Amanda’s HBAC Story

shared with permission

In the weeks and months that followed Lou’s birth I grieved.  I clung to my baby like a life raft in the choppy seas after a ship wreck.  I couldn’t bear to be separated from her.  I was exhausted, but every time I laid my head to pillow nightmares would torment me.  So vivid and real I was afraid to sleep.  Little things would bring back the memories.  I couldn’t drive on the interstate.  Every time I passed the hospital I would sob uncontrollably, I would have to pull over because I was unable to drive.  I would look at my tiny baby and wonder if she was really mine.  How could I be sure?  I felt so guilty for thinking such things but still she seemed so alien to me.  In short, I was a mess.
I replayed the events over and over.  Trying to make sense of what had happened,  to find where I had faulted.  What had gone wrong?
But then I found support,  other women who knew what I had been through and one in particular who had experienced something remarkably similar.  It was such a relief to be understood, to talk about this pain and to let it all out.  They were so wonderful to me, so caring and compassionate.  I began to wonder if I could try again.
At first I assumed that any subsequent children would be born in an operating room. But this never felt right to me, try as I might I just couldn’t picture it.  It took me a long time to realize that I could probably give birth, and to want to try.  At some point I had to make a pact with myself,  I wanted to have more children, and if that meant I would have to undergo surgery again, then that was okay.  But I wasn’t going to give into that without a fight.
It wasn’t long after that that I discovered I was pregnant.  All that I thought I had worked though came back to me.  I was terrified.
I went to an OB and I discussed what I wanted for this birth.  I tried to go the more traditional route, but it just left a bad taste in my mouth.  I just couldn’t walk into a hospital while in such a vulnerable state as labor.  I researched UC and planned out how I would give birth alone,  in secret.  The idea was more comforting to me than the thought of giving birth in a cold hospital room under bright lights.  I had to talk to my husband, feel him out a little and see what he would say to another homebirth attempt.  Much to my astonishment he was all for it, he said, “I don’t have any doubt that you can do this,  what happened last time wasn’t your fault and the chances of that happening again are incredibly small.”  I was so excited I thought I would burst.
Everything was going smoothly in my prenatal care with D.  We knew each other, she was there for Lou’s “birth”.  I didn’t have to explain anything to her.
Around 30 weeks I had a short lived breech scare.  It only lasted 2 weeks, but in that time I had mentally run thru every option available to me.  Truthfully there weren’t that many.  Luckily he turned and it became a non issue.
Around 34 weeks we discussed our transport plan and what would happen if my cervix was torn during this birth.  This was a scary discussion.  Worst case scenario, I would hemorrhage, requiring transport via ambulance.  If this happened I would be leaving the baby in the care of my sister.  I was not willing to take the chance that they would try to keep him in the hospital.  As a precaution we decided to have a second midwife, C, attend the birth.  We hoped she would be unnecessary, but in case of this emergency she might be able to stop the bleeding and suture the cervix herself.  Of course we didn’t think it would tear, but we just didn’t know.  There certainly wasn’t a lot of information about birthing with a previously torn cervix, especially one that had torn completely up to the uterus in two locations.  The other side of this was that we didn’t know how well my cervix would dilate.  The scar tissue might seriously impede my progress.  I prepared myself for a long labor.
This discussion weighed heavily on my mind.  Up to this point I hadn’t really thought much about this particular what if.  The reality of the potential situation was unsettling at best, but I felt we had a good plan in place and I tried not to let this idea interrupt my gestation.  A long labor I could handle, screaming sirens and flashing lights I wasn’t so sure about.
At 36 weeks I received the devastating news that my midwife had breast cancer and would be having surgery.  She was recommending me to a new midwife, C, who lived about an hour and a half away from me.  C was a totally different midwife than J in temperament and personality.  I liked her, but it was hard to transition especially this late in the game.  I drove to C for our prenatal appointments and didn’t see D again until after the birth.  I worried about her, but was assured by C that she was well, or at least as well as could be expected.
That takes me up to the 40 week mark, you can imagine my crazy mindset at this point.

