by KMom
Copyright © 2000-2006 KMom@Vireday.Com. All rights reserved.
This FAQ last updated: February 2006
DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.
BBW Birth Story Pages
BBW Birth Stories: Baby Malposition Stories
CONTENTS
This particular FAQ is on baby malpositions in order to show the effect this has on labor and birth. Although there are many causes for cesareans, it is quite likely that many cesareans today are actually due to undiagnosed or unresolved baby malpositions. However, few OBs pay any real heed to the possibility of malposition influencing birth progress or causing cesareans for "Failure to Progress" or "Cephalo-Pelvic Disproportion" (CPD). Yet it has been Kmom's observation (and her own experience) that many women of all sizes are having more complicated, difficult labors (and often surgical births) because of this problem.
The purpose of this FAQ is to document these births so that women can begin to see the patterns involved and to learn more about malpositions in general. If you are interested in reading more about this, check out the Baby Malpositions FAQ on this website, click on the links within it, and/or read the books, Optimal Foetal Positioning or The Labor Progress Handbook (reference/purchasing information on the Malpositions FAQ).
Unless specifically requested, all identifying information has been removed or changed to protect the privacy of the participants. All stories are copyrighted; none may be used elsewhere without specific written permission from both Kmom and the mother involved.
More stories will be added over time, so keep checking back if you are interested in reading further stories. If you are interested in sharing your birth story, click here for more information, birth story format, and submission guidelines. New birth stories are always welcome; Kmom updates the birth stories FAQs about once or twice a year so be patient for your story to show up. If you do submit your story, please carefully follow the format and directions given in order to shorten the amount of work involved for Kmom. Kmom's family will thank you!
Information About Baby Position and Implications for Birth
There are two terms that are used to refer to how the baby is located in the mother's body, presentation and position. Although some resources use these terms inconsistently, presentation properly refers to which part of the baby 'presents' first at the vagina; in other words, whether the baby is butt-first (breech), head-first (vertex), or shoulder-first/sideways (transverse). Position usually refers to how the back of the baby's head is lying in reference to the mother's spine (towards her spine or away from it, etc.).
For more information on breech presentations, check out the Midwife Archives at www.gentlebirth.org, and also read the book, The Thinking Woman's Guide to a Better Birth by Henci Goer. This websection is NOT mainly about breech presentations, but mostly about subtle problems in baby position because this problem is largely ignored in the obstetric community. In other words, the baby is head-down and so assumed to be ready for vaginal delivery, but because of subtle variations of this normal head-down position, a longer and more difficult delivery occurs, often even necessitating a c-section, yet the obstetric community does not recognize the role positioning played.
It is Kmom's personal opinion (and experience) that many c-sections are performed unnecessarily because of subtle baby malposition problems, and few doctors or even midwives pay close enough attention to the influence of baby's position on the progress of labor. In Kmom's opinion, many c-sections (or long, hard labors) could be avoided with more careful attention to preventing baby malposition, a quicker diagnosis of malposition during labor, and by employing corrective measures during labor if malposition is a possibility.
There are excellent online resources about baby malposition. To see illustrations of various positions, visit www.cefcares.org/fetal/position.htm, read the article by Valerie El Halta on turning posterior babies at www.cefcares.org/doula/FetalPres.htm. Another great resource is the booklet, "Optimal Foetal Positioning" by Sutton and Scott, available from Cutting Edge Press at www.childbirth.org/CEP.html or by calling (802) 635-2142. A more technical but extremely valuable resource on how baby position can cause labor problems is The Labor Progress Handbook by Penny Simkin and Ruth Ancheta, available from www.amazon.com. Kmom highly recommends checking out these resources, especially if you may have had a malpositioned baby in the past.
The basic presentations are breech (head-up), vertex (head-down), or transverse (sideways). In most current obstetric practices, only vertex presentations are considered for vaginal delivery, although some providers trained in the old ways will consider vaginal delivery for some breeches or will try everything possible to turn a baby to vertex before resorting to a c-section. However, most OBs these days simply schedule a c/s if the baby is thought to be breech or transverse.
The following is a description of the most common presentations.
Vertex: Baby is head-down. Most OBs will not deliver the baby vaginally unless the baby is head-down. However, once the baby is head-down, they generally don't distinguish between the subtle variation in positions.
Transverse: Baby presenting with its shoulder or side first; high chance of cord prolapse. Baby either must be delivered by c/s, turn (or be turned) for birth. If baby does not turn and a c/s is needed, the incision may need to be low vertical or perhaps 'classical' (up-down) because of the baby's difficult position. Transverse can sometimes be prevented/fixed through maternal position or external 'version', but few doctors try.
Breech: Baby's head is up by mother's ribs; the baby's bottom or legs present first instead of its head. More risk to baby, either by c/s or vaginally. Most OBs today have not been trained in the art of vaginal breech birth and so routinely deliver by c/s (despite lack of evidence that it improves outcomes); a few midwives and OBs still know how to do breech births and will attempt it.
Please note that position terminology refers to how the BACK of baby's head (occiput) relates to the mother's body; occiput anterior (OA) means the back of baby's head is toward the mother's front and occiput posterior (OP) means the back of baby's head is towards the mother's spine. However, most people find it easier to think in terms of where the baby's eyes are facing, and this is the referencing used here.
Common Complications Seen With Baby Malpositions
There are a host of problems often associated with subtle baby malpositions, most of which get attributed to other causes by most OBs. If you've been told your pelvis is "too small", your babies "too big", or that your cervix "just doesn't dilate well", you may well have had a problem with baby malposition instead.
When a baby is LOA (anterior and perfectly positioned), the pressure placed on the cervix is even and smooth, labor advances smoothly and usually fairly quickly, and the baby is usually able to proceed through the soft pelvic bones without problems or delays. The mother's pelvis stretches and expands at the ligaments to let the baby through, and the baby's soft head bones fold like a vegetable steamer at the fontanelles (called molding) to also facilitate easy passage. The labor curve generally follows the accepted 'averages', and the birth usually proceeds without any real difficulties.
When a baby is malpositioned, the pressure on the cervix is placed inconsistently, and it often dilates slowly, erratically, or stalls out altogether, even though the mother experiences sufficiently strong contractions and significant pain. The diameter of the baby's head that presents is usually bigger, which means that more molding of the baby's head must take place. If the baby is at the wrong angle, he may be forced against the pelvis uncomfortably (especially if pitocin is added to augment contractions), which may cause fetal distress.
Often the baby gets 'hung up' or stuck before getting past "0" station (entry to the pelvis proper). This also often causes the labor to be slow and inefficient ('uterine inertia' or 'uterine dystocia'), stop altogether ('failure to progress'/FTP), or keeps the baby from moving through the pelvis despite good contractions or even full dilation and pushing ('cephalo-pelvic disproportion'/CPD, or 'baby too big for mother's pelvis').
For example, although there is more than one possible cause for the following
problems, the occurrence of one or a cluster should raise a high suspicion for
baby malposition:
Not all malposition situations follow the same scenario. A lot depends on how the baby begins labor and what happens thereafter. For example, some babies start labor malpositioned but rotate during labor. These babies usually have hard labors but things ease once the baby resolves its position. Most of these babies end up being born vaginally and all is well.
Some babies start labor well-positioned but rotate or shift to a less-optimal position during labor. This may be because of the mother's position (often on her back) or the lax musculature caused by an epidural. These babies often are born vaginally but not easily (and some end up being born by c/s as well). However, most of these babies tend to do pretty well.
The most difficult cases involve babies that start labor malpositioned and stay that way all through labor (i.e., a 'persistent posterior'). Studies show that between 60-90% of these babies are born via 'operative delivery' (i.e. forceps, vacuum, or cesarean). These tend to be very difficult, hard labors, and often the doctor breaks the waters or utilizes pitocin along the way; fetal distress, meconium, or even bruising is not unusual in these cases. Many persistent malpositions result in cesareans.
