April's Birth Story (respectful natural hospital birth)

April's Adorable Baby

Because there are many egregious examples of bias in the maternity care of women of size, sometimes it can sound like no women of size receive respectful care during birth, but of course that's not true. There are some WONDERFUL care providers out there who really do give appropriate and respectful care to women of size during pregnancy and birth. Periodically it's important to share those stories too. That sounds like a wonderful and upbeat Christmas week post to me!

Here is the story of a "supersized" woman who gave birth recently in South Dakota. Many care providers would have predicted gloomy things based on her size (over 300 lbs.) and age (35). Yet she had a healthy pregnancy and baby, as well as an easy and completely natural birth in the hospital with a very caring OB and supportive nurses.

Remember, while there is a higher risk of some complications in "obese" women (especially as size increases), many high BMI women have completely normal and healthy pregnancies and births, especially when they take good care of themselves and are able to labor spontaneously with excellent support. 

The value of truly supportive care providers cannot be underestimated. So let me stop and speak to the care providers among my readers for a moment.

Providers, the most powerful intervention you can provide to women of size is to treat them with dignity and respect at all times. Some women of size have been so shamed and mistreated that they avoid care providers whenever possible. Regardless of what the scale says, all women deserve gentle and respectful care, but far too often they do not experience it. Respectful care can be a transformative experience for women of size who have had mostly negative contacts with health care before. Help heal that relationship; go out of your way to be as respectful and gentle as possible. 

Today, we women of size send a big shout-out to all the providers who DO provide respectful, excellent care to women of size. Thank you for all that you do.

We thank you for your gentle care and for your advocacy on our behalf. We know it's not always easy to do so in the weight-biased environment of many hospitals, but it is SO important that care like this be available to women of all sizes. Thank you for your efforts on our behalf.

And now as a holiday treat, here is April's birth story, an example of respectful care for a woman of size giving birth in the hospital.

I'm from South Dakota and I got my pregnancy care and gave birth at Sanford Hospital in Sioux Falls.  

On my first visit with my obstetrician, she did make a point of talking with us about the increased risks due to my weight (340-ish at the time) and my age (35). She said that I needed to be cautious about gaining too much weight and that I shouldn't be alarmed if I lost weight but also that I shouldn't TRY to lose weight. She also made a point of saying that even though the risks were increased, they were still quite low - especially since I am healthy with no major medical problems.  

I ended up losing about 20 pounds over the next couple of months and then my weight just stayed the same until my last month when I gained back about 5 pounds. Neither she nor any of the nurses that weighed me every visit ever commented on my weight except once when the nurse asked if I was deliberately trying not to gain weight. I told her now, that I ate when I was hungry and she was good with that, she didn't want me dieting.
I did have several ultrasounds over the course of the pregnancy but that was because she didn't like to sit still and the tech had trouble seeing the bits of her anatomy that they wanted to see. Everything went very well with the pregnancy. 

I went into active labor 2 days before my due date though I had been contracting for a couple days before that - just very far apart. I said I wanted a natural birth and they had a copy of a birth plan (checkboxes) that my obstetrician had given me months before. I also brought a simple birth plan I had typed up myself - one page with simple goals and requests. I also requested a nurse familiar with natural birth if possible.   

My nurse was wonderful. They assign each woman her own nurse so she was by my side the whole time. She was super supportive - kept saying how wonderful I was doing and helped keep my confidence up.  I didn't have an IV - they were okay with a heplock and only intermittent handheld monitoring so I had complete freedom of movement. Also, I had a jacuzzi and a shower.  

I labored from early morning until about 4pm I was 7cm dilated. Contractions came constantly after that and I got the urge to push. They checked me and I was 8cm so they said not to push. I couldn't really not push, though I tried and the midwife tried to help. 10 minutes of that and they checked me again and I was 9 1/2 and could push. FINALLY!  

I was half on my side hanging on to the bars on the side of the bed and the nurses (not the midwife) tried to get me to roll onto my back. I refused and said the doctor had said I could push in any position, even upside down (which she had said). So they let me be. 

The doc came in and it was my obstetrician since she just happened to be on call that day. She confirmed I didn't need to move and my daughter practically flew out she came so fast!  The doc almost didn't make it to the room in time - they were seeing hair! 

I believe because of this [being in a side position], the birth went very quickly and I didn't tear at all. All the nurses were very surprised and I feel that they will be more supportive of alternative positions in the future.The nurses were amazed that she came so easily and that I didn't tear even though it was pretty fast. My little girl was 7 lbs 6 oz and in perfect health. 

So, even though there was a lot of pain (though I don't really remember the worst of it now) I'm glad things went as they did and I hope you all can have as wonderful an experience as I did. 

Key thing is ask lots of questions to find out what your doc/nurse is okay with and don't be afraid to speak up for yourself, though keep it civil - if you are confrontational it will just hurt you in the end. You need to radiate calm, confidence, and that you are sure you know what you want. Also remember that we have the right to give birth in the position we choose. 

I found the book "Natural Hospital Birth" by Cynthia Gabriel very helpful also. I highly recommend anyone wanting natural birth in a hospital setting to read it - it is full of tips on how to stay in control even in the hospital. 

Also, I'd like to mention that I'm donating my extra milk to the Mother's Milk Bank of Iowa and I'd like to encourage anyone who has extra breast milk to donate to their local bank. It is so important for the little sick babies in the NICU to have breast milk.  

