Allison’s VBAC to CBAC story: Twin Cities, MN

I had an intense and frustrating 30 hour labor with Avery (my first).

After 14 hours of unmedicated labor with very little progress, followed by pitocin and an epidural, and eventually 4 hours of pushing with the most intense back labor pain… the experience ended in a C-section. She was in a posterior/sunny side up position and 9 lbs 10 oz. The doctor who delivered her assured me that I had a lot working against me and that a lot of women can’t give birth to babies in this position. Although I’m so thankful that both her and I were safe and healthy every step of the way… I had a lot of concerns about my care at the hospital I was at, how everything was handled, and how I was treated. I knew with my second that I wanted to do my prenatal care and deliver elsewhere and try for a VBAC.

During my second pregnancy, our wonderful doula Diana helped me prepare my body for this birth.

I did spinning babies exercises and did pelvic floor physical therapy. I tried to navigate the balance of setting reasonable expectations for the possibilities to keep my worries and anxiety at bay, while also going “all in” with a VBAC and believing I could do it. I worked with a VBAC supportive midwife whom I love and chose a hospital that has a great reputation, especially for their mother/baby center.

Leading up to my 40 week appointment, I did what I could to get labor started (again, while trying to avoid stressing myself out!), including a membrane sweep. I was feeling light contractions for a few weeks, but nothing consistent. I knew that at my 40 week appointment, they may want to do an additional ultrasound since the baby was measuring “big” (and my first was a “big baby”) and they were, of course, worried about uterine rupture. Sure enough, that’s exactly what happened… I ended up going forward with the ultrasound at that 40 week appointment, the baby was measuring over 10 lbs, and the ol’ “bait and switch” took place. My midwife (whom I still do love, for the record) recommended induction.

After lots and lots of processing and weighing the risks and benefits with Josh (my husband) and Diana, I decided to move forward with the induction.

My body had responded positively to pitocin before and I was already 4 cm dilated! This may just be a little nudge and hopefully things would go smoothly.

The big blessing in all this was that my midwife happened to be working the next day at the hospital I was planning to deliver at! So we scheduled it for the next morning (February 14… Valentine’s Day!) and hoped for the best.

After taking a picture of my enormous belly and saying a tearful goodbye to Avery (our 3-year-old) and Grandma who was staying with her, Josh and I headed to the hospital. We arrived and settled in around 8:15am and they got me started on a really low dose pitocin. At the advice of Diana, who we kept updated via text, I rested as much as I could. I ate some. Then as they gently turned up the pitocin, I started walking the halls, moving around on the birthing ball, and some initial exercises and positioning.

Contractions became consistent and closer together in the late morning and although I was feeling some more pressure, I honestly wasn’t feeling uncomfortable or in pain. I couldn’t even feel all of the contractions as they came (we were mostly following the monitor for confirmation).

Around 3:30pm, my midwife did a check and there was very little change in dilation and station. (I was barely 5 cm and baby was at -2 station). She recommended breaking my water as the next step, to help things progress. We agreed to it. It was pretty painful – turns out the sac was thick and she had to try and puncture it multiple times using different tools. Yikes.

But once it broke… boy, did it get things moving.

Pretty much immediately, contractions started getting very intense. It was overwhelming how quickly it all happened. Within 10 minutes, I went from being able to talk and carry on a conversation to having very painful contractions very close together and really needing to breathe through them. We asked Diana to join us at this point!

I was doing as much positioning as I could (it was so hard!), knowing that moving into different positions could help the baby get in the best position possible. My midwife was thrilled and excited to see so much progress so quickly. We all were hopeful that this VBAC was going to happen!

Shortly after 5pm (about an hour and a half after my water was broken), I remember telling Josh that I felt like my stomach was “convulsing” (that’s the word I used). After it happened a few times, I told him to go get the nurse since Diana wasn’t quite there yet. Turns out, my body was naturally starting to PUSH. I hadn’t felt this natural instinct with my first (add that to the list of things that did not make sense to me the first time around).

It was uncontrollable… literally my body just started pushing.

My midwife checked me and sure enough, I had gone from barely 5cm to 10cm in 90 minutes. Diana arrived and helped me continue to try different positions as I pushed, reminding me to rest in between contractions (the very short time I had) and that I could totally do this. I labored throughout the room – using the squat bar on the bed, on my side, standing up, on the toilet.

Then… I started to feel the back labor. The familiar crazy pain that I felt the first time with Avery, but worse because I didn’t have an epidural this time (there honestly wasn’t even time!). Even with Diana and Josh applying heavy counter pressure, switching positions, etc., nothing was helping relieve that pain. It was the most intense pain I’ve ever felt in my life.

