By Jennifer Baize Naylor
When my first son was born by cesarean, I was still in the recovery bay outside the operating room when I said to my caregiver ‘Well, I guess all my babies will be born this way now’. I can still clearly remember her looking me straight in the eye and shaking her head, telling me that was not necessarily true. In the first months of my life as a new mother, I thought a great deal about my c-section, I relived my labor and birth many times, both in telling my story and in moments of solitude that were sometimes filled with incredible doubt, grief and regret. However, my son has from the beginning consumed me with his sweet nature and his insatiable appetite for my attention…he grew quickly and we bonded beautifully, and in a blink it was his first birthday.
One week later I would learn that I was pregnant again, immediately leading me to start considering how I wanted my second birth to unfold. I started attending the Cesarean/Vaginal Birth after Cesarean (VBAC) support group at BABS each month, which allowed me to revisit the experience of my own c-section and process some of the emotions I had still been holding tightly. Time seemed to just fly by, my baby now a toddler and my heart being tugged between the exhaustion of pregnancy and the constant demands of a parenting a one year old.
As I entered my third trimester, I started to consider my birth plan in earnest. I found a doula who had delivered her second child in a VBAC. I thought long and hard about what it would mean to me if I had another surgical birth…and I thought about what I could do to avoid one. What I found through going to the support group at BABS, talking to my doula and doing a great deal of introspection was that there were three specific moments during my first labor and delivery, when I had a decision to make and I felt perhaps I made the wrong choice.
The first choice was my provider; my provider during my first pregnancy was not a good fit for me, which is another story entirely. Although I felt she would accept me as a patient and allow me a trial of labor to attempt a VBAC, I felt that she was not who I would need in the 11th hour. So, I asked around about the best doctor for a VBAC and got more or less unanimous advice on a doctor who was a great fit for me. He was open and supportive of my plan to try for a VBAC, and I appreciated that he was not looking for a problem but was instead viewing pregnancy as normal and healthy as a rule, with problems being the exception.
The second choice was regarding when to call the doctor. With my first son, my water broke the evening before my due date. I called my provider a few hours later, although contractions had still not begun. That decision led to me being admitted to the hospital twelve hours later, still without contractions; pitocin was administered and labor was more or less induced. I knew that I needed to be more patient and have more faith in my body’s process in going into labor…of course, I had not expected my water to break so early again since it is rather unlikely. Birth has a funny way of teaching us though, and as I lay in bed two days before my due date nursing my toddler, my water broke around 6:30 a.m. I had been having pre-labor for several days, including irregular contractions. They did not change when my water broke. I cried that morning, more than once, over the decision to simply do nothing. I felt guilty over not calling my doctor, but I had also thought long and hard about what I would do in this situation, and followed that resolve as I bounced, walked and nursed my toddler through the next 12 hours. I spoke with my doula, who listened patiently as I told her about my feelings, about my sense of history repeating and gave me permission to follow my own instincts. Baby was active, and the water was clear; there was no reason to worry. My sister and her two young children came down, as they were to stay with our older son while we were in the hospital. That day was filled with…normalcy. We as adults knew what was happening, but the children distracted us wonderfully as we played outside, took a walk, and generally went about the business of wrangling three young children all day. By the time I put my son down for the night, contractions were getting stronger—what a memory, rocking him and reading him books all the while breathing through contractions!
My husband went to bed early, knowing he needed to get some sleep. I stayed up to shower and talk to my sister, kneeling over my yoga ball and timing contractions. She finally looked at me around 10:30 and told me to go to bed—so I did. Immediately contractions became stronger, as they had all day when I tried to sleep. Not long after I had come to bed, we both got up and I got back onto that ball…I spent a lot of time on my knees leaning over that ball, a position that had never been comfortable during my first labor. The contractions were between 5-8 minutes apart, usually closer to eight, and although I was well able to converse between them, I did have to take time to manage the contractions when they came. This continued for a bit, and around 12:30 I called my doula, telling her I was feeling ready to have another person here to help me decide when to go to the hospital. Having never really gone into labor on my own with my first son, this decision felt very heavy. She arrived quickly, and things continued as they had been for a few hours—only now our amazing doula was there to help with comfort measures. Around 3:30, I decided to call my doctor and tell him we were headed into the hospital. I did not want to travel when I was in the transition phase of labor, knowing that the move was bound to slow my labor down. So, we packed up and headed out.
As I had anticipated, contractions all but stopped once we arrived. I was admitted, and felt grateful for the break while I answered countless questions, got put on the monitors and had the saline block put on my hand. Everything went smoothly and the nurses finally did that first cervical check—and found me to be five centimeters! We felt celebratory at that point, as it had been a relatively easy road until then. My doctor came and was optimistic, supportive and positive. He gave me permission to do more or less whatever I wanted and told me he would be back around 7:30 to check on me before he went into his office to see his morning appointments. This was about 5:30 a.m., and we quickly got moved into the bathroom to use the tub, where contractions soon picked back up to where we had been before leaving home, and I sat chatting with my husband and doula while we basked in the excitement of knowing the baby would be born soon. I soaked until the water became chilly and then climbed out, deciding I should walk around a bit to see if we could speed things up a bit—contractions were still rather spread out, though fairly strong. So we started walking, and shortly after the nurse came to tell us my doctor had returned to check my progress. We were elated to hear him announce I had made it to between 7-8 centimeters! He left with a big smile, and we all relaxed, knowing that surely the baby would be here by lunch.