Over
the years, physicians’ attitudes about malpositions have changed.
In the early part of the 20th century, many doctors were very
concerned at the problems associated with posterior and other malpositions.
Because a cesarean was
such a dangerous operation at that time, doctors developed a number of highly
interventive forceps maneuvers to help turn the baby. Although this was sometimes harmful to the baby, it was seen
as less risky than cesarean surgery or prolonged labor in a ‘stuck’
position.
Over time, however, physicians began to become more and more troubled by the amount of risk posed by some of these forceps maneuvers. Soon, conservative and expectant management become the norm; forceps maneuvers were seen as too risky once cesareans became safer over the years. Since some posterior babies are indeed born vaginally anyhow (generally those that are smaller and whose chins are well-tucked under, or who did not start labor posterior), they reasoned that malpositions are not terribly relevant. In fact, even today, baby malpositions are often not charted at all, even when a cesarean occurs. The size of the baby or the mother’s pelvis (“CPD”) is considered to be the main problem, not the baby’s position.
No one knows for sure why baby malposition occurs. There are probably many causes, depending on the woman involved. They may include an anterior placenta, a woman's pelvic shape, a short-waisted or 'sway-backed' woman, a woman with a previous back or pelvic injury, a woman with chronic back pain, or a woman with a misaligned pelvis/sacrum.
In particular, women with pelvic pain in pregnancy (pain rolling over in bed, pain putting on pants or other clothes, sciatica, pubic pain, low back pain, hip pain, 'freezing' in place, clicking or popping sensation in pelvis, etc.) may actually be suffering from a misaligned pelvis, and may be able to prevent malpositions by getting chiropractic care to realign the pelvis (especially the pubic symphysis area) and balance the supporting ligaments of the uterus. More information on this can be found on this website on the FAQ on Pelvic Pain.
In addition, some midwives strongly believe that a woman's posture near the end of pregnancy (and in particular her posture and position shortly before or during labor) can cause fetal malpositions. Although this may sound ridiculous on the surface, more and more midwives and others are now beginning to pay heed to this, and are finding the utility of maternal position/posture in resolving baby malpositions.
Recently, attention has begun to return to the issue of baby malposition. Childbirth educator Pauline Scott and midwife Jean Sutton wrote perhaps the most valuable contribution on the subject, called Understanding and Teaching Optimal Foetal Positioning. This summarized their experience with diagnosing, preventing, and treating baby malpositions. They contend that greater attention to posture in the late stages of pregnancy can lower the number of cases of fetal malpositions, and that proactive use of certain maternal positions can often turn the malpositioned baby in labor, preventing the high rate of operative deliveries and difficult labors (“dystocia”) common to malpositions.
Childbirth educators and doulas Penny Simkin and Ruth Ancheta have
recently published a new book called The Labor Progress Handbook, which
addresses the same issues in even greater detail, along with other suggestions
for helping labor dystocia situations. A few nurses
and midwives have also written about the importance of maternal positioning for treating
malpositions in recent years, but mainstream journal literature largely ignores
the issue. Of the
doctors who have written about posterior positioning, most are European or
Chinese. Thus, because most of the
information about baby malposition, its influence on labor, and proactive
treatment for it has been written about in foreign journals, nursing journals,
or in midwifery journals and texts, most American OBs do not know this
information or largely dismiss it.
Can fetal malposition be changed during labor, or better yet, prevented ahead of time? The answer is that many midwives and doulas now believe that it can be, but this information is only now just beginning to catch on. For more information on how to prevent or turn a malposition, see Optimal Foetal Positioning, The Labor Progress Handbook. There is also some basic information on this website in the FAQ on Baby Malposition, as well as at the websites at www.cefcares.org/doula/FetalPres.html, www.horns.freeserve.co.uk/ofp.htm, and www.aims.org.uk/posterior.htm.
It's important to note that Kmom has a special interest in this subject because all 3 of her births involved malpositions. (You can read a brief summary of Kmom's births below.) 2 of the 3 births ended up in cesarean, but by being more proactive and educated about birth position, she was able to have a normal birth with her third child (a Vaginal Birth After Cesarean, or VBAC). She strongly recommends that women who have had past malpositions or cesareans for "CPD" or "FTP" read the FAQs on fetal positioning and pelvic pain, and get the books Optimal Foetal Positioning and The Labor Progress Handbook if at all possible.
Most moms will recognize most of these terms, but women new to reading about childbirth may be puzzled by some of the terms and abbreviations used in these stories. This section briefly defines some of these in order to help women understand the stories better.
Rachel's Story (homebirth, posterior)
Kmom's Notes: A wonderful homebirth, even with a posterior baby (facing towards mother's tummy instead of towards spine).
Birth Story:
Can be found online at www.childbirth.org/articles/stories/HH.html
Summary: This mother, a lawyer in New York City, originally intended to have a hospital birth with midwives, but changed her mind after touring the hospital. Also, all her lawyer friends in the area had had c-sections, and she felt there might be a tendency to practice defensive medicine with her due to her occupation. She then considered a birthing center but felt their guidelines were too rigid about transfer to hospitals, causing a very high transfer rate (about 20%). So she found a licensed midwife in the area who delivered at home.
At 8 days overdue, she went into prodromal labor for 3 days (common with posterior presentations). She feels that at a hospital they would have forced the issue much earlier and added pitocin (which may well have caused a c/s if the baby did not turn). She finally went into regular labor on the 4th day, had painful back labor and progressed very slowly (other signs of a posterior baby). She finished dilating but had an 'anterior lip' left on the cervix (also common with posterior babies!); her midwife helped move the lip aside and get the baby through.
Pushing lasted only 40 minutes; she pushed in the semi-standing position. It's not clear if the baby turned before descent. She was born with only very minor tearing. Labor lasted about 15 hours, once it started up in earnest. In retrospect, she found labor hard (understandable with a posterior position!) but was very glad she had chosen a homebirth. If she had been in a hospital, it's quite possible she would have ended with a c/s for 'failure to progress' due to not dilating quickly enough.
Shawn's Story (c/s, posterior)
Kmom's Notes: The circumstances of the labor suggests that this baby might have been posterior and gotten 'stuck'. Note that she had lots of tiring 'false' labor ahead of time, her water broke ahead of time (although apparently not completely), the pitocin augmentation, the fetal distress, stalled dilation, etc.
The midwife felt that the fact that the baby's amniotic sac was apparently not fully ruptured was keeping the baby from moving down, but rupturing it did not improve the situation and probably caused the baby's position to really get 'stuck.' After the baby started having heart rate problems, they decided on a cesarean, which at that point was probably a good idea.
Shawn confirms that her baby was indeed 'sunny side up' but that this was not noted in her medical records. This is not unusual; many doctors don't see posterior position as relevant and fail to note it in records or mention it to parents, yet many other providers feel that it is the cause of many c-sections. Positioning often helps facilitate rotation, but Shawn was not able to try these. Note that having a nurse-midwife did not mean that any more attention was paid to the posterior positioning; although some nurse-midwives are beginning to pay attention to this more, not all are. No certain job title guarantees attention to baby position.
Birth Story
When I went to see my OB about fertility treatments, I remember one of her first comments being, "You really should try to lose some weight prior to beginning treatment...but I have had patients close to your size who have conceived." "Whatever," I thought, "just give me the prescription." After the first cycle of Clomid, we conceived and we were both surprised and elated. MY OB was skeptical, however, and ran at least 3 progesterone tests and two ultrasounds before she was convinced.
My physician had not been derogatory in our visits, but I was concerned about her pessimistic approach to my care. After my second U/S the technician was able to see the baby's heartbeat. What a sigh of relief! Prior to seeing the U/S the doctor kind of walked back and forth past me as though she was preparing to give me bad news. When the U/S Technician finally put the report in the doctor's box she appeared amazed that it turned out so well and then stuttered over the words "Have you rescheduled your OB appointment yet?" Of course I hadn't because a week prior, she had told my to wait to schedule the appointment until after the U/S (as if to say if it's bad there will be no NEED for an OB appointment) So much for positive thinking!
