VBA2C birth

Two weeks apart, I've had some marathon births.....both began on a Wednesday and finished up on a Friday.  Exhausting hours spent serving mothers who had a goal.  Keep birth as normal as possible within the boundaries of safety.

This week's momma came into my care in south Georgia.  First cesarean birth was for 'suspected' pre-eclampsia, which actually the labs did not support (I saw her records).  She was induced way before her body was ready and never dilated.  Baby in distress and emergency section.  2nd surgery was just because there were NO VBAC options in her area so she had a scheduled cesarean at 38 weeks.  This 3rd pregnancy, someone had told her about me.  She approached me just before I permanently moved to Atlanta.  After I settled up here, she continued to see me, traveling great distances once a month in order to achieve her goal.  Towards the end of the pregnancy, the distance made it difficult and expensive for me to monitor her but we did what we could.  Blood pressure crept up into a zone a few times that made me a little edgy, but we ended up running liver enzymes several times that gave us the assurance that it was not really pre-eclampia but just pregnancy induced hypertension.  Her blood pressure was monitored daily by a nurse in south GA and we also arranged for a consult with a perinatologist who is home birth supportive.  He agreed with me that we had time to wait for this baby to arrive on her own steam without our interventions.

So this past Wednesday night, mom's water broke about bed time (I'm learning that bed time for a midwife is a very subjective term).  I was called and they made plans to go ahead and drive up.  Upon arrival, it was obvious that somewhere between our phone call and the drive up, labor had begun.  Upon checking though, mom was still about 2 cms  We still had a long way to go.  Baby was posterior, meaning she was facing forward instead of facing towards the mother's back, which creates a situation where the head just does not put good pressure on the cervix, so you frequently don't get a lot of progress.  The mom had been seen by a local chiropractor who specializes in pregnancy issues and she made a series of house calls, one time staying for several hours to adjust, work with and support this mom in her attempt to achieve a vaginal birth.  At one point during Thursday night, we were able to get mom to sleep for about an hour and a half before contractions again picked back up and became painful enough to wake her.  That was the only sleep I got during the long ordeal also.

After that nap, when contractions picked back up and were very painful because of the back labor, and there were still no cervical changes for about 24 hours (3 cms) the decision was made to transfer in to a facility that would be able to offer her some pain management options, perhaps something to increase the intensity and frequency of the contractions and allow her to achieve her goal of a VBAC.

Our first choice hospital only had one practice that allowed VBACs and they turned her away.  To stay there would have meant a mandatory repeat section.  So we left there, still in labor and traveled to Emory. Our first choice physician there turned us down also, but then we learned that their staff OBs and residents there routinely do VBACs, even VBA2Cs.  They were extremely supportive, curious about her situation and they took her into the system.  I was introduced as her midwife and no one blinked an eye.  We had a bubbly, friendly, supportive RN who worked hard with my momma to help her get the birth experience she wanted.  It took an epidural and some pitocin to provide the pain relief she needed and for her to relax enough to finish the job, but the combination is just what it took for success.  We went in at about 5:30 AM and momma requested and got an epidural around lunch time.  Baby was born pretty quickly after that, at 2:16 PM.

Lots of tears in the room--momma, daddy, doula and me all knew the determination it had taken to achieve this moment and we were most grateful that it had happened.  Nursing has been going great too.

We are very grateful for a medical facility that offers this option for mothers with previous cesarean births and for the respectful way in which we were all treated.  It made this mother's dream come true.