Expecting their third child, Kara and her
husband Alex planned a vagainal birth after two caesareans (VBA2C). (Click
here to read the story of her second birth.)
After labouring all day, however, Kara and
Alex chose a caesarean when the baby was not moving from an unfavourable
position. Kara felt happy to have planned a VBAC, even if it did not
come to pass. She was glad that her baby had the benefit of labour
before the caesarean, and she again made the choices to ensure she would
have a positive experience for her caesarean birth.
There's something about getting towards the end of pregnancy for me –
impatience for the little one to arrive (even though I know I will go
past my due dates) and hope (tinged with a huge dollop of anxiety) that
all will go well this time.
At my week 40 checkup, my doctor, Paul Tseng, tells us that he had to go
away for a couple of days and that his backup, Dr. T.C. Chang, would
cover for him should I go into labour while he was away. Both my
previous pregnancies went past my due dates, so I was pretty sure I'd
still be pregnant when Paul got back – and I was. My grandmother had
been saying "I think you'll go into labour within the next few days"
since week 36. Guess she was pretty excited to meet great-grandson
number 3.
That's when I got the bummer of news that he was going away yet again! I
was at the point where I didn't want to get to know another doctor who
didn't know me and who might not be as likely to be flexible with my
wishes. So I kept hoping and praying that my baby will be born before
then. Toyed with the idea of a medical induction, but kept putting it
off as it wasn't what I wanted.
One week past my due date, I made the decision to go for an induction at
the hospital the next day. So on my ‘last' day of pregnancy, I just
bummed around with my kids at the zoo and went for a massage after that.
Although I was disappointed, I made my peace with myself and had an
early night. Nikki would meet us at Thomson Medical Centre in the
morning at 9:00 a.m. if she didn't hear from us that night.
Regular contractions started around 2:00 a.m. that night, 5 to 6 minutes
apart. I was elated. Waited another hour or so before giving Nikki a
heads up on her mobile. I didn't need the induction after all. Was too
excited to sleep anymore, so just stayed awake, sometimes lying down,
sometimes pacing the room. I light my cardamom candle and put on my CD
with sounds of rain. Hubby made me a breakfast of waffles with sour
cream and jam. Yum yum. By 6:30 a.m., my contractions were about 4 to 5
minutes apart, lasting 1 minute.
Nikki came by at 7:40 a.m. to be with me so that hubby could settle our
kids at my parents' place and get them sorted out for the day. He didn't
want me to be without someone else in our house in case things suddenly
got out of hand while he was away. After all, this was a hard-fought-for
VBA2C (vaginal birth after two caesareans). Our two boys hugged and
kissed me good-bye. They knew baby was "coming out" today.
I get my greedy hands on Nikki's TENS machine and got some relief. Felt
most comfortable just sitting in a tailor's position and rocking. Nikki
guided me to lower my vocalization pitch - it
was rising. I had forgotten what labour was really like.
Endorphin-induced amnesia from my previous labours? Nikki rang Paul and
told him I wouldn't be needing that induction.
Nikki left us an hour later after hubby returned and we had gone through
our options and concerns for this labour. I was pretty sure baby was not
posterior, so I felt more confident this time. Hubby plied me with eats
and drinks throughout, and reminded me to go to the loo frequently, and
we kept in touch with Nikki by phone.
Many hot packs and hot showers later, the contractions felt stronger.
Nikki came over at 1:20 p.m. It had been nearly 12 hours since regular
contractions first started. Hubby's thumbs were getting tired from all
the counterpressure and lower back massages that he had been giving me.
We talked about whether to continue staying at home or get going to the
hospital. I was concerned about labouring for a long time, and then
finding out that there is little progress when I get to the hospital.
Nikki suggested getting a VE (vaginal exam) done at Paul's clinic and I
could then decide whether to go home or go down to the labour ward.
We arrived at the clinic at 2:00 p.m. I was 3 cm dilated and baby was
still high at –3 station. There was some mild swelling at the cervix and
baby's head was occiput transverse (OT -- where the
baby's head is side-to-side, facing the mother's hip). I was
floored. OT was even worse than occiput posterior (OP) – the presenting
diameter was the largest of all the occiput presentations.
Paul suggested going home until about 8:00 p.m. and returning for
another check after he had finished his evening clinic at Woodlands. He
felt that if there were going to be any progress, it would manifest
itself by that time. If there were no progress, he would recommend a
repeat caesarean as the extra time would not help very much. I could
always come in earlier if necessary.