After a great 'start OB care' appointment the doctor commented "things look really good, but because of your low progesterone I don't want you to get your hopes up until after the first trimester." I thought I would never get the green light that my pregnancy was fine. Although the pregnancy had been progressing fine and all signs were good, she was treating me as though the pregnancy was a risky one. Her attitude when I visited her was usually apathetic. I remember feeling that she just couldn't believe that someone my size was having such a healthy pregnancy. Nine UNEVENTFUL months later...to the day (my original due date had been 11/20, but was changed to 11/13 after my third U/S), I began my birthing journey:
Wednesday: False labor pains begin at 2:00 AM and continue on and off throughout the morning and afternoon. About 3:00PM I lost the first of what would be several parts of my mucous plug followed by general crampiness for the rest of the day and evening.
Thursday, 12:00 AM: Contractions begin at 7-10 minutes apart. I figured it was more false labor pains since I had not had a bloody show (but ultimately learned that these were in fact the real thing). I called my midwife when the office opened at 9:00. She thought I may be right in assessing the pain as false labor. I had not slept all night from the pain and she prescribed a sleeping pill. She said, "If it's false labor, the pills will stop them and you'll sleep, but if it's the real thing, you won't be able to sleep through the contractions." I decided not to take the pill just in case. I didn't want to be in pain AND groggy! At 2:00 PM my water broke (although it wasn't as much water as I had expected) and the midwife asked me to come in to be checked. Once there, she confirmed that it in fact my water had broken and then informed me that the fluid was stained with meconium. She also stated that I was only 1 cm dilated and at this point I had been in labor for over 13 hours. She recommended pitocin to get things going. I'd learned that those moms induced with pitocin had very hard labor pains and my midwife confirmed that this may be the case. I told her that I wanted to try it without an epidural and knowing the c/s rate for overweight women, reminded her how important it was to me to wait as long as possible before a C-section was considered. We then left for the hospital.
4:30 PM Contractions still irregular and topping off between 70 and 80. I am confined to bed with external fetal monitor. I am told that I may be able to walk the length of the bed if the baby responds okay to the contractions. So far so good.
8:00 PM After 18 hours of labor, the pain is more than I can handle. I admit defeat and request the epidural.
10:00 PM According to the monitor, contractions are double and triple peaking at 100. I breath a sigh of relief that I can't feel anything but pressure. Midwife checks and I'm still only dilated 3 cm. She waits for a contraction and stretches the cervix another 3 cm to 6!
Friday,12:00 AM: Midwife tells me there have been a few drops in the baby's heartbeat and asks to insert an internal monitor for more accurate readings. Realizing this would confine me to the bed but wanting to do what was best for the baby, I reluctantly agreed. Midwife discovers that my bag of waters had not completely ruptured and may have been delaying the baby's drop into the pelvis. She breaks the sack and the baby moves to -1 station. (NOTE: looking back, I realize that if we had known this back at the office, I may have avoided using the pitocin altogether since the unruptured sack was preventing the baby from moving down into the pelvis, thus stimulating more productive contractions.)
3:00 AM Dilated 6-7 cm. I am exhausted and disappointed, but ask to be given more time before considering a C-section.
4:30 The midwife brings in the doctor-on-call to evaluate. The baby had several heartbeat decelerations after contractions and she was concerned. I am dilated 8 cm and he tells me to push although I have not yet felt the urge. It is unproductive and a C-section is recommended. I begin to cry from the exhaustion and disappointment, but after 28.5 hours, I agree.
5:10 AM Our darling daughter is born. We had chosen not to learn the sex of the baby and although we both wanted a girl, we felt very strongly it was a boy. When the doctor announced "IT'S A GIRL" I cried and cried and cried. She was suctioned well and the meconium had minimal effects on her. Apgars 8 and 9. My husband left to go video the baby for me and I was whisked off to recovery.
I invested a lot of time developing my birth plan and although this is the farthest from my dream birth, my daughter far surpasses any hopes I had for my baby. There were times during the months following her birth when I thought I could have done something differently to lessen the need for the c/s, but in time I have learned to focus less on the way she arrived, and more the sheer joy she brings me and my husband now that she is HERE! I wish all of you the best in your pregnancies and pray that each of you have an uneventful labor and delivery.
Monika's Story (pre-eclampsia, postdue, 2 homebirths, posterior/ compound position)
Kmom's Notes: Be sure to visit this site. Very interesting story, great photos!
Birth Story
This is the story of two homebirths despite some high blood pressure and postdue concerns. The story (with graphic photos) can be found at http://members.home.net/mcmahan/. Below, Kmom summarizes the gist of the stories.
"This mom is a mid-sized BBW. She is not self-conscious at all about being in the very graphic photos, and the photos of baby #2 coming out are just AWESOME. Not bad considering the photographer is the teenage babysitter! Details about the births:
-First baby: high b/p concerns at end of pregnancy; used herbs (their site contains details for those interested). Mom was also almost 3 weeks past her due date when she finally goes into labor. Despite all this, they had a homebirth, though the labor was not easy (the baby was posterior) and the baby passed meconium. After the birth, the midwife was concerned about possible meconium aspiration, so they transferred to a hospital and had a hard time negotiating the bureaucracy and hassle there, but in the end all turned out well.
-Second baby: similar concerns with high b/p but all lab tests are reassuring and the herbs again seem to help. Baby similarly overdue, posterior at first, but this time mom's hands/knees position flipped the baby to anterior shortly thereafter and back labor ceased. Baby was large (10 lbs. 6 oz, considered 'macrosomic' by OB standards; most OBs would have called for an early induction or elective c/s), and did birth in a compound position (hand by head), yet despite baby's size and position, baby was born without any damage or trauma to mom or baby because of the careful handling from the midwife. The baby's older sister (not quite 2 years old) is present for the birth; shortly after the birth she demands that the baby be nursed immediately and that socks be put on his cold feet. ;-) The sweetest photo is of the 2 children, tandem nursing (nursing one on each side) after the birth.
Please note that even very big babies can usually be born without problems *IF THE PROVIDER IS WELL-VERSED IN BIRTHING BIG BABIES*, if mom has full freedom of position for laboring and pushing, and if the provider is patient and doesn't force the issue. Baby size does NOT have to mean a ton of intervention.
The photos are very graphic but beautiful; if you are not sure how birth happens or if you have a hard time visualizing that happening with you, you should go to the site and check it out. You may not be choosing homebirth, which is fine, but reading a variety of birth stories while you're pregnant is very important. And the very graphic photos really help show what happens in birth."
Margie's Story (5 children; #4: c/s, insulin-dep. gd; #5: VBAC, insulin-dep. gd)
Kmom's Notes: Margie has 5 children; this is mostly the story of #5, her gd vbac. The fact that she'd had 3 vaginal births before her c/s increased her chances for a VBAC, as did her supportive staff and taking good care of herself. Her birth stories (all of them) can be found at:
http://pregnancy.miningco.com/health/pregnancy/library/stories/b13797.htm (1st 3 births)
http://pregnancy.miningco.com/health/pregnancy/library/stories/blcameron.htm (4th birth)
http://pregnancy.miningco.com/health/pregnancy/library/stories/bl9907196.htm?pid=2839&cob=hom
Birth Stories
Baby #5: This story begins with pre-pregnancy. This was a much planned for baby for a few years before she was even a sparkle in her Mother and Father's eye. I have four children, one of which I had Insulin Dependent Gestational Diabetes with. I wanted to have more children and knew that I would have to deal with this again. We got pregnant on our first try with In Vitro. Our previous son was conceived through In Vitro also. I found out I was pregnant and was very overjoyed. I was prepared for the pregnancy and hoped to make it better than my last. Even with Insulin-Dep. GD.
