Hospital Birth | VBAC | Durham,NC
Amanda and Adam hired me partway through their second trimester. They had just moved here and wanted the support a birth doula could provide during labor and birth. Amanda had a cesarean section with her first daughter, due to her being breech. She really wanted to have a VBAC (vaginal birth after cesarean) this time. She worked hard to prepare herself for a successful VBAC. She researched and went with a care provider, Women’s Health Alliance Midwives, that had an awesome VBAC success rate. She took the VBAC preparation class that I teach, as well as, hiring a doula.
Amanda’s due date was May 24th, but babies rarely ever pay any attention to due dates. That day came and went. Amanda and Adam were very anxious to meet their baby. Amanda also hoped to avoid an induction. The midwives recommend being induced at 41 weeks with a VBAC. As 41 weeks approached, Amanda requested to push the induction back a few days. She wanted to allow for a few extra days in hopes that labor would start on its own.
Beginning on Wednesday, June 1st around 4:00am, Amanda woke up with contractions. She sent me a text around 7:00am to let me know that they had been happening about every 10 minutes for the last 3 hours. I told her I had my fingers crossed for her that it was early labor. I told her to make sure to eat and stay hydrated, and to just take it easy and rest to conserve her energy. She said she had a peanut butter and banana smoothie, and that she had an appointment with the midwife already scheduled for 11:45am. At 8:10am, Amanda let me know that contractions were getting a bit closer together, but were still fairly short. At 11:30am, she mentioned that contractions had spaced back out some and that she was heading to her appointment.
At 1:30pm, Amanda updated me on how her appointment went. She said she was 3 cm dilated, but that her cervix was still very posterior. The midwife did a non stress test, and all looked good. Since Amanda and the baby were healthy, they cancelled the induction and scheduled an ultrasound for that Friday, if Amanda was still pregnant. I suggested that she eat a good lunch, go home, take a nap, and then try a few things to get labor to pick up. She agreed. Around 4:00pm, Amanda let me know that contractions were all over the place. Some were 15 minutes apart and some back to back. We discussed how the baby might be posterior and different ways to help with that. We came up with a plan, and Amanda said she’d check back in that evening, if things didn’t pick up before then. At 7:30pm, Amanda let me know that things were still stalled. She said she was going to go on a walk and do some squats, and if nothing changed, then she’d head to bed early and get some sleep. I told her I thought that was a good plan.
The next morning, on June 2nd, Amanda let me know that things were still the same. She said she planned to go swimming and that she had both a chiropractor and acupuncture appointment that afternoon. Around 6:00pm that night, Amanda let me know that contractions had started back up again. They had been coming every 15 minutes for the last hour and a half. Around 11:00pm, she let me know that contractions were still 10-15 minutes apart, but they had gotten much more intense and were lasting for about 2 minutes. I told her that I knew she didn’t want to hear this, but that sounded more like a prodromal labor pattern to me. I suggested she take a warm bath and drink lots of water, and then try her best to get to sleep.
On Friday June 3rd, around 5:00am, Amanda sent me a text to tell me that the bath had helped to slow things down a bit, and that she was able to get a few hours of sleep, but the contractions did end up picking up again around 2:30am. She said they were now happening every 7-10 minutes and lasting about a minute to a minute and a half each. She also mentioned that she lost her mucus plug. I told her that sounded like a much better pattern, and to continue to try to rest until contractions got much more intense and closer together. She mentioned she was having trouble lying down through contractions. I told her that was normal and suggested trying the exaggerated Sims position. She tried this and managed to get some rest. Around 8:30am, she let me know that she was going to get a bath and had sent Adam to the store to get more bananas for a smoothie. She also mentioned that her appointment that day was at 3:00pm. Around 12:00pm, Amanda mentioned that things were feeling much more intense. I told her I would get a shower and head her way. By the time I got out of the shower, Amanda said that her contractions seemed to be spreading back out again, and that it had been 20 minutes since her last one. I told her since things had slowed down, then I would hold off on coming to her, but to let me know as soon as she needed me.
Amanda went to her appointment at 3:00pm. She updated me on how it went. Her cervix was about the same, and the doctor suggested grabbing some dinner and then heading to the hospital. At 6:00pm, Amanda sent me a text to let me know that she had been admitted, and that they planned to break her water in order to help things pick up. She asked that I come out there. I arrived at the hospital around 7:30pm. The midwife on call, Mary Ellen, broke Amanda’s water at 7:00pm. Amanda wanted to try this before pitocin to help pick things up. Contractions were still very spaced out. We decided to alternate walking around the labor and delivery floor, squats, and sitting on the ball to try to get contractions to pick up. We did this for about two hours. At 9:30pm, Mary Ellen came in to check on Amanda. She also suggested maybe trying to start some pitocin to get contractions more regular. Amanda decided to take a 30 minute cat nap before making a decision. During this time, contractions really started to pick up, and they were occurring every 2 to 3 minutes. She got up and sat on the ball for a while. I applied heat to her back, and did hip squeezes during contractions. Then she walked around the room, and got on hands and knees.
