allowed her to even get close to me and here she was sleeping next to me while I moaned through my contractions. Here she was able to be as involved as she wanted to be with no prohibitions. She could also find her uncle Andy in another room and play with him, as needed.

After a couple more hours of some very hard contractions I asked Marcia if there was anything I could do for the pain. I had been in labor now for at least 24 hours and was exhausted and miserable. I had not eaten since 6 pm the night before and was worn-out. We discussed administering Stadol. I was reassured that this would not be harmful to my baby. So, Marcia tucked me into the bed, next to Hannah, surrounded me with pillows and injected the Stadol into my IV. She and Kari massaged my legs while I drifted off to sleep. I do not know how long I slept, but I awoke several times to see Hannah and Steve sleeping next to me in bed. I was having hard enough contractions that they finally broke through the Stadol but also remained part of my “dream like state.” I was not really sure if I was having them or if someone else was experiencing the pain. Shortly after this my contractions fully awakened me and I was in full labor again. I felt enormously better than I had a few hours before. I felt ready to have my baby. Steve got up and supported me for the next couple of hours while I labored in the tub, while squatting, and on a birth ball.

It was now about 5:30 am, the sun was starting to come out and I was not sure if I preferred it totally dark or whether the dawn of the morning might inspire me. Hannah was still fast asleep. Marcia checked me and I was dilated to almost 10cm, only an anterior lip stood in my way. We agreed that my brief respite during the night relaxed me enough to allow for further dilation. We joked that I could start pushing and may well have an 8:04 am delivery time (the same time Hannah was born). Marcia suggested we could all go out to a celebratory breakfast. I felt energized and ready to have this baby. I got in the tub and tried pushing during contractions while in several positions. I could see a clock and 8 am came and went and it seemed I still had a ways to go. I had been in labor now at this point for 30 hours.

Marcia and Kari continued to encourage me to push as hard as I could and at times I pushed as much as I could, but knew that it was only half of my prior effort. I started to doubt whether this baby could really come out. I would seriously zone during most of my contractions trying my best to push. Hannah awakened while I was in the tub and called out for me. I could not answer, but Steve and Kari both called out to her and told her where I was. Hannah came over and held my hand clearly disoriented and needing me. She spent the next several hours sitting close to me, kissing or stroking my arm and generally being as close to me as she could.

I was worried a few times that my sweet, sensitive husband was a little frazzled. Who could blame him? He had also had been awake as much as me over the last two days and supporting me in every way possible. I was concerned that he might start to fall apart, but I also knew there was not much I could do to help him. Later I found out that my pain was what upset him. He told me a couple days later that when he would go into the bathroom he would cry because he just could not stand seeing me in so much pain.

By 1 pm I didn’t want to be checked by Marcia or have my pelvic bone, anterior cervical lip or any other body part stretched out of the way. Marcia was working hard trying to help my baby come out, but I just wanted her to stop. I asked to go to the bathroom so I could avoid any more of this, but of course the contractions kept coming. At this point, I decided to try pushing while on all fours in the bed. My head was buried in Steve, my hands clutching the mattress trying my best to push with each contraction. Hannah would cheer me on, “you can do it mom!” After Kari and Marcia told me to get angry at anyone who had doubted me or ever done anything to upset me Hannah ran around to my head and said, “get angry mom.” I tried to remind myself that I was modeling for Hannah how to remain true to her beliefs and to show her that I would not allow adversity to take away my ability to birth in the way that was best for my family and me. I also repeated the mantra, “stubborn, stubborn, stubborn,” to try and remind myself what got me this far. But nothing stuck for very long. In between contractions I would try and conjure up some imagery or idea to inspire me, but I would inevitably fall asleep and immediately start dreaming. I was just about done. I could not connect to anything helpful or meaningful or feel much of anything other than excruciating pain.

Marcia and Kari worked hard to encourage me and suggest that each contraction and push was moving things along. Several times out of desperation I asked Kari, “Did that push help?” She always smiled, no hesitation and said, “yes.” I do not know how these two women kept up their spirits. They never snapped, frowned or looked annoyed. Sometimes I forced them to stare into my eyes by staring at them hard. I was losing focus and staring one of them in the eyes was the only thing that kept me grounded. They let me do this. They did not break the stare until I did. They were so amazing. If they had faltered that might have been by undoing. As it was, I almost gave up a couple of times. By early afternoon I whispered to Steve, “I don’t know if I can do this.” I asked him, “Will you be disappointed in me if I have a C-section?” He said, “of course not.” But in my state I was afraid that if I gave up he would be forever slightly disappointed in me. I know now that this would not have been the case, but in my exhausted and emotional state I did not know what was true anymore.
Marcia started guiding me harder at this point. She’d say, “one more push” but then would tell me to do yet another after the “one more push.” I knew what she was doing, but what was I going to do? I knew if I went across the street to the hospital and asked for an epidural they would force me into a C-section. I also knew that it would take a few more minutes to get to the hospital and then the OB unit and that I would still be in tremendous pain. So, why not just be in tremendous pain here and get it over with? At this point Marcia assertively yet cheerfully announced that I needed to try another position and that she felt I would be happiest if I gave birth in the tub. So I agreed, but I did not believe it would happen there. I just did not believe this baby was going to come out. It was now almost 3pm. I had been in labor for 37 hours and pushing for almost 9.

