Tuesday, October 21, 2014

Home Vaginal Breech Birth After Cesarean of a Rainbow Baby

I want to say that while I had a vaginal breech birth, I don't think that it is the right decision for everyone. However, I do want to clarify that after hours and hours and days of research and courses, that breech birth is not nearly as dangerous as the medical profession makes it seem so long as there is a skilled care provider present.

This might get a little long, but to truly understand the birth, the pregnancy roller coaster also needs to be understood, so I am going to start with some background information.

I have a half-uterus. In medical terms, it is called a unicornuate uterus. As an embryo only half of the uterus formed, creating a banana-shaped structure instead of a pear shaped structure. My first child was breech and born via cesarean birth at 37weeks 1day 2 hours after my water broke. My son was born via VBAC at 38weeks 1day in a hospital. 

It was not easy for us to maintain a pregnancy the third time around. After four miscarriages, we were starting to question whether it was worth the hurt to keep trying. Immediately following our fourth miscarriage, I found out I was pregnant again. I was terrified. The first half of the pregnancy went great and I was relieved to know that we had a strong baby growing inside me. My kids ironically nicknamed the baby “Rainbow”.

At 27 weeks our baby was head down and doing fabulous. I assumed at this point, he/she would stay head down since there wasn’t much room to turn. I was seeing a chiropractor regularly and everything was going well. That is, until I got a stomach bug. The couple days of vomiting flipped my baby breech. When my midwife checked baby’s position at 28 weeks, I knew exactly what she was going to say before the words came out of her mouth.

I left my appointment with her in tears and with a million thoughts running through my mind. Feelings of anger, fear, and returning memories of my cesarean birth came flooding back. I felt completely out of control. I immediately contacted my good friend and doula trying to hold back tears. She reminded me that this birth was not the same as my daughter’s birth and that all those feelings were coming back. She reminded me I had time, that anything was possible and that I would not have a surgical birth again. I got off the phone with her feeling a little better, but still really upset. My intuition kicked in, and I knew in my gut that this baby was not going to turn. He/she would remain breech the rest of my pregnancy.

I spent the next 9 weeks doing everything I could to try and encourage my baby to turn. I saw a chiropractor weekly, tried acupuncture, moxibustion, hot/cold, music, swimming, headstands, meditation, prayer, and even external cephalic version. Nothing worked, and my intuition kept reminding me, I could keep trying but baby was happy breech and I needed to let him or her be.  

By 35 weeks I had gone to see a chiropractor for the 4th time who had an excellent track record of getting breech babies to turn. He looked at me, felt baby’s position and told me that he wouldn’t treat me because he was convinced baby would not turn and with my uterus, was afraid his method would be harmful to me and the baby. He told me that he had a 100% track record of getting babies to turn, but that mine was the first to defeat him and that his ego was shot. I walked out of his office in tears and frustration.  By now, I had an external cephalic version scheduled for the following week.
Before the version I was having a very real realization that I was miserable in my pregnancy. I hadn’t enjoyed the last 8 weeks, and felt completely disconnected from my growing baby. It wasn’t his or her fault that he/she was breech, it was my body, and yet I felt so consumed with getting the baby to turn that I forgot to try and connect with my child.  I had absolutely nothing done to prepare for the baby and I didn’t want to do any of it. My two children at home needed my attention, so I didn’t have the energy to try and connect with my baby. 

Onto the version experience…it was horrible. I was treated like a crazy person for wanting to VBAC at home and the Maternal Fetal Medicine specialist did not want to attempt the version if I was planning a homebirth due to liability. She didn’t even realize homebirth VBACs were legal in our state. We eventually got her to agree to try. I should have realized she wouldn’t actually give it a shot, but we tried it anyway. I felt like I was getting a belly massage. There was no pain involved in the procedure whatsoever. My baby didn’t like the doc and pushed its head right up under my ribs. The baby never went under my ribs, but today seemed like a good day to hide, so it did. After a failed attempt with suggestions ignored, I went back to the room where we waited for baby to adjust positions for another attempt. We waited 3 hours for the doc to get back to us. Instead, when my midwife and doula left to run an errand, a nurse came back and got us to check baby’s position, if it’s head was in the same position, they wouldn’t try again. I held my hand as a shield to prevent the head from crawling under my ribs and the ultrasound tech moved it with her wand. It all seemed very calculated. Of course, the baby’s head was in the same spot, so another round was not attempted. Note: belly massage like versions aren’t as effective as other versions.

