Lin's Birth Story

1^st May 2011

3.85kg

Natural tear, drug-free  

I have always expected that I would give birth naturally. I had this constant fear of childbirth though, as we grew up hearing horror stories and seeing images on TV.  Everyone around me was telling me that it was going to be very painful and I should opt for epidural. It was even more scary to me as I had zero pain tolerance.

First Birth

My first pregnancy went on smoothly. Baby was growing well. I went to a gynae recommended by a friend. I trusted the gynae and did not read up much. As my weight ballooned, I grew apprehensive. I asked the gynae whether my baby would get too big. He told me there was no correlation between the mother’s and baby’s weight. He even said that eating durians was okay. As I had cravings for sweet stuff, I happily ate carbohydrates, durians, cakes and desserts. Only in the last stage of the pregnancy did he tell me that my baby was overweight.

“Just Go With The Flow”

When I told him I was worried baby was too big for me to birth naturally, he said, “What’s there to worry? Just go with the flow.” He meant that if I could not birth naturally, just go through Caesarean. No big deal. To him, it was a surgical procedure he performed every day.

Impending Induction

When I was almost due, the gynae gave me a ‘grace period’ of 3 days. Why 3 days? It was just a magic number, his tolerance level. I was so stressed the week before the EDD as I knew I had to be induced if birth did not start spontaneously. I knew that induction usually led to C-section. No matter how much walking and exercise I did, there was no sign at all. I was tense and cried every day.

Just 1cm More But...

Finally 2 days after the EDD, we admitted to hospital for induction. Big mistake. After 20 hours of induction plus epidural, lying in bed waiting for the dilation, my cervix dilated to 9cm and stopped progressing! The nurses came in for the VE every hour. I developed fever, maybe due to the side effects of epidural or the frequent VE which caused infection. I asked for more time for the cervix to be fully dilated, as it was just 1cm left. The gynae said, “Well, you have to bear your own risk if you want to wait further.”

Devastated and Disappointed

So I was not given a choice. I cried while being wheeled into the OT. I came out devastated and disappointed, and with a painful wound on my tummy. The recovery was painful and breastfeeding was challenging. I was not even able to carry my son for the first few weeks.

Yes, my boy was big, 4.1kg, but I still don’t believe that that was the reason for the failure to progress.

This Time I Want a VBAC

For my second pregnancy, I wanted a VBAC badly and started to read up. People around me were not supportive of VBAC at all. You'd think that women would understand how important the birth experience is to a mother, but no. I was quite affected when a mum told me that it was no big deal to have c-section again since I had my tummy ‘cut’ once. Another mum told me, the scar was just like a zip. “Go for elective Caesarean and you could be in control.”

Making Changes

I went through the forum looking for mums with VBAC experience. I knew I had to make a few changes if I wanted to have a successful VBAC. That was when I got to know May, and she gave me very sound advices:

1)               I had to change my gynae to a pro-natural doctor, who had experience with VBAC. I got to know from a few mums that Dr Paul Tseng is a very good doctor and all had natural births with him.

2)               I took a hypnobirthing course, as it would help me have a gentle birth, which was essential for VBAC.

3)               I engaged a doula for labour support.

Dr Paul gave me good vibes at the first consultation. He said the reason that my cervix failed to dilate could be due to the size of the baby or the position. So we set the understanding right at the start. He did not promise me that I would get VBAC, but at least we could try. So I followed a strict diet to ensure that my baby did not get too big this time. I exercised regularly and practised hypnobirthing techniques.

I liked it that Dr Paul did not need to scan every visit to check that my baby was doing well. He would estimate the size of the baby and not worry me with the numbers, though one of the scans revealed that the baby seemed to be on the big side.

No Signs At 40 Weeks

On the 40^th week, I started to panic, fearing it might be just like my first birth. There were no false contractions, no lightening, no signs at all. I went for the checkup with a heavy heart, as I was afraid that Dr Paul might ask me to fix a date for C-section. (VBAC births cannot be induced as it will cause undue stress to the previous scar.)

Dr Paul checked the heartbeat and the water level, and told me, “Okay, see you next week if nothing happens.” He estimated that the baby was around 3.3 – 3.4kg. He told me that he could wait for 2 weeks, but he would monitor the situation closely. I was so relieved!! That day, I put my heart at ease and went shopping and eating with my husband and son.

