More Business of Being Born VBAC Segment

I was so excited to watch this. I thought that I would enjoy lending it to clients of mine, and had even prematurely asked if my Professor friend over at the college would help me set up another campus screening with a followup Q&A about VBAC.

Boy was I wrong. So, so wrong.

The VBAC segment was not only mostly one-sided, the risks were over inflated and misrepresented. The title of the segment is a load of crap, because it really DOESN'T talk much about what a woman's options are. It shows the incredible amount of unbalanced information that is out there, especially from OBs.  A sound resembling a dying cat escaped my throat every time I heard the words, "attempt a VBAC", "try to have a VBAC", and "trial of labor". Yes, this is OB lingo. And while I will agree that in the hospital it really IS "attempting" a VBAC, because hospital VBAC "attempts" are rarely successful...and even less so if we look at the big picture and include women that start out interested in having a VBAC, and then are dissuaded by the OB...it is hurtful language. I believe in the power of words. What if we told each mom who wanted a natural birth that she was, "attempting a natural birth", or that she could, "try for a natural birth"? What does this imply? This, to me (and many other women) implies great room for FAILURE. Never mind that most natural birth "attempts" are hindered by the hospital staff, or by lack of support, or by lack of knowledge.

What if I told my clients that I would be happy to help them "attempt" a home birth? Holy cow, that would be scary! That would leave their minds open to the idea that they are likely to end up in the hospital, and not with the home birth that they planned for.

One thing that they did portray accurately - though I'm sure wasn't the intention - is the fact that the Obstetric system is NOT set up to support VBACs. The doctors interviewed spoke openly about issues with hospital protocol, and mainly, liability insurance. And that's what it comes down to. Not risk. Not a woman's ability to have a VBAC. Politics.

One of the most common things I have heard from women and OBs is that a VBAC isn't allowed at a certain hospital because they are not equipped to handle emergency surgery. Let's think about this for a moment. A uterine rupture is HARDLY the only emergency that can come up during childbirth, necessitating immediate surgical delivery. Cord prolapse, placental abruption (both of which occur more often with intervention, for the record) both would fall in this category. If a hospital isn't equipped to handle a VBAC, it isn't equipped to handle ANY birth. Period.

I screamed outright at the screen when a woman was interviewed who had found a supportive OB, and planned for a VBAC. She labored at home before going in. Once in the hospital, her OB discussed the need for her to progress consistently and timely (?!?!?!?!) in order for her to have her VBAC. He discussed breaking her water to speed things up if need be. (!?!?!?!?!?!?!)  She was a good girl and progressed from 7cm to 8cm in an hour. Then an on-call OB came in 2 hours later and checked her AGAIN, and found her to "still" be at 8cm. Started talking cesarean immediately. She mentioned breaking her water (!!!!!!) and asking for her OB to be called in. The doctor was upset that she was refusing medical advice. Her baby was fine. She was fine. But she had not progressed in 2 hours - or so the new OB said. Her OB was called back in, and in this Mama's words was, "So gracious to allow me more time". OMG! So gracious to ALLOW you and your perfectly healthy baby more time in labor?!?! Let's give her OB of the year award, shall we? The OB said she MUST progress to 10cm quickly, and baby must be descending.

She got to 10cm. But baby was not descending. What did she do?

She said that she had already put her OB in a difficult situation, and she knew it wouldn't BE FAIR to her OB to expect more. She agreed to a cesarean.

SHE AGREED TO A CESAREAN AT 10CM, BOTH HER AND BABY WERE FINE. ALL SO THAT HER OB WASN'T MADE TO BE UNCOMFORTABLE?!?!?!?!?!?!?!?!?

This is what happens to a HUGE chunk of women who think they are going to have a hospital VBAC. They get HUGELY manipulated into thinking that they should be FAIR to the person they *hired*. At the expense of their body, and their baby. They agree to surgery that is NOT medically warranted...because they love their doctor.

One OB who was interviewed said that the risks of VBAC may *seem* low, but that those low risks can come with catastrophic results. Hmmm...so can induction of labor. How many women has he ordered induction for, in his years as a doctor? How many amniocentesis has he performed? An amnio comes with a higher risk of death to the baby than a VBAC does. (1 in 200-400 vs 1 in 2000)Yet, many women wouldn't blink an eye at having an amnio done if their doctor said it was best.