At 11:30pm, Amanda decided to try the shower. She stayed in the shower about 30 minutes. Contractions were still about 2 to 3 minutes apart and very intense. We set up the bed in a way that she could be on hands and knees, but rest her head on the peanut ball and pillows in between contractions. This was a really great position for her and worked well for a while. At this time things also began to intensify more, and Amanda began making deep moans during contractions. At 12:30am, Amanda began to have a small urge to push. About an hour later, she decided to change positions and lie on her right side for a while, in an attempt to rest. At 2:30am, she got up to use the bathroom, and then when she returned to the bed she decided to do hands and knees again, while lying on the peanut ball.
Around 3:30am, Amanda was beginning to feel the urge to push intensify, so Mary Ellen came in to do a cervical check. Amanda was 6 cm dilated and 100% effaced, but her cervix was beginning to swell some due to her involuntarily pushing. Mary Ellen advised her to resist the urge to push, because it wasn’t yet time. After this Amanda got in the shower again to try to help with the intensity of the contractions. While she was in the shower, Adam stayed next to her and sprayed her back with warm water. Around 4:15am, Amanda got out of the shower and said she’d like to get something to help with the pain. Mary Ellen and the nurse came in and discussed with Amanda her options for pain relief. After a lot of discussion and inquiring about benefits and risks of each, Amanda decided to get an epidural. We all supported her in her choice. She was so very tired after being in labor so long. Before she could receive the epidural, she first had to get a bag of IV fluids. She leaned on the bed during this time, and would sway her hips and make deep moans during her contractions. Adam and I would apply heat and counter pressure to her back and hips. She worked through each contraction so beautifully.
Finally around 5:00am, the bag of IV fluids was done, and the anesthesiologist came in. He was a very nice and friendly doctor and did an amazing job administering the epidural. It started working fast. Amanda still had really good range of motion, but she was no longer feeling the contractions. By 5:45am, she fell asleep and got a well deserved nap in. Adam fell asleep on the couch, Amanda’s mom slept in the rocking chair, and I put some blankets down on the floor and slept. We were all exhausted. After a few hours, it was time for the midwives to change shifts. Leigh Ann was the next midwife on call. Around 8:30am, she came in to talk to Amanda and check her cervix. Amanda’s cervix hadn’t changed much. She was still 6 cm dilated. Her contractions had also spaced out a lot. Leigh Ann suggested maybe trying a little bit of pitocin to get the contractions to pick back up again. Amanda agreed. They started the pitocin, and contractions began to come more frequently.
Around 10:15am, the baby’s heart rate began to drop and was not recovering. The nurses came in the room, as well as, Leigh Ann and the OB on call, Dr. Schreiber. They put oxygen on Amanda and moved her from side to side to see if they could get the baby’s heart rate to come back up. Leigh Ann did a quick check at this time, and found that Amanda was 9 cm dilated, and that the baby had come down significantly to a +1 station. Leigh Ann felt that the sudden drop was the reason the baby’s heart rate went down, but did advise they needed to get it to come back up, or Amanda would have to have a repeat cesarean. Leigh Ann suggested Amanda try hands and knees if she had enough mobility. She did, and she got back into the position she had felt most comfortable laboring in prior to receiving the epidural, hands and knees, leaning and resting her head on the peanut ball. Immediately, the baby’s heart rate went back up. Evidently, the baby also really liked that position. She stayed perfectly happy the rest of the time!
At 11:20am, Amanda was beginning to get tired again, and wanted to try and nap. We helped her to flip over to her left side and sleep that way for a while. She napped, and ate a popsicle when she woke up. Then at 2:05pm, Leigh Ann came in again and checked Amanda’s cervix. She was completely dilated, and the baby was very low at a +2 station. It was time to push! Amanda and Adam were so excited. Amanda had waited so long and worked so hard for this. She began pushing and the baby began descending fairly quickly. I applied cool cloths to her head and neck. Amanda’s mom and Adam stood by her side encouraging her. As the baby was coming down, Leigh Ann commented on the color of her hair. Amanda and Adam were shocked that she had hair at all! Once the baby was crowning and half of her head was out, Leigh Ann grabbed Adam’s hands and guided him into helping the baby emerge. Then as her shoulders came out, Leigh Ann, told Amanda, “reach down and pull up your baby to your chest.” Amanda did, and it was such an amazing, beautiful moment. She was in awe of her baby and what her body just did. Everyone was in tears. She did it! She got her VBAC, and she certainly worked so hard for it! It was an honor to be there as they welcomed sweet Caroline into the world <3
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