The Birth Story

It’s funny the things you remember.  I can remember repeatedly telling my sister that I would be waking her up when I went into labor.  I told my husband he would have to make me a big breakfast in bed after the delivery.  And I told them both that this baby would either come before my due date, or after a really fast labor.  At the time I didn’t give these comments much thought.  I can even remember my sister saying to me once, “why are you so sure you’ll go into labor in the middle of the night?”
“I don’t know, I just have a feeling.”  Apparently I had some pretty accurate feelings about the events to come.  I also had a feeling about water birth, I just couldn’t decide whether or not to invest in the supplies.  I had labored in water with my first baby and loved it.  But for some reason this time, I was completely up in the air about it.  I eventually got the supplies, but in my minds eye I still didn’t see myself using them.
Wednesday was my due date.  Friday was my birthday, I really wanted to have the baby that day.  But no luck.  Saturday was Birth in the Bluegrass, which was fun.  Monday I had a blessingsway.  That evening I had a little more energy than normal and decided to get all the housework together and bake some cupcakes.  Oh boy, cupcakes.  I had made a “birthday cake” the night before I went into labor with my daughter.  I was sure it was going to be the night.

Amanda’s Cesarean Story

shared with permission

“I want to tell you that the day that you were born was the best day of my life.  I want to tell you that the moment your body emerged from mine I lifted you up into my arms and wept at the beauty of this event.  What I have to tell you instead is that the day that started out to be the best, became the most terrifying.  It is my sincerest hope that you never ask me about your birth, but I’m sure you will, and I hope at that point I will know how much  I should tell you, that I will have the courage and strength to give you all the information you desire.
On August 28th I knew you were coming.  I made a huge pot of potato soup, a dozen dinner rolls, and a chocolate birthday cake.  I suppose I was in serious nesting mode.   Other than that the day was uneventful, I was to have a midwife appointment in the morning and we were going to try once again to induce labor.  I went to bed and slept well.
At 3:58 am I awoke with contractions, I knew they were different.  I waited thru 3 or 4 to make sure they were consistent, by then I had roused your Pop with my moaning.  He was a little leery of the early hour but quickly realized this was serious.  Since I was already 4 cm before labor had started we were optimistic that it might go quickly.  In truth I was optimistic and your Pop was terrified that it would go too quickly and he’d end up catching a baby.  We were so excited, finally the big day had arrived!  So we went downstairs and started timing the contractions.
Around 7:30 we were sure it was the real deal, so we called “D” (the midwife) and explained what had happened.  She told us that it sounded real and to keep her posted, she would see us soon.   It didn’t take long fort things to intensify, and about an hour later I had some bloody show.  So we called “D” back and she listened thru a few contractions to get a feel for my labor.  At this point I could no longer talk thru contractions and “D” decided she should just come on over.  I told your Pop to unlock the door, and begin filling up the pool.  It didn’t take long to fill  up and it was a wonderful feeling to get in.  It didn’t’ make the contractions that much easier, but the time between them was so much more relaxing.  Pop got me a bathing suit top and helped me on with it.  He was a great coach, always ready with a cold washrag or a drink of water.
“D” arrived and monitored us for a while.  We were 5-6 cm and doing well together so she decided to run a few errands.  While she has gone your Pop and I talked about how excited we were, I told him I was having a really good time.  We also took a few pictures.
About an hour later “D” returned, this was around noon.  My mimaw called and Pop let her know what was going on.  It was also around this time that things began to intensify.  I let “D” know that the contractions were right on top of each other, I wasn’t getting any breaks in between, and they were stronger.  She told me it sounded like I was transitioning.  She stayed with us in the room,  your Pop was a little unsure of how to help at this point as I was focused more inward.  I was defiantly “in the zone”,  saying things like, “I’m okay” and “this is hard”, “I can do this”.  They also offered a lot of encouragement.  “D” checked me again and I was at 8 cm.  Your Pop stayed with me and gave me water and tried to help me relax.  Pretty soon I began to feel a lot of pressure, so “D” checked me again and I was at 9 cm.  I told her I thought I felt like I wanted to push, but she assured me it was not yet time and I’d know when I had to push.  She told me it was probably the bag of waters that was creating the pressure and I could do some little practice pushes to encourage it to break if I wanted to.  “D” went to make a few phone calls and I told your Pop I needed a break.  What could he say to that?  He basically just laughed and told me I was doing great and it would be over soon.
Quite suddenly I started to feel different, more alert, the contractions slowed down.  We alerted “D” and she told us that sometimes you get a short break before the pushing stage, I should rest up.  Ah, the break I had wanted!  So your Pop called your Gammy to let her know, she was so upset because she was in Florida and would miss the whole thing.
I tried to encourage both your Pop and “D” to eat something while I was feeling so good, they needed their strength as well.  So we all had a little snack and chatted for a while.  I began to get cold so some of the water was removed from the pool and replaced with hot water.  It felt so good to be submerged and just relaxed.  “D” decided to listen thru a  few contractions and she noticed your heart rate was a little high, since I was sweating and felt a little hot, she had me get out of the pool, much to my dismay.
We moved to the bathroom to labor on the toilet, hoping the pressure would get labor moving more quickly.  When “D” checked me I was still at 9 cm, but I had a bulging bag of waters.  She got the flashlight and looked at it and there appeared to be some meconium.  She wanted to go ahead and break it first to check to see how much and what type of meconium and second to get labor going more quickly.  I felt for myself where the bag of waters was and instructed her to go ahead and break it.  There wasn’t that much meconium and what was there appeared to be old.  Unfortunately when we broke the bag I went back down to 8 cm, this was at 3:30pm.  “D” told me you had a lot of hair and I got to touch your little head,  I knew then that I could easily labor for 12 more hours if I needed to just to meet you.  She tried to get a better idea of your position and she thought she could feel your hand up next to your head.  This explained the back labor I’d been experiencing.