I recently read a study that said that women are more likely to go along with whatever their doctor says is the right course of action, regarding a VBAC or a ERCS. Regardless of empirical research that shows that a cesarean comes with a 2-4x greater risk of death for both mom and baby, if a doctor says it's best to do - most moms will go with it.

The study was a survey provided to women upon admission for their elective repeat cesarean section (ERCS) or trial of labor after cesarean section (TOLAC).  I am really shocked at the level of knowledge most of the women had. 73% of the women admitted for a ERCS did not know the chances of a successful VBAC and 64% did not know the risk of uterine rupture.  54% of women choosing a TOLAC did not know the chances of a successful VBAC and 45% did not know the risk of rupture.

So then I question - are WOMEN really making the choice if they are presented with inaccurate information? If they are willing to agree to major abdominal surgery on the suggestion of their OB? This is NOT informed consent. This is manipulation in the most base of forms. Women need to do their research. I've said it before - women research the type of car seat to buy, crib, diaper bag, more than they research their options in birth and weigh the risks/benefits of each. In our culture, however, we are pretty much brainwashed to view our doctor as our authority figure and not question. I have seen this with friends. Their OB lied to them or misrepresented risk, and they ended up with a cesarean. They go BACK to the same OB and talk to him/her about a VBAC. One of two things occurs most often:

1) OB says, "Well, you could TRY, but with your history of __________, the chance of needing an emergency cesarean - which is more dangerous for baby - is high. It's up to you though."  (yeah RIGHT)

2) OB says, "Sure, you can TRY for a VBAC. It doesn't LOOK like your issue should repeat." and then finds a reason at the end of pregnancy as to why a VBAC isn't going to happen. OB seems supportive, and then lovingly (HA!) finds a gentle way of telling mom that it doesn't look like a good idea after all.

Do you think she's going to switch care providers? For most women, no. It's this sick dependency thing we have going on, along with a very twisted romancing of complications and emergencies in birth and "needing" to be saved. Apparently this ranks higher than empowerment and an innate knowing that we are MADE to birth.

Anyway, back to the film. A doctor who was interviewed was asked to touch on the subject of HBAC - Home Birth After Cesarean. He inflated the risks. He talked about needing an OR available immediately - which is NOT GUARANTEED in the hospital!!! Nor is it evidence based. Studies show that you have 20-30 minutes to get to baby after a uterine rupture is suspected. Guess what? They can't have the OR prepped and ready in less than that in the hospital. But then he followed with, "Of course, a woman has to make this decision for herself."  HA! How many women do you think would choose this, or even do her own research if she was told that her baby is likely to die if she ruptures at home? (Let's go back to the fact that uterine rupture occurs in only 0.3-0.7% of VBACs, and those include the most common, asymptomatic uterine dehisciences, and that the risk of catastrophic rupture is a fraction of the 0.3-0.7%!)

Even Dr. Moritz admitted that in the hospital a VBAC has to go PERFECTLY. He called it a "Cinderella Birth." Which is realistic, how?? He also admitted that if there are ANY fluctuations in baby's heartrate, that it would be an immediate cesarean, without waiting any time at all to see if things were fine. Never mind that external consistent monitoring is highly inaccurate.

If I had been a mom watching the film for information on VBAC, I wouldn't be compelled to do my own research. I would walk away from the film with the idea that I should talk to my OB, and should act on his/her recommendation. I wouldn't look into my options, I would acquiesce to my doctor's advice and not think twice about it.

Ricky Lake and Abby Epstein had the opportunity to REALLY explore the problem with our current cesarean rates, and the extremely low rate of VBAC in our country - and they failed miserably. The only SLIGHTLY redeeming factor of this film is the birth story at the very end. Mom refused to bow to scare-based protocols of her local hospital, and planned a HBAC instead. Even in the face of the OB who refused her a "TOL" (trial of labor) calling her at 34 weeks to say that he would ALLOW her to TRY after all, she continued with her plan. It showed the very emotionally damaging effect that cervical exams can have, especially in a VBAC, when she was checked to be "only" 1cm, and wanted to give up and go in for a cesarean. Instead, her husband rallied by her side and helped her pick back up her resolve. She had a beautiful HBAC in the water - where she caught her baby herself.

