Saturday, November 27, 2010

Andrea's Path to VBAC

I asked one of my friends to share her VBAC story and here it is! Thank you Andrea!

My VBAC Journey
I suppose my story begins with my first pregnancy. It was a healthy and normal pregnancy. My husband and I took a childbirth class which spent one entire session discussing Cesarean Section. I spent most of this session thinking about what I needed at the grocery store. I tuned out because I wasn't going to have a Cesarean Section. I was going all-natural. My prenatal care was with a group of OB's with an outstanding reputation. Towards the end of my pregnancy, one of the doctors told me that I may run into problems with cephalopelvic disproportion. (which turned out not to be the case...) My water broke late at night and I was already tired. As soon as I arrived at the hospital, my OB ordered a Pitocin drip, even though I was in labor and having contractions. After several hours of increasing amounts of Pitocin, I felt like my spirit was broken and caved and had an epidural. My labor lasted into the next day. I was finally fully dilated after 21 hours and began pushing while laying on my back. I pushed with all my might for THREE HOURS. During this time many strangers came in to "observe" it was really humiliating. My doctor came in periodically to bully me. She reminded me that the hospital policy was to only allow a woman to labor for 24 hours after her water breaks. After that she "had to have" a C-Section. I remember during a previous appointment (when the doctor mentioned that I should be prepared for a C-Section) explaining that I didn't want a surgical delivery and he explained that occasionally they obtain court orders to require a woman to have a C-Section against their will. Nice, huh? The baby crowned over and over again. My doctor came in and determined that the baby's shoulder seemed to be caught on my pelvic bone. There was never any mention of changing position or other methods to remedy this. She tried the vacuum three times. When this was unsuccessful she pushed the baby back inside me. To say this was uncomfortable would be an understatement. Then she announced that I was going to have a C-Section and told me to remove my jewelry. They wheeled me in, I was so defeated and sad that I asked not to be awake for it. The anesthesiologist told me that he could do that as soon as the baby was out. He also told me that since I had an epidural, that I would have some dreams. Well, it turned out to be hallucinations, HORRIBLE hallucinations. Thankfully, the procedure went well and the baby was healthy. A few hours later I woke up to find my husband rocking her next to me. I was overjoyed. After the next few weeks I battled post-partum depression, undoubtedly exacerbated by grief over the delivery. I felt a sense of loss, as if I had failed, less of a woman, and missed out on a right of passage. My wound did not heal well. I wasn't able to do much for a couple of months. I had to be driven to the OB's office every week for 6 weeks for the wound to be drained. I remember one night after nursing my daughter, I leaned over to the side of my bed to put her back in her co-sleeper and I dropped her because the pain in my abdomen was too much to bare. I quickly learned that although Cesarean Section is the most common surgical procedure in American hospitals, it is not to be taken lightly. It is a major surgery that leaves physical and emotional scars. When I became pregnant with my second child, I knew I didn't want to have another C-Section. I had moved to a much smaller town, one with only one hospital. Turns out this hospital has a "VBAC Ban". Don't get me started on this! There have been several challenges to the legality of these bans, but I didn't have the time, money, or energy to fight it. I received prenatal care from an OBGYN in a nearby, ironically, smaller town. She was one of the few doctors in the area who would attend a VBAC 'attempt'. After the first half of my pregnancy, however, I left her practice as she didn't seem to have the same goals as I did. VBAC was very important to me, as this was to be my last child and only chance to experience a natural childbirth. She treated me as if the idea was a novelty and at one point told me I had a "38% chance of successful VBAC." I often wonder what scientific formula she used to calculate these statistics. I got in touch with the local ICAN chapter...( International Cesarean Awareness Network) . The woman that I talked to was very understanding of my situation and recommended another hospital in another (much bigger) city. I wasn't too excited about driving an hour each way for my prenatal appointments. I was also uneasy when she told me the group was midwives. I had a vision of a women delivering a baby on a kitchen table, Little House on the Prairie style. I was so wrong, these women were professional, educated, and very sincere. They practiced in a very beautiful hospital next to a group of OB's. The technology they used was modern I and received similar care to what I would expect from an OB. These women just had a different approach. The focus seemed to be on letting birth happen and minimizing interference during labor. I AM SO GLAD I found them. I met most of them over the course of the rest of my pregnancy. By the end of my pregnancy, I felt at peace that whichever midwife was at the hospital when I arrived in labor, I would be in very capable, supportive hands. I believed that my vision for the birth was indeed their vision for my birth. They actually REQUIRED me to have a birth plan.
At one week past my due date, my water broke in the evening after dinner. We left for the hospital and arrived in the early hours of the night, it WAS a full moon, and everybody and their sister was in labor! They didn't have a labor room for me. I eventually got a better room. Progress was slow. My doula came and I got on the birth ball. Later in the afternoon, I got in the shower as the pain was intense and the only birthing tub was in use ...I never did get to get in the tub, even though that was the plan. The shower only helped for so long and it seemed as if there was no end in sight. I tried various positions and rocking in a rocking chair, but eventually decided to have an epidural. I wanted to see if I could go without, but it seemed obvious that I was in for another long labor. It was more important for me to have a VBAC than not to have an epidural...if that makes sense. Finally, at 1 a.m. the next morning, I was dilated and pushed for three hours. After this, they started some Pitocin to get labor to speed up. The OB's at this point came in and sort of threatened a C-Section due, which was stress I did not need. The midwives and my doula were taking care of me just fine, thank you very much....My midwife told me to "get really mad and push", which was easy to do. I tried lots of positions, but finally ended up reclined with my feet on the shoulders of my doula...poor thing had severely bruised shoulders at the end of it all! They could tell I was starting to lose steam and they pulled out the mirror, in which I could see my baby crowning and that was what I needed. I finally pushed out Fiona at 10:08. I can't really describe the feeling, but it certainly empowering. I felt so proud of myself. I had this internal dialog ever since my C-Section that I was somehow incapable of giving birth to my babies, and therefore, less of a woman and a mother. Now that I have been a mother for 5 years, I realize that mothering makes you a mother, not how the child came into the world. However, I am SO glad that I had this experience and wouldn't change a thing.