I walked out of the hospital in tears again. As a doula, I see the hospital systems play my clients on a regular basis and my job is to help deflect and make them feel empowered. I left feeling very played myself. By the time my husband and I were 10 minutes away I was in full-blown ugly-cry mode. I had felt like every birth I had was a battle and this one seemed to top both of them. Again, I called my doula telling her I wanted to give up and I didn’t even know what that meant. She reminded me again that from the beginning I had said that I trusted my body and baby to birth exactly as I was meant to. I knew I didn’t want a surgical birth, yet, I felt so defeated and worried that my midwife might decide she wasn’t comfortable attending my birth and that I would be stuck trying to figure out what was next. 

It took me two days before I started to get a resurgence of faith in myself and I started feeling strong and confident again. It was then I realized I needed to start preparing for this baby and hopefully that would help me feel connected.  On Thursday, another doula called me to talk about a client we had both worked with and without knowing my exact situation, she shared with me that she has a similar uterine anomaly (a bicornuate uterus) and that all of her babies were breech. Two of them were born vaginally in a hospital because they came before she could be prepped for a c-section. She told me “they just slide out”. I held that sentence in my mind and was so thankful I had the opportunity to speak with another woman, that I knew, who had experienced a breech birth. Little did I know, it was perfect timing because my baby would be arriving just a couple days after we spoke.

On Friday, I wrote my hospital transfer cesarean birth plan. It almost killed me to write it, but I knew it needed to happen. Facing the idea of another cesarean birth scared me, but I knew if I didn’t write it and I did have a cesarean, I wouldn’t have the peaceful birth I wanted. At work, I spent a lot of time preparing things “just in case” I wasn’t there on Monday. It was time for me to start realizing that with a history of early term births, I needed to be ready and didn’t want to leave my co-workers stranded without the materials and information they needed.

At 37 weeks, I had a midwife appointment in the morning. The baby wasn’t engaged and the butt was just sitting on my public bone. My midwife guessed that my baby was about 6lbs. She and I spent time talking about my options and telling me that so long as baby was frank breech when I went into labor, we could proceed with a homebirth assuming the labor progressed smoothly. I felt so much better after talking with her, knowing my baby would cooperate and that so long as my labor cooperated, things would be good. She had a family birthday party 2.5 hours away that I told her to attend. I didn’t even bother asking her if she was staying overnight because in my head, the baby wasn’t coming anytime soon. I had a gut feeling when my son was going to arrive, and I had no feelings of a pending birth. She left and I felt an overwhelming peace and confidence in my body and my baby.

Regardless, I was 37 weeks and it was time to get everything together. My husband and I gathered all the homebirth supplies and I blew up the birth pool. I organized the supplies and went grocery shopping. The next day, I was going to make freezer meals. I was trying to force myself to nest. We took the kids to the park for lunch and then went home to finish cleaning the house and washing laundry. The kids played outside. It was a gorgeous 80 degree day. The next day was supposed to be cold, so we were soaking up the sun while we could!

My husband and I went for a pajama walk with our two kids at bedtime. In separate strollers, they wanted to race and I tried, but the pressure on my pelvis only allowed me to run about 10 feet before I would stop. My husband turned to me out of nowhere and told me that a weird feeling came over him that if the baby wanted to come that night, he was ready. I laughed and told him I had at least another week and that I didn’t feel like the baby was anywhere near coming. I wasn’t ready.
We put the kids to bed and just spent time together. We both finally called it a day and went to sleep. Around 1am, I thought I dreamt that I sneezed and peed my pants a little. I was half awake and realized I may have actually peed a little. When I woke up, I realized I was soaked! I thought maybe I peed myself, but that didn’t quite make sense since I hadn’t had any incontinence issues during the pregnancy. Upon hopping out of my bed, I realized that the water continued to pour out. My water had broken, and I had not peed myself after all. I woke my husband and told him my water broke. In true third-time-around fashion, he threw his hand over to my side of the bed and laughed a little as he said “yep, your water broke”. He grabbed a few towels, laid one on the bed and handed me the other to soak up the puddle on the floor. My being a doula, I immediately noted that the liquid was clear with no smell. 

