My VBAC Story
4 Years Ago...
It all began almost 4 years ago when I had my first son’s failure to progress induction ending in an emergency c-sec. I was induced because I had Gestational Diabetes (GDM) and the doctor insisted that I get the baby out by 40 weeks. Although I knew that my sis in law in Canada also had GDM and a big baby (4.5kg) who was allowed to go to 42 weeks, when I brought it up with my doctor, he was insistent that we have an induction by the EDD. I was a new mother and was not sure of myself, so I agreed. Until the EDD, there was absolutely no sign of imminent labour. I went in for the scheduled induction. Suffice to say that after 2 pills, lots of pitocin, 26 hours of labour and dilation to only 3 cm, water bag being released at 12 hours after the first pill (at 1cm dilation), there was fetal distress and we had to proceed to emergency c-sec. The doctor put it down to non progression of induction.
Note that I was a very healthy mom, I had my sugar levels well controlled with diet alone and I exercised throughout the pregnancy. I am also big sized (XL usually) and so I could foreseeably birth a bigger baby. My son was only 3.2kg. I felt very cheated at that time that I had to have a c-sec. I have always wanted a natural birth and did not believe in elective major surgery. I felt that I had not been given a chance to have a natural birth, but because I did not dare gainsay a doctor, I agreed to go along with his planned induction. Now when I say natural birth I do not mean that I wanted everything au natural. I am all for the modern medical benefits like pain control and intervention if it is so warranted. What I wanted was a vaginal birth. However, I felt that in this case, my son was nowhere near ready to come out and we basically forced him out. But since he was not ready to come out, we had to have an emergency c-sec. I must also point out that since I was a first time mom, and did not foresee any problems, I did not do enough reading and was not prepared for eventualities like a failed induction ending in emergency c-sec. So I was not entirely blameless in this.
3 Years Later...
Fast forward 3 years later. I got pregnant with my daughter. I traveled extensively for work and was very busy throughout my pregnancy. I continued my usual practice of going to the gym and working out at least 2 times a week while also looking after my son after work when not traveling. I usually attend step classes ( please, this is not recommended for everyone; I did it because I have been going for Step for more than 10 years and I am one of the least clumsy people I know, including during pregnancy). My weight gain was acceptable. I was worried about GDM again and I kept asking my current obgyn if I should do the OGTT (glucose tolerance test) and monitor my carb intake, since normally if you were previously diagnosed with GDM, doctors usually recommend doing the test around 20-24 weeks. But no, this doctor said not to worry; everything (from his observation of the ultrasounds) seemed to be ok.
33 Weeks: Breeched
Time passed, suddenly it was 33 weeks! And my baby girl was breeched. And she was 1-2 weeks bigger than her gestational age. This doctor who was not worried about my GDM was pro c-sec. His reasoning was that since I’d already had one, I might as well have another one. This even though I stated from the very get go that I prefer to have natural if possible. He wanted to schedule a c-sec that very week! I was aghast. I had another 7-8 weeks till my EDD, why did I have to schedule a c-sec right now? Was it impossible that she would turn in that time?
That was when the reality of another c-sec sank in. I really did not want another c-sec. I decided to do some research on VBAC. I came across HypnoBirthing, Spinning Babies and many websites on successful VBAC, VBA2C even VBA3C. There were exercises that we could do to help turn a baby the right way, to improve the chances of a successful vaginal birth. I managed to speak with Ms Soo Wai Han, a renowned HypnoBirthing practitioner who was willing to meet me to share with me her experiences. She also recommended that I stop seeing the pro c-sec doctor and to meet with a pro natural one. I took her up on her advice and went to see Dr Tan Ee Ping from CT Woman and Child Specialist Clinic in Seri Kembangan.
36 Weeks: Big Baby
Dr Tan was very open, and frankly adviced that I do the OGTT, since by that time at 36 weeks, my baby was already on the large side, 3.0kgs. She said that she is pro natural, but when the baby is too big as in many diabetic mothers’ cases, then the chances of complications are higher. She said that I had to control my diet carefully in order that the baby’s size did not become too big if I wanted a VBAC. In her experience, if baby is smaller, the uterine contractions are usually slower and less intense; if baby is bigger, uterine contractions are usually faster and stronger which increase chances of rupture. Also with GDM, there are higher chances of stillbirth near the end of gestation as the placenta tends to mature faster. I wanted to go to Dr Tan for the birth, but since my hubby and I were strapped for cash we had decided on a government hospital – UMMC. And I had been going there for regular check ups since 35 weeks.