But really, More Business of Being Born?? ONE positive, empowering story in all of an hour?? ONE? And the ONE woman you had talking about the risks of repeat cesareans - which are MANY - was not a "professional", but a mom. How does that look to people? The "professionals" are reiterating the risks and limitations of hospital VBAC, and a non-formally educated woman is citing the risks of surgery. Totally biased in presentation of risk/benefit. The risks of repeat cesareans were skimmed over, and the HUGE problem of care provider manipulation, hospital protocol, and misrepresentation of VBAC risks were barely touched on in the right way.

A study done on the morbidity rates of repeat cesareans:

METHODS:
Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002).
RESULTS:
There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.
CONCLUSION:
Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.

And these are JUST the risks associated with repeat cesarean for MOM. This also doesn't take into account the rates of infection, the increased risk of DEATH, nor does it take into account the difficulty of healing from major abdominal surgery while having multiple children (and a newborn) to care for.

Once a woman has had a successful VBAC, her risks actually DECREASE for future pregnancies.

RESULTS:
Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
CONCLUSION:
Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.

The problem is that when women are given the MISREPRESENTED information about VBAC, very few who are initially interested end up having one. So they end up in the category above - at higher risk for serious complications with each subsequent pregnancy. We have a HUGE issue on our hands here, and most days I feel hopeless for change. With women refusing to do research on their own, because it might mean choosing a different OB (or - :gasp: - a Midwife, increasing her chance of a successful VBAC!), or standing firm and choosing a VBAC against the advice of her care provider....we are going to continue to see a very high rate of uninformed women choosing repeat cesarean. We will also see higher rates of complications in pregnancy, and eventually, higher infant mortality.

And the root of the problem lies in the lack of ethics and evidence based protocols in Obstetrics, where it is commonplace to manipulate, scare, and even bully a woman into intervention that increases her risk of that primary cesarean. Women NEED to become better informed of what empirical evidence says about the common issues that arise in pregnancy, labor, and birth. Until women make a stand and demand better care, these risks will only continue to increase.

Strength Has Different Faces

Throughout the years I have been "given" (thrown into?) opportunities to show me that I am stronger than I ever thought I could be. Cutting through all of the lies after my very unnecessary and damaging cesarean in 2004, to have a triumphant and empowering home VBAC in 2005. Going through that labor in 2005 after weeks of exhausting prodromal labor, only to end up with a stubbornly posterior baby whose gift to me was 100% back labor on my injured back. But, I did it. I gave birth to my 10lb 10oz, posterior baby girl only 19 months after I was told that I could not safely birth my 8lb 8oz son safely because of his size. Oh, I wanted to give up. Several times. But due to the support of my husband (which was a surprise, because he had been VERY against the home birth), and my amazing Midwife - I did it. It was an amazing feeling.

I didn't think that I would go through anything as physically challenging as that labor and birth. Boy was I wrong.

One year ago, three days after my due date with baby #4, I was in early labor. I knew he was breech. I knew he was larger. And I was struggling with knowing that he wasn't in a good position for breech. I am trained in breech deliveries. I have caught breech babies. And due to this, I knew the position that he was in wasn't favorable. Added to that - my intuition, my heart, my gut told me that things weren't going to go as planned. However, I wasn't willing to change my plan of me birthing with my husband. I had no idea that early labor would continue tomorrow, then heavy (and very hard) active labor would go on for a full 48 hours before I met my son.

I actually began early labor on November 12, one day after my due date. It was definitely early labor, but it was spaced out enough so that I could get some rest and try to get things done. In the wee hours of November 15, labor developed into something harsh. Contractions were still decently spaced, but they were incredibly rough. I'd not experienced contractions like this until *much* further along in labor. The next day, November 16th, was my HBAC baby's 5th birthday. I tried as best I could to celebrate with her, in between contractions that were wreaking havoc on my body. Labor spaced out a little bit in timing, not intensity, in the middle of the day...but then came back with a vengeance that evening. Several times in the course of the week or so before meeting my son, I cried. And I sobbed. You see, in my heart I knew something was wrong and that I wouldn't meet him the way that I had planned. And this was nearly impossible for me to accept. In fact, I didn't accept it until after I decided to go into the hospital for a cesarean.

