Last month (April) was Cesarean Awareness Month. And though published late, we wanted to share this uplifting story from a mother who had a successful vaginal birth after cesarean (VBAC). Despite discouragement from doctors, family and friends, Amena persevered and continued to research and remain strong in her quest for a VBAC. This led her to switch care providers in late pregnancy to a doctor who was supportive of VBAC, and ultimately her success!

When reading Amena’s story, we noticed that many things said or done to her were not evidence-based. This is why we will be publishing a follow-up blog that “fact checks” this information and practices. Wherever you see RED TEXT with a footnote, know that this statement or practice will be fact checked in the next blog.

So please read, and remember the motto: once a cesarean, always a cesarean likely never again with the right care providers!


Baby #1

Three years ago, in April of 2015, I delivered a baby boy. The pregnancy was my first and I was healthy and I was active until labour. I always wanted to have a normal delivery and I did all to achieve it. I sat on the floor instead of a chair, I mopped, and I washed clothes by hand. I stayed at home 12 hrs from when my labour started. When I went to the hospital, the doctor said I was 5 cm dilated. She waited for 5 hrs. And then she opted c section giving the reason that baby’s heartbeat was decreasing.

However, I don’t believe this rationale to be true.

Baby #2 – doctors, doctors everywhere, and not a drop of support in sight!

The second time around, when I conceived in May 2017, I was sure to try for VBAC. Many people discouraged me, saying “once a c-sec always a c-sec.” [1] But I searched for people to support me. I met six doctors who have good reputations. Still, everyone told me –  its a 30% chance [2]. And there were so many conditions – baby weight needs to be less (big baby an issue), labour must start naturally (no induction allowed), and scar thickness needs to be adequate (checked at 37/38 weeks through sonography) [3].

Through those eight months of pregnancy though, my health was good. However, during my 33rd week, the doctor I was seeing at the time in Pune told me that I was at risk of premature birth and gave medication. I was so scared. When I asked her about my possibility of normal delivery and how much she will wait, she got angry and said I should only concentrate on my pregnancy and should not think or plan on delivery. She told me that I have too many risk factors to opt for a natural birth like I am overweight (70kg at 33rd week) [4]. I never thought I am overweight until then! She also said, she herself will not be there in the hospital during my delivery, but her assistant will be present. If I am seeking her, I need to go another big hospital. At that point, I felt like, this doctor is scaring me.

So again, I thought to change my doctor.

A change of plans to meet the goal

During my 33rd week, I was connected to Birth India group through Facebook. I found a certified Lamaze childbirth educator and spoke with her. She suggested me to hire a midwife or doula. And she suggested possible good doctors who do VBAC or are in favour of natural birth. On her suggestion, I visited a new doctor in Pune on the 1st of January, 2018.

This doctor didn’t talk much but she was straightforward. She didn’t scare me about premature birth. She didn’t speak a word on it. According to her, things were fine. There were no unnecessary sonogram, no unnecessary tests. She just said I should have natural pain and that she won’t induce pain for a VBAC [5]. Other than that, no other problem.

During my 36 & 37th week, she said I am progressing good and have good chances of vaginal birth. I was happy. Till now, no doctor gave me this hope. I still remember, she said, whenever I come to the hospital (at time of labour) I should come with lots of patience.

Finally…the time has come…

On 38 week, 3rd February 2018, my labour started at around 10:30 p.m. I didn’t wake up anyone and just let things happen as I know I have a history of slow labour and was not yet in active labour. I could bear it. At 1:00 a.m. my husband woke up and I told him, I think labour has started but we can easily wait till morning.

We chit chat, made some food, drank plenty of water, and had fruits as I wanted to maintain my energy. I walked around in my room and did some yoga and exercise to boost labour. We timed the pains, and I found, the intensity was increasing – but, I was mentally prepared to labour to next night.

Next morning, the 4th February 2018, 8:30 a.m. after breakfast and feeding the firstborn, we got ready for the hospital. Upon arrival, I was sent to an assessment room. They did NST and internally checked me (OMG…that really hurt. My doctor had previously never checked me internally). They said I am 1cm dilated [6].

It was Sunday so my doctor was not there. But they assured me, when the time came, they will call my doctor.

Since my primary doctor wasn’t there, I was in the care of other assistant doctors. One doctor who was there told me I will have to have a c section as I had one previously [7]. I told him firmly, my doctor told me I could have a fair VBAC trial. Soon after, he instructed the nurse to give me an IV and to restrict my food [8]. However, I denied IV and said I am fine. They then sent me to the labour room and told me I will be under continuous monitoring [this is a device that is strapped on to the woman’s tummy that tracks the baby’s heartbeat and the mother’s uterine contractions and usually confines the mother to the bed]. I denied this too because I needed to walk and move around. They finally agreed to let me walk, but only in labour room. I thought, “Definitely these people will do a c section.” See, these doctors didn’t talk to us. They don’t understand what we are going through nor ask us.

