At the time I was nervous, scared, in pain, and exhausted.  Now, of course, I look back with nostalgia – And am only now able to really appreciate the beauty and miracle of the whole event.

Sunday, 2:30am:  I awake from my half-slumber (real sleep is damn near impossible those last few weeks of pregnancy) with some abdominal pains.  Nothing new… I’ve been having Braxton-Hicks contractions for weeks now.  Glad I’m now off work though so that I can hopefully sleep in after another anticipated sleepless night.

Sunday, 3:30am:  Ugh, these pains are getting really annoying.  I know they’re not real since they don’t radiate in my lower back, as I’m told real ones will.  Only in my lower abdoment.  So just go away already!

Sunday, 4:30am:  Okay, this is really starting to hurt.  I’m gonna start tracking them so I can call my doctor tomorrow.  Where’s that Contraction Counter app?  Okay, here we go.  Start, stop…  Start, stop.  About 10-15 minutes apart.  Still only in my abdomen though.

Sunday, 5:00am:  Owwww – That one HURT!  Made me tense my whole body up.  Okay it’s going down…  Breathe… Relax.  Glance over at hubby for support.  He is sound asleep.  Gently shake his arm.  He grunts and pulls away.

Sunday, 6:00am:  Confused.  These Braxton-Hicks are getting pretty strong.  How strong can they get?  I know they’re not real since I still have yet to feel any lower back pain.  App says they’re still about 12 minutes apart, but some even longer than that.  Surprised hubby is still sleeping through all of this.

Sunday, 7:30am:  Hubby yawns, rolls over.
Honey, are you awake?
Mm.
I keep having more Braxton-Hicks.
Do we need to go to the hospital?
No I don’t think so.  I only feel it in my lower stomach.  Not in my back.
What does that mean?
I think they’re only real contractions if I feel them in my back.
Are you sure?
Yeah.  You can help me time them though.

Sunday, 8:30am:  Hubby is upstairs making breakfast.  I call my sister.  She doesn’t pick up.  So I text: Braxton-Hicks not going away.  She calls immediately.
OMG are you in labor??
No I don’t think so.  Only feel in my stomach, not back.
Yeah, usually you feel in the back if it’s real labor.
It hurts though.
How far apart??
I dunno, like 10-12 minutes…
You’re in labor!!
No I’m not.  They’re not that bad.  Once they go down I feel fine.
YES, THAT IS LABOR!
Intensity is not unbearable.
Because it starts out slow and then it WILL GET WORSE.  Where is your hubby?
Making breakfast.
Making breakfast!?!  Have him call the hospital!  I’m getting dressed.

Sunday, 9:00am:  Just in case this turns into something, I send hubby to pick up a smoothie and some oatmeal.  I am not hungry whatsoever, but my sister and mom friends have all told me to eat before I go to the hospital (as they won’t let me at that point).  My sister also told me to shower before I go to the hospital.  So I do.  And the pain is getting worse.

Sunday, 9:45am:  By this point, each contraction has me bending over the counter or table to clutch onto something.  These are getting really strong.  But STILL… Only in the abdomen.  Hubby calls hospital.  Nurse asks to speak with me.
How far apart are the contractions?
About 10 minutes or so.
What is the intensity?
I dunno, getting a bit worse, maybe like a 7-8?  Then I’m fine.
Where is the pain?
Only in my lower abdomen.
Are you feeling any lower back pain?
No.
Okay.  So it sounds like you’re experiencing strong Braxton-Hicks contractions.  Your body is preparing for labor, but it doesn’t sound like actual labor.  Of course we would have to check you to make sure.  It’s up to you if you want to come in.  We can check the baby for any signs of fetal distress if you want.
Okay thanks.

Sunday 10:15am:  We decide to go in and have them check on the baby.  We pick up the hospital bag just in case.  On the ride over – Contractions becoming much more intense.  Who knew Braxton-Hicks could get this bad??

Sunday, 10:45am:  Checked into hospital.  They are taking vitals and monitoring contractions to see if I should be admitted and will let us know.  Pain now becoming really intense.  First tears during a contraction.  This is the first point I realize – these are no Braxton-Hicks!  Hubby holds my hand (or rather, I dig my nails into HIS hand) and reads me the monitor levels: Okay hang on, another one is coming, it’s going up, up, up… Okay it’s leveling out… Hang on, it’s leveling out… You’re done now, it’s going down, down, down.

