Isaac’s Birth Story – Water Home Birth After Cesarean with Preterm Classical Incision

This was my third birth but the first one I’ve been able to write about. I can’t even make it through the first sentence without fighting tears that swell with the pain that is carried from the first two. A little back story: my first birth was a hospital vaginal delivery to a baby boy with gastroschisis in 2011. My water broke in my sleep at 35 weeks and labor was eventually augmented with pitocin. I delivered with an epidural and epesiotomy and my son was taken straight to his first of many surgeries. My second birth was an “urgent” c-section in 2012, after my water broke in my sleep again, this time at 33 weeks 1 day. He was breech and because of this, my obstetrician performed a classical c-section, using a vertical incision in the upper part of my uterus. I was told that every delivery I would have going forward was going to have to be a repeat c-section at 36 weeks due to the increased risk of rupture for this type of incision. I spent the next two years researching my options, informing myself of the risks, connecting with women in similar situations, and consulting with many different providers, both obstetricians and midwives. Unfortunately, I met more hostility than support. I even had one doctor tell me that another pregnancy, let alone attempting a vaginal birth after cesarean (VBAC), would be like playing Russian Roulette with two guns – one pointed at myself and one at my baby.

I found my midwife Heather before even becoming pregnant. She was the only home birth midwife I contacted who didn’t give me an automatic “no way, Hosea”. I never managed to arrange a meeting with her though, prior to conceiving. As this pregnancy began, I was not at all comfortable with the idea of a home birth and was sure I wanted to have a VBAC in a hospital, in case anything should happen. I was also put on weekly progesterone injections in the hopes of making it full term for the first time. As I continued my pregnancy journey and learned more about the hospital’s “cascade of interventions” and about natural birth, I began to realize that many of the complications I wanted to avoid were actually caused by interventions and the safest way for labor to progress, especially with a “risky” uterine incision was to not intervene at all. When you labor with a scarred uterus, your body likely knows its limits better than your mind and will contract just how it needs to in order to get you through labor the safest way. Unfortunately many don’t realize this and when labor stalls or take breaks or is very sporadic, they want to intervene to get it back to the “labor bell curve” (or how labor “should” progress) and these interventions can strain the uterus beyond what it is capable of managing. I had to remind myself of this time and time again when frustration with contractions (or lack thereof) threatened to overwhelm me.

I met Heather for the first time around 21 weeks. Our plan A at the time was to make a 5 hour drive to a hospital in a neighboring state that was “tolerant” of my decision to VBAC. Each appointment with them gave me more of an uneasy feeling and I eventually decided to stop seeing them and a home birth became plan A. I cried with relief the whole ride home after meeting her; finally, someone believed in me and my ability to birth as much as my heart was screaming for them to! When my husband met Heather, he was also very impressed with her knowledge and experience. I remember while waiting for her to arrive to this meeting, he was adamant that we needed to request references form her and check them out. After out meeting, I realized we forgot to ask her for references. I voiced this to my husband and he responded “Nah, she’s good!”

Thursday October 9th (37 weeks 6 day) I was having more difficulty walking than usual; I’ve had pelvic issues throughout this pregnancy but today felt different – so much more pressure on my tailbone and in my butt and it felt like a bowling ball was between my legs. My Braxton hicks contractions were beginning to come more frequently. The day before, I had a good run of contractions about 5 minutes apart that lasted for a few hours but faded once my toddlers woke up from their nap. They weren’t as frequent this day but I kept feeling like I had to have a bowel movement, though the many trips to the bathroom produced nothing. That afternoon, I went to what would be, one way or another, my last appointment with the local OB I was seeing for prenatal care. This ended up being one of the worst appointments I’ve ever had. He literally grabbed my hands and begged me to let him just do a c-section because he was afraid my baby and/or I would not survive a home birth. I’ve never been made to feel more uncomfortable by a care provider as at this appointment. When I left, I knew I didn’t want to go back. I was secretly hoping that I would deliver before my next appointment with him on Tuesday. When I got home, I sent a message to my midwife, checking in and updating her as to how I was feeling and also our address so she could program it into her GPS. Around 5:30pm, I was working on cooking dinner when one of my toddlers needed a diaper change. I laid him on the rug and went to kneel next to him. As I squatted, I felt a small rush of fluid and immediately thought I had peed myself. Usually I have more control over it but it wasn’t enough to make me think it was my bag of water. I had my husband finish the diaper change so I could change my pants and finish cooking dinner. Over the next hour or two, I would have an occasional trickle of fluid and started to question if it actually was my water. It wasn’t a constant trickle of fluid and it certainly wasn’t the unmistakable gush of fluid that accompanied my first two pregnancies. You should have seen me with a mirror trying to figure out where the fluid was coming from; I’m sure it was pretty comical. Nursing the boys to bed that evening brought on some frequent and uncomfortable contractions. I gave my midwife a call once the boys were in bed to update her on the leaking fluid. She said it sounded like a high leak, where the fluid can come sporadically, and to keep her posted on contractions. I took a hot shower then turned in for the night. The contractions spaced apart after going to bed but were enough to keep me up most of the night. Around 1:30am, I had an episode of loose stool and around 2am, enough fluid leaked to get on the bed sheets. It was still coming sporadically, just like the contractions, and still only a trickle each time. The contractions were feeling more powerful than before, especially into my hips, back, and butt.

