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Ian's birth story
by Penny Lindballe
It's December of 1999, and I had just found out I was pregnant
with my first child. I was excited, elated and somewhat resigned
that I would have a c-section as my family history certainly
seemed to point in that direction. I entered into the world
of a pregnant first time mom vowing to be open to all possibilities.
I would just see what happened, it wasn't in my control,
no sense in overanalyzing (as I often do), were all the things
I told myself. Don't let your medical background cloud your
judgment, trust the doctors to do what's best, you don't
have anything to contribute, were a few other thoughts through
my mind. I concerned myself with learning about being pregnant,
not with delivery. After all pregnancy is nine months but
the delivery only lasts a day.
Finally the day arrived. My membranes ruptured, I headed
to the clinic to see my doctor and from there to the hospital.
My contractions were never really strong and never regular
so after eight hours of slow progressing labour it was decided
to start pitocin and an epidural. After pushing and an attempt
at forceps the decision, that I now realize I anticipated
from the moment I was pregnant, was made. It was to be a
c-section. I remember telling the nurses that I was not upset;
how this baby came into the world made no difference to me.
I gave birth to a beautiful 8 lb 11 oz baby girl (Kiersten)
and was absolutely ecstatic. Then came the recovery from
the surgery.
I had never had any type of surgery before and was completely
unprepared for the debilitating effects major abdominal surgery
entails. I was shocked at how long it took and how painful
it was for me to simply get from my bed to my chair and back
again the first time they asked me to move. It was so difficult
to move that I wasn't taking care of my child the way I thought
I should. On one day in particular I simply dissolved in
tears not knowing how I was possibly going to take care of
her properly once I brought her home. She had been on this
earth for two days and I hadn't even changed her diaper yet!
By my six-week checkup I was back to normal although my
incision still bothered me (and did for months after) every
time I engaged in physical activity above and beyond the
normal. I hadn't forgotten that debilitating feeling though,
and looking ahead to my next birth with a two-year old in
the house, my only question was "Would I be able to
try again?" The answer I received from my physician
was "Yes," but with a number of conditions attached.
At that time the yes was all I needed to hear and I never
gave it another thought as I pressed full speed ahead into
mothering my new little girl.
Then, in May of 2002, I found out I was pregnant again.
Again I was excited, elated, and yes somewhat resigned to
the fact that this too would be a c-section. I was sure that
I would try again but not quite as sure that I would deliver
vaginally. Once again I didn't give the delivery much thought.
I was too excited to be pregnant; too eager to enjoy all
that pregnancy brings to be concerned with something as small
as the actual delivery. Thankfully that all changed and what
follows is the story of my journey towards the birth of my
second child.
I decided to see Dr. R our local physician for pre-natal
care and worry about finding a delivering physician later.
My pregnancy progressed completely normally and I approached
it pretty much the same way as my first. I had been accepted
into the practice by referral (transfer at 30 weeks) that
my friends recommended which was wonderful. However I still
did some preliminary research into VBACs and how to prevent
OP (face up) presentations (the cause of my first section)
but nothing too in depth. I read in my searches that a doula
could help reduce my chances of a section substantially and
I vowed that I would contact the company that provided those
services in my area. However, my enthusiasm for research
soon faded and time started ticking by at an alarming rate.
Before I knew it the 30-week mark was upon me and it was
time to transfer from my prenatal physician to my delivering
physician. Arranging an appointment with Dr. S turned out
to be more difficult than I anticipated and unfortunately
I was closing in on 32 weeks before they were able fit me
into her schedule. Although she had closed her practice to
new maternity patients she was still willing to take my case
on. However, when I indicated my wishes for a VBAC her smile
disappeared.
What transpired next I would admit is a bit of a blur. There
were discussions of uterine rupture and of an unfavourable
VBAC she had experienced in the past. I tried to bring up
what little research I had done and was dismissed outright.