Sunday, 11:00am:  Become inexplicably angry about a conversation between a patient and doctor that is happening in the bed next to us.
I think maybe my water broke?  I was wet all over so that’s why we came in.
Yes, it definitely broke.
Oh no.  Can we go home and come back tomorrow?  We have a birthday party to go to.
Uh… No.  If your water breaks, you are going into labor.  You will need to stay here for observation.
Oh shoot.  Really?  Can’t I just call my doctor and have her release me?

Sunday, 11:30am:  Doctors confirm I am in labor.  Now they want me to walk around the hospital floor to speed things up.  Really??  So hubby and I waddle around the floor.  Each contraction has me bending over a windowsill, a counter, or a table.  People walking by and looking.  Embarrassing.

Sunday 12:30pm:  My doctor calls.  She is not on duty, but I told the hospital to call her anyway.  They would not.  So I called a friend who could contact her.  Doctor is wonderful.  Reassures me right away that she will be here.  Also reassures me that she told the hospital to give me the epidural ASAP (my birth plan = epidural as soon as possible, and my doctor knew that.  Hospital would not give it).

Sunday 1:15pm:  EPIDURAL AT LAST!!!!!!!  Ahhhhhhhhhhh….

Sunday 2:30pm:  Sister arrives.  I’m in much better spirits since the epidural.  Somewhat relaxed.  Just waiting.  Even napping a few minutes here and there.

Sunday 7:30pm:  Besides having to continually fight for more pain medication (to this day, I will never understand why the epidural administrator was so reluctant to give me more, even when I expressed my pain levels AND showed full function in my legs and lower body to address her concerns of numbness), things have been going smoothly.  Nurses keep checking dilation levels, which are proceeding as expected.  We are watching some music awards show on television.  Hubby and sister eat burgers.  Hospital allows me to drink cranberry juice and eat popsicles.

Sunday 7:45pm:  My wonderful doctor is back to break my water.  Who knew they use basically a plastic crochet needle?  No pain.  But then WOW a flood of water.  Keeps coming out and out.  Warm.  Sticky.  A LOT.  I suppose this is why L&D patients are carefully laid on beds covered with doggie pee pads.  More water.  I ask the nurse how much is going to come out.  She said it will keep coming out until the baby is born.  Oh and there’s something else, she says, no big deal but we did see some meconium in the water (this means that the baby’s first bowel movement has occurred in utero; not a good thing).  I immediately freak out.  What!!  Oh no!  What are we going to do??  It’s fine, she says, we will have people ready to immediately clear out the lungs once he’s delivered.  We will closely monitor but it should be fine.

Sunday, 9:00pm:  Nurse says we are getting close to the point of pushing.  Get ready to have a baby tonight!  We’re calling your doctor back in.  Sister is thrilled.  I’m still worried about the meconium.  Nurse gives me an oxygen mask and tells me I need to use it for the baby.  So I do.

Sunday, 11:00pm:  Showtime.  They remind me to keep using the oxygen.  It’s time to push.  Finally.  For a 10-count each time.  Takes a few times to get how to push in the right way.  Okay, got it now.  Out of breath.  Wow, not so easy.

Monday, 12:30am:  Still pushing.  Hard.  With literally all my strength.  HARDER, HARDER!  The nurse and doctor are annoying me.  I AM ALREADY PUSHING AS HARD AS I CAN.  HARDER, says hubby.  I snap at him.  And then I tell doctor that he has not moved a bit.  It’s been an hour and a half, but I can feel he is not moving down.  She nods.  I become more irritated.  So now what?  How long do we keep this up?  Nurse calms me.  She tells me that typically if there is no progress after 2 hours, they will proceed to c-section.  Okay, I figure, at least there is a backup plan.

Monday, 1:00am:  Still no progress at all.  I’m becoming exhausted.  The 10-counts are becoming more drawn out.  From time to time, the doctor has me push for a 15-count.  And the baby has still not inched a bit.  Frustrated.  We’re now at 2 hours.  Doctor knows what I’m thinking.  Let’s try just another 15-20 minutes, she says.  I am angry, not sure why she keeps willing something to happen that clearly won’t.  But I say nothing.

Monday, 1:30am:  Still not a bit of progress.  I am convinced that the baby simply won’t fit through the pelvic bone.  I keep telling them all – He won’t fit.  He’s not moving down.  They don’t really respond, but I can tell they are getting discouraged too.  Hubby has stopped counting.  I look over at sister and she’s half falling asleep.  Everyone looks tired and disappointed.  I keep pushing.

