Thursday, September 19, 2013

Natalie's Birth Story

On 30 June 2013, Natalie had a natural, drug-free VBAC. After having gone through a harrowing emergency C-section experience that left her feeling 'like a failure', she was determined for history not to repeat itself. She armed herself with birthing knowledge and listened to her body, trusting it to take the lead this time round. With the courage to follow her birthing body and a woman's birthing instincts, and a supportive gynae, she got the VBAC she wanted. 

This is her story.

30 Jun 2013
VBAC without epidural (40w5d)
Baby 3.4kg

6 Oct 2010
First birth with Emergency C-section (41w3d)
Baby 3.6kg

Asked to induce
I had always wanted a natural birth so I was very disappointed when my first birth ended in an emergency C-section. When week 41 passed and there was no sign of baby coming out, I was asked to go for an induction. I had 2 induction tablets and dilated to 3cm. The gynae burst my water bag and put me on drip to induce.

Offered epidural
Initially I did not want an epidural but the gynae says this might be the reason why I am dilating so slowly. Hence I took epidural and waited. I thought that everything will go well after that. I further dilated 2cm in 9hrs after I burst my water bag.

Gynae did not want to wait
I failed to progress more than 5cm dilation. Although there was no sign of baby in distress, the gynae did not want to wait. We asked him if it was ok to wait but he says no point since already waited for 9hrs and no progress.

Gynae said baby is big
As new parents without much knowledge, we can only trust the gynae since we did not wish to take the risk of baby passing motion in utero. The water bag had burst too and gynae was not really giving us much advice on how long can the baby stay inside the tummy with the water bag burst. Gynae said the baby is big so. Later after delivery he said that my cervix is sharp angle. I did not quite believe him because I am a big size so if my petite friend whose baby is heavier than me can have hers naturally, why can’t I? He had never informed me about my sharp angle during pregnancy. Why only now? I feel that he just does not want to go back home and return again after midnight – overtime for him. I am really bitter about this although I try to tell myself that my baby is healthy and even if I managed to dilate to 10cm, there might be still some other complications.

Gynae say impossible to try natural
I had my 2nd baby when I was staying in Perth. This time I wanted to try for a VBAC. As I am not familiar with Perth, I decided to have my baby in Singapore. I read up on VBAC and found my gynae – Paul Tseng. I did not wish to go back to my previous gynae as he had told me that it is impossible for me to try natural and that my next birth would be a C-section. I do not believe him anymore.

Discovering other birthing options
Australia is a very pro-natural country for child birthing as compared to Singapore. They have many different methods of birthing (home birthing, water birthing, midwives etc) I attended a prenatal yoga course and this must be the best thing that I did. At the end of every lesson, they would discuss topics on child birthing. After listening, I was very certain that everything was wrong for my first birth that resulted in emergency C-section. If only I had more information back then.

Determined to stay at home as long as possible
For my 2nd birth, equipped with all the information, I was ready to try for a VBAC. I try to eat lesser and healthily to keep my baby smaller. Paul told me to go to the hospital only when the intervals between my contractions were strong (1 min every 4 mins) or if my water bag burst. Now that I know babies don’t come out so fast, unlike on TV and I don’t dilate so fast. I was determined to stay at home as much as possible. Despite Paul been pro-VBAC, I am still not going to take any chances. I strongly believe that if I go to the hospital too early, there is a chance that they will say I fail to progress if I stay there for too long. Baby monitoring will also hinder my movement and make it harder for me to dilate. Nurses might check dilation frequently resulting in water bag burst and they may psycho me to take epidural.

Natalie’s Birthing Journey

28th June
Morning - Mucous plug came out. Contractions was 30s every 9mins. I was worried as I am not sure if I should go to the hospital. I did not.
Afternoon – Contractions disappear after a nap. They are false contractions.
Night – Contractions came again around 10pm. Intervals of 10mins and 15mins. Last longer(90s) and much more painful than the contractions in the morning. I was able to sleep while I was having contractions so I guess they are fake since I can still sleep else my pain tolerance is very high.

29th June
No more contractions in the morning and afternoon.
Night – Contractions started at 10pm. Mucous plug and diarrhea too. I was able to sleep so I suppose it is not the real thing.

30th June
Morning - Woke up at 2am feeling great pain and not able to sleep. I was timing my contractions from 2am to 4am. It was getting very painful. I was wondering why fake contractions are so pain. I had bad diarrhea too, keep running to the toilet. The intervals are not consistent still so I thought they are fake. It was about 1min every 4min or 5min. There were also longer ones every 7 or 8 mins. 
I was moving around a lot every time during my contractions. Making sure I am in positions that will help me to dilate faster and relieve the pain.
 4am – Pain got worst. Something is not right. I was having contractions every 2mins when I was getting ready to go to the hospital. Oops!

In active labour
I was bleeding when I went to the toilet in the hospital. Nurse confirmed that I was in labour. She checked and I was 6cm dilated. Nurse was very rough when checking; I was so scared my water bag will burst. She even told my mum (my husband is overseas) that VBAC was very risky and my uterine will rupture. I was quite irritated with her because if I have not warned my mum before this she will probably be very scared. Luckily I told my mum much earlier that Paul said there is 1% risk and I have already signed the indemnity form.

Birthing ball and birthing stool sped things up
I was plugged on the CTG and had to take laughing gas for the pain. I did not take epidural. Within less than an hour I was 8cm dilated. I was still worried that I will not dilate to 10cm so I asked the nurse to remove the CTG so that I can at least lie on the side and not on my back. She was quite unwilling but allowed me to do it later. There was no progress during the next dilation check so I requested for birthing ball and birthing stool. She was not very experienced as she had to make me get up to the bed again before she can check my dilation. I was quite irritated because my contractions were coming very fast and I had to wait for the contraction to subside before climbing back into the bed again. I was 9cm dilated. The birth ball & stool definitely sped things up.

Luckily they change my nurse after this as it was time for them to change shift. The new nurse was able to check my dilation when I was on the birthing stool. She told me to push since I am quite near 10cm and advised me to push on the bed as it will be much easier. I was sceptical but since already 10cm so might as well. It will be easier for Paul to deliver too. Paul had not arrived yet.

I asked the nurse how long I need to push before baby can come out. She told me an hour. I really feel like giving up on hearing this. I wanted epidural if it is going to take another hour but I guess it is too late so I did not bother to ask.

Baby's head after a few pushes
My mum said she saw the baby’s head after 3 to 5 pushes. That really gave me the encouragement to go on. Paul finally arrived and after 2 to 3 pushes the baby was out. It was less than an hour! Paul’s voice was very encouraging and it really gives me the strength to continue.

A natural, drug-free birth
I am very glad as it takes only 3hours after I reach the hospital to deliver my baby. The pain was bearable and I had no medical intervention or epidural. No drips and no catheter. The experience is so much better compared to my first. I was also able to directly latch my son in the delivery room. No shivering and no vomiting. My cervix was not acute angle afterall.
Giving my body time to dilate
I personally feel that I made the right choice to stay as long at home as possible. If I had gone to the hospital earlier (on 28th June), either they would have sent me home or I would not have been able to wait till 30th June to fully dilate since that will be almost 3 days in the delivery ward. No stress from the nurses and unnecessary medical interventions too. Home is definitely more relaxing and less stressful.

For hundreds of years, women have been giving birth without any medical intervention. I do not see the reason that any of these are necessary especially if I am not having any medical complications. If I had gone to the hospital earlier, I will have insisted on a drug free natural labour too.

I was told that my first birth was a failure because the baby is not ready to come out (no contractions at all) and we forced him out. The end result is a C-section.