However with each visit to UMMC I was getting very disillusioned with the attitude and service there. The doctors were very young, inexperienced even though they are led by senior consultants, and the nurses were very military. The hospital was NOT mother friendly. No one was allowed to accompany the mother during the labour as they did not have individual labour rooms. Birth plans were simply not heard of or done. We were told by a nurse that we could not bring anything into the labour room except for personal medications including our handphones - in case the use of the phone interrupts the workings of the machines. Nonsense I felt. During one of my checkups, the administration was not up to par, they actually misplaced my file and could not find it even though I waited 5 hours that day. The antenatal and post natal rooms in the new building were nice though.
39 Weeks: Switching Careprovider
One week before my EDD, I spoke with Wai Han again and went to see her. She shared with me some techniques and HypnoBirthing philosophy. It was good that I did, as reading from websites did not really show how things should be done and Wai Han answered many of my questions. She also helped me visualize how the birthing process would go. This was very important for me so that I did not panic and knew what was coming at each stage. Many times a labour may take many hours or many days and if you were to admit yourself to hospital too early, then there is a high chance for interventions. As long as there are no signs of complications, it is often better for the mother to experience the first stage of labour in the comfort of her own home. This is how it is done for many births in the Western countries where doulas and midwives are the primary caretakers of mothers during pregnancy and births.
I was now at 39 weeks and seriously upset with UMMC’s cavalier attitude towards gentle births. Wai Han recommended that I see another pro natural doctor, Dr Roslan who is the head of O&G in Selayang Hospital, a government hospital. Since it was the weekend, I made an appointment with Dr Roslan in KPJ Damansara where he is a visiting consultant. On Saturday (T-3 days to my EDD), after discussion with Dr Roslan about my wish to attempt a VBAC, my history of unsuccessful induction, my good diet based control of GDM and checking the baby’s size and health of placenta on the ultrasound, he agreed to accept me at Selayang Hospital and gave me a note to take along for my appointment which was scheduled on Thursday, 2 days after my EDD. He also made sure to put me in the hospitals system that day itself.
3 Days to EDD... Birth Show!
Jan 17 (T-3 days to EDD, the same day that I’d gone to see Dr Roslan) Saturday night, after dinner with my family, I had my first show. I’d had Braxton hicks contractions for the past 2 weeks, but these were easily ignored, painless tightenings of the uterus which I could sleep through. When the first show began, the surges were no longer painless. I was excited, nervous, but tried to keep cool. I spent the night periodically waking up. The surges were irregular, between 3- 12 minutes but sometimes would stop for half an hour.
2 Days to EDD... Surge On!
I messaged Wai Han in the morning and she confirmed that most likely I was in early labour. She recommended that I do not inform anyone other than my husband of the imminent labour as she knew from previous experience working with VBAC mothers, the labour may take some time, and it was pointless to cause worry (and in turn negative pressure on the mother). So I bore with the surges, did what I always do with my family on Sunday (T-2 days to EDD), tried to rest a bit more. That night, I could not sleep, the surges were becoming more and more regular and uncomfortable. The birth show continued. The exercise ball became a good friend. It helped to ease some of the painfulness, but this was a good pain. As Wai Han said, every surge is bringing the baby closer to me. Bring it on!
1 Day to EDD...To the Hospital
Jan 19th (T-1 day to EDD), Monday. I was off work that day already but my husband had to go into work for an important meeting. The pain from the surges was getting more intense, I was tired from a sleepless night. However I managed to send my son off to school, then took a nap after he had gone. I felt much better after the rest and decided that I had better go into Selayang to meet with Dr Roslan or at least get registered at the hospital, just in case I went into active labour that day. Again with the support of Wai Han, I managed to bear with the pain and go through with the normal motions of life. When my husband got back around lunchtime, we got ready our things (perhaps to be admitted) and left for Selayang Hospital around 2 pm. During this time the contraction pain was bad enough that I could not speak during one. However I could pick up the thread of conversation after the surge had passed.
When we got to Selayang hospital, I went to the FPP counter only to be told that Dr Roslan was on Emergency Leave that day. The nurse was confused and not very happy when I told her that I’d seen Dr Roslan only 2 days before in his private clinic and he had said that I could come to Selayang Hospital to give birth. I told her that I wished to register and make an appointment to see him. She made me an appointment with Dr Roslan for Tues (20th Jan, EDD) for 2.30pm and wrote me a note for the Labour Ward nurses in case I went into labour before the scheduled appointment.
Then as there was nothing to be done and my surges were continuing with not much change in intensity and timing (plus my hubby could not find a parking spot!), we decided to leave Selayang Hospital to catch a movie and have dinner before we went home.
