Caleb James

Thursday 18 February 2016
Calmbirth Story

Born 5.45am, 53cm long, 3.936kg

Previous birth story – Why I am VBAC

I am the proud mum to a chekky 2 year old Tahlia Rose! She was born via c section in 2013.

After being induced at 40+12 I delivered large 4.396/10pd baby via emergency caesarean section due to ‘failure to progress’ at 40 + 14. During the induction she was posterior and did not descend. The method was cervidil Thursday night, ARM Friday morning followed by high dose syntocin drip and EMCS decided at 10pm due to only being 4/5 cm despite contracting from 11/12pm. A fairly calm C Section was done at 1.15 am.

The recovery both mentally and physically was exhausting. It was so debilitating not being able to do anything for myself let alone my child. The recovery made me feel like a failure, not for the way I gave birth but the way I was so helpless. I am unsure if I had of done anything different in my labour if I would of delivered my first baby ok or not due to her large size and am thankful she is now a happy and healthy 2 year old. Caesarean sections are a god send to keep mums and babies alive!

Why I wanted to have a trial of labour and attempt vbac

Simply I am too scared to book a c section, having the courage to turn up on a given day to a surgery knowing what recovery you have ahead takes a very brave woman. Thinking about this caused me much anxiety throughout pregnancy! I also asked Drs at appointments about maternal friendly sections – these were not available! I just could not come at it! Most doctors I had seen in the clinic were apprehensive of induction with a baby over 4kg due to increased risks and had sited the risks to a baby over 4kg as well as risk to mother using syntoncin. A section a 39 weeks had been suggested a few times.

I had decided I would elect a c section – if I got to 41 weeks, If I was required to take insulin, if baby was estimated over 5 kg. It was my preference for the baby to have the benefits of labour – a bit of warning life on the inside was ending! It was also my hope to labour on my own without inducement but I was happier to have a tolac and I was very prepared for an emcs.

Why I chose induction for 39 weeks

At 33 weeks I saw Head OB Dr Amanda Dennis who knew I was on track for a large baby and said inducement would lower my chances of a successful VBAC but it could be done on a low dose of syntocin, but ideally I would go on my own by 41 weeks and that being left to labour unmonitored would be my best chance. Inducement would be reviewed pending further scans.

At 36 weeks I had a scan saying baby was 97th centile and estimated 3.66 kg with a 300g gain per week. I saw another experienced OB Shelby who took a look at my height, asked about my family sizes and was very cool and said simply your designed for a big baby, it has a big head, head comes out, shoulders come out! I felt much more confident! He did also reiterate that would reassess at 38 weeks and ideally I would have gone by 40/41 weeks.

At 38 weeks the Growth scans revealed 4.4 kg and once again looking at a 400g gain per week (normal expected gain is about 200g). I estimated at 39 weeks baby would be over 4 kg but not 4.8 kg like the scan said at 39 weeks. Previous scans had revealed baby to always be 80th plus so I was satisfied I was having a big baby I elected to be induced on 39 weeks. I was happy with baby’s development at that gestation and also comfortable with size.

My support post potential c section would be my mum and husband. My mother was going away three weeks after this date – ie 42 weeks, and my husband’s 6 weeks leave started at 40 weeks. If I got to 41/42 weeks again I think an induction would have been not on with my hospital due to my large baby and the associated risks and given the size at 39 weeks he didn’t need another 2-3 weeks to grow!

So basically it was induce soon, wait and hope for spontaneous or have a section at 41 weeks. I made the decision after my scan at my clinic appointment and saw a different Dr again – Ramesh he took a look at the scan did some OBS went over risks of uterine rupture with me, then booked the inducement in for the following week I was given a time frame of 8 hours.

Birth Story

Tuesday 16/2/2016 38+5
My husband and I dropped our daughter off a childcare and I held back tears knowing her world would soon be forever changed! We then headed to the hospital to get the Balloon catheter in for at least 12 hours. I was worried that we would be sent home due to them being too busy or that I would be 2/3cm and the would just do ARM! My husband left me for work for the day as we wanted to keep things quiet & he had a big load to get through before the baby came!

I had the balloon inserted and went about walking around the hospital, watching movies on the fitball, listening to calm birth tracks and more prenatal expressing. I was feeling crampy all day and getting regular Braxton hicks. I had really hoped my waters would break and things would progress. My husband and daughter joined me for dinner then headed home. My afternoon shift midwife said the Drs were busy and it was fine to just leave the balloon in overnight. I had a very sleepless night, just like the night before at home waking every hour or so! At 4 am I woke up and had some Obs done by my night shift mw who explained they were really busy so I wouldn’t be started at 7am, I was advised to get some rest.

Despite the 6 last trimester scans I still didn’t know what I was having and we had not decided on names, but out of nowhere I decided it was a boy and he would be called Caleb James.

Wednesday 17/2/2016 38+6

I had a shower and breakfast and was joined by my husband, we were told it would still be a while before we could get started so we went for a walk outside in the sun and I did some stretching! I had Anita as my day shift MW again and felt confident having another great MW. We headed around to the birthing suite and Anita told me to bring my toiletries to shower in the birthing suite afterwards. I really wasn’t sure if I would be taking that shower or not! I wasn’t even going to pick them up! But I did!

At 11:30 Dr Felicty broke my waters, it was like Niagra falls, Chris had to run for towels, it was crazy! My baby was not fully engaged and I had about 20cm of fluid at my last scan so breaking the waters in this situation there was a possible risk of cord prolapse. Amazingly enough the baby popped out of pelvis n went transverse! Dr Felicity and MW Anita kept their cool and used their experience to get the baby back into position. They then got the ultrasound to ensure that no cord was going to drop out. I felt so lucky to have already had these two experienced staff as I’m sure things could have easily gone wrong at this point and an emergency c section could have been needed.

I had been hoping to have 2 hours with just my waters broken (no Synto) and also some intermittent monitoring. I couldn’t believe it when Felicty said I could have 4 hours and no monitoring needed unless labour started! Yesterdays Dr said this was not possible. For this period I stayed on my feet walking around the room in my cross trainers, keeping my bladder empty and sitting on the fitball. I had less noticeable Braxton hicks and cramping for this period than the past 24 hours. We also made up our playlists to listen too as labour progressed! My girlfriend Phillipa who worked at the hospital came to wish us luck and bring me a can of coke! Aside from Phillipa no one knew we were there!

Afternoon shift started and I had Jane as my MW we decided to get on with the syntocin since nothing much was happening with just the waters being broken. Felcity came back at one point and said that she and Amanda Dennis had the same views on using synto, if you’re going to do it go all the way to 120ml. I was happy to have some Synto but didn’t want to be on a high dose. Contractions soon started and the synto was upped every half an hour by 6 ml I believe (12 is standard but not for VBAC). I was excited to be having contractions and just breathed through the bad ones! Jane also suggested here that the baby was likely in OP position which was like my previous labour! I was already a little deflated! There was also a lady screaming in absolute agony – this was very off-putting and left some doubts in my mind if I could do it!

I was also monitored at this point so spent most of the time standing and fitballing Jane and Chris were great at helping me move around but the CTG was very annoying so we had Felicity connect a head scalp trace to the baby at 5.30 pm during this time a VE was done and Felicty advised improvement on 11.30 am 3cm and soft and stretchy. I had a 90 minute routine which included a 15 minute rest and toilet break. I also had to have my blood sugar levels monitored every two hours. I tapped my foot a little here and swayed through the pain. The synto kept going up and I was having to concentrate more and more on them and let a few curse words go.

Towards 6 pm things were amping up and I sent Chris for his break as I knew soon I wouldn’t be able to be without him. I kept at my routine of fitball standing, toilet break and by 7.30 pain escalated again! Jane had said I still wasn’t in active labour even though contractions were 4 in 10 I think. A week on trying to write this and I really can’t recall much here. I breathed, counted back and fourth to 5, and pictured my Fiji Honey Moon to get through. These were lessons I had learnt in calm birth.