And yes - here's where the skepticism, the questioning, and the downright unbelief comes in. Women are told to trust their intuition in birth....except when it comes to accepting intervention. A home birth Midwife went into the hospital to ask for a cesarean. I've been told that things were said about me, everything from, "She went in and asked for a cesarean because she was scared of breech. She didn't labor or push as long as she said.", to, "Karma's a bitch." The latter is because of how outspoken I am about birth. I speak often about breech being a variation of normal, and long labors sometimes being necessary. I still stand by them. I have also, when asked, critiqued a birth story so that the mom can have a better understanding of what choices she can make differently in a future labor/birth, in order to have a better shot at a different outcome. There *were* times, I'm ashamed to admit, that I critiqued a birth without invitation, though not TO the mother, but with friends. Not that it justifies it, but these were almost always hospital birth stories where it came out that mom decided to allow intervention, or home birth stories that started with mom inducing "naturally" and allowing intervention. The only comfort that I have is that *I* know what I went through. *I* know that I did absolutely everything I could, and everything "right", and still ended up in the operating room. Also, I have the comfort of knowing that anyone who knows me well, knows at least that my story is likely true - though, I got questions from people who I thought knew me well enough to know that I would NEVER step foot in a hospital, never mind ask for a cesarean, if it weren't 100% necessary. :shrug: I'm not sure many people will ever understand the agony involved in this journey. The decision to go into the hospital was necessary, and I was actually at peace with it at THAT point. But the agony before that point is indescribable. And people have told me that I shouldn't care what people think, or want to believe, and I know I shouldn't.

Knowing that doesn't stop it from hurting.

I have received incredible validation from Gail Tully, of Spinning Babies. I met her at the ICAN conference in April. She was doing a lunch session on breech births. She pulled out a sketch of the exact breech position that Caleb had been in and said, "I wasn't going to draw this one for this session. But last night as I crawled into bed after reviewing my notes, I had this tugging feeling that someone here needs to see this.", and she went on to explain how this particular position more often leads to bad outcomes. That the way he was sitting can cause major complications when the baby rotates. I sat there in disbelief, and began crying. Whether anyone believes this to be intuition or fear - it was there. I had an increasingly unnerving feeling about head entrapment as my labor went on with Caleb. And I've never seen one. The breech births that I have attended have all gone beautifully. But it's what kept grabbing me. Now, I will never know for sure if that's what would have happened had he been able to descend. Some have told me that him not being able to descend is probably what saved him. I don't want to be that dramatic, because I don't know. I never will. Maybe he would have been born just fine had he been able to descend. Maybe he wouldn't have been. I can't keep thinking of "maybes", because it'll drive me nuts. But this validation from her is invaluable to me. In the past week I found a comment from her on my birth story, from last January. Three months before I even met her. I didn't see the comment before last week. She reassured me that I did absolutely everything I could, and that sometimes these breech babies are just not able to descend, and a cesarean is necessary. I know that mine was, but having the validation from a woman who has seen breech more times than I probably ever will, and who very much believes that it can be normal and totally fine ... it was amazing.

On the night of the 16th, once the kids were in bed, labor picked back up to an excruciating pace. I texted back and forth with a friend. I told her that I didn't think I could emotionally survive another cesarean, yet I knew unless some miracle happened in the middle of the night, that it's what I would end up with. Things were wrong. I sobbed, and I raged, and I sobbed some more in between contractions. I cried to my husband, who tried to reassure me that everything would be okay. He didn't get what I was saying, he thought it was from exhaustion and the intensity of labor, and how long the intensity had been going on without progressing further. I tried to lay down to get some sleep, and labor picked up to another level I didn't think possible. The pain was unbearable. I had never felt pain like this, not even in my posterior labor. But I had made an agreement that if things didn't change by morning, that I would go in for a consult to see what was going on. I was determined to keep going, trying to hold on to some last hope that things would totally change and he would be born into my hands in the water as planned.

At 3am my waters released. I was renewed with excitement, determination, and hope. Maybe that's all I needed. Maybe that's all HE needed, in order to come down. I woke Jeramy up and got in the water. My waterbirth tub was my comfort. I labored in there with candles lit and my playlist playing.

When pushing sensations started to take over my body at about 8, I was once again renewed. He would finally come! I had no idea that six more hours of unstoppable, excruciating pushing would be my labor.

48 hours of hard, active labor, and six hours of physiological (unstoppable) pushing later ... I saw that my son wasn't descending. He hadn't moved down even an inch. He was in the same exact spot, same exact height, as he had been in the last few weeks of pregnancy. His hard little head was still right underneath my left breast. Waters releasing, and pushing hadn't changed it. I knew this was the sign that it was time to ask for help. His heartrate was still strong, and I knew he was okay ... but I wasn't sure how much longer he and I could endure a labor like this. It took *forever* to get to the car, because contractions weren't only a mere 2 minutes apart, but they were well over a minute long, and double peaking. The car ride was excruciating. I've never felt so trapped, so immobile, and in so much pain.

