An OB and I work Together: Tracy has the VBAC of her Dreams

    Tracy had the birth of her dreams on Friday.  She did this at our local hospital where such a birth, a VBAC, is banned!   She came up with an amazing plan, and it worked out magnificently.  This plan included hiring both myself and an OB.   The result was an unprecedented collaboration between myself and someone who has been hostile towards me in the past.   Let me fill you in on the details!

     First, a little of Tracy's story...   Tracy's first birth was the typical hospital induction that went awry and ended in cesarean section.   Baby was posterior.  She was induced with pitocin.  She needed an epidural.  The baby never rotated.  She pushed for five or six hours, numb from the waist down and  on her back.  Not feeling the contractions, her team had to scream "Push!" for her when contractions showed up on the monitor.  Rolled into surgery finally.  The drugs from surgery gronked her little system so the first hours with her baby were just a blur, she can't even remember them.  The first weeks were a misery of  surgical pain, drug-induced fog, depression, and breastfeeding problems.  She was shocked this had happened to her - her mother, grandma, and aunt all had easy natural births!  She felt betrayed by her doctor, and upset with her husband and mother for not protecting her from this.  She felt guilty for having such emotional turmoil around her birth experience, even though she got her healthy, beautiful baby.  "My first birth was the worst experience of my life." She wanted her second to be the best.



    When Tracy became pregnant again, she was determined to avoid another cesarean.  She lives out in the rice fields, almost an hour from the closest hospital.  She and her husband decided homebirth was out of the question due to the distance to the hospital.    But  VBACs are officially banned at our local hospitals!  Despite this fact,  OB docs occasionally tell very determined women that they CAN refuse surgery.   To everyone else, they say sorry, their hands are tied!  They don't want to get in trouble!  Tracy's OB doc Dr L agreed that she had the right to refuse surgery. He told her that if everything was "perfect" and she showed up in advanced labor, he would attend her as a VBAC.  Tracy hired me to help her do that.  She planned to take a hotel room in downtown Chico to labor in.  We would have her labor there, just two minutes from the hospital, We would go to the hospital somewhere between 8cms and complete and Dr L would take it from there.
    Second, some back story on me and Dr. L:   This particular OB has been very communicative about his disapproval of me.  He happened to be on call for my two most medically intense transports from home, and let me and my clients "have it" in those cases. My clients and myself have experienced his communication style as intimidating and inappropriate at times.  He tells his patients "they are crazy"  if they decide to have a homebirth, or if they have had a homebirth. Tracy let him know that she had hired me to monitor and support her first stage of labor out of hospital, and come with her to the hospital as her doula for the delivery.  I was shocked that he agreed to the plan!  
   Third, the lead-up:  .  I gave Tracy my best holistic prenatal care.  We met several times over the months.  She cried at every visit as we gave time and attention to her emotions and fears.  We processed the trauma of her first birth with EFT and a supportive, listening ear.  We did guided visualizations of what this birth could look like.    She did acupuncture and chiropractic, and poured over the spinning babies website, www.spinningbabies.com   doing the recommended exercises religiously.  She prayed and meditated and practiced relaxation.  She chatted on Baby Center's VBAC listserve and paid attention to what worked and what didn't work for other mamas.  Dr L saw her for routine prenatal care and would ask her if he could talk her out of it.  When she said "no", he said  " All right then."
   The Last Week:   On Tuesday, she came in for what would be her last her prenatal.  Her baby was STILL posterior, and she was discouraged.  I checked her and found her 2cms, 80% effaced and the head low in the pelvis.  Very good sign!  I noticed that her pelvis did have a narrow arch at the outlet, and at 5 feet tall, her belly looked huge.  Not good sign.  She asked me, can I do this?  I looked deep within myself, remembering that you JUST NEVER KNOW who can or cannot birth.  Everyone deserves a chance!  "Absolutely."  I said calmly, smiling, and gave her a big hug.  "You CAN."  She wiped tears from her eyes for the zillionth time . "And your baby will rotate, if not before, then during labor.  So stop worrying about it now, relax and soon we will have a baby." I said.
    The Grand Finale:  Two nights later the Call woke me up at 2:30 am.  It was Jay, Tracy's hubby, telling me her contractions were 2 to 3 minutes apart, lasting a minute long.  They were getting into the car and would be in Chico in 45 minutes.  2 to 3 minutes!  That sounded like labor was already well underway.  I called him 20 min later and he said now they were two minutes apart.  Let's just go straight to the hospital, we decided.   We met in the parking lot at the hospital, where I was prepared to examine her in her car to make sure it was time to go in.
     Tracy got out of the car in the dark parking lot, and I took one look at her and thought, "She is completely dilated!"  "Don't touch me" she growled at Jay.  Then she grabbed him and bent over, putting her hand over her crotch for the contraction.  I smiled at Jay.  "This is great, really great.  Tracy is almost done!"  Over about 20 minutes, we crossed the street to the hospital.  They brought out a wheelchair but she refused it.  Then she climbed onto it so she was kneeling backwards on it, her bum in the air.  She was brilliant, letting her body guide her and not letting anyone get in the way of that!
   When we finally arrived in the labor room, she was checked by the nurse - completely dilated just as I thought, and the baby's heart sounded great.  "Tracy"  I said, "Why don't you get up and go to the bathroom.  You probably need to do that."  So we got her off the bed after only about 10 minutes and she went into the dark closet-like bathroom with me.  We spent the next hour in there so she could find her own way with pushing.  "Just let your body guide you" I whispered.  "Push if it feels right with the contraction. For some women it feels GOOD to push".  Slowly, slowly she began feeling into pushing.  And over the hour she pushed with more and more gusto until finally she made those sounds that let us know the baby is moving through the pelvis.  The nurses were respectful of our process. So was Dr L!  He popped his head in, said "Oh , you're in the bathroom!" and disappeared for another 40 minutes.   When her pushes were the roaring, baby-ejecting kind, she went onto the bed and Dr L. came in.  He looked at her bulging yoni and said "Oh, the baby is coming out this way." 
     A few minutes later she was crowning.  Dr L cut a tiny episiotomy and then looked at me and said "I only cut her a small one." "Thank you."  I said, "I am sure she appreciates that."  Then, the baby was born.  Tracy was on the moon!  "Wow!  That was SO MUCH EASIER THAN I THOUGHT! I can't believe that was it!!!!!!"  

Here is how she looked:

   Afterwards, Dr L admitted to Tracy, "I didn't think it was possible for you to do this.  I was just humoring you."  "I know", Tracy replied,"That is why I hired Dena."  He and I had a friendly exchange at the nurse's station, acknowledging that this was a nice collaboration of available resources, and how well it worked out.  He expressed again, how with her narrow pelvis,short stature,  history of a stuck baby, and the size of this baby, he had been sure she wouldn't be able to birth.  I told him that I have seen VBACS like this before, and that you just never know who can do it and who can't.  Everyone deserves a chance.  The nurses listened, smiling to themselves. On his way out, Dr L stopped in the room one more time.  "I am surprised, impressed, and proud."  he told us. 
    I left soon after.  Tracy was still flying high, raving about her experience.  The baby was nursing away.  My heart was full of joy.  This birth has changed Tracy's life.  She wanted to experience natural birth more than she has ever wanted anything.  She got to experience a fierce, primal, undisturbed birth where her body just found its way!    This birth also helped to bridge some of the abyss that had grown between myself and the hospital staff.  I was treated like a valued member of the team.  And that, dear readers, is progress for all birthing women in our community.