I positioned myself in the tub, with Steve behind me, pulled my legs back against the foot rests, grabbed Steve’s hands and fixed my gaze on the ceiling tile above me. I told myself that if I could get the baby out I could rest. I repeated to myself over and over, “sleep, sleep, sleep.” When the next contraction hit I pushed like a crazed woman. I didn’t care if I tore. If this burst was not going to get my baby out, I did not know what would. I heard Kari announce excitedly, from somewhere far away, that my baby was crowning. I quickly sucked in more air and pushed and pushed. Marcia eagerly asked me if I wanted to feel my baby’s head? I shook my head no, while continuing to stare at the ceiling, and just told her to, “get her out.” I was so afraid that if I left my zone, my baby would go back inside and we’d be right back where we started. So, I pushed until it felt like a large brick was ripping through me. It felt as if there were corners and edges on it. I realized later that this was the feeling of bone grating against bone. Suddenly I looked down and my baby was on my chest. I was shocked! There WAS a baby in there all along and here she was. I was done! Just moments before I thought I would never get her out and that we’d be at this all day and now she was here at 3:24 pm. I counted her fingers and toes and checked to see if she was a girl. I examined the cord and after it stopped pulsing Steve cut it. Marcia then wrapped Haley up and new sister Hannah held her while I got out of the tub to deliver the placenta. As I stood up it slid right out. Marcia wrapped me up and helped me get into the super comfy bed, my other reward. At some point I got a shot of Pitocin in my IV because I had bled quite a bit while in the tub. I felt euphoric because my labor was done and I had my baby.

I was able to watch from the bed as Marcia examined Haley and gave her a bit of oxygen to pink her up. Her 1 minute Apgar was 8 and was 9 at 5 minutes. She was doing great. Shortly after this I was able to nurse Haley. Steve called everyone on our birth list to let them know that our daughter had arrived. Andy had gone out and bought a cake, at Hannah’s request, and we all convened around my bed, and sang Happy Birthday to the baby and ate cake. The taste of chocolate cake and chocolate frosting with colorful sugar confetti, after having been in labor for 1 ½ days, and not having eaten for almost two whole days was amazing. I don’t think I’ll ever forget that taste. A little later Marcia weighed Haley in the other room and Hannah reported to me that she was 10 lbs and 22” long. 10 lbs? I could not believe it. Marcia also told me that she was born with her hand next to her head, which most likely added time to my labor and probably had something to do with my good-sized hematoma and needing quite a few stitches. And in spite of a day and a half of labor Haley’s head was barely molded.

After spending a few more hours at the birthing center Steve and Andy packed up the car and we drove to the hotel. Andy headed home to San Diego. While Steve heated some food for us in the lobby, Hannah re-enacted some of my labor by lying in various positions and moaning and groaning. She then fell asleep after eating a little bit and Steve and I fell asleep on either side of her shortly thereafter. We set the alarm for every 3 hours to feed Haley. I was blissed out, high and in-love with my baby.

I felt so close to my amazing husband who supported me during my whole labor. Whenever I needed him, he was there. He was patient, unfailingly believed in me, told me how much he loved me and encouraged me over and over. I was so proud of my preschooler Hannah, who repeatedly told me, “thanks for getting Haley out,” for having survived the last day and a half. I was so grateful that gifted people like Marcia and Kari existed and believe enough in birthing women to give them the chance to choose the birth they want. And I was proud of myself! I have never considered myself athletic and was never particularly impressed with my body’s abilities. However, after my labor I felt like an Amazon woman. It couldn’t have been more perfect to have a leap day baby after my leap of faith in my body, in my baby and in my support system. I had my VBAC. I DID it. It was on my terms. Just as it should be for every woman!

Jill Kuhn Ph.D. teaches psychology and child development college courses, writes a column about feminist parenting and along with her husband practices attachment parenting. She is also a member of ICAN. You can contact her at kuhngale@earthlink.net [1].