Tuesday, August 24, 2010

Helpful Pain Managment When Saying No to Drugs

I remember when pregnant with my first I often anxiously wondered how bad is this going to hurt. The thought of pain can be scary! No one can tell you exactly what it will feel like to give birth. It is different for every woman and even for every birth.

When I told people I was going the "natural" route with no drugs I definitely got different reactions. Obviously many not very encouraging with looks of disbelief as if it has never been done, to jokes about how I will change my mind once labor starts, a lot of "good luck with that," or how crazy I was to even try it. I was thankful for those who said "good for you!" Positive encouragement sure can go a long way!

Of course I wasn't going to go into it blindly. I was going to do research on "alternative" pain management. I knew having the right support from people around me would be key. I also knew I needed to learn techniques to help me relax. Being tense in labor will only make the pain more intense. I also decided to take a birthing class which would help me and my husband learn some of these techniques.

There are quite a few different types of birthing classes. These are not the generic birthing class that all hospitals offer. Sadly most of those focus more on how to be a good patient then on ways to actually help a women achieve a non-medicated birth. The most common classes are Bradley Method, Lamaze, and Hypnobirthing.

We decided to take a Bradley Method class. This style focuses more on the natural birthing process and involving active participation of the husband and is even also referred to as husband-coached childbirth. They teach you how a women's body works during labor and are taught how to work with your body to reduce pain and make labor more efficient. The class teaches relaxation techniques, and effective labor and birth positions and how the husband can really support the woman through it all. The classes offer relaxation practice and labor rehearsals. I remember at the time I felt pretty silly doing all that practice and role play but in the end I do think it helped a lot. Especially for my husband because when I was in real labor he remembered a lot of what we had practiced. These classes also cover everything else from nutrition, exercise, phases of labor and delivery, how to avoid episiotomies and c-sections but also covers what happens if you do need a c-section, circumcision, and breastfeeding.

I liked this method a lot because it really focused on how birth is a natural process and taught me how to trust my body. It helped me focus on working with the pain and learning relaxation instead of controlling the pain or ways to just distract from it. One thing I will always remember is how you look at the pain can really effect the way you handle it. If you think of it as pain like breaking your arm where it is just intense, continuous, with no reason or accomplishment it will be harder to work through it. But if you think of it as work, hard, intense, physical work that has a purpose, and a goal, and an awesome accomplishment and reward at the end, you will have a much easier time working through it. They even had us not call it "pain" because of all the negativity that surrounds that word, but rather "extremely hard work."

Besides taking a birthing class there are many ways to help manage the pain. I found it best in both my labors to use a variety.

