Water VBAC in a Hospital

Ok - I LOVE this birth story. So beautiful and a nice look at how hospitals CAN be baby and mom-friendly.

Here's Kristen Oganowski's guest blog. She delivered her second child, Alec Oganowski Redding at 12:03 p.m. May 25 in the first water birth at Crouse Hospital. She'd had a Caesarean section with her first child, Miles, now 2, and really wanted a VBAC -- vaginal birth after Caesarean.

(Doula Chris Goldman's guest blog about the birth follows, so keeping scrolling down to read it.)

My membranes ruptured about 10 p.m. May 24. I was sitting around the dining room table with my mom and my two friends, cursing the "Braxton-Hicks" contractions that I had been having for the past hour and complaining that I wasn't even going to time them anymore.

(In my words, "They haven't started labor for the past two weeks, and they aren't going to start labor tonight!" Famous last words.)

Then, I made the remark that I actually hoped that I wouldn't go into labor that night because I had just finished one of the largest meals of my entire pregnancy -- and topped it off with homemade blueberry pie and Williams-Sonoma hot chocolate!

Of course, not 20 minutes later, I shifted in my seat, felt that tell-tale trickle, and said what many a woman before me has said: "Either I just peed my pants, or my water is breaking."

Everyone jumped up and cheered as I waddled and leaked my way up the stairs. My mom went out to get some Depends (We planned on staying home as long as possible), my friends took our 2-year-old home to stay the night with them (We had always planned on him staying with them anyway--how convenient that they were there), and (my husband) Tim (in his words) "felt his life flash before his eyes."

My contractions started around 11 p.m., and they started and stayed 3 to 8 minutes apart. I was obviously in early labor because I was joking, dancing, and even insisting that my mom take a photo of me with a pair of Depends on my head! Once the contractions became more intense -- and once I became more "serious" (around 12:30 a.m.) -- I started my Hypnobirth hypnobirthing program (the best $100 I've ever spent) and had Tim call our doula, Chris.

I didn't quite feel that I needed her yet, but I did want her to be with us for the transition from home to the hospital, and I wasn't quite sure when that was going to happen. (My contractions were getting closer to 3 to 5 minutes apart at this point.)

Chris arrived around 1:45 a.m. and was fantastic. She really wanted me to get in the tub, but I just did NOT feel like getting in the water then. (How that would change!) But all of her other suggestions were spot on. She knew when to suggest that I change positions: when to try the birthing ball, when to try laboring on the toilet, when to try and rest on the couch -- changes that I thought would make things "worse" but ended up making me feel SO MUCH BETTER.

And even though Chris came fairly early in my labor, I think that her presence truly helped the entire "labor team" to forge the incredible bond that got us through the next exhilarating and exhausting 10 hours. And so we stayed in the living room (for the most part), me listening to my hypnobirthing CDs, going "deeper" with each contraction, and Chris, my mom and my husband taking care of me and, I think, also taking care of each other. (I do remember Tim brewing some lattes at one point!)

Chris was also great about giving us advice on when to call the doctor's office. (We didn't even call Dr. N's office until 3 a.m.) Around 4 a.m. (I'm guessing), I started feeling what I thought were signs of definite -- perhaps even later -- active labor. I felt like I wanted to throw up, I was shaking in between contractions, and I was getting major hot and cold flashes. I wasn't feeling terribly "pushy" yet, so we decided to wait at home a bit longer.

I finally asked that we call and alert the midwife-on-call at 6 a.m., and we arrived at the hospital at 6:45. I truly don't know what made me want to make the phone call. I'll chalk it up to this "inner voice" that I listened to all throughout my labor. And I must admit, I was about to have some serious doubts about this inner voice.

I hadn't even met this midwife before, but I am really glad that she was the first medical person who I encountered in the hospital. She was sooo laid back and fantastic. After introducing herself, she said, "So, I can check you, if you want." (A woman is very vulnerable during labor, and simple statements like this one can really reaffirm her power -- I had a choice about my cervical checks!) I told her that I wouldn't be discouraged with whatever my "progress" was, and that, yes, I wanted to be checked. I was hoping for a 5, 6 or even 7 (centimeters dilated), mentally preparing for a 3 or 4.

But I never could had prepared myself for 1 to 2 centimeters. The midwife was great, however, saying with all of the optimism in the world, "But you're almost 100 percent!!!" Chris reminded me too, "100 percent effacement is great."

At this point, I turned entirely inward. I don't think my mom, Tim or Chris said more than 30 words to me for the next three hours. I knew that we were all disappointed. I even told Chris, "I wasn't expecting that." And even though the hospital was "willing" to let me go home -- and even though Chris suggested to me to that I could go back home if I wanted to -- that little voice in my head told me to stay put. (Yes, I was still willing to listen to it!)

Looking back, I think I knew that the car ride home would be too much of an interruption in my labor. (I could hypnobirth my way through a blood draw and the million-and-one silly questions the nurse was asking me, but I couldn't hypnobirth my way over the "thousands" of potholes on the road!)