Caleb Eliuddin Fiscer was delivered via cesarean section at 2:39pm on November 17th, 2010.

In the end, we were treated with respect. They honored our wishes. I was spoken to like a human being while on the operating table, which is a far cry from my first cesarean. I was awake. And I held and nursed my son - all 10lbs 6oz of him - within 20 minutes of his delivery. Caleb didn't have any drugs whatsoever - I refused any narcotics in my IV, much to the disagreement of the anesthesiologist who tried his best to convince me that I would be in horrible pain as soon as the spinal wore off. He didn't have any shots, vaccinations, eye drops. He was handed to daddy in the operating room. So very, very different than 2004.

I still cry. I still hate how this birth went. I still mourn the loss of my home and water birth. I mourn the loss of a peaceful, safe, and easily healed vaginal birth. My body is wrecked from this labor, in ways I won't go into detail about here.

But all in all, it showed me (much to my anger some days) that I am much stronger than I previously believed. I made it through the labor from hell, through 6 hours of incessant and excruciating pushing, and ultimately through surgery again. I didn't think I could make it through the latter. But I did. For a while I was angry because I didn't think I needed another birth "lesson", as to what can happen, and what we as women are capable of. I didn't think I needed to have another experience to be an example. All I wanted was a peaceful, beautiful birth. I didn't have a peaceful birth. To me, I didn't even have a beautiful birth. But it taught me some things that I will never forget.

I'm not sure how long it will take me to be able to think about this labor and delivery without crying, and mourning. Hopefully the sadness will continue to decrease in intensity.

Happy 6th Birthday to my HBAC Princess, who showed me just how amazing and empowering birth can be. And Happy First Birthday, my Caleb. My heart and joy, who showed me that I am capable of strength even in the face of heartbreakingly hard circumstances.

"You were not born in the way that I had intended.We did not meet in the way that I had hoped.You cried with confusion and hunger. I cried with confusion and pain.
We returned to our cocoon together. When we emerged – transformed. Beautiful and with delight. For we had fallen in love in the way I had dreamed." - Karyn Peabody

My Baby's Birthday, and My HBAC Anniversary

Four years ago today, I gave birth to my youngest child Megan. It was a triumph on multiple levels, as I had a cesarean with my second child, and was told that I would surely kill Megan or die myself if I "attempted" a VBAC. You see, I am prone to having larger babies ( those of you who have met my husband understand, lol ), I was closed with a single layer of suturing instead of double after the cesarean, *and* I got pregnant with her less than a year after my cesarean. I was told that all of these lined up would mean certain uterine rupture. The OBs who had agreed to "let me try", all gave me a gestation limit of 40 weeks. They all said that it would be an automatic repeat cesarean if I got to that point with no signs of labor in sight. And if she was looking to be "too big", it would be an automatic repeat cesarean. Basically, if I looked at them funny it would be an automatic repeat cesarean. It took some women from ICAN ( International Cesarean Awareness Network ) to challenge by beliefs about childbirth, for me to even look in a different direction.

Like most people, I believed that doctors know best. After all, they go to medical school for years and years, and HAVE to know all there is to know. It took me a while to learn that Obstetricians are NOT trained in natural birth. Most go through their entire residency without seeing a single truly natural birth, with the exception of the mom who walks in ready to push ... and even then everyone freaks out. Obstetricians subscribe to the belief that childbirth is a pathology, not physiology. Now, there are certainly exceptions to the rule ... just as not everyone home birth Midwife is trusting of the birth process, or best for mom and baby. But it took me from the beginning of my pregnancy, until 33 weeks, of research to come to this epiphany.

If there is one thing that I can tell women who have had a cesarean, and were told that either their body failed them ( pelvis is too small, labor was too long, cervix didn't open enough, body got too tired ), or their baby failed them ( baby too big, baby didn't come soon enough ) ... is to research their butt off. Because it is so much easier for a care provider to tell a woman that her body didn't work right, rather than to admit that baby and body just weren't ready, or that he/she ( the care provider ) unnecessarily intervened in the process, causing it to spiral into the operating room.