Friday morning (38 weeks), while nursing one of my toddlers, the contractions were coming every 2.5-3.5 minutes and lasting about 45-55 seconds. Fluid was still sporadically leaking, especially every time I would sit on the toilet. I checked in with my midwife and updated her on my night and morning. Once the toddlers stopped nursing, the contractions spread out. I went about my day as usual and was even able to take the boys for a walk to the boardwalk. I was having a much easier time walking today than I was yesterday; the back pain was still present but the feeling of having a bowling ball between my legs was gone. Contractions were still sporadic but by the time I was cooking dinner, they were coming more frequently and were very uncomfortable. I tried different positions, especially “cat-cow”, to try and relieve some of the back pressure and pain, but that seemed to cause more sharp cramping, most likely from the baby’s head pinching against my pubic bone. After sitting for a while, the contractions faded again until I nursed my toddlers to bed. They got to the point where I had to breathe through them and couldn’t handle them sitting down in the recliner. They were lasting over a minute long and each one was bringing a trickle of fluid. Not 5 minutes after my husband brought our second child to bed, around 9pm, I had a strong contraction that brought fluid with it – and then the fluid just kept coming. I grabbed my skirt and rushed to get off the rug and onto the hardwood floor while my water completely ruptured in the unmistakable gush I was waiting for. My husband threw me a towel to stand on and ran to grab a Depends (yep, the adult diaper. Boy were they amazing!) and a change of clothes. I called my midwife Heather and we decided that her and her apprentice Becca would come because neither of us knew what to expect from this labor and they were coming from almost 3 hours away. In those hours it took for them to arrive, my husband rearranged the boys’ playroom and inflated the birth pool we were borrowing from a friend.

My contractions spaced out again so I tried breast pumping, which worked to get them close again but only while I continued to pump. When Heather and Becca arrived, contractions were still not coming steadily. Heather checked my fundal height (The location of top of my uterus; to set a baseline for future dilation assessment) and listened to the baby’s heart rate (140s-150s), then I tried pumping again. As the contractions spread out once pumping stopped, we decided to try and rest some and work on getting them going in the morning. Sleep was sporadic again that night, with strong contractions that would wake me and came with every shift in position.

Some of the timeline and spacing of contractions from this point forward was provided by Becca at my request; time had become irrelevant to me.

Saturday morning (38+1), I was awake bright and early and ready to get labor to kick in. Once my toddlers woke, I was able to nurse them which helped at the time. Heather suggested walking around, so around 9am, we decided to take a trip to Wal-Mart while my husband stayed home with the boys and watched “The Muppets take on Manhattan” again (current favorite movie, watched in total 2.5 times this day!). On the way to Wal-Mart, I stopped at a gas station because we realized we forgot to pick up vodka for the placenta tincture I wanted to make. Buying vodka first thing in the morning when you’re 9 months pregnant and in labor is awkward, to say the least!