Only thing I wasn't prepared for was the onset was much earlier than my previous pregnancy. I began insulin at 12 weeks. My previous baby was born via C-Section due to Macrosomia. He weighed 11 lbs and 3 oz. I knew that if I kept with the diet and insulin that I would not have a huge baby. So on with the diet and insulin. My goal was to keep the baby's size down and hopefully go into labor on my own. I wanted to know what it was like to go into labor and not have pitocin. My three previous babies were either induced or augmented with Pitocin. As we were approaching the due date, all tests were showing that she was fine and not at all huge. I had twice weekly NST's (Non Stress Tests) and AFI's (Amniotic Fluid Index) tests. All were great. One nurse did however say that I had a decrease of fluid and was concerned. More on that later.
My due date approached and I asked if I could go another week in hopes that I would go into labor on my own. OB agreed. I thought for sure that I would have contractions and so forth, but by the next week nothing was going on. I had JUST gotten to 1 cm. Insulin-Dependent GDM has many risks. One is the function of the placenta could stop, resulting in placenta failure and stillbirth. That was why all the NST's. When it came time to decide if I would consent to an induction I reluctantly agreed, feeling that this was what was best for my baby. So Induction Day rolls around. I'm instructed to report to L&D with my orders in my hand at 7:30am Monday morning. I'm really apprehensive since my last induction was during a span of four days and I had a c/s anyway.
We get settled into my room. We meaning my husband, my Doula, and myself. They are very nice and sensitive to my needs with the monitors. The L&D nurse made sure I wasn't on them any longer than I had to be. She found out that I'm a clock watcher!!! I had my first application of P-Gel and asked her about my status. I'm 1 cm, 0% effaced, my cervix isn't too soft, baby is head down, and cervix is almost in an Anterior position. At the 2nd application I continued to have contractions on my own for several hours. This brought me to 1+ cm, -2 station, 30% effaced. An hour later the 2nd dose of P-Gel is given. With this exam I am 2cm, -2 station, 30% effaced. We are encouraged to walk the halls. We do so leisurely and this results in some contractions. So after all that walking I progress another centimeter. Monday night at 10:20pm I get another dose of P-Gel and we all get some much needed sleep for the next day. The contractions just about stop.
I am impressed with my nurse's sensitivity to my needs. I had drawn up a birth plan, but did not give it to them. They seem to be just as committed to me having a VBAC as I am. They all have studied my previous birth and remind me often that this is so much more different. After she got past -2 station, I relax. Cameron never made it past -5. Things certainly do seem different. At 4:15am it's rise and shine. I get back on the monitors for a test strip and the endocrinologist orders hourly Blood Glucose Tests. I think this was the most annoying part. He also orders an IV push of insulin as needed. At 5:00am the IV is started and pitocin is started at the lowest dose.
5:35am my water breaks. Remember, one of the nurses said I had such low levels of fluid. I change positions and noticed my water had broken. There is water coming out that is clear. I soak 2 chux pads. The L&D nurse has to rush to get more, I soak 2 more pads. She puts a towel between my legs as the water keeps coming. Every time I laugh, there is more water!!! I soak through another set of chux pads and another towel. Seems like enough water to me. We all cheer that my water broke on its own. Something's happening. Pitocin is steadily increased and contractions are going nicely in a pattern.
At 7:30am the new crew comes in. Our nurse ended up being the same nurse I had the day I had my c/section with Cameron. At first this worried me, but she reminds me that we have gotten further than we ever did with him and this is all together different. This relaxes me and we get ready for the hard work ahead. It's 8am and she checks me. I'm at 3cm 50% effaced, -2 station and my cervix is soft. The monitors around me are really irritating me. We discuss internal fetal monitors. One thing that I was most afraid of was the internal catheter to measure contractions. The nurse shows me that they are much different than they used to be. I had one nearly 15 years ago and the memory was terrible. I realize that they cannot effectively monitor the strength of my contractions with the straps. I'm a big woman and the baby is small. So I agree to the internal monitor for contractions so I will not be over stimulated on pitocin. That alone makes me fear for a rupture. In the 20 minutes that we discuss this and they place the monitors, I progress to 4 cm, 70% effaced and still -2 station. Contractions are 2 1/2 minutes apart and bearable. I can't believe how much the effacing is happening since this usually is the slowest part for me. I also had went from 4cm and 70 to 90 percent effaced to delivery in a matter of minutes with my previous pregnancy. I warn them. The contractions are really bearable and not at all painful. Just a force, but not really painful. They peak quickly and resolve quickly. The atmosphere is still very upbeat and we are playing Hymns on the boom box. This creates a very peaceful and serene atmosphere in the room.
I get my next exam at 10:00am. I have already progressed to 5cm, 80% effaced and still at a negative -2 station. I'm amazed at how easily everything is going. It just seems to roll along. In 30 minutes I progress to 6 cm, 90% effaced and she drops down to -1 station. Still the contractions have not changed or even seem to be that hard. In the next 30 minutes I again progress even further to 8 cm, 90% effaced and 0 station. They tell me I'm in transition. I'm amazed at how easily everything is going and even being in transition, I'm not in that much pain. While I was at 4, I was getting a bit apprehensive that the contractions would get harder to deal with and was asking about an epidural. My previous births were horrendous with the over-stimulation of pitocin. Sue talks me out of it and I agree to forge on through. So I'm at 8 cm and it doesn't' seem to be that bad. It's 11:45am and the OB is called. I am 9 cm, 100% effaced and zero station. The OB gets there and things start to halt. The contractions are getting harder and she isn't coming. I'm getting really concerned that I am some how unconsciously holding her back. They tell me she is posterior and is pounding on my cervix causing it to swell from 9cm back down to 6cm. At this point I am standing trying to get her to come down. I tried going to the bathroom and she still isn't coming down. Her heart rate drops severely and the OB nurses rush into the room. We are really scared at this point because it isn't coming back up. I'm laying on my side with oxygen mask on praying that she is OK. All sorts of things rush in my mind. I ask my husband who is an Elder in our church to give me an emergency blessing. He does and her heart rate normalizes.
I then get an epidural. The epidural doesn't take on a strip going along my belly and I can feel the contractions in a localized area. The Anesthesiologist tells me that this is called a window caused by the position of her head. They turn off the pit drip and I lay on another side to get the medicine to hit that awful nagging spot. Things settle down and I snooze. During this time DH gives baby a blessing by laying his hands on my belly. I didn't find this out till later. It's 3:00 and I'm at 10cm, 100%, and +1 station. They ask me to push. I have to say that I would make fun of the ladies on "A Baby Story" pushing through their epidurals. I now know that it is so hard to push. I haven't pushed in 15 years. I didn't practice this part!!! It was difficult to coordinate the pushing. No one counted in my face and I was really glad about that.
It's 3:15 and we have put the Hymns back on. She is slowly moving up and her head is crowning. I'm not sure at which point they called the OB. Her head is slowly pushing it's way out. The entire time her head is exposed the OB nurse is gently stroking her head. She is treated gently from the beginning and the tone in the room is quiet and not tense. She decides that she has had enough of the womb and her head pops out. No pushing from me. Then the body just slips on out. She is born and my first look at her is in amazement at her size. All of my babies are over 8 lbs including my 11lbs 3oz boy. She is really long and skinny. The OB walks in fully expecting to deliver a baby. He missed it and gets to catch the placenta. She cries and is cleaned off and placed on my stomach. I get to cut the cord. I couldn't see it and Bill took pictures. They ask me if it is OK to take her to clean her off. They are very quiet and gentle with her care. She is cleaned off and they assess her. She is measured and weighed. 7lbs 9oz. 19 3/4 inches long. Her Apgars are 8 and 9.