Monday, 1:45am:  The doctor and nurse have now left the bed, although they are still in the room.  I hear the doctor tell the nurse to begin preparing for a c-section.  I hear the nurse on the phone with somebody.  Hubby and sister are sitting, discouraged.  I suddenly have a burst of energy.  I will be damned if I worked this hard to end up with a c-section!  I am angry.  KEEP COUNTING, I scream at my husband and sister like a maniac.  (As an aside, I never understood how important the counting was until I experienced it – It is the only thing keeping you sane during each push – Knowing that you only have 6 counts left, then  5, then 4, etc).  My sister perks up.  She stands up, I know she’s exhausted.  But she’s forcing a smile for me.  Okay, you can do this, keep it up, you are doing great!  I will count for you!  You’re doing so good!   I feel the contractions and I know when to start pushing.  I push and she counts.  ONE… TWO… THREE….  You’re doing so good!  Don’t give up – push push!  You’re doing amazing!  I am just concentrating everything on her, her voice, her counts.  And pushing, pushing, pushing.

Monday, 2:00am:  I vaguely hear the doctor and nurse discussing c-section logistics.  I don’t care.  I am still concentrating 100% on my sister.  She is counting, loud, encouraging.  I keep pushing with every contraction.  And then suddenly – I felt it.  A nudge.  An absolute movement inside.  HE MOVED!  OMG, I shouted, he moved!!  I felt him move!!  I start shaking, adrenaline.  Hubby stands up.  Sister squeals.  Doctor and nurse come rushing over to check it out.  Doctor feels.  I push through another contraction, this time with them all there.  He moved again!!  I am deliriously relieved.  I see doctor nod at the nurse.  I just keep pushing.  Eyes clenched, pushing.  I open my eyes and now the doctor is in some sort of bomb suit, complete with full face shield.  The nurse is manipulating the table.  I look over at my sister.  She is literally jumping up and down, clasping her hands, thrilled.  Hubby is wide-eyed, shocked.  It hits me that it’s happening.

Monday, 2:31am:  The next 30 minutes are a blur.  I don’t remember them.  My recollection is 1 or 2 more pushes and the baby was delivered.  But clearly it was another 20-30 minutes.  I feel him being delivered.  I hear the doctor say, sunny-side up!  THIS is why it was so difficult!  (That means he was a posterior delivery, face up instead of face down).   He is laid on my tummy.  I am in shock.  See hubby cut cord.  And then they immediately take him away.  The room suddenly fills with people, activity.  Teams of people are running in. I am dazed.

Monday, 2:33am:  Suddenly I notice he isn’t crying.  No sound.  The nurse tells me that the people running into the room are NICU doctors.  I panic.  He is on a heating pad on the other side of the room.  There are too many people around.  I can’t see him.  They are hovering over him.  I shout to my husband, WHAT’S WRONG??  Why isn’t he crying??  What’s wrong!!!  He is confused, doesn’t know.  I shout to the nurses, the doctors, WHAT IS WRONG!  WHY ISN’T HE CRYING!  Nobody responds.  I catch a glimpse of one arm on the table, completely limp and blue.  I’m panicking.  Nobody is paying any attention to me.  Heart pounding.  WHAT IS WRONG WITH MY BABY.

Monday, 2:34:  The sweetest sound in the world.  Baby cries.  Screams.  I exhale.  The NICU doctors are leaving.  Now people are starting to pay attention to me again.  Nurse finally stops avoiding eye contact with me.  And I know it’s going to be okay.  I’m not able to have the Golden Hour with him, as they’re still working on him.  But it’s going to be okay.

Ongoing:  After that, it’s all a blur.  I eventually am taken to Recovery, where the parade of doctors, nurses, test specialists, etc. begins.  So much for rest until we get home!  Visitors come.  I am exhausted and everything is surreal.  I have to stay an extra day than planned in the hospital for my own recovery.  The difficult birth was tough on my body.  I am at some point reassured that the meconium never reached the baby’s lungs.  And he is alert.  Everyone comments on how alert he is, and we notice it too.  So that’s good.  More doctors, nurses in.  Questions.  Instructions.  Checks.  Pokes.  Blood.  Half-listening.  I’m hot, sweating.  Nurse constantly coming in and imploring us to turn off the air-conditioning.  Just ready to go home.  Ready to start.  Ready to be a family.

And then we were.  That beautiful November day when we took our baby home for the first time.  So scared to drive.  So scared to carry him up the stairs.  And then just sitting on the couch with hubby, starting at what we created.  In awe.  And ready for the adventure to begin.

(And for the record, I never did experience the lower back pain during labor).