As anyone who has endured labor knows, getting from eight to ten centimeters is the stage of labor called transition, and it is generally the most painful and difficult phase. Within an hour, it was clear I was in transition. Contractions became stronger and got closer together, and I was focusing 100% of my energy on managing the labor, both during and between contractions. The next hours are a blur…I know we tried various positions, and I know I started to feel extremely overwhelmed by the pace and length of my labor. I remember seeing the clock say 12:30 and starting to talk about an epidural. I remember getting checked around then and the doctor telling me I was 9.5 centimeters with an anterior lip, and that there was still a bulge in the bag of waters cushioning the head from the cervix. And finally, I remember being checked again, and the nurse telling me I was at fully dilated and baby’s head was at a minus one station.
This would be great news, had it not brought me back to the third crucial decision that I had pinpointed from my first labor and delivery…I labored for hours, got to ten centimeters and baby was still high. And I felt no urge to push. With my first son, I never felt an overwhelming urge to push. I felt pressure, but mostly I felt hope that if I pushed he would come out after all those hours of labor. I asked for help with directed pushing because I did not feel I knew how to push effectively; in hindsight, I simply did not feel a strong physical urge to push. During my pregnancy, I swore I would wait until I felt like I could not help myself, until the urge was so overwhelming I could not stop, before pushing. But here I was, after hours of being in transition…fully dilated with no urge to push. I knew I had to do something different, so I asked about the epidural. Or perhaps I just barked that I wanted one. I do not remember, but I do remember my nurse looking me right in the eyes and asking me this question: What is your goal today? Is it a natural birth, is it a vaginal birth, or is it to get the baby out?
I did not miss a beat. I answered her immediately: My goal is to be able to go home and hold my toddler on my lap. My goal is to be able to go home and take care of my children.
She told me she thought the epidural would work, and explained that it was called the ‘epidural slide’. I had known birth stories that took this turn, when the mother is fully dilated but exhausted and baby is not moving down. The pain medication offers an opportunity to relax, get some sleep and gain some energy to push the baby out. I looked at her and told her to get that anesthesiologist in here, because I had to do something different. The fear of history repeating itself was positively overwhelming, so much so that my nurse could see it in my face. She was kind enough to acknowledge that fear, and told me that she felt confident that this baby was not in a posterior position, which was how my first son was positioned when the doctor did the c-section. She was also kind enough to tell me the anesthesiologist would be here soon.
I remember getting the epidural and seeing that the clock said 2:30. The next thing I knew, I opened my eyes and it was 4:15. Clearly, I had been tired! I felt great, my spirits were restored and of course I was numb so the contractions were no longer painful. The nurse came around and talked to us about a time table; my doctor would be back at 5:00 and she suspected he would order me a small dose of pitocin for about an hour to get contractions more regular, as they had slowed down a bit after the epidural. Having been on a heavy dose of pitocin for many hours last time, this idea did not bother me in the slightest…I was really just relaxed and happy to be on the other side of that dark space I had entered.
Then the moment of truth…the nurse checked my progress. Her face lit up as she announced that baby’s head was firmly at a plus one. My first son had never made it past a zero station, even after three hours of pushing. A small part of me knew that I had made it that one tiny bit past my stopping point last time, which is what many people will say is needed to have a VBAC. Just get past that stopping point from your labor that ended in cesarean—and I had done it! They started me on the lowest possible dose of pitocin after the doctor came to check on me, and we continued to rest for the next hour, only now we were talking and I was starting to feel the pressure of the contractions. The epidural was wearing off so that I could feel my feet, and by the time an hour had passed I had an urge to push—a feeling I had honestly never had before, even without an epidural!
After an hour and a half of pushing, my second son was born. It was not until I felt the ‘ring of fire’ that I remember learning about in my childbirth education class during my first pregnancy that I really believed I was going to have a VBAC. Everyone else in the room believed it far earlier—even the doctor announced about an hour before my son was born that we were not having a c-section. It was surreal getting to hold him straight away, and honestly everyone else in the room was just glowing with these huge smiles and I just wanted to eat and go to sleep! It turns out I had some medical issues that led me to feel so overwhelmingly tired, so who knows how I would have felt otherwise. I have a feeling I would have still been pretty worn out; it had been one long day.
Having a VBAC may have been just as humbling for me as having a cesarean. I had always envisioned a vaginal birth as being so much more…beautiful, graceful. Easy. And it was a beautiful moment to have my son placed onto my chest immediately after birth; it was incredible to see my husband, doula, nurses and doctor all so unbelievably excited and proud to see me succeed at pushing that baby out. But it was not easy. Not even close! For me, my moments of victory came later. Getting out of bed the next morning and taking a shower alone. Caring for my new baby in a room alone without feeling anxious that I would need to get up and be unable to do so. Being released from the hospital exactly 48 hours after delivery and reaching into the car to put my son in his car seat myself. Getting home and carrying that car seat up my front steps…and the next morning my older son walking into the room and inviting him to come hug me and sit on my lap, without fear of the searing pain that he could have inflicted on an abdominal incision. These moments continue to this day, six weeks after my new son was born. These are the moments that motivated me to avoid surgery, even if it meant straying from my initial plans for the birth.
Birth matters. How we give birth matters because it can give us a sense of strength and power, or it can strip us of our sense of ability and control. After my first son was born, when I would remember his birth it would always raise doubts, questions or grief in my heart. I look back at the birth of my second son and I feel nothing but peace with the process. While it was not easy, and it was at times not pretty, I would wish that gift of peace on any mother giving birth, be it their first or their fifth, be it a vaginal birth or a cesarean.