On EDD... To the Hospital, Again
That night the surges became more intense and regular from 1 am. As I kept waking up at the start of each surge, I decided to time them. By 4 am the surges were becoming regular, every 3-6 minutes. I debated whether to wait till after the morning jam to go to the hospital or to leave before the jam. Also I became hungry and decided to have a snack at 4.30 am. After a slice of bread, I decided it was probably prudent that we go before the jam. I told my husband that surges were becoming really regular and close together therefore we’d better go to the hospital soon. He agreed. We took the bags that we’d already packed yesterday, informed my parents and left by 5.30am.
6:30am: 4cm Dilation, Active Labour
At 6am we arrived at Selayang hospital. I walked to the Labour ward counter, passed the nurse my blood works, the letter from UMMC, and the note from Dr Roslan’s nurse. They were a bit taken aback but when I told them that my surges were now 3-5 mins apart, they agreed that I should be admitted. Then they put me on the CTG, which was really painful as I had to lie down on my back for half an hour and they did a VE. I was dilated 4cm. It was 6.30am.
The MO in charge called Dr Roslan shortly after. Dr Roslan was due to do his rounds at 8 am. I said ok. I wasn’t timing my surges anymore. They wheeled me into the labour room. All labour rooms in Selayang Hospital are individual. My husband was allowed to accompany me the whole time. I was allowed to have light food and drink, although I couldn’t really eat. I did however bring some granola bars which were handy as they gave me energy without a lot of bulk. I kept drinking water to keep myself hydrated.
Before Dr Roslan came, the nurses and doctors tried to get me to lie down so they could do another CTG and monitor the surges. I said that I’d already done a CTG in the outer labour ward, and not half an hour ago. I refused to do another CTG. I did not want to lie down. I told them that I wanted minimal checking and we agreed that the nurse could come check my surges by hand once every 2 hours, and the baby’s heart beat via the Doppler once an hour. I also told them that I would prefer minimal VE unless I asked or was necessary. The nurses and doctors were reluctant but once Dr Roslan came, and he informed them of my preferences, they became more willing to let me give birth the way I wanted. Dr Roslan is very pro natural.
Thereafter, the nurses and doctors became very respectful of my wishes. They always inquired before they decided to do anything and in the end they did not overly disturb me and my husband. I was allowed to switch off the lights in the labour room, I was given an exercise ball, there was no CTG, only checking of contraction by the nurse by hand once, no VE unless I requested.
With my husband there, he was able to help me by reminding me to breathe, getting the heat packs warmed up frequently, reminding me to drink water, eat if I could. I could not have done this without him. The other person who was of immense help was Wai Han. Once I got to the labour room, I messaged her to update her on my condition. She asked to speak with my husband. On the phone she adviced him on how to keep me hydrated, keep my energy up, to remind me to breathe the baby out, to massage my back and provide overall encouragement. She also told him to distract me if I asked for painkillers and to call her if I was really demanding painkillers.
So for the next 7+ hours I stayed upright, I walked, I sat on the ball and toilet when I was tired, sometimes on fours on the bed. I used the heat pack to alleviate the pain in my lower back and tummy area. The heat pack was extremely helpful, although you have to be careful not to overly heat them and burn yourself. When I was tired I lay on the bed to rest. I tried sleeping but it was nearly impossible as the surges kept waking me up.
1:00pm: 7cm Dilation, Hallmark of Labour!
By 1pm the surges had become really painful and intense and I had the bearing down urge. I asked the doctor to check and to call Dr Roslan. She checked but said that it was only 7 cm and not yet time to push. I laid on the bed for a while despairing that I would ever give birth to this child! I was on the point of giving up, I demanded painkillers, asking my husband to check with the nurses my options. His attempts to pacify me and reassure me that I could handle the pain and to push through were in vain. I was convinced I was not going to survive the pain much longer. However by that time the options for effective painkillers were limited. We called Wai Han.
Her first words were,”What is her position?” I was lying on the bed still after the last VE, it was excruciatingly painful.
“Get her upright, sit on the toilet bowl for a while, do not lie down!” were her next words.
Painfully I got up, walked to the toilet and sat down. By this time I was dripping with blood and standing up caused some really strong surges to occur (I think gravity was helping here). But it was not as painful as lying down. All this time, my water bag was still intact. Only once I sat on the toilet for a while did it burst and the amniotic fluid started leaking. However the flow was in stops and starts as when there was a surge the head of my baby would stopper the cervix and the fluid stopped leaking. Once the surge ended, the water started leaking again. Staying upright definitely helped the birth along and soon I could feel my baby’s head crowning.