One nurse said I was bleeding pretty bad. They call the OB back in and he finds clots in my uterus causing it not to contract. They take care of this and the bleeding slows down. I am sat up so I can nurse, but when I am moved up I nearly pass out. My BP is extremely low. 99/34. They call the Anesthesiologist back in and she puts some medicine in my IV to get my BP up. I continue to have low BP the remainder of my visit. I am able to nurse her and the colostrum is able to maintain her blood sugar. She looks great. As soon as my epidural wore off we were back in our room getting to know each other.
Despite these little mishaps and having to get the epidural, the birth was very positive. I was able to have a VBAC. I did not submit a birth plan to the floor. I wonder if my doula did since everything I asked for was honored. I nearly got everyone I asked for. It almost seem too good to be true. During the entire time of my labor, a friend of mine is calling and being called to update my lists on my progress. I have an enormous amount of support and prayers during this time. This birth is a triumph. Not only that I got the most beautiful baby in the world, but that being diabetic I was able to make it post dates, I had a small baby, and she had no side effects of my diabetes. Most important that she was born a VBAC. She was at one point a twin. Her brother or sister was 10.2 weeks before he/she died in utero. We will always hold that precious baby in our hearts. But we say Welcome to the World to this baby.
Postscript: Breastfeeding does not go well, due to the anemia from all the blood loss after the birth. Additional factors may also include low thyroid levels and abnormal nipple shape. This was very disappointing but the baby did get the benefits of colostrum and some early milk.
Franny's Stories (PCOS, induced vaginal birth, posterior, forceps; cesarean for breech baby; home VBAC)
Kmom's Notes: Another case where the baby's position makes the birth difficult until it is fixed. In this mom's first birth, it was probably the combination of the hands-knees maternal position and the doctor using forceps that helped the baby to turn and be born vaginally.
Franny's second baby was breech. This may reflect a tendency among women who have had prior malpositions to have future malpositions as well. This may reflect a pelvic misalignment more than anything else, and we speculated that regular chiropractic care could help prevent position problems in the future.
She got that chiropractic care in her 3rd pregnancy. Did that help her to a vbac? Hard to prove. It's notable that this was the only pregnancy of the three without a malposition, so the chiro care may well have helped. However, she might have had a VBAC even without that care. It's more like an extra step to take, just in case.
Another notable thing about Franny's story is that she was told that she had to sign up for an elective repeat cesarean because her hospital didn't offer VBAC anymore. Fortunately, there were other choices in her community, and rather than being forced into unnecessary surgery against her will, Franny gave birth at home with a good midwife. And then she had the strength of will to write about it for her local paper!! She put those local doctors on notice that women will NOT be forced into unnecessary surgery!
Birth Story
Baby #1: I gave birth at the hospital where I worked at the time. I am an RN; I was working OB at the time and delivered with my 2 best friends as my nurses.
My B/P was elevated at my 38 week appt. and being the beginning of July and very hot and busy on the hospital floor where I worked, my MD sent me home with bedrest. I was swelling, but not spilling any protein and my labs were ok. I got a Non-Stress Test (NST) and baby looked fine. The next week we scheduled my induction because B/P and swelling continued and my cervix was favorable (ripe).
I entered the hospital at 6 a.m., my IV was inserted and pitocin began. I was having contractions, but they weren't anything. I was 4 cm when I started out. I walked the halls and rocked in the rocking chair. My husband and his parents were there. I worked on OB at the time and a Radiant Warmer Representative was there to in-service the staff on a new Warmer. I stood in the hallway with my IV pump and listened to his in-service at 9 a.m. By 9:30, he was done and I was tired, feeling contractions, but they weren't uncomfortable. I thought, if this is going to last all day I'm going to try to get some rest.
I went back to bed, got hooked back up to the monitor and my contractions were every 2 minutes, palpating moderate, but not uncomfortable. I had been laying down for 15 minutes and just got my eyes closed when I had 3 strong contractions that I had to use my breathing techniques through (I had coached so many other labor patients that I felt like I could do it). Then my water broke. Talk about warm soup down your leg! The contractions got really strong then. I was 5 cm. Got up to the bathroom to get cleaned up and got some pain medicine, Nubain 10 mg. I got back in bed, turning side to side and in 2 hours I was 8 cm. The contractions hurt, but they ended and knowing there was an end to every pain was a relief in itself. Back rubs, ice chips, and a cool washcloth over my eyes helped tremendously.
At 1 o'clock in the afternoon I started pushing. I pushed sitting up, lying on each side, on the toilet, standing up, squatting, and regular old lithotomy. I just couldn't get him to budge and I had pretty bad back pain. He was posterior. After 2.5 hours of pushing, I got on my hands and knees and pushed every other contraction because his heart rate was dropping. Finally, my doctor came in and I got a spinal in case I would have to go for an emergency c-section. They got me all set up for delivery and the doctor used forceps. After 3-5 contractions with pushing and pulling, we got him turned face down and delivered at 4:35 p.m. He was a bit exhausted and got a little oxygen, but cried well and after an hour of stitching, mom got to feed him. He nursed for 20 minutes like a trooper.
Baby #2: I was due 4/7. We knew dates for sure because we got pregnant with the assistance of Clomid and Glucophage for PCOS. My pregnancy really went quickly and pretty smoothly. From about 28-34 weeks baby was breech except for one brief period. Around 34 weeks I started doing the routine to turn her---lying on the ironing board, used a moxibustion stick at home, homeopathic pulsatilla, prayer, relaxation, imagery, talking to the baby, flashlight, music, the whole nine yards. I was on the verge of a breakdown about 35 weeks...called my midwife crying, "What am I going to do?"
We had talked about delivering breech and they weren't really sure. I had an appointment on Friday 3/14 for a consult with the OB (he's probably in his mid-50s and still does some vaginal breech deliveries) who backs up my CNM and possible External Version. We had planned to deliver at a birth center. That was all I was planning. I was thinking positively, I was relaxing and working on the imagery I was planning to use for labor...this baby was going to have a peaceful delivery and I was going to have a healing, positive birth.
I am a RN and work as a prenatal care coordinator for a community health clinic. I do home visits, education and referral for pregnant moms on the Medicaid program. I have worked as a doula in the past, but don't have time for it at present. I teach childbirth classes and had a class on Tuesday 3/11 from 5-7. Talked with a couple for about 30 minutes after class, then drove home, picked up my son at church (my husband is a pastor). We came home, I [ate] and read my email. I had just got Ina May's new book via Fed Ex that day and while my son was winding down...I started reading in the recliner. I had been sitting there about 15 minutes when I felt warm and wet---I jumped up so I wouldn't get the recliner wet and freaked out, "OH NO, that can't be my water!" When I pulled down my pants in the bathroom there was a lot of blood. Now of course, I'd just worked about a 12 hour day, moving constantly, and not really noticing much movement from the baby. In class that night we talked about Cesareans and abruption was going through my mind. I'm absolutely losing it, my heart was pounding, I was shaking all over, I'm shaking now just remembering how I felt. I read Prenatal Parenting early in my pregnancy and I had worked really hard on remaining calm and talking to the baby, taking fetal love breaks, especially when I'd had a rough day---now when she decides to come, I'm a mess.
I called DH on his cell phone. "Come home now, I'm bleeding." It was about 10 p.m. My son could tell I was worried because he was right there. "Mommy, are you ok?" (Side note: The next evening at Bible Study he asked for prayer for Mommy because she "Pooped blood in the toilet and it looked like Koolaid." He's still talking about that night!) DH got home, helped me find my midwife's phone number and we called her. She was a voice of complete calm, "I'll meet you on OB. It's probably just your water." DH has never driven so fast in his life! Now I was nearly a month early, I had just gotten finished saying that night at class that I would probably go close to my due date, I was too busy to have the baby early, I had home visits scheduled through the end of March, blah blah blah. I had no bag packed, had no comfort items gathered, had only 2 outfits for baby clean...I didn't have the crib pained, had no mattress, didn't have a pediatrician picked out, had not pre-registered at the hospital, I was going to deliver at the birthing center for heaven's sake!!----I WAS NOT READY!!!!