Doulapalooza 2008

Save the date for the Fourth Annual Doulapalooza

at Willow Park on Sunday afternoon Sept. 28 from 1 -6 PM.

More details coming soon

Interviewing your Doctor or CNM for a VBAC

Here’s the list of questions that ICAN of Louisville co-leader Erin used when she was interviewing doctors and hospital-based midwives for her VBAC (birth story and Homebirth midwife interview questions coming soon).  Feel free to use this as a guide when interviewing care providers, and add additional questions and points to consider in the comments section.

Remember that you are shopping around.  You are doing the interview!

Consultation & Pregnancy

1. Do you feel a VBAC is a safe option for women?
2. Approximately how many VBACs have you attended?
3. Of those patients in your practice who wanted a VBAC, how many were successful?
4. What do you think my chances are of a VBAC success, given my childbirth history?
5. What is your rate of cesarean sections and under what circumstances do you usually advise them?
6. Who is your back-up? Is he/she VBAC friendly? Would he/she support my birth plan?
7. What hospital(s) do you have privileges at? (Which would you recommend for a VBAC?) (Natural birth?)
8. What book(s) would you recommend that I read?
9. Are you familiar with ICAN?
10. What prenatal tests/procedures do you usually require? Recommend?
11. What do you think of Birth Plans/ Preferences?
12. How do you usually manage a postdate pregnancy? Or a suspected Cephalopelvic Disproportion (CPD)?
13. Do you have a vacation scheduled near my estimated due date?

Questions regarding Labor & Delivery

1. What’s a reasonable length of time for a VBAC labor if I’m healthy and my baby appears to be healthy?
2. Do you know any kind of restriction I should expect from the hospital on a VBAC? (Who do I need to have policy exceptions approved through?)
3. How many people can I have with me during the labor and birth?
4. How do you feel about doulas?
5. What is your usual recommendation for IVs? Pitocin? Confinement to bed?
6. What’s your approach if the bag of waters has broken at full term but the mothers feels no contractions?
7. How often do women in your care give birth un-medicated? How many with minimal medication? In what percentage of your patients do you induce labor?
8. Approximately how many of your patients have un-medicated births?
9. Do you do breech deliveries?
10. What would you suggest if I had another breech baby? (Before labor? During?)
11. At what point do you arrive at the hospital during labor/delivery?
12. What labor positions do you recommend to your patients? Do you encourage movement during labor?
13. How much fetal monitoring do you routinely use during labor? Intermittent?
14. Do you allow light eating/ drinking during labor?  Does the hospital?
    
15. Are you OK with No IV – but a Hep Lock?

These questions should be asked fully clothed, in an office.

This is your baby’s birth — there are no repeats, so make sure you are comfortable and on the same page with your care provider.

The Birth Survey

ICAN of Louisville’s own Robin Weiss has been activly working with The Coalition for Improving Maternity Services (CIMS) on an exciting project that launched today!

The Birth Survey works by asking birthing women nationwide to provide feedback about their doctor, midwife, hospital, birth center or homebirth service. Responses are made available online free to other women who are deciding where and with whom to birth.

The Birth Survey is…

· FREE

· Available to women who have given birth in the US in the last three years

· Accessible online 24/7 at www.thebirthsurvey. com

Check out this fantastic resource and share your experiences to help others in you area.

“VBAC and Choice: Many Questions and a Few Answers”

Read the excerpt from Nancy Wainer’s Midwifery Today article by clicking here.

