Tuesday, February 16, 2010 ;
Dd's VBA2C Birth story
In the weeks leading up to 2 Feb, we were already wondering if dd was coming because of the intense Braxton-Hicks contractions I was experiencing, especially at night. She was also already engaged and her head was pretty low such that I had difficulty walking normally since Week 37.
We were thinking though, that 3.2.10 would be a nice date for her arrival because it was so easy to remember and had a ring to it "3-2-1-0!!" kind of thing. However, I was also hoping she would come sooner than later because I was having sleepless nights because I couldn't get a comfortable position to sleep.
2 Feb 2010
Whenever a tightening occurred, it would be like a bad cramp such that I would awaken and have to shift positions. I found lying on the back tough, and lying on the right downright painful. Lying on my left seemed best to cope with the "surges".
Like all the nights before, it came about every 10min, sometimes shorter, sometimes longer, so I just had to shift from sitting on sofa to leaning/ reclining on the La-z-boy, back to the bed to lie on my side and so on, trying to snatch some sleep in between.
I gave no further thought to the contractions because it has happened like that for the past week or more.
After being awakened by a particularly painful contraction, I felt a small gush of fluid in between my legs.
Oops, was that the water bag?? I had prayed hard this time, not to have my amniotic sac burst like in ds1 and ds2's case.
I rushed to the toilet and sat there, and true enough more amniotic fluid came out. Having had the experience twice before, there was no mistaking the smell and sight of the fluid.
However, this case was slightly different, thank God. Whenever I stood up, the flow stopped, so I guessed it was more of a leak than an outright burst. The pressure of the baby's head would stem the flow of fluid out whenever I stood or sat up.
So I just put on a pad, smsed my mom and doula, and then tried to rest in between contractions.
I begin to think this time it is for real. The contractions are getting closer together, and longer in duration. They are feeling more intense as well.
So I sent Dh off to get my mom, in case I need help while Dh is sending the kids off to school.
My mom arrived just before ds1 was due to go to school.
I could still manage to eat a little for breakfast, having a cup of milo and a little bit of Meiji Plain crackers and some oats water. But that's all. I had no appetite for my usual bread and peanut butter and then another piece with butter and sugar. That's what I normally eat every morning.
I couldn't really bid ds2 goodbye already. It was getting tiring to get through each tightening and required more of my concentration to get past each one. But everything was still bearable. I hadn't felt the need to scream or moan or thrash about yet.
Dh sent ds2 off. The house was much quieter now.
Shortly after, Dh got news from both doulas that they would be making their way over soon. G advised me to get into the warm shower. So I did. And I stayed in the shower for 30min till I felt I can't take the heat and humidity anymore. But the warm water on the tummy did feel really good and made the many surges in the shower easier to cope with.
Some time between this timing and 9am, I felt the need to get up and sway my hips with each contraction. But then in between the surges, I would want to lie or sit on the bed and close my eyes to rest.
I tried to listen to my CDs and relax. It was still ok, I could still focus on the CDs.
S, the doula-in-training, arrived first. She took over the warming up of rice socks in the oven from Dh and then she helped me through a few surges. She showed Dh how to hug me while I stood up to cope with each surge.
But then later on she observed that I might get too tired so she suggested that I sit on the bed and lean back on Dh. When the surges came, I felt the need to lean forward, and breathe deeply and she asked Dh to support me when I leant forward.
We assumed this position for about an hour, I think. I was hazy about the timing, because as I mentioned, the surges required most of my attention already, and the rest in between was not very long.
I could still listen to the CD at this point in time.
Some time later, G arrived. Again, I am not sure about the timing now.
She had a previous birth the night before and was kind of sleep deprived but she still guided me through each surge, and kept reminding me to breathe in and out deeply and slowly.
I think they sent Dh off to rest for a while since he was quite tired too. He also went off to make coffee I think, because I can smell the strong aroma of his coffee.
I had both doulas with me for some time, and they timed my contractions and helped me through them.
Somehow, it got a bit more difficult to cope, and they suggested I come out to the living room and try working through them on the sofa. So I sat on the sofa and had my legs propped up with an Ikea stool, had pillows behind my back and I think we did that for another hour?