Cesarean Birth After Cesarean, 18 Years Later

Image from Wikimedia Commons, here

  Remember, no effort that we make to attain something beautiful is ever lost. –Helen Keller

This month, we are focusing on CBAC, or Cesarean Birth After Cesarean. The following was expanded from an article written for the Spring 2015 Clarion, a publication of the International Cesarean Awareness Network (ICAN), now appearing on the ICAN blog. 

My CBAC Story

Eighteen years ago, my second child was born. He was born by repeat cesarean after a long, hard “trial of labor” which included 5 hours of pushing with no progress because he was big and posterior with an upright (“military”) head position.

I’ve second-guessed that birth for many years. It’s possible that if we’d pushed even longer, his head would have molded enough to fit through my pelvis and turn anterior on the perineum, as many posterior babies do. However, at that point, I was absolutely exhausted, in a lot of pain, and was worried about the wisdom of continuing when things had gone so long without progress. I knew a non-progressing labor was a risk factor for rupture, plus my baby had experienced some issues with his heart rate. They resolved, but I didn’t want to go into a repeat cesarean in true emergency mode because of a rupture or fetal distress, and emotionally I needed to make sure that I didn’t have an anesthesia failure like I did with my first cesarean.

At that point, I just had a strong sense of Inner Knowing that it was time to be prudent and stop before things became a real emergency. I believe I made the right decision, but it was hard to communicate that to my husband and support team. My doula treated me like I had wimped out and thrown in the towel too easily. I never heard from her again after the cesarean. It was clear she viewed me as a failure.

I dreaded having to go back to my VBAC groups and tell them I’d had a CBAC, but I gritted my teeth and did it anyway. I got some sympathetic responses, but mostly I got a lot of silence or tepid responses that felt judgmental. No one knew how to reply to someone who hadn’t gotten their VBAC . 

Over the years, there was a lot of armchair quarterbacking about my decisions. People meant well, but I was left feeling pretty unsupported. And I didn’t feel I could really emotionally process the birth fully in birth spaces because I was afraid of discouraging new mothers or those planning their VBACs. No one wants to hear about when VBAC doesn’t work out.

Eventually I was able to access some resources that helped me emotionally process my first two births. It took a lot of hard, emotionally grueling work, but in time I came to peace with those births, and I did have two VBACs afterwards. 

In some ways, the CBAC was healing from my highly traumatic first cesarean, but in other ways it would always remain hard, even though I felt like it was a prudent and wise call under the circumstances. My consolation was my precious child, but his birth would always remain bittersweet to me in some ways, especially because of the initial lack of support. And that led me to trying to improve support for other women who had difficult or traumatic births, especially CBAC mothers. 

Expanding CBAC Support

If about 75% of labors after cesarean end up with a VBAC, that means that about 25% of these labors end with another cesarean. Where is the support for women who have an undesired second cesarean? Where is the acknowledgement of all the work they put in towards a VBAC, the hours of labor, the pain, the worry? Does all that preparation and work not count if you don’t end up with a VBAC? 

In time, I began to realize there was a vacuum of support for the mothers who didn’t VBAC. It wasn’t just about my own experience anymore, but also about other moms. How could we make it so that all mothers felt supported, regardless of outcome? Shouldn't we offer emotional support after any cesarean, whether it’s your first or another one?

I wasn’t the only one, of course. A number of us shared this experience of another unwanted cesarean, including people in the leadership of ICAN, and we began to talk about how to offer better support. One of the first things we did was ditch the terms used in the medical literature, terms like “Failed VBAC” or “Failed Trial of Labor After Cesarean.” We felt this was too judgmental and insensitive. We were not “failures,” we did not fail, and we should not have been on trial.

We created the term Cesarean Birth After Cesarean (CBAC) as a more mother-friendly alternative. It refers to a cesarean that occurs when the mother really wanted and worked for a VBAC but didn’t get one. These women had different emotional needs than those who wanted a repeat cesarean, and terminology needed to reflect that difference. So we used “CBAC” to differentiate another unwanted cesarean from Elective Repeat Cesarean Section (ERCS), where women truly wanted another cesarean and voluntarily chose it. Neither one is good or bad; they are simply different experiences.

There are many shades of CBAC. Most of the time, it refers to someone who labored and ended with another cesarean, but it can also refer to a cesarean performed before labor for medical reasons, because the mother had no choice, or because the mother was coerced or scared into a repeat cesarean. Some women prefer "CSAC" (Cesarean Surgery After Cesarean) because they consider the term “birth” too emotionally loaded. Women get to choose the term that seems right for their own experience. The important thing is to acknowledge and validate the range of feelings that women have over this experience.

Of course, all CBAC mothers are not alike. Having the shared experience of a CBAC doesn’t mean other details of our situations are similar. Each CBAC is unique, and each carries its own particular color and resonance of pain. 

Some had disappointing or traumatic experiences, and some didn't. Some felt very betrayed by their caregivers, while others had very supportive caregivers. Some felt they had a “prudent CBAC,” where although it was difficult, a repeat cesarean felt like the right choice under the circumstances. Some had an “empowered CBAC,” where even though there was disappointment and sadness, there was powerful learning and healing too.  

Some CBAC mothers go on to have a VBAC eventually, while others never do. Some have multiple CBACs, each with their own emotional resonance. Some have a VBAC and then a CBAC, which has its own particular pain. A few have had the bitter experience of having lasting physical and emotional damage from their CBAC, including uterine rupture, hysterectomy, and damage to or loss of their baby. As always, each person’s experience is different and unique, and each CBAC mother needs safe space to process all the varying feelings about those experiences. But this can be difficult to do within regular birth forums.

Some people don’t think there needs to be any separate support for CBAC mothers (“a cesarean is a cesarean”), and to this day, many of us with CBACs still have our decisions questioned and second-guessed in birth forums. Although many doubters have come around to offer more support, CBAC still remains a topic of friction at times within the birth community. This needs to change. 

New CBAC Resources

Over the years, we have tried to expand resources for CBAC mothers. We have offered several CBAC sessions at ICAN conferences and at local chapter meetings, and until recently we had a Yahoo group for online support. 

In 2011, I offered a CBAC workshop at the St. Louis ICAN conference. The session was derived from discussions by mothers on the Yahoo CBAC Support Group, and many graciously consented to sharing their thoughts and quotes to help others. At that session, we brainstormed ways to offer further support for CBAC moms. 

One of the main ideas was to have an online website devoted to CBAC support and information. So last year, Melek Speros, Catherine Kowalik Harper, and I created a CBAC Support website, based on my material from the 2011 workshop and suggestions I got there. On this site, we share CBAC research, websites where CBAC moms can go for emotional healing, information on the unique emotional needs of CBAC mothers, suggestions for processing a CBAC, CBAC birth stories, inspirational quotes for healing, and suggestions for birth professionals to help them better support CBAC mothers. 

ICAN has also created a new online support group via a Facebook page for CBAC mothers. This is a closed group; you have to be a CBAC mother to join. It offers intensive, personal support for those dealing with the aftermath of a CBAC. 

ICAN is also about to publish a brand-new brochure on CBAC. It is intended for ICAN leaders and other birth professionals who may encounter a woman who has recently had a CBAC and is in need of extra support. We encourage birth professionals to include this brochure in a resource packet that they can send to women shortly after a CBAC so these mothers realize that they are not alone, that others have walked the CBAC trail and survived, and that there are resources for further support if they want it. 

In future years, I hope we can create even more ways to help support CBAC mothers. If you have other suggestions for how we can do that, please add them in the comments section. 

Final Thoughts

Eighteen years after my own CBAC, it remains a potent memory. My sweet little boy is a strong and independent man now, flying off on new adventures, but his birth is still a touchstone for many different emotions. Although I did eventually go on to have 2 VBACs after the CBAC, those experiences didn’t "fix" the CBAC or make it go away. They simply are different entities – not better or worse, just different. Although there are things I still mourn about my CBAC, I have learned to honor all my birth experiences, difficult or easy, because they are a big part of the person I am today.

The lessons I learned from my CBAC remain powerful and still resonate in my life. My CBAC helped me to be more compassionate about other people’s births, to recognize that sometimes there are just things that are beyond our control in the moment. It helped me to realize that sometimes birth is more about the willingness to heal and change; that birth is more about the journey and less about the destination. 

In time I learned to honor both the disappointment and the joy in all my births, to remember that what counts most is the parenting we do throughout life rather than how we birth, but also that how we feel about our births counts, even years later. Our deep love for our children is a different and separate thing from our emotions about their births, and while these things intertwine, one does not take away from the other. We can honor the disappointment and mourn the difficulty of a birth while still celebrating and fiercely loving the child that came from that birth. 

I found that out of my suffering came the ability to transform pain into advocacy. I found my voice in a new and potent way, and I have endeavored to channel the power of that voice to create change, as well as to create and hold safe space for other women and their unique experiences.

A CBAC is never an easy thing. The pain and disappointment of it stays with you forever, but like other grief, it does ease some and you find a way to live with it, just as you find a way to live with other disappointments in your life. You can celebrate certain aspects of it, you can mourn parts of it, you can still be upset that it occurred, but you honor what it has brought to your life, both difficult and wonderful. 

You also learn that in time, out of the pain and conflicting emotions that accompany a difficult experience, there can also come great growth and power to create change for yourself and others. Just give yourself the gift of time and space for that healing. It will come.

Placenta Accreta: Brandy's Story

Brandy and her 7th baby postpartum
Notice the large central IV line in her neck and IV line in her arm for quick blood transfusion

As part of Cesarean Awareness Month, we are drawing attention to the high cesarean rate and the public health implications of too many cesareans.

One of the complications of multiple cesareans is that the placenta in a subsequent pregnancy can implant too low in the uterus (placenta previa) or grow into the uterine wall (placenta accreta).

This can cause life-threatening complications, including premature birth, impaired growth, or stillbirth for the baby, and severe hemorrhage, hysterectomy, and even death for the mother. Placental abruption (placenta detaching too early) is another potential risk after a prior cesarean.

We've written about placental complications after cesarean before. As a brief reminder, there are three levels of severity in accretas:

1. Accreta (placenta is abnormally attached to uterus and can't detach easily after birth)
2. Increta (placenta grows into the wall of the uterus and cannot detach after birth)
3. Percreta (placenta grown through the wall of the uterus and into surrounding organs)

Image Source: Reitman 2011, Anesthesiology

[If you are looking for more technical information about placenta accreta, see Part One (what is accreta, how a placenta works), Part Two (risk factors, symptoms, and incidence of accreta), Part Three (risks to mother, baby, and future pregnancies), and Part Four (diagnosis and treatment) of my prior series on placenta accreta.]

This time, rather than writing about what accreta is and how to manage it, we present the first-hand story of one mother's experience with placenta accreta (increta in her case). 

It's important to remember that placenta accreta is real and affects real women and babies. Do enough cesareans, and increasing numbers of women will face this devastating and life-threatening complication. I've known several women now who have been affected by this condition; all suffered severe hemorrhages and several lost their fertility and uteri forever. One lost her baby and very nearly her life too.

That's why it's so important to do cesareans only when medically indicated and to keep VBAC (Vaginal Birth After Cesarean) an option for those who want it.

Brandy's Story

Brandy has had 7 births and 2 miscarriages. 3 of her births were by cesarean.

Yes, high parity is a risk factor for placental complications, but multiple cesareans is a stronger risk factor. Combine the two and the risks multiply.

Her first birth was a c-section after mismanagement by her doctor. She was told she'd never deliver a baby over 8 lbs. and that her babies were "too big" for her to deliver vaginally. She developed a terrible infection and wasn't allowed to hold her baby for 3 days.

Her second birth was a VBAC at 32 weeks. The placenta detached prematurely and baby might have had some lack of oxygen issues. He passed away at 21 months from seizures.

She miscarried her next pregnancy. Her third birth was another VBAC. She had to fight hard for it when her labor stalled for a little while but in the end she had a VBAC.

Her fourth birth was a CBAC (Cesarean Birth After Cesarean). She had a big baby (10 lbs.) and her doctor scared her into a repeat cesarean because of a recent shoulder dystocia in the practice.

Her fifth birth was another CBAC. Her doctor was opposed to a VBA2C. After her water broke and labor did not start for several days, she had the repeat cesarean. The doctor said she had very little scarring and could have more children. The risks of multiple cesareans, including accreta, were never mentioned.

In her next pregnancy, Brandy weighed the potential risks of VBAC after multiple cesareans against the cumulative risks of multiple cesareans and chose VBAC. She stayed at home in order to have a supportive provider. Her sixth baby was a homebirth VBA3C. He was 11 lbs. 4 oz., three lbs. bigger than her first doctor said she could ever birth vaginally.

She had another miscarriage again, then became pregnant a few months later. She planned another VBAC. Unfortunately, this time the fertilized egg implanted low, near the cervix (placenta previa) and the placenta grew into the uterine wall and into the cervix itself (placenta increta).

In the end she lost her uterus and most of her cervix and suffered a severe hemorrhage but was very fortunate to escape with her baby and her life.

This is the story of Brandy's placenta accreta pregnancy and birth.

I was so excited when I found out I was pregnant. I was also very scared since I had just miscarried 8 months prior. At 7 weeks when I started spotting I just knew something was wrong. I had no idea what the real problem was and what I would end up facing.

I decided to go to the ER and get checked. It was a pleasant surprise to see a healthy little heart beat. I did notice on my discharge paper that it was noted that the placenta had attached to the lower uterine segment.

A week went by and I was still spotting. I called my OB and they decided to schedule a ultrasound to check on things. The ultrasound tech noted that I had a short cervical length. I was sent to a perinatologist to see if they wanted to place a stitch. I was very confused. I had already carried 6 other children. I did deliver one of my babies at 32 weeks, but I never had a incompetent cervix.

The perinatologist quickly pointed out that I had a complete posterior placenta previa. I was so upset; I knew that would mean another c-section. I had already had 3 c-sections; I did not want another. I had already begun dreaming of another beautiful HBA3C. I had it in my head how I was gonna make a music list and dance through labor. I was gonna walk around outside in the nice cool October weather. I was looking forward to feeling every contraction and being more relaxed this time since it would be my 2^nd HBA3C. [kmom note: Home Birth After 3 Cesareans]

Time went on and I continued to get ultrasounds monthly. It was always the same thing...the placenta had not moved. I was still spotting everyday; it was there every time I wiped. At one ultrasound appointment my OB made a comment that she saw a lot of placental lakes. I started researching placental lakes and learned that they are seen a whole lot with accreta. I started to worry.

I finally got good news at my 20 week ultrasound. The perinatologist said it looked like the placenta had moved and it was only the tip of it covering my cervix. He did say that there was a blood clot covering the cervix now, but that my body should reabsorb it. I questioned him a little bit about the blood clot. He reminded me that I had been spotting and that is what it was from. I had noticed the spotting had been slowing down so it all made sense. It was good news! The placenta moved some and I had a healthy baby boy. No one had to tell me I was having a boy; he decided to show off for momma.

I left the doctor's office practically skipping. I went and bought a bunch of "It's a Boy" balloons and filled a bag with them to let my other kids tear open. We were all so happy and back to planning our home birth.

At the next ultrasound I was 24 weeks and I just knew they were gonna tell me the placenta had moved more.  The look on the ultrasound tech's face said something was wrong. When she told me she wanted the doctor to see it I felt my stomach go into my throat. 

Two minutes felt like a century as the doctor was looking at the ultrasound. He said, “What I believed was a blood clot last appointment actually looks like a accreta.” He then went on to say that unfortunately with your c-section history and what this looks like, it I am pretty sure we will have to take your womb. 

He went on to show me how vascular one section of the uterus was. He continued to talk about unfortunately this is like the weather, there is nothing you can do about it. He continued to talk and all I heard was some mumble about any OB can do a hysterectomy and I should be able to deliver at my local hospital.

I was numb, how could this be. I waited at the check-out desk trying to breathe, trying not to cry. I got my card for my next appointment as the tears started to fall. I don’t know how I walked to my car. My phone rang and I could not get out hello.

After I had a little while to process things and talk to a few people I decided to go to get a second opinion in Baltimore. The blood clot theory made sense. My spotting stopped at 22 weeks.  I figured that was a good sign. The specialist in Baltimore knew more about accreta and could give me better answers.

Once I got to my appointment in Baltimore, that look the first tech had, I saw it all over again. This look of fear, maybe even confusion, just like the tech before she went to go get the doctor. He showed me that the placenta was supposed to look black on the ultrasound and there was these weird gray areas. He told me that at the least we were dealing with increta, but that he believed it was percreta. 

He went on to say all my care would be transferred there. That with this condition there would be massive blood loss and my local hospital could not handle delivering me. I tried to be strong but I burst into tears. We decided to do a MRI to try to get a better ideal if any of my other organs were involved.

Everything then just became a blur. I spent every Monday in Baltimore seeing doctors and having ultrasounds. The group of specialist were waiting on the MRI results to decide whether to deliver closer to 34 or 36 weeks.

Once the MRI results came back it looked like no other organs were involved but that the placenta was invading the uterine wall. I was so happy to get the news that none of my other organs were involved. That was the first time through all of this I got good news. It is funny looking back now how wonderful that news really was to me.  Since I was doing good and had no bleeds they decided to schedule my c-section at 36 weeks. Some of the doctors were still hopeful that once they got in there the placenta would detach easily.

I had 6 weeks until delivery and I was trying to understand and accept things. I was terrified. I felt like a ticking time bomb. I could not sleep. My husband was working nights so I was alone with 4 little ones, eight and under. I was scared I would have a bleed in the middle of the night and the kids would be terrified. When I did sleep I would have nightmares of having a c- section and my incision opening up and I was standing there holding my insides. 

I would hold my little ones and wonder if  I would be able to see them grow up. I would think, "My 2 year-old will not remember me." I think all these thoughts but had no patience with my kids. Then I would think if I don’t make it all they will remember is me snapping at them. 

One of the hardest things I had to deal with was knowing that the people that got me here by doing 3 unnecessary c-sections on me were the same people I now had to trust to get me out of this.

As the weeks went by I realized that I had no control over the outcome. I had to do the best I could and control what I could and give the rest to God.  I had to believe that even if I did not make it through that God would take care of my kids and it would be OK.

Days before my delivery I had to go do pre-op blood work and meet with anesthesia. I was told with the blood loss they were expecting I may have a lot of swelling and fluid in my lungs. They may have to keep me asleep until Friday until the swelling went down. They wanted my family to be prepared. That broke my heart to think I may not see my baby on the day he was born. They said I would go home with a bladder bag if they had to do the hysterectomy. With the scar tissue from my c-section they were sure that they would rip my bladder when they removed my uterus.

Delivery day came saying good bye to my kids was one of the hardest things I ever had to do. They were so excited to meet their brother the next day. And I had no idea if I would ever meet my baby or see my other kids again. 

I got to the hospital around midnight. They got me situated in my room and then let me sleep for a few hours. I would doze off for a few minutes then wake back up with a knot in my stomach and a lump in my throat. I didn't want to be there. I wanted to run far far away from that place.

At 6 a.m. they came in and started to get me prepped for surgery. We had decided that it was best for me to just be put under general. My surgeon was afraid he would lose time if I began to hemorrhage and they had to put me under then. They did not want the baby to be under general any longer then he had to. 

All the prep was done in my room. Anesthesia came and placed a central line in my neck and a large IV in my wrist; both of those were for blood transfusion. They also placed a monitor in my wrist that would send labs and gives them second-by-second blood pressure reading. By this time I was numb, I had shut down. I just prayed and sang worship songs in my head and took myself away from there.

My surgeon came in and did a quick ultrasound to see where he was gonna cut.  As funny as it sounds I was still hoping that he was gonna find that the placenta had moved.

Once it was time to go to the OR the two main surgeons wheeled me down. My husband got off on another floor to wait in the waiting room. I just wanted to scream, “NO!” I didn't want my husband to go. I wanted him there when I fell asleep. I just gave him a kiss and told him I will see you in little while. He said a quick prayer and slipped off the elevator.

We were outside the O.R. doors and had to wait. The blood bank had not brought down the blood that was to be on stand-by in the O.R. There were doctors everywhere. My neck hurt so bad from the central line. I could barely move. And there was so many people coming up introducing themselves. MY nurse kept saying, “Oh my goodness, everyone is here.” She said, "You have the best of the best!"

All of a sudden here comes two big coolers. I just hear everyone say, “OK, let's go.” My surgeon told me, "I have been resting for 2 days for your surgery." 

I said, “Hey, you have to take good care of me. I have lots of little ones that need me.” He said, “Brandy, we know what you got and we are gonna take good care of you.”

Things got real busy in the O.R., they put the oxygen mask on me, and kept telling me to to take nice slow breaths. The mask made me feel like I could not breathe. I was getting frustrated that I was not asleep yet. I wanted it over. No matter what the outcome was gonna be I was ready to get there. Everyone was rubbing my arms telling me that they were there and they aren't gonna leave, that I was OK. I remember thinking I am never gonna fall asleep.

I heard, "Don’t talk, you still have the breathing tube in." I raised my arm and started to write in the air. The nurse got me a paper and pen. I wrote "b" and dozed off, I wrote "a" and dozed off. The nurse said, "Are you writing 'baby'?" and I shook my head yes! She told me that he was healthy, 7lbs 2.5 oz. He had no problems and went straight to the newborn nursery.

They took the breathing tube out and I said, "Is it Friday?" and the nurse said, "No, it is Thursday, 2 in the afternoon!" I was so so happy my baby was OK and I was still here. It was finally over! The worry, the fear, the unknown!

My surgeon came and held my hand and  told me that they did have to do the hysterectomy, the main vein in the placenta had grew very deep into my cervix. They also had to take most of my cervix. I lost 7 ½ liters of blood. I was given 13 units of blood products. 

[kmom note: 7.5 L is 7500 ml. Normal blood loss in a vaginal birth is 500 ml; 1000 in a cesarean. She had more than 7x the normal blood loss for a cesarean.]

I didn't care at that point. I was alive, my baby was healthy! We made it to the other side. PRAISE GOD we were OK!

I met my little man when he was 8 hours old. He is perfect. I would do it all again to have him. We have both done very well recovering physically. I didn't need a bladder bag after all. I delivered on a Thursday and we came home together on Sunday. 

But emotionally it has not been so easy. I do sit here in disbelief sometimes wondering why me? Other days I get angry. I want to punch something and yell GIVE ME MY UTERUS BACK! I mourn the loss of my fertility, the loss of his birth and the first 8 hours of his life. The loss of my last pregnancy. The loss of some relationships that have been damaged through all this for one reason or another.

I share my story not to scare anyone. I know what it feels like to be scared into something. I would never want to do that to someone else. I just want women to be aware of all possible complications. I want women to be able to give true consent and be aware of all risks. 

If sharing my story saves one women from having a different ending than me then it wasn't all for nothing. Accreta is not talked about, but it is real, very real!

A Lovely VBAC After CBAC Story

The "OMG, A Baby Just Came Out of My Vagina!" VBAC Face
(Also called The Official VBACFace™ by Jill at the Unnecesarean)

As we enjoy the holidays, it's nice to be able to share some good news for a change.  And what better news can there be than a lovely birth story, with GREAT pictures to boot?

Below is a brief summary of Melek's birth stories and some of her birth pictures, all shared with permission. You can find longer versions of her stories on the ICAN blog, which she helps run.

I love these stories and just had to share them because she has some of the best birth photos EVER.  They just brought a giant smile of happiness to my face when I saw them.  And what better time of year to share them?

I always love to share VBAC (Vaginal Birth After Cesarean) stories.  This one is particularly poignant to me because she had a CBAC (Cesarean Birth After Cesarean) when she tried for her first VBAC, as I did also.  And yet we both went on to have VBACs afterwards.

Many care providers assume that once you've had a cesarean, somehow your body is just not capable of birthing a baby vaginally.  Research shows that most of these women can, in fact, birth vaginally if given the chance to VBAC, but many are erroneously told they cannot.

And if you've gone for a VBAC and ended up with another cesarean instead, care providers almost without exception assume that you are somehow "broken" and cannot possibly have a vaginal birth.

Yet the experiences of Melek (and me, and many others I know) show that it is possible to have a VBAC after having gone through a CBAC.  And research shows that VBAC after more than one prior cesarean is definitely possible and reasonable.

It's important to note, of course, that not every cesarean or CBAC mother goes on to have a VBAC.  Sometimes it's truly not possible, sometimes medical considerations make it prudent to have a repeat cesarean, sometimes the mother is just done having children or doesn't want to consider laboring again, or sometimes she simply cannot find a supportive provider.  A vaginal birth is not the end-all, be-all of birth.  You are a mother regardless of how your baby arrives.  

But even so, there is something wonderful about women finally able to get their desired birth, something incredibly special about women who keep pushing for VBAC despite lack of support from some in the obstetric establishment, something incredibly brave about the tenacity of women who persevere despite medical professionals telling them that they are "broken*" or "damaged," something incredibly affirming about women showing that their bodies can give birth vaginally after all.

This is one of those stories.

Congratulations, Melek, we are so happy for you.  Congratulations on your new baby.  Thank you for being willing to share your birth pictures and your joy with us all.  Bless you and all your children.

*Sometimes when a birth story like this (i.e., someone who felt "broken" by their cesarean, etc.) is posted, some people's feathers get ruffled.  It's important to remember that this is one woman's story, one woman's perceptions about her births, and it doesn't have to reflect your own reality or opinions.  It's okay if your story is different.  Be happy for her anyhow.

Melek's Stories

Baby #1 (Cesarean):

Risked out of a birth at a birthing center with midwives because of essential hypertension, Melek was induced and ended with a c-section.  She was emotionally devastated when her doctor told her, "Well, all your babies will have to be born by cesarean and seeing how difficult this pregnancy was, you should probably only try for one more.”  She felt broken and damaged.

After the disappointment of her first birth and her doctor's discouraging words, Melek let her health habits slip for a while.  Realizing that she wanted to avoid intervention in a future pregnancy, she made an effort to improve her health. [Trigger warning for brief weight loss talk in the original story.]  In time, she was able to get off her blood pressure medications and conceive again.

An abbreviated version of this story can be found here, near the top of the entry.

Baby #2 (CBAC):

After getting off her blood pressure meds, Melek planned a home birth with wonderful midwives.  When she went into labor, however, baby's position was not quite optimal and labor was long and slow, then turned hard. Some non-reassuring signs were found and a hospital transfer was made.  She ended up with another cesarean, but while disappointed, did find the experience empowering in the end.  She wrote:

I was expecting to be devastated if I had a repeat c/s, but I was surprised with how not only content, but happy I was about my birthing. I had worked so hard for two days, listening to my body and working through contractions. I felt really respected by the hospital staff. No one ever once made me feel bad about being a home birth transfer. In fact, the OB that delivered Emre told me that he is sorry that it ended in a cesarean because he knew how badly I wanted a natural childbirth and how hard I worked for it. He didn't downplay the importance of my birth to me and that was so very special to me. I felt respected, validated and valued by every single person who was part of my birth experience. I never knew that a CBAC could feel like that.

Melek's full CBAC story can be found here.

Baby #3 (VBA2C): 

Melek spent a lot of time emotionally processing her first two births while preparing for her third.  She also prepared physically, utilizing Maya Abdominal Massage to help break up any scar tissue, chiropractic care to help promote a good fetal position, and acupuncture near term to ready her body for labor.

Her midwives were totally supportive, but, like many CBAC moms, she had many concerns that something was going to interfere with her much-desired VBAC.  She despaired that she would have another big baby, would go well past her due date, and that as a result, baby's head would be big and not mold-able enough to be born vaginally.

In the end, she had the baby a week past her due date, one with a big head that did not mold, and he was another sizable baby (9 lbs. 13 ounces).  And she still had a VBAC.

And what a beautiful VBAC it was.

Full story can be found here.

More Birth Photos

Here are some more birth photos from Melek's VBA2C (Vaginal Birth After 2 Cesareans).  Keep in mind that some are from a cell phone, and I re-posted the picture from the top of this post to show its context in the birth story (and because it may be one of my all-time favorite birth photos!).  I couldn't get Blogger to rotate the second-to-last photo, but it was too wonderful to omit, so turn your head to the side and enjoy her giant smile of joy anyhow.

in labor

Best VBAC Photo Ever?

overwhelmed 

snuggling up

beaming with joy

the happy family

Birth Story Video: Jennifer's Waterbirth

Here is the birth story and wedding/birth video of a plus-sized mama I thought readers might enjoy.  It's not a short video (about 6 minutes) but it's well worth watching!

Below is the mother's story (which includes 4 previous miscarriages) and what she wants other women of size to know about pregnancy and birth.

My name is Jennifer. I live in southern Oregon and am a midwife apprentice. I have attended many births and have caught 4 babies under supervision. Of the many births I have attended, a good handful have been to plus-size mommas. 

Two off the top of my head were between 300-400 lbs. Both mommas had very healthy uneventful pregnancies and wonderful easy labors, and both mommas delivered in water at home. Water is great for plus-size mommas because it allows you to move more easily into different positions.  

I myself am a plus size momma. I am 5'6" and started my pregnancy at 232 lbs., about size 18. I finished my pregnancy at 276. I know doctors like to tell you to only gain 15 lbs. if you're "obese" but that's one of many reasons I didn't choose a doctor! I am a firm believer that as long as you gain your weight on healthy food then you gain what you need, and restricting food can cause issues in pregnancy. Nutrition is key in pregnancy, especially protein!   

I had a wonderful very healthy pregnancy with a midwife, and gave birth to a beautiful baby at home on Christmas eve.  A baby girl,  9 lbs. 12 ounces, 20.5 inches. 

Being plus size and pregnant is a challenge but I think it's because we set up obstacles in our minds. Will I look pregnant, how much weight will I gain, will I be able to handle the physical demands of labor, will I be bullied into tests and procedures because I'm overweight? 

Remember that you are a strong, intelligent, beautiful woman who can birth a healthy baby, regardless of your weight. If you aren't comfortable being your own advocate, then hire a doula! Get educated, know your options, and don't forget to celebrate this beautiful rite of passage!

Welcome, Maceo: Newborn Video

In our last post, we shared pictures of pregnant women of size to show the diversity of bodies and belly shapes for Honoring Our Bellies Month and for our Plus-Sized Pregnancy Photo Gallery. 

I'm happy to report that one of those women who shared belly pictures, Theresa, gave birth exactly one week ago to her son, Maceo.  She sent us a video of Maceo's first moments in the world, just after he was born.

The video is about 3 minutes long, doesn't have any graphic birth footage, and is mostly just sweet sweet pictures of baby Maceo with his mommy and daddy.

Beautiful, just beautiful. Thank you for sharing, Theresa.

Here is an abbreviated version of her birth story.  To me, it illustrates the importance of maternal mobility in labor as a way to deal with the pain without drugs, and probably as a way to help correct any position issues with the baby (in this case, possibly a hand by the baby's head). 

Can you imagine how hard it would have been for her to deal with the pain if she was tied down to a bed, flat on her back, not permitted to move around much, like most women (and especially women of size) are in hospitals?  This is why the epidural rate is so high in hospitals, even among women who want to go without drugs.  Such restricted movement just makes it incredibly hard to deal with the pain; free range of motion and unlimited mobility makes it at least doable for many.

Notice how much Theresa moves around in her birth story, and notice how many positions she uses for labor and pushing.  Notice also how she switches positions at the last minute.  This frequent movement and re-positioning was probably very important in helping the baby out, yet it's something that's rare in many hospitals.  How many problems could be avoided if women were just encouraged to have free range of motion like this?

Here, then, is Theresa's birth story.

"Suddenly instead of five people in our bedroom, there were six."

Okay, so Thursday I started having what I can only describe as gas pains..It wasn't painful, more like the kind of sensation that makes you want to wrinkle up your nose. Also I noticed when I was in the "library" that I had started to let go of the mucus plug.  I had an appointment to go see the midwives that morning and luckily I had asked [my husband] Moonie to start his leave a few days early because I didn't want to drive to the midwife's by myself (good thing, too!)

Everyone agreed my gas was likely early labor but it could be really early and start and stop or maybe it WAS just gas. Anywho, the appointment went well, my BP was great, my urine was fine and about an hour later the sensations subsided.  [I took] an afternoon nap (good thing, too). 

Moonie made us some dinner about 6pm and we watched a movie and my "gas pains" started to return.  I finished eating and felt like I really needed to go take a leak and Moonie helped me up off the sofa and followed me to the "library" but I was to do no reading here for a while!  As soon as I got in I got an EARTH SHATTERING contraction that made me grab the over toilet towel rack and moan, "Ohhhhhh AHHHHHHH"   We had been discussing that maybe I wasn't in labor and we didn't want to go getting excited over nothing especially since first labors are usually long.  Moonie just said, "Yeah, kid I think you really are in labor!"  and called the midwives to put them on alert and I tried to go back to watching the movie but all you moms probably can figure how well THAT worked out! 

By 8pm I was seriously in first stage. The midwifery student came over an hour later and I was just dealing with each contraction as it came. [I was] sitting on the exercise ball, using the sock warmers (socks filled with rice and warmed in the microwave), and Moonie was timing my contractions as we played my "Relaxing" playlist on iTunes and tried to veg out to the visualizer. 

Soon after the student came she started inflating the baby pool and I could no longer sit and deal with contractions I was walking around moaning and chanting OM while doing belly dance moves and pelvic stretches.  Walking it off was really the only way I could deal with these harder contractions, the thought of laying down was uncomfortable. I did try to lay down through one and it felt all wrong so I scrapped that idea.  

For me the contractions weren't painful per se, they were more like the most intensely uncomfortable sensations ever mostly because I couldn't lay down, I couldn't sit and standing and walking all felt crappy.  Then one thing that only one mom ever mentioned to me was the flu-like sick feeling you can get. Boy did I EVER get it!  I threw up that dinner like nobody's business and I felt like was gonna hurl up everything I had eaten since I was 2 years old. I felt really sick to my stomach between contractions and that continued until the end pretty much.

Later that night...the midwives came.  The midwifery student had been helping me through the contractions because the sensations were so STRONG that they scared me at first and I would [think], "Oh another one! What do I do???" I couldn't believe how close they were and she just hugged me and let me lean on her and reminded me to breathe and helped me through it.

I tried to sit in the pool which was filled by a hose hooked up to the shower head.  The water seemed too hot and there wasn't enough of it. Also it was on my hard living room floor so kneeling in the pool sucked. I couldn't SIT for love or money and leaning on the side just made it sink down and overflow.  I tried a second time during the labor but it just felt wrong and so I scrapped it. 

We all ended up in the bedroom and to be honest, I'm surprised my neighbors didn't call the police. I was told that I wasn't so very loud because I was moaning instead of screaming.  I was on all fours on our bed and it seemed like forever! I was getting these MASSIVE pushing contractions one at a time and felt sick as dog in between along with the front of my hips hurting like Satan was cracking my bones so in between loud moans I just yelled "SICK SICK! I'm not gonna be sick I FEEL sick!" and "DAMN IT MY HIPS HURT LIKE HELL!"

My midwife wanted me lay on my back to try and examine me but there was no WAY I could lay on my back!  I just instinctively knew that would make everything worse. She thinks Maceo's hand was up by his head because I had been pushing for a bit and the head would come out and go back. So she did a clear of my cervix which I  was told I complained about loudly (I have no memory of this) and then switched positions.  They suggested I try the birth stool. I got up off the bed and then another massive contraction came (they were now two or three pushing urges in a row then a break), and I just grabbed my rickety bedside table and got into a squat and yelled. I got into the birth stool and pushed there for a bit. Got back on the bed and pushed there, yelling about how my hips hurt in between while they kept repeating, "Push it out and it'll all be over!"  I remember being covered in sweat and seeing Moonie's face and holding his hand and crying.

"This is taking so long!!!" I yelled and they said something and I remember saying, " I just want to get the baby OUT!!!" I slid off the bed to the birth stool and  had the most massive contractions ever and pushed with all my might with every ounce of strength I had in my entire being and the midwife said, "It's coming!" and Moonie dove to the floor to help her catch baby and he said "I see the head, baby! I can see it, it's almost here!" I said "You do?!" and then pushed Maceo out into the world and suddenly instead of five people in our bedroom there were six.  The midwife and Moonie both caught baby.

"Is it a girl?" I asked and she said, "It's a boy!"  and I said "Oh it's Maceo!" and I just repeated his name over and over again.  The cord was around his neck but she just slipped it off and handed him up to me.  We waited what seemed to me like five seconds but was an hour we clamped the cord and the student cut it. 

Then we waited for the placenta to come out but it had stage fright I guess. I tried coughing and pushing but to no avail. I took a few doses of Angelica tincture  and still nothing. The midwife suggested we move to the toilet because it might come out easier. I sat there and sat there and nothing and finally the midwife said, "You know if you can't get it out we'll have to go someplace where they can take it out."  Then before I could even say "Oh" I had another contraction and this was actually a little painful or maybe it was just that it was stronger than I expected and it was over before I even knew what happened and out it came.  I looked at it when they put it in a specimen bowl and was like "uh-huh" and thought about how tired I was.

I went back to the bedroom and Maceo was in his Poppi's arms and the student took some photos. Then I had him again and we took some more photos.  Then the midwives started cleaning everything up and sump pumping the pool and deflating it, loudly.  Finally that crap was over and we had quiet time. I just laid in bed with Maceo and Moonie was totally enraptured with us both.

Our midwives examined me and I had  no rips but something called a skidmark which is like a little scrape on the taint and they were all so happy (so the hell was I).

I think I just laid in bed and dozed with Maceo and Moonie just laid diagonally at the foot of the bed, completely dressed with glasses and everything and slept for the next four hours until his parents got there and brought us breakfast.