I told him I wasn’t having contractions and that I wanted to go back to sleep since it could be awhile before they started. My body was shaking as it had when my waters released to start my labor with my daughter. I knew I wasn’t cold, it was just hormones. I asked my husband to make up the bed with the extra sheet, the vinyl cover, and all of the extra stuff to prepare for the birth. I went into my dark living room after changing into my birth skirt and a dry pair of underwear (with a giant pad of course!) I sat on my yoga ball in the quiet realizing I needed to come to terms with the fact that my baby was coming soon whether I was ready or not. I needed to find peace with it in order for my labor to proceed properly. I said a few prayers asking God for a smooth delivery and for strength and peace of mind for everyone involved. I prayed for confidence for everyone involved and to help me let go. My mantra had been to trust and let go. 

I called my doula and best friend who was planning on coming to manage our kids if they woke up, and let them know my water had broken but that I wasn’t having contractions, so I planned on going back to bed. I let both of them know that I would let them know when I needed them. I then toyed in my head whether I should call my midwife yet or not. I didn’t want her to come if nothing was happening. My husband repeatedly asked if I had called her yet. Every time I said no, he told me I needed to. I wasn’t ready. Once I called her, it felt like everything was so final. I did call her and let her know what was going on and repeated the same things I had told my doula. Clear fluid, no contractions, I was going back to sleep. It was then that I realized that she was greater than 2 hours away when she said she was going to head back. She asked me to check myself and make sure there wasn’t a foot or cord in my vagina. I got off the phone with her letting her know I would tell her when contractions started and I would tell her if there was anything in my vagina. I went to the bathroom, washed my hands and checked myself. Nothing was in my vagina. I could feel that my cervix was the same it had felt two weeks before. It was mushy-soft, about 2cm dilated and I felt something round and smooth, which I assumed was a butt. I reminded myself to trust and to let go.
I spent more time walking around my house quietly trying to rest my mind and continue to find peace with the fact that my baby was coming soon. I placed some Calming essential oil on my wrists and I cleared my head of worries and what-if’s and instead decided to focus on the coming task. My husband brought the birth pool up from our basement and started to set it up. Being that baby was breech, my midwife was not comfortable with the baby being born in the water. It was fine to labor in the water, but when it came to pushing, we decided with possible complications, a land birth was best. As soon as I saw the tub I was overwhelmed with how much space it took up in my bedroom and I asked my husband to remove it. He thought about questioning me, but instead was smart and decided not to argue with a laboring woman. At this point, my contractions started. There were no warm-ups. The first contraction stopped me in my tracks and I had to sway and breathe to get through it. Two minutes later another more intense contraction. I called my doula and midwife back and told them contractions had started and they hurt so I needed both of them on their way. My doula started on her way and my midwife was already on her way. 

The problem with being a doula is that there are two parts of my brain that were in conflict during my labor. My doula brain was telling me that this was going to be quick. The rapidly intensifying contractions were a main signal that it wouldn’t take much time. The mom side of my brain was telling me that this might take a while, so I needed to roll with the waves and take each one, one at a time. Every contraction that came was more intense than the last making it very difficult to get on top of them. My daughter woke up in between contractions asking for water. I handed her the bottle of water my husband had just prepared for me and she went back to her bed. It was then I asked my husband to call my best friend because I knew with the intensity of my contractions, I couldn’t have my kids waking up. I needed the mother in me to rest so I could focus on the task at hand. I started running a bath and grabbed an LED candle to bring in the dark bathroom. My iPhone was on the dock with my birth playlist running. I timed a few of the contractions and verified they were approximately 2 minutes apart and lasting about 1 minute and 15 seconds. After timing about 5 of them, I stopped timing them and focused on laboring instead.

Once I settled into the bathtub I was immediately in a different place. Leaning over the side of the bathtub, I opened my eyes to see my best friend walking in. It was so nice to have some companionship between contractions. My husband was getting everything set up around the house and doing everything I asked him. At one point I realized we needed a placenta bowl in the bedroom since we didn’t have one out yet. At the same time I realized I was queasy. A bowl was placed in the bedroom and a garbage can lined with a plastic bag appeared in the bathroom next to me. In between contractions I was having quiet conversations about nothing with my best friend. During contractions, I buried my face in my hands and went to labor land, quietly breathing through the contractions and reminding myself to trust and let go. Soft and open would repeat in my head and as the contractions peaked, I would do everything to relax my whole body and let my uterus do the work. 

