Levi Alexander Plyler
August 19, 2010
7lbs 3oz 20" Long
Today was the day! Once again plans had changed due to uncontrollable blood pressure issues. Thankfully I was given the option to try for an induced VBAC instead of having to have an automatic repeat c-section. I hardly slept at all last night for several reasons. Number one, I was a nervous wreck about the events that were about to take place in just a few short hours, and I was also really uncomfortable and having some contractions as well. All in all I got about two hours of sleep, but the adrenaline kicked in this morning for sure - I was so excited! I got out of bed at 4:30am, sat on the edge of the bed stroking Ava's head and rubbing her back for a few minutes. I laid down again beside her, cuddled her close, and shed a few silent tears knowing that the next time I saw her she would no longer be the baby, she would be a big sister! I knew big changes were coming for her and I prayed she understood that mommy still loved her beyond words. I also took a few minutes to pray and ask God for strength for the coming events. I asked him to please give me the strength to do this, to please keep both Levi and I safe and healthy, and if it was his will, to please allow me this healing VBAC that I desired so much. My mom and dad arrived at 5:30 to stay with Ava until she woke up. A few words of encouragement, a quick hug and kiss from my parents, and we grabbed our bags and headed out the door!
We arrived at the hospital at 6am and nervously headed up to Labor & Delivery. A quick detour to the newborn nursery to take a peek at the littlest arrivals and the excitement grew even stronger! I was taken to my room - Room 5 - where I changed into my own personal "labor gown" - a nice comfy nightgown of my own from home. I then signed all my paperwork and consent forms, and crawled into bed to get my IV line started for fluids, and later, the Pitocin which would induce my labor.
At 7:00am shift change, I was assigned my nurse - a WONDERFUL nurse by the name of Paola. She was very supportive and super, super sweet. She came in and went ahead and started the Pitocin on the lowest dose possible. I had several questions about the progression of the Pitocin and she was happy to answer all my questions. She also asked if I had a birth plan written out and if she could have a copy of it. She said she was going to go check on another patient, look over my plan, and she would be back soon. Shortly, she appeared back in the room. On my birth plan introduction, I mentioned that I was really firm in my choices because of so many things that went wrong during my daughter's birth. Paola was genuinely concerned and wanted to know all about Ava's birth - what went wrong and what I didn't like - and was so sympathetic to everything. She really calmed my nerves about some of those things not having a chance to repeat themselves simply because of this hospital's protocol which was great. She did make me aware that someone from the newborn nursery would be coming to discuss the Vit K injection and Antibiotic Eye Ointment with me since I was refusing those and I would need to sign a consent form. I noticed by now, my contractions had started and were 5-7 minutes apart and felt like really strong menstrual cramps. I had Paola dim the lights on her way out and I tried to rest a bit while I could.
9am rolled around and my midwife Pam arrived and we went over my birth plan. A few slight changes needed to be made, and that was ok with me. First off she said if the Placenta looked ok it would be no problem to take it home but she cautioned me in encapsulating it because of the large amount of toxins that had built up in it due to the blood pressure issues and medications I had been on my entire pregnancy. She said at this point it would be of no nutritional value to me. She also mentioned that if the OB she was "under" started pushing "Failure To Progress", we'd discuss AROM (Artificial Rupture Of Membranes - aka - Breaking My Water) or placing an internal contraction monitor just to show I was making changes, but if I was progressing nicely we didn't have to worry about AROM or internal monitors. She said she would come back in a bit to check me and increase my Pitocin. My contractions continued nicely. At this point I was in bed still trying to rest up for the day but baby didn't like that and my back was absolutely killing me laying in bed. While laying on my back, Levi was having heart rate decelerations with each contraction. Tried turning me on my left or right side and still decels. So I got on my birthing ball which felt so, so, so good but after nearly 1/2 hour of constant readjusting we couldn't stay there either because she couldn't get a fetal heart tone tracing at all because of my position. She asked if I thought I could stand, and I did. So I stood and swayed through contractions for the next hour or so and the decels stopped thankfully. It was getting really uncomfortable standing through contractions and I wanted so badly to sit down, but they said we had to get a fetal heart tone tracing, so I continued swaying and standing. By this time, I also had a full audience. My grandmother, mom, dad, and Ava had arrived. Originally, I had planned on wanting my mom, dad, hubby, and Ava in the room during labor, and hubby, mom, and Ava during delivery, but all of the talking, the fussing from Ava, the noise from Ava's toys, ect.. was really, really breaking my concentration and I couldn't deal with it. I asked my mom to please get everyone out and NOW! She decided to go ahead and take everyone back to my house and then come back.
