Birth Story – vba2c (Virginal Birth After 2 Caesareans)

How did we end up here?
First child’s emergency-c
I had my first child Zoë by emergency-c in HK. I was three weeks away from the due date, in my gynaecologist’s office. HP was with me, as with most prenatal visits and we were there during his lunch hour. Just before leaving the ob’s office, I re-opened the door and said, “Btw, I’m still spotting blood on my panties; any concern?”

“Let’s have a look.” The ob said.

That was the start of the nightmare.

He had tweaked something in my virginal and he couldn’t stop the bleeding. He was very calm when he said, “Take a cab to the hospital. In the delivery room, there are brighter lights and leg supports where it might help me stop the blood flow.” We were in the city (like Orchard) and heading towards our booked hospital (distance: like travelling towards K.K. hospital).

In the meantime, he had used a metal gauze to stop the blood from leaking out..

At the hospital, after a couple of attempts, he still couldn’t stop the blood bleed. So he decided to perform an emergency-c, to save the baby’s life then resume with stopping the blood bleed.

Second child’s “pressurised”-c
I felt that my second gynaecologist changed his tune towards the final weeks of my pregnancy. Firstly, he had seen how I squirmed whenever he gave me a virginal exam. I couldn’t handle any pain or equipment(s) (with the shape of scissors) used to open up the virginal for examinations.

Secondly, he said, “You are past your due date and the baby’s getting bigger.” But the thing that got my goat (actually, I was more anxious than angry) was when he said, “Tomorrow’s Sunday, I can’t wait indefinitely for you!”

The first stage of labor
Tuesday 22nd June 2010 9am: I had a show of blood on the panties. I learnt from the previous experience with Cayla, having “tried” to go into labor for twelve hours after that show, that a show may mean nothing for a week or two. This time, I was excited but expecting nothing may happen. I was also due to see my gynaecologist on Friday, at 40-weeks gestation.


I resolved to be like LK, my friend who labored outside the hospital for as long as she could, even enjoying a dinner with family so that the hours spent labouring at the hospital might be short. What do I know about labor, anyway!?


So I spent the morning anticipating and cooking vegetarian fried rice for my vegetarian friend Eve, whom I haven’t seen for a couple of years. Later, I realised I was privileged to have her company while in early labor. Eve wasn’t just any friend I was entertaining: even though we haven’t been in regular touch, she was someone I lodged with for a couple of nights when I fell out with my family years back. I even felt something for Bukit Batok area because that was where she stayed then.

When Eve arrived, I pre-empt her about my tummy aches and the possibility of me being in early labor. After lunch, she decided to accompany me to the hairdressers. I drove there and back. At four plus, she decided it was time to head home to beat the after office hours traffic. I insisted on walking with her and her younger child to the bus-stop. I said that the walk was good for me. I think she was really worried about me. She said she would have headed for the hospital the moment she felt any contraction pain. …

By dinner time at six plus, I was convinced I must be in labor. The surging contractions were obvious. The only thing I wasn’t sure was when to go into the hospital. I sent a text message to my doula to inform her that the intensity was about 20s, with a 5-minute interval. And that I would continue monitoring.

By seven plus, the tummy aches were getting a little painful. At one time I was pushing Cayla, my two-and-a-half years old away and she cried… I text my doula and informed her that I would like to be at the hospital by nine. She called to have a chat with me about the duration of the intense pain. Her comments were that at 20s, I might find myself labouring for a long time at the hospital. I asked if I really have to wait till the duration was 70s long before I head for the hospital. She said no, perhaps 50s.

When HP got home at about eight, I didn’t care anymore. I was on my fours at one point when the contraction surge came. I WANTED to go into the hospital. I feared that I may not be able to take the car ride with the pain.

8pm: I can never forget how I managed to mend Zoë’s shorts with a sewing machine between the contractions surges. Doing something took my mind off the pain.

