Preparations

For my 36th birthday my husband took me out to Quiessence at South Mountain in Phoenix. It was amazing; course after course of rich, fine food and plenty of wine to go with it. We spent more money on that meal than we ever had before, no small feat after living right down the road from the Gormet Ghetto of Berkeley, CA for six years. I joked about framing the receipt to show our boys what happened to their college funds. The next night I went to a girl's night party down the street, drinking more wine and reflecting on life and kids. I remember talking a lot about being happy to be done with babies; looking forward to getting back into teaching, putting my youngest in underwear and in preschool and my oldest in kindergarten soon. And the next day? I realized my period was late. Like days late. And, thanks to a leftover pregnancy test, I discovered that we might not be done with babies after all...

Pregnant??!! If we were going to have another baby, there was no way I wanted another repeat c-section. I had no idea if VBA2Cs were more risky than VBACs, but that was what I wanted and I was going to find a care provider who wanted it, too. We had only moved to Arizona seven months prior, and our insurance had just kicked in. My husband and I hadn't picked a primary care doctor yet, so we were starting from ground zero. I googled around about midwives and homebirths (midwife-attended VBAC homebirths are illegal in Arizona, fyi; and so finding a provider is tricky), VBAC-friendly hospitals and OBs and called a few in the area on the list. I only found one practice, consisting of a midwife and 2 obs, willing to take me on as a VBA2C with no previous trial of labor. I was not impressed with the appointment scheduling process or the cramped, cold office, but I did like the demeanor of both midwife and OB, especially the doctor. He was very down-to-earth, an East-Coaster like us, smart but sensible, and very easy to talk to. Most  importantly, the practice was evidence-based. During the first visit I asked for transvaginal ultrasound to establish dates and check for a heartbeat, even though I was only 6 weeks LMP. I had had a miscarriage between my two boys and didn't feel like waiting around to see if this pregnancy was going to "take." He cautioned me about what we might see or not see; about the rates of loss that early on, etc., etc...and then, low and behold, there was a perfect little yolk and sac and a teensy little heart fluttering away. This one looked to be hanging in.

I went in again at 12 weeks and this time we really discussed the potential and possibility of VBAC. I explained the rational for my previous surgeries and how, in retrospect, I didn't feel like the recommendation for c-sections was warranted or even valid.The doctor agreed, but was also very straightforward about the reality of the local hospital policies and protocols. Basically he told me that if I really wanted this, he was all for it, and would do everything in his power to help it happen, but that the best case scenerio was to waltz into triage already dilated to 7-8, because no one else on staff was going to be comfortable with a VBA2C labor that wasn't progressing strictly by the book, especially since my last two babies had been so large. His recommendation stuck in my head throughout the pregnancy, and the irony of what happened in labor is not lost on me.

If we were going to do this - have 3 kids, then I wanted to at least go into labor. This was my only real goal the entire pregnancy. Many people looked at me like I was nuts, but it felt really weird to be a mom two times over with no labor stories to share. I wanted to feel my body working in cooperation with the baby, and I wanted to know once and for all that my body was not broken - that though I may grow big babies, that doesn't mean I can't get them out.

I focused on growing a healthy baby in a healthy body. I had "morning sickness" the entire pregnancy and craved macintosh apples and Coke (I don't normally drink soda), but I tried to focus on protein and veggies and WATER. Growing a baby during the summer in the desert is no joke. I did a lot of yoga to try to get the baby into a good position, and she was head-down from 19 weeks on, though always settling back into a ROT position (looking sideways.)

I did have a complete placenta previa early on, something my OB wasn't the least bit concerned about, but it had me researching accreta and hysterectomy statistics, and freaking out, convinced that the scar tissue from my 2 previous surgeries were going to head me right into an early c-section and the loss of my uterus. We went to Pennsylvania at the end of the summer, in between ultrasounds, and I spent that whole trip sweating on my "c-sections suck" soap box trying to explain scar tissue, placentas and adhesions to my perplexed in-laws; having nightmares about emergency surgeries. But by 26 weeks the previa had resolved and I needed to find something else to worry about...luckily worrying has never been tough for me!