She was not interested in my knowledge level, background
or least of all my personal wishes. Unfortunately I did not
have my surgical records with me, so I did not expect an
absolute answer that day. However I did get one. If those
records indicated CPD (cephalo-pelvic-disproportion) then,
in her words, the discussion was over. I wandered downstairs
a little stunned and disoriented to request my surgical records
be sent.
I headed to my car and when I got there I just sat for a
long time letting what had just transpired fully sink in.
Everything that I had planned believed and looked forward
to had been taken away from me in less than 15 minutes. I
knew that my records indicated a pre-operative diagnosis
of CPD, but how could the discussion really be over? I started
driving to Edmonton and it wasn't much past the city limits
that the tears began to blur my vision. However, once the
tears ended, all that was left was anger. How dare someone
dismiss me so readily and treat me so poorly. She never even
gave my wishes a second thought. Don't I have a say in whether
I undergo major surgery or try other options? Do I really
want to be in a practice where the doctor doesn't want to
deliver any more babies? The questions swirled so fast in
my head and I didn't know where I would get the answers.
The number one question was what was I going to do with only
eight weeks left until this baby was to arrive?
It was from here that my research into the safety and advisability
of a VBAC began. Once again I pulled out the SOGC guidelines
to be sure that I hadn't missed some hidden caveat that would
apply to my situation. Instead I found "The effectiveness
and safety of labour after previous Caesarean section are
such that some authors suggest that it should be mandatory
in the absence of contraindications." My eyes flew to
the section regarding contra-indications to VBAC and I didn't
meet any of the criteria. I devoured The VBAC Companion in
one sitting and still didn't find any medical reasons as
to why I would meet resistance. Sure that I must be missing
something, I expanded my search to the Internet. My husband
became a widower in the evenings as I read everything that
I could find. I tried to limit myself to scientific studies,
meta-analysis, clinical guidelines and anything else that
would be respected in the medical field. If I were going
to fight this fight it would be with their own words. I became
absolutely convinced that a trial of labour, even one that
ended in a c-section, was the best medical decision
for the health and welfare of both my child and myself.
With time so short I decided I could not afford to give
Dr. S a second chance. I had made contact with Connie, the
owner of Mother-care, who provided doula services in my area.
It was partly through her support and encouragement that
I continued to seek out a delivering physician. I made an
appointment with Dr. M (the only doctor in town taking new
maternity patients). However, by this time I was determined
to cover all my bases, and I also made an appointment to
see Dr. N, which was Kiersten's delivering doctor.
The appointment with Dr. N came first and I was somewhat
optimistic since he had indicated after Kiersten's birth
that I would be able to attempt a vaginal delivery. At this
point all I really wanted was to be able to go into labour,
giving this baby all the benefits of being ready to be born
and the natural rush of hormones that would prepare it for
life outside the womb. I was willing to accept just about
any restriction placed on this birth if I could at least
achieve that. Unfortunately the discussion would never reach
the point of going into labour. He insisted on an internal
exam and pronounced my pelvis too small to birth more than
a 6 lb baby. The reasons continued to include the fact the
baby hadn't dropped yet and that the region was pressuring
them to do repeat csections over VBACs. My next question
was met with stunned silence -- "What if I refuse the
section?" With no guarantee of a trial of labour in
place I crossed one more delivering doctor off my list.
That day was without a doubt the hardest day of this whole
ordeal. This time e-mail wouldn't suffice, I had to call
Connie and talk to her personally. Thankfully she was home
and listened as I dissected all that had just been said to
me. None of it made any sense in light of all of the research
that had been done recently. At a time when I was questioning
all that I had learned, she was there reassuring me that
what I was fighting for was not unreasonable. Then she asked
if I had ever considered a midwife. My quick and unequivocal
answer was no, my baby was going to be born in the hospital
with a doctor; that's the only option I was comfortable with.
