The attack of the VBAC

Some of you may have read my blog posts on my first pregnancy (here and here) or part 1 of my ‘To VBAC or not to VBAC’ on my second pregnancy - and if so, I'm sorry to have kept you waiting so long for an update on how my second birth turned out!

In my last post, I talked through my decision making when it came to scheduling a repeat caesarean, or attempting a VBAC (vaginal birth after caesarean). Close to the end of my pregnancy, I had finally decided I would attempt a VBAC, and I was still feeling very anxious (and a tiny bit empowered) by my decision.

At 39 weeks and 6 days, I had an OBGYN appointment at 8:40am. Although I had decided on attempting a VBAC, I still had check-ins with the OBGYN at the hospital to make sure everything was tracking well and to talk me through any questions or options available if things didn’t go to plan. Sydney had also just gone into full lockdown 3 days earlier, so unfortunately I was all alone as my partner wasn’t allowed to come with me, and I had added anxiety as I knew I would be spending my fourth trimester in lockdown, with no family or friends able to visit or support.

I tried to put the anxiety aside and focus on what the OBGYN was telling me. Coincidentally, the OBGYN that I was assigned to was the same one who did my emergency c-section for my first birth, 4 years earlier. She remembered my situation from then, and told me based on the positioning of this baby being slightly better she felt I had a pretty good chance at a successful VBAC.

She also explained that because I had been positive for GBS in my pregnancy, I would need to get antibiotics for four hours during labour. She was also slightly worried about the size of the baby, so organised a scan for the following day (at 40 weeks) to check on the size and positioning. I had another stretch and sweep, where she said I was already 3-4cm dilated and 1cm long - my cervix was ‘favourable’ and this was a good sign! I was sent home with some real dates - if I hadn't gone into labour naturally by 41 weeks, they gave me the option of manually breaking my waters at 41 weeks, or instead doing a c-section at 41 weeks. If my growth scan came back and she was looking big, the date for either would be brought forward sooner.

On my way home from the hospital about 10am, I started feeling bad ‘period’ like cramps, every 5-6 minutes or so. I messaged Bron to update her, and she responded: Did you call your birthing unit? Get that bag packed! Shave your fanny!’

Shave your fanny birthThanks for the advice, Bron!

5.5 hours later, at 3:30pm I admitted to myself that they were definitely contractions. They were still 5 minutes apart, lasting about 50-60 seconds each and they would stop me in my tracks - I would need to breathe through them. They were painful enough I knew I wouldn’t be able to sleep through them.

I had been messaging my midwife on and off keeping her updated, and she told me I was doing great. Her shift finished soon, so I told her I was going to try and lay down, and that my contractions were about 6/10 at this point (7pm).

I had another wonderful midwife message me to check in at 8:30pm - I explained the contractions had remained 5 minutes apart for around 10 hours now. She advised to have a warm shower, take 2 panadol and try to get some sleep (spoiler alert: no sleep was had).

Throughout the whole day, I'd managed my contractions by bouncing on a birth ball, having warm showers, meditating, breathing exercises, stretching, using a heat pack and getting my partner to use his thumbs to massage down either side of my lower back during each contraction. The pain was steadily increasing, however my contractions were still around 5 minutes apart - right up until 11:15pm, when suddenly I felt a ‘POP’ like my waters had burst - although no water came out - and suddenly my contractions went to 90 seconds apart and the pain shot straight to a 10/10. I went from groaning and breathing through contractions to screaming in an instant - and I felt like I was about to birth my baby that moment!

My partner tried to get me dressed while I yelled the house down - unfortunately my meditative breathing went straight out the window and our poor neighbours were probably scarred for life. We got in the car (with me still yelling the whole time that it felt like the baby was about to come out). He called the hospital to advise we were on our way, and a kind nurse asked for my patient number - as another contraction hit and all she heard was me screaming in response. She quickly said not to worry about it and she would meet us out the front in the emergency bay. As we pulled in at 11:45pm, she and a security guard came rushing out to help get me to the birthing unit. I was in excruciating pain, and the minute I saw the nurses on the birthing unit I begged them to organise an epidural, ASAP.

