Tuesday, April 23, 2013

Joanne Yau's Birth Story

27 Sep 2011
VBAC with epidural (38w5d)
Baby 2.515kg

3 Apr 2009
First birth with C-section (EDD) 
Baby 3.19kg

From the get-go, I had wanted a natural birth. But I guess I was ill prepared for it because I was slightly overweight and didn’t read up on what to expect during a normal delivery. I ate outside food daily. Home cooked meals were rare. I didn’t exercise much.

Diagnosed with Gestational Diabetes

Coming from a family with a history of Gestational Diabetes (GD), I was diagnosed with it when I was 28 weeks along. The endocrinologist and gynae frowned upon my weight gain and put me on insulin injections twice daily from 30 weeks to delivery date. That’s on top of the painful pricking of blood three times a day to check the glucose level.

Insulin weakened uterine muscles

By 40 weeks, there were no signs of labour, not even BH contractions. Then, my No.1 disengaged from my womb at the last minute. The reason to date is unknown. This made the success rate for induced birth only 25%. Because of gestational diabetes, the gynae told me (only much later when I was pregnant with No.2) that the insulin injections weakened my uterine muscles to the point that they couldn’t contract. I had to be on insulin drips if I wanted to attempt an induction.

2 days to C-section

The gynae didn't want to wait beyond 40 weeks because of increased risk of stillbirth. Neither did my husband. I was given a mere 2 days to prepare for the C-section. Even though the hospital records said “elective C-section”, I considered it “emergency”. Postpartum period was most horrible. Well-meaning folks who tried to comfort me said, amongst other insensitive things, "C-section babies look more beautiful than babies who passed through the birth canal."

Last chance at natural birth

Believe it or not, I got pregnant with my No.2 because amongst other intentions: I wanted to experience a last chance at having a natural birth. People listed out plenty of arguments why I should go through another C-section.

"You need to work hard for VBAC"

I read reviews about Dr Paul Tseng who is pro-VBAC. However, my husband preferred not to change gynae because he has all my medical history. Agreeing, I went back to see Dr LC Cheng. At the very 1st consultation, I told him I really want to attempt a VBAC. He gave me a photocopied newspaper article (I still have it today) headlined: "You need to work hard for your VBAC". He told me, in his usually relaxed attitude: “We can try. But there are no guarantees in success.” His words encouraged me and I decided to stick with him to the end.

Controlled diet

No.2 was growing well and healthy in my womb. At around 24 weeks gestation, my gynae advised me to start my controlled diet and I started with no qualms at all. Expectedly, I failed the glucose test again. The shock and sadness that used to weigh me down previously was then replaced with resolute desire to fight this war against GD again.

I started off this pregnancy weighing 52kg and gained a total of 6kg at the end. Compared to No.1 pregnancy: 58kg and 10kg gained in total. This was a vast improvement. The controlled diet I started since the 1st time I was diagnosed with GD is till now, a significant part of my life.

"Give me a fighting chance at VBAC"

At the beginning of my 3rd trimester, Dr Cheng seemed to hint at me at the possibility of a repeat c-section (RCS). Unlike in the past when I agreed to everything with no questions asked, I told him to at least give me a fighting chance at VBAC.

Guidelines for attempting VBAC

He gave me 3 guidelines to attempt a VBAC delivery:
1.  The birth weight for my #2 cannot be more than that of my No.1.
2.  I’ll have to take a pelvic bone Xray test at 37 weeks to ensure my pelvic opening can expand enough to have my #2’s head pass through safely through my birth canal.
3.    Inducing labour is not allowed as it will stress the body, thus increasing the risk of uterine rupture.

Of the 3 guidelines, number 1 should be easily attainable given my controlled diet since I was 6 months pregnant. Number 2 depends on my genetic makeup which I have no control. Number 3 is the hardest I guess. If my #2 doesn’t want to come out, I have no control, again.

There I had it, 2 strikes out of 3. From the beginning of the 3rd trimester till the very end, thoughts of RCS kept hanging in my mind. I was more mentally prepared this time round for a RCS though a VBAC would really be an icing on the cake. I started praying, fervently for God’s will for a favourable result for guidelines 2 and 3.

My diet plan worked, only too well.People around me commented on how fit I was. The severe retention on both feet during my No.1 pregnancy was nowhere to be seen. Best of all, I had no need of a single insulin jab! The painful pricking of fingers was reduced from 3 times a day to 2 times on alternate days. If I ate the same foods that gave me good glucose readings, I did not need to retest again. The same endocrinologist whom I saw since my 1st pregnancy, Dr Kelvin Tan, praised me for my efforts as I achieved HbA1c of 5.2% and wrote a very favourable report about me to Dr Cheng. That’s 1 down.

The pelvic bone Xray test done at 37 weeks produced a better than expected result. Medically, there isn’t any reason why my baby can’t come out easily through the birth canal. That’s 2 down.

Praying for spontaneous labour

I began to pray more fervently than ever for the spontaneous labour which eluded me in the past. A fantastic group of mummies who were pregnant at around the same time as me reminded each other to get the raspberry leaf tea and start drinking it from 37 weeks onwards as it’s known to kick start labour naturally. I also started walking more in the evenings after work, often bringing my elder son for a strolls and to the playground. A very important exercise I did especially when visiting the washroom was the pelvic floor exercise.

Miracle birth

Thinking back now, it could be the raspberry leaf tea, or the exercises, or the non-insulin injections. I don’t know. I got my spontaneous labour at 38w5d! I am thankful to God till today for the miracle birth He has granted me. Out came my beautiful baby boy born so tiny at 2.515kg I regretted controlling my diet so much.

My husband didn’t manage to see my No.2 come out of me, what a waste! The birth was so beautiful and surreal that when he came out, my tummy suddenly shrunk from being round to flat. I didn’t cry, but I remembered thanking Dr Cheng and his team for the umpteenth time for helping me achieve a vaginal birth.

Feeling great

Postpartum recovery was a lot easier for vaginal birth compared to C-section. Dr Cheng came by my ward the next day. I told him I was feeling great. He said, “Much better than C-section, yes?” Undoubtedly yes! I took a few painkillers for a few days due to my womb shrinking back to original size. By the 2nd week, the pain was all gone. 

Today when I look at the super active 9.3kg toddler who is almost literally an Energizer bunny, I am still amazed at his mode of delivery given the unimaginable odds stacked against me.

No.3? Drug free with hypnobirthing

If I had a RCS, I would have stopped at 2 already. But now my husband and I are undecided whether to go for another one. If in the unlikely event I get pregnant with #3, I’ll not just attempt another VBAC, but will do it drug-free with a hypno-birthing doula. That is for certain.

(Joanna Yau is happy to connect with other mothers working towards a VBAC. Kindly email May to be linked up with her.)

My labour story

5am: Woke up with tightening and cramp pain. Leaned against the wall for support. Instinct tells me this could be it. Started timing contraction intervals. 5min! Used deep breathing techniques to manage pain. Drank Milo kosong and felt slightly better.

8am: Had a burning urge to call gynae clinic but interval fluctuate between 5-10min so decided against it.

10am: Bloody show! Decided to call gynae clinic and nurse told me to straightaway go labour ward. Grabbed packed luggage, daily necessities and rushed out of home.

10.30am: Reached labour ward. Nurse told me to remove all clothing, jewellery and wear a pink gown while they prepared a bed for me. Hb went to attend admission procedures. Got a drip due to gestational diabetes. Totally no food until evening thank God I ate some fishball noodles. Hooked me up to contraction monitor. Interval remains 5min. Bb heartbeat between 120-160bpm which is normal. No signs of distress. Tested blood pressure which returns normal. Did a hurting like hell VE check: 6cm!

12.30pm: Hb went out for lunch. Gynae came to labour ward and broke my waterbag. I asked him isn't he inducing labour by breaking waterbag. He said I'm already in labour this is not inducing cos inducing isn't allowed for VBAC. He and all the nurses kept asking me whether I wanna pain relief. But I think my pain threshold is high so declined the offer. Gynae said bb poo inside my womb. 1st sign of fetal distress.

12.30pm-2.30pm: The contraction pain intensified so greatly after waterbag burst. Had a feeling I'm not progressing well. VE check: 7cm. Worse, every time I'd contraction, bb heartbeat dropped. 2nd sign of fetal distress. Decided on either gas or epi.

2.30pm: Epidural administered. Slight pain upon insertion. Moderate numbness set in not soon after. Started to have severe shivering and bit of headache. Blood pressure monitor attached to me all the way. 1 time dropped v low at 70, causing panic. Hb came back for awhile and left to pick up elder boy from CC. Catheter inserted in bladder.

2.30pm-6.41pm: Everything started going fast and furious. Contraction continued to peak to 1-2min at alarming levels but all I felt was an urge to poo. Felt totally relaxed. Epi reduced to 1ml per min from initial 10ml-11ml. Nurse was happy with my progress and transferred me to delivery ward. Watched tv, slept, friendly chat with nurses and listened to songs to pass time. Dilated the remaining 3cm during this period.

6.41pm: Fully dilated and bb engaged! Nurses and me called hb to witness birth to no avail and decided not to wait for him anymore cos bb poo inside me again. Gynae came and praised me for not using up the epidural anaesthetic. Encouraged me to push whenever I felt a contraction.

6.56pm: Few strong pushes and bb was out. Felt a tremendous sense of relief! Placenta expelled in pieces and gynae removed a fair bit, leaving the rest to my womb to expel the remaining portions. Stitched me up due to a minor cut while pushing.

7pm: Hb finally arrived with elder boy (crazy traffic jam) and managed to at least witness the weigh-in.

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