Birth Story, Uterine Rupture

Cora River’s Birth Story (Lisa’s VBA2C and VBAR)

Summary version: In June 2018, after many years of preparation, I had a successful vaginal birth after two cesareans and uterine rupture, which happened in 2015 with my second birth. Everyone said I couldn’t/ shouldn’t, but I did. Here’s my story…

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Photo credit Milk and Hannah Photo: https://www.milkandhannahphoto.com/

I love birth stories. And like most, this story begins with the birth of my first son in 2013. I wanted a natural hospital birth. I hired a monitrice, had a great uneventful pregnancy, went into spontaneous labor at 41+6, and after 23 hours of mostly unmedicated labor (had Demerol at one point), ended with a cesarean due to failure to progress (despite being 8-9 cm), though they told me it was because his heart rate was dropping and my cervix was too swollen to make it worth keep going. He was healthy, beautiful, amazing, and 9 # 3oz, 20.5”. Our first baby. My incision took three months to heal, as it re-opened in the week following birth, and my (amazing) husband had to dress the wound twice daily.

Our second son surprised us with his presence in 2015. Again, wanting a natural hospital birth & vbac this time. I’d read a lot and as many of us do, felt prepared on my own. I considered a home birth and/ or doula, but for various reasons decided to go at it alone (with my husband). I switched doctors to the “best” vbac-friendly OB in the area. As 42 weeks came, my dr suggested induction, which I agreed to. I was induced with pitocin at midnight of 42 weeks (why do they even have that appointment time?!). After about 12 hours of labor, I opted for an epidural as the shower and tub options became further out of reach due to hospital “policies”. My kids don’t seem to like me laying on my side, and approximately 5 hours after that I was recommended to undergo another cesarean due to late decels & FTP. (Again I’d made it to 8-9 cm at this point). My Dr knew how I wanted a vbac, and since I was 10 cm when we got to the OR, he said I could try pushing (!!). Despite not being able to feel anything, I pushed, and he used both a vacuum and then forceps. Whether I developed a Bandyl’s Ring or not, I don’t know, but my uterus ruptured in that moment along my previous cesarean incision line, and down towards my cervix. Thankfully, I was already prepped for the CS, and baby (and I) made it out safely – 9 # 6 oz, 21 3/4” long baby boy. We were able to go skin to skin in the OR, but I was an emotional mess, as I was told (while being stitched up) that further pregnancies would have to end with a scheduled cesarean. My heart broke in that moment, and it took a long time to heal. Online communities like Special Scars were my best healing tool during that time, along with seeing a counselor for PTSD-like symptoms and going through the story with close friends.

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Photo credit Milk and Hannah Photo: https://www.milkandhannahphoto.com/

 

When my second son was around a year old, I enrolled in a doula training program. It’d been on my heart to learn more about birthwork and to attend and support women in labor. Between 2016-2018 I attended six powerful and different births, which helped me visualize my own path and learn so much from the mothers who were not only clients, but friends.

My husband and I went back and forth about a third baby. Two boys were a lot of work, and with money already tight it didn’t seem like the best option. I wanted a third child; I didn’t feel like we were “complete” yet, and I eventually talked him into it. I needed to make sure that I wanted a third child; not just the chance for a vaginal birth. But I also wanted a TOLAC (trial of labor after cesarean), aka unless there was a true need, I would not be scheduling an unnecessary cesarean, despite the fact that ACOG (American College of Obstetricians and  Gynecologists) does NOT recommend a TOLAC after uterine rupture, and it’s extremely rare to find a provider who will “allow” you, much less support you, after a rupture. I met with several different providers who all said No, including trying to persuade my OB who was attending when I ruptured, but he said the “hospital policy” would not allow it. However, there is a local OB who’s one of the leading doctors in the field for VBAC studies, and I made an appointment to see him. I was scheduled to meet with a Fellow doctor there instead, who (surprisingly!) said she thought I’d be a good candidate for VBAC if that’s what I wanted. I could not believe it. Another doctor came in and disagreed, but when she left, the Fellow wrote down a doctor’s name at that practice (not who I originally went to see), and said if I ever wanted to try for a vbac, and I couldn’t find anyone else, to look up this doctor and see what he thinks. I was elated. That was around June 2016.

