Birth Story, Inverted T, Uterine Rupture

Elissa Marie’s Birth Story (Kristie’s Rupture During a VBAC Attempt After an Inverted T)

Early labor started on Friday, May 11th, at about 2pm. I was having painless contractions every 5-7 minutes so I just went about my day as usual. The next morning, Brian and I took Emma to soccer and I noticed I was still having a lot of contractions. I decided to time them when I got home while I was getting lunch ready for Emma and Erika. They were now consistently 2-3 minutes apart so I called my midwife, J, who was in Columbus for a midwife convention to let her know what was going on. I decided to see if my Dad and step mom could take Emma and Erika for a while so Brian and I could take a nap. I hadn’t slept well the night before and wanted us both to be well rested in case it was the real thing.

After sleeping for about 1 ½ hrs I felt better. I was still having contractions but wasn’t timing them anymore. Around 6pm I called to talk to Emma and Erika who were both excited that they were going to spend the night with Grandpa. I thought the contractions might be the start to the real thing and if it wasn’t, we were planning to go to my Dad’s on Sunday, Mother’s Day, anyway and we would just see the girls then. So once arrangements were made for the girls, Brian and I ate dinner and went for a walk through the neighborhood. We talked about how the last time we had walked, and it’d been just the two of us, was last summer on the beach in Florida, just a few weeks before we had conceived the baby we were getting ready to welcome. We were both ready for labor to start!

At 2:13 am, Sunday, May 13th, and Mother’s Day I awoke from a strong contraction. I knew this was it! These contractions were easily bearable but I was excited. I couldn’t sleep so I got up and baked chicken so I could make chicken salad for everyone to eat during my labor. I did a little cleaning too. I found some soothing music to listen to and tried lying down for about an hour. About 6am I decided to wake up Brian to have him set up the birth pool. I called J to let her know that this was it. Even though I didn’t think I needed her just yet, I wanted her to come as soon as she could because I thought my labor might go fast like it did with Emma. I decided to make some eggs and toast for breakfast because I was starving and didn’t know how much I‘d be able to eat once labor became more intense. Then I decided to lie down, and to my surprise, was able to nap for about an hour. The pool was half filled when I woke up. At this point my contractions were getting more painful but still pretty easy to get through. I was looking forward to the warm water. I finally got in around 9am and decided to call my Dad and 2 of my sisters just to let them know that I was in labor and wouldn’t be coming to Dad’s. J arrived at around 10am and her apprentice, M, arrived soon after. I started thinking they could have waited to come, because it was still pretty easy to make it through contractions. I actually felt guilty for asking them to come so soon. But I did think that things would move pretty quickly.

I remembered to ask Brian to light my Mom’s candle. She had started making candles when she was at Temple University about 1 yr before she died. She died last June (2006) and it made me feel like she was with me during my labor. I was still in the pool and enjoying it very much. The contractions were hardly painful when I was in there and we would all just talk in between. I asked J if laboring moms ever got out once they were in the birth pool. I was thinking this was too easy in the pool and finally decided to get out around 11:40am. This is when the contractions started getting more intense. Not long after noon I began feeling nauseous. I thought that things must be moving along well now. I remembered things going pretty quickly after I got sick during my labor with Emma so I decided to have J check my progress. I was quite disappointed to find that at 1pm I was only 2cm dilated but I tried not to think about the number.

J’s husband came by about an hour after my cervical check so that J could nurse her son and he brought the birth ball. I was glad to try something else now. I’d been on my hands and knees against the stairs or leaned against the couch with J or Brian putting pressure on my sacrum for most of my contractions. It felt really good to rock my hips and be able to sit fairly comfortably and move on the birth ball. I would push my sacrum against Brian’s hands during my contractions or have him squeeze my hips, but it felt like no one could squeeze my hips hard enough. I started getting horrible pain in my right hip and had to change positions. We tried the birthing stool with Brian in front and J supporting me from behind because I had to squat through contractions to help the pain in my hip. It was around 5:15 pm and I finally got sick. J had given me something to alleviate the nausea a couple times already and this time I declined it. It was actually a relief. I went back to the birth ball for a while and then to the pool again. Around 8:45 pm I asked to be checked again. I was afraid I wouldn’t have progressed much. I was 6cm and could be stretched to 7cm and had a bloody show! I was really excited that I was more than 5. I joked with J that it was a good thing that I hadn’t waited to call her until I had a bloody show and we all laughed.