I saw them glance at each other and one said ‘Oh, lets just take a look at you for a minute first’ and my heart dropped. I knew that meant they didn’t think I'd have time for one, and to be honest with the pain I was in and the feeling like this baby was about to come out, I already had a feeling that was what they would say when I asked.

They checked me over, and told me what I had already feared - I had arrived at 10cm dilated, and there was no time for an epidural or those antibiotics I was meant to have in labour! They gave me some gas (which didn’t help me at all), put some equipment on me to track the baby's heartbeat and then it was time to start pushing. The midwife arrived just in time to start, and she was amazing at talking me through it but I was still finding the pain excruciating.

I pushed in multiple positions for over an hour, fully dilated with no real pain relief - and unfortunately my baby wouldn’t descend. They could see the babys hair each push, but it just wasn’t coming any lower. I begged them to organise an epidural - I had already pushed naturally for so long, in so much pain, and it wasn’t getting me anywhere - after labouring all day and pushing, I was exhausted. The midwife agreed that as the baby wasn’t descending, I could get the epi in the hopes it helped my body relax and I could concentrate more on each push.

 

Your friends get you through labour

Sometimes you need your mates to get you through.

At 1:30am, once the epi was placed, I felt pure relief. I had been 10cm dilated for over 2 hours, and the midwife explained that we needed to keep working to get this baby out - as it was a VBAC, there is concern that the longer your labour and push for, the higher the chance something can go wrong. I pushed for another 75 minutes - and my baby still wouldn’t properly descend, and now kept having decels where the heart rate was dropping dramatically after every contraction.

It felt like deja vu all over again. My son ended up as an emergency c-section due to his position and not descending when I was 10cm dilated, and I felt like history was repeating itself.

The doctor came in to see me, reviewed the situation and explained that I either needed to be sent for a repeat emergency c-section, or they could attempt to do an episiotomy and use forceps to get her out in the next few pushes. I cried as I looked at my partner for help - I didn’t want to make the wrong decision, and felt like I was failing again. I fully support informed consent, but at that moment all I wanted was for someone to take the decision out of my hands so that I wouldn't choose the wrong one.

In the end, with the heart rate still dropping after each contraction and them able to see the baby's head (meaning a c-section could be more difficult as she was further down the birth canal than my son was) I told them to go with the episiotomy and forceps. Five minutes later, my daughter was born, and I had achieved my VBAC.

It was a different experience to the birth of my son - I was able to have skin to skin with my daughter straight away, and spend precious hours of extra time with her directly after she was born that I missed with my son.

CALISTA ROSE CASSIDY
Born 3:20am on 01/07/2021
3.84kg
50cm long

New baby born via VBAC 

Am I proud I managed to have a VBAC? Heck yes!

Am I grateful that I ended up achieving it? Absolutely, because if I hadn’t, I wouldn’t have been able to experience these two very different ways of birth.

Would I choose a VBAC again? To be honest - I’m undecided.

Due to the episiotomy and forceps, I still struggled quite a lot physically with recovery, compounded with a cystocele (prolapsed bladder) which took months of physio and additional tools to be able to walk and stand without pain. At 11 months postpartum, I can say that I am finally able to do most of the things I used to be able to do pre-baby, however there are some permanent things I need to live with and be careful to avoid in future to ensure I don’t make it worse. We can’t say the cystocele was 100% from my VBAC, as people can get them without a vaginal birth - but it is likely, and it took a long recovery time to get to where I am today.

Many women have really successful VBACs, and to be honest, even with the forceps and episiotomy I would probably choose a VBAC again over a csection - but when you add the cystocele on top it starts to sway my decision.

However, I probably won’t need to decide again in future - with two HG pregnancies, and two difficult labours and births, we are happy with our amazing family of four - two beautiful kids who I would do it all again for in a heartbeat.

Young mum with her two children


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