Getting discouraged, but got support

At 1:00 p.m. my labour stopped. No pain, only my back was paining badly. I was sad. Whole afternoon my husband tried to make me happy, sang songs and explained to me how important it is for me to be happy. He read some online article which helped me understand why my labour stopped. I was feeling stressed, so oxytocin, the happy hormone, stopped flowing.

By 4 p.m., my doctor came to visit me. She asked whether I am stressed. About to cry, I told her I don’t know what to do. She said I don’t need to do anything. We will be patient and wait till next morning. If pain starts before then good, if not, she will send me home. Oh…I was relieved! She will send me back rather than operate! I was happy now!

At evening, again I got pain but not so frequently and not so strong. My husband went home to pick up my firstborn. We all dined together and slept. No pain whole night. But it was fine as I was able to get some sleep and food.

Next morning, 5th February 2018 my mother came from Ahmedabad. OMG…I was so happy and relieved to see her. Now I don’t have to worry about my firstborn. She can be with me and my husband can take care of my firstborn.

At 11:40 p.m. they did a sonogram to check the baby. My baby was about 3kg little bit bigger than my first born who was 2.75 kg. But the doctor didn’t mention any worry. I asked about scar thickness and doctor told me, it is not possible to check scar thickness through sonography. I don’t know then why every doc before this was asking for it?

After my lunch, at about 3:00 p.m. I got strong pain. NST was done. They internally checked and found, I am 3cm dilated and about 70-80% effacement. Thank God. I am progressing! But again, pain intensity decreased and interval increased [9].

Can I really do this?

At 8:00 p.m. I took a hot shower and got back a massage from Mummy. But, now I lost my patience. It had been two days by then and my back was paining like anything.When my husband came with a tiffin and my kid, I literally cried and told him I can’t wait now, can’t bear the back pain now and that I want a c section! But my husband gave me support, took a stand against my will and gave me lots of courage. He told me to wait until morning, but I denied. He convinced me to have pain killer and wait for few more hours. I agreed.

He talked to the doctor about my pain and asked for a painkiller.The doctor gave us the option of epidural but said, if we break the water and things progress within 2 hrs, then epidural won’t be needed. We agreed. At that point, there had been 5 hours halt in labour and it was 10:30 pm. Again, internal check-up, and she broke the water which was even more painful than internal check up. But I found it worth it when I progressed on labour. After that, I got strong contractions till 1:00 a.m.

I was shivering due to pain. My mummy and my husband both were with me, comforting me, giving me back massage and courage. The doctor did internal check up and I was 8 cm dilated and 100% effacement. Watching me in strong pain since last 2 hrs, My husband asked for the epidural.They said, epidural have some side effects. They will check once again, how much I am progressing, if needed, they will give epidural otherwise epidural will slow my labour and will numb urge to push.

At 1:00 a.m., When I went to urinate, I got the urge to push. They checked and said, I am 100% dilated…Yipee! I got energetic again!

The home stretch and the greatest reward!

They sent my mummy out of labour room and let my husband in. They called my primary doctor and she came in just 10 min. All the staff assembled – the paediatrician, all nursing staff, and all doctors were there within 10 min. They all were encouraging me. Within 5 min and a few pushes, my baby was on my tummy, from inside tummy!!!

It was unbelievable, how I did it. My doctor said I did a wonderful job. It was 1:27 am, 6th February 2018. I delivered a beautiful baby girl! After this experience, I am sure vaginal birth is optimal because it is the way our body is designed.

And last, my message to all pregnant women:

Don’t be scared of pain because you will have only that much pain which your body can bear.

Don’t lose hope and don’t lose patience.

Always ask cross questions, reasons and alternative options to doctors.

Educate yourself for birth!

Birth India guides well.

Good luck,

Amena

Remember to check out the next blog that will fact-check all the statements in red!

Amena is a mechanical engineer and former assistant professor by profession in Pune. She is now enjoying life with her two kiddos – her son Zayaan and daughter Rida. In her free time, she reads, makes cloth diapers, and watches movies.
Zoe Quinn is a Lamaze certified childbirth educator living near Pune, Maharashtra. She is studying to be a midwife, works as a doula and spends time with her family in their cob farmhouse. Her son was born at home, in water, naturally, in the presence of midwives and family and it was the best experience of her life, motivating her to do the work she does/pursues today.

 

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