Shortly after 3am my doula walked in. I heard her ask my husband how I was doing and how long the contractions were lasting. I heard him say “about 20 seconds”. I looked up at my best friend and told her my husband clearly has no concept of time. My doula walked in and I repeated the same statement. As soon as I finished my sentence another contraction was building. My best friend handed me a cool washcloth and I quickly buried my face in it. My doula was instantly echoing the inner voice that was reminding me to relax and let the baby come down. She reminded me that I was doing great. I tried to check myself again, but couldn’t feel much with the way I was positioned in the tub. 

I started to get really uncomfortable in the tub and decided that I wanted to get out and that I needed to go to the bathroom. When I told my husband I needed to go to the bathroom, I asked him to leave. I immediately got the wide eyes that everyone makes when you are in labor and tell them you need to have a bowel movement. I reassured him that I really just needed to go to the bathroom and that it wasn’t the baby. I was still too “with it” to just push out a baby. Funny how I kicked my husband out, but my best friend stayed in the dark corner of the bathroom while I emptied my bladder and my bowels. It was at this point that I washed my hands and checked myself again. 2cm...still. I did my best not to let my brain mess with me after knowing my cervix was a 2 and I felt like I was in transition. I erased the number from my brain and focused on my baby.

 After I flushed the toilet, the bathroom door opened again and my husband and doula were back in the bathroom. My best friend then offered to go get me “good ice” from the gas station around the corner. I thought I still had time so I said yes and then continued to labor on the toilet. Things were getting too hard in the position I was in, so I stood up. My doula was smoothing my sacrum and later told me that after lightly rubbing my back a few times, she felt it go from buckled to smooth almost instantly. The baby had shifted positions. For whatever reason, I insisted on getting my skirt back on. It took 5 minutes because I kept having contractions when I would try to get it on. My doula helped me slide it up and I asked my husband to bring my birth ball into the bathroom because I didn’t want to leave my warm, dark space. I got on my hands and knees and leaned over the ball. 

The next contraction was strong enough that I had to hum through it and I started to feel like I was about to crawl out of my skin. I could feel the pressure building and felt my pelvic bones spreading. “Where is (insert midwife's name)” came out of my mouth. My doula responded with “do you feel like you are going to need her soon” with a little nervousness in her voice to which I responded “yes”. She asked if I was feeling pushy. I explained that I felt a lot of pressure like my pelvis was going to break. I heard the door open and thought the midwife was there, but it turned out to be my best friend returning with the ice. 

A building contraction with intense pressure took over and my body started pushing. My doula was behind me and asked to flip up my skirt. She called my husband to come back by her and my baby slid out of my body. I was doing everything in my power to relax, but I could feel the baby kicking and turning as it slid down. It was the most uncomfortable intense feeling in the midst of my body moving the baby down. I heard myself saying out loud that I could feel the baby kicking as my body was pushing. “where do you feel the kicking” was asked and I whimpered that it was my stomach. It felt almost explosive as the baby was released from my body. I had no idea how far the baby was out, but I knew that the baby was part inside me and part earthside. My inner voice was telling me to relax and release my baby. There was no tensing up or I could trap my baby inside of me. That intensity needed to happen and I could not fight it no matter what my body was saying.  I heard my midwife on speaker phone as my doula explained that baby was out to his shoulders with one arm and the head still in my body. She asked if they needed to do anything with the arm. My midwife explained that nothing needed to be done and that it would likely come out with the next contraction. She started to explain how to release the arm if it didn’t come out with the next contraction. As she was finishing her explanation another contraction was building and I could feel my body moving my baby out. I needed to pull my pelvis in toward me. My doula was telling the midwife that the baby was out to the nose. It was then that I finally chose to push with my contraction and get the rest of the baby’s head out. My husband had been supporting the baby’s body and caught him as he eased out of my body and joined us earthside.

My husband was behind me, in awe that he just caught our baby. My doula told him to pass the baby between my legs. I sat back and pulled my baby up to my chest. I was in shock that my baby was out of me and that the intensity of labor was over. My husband then told me we had a boy. He had cried a little and then immediately started sucking on his fingers.  The voice on the phone was gone. Another doula walked in shortly after and somewhere around 10 minutes later, my midwife walked in. She came in congratulating us and had the perfect calming presence. She assessed the baby and we moved into the comfort of my bed instead of sitting in the corner of the bathroom. I had trouble delivering the placenta in a semi-sitting position in the bathroom, so in my bedroom, I squatted on the side of my bed to deliver the placenta into a bowl and it slipped right out. I snuggled my baby on my bed still attached to the placenta in the bowl next to me. At some point, my husband cut the cord and we snuggled in with our new baby. From water breaking to birthing my baby was under 3 hours, with under 2 hours of contractions. It was extremely physically and emotionally intense, but completely worth it. I am still in shock that I did it. I got my homebirth, VBAC, and vaginal (breech) birth all at once!