One year ago I supported a VBAC mother through both a natural childbirth series of classes and as her labor support.  Her labor began spontaneously at 41 weeks.  She called to let me know she was in labor so that I could make arrangements for my family’s care.  Around 3pm that afternoon Dad called to say she would like me there now.  I arrived to her moaning through contractions yet speaking to me in between.  She let me know how she was feeling, what she was feeling, what she’d been doing to cope and how being on her hands and knees felt so good right now.  Her biggest concern?  That she would dirty the brand new slate flooring!  Around 8:00 p.m. she decided she was ready to go to the hospital.  We left a clean home and we arrived at the hospital with her bearing down.  The midwife on call wanted mom on her back for an exam.  Mom went to her side, midwife propped one of mom’s leg’s up, saw the baby’s head and decided there was a dystocia.  Dad stated mom did not want an episiotomy, midwife said she’d let mom have one more push.  After the next push contraction the midwife cut an episiotomy and proceeded to ‘guide’ the little baby girl (just under 8 pounds) out.  We were all subjected to a lecture on how mother’s previous C/S was due to ‘failure to progress’ and she probably had pelvic issues.  FACT:  This mom’s ‘failure to progress’ was in actuality a posterior presenting baby whose birth had been augmented with pitocin and the back-up OB for this subsequent VBAC birth was on his/her way in to the hospital.

Two years ago I provided labor support for a VBAC mother whose labor began very slowly at 40 weeks.  Her first birth was a scheduled cesarean without labor for twins with Baby A presenting breech.   At the 12 hour mark with mother wanting nothing more than to just hang out at home Dad became fearful…both family and friends were calling to tell him he was crazy not getting her to the hospital right now.  We arrrived at the hospital shortly thereafter and mother proceeded to labor at the hospital for 48+ hours.  Again, the labor was never intense.  She did not experience the classic, intense transition.  More than once cesarean was brought up, not by the doctor.  Rather a second cesarean was ’offered’ by her husband and sister who was now also present for the labor.  The doctor did however bring up time.  Mom went through two doctors’ shifts and two other women’s deliveries by c/s for failure to progress.  Mom’s sister’s c/s had also been for failure to progress as she had ‘made it’ to second stage (with an epidural) and after almost two hours of pushing had made no progress.  Fortunately for mom, Dr. Carolyn Zelop of the Boston study on VBACs (and co-author of the most recent ACOG VBAC practice guidelines) was on and in the hospital (she is not affiliated with the primary careprovider) for this labor.  Dr. Zelop smiled at mom and stated the best care for VBAC is to allow for the labor to progress gently and naturally.  Were it not for two women secure in their knowledge of the birth process this mom would have been coaxed into a second cesarean.  FACT:  This mother was experiencing labor for the first time.  She labored spontaneously, naturally and consistently slowly as is typical of most first labors.  The coping mother did wasn’t easy to see because the physical aspect was not the main influence.  In other words, mother’s mind was not reflecting on pain, but rather that it was truly laboring, something she didn’t ‘know’ her body would do and did not believe her body was doing until the final release of her son into her arms.abor is physiological and nowhere is the power of the mother’s frame of mind stronger and a greater aspect to appreciate than that of the VBAC mother.  Patience and respect for the mother’s sense of security in her body are crucial to the positive VBAC experience.

Women reading this post are likely to be aware for the first time of two pieces of birth consumerisms: posterior labor knowledge is scarce among the medical birth trained practitioners and that natural, spontaneous labor is a good thing for VBACs and are likely to lead to healthy outcomes.  Families and friends reading this post are mulling over their fears over some aspects of the births and probably empathizing with the father and sister in the second birth.  Practitioners are thinking one thing and one thing only:  these mothers labored without any hands on medical observation or protocols which equates with ‘not under their control’ and therefore, must be stopped.

Have these births had an impact on VBAC care?  Yessss, in a way.  The midwifery group mentioned in the first and second births continues to support their client’s informed choice but their back-up OB group is now pushing (no pun intended) to have VBAC birth plans submitted for their review/scrutiny and approval/counterfire.  The practice mentioned in the third birth no longer takes VBAC mothers. 

The VBAC mother continues to confound the medical birth world.  She is in the precarious predicament of representing evidence of and liability for the obstetrician’s or his/her colleague’s previous actions.

More birth consumer’isms’ – VBAC mothers require mental and emotional support on a greater level than the physical coping with labor.  Medically trained birth practitioners offer little by way of mental and emotional support for laboring women as that is not in their scope of care admittedly.   A medically trained birth practitioner as the primary careprovider is NOT the best choice for VBAC labors.   It is difficult for a mother to find a VBAC pracitioner at all let alone one who has the vision to see that the midwifery model of care can provide the support VBAC mothers need and can fill the void in hospital-focused birth advocate’s call for improving maternity health care.