Dh was having his nap, G also power napped, but in between she will remind me to breathe. S will continue to change the rice sock for me. I was vaguely aware that my mom was cooking many things in the kitchen. I can hear all the sounds and smell the aromas. But I didn't feel like talking at all.
I didn't feel like listening to people talking too, and I didn't want to have the CD on anymore as well.
I was beginning to perspire quite a lot and it was tiring and getting unbearable so I mentioned to G, and asked her when I could go in to the hospital because I feared not being able to make it.
She encouraged me to wait longer, and said she needs to see the "show" before we go in. And I need to be in some kind of "zone" too, I can't recall exactly what she said. Everything's a bit hazy now. Because I used most of my energy just to get past each contraction in a pain-free manner.
I already had the mucous plug drop out in the morning, I think about 5+am?? I can't recall. But haven't seen any "show" yet. That meant the cervix hasn't thinned out enough yet.
So the doulas suggested I move back to the bed. G felt maybe it would take a while longer, so she asked me to lie on the bed to rest.
Somehow, lying on the bed, on my left side, made the contractions come a lot closer, a lot more intense and well, it made the "show" come on.
Oh, I can still remember that stage vividly. It felt like wave after wave of something very energy-consuming coming upon me and if I didn't concentrate hard enough, I could get swept away. So I fought very hard to be on top of it all.
I tried to breathe but I end up moaning and groaning already. I felt this unexplainable need to clutch and grab a cold and wet towel in the midst of the surge and another hand needed to grip the table leg. (table is beside my bed).
G says low grunts and moans are good, they are vocalisations that are natural. Screaming is not encouraged because it makes me more tense and builds up the fear factor. Fear will bring on more adrenaline (and pain) and adrenaline is antagonistic in action to oxytocin. This will slow the progress of labour. So I need to focus on being relaxed. I didn't scream at all and I noticed my moans (hmmmm, and ermmmm sounds) coincide with each exhalation.
Sometime in between, G asked me to get into the warm shower again. So I did again. It was so much more difficult this time than in the morning. The warm water felt good again as it trickled onto my tummy. But I had to press on the glass partition really hard when each surge came now. I was getting really hot and tired. Ugh. I think I lasted another 30min before getting out again. I felt a little more refreshed after drying myself. I wore the clothes I would be birthing in - a Moms in Mind nursing top, and a flare skirt (for easy access during birthing, no pants, of course!).
I got back to lying on the side on the bed.
Now from here onwards, I may get some sequence of events mixed up but to my best recollection, it is as follows. (Not sure of exact sequence cos I was already in Lala Land, or in a world of my own, just trying to cope with everything in a calm manner.)
About 12pm thereabouts, I knew my doulas and Dh were getting hungry. I heard Dh getting some corn and soup from the kitchen (which my mom prepared). I think S went out to buy some lunch for herself and G. S herself is still nursing her baby, she must be famished. She had a donut that morning (courtesy of my sis who gave me 6 the night before) and that's about it.
G stayed behind with me. After S had her lunch then S took over and G went and had her lunch. I could smell coffee again and guessed that Dh made some for G and maybe himself. I had this nagging concern over Dh's lack of food and too much coffee. Funny I can still worry about him during all the "labour", which really = hard work.
What G did for me throughout this time was to rub my lower back with her warm palms or the warm rice sock whenever the contraction climax came. It did help a lot. I grew so dependent on it that when she switched with S, I requested S to do that same as well.
Then Dh came to take over, perhaps after half an hour or so, and he pressed the wrong spot, and somehow I got very irritated and snapped at him to rub and press harder and shifted his hand to the correct spot. Sometimes doulas really help cos they're women who went through childbirth too, and they know exactly where and how to help. Dh wasn't a bystander though, they made sure they showed him how to help me and he was there to support and help me all the way, which I really appreciate.
This went on for a while and I felt I needed to use the toilet, but then nothing came. Funny, I felt a full bladder but just couldn't pee. I had to endure several contraction on the toilet bowl. At this time, G said she made the decision that we could possibly start getting in to the hospital, because she saw lots of "show" (i.e. blood) and that my belly was sloping already, which meant baby's head was very low. Also, perhaps I had entered my "zone" whatever she meant. I only know I can barely concentrate on anything else.
