HBAC success

JOHAN’S BIRTH STORY:
MY HOME BIRTH AFTER A CESAREAN
By Stephanie Nyhof-DeMoor

previously published in Birth Issues Summer 2009

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On Thursday January 29, my due date, Liesbet and I went to West Edmonton Mall to do some walking and to try to get labour started. I started to feel these twinges in my pelvis, at first I thought is was the baby’s head moving but I noticed they were rather regular, hurt a little bit, went away and then came back. I realized that they were contractions. I didn’t think too much of them as I had been having contractions on and off for weeks. We left the mall around 1:20 pm to go pick Michael up from work so we could go to our midwife appointment.

The contractions were coming every 5-8 minutes but were very mild and almost pleasant. We picked Michael up and then drove to the midwife’s. Her opinion was that I was probably in early labour but that it could be a while before the baby came. We went home excited and I continued timing the contractions, which were still 5-8 minutes apart. We called Michael’s parents to let them know that we might need them to take Liesbet for the night. The midwife, called in the evening to see if we wanted her to stop by to check me and to see how things were progressing.  She checked me but my cervix was still high and posterior. She said she didn’t think the baby would arrive that night and that we should try to get as much rest as possible.

We called Michael’s parents again and told them we would probably pick Liesbet up in the morning. We went to bed around 11pm and I fell asleep right away. At about 3 am I woke up and had to go to the bathroom. When I got back from the bathroom I had a contraction that was quite strong. About 5 minutes later I had another strong one. I tried to get some more rest but the contractions were just too strong to rest through. Michael got up with me and we went out into the living room. He put the TV on to distract me and I draped myself over the birth ball during contractions. Michael started timing them, they were every 4-5 minutes, 45-60 seconds long, and were quite strong. At 4 am he called the midwife to let her know what was happening. She suggested I take a bath for an hour to see if they slowed down or not. I got into the bath which felt really nice but the contractions did not slow down or ease in intensity.

Our midwife called at 5 am and said she was coming over. When he got off the phone he called our doula and our other birth support person. The contractions were still 4-5 minutes and getting quite intense. I found moaning while draped over the birth ball to be the most comfortable position. While we waited for the others to arrive Michael inflated the birth pool. The midwife arrived at about 5:30 am and immediately came and put counter pressure on my back which was heavenly. The others arrived soon after and took over for the midwife so that she could fill the birth pool.

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The pool was ready at about 6 am and my midwife told me I could get in. The warm water was a nice relief and helped me to relax. The contractions were coming fairly close together; I have no idea about the timing or duration, as I was deep in labour land. I found that being on my hands and knees during the contractions was the most comfortable position. I moaned a lot during the contractions as I found vocalizing to really help get over the peak of each contraction. My doulas would make sure I got water between contractions, would wipe my face, and rubbed my back. One of them also vocalized with me during contractions, which helped me keep pace and not hyperventilate. Michael was busy helping our midwife get things set up, finding towels, getting warm water, and I’m sure he did a ton of other things that I just wasn’t aware of.

At about 8 am I started nearing transition. I started to get really pushy. During one particularly strong contraction I got and overwhelming urge to bear down. As I did so my water broke. It felt like a pop with a gush. My response was to say “Oh! My water broke” I guess I really am in labour”. The others laughed, but I really didn’t believe I was in true labour until my water broke. I kept expecting the contractions to stop at any time and to be told it wasn’t really anything. There was a bit of meconium staining in the water but I did not know this at the time. I was about 7-8 centimeters at this point and really pushy. I had a cervical lip that my midwife was trying to get out of the way.

The urge to bear down was really strong even though it was too early. She suggested I get out of the pool to see if that would help me dilate the rest of the way. My doulas then helped me move from the pool to the toilet to see if sitting there would help. They wanted me to try to breathe through the urge to push which was really really hard. One of my doulas helped me in the bathroom by getting me to match her breathing so that I would breathe steadily and not hyperventilate. After a number of contractions in the bathroom I was exhausted so they moved me to the bed to lie on my side. That change helped to get the lip out of the way and bring me to complete dilation.

We moved back into the living room then so I could get back into the pool, the baby’s heart rate started to decelerate so the midwife decided it was best that I not get back into the pool. This was fine with me as I didn’t think I would make it over the walls of the pool anyway. I got to start pushing in earnest now. Because the baby’s heart rate was decelerating they got me to stand after each urge to push to bring the baby’s heart rate back up. This worked well. Because I was a VBAC (Vaginal Birth After a Cesarean) the fetal heart monitoring was done more than it would have been for other births. Because of the heart rate they also wanted to get him out fairly quickly. Fortunately when my water broke he descended a lot and afterwards descended very quickly. He started crowning quite quickly. I didn’t believe he was coming out but he was. Michael sat on the couch and I squatted between his legs and gripped his hands for support.