About 9pm I told J that I felt like the contractions were on top of the last one and she said I was having double peaks. All I knew was that they hurt like hell and my hips felt like they were coming apart! I got back in the pool and by 10:20 pm I was feeling a lot of pressure. Surprisingly, I started falling asleep in the pool in between contractions. I was really tired and ready for the baby to be born. I asked J to check me again at 11:30 and my cervix was swollen and 9cm. M gave me arnica and J recommended I lay down in bed for a while on each side to let the swelling go down. Brian decided to lie down too and quickly fell asleep. J stayed with me while I lay on my left side with my pregnancy pillow strategically placed between my legs and chucks pads where they were needed. I was exhausted and managed to fall asleep between contractions. It was terribly painful to lay down at this point in my labor but I tried my best to relax my body during contractions. J had to keep reminding me to relax because I would immediately tense up. After about an hour, J went to Emma’s room to nap and M came in after having taken a nap and I switched to my right side. I couldn’t take the contractions anymore. They were unbearable lying down, but even more so on my right side. I was already thinking in my head about transferring, but I said nothing about it to anyone. I didn’t really want to transfer, but I didn’t know how much longer I could do it. Instead I told M I just couldn’t lie down anymore. She suggested trying to go to the bathroom and laboring on the toilet for a while. I really couldn’t pee anymore. I’d try to relax, but nothing would come out. Then she wanted me to try to eat something because I hadn’t had anything since around 6pm and that was just honey on toast. Nothing sounded good to me. I tried peanut butter toast with honey. It was all I could do to take a couple bites.

I decided to get back in the pool and finally said that I just couldn’t do it anymore. M went to get J and I finally told her that I was thinking about transferring…that I didn’t feel like I was getting anywhere. J suggested another cervical check so I got out of the pool and back up to my room where Brian was still sleeping in bed. It was so hard to get my legs up high enough to get out of that pool. I dreaded it every time. Then I had to get all the way up stairs and onto our bed with a pillow top mattress. It was excruciating to lie down on my back and be checked. We had to get Brian to move over a little but he stayed asleep. Now I can’t remember exactly when, but earlier when I’d been in the pool, we all thought my water had broken. There was a lot of “stuff” floating in the water after I thought I felt it break. It looked like hair and vernix I thought. But when J checked me, my amniotic sac was still intact and I was down to 7cm. I was crushed. J said she could break my water. It would move things along and that would be the first thing they’d probably do at the hospital. Now, before my labor, had someone asked me if I’d agree to an amniotomy, I’d have said no. I knew that it would not be without risk, but felt that it was my best option at this point. It was 3:20am and I told her to go ahead. I noticed that it seemed difficult to break. I asked if it was clear, fully expecting it to be. She said no. It was brown but it wasn’t “bad” meconium.

Having my water broken actually felt good, for a minute anyway. Then I was completely overwhelmed with contractions that just didn’t end. I flew off the bed onto the floor howling in pain and Brian sprung up out of a deep sleep and was on the floor next to me and J and M. J assured me that it was normal for contractions to get this intense after AROM. Then I felt a terrible pain in my right side and said so out loud. J immediately asked if I thought I had ruptured. I really couldn’t separate the pain I was feeling from the pain of just the contractions. I just said I didn’t know but didn’t think I ruptured. J checked the baby’s heart rate and since it was normal, I felt reassured that I didn’t rupture.

The contractions began settling back into a more normal and tolerable pattern. It wasn’t long after AROM, about 4:10am, that I got the urge to push. Once I was able to move from the hands and knees position I’d assumed on the floor in our bedroom, Brian and J helped me back down the stairs and into the pool. I really enjoyed the pool. J really wanted me to pee because I hadn’t in hours. She insisted but I just couldn’t go. My body wouldn’t let me. I finally agreed for her to try a catheter but it wouldn’t go in.

She checked me again and said to my utter amazement, “Oh, there’s your baby’s head. You’re complete! Now go push your baby out!” I was really excited now! I got back in the pool and kept pushing when I had the urge. I could feel my baby’s head and hair in my vagina. I thought to myself, “This is really going to happen”. I pushed in the pool for a while and then J suggested I get out and try in other positions and that when the baby started to crown, I could get back in. I really wanted her to be born in the water. It was a dream that I thought would never happen.

So I got out of the pool. I tried pushing on the stairs, in a lunge position, and then moved into the living room. The baby was having trouble getting past my pubic bone so I kept switching positions to help her get past. I pushed while squatting, on hands and knees, on my back, and on my side. Brian, J, and M were all cheering me on saying that the baby was so close to crowning. I was pushing on my side and I got that darn pain again on my right side, kind of like a severely pulled muscle.

The whole time, the baby’s heart rate was fine, 140s to 160s. I pushed while leaning on the stairs again like I had earlier. Then I went back to the birth stool. This is when late decels and tachycardia were first mentioned. I was already discouraged because I felt like the baby wasn’t moving down anymore. I’d been pushing for 2 hours without much change. I just said calmly, “I think maybe we should go to the hospital now.” J asked if that was what I wanted to do and I looked at Brian and asked him what he thought. He said it was up to me.