I managed to get back into bed and informed the nurse. She called the doctors and soon the room was full of doctors and nurses, some trying to call Dr Roslan, some checking on me. They didn’t manage to get Dr Roslan immediately. The main doctor who was checking me all this while, told me to stop breathing/stop pushing, but as I had been breathing down the baby for the past 3 days now, it was difficult for me to change my breathing. They wanted to wait for Dr Roslan to come before the baby came out, but by this time it was beyond anyone’s control. The uterus had taken over. The baby was coming whether we wanted it to or not. The doctors wanted to do an episiostomy, but I declined, I said NO!
Then suddenly I felt a tremendous surge and yelled out, “Sorry guys! She’s coming!”
My baby was born. Dr Roslan arrived a few minutes later. I had a 2nd degree tear. I had given birth on my EDD. The total time of labour from first show was 66 hours or 2.75 days.
My baby was born finally! The time from the last VE at 7cm to birth was about 45 minutes! Her APGAR score at 1 minute was 8 and at 5 minutes it was 9. She was a very healthy baby weighing in at 4.02kgs. She had no issues with high sugar levels. She started crying a bit, then, when they placed her on my chest she immediately calmed down. I asked for delayed cord clamping, which confused the young doctors a bit, but Dr Roslan told them to allow me that also. I had no injection to help eject the placenta. I tried to latch my baby but I think she was curious and not hungry. She was not interested in the nipple, so I let her be. The placenta was delivered shortly after and the nurses placed it beside me on the bed. Once the cord had stopped pulsing, they allowed my husband to cut it. All this time I was happily chatting with the young doctors and nurses, taking photo of my baby and comparing notes with my husband about her size and my firstborn's size. I knew she was bigger, but it wasn’t till much later that we found out how much bigger. I was tired but not exhausted.
After about an hour of skin-to-skin, the nurse took my baby to be cleaned and dressed. I was asked to go to the toilet if I could and I did. After they had brought the baby back, we packed up our things and left to go to the postnatal ward. I was finally tired around 5pm and took a nap while waiting for my family to come around 7pm. That night, they checked my baby's blood every 2 hours for signs of low blood sugar, but she was fine. The next day we were both checked by our doctors and given a clean bill of health. I was discharged at 1pm.
A Note on GDM
A note on GDM: if I’d had had the OGTT earlier, I would have controlled my diet earlier on, perhaps resulting in a smaller baby or not, since it is a malfunction of the body’s system that oversupplies glucose (sugar) to the baby. About 5% of mothers are diagnosed with GDM. However, since my first doctor was of the opinion that GDM was not a concern, I also did not really control my diet before 33 weeks. Basically with GDM, we need to control the amount of carbs and sugars that we consume. If we can reduce it to minimal levels, then there is less chance of a big baby at the end. When I was controlling my diet, I ate very little rice, noodles, bread. I ate more veggies, proteins like meat and chicken, eggs, tofu. I totally cut out chocolates, desserts, sweet drinks (although I have a sweet tooth but the baby is more important).
What have I learnt from these experiences? One glaring issue I’d like to bring up is that mothers are often treated like simple-minded children when it comes to making decisions on the birthing process. Doctors and nurses often don’t take the time to share with the patients the birthing process and give them all the options. Doctors and nurses take the stand that they know better. Perhaps in their eyes, birth is not a natural thing and has been elevated to a pathological issue, since they probably spend a lot of time going over and dissecting the problem cases. Perhaps they forget that birthing has been going on for a long time without the help of modern intervention, but I think there are signs that this situation is changing. Doctors should also spend more time going over the successful natural births and study how they are achieved.
Mothers need to take responsibility for the birth. Childcare begins when the mother gets pregnant, gestates, gives birth and subsequently parenting. More mothers are empowering themselves with knowledge so that they can be in control of the birth and not just hand over to a stranger who only wants to deliver a baby quickly with no idea of the consequences of subsequent issues like difficulties in recovering from a c-sec, impact on baby’s health when not born naturally, impact on breastfeeding success, as the mother may be too traumatized by the birth. There are many many issues, which can all be read from the gentle birthing groups and talking to other experienced mothers, midwives, doulas, etc. Mothers need to educate themselves on their rights. Do not allow others and circumstances to derail you from the kind of birth that you want. Only you know what that is, you need to be able to communicate this to the caretakers around you. In general, make sure you eat healthy, keep exercising and keeping yourself informed of your choices.
- Erin Tan (Jan 2015)