Tried to get some rest after getting home. Managed to doze off in
between contractions. Hadn't had anything to eat since 1:00 p.m., so had
a yoghurt drink. Felt rather discouraged with the VE findings (though in
hindsight I'm glad that at least I knew where I was and that I had some
time to come to terms with it before my caesarean) and prayed for my
baby's head to rotate just that little bit more. Started walking around
again after a short rest as hubby said my contractions seemed to be
spacing out a little when I was dozing.
At 4:30 p.m., there was still no change in the pattern of my
contractions – still 4 to 5 minutes apart, 1 minute in duration, just
like my previous labours. I didn't want to wait until 8:00 p.m. anymore.
I guess something was telling me this was maybe an exercise in futility.
Hubby rang Nikki, and we agreed to meet at Thomson Medical Centre at
6:00 p.m. to see if there was any progress.
When we got up to the labour ward, a midwife asked me for my room
preference. Remember telling her I didn't care, any room would do, just
didn't want to labour in public any more than I had to. Somebody's
husband was staring at me. We got to room 6 (the room with the labour
pool), turned the lights down and tried to get my rhythm back. The ward
Sister paged for Paul, who arrived shortly.
Paul checked me again at 6:30 p.m. Still 3 cm, baby at –2 station (yay,
some progress!), but my cervix was even more swollen due to baby's OT
presentation. Both hubby and I could see where this was going. Baby was
having a tough time negotiating through my pelvis. Paul wasn't keen to
try Syntocinon [a drug that can make contractions stronger] due to
higher risks of uterine rupture as this was my second VBAC attempt.
Another option, rupturing of membranes, would simply move my baby, who
was already not in a very good position, down in a bad position which
could lead to foetal distress. Not good.
Hubby and I decided on a caesarean birth for our baby once again. We
went through our caesarean birth plan with Paul and the nurses. Nikki
got me some sweets and orange juice to prop up my glucose levels – I was
leaking ketones and that isn't too good for healing later. Some tears
and one last shower later, Nikki took a photo of hubby and me together,
my last pregnancy photo, and I was ready to go to the operating theatre.
The midwife asked me if I wanted to be wheeled into the theatre in a
wheelchair or bed. Surprised, I asked if I could walk. Settled for a
compromise of sorts – wheelchair to the doors, and I walk the rest of
the way, something about clean feet (?). Nikki gave me another hug
before going home. Paul met me at the door while hubby went off to
change into scrubs. I was helped onto the operating table. The
anaesthetist, Philip, got the IV and epidural going, and hubby joined me
after changing. I remember being amused when I noticed that everyone was
wearing flipflops. Shortly after, I started shaking and shivering
uncontrollably. At one crazy moment, I thought I was going to roll off
the table.
Everything went very quickly from then on. The epidural was not complete
again. I declined the gas mask and just kept asking Paul to hurry up and
get my baby out. I wasn't going to miss out on my baby's birth again.
After some tugging (by Paul) and pushing (by Philip), I felt a sudden
sensation of a great weight being lifted off me. It was 7:30 p.m. as
Paul lifted my baby over the screen for me to see, and introduced Ryan
as a sumo wrestler, weighing in at 4.35 kg. Ryan was beautiful. At the
moment, I forgot all my pain and simply gazed at my precious little one.
Ryan's caesarean birth couldn't have gone better. I am happy that I got
to try for a VBAC and labour before my caesarean. All this was possible
because of my extremely supportive hubby who took everything in his
stride, Paul who was open to my wish to try for a VBAC, and Nikki who
helped me to believe in myself again.
What's going on
here?
Kara had planned a vaginal birth after caesarean
(VBAC) for her second birth (click
here to read the story), and although that birth again ended
with a caesarean, she and her husband Alex again planned a VBAC
for their third baby.
An examination at her doctor's clinic during labour showed that Kara's
baby was still trying to move into the most favourable position for
birth – not quite there yet! Kara and Alex
returned home to get some rest, as the privacy, calm, and comfort of
home often means it's the place where women can relax most.
When Kara returned to hospital later in the day, an exam showed some
progress, but labour was not progressing. Kara and Alex went over all
their options in consultation with their doctor and doula working as a
team, and with a full understanding of the implications of each choice,
decided on a caesarean birth. If you'd like to learn more about how a
doula could help you and your partner as Kara and Alex's doula did,
click here for more information.
If you are considering a VBAC, it can help to meet with someone who can
answer your questions about the pros and cons of different options and
sort through the myths and realities of safety when it comes to VBAC and
caesarean birth. You and your partner can meet with a professional
labour supporter (doula) for a birth plan consultation,
and get the information and support you need to help you make the
choices that are right for you and your family. You'll end up with peace
of mind, a place to discuss your concerns, and an effective
written birth plan tailored for you.
Click here for details.
To talk over your particular needs or concerns, you can:
call Tania at +65 9671-8428
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