Monday, March 27, 2006

Twin VBA2C

I got up at 1:30 this morning to use the bathroom. When I returned to bed, my next due client was on my mind. Had I provided enough prenatal support for her thus far? Was there anything else I could do for her in the days, weeks before she delivered?

What's that? The phone is ringing? 1:50 a.m. Who else could it be?

My client's water had broken around the time I got up for the bathroom. She was going to drop her other children at a friend's house and then head in to the hospital. I met her there around 2:30. She was lively, chatty and witty. And, when they checked her, eight centimeters dilated. The nurses were amazed.

Because she was carrying twins, the protocol was for her to deliver in the OR. A second vaginal exam 40 minutes later had her at 9-10, so they took her in the OR. Though she wanted a natural delivery, she still had to get an epidural catheter placed. Again, standard procedure. Her spouse and I waited outside while they got the epidural in and gave her a bolus dose to make sure it worked. Only then could we come it. I don't understand why her husband couldn't go in with her. For that matter, I don't understand why she had to deliver in the OR. And I certainly don't see why she needed a "dry" epidural in place, "just in case." But if that's what she had to do to try for the birth she wanted, so be it.

So with nine people in the room in addition to my client, her spouse and me, she was instructed to begin pushing. She was on her back with her legs up in stirrups. I have never seen this setup for a delivery, which I suppose says good things generally about the hospitals around here. It was the classic "dead cockroach," lithotomy position.

Anyway, my client couldn't feel when to push because the bolus was stronger than they'd said it would be. She pushed a few times but then the doctor rechecked her cervix and reported it had significant anterior and posterior lips and that she was probably about eight centimeters. The doctor said with a cervix that has been through labor before, it can sometimes slide down with the baby.

I don't doubt that. But I also had to wonder whether the 20 minute separation from her spouse, the bright lights and commotion of the OR and the lock-step order with which she was being moved from one thing to the next hadn't made her body feel it was not a safe time or place to deliver.

They ended up moving her to a room where she labored fabulously and with increasing power as the bolus wore off. The was one tough woman. When nurses asked how she was doing with the pain, she always said "fine" and forced a smile that said "I will choke you if you ask me that again and don't you dare ask me if I want any medication."

Finally she had just a tad of lip that the doctor slipped past the head while she pushed. After that she could not hold back from pushing. It was probably ten minutes from that point to the birth of her first child. They ran her down the hall into the OR. Nurses and pediatricians were flying all over the room getting into position. After the first baby arrived, there was just enough time to get a quick ultrasound of the second baby and confirm it was head down before my client delivered that baby, too. They were born five minutes apart. Both healthy and with a combined weight of more than 14 pounds!

This was the third VBAC for this mother, who describes her first VBAC as "transforming." We can NOT take away this option from women.


Anonymous Anonymous said...

WOO HOO! Doing a happy dance.
Yes, these rights should not be taken away!

9:04 AM  
Blogger Tina said...

Awesome. Gives me hope!

4:52 PM  
Blogger I am a Milliner's Dream, a woman of many "hats"... said...

I needed this today...I have been a bit down about some of the negatives associated postpartum with the wonderful birth I just attended and the doctor and nurse's behavior. This was encouraging! Both our clients are such strong women.


7:06 PM  
Blogger I am a Milliner's Dream, a woman of many "hats"... said...

Tina--I tried to comment on your blog, but it said it only allows team members. :(


7:09 PM  
Blogger Julie said...


8:29 PM  
Anonymous Anonymous said...

What an encouragement! Thanks. A friend of mine is expecting her second child, and wants a VBAC, but it will be an uphill battle. Your story gives me hope!

2:57 PM  
Blogger Rhainnon said...

I love hearing these birth stories. How interested from your perspective!

It's sad how they have proceedures they have to follow that go against the mother's wishes. Why do they need to put in an epidural if the mother doesn't want one?! I never heard of that!

10:37 AM  
Blogger Dr. Deborah Serani said...

That is great!!

11:17 AM  
Blogger Kristy said...

Although I'm with you on wondering all the hub-bub ("dry" epidural? OR?), it's stories like these that make me happy after a not too good week in the world of babies and birth. Witnessing the NIH conference this week, the published (draft) findings from it, and the subsequent press "spin" on it has been nothing short of depressing. This story? Brings a smile to my face. Thank you for showing me why it's important to keep the fight...

2:15 PM  
Blogger ladyelms said...

How impressive! Not only that she was "allowed" a vbac, but that she delivered twins vaginally (again, as a vbac!). I want to share this story with everyone!

10:17 PM  
Anonymous Ahavah said...

What an awesome birth story! Still, it's kind of sad what 'standard protocol' does. Imagine how powerful it would have been if she's been able to stay focused in a quiet room, not poked & prodded & wheeled back and forth. *grr* But I'm so glad to hear that her birth dreams were realized. Yay, momma!

1:36 AM  
Blogger pipsylou said...

I would LOVE to pick your brain. I have had 2 c-sections (first for birth defects in the baby, second because i was afraid of natural labor). What do you know about the risks of VBA2C? I would love to talk to you more about it..

11:46 AM  

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