Wednesday, January 30, 2013

My Birth Story - Part 2




 Having a Natural Unmedicated Childbirth After a Cesarean is Possible 
 My Personal Journey

             
My Quest for a VBAC


Never Quit. Stick to the fight when you’re hardest hit.

     This was my motto in my 7th grade yearbook (and that was ages ago!), but I still hold this saying close to my heart because I believe failure shouldn’t stop us from trying. It should just make us want to try harder.
     My first childbirth experience was not exactly a complete failure – because I received my reward - a beautiful baby who was perfectly healthy, and that I am thankful for. But my method of delivery and the process that led to it made me feel that I could have done better. It wasn’t my desired outcome and how I wished then that I could go back in time to change things.
     I am glad though that I already knew about VBAC (Vaginal Birth After Cesarean) even though having a C-section usually places women at a dead end. We are often led to believe that the saying “once a Cesarean, always a Cesarean” holds true. But we need to find out the facts first and see if this indeed applies to us. It may for some, but surely not for all.
     During my first pregnancy I had read about VBAC in passing. I wasn’t expecting to end up having a C-section so I thought I wouldn’t spend my time reading up on it so much. But I knew what it was about. And my curiosity just grew as soon as I came home from the hospital after giving birth to Audrey.
     When I had some time on my hands, I would read up on what went wrong with my childbirth experience and what my chances were on having a VBAC. It was quite a challenge trying to learn all this since I lacked sleep and was very preoccupied with the new baby, but I had to make an effort. I was so convinced that I really could have had a normal birth and I wanted to bring up the possibility of having a VBAC for my next pregnancy to my doctor during my postpartum checkup.
     I began my research by looking through my operating room notes from the hospital. The pre-operative diagnosis stated that there was an Arrest of Cervical Dilatation secondary to Uterine Dysfunction (Incoordinate Uterine Contractions) – meaning my cervix failed to progress dilating because my contractions were not synchronized. Apparently, labor induction can cause abnormal uterine contractions that not only fails to do the job of dilating the cervix but also results in prolonged labor (aha! sounds familiar).

     Check out a section in this book by P. McCall Sellers - Midwifery, Volume 2 about Disordered Uterine Action and Augmentation of Labor:

"...The intensity, the rate and the duration of the uterine contractions are irregular and the contraction wave is uneven and does not reach all parts of the uterus simultaneously. There is often also a raised resting tone. This type of uterine action results in uneven and painful uterine contractions, which are ineffective in dilating the cervix and therefore cause prolonged labor.”

      And a C-section has an increased chance of happening in first time mothers (like I was), especially if the induction is done before the baby and the cervix is ripe and ready. Studies show that this usually happens if induction is done before 39 weeks.

 “The American College of Obstetricians and Gynecologists (ACOG) reports that 20 percent to 40 percent of labors are induced—a number that, along with C-section rates, has doubled in the last decade. A 2005 ACOG study determined that inducing first-time mothers was directly associated with an increased risk for C-section: The rate was 12 percent for spontaneous labor, 23.4 percent for medically indicated inductions and 23.8 percent for elective inductions.”

- From an article published in http://www.fitpregnancy.com/labor-delivery/labor-delivery/truth-about-induction-0 by Jeanne Faulkner, R.N., a labor and delivery nurse and mother of four in Portland, Oregon

     If you were able to read part 1 of my birth story, the first reason why I think I could have had a normal birth was because my labor was induced for no apparent reason. It was just done upon my doctor’s recommendation which I should have questioned then (lesson learned!). And because labor didn’t start naturally, I was convinced the outcome would have been different if it did.
    Second, I knew I was a good candidate for a VBAC because my C-section incision was a low transverse cut (bikini cut). So the risk of uterine rupture was significantly lower. (And no, it does not mean your uterus will explode – there is just a possibility that the scar will separate and tear during labor or birth, causing bleeding and shock, and an emergency surgery will be needed). I know it sounds a bit scary or even dangerous, but I chose to focus on the benefits rather than the risks. After all, it occurs rarely and in only less than one percent of women laboring for a VBAC based on reports by the National Institutes of Health Consensus Development Program. I just prayed I wouldn’t fall under the one percent who would actually experience it.
   When I finally went for my postpartum checkup and asked my doctor then what my chances were for a VBAC for my second baby, I was told that I failed to progress because I had CPD or Cephalopelvic Disproportion - meaning my pelvic bones were too small for a baby to fit through them. So that meant that I cannot have a normal birth and my only option was to have a repeat Cesarean. 
    I didn't want to accept this diagnosis because as far as I was concerned, there was no actual proof that my pelvic bones were too small. I didn't even fully dilate to 10 cms during the birth and attempt to push the baby out. If I did and Audrey didn't fit, maybe I would have believed it. I have also read that only a very small percentage of women actually have this condition, and yet it is a very common diagnosis nowadays. A pelvic xray or a physical examination that measured pelvic size was not done either to confirm that I had CPD, so there was just no way to prove this.  This was the third reason why I believed that I was a good candidate for a VBAC - there simply wasn't enough evidence to pin me down to a repeat Cesarean.