*Edited to add:
As we approached the entrance of Wal-Mart, my heart stopped; who else in the world would be walked out the doors but the local OB I had been seeing! Not even two days prior, he was begging me to let him perform a c-section because a home birth would kill my child. Heather and Becca could tell I was in startled but were unaware as to why. I didn’t want to point him out and draw attention to myself, so I walked quickly, trying my best to hide behind them. I was holding my breath and silently praying that no contractions would overtake me until I was safely inside and away from his sight. Could you imagine if he saw I was in labor?! At this point, my water had been leaking for about 40 hours and completely ruptured for 12! We were not seen by him and once safely inside, I exhaled in relief and explained my odd reaction to Heather and Becca. That close encounter left me shaken. Those simple words of his, harmless as he thought and with his best intentions (though perhaps not), resonated through my head like an unceasing echo. ‘What am I doing?’ I thought to myself. Doubts tried to creep back in and I had to consciously push them from my mind again and again. It’s amazing how powerful simple words can be when you become vulnerable in labor.*

Walking around Wal-Mart helped to get the contractions more frequent and intense. I had two big contractions about 20 minutes apart, while there. I remember thinking I was nearing the end of one when it surged again, as though my body was saying “just kidding.” I decided I wanted to try and do make lasagna for dinner, in the hopes that cooking would stimulate contractions like it did yesterday evening, so I picked up the ingredients I would need and we headed home around 11am. After coming home, we got lunch together and fed the toddlers, then my husband tried to get them down for a nap. My contractions were still averaging 15-20 minutes apart. Nursing my toddlers before their nap brought them closer to 7.5 minutes apart. We called a friend to come and watch them for us so we could go outside and walk up some big hills. She offered to fill the birth pool while she was there, so it would be ready when we returned. I can’t say how long we were out walking but the contractions were more regular and I was noticing different types of contractions. Some I felt more in the front of my belly and then felt like they were pushing things downward. Some I felt more in my back and hips and butt, and some just felt like a belt of pressure all around my belly and back. My husband climbed the hills over and over with me, reenacting Rocky’s triumphant fist pump at the top each time. We would scale the steep one a few times, then take on the more gradual one, pausing to embrace through each contraction. I had to use the porter-potty at one point because each contraction brought tremendous pressure and it felt like my bladder would give out at any moment. It was actually one of the cleaner ones I’ve ever visited.

When we returned home, the boys were awake and watching The Muppets again. My contractions continued more frequent than they had been all day, about 7.5 minutes apart. I sat on the birthing ball and tried to distract myself on Facebook for a little while, until I came across a friend’s post; she and I were pregnant at the same time, her being 2 weeks ahead of me. She delivered her daughter that morning. I couldn’t help but think “How unfair is that?! I went into labor first but she’s already delivered.” This was one of those moments I needed to remind myself through frustration that my body knew its limits and was laboring just how it needed to get us through safely. I decided to try laboring in the birth pool for a while, so I changed into my bathing suit top.

In the pool, the contractions themselves were felt more acutely but the warm water’s cocoon enveloped me and the weightlessness of being in water allowed me to relax more deeply between them.

While I labored in the pool, Heather left to pick up some groceries so she could cook dinner and dessert for us, allowing me to simply focus on laboring. I’m not sure how much time I spent in the pool but as supper neared, I got out and walked up and down the stairs a few times, stimulating more contractions. I wanted to stay as active as I could, in fear of stalling out again. I could feel the edges of fatigue creeping in. It had been a long couple days without enough sleep between them. I tried eating dinner but only managed to nibble between contractions. My stomach already felt full and my appetite had faded away. After supper, another friend came a picked up the boys and brought them to her house for a few hours. I can’t recall if during this time, I labored on land or in water. The boys returned around 8pm and after my husband got them ready for bed, I nursed them to sleep. I couldn’t handle the contractions reclining on the couch so I sat on the floor with a heating pad on my lower back to nurse them. They were starting to come about 5 minutes apart. Around this same time, Heather brought me a drink of water with tinctures and honey. I can’t say if it was the nursing, the tinctures, or a combination of two but the contractions began to come harder and faster than they had been all day. I laid on the couch and she checked my fundal height during a contraction to see how far I was progressing. I changed and climbed back into the pool. It was becoming more and more difficult to relax during the contractions. I found the best position to resist tensing up was to hang over the side of the birth pool during a contraction.

Relaxing in between contractions, I feel a sudden urge to be connected to my husband. He was sitting across the room at the time, watching me labor to bring forth our child. I beckoned him to me and grasped his hand in mine. It only lasted until the next contraction but this physical connection renewed my strength more than he could understand.

