By the end of my second pregnancy, I had unwavering faith that this birth would be smoother than the first. I was strong mentally and physically. I came from a long line of strong and fecund women. My body was perfectly designed to bring life into the world. No surgeon would diagnose non-existent pathologies or convince me of unnecessary interventions. I would do this on my own terms, empowered and supported.
I allowed myself to visualize the labor: I’d sway on my yoga ball, listening to an inspiring playlist, welcoming each contraction as it brought us closer and closer to new life. David and our doula would ease the pain with massage, and would feed me affirming mantras. It would build gradually and naturally to a powerful, yet tolerable crescendo, in which perfectly positioned baby and I would work in harmony as he descended into the world.
Now, I knew that child birth is the last thing you can dictate or control. I knew that going in the first time too. But the first time, I went in with almost the opposite mindset. I’d go with the flow. Just do what they told me. If it really hurt, there were ways out. What I wasn’t counting on was one premature medical intervention leading to the next, mucking up the whole biological process, ultimately ending in an avoidable C-section.
I think to many, a C-section seems like an easy way out of the pain and potential trauma of child birth. But that perception annoys me to no end. C-sections are no picnic. Whether or not they come accompanied by a trial of labor (which, in the case of our first birth, was 24 hours of mostly epidural-numbed contractions and three hours of pushing), there are days or weeks of pain and recovery to follow, they significantly add to risks of future pregnancies, and the surgery comes with its own risks of complications. Not to mention, for many women, C-sections can bring feelings of failure or defeat that don’t ease the roller coaster ride of hormones that welcome you postpartum.
So this time, I gave myself permission to give my body and my mind a bit more credit. I began to believe that there’s no timeline for birth, no correct order of things, no need to acquiesce to some arbitrary medical protocol because of convenience or remote statistics or my age (at 35, “elderly” on my maternity medical record). Throughout history, billions of women have brought babies into the world, and I could too. Of course, because of the first C-section, there was a slight risk of the scar rupturing during labor, leading to potentially catastrophic results for me and baby. So there was that. But the risk was so slim. Different studies reported varying statistics, usually around 1 in 200 or better. I was willing to take my chances.
In our case, trying for a VBAC (vaginal birth after Cesarean) took some logistical maneuvering. The only available hospital to us (we live on the island of Maui) has a policy against VBACs, which meant if I wanted to try for one, I’d have to either find someone willing to assist a home birth or seek treatment at a hospital off island. Because of my history, home birth wasn’t for me. So that left orchestrating a “have a baby holiday.” It took some sacrifice. Thanks to the generosity of my parents, we all rented a condo and a car together, and headed to Honolulu two weeks before due date just in case, starting my unpaid maternity leave early, but enjoying the rare family time.
The due date came and went, just like with our first. By the time he was a week late, I joked that he got his sense of urgency from his very laid back dad. We took a non-stress test, which is a check to see how baby’s heart was handling things, how was that old-ass placenta holding up, did he have enough water to swim around in? He passed with flying colors. As long as this held true, he could take all the time he needed, as far as I was concerned. A pitocin induction was almost as distressing to me as a scheduled C-section. They work beautifully for many, and often come due to medical necessity. But, in my case, it was one of those interventions we succumbed to with our first birth that I believed led to complications. I regretted not waiting for my natural contractions to kick-start labor.
So a day after that NST, I was very pleased when I woke at 2:08am to mild, yet natural contractions. I think this is it, I whispered to David, as I got out of bed to take a shower. Hmmm?, he said, and drifted back to sleep. Good, this was exactly the kind of stress-free labor I’d envisioned. After a refreshing shower, I rocked back and forth on the yoga ball, and decided to time the contractions. Odd. They were lasting a minute, and coming every two. That’s a lot more frequent than the every five minute rule of thumb that tells you to head to the hospital. Mine were fairly mild, not much stronger than the gentle Braxton Hicks I’d been feeling for weeks. I wondered if this wasn’t it yet.