I had a miscarriage around 6 weeks gestation in February 2017. In early September I found out I was pregnant again, and my mind was made up that barring any issues, I would be aiming for a TOLAC, with or without a supportive provider. When I asked my OB one final time if he’d support me, and he said no, I said Okay, and I was done. I pulled my records immediately and had them make me a referral appointment to see the OB at the university who’d been suggested to me. I was done, and ready to move on! I was so nervous for my first appointment! But there I was, getting an ultrasound (with the tech telling me I wouldn’t be able to have a vbac, like it was her business!), and me ignoring her comments, saying “I already have someone who will support me”. I met the OB. He said he’d read my records, and he wasn’t sure I ever actually ruptured. UMM…WHAT. Long story short, he read my first cesarean operative report and thought it was my second birth! But either way, he said ‘we can’t force you to do anything you don’t want….if you want to try a VBAC, then I’ll stand behind you and help watch over you and guide you”. I cried. In his office, in front of him and a random Resident/ Fellow. I cried and told him that more than anything, I needed a *healing* birth experience. Whatever path baby needed to go down, I needed this to be healing. And it was such a crazy feeling, of meeting with someone after years of wondering if I’d ever find someone to actually support me, who said he would. (He later told me the nurses call him a “cowboy” because he supports women who other doctor’s wouldn’t normally support, and who’d normally perform CS on without hesitation – I think he’s kind of incredible).

As they do, the days, weeks and months of pregnancy went by, and thankfully for me, without any major issues. My placenta implanted in a great position (far away from my scar and cervix), baby was continuously doing great. My husband and I sold our house (before it even went on the market!), and moved into a rental house with our two kids and two dogs.Despite my husband’s wishes, I was adamant that we keep the baby’s gender a surprise, as this would be our last baby, and I gave in to finding out previously. As well, my husband had decided I was making all the birth decisions with this experience. Initially, he wished I’d have a scheduled CS, since that is what is recommended. But after I refused, he supported all of my decisions, and knew I was tired of doing things the way other people wanted me to, so we continued on the path together.

I hired a highly recommended local doula, and eventually decided I wanted a birth photographer as well. I listened to hundreds of podcasts about birth, about body physiology, and how the system has messed up so many women’s stories. I really loved listening to the FreeBirth podcasts, even though Freebirth wasn’t necessarily my path. In my mind it was. I envisioned giving birth in my shower, unassisted, alone, and at peace. And this vision stayed with me through most of my pregnancy. My previous two full-term pregnancies lasted very close to 42 weeks, so I fully anticipated being pregnant at least that long, if not longer. My OB knew I planned to go to 42 weeks, even though once 39 weeks came around, he began to discuss worry that I could rupture with baby getting bigger, the placenta degrading, etc. I remember telling him at one appointment, “I am not worried. It’s your job to worry if you want.” Rather than having moments of questioning myself and my choices, I would more so develop anxiety about ideas or fears other people (usually the OB) would try to push on me. But again, I felt that my previous experience of rupturing was based on poor stitching from my first cesarean, pitocin induction, the use of forceps and a vacuum (I later learned you should use one or the other; not both), and a possible Bandyl’s Ring. I felt that I knew my body well enough to know that if I were to rupture again, it would be during labor and/ or pushing. I played out different scenarios in my head – the use of general anesthesia, a repeat cesarean, or even losing the baby, though I kept many of these thoughts to myself. I knew others were worried about my path, and I did not want anyone’s fears to impact my journey with my body and my baby.

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Photo credit Milk and Hannah Photo: https://www.milkandhannahphoto.com/

40 weeks, then 41 and 42 weeks came and went. I agreed to NST (non-stress tests) past 41 weeks, and baby did wonderfully. My OB asked when we were scheduling the cesarean, and I told him I wasn’t going to, and that I’d let this baby come when it was ready. Though he disagreed, he did not try to force me to do anything I did not want.  The day of my 42+1 appointment, I had to leave work early to pick up my 5 year old from his sitter’s house, because he was feverish and vomiting. (Excellent timing!). I took both boys home to rest, and after using the toilet, found I had some mucous discharge – Wow, perhaps this baby would finally be making a grand entrance! I messaged a few close friends and my doula, waited for my husband to be home with the boys, and left for my NST & OB appointment. I hadn’t been checked for dilation up until this point (much to everyone who asked dismay), but I went ahead with having him check me this time (to his surprise) and I was 2-3 cm, with a thick, high cervix. I had been worried he’d really try to push cesarean since I was past 42 weeks, but he didn’t say anything after I told him I was continuing to wait, other than that he was travelling during the weekends, so I may not get him once I got into labor, and there was worry about whomever I might have really giving me a hard time about TOLAC. But I knew worrying about something that may or may not happen was pointless, and I let it go.

Along with the mucous plug, I’d had some stronger Braxton Hicks contractions all day, on and off. Not many, but a few were strong enough that I had to stop what I was doing and work through. Good progress, I thought, if nothing else.

I got home, and helped my husband with dinner and taking care of our oldest who was still sick. Over time the contractions picked up more frequently, and I let the doula and photographer know, but knew that this could go on for days and surely could stop once I went to bed. We settled in and I figured I’d sleep through them and they’d go away, but every 10-20 minutes another good contraction would come. At first I could lay in bed breathing through them. Then I was getting on all fours next to the bed on the floor. Then I’d be getting on the toilet because I felt like I had to pee/ poop immediately after them. Oh and between some of these contractions my 5 yo was waking up crying in pain/ fever and throwing up. It was a long night for all of us. My husband seriously/ jokingly said “I’m still going to work in the morning!”, to which I told him I really didn’t think that was going to happen! Around midnight it seemed things were definitely in full gear, though I wasn’t really paying attention to the timing of things, despite trying to use a contraction timer. They seemed to average about 8-12 minutes apart, lasting for about 1-1.5 minutes (which I remember my doula teaching me the length of the contraction had a greater impact than the closeness of them, so I thought we must be doing good). We called my doula around 3:30 am and let her know what was happening, and she reminded us that we didn’t want to go in too early. I worked through them for another 45 minutes or so, and decided we needed to call my mom to come watch the boys when we went to the hospital. They were coming pretty strongly now, and I would have to get on all fours to work through them. I got in the shower, and that definitely kept them coming. In the tiny rental house shower (not even a full-size shower; more like a small triangle/ corner shower) I would be on all fours, trying to figure out how to get water on my back, while on all fours, while working through strong contractions. Even I was laughing in my head at how ridiculous it was, and how happy I was to be in labor, even though I didn’t know how my story would unfold. I also remember hanging from the side of the shower and letting my legs relax, which felt so good. My mom arrived and I could hear the panic in her voice of her daughter in full blown labor, at home. I told her I was fine – this is exactly what I’d wanted to happen for months and years since my last birth. I told my husband it was time, and he asked me if I was sure, since I didn’t want to go in too early. The hospital is at least a 30-40 minute drive, plus the long walk to labor and delivery – I was sure! Plus, I knew that deciding to go, and actually getting there would take time too; just getting out of the shower, dressed and into the car (riding on all fours in the back of my SUV!) would take time too to work through the contractions.

He called my doula and photographer, whom likely both heard me moaning and grunting in the background. I know enough about birth that I knew my body wanted to push in the car; I did my best not to, and to try to breathe through the urges instead. We finally arrived at the hospital, where every person who encounters us asked if we need a wheelchair and if they can help at all. It hurt too much to sit and my husband thanked them but said I was working through normal labor. I got to triage and immediately got on the floor on all fours again. It’s so funny how people ask you to do things when you’re in full labor, or have a conversation with you, as if that’s going to happen. They convinced me to get on the bed while they placed a saline lock and did their standard protocol. In pure disbelief, they told me I was at 9 cm. NINE. I could not believe it. My other two labors basically ended around this stage, and here I felt I was just getting started. The nurses told us the rooms were full and I may have to deliver in the OR – I told them I didn’t care (though I was annoyed). They told me how VBAC has lots of risks- Yes, I’m aware. They thought I had a Classical incision – no, I don’t, and I’m glad you all clearly have no idea what you’re talking about. I know my risks. I know the statics. I’m going forward with my plan. (This was around 6 – 6:30 am).