I decided I needed to feel more prepared, and more supported. Somehow, at 32 weeks,  I ran across a referral for ICAN (International Cesearean Awareness Network) and joined the local Facebook group and sat in on a couple meetings. Here were plenty of women who felt just like me about their c-section births, and many of them had successfully VBACed HBACed VVBA2,3,4Ced...their stories and support were inspiring, and made me cautiously optimistic. They clued me into some of the specifics of local practices and offered a lot of advice and support. There was a lot of discussion of informed consent, of trusting intuition and tuning out everything else. I realized how important it was to be making my own decisions, whatever the outcome, and to feel like I was in control of my body and the process. I only wished I'd found them four years prior!

Nat and I discussed hiring a doula again - we had done it twice already and never used their services. Somehow I had the idea that if we didn't hire one this time it would make the labor more probable. But my good friend, who happens to be a doula, pointed out that logical fallacy. Plus, with two other kids to think about, it was going to be a given that practicing for labor was going to be tough, nevermind the triage of handling the kids when I was in labor. We were going to need help, and we found it in Anne. Thank God.

I re-ordered and re-read all the books I'd loved so much in my other pregnancies (and had passed along because we weren't haveing more children, hah!): Ina May, Birthing from Within, The Thinking Women's Guide to a Better Book, Giving Birth. I watched the Business of Being Born and More Business of Being Born over and over on Netflix, and read every birth story and birth study I could get my hands on. Every discussion Nat and I had was about birth and birthing rights. My husband is an amazing father, and a very patient partner.

My only loose end, mentally and physically, was what to do with the kids. In a new place without much of a support system, the prospect of laboring at home for (potentially) days with a 2 year-old and 5 year-old in the wings was not ideal. My mom had decided to come at (what we thought would be) the last minute, at 42 weeks in order to focus her energy on helping while the baby was here, so I created an on-call network of neighbors and school friends and packed backpacks for the boys. But I was still worried about leaving them with people they didn't know very well, worried because we were starting to go through the usual winter cold and flu season and didn't want to leave them when they were feeling crappy, worried because suddenly this whole labor thing seemed dark and long and, well, hard.

I kept joking that I needed to just find a homebirth midwife (at 38 weeks) so I could feel more comfortable that the kids were being cared for. "You'd never be able to labor with them around!" said my husband, and apparently he was right.

But I also couldn't apparently labor worried about them, because I didn't go into labor. Not for a very long time. At 39 weeks I felt close; baby had dropped lower, Braxton-Hicks were picking up, my midwife got the sense that things were going to start soon and so my husband spent 24 straight hours hammering out his research and setting up his class for another professor to take over so he would be available for me. But then the kids got a nasty virus and my body shut down for a bit. It didn't start up again for three weeks!

watching the legs in action at 41 weeks

I cannot begin to describe how clean my house was for that last month - how many "labor projects" got started and completed, how sick my husband and I got of each other. Pedicures, massages, visits to the chiropractor to help turn the baby from her ROT position. Countless hardboiled eggs and cups of raspberry leaf tea consumed.

I hadn't shared the official due date (November 17th 2012)  with anyone except our parents. When anyone would ask, I'd say something like "around Thanksgiving" or "by the beginning of December". My due date came with the arrival of a close friend's 3rd child (at home, 2 weeks early), but no signs that our little one was any closer. I'd fudged my LMP date a bit to us a few days, and I reiterated with the midwife and OB that I didn't want any discussion of induction until after 42 weeks, though their practice was usually to start getting nervous around 41 and 3. I had my membranes stripped at 39 weeks and again at 41. I was a fingertip dilated, the baby was lower than I'd ever felt either of the other two, but not very low in the grand scheme. My midwife mentioned that the baby felt big. She mentioned elective ceserean. I burst into tears and blubbered my goals, she backed off right away. I wondered again if it might be possible to arrange for a HBA2C (homebirth) at 41 weeks...