When my water broke only roughly an hour after contractions, it was welcome confirmation that this was the real deal. I called the doula. Groggy and disoriented, she advised me to head to the hospital, and ask for a ball and a room with a bath. She’d meet me there later. Okay. My coach and intervention-avoiding advocate might not be there with me right away, but I had this. Plus, we’d quickly learned that Honolulu traffic is INSANE, and I was about 40 minutes from the hospital without traffic. Heading out now was good timing.
If anything, contractions seemed to slow down on the way to the hospital, and we checked in sometime around 4:30am. First order of business, check how baby was doing. Which meant the machines, IV, all the stuff I’d hoped to postpone. Our Korean nurse was severe and hard to understand, and I worried we’d be bullied into going with the clinical “flow.” But then came the compassionate midwife, and I was reassured this was just a formality. Before long, I’d be peacefully laboring in that tub or on that ball, listening to Uptown Funk, and getting massaged by my husband.
But the monitor indicated baby wasn’t doing so well. With each contraction, his heart beat limped along alarmingly slowly. If you’re familiar with the sound of a baby’s heart beat, it’s noticeably faster than an adult’s. But our little guy’s was draaaaaaagggging along, a fraction of the pace of my own. Dun dun…………………………..dun dun……………………….. This wasn’t good. However, when the contractions passed, his heart beat steadied. As for me, as soon as I was lying down and hooked to machines, my contractions rapidly intensified. Where was that fucking doula?
The midwife suggested the cord was being compressed, and she got me to try lying on each side for several minutes. 45 minutes of this, and nothing was working. Each contraction came like a huge, powerful wave, while I writhed in agony, and baby’s heart plummeted. What about standing up? I begged. Passively lying there was bordering on unbearable. But the midwife couldn’t permit it. She warned me that the OB on duty was very pro-Cesarean, but that she could try one more last-ditch effort to help baby. Inject my uterus with fluid. Having already lost the amniotic fluid, this may be compromising the cord. The midwife gave us a half hour to see what that added fluid would do, hoping it would unstick the cord from whatever was compressing it.
By this point, the pain was beginning to overtake me. I was acting the way women act in “transition” between active labor and the pushing stage: wild, primal, animalistic. I tried to keep my head during contractions, tried (mostly unsuccessfully) to breathe low and calm. But the pain was a vice torturing me. I felt the uncontrollable urge to push, and I gave in to the urges.
It had only been a few hours, but maybe it was already time. The midwife quickly checked my cervix. Three centimeters dilated. My heart dropped. A repeat of my pitocin-induced first birth. Horrific contractions accompanied by an unbearable urge to push, and still seven centimeters away from my body actually being ready to push. Plus, baby hadn’t dropped into a station for pushing. It was at this point with our first labor that I’d asked for an epidural. I didn’t think I could stop myself from pushing (or handle that torture) for seven more centimeters. I’d always blamed the pitocin for the intensity of the contractions. But here we were again, and pitocin-free.
Another contraction overpowered me. I was starting to really lose focus. Several people were gathered around me, concerned, glued to that monitor, and I was starting to shut them all out, even David’s loving and concerned eyes. I shut my eyes, and it was just me and inescapable pain. Around this time, the doula appeared. I barely noticed, but detected concern, and then, working that paycheck, tried handing me a pillow? She wasn’t the angel I’d banked on, but still, I cued in to her voice. In my grunting and moaning and bearing down and pushing, she told me my body was doing what it had to do, and I found that incredibly reassuring. That’s right, there is no “normal” birth, she reminded me with those words.
At this point we’d only been at the hospital about an hour and a half. The added fluid didn’t appear to be solving the problem, but the midwife left the room briefly. And with another amazing surge, I felt a popping similar to my water breaking. Suddenly, baby’s heart stopped. At this point, my mind was gone from everything going on around me, but later David credited the stern Korean nurse for her quick action. “Baby down!” she called, and suddenly a handful of medical professionals descended on us, midwife and two OBs included. I wouldn’t recognize any of their faces today.
