The Birth of Micah (VBAC)

I was so excited for this birth. Last time we tried to do this birth thing at a birth center, this momma’s baby ended up failing a biophysical profile (BPP) just in a prenatal check and going in for a surprise cesarean birth before I could get there. (I was supposed to be the birth photographer, and ended up doing newborn pictures instead.) Needless to say, it was rough to process that change of plans. One thing Tiffany said when we were chatting this time around is that the presence of her midwife during the whole time she was in the hospital was so calming and soothing, and she wanted to have that presence for this second baby. And she wanted a VBAC to avoid all the complications that come with a cesarean.

This time, I was both doula and birth photographer, and I promised myself two things. 1) I was going to make up for them not having those birth photos and 2) I was going to try my darndest to help her get the VBAC she wanted and thus make her postpartum life a little easier.

I arrived at Tiffany’s house in the morning to help Tiffany and Cliff because contractions were picking up and Big Brother needed to be seen at urgent care just to check on an elevated temperature he was having. Her husband was able to take care of him and keep him occupied while I helped Tiffany with contractions and positions.

“This is so hard, Babe!”

“Baaaaall!” My little doula helper!

Contractions were stronger, closer, and she was having signs of transition. Most of all that was a key to me was her emotional state. I said what I say to everyone who starts having those signs at home but is planning a hospital or birth center birth: “I’m seeing you’re having these signs of transition…It might be a good time to start thinking about heading to the hospital and preparing yourself mentally for the change in location.”

We packed up shortly after that and got Tiffany as comfortable as possible in the car with pillow support and a bark bucket, just in case. It was a long drive and we didn’t want to have to pull over and push a baby out there by the side of the road.

Even though she was having transition signs, Tiffany was at 3cm – and baby was very low. I have seen this so many times (and experienced it myself), where baby’s head is low and right on the cervix, but her body hasn’t caught up to full dilation yet. So the nurses had her walk the halls, which was slow and intense. She hugged her pillow from home and we plodded down the empty halls of the labor & delivery unit…pausing once to throw up a few times right on the floor. (Against my better judgment, I left the puke bucket in the triage room. I was trying to have my hands as free as possible while we walked around. So, Hospital Custodian, you can blame me. I am sorry!)

Tiffany was finally admitted into a room three hours after arriving at the hospital. A wonderful nurse named Brittany with blonde hair and a spunky attitude said something that will forever stick in my mind. She said something every nurse should say to every laboring mother who has firmly decided she doesn’t want the epidural option. “How do we feel about epidurals? No? Okay, we’ll just get out of that mindset right now then!”

In the middle of the night, this happened:

Tiffany and Cliff sang softly together, their voices combining together in a way that would bring you to tears if you heard it. “That was beautiful, Babe,” he said, sounding like he didn’t have as much confidence in his own singing voice, but was completely in love with this woman he had married and the voice she sang with.

She labored…and labored…and labored.

At some point, after a day and a half of labor, Tiffany started thinking about an epidural. Since she hadn’t originally planned on medications, I encouraged her to take one contraction at a time and try a few more positions to help with her pain while she thought about it. “I just don’t know!” she exclaimed. “I don’t know what to do! Guys, I am SO TIRED!” she said, almost in tears again. “I’m SO tired! You don’t even understand!”

My heart leapt. I wanted to cry out with all the compassion in me, “I do! I do know how you’re feeling! I’ve been through a labor like this and I feel every contraction with you!” But I whispered softly, “I know….I know…it’s ok….let’s get through this next one and then you can think some more.”

And then we began the process of weighing the pros and cons. Some of the factors we talked about, which I want to share because someone reading this may find themselves in this situation someday:

  • She had been up without much sleep for over 30 hours
  • She had post partum depression with her last baby
  • She knew she was a wreck when she didn’t have enough sleep
  • She would be starting off parenting this newborn by being sleep-deprived, AND she would be have a toddler at home who would need some of her attention, even if family members were helping out
  • She was aiming for as natural of a birth as possible to avoid the side effects and cascade of problems than can come with medications.
  • Some of the side effects of an epidural include labor stalling, problems with baby’s heart rate, and low blood pressure for moms. If not put in correctly, the medication can be uneven, causing more discomfort to have pain on one side and numbness on the other.
  • However, she was past 5cm dilation and baby was low (0 station). If a woman can make it to at least 5cm before getting an epidural, it decreases the risk of labor stalling out.
  • She would be limited to fewer positions on the bed (basically rolled on one side or another with the upper leg hiked as high as possible with pillows or a stirrup, then sitting straight up in bed with feet in a “froggy” position and pillow supports under arms and knees). But we would try to move her every 30 minutes or so to keep the medication from draining to one side and making the numbness uneven.

In the end, I asked her what her highest priority was right now, in this situation when labor was much longer than expected.

Sleep. The answer was sleep. And an epidural would help her accomplish that.

So she talked to the doctor about doing a low dose so she could still feel things. She had to lay nearly flat on her back for about 30 minutes while it took effect, a position that doulas tend to hate because the bed puts pressure on the sacrum, thus causing the pelvic opening to get smaller instead of bigger. It can also be uncomfortable for the mom, and make the baby prone to turning “OP” because the heaviest part of his head will sink to gravity (Mom’s back). This causes extreme nerve pain because baby’s head and body are pressing on Mom’s spine and can make the labor longer. (Thankfully, non of that happened.)

After some glorious nappage (Dad in the chair and myself on a makeshift pallet of knee pads, towels and my doula bag), we set to work again. With her sweet new nurse the following day and a woman-friendly OB named Andrea Cobb, we turned Tiffany all over that bed to keep her as “active” as possible, even with numb legs. Eventually, it was time to start “practice pushing.” Contractions would build and be felt, even with an epidural, and she had the option to push a button to get a small extra boost of medication if she felt like she wanted it. With the recommendation of Dr. Cobb (who said her sister was a midwife, so you can see some influence there), Tiffany pushed on her left side with the hopes of minimizing tearing…she was grasping the side rail and hands as necessary, focusing her energy on the same muscles she would use to blow up a balloon. With a mirror on a stand, she could see baby Micah’s head making progress….two steps forward, one step back, but it was progress!

The excitement is building on Dad’s face as he sees more and more of his baby boy appearing before his eyes.

Did you notice in the picture above that Cliff is wearing blue coveralls? If you watched the video interview in the link above, you have a hint of what is about to happen.

A mixture of amazement and, “Am I doing this right?!”

When Dr. Cobb asked if he wanted to help catch the baby, Cliff was taken by surprise. It seemed as if he had never thought of that possibility before. He was shocked but all for it! And from this photo, it was probably one of the coolest things he has ever done.

This kid and those hands….

Such a strong neck!

“We did it!!”

“You have the best Daddy in the world!” she said…