We got to the hospital and up to OB. They wanted me to change my clothes, I wanted heart tones. 130s, but very little variability...My midwife cam in and did a quick ultrasound, the baby's head was under my right rib cage, her bottom was inside my right pelvis, and her feet were over my cervix. My midwife sat on the bed with me, held my hand, and said, "We are not comfortable with delivering her vaginally this way, you need to make some decisions." DH went down to sign me in. When he came back I bawled in his arms for a few minutes then collected myself. My midwife and I talked about VBAC and she said that the doctor still did VBACs and was very pro-VBAC and had a good rate....I think she said ~80% success rate for VBACs. I made it clear that if the baby was OK, she was to be with me at all times. If she was not with me, DH would be with her. My midwife said that the pedi on call was a stickler about the baby going to the nursery, but she would do what she could.
DH's parents arrived to stay with my son during the birth. IV started (after 3 tries), into a gown, consent signed, we went to O.R. After the anesthesiologist got my fluids in (she about froze my arm off pushing about 700 cc in 10 minutes), she sat me up for my spinal (again, third time was the charm). The doctor was at my feet, my midwife at my side, and nurse on the other side. They were all awesome!---kept trying to recruit me, though. I laid back down and felt everything go to sleep, boy that is a funny sensation. With [my first child], the spinal took the pain away, so it didn't feel so weird. With no pain, it just feels like they put lead in and made it all go to sleep, kinda pins and needles sensation. They put my catheter in (gave me the option not to have it at all, but I figured I'd probably not want to get out of bed for a little bit once the spinal wore off and I knee it was also in place to make sure my bladder wasn't nicked during the surgery, so I got it).
I informed everyone that if my baby was ok, I wanted to keep her with me. I got this weird sense of humor and was defensive by joking about things, I was kinda strange. My BP bottomed out at 60/40 and my heartrate was going nuts in the 120s. She gave me something for my BP and I felt a little better. DH at my side, they started my baby's birth; tears rolling down my face, I asked him to pray with me. DH prayed from the moment he placed his hand on my face until we heard them say, "Here's baby." My heartrate came down to the 90s while he was praying and the anesthesiologist said, "Wish we could bottle that."
During prenatal ultrasounds, we had a brief peek to see girl parts, but never saw them again (breech), so I was not getting my hopes up. I knew that they would see sex before she was even out, but they weren't saying anything! After her birth, the doctor made the comment that he went in and felt limbs, he grabbed two and started to pull them out, but had an arm and a leg, had to go back and find a matching set. She cried quickly and after a peek at her, to the warmer. The pedi checked her over and I kept talking to her, "Keep crying," "Hello Amy," etc. I had tears streaming down my face and into my ears. They wrapped her up and handed her to DH; I got to touch her. The anesthesiologist held her face right next to mine so I could talk to and kiss her.
The doctor held a section of cord up for me to see. "See why she wouldn't turn around?" She had a true knot in the cord that was really pretty snug. He felt that she was lucky to be here and that she would have probably not tolerated the version we had planned for 2 days down the road. Now, I have seen true knots before, even after vaginal deliveries, and everything was okay, but I also assisted a twin delivery where one twin had a knot and was stillborn, the other was ok.
The anesthesiologist offered Demerol to help with cramping and I refused because I didn't really want to see my supper again. I asked to have my placenta and the anesthesiologist said, "Well, what on earth for?" I said, "Because it's mine!" I got my placenta in the freezer, going to plant it with a Magnolia tree outside Amy's bedroom window. (I had a Magnolia tree outside my window growing up.)
The pedi took her to the nursery. DH followed and picked up our son and my in-laws so they could see her and 10 minutes later when my surgery was over, the nurses and doctors took me to recovery, and my midwife went to get Amy. I got her to the breast within about 45 minutes after delivery. She was cuddled up with her head on my breast...My son came in and asked me, "Did you get your miracle, Mommy?" More tears. He got to see her, my in-laws were in the hallway looking in, and DH was walking around with my placenta in a bucket under his arm. Back up to the OB floor at 2 a.m., got my morphine [Patient-Controlled Analgesia] pump and slept off and on through the rest of the morning with Amy on my chest. [We] ended up skin to skin for quite a bit of that time. They checked me often, but basically left me alone, never asking to take her to the nursery for her admission bath, etc. I got out of bed for the first time around 10:30 a.m. the next day, got to oral pain meds and my IV out around noon. Kept Amy with me around the clock and nursing went well. Went home Thursday afternoon around 3:30 p.m. I refused her Newborn Screen on discharge and brought her back that Saturday.
OK, the last thing I wanted was a cesarean. But what I was praying for was an empowering, positive, healing birth and even though I didn't have the natural birthing center birth, that wasn't what I was praying for. Next time I will be more specific, but I did get control in my birth experience, I was hyperaware of what I was feeling emotionally, physically, and mentally, and I feel I was so prepared for coping with pain that it has made my recovery super rapid. As far as healing, in that I feel like I can delivery vaginally without the medical need for management. I have not had that yet, but our daughter is named for 3 very special women, 2 very dear to me. Amy's birth was healing to me in that way, a healing I didn't even know I needed, but God took care of nevertheless. Positive, a resounding yes, I have a beautiful baby girl with a perfect round head, she has dimples just like mommy and lots of dark hair.
Did I get what I wanted---no, but I did have control over what I did get. Did I get what I needed---definitely. I will no longer feel sorry inside for women who had to have a cesarean, but instead I will ask how they felt about their birth. That is so much more important. A cesarean is not fun, it's not natural, it can be unnecessary, but it does sometimes save lives, and it is a birth of a precious little one, and an event that is no less memorable or special...Sometimes we just need to be reminded of it.
Amy was 6 lbs., 14 oz., 20.5 inches. She is a good baby, nursing well. At three weeks of age she is 8 lbs. 5 oz., solely breastfed, and I have an additional feeding built in for pumping. I love the Lansinoh Ziplock bags for breastmilk storage, and the Avent pump is great. It's like "I can't believe it's not electric!"
Update: Franny went on to have a home VBAC too. This is her VBAC story.
10 days past my due date I was miserable and called my midwife for help (this pregnancy lasted more than 2 weeks longer than my first and 6 weeks longer than my second...I felt like I was pregnant forever, add to this that I took off work for maternity leave at 38 weeks and I felt a little like an elephant, in more ways that one). My midwife recommended that I see the Chiropractor and get a massage. I chose the latter and by evening (Wednesday) my contractions had started.
I went about my normal activities, fixed supper, went to church, bathed the kids, put kids to bed, went for a walk. Contractions were regular, but not very strong, more like annoying. Thursday AM we were to drive an hour away to see the midwife...I didn't think I could handle being in the car that long, so I told her to head our way. (She has 7 kids of her own, the youngest just turned 1 in November). I napped and felt like they were fading away and she said she'd just drop in to see how I was. I had gone into work for a bridal shower on Tuesday and one of my co-workers, an OBGYN Nurse Practitioner said I should just go to the hospital and have another cesarean since I was so far over my due date...had a lot of mental work to do to get over that.
Midwife arrived at 3 and I told her what I was thinking/feeling and she helped me get rid of it and by 3:30 my water broke. By 5, my doula and our friends that were going to watch our kids were present and I was starting to get uncomfortable. Around 7pm, I was 4cm (the first time my midwife ever had her hand in me). I got in the tub ( borrowed a spa in a box from a friend) and got hot, then had to get out to cool off. I had just attended a Michel Odent conference and had his words in my head. If a woman gets in the tub at 4 and makes no rapid progress after 2 hours, he recommended a cesarean. I kept thinking that I didn't have the urge to push, so had I made progress? After dark (9ish?) I got back in the tub and was very cold, my husband found a space heater and was holding it on me next to the tub and jokingly went "oops" faking dropping it into the tub and it took me over an hour to get back into a regular pattern. Had to get into the shower to get warmed back up and they encouraged me to drink some really salty hot broth.