At 10am, Pam came in to check me and bump up my Pitocin. At that point I was 3cm/80%/-2 station. By this time I was getting more and more uncomfortable and was also getting fearful because 100% of the pain was in my lower back and I know Levi had to be posterior, or "sunny side up". Thankfully, my nurse Paola called the doula who was supposed to be coming in for her shift at 12pm and let her know someone really needed her. Catherine (the doula) was willing to come in 2 hours earlier so she could help me, and oh what a help she was! She got there around 10:30 and I explained to her my fear of a Posterior baby and she suggested lots of things. She also looked at my belly and noticed the dip in my upper abdomen and also that he was most definitely off to one side and not in optimal position. I stood and did hula hoop circles with my hips between contractions, and during contractions I sat down in the rocking chair while she pushed me back into the chair by my knees which put lots of gentle counter pressure on my back and helped ease some of the discomfort. By this time, my mom had arrived back at the hospital and swapped places with my husband while he went for a breather walk and to get some coffee. When he came back things had intensified and I was feeling so sick to my stomach. He smelled so strongly of coffee and I remember telling him to go find a mint, mouthwash, gum or something because the coffee smell was going to make me puke. He disappeared, and came back smelling very strongly of mint gum which also made me feel horrible and I had him get rid of that. Again he came back and this time decided to sit in the corner of the room and hope I didn't bite his head off again. My mom got cool washcloths for my neck and head at Catherine's suggestion that they may help with the nausea, and they did! Around noon my Pitocin was upped again. Contractions were now 1-3 minutes apart and were really, really strong. I breathed deeply and let out a long, low pitched moan through each contraction and that seemed to help more than anything. It was slightly frustrating because my contractions were not showing up on the monitor, but it was vividly obvious I was having them! Would have been nice to have "tangible" proof though! Catherine continued to push my knees back pressing my back into the chair, and I held my my husband and mom's hand and squeezed really tight, all the while keeping my eyes closed and praying to God to help me make it through this. "I can do all things through Christ" were words I repeated over and over to myself through each and every contractions. I could feel God's hand on me. I kept reminding myself over and over that my body could do anything for 45-60 seconds and that I could and was in fact doing this! Catherine, my mom, and my husband helped keep me focused. Several times I allowed the contraction to overtake me but I was able to regain control with their help.
Around 2:30pm I was feeling defeated - like I hit a wall. I just couldn't take another painful contraction. I knew I wanted the epidural. I just knew I wasn't progressing despite all the contractions and I felt like I couldn't do anymore without some sort of pain medication. I remembered the immense relief the epidural brought when I got it at only 3cm with my daughter - the pain vanished and it was so nice. My husband reminded me of what I had told him that morning. To please, please encourage me not to get the epidural. To remind me that it may slow my progress and would confine me to bed. That this is what my body was made to do, and I could do it. We made it through two more contractions and I asked for something to take the edge off. They asked if they could go ahead and check me first, and I agreed. The nurse checked me at 3:00 - a solid 5cm/90%/-1 station. They gave me one dose of Nubain which didn't seem to help with the pain in the least, but it did allow me to rest more between contractions and helped me to relax my tense body. I seemed to drift off in a dream-like state between the contractions, which was nice. The entire time from here forward, I said positive birth affirmations to myself and silently talked to my precious baby boy - letting him know it was time to come out and into mommy's arms.
My blood pressure spiked a little at this point and I was given my daily dose of BP medication and asked to lay on my left side for just a bit to bring it down. It did the trick and it quickly returned to normal. I was doing ok laboring in bed at that time and even though I knew I had a much better chance if gravity could help me, I also know laying down kept Levi on the monitor and kept my blood pressure down, so I decided to stay. I started feeling very nauseous again at this time. I swore I would throw up, but I didn't. I said I couldn't do this anymore, I just can't. By this time it's 3:50 and my midwife came in to check me and I was 8cm/100%/-1 station. THIS is why I hit the wall. THIS is why I'm nauseous. THIS is why I feel like I can't do it anymore! I'm in the peak of transition. I went from 5cm to 8cm in less than an hour! 3-4 minutes go by and I yell that I feel like I need to push! She said to blow, blow, blow and lets check - checks me and still 8cm and membranes are still intact. 1-2 minutes go by and I yell again - I have to push!! This time, yes, sure enough I'm complete, 10cm!! I was overjoyed! I made it! I was fully dilated! 8cm-10cm in about 5 minutes, and I made it from 5cm to 10cm in slightly over an hour! I couldn't believe I was actually getting ready to push my baby out and into this world!! About that time my membranes spontaneously ruptured - nice clear fluid. My husband was grinning from ear to ear and my mom had tears in her eyes! It was almost time to meet our baby boy!