I kept laboring through. After pushing for about 90 minutes, my midwife asked me if I felt like I was pushing against a brick wall. And I told her… yeah, kind of. She also let us know that the baby’s heart rate wasn’t recovering after contractions as well as she would like… she was keeping an eye on it and it was making her concerned. She checked me again and although there may have been some movement, she couldn’t tell if it was the baby’s head being a little swollen as he was being pushed down. She was starting the conversation about moving to a c-section.

Josh, Diana and I spoke alone at that point.

I remember telling Josh and Diana that I didn’t know if I could do this anymore… the back labor felt so unbearable. I was feeling the same exact way as I did with Avery and I just knew where it leads. I just KNEW he was posterior. And that in combination with his heart rate made me nervous. As hard as it was, with all the preparation I had done and hopes to have a different birthing outcome this time, I just knew I didn’t want to continue in this direction and have another grueling labor like I did with Avery, or put the baby at risk.

Diana asked me if I was sure this was purely MY decision I was making and I really knew it was.

My midwife came back in and I told her I was ready to move into a C-section. I wanted a VBAC so badly, but something inside of me just didn’t feel that I should put the baby or my body through more hours of pushing. I knew it was time to change course. And honestly, knowing the back labor would be over and I’d get to meet my baby so soon felt like… a huge relief.

From there, things moved fast as they did with my first birth. The experience of going from a dimly lit room into the OR was so jarring during my first birth… I knew what to expect this time around and the care at this hospital was so incredible, so it didn’t feel as difficult or jarring.

While they prepped everything and me, my body was still pushing (you can’t exactly stop!). I remember the wonderful OB who delivered Kieran telling me to hug her while they put the spinal in… I was trying so hard to hold still as they did it in between contractions. That was the most difficult thing EVER. But after it was in, ahhh what a relief.

From there, I got really emotional and was crying, hoping I was doing the right thing (again).

Both Diana and my midwife were able to be in the OR with Josh and I, which I am eternally grateful for! I felt so supported by them and everyone there. Kieran was born around 7:30pm. He was 9 lbs 15 oz. The nurses and OB held him up so I could see him, and celebrated with a big “Happy Birthday!” They were excited to see how much he weighed.

Although I didn’t get the experience of having him placed on my chest immediately without being cleaned up, etc., Josh was able to bring him to me and I got an hour of skin to skin, he latched right away, and I got to just stare at him. When he was placed on my chest, he immediately calmed down and I did too. I remember locking eyes with him (something I don’t remember with Avery, to be honest, mostly because I was so incredibly exhausted) and thinking…. omg he is so unbelievably cute. How did we create him?!

While in the hospital, I was just so relieved he was here and it was all over. But, of course, in the days that followed, I definitely had feelings of disappointment around things not going the way I had planned or hoped for. I did have a lot of sadness around the recovery involved (particularly when it came to mobility and not being able to fully care for my 3-year-old). And I wondered (and still sometimes wonder), what if I just gave him more time and didn’t do an induction? Would he have gotten in the right position and come on his own? And why in the world couldn’t my body do it?! Why do my babies end up in a difficult position and why can’t I push them out?!

But then… I came back to why I made the decision I did, in the moment, the red flags that were present and instincts I was following, and what I know now.

There were some minor complications during Kieran’s delivery. First off, he was in a weird position (and he has some pretty intense bruising on his head due to the pushing in that position). I also had an accidental extension of the uterine incision, which suggests that my uterus was very friable for the surgeon to lose control of it. I was on the table for almost an hour after Kieran was born, compared to the usual 30-40 minutes, as sewing me up internally was more complicated than usual. And Kieran actually ended up with a laceration – a little cut on his shoulder. When the OB went to cut me, my uterus was so thin it hardly took anything to get the incision to open. Kieran was RIGHT there. I was probably at a higher risk of uterine rupture…!

Knowing my choice to go into a cesarean was maternal instinct (even if I didn’t fully realize or understand that at the time) has brought me so much healing.

And I was given the gift of being able to experience a whole lot of both different types of delivery, and we were both kept safe. Those are all things to be grateful for.

If I could give one piece of advice to someone planning a VBAC, it would be, to allow space for the mystery of birth to unfold.

This is something that Diana shared with me in the final days as I was getting ready for Kieran to arrive and after I made the decision to move forward with an induction. There’s so much reading we can do, stats we can read, body prep we can do. And all of it is important and is a reflection of our commitment to having a different birth experience. And also… there’s so much we don’t know about birth. And as hard as that is for a control freak like me to wrap my brain around… I’m realizing, in retrospect, that there’s beauty in it too.

Thank you, Allison, for sharing your story!

Every birth, every story, regardless of outcome, is sacred, and it has been my honor to witness you in this process. VBAC is in the journey, not the outcome.

Allison & Josh gave birth at Fairview Saint John’s in Maplewood, MN with the Minnesota Women’s Care midwives.