For example, when my mom asked if I wanted anything to eat. I wanted to tell her I had no appetite at all and really didn't want anything to eat. But it came out too quick and angry-like. Maybe I snapped, I don't know. She also tried to massage my feet. I know she meant well, but I somehow couldn't bear anyone touching me any other part apart from my lower back. So I told her not to touch me.
She then said she had nothing to do at my house anymore, and said she'd go home first then return in the late afternoon to pick ds1 and ds2 up at the bus stop. G commented after the delivery, that my mom was quite calm and collected, not like other moms who might be very anxious and in the way. I was glad she was that way, otherwise I might be more stressed. I was glad I wasn't living with my in laws too, which might have added more pressure on me to go into the hospital soon.
I guess it was about 1pm when we left for the hospital. The progress was slow. I had contraction after contraction along the way from apt to lift. Imagine, I can't face that elderly uncle anymore. I was walking along the corridor, and G did say that whenever a contraction came, I can stop and lean against her and Dh or S. So I did, for the first one, but I somehow had to lean all my weight during the peak and I felt it was too heavy for S and G. (Dh went to get the car at that time)
So there was this rattan chair that a Malay neighbour placed in the corridor. Her flat was near the lift already. I had to rush and sit in it to ride out one more surge.
Then in the lift, another came.
And while walking from lift to car, yet another one. So we kept stopping. By that time, Dh was with me and I leaned on him with all my strength without fear, but later he reminded me I was heavier than him. haha. Yup, he's so underweight he weighed 63kg while I had attained 65kg at the peak of my pregnancy. But it's ok, he's strong enough.
The car journey was pure misery for me. I kept my eyes closed because I didn't want to be reminded how long more the journey would take. I wanted to just focus on each surge at a time. Cos I kept wondering whether I will make it, it was getting all too intense. I had to moan and groan through every single surge now.
I heard G tell Dh that women in active labour maybe very sensitive to bumps, humps and turns so he should drive gently and slowly. She couldn't be more accurate! Somehow I was very very irritated with each hump that Dh had to go over, and I felt he was swerving too much with every turn. It was excruciating to be stuck in the back seat. I rather move through the contractions.
Like even when I was lying on the bed on my side, I would move my legs back and forth through each surge.
In the car, I would just grip the handle on the top right side of the car door and pull myself up and down slightly during the surge. No wonder my right bicep hurt so much after the delivery. I discovered a lot of muscle aches here and there and was able to trace back how I used those muscles during labour, that was pretty funny.
The other interesting thing was that Dh tried to make small talk at first, in the car. I recall feeling very angry. I wanted to shout at him to stop talking about trivial matters. I remember being very irritated. But of course, I controlled myself since my 2 doulas were present. Somehow though, they instinctively knew? They didn't engage in small talk and just checked their cell phones. I vaguely recall them texting or whatever. Anyway I was glad they were quiet. Dh said it was the quietest car ride for him, ever.
Finally I heard S offering to park the car for Dh and that he should get out with G and me at the entrance cos that was the shortest route to the delivery suite.
Oh man, I remembered opening my eyes and seeing the lunch crowd at Mt E hospital's entrance. I was not in a pretty state, I knew. I had perspired so much for so long, I didn't comb my hair properly, and I think I look haggard and tired. No make up, of course. My clothes were probably in disarray too.
But you know how being a mother makes you more thick-skinned? Ok, don't bother, don't make eye contact with anyone, I told myself. I lifted myself gingerly out of the car and walked out.
Several nurses at once assessed our state and kept asking if we needed a wheelchair. G said no, I will walk. She had asked for my opinion and I agreed I wanted to walk. She said walking will help baby drop further down, and yes, I wanted that to happen. I just hope I can have baby out soon, I recall thinking. She said anyway we definitely have time, and will make it to the delivery suite.
I remember the wait for the lift. I hated the lift at that time. In my heart I was grumbling and ranting at the Mt E's lift system, so slow, so inefficient. There was a huge crowd waiting for the lift by then, and all of them had their eyes on me, cos I had a surge and had to moan. Everyone heard me moan and could see me work my way through it. Ugh. Of course, I made absolutely no eye contact.
Then, when the lift came, I heard G ask for me to be let in first. haha, that's the advantage of being in labour. I was in the back of the lift with Dh. Sigh, we were supposed to get out at the 2nd floor but I had to have a contraction inside the lift. I buried my face into Dh's body and moaned my way through it. They had to hold the door open for me at 2nd floor and wait till my minute plus-long contraction end before I could make my way out. Of course everyone looked at me and I heard a lady even ask, "Is she in labour?"
I was thinking "Then? What else??" Man!
I also saw a Caucasian lady cast me a very sympathetic look. Wonder if she just went through the same thing. Anyway lots of people were staring at me since the lift was chockful of people and at the 2nd floor landing there were many people as well.
We walked slowly to the delivery suite and I had yet another along the way. I was feeling happier already since I could see the large swing-doors and the huge letters above that read "Delivery Suite".
Once inside, they got the preadmission documents from Dh and let me go into Suite room no. 4 first while they settled stuff with Dh. I got onto the bed with relief. I lay on my left side again. I was tired of walking. This position seemed the only bearable one for me. Yet the surges were so so intense, I thought maybe I couldn't bear with them anymore. But I didn't say anything. Bear with them, I must. I had wanted this myself. I need to see through it.
I vaguely recall the staff nurse being alarmed at so many in the delivery suite. She had to confirm and reconfirm that I had 2 doulas and that my doctor was agreeable and that we had prior permission. G dealt with all that.
1.45pm (Time noted by S, thanks)
Then this same staff nurse/ midwife asked me to change into the hospital gown. I rejected it and asked to birth in my own clothes. Good, she had no objections, unlike in KKH the previous 2 times, they refused to let me. Then she asked if she can do a VE. I refused to lie on my back though, so she did it with me lying sideways. Wonder if that caused inaccuracies? But she said it was 3cm. What??!?
I remember my head exploding. Fortunately it was 2nd nature and habitual of me not to use swear words, or else they may just come out then. So intense, so long, so frequent, only 3cm? You got to be kidding. I think she noticed the look on all our faces.
She said my cervix was all thinned out already, fully effaced, whatever, and it was not tight at all, her whole hand could move without restriction, and baby's head was low. Ok, that wasn't much of a consolation!
Even though I was not able to talk, but somehow all her comments stuck in my head and affected me deeply. I guess that's why it is important not to talk so much while the woman is in the last part of labour.
Cos she went on to comment that there was far too much blood for 3cm stage of dilation. That at once made me very fearful that my previous C-section scar ruptured. That is the main risk of VBACs and for VBA2Cs the risk is much much higher. A scar rupture can cause the death of both mother and baby in a very short time. I was feeling very intense pain in my lower back and abdomen too. On hindsight, it was probably the baby's head, but at that time, I really thought perhaps my scar ruptured already, that's why it was so painful.
Remember fear causes a vicious cycle to start running and then cause more pain? Well, suddenly I felt I couldn't deal with the pain.
Yet during that time, my mind fought furiously. I want this pain to go away. I need relief, but I don't want to ask for epidural, it may lead to a C-section for me again? I badly want to have a VBA2C, and I know this might jeopardise my high chances. Everything had been smooth till now, do I want to ruin it?
As surge after surge came, my mind started to swing in favour of an epidural. I began rationalising, well, the risks and side effects may not kick in. I may still have a VBA2C with epidural right?
Didn't help that the staff nurse also kept telling me that I can ask for epidural, and that even my obgyn said I can have it. And that if I was already in such agony at this stage, it could still take a long LOOOOOng time to reach the final stage. G told me, don't be discouraged by a statistic, it could be very fast, I never know.
Then the staff nurse came and said she has to give me antibiotics. Because of Group B Strep infection and because my water bag had already sprung a leak since 5am. I needed to have the IV in my left hand. I was very loathe to do that actually. On hindsight again, my obgyn said in his standing instructions to give me a heparin lock instead of an IV. That meant I just needed a dose of the antibiotics and then some heparin is introduced and the thing plugged. If an emergency surfaces or if more needs to be administered then the vein is already opened.
