December 12, 2010

Finnegan's birth, c-section after vba2c

My little guy is 2 months old today, can you believe it?  Being that it's his two month "birthday," I thought I should get to writing up his birth story.  I probably should have done it earlier, so things were more clear in my mind, but having a c-section after having a vba2c (vaginal birth after 2 c-sections) is a bit of an emotional journey.  And, of course, finding time with a newborn and three other kids isn't always easy!

Brief birth history- Dd1 was induced at 41 weeks at my insistence (I wanted induced at 40!  But 9 years ago they made you wait :) )  I was very young, only 18, and knew very little about birth.  I was induced with cytotec, which caused intense contractions that hyper-stimulated my uterus and was causing her distress.  And so after 9 hours, with her worrisome heart tones and a total lack of progress (I did not dilate at all and only effaced a little bit) I had a section.

I got pregnant with dd2 3 years later.  I basically went to the other end of the birth spectrum.  We started out at a birth center, but halfway through they decided not to do vbacs there anymore, and so we decided to have a homebirth with a midwife.  There's so much to this story that I can't do justice in brief, but suffice to say, it did not go well.  After days of agonizing pain my labor was stalling and her heart tones were getting worrisome.  We transferred to the hospital and by the time we got there her hear rate was very bad.  They did a c-section and she started having seizures immediately, and was whisked off to the NICU.  She spent two weeks there.  It was an awful experience.  Long story short, she had suffered a stroke that caused serious brain damage, and she's permanently disabled as a result.

So with dd3 I was very torn on what to do.  Although I support the right of other women to chose homebirth, after our experience it was not something I would ever chose again.  Luckily I found a great OB on my first try, and had an easy, natural vba2c in the hospital.  It was so nice to be the first one to hold my baby, especially after the pain of not being able to hold dd2 until she was 5 days old!  And the recovery was so much easier, I was shocked at how great I felt after she was born.  Honestly, after how easy her birth was, I fully expected that any more children I had would be vaginal!

So back to my little man.  First, I think it's important to talk about how emotionally difficult pregnancy after loss is.  I thought that once I passed 16 weeks, when I miscarried Dominic, I would relax and be okay.  Well, it wasn't that easy.  If anything, my fear and anxiety was worse.  I spent most of the pregnancy terrified that I was going to lose him, and the closer I got to my due date, the more afraid I was.  The online "pregnancy after loss" group that I posted to was a blessing in many way, but it also terrified me.  So many of the women in that group had had full term stillbirths.  It made the fact that there are no guarantees that much more real to me.  Praying and trusting God were so hard!  But what can you do but keep going?

When my blood pressure spiked at the end of my pregnancy with Finn I was definitely worried.  I've never had blood pressure problems, my blood pressure has always been pretty low (normally around 105/65).  Even during my 2 hours of pushing with dd3, my bp never went over 120/80!  (I vaguely recall one of the nurses commenting on this, but I was pretty focused on getting her out!)  When I went in that Monday, October 11th, for my check up after 4 or 5 days of bedrest, my OB said that my bp was stable, the bedrest was working, and I could continue on.  But, I asked to talk about induction.  Boy, was she surprised!  She was the same OB I had had for my vba2c, and I had be very adamant about not inducing, and had gone into labor naturally 10 days after my due date.  But I talked to her about how nervous the blood pressure issues were making me, and how I didn't really feel like carrying on now that I had reached my due date, plus the fact that dh had already had to take a week off of work while I was on bedrest and couldn't take much more time off of work.  She preferred Friday, because she would be oncall Saturday.  Dh preferred that night, and so did I, but only because the on-call for that night (Dr. G) was the same OB that had been on-call when I miscarried Dominic.  She was a very sweet doctor, and it just seemed right to have her start the induction.  My doctor, Dr. S, guessed that the induction would take a couple hours longer than my last birth, which had been 12 hours long.  So, I figured that if I didn't deliver that night with Dr. G, I would deliver in the morning with Dr. S.

So we went home and got every thing ready, called my doula, J, and arrived at the hospital at 3pm.  L&D was VERY busy; one of the nurses joked that there must have been a snowstorm 9 months before!  The induction didn't get started until almost 8:30.  Because of my previous c/s, Dr. G started the induction with a folely bulb, which is basically a little ballon they insert up against your cervix.  Once you dilate to 3cm, it falls out.  This basically "ripens" the cervix in a safe way for vbac moms (the medication they give non-vbac moms to do this can cause increase the risk of uterine rupture).  When they had hooked me up to the monitor, I was already having mild contractions, and when Dr. G inserted the bulb, she said I was already 2cm, -1 station, and about 60% effaced.  Dr. G was optimistic that the folely bulb alone might put me into active labor without needing pitocin.