At 33 weeks I started calling Midwives. I was turned down by many. I was starting to lose hope of giving my daughter a better birth, because I knew it wasn't going to happen in the hospital. I was down to one last name ... and thankfully, God had us matched perfectly. Brenda is an amazing Midwife who serves women who need it the most, especially when many others would turn them away. Without her, not only would I not have given Megan a better birth, but I also wouldn't be the Midwife I am today.

I will premise my birth story by saying that four years ago, I wasn't where I am now in my beliefs about birth. There are certainly a few things that I would do differently. I do NOT advocate castor oil inductions by any means. Nor do I advocate artificial rupture of membranes. At the time, having my midwife break my water was a blessing. I was starting to pass out. But in my own practice, I have not yet found a valid reason to break the bag of waters ... leaving things to occur naturally in their own timing.

Now, without further ado, Megan's birth story. My triumphant ( and HARD! ) HBAC.

Megan Ohana Fiscer
November 16, 2005
10 lbs 10 ozs, 23" long



I had been doing the yucky prodromal labor think for what felt like forever. I had almost 6 weeks of contractions that would get so regular and start getting more intense, that I was sure it was "it" a few times. Even had my poor midwife drive out here in the middle of the night which ended up being for nothing. I had regular contractions all through the night on the 10th and called Brenda at about 4am. She came and when she checked me at 8:30 or so, I was a mere 2cm and not effaced much. Megan was also floating high still. I was crushed. Jeramy had the day off and since his grandmother had come up to help with the kids, we decided to go walking that evening to see if it would help anything. I had horrible pressure on my cervix and ended up passing some bloody show. Nothing more though.

The pressure on my cervix changed to a stabbing pain anytime I was doing anything other than sitting, so on Monday the 14th we decided to go walk around a shopping center that is a mile around. The pain was awful, but I wasn't having any contractions at all. I asked Jeramy to stay home on Tuesday because of the pain, and to help around the house. That evening I decided to call Brenda to see if we could try castor oil in the morning. ( Added note: At the point of Megan’s birth, I wasn’t at the point where I really believed that birth was best left alone … I still had a LOT to learn! ) The pain was really awful, and I was having an incredibly hard time getting around after my kids and doing much of anything. I was also a week past my due date and more than a little miserable ( I know, bad reason to try castor oil...but I felt I couldn't take it anymore ).

Right after I got the go ahead from her for the cocktail in the morning, I used the restroom and had at least 3 tissues full of mucous. I called her back to give her the heads up, as I went into labor the same night I passed mucous like that with Noah. I decided to go to Walmart to get some laundry detergent and some needed things and then came home and took a shower. I had been having very small contractions on and off all day, but not much of anything. After the shower, I began having really strong contractions all of a sudden. I went in to lay down to see if they were staying...and they only got stronger. Stronger to the point where when Jeramy checked on me I was in tears. I said it was time to call Brenda. He wanted me to make sure it was really time so she didn't come out again for nothing. I assured him it was! Jeramy filled up the tub, which I went back and forth from because I kept getting too warm. She got here at about 1 or so...and by that time I had already told Jeramy I wasn't sure I could do it. The contractions were very intense and I couldn't imagine it just getting worse. I was also afraid of how far I had progressed...not wanting to hear 3cm or so. When Brenda checked me I was happy to find myself at 5, and she could actually stretch me to 6cm. I tried getting back into the tub, but only ended up getting too hot again. I decided to go lie down in bed to try to cope with everything. I did okay for a while, until things got REALLY intense, at which point I would lose it when a contraction peaked and start shaking my head hard saying I couldn't do it. Brenda was amazing in helping me relax through some of them, reminding me to relax my entire body and even asked if she could pray over me...which I welcomed gladly. Back labor was awful, and my poor husband tried applying counter pressure when I almost felt like I jumped out of my skin...it didn't feel good at all, it only intensified things. I got up and labored on the toilet for a bit which felt good for a while, but then let out a grunt when it felt good to bear down. This alarmed Brenda, and she and Jeramy got the bed prepared. They got the shower liner under the sheet and the chux pads out on the bed. She decided to check me again to see if I was complete, but I was only at 7-8cm. The pressure was awful and I felt like I was having one big contraction and was starting to feel like I was going to pass out, instead of breaks in between. After lots of discussion, we decided to go ahead and break my water, and that helped TREMENDOUSLY. I was able to relax and sleep in between contractions somehow. By this point I had gotten REALLY vocal and was having a hard time relaxing during contractions at all. I started feeling pushy again, and when checked I was complete with just a little lip. Brenda said if I was feeling the urge to push, she could help move the lip out of the way. I began pushing and that became an exhausting experience. When I would push, burning pain would radiate through my hips. It felt amazing once I was really pushing effectively, but at the beginning of each push it hurt horribly. I was really becoming exhausted, and Brenda had me change to a side-lying position to push which seemed to be helping, but still not as effective. She suggested the toilet again, but I didn't think I could get up to it. So I rolled over and got on hands and knees and tried that way. Now I was REALLY screaming that I couldn't do it...I was too tired. Jeramy and Brenda kept reassuring me that I could, but I really needed to push. I was the only one that could get her out, and I needed to do it now. I ended up pushing more in a sitting/squatting position and even bit poor Jeramy's hand during one big push. Megan started crowning and I had never felt a burning sensation like that in my life. I was sure everything was going to split wide open. I remember the feeling of Brenda stretching me to keep me from tearing, hurting pretty badly as well. But getting her head out was the hardest. Brenda kept telling me I needed to push through the burning and get her out now, as she had been in that spot for a while and her head was kind of stuck behind my pubic bone. Megan was also going back up in between pushes because I couldn't hold it. So I pushed through the burning and felt her head come out, and then very quickly the rest of her slid right out. It was an amazing feeling.