And then my Mom finally came, and I finally went into labor.

putting up the tree, 42 weeks

My 2Cs

My sons were both born via elective c-section. My first, Silas Fen, on March 26, 2007 at 40 weeks, 6 days due to "suspected macrosomia and cepholopelvic disproportion" which is a fancy way of saying he looked big. And he was big. But "big" is not a great reason to undergo major surgery, and though my instincts told me this, my smart, kind, doctor (whom I had no reason not to trust, right?) was nervous - nervous about the state of my cervix, the position of his head, the results of the 38 week ultrasound, the stats on shoulder distocia....and though my husband and I had been planning and practicing for a natural labor and birth, we took her advice. I waltzed into triage rested, showered, and contracting regularly and proceded to have a lovely c-section with kind nurses, great anesthesia, excellent surgeons, and good music. I was wheeled into recovery right behind a beautiful 11 lb, 4 oz. boy who nursed like a barracuda and had a sweet little ridge on his 16 inch head where it had been wedged against my pelvis. Actually, he had to be vacuumed out of the incision...first time the doctor had ever had to do that. I felt good about our decision. Sure, the recovery wasn't awesome, and I'd have preferred not to be on mega doses of oxycodine and motrin when nursing, but who knows what sort of hellish labor we might have had?

going to have a baby

new family in surgery

nursing and recovering

With my second son, Caleb, I decided to try for a TOLAC (Trial of Labor After Cesarean) hopefully leading to a VBAC (Vaginal Birth After Cesarean). Mostly I wanted to try to go into labor on my own and get to try all of the awesome techniques we'd gleaned from Birthing from Within and the Birth Partner. And I wanted to get to use my doula's expertise. Of all the OBs in the practice, mine was the most supportive of VBAC (as evidenced by one of her colleagues basically offering to cut the baby out of me when I went in for an exam at 37 weeks, yikes!)  but she was also the same OB I'd used previously; an amazing surgeon and a bit of a control freak. The hospital where I had delivered previously was one of the few in the area that allowed a trial of labor after a previous c-section, so I stuck with it, too. (This was 2009/2010 right before the ACOG guidelines on VBAC loosened up a bit.)

When it came right down to it, I didn't gather the kind of information and support I really needed to VBAC. I didn't realize that the model of care I had chosen was basically in direct opposition to my goals. I didn't chose a midwife or a homebirth because we didn't think we could afford it on our post-doc/ part-time teacher salaries. My doula was inexperienced with VBAC. Most of the doctors in the OB practice were dubious after my 11+ pounder.  And most of the friends I knew who had had c-sections with their first child had also had repeat ones, no questions asked. Two friends who had VBACed had had tiny, early babies and lived far away.

Again, this baby looked "big" and, again, I said okay to a late ultrasound. Again, the baby measured over ten pounds. And, again, there was talk of a floating head and a closed, tight, high cervix. And then there were all these extenuating issues of my new teaching job and leave allotments, of my mom only being able to come out for a week and having already booked her ticket for the due date, of my husband's brother's wedding coming up in 8 short weeks in which my husband was to be best man and my son the ring bearer...and so, basically, I gave up and gave in. When the OB suggested scheduling a c-section for the due date, I said "fine."  And at 40 weeks to the day I walked into the hospital, showered and ready to meet my baby. Caleb Oaks was born on February 12, 2010. He was 9lbs, 7 ounces, two pounds less than they'd expected. This time the experience wasn't so lovely. And this time he wasn't so big. And this time I really felt like a failure, like I could have and should have given him a chance to come on his own terms.

