I had my first c-section on March 2nd, 2007 after an induction led to hyperstimulation of my uterus causing fetal distress in my daughter. She was born healthy and beautiful by cesarean, but tiny weighing only 4lbs 15oz. Supposedly I was 41 weeks pregnant. Her placenta showed no sign of deterioration, was a normal size, and appeared to have adequate blood supply. What could account for her size? How about I probably was more like 38 or 39 weeks? I didn’t discover my pregnancy until I was perhaps eight or nine weeks, putting me just outside that window where the early dating ultrasound is highly accurate. An excellent example of why consenting to an induction without a medical reason is not typically a good choice. A low birth weight baby and a cesarean are good reasons to wait for your baby to be ready.
When I became pregnant again, I went to my first prenatal appointment certain that my doctor would be supportive of my wish to have VBAC (vaginal birth after cesarean). She told me no. When I came home I sat down with my laptop, phone, and the Yellow Pages and called every OB I came across. It seemed they either did not accept my insurance or did not accept VBAC patients. Not to be deterred, I gathered my research on the safety of VBAC and presented it to my OB. She said, “Well, a repeat c-section isn’t a big deal unless you want like five kids or something.” I explained I wanted four. She reluctantly agreed to a trial of labor if I began labor on my own before 40 weeks and my water did not rupture prematurely as she would not use Pitocin. At my 39 week appointment, she scheduled my c-section on the day I would turn 40 weeks. I drove home crying the whole way. The next Monday, I gathered my courage, called her, and asked for just 3 more days. She told me “no”. My c-section was performed on July 14th, 2008. A beautiful 7lb 14oz baby girl was born!
During the next couple years my disdain for my birth experience grew instead of abating. I became angrier instead of more at peace. I did not want another pregnancy unless I could find a doctor who would just give me a fair chance. I didn’t expect promises or guarantees, just honest support and evidence-based birth practices.
One afternoon my husband came barging in the kitchen and cranked on the radio. It was a WSB news report on ACOG’s revision of VBAC guidelines. They officially considered a trial of labor after two cesareans to be a safe choice.
My husband was not supportive of me leaving my provider after my first c-section but this new news changed his mind. Why choose a doctor who is clearly not willing to practice evidence based medicine? After several months of trying to conceive, I had a consult with Dr. Joseph Tate. Three months later, I was pregnant. Five months later, we discovered I was carrying triplets.
Now I had a huge decision to make. There is no data regarding triplet VBA2C (vaginal birth after 2 cesareans) success rates or uterine rupture rates. There was an excellent twin VBAC study that I regarded highly and could only extrapolate that I had an extremely low chance of rupture, but only a marginal chance at success. Rupture rates among twin VBACs are quite comparable to singletons; success rates, however, are… let’s just say not great. I would try anyway. I carried my babies to 37 weeks and 4 days before an induction became the option my doctor and I both felt most comfortable with.
I arrived at Emory University Hospital Midtown for my induction at 7:30am on March 12, 2011. Doc T was taking forever. Finally, a nurse told me he was stuck in an interdepartmental meeting regarding my birth. We finally saw him around 10. We found out there was an issue, but we didn’t know what it was. Finally at 12:30 after again acknowledging for everyone involved the risks associated with VBACing, I found my voice, and said “I’ll be VBACing today.” I signed another consent form agreeing to a section should it become necessary (DUH…like anyone would choose a dead baby over a section). I felt like a warrior. I was getting my VBAC.
So after all the poking, monitoring, and fluid administering the Pitocin began around 2:30 am. At first it felt like my first labor; felt the cramping but no big whoop. Then as previously agreed upon, Doc T checked me, ruptured baby A’s water, attached a heartrate monitor, an amnio infusion tube, and an intrauterine monitor to make sure the Pitocin was not over stimulating the uterus. (I know it was a lot of interventions, but I felt like my babies were safe this way. A triplet VBA2C is not to be messed around with, in my opinion!) After my membranes were ruptured, the contractions instantly went from noticeable to ruthlessly strong. I wanted to hold out on the epidural until I was certain I was in transition. Soon, they were slamming me one on top of another and double peaking repeatedly. I was shaking and shuddering and unable to talk through them so I suspected I was close. These were nothing like my contractions that were jump-started by Cervidil (which is contraindicated for VBAC). I was unable to hold still to keep the monitors on and I asked for the epi around 5am.
Then I rested, NO checks. Around 8:30 I began to feel pressure in my rectum. At first it was minor but only about 3 contractions later it felt urgent, so I called Doc T. He said he’d be in at 9; it was 8:45 and I felt like the next 15 minutes would kill me because I knew in my gut it was time! When he arrived he did a quick check and said, “When do you wanna push? You’re at 10 and +2!” My husband was dumbfounded and my mom sprang up like a gazelle to make phone calls. They both donned their hospital get-ups and Doc T had me do a quick practice push… which he stopped pretty quickly! Then there were nurses running in and orders being given.