I really wanted to give birth and really wanted it to be at home after all the research I’d done. I didn’t want to go but I said I did anyway. I felt like I needed to for some reason and that it was the best choice. It was 6:30am. I thought about everything: the meconium, the late decels, the long pushing stage, and not much progression through the birth canal. It was just time to go.

Brian got the car started. J called ahead to the hospital. I just put a robe on over my naked body and reminded Brian to blow out my Mom’s candle. I felt sad as we went to the car, thinking of my Mom I missed so much and another possibility of a lost birth experience I so desired. I climbed in the back seat and positioned myself facing out the back window on my knees. There was absolutely no way I could sit down.

I tried not to push, but it is such an uncontrollable urge. My body just did. I secretly hoped the baby would just fall out before we could get to the hospital. J rode in the back seat with me. She wanted to check the baby’s heart rate but I couldn’t move. It was hard to even stay steady while Brian turned sharply and ran stoplights and stop signs. I could feel his sense of urgency.

We arrived at the hospital in about 15 minutes. J got a wheelchair for me and I was wheeled through the emergency room. They already knew I was coming so I was taken straight to the maternity ward. I was thankful that Brian and J were with me the whole time. M stayed at our house and cleaned up. I was wheeled into what would be my room for my entire hospital stay.

I was still in excruciating pain and all I wanted to know was when I could have the epidural. I had to wait until my blood work came back. I was poked 6 times, 3 in each arm, while several nurses tried to get an IV in me and take my blood for lab work. One nurse took my temperature and I had a fever of about 100F. It was awful being on my back and I asked if I could lie on my side. A nurse wanted to check me first to see where the baby was. I told her to be careful because her head was right there. I just pictured her poking my poor baby right in the head.

Finally I was “allowed” to lie on my side. J kept asking the nurses to try a catheter because it had been so many hours since I had peed. Dr. Z, the on-call doctor, came in to talk to me. She checked me and said that she thought the baby might be posterior. I didn’t think so at this point and J didn’t think so either. Getting checked was horrifically painful. Dr. Z said that she couldn’t feel very well where the baby’s head was without hurting me. She wanted me to get a spinal so that she could check better to determine if she could get forceps around the baby’s head. If not, I would need another c-section. I didn’t want one, but was worried about my baby and still in an indescribable amount of pain. She insisted on the spinal over an epidural and that this was all done in the operating room.

I was wheeled to the OR where I met a team of nurses and the anesthesiologist. The anesthesiologist, Mike, was very compassionate. He had me lay on my side to administer the spinal. He was empathetic of my pain and that I just couldn’t lay on my right side. The spinal was really strong on my left side but I could still feel on my right half. I had to switch to my right to try to get it evenly distributed but it wasn’t working very well. I was so afraid that I would feel something if they had to do the c-section because he gave a pretty light dose at my request. I really don’t remember ever feeling so clear headed, though, with my previous 2 c-sections. It took a while for the anesthesia to work its way to the top of my stomach. Dr. Z came in. I felt compelled to confess that I had an Inverted-T incision from my first cesarean and I think that sealed my fate. Dr. Z checked me again and said that the baby’s head had a caput, which is basically swelling of the scalp. She said that too much of the baby’s head was behind my pubic bone to use forceps and she would have to do the c-section. I was kind of relieved because I had a bad feeling about using forceps.

The curtain was put up. It was so high that I couldn’t even see the doctors. Brian was led in to the OR to be at my side. I was very disappointed that I couldn’t watch my baby’s entrance into this world with a mirror as I had during my first two cesareans. They wouldn’t lower the curtain at all and had never heard of using a mirror to let a mother watch her own cesarean. I felt so disconnected from everything that was happening at this point. I knew they had started but they didn’t walk me through what they were doing like my previous obstetrician had. I only knew she was born because I felt the weight lifted out of my body when they pulled my precious baby out. They didn’t hold her up for me like they said they would so I only caught a glimpse of her as she was taken to be cleaned off behind me. They only said she was okay. I told Brian to go to her, that I was fine.

Her apgars were 8 and 9. They weighed her and I just couldn’t believe it when they said she was 10 lbs 5 oz! My first two babies were 8 lb 2 oz. and 8 lb 1 oz. They were concerned about undiagnosed gestational diabetes so they insisted on testing her blood sugar which came back normal of course. The doctors continued to talk amongst themselves while they worked on me but it was as though I wasn’t even there. I heard someone mention the word rupture so I spoke up, “Did you just say that I ruptured?” Dr. Z said that I did but that she wasn’t planning to tell me until after surgery.

Apparently, my uterus had opened up at the intersection of the T scar. It ripped up the right side of my uterus, just under the placenta, tore straight down and all the way through my cervix. Her arm and shoulder were hanging out of my uterus and I had meconium in my abdomen.