Going to have another baby!

swift entrance

greeted by OBs

our growing family...all I felt like doing was throwing up.

the scene as nat left with the baby

My second recovery was faster than the first physically, but I experienced more trauma emotionally. I felt like I'd let myself, and the baby, down. I was pissed that the baby was almost two pounds smaller than estimated. I was pissed that I'd let extenuating circumstances and a healthy dose of fear inform my decision-making. I was pissed that I'd chosen the same medical team expecting different results. But my baby was healthy, wasn't that all that mattered? Not quite, because I wasn't healthy, and I wasn't enjoying my baby the way I wanted to be. I was sad and mad and anxious and worried... and exhibiting most of the symptoms of postpartum depression, though I pushed real hard for over a year to ignore and conceal it. We decided that two children was probably enough for us. Probably...

nursing and recovering take 2

Maeve's Birth Story

"And she'd had lucky eyes and a high heart,
And wisdom that caught fire like the dried flax,
At need, and made her beautiful and fierce,
Sudden and laughing."
-The Old Age of Queen Maeve, William Butler Yeats

It is Mother's Day and I am finally ready to share this story, I find myself wishing (as I often do) that I was still a journaling sort. Five months have passed since Maeve's birth, and though there are hundreds of pictures (thanks to her camera-addicted father), she has barely a page written in her baby book. There are so many moments that blur together and that the fog of my nursing, sleep-deprived brain can't dredge up in the correct sequence, but what follows is an imperfect account of my first labor and the birth of my third child, Maeve Luisa.

the belly, 42 weeks

 I'd never dilated more than a fingertip with either of my boys, who were born at 41 and 40 weeks respectively, and I'd never had very consistent contractions, so I did not expect to dilate before labor with this pregnancy. Still, it still felt horrible to finally consent to the pelvic exam and membrane stripping at 40 weeks and have nothing happening. I walked and walked and walked some more; through the fountains of Scottsdale, all over the neighborhood, at the Tempe arts festival, the Botanic Garden...

 My mother arrived two days before the 42 week mark. She had been certain there would be a baby to help care for by then, but instead she was greeted by two kids with the flu and two parents haggard from sick and sleepless nights (and all that walking...) But, with her arrival my worry over the kids' security was finally put to rest. They loved my Mom, were comfortable with her, and she knew the routine. No need to shunt them from one neighbor to the next, they could continue their usual routine at home and in school. So, on Sunday, December 2nd, at 42 weeks and 1 day, with everything on the "to do before baby comes" list completed, I finally went into labor.

The contractions had been coming intermittently all day. I'm not sure what I expected them to be like, but I was surprised how similar to menstrual cramps they felt. We had gone to the Zoo in the morning, mostly to walk, and left when I was starting to feel too tired and uncomfortable. By the afternoon it was clear that I was in early labor, I was having steady surges every ten minutes or so, though they only lasted for 30 seconds. My mom and Nat played with the kids while I tried to rest and walk and used the bathroom constantly. By the time the kids were heading to bed things were picking up. I set up my birthing ball in the living room and put in the a Coupling DVD.My Mom, Nat and I watched a few episodes but I couldn't focus on it. I actually ended up using none of the video or music I'd assembled for labor; I found it distracted me from getting through each contraction.

Nat called our doula around 11pm and she was there within the half hour. My contractions were steady as a train, at least a minute long, 4-6 minutes apart. We went for a long walk around the neighborhood and they picked up in intensity, so we camped out in the bedroom, alternating between the birthing ball and the bed. From 1 am to 3:30am the labor was hard; steady. I took each contraction as an opportunity to remind myself to let go. With each surge in pressure and pain, I'd catch myself tightening up, and for the rest of the surge I'd work at breathing relaxation back into my body. Anne and Nat took turns resting and putting pressure on my sacrum.The baby was also working like heck to get out of that damned ROT position; I could feel her grinding and pushing with each contraction; her movements were sometimes more uncomfortable than my own muscles. And then, around 3 am, I heard my mother get out of bed, go into the kids bathroom, and throw up. Crap. My labor began to shut down. We all decided to get some rest, drop the kids off at school, and head to the midwife for my already scheduled 9am appointment.

The midwife was was worried. We had already ordered a foley induction for the next morning, but she decided that a biophysical profile (BPP) would be helpful at this point just to make sure the baby was fine. Anne headed home and Nat and I discussed the pros and cons of heading to the hospital. We decided to try to rest first and check on my Mom, who was feeling okay. I tried to nap, failed, showered, and by 12:30pm we checked in for the monitoring.