Dh, doula J and I chatted for awhile, then around 10:30 we decided to try to sleep.  Sometime after midnight I woke up and realized the foley bulb had fallen out, yay!  The nurse called Dr. G, who checked me; 4cm and -1 station still.  My bp looked good and I was still having mild contractions, so Dr. G decided to hold off on the pitocin and break my water to see if that would get my labor going.  The contractions did pick up, but still aren't terribly strong, so at 3am they started a pitocin drip.  Because of the previous c/s, they were very cautious, starting it at 1 and increasing by 1 every 30 minutes.  I labored on throughout the night, and around 9am the next morning, a nurse checked my progress (I think I asked her to, but I don't remember for sure!)  I was disappointed to hear that I was still 4cm and -1, no change in effacement.  Because of the IVs I couldn't get up and walk, but the nurse brought me a birth ball.

 Tyson being silly, putting my socks on while I bounce on the ball!

I bounced on the birth ball for over an hour, but felt like my contractions were getting weaker.  The nurse looked over my strip and agreed, checked me and said I was still 4cm and -1, but thinned out to 75%, which was a little encouraging.  My bp went up some from being on the birth ball, so I rested in the bed.

Around noon is when Finn started having some post-contraction decels.  His heart rate had been consistently around 145, dropping some during contractions, as it's supposed to.  But heart decelerations *after* contractions are worrisome, and with this one he dropped down under 110.  I rested for awhile longer and then got back on the birth ball to try to move my little man down; I knew I need the pressure of his head against my cervix to keep things moving!  Unfortunately, we just couldn't get him to stay on the monitor while I was on the ball this time, so had to get back into bed.  Not long after that Finn had a big post-ctx decel- down to 73.  It was so scary to listen to.

The contractions were getting more painful.  I "vocalized" (a nice way of saying "moaned!") through them and asked for a shot of Nubain (I love Nubain!)  It took the edge off and let me relax and doze off in between contractions.  My contractions were getting irregular, but I kept laboring and dozing.  Around 3:30pm Dr. S checked me.  I was 5cm, but he had moved UP to -2 station!  Dh was ready to talk about c/s, but I was willing to keep going, and Dr. S really wanted me to deliver vaginally because my water was broken, and a c/s after your water has broken increases the risk of infection.  She said my cervix was just not ripe enough and it's going to be a long labor.  Finn's post-contraction decels are worrisome, but not serious yet, so Dr. S suggests "rehydrating" my uterus to give him some cushion, because his cord may be getting compressed.  I got my second Nubain injection around this time, but it wasn't as nice as the first one; it just made me nauseous!  Dr. S doesn't like moms with broken waters to have very many vaginal exams, so she tells the nurses not to check me for 5 hours, unless it looks like I'm getting close.

I was starving, I hadn't eaten in over a day.  I got some chicken broth and jello and felt so much better!  But after a couple of hours I was getting hot flashes and having a lot of nausea.  I remember getting Zofran when I was nauseous from the morphine they gave me during my miscarriage, so I requested some at 6pm.  Around 7pm I decide to get an epidural so I can sleep, assuming it's still going to be awhile before my guy shows up.  I told doula J to go home and get some rest!  I got the epidural, which, for the record, I HATED.  I don't know if he gave me an extra strong dose or what, but I could not feel my legs at all or move them, and it freaked me out.  I much preferred the pain of labor! I asked the nurse to call the anesthesiologist back in to turn the dosage down. While we were waiting for him to show, the new on-call OB, Dr. R, came in.  (He had come in before around 4pm, I think, but I don't remember for sure).  He checked me, and again, no progress.  By now it had been over 24 hours, and my little guy was not interested in moving down and out.  Dr. R suggested a c/s, and I agreed.

I have to admit, I was fighting back tears while they were prepping me.  I knew it meant I would never have another vaginal birth.  (I have no desire to vba3c).  But nothing mattered more to me than having Finnegan safely in my arms, and I felt like he had his reasons for not wanting to move down.

I'm not sure how long the surgery itself took. I know they took me back around 9:30 and he was born at 10:21pm.  I think it took them around 20 minutes from the first cut to get him out, due to all the scar tissue from the two c/s and the ectopic repair surgery I had.

I don't know how long it took him to cry, but it seemed like forever.  He had a lot of "gunk" they had to suction out.  I hated not hearing him cry.  I was having flashbacks to dd2's birth, and dh kept asking over and over if he was okay.  Finally, he cried, and it was so beautiful to hear!  Once they got him suctioned out he was doing well.  Dr. R was having a bit of a hard time with my uterus.  He said the lower segment was "paper-thin" which made it difficult to suture back together; it was basically disintegrating as he tried to sew.  I lost a fair amount of blood (you can see a big splatter of blood on the drape in the very first picture; not what you want to see during major abdominal surgery!)  I was pretty out of it from the medications, and I kept "forgetting" to breathe, so every once in awhile I would black out and then hear the anesthesiologist yell "breathe!"  Scary!