I had been drinking Red Raspberry Leaf tea all day long and was beginning to regret it. I kept having to leave the pool to go to the bathroom. I knew I was guaranteed a contraction as soon as I sat on the toilet and in that position, they felt sharper. I dreaded having to make the trip there and back. When the contractions were coming very frequently, I wouldn’t even make it back to the safety of the pool before having to fall to my knees and surrender to one. I was feeling exhausted and chilled, so more water was boiled on the stove to replace the cooling water in the pool. With one of the refills, Heather added some essential oils and the aroma was heavenly. I inhaled to my bones and was grateful to feel some tension fade between surges.

At some point, my husband found “I Love Mud” by Rick Charette and played it for me, the moral being I had to go through this to reach the end, no ways around. I also remember him asking if I felt like a circus act or something like that because the three of them were sitting across the room, just watching me.

By 10pm, the contractions were coming 3 minutes apart, and by 11, they were down to 2 minutes apart. Around midnight, the contractions began to change in sensation and the pain became more terrible than I could have imagined. I knew this must be transition. The contractions brought an unearthly burning into my lower back and pelvis. I swore I was breaking apart. The pain seemed to have no boundaries, no limits, and was pushing beyond what I could bear. I couldn’t tolerate them without pressure from my husband, holding me together so I wouldn’t shatter into pieces.

I was becoming more restless between contractions and couldn’t find a position that didn’t hurt. I was rocking and swaying and trying to surrender to the pain. I didn’t think transition lasted this long! It felt like hours were passing and no progress was being made. I began to doubt this would ever end. I began to think that a c-section would have been so much easier. I longed for an epidural to find respite from the fire alive in my hips. Nausea was overwhelming me and I vomited. Eventually, the time between contractions seemed to lengthen and I caught myself nodding off between them. I could only think of the “rest and be thankful” stage, but there was no great pause, just more space between. While I had felt chilled in the water before, I began to feel flushed and requested a fan in addition to the cool washcloth I was using. Around 1am, my vocalizations began to morph from moans felt high in my body to deeper-seated grunts. My husband asked if I wanted to push and I found I was resisting the urge because it felt like I was holding back loose stool. I made another trip to the bathroom and indeed, I was right. Another contraction overwhelmed me and I vomited again. After making my way back to the pool, I felt more at ease trying to push. I didn’t feel an overwhelming sensation to do so, but I was able to direct the pressure from the contraction into a more downward force. At this time, I was in a squatting position, with my back to the side of the pool.

One of my legs was cramping up and it hurt to bend and bear my weight. Heather had my husband fetch a bed sheet and he climbed into the pool with me. The sheet was looped under my arms and during contractions, he would suspend me, allowing me to surrender more deeply to the gravitational pull downward. I could feel the burning shifting from my hips to my perineum. I could feel the bones of my pelvis being pushed apart by a round mass forcing its way between them. It felt to be the size of a bowling ball, though I knew in my mind it was much smaller than that. I reached between my legs and felt an incredible bulge. I didn’t realize how far I had progressed until I could feel that bulge and had his hair in my palm. I stroked the top of his head and knew we were almost through this. I couldn’t bear being in the position any longer, so I went to my hands and knees. In this position, I could feel my body beginning to push during contractions, like waves that surged down and out of me. It still wasn’t feeling right with my hands on the bottom of the pool, so I leaned onto the side. I used one hand to feel the progress these waves were making and support his head as it slowly emerged. The ring of fire was burning white hot, but at least I could feel the boundaries of this pain beyond which, it didn’t swell like the pain and fire of transition. I remember Heather telling me that once his head was out, I would experience an incredible relief, then I would feel him turn and during the next contraction, the rest of him would emerge. I wasn’t sure how much further I could stretch apart for him. When I reached down, it stung to touch so I just focused on breathing through the waves. I remember feeling the part where his ears and nose slid by and then the relief was immediate. I was expecting a pause, but instead felt his body turn inside me and the rest of him slid forth. I sighed in relief, then sat back so I could reach for him. I grasped him beneath his arms and then moved to bring him out of the water, only to realize that his cord was wrapped over his shoulder. I rotated him so he would remain under the water, then unwrapped his cord and brought him out onto my chest. That was the moment that, until now, had only existed in my dreams! 2:33am, Sunday October 12, 2014 (38 weeks 2 days). 57 hours after my water started leaking and almost 30 hours after it had ruptured completely.