So I got the heplock, was strapped to the monitors, and stayed very quiet for the next three hours until Dr. N arrived. Don't get me wrong -- I heard lots of negative things "in my head." "You got a c-section for fetal distress last time, and now you're going to end up with a failure to progress c-section." "If it is this tough to get to 1 to 2 centimeters, there's no way in hell I'm making it to 10." And so on. I don't know if it was my AMAZING labor team or my AMAZING hypnobirthing program, but I was able to move past those negative thoughts and reach even deeper inside of myself, drawing on some sort of unknown well of inner strength.

In fact, I wasn't even explicitly practicing my hypnobirthing program anymore. I was under some sort of self-hypnosis, giving myself little pep-talks and just forging on with each contraction.

Right before Dr. N arrived, I was able to use the telemetry monitor and labor on the toilet for a couple of minutes. Tim showed me some pictures of Miles, our 2-year-old, at this point. And, just as I had practiced with my hypnobirthing program, these pictures reaffirmed for me the unconditional love that was surrounding me during my labor. I was completely taken care of, and my body knew exactly what it was doing.

Dr. N arrived around 10 a.m. and offered to check me. I was 4 centimeters!!! I was making progress!!!

And this is where things get good. I mean really good. Dr. N and/or Chris suggested that I try laboring in the tub. (I think that it was a "joint" suggestion.) He praised the water's ability to "make the mom buoyant" during contractions and really thought that I would benefit from it. Unlike earlier in my labor, I was pretty excited to get in the water, and I hastily agreed to give it a try. And then Chris asked the question of all questions: "Dr. N, I heard at the panel discussion that you have done water births before. Do you think that Kristen could try giving birth in the tub?" (The panel discussion was following a screening of "The Business of Being Born," (a film about home birth) from a couple of weeks ago.)

And Dr. N said, "Sure! I think that's a great idea! She'll be the first mom IN THE HISTORY OF THE HOSPITAL to have a water birth!" Wow. It was thrilling. I made it into the tub around 10:30 a.m., and as my body sunk into the warm water, I smiled for the first time in what felt like years. I still felt my contractions (Oh, boy did I), but the water eased them somehow.

And so I labored very quietly in the tub, with my mom, Chris and Tim performing what I have come to call the "cool washcloth and Gatorade assembly line." (Don't worry. The cool washcloths weren't soaked in Gatorade. I drank the Gatorade and wore the washcloths on my forehead. )

At 11:15 a.m., I did start to feel a bit "pushy." As I told Chris, "During the past contractions, my uterus kind of (made this) sound like a washing machine. "Do you think Dr. N should check me?"

Granted, this was only about one hour after he told me I was at 4 centimeters. Of course, I was 12 hours into my labor, but I also knew that I was a first-time laborer who only four hours ago had been 1 to 2 centimeters dilated. I don't know what I was expecting. In fact, I don't think that I was expecting anything: I was just paying attention to "that little voice."

Dr. N arrived at my side a couple of minutes later, checked me, and then very calmly said, "Well, Kristen, you're fully dilated, so bear down whenever you get the urge." Wow. I choked up, grabbed his hand, and said through my sobs, "Dr. N, I have been waiting for so long to hear someone say that to me!!!" (The tears are streaming down my face as I type this.)

I had my mom take one of my favorite labor photos at this point: me, in the tub, grinning from ear to ear, holding up "10" fingers.

My entire birth team continued to be amazing. Dr. N had everyone dim the lights, so that I could push as peacefully as possible and even unscrewed some of the light bulbs that wouldn't dim well enough. He and Chris helped me to get into a hands-and-knees position, so that I could get the assistance of gravity in my pushing.

And then he turned to my nurse and said, "Well, it looks like you aren't getting her out of the tub!" But then he took the time to tell her the following: "Look at how beautifully she's doing. Look at how natural and normal this is. She's pushing on her own, and no one is yelling 'PUSH' in her face; no one is counting for her." And you know what? My nurse started to get really excited about this birth.

Pushing was as intense as it was incredible. My body took over with each contraction, and I grunted and groaned like a wild animal as I felt Alec's head moving through my pelvis. It was hard work. And, not surprisingly, Tim, my mom and Chris continued to be amazing. Chris reminded me of what I was feeling ("This is his head molding," "That is his head crowning.") My mom made sure each moment was captured on video and on camera. And Tim stayed right by my side, replacing my cold washcloths every couple of minutes and spoon-feeding me ice chips.

And then Alec was born. Dr. N reached down to help me deliver the shoulders, but I pulled him up onto my chest (I did it instinctively. I don't even remember intentionally doing it) and I massaged his back until he cried. We stayed in the water for another 10 minutes, and then we moved out to the main room. And my nurse was nearly jumping up and down saying, "That was the most amazing thing I've ever seen! You are AWESOME!"

Later, I learned that about five nurses rushed into the room to see the woman who had the hospital's first water birth. Everything since has been smooth and incredible. Miles showed up about two hours after Alec's birth and stayed with us for a few hours. Alec was soon nursing like a champion. And I'm feeling great. On cloud nine, actually.

So yes, I birthed my baby. I did it in the water, with intermittent fetal monitoring and no heplock. I did it in the hospital, with an (obstetrician). I did it with the world's best support team (OK, I'm a bit biased). But I did it, and it was an experience that I will treasure for the rest of my life.

Chris Goldman, a mom of five from Syracuse, is a doula and co-owner of Doulas of Central New York. Doulas offer support services for expