Resources that helped me:

VBAC

NIH Consensus Statement
ICAN
     * "Question CPD" Video - very inspiring!
ACOG - Practice Bulletin 115, August 2010
     * Medscape Article RE: ACOG & VBAC June 26, 2010
     * VBAC - ACOG vs RCOG
VBAC Calculator - it said I had a 54% chance.  HA!
The Unnecessarean
Peaceful Parenting VBAC Resources

Weighing the Pros and Cons of Planned Vaginal Birth after Cesarean and Repeat Cesarean Section

Pros & Cons Chart (GOOD!)

What are my legal rights? 

BREECH Baby


SpinningBabies.com
Version Videos - YouTube
      * ECV Video #1
      * ECV Video #2
ECV and VBAC info
      * A breech version may avoid a first cesarean or lead to a vbac.
      *Safety of ECV for VBAC candidates.
      * http://www.rtcog.or.th/html/photo/03-01-03-10-43-38filepdf.pdf

My VBAC!!!!!!

Can you tell how excited I am about my VBAC?! I just can't express how amazing an experience it was - I'm so happy I fought so hard for my VBAC. The long drive to the hospital in labor, though horrible, was completely worth it and I'd absolutely do it again.
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At almost 39 weeks I started having false labor – back pain, nausea, hip & pubic bone pain along with regular, timeable contractions that would eventually disappear on their own and when I changed activities. The first day it happened I was standing in Lowe’s buying painting supplies and my back started hurting and I had weird pains in my belly, almost like I was going to get sick. Then two days later my pain got substantially worse plus regular contractions coming every 20 minutes at first and every 7 minutes by that evening. I thought for sure I would have my baby that night or the next day but then I went to bed and slept great and woke up in the morning feeling great, even had a burst of energy so I cleaned the house! It returned several times over the next several days and I was exhausted. I took many hot baths to help the back pain, sat on my birth ball, laid on the couch, took walks, anything to help the discomfort and either make it stop or hopefully make me go into real labor.

Then at my last prenatal appointment on Monday April 25th at 39 weeks 2 days pregnant, the doctor I saw was very concerned about all the false labor I was having and the long drive to the hospital, even though I wasn’t dilating at all yet. He didn’t like that I was avoiding getting checked out because of the distance to their regular office in Tucson (most of my prenatal appointments were in their local office where they only saw patients on Mondays). He strongly encouraged me to go stay in a hotel near their regular office and the hospital. Right after the appointment I called my mom and asked her if she could come into town earlier than planned since I’d need help with my daughter while staying in the hotel especially if I went into real labor while there. Then I booked a room at a hotel for Friday through Sunday nights, planning to stay longer if necessary. .

However, after almost a week of false labor it finally turned into the real thing on Thursday, April 28th. I spent the morning having pretty regular contractions, like 10-20 minutes apart and getting more intense throughout the morning, but I was in serious denial after all that false labor, I just kept expecting it to peter out again. A few hours after my husband returned home from picking up my mom from the airport we decided to go to dinner and then grocery shopping - by that point my contractions were 7-10 minutes apart and I was having trouble talking through them. Yet, I was still in denial. LOL! In the grocery store parking lot I had to stop for a contraction, some store employees freaked out when they saw me and asked if I wanted a wheelchair. I told them I was fine and I needed to walk. Once home I thought maybe a hot bath would help ease my contractions so I could get some rest. But unlike the baths I took when I was having false labor, my contractions didn’t slow down or get less intense this time. My husband went to bed because he had to get up super early for work, and since I was still in denial that I was in real labor, I tried to go to bed as well. After several minutes in the bed I realized I wasn’t going to be able to fall asleep so I went out to the couch - hoping I could get comfortable there and the contractions would go away. No such luck! They just got closer together – coming ever 4-8 minutes at this point - and by midnight I was moaning through them. I was moaning so loud that my husband woke up and came out to the living room. I told him that I was finally convinced this was the real thing and we should go, so we got everything together and woke my mom to tell her we were leaving.

The drive to Tucson was not fun AT ALL, once in the car my contractions started coming every 2-4 minutes which made the 90 minute car ride miserable for me. I did my best to breathe through each contraction but sitting down and being confined to that car seat was horrible, I felt like a caged animal. I did my best to focus on my breathing, with each contraction I would take a deep breath and let it out slowly while trying hard not to tense up. No small feat since tensing up was exactly what my body did when a contraction started. Once to the hospital I was thrilled to be on my feet.

We got to the hospital around 2:30am and I was 3cm, 90% effaced, at -1 station, bulging bag of water and having contractions every 2-4 minutes so I was admitted. I’m pretty sure the Triage nurse was happy to get rid of me because I wouldn’t stay in the bed which made the monitors slip down my belly. But staying in that bed was NOT an option, I had to be up on my feet. My contractions by that point were so intense I was having an intense burning & cramping pain down the front of my thighs, it was a feeling I don’t remember from my first labor. I asked my husband to press on my lower back with the palm of his hand during contractions, while I was standing and that really helped. Once in my L&D room (around 4am) my new nurse was awesome and let me stand by the bed, rocking & swaying through contractions, except for when they had to put the IV in (which took much longer than it should have and the nurse manager had to come in and do it!). My nurse stayed with me as I labored and if the monitors slipped she fixed them, never insisting I get in the bed.

By 7:30am or so when I was about 4cm, I asked for my epidural and labored on my feet until the anesthesiologist arrived. Once there we discussed what I wanted and my expectations for the epidural - I told him I wanted a low dose so I could still feel my feet and legs so I could move around the bed. He agreed to give me the lowest dose possible and told me I could use the pump and/or have him paged to come dose me if I needed more. He was awesome at listening to what I wanted and not trying to talk me into stronger pain relief. I had to sit on the bed to get my epidural and J sat in front of me in a chair while I hugged a pillow. It took the doctor several minutes to get the epidural placed and it sucked sitting there through contractions plus feeling him placing the epidural was not comfortable either. I felt the pop he kept warning me about, that didn’t hurt but it felt weird, and I was relieved once I felt the meds going in. Throughout the procedure I had to keep my mind off the doctor so I kept thinking about my daughter at home and the game she likes to play with me when she wakes up from naps – she likes to run around her crib when I try to get her out, all while laughing like crazy - thinking of that really helped me get through the contractions and avoid moving while he worked behind me.

After my epidural started working I could feel my feet and move my legs, yet I didn’t feel all the pain from the contractions anymore, it was GREAT. I could change my position on my own and I never experienced any aching in my legs like they did when I had my epidural during my first labor. At that point my husband and I tried to get some rest since we’d been up all night, I sat, slightly reclined, in the bed half watching Prince William’s wedding and half trying to sleep. Throughout the morning I kept trying to visualize my cervix dilating – I know it sounds kind of crazy but I did, I would try to picture it in my head (even though I honestly have no idea what my cervix looks like, ha ha ha!). I just felt that staying positive and focusing on the outcome I wanted would help.

I met the hospitalist OB from my OB practice somewhere in the early AM and she said she’d probably deliver my baby – I’d never met her before since she doesn’t have office hours and only delivers babies, but I could tell immediately that I’d like her. She had a really calming energy about her and she was so excited that I was trying for a VBAC, I felt like I had my own personal cheerleader.

Around 9am my nurse checked me and I was 5cm. The doc came in a few minutes later and she said she felt like things were moving along well and was certain I’d have my VBAC so she asked if I’d like to speed things up by breaking my water, I agreed. There was a little meconium when she broke my water but she wasn't concerned. By 11:30am I was 7cm and +2 station which was great because prior to that the doctor was considering internal monitoring to monitor the strength of my contractions but since I'd made such progress she said there was no reason to do it now. Then she suggested a small amount of Pitocin to make my contractions a little more intense and I agreed. She was sure I'd deliver before 5pm and that really motivated me to stay optimistic.

A little before 2pm I was whining to my husband about needing caffeine because I was getting a headache and I was soooooo tired from being up for well over 24 hours so he called the nurse to see if I could have some. She suggested checking me first since I was feeling lots of pressure in my bottom, and if I was ready to push I could just have a coke after I delivered. I was completely shocked & elated when she checked me and I was at 10cm!!!!! She went out to tell my doctor the news and I could hear her yell “YAY!” When the nurse came back in she had me do a few practice pushes until the doctor came in. Even with the epidural the urge to push was intense and, as I pushed the need just became stronger and stronger.

After quite a few pushes I remember getting so annoyed at my nurse when she’d talk – though she was just being nice and explaining things to me – and I remember very bluntly telling her I needed her to count to me because it was motivating and when she didn’t I would lose track. I also remember snapping at my husband to do a better job of holding my foot and leg, he kept letting go or not holding it firm enough. After pushing for over a half an hour I was losing motivation and getting really tired so I asked the doctor how much longer, so she asked me to reach down and I felt my daughter’s head – I was just in awe! It was amazing! I felt an intense rush of renewed motivation.

After several more pushes the doctor looked at me very seriously and said that she thought I needed an episiotomy even though the entire time I was pushing she had been massaging my perineum and rubbing oil on the baby’s head to help her come out easier. I looked down at her and growled “cut me” right as I had to push again. I never wanted an episiotomy but at that point in time I just knew I needed it. A few pushes later and my daughter was born – 3:04pm, weighing 6lb 9oz and measuring 19.5 inches long! It was just amazing to see her head come out and then shortly after to feel such intense relief as her body came out. Seeing her there, held up between my legs by the doctor was awesome! The doctor laid her on my chest and I just couldn’t stop staring at and touching her. The doctor told me to give one more push and the placenta just seemed to plop right out. I laid there holding my baby while the doctor stitched me up – not only did I have an episiotomy I also ended up with a 3rd degree tear. I held her on my chest for quite a while before they asked if I wanted to find out how much she weighed. Then before I knew it she was back in my arms and I was breastfeeding her.

The doctor congratulated me on my VBAC and told me I did a great job before hugging me on her way out. I honestly believe the positive attitudes of my OB and nurse helped me get my VBAC - the word c-section was never mentioned and I never felt pressured to dilate or anything.

Before delivering I always knew a vaginal delivery and recovery would be easier but honestly I had no idea how much easier. I was up and out of my bed as soon as the epidural wore off, which didn’t take very long since I had such a low dose – it wasn’t long after the doctor was done sewing me up. I almost felt silly when they insisted I sit in a wheelchair as they took me to my postpartum room. A couple of hours later I was up moving around my room when the Pediatrician came in to see my daughter and she said “You just gave birth?!” as though she’d never seen a new mom up so soon. And when my husband returned later that evening with our 17 month old daughter I was able to pick her up and hold her – something I wouldn’t have been able to do so soon if I’d had a c-section.

After my VBAC I spent several days just high on my success, thrilled every time I thought about the delivery. And then one day, not long after my stomach had shrunk down some more, I looked down and saw my c-section scar and for the first time in almost a year and a half I didn’t hate it. Then a couple of weeks ago my daughter saw my scar and rubbed her finger across it – pure toddler curiosity – and my heart melted. There was my beautiful baby girl touching the scar I always hated, she wasn't repulsed, she even giggled, and I realized I love my scar because from it I got her.

I don’t think I can properly express how my VBAC helped me heal from the heartache I experienced after having a c-section.

My External Cephalic Version

I had my external version this morning. I went in fearing the worst - expecting a lot of pain and/or discomfort and dreading the doctor not being able to turn her. However, it went better than I expected.

I had my ultrasound at 9 and everything looked great with the baby - she's estimated at 6lb 15oz and I had plenty of fluid, so they sent me over the hospital. Once there they hooked me up for an NST and gave me an IV lock "just in case".

The doc came in and did an ultrasound to see which way she was facing then the nurse gave me a shot of terbutaline in the back of my arm to help relax my uterus since I was having minor, non-painful contractions and the tightening would make it tough to move the baby. The doctor gave the baby a few practice pushes and said I have really tight ab muscles - pretty good for not working out since I had my daughter, ha ha ha!

Then she started nudging her head to the left, went to push up on her butt and the baby immediately popped her head back over to the middle of my tummy above my belly button. So she checked her position again. I closed my eyes and took deep breaths and she started nudging her again and I felt her butt pop out of my pelvis and over my hip line, then as soon as the doc got her head below the level of my belly button it just kind of popped down into my pelvis! It was so fast I couldn't believe it - seriously less than 2 minutes and pain free! It was uncomfortable but seriously that was from the doctor's bony fingers digging into my skin and her nails scratching me (and she had short nails!) - I still have scratch marks on my tummy but not bad ones. The terbutaline shot hurt more.

After she was head down the doc checked her again on ultrasound to confirm her position and everything looked good. I was hooked back up to the monitors and her heartbeat was great. The doctor was very happy with how we were both doing and then left while I was monitored for an hour. When the nurse came to set me free I was given a belly binder to help keep the baby in place so I'm keeping my fingers crossed she doesn't try to spin around again.

Before the doctor left though she said something to me that really boosted my confidence. She said she believes I'll get my VBAC because I'm so determined and that it was that determination that convinced her to agree to doing the version because prior to meeting with me she wasn't sure if she would do it. Then she gave me a hug and wished me luck, saying she hopes she's in the hospital when I show up in labor.

The Meeting and Informed Consent

The meeting went better than expected - though it was a bit brutal. The OB I met with is the one who will doing my version on Wednesday and she said she's never done one on a VBAC mom before but only because most women opt to go with a repeat c-section. But she did agree to do it!!!!! Whew!!!!!

She then asked what happened with my first c-section and why I wanted a VBAC. When I told her she said my reasons are understandable and then the meeting pretty much turned into an "Informed Consent" meeting for my VBAC. She pulled out their VBAC consent form which basically outlines ALL the risks involved. Let me just say, I totally understand why many prior c-section moms opt out of the VBAC after this meeting!!!!! It was BRUTAL! She was never rude to me nor did she ever talk down to me and even though I know all the risks since I've done a ton of research, it was hard to hear her talk about baby death and uterine rupture. I never felt like she was trying to scare me but it's hard stuff to hear when you're almost 37 weeks pregnant. I told her I understood why she had to go over all the info and respected it but I was sure a VBAC is best for me - she visibly relaxed when I said that, I got the feeling she's had some bad experiences with other moms before during meetings like this. I told her I had to weigh the risks and benefits for myself and absolutely still want the option, and then I signed their form.

And I'd like to say it irritates the crap out of me that the form barely mentioned the risks involved with a repeat c-section - there was like one thing that said something like a "repeat c-section has more risk for the mom" but basically it's glossed over. It's no wonder many women say no to the VBAC but sign right up for the c-section - the risks are barely discussed!

At that point she offered to do my version today which shocked me! But since we had our daughter with us (and she was already getting tired and cranky) I told her I could wait until Wednesday since it's already scheduled then. She told me to continue doing the positions I'm doing and said I should consider acupuncture as well (which shocked me because my husband is very opposed to non-traditional medicine so I'm not used to that attitude in a doc). Before we left she felt my stomach and felt the baby's head right above my belly button which is where I thought it was because I had been rubbing it during the meeting!

My only worry now is the baby won't turn because they don't deliver breech babies which means I'll need to find another doc or schedule a c-section (or have a c-section if she's still breech when I go into labor - which is the route I'd like to take). I've already started looking around for a doc who will deliver a breech baby but I'm not 100% sure I want to go that route. So I'm off to lay upside down some more.

Wondering if I'll get my version.

I'm so upset, discouraged and annoyed right now. As of Monday this baby was still breech and since I spent the weekend having lots of Braxton Hicks and some cramping the OB I saw wanted to schedule me for a version sooner rather than later. So I was scheduled for next Monday - I ended up changing that to Wednesday so my husband could go with me. Everything seemed to be a go and all good.

Until this afternoon.

I got a phone call from a nurse at their office who said the docs had their group meeting today and I was one of the "cases" (I just love how I'm a case now) they discussed. Apparently all the OBs aren't on board with doing a version on me since I'm also a prior c-section mom. They want me to come in and have a "meeting" with them. It couldn't seem more ominous to me. I asked when and she said any time I can make it - really? So then I'm thinking it must be pretty serious if a doctor can meet with me anytime it's convenient FOR ME. We're going tomorrow morning to Tucson for this meeting at 9am. I pretty much demanded that my husband go with me because I figured he could get around all their medical mumbo jumbo especially if trying to scare me into a scheduled c-section

Can I just say I'm freaking out? I dread them trying to talk me into a scheduled c-section. They might as well save their breath because the only way I'm having another c-section is if it's medically necessary. Only 4% of babies are still breech at the time of delivery (spontaneous labor anyway) so I'd rather take my chances of going into labor and seeing if she's still breech before signing up for major surgery, no thanks. My c-section with my daughter was a freaking nightmare that I don't intend to ever repeat.

Did I mention I'm freaking out? I'm already stressed that she's still breech and now this "meeting" has me completely upset.

36 weeks . . . still breech

I had my 36w appointment this morning and of course she's still breech. Friday and Saturday night she was super active and kept me up, so Saturday night I stayed up until midnight until she calmed down. I really thought she had turned at least transverse but no, she's still breech, butt in my pelvis, legs crossed.

I told the doctor about the cramps and Braxton Hicks I had over the weekend - I had them all day yesterday. He seemed concerned and didn't want to wait until next week to schedule a version. He wanted to send me to Tucson for the version this Friday but I'll only be 36w 6d and the doctor he talked to at their main office thought it would be better to wait until Monday. They scheduled me for an in depth ultrasound (to check her size, position, location of the umbilical cord, etc.) and if she's still breech they will do an NST and then send me over to the hospital for the version if all looks good. Since my husband can't go Monday I'm now trying to change it to Wednesday because I really don't want to go alone - especially since there's a small chance it could cause me to go into labor. I've done my research and know the risks are super low of anything bad happening, there's more risk in having a repeat c-section,(and the reversion rate is very low after 37 weeks) but I'm still not too excited to get this done - it sounds uncomfortable to have them pressing on my tummy and getting her to turn.

Thankfully I already found a friend who said she'd watch my daughter while I go up to Tucson - the doc said it could take several hours.

So everyday this week I'll be doing breech tilts and inversions hoping she turns. Ugh. Turn baby turn!!!

34w Appointment and STILL Breech

I had my 34w appointment today and I was so hopeful she had turned. She moves around all the time, more than I ever remember my daughter moving. Yet she hasn't turned vertex yet. My doctor still didn't seem too concerned, said I feel like I have plenty of room & fluid for her to move around in, and suggested I get on my hands & knees with my butt in the air. She mentioned an external version wouldn't be discussed until I'm over 37w if the baby is still breech then.

My new favorite website is www.spinningbabies.com. I am now spending time laying upside on my ironing board propped against my couch, inversions, and on the floor with my butt in the air. My daughter thinks this is all hysterical and loves to sit on me, often on my head.