By 11 I was loud and hurting, they also tried to cram a peanut butter and jelly sandwich and juice down my throat...PB is NOT easy to get down with 'labor mouth'. I was all over the place position-wise, remember enjoying a forward leaning position. I starting pushing around midnight, although my midwife said I wasn't *really pushing* until about 1 or so. Was in the tub when I started to push, but kept a rim of cervix and got out to the birth stool so the midwife could help hold it while I pushed. While on the birth stool I remember saying, "I give up. Take me to the hospital, Help me" and they gave me some homeopathy. When she was crowning I got back in the tub.
The midwife said I have 'a large perineum' and so it felt like crowning took FOREVER. I remembered what It was like with Daniel and I realized that I ever got to the point where I could push past the pain and make progress...I finally figured out the pushing thing this time...but the pushing into the pain to make progress, then the contraction ending and feeling the baby slide back up and knowing I'd have to push back through that pain again with the next contraction was nearly overwhelming. I was on my knees in the tub, resting my head on the side of the tub, Aryn put his arm along the back of the tub so I could rest my head and I accidentally bit him...didn't even realize I was doing it until he flinched.
I got to the point where I felt like my urethra was going to explode and I reached down to support my labia and felt her head...It didn't take long from that point...it was so empowering to realize how close I really was. Once her head was out, her body followed quickly, the midwife just allowed the water to catch her. Once she was out, I flipped over and reached for her. Within seconds, I was pulling her up so I could see her, unlooped 2 nuchal cords and brought her out of the water to my chest. She opened her eyes and looked at me and started to whimper. No lusty painful scream, but more like..."Wait a second, what just happened?"
I felt between her legs and discovered she was a girl, but waited until our son came into the room to lift her out of the water for him to see and announce. I was convinced I was having a boy because my pregnancy was so much like it was with Daniel...Instead I have a little girl that looks just like her big brother. I was out of the tub about 30 minutes after her birth and we left the cord attached for about 2 hours, at that point we were able to cut without clamping and it fell off when she was 4 days old. I had a small 'scuff', but nothing worth messing with suture-wise. My midwife had a herbal bath to soak in with Abby and it felt wonderful...had to learn the hard way to strain out the herbs though :-0 clogged the tub.
Abby nursed very well and my milk was in by 24 hours. She never lost weight. Was 8-5 at birth, 2:04am Friday, October 14th and was 8-9 on Monday evening. Abigail has been a joy, a wonderful baby. Sleeps through the night (started at about 1 month) and was smiling by 6 weeks. She does have some gassy spells, but they are brief. Will definitely do it again!!! But will wait until Abby is in preschool or Kindergarten...a newborn and a strong willed 2 1/2 year old is just way too much for me!
This was an editorial I sent to our local newspaper after my daughter's birth explaining my decision and outcome in relation to the release of 2004 C/S rates. Several of the OBs in our area were really ticked and found out that I was the Childbirth Educator at the local Medicaid clinic and were not happy. Our Medical director wanted me to assure him that I was not teaching or encouraging homebirth in my class. I replied that I simply told my story and that I did not believe that homebirth was an option for our clients for 2 reasons...they can't afford the out of pocket expense of homebirth and local docs refuse to provide back up.
The results are in and 2004 saw another increase in surgical birth rates -- 29.1 percent of women delivered their babies by cesarean last year, according to a National Center for Health Statistics report released last week.I chose not to become a statistic
Some doctors cited the reason for the increase was that more women are having elective cesareans, but keep in mind that "elective" does not mean that it was the woman's choice.
Earlier this year when we discovered we were expecting our third baby, I visited my OB/GYN to begin prenatal care. I was informed that we would be forced to have a cesarean if our baby was born at their hospital simply because I had a cesarean with my second child.
The cesarean rate has increased astronomically in the past 30 years: 5.5 percent in 1970, 16.5 percent in 1980, and 22.7 percent in 2000. The World Health Organization states that the cesarean rate should be 10 percent to 15 percent. Our bodies have not changed in 30 years, but medical management has. Although some babies have been saved by surgical delivery, a look at maternal and infant mortality rates show that nearly 30 countries lose fewer moms and babies than the United States and most of those countries have lower cesarean rates.
Having a vaginal birth after cesarean (VBAC) carries nearly half the potential complications than repeat surgery. Due to a 0.5 percent to 1 percent risk of uterine rupture, The American College of Obstetricians and Gynecologists has put very strict guidelines on VBAC, stating that the doctor and operating team need to be immediately available.
American Academy of Family Physicians guidelines noted that there are other problems that occur more often, and they found no evidence suggesting better VBAC outcomes based on the availability of resources. American Academy of Family Physicians went on to state that policies for VBAC "appear to be based on malpractice concerns rather than on available statistical and scientific evidence."
So, how'd I do it? I hired a midwife and kept my OB/GYN as backup. I found a doula -- someone trained to provide emotional and physical support during labor... and obtained a portable hot tub for pain relief. I ate well and read to educate myself. When labor started, my midwife came to me, and my daughter was safely born at home in water.
I'll do it again with my next baby. As long as doctors and hospitals do not allow alternatives, such as midwives, birthing centers and natural options for pain relief, more informed women who want to be able to make their own decisions will join me.
Kimberly's Story (posterior, induced vaginal birth)
Kmom's Notes: Another 'typical posterior' story. Her bag of waters broke before labor (not unusual with posterior babies because they tend to put uneven pressure on the amniotic sac), she dilated but had an 'anterior lip' (9.5 cm) that was difficult to finish, and she 'got stuck' in the second stage (pushing), almost leading to a c-section. In the end, however, the baby came unstuck and was born face-up just as she was being wheeled in for a c/s. Although it's not easy for a baby to be born posterior, it can certainly happen, especially if the baby's head finally molded enough to go through, the head slipped into a better position, or the chin suddenly tucked down (which reduces the head diameter that has to go through). Whatever happened, something occurred that allowed the baby to be born suddenly.
As a follow-up note, Kimberly notes that her first baby was also posterior (turned after hands/knees position), and that her mother and maternal grandmother also had some posterior babies. This second baby had a touch of jaundice, but that is common afteraffect of induction with pitocin.
Birth Story
I guess you could say I am a classic example of how average and "normal" a pregnancy and birth can be for a larger woman. C was conceived easily, one month after we started 'trying'. My pregnancy was fairly uneventful, except my doctor actually got concerned that I was LOSING weight. I found that my heightened sense of smell, couple with all-day morning sickness made eating a less-than-wonderful chore. In the end I delivered at a weight of 269 and left the hospital at 249, almost 20 lbs. less than pre-pregnancy. All of my health-care providers (nurses, etc.) were fantastic throughout the pregnancy, and I only had to ask once for the large bp cuff (new nurse).
My labor was induced with iv pitocin because my water had broken without real contractions for more than 12 hours. The presentation was [posterior], which slowed things down considerably, and put me in misery with back labor. During the final hours of labor I spent at least 2-2.5 hours on my hands and knees with my husband and nurse applying pressure to my lower back to manage the pain. The nurse also talked me through a lot of visualization, who knows if that helped? It almost seems like I was keeping her stuck because I couldn't relax through the pain.
The baby "got stuck" trying to pass into the birth canal and the doctors had decided that a cesarean was in order, which was fine by me at that point (was stuck at 9.5 cm, fully effaced for over 2 hours). When they mentioned c-section I finally relaxed because I knew that I wouldn't have to do the impossible (push her out) and BOOM there she was. The baby had other plans!
As I was being wheeled across the hall to the shiny metal-filled delivery room, she decided she was coming "unstuck" and fast....I was crowning in the hall and I shrieked that the baby was coming NOW and a nurse reached down and held her in till we got to delivery. She shot out like a wriggling cannonball (as my husband put it) about 5 seconds later. She had a touch of jaundice but that didn't even require bili lights and we went home about 40 hours later.