But she did an IV and my hand was more immobilised than if it were just a heparin lock. Grrrr.
When she was preparing to give it to me, I finally asked G about the epidural. It's funny how come I asked her. S said when she was delivering her baby, she also wanted it, and telling herself why she should be so stupid to not want it, but she was afraid of G and dare not ask. For me, I knew Dh would be on my side whatever I wanted, so the only person I was scared of was G also. I was afraid that she would disagree or disallow and I was afraid she'd be disappointed since I asked her to be my doula precisely to help me have a gentle natural birth. So ya, naturally I sought her "approval".
I was glad she talked to me very diplomatically. She didn't say yes or no. She said, "errm, let's have this heparin lock first (we all thought it was going to be a heparin lock): then we'll decide about the epidural. I think if she said yes, I'd have done it at once, I was so fearful then, I thought I was going to have an emergency operation cos my scar already ruptured and I was bleeding to death, there was really a lot of blood.
If she said no, I'd probably had gone mad and shouted and be very upset that the pain relief was denied me. So she was very wise indeed. It was a delay tactic.
It took a while for the staff nurse to get everything ready, I had many surges by then, I was gripping the bed handles so hard, and S was busy feeding me water in between, really thankful for her water bottle! It was the kid's kind (with a sucking spout), easy to feed. My own was the pouring drinking kind, impossible to drink without spilling, with me lying sideways.
Dh was holding my hand or helping me wipe my face. S alternated with wiping my face too. G had to hold the monitor on my belly.
Oh yes, I failed to mention that the staff nurse was not happy with me and vice versa too. She put the monitoring belt so tight on my belly that the hard round device pressed too tightly on my abdomen which caused every contraction to be even more excruciatingly felt. But when I told her, she refused to believe me and even showed me the belt was not tight, and put her fingers through and said "see? I can put my finger through, it is not tight. It's very important to monitor baby's heart rate continuously cos you have 2 previous C-sections!".
I was very bothered by the pain on my tummy though, and was insistent on having it removed, so G offered the compromise of holding the monitor on my tummy for me, without the belt. It felt so so much better! Ahhhh, thanks man! So I effectively made everyone very busy for me. It's the only time in my life I made others work so hard for me, I think!
When she was ready to poke the vein in my left hand, I had to work through a few contractions first. I kept hedging because I kept feeling yet another contraction coming and told the staff nurse to wait. I can tell she is very impatient with me already.
Anyway finally I allowed her to. She got the stuff into my vein and hooked the IV to me. (After the delivery, G said fortunately I didn't go crazy mad. She said she remembered Dr's instructions was a heparin lock and the IV was inserted instead.) It was too late for her to object as well.
I don't know what the time was at that time, but as I was going to ask for the discussion on the epidural to resume, I felt the urge to push, and with the next contraction, I was in uncontrollable pushing mode. It was a force to be reckoned with because they kept telling me not to push and I kept trying NOT to push but my body still pushed. With each push, I can feel more fluid gushing out and baby's head seemed to be moving lower still.
The staff nurse was in kancheong mode and they wanted to do another VE. So this time they insisted I get on my back properly and she did a VE and I was fully dilated. Huh? really? That was great news, but so quickly after the 3cm announced at about 1.45pm? It should be only about somewhat past 2.30pm then?
She rushed off to telephone my obgyn (cos earlier she told him that it would take much longer cos I was only at 3cm).
I stopped asking about the epidural already. There was no point now, everyone knew that.
Ok, now everyone asked me to focus on not pushing until dr arrived. Aiyoh, that was tougher than expected. So every contraction that came now, I had to fight my natural urge and blow. They said blow hard. I blew so hard I thought I'd be blown away. To my surprise it did help. I don;t know why blowing air through the mouth will channel the force of pushing away, but I just did my best. Sometimes when the surge was particularly intense, I had to blow very hard and with sound too, to distract myself away from the pushing.
Finally, about 10-15min later, Dr arrived. Everyone was so relieved and they actually smiled and said, oh he is here, now can push! They got me to lie on my back, get into position, asked me if that position was ok. It was not very ok but lying on my side was very intense as well, so might as well. Cos if I was sideways, someone has to be occupied in holding up my right leg all the time. I didn't want to torture that poor person.