The second stage of labor
During the car ride to the hospital, I was still ambivalent about taking the epidural anesthesia during labor. The “natural delivery” books I’ve read and the doula I’ve had meetings with make it seem as if taking epidural might be detrimental towards a natural delivery, by slowing down the contractions. I asked my obstetrician PT about it and his take was that the pain relief epidural might be good for some women - because these women need the respite and when it’s time to push, they are able to do it.

8.30pm: We got to the hospital and I was convinced I wanted the epidural: I could not handle the increasing intensity of the contractions.

9+pm: People have been giving me feedback that the doula I hired is pro drug free. So, I felt bad about asking for the epidural. I tried to ask her about the different lying positions on the bed that might help advance the labor and her comment was that “it doesn’t matter anymore, you’re taking the epidural.” But, with each contraction surge she would come over to help me with the breathing, by voicing it aloud with her low soothing voice (she said “in, out, in, out”).

Shortly after, my obstetrician PT came in to say hello.

I responded, “Are you going home?”

He chuckled, “Of course, there’s no point for me waiting here.”


Then the anesthetist followed right behind him. This was my first encounter of the gentleman who was about to give me the pain relief. He looked at my notes and with a grave, negative tone he said, “You’ve had two caesareans before, are you sure you want to do this natural delivery?”

“Yes,” my faint reply, through my pains of the contractions that was going on (I’ve been forewarned by the doula, of people who might not be so supportive).

He said these words before giving me the epidural, as if it’s his disclaimer, “Then you know that your baby might be compromised.”

i can’t remember how I reacted towards him but I know I felt angry at his insensitivity at saying these words - when I was in pain, and fragile and also when we would have already make the decision for a VBAC weeks/months back.

“Creep!” I thought, without voicing it aloud.

Before leaving, the anesthetist said it’ll take twenty minutes for the epidural to take effect. I waited and waited for the epidural to kick in, to take away the pain. Time crawled like never before. At one point I kept asking them why I still felt the intense pain. The nurses came in to administer a higher dosage. They also had a maximum dosage specifically for my VBA2C condition, where they didn’t want to mask off the pain totally, and I had to inform them if I felt other tear pains (ie, unlike the contraction pain which comes and goes, the tear of a rupture would be a constant pain).

I spent the next 2-3 hours labouring in pain. It was close to two am when I felt more relieved. It was also about this time the doula said she’s going home for a rest, since the epidural kicked in. We had no idea how the labor would progressed.

After she left, I managed to sleep for about an hour. When I woke up at about three plus, I felt no contraction pains. I started to worry that the labor wasn’t progressing and that it had come to a halt. I rang for the nurse. She looked at the machine and said that the surges were still there, that the epidural had kicked in and so I wasn’t feeling the pain. This was good news but it lasted not more than an hour.

After that good hour of rest, the surges came back. The nurses had already administered to me the maximum dosage of epidural. I remember feeling that laboring was like conducting an orchestra: its rhythm was: intense pain, (short relief), intense pain, (short relief,), intense pain, (short relief), intense pain, (short relief), intense pain (short relief)… Each time the pain peaked, HP could see the contraction surge on the machine and he would walk towards the bed and hold my hand. This was the best advice that I read from one of the books: that the spouse support by being there for EACH CONTRACTION.

6am: I felt that I couldn’t take it anymore. I asked HP to text my doula, to inform her that I’m feeling awful about the whole thing (we had called her earlier to say we were “not OK, and then OK - when I had that hour of sleep”). I begged for General Anesthesia (ie, to perform whatever it takes to stop the pain –emergency caesarean… at least I tried!). As an alternative, the nurses gave me the mask to breathe in the gas each time I had a contraction. It couldn’t mask off the pain but at least I was doing something whenever the pain peaked.

The doula came in and said that the doctor was coming in.

I have no idea how I passed that hour.

After 7.30am, closer towards 8am: PT came in. I asked him to give me the epidural and he replied that he couldn’t give it to me just because I asked for it. He examined me and said I was ready for the delivery. He said he’ll use the vacuum (I was so thankful when I heard this!) to take the baby out but that I had to be the one to push. He tried to get me to move a little here and a little there, to get ready for the delivery but my body wouldn’t budge. He even asked, “Why are you so sleepy?” When he was ready with the vacuum, I was ready to push (it was my version of “caesarean” – if I get him out, the pain will all come to an end).


