Wednesday, April 13, 2011

What's What Wednesday: Birth Planning-Part Five

My Victorious VBAC
A Guest Post By: Angela Vogel

From a young age, I knew that birth was natural and beautiful.  I knew that if I ever gave birth, I would try to do so naturally.  My mother is a childbirth educator, after all!  However, I became pregnant shortly after moving 800 miles away from my family for my husband’s job.  I was terrified of beginning this journey into motherhood so far from my support system and with a husband who worked 80 hours a week.

We took the generic hospital childbirth class and made a written birth plan.  Unfortunately, since I was planning a natural delivery, I didn’t pay much attention when the instructor was talking about cesareans.  I had no plan, written or otherwise, in the event of a cesarean.  As it turned out, my water finally broke 11 days after baby’s due date.  After 12 hours of labor, I was completely dilated and they told me to push.  I had heard about the strong urge to push that women get when it is time.  But, I never felt that, despite the fact that I was un-medicated.  I pushed for 3 hours with no progress.  Baby was still at 0 station.  My doctor was at another hospital in surgery.  One of his partners checked on me and it was decided that it was time for a cesarean.  We found out that our son Ignatius was posterior.  He was also 8 lbs, 9 oz.  Immediately following his birth, I blamed my “failure to progress” on his size and his position.  After further reflection, I realized that it might have had something to do with all of my fears.

Eighteen months later, we were excited to find out that we were expecting baby #2.  I knew as soon as Ignatius was born that I would try for a VBAC (Vaginal Birth After Cesarean).  I knew I needed to surround myself with positive birth information and supportive people.  I needed to take a proactive approach.  I now had some support in the area.  I loved attending La Leche League meetings and found a number of other moms there who had delivered their babies naturally, and even one who had two successful VBACs.  I started taking prenatal yoga to be more in tune with my body and try to avoid a posterior baby.  My husband and I decided that we were more confident having a hospital birth in the event that there were an emergency.  However, this time around, we found some midwives who offered a natural childbirth class.  During the class, I realized that my biggest fear going into this birth was not that it would end in a cesarean, but that I would be separated from my baby.  I had been separated from Ignatius for three hours after he was born!  We also found out that our hospital was not very VBAC friendly.  If we really wanted a chance at a successful VBAC, we needed to change hospitals.  Driving 40 minutes instead of 25 minutes was definitely worth it! 

During my first labor, my mother had come in town and acted as both mom and doula.  For this birth, we decided to hire a doula who worked with the midwives.  This way, I didn’t have to worry about whether or not my mother would make it to town in time.  It also gave us someone who was on our side supporting us, but not emotionally involved.  Luckily, my obstetrician agreed to a trial of labor.  Where we were living, it is hard to find a doctor willing to do this.  We tried to research our hospital’s policies on VBACs and certain protocols, but were often told varying evasive answers.  After consulting a number of birth planning websites, we made a simple, one page, written birth plan that our doctor signed, but we still expected there to be a few hiccups.

Birth Plan for Angela Vogel

Obstetrician:  Dr. Michael Last Name                       Due Date:  Friday, November 28, 2008

Attendants:  Dave Vogel (Husband), Kylene Last Name (Doula), Mary Last Name (Mother)

We believe that labor and delivery can occur naturally.  These are our preferences for the birth of our baby.  However, we understand that complications can arise such that our plan cannot and should not be followed.  We hope that barring any extenuating circumstances, you will be able to keep us informed and aware of our options.  Thank you.

During Labor & Delivery
            Room Quiet with Dim Lights
            Saline Lock Instead of Routine IV
            Drink Clear Liquids
            Free to Walk, Move, & Change Positions
            Intermittent Fetal Monitoring
            Please do Not Offer Pain Medication
            Access to a Tub and/or Shower for Pain Relief
            Minimal Vaginal Exams
            Freedom to Videotape & Photograph Labor & Delivery
            Perineal Massage & Support to Avoid Episiotomy
            Dave has Option to Cut the Cord
            Immediate Infant Bonding

In Case of Cesarean Section
            No Medication Prior to the Spinal or Epidural
            Dave will be Present for Cesarean
            Baby will Remain with Angela in O.R. & Recovery Room
            If Medically Necessary, Dave will Accompany Baby to Nursery & Kylene or Mary                                   will Stay with Angela

Baby’s Care
            Immediate Bonding
            All Care Performed at Bedside or On Mom
            Baby Exclusively Breastfed on Demand (No Pacifiers or Supplementation of any kind)
            Do Not Treat Baby’s Eyes
            Do Not Give Routine Vitamin K, unless requested due to traumatic birth
            No Routine Blood Sugar Tests
            No Circumcision
            No Hep B Vaccine in Hospital
            No PKU Screen in Hospital (will perform at first visit to Pediatrician)
            Dave and/or Angela Notified and Present During all Procedures Performed on Baby

For the most part, things did go according to our plan.  Labor started one and a half days after my mother arrived and two days before baby was due.  When we got to the hospital, I was already 5 cm dilated.  They were concerned that baby’s heart rate was slightly elevated.  My doctor suggested giving me some fluids and that seemed to calm me and baby down.  There had been a few things that the hospital had said would be left up to my doctor.  My doctor had said those things would depend on hospital policy.  (Varying evasive answers!!)  Though we had been told intermittent fetal monitoring would be fine, once we were at the hospital, they wanted me continuously monitored.  Since we were expecting a few hiccups like this, it wasn’t a huge disappointment, just a nuisance.  Luckily, I was still able to move around.  I did not use the tub or the shower during labor, I don’t think it ever really crossed my mind.  Thank goodness they never offered me any pain medication.  I was experiencing some intense back labor and probably wouldn’t have had the fortitude to say no to pain relief at that point.  My doctor checked me once when he arrived at the hospital.  Then he told me he would leave me alone for a couple of hours unless I wanted him to see me again sooner.  As it happened, I did request to see him sooner when I felt the urge to push.  He checked me again and I was, in fact, complete.  I pushed for 90 minutes and out came another beautiful baby boy. Our son Augustine arrived posterior asynclitic (sunny side up with his head tilted) and weighed in at 9 lbs, 2 oz.  This explained the severe back labor I had experienced!  I did tear during delivery, but I preferred that to getting an episiotomy.  Dave was able to cut the cord and I was able to have immediate bonding time with Augustine.

Labor had been challenging and I was exhausted.  My back continued to ache and my stitches were extremely uncomfortable.  But this was nothing compared to the grueling recovery from my cesarean.  I could use my abdominal muscles to sit up, get up, and lift up my two year old.  Best of all, I had been able to initiate nursing right away.  It had been a wonderfully empowering birth.

Angela Vogel lives in Ohio with her husband Dave and their two sons, Ignatius (4.5 yrs) and Augustine (2.5 yrs).  They are eagerly counting down the days until they can finally move closer to their families this summer!

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