It was during this next 30min that I hurt my tailbone badly I think. With each push, I think I pushed my tailbone against the edge of the bed. Sigh, but of course I didn't notice it then. I was too focused on the pushing.
Somewhere halfway through this, the 1st staff nurse had a change in shift and a sister came in. Blessed relief. This sister was very friendly and encouraging and never made any negative comment. So she will count for me and guide me in pushing. G was the one who would tell me when to change breaths. Dh was encouraging me all the time, and he also helped support my back. In fact, he got backache because he had to help push and support me when I pushed as well! It was like we were both pushing during that stage.
Somehow I kept my eyes closed during all the pushing. I needed to concentrate, I think.
Sometimes I pushed in the wrong direction. As in, I channeled the energy to the wrong place, I think, cos they would say no no, push downwards. Sometimes, I knew I was making good progress cos they'd exclaim and say yes yes, push this way, harder! And they'll count and make me push longer than I would normally do. I took a lot of deep breaths and push long and hard.
It was a very tough workout indeed, I sure burned lots of calories.
Towards the end, they kept seeing her head of hair, but still her head didn't come out. Dr tried to locate her head position and said it was in good position, so we continued pushing. Then he said since I had 2 previous C-sections, he would prefer me not to push too hard for too long and asked if he could use a kiwi cup (a form of vacuum cup) to guide her head out. This would not require an episiotomy (cos I didn't want one) and I would still have to push her head out for him to attach the cup to her head then he'll just help the head out.
I kind of turned to G for "consultation". She said I might be exhausted, so a little assistance is ok. So I agreed.
I think the entire "pushing" stage took about 20-30min (from when Dr came) and dd was born at 3.21pm. Everyone cheered. We were all so happy.
After that, how the placenta expulsion stage took place and how we bonded with baby was posted in another post earlier.
When Dr took off his hospital scrubs, his long-sleeved shirt was totally drenched. Dh commented to me that he thought that our Dr didn't need to do much, just sit there and wait for baby to come out, but he actually perspired to that degree! Maybe he was just kancheong (anxious) about me being a VBA2C case. :-) G did say he was especially concerned about such cases. He had only done 4 before, and only 1 out of the 4 was a success. So now we upped his stats to 2 in 5 successes. hee.
He came in to check on me every morning of my stay in hospital and after I got home, he also called me at home to check on me. Very good postnatal care as well, I must say.
I also had a postnatal check up.
Dh now wants more kids. He was so in awe of the wonderful process. I told him, I am still recovering from the "aftermath" and you talk about more kids?? We had agreed to stop at 3 and I think we will eventually stop at 3 (I will get him to agree to stop at 3). I must get him to help out more, then he will realise it is hard work.
Since I wrote this while the experience is still fresh in my mind, I am sure it contains a lot of details. Years down the road, I think I might, like my mom, suffer from selective amnesia and remember only the happy parts. Cos my mom always says childbirth is pain-free, no biggie. Just like everyday business in the toilet. I went through it 3 times and I don't believe her.
But then again, who knows, next time I might forget all the ouch part of it and tell my dd the same thing? Just like how the elderly say it was so easy taking care of their kids in the past, not like OUR kids now, so difficult. That's also selective amnesia isn't it?
Anyway I have always been an honest person. I know my account above isn't those that gloss over the hard parts and make it sound easy to others so they'll be greatly encouraged to go have more kids. I also didn't use all the politically correct terminology. Hypnobirthing and gentle birthing books say we cannot use the words "pain", "contraction" and all thes negative-sounding words. I used them, so I am not very encouraging, I think.
But then I am honest, and I don't want people to think I have a high threshold for pain, that I am a superwoman or someone who can birth children easily, cos that was not the truth for me. It was hard work and tough for me. I am glad it is over yet I am glad I chose this path. I would still do this and choose this over a C-section. With pain, there is gain, I think.
So go ahead and have more kids. The more pain, the more you treasure them, I think. :-)
rainbows every day, do not worry for the morrow