Waiting for this moment to arise: A healing VBAC induction

by Ashley Ashbacher, MSW, CD(DONA)

The birth of my first child was not what I expected. A lot of what happened was traumatic for me and several days of labor ended when my daughter was born surgically.  It took me a long time to heal both physically and emotionally following her birth. I knew that when I had another child wanted to have a VBAC and I wanted it to be a waterbirth. I decided to see Dr. Hartung with Hudson Physicians for my prenatal care and was planning on having a water birth. At 30 weeks pregnant I was diagnosed with gestational diabetes and because my fasting numbers were consistently high I ended up on insulin. Unfortunately due to changes in policy at the hospital, going on insulin meant I could no longer attempt a waterbirth. I was pretty bummed about that. I had a good cry and then I decided that I wouldn’t let this setback spoil my my plans for a VBAC and more importantly, a positive birth experience.

I had hyperemesis gravidarum (HG) my entire pregnancy. Toward the end of my pregnancy my HG started getting bad again and anything I could eat to and not vomit back up would spike my blood sugar. I was concerned about the risk for baby with my blood sugar running high. At my 39 week appointment my doctor and I had a conversation about my options. We discussed the risks vs. benefits of inducing. This was a surprise for me to even have this option as many VBAC moms would likely be faced with another c-section if the benefits of ending the pregnancy before the onset of spontaneous labor outweighed the risks. We discussed a foley bulb induction but it turns out I was too dilated to even consider that so we talked about doing a light pitocin induction and artificial rupture of membranes. We discussed how that would increase my risk of uterine rupture and it was only a small increase and a risk I was willing to take. I felt (based on our conversation and my own research) that inducing was less of a risk than a repeat c-section for me and less of a risk of low birth sugars for baby if we waited for spontaneous labor. I was very favorable for induction and my doctor said he felt like it would go smoothly but he also didn’t feel that it was necessary and he suggested we wait a week and reevaluate.

That week my HG got really bad and I called my doctor and told him that I was ready to induce. On 6am on Thursday May 30th, we dropped my daughter off at my parents’ house and headed to the hospital. When we got there the first thing that the nurses did was attempt to put in an IV. It took three people and four painful attempts to get an IV in and the only place they were able to get one in was in my right hand, which was the absolute last place I wanted it. It was pretty rough start to my birth experience and I considered just going home. I took some time to think about it and I decided to stay and move past that bad emotional spot I was in. Thankfully that was actually the worst part of my birth experience.

They started me a low dose of pitocin and got the monitors on. When I was first planning for my birth I didn’t want continuous monitoring but because I was a VBAC mom on pitocin and because I knew it would make my interactions with medical staff easier, this was a trade off that I chose to make in order to have a positive birth experience. I don’t advocate making decisions just to please medical staff if you truly don’t want it, but in my case I was fine with it and I felt like it made both sides more comfortable. I settled in with my snacks and pulled out my movies, expecting we had a long day in front of us, and found that there was no DVD player in the room. I’d had plenty of hospital visits during my pregnancies and I’ve doulaed a fair amount of births, and I’d never been at a hospital where there was no DVD player. I was a little bummed (daytime TV is awful) but my awesome nurse snuck into the staff breakroom and stole the DVD player for me. So Tony and I watched Les Mis and snacked while I bounced on the birth ball. My contractions were annoying but not unbearable.

When Dr. Hartung found out I was ready he came to break my water. I was 3cm dilated, close to fully effaced, and my cervix was in good position. He said I was extremely favorable and he felt it would possibly go quickly. Once he broke my water things intensified quickly and I decided to get into the tub. I was doualing myself through my husband and telling him what I needed him to do. Once my water was broken I got really bad back labor. I taught him how to do counterpressure and had him call our doula. It was crazy how fast I went from feeling totally fine to feeling a fair amount of pain and having a difficult time managing it.

Doula note: Instances like that are a good example as to why it is important to call your doula when you feel like you might need them in the next hour or so instead of waiting to call until you really need them and then you’ll have to wait while they travel to you and they also may need to drop their kids off or wait for a babysitter to arrive.