“On your hands and knees!” someone shouted. Thank God there had been no time to beg for that paralyzing epidural, because I sprung up on all fours. Baby’s heart was still gone. A surgeon got in my face, saying something about, “You don’t have a choice. We’re going to have to perform a C-section, blabla.” I interrupted in a whimper, “Do what you have to do.” And three times, “Get baby out. Get baby out. Get baby out.”
Oh, God. I’d made the wrong decision. My arrogant VBAC had killed our baby.
And then it was the kind of crazy choreography you see in ER shows. Now what seemed like a dozen people appeared, all with really genuine anxiety on their faces, each with some role: Securing me, grabbing tools, wheeling me. I remember they bumped me into door jambs and someone dropped some tool. I could hear the stress in their voices as they confirmed who had already done what, and I knew they weren’t messing around here. This wasn’t a situation they encountered daily.
All the while those unearthly contractions kept coming. They strapped the mask over my face, and just before that anesthesia took me peacefully away from that hell, I screamed the kind of scream that adults rarely if ever need to. For a brief moment I wondered if I’d wake up. And if I did, I expected I’d wake to a dead baby. Even in the midst of drama, grief was already blooming like a cut.
Three hours later I awoke, a bit disoriented. Someone was quickly at my side. I don’t really remember those moments, except for the wonderful relief. David was with the baby, and the baby was okay. In fact, he was taken from the womb crying and vigorous.
The moments that followed our first C-section were marked with exhaustion, defeat, almost a kind of indifference. The moments that followed this one were overwhelming gratitude, joy, relief.
David filled me in on details of the surgery (he was not allowed to be present due to the emergency, but spoke with the surgeons afterwards). When they cut me open, they saw baby’s hair poking out of my uterus. The cord had been wrapped around his neck the whole time, which was what had been causing his heart rate to drop so dangerously low. Even had the uterus not ruptured, the C-section was a medical necessity. They called in a bladder specialist from another floor, because the scar rupture happened so close to the bladder, but fortunately no other organs were compromised.
In the end, David got to meet our babies first both times, and I couldn’t be happier about it!
The days that followed were so different from the days that followed our first birth. Probably most important, David could stay the nights!! That is the single dumbest policy of our local hospital. What is the logic of having babies room in with mothers who have just had major surgery and are bed-ridden with catheters and morphine drips, and the dads get kicked out at 10pm? I felt guilty every time I called for a nurse to pick up my crying baby for me. The support at Moanalua for our second was hands down more caring, sincere, and consistent than the care at our local hospital. I was visited daily by OBs who’d been in the surgery, one of whom said, “You’re famous around here.” I never felt that I was inconveniencing anyone. The midwife called to check on me. Every nurse was fantastic and when we got home to Maui we were greeted with a card from one. I always said that even if our VBAC resulted in a second C-section, I’d rather it be at that hospital, and I wasn’t disappointed. Also, the recovery seemed a bit easier than the first, perhaps because I didn’t labor as long or undergo hours of pushing. Or maybe just because I knew what to expect this time.
The most welcome surprise of the experience is our wonderful son! He is an absolutely DELIGHTFUL newborn. He knew just what to do to nurse, and slept like a champ from the beginning. He barely ever cries, and when he does he’s very easy to please. We went through so many stressful and exhausting eating and sleeping struggles with our first that we just expected to do it all over again. Instead, we’re enjoying a much more relaxed experience this time around. Plus, I learned the importance of a support system, and we have my mom staying with us for a month.
On top of that, our two year-old son is welcoming his little brother into our family in a way I didn’t expect. I worried he’d be jealous or insecure about the new addition, since he’s such a little mama’s boy. But he’s really embracing his role as big brother, and has been so gentle and interested in “his baby.” His favorite thing to say is, “Baby funny!” He also gets a huge kick out of breastfeeding, something he quit about a year ago, and baby eating “Mommy yogurt.” (????)
Maybe it was good that we needed the extra recovery time in the hospital, because it took us until the very last minute to decide on a name. We were all over the board, switching it every five minutes. In the end, we landed on Nico, because it seems like he’ll be a fun-loving and laid back person. We contemplated naming him Nan Soo after the Korean nurse.