The day finally arrived for my appointment with my third
and seemingly final option for a delivering physician. An
incredibly pleasant and agreeable doctor greeted me and I
began to relax and entertain the possibility that this could
be the end of my search. For the first time I heard the admission
that if this baby was a different size and in a better position
a vaginal birth was entirely possible. She reserved her final
decision until she could find my chart but assured me if
those records indicated an OP presentation I would get my
chance.
After the initial elation of finally finding a delivering
physician wore off, I began to get worried once again. After
all she hadn't really given me her final word and my next
appointment wasn't for another two weeks. The stress of not
knowing for sure was beginning to take its toll so I decided
to ask Dr. R to call and confirm that Dr. M would attend
a VBAC. My worst fears were confirmed, the answer was no.
She didn't have time to "baby-sit" someone through
labour who would probably end up in a section anyway. I was
at week 34 in my pregnancy and could not find anyone to attend
the delivery.
I cannot even begin to describe the sense of desperation
I was feeling at this point. This search for a physician
was affecting every aspect of my life. I worried that all
the stress was affecting not only the family that was here
but also this poor little baby waiting to join us! Thankfully
Dr. R supported me through everything and ensured that my
prenatal care did not suffer as a result. She was my one
ally in the whole medical field and set about trying to find
someone to deliver my baby. I decided to take my fight to
the head of physicians in my region; surely he could help
me obtain the services that I needed.
In the meantime Dr. R. had done some research and found
a midwife in Red Deer who did hospital deliveries. My heart
sank a little, a midwife? This question of a midwife just
seemed to keep coming up. The first two times my answer had
been "absolutely not" but as Dr. R told me more
I began to soften a little. The midwife loved attending VBACs
instead of loathing them. She would be with me during the
whole course of labour, no shift changes or nurses that I
did not know and she was able to deliver in the hospital.
I had prayed for an answer; could this be it?
I was still unsure as I explained things to my husband.
We were in the middle of the discussion when the phone rang.
It was Dr. O, the head of physicians in my region. I was
finally able to express my disappointment with my treatment
thus far. He was very kind and felt badly for all that I
had been through to this point. He offered to personally
find an OB who would deliver me, but it would be either in
Edmonton or Red Deer , outside the region. Then I mentioned
to him the idea of a midwife. Much to my surprise he was
supportive of the idea. He felt that a midwife delivery in
the hospital was, from a safety and success standpoint, an
excellent option. In a few short hours I had gone from a
point of desperation to actually having options to choose
from.
The discussion of OB versus midwife continued late into
the night and was picked up again the next morning. I started
doing some research and began to realize my resistance to
midwifery was based on ignorance not on fact. Finally my
husband suggested that I just phone the midwife and see what
I thought. Still nervous and unsure I picked up the phone.
That first conversation with Barb was a stark contrast to
all that I had experienced so far. I felt that finally someone
was respecting my right to choose how I was going to bring
this baby into the world. What was even more incredible was
that it went beyond respect of my decision to wholehearted
support. Three doctors had dismissed me stating that a vaginal
delivery would be too difficult if not impossible; now someone
was telling me it was possible and empowering me to help
make it happen.
From this point on there was a perceptible change in my
attitude. I realized that despite everything I had read to
the contrary, I still was not convinced that I had a good
chance of delivering vaginally. All along I had been looking
for a physician to allow me to be in labour before they cut
me. What I found was a midwife who would support me and show
me how to safely bring my child into the world. It is the
profound difference between these two statements that led
us to choose Barb Bodiguel as the attendant for the birth
of our child.
I had only five weeks left before my due date when I finally
met Barb face to face. You would think not much could happen
during such a short period of time but you would be wrong.
There were chiropractic appointments to ensure that the baby
was in an optimal position and massage to try and smooth
out the stress of the preceding month. In addition to the
standard pre-natal medical checks there was ample time to
discuss anything and everything. My mind always seemed to
come back to the same thing. I found myself going over Kiersten's
birth and the three doctor's reactions again and again. I
felt sure that Barb's patience would run out but it never
did! I realize now how important it was to get all of that
out, no matter how long it took. Sometime in those five weeks
I stopped thinking about the probabilities, risks, and medical
controversies. Sometime in those five weeks it ceased being
about a VBAC and became simply a birth.
