Whitney and Ben had an unplanned cesarean with their first daughter, and decided they wanted to try for a VBAC this time. We met at a Doula Info Session over the summer when they were just beginning to think about this birth. They took a Planning your VBAC class and a Labor Skills class, and we talked and prepared. Their doctor was supportive to try for a vaginal birth until 41 weeks. At her last checkup she was only 2cm dilated and very thick at 20% effaced.

 

Whitney thought her water broke around noon on 1/26 but nothing much was happening. Overnight on 1/26 and 1/27 Whitney had increasing contractions which kept her up most of the night, but by morning they had “pooped out”. They did a morning walk, but contractions were still nowhere near the intensity or frequency they had been overnight. We decided to have a meeting to discuss options/expectations.

 

I met at their house around 9:45am and we talked about the “what if’s” — if indeed her water had been broken now for 20 hours, and she was not in labor, it was likely they would end up with another cesarean later today. I know that was not what they had hoped for, but they understood the reasoning, and were mentally prepared. We did a few “spinning babies” techniques to help the baby engage into the pelvis better (just in case that was the problem with the start/stop labor) and then Whitney called in to the Dr’s office.

 

They alerted me that he was out for the day and were headed to L & D around noon. Apparently the contractions had started picking up. In triage, the nurse checked her and she was 3.5cm and 100% effaced! BUT- her water wasn’t broken. Wow- that’s what all those overnight contractions had done! Since she was having contractions every 5-6 minutes, they decided to keep her and check again in an hour.

 

At 1:45pm Whitney texted me again and said she was now 4.5cm and they were admitting her! She was in labor! They were moving to a labor room, told me to “take my time” but I went ahead and packed up and headed over. I arrived there at 2:30pm and was glad I did. Whitney was on her hands and knees on the bed, working hard through the contractions! It was a distinct change from when I saw them just a few hours before. Ben was calm but happy to see me.

 

I helped Whitney remember to use her vocalization (dying cow) sounds and that helped her get focused again. Ben was doing the double hip squeeze which helped a lot. She had a lot of hip and back pain.

 

The doctor who was on call came in around 3pm. He took Ben aside and said he understood that they were hoping to VBAC and reviewed what he thought an “ideal” VBAC candidate was, and we’d have to see how today went. We were having a hard time keeping the baby on the monitor with Whitney in the hands and knees position, so he was worried about the baby. Overall, he didn’t seem overly supportive or pleased, but luckily, we had a super supportive nurse who reminded Whitney and Ben of their rights and the safety of VBAC.

 

Whitney continued to work hard, we took a bathroom break, where she started to wonder about pain meds. Because the epidural had significantly slowed her labor last time, she hoped to do without, or at least get one very late. I suggested some IV meds in the meantime to see if that would buy some time. Our nurse could see Whitney was progressing quickly and suggested an exam before the meds- at 3:45pm Whitney was already 6cm! Things were moving well. She received the dose of Fentanyl at 4pm and was able to relax more. The contractions were still strong but the intensity was less.

 

We helped Whitney with ice packs, hip pressure and counter pressure, but within 30 minutes she was feeling overwhelmed and asked for an epidural. We hoped that with her moving so quickly now it would not have a negative effect on her labor.

 

Our nurse got fluids started and we continued to help Whitney manage the contractions. Around 4:45pm she started to gently “bear down” with the contractions and reported she was feeling some rectal pressure. Hooray! That was great news. We assured her she could still get an epidural. At 4:59pm her water broke, (for real) and we wondered if she would progress to complete soon! The nurse did another exam and found her to be 9cm! The doctor walked into the room very soon after the exam and was genuinely surprised to hear such good news!

 

Anesthesia walked in the room at 5:07pm and by 5:20pm he was done. It was literally the fastest epidural in the west! It took a few minutes but in a short time, Whitney was feeling some good relief! By 6pm her foley catheter was in, peanut ball in place, and she welcomed the chance to rest. I encouraged Ben to take a quick break and get some food.

 

When he returned, we talked about how crazy this day had been- physically and emotionally, from this morning thinking her water was broken and planning for a repeat cesarean, to full blown labor and now 9cm dilated! We wondered which of the “spinning babies techniques” did the trick- or had it been a combo? We’d never know.

 

At 6:30pm the nurse did another exam and reported a “tiny” bit of anterior lip left- 9 ½ cm/100/+1. The baby had come down a lot! She recommended let Whitney rest more and let the baby move down. We tried switching Whitney to her left side, but the baby would have nothing to do with it, so back to her right, where she remained happy as a clam.

 

I encouraged rest again, since I knew Whitney would need energy for pushing. Our new nurse came on at 7:20pm and checked Whitney at 7:45pm- officially complete and ready to start pushing! We started at 8pm and within an hour we could see lots of hair! It was exhausting work but with the nurse’s help and Ben’s and my encouragement, Whitney kept going. At 9:40pm the baby was nearly crowning so the doctor was called in. After 15-20 minutes we saw that Whitney wasn’t making much more progress, and he suggested a small episiotomy to release the tissue and help the baby come more quickly. It worked! Jocelyn Morgan arrived at 10pm on the nose and was immediately placed onto Whitney’s belly, where they could welcome their daughter with love. I reminded the doctor they hoped for a delay in the cord clamping, which he honored. Jocelyn had a lot of fluid in her lungs, but after a few moments, she was crying vigorously and worked it out on her own. Whitney was thrilled it was over and so happy she got her VBAC!

 

Comments are closed.

How does a doula really make a difference?
Results from different studies have all suggested that having a doula reduces the overall cesarean rate by 50%, Pitocin use by 40% and requests for epidurals by 60%. The use of a doula also showed a major reduction in the length of labor due to fewer stress hormones being produced in the laboring woman’s body.

The Doula Book © 2002; Klaus, Marshall, Klaus and Kennell.