It was really difficult but I was managing with being in the tub and my husband doing counterpressure. Unfortunately right when things got really intense , the batteries on the wireless telemetry unit died and I had to get out of the tub as it wasn’t safe to plug it in when I was sitting in a big pool of water. That was rough for me. I lost all the benefits of the water for pain relief and I started feeling the back labor very intensely. I felt like I was going to break in half. At this point I felt myself losing control (not in the good way, but more in the way that I couldn’t bring myself to a good place and starting tensing and freaking out whenever I had a contraction building. Holding tension is counter productive in birth and it often leads to greater feelings of pain.

I was feeling a lot of fear/stress, I’d tense, and then I’d feel more pain. It would continue to cycle and get worse. I very much wanted a birth that was as low intervention as possible but my number one goal was a vaginal birth. Despite my best efforts and the fantastic support from my husband and doula, I couldn’t pull myself out of that cycle. At this point I started to consider and epidural. My husband and doula talked to me about my preferences and encouraged me to keep working through contractions one at a time. My husband kept pushing back when I said I wanted one and he voiced that he was afraid that I would feel like he let me down if he didn’t prevent me from getting an epidural. I assured him that I wouldn’t be angry with him and that was important was that he was supporting me. I did request to get checked before I got it to make sure that I wasn’t nearing 10 cm. I was at 4-5 cm so I decided to go forward. I know that dilation doesn’t always follow the expected one cm an hour so just because I was around 5 didn’t mean that I had at least 5 hours left but I also knew that since I couldn’t pull myself out of that bad place my labor was likely to go slower or possibly stall, which is not something I wanted when working toward my VBAC.

I got the epidural and holding still for that was one of the hardest things I’ve ever done. The nurse asked to check me once the epidural has taken effect and I consented. I was at 10 cm. One I was finally able to let go of all that fear and tension, my body zoomed through the rest of dilation. I didn’t feel the urge to push so the doctor was fine with letting me labor down for a while. I kept having the anesthesiologist come in to turn down the epidural in hopes that I would feel the urge to push. I took this time to catch up with my doula and photographer who are also my friends and also to eat and drink.

Around 2 hrs after I was complete, I still had no urge to push and my doctor suggested that even though I didn’t feel it, maybe it was time to try some pushing. So we started doing directed pushing. I was having a really hard time pushing because I couldn’t feel it. I was pushing toward what I thought I should be but it was hard to know exactly what I was doing. I had the anesthesiologist come in several more times to turn down my epidural. After a couple times of having the epidural turned down, I could feel and move my legs but I still felt no urge to push. I was a little worried at the point. I got to 10 with my daughter, I pushed with her, and after pushing for an hour my former OB told me that she wasn’t going to be born vaginally and I ended up going in for a c-section.

Pushing on hands and knees with an epidural.

I decided to try some different positions to see if that would help me progress or feel the urge to push. I started doing some lunges in the bed and I scared the daylights out of the nurse who said she’d never seen anyone with an epidural do something like that before.

Tug of war with a bed sheet and squat bar.

I tried a variety of different positions (lunges, hands and knees, leaning over the top of the bed) and although I was making slow progress I never got the urge to push. Dr. Hartung came in and suggested we try a squat bar (which is awesome to have an OB suggest when you have an epidural) I did some squats with that and some tug o war with a bed sheet.

Using a squat bar for pushing with an epidural.

I continued to make slow progress. My OB was in there for most of it even though I was pushing for several hours. He had a very calming presence. He would take his shoes off when he entered the room to minimize noise, and used a flashlight to watch my progress so he didn’t have to turn any additional lights on. After hours like this, my doctor asked me to remind him of why I had my c-section with my daughter and when I told him he said based on his observations of me pushing, he felt like she likely would have been born vaginally if I had been given more time to push. It was extremely validating to me to have a medical professional say the same thing that I have felt about her birth. When I brought up my feelings that my c-section was unnecessary to my former OB, she very much brushed me off. This affirmation of my feelings was very healing to me.