Water is a great way to manage the pain. Using a shower helps a lot and you can also target the water on any specific areas of discomfort. To me a shower is just relaxing anyways. With my VBAC I spent plenty of time in the shower while sitting on a birth ball. My midwives gave me that excellent idea and it was very relaxing and helped with some discomfort. Along with the shower getting in the tub is another way to manage pain. What women doesn't find a bath relaxing anyway right? The water actually helps decrease the pressure on a woman's body, which helps eliminate pressure and discomfort and makes her more buoyant too.

With both my births I desired a water birth. I labored in a birth tub with my first child and I did really enjoy it. Unfortunately I never got my water birth since I ended up with a c-section. I again wanted a water birth with my VBAC but once again plans changed when right before getting in the tub while getting checked I all of a sudden felt the urge to push. So I never made it to the tub for that birth.

Another great technique that helps ease the pains is counter pressure. We learned about and practiced this a lot in our Bradley classes. It basically is just having another person using significant pressure against you in your specific area of discomfort. It feels especially good with back labor to have someone pushing pretty hard against the small of your back. I had a lot of pains in my upper thighs and hips and I needed someone to just push as hard as they could into my hips and legs.

Massage is also a great way to help with relaxation which in turn will help you cope through the work of labor. It might feel good to have someone massage your back, thighs, or hips. Make sure there is communication going on so the laboring mama is able to tell you where they need the massage and for how long and how hard.

Breathing and vocalizing techniques can help a women relax and focus on working through the labor. Breath through each contraction, don't hold your breath. Remember to use low sounds when vocalizing it once again helps your body to open up the way it needs to and not tense up. My midwives would remind me to keep my sounds low throughout my labor. I never thought I would really be very vocal in my labor but I found that making these low sounds actually did help me to work through the contractions.

Sometimes applying heat to areas of discomfort help ease the pains. A good thing to have on hand would be a rice bag or sock or even hot water bottle that can be placed on the areas of discomfort.

Don't forget to think about what type of environment would help you relax the most. Would it be helpful to dim the lights, have candles, aromatherapy, certain music, etc. For my first birth I spent time beforehand going through my CD's picking out the music I thought would be most relaxing. For me it really didn't make any difference. I actually didn't even realize they had turned on the music. But I'm sure these factors could be beneficial to many so it is something to think about.

Visualization is something else that can help prepare and help a women relax more in labor. We also did some visualization in our childbirth class. It can be helpful to visualize each stage of labor and how you will respond. I think it helps with the anxiety and fear of the unknown which when you get past those fears you are more likely to relax. I remember being encouraged to visualize my cervix opening, the baby moving down the birth canal, pushing the baby out and holding her in my arms.

A variety of birthing aids can be useful for labor pain management. These might include a birthing ball, squat bar, and of course effective birthing positions. I used a birthing ball with both of my labors and it really helped with the pain. I didn't have an actual squat bar but I used the end of a bed and a bed post to hang on to as I squatted. I hated squatting but at the same time it did help and I really did notice the benefits. Effective birthing positions are so important to help get you through labor and delivery. I found a variety of positions helpful and just movement in general was helpful to get through the pains. I will talk more about good birthing positions in another post. Women need to get off their back!

Red Raspberry Leaf Tea has been said to make labor quicker along with lessening the pain.

Acupuncture has been used by many who have said that this technique was helpful with the pain and increase relaxation during labor.

Saline shots are a good way to help with back labor. It is when an injection of saline is put into your lower back. This is also called a subcutaneous water block. It is supposed to last 90 minutes and can be repeated. My sister had extreme back labor with her first child and I remember watching her midwife inject the saline. She said it really did ease a lot of the back labor pain.

As you can see there are so many things you can try to help ease some of the pains with labor. Most likely you will need to try a variety of them and at different stages of labor as well. Also keep in might that what was helpful 5 minutes ago might not be helpful the next 5 minutes, and what you like will change over the course of labor too. The important thing is to listen to your body and be open to trying new techniques. Also remember that with each wave of painful contractions means you are that much closer to holding your precious baby in your arms!

I would love to hear from you what you tried during your labor and if you have any other good suggestions on pain management to share.

Monday, June 7, 2010

I'm back!

Ok, again I apologize for the neglect. Life is just getting in the way! :)

I am still just as passionate about helping women who have a desire to learn more about VBACs. I want all women to be informed about the birthing process.

That is one thing that has changed me since having my VBAC is just really becoming more informed about everything. I grimmace when I hear of people who just accept everything the so called "professionals" tell them without even doing research or questioning. And when I hear a woman say "well, I have to have a c-section with this one" there is just so much I want to ask and inform her of.

I would love to hear from you what led you to desire a VBAC and how did you make an informed decision?