“Each baby has only one opportunity to be born, there are no second chances; so whenever possible, the experience ought to be safe, wonderful, natural, empowering and amazing. I have a sincere passion to assist women in having the best births possible. VBAC feels like my baby. Having had my own VBAC in the early seventies and having coined the term, I’ve spent my adult years researching the subject—teaching it, talking about it, thinking about it and writing about it. Along with many other midwives and childbirth educators, I’ve done my best to bring the subject of VBAC to light and to assist women who choose to birth normally after having been surgically delivered. My heart still drops into my toes every time I learn about a woman who received a c-section and leaps with delight when I either hear from, or am able to assist, a woman who has had a VBAC.”

Listen! WFPL 89.9 August 13th at 11am

Beth Bary, CNM and Amy Goforth, doula and childbirth educator, are going to be guests on 89.3 WFPL’s radio show State of Affairs tomorrow. The show’s topic is Childbirth Decisions, and they’ll be joining obstetrician Margarita Terressa from U of L.

Tune in, and feel free to call or e-mail with good questions on birth, doulas, midwives, and other BIRTH OPTIONS!

(To join the conversation, call (502) 814-TALK, toll-free 1-877-814-TALK, or email soa@wfpl.org)

Here are the show times:

State of Affairs, WFPL 89.3 FM
Wednesday, August 13
Live broadcast: 11 a.m.
Re-broadcast: 9 p.m.
Listen online: http://www.wfpl.org
The program is archived online; listen here

Wednesday, August 13, 2008
Childbirth Decisions

“You might think of your baby’s birth as the happiest moment of your life. But childbirth can also be scary, especially for first-time or high-risk parents. Having a plan and feeling like you have some control over what will happen to you often lessens the anxiety associated with labor and delivery. Birth plans run the gamut from pre-scheduled C-sections under general anesthesia to medication-free water births at home. You might be assisted by doctors, nurses, anesthesiologists, midwives, doulas, your partner, or your whole extended family. This Wednesday we’ll take a look at the decisions surrounding childbirth, and how to determine what kind of experience is right for you.”

Meeting Recap: “Homebirth: a Safe and Important Option”

Last night, August 4, 2008, ICAN of Louisville had our meeting on Homebirth.  We had a good turn-out, including several dads (and dads-to-be).  Local midwife, Jennifer Woodmansee, was our guest speaker.  She spoke on the safety of homebirth and left ample time for questions, of which there were many. 

Some of the information referred to last night are listed below:

Responses to “Why Homebirth?”

Homebirth midwives are expects in “normal birth.”  Only CPMs (Certified Professional Midwives) are required to have training in normal, out of hospital births.

In a homebirth setting, you are in charge of your body.  You choose who will be there, what you eat and drink, and you have freedom of movement.

You are the only patient, versus 4-6 other laboring mothers that a hospital nurse attends to.

You and your baby are not separated.

Homebirth is as safe, or safer, than hospital birth.  Several stastics and studies were shared on the safety of homebirth.

Jennifer answered several questions from the meeting attendees.   Discussion included:

*how a homebirth midwife monitors the laboring mother and baby

*how much a homebirth typically costs, including supplies

* prenatal care and visits

Other organizations to check out:

KAAM of Louisville

Kentucky Midwifery Taskforce

HomeBirth: A Safe & Important Option

Join ICAN of Louisville at our August 4th educational meeting to learn about homebirth.

Meetings are at 7pm and held at Louisville Family Chiropractic, in Lyndon.  (8117 New LaGrange Road — between the Thortons [on the corner of Lydon Ln/New LaGrange Rd and Lyndon Lanes Bowling)

Jennifer Woodmansee, a local midwife, will be our special guest speaker.

Topics to be discussed:

• The Safety of home birth
• Common homebirth myths
• What midwives do/don’t do ( in prenatal care, labor and birth)
• FAQs
• HBAC Safety (Homebirth after a Cesarean)
• Local Midwifery organizations

July 17, 2008: Birth Care Network’s “Transparency in Maternity Care”

Birth Care Network is hosting an educational meeting and panel
discussion focusing on the issue of “Transparency in Maternity Care”
on Thursday, July 17, at 6:30 p.m. at Commonwealth Bank, 286 North
Hubbards Lane. BCN members and the public are welcome at this free
meeting.

A panel of medical and birth professionals and maternity consumers
(a.k.a. moms) will discuss why transparency matters to pregnant women,
how they can get the information they need to make informed choices
about their maternity care, and what to do with the information once
they have it.