In Labour on Labour Day

The very next morning, 1^st May 2011 which incidentally is Labour Day, I started to feel surges at 4.30am, It was a strange sensation I'd never felt before. I couldn’t sleep although I was very tired. So I walked around, timed the surges and tried to go back to sleep. By about 7am, the surges came fast and furious! My son woke up and looked for me. This distracted me from my breathing and the surges became unbearable. I called my doula, Manu, and she was so upbeat about it. She said, “Yes, this is it! I’m so happy for you!”

To The Hospital

We rushed to hospital, and reached there about 9am. Manu reached there about the same time. It was so comforting to see her, and she had a big backpack of stuff and a birth ball. I knew I would be taken care of. It was a pity that I couldn’t get the room with the water tub, as I heard that it was very comforting to soak in water, like natural pain relief.

Already 9cm Dilated

The nurse requested to perform a routine VE but I insisted that I wanted Dr Paul to do it.  Thinking back, I made the right decision, as Dr Paul was very gentle and I only had to do it once. I was already 9cm dilated! From then on, I just managed the surges, and breathed through every one of them. Manu kept reminding me to breathe deeply, as I was taking short breaths when the surges came.

Kneeling, Eating & Drinking

I changed to a kneeling position, to give baby more space to move down the birth passage. However, the kneeling position was very intense, and it took a lot of effort and strength to stay that way. I didn’t know how long I lasted in that position, but I had to turn around and lie on my back again. I ran out of energy as I did not have my breakfast. My husband kept me hydrated with water and Milo, and Manu made me oatmeal which was filling and so comforting. I was actually allowed food while in labour. (I was denied food and water for 24 hours for my last birth).

The Hardest Part

When Dr Paul came back again, I was told that they could see baby’s hair at the opening, but I had to push baby out. Dr Paul said, “This is the hardest part.” That was the time I followed the contractions and the sensation to poo, or push. I nearly gave up after many, many pushes, as the baby seemed to be going back and forth, but not out of the opening. Dr Paul was very patient and was with me the whole time, and gave me lots of encouragement.

We tried different breathing methods, lifting my legs, etc. For all the surges, I was so glad to have my hubby’s big, strong hands to hold on tightly to. It gave me the comfort and strength to pushed for almost 2 hours. Finally, I heard positive comments that the baby’s head was out. Dr Paul told me to stop pushing and just breathe.

The Ring of Fire

As I did, I could feel a burning sensation. I was thinking to myself, so this is the ‘ring of fire’. It lasted only 10 seconds, and then my baby was out.

Mind Over Body

Baby Alivia was placed on me with her umbilical cord still attached. She was gorgeous. I was so happy that I did it, without any pain relief, just pure mind over body, concentration and positive thoughts. I didn't have IV plugs on me, and baby was alert and could suckle immediately. The wonderful nurse who was with me throughout my labour, requested if she could weigh Alivia before her shift ended. She really wanted to know. She came back and announced, “3.85kg my dear!” and remarked how brave I was to birth a big baby naturally.

Fast Recovery

I had a natural tear (no episiotomy) and the stitching was surprisingly not as painful as I had imagined. The after-labour pain was manageable, compared to a C-section wound. I did not even need to take any painkillers for it. In less than 2 weeks, the wound healed completely.

It was such an empowering and amazing experience. My mother gave birth to 3 kids without pain relief and I thought women of that era were so strong and had high pain tolerance. It is actually just the fear of childbirth that make us think that we are less capable than our mothers. It was absolutely true that our bodies are made to birth the natural way, and it should be the only way.

I DID IT!!!

- Lin

Congratulations Lin Sia You Did It!

Just to share another mummy, Lin Sia, whom I've been in touch with has successfully had a VBAC on Labour Day, 1st May 2011.

Look out for her story to be shared here soon!

Reuters Report: New Guidelines Say Vaginal Birth Okay After C-section

Wed, Jul 21, 2010 (Reuters Health) — Even if they aren't staffed to handle emergency cesarean sections, hospitals should respect a woman's informed choice to have a vaginal birth after cesarean (VBAC), new guidelines say.

VBAC is known to increase the risk that the scar left in the womb from a previous cesarean will tear during labor, leading to massive bleeding that can threaten the baby's life. That has led to previous guidelines urging caution for women who have had cesarean sections.

But recent research shows so-called uterine rupture occurs in less than one percent of women who opt for vaginal birth, and that between 60 and 80 percent of VBACs are completed successfully.

While the new guidelines from the American College of Obstetricians and Gynecologists (ACOG) still say a full surgical team should be present in case an emergency cesarean is required, they now put a bigger emphasis on the woman's decision.

"Respect for patient autonomy supports that patients should be allowed to accept increased levels of risk; however, patients should be clearly informed of such potential increase in risk and management alternatives," they say.

"For most women with a previous cesarean delivery, a trial of labor is a safe and appropriate option," said Dr. Jeffrey L. Ecker, referring to a planned VBAC attempt.

Ecker, who directs maternal-fetal medicine at Massachusetts General Hospital in Boston, co-wrote the new guidelines, published in the journal Obstetrics

Even women who've had two prior cesareans might be good candidates for vaginal birth, he said.

He added that he hoped the new recommendations would help reduce the concerns about medical liability that many doctors have held out as a reason for not offering VBAC.

Today, about nine in 10 pregnant women in the U.S. end up with a repeat cesarean if they've already had one. By comparison about a third of all women who give birth have cesareans.

"I really think the cesarean rates are going up too fast," said Dr. Peter Bernstein, of the Albert Einstein College of Medicine in the Bronx, New York. "There is no good evidence that newborns are better off now than they were 20 years ago."

Bernstein, who is an ACOG fellow but did not work on the guidelines, said he was pleased with the new recommendations.

He said they updated information on what women would be good candidates for VBAC and were important in the discussion of delivery options that a woman should have with her doctor.

But he said it was hard to say if the guidelines would have any impact on the low VBAC rates.

Indeed, the guidelines note that health providers who feel uncomfortable with the delivery choice a woman has made may want to refer her to another provider.

-- Frederik Joelving

Anna's Birth Story

Prince T
February 2003
My first baby was in a breech presentation. "Your water bag has burst for more than 24hrs, leaving little fluid for baby to turn." my doctor told me. I was advised to have a Caesarean section.

Prince J
Mar 2005
For the birth of my 2nd son, I wanted to have a VBAC. I read up, did my research, planned, consulted, and did my exercises. My gynae was supposedly supportive, but on hindsight, I realised a lot of things went in the way of a Caesarean section. I went into labour spontaneously and laboured for more than 24 hours, but was still not fully dilated. It was then that my gynae suggested a Caesarean section due to "Failure to Progress".

I was very upset at the turn of events. I was not sure if I even wanted another baby because of the kind of birth process I had gone through. Family and friends reminded me to focus on the bundles of joy that I have, and not on the process. Over time, I got over it, but never forgot how it felt to have things out of control and totally the way I didn't like it to be.

When I finally felt ready to have another child, I was very determined that it not be a scary experience, but a joyful one. I engaged a doula, and prepared for it even more than for my second child. I also decided to switch to a doctor that was fully supportive of a VBA2C (Vaginal Birth After 2 Caesareans).

Princess E
Feb 2010
Successful VBA2C (Vaginal Birth After 2 Caesareans)
Natural birth, drug-free

It was the most amazing experience. Much more relaxing this time round as I laboured mostly at home. I got to the hospital at 1.45pm, and in less than 2 hours, Princess E was born at 3.21pm. Even my hubby felt like crying tears of joy. He keeps saying he wants more kids now, because of how joyful he felt, and how wonderful the birth experience was. But we are stopping at three, as they are already quite a handful!

- Anna

VBA2C Mom Writes In

Thanks to the publicity of this blog on the Straits Times feature, a VBA2C mom writes me. Having a VBAC is already courageous. This mom had a natural birth early 2010 after two Caesarean sections! Will post her story here soon.

VBAC Feature in Straits Times

Today, Strait Times features an article about VBAC in the Mind Your Body section. It is pretty informative, highlighting the common view of most gynaes in Singapore and shares some current findings on the safety of VBACs.