I watched my son as he worked to clear the fluid from his lungs and take his first breaths. He had a calm, quiet cry that escaped his mouth between efforts. His butt was covered in a thick layer of vernix, a substance I’ve always wondered about. Finally experiencing it, it felt thick and waxy, reminding me of the lanolin cream I’ve used on my nipples in the past. His head was very molded, a tribute to his effort descending through my pelvis.

A towel was placed over him to preserve some warmth and he continued to pink up with each breath he took.

Isaac was born safe and sound into my arms and the overwhelming relief that we were both here and safe and alive overtook me.

From this moment, time seemed to slow down. I had help untying my top so I could try to nurse Isaac but my breasts were below the water level, so I just held him to my bare chest.

It was sometime in these moments that Heather realized I was bleeding a bit more than she would have liked, so I was helped out of the pool. I remember looking into the water as I climbed out, still clutching Isaac to my chest, and I saw large clots in the pool. Blood poured out of me as I was helped to the couch. I made a feeble attempt to latch Isaac to my breast but he wasn’t showing much interest. Heather kept checking his cord for a pulse and eventually cut it and took him to my husband who was waiting in the next room (because of the blood).

I wasn’t feeling cramps, so Heather was massaging my uterus while Becca grabbed my breast pump and helped me try to stimulate my uterus to contract. I felt as though I was fading and wanted nothing more than to close my eyes and fall asleep. In that moment, I didn’t care that the cord was cut and not burned, I didn’t care that I wasn’t still holding my child. All I wanted in that moment was to surrender to the exhaustion and close my eyes. But I fought against it. I was fed tinctures and massaged and at one point, felt a contraction, so I stood from the couch. I could feel my body pushing on its own like it did to welcome Isaac and I felt my placenta slide from me. I moved to catch it but wasn’t quick enough and I believe it landed on the floor. I was still bleeding, so I was helped back onto the couch. Heather said we would have to transfer for pitocin if the bleeding wouldn’t stop. I made the suggestion to consume a piece of my placenta to try and get the bleeding under control. Heather cut a small piece from it and brought it to me. I placed it in my mouth, between my cheek and gums. It was warm, soft, and spongy but didn’t seem to have any distinct flavor. I held it there for a while and eventually the bleeding let up. Heather asked if I wanted to try and shower, which I did, so I swallowed the piece of placenta and was helped from the couch into the shower. I wanted to wash my hair because “I had goo in it” from the birth pool. I felt weak and dizzy during the shower and was fed more tinctures. I think I may have sat down to keep from blacking out at one point. My memory is a bit fuzzy. After my shower, I was helped to the couch and given my son. This time, he latched effortlessly. I may have dozed off while my husband, Heather, and Becca worked to clean up the birth room.

Time was still irrelevant to me at this point. Once the room was cleaned, Heather suggested I try to empty my bladder. She couldn’t leave us until I was able to. I tried but was unable to pee. She put a few drops of peppermint oil into the toilet to try and help but I still couldn’t do it. I put on a nightgown and made my way back to the couch. Heather performed Isaac’s newborn exam (6lbs 15oz), checked me for tears (finding only “paper cuts” at the time; I found a larger tear later that day but it’s in a location that can’t be easily repaired, so it’s being left to heal on its own), and then we all decided to try and get an hour of sleep. I dozed off with Isaac on my chest.

When we woke, I was able to get to the bathroom and it wasn’t any trouble at all to pee. What a relief! I felt so bad for how long Heather and Becca were with us. None of us really had any idea how long it would take to welcome this beautiful bundle into the world. I am grateful beyond explanation for so many thing – for my God and the intercession of St. Gerard, whom I leaned on so heavily for this pregnancy. For my husband, who supported me throughout the pregnancy, labor, and delivery, and who went out of his comfort zone to support a home birth, trusting my judgment. For Heather for believing in my body as much as I did and supporting me without any hesitation or doubts. For Becca, for supporting me through labor and delivery, and capturing the most amazing moment of my life on video! For myself, that I listened to my heart and did not surrender to the fear. And looking back, I absolutely have no doubts that choosing to birth at home was the best and safest decision for us. There is no way we would have been able to delivery in a hospital without any interventions after having my water ruptured for so long. Delivering my child into this world after being told I was incapable of doing so safely by so many people has left me with such a raw feeling of power in my body. I did it! And for the first time in my life, I have a healthy newborn to hold.