On January 21, what was to be the coldest night of the year,
my water broke. I had been anxiously waiting for this moment
and finally it had arrived. I called Barb, and as I had no
contractions yet, she advised me to try and get some rest
until things started happening. I climbed back into bed but
rest was to be short-lived. The baby gave a tremendous movement
and I had the strange sensation of what seemed like the head
scraping against bone. My heart leapt into my throat and
my brain kicked into overdrive. What if I rupture? What if
I die and leave my husband and daughter? What have I done?
After a few deep breaths I regained my senses but I was shaken
enough that I wanted to go to the hospital now. It was the
only time that the fear of a catastrophic outcome ever entered
my mind.
Once we started readying ourselves to go to the hospital
my mind calmed down considerably. The contractions were three
minutes apart but not really strong. As he took our sleeping
daughter out to the car my first really strong contraction
hit. Due to an epidural in my first labour I had never really
experienced strong contractions so to feel that strength
in my body was a clear signal that things were going right
this time. I headed to the car more confident than I had
ever been and readied myself for the 160 km trip to the hospital.
Barb arrived shortly after we settled into a room on the
maternity ward and after a quick exam declared that I was
8 cm dilated already! They hooked me up to the fetal monitor
and after a 15-minute strip I escaped to the tub room. And
what an escape it was! Once again my mood changed as I felt
I could finally settle in and get at the work of having the
baby. Low lighting, quiet surroundings, warm water, and strong
comforting company all combined to create the ideal environment
for me. I settled deep into myself and rode the wave of each
contraction gratefully as it signaled to me that everything
was going just fine. The urge to push came quickly but quietly
and I started to gently push. There was faith that my body
knew what to do and when to do it. Too soon it was time to
leave the tub and head back to the room.
Once there we tried a number of different pushing positions
from the birthing chair to squatting but eventually I ended
up in bed. Then Barb said she had to call the OB for a consult
because it had been longer than two hours of pushing and
that was all the hospital policy allowed for a VBAC. I'm
sure they could see the fear in my eyes. It was the first
time since labour began that c-section even crossed my mind.
I begged to know what he was going to say. They tried to
reassure me by telling me the baby was at +2 station but
in my foggy mind I thought that meant it hadn't even reached
zero station yet and my sense of desperation increased. The
OB was on his way and had asked that I not push anymore until
he arrived. While it is physically difficult to stop pushing,
I know I could have done a better job than I did. In my mind
if I stopped it was like giving up and just waiting for them
to come and cut me. I had fought so hard that I couldn't
stop now.
After what seemed like an eternity the OB finally arrived
and pronounced the baby would come easily with low forceps.
Suddenly the room was a flurry of activity as they prepared
for a forceps delivery. Before I knew it the first blade
was in. It wasn't too bad and I relaxed a little. The second
blade was not as pleasant but I didn't have time to dwell
on that because the urge to push was upon me again. In my
mind this contraction was my last chance. I had been to this
point before and really wanted to see the other side so I
pushed harder than I ever thought I could. Suddenly everyone
was yelling to stop pushing. The head was out and the doctor
needed a moment to clamp and cut the cord that was around
his neck. I couldn't believe my ears. The head was out? I
didn't have much time for that fact to sink in because next
thing I knew my brand new son was lying on my chest. I was
still in a state of disbelief when the pediatrician took
him over to the warming table to check him out and clean
him off. He was just fine, a beautiful, healthy 8 lb 6 oz
little boy!
As I write this my little boy, Ian, is now two months old
and napping in his bassinette. The excitement still hasn't
worn off from the incredible experience of his birth. The
recovery period was not without its hurdles. Forceps and
an episiotomy were painful, yes, but not debilitating like
with the section. I have found that I was not nearly as weak
this time around and the baby blues did not hit quite so
hard.