It’s easy to ask questions. What if I’d just scheduled a C-section? What if contractions had come on a couple hours later? Or I had decided to wait a bit to head to the hospital? It all happened so quickly, I easily could’ve been stuck in traffic. What if the Moanalua team hadn’t acted so efficiently? What if the uterus hadn’t ruptured? That rupture forced action that may have prevented another catastrophic outcome due to the cord. It was pretty much the opposite of the birth we’d hoped for, but gosh, in some ways it was every bit as beautiful.
In the end, although I don’t think I’m exaggerating when I say this birth was traumatic, I’m left in a totally different and more peaceful place than I was the first time around. I’m left wondering if this is perhaps a more valuable birth experience for us than that perfect, empowering birth I’d prepped for, believed in, and allowed myself to envision. I wanted to surrender to it, I wanted to do it naturally and by my own power, I wanted to come out of it feeling that my strength as a woman wasn’t taken away. And somehow I feel those things and more. I also feel incredible gratitude, humility, and appreciation for the interventions that can be life-saving and necessary. As usual, life rarely throws at you what you’re expecting, but it often throws at you what you need.
A happy, healthy year and change have passed, and I’d like to add some information for those readers who are interested in more specifics, especially Maui mamas considering an Oahu birth.
How did you decide to try for VBAC?
When I first discovered I was pregnant the second time, my initial excitement and happiness was almost instantly met with anxiety over having another terrible birth experience. I didn’t want to have another C-section and I didn’t want to have a vaginal birth. I just wanted a stork to bring us our new bundle of joy. Unfortunately that’s not an option. Nor is it an option for my husband to take one for the team, so eventually I got to the business of confronting my fears. I read multiple birth stories, including successful VBACs, I talked to friends who had had successful VBACs, I talked with numerous doctors, I read empowering books such as Ina May Gaskin’s empowering Guide to Childbirth. I was back and forth for several months, mostly leaning toward scheduling a repeat C-section. As inspiring as my friends’ successful births were, the fact that I would have to travel and spend many weeks away from home seemed too daunting a challenge.
I don’t know what it was that finally tipped the scale. Honestly, as much as I hate to admit it, I think it was a flippant comment when someone, not knowing my history, found out I’d probably have another C-section because I had a previous one, and her response was, “Why don’t you just have a VBAC?” Like, easy as that. It shouldn’t have, but it got to me. Because the truth is, I wanted to try for one. I needed healing from our first birth, a do-over, a chance to be stronger, to trust my instincts. That, combined with the inspiring stories of women around me, and all of my doctors giving me the nod of support told me since it was important to me, we could figure out the logistics.
How supportive were your doctors of your decision?
At Kaiser, expecting mothers don’t get to keep “their” OB. There’s no guarantee of who will be on call the day you deliver, so they encourage you to become familiar with as many (approx. 9 total) as you can at your pre-natals before the big day. I actually like this system as I value multiple perspectives and styles, and it helped that I more or less liked every Kaiser OB I met. Especially when considering a VBAC, I appreciated the opportunity to get various opinions. Every single one was supportive. Now, they had varying opinions on how strong a candidate I was (for example, since I had made it all the way to pushing with #1, my statistical likelihood of having another C-section was higher), and they had varying experiences with complications such as rupture (all had seen it happen), but every one was some degree of encouraging, supportive, or respectful of the choice.
I would whole-heartedly recommend Maui Kaiser doctors to any expecting mom. Since I had to go to Oahu two weeks early and went into labor a week past due date, I had plenty of time for prenatal appointments there too. The OB was great and also supportive of VBAC, but wait time alone made me appreciate our smaller, more intimate community on Maui.
Since you decided to travel away from home, what did your insurance cover?
Hoping to get pregnant that year, my husband and I switched to the best Kaiser insurance plan during open enrollment time through his work. It covered everything in the hospital and all prenatal appointments. I think when it was time to check out of the hospital, David paid some tiny copay (like $70?) for pain meds and birth control and that was it. It covered travel to Oahu for me and spouse two weeks ahead of due date (and we got a super nice booking agent who included our toddler even though that isn’t part of their policy). No matter your plan, though, your insurance should cover you to go to Oahu to try for VBAC since it isn’t an option on Maui. What they don’t cover is lodging while you wait to go into labor, and that of course, is expensive.