Wednesday, December 18, 2013

Planning Rainbow Baby's Homebirth

It has been a long time since I have posted! Between my full time day job, my doula work, raising my children and pursuing my calling to become a midwife, things tend to be a little busy around here. In the midst of it all and after our fourth heartbreaking miscarriage in 12 months, I am thrilled that we are adding baby #3 to our family. Since I want to be a homebirth midwife and since I want a very hands-off birth, it seems very natural that we are planning a homebirth.

If you have followed this blog in the past, you know that my first birth was a c-section from having a breech baby and my second birth was my first VBAC in a hospital. Since wanting a homebirth with our first and having the farthest thing from it, I feel like have slowly made the journey back to square one. Back to the most basic way to birth our baby.

Our midwife is absolutely amazing. She is a dear friend of mine and has been with me through a lot. I have seen her in action and she is exactly the type of care provider I want supporting me through the birth of a child. 

I am so excited to share my journey as I go through it.  I am about halfway through the pregnancy at this point and so far I haven't had to do to much for the homebirth. I have met with my midwife for prenatal appointments and also agreed to the mandatory ultrasound scan to determine location of the placenta. As a VBAC mom, the care providers in the state I live in like to know that VBAC moms don't have the placenta embedding into the cesarean scar or over the cervix. My intuition told me that the placenta was in exactly the right place. That, and the fact that I felt little baby wiggles around 12 weeks and most of the movement I feel is in the front.  Our 2-minute ultrasound revealed a placenta up in the back of my uterus. Excellent! We can now move forward with confidence that there shouldn't be complications with the placental location!

Today I started my homebirth supplies list. I will post again with my list and where I am purchasing from when I finalize it!

Affirmation for the day "I trust that my body is nourishing my baby and that he/she is growing exactly as he/she needs to"

Friday, November 16, 2012

Exploring Drugs Used During Labor: Pitocin

As many of my readers know, I think that babies should choose their due dates and that inductions should only be performed out of medical necessity. There is a part of the Business of Being Born documentary where someone makes the point that pregnant women avoid so many things during pregnancy, doctors tell them to avoid just about everything, but when it comes to labor, all of that stuff goes out the window. All of a sudden, doctors are giving you three different medications that all lead to a cascade of interventions. 

I am a huge believer that educating moms is the best way to prepare them for labor and birth. Mom's should know what is going into their bodies and should know the risks and side effects.  Today, we are examining Pitocin. Pitocin is a drug that many providers use for labor induction, as it is a synthetic form of Oxytocin (a hormone a woman's body creates that causes the uterus to contract). Some providers simply use it to augment or speed-up labor. Notice how most doctors never talk about the risks of pitocin to the baby or the mom?

The below image was taken from safefetus.com and describes the Risk Category, Indication (suggested use) and Fetal Risks of Pitocin. In the labors where mother's were given pitocin, I will venture a guess that most of them never get this information.

Medical Interpretations:

Fetal Bradycardia - Slow heart rate, usually under 100 beats per minute (bpm)
Neonatal retinal hemorrhage - Abnormal bleeding of the blood vessels in the retina, the membrane in the back of the eye
Neonatal Jaundice -yellowing of the pigment in the skin and eyes due to high billirubin levels
Tetanic contractions - long, strong contractions where there is no resting period for the muscle
Abruptio Placenta - the placenta separates from the wall of the uterus, which can cause severe bleeding
Cardia Arrythmia - abnormal heart rate
Intracranial Hemorrhage - bleeding in the cranium
Asphyxia - lack of oxygen, suffocation

Courtesy of safefetus.com
Amazing how when you look at it from this angle, it doesn't seem like such a good idea. According to Ina May's Guide to Childbirth, using induction drugs like Oxytocin during labor causes approximately 1-2% of women to suffer uterine rupture, a potentially fatal condition for mom and baby. The risk for Vaginal Birth After Ceserean (VBAC) moms (not using pitocin) is only .6-.7%.  Funny that doctors won't do VBACs because of the risk of uterine rupture, but they do routine elective inductions with Pitocin like it is risk-free.

Of course, sometimes you have to pick the lesser of two evils, and induction becomes medically necessary. Regardless, it is good to be educated on what you are putting into your body (and your baby).