I have to admit though that I'm starting to lose hope that she'll turn. I'm trying so hard to be positive and get her to turn but nothing seems to be working. I want my VBAC so bad but I see my chances slipping away everyday that this baby is breech.

3D Ultrasound and 30w Appointment

We went for a 3D ultrasound last Friday. The baby was head down and cuddled up to the placenta almost the entire time so getting good pictures was really tough. We did get a few though so that was nice.

The next morning I woke up around 6am and felt this big rolling movement. I'd never felt anything quite like it before and wondered what it was.

On Monday, I had my 30 weeks prenatal appointment and they did a growth ultrasound. The baby was measuring right on track at about 3lb 11oz and everything looked good . . . EXCEPT now she was breech! Yep, that big rolling movement I felt on Saturday morning was her turning. She was head up and right behind my belly button. The doctor didn't seem concerned and said she should flip on her own in the next few weeks.

A VBAC Ban

Since having my daughter we moved to another state. Shortly after we moved I started researching the doctors and hospitals in the area. I quickly found out that the local hospital has a ban on c-sections. I was pretty shocked - I knew bans existed but I guess I didn't think I'd have to deal with one. I thought my biggest hurdle would be finding a VBAC friendly doctor.

The hospital here told me via email:

"Our facility does not do VBAC’s. The standard of care is that if you do them there needs to be an Anesthesiologist and OB doctor in the hospital for the entire duration of the labor. We have primary care doctors here, meaning they are back and forth between their clinic and the hospital during business hours and in the hospital after hours, as needed, per each individual patient’s care needs. This is the same for the Anesthesiologists."

I then expanded my search to the closest city - Tucson, Arizona. I quickly found two hospitals who allow VBACs and then I began checking with my insurance for in-network doctors. I contacted a few different doctors and OB groups to find out if they supported VBAC. I was relieved to find one that has local office hours once per week so I don't have to drive to Tucson for all my appointments - Tucson is over an hour away (80 miles).

At my first appointment my husband and I sat down with one of the doctors in the group. She stated that I'm a great candidate for VBAC and said the risk of uterine rupture is less than .2% for me. We then went over all the risks of having a VBAC and I received a list of the risks, which I have to initial each bullet and sign at the bottom. I was relieved to find a doctor who supported me.

There were a few things that concerned me though. First, we went over all the risks of a VBAC but not much was said about the risks of another c-section. Next, the doctor told me that if I don't go into labor on my own by 41 weeks then they will schedule me for a c-section. Third, they will not induce me if I go past my due date since it increases the risk of uterine rupture. And finally, they prefer that women attempting a VBAC get an epidural in case they end up needing a c-section. I'll go into detail about why these bother me at another time.

A little about me.

I had a c-section in December 2009. I will avoid a repeat with my next baby.

While pregnant with my daughter I was terrified of having a c-section and hoped for a normal birth. I even counseled my husband on what he was supposed to say if the doctor started talking about a c-section while I was in labor and he performed great in his role when the time came. In hindsight now I see where I could have prepared myself better for my labor & delivery though.

While pregnant I held on to this hope that all would go as planned - I would go into labor on my own, dilate appropriately, get an epidural, and birth my daughter. What I didn't plan for was a posterior baby and how unprepared I was for the pain of labor.

I was so worried about being able to breastfeed successfully - I read a ton on the subject - that I failed to do anything proactive to prepare for childbirth. I didn't read any books on the subject, I took the one day course at the hospital with my husband which only taught like 15 minutes of breathing techniques, I didn't research pain relief options (who needs to right? Everyone knows about epidurals. Ugh). What I didn't think about could fill a book.

Now I'm pregnant with my second baby (24 weeks!) and I'm committed to avoiding the same result. I'm planning for my VBAC as though it's my full-time job. I'm currently reading Ina May's Guide to Childbirth, Easy Labor: Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth, Husband Coached Childbirth and Natural Childbirth the Bradley Way. Yes, I'm reading all of them at once!