Pam quickly grabbed all the supplies between contractions. The next two contractions my body pushes on it's own without any help from me. I need a little direction in pushing since this is my first vaginal birth and I'm a little unsure of exactly "how" to push. I can tell at first I'm pushing with my head and face - which will later be obvious by the bruising and broken blood vessels in my eyes and face. Pam and Paola both just give me help on where to push, never once did anyone yell in my face "PUSH" or "PUSH 2, 3, 4, ect..". No counting no yelling, just quiet direction which I really appreciated. I pushed through numerous contractions in about 20 minutes and couldn't feel baby coming down at all. We kept on pushing and slowly he started to come down. Pam tried to help things along by applying lots of mineral oil up around Levi's head and by reaching in and trying to 'help' his head come on through. This was very, very painful - I ask her multiple times to please stop whatever it is she's doing, but she doesn't. After about 40 minutes he's finally making some good progress but she quietly mentions to the nurse to page Dr. Stallard - the OB on call - for a potential vacuum extraction. I had my mom holding one leg, and my husband holding the other - I glanced back and forth between the two gaining every ounce of support I possibly could from them. The next several contractions I am determined. I will do this. There was no way I was letting them suction him out when I knew I could do it. I will push my baby out. 2 more pushes and his head is 100% out! 1 more push and I deliver the shoulders and body!!! I did it!! I birthed my baby vaginally!! No epidural, no vacuum, and most of all - no c-section!
Since it was in my birth plan, Pam had originally planned on letting the cord stop pulsating and become silver before clamping and cutting so that Levi could receive all of his cord blood, but right after he came out there was some meconium in the fluid that followed him after birth so he had to be suctioned immediately - he was also a touch limp and pale also. Daddy was able to cut the cord and Levi was placed immediately skin to skin on my chest - covered in blood and other birth fluids and I loved it. I loved him. I was able to hold him for just a minute while they suctioned him but he was having just a touch of difficulty and had to be taken over the to assessment table and NICU was called for an assessment. He needed a little help, but was soon breathing perfectly.
Delivery of the placenta was a little rough. Cord traction was done and it felt quite painful - as if she was pulling way too hard. The placenta released and Pam looked at it thoroughly and decided it wasn't quite all there and neither was the amniotic sac. Uterine massage was performed and Pam spent a good 45 minutes manually extracting what was left inside. This part was actually more painful than any of the contractions or birth and I was given another dose of Nubain during that to help me relax and take the edge off. She ended up literally elbow deep removing pieces.
I also required some pretty extensive repair work. I had 2nd and 3rd degree bilateral sulcus tears (internal tears) that originated at the cervix and continued the length of the birth canal. I also had several external tears that were less severe. Because of the severity of the tears and how deep internally they were, the OB had to be called to suture them. Dr. Stallard was called and came in to do the repair work. He assumed I had an epidural and was surprised when we told him I did not. In a very, very rude manner said a VBAC should never be done without an epidural - it was way too risky - and that Pam should have refused me as a patient if I had planned on no epidural. He also started suturing with no local because he assumed I was numb from the epidural. He ordered a dose of Demerol to help take the edge off, and of course several injections of a local to get me fully numb. Repair work took well over an hour from the time he started stitching. During this time NICU was still giving Levi a little oxygen to help him get going and we also decided to go ahead and have the VitK injection because he has some severe bruising on his head from being stuck behind the pelvic bone for so long. His head was swollen and bruised - a cephalohematoma. Minutes later they decided his color was much better and he finally let out some major cries - I was able to hold him again and it was the most amazing feeling in this whole world. The Demerol had made me very, very sleepy so while I finished getting repaired, my husband, mom, and doula took turns giving Levi tons of snuggles.
My doula Catherine holding Levi.
Finally the repairs were done. Pam gave me a huge hug and told me how proud of me she was - and that meant so much to me. She also held Levi and gave him lots of snuggles and kisses.
Pam giving Levi some snuggles.
So, so, so proud!
After she left, my doula Catherine helped me latch Levi on and we nursed for a few minutes before he settled down into my arms for a much needed nap.
I got huge hugs and congrats from my husband and my mom - both were thrilled I was able to do this!! I was taken to my postpartum room shortly after and we began life as a new family. Levi nursed great for the first few days, although we are going through a bit of difficulty now, I'm sure we'll get things worked out!! I had a few complications with all of my sutures - an entire section actually separated and had to be chemically cauterized, but thankfully that's over with and I'm feeling much better!! I am absolutely elated and on cloud 9! I am so proud of myself. I've never in my life done anything I was really, really proud of - but this has given me such a new found confidence in myself and in my body! I'm so thankful for the peace and healing this has brought to me! Not only did I VBAC my beautiful baby boy, but did so in 9 hours of labor, 1 hour of pushing, and no epidural! I am finally beginning to realize that I didn't fail with Ava's birth, my "supporters" failed me. I was rushed into a cesarean section that wasn't needed. Finally I'm starting to accept that it wasn't my fault. I know Levi's birth will bring great healing to my heart and I'm thankful for everyone who supported me through this journey.
Levi meeting big sister Ava for the first time!
Holding my two precious gifts.
A thumb sucker already!!