A Doula Story: Supported Hospital VBAC

I was downright giddy after my first doula birth but I am an emotional mess (in a good way) after this second one. I just stood side-by-side my Nashville bestie as she delivered her sweet baby girl. For this story to make any sense, you are gonna need a little background info.

Her first baby was delivered by emergency C-section around 35 weeks for IUGR and baby spent a few weeks in the NICU before going on to become the amazing, perfectly healthy, 4-year old that he is now. For this pregnancy, mom had to overcome some serious mental and medical obstacles. She feared that this pregnancy would be a repeat of the first resulting in another NICU stay after a planned cesarean. However, mom desperately wanted a VBAC. The first step was getting past 32-34 weeks because this is where things went downhill last time. Mom's cervix also started thinning early. We had many late night conversations to work through her concerns and to help her trust her body and our God. I will always remember those chats fondly. Once 37 weeks arrived, we celebrated that she was full term. Mom now faced the possibility of an induction if she went too long. Ultimately, this would mean an automatic repeat cesarean due to the concern of uterine rupture by her OB. Mom researched her options. I continued to reassure and encourage her.

Fast forward to 37 weeks, 3 days. Mom called saying she "thinks" her water might have broken. We chatted for a bit and I was convinced. I arrived to their home and mom was excited that labor was actually beginning and this was not more Braxton-Hicks. Contractions were 3-4 minutes apart and lasting about 30-45 seconds. Her OB requested for them to come in to the hospital so we loaded up. It took about an hour after arrival to finally get mom checked in and situated in her room. Mom was at 5-6 cm. Let me tell ya, hospitals love them a paper trail and they like to ask lots of questions, over and over. Hospitals also love their policies and protocols. Despite her OB being okay with intermittent monitoring, hospital policy said she had to be on continuous monitoring. Her Group B strep test had not come back yet so they automatically gave antibiotics. Because she got IV antibiotics she had to have IV fluids as well. All of the above said she had to wear a blood pressure cuff which automatically inflated every 15 minutes. This is a perfect example of how one intervention leads to many. We asked for a couple of alternatives but they were denied. They did finally allow mom to be out of bed but she couldn't go far because of the wires. She really only had about 2 somewhat comfortable positions to use that would also keep baby on the monitor. Mom wasn't necessarily happy about these policies either but she took it like a champ and carried on in spite of being hooked up to lines left and right.

Mom labored quite easily for several hours. A nurse would appear any time baby was off the monitor, reposition mom, and then leave. Things started to get more intense around 3:30 a.m. Mom was still doing great and showing good signs of progress. Dad and I helped mom with whatever she needed. She has doing fantastic with her breathing and was coping very well. Mom was definitely in active labor but the atmosphere was calm and peaceful. Around 4:45, mom moved to a side lying position. This slowed things down considerably. I let mom have a little rest because I knew she needed it. I also knew if contractions stopped completely, that they would push pitocin. After a short rest, we got mom back up on hands and knees. Mom felt a little pushy so the nurse came in to check her. She said mom was a 7-8. As I expected, that number was devastating for mom to hear. I knew she was right there because she was showing all the signs of transition (sweating, nausea, feeling pressure, thinking she can't do it anymore). This is where labor becomes a mental battle. She labored just a bit longer but couldn't quite seem to get in front of the contractions so she asked for her options regarding pain relief. Even then, she waited about another 10 minutes before choosing an epidural. Considering her frustration with all the monitors and belts and IV lines, I was thrilled that mom had made it this far.

Anesthesia arrived and we were told that only one non-medical person can be allowed in the room while they place the block. Her husband was the obvious choice so I voluntarily left the room. This may have been the hardest part of the night for me. I stood alone in the hallway and listened to my friend and client try her best to cope with contractions on her own. I knew that strangers were asking her to get into an impossibly uncomfortable position and remain absolutely still. After standing side by side with her all night long, I now felt helpless. Not being able to verbally reassure and physically comfort this mom was painful for me. After what seemed an eternity (apx. 30 minutes), I was finally allowed back into the room. Mom could still feel her contractions but they were much more manageable. I told mom this would be a good time to rest as I suspected she would be ready to push with the next shift change.

Mom, Dad, and I got comfy and closed our eyes. We had a whopping 10 minutes before the day nurse arrived and asked to check mom. Mom was complete so she prepared the bed and coached mom on how to push from her back. Mom asked for the epidural to be turned down so that she could feel some pressure that might help her know how to push. Baby was already at +3 station at this point and her head was visible from the very first push. They asked mom her preference on a few decisions. This was the other difficult part of the process for me. As a doula, my job is to provide information but I absolutely cannot make decisions for the parents. Mom looked right at me. I simply held mom's gaze and gave her a reassuring smile knowing that she would make the appropriate choice on her own. Had she asked me a question or for more information, I would have happily provided it. However, time seemed to stand still as I watched her weigh the pros and cons in her own mind. It was a proud moment to see her make these decisions and stand up for her preferences.

The day shift folks seemed to be a lot more reasonable and were much more laid back. At this point, all signs were pointing to the fact that this would be a successful VBAC and I was doing a little happy dance in my head. Mom had pushed for just over an hour, when she delivered her baby. This was a huge emotional moment for mom, dad, and me. OB allowed the cord a full 3 minutes before he put the clamp on. Mom had not specifically asked for this but I was pleased to see him offer it and explain the benefits to the family. Dad had been really quiet all night long but really perked up during this final stage. He even cut the cord. I was really proud of him too. As they snuggled their baby girl, I teared up. She did it! My bestie really did it! From the very beginning, we prayed for a normal, normal, normal pregnancy, labor, and delivery and that's exactly what she got. She patiently waited, trusted, worked hard and got her VBAC! Little miss weighed 7 pounds 7 ounces. It just doesn't get more "normal" than that! :)

Baby was very calm and content while dad snuggled her. I just love seeing the dads with their baby girls. When baby started sticking her tongue out mom gave nursing another try. She latched right on and proceeded to nurse for a good 30 minutes, both sides. I showed mom a couple of positions and she was doing fantastic with it! This was also something new and different and "normal" compared to her first birth. Mom and I were both simply ecstatic!

When I left, mom and dad were all squared away and studying the precious face of their new daughter. Let me tell ya, this particular hospital isn't exactly known for their VBAC rate so I definitely walked out of there with my head held high. Now, I was an emotional basket case for the rest of the day but it was for good reason. Part of my emotional state was the fact that I ended up going 36 hours before finally getting some sleep but also because I was just so happy and proud for this mamma.

Looking back on the whole experience, the best part was hearing both mom and dad say, "I'm so glad you were here. I don't know what we would have done without you." That, my friends, is what this is all about.

And here's a little Facebook evidence to prove it! :)