Brian brought our little girl closer to me. She was beautiful but I could only see her face. I was so tired but I was concerned because she kept gagging and coughing. This went on for what seemed like half an hour before the nurse came over to check her again. They decided she needed to be observed in the nursery and I told Brian to go with her. I didn’t want our baby to be alone with strangers.

I started crying after he left. I was trying to be quiet because I didn’t want to appear weak to the medical staff that I assumed was already judging me for my choices. I was exhausted, trembling, had a horrendous pain in my shoulder, worried about my baby and was in a room full of strangers and felt immense loathing towards me in that room. Mike, the anesthesiologist, noticed I was crying and came closer to me to make sure I was okay. I was so grateful that he had compassion for me at that time. The spasm in my shoulder was unbearable, almost worse than labor had been. He massaged it for me to help ease the pain a little and stayed by me until they were done. I started getting worried at the end of the surgery because I realized the spinal wearing off. I could feel my toes and wiggle them. Mike had offered morphine before for the shoulder pain and I had refused because I wanted to stay as clear headed as I could. But I decided to take it now for fear that I might feel them closing me up. I did feel them shove my exteriorized uterus back in, but it wasn’t painful, just nauseating. Finally after an hour and a half surgery, I was wheeled back to my room.

J was there waiting for me. I was so glad to see her! Dr. Z had already told J that I’d ruptured and chastised her for trying to help me deliver at home. She told her that she could see meconium in my abdomen as soon as I was opened up. Then Dr. Z came in and asked me why I would even try to do this at home after having a T incision. She said she wouldn’t have even let me try in her practice. I told her I already knew that because I’d called her office during my search for a new provider. I told her about how I’d researched it and even told her about the UK study that came out 2 wks before that sited a rupture rate of only 1.9% for an inverted-T. Dr. Z snidely remarked that, “No, it’s more like 4%”. I just didn’t say anything else. I was exhausted and didn’t have the energy for what seemed like a useless fight. I’d just come out from surgery and was feeling loopy on morphine. After Dr. Z left, J asked how I was feeling. I really just wanted to know if my baby girl was okay so I asked her if she’d check on her. When J came back, Brian was with her. They both said that our baby girl was fine, but was retracting. The nurses told me they’d bring her to me as soon as they could. J left to go to our house to make sure everything was cleaned up.

Brian and I were alone for the first time. Brian was really upset about what had happened. Dr. Z had told him that he was seconds from having to choose the baby or me and that it was a good thing they’d done the c-section when they did. He was very shaken up and rightfully so given that information. However, I didn’t need a blood transfusion or a hysterectomy. I had been told that I wasn’t even hemorrhaging at the rupture site. It was bleeding but not uncontrollably and I don’t think the situation was as dire as she described. I had lain in a hospital bed for 2 hours, waiting for blood work and such, before I was even taken to the OR to try forceps. If it had been such an emergency situation, that they were aware of, I’d been taken straight to the OR for an emergency cesarean. At this point, I was just concerned about my baby girl and wanted her in my arms where she belonged.

Elissa Marie was finally brought to me at 1:30 pm. She latched right away. I was so worried that being separated for 5 hours would negatively impact our breastfeeding relationship. I asked not to be served clear liquids because I knew I needed a lot of calories to make milk. Luckily, I was allowed to eat real food for my first meal because later that night I developed a fever of 102 F. My blood pressure got down to 86/33. The nurse asked if I felt weak, and I said yes. They started IV antibiotics right away. I was not allowed to eat or drink anything because they said I might need surgery again. It was pretty scary for a while. I kept having intermittent shoulder pain too. The pain was like it felt during the surgery. There were times when I felt like I was dying or that something was just terribly wrong because of the pain I kept having. It was explained that it was air that had been “trapped” in my abdomen during surgery and had moved to my shoulder. I just had to wait for it to dissipate on its own.

I was very thankful when my blood pressure went back to normal. I was on IV antibiotics for 4 days. My fever did go back up a couple times throughout my stay but would go away with Ibuprophen. Once I started feeling better, I decided to ask the nurse for my operative report and got the strangest look. I needed to read what happened during my surgery so that I could really process what happened.

Due to all the stress my body went through, it ended up taking 4 full days before my milk came in and by then, Elissa was starving. Luckily, Elissa’s weight only got down to 9 lbs 9 oz though before she started to gain. She was 9lbs13oz when we were released and despite everything, was a beautiful, healthy baby.

4 Years Later…

Elissa is going to be 4 years old next month. She is exceptionally smart. She is one of the sweetest and definitely one of the spunkiest little girls I know. She started talking in sentences when she was only 13 months old and is often mistakenly thought to be much older than she is because of how well she speaks. I feel so blessed that she is alive and healthy and didn’t have any adverse effects from her birth.

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