Please note that the above are my own views based on what I read and heard. They are not been medically advised by doctors so please do your own research. You need to know yourself and your limits well and what you are doing is not posing any risk to you or your baby. If there is any point of time that my baby or I are in danger, I would not have hesitated for medical intervention. Please do not insist on trying natural if there are already signs that things are not going well. You still have to trust your gynae. 

Natalie shares some tips based on her own experience

1)  Epidural before you are 6cm dilated will increase chance of C-section to 70%. You are not able to move around after having epidural, dilation can happen much slower. It might also cause baby to be in distress. Lying on your back will block your baby from going downwards due to the position of your tail bone. If you can bear with the pain, don’t take epidural.

2) One Australian mummy took 40hrs to dilate at home. Dilation varies so some people can take days to dilate.

3) Never ever let them burst your water bag. Do not let the nurse check too frequently in case they are too rough and burst your water bag. Even if burst, you still have 24hrs to deliver the baby. Gynae just have to give you antibiotics to ensure the baby does not get infected.

 4)     Never induce your baby unless medically necessary. Chance of C-section is much higher after induction as it might cause baby distress and failure to dilate.

 5)     Week 41 is not late. I am allowed to wait till Week 42 and he will then check to see if I can wait till Week 43.

 6)     Moving around dilates faster. Do not lie on the bed like what you see on TV.

 7)     You are allowed to consume food when trying for natural. I was not allowed to eat for my first birth. I was so tired and hungry by the time I was told to go for emergency C-section. My mind was too weak to even want to wait any longer.

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.

Monday, April 15, 2013

Pressured into Inducing

Two years on and the stories I hear are still the same:

Women being "gently" pressured towards induction for non-medically threatening reasons like "a few days over due date".

And the storyline that unfolds from there on is all too predictable and familiar:

Mom isn't prepared for induction. Mind isn't prepared for induction. Body isn't prepared for induction. Baby isn't prepared to come out.

So Mom's body is tense. Because her mind is tense. It goes against her natural instinct of giving birth to her own baby.

She starts to doubt her own body's ability to birth her baby.

And when mom tenses up, her birthing muscles tense up, and the cervix can't dilate. AND NO AMOUNT OF INDUCTION MEDICATION CAN UNDO THIS.

What happens next? Mom is told baby is in danger due to long labour, Mom feels helpless and tired and disappointed with herself. By now, she just wants the ordeal to end, so "whatever you say doctor, if you think I need a c section now, then so be it."

Mom comes out of the c section traumatised, but tries to convince herself that she did the best thing for her baby, and that her baby is healthy is the most important. All attention is now on the baby and mom is left wondering what she had just put herself through. She feels scarred (literally and psychologically) and in most cases, feels the anti-climax of the birth she never experienced.

THIS HAS TO STOP.

Moms, start educating yourself about the birthing process. Learn the techniques to get the natural birth you want. Do not "leave it up" to your gynae to dictate what's best for you.

Despite what you have been taught at hospital pre-natal classes, that casually tell you about various pain relief options as if they are the norm, find out for yourself alternative ways of pain management that are drug-free and effective.

I am sure there are many out there who are simply resigned to "screaming it out" and "enduring until cannot endure" when the time comes. And if cannot then "no choice" ask for epidural.

You have a choice.

YOU CAN HAVE A GENTLE BIRTH IF YOU PREPARE FOR IT.

Like a triathlete preparing to run a marathon trains for months. Like a gungfu master who spends hours each day training his mind. Like a diver practises a new way to breathe underwater.

It is possible if you set your heart, mind and time to it.

You can call it hypnobirthing, gentle birthing whatever. It's about a technique of breathing that needs to be practised daily, and mind conditioning.

Because only if the mind is fully relaxed can the body fully relax. And only if the body relaxes can the cervix dilate, and the birth passage expand to allow baby out. The concept is that simple.

Of course not everyone is a suitable candidate for a VBAC. But if you are, as confirmed by your gynae, do prepare yourself well for it.

So you can fully enjoy the empowering experience of a natural birth.

May you have a successful VBAC!