During all of this we turned on my ipod to see if music could help me turn off my head a little bit. We started off with some upbeat stuff to see if it would energize me. It didn’t work so much but it did entertain me. Jump (for my love) by the Pointer Sisters came on. It’s the song from Love Actually that Hugh Grant dances to after he tells off the American president. Whenever it comes on, my husband starts doing that dance.

We switched the music to my mellow playlist and it was much better in helping me relax and enjoy the experience.

We were getting closer and I really wanted to get out of the bed but I was still hooked to the epidural. I often encourage my clients to try pushing on the toilet when they are struggling to push because it’s an area where we are used to relaxing our bottoms and pushing. That sounded really appealing to me. I told my doctor my thoughts and he suggested we try a birthing stool. So with my epidural, I got out of bed and sat on a birthing stool.

Pushing on a birth stool with an epidural!

I started making a lot more progress and it finally got to the point where I could feel everything. I could feel my baby right there but I still had a little bit left to go. By this point though I had totally petered out and I wasn’t pushing effectively. I started to get desperate and I was begging my doctor to try the vacuum or anything to get him out. He told me that based on the baby’s position he wouldn’t be able to do the vacuum; that he could use the forceps, but he didn’t need to. He said I could do this, that I was strong, and to trust in my body. I got to the spot where a couple good pushes could get him out but he wasn’t going anywhere. I felt completely unable to push. I tried and nothing was there. I completely lost it at this point and starting crying that I couldn’t do it and that I was never going to be able to push him out. I felt totally irrational and nothing anyone said seemed to help. My doctor interjected into my moment of doubt and exhaustion. He told me that I could do it but the little pushes I was giving weren’t good enough. I was almost there and I had to try a little harder. I decided to climb back on the bed to try hands and knees. My husband  got right in my face and keep telling me that I could do this and I was almost there and really encouraged me to give it everything.

I was right about there and at that point a new song came on and my doctor commented on what a great song it was and how appropriate it was. The song that came on was the cover of Blackbird by the Beatles from the Across the Universe soundtrack.

Blackbird singing in the dead of night
Take these broken wings and learn to fly
All your life
You were only waiting for this moment to arise.

Blackbird singing in the dead of night
Take these sunken eyes and learn to see
All your life
You were only waiting for this moment to be free.

Blackbird fly
Blackbird fly
Into the light of the dark black night.

Blackbird fly Blackbird fly
Into the light of the dark black night.

Blackbird singing in the dead of night
Take these broken wings and learn to fly
All your life
You were only waiting for this moment to arise
You were only waiting for this moment to arise
You were only waiting for this moment to arise.

Finally, thankfully, that moment I was waiting for came and I was able to push my son’s head out. One more short push and the rest of him came too. The doctor caught him and placed him under me so I could see him.

It was the most amazing and crazy thing. I couldn’t believe it actually happened. I remember saying “oh my god” over and over again. He was underneath me and still attached to his cord. I wanted to lay down with him on my chest but I couldn’t figure out how to make it happened with him attached and all of my IV and epidural tubing. My repeated “oh my god” was then followed by “what do I do, what do I do?” They helped me get on my back and hold him then it all really sunk in and I felt such amazing joy, relief, and awe that I was able to do this and I was holding my little boy and I never set foot inside an OR.

I needed one stitch and I was able to nurse him right away. I held him for over an hour before I chose to have him be weighed and measured. He was 9 pounds, 1 ounce and had a 15 inch head. He was almost a pound bigger than my daughter.

I made some trade offs in my labor. But being able to VBAC was worth it all. My son’s birth was tremendously healing for me. I felt respected. I felt heard. I felt like everything the happened (with the exception of having to get out of the tub) was my choice. I never felt rushed or like I was on a clock. I actually expressed concern about that during my labor and my doctor said there is no clock and no need to worry about that. My son was born at 9:05 pm. I was complete around 2pm. I was pushed for a c-section after an hour of pushing with my daughter. I pushed for 7 hours with my son and the word c-section or any fragment of doubt that I could do it was never uttered by anyone on my care team. I felt so loved, respected, and honored in this process.

Ashley is a certified birth doula and is completing her master’s degree in social work. She has a 3 year old and a 10 month old.