I relaxed my entire body, still in that squatting position, onto the pillows in front of me. My hair was soaked with sweat and I was exhausted beyond belief, and also incredibly relieved that she was out. I smiled up at my husband and told him that I could feel her kicking against my thighs. They had me roll over, and Jeramy got to hand her to me, but had to be careful since the cord was short. She was beautiful. The first thing I noticed was how long her fingers were. She was so calm and alert. Jeramy was beaming and told me I did it and how proud he was of me. We waited for the cord to stop pulsating and then Brenda clamped and Jeramy cut. I spent some time admiring her, and then Jeramy took Megan out to the livingroom to meet her brother and sister and great grandma so that I could deliver the placenta. It wasn't hard at all, I just pushed and it came out easily. That also felt really good to get out. I was still burning quite a bit, but was laying back and relaxing knowing that the hard work was done.

Jeramy came back in with Megan, and I latched her on to nurse. She latched on immediately and did so very well. I asked if we could weigh her and get measurements...I was so anxious to see! When Megan was born, Brenda said she thought she was a good 8 1/2-9 lbs. Well, Jeramy was the one to weigh her, and he got wide eyed and asked Brenda if what he was seeing was correct. She looked at the scale and got the same look on her face! He then announced 10 lbs 10 ounces and I couldn't believe it. Furthermore, I couldn't believe when Brenda measured her and she was 23 inches long. I knew my belly had been huge, but never imagined she'd come near to 11 pounds. Jeramy went out and announced it to his grandma, who couldn't believe it either.

Brenda checked me for tears, and said it looked like I had one up towards my labia, and then one on my perenium and she could sew me up after I got cleaned up and showered. I tried twice to get up and shower, but while sitting on the toilet I almost passed out after the burning from peeing. So I was sent back to bed until I could get some fluids in and some toast. When I did take a quick shower and get back into bed a few hours after Megan was born, Brenda checked me to find that by me laying with legs together for so long, I was already starting to heal naturally. She had to really look for the tear she found before on my perenium, and she said there were only a few slits up towards my labia from the skin stretching, and those would heal on their own. As for the perenium, she numbed me, which didn't take too well...and I cried through the single stitch she put in. She said one would be enough along with me keeping my legs closed for a while. I was relieved not to have to endure another stitch. She gave me my instructions and a big hug and kiss and left us to our new family.

Recovery has been amazingly fast in comparison to both my previous vaginal birth, and the cesarean. It's amazing how things work perfectly when done naturally. My system didn't have to get over any drugs being pumped into me, or soreness from an episiotomy and stitches. Compared to a lot of homebirth stories I have read, I didn't feel mine went as smoothly, and I definitely didn't cry out that I would do it again after all was said and done...but it WAS beautiful. It was beautiful that my baby was handled gently at birth, not rubbed down and tagged with plastic and handed from one unfamiliar hand to another. She was treated peacefully and gently, and for that alone I would go through the pain all over again.