At 9pm I was speaking with one of my close friends mums Kim who is a MW at the hospital the Synto was at 54 which was the max it could be at that point, I told her that the contraction peaks were terrible but the breaks were great. The baby was doing well! Kim asked if I thought I needed an epidural.
I began saying how I didn’t want an epidural as I wanted to keep moving I also didn’t want much more synto. Kim was concerned I would become more tired, with little sleep Monday before my Tuesday morning admission it was already a long and tiring process. The screamer was going off again, or a new one arrived this caused me some anxiety! I really did need some pain relief now. Kim told me night shift would be on soon and Donna was working that she was very good and to trust the girls they would help make the best decisions. I was still calm and knew that I had to let things unfold and not let the pain take over.

I started thinking about a section, I was in bad pain but still mostly able to think clearly. I was happy that I had been given more than the 8 hours I was told in clinic I would get to labour. I said to my husbandnI felt like it was Tahlia’s labour again and that if this went on another 6 hours then I went to theatre I would be upset, and I was of course already exhausted as the previous two nights only 4 hours broken sleep.

I was also group messaging some of my mothers group friends my thoughts on the section and they were saying get the bloody epidural! Contractions were 40 seconds long and 2-4 minutes apart. I was saying if I had a section now I would still be happy as I got what I wanted in regards to induction methods and TOLAC. I know all of my other February mums really loved their epidurals so that was a plus for considering one.

By 9:30pm I was really sooky! I was on the bed and couldn’t stand any more – two days standing was enough! Night shift has started and Lucy was now my MW, Jane was on late hand over so was around for a while too. I was ‘due’ for a VE however Jane had said I was finally just in active labour and a VE would not be helpful. I was shaking and throwing up from the pain, I had some Maxalon and tried gas and heat packs, the heat was OK the gas was awful!

I discussed the section again with Chris and decided to get a VE if under 5 have a section. Dr Ramesh did this and said 4cm, as I was 3cm 5 hours earlier I was so was deflated baby was also confirmed posterior and still not fully engaged. It felt just like Tahlias labour again (I had failed to progess at 10pm at 4cm) and I was asking about a c section Jane, Lucy and Ramesh were all speaking I think Jane was saying that I had progressed as I was fully effaced and had only been in ‘active’ labour an hour. Ramesh was very respectful and said that I could have a maternal elect section or I could wait until 2 am for a further check on progression. At this point Chris took charge and said no section and I was to get the epi! All staff were agreeable and I was too but I did say no more synto increases.

A lovely Anaesthetist showed up seemly experienced and went about the normal procedure I felt confident again in her skill, until a registrar walked in and it was done in a verbal training mode. It seemed to take forever and I was asked to sit up and curl over quite quickly. It took a while to get it done and I just wanted an update. No one gave me one. It wasn’t painful but it was concerning as my previous epidural was very quick and done by some one very experienced.

Whilst curled over for the epidural procedure I felt immense pressure in the pelvis and the contractions were very strong! My breathing changed and Lucy told me to breathe not grunt! Once it was all hooked up I was moved back onto my side/back and I hugged the bed rail for dear life and clicked for the drugs! I was told only 3 clicks an hour. I had been very quiet the last hour or so. I sort of yelped out ‘poo’ Lucy was lifting up my bed sheet looking at my bottom, for the purple line or for actual poo I don’t know! I knew the poo feeling was good, but figured it was an actual poo since I had only been 4 cms moments ago – there was no way that was the ‘push’ poo feeling.

They then arranged the Dr to do a VE. Well bugger me 9 cm but baby was still only at station -2! The drugs had not kicked in yet and I think there was some talk of how far away the baby was, and if in fact I should be having pain relief. After a while the drugs kicked in and I became quite chatty in the contraction breaks and could manage them again. It got to 2.30 and the Dr did not return for the scheduled VE. After a while maybe 3.30 am Lucy did one and thought I was 10cm and that the baby was posterior and still station -2. So in the last 4 hours the baby had not descended any further.

I asked should I practise pushing and it was a strong no from Lucy! The Dr was tied up somewhere so Lucy consulted with Donna who came in and had me change positions as best I could to open the pelvis as I thought sitting upright was good, it was not! They discussed that even tho I was at 10cm without the baby coming down all the way I may require a c section. I knew this was a possibility as I have heard of this happening (a friend in my due group had pushed for 3 hours and her baby still wouldn’t come). They then waited a little while more and for the first time the fetal HR dipped a little, Lucy left the room to consult Donna. While she was gone Chris was watching the monitor very anxiously and I asked him did he want me to have a c section now. This was a where calm birth really came into play! I instinctually moved onto my left more as you always hear labours turning to the shit and women being tilted before the Drs come running in! I started thinking that we could go to theatre and do assisted delivery there or if that didn’t work we would be ready for emcs. I wanted my VBAC but a safe delivery was the priority.

Midwives Lucy and Donna returned and said it was time to start to push this was around 4.30 am! They explained how to breathe like swimming and asked me to do 3 good pushes per contraction. It took me a few goes but they were very encouraging and explained well! I had my legs up leaning on the stirrups and Chris and Lucy were holding each one. With the very first push I felt lightly the head hit! Lucy and Chris told me they could see the baby! I was not expecting that!

Dr Ramesh came in as well as a secondary Dr Sabrina, Sabrina was kind enough to take our amazing photos. During the pushing stage Ramesh commented on how he thought I was too tired. I was dog tired! I had been up close to 24 hours on bugger all sleep, but I could easily find the energy needed!

The epidural was really great, I could feel the pressure of baby start to crown it was very encouraging but not painful at all. Ramesh made some further comments about being worried I was going to rupture my uterus which is a big concern for vbac and large babies. The syntocin was only on around 40 or so here (it was stopped and re started with the epidural) so I was not concerned, I also knew that if that happened I was in the right place! Donna told him everything was fine. Donna made me feel very safe and secure and that my baby and I were in excellent hands.

During the pushing there was some blood and Ramesh was keeping pressure I believe on the perineum area. There was some talks of episiotomy and forceps too. Chris could see what was going on and said Lucy was being prepared by Donna to do an episiotomy if need be and that it was all very calm.

Donna took my ‘modesty blanket off’ and told me she would soon be placing my baby there! I couldn’t believe it!!! I was actually going to get a VBAC and not require assisted delivery or episiotomy! I was then asked to cough a few times.

Then my baby was born! It was an amazing moment. I was never sure I would vbac, I was never sure It wouldn’t end in emcs! I never imagined that I would have the most amazing staff who would push the outer policy limits to give me the best shot!

My baby was given a wipe down and then Chris was shown the gender – it was a boy! It was our Caleb!

I then had a PPH of 1.5 litres and the Placenta wouldn’t come out of the cervix. But Donna got it all out and I was not needed to go upstairs for that either! While this was going on Chris took Caleb and I grabbed at my nipples to stimulate the uterus I was thinking clamp down Uterus, somehow I was very calm. I put this down to calm birth!

Once this was all under control Caleb came back to me and had a feed. Sabrina stitched me up and I was required to stay in the suite while I got some more fluids.

Calebs Blood sugars were 4.7 needed to be 2.9 so smashed it!
Having gotten all the way through my VBAC was an amazing achievement, I had not a great deal going for me for the likelihood of the amazing outcome we got. I owe this to the fantastic staff I had on the day and my wonderful husband who supported me through pregnancy and supported my decisions.

We really did have an amazing and calm birth.

Labour preparation methods utilised
Maintained health, improved fitness by learning to jog in first two trimesters, walking, résistance training
Acupuncture – Pin & Tonic 36, 37 & 38weeks
Osteopathy – 35 weeks
Prenatal expressing – 35 weeks
Raspberry Leaf tea tablets
Cherie Chugg Calm Birth classes – also listening to the accompanying USB multiple times and practising visualisations
Reading a variety of birth stories from face book pages such as birth without fear
Birth skills – JuJu

Holly.

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