 I continued to research and read about successful vaginal births after a Cesarean section,
and it just encouraged me to try it the next time around.

     It was then less than a year and a half after Audrey's birth when my husband and I were pleasantly surprised with another pregnancy. Prior to this, I had already asked for a second opinion from another ob-gyn during a general checkup about my chances of having a normal birth the second time around. This doctor said I cannot do a VBAC because of the arrest of cervical dilatation that happened during labor. According to her, it would be difficult to try for a VBAC because I already failed to progress before. She also requires a waiting period of three years before trying for a vaginal birth after a C-section.
     And even though Doctor no. 1 and Doctor no. 2 had already told me that what I wanted wasn’t possible - at least in their opinion – this didn’t stop me from choosing to attempt a VBAC. I just focused on my goal and hoped to find a doctor who would be open and willing to help me.
     So as soon as I found out that I was pregnant again, I decided to go to yet another doctor to get a third opinion. This doctor also was not sure if she could help me with trying for a vaginal birth this time around because she was concerned with the failed induction the first time. She said an arrest of cervical dilatation will lessen my chances for a successful VBAC because I already had a trial of labor and it failed. It was pretty much the same answer every time - which was a no, but I wasn’t about to give up. There has got to be a doctor out there who thinks differently and actually knows that a VBAC is indeed possible with me.
     I did not stop looking for an ob-gyn who would be open to my birth wishes because I knew in my heart that I could do a VBAC, and all the information that I was able to gather while reading backed it up. And thank God the fourth doctor I went to was open and very positive. She was the fourth reason why I knew that a normal birth for me was possible. She only required one year after the previous C-section before getting pregnant in order to perform a VBAC. And when I relayed the reasons for my previous C-section, she said that one pregnancy or birth is different from another. What happens during delivery in each pregnancy will not always be the same.
     When I asked about induced labor as compared to natural labor, she said that they are very different from each other and yield different results. And because I only dilated up to 5 cms then and didn’t have a chance to push Audrey out, there really was no actual proof that a baby wouldn’t fit through my pelvis. (In my mind I thought - Exactly! - it felt good to actually hear this from a doctor at last!).
    I loved the fact that my operative notes did not give this doctor a worried look or make her say that it’s not possible. It seemed as though what was written on it practically didn’t matter anymore. I was so relieved and excited. Finally!!!
     And though it still wasn't a hundred percent sure that my attempt to do a VBAC was going to be successful, being given the chance to actually try for a natural birth was good enough for me. And you guessed it - I decided to stay with this doctor and I am so glad that I did. 

     Join me next time as I share about my second pregnancy and how I was able to successfully labor without anesthesia.


References and Links that you might find interesting:

About VBAC:

About Uterine Rupture:

About CPD:

About Labor Induction:


4 comments:

  1. oh i am so excited to read the 2nd part of your story. I also undergone CS from my previous ob , now with my second i want to try VBAC. please help me how to do it naturally. will it cause too much pain ba? Can I get the name of your doctor as well.

    Thank you

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    Replies
    1. Hi charmie! Kindly send me an email at thedailyaudrey@gmail.com so I can get your email ad :)

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  2. Congrats Cecil on successfully doing VBAC! I have similar experience as you with my firstborn. I'm aware of VBAC but I didn't know anybody who have tried doing so. This is a very encouraging post! Wish we were able to talk before I gave birth the 2nd time too!!! I wonder what would've happened. Keep on blogging. Love your posts. - Evelette

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