They brought Finn over to me before they took him to the nursery, he looked so much like his sisters!  He was so beautiful, and I was so happy to have him here, finally!  Unfortunately I had to tell them to move him away before I threw up on him, I was still so nauseous.  I threw up some and they gave me more Zofran, even though I think they weren't supposed to because I had had some earlier (oops!)  I'm not sure exactly what time they took me to recovery, but I think it was around 11:30pm.  Doula J met me in recovery, she was great!  She had snapped some pictures of dh and Finn in the nursery to show me.  She was good company!  I wanted my baby but I was still pretty out of it and wouldn't have been able to hold him.  Every once in awhile the nurse would ask me to wiggle my toes, and I kept saying "I can't move my legs, I'm trying!" and she would say "but you are moving them!"  I couldn't feel it, though!  Like I said, not being able to feel/move my legs really freaks me out.  I kept asking the nurse if I was going to be paralyzed, lol!  She was nice and re-assuring.

The finally took me back to my room around 12:30pm, and doula J went down to the nursery to tell them I wanted my baby!  I was feeling much better and more alert by then, I was so happy to see him.

He was still very alert and eager to nurse, thankfully!  I noticed he sound very congested and asked the nurse to check him out.  She ended up suctioning out a ton of "gunk" that he still had in his lungs!  She was shocked he had so much left after all the suctioning they had done right after birth.  But all was well :)

I won't lie; having a c-section after a successful vbac is disappointing.  I admit that I'm jealous of women who have easy vaginal births.  It doesn't seem fair!  If I'm being "good" by being open to life, shouldn't God cut me slack and reward me by making it easy?  But, that's not the way it works.  Submission to God isn't conditional!  So, I'll bear my cross.  It can't be that bad anyway, can it?  Major abdominal surgery isn't fun, for sure, but three times I've gone through it and three times it's brought me beautiful children that I'm eternally grateful to God for.

I never have felt like my c-sections made me less of a woman, or that having a vaginal birth made me a "real" woman.  I never really understood what that was supposed to mean, anyway.  Does that mean women who never have children aren't "real" women?  Of course not! I don't think about my children in terms of their births, the vbac baby and the c/s babies.  They're just my children.  They all had their own journeys, some easy, some hard.  I've always resented the notion that only a certain type of birth is allowed to be beautiful and sacred.  No matter what it looks like, birth is beautiful in its own way.  We women who are blessed to carry children in our wombs are blessed even more so because we're intimately invited into the act of creation in a way that our male counterparts are not.  How amazing it is to carry another immortal soul within you!  Birth is the culmination of that, the beautiful but bittersweet moment when the body that houses that soul is brought into the physical world.  Each birth is perfect to me because it's the one that brought me that baby, I could never regret it!

ETA- I totally forgot to add that when Finn was born, he had a "true knot" in his cord!  True knots aren't always a problem, but they can be.  We figure that was why he was having post-contraction decels in his heart rate- it was tightening the knot!


P3 said...

What a beautiful birth story!!! And hey, you beat me by a lot. Mercy's story STILL isn't written in full. I did a placeholder one, but the real story is so much longer, so much more in depth than I could write quickly.

I'm so glad that everything worked out the way it needed to, and I will pray for your peace going forward from this birth. And Finn is ridiculously cute! :-D

ccc said...

I LOVE birth stories! I also like your pictures. So good to hear of good outcomes after pregnancy loss. I also love your input about type of birth/being a woman. I too have had a C section and then vaginal births at home and at hospital. The only important factor is a healthy baby--I know it's a cliche, but it's so true!

Angela said...

I "dislike" ;) that some moms that can have easy vag births and me, sister, do not have that easy path. My pattern was stillbirth (vaginal, transverse at 33 wks), c/s for fetal distress (b/s but let's move on), vbac and then a c/s (same as you...really high b/p, induced, c/s for really bad malposition...and then they found out I was mid-rupture).

And, yes, you did get it down on paper. Not easy to do...especially when the outcome isn't what some might "want to hear". We are not the textbook successes...but we live, we celebrate our children and what we survived to have them. All the best.

Rightthinker-Andrea said...

Thank you so much for sharing your birth story! I appreciate the fact that not all birth (or pregnancy) is easy...and whether or not the natural birth community wishes to admit it, cannot always be "natural".

You indeed have a healthy baby to show for it, and therefore, his birth was remarkable and miraculous!

I've experienced an array of differences in my pregnancies and births-so I relate to your sentiments...Praise God for your beautiful boy arriving safely!

God Bless!

Katie said...

Thank you! And I totally forgot to add that Finn had a true knot in his cord, which was probably what was causing the post-contraction decels!