8.05am: And that was how Ethan (meaning: sensitive) came into this world. He was 4.015 kg at birth.

The hospital listed it as “vacuum” delivery. That meant we could have two separate bills (vs “normal” delivery). I was surprised TLC used the “normal” lift (ie, shared by the public) to wheel us (newborn and me) to the room.

Reflection
I thought a lot after Ethan popped. I wondered why I equate death to pain. I am sure God wouldn’t want us to die in pain.

I began to feel thankful we had a caesarean for Cayla’s birth. If we had delivered her naturally, I felt, in the immediate aftermath of the delivery, that we might not have tried to have Ethan. I remember that with Zoë, I was naïve about raising a child. With Ethan, I am naïve about labor pain.

HP said that putting all the emotions (‘cos I felt so violated about Zoë and Cayla’s being taken out from my womb so abruptly) aside, he felt that my low threshold for pain and my quicker recovery from caesarean (I was able to walk within two days whereas for the “naturally” delivery, I got out of bed and walked *normally* after a week!) makes it seem more suitable for me.


Q & A
1. Most people asked me this question: Would you do it again (ie deliver the baby naturally)?

Well, ask me this question immediately after the delivery and the week that I was still in pain, I honestly don’t see how I can ever do it again.

A week after the delivery, I would give a thinking answer: If we have the support for a week’s recovery, we might try again (in this case, my mother-in-law was looking after the other two children). Even though the pain was more than I can take, at least I didn’t suffer the depressive thoughts of a baby taken out of the womb so abruptly.


2. Hypnobirthing
A buzzword for delivering a baby into the word using self-hypnosis. Honestly, it’s about “mind over matters”, where you focus on something (like a safe place, Eg. A beautiful garden) when the contraction pain comes (and when it goes, you relax).

–I wondered what my safe place was and I found it in the deep and fulfilling relationships I have with people… so, I thought I’ll think of all the people who have inspired me with their words when I’m confronted with the contraction pains. In the end, the practise was too short (I believe like meditation, one has to practise). I ended up hitting the railings whenever I was in pain.


I had a few prenatal visits with my doula. Firstly, I wrote down all my fears regarding this pregnancy, the delivery process and the anxiety of having this child. After that, she taught me to use words to combat those fears. Eg. I was afraid of having a boy, ‘cos we’ve never had one. And my “positive” column had words like “God gives us what we can handle.”

I also made a motivation list for having this natural delivery. I was told to read it frequently, to prepare for the birth.


3. How do we know we’re in labor?
i) Frequency of the contraction surges (Eg. it gets closer and closer; from 5 minutes to 4 minutes)
ii) Increasing duration of each surge (it gets longer and longer; from 50s to 70s)
iii) Surges will increase in intensity (more and more painful)
iv) Physical signs like much stronger bowel movement sensations or there may be more and more bloody show


4. Questions for the gynaecologist
i) If labour does not start by 42-weeks, what happens/ options are available to me (Sweep/AROM induced labour)?
ii) If labor slows down or stalls, what options are available to me?
iii) Do you have guidelines to show if “labor is progressing”? (Eg. Dilation of 1cm every 1-2hours?)
iv) How long will you be comfortable with my VBAC labor duration?
v) Do you measure the thickness of my skin, for my suitability for VBAC?


5. Birth plan
State everything you want for the doc/the-ever-changing-shifts nurses/doula to read. It’s like your “*” commandments. You can state your preferred delivery room, subject to availability. In my next birth plan (if we are blessed with another child), I would include this: Immediately after the delivery, do NOT place the newborn directly into my breast for feeding. Place just below the nipple. [I would like the wonder of seeing the newborn crawl towards the nipple].


6. VBAC obstetrician in Singapore
I will certainly use PT again. (PT: Paul Tseng. Note: only actual name used here. TLC Clinic, Thomson Medical Centre)

In progress