I have been asked many questions and received many comments
in the last few months. Some of these questions challenged
me and some angered me but I am grateful that I can answer
them all.
Was Ian's birth better than Kiersten's? This is one question
that really bothered me. I never want Kiersten to believe
that her entrance into this world was anything but spectacular,
because it was so precious. The two experiences were certainly
different but not better or worse. A birth is what it is
and unfolds exactly how it's supposed to. Barb taught me
that and I have to wholeheartedly agree.
Do I feel differently about Ian? Not in the least. I carried
and cared for both of my kids for nine months before the
day they were born. I worked extremely hard to bring both
of them into this world. That is what creates a bond between
a mother and her child and it can't be broken or compromised
simply by altering the circumstances of birth.
Did Kiersten need to be a section? Maybe, maybe not but
I am grateful that she was. By her birth she gave me a gift
that will be hard to ever repay. She gave me this experience
of fighting for my right to give birth to her brother in
the best way possible. If it were not for the circumstances
of her birth, I would have never experienced the incredible
journey that can only come from first giving birth surgically.
"I'm glad you got what you wanted." This statement
was one that came up multiple times both before and after
Ian's birth. Sometimes it was said with kindness and sometimes
with a note of contempt. Some thought I was selfish, putting
my child in danger to satisfy my own needs. Others were simply
happy that things worked out in the end. What bothered me
most were people presuming to know what my motivations were
in choosing a VBAC. What I "wanted" was to give
my child the best entrance into the world that I could. That
was my primary motivation. I "got what I wanted" the
moment I went into labour because from that point on things
could unfold the way they were intended. Whether it was to
end in a vaginal birth or a c-section was irrelevant. I had
given Ian exactly same thing I gave his sister: the best
chance I could.
What made the difference this time? Everything and everyone.
The experience of the birth that came before, a supportive
husband, Dr. R's support and guidance, Connie's counsel,
all the friends and family who listened to my problems, chiropractic
treatment, Barb's expertise and yes even the doctors who
told me it couldn't be done. All of these people combined
helped make everything possible. Of course don't forget Ian,
who worked so hard and so well to make it here safely.
Finally, was it worth it? Absolutely, without a doubt. Anything
so precious as a child is worth whatever it takes.
June 29, 2003
Midwife's note
Having admitting privileges as a midwife to a hospital has
had benefits for the women in my practice. Being the only
registered midwife in a very large Health Region, I cannot
attend home births that are much farther than an hour's drive
from the urban center of my practice. The logistics and safety
of home birth requests that are too great a distance are
a challenge for rural midwives. With the possibility of a
midwife attended hospital birth, there has come at least
a compromise for women from the far corners. For Penny and
Ross to consider a midwife attended VBAC, the hospital offered
the best solution for their needs.
When admitting privileges for midwives, including the ability
to attend VBAC women, were granted, a number of policies
had to be worked out. The "two hour limit for progress
in second stage" and "no water birth" were
part of the conditions we agreed to work with. To date, although
most of my VBAC clients make a choice for homebirth, I have
had eight women have successful VBACs in the hospital setting
since privileges were granted in January of 2001.
As a midwife, I know that these two policies are not founded
on good research nor do they recognize the unique aspects
of each birth. However, I must respect the agreements reached
when midwives were granted privileges. With every woman in
labour I work to support their journey, both physically and
emotionally. In the hospital setting I must also accommodate
the policies of the institution. Flexibility and "grace" are
my operative strategies . . . . . . Some would argue that
I am betraying principle tenets of midwifery when I don't
insist on water birth or ignore policies that are restrictive.
I often ask myself if I am compromising too much for the
sake of admission to the system? Can my presence as a midwife
in the hospital setting influence long held convictions and
strategies for care? Realistically probably not until there
are a lot more of us practicing there. Can it make a difference
for women like Penny who just want a chance to birth their
babies? I pray so.
Barb Bodiguel, Registered Midwife
Story from Birth Issues magazine, published
by ASAC in Edmonton .
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