Johan01It only took about 30 minutes of pushing and Johan was born at 10:03 am. He came out with both hands by his face giving me a second-degree tear. I knew he was going to be born with his hands by his face; he always had his hands by his head before he was born. He was a little blue at birth because he had aspirated a bit of meconium, his heart tones were good and his lungs quite clear but he needed a little help getting started. The midwife and the backup midwife gave him oxygen and massaged him after suctioning him. After a little bit of coaxing he finally let out a good squall and pinked up.

Shortly after all this I delivered the placenta. The midwife said I should start feeling more contractions, which I was already feeling. They were barely ready for the placenta when it slid out. Johan was still attached. His cord was really thick and his placenta was quite large. My midwife was really impressed. I guess the hypertension wasn’t bothering Johan. Michael got to cut the cord. Johan and I sat on the floor wrapped in towels for about an hour. I called my mom and told her he had been born. She was so surprised since when I talked to her the night before we didn’t think it would be any time soon.

After I got cleaned up and had eaten and rested a bit my midwife examined my perineum and did the suturing of the tears. It took about an hour, as the sutures were fairly complicated since the tear was a bit unusual. It was the easiest part of the birth though. I didn’t feel a thing. The lidocaine needles were so thin I didn’t feel the injections and then the suturing was painless. She was impressed.

After the suturing was done I got back into bed with Johan and Michael and we called family to tell them about Johan’s birth. The doulas had gone home and the midwife finished tidying up. She left at about 3:30pm. That evening Michael’s parent’s brought Liesbet over to see her new brother. She was so excited. She was talking about “Baby Han” all the way to our house. They didn’t stay too long since we were exhausted and they took Liesbet for the night again so we could get some rest. The following day my mother arrived from Michigan, perfect timing all around.

I am so happy that I was able to stay home for the birth. There were a few touchy times when my blood pressure went up where the midwife thought we might have to transfer. As long as I was in the pool the blood pressure stayed down enough that we could stay home. It was hard and intense but also amazing. I still can’t believe that I had a successful home VBAC. It was so nice to be at home and to be able to yell during pushing without worrying about disrupting anyone. I’m still sore and tender from the tear but it sure beats a c-section incision.

Stephanie E. Nyhof-DeMoor is a stay at home mom to three energetic children. She gave birth with the support of midwife Barbara Scriver. When not homeschooling, nursing, changing diapers or volunteering with ASAC, Stephanie likes to read, cook and can salsa. Stephanie is the ASAC librarian.

Editorial notes:

A few years prior Stephanie gave birth to her daughter Liesbet in Ontario. She had gestational induced hypertension which turned into preeclampsia. Because of the serious nature of her high blood pressure during pregnancy, she had a surgical birth. It was a very difficult recovery and Stephanie suffered from a deep postpartum depression. Her second birth was a huge victory for her, on a physical and emotional level. Since then, Stephanie has given birth a third time. She planned another home birth, but her blood pressure was so high again she needed to have another cesarean. Despite the disappointment of not being able to give birth at home and vaginally again, she was grateful for the life-saving procedures she had access to.

A pregnant woman’s blood pressure is usually higher than when she isn’t pregnant. Although a slight increase isn’t usually an issue, it is important to know that high blood pressure can lead to serious conditions such as preeclampsia. High blood pressure is traditionally defined as blood pressure of 140/90 or greater, measured on two separate occasions six hours apart. This is one of the most important indicators that preeclampsia may be developing. However, during pregnancy, a rise in the diastolic (lower number) of 15 degrees or more, or a rise in the systolic (upper number) of 30 degrees or more might be cause for concern, warranting closer observation, even though it is not, by itself, a criterion for preeclampsia. This relative rise may have added significance if you have other symptoms of the disease, as well. If you are distrustful of the reading, yopu can always bring your own blood pressure cuff that is calibrated by you so you know you can have continuity. Some people have an increase in blood pressure when they feel stressed: before an exam, going to the hospital, seeing a doctor (or a white coat), or just at a prenatal visit. Their blood pressure is always higher at the doctor’s office than at home! If this is your case, make sure you take a few months to breathe, perhaps mediate, and relax your body before measure your blood pressure. You can also opt to do the measurement yourself.

Preeclampsia can occur during pregnancy, labour, and after the birth. It can be induced by your pregnancy or a side-effect of pre-existing health concerns. You may have a combination of the following symptoms: high blood pressure, protein in your urine, blurred vision, headaches, nausea, pain in shoulder and/or abdominal area, swelling in parts of your body, racing pulse, mental confusion, heightened sense of anxiety, shortness of breath, and a sense of impending doom. Preeclampsia is very serious and can lead to seizures, stroke, multiple organ failure and death of the mother and/or baby. If this happens, make sure you consult with your caregiver as soon as possible. In this situation, giving birth by cesarean is usually the only way to keep a woman and her baby safe.

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