We got moved into a room and I stayed on all fours. My doula and photographer were there with me, and I was so happy to hear their voices. My doula reminded me often that I didn’t need anyone in this room. The only person to have this birth that I needed was me, and my baby. Such powerful words. I asked repeatedly for my OB – I told them I wanted him and that he’d be there, to which they said they would “try” to call him. (He told me later they told him I was there, but that they didn’t need him, so he didn’t come. Still disappointed he wasn’t there.)

My bag of water was bulging far beneath my vulva, and I declined to break it at first, but decided later to go ahead – baby was already a +1 station and made a seal so only a small amount of water came out. I worked through each contraction, one at a time. Going from all fours/ hands & knees, to trying the squat bar (and not liking it), to squatting with one leg up at a time in bed. At some point I was checked again and found to be “complete”- possibly my new favorite word – and being told if you want to try pushing, go ahead. I tried for awhile, though I wanted my body to feel the urge to push (it had been for awhile now) and for my uterus to be doing the grunt of the work, rather than me forcing it. Someone mentioned that I hadn’t peed since I’d been there, and we all decided to make the long walk (about 5 steps) to the bathroom. I’d also wanted greatly to use the shower, but the hot water wasn’t working! What a disappointment! So I sat on the toilet backwards, where it seemed like nothing happened, other than more contractions. I turned around to face forward to see if that would help me pee (I knew an empty bladder would give baby some room to move around/ down), and baby was quickly coming. I could hear my moans/ pushes/ opera-singer sounds coming out of me, and knew what I felt was most likely the ‘ring of fire’. I felt between my legs, and there was the top of a head. Again, I couldn’t believe it! Without seeing it, I knew I was feeling hair, and a little head that I’d soon meet. I think I kept it to myself for another 1-2 contractions, and then told my husband and doula “I’m crowning!”. I don’t know if they didn’t believe me or what, but they both said “Great!”. I thought …. Yeah, no, seriously!!

At some point, an anesthesiologist came in, said something to me about …. I honestly don’t even know what, and then left. My doula & photographer later said he said that I’d be a “Stat OR”, meaning I’d probably be needing to undergo general anesthesia or something (assuming I’d be rupturing soon, not realizing I was nearly pushing the baby out in that moment, on the toilet).

My doula mentioned that I might want to get in the bed before the hospital staff put me in the bed, so I agreed. With one hand holding my baby’s head, and the other holding onto my husband, walking with my knees bent and legs wide, we slowly went back to the bed, still getting back onto all fours/ hands & knees. There was a mention from one of the staff of getting into a different position, which I said I was staying as I was. The moment in my memory is blurry, as it usually is in labor, but I believe I pushed for around 10-15 minutes, only with contractions and as I felt the urge, and pushing how I wanted (an important part of my birth plan), and a head emerged, and then a slippery body, along with the rest of the water bag. The doctor asked my husband to announce the gender (another part of my birth preferences) and with tears in his eyes, he announced she was a girl. I looked through my legs to see a little screaming bloody baby who just made her way into this world in a way I didn’t know that I’d ever experience. They suggested I flip onto my back, and again, one of my strong wishes, she came immediately to me on my chest. Crying, screaming, bloody, beautiful, girl & daughter. How is it possible I got everything I wanted from this birth?  Somehow, I was one of the few in the room not crying, but I was happy beyond words. I’d done it. I had my vba2c and I proved every single person wrong who thought I was crazy, who said I couldn’t do it, who thought I was being irrational and unsafe. We did it together.

Miss Cora River was born at 9:29 am on the summer solstice, June 21st, 2018. She was my smallest baby, yet longest gestation, at 8 lbs 7 oz, 19 ¾” long, with a 15” head circumference. Looking back, even less than two weeks later, it all feels like a dream. The most important lesson I learned from this experience, would be that I believed in myself, and I believed in the birthing process. I knew and understood the risks. There were many people who wished I’d scheduled a cesarean instead, but I knew in my heart and mind that I needed to try; I needed to let baby decide when she was ready to come earthside. I didn’t let other’s fear impact my journey, and I learned from another’s birth story, if you feel like you’re in a river, and flowing with the current, you’re going the right direction.

And one last note: somehow during the beginning of my pregnancy, my LMP date was written incorrectly in the hospital system. So while they believe my baby was born at 42+2…she was actually 42+5. I’m so glad she chose her birthday.

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Photo credit Milk and Hannah Photo: https://www.milkandhannahphoto.com/

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