Maddy's Story (2 c/s, 1 posterior VBAC, due soon with #4)
Kmom's Notes: Another posterior baby story. She used a combination of patience, homeopathic remedies, rocking the hips, and the 'all-fours' position to turn the baby, plus a tub to help cope with the pain in the meantime. Labor stalled at 6 cm, common with posteriors. But because they were willing to wait things out and not force the issue with pitocin, their proactive measures did turn the baby and resulted in a VBAC; in most hospitals this would have turned into another c/s.
Birth Story
Baby #1 was a 42-week planned c-section for breech. The doctor wasn't comfortable trying to deliver her, and couldn't turn her (the cord looked like it might be around her neck). No labor or cervical changes at all.
Baby #2 was also a 42-week baby, an attempted VBAC with "midwives." (Hah! I trusted in the "midwife" label, but they really knew next to nothing that could have helped me. Spontaneous labor began the day before I was to be induced, but I was "only" progressing 1 cm every few hours, which wasn't fast enough. By the time 30 hours had passed, I was "stuck" at 6.5 cm, and had a beta-strep infection, so I consented to a c-section.
The hospital was horrid, and I vowed never to go back there, no matter how far I had to travel. Later, I learned that not eating, and being tied to the bed to "get a good reading on the monitor" had probably significantly contributed to my "failed" VBAC effort.
With Baby #3, I searched everywhere for a caregiver that would give me the benefit of trusting my body to do its job. I needed to move, I needed to eat, I needed to progress at my own pace. I called everywhere, and visited two local practices. One doctor took a look at my chart and told me, "You're overweight, you're out of shape, you failed at labor twice before, you don't progress, and you're going to end up being sectioned anyway. This is a waste of your time and mine." I picked up my jaw from the floor, and moved on...
I was ready to drive almost two hours to a midwifery practice, but one more doc was recommended to me, just across the state line (about 15 miles away). He was wonderful! He calls himself "a midwife in a doc suit," and it's *so* true. He truly believed I could do a VBAC, and was willing to work with me.
Because the first two babies were 9 pounders at 42 weeks, I consented to using a prostaglandin gel to see if we could coax a smaller baby to come at 40 weeks. For three days, I had three gel treatments a day, doses of castor oil, herbal tinctures, homeopathic remedies (pulsatilla and Kali Carb 30) to turn a posterior baby... I had decent labor during the day, went home at night--not too bad, except that by the third day, I was still only about 6 cm dilated--the same place I got stuck last time.
I consented to having my water broke, even though it was a bit earlier than I would have liked. My contractions completely stopped for almost six hours! They suddenly returned though, hard and heavy, at which point, I used a tub (what a lifesaver, especially in getting my own weight off of my back!), and a lot of hot compresses on my back. After three hours of hard back labor, the baby rotated around from her posterior position. Another two hours, and I had dilated the final 3 cm, and she was born!
It was the most wonderful, exhilarating experience of my life. I did it! I actually conquered the beast within, and my body worked as it should, to birth my baby. Funny thing was, even at 40 weeks, she was right at nine pounds anyway! But I did it, with no pain medication, no pit drip, no c-section!
My doc said, "You had the most functional dysfunctional labor I've seen... way to go!" I know I would have been sectioned eight times over anywhere else. The staff was so supportive, and no one made any of those horrible comments like the one nasty doctor had made. (I did want to take my baby and hold her in his face and say, "How's THAT for a waste of time?!?!")
Here I am, almost three years later, with a midwife (new to my area, and absolutely terrific!) who "doesn't see any reason whatsoever why I can't have a home birth." I'm still the same size, but I'm a different woman... I'm confident, I know my body can do it, and I'm looking forward to a great home birth!
Update: Maddy had her home VBA2C just recently! She had another girl, and this baby was 9 lbs. 11 oz. Below is her short version of the birth story.
I had labor off and on all week, so my midwife came Wednesday afternoon to see what we could do to get long and strong and steady labor. I agreed for her to strip my membranes, and things kicked in quickly then. From 7 p.m. to 1 a.m., I dilated from 5 cm to 9-10 cm. I would contract well for an hour or more, then they would slow down and I'd sleep for 45 minutes of so, with contractions spreading out to 5-10 minutes apart. Then my friends would get me up and get me back to work again.
I started pushing about 2 a.m., in the bathroom on all fours, then with one leg half on the toilet seat and me sort of crouching over, then standing....you name it, I tried it!! She was moving down but would NOT crown! My perineum is like vinyl, they said. ;-) She was "right there" for over an hour, and in spite of hot compresses and massage, she just wouldn't crown completely. So my midwife snipped (her second episiotomy EVER!!!), a tiny, tiny little snip, and let me tear from there.
I pushed her out slowly---her head stopped AFTER crowning, but before it was out, and I got a great look in the mirror, and FELT her head finish delivering!!! It was SOOOO cool!!! Then the rest of her came out, again with me feeling her descent and move out---one shoulder at a time...and then it was DONE!!!.....She nurses like a pro, and we're doing well.
Becky's Story (posterior, fetal distress, c/s)
Kmom's Notes: Classic malposition story. The baby's posterior position was discovered only AFTER the mom was fully dilated and pushing and the baby was firmly stuck; a posterior is difficult to turn at that point. Baby displayed some fetal distress (another possible side effect of malposition) but her apgars were good.
Birth Story
I was scheduled for an induction on Mon. the 27th and it looked like I would get in sometime in the afternoon, but I hadn't felt any strong fetal movement since Saturday so they had me come in for a NST. The nurse said that baby's heartrate should spike up when I had a contraction or when she moved but it didn't, so they admitted me at 10:00am and by 11:00 I was hooked up to the Pitocin (I was already dilated to 4 and 80% effaced) and boy, did it work quick!!
The Doc. was in and out checking the heartrate and seemed concerned about it enough to tell me that if it didn't pick up when she moved we might need to do a c/s. So, he put me on an oxygen mask for the whole time (yuk) and attached the internal fetal monitors. [Kmom note: Internal monitors means they must have broken the waters at this point if they hadn't already, which may have fixed the baby's position.] I almost came off the table it hurt so bad...she was still at a -2. Finally [the heart rate] started to go up like it should (whew!). He was also concerned about my BP, it was very low...85/40 average.
When the contractions got too bad to handle (about 2:00pm) the Doc. said I could have an epidural, and then all was good for a while. By 5:00pm I was fully dilated and ready to push....we pushed for 2 hrs. and by the end I kept telling them that it hurt really bad on my right side, the Doc. came checked me and said that she was face up and stuck firmly in my pelvis....so a c/s was our only option. I was very scared and upset, my mom and DH were in there with me and I made them both cry (I was a baby), they had my husband change his clothes and whisked me off into an OR.
The Anesthesiologist pumped up my epidural and we were prepped and ready at about 7:15pm, it felt like my doctors were going to yank me off the table but she was wedged in there pretty tight...it took them 7 min. to get her out after they opened me up. She was born at 7:28pm she weighed 8lbs 1oz and was 21 in. long, and her apgars were 9 & 9.
She looks like I took her to a salon to have her hair highlighted, it's auburn and red with blonde highlights in it. Everyone at the hospital told me how beautiful she is (and she is!!). Well, it wasn't the most wonderful experience but I would do it all over again if I had to. G is so sweet! Nursing is going well too, she's a pro at it....and she even started in the nursery on bottles and pacifiers, so if anyone says that you can't nurse with big breasts (mine are G cup) tell them to take a hike!
Lisa L's Story (induction, c/s)
Kmom's Notes: Lisa shows classic signs of a malpositioned baby: prodromal labor for a long time (including going overdue), back labor, feeling an urge to push too early, no progress in pushing despite strong pushing for a long time. The baby was also big, which could also have been or added to the problem, but it's difficult to know for sure what happen