A timeline of a nearly 40-hour preterm Vaginal Birth After a Cesarean

November 1, 2011: 6:30PM

My water breaks while we’re discussing what to cook for dinner (roasted chicken and potatoes!). I call the midwife on-call and tell her what happened and she is pretty convinced that my water did actually break. She tells me to come on in to labor and delivery where they can evaluate me to see if I can hold baby in a little longer or if this is a true water break.

We finish eating dinner and I hop on a bus and go in by myself at about 8:30PM. My partner Nick stays home to watch our son Mateo, who was about to go to bed. I bring the clothes on my back and my purse. I am met by my kickass nurse Kate (she is seriously the savior of this story) at the front desk and she shows me to the labor evaluation room. Liz the midwife examines me and at first there is nothing leaking out onto the bed pad so she does a speculum exam and basically got squirted with fluid. She also did a Nitrazine strip test and it turned blue, which meant it was positive for amniotic fluid. She tells me that I have bought myself a ticket to stay BUT I have risked out of midwifery care because they aren’t comfortable handling labors that start before 36 weeks — I missed their cutoff by 6 days!

I am shown to my room and handed off to the OBs. In the initial talk, they push pitocin and I push back because I have a damn scar on my uterus that I’d really like to keep intact. They leave me to get situated and I call Nick to let him know my parents are on their way to pickup Mateo and ask him to bring in stuff we’ll need like toothbrushes and music. The resident asks to check me to get a baseline cervix measurement and I agree to it. It hurt like heck (she was NOT gentle) and I was only 2cm, 80% effaced. Nick arrives and we prepare to sit tight and wait for labor.

Around 11pm Pitocin is advised again. We declined and asked to wait 12 hours for labor to start. A penicillin drip is started since my GBS status is unknown. I sleep very little because there is always something for the nurse to check on — blood pressure, baby’s heart rate, antibiotics, etc.

November 2, 2011: 6:30AM

We sit and wait aaaaaaaaaaaaaall day and aaaaaaaaaaaaaaaall afternoon and aaaaaaaaaaaaaaaall evening.

Labor still has not started. I make one last ditch effort to give birth without medication and ask to use a breast pump to stimulate contractions. I get only 15 minutes per side (WEAK). Very mild, regular contractions begin, but not anything close to active labor. The doctors declare it a failure and I agree to start pitocin. They start me at level one of twenty. A med student comes in and loudly and annoyingly introduces herself. There is a shift change, Kate leaves and I get a new nurse name Jenni who is not as awesome as Kate. The new doctor, Dr. Pete Singson is a good one. We sit and wait aaaaaaaaaaaaaall day and aaaaaaaaaaaaaaaall afternoon and aaaaaaaaaaaaaaaall evening. At one point, Jenni went on a lunch break and Nick went to get something to eat. The two nurses relieving Jenni come in and look at my monitor paper and decide I need oxygen. A resident wants me to get a pressure catheter up in my uterus to measure contraction strength.

I ask, “Why do I need this catheter? I thought our main concern was infection. Why do you think it would be a good idea to shove a tube up there?” The resident falters and backs off. I am thoroughly pissed that they came in and bombarded me with this when I am alone. Nick came back with his food and freaked out: Why do I have an oxygen mask on?? Why are there three nurses and a resident hovering about? What the hell is going on? I tell him it’s ok and they are just leaving… and they do.

My doula, Lena, is in school all day so she sent her backup doula, Scarlett, to keep us company while we were getting bored out of our minds. Jenni came back on shift and said we could walk the halls so we did. Scarlett helps facilitate conversation and pass the time until Lena can finish up at class and get prepared for the long haul. Obviously, neither of them were expecting to have me go into labor a month early.

Kate assures us that he is not an asshole doctor who is scalpel-happy, and says he’s a good guy and thoughtful.

At about 8:30PM, the doctor wants to check me because I’m up to a 16 microliter dose of pitocin (out of 20) and I’m still able to joke and talk through contractions and baby’s heart rate is decelerating with them. Still 2 cm, 80% effaced. They back the dose off at about 6:30PM and contractions back off too. There is a nurse shift change and we request Kate and she came back! They decide it’s ok to gradually move the dose back up again, I think I get up to 18 microliters when shit finally gets real at about 10:30pm. Shit is so real, in fact, the decels come back and the doctor is getting worried, like, legitimately worried.

Kate assures us that he is not an asshole doctor who is scalpel-happy, and says he’s a good guy and thoughtful. So, now we’re all scared and the doctor recommends a C-section because he thinks pitocin is too hard on the baby (he’s not the one who suggested pitocin, he came on shift when I was already on it). We ask for some time to discuss things, just my husband, Lena and I.

I immediately burst into tears when they step out of the room because I do not want another C-section, but I also don’t want to harm my child. We decide to ask a few more questions and ask if there are any other options. Nick pops in with the observation that the doctor said we should start having a conversation about C-section, not that it is time to have an emergency C-section right this second. We make the call to wait and try other stuff first. This doctor suggests a pressure catheter again to see how strong contractions are and to infuse sterile fluid around baby since my water has been broken for so long. I agree and it helps a little with the decels, but it doesn’t last.

Kate got the doctor to OK turning off the pitocin to see if my body would pick up laboring on it’s own without causing decels for baby. And guess what — I work! I start laboring hard all by myself.

My awesome (AWESOME!!) nurse Kate persuades the doctor to check me. I was 4-5cm, still 80%. We were hoping for a better number, but the fact that I was opening up was good enough for everyone to stave off the C-section discussion for a while. Kate got the doctor to OK turning off the pitocin to see if my body would pick up laboring on it’s own without causing decels for baby. And guess what — I work! I start laboring hard all by myself. Things got WAY more intense for me at this point and baby’s heart rate is looking really great. Dr Singson comes in to give his approval of me doing this thing without meds! YES! He was all happy and smiley — it was really awesome. I think this was all around midnight.

November 3, 2011: 12AM-6AM

I am in hard labor and vocalizing. We’re right next to the nurses station so they all totally hear me yelling “OOOOWWWWW-OOOOOOOOOH-AAAAAAAAAAH — OUCH!”. More than once, I think about epidurals and how I should have taken my chance at that C-section because this HURT! Nick is exhausted. I’m sitting on the birth ball, leaning over the foot of the bed, dozing off between contractions. Lena is worth her weight in gold. She’s keeping me as comfortable as possible and focused. Nick sat in front of me on the bed, Lena was behind me massaging my hips.

By 6AM, Kate and Lena think I might be in transition so they usher me off to the bathroom to labor on the toilet. It feels MUCH better than sitting on the birth ball or laying in bed. I got my legs really wide to the sides of the toilet and rocked and they put pillows around me. It was pretty awesome. Kate checked my cervix around 6AM and I was 8-9 cm. She said I could get started bearing down because baby was at 0 station and she wanted him low when the next shift came on board. Kate hangs with me while Lena grabs a much needed break.

At about 8AM Kate leaves and Jenni is back. The resident comes to check me with the annoying student from the previous morning, sees that I’m pushing on the toilet and says, “What’s going on in here? Not having a baby on the toilet, I hope!” She is rude and I don’t like her attitude. She checks me and I’m 10 cm, +2, no cervix in the way. She wants me on my bed and I comply to not be an asshole.

They keep yelling “PUSH PUSH PUSH PUSH!!!” and poking my vagina, “RIGHT HERE RIGHT HERE RIGHT HERE!!” And I want to say, “SHUT UP AND DON’T TOUCH MY VAGINA!”

From then until 11AM I push and push and push. I’m on my back, on all fours, on my side, using a squat bar, etc. They keep yelling “PUSHPUSHPUSHPUSH!!!” and poking my vagina, “RIGHTHERERIGHTHERERIGHTHERE!!” And I want to say, “SHUT UP AND DON’T TOUCH MY VAGINA!” Baby keeps popping out and going back, he won’t go past my pubic bone and stay. The annoying nurse is shoving a heart monitor into my belly to keep track of baby’s heart rate. They ask me to get out of my hands and knees position to get a better reading. I say, “Can’t we just skip it?” And the resident says, “You don’t want us to monitor your baby’s heartrate?!?!” I shut up, but I feel like saying something about how women have been doing this for millions of years without heart rate monitors.

They say something about how perhaps my bladder is too full and I should empty it. They offer a bed pan or a catheter and I say, “I’ll pee on the toilet!” and I’m up and out of that stupid bed before they know what’s going on! I sit and empty my bladder and push my heart out! Lena followed me in for reassurance and coaching. She’s amazed at the move I just pulled and lets me know that this is almost over. After just a few minutes of doing what I should have been doing the whole time, I the baby is crowning — and he’s staying!

The resident is flipping out because she is afraid I will push baby out into the toilet bowl. The real doctor is telling her to chill out and that the toilet is great for pushing! Somehow they got me off of the toilet and back in bed again and I continue to push baby out. Our baby comes out with the umbilical cord around the neck, then his body, and then he’s out. Nick starts sobbing! It’s a boy!

His body is a little limp so they cut his cord and send him over to the warming table where a pediatric nurse was waiting. She is a pleasant change in attitude compared to the antagonistic doctors. All smiles! We name our son Ivan. Meanwhile, I’m delivering the placenta and getting stitched up. We get to see the placenta and amniotic sac, totally awesome. We don’t get to keep it because they have to send all placentas from preterm babies to pathology for testing.

We find out Ivan’s APGAR score was eight, which is in the normal range. He had low blood sugar so we fed him the 10 ml of colostrum that I pumped while I was trying to kickstart labor. He latched on like a pro, and the nurse syringed the colostrum into his mouth. And that’s all about how Ivan was born!