Now, if you are braver than I am, you could try pushing the flight closer to your expected due date. However, insurance may not cover the flight. A successful VBAC friend of mine happened to go into labor three weeks early, and she BOARDED A PLANE IN LABOR. That? Not for me. And knowing my story, you can see an airplane would have been just about the worst place imaginable to be.
How did you arrange to stay away from home for so long? Where did you stay? How was your family able to all make that trip?
My mom is retired and my dad is a postal worker who likes to save up his vacation days to take month-long winter trips. My due date was April 13th. My parents planned their winter trip to coincide with the birth. At first, we planned to split the cost of a two-bedroom vacation rental for the month of April, but my dad ended up gifting us with the accommodation. He found a place for a reasonable price in the Ko Olina area of Oahu. It was right down the road from the Disney resort and perfect kid-friendly beaches, works for our two year-old. 40 minutes to the hospital, works for me. 5 minutes to a golf course, works for Dad. My mom, my son, and I were there together for the first week. Then my dad and husband joined about a week before due date. Even my brother flew in from Maui for a weekend.
Since Nico took so long to arrive, we really were stuck sharing one vehicle and not wanting to be too terribly far from the hospital for longer than I would’ve liked. It ended up feeling like a whole lot of waiting to me. But our two year-old got to spend his last days as an only child in a household full to the brim with love, play, sunshine, family time. I’m not one to throw around the word blessing too often, but that time together really was a blessing.
Why were you pushing before you were supposed to?
So, I had the bizarre experience during both my births of feeling an overwhelming urge to push long before baby was ready to come. The doula later told me that neither she nor the midwife had ever seen a laboring woman do that. I have no idea what that’s all about. I’ve tried googling it, and have read of others experiencing this.
All I can say is that it was absolutely uncontrollable. I would really try to just focus, breathe, and NOT push, and halfway through the contraction my body would just PUSH against everything my mind was telling it. And not just push but PUSH!!!! Like popping blood vessels push. The only other thing I can say about it is that with both labors when that pushing urge started, the babies were still very high. I don’t remember the “station” names, but hadn’t dropped at all. I don’t know if that crazy urge had something to do with getting him down? I have no idea. All I know is that I don’t want to experience it again. It was very unsettling.
What did the uterine rupture feel like?
The rupture happened during one of those crazy pushes. I honestly think I pushed the pop. I couldn’t feel any pain above the contraction. The contraction was overpowering everything else. I’ve heard other people describe the rupture as being very painful, even feeling it through an epidural. That was not the case for me as all I could feel was the contraction and a physical ripping or popping sensation of the uterine rupture.
If they lost his heartbeat, why was he born conscious?
I could hardly believe it when they said he was born strong and alert. They told me that although it appeared they’d lost vitals after the rupture, it was still there but just extremely weak.
Do you regret trying for a VBAC since it was unsuccessful?
No. It was a wonderful birth experience. The month was wonderful family time. I did what I felt was right, and fortunately it worked out. It might not have, but we were incredibly lucky. I’m not sure what kind of birth we would have had if we scheduled a C-section on Maui, but I know I would’ve wondered about the VBAC. I feel incredibly proud of myself not only for trying but for going through what I did, proud of my little son for fighting through what he did, proud of my husband and parents for supporting and trusting my instincts as a birthing mother, and proud of the medical team that was behind us, respecting us from start to finish, and viewing us as humans and not just patients.
Would you recommend other C-section mothers to try for a VBAC?
Do your research, talk to your doctors and loved ones. Ultimately listen to your heart and your gut. Don’t take the risks lightly, but also believe in yourself and your caretakers. If you decide to try for a VBAC, be sure you are in a safe place with a solid back-up plan. (Given my experience, I would not recommend home birth for VBAC.)