The hospital was intense. We waited for over an hour before being checked into triage. The nurses were shocked at my dates, at the fact that I was attempting a TOLA2C. The nurse who took my vitals had some very unwarranted advice about the risk to my baby if she was as big as she was looking to be. The NST portion of the BPP was good; baby was active, reactive, pretending to breath, but big. The fluid wasn't as great (but we were looking at a 42 week old fetus and placenta!) Altogether we scored a 5, and the offer of admission to the hospital. Hmmm. "Could we go think about it and get our stuff?" "Uh, no, you need to be admitted." "Well, we don't have our stuff, so I think we'll just do that first." "Why don't we check you in and your husband can get your stuff?" We did actually have our "stuff" out in the car, but that wasn't the real point, now was it? The real point was that my OB had told me nevereverdonotever show up at the hospital before I was in transition. And here I was, barely contracting, and very early labor, about to be admitted.

But the flip side of it was that it was now 3:30pm. My kids were home from school; my mother was in our house with them. Would I be more comfortable laboring at home with the sickly hellions, or alone in a quiet room at the hospital? Could I get my doctor to let them just leave me alone for the night and still get the foley bulb in the morning? Yes. Could I sneak some hospital fries and watch t.v and just veg out for a bit before hitting this labor thing again? Sure. Was I at 42 weeks 2 days and the end of my rope? Definitely. So I was admitted.

Goal for today? Supermom. (from my my first c-section baby)

And everyone left me alone. Seriously. After eating some dinner and waiting for the labor room I got my heparin lock put in by a very sweet nurse (who was also very VBAC and natural childbirth supportive), then got my vitals checked by a not-as-sweet nurse who, after hearing my situation and my goals, said they were ready to have an operating room available whenever I wanted one and then pretty much ignored me. Which was good, because not much was happening. We watch some t.v., tried to rest (and failed), talked briefly with my OB who was getting ready to deliver in the next room, He was fine with waiting the night to see what happened. And by 7:30 the contractions began to pick up again, 1 minute long, 5-7 minutes apart.

In the middle of one of these contractions, as I was breathing my long breaths and Nat was pushing on my back, an extremely high-stress, high-energy OB from the high-risk obstetrics group burst into the room and began to freak out. I truly wish I had recorded what she said, because it was straight out crazy. She told me that they "didn't do this" ("this" being letting women be pregnant until their baby decided it was time to come out, apparently), that I was putting my baby at risk, myself at risk, that it was against hospital protocol and procedure, and that she understood that my doctor was a low-key guy, but he hadn't okayed this with the high risk team (he had actually gone to bat for me quite firmly), that we weren't in Africa (no clue what she was going for with that comment.) She couldn't believe we hadn't gotten a weight estimate done yet and wanted to order an ultrasound right away.  My husband, a very quiet man by nature, was incredulous as well as speechless, and so, in the throes of labor, I stood up for myself. It was awesome. And terrifying, because she was basically threatening to kick me out of the hospital if I didn't consent to a c-section right then and there. But I told her that I wasn't into being threatened or scared into another surgery, that a TOLAC was important to me, that both of the patients were thriving and healthy, and that we had plenty of evidence to back our stance (she asked me for authors and reference numbers...seriously.) I told her I appreciated her expertise, I was glad she was there to help us should things get rough, that I was sure she had plenty of reasons for her concern, but that she didn't need to worry about me right now. By the end of the conversation she was less psycho, but still said that she was going to run it by the head of obstetrics and order an ultrasound. Luckily, my OB played interference and we never saw her again.

on the one birthing ball the hospital had

And so I was left to labor. LABOR! It was rough. At 2am Anne was back with us, with her magical hands. In the early morning the contractions became too intense to talk through. I was most comfortable on my left side, but no one let me stay there for long. I lunged, sat on the ball, used the peanut ball, hung my leg off the bed to get the baby to turn, walked and walked some more. I made the wireless monitor fall off at least 32 times. I began to lose some mucous plug. At 9am I finally consented to being checked and was almost 2 cm. After 36 hours of off-and-on contractions. I was totally defeated, but rallied to try the birthing tub and we made the long trip down the hall. The tub felt good, but it was also way too hot and the monitor kept slipping off. Anne kept me supplied with cool washcloths, Nat got in with me and I hung on to him, riding each contraction like a wave.

in the tub

Then my blood pressure started to rise. I felt awful. They made me get out of the tub and stumble slowly back to the room. The contractions out of the tub were insane. I was so wiped that I was falling asleep in between them, only to wake up in agony and try quickly to get on top of the pain. My focus was slipping; I couldn't ride the contractions well and I wasn't coping. I kept apologizing for not being able to handle them, trying to explain how they felt as I caught my breath in between. But the "in between" was getting shorter and shorter.I felt like a crazy person. I was still changing positions in the bed, but Anne ased me to try a squat/lunge on the floor in an effort to get the baby to turn. Standing made the contractions so intense in my back that I dropped to the floor, and as soon as it was over, climbed onto the bed on my hands and knees. The next few contractions were all in my back and it was excruciating. I started to dry heave and whined for relief; for sleep.I think I mentioned demerol, and Anne suggested another cervical check before deciding what to do. I think she thought I might be approaching transition, but I was only at 3cm. I asked for an epidural and no one argued.

epidural nap

I've since read a lot about cervical scarring, and I think that must have been what was going on with me, beyond the tricky positioning of my baby's huge head. I don't regret getting the epidural at all. It allowed me to rest and my body was relaxed enough to dilate at a more rapid pace (rapid for me, anyway) I do regret that I didn't know to ask for a "walking" epidural. The medication settled on my left side and I couldn't move or lift that leg at all, which didn't help for positioning, though Anne and Nat valiantly helped to shift me from side to side each time there was a blip in the baby's heart rate.

I napped from 5pm-7pm At 7:30 I was at 5cm. But then my blood pressure started to rise again, and an hour later the baby's heart rate began to drop and then disappeared. The wireless monitor was tricky, but not that tricky, and suddenly we were all in panic mode. They thought they had her back on, but then thought it was my heartrate they were tracking. One nurse sternly told me to relax to lower my heartrate so they could find hers. They administered oxygen at 10:20 and began to prep the OR. I remember saying something to Nat like "let's hope she's okay" as they wheeled me out and his response wasn't too reassuring; we were both scared. But as we got out the door they had her tracking again. I seriously considered asking to turn around. In the OR, the surgeon on call said "well, they look good now, we still doing this?" and no one said a word. It is the one moment I regret in the entire process. But, then again, I was strapped to an operating table without any of my support team, a pretty powerless position (they finally remembered to let Nat in right before they began operating.)  And the baby was clearly stressed, who knew what would happen during the second stage. After all these weeks of trying to get into a good position, she was still having to work too hard. It was time to let go.

My doctor is a speedy driver and he was on hand to assist in the delivery. Maeve Luisa entered the world at 10:52pm December 4, 2012. She was 8 lbs, 10 oz, 21 inches long, with a 15 inch head circumference, covered in meconium and flaky skin, and pissed as heck to have been stuck in my body for so long. They let me see her right away, and kept her in the OR as long as I was there. I nursed right away in recovery and she wasn't bathed for the first couple days (to help with bonding.) All in all it was a very respectful and gentle process.

She nursed like her brothers before her, which is to say, like a barracuda, but had no patience for the 2 days it took my milk to come in. She is our 3rd ginger baby; firey, smiley, smart, and a great communicator. Most importantly, we are excellent and contented partners in the bonding dance, thanks to all those labor hormones!

nursing in recovery

in awe and ready to hold her

My recovery was long, and my abs are wrecked for sure.  But I'm thinking a 4th kid might not be so bad...maybe a HBA3C this time?

(that's for my husband)

at 2 months