My heart raced. I felt giddy with anticipation and nerve wracked by fear of failure. I couldn’t believe it was really time to push, but the sensation in my hiney kept promising that it was indeed time! They quickly wheeled me to the OR. I was transferred to the table and it started to feel a little like right before my c-section. I forced the fear from my thoughts and allowed my husband’s and mom’s excitement and confidence to flow into the spaces in my heart that fear once occupied. Monitors were repositioned; all babies were on and heartrates were wonderful.
Josh grabbed one leg and my mom grabbed another. Doc T said, “With your next contraction take a deep breath, hold it and bear down!” I was so flat on my back that I needed Josh and my mom to help me curl forward. Because of the epi I could not feel a contraction building, only the pressure at the peak, so I had to be told when to breathe in and PUSH! I pushed through 1 contraction and with my husband yelling, “OH MY GOD BABE, YOU’RE DOING IT! HE’S RIGHT THERE!!!” out popped Joshua with the 2nd. The sensation was strange; I felt a plop-plop-plop feeling and then he was out! Doc T held him all slimy and gooey up to my face and I gave him huge kiss and head hug and off he went to the neonatal team – I had a lot more work ahead of me!!! As more contractions came, more yelling to “PUSH” came, and more cheering from my mom and Josh spurred me on. James was here, 8 minutes after Joshua! Another gooey kiss and onto the work ahead. Either Doc T or the resident was feeling around inside my uterus for John William’s feet. They could not be reached. Then I heard the neonatal teams calling out weights – 5lbs 11oz for Joshua! Hell yeah! Big ol’ triplet! Then James’ weight was called – 6lbs 9oz! Are you serious right now?!! AMAZING!!! Then it’s time to push John William out; Doc T used the vacuum to extract by the head since the feet could not be reached. After a few pushes I began to feel lightheaded and asked for a pushing break. I rested through the next contraction and then it was time to push again. Finally, I felt the final plop-plop-plop sensation – 5 minutes after James was born, John was out! I had done it! They were all out and my abdomen was still intact! John William was 5lbs 12oz!
They placed him in just a diaper under my gown against my bare chest. It felt wonderful but I didn’t feel like I could safely hold him. I was thrilled but having trouble focusing. I felt lightheaded and nauseous. The table felt like it was spinning and voices were all echoey. Something was taking a really long time in my nether region. The Docs were still working on me. But why? I was so woozy. Then my mom was gone. I heard a nurse say, “Someone go check on Grandma; she looks like she’s about to pass out!” Funny. That’s just how I felt. I told someone. They gave me smelling salts, which were disgusting and pissed me off. At some point I figured out that I was hemorrhaging. I got numerous shots in my thighs. The docs were massaging my uterus so aggressively that it was extremely painful and I begin retching forcefully (my nerves and the nurses had prevented me from eating). They were calling for my blood type. It was there quickly and I received 2 transfusions. My husband was drunk with baby lust and wasn’t paying attention to me as he chatted up the neonatal team. Then Josh looked right at Doc T and asked, “Is she going to be OK?” Doc T said, “Yes.” Josh went with the babies as he and I had previously discussed. I wish I had yelled, “Forget what I said! They are fine! I am bleeding to death over here and I’m scared to death. DO NOT LEAVE ME!!!!” (This was when I wished for a doula. I expected my mother to be able to handle anything, but I’m her kid and she just couldn’t.) I was alone. I was scared and my epidural was starting to wear off which was scaring me even more. I decided to count to 30 then tell them if they couldn’t get it under control, to put me under while they finished because I was losing control. Just then, they stopped working and explained to me that they got the bleeding under control with a balloon they inflated inside my uterus. I was informed that I had a mild 2nd degree repair and that I would be just fine.
In recovery, I was decidedly not recovering. I felt awful and my uterus was clamped down so hard from all the meds and the balloon that it felt like one continuous contraction. The pain and nausea were unbearable; the retching would not stop. I found my voice and once again spoke up for my own well-being. I told the resident, “I am in excruciating pain. I am not getting better. You HAVE to make me better.” He took me seriously and ordered me a morphine injection, another bag of blood and removed about 30ccs of air from the balloon, making it more tolerable. Once those 3 things took effect, I improved. Shortly after that, I was reunited with my babies!
The first day was rough as I was bed bound because the balloon had a drain associated with it and required me to be catheterized as well. The next day, Doc T carefully removed the balloon and I kept my blood to myself! I ate to my heart’s content, nursed the boys successfully, showered, and visited with family and friends. I was ready to fly the coop the next morning… and so I did!
Editor’s Note: I know Michelle through ICAN of Atlanta, and I have always loved her empowering story! I am excited she is willing to share it with you all! If you have had a c-section and would like support both in recovery and future VBACs, I highly encourage you to check out this amazing group. If you’re not local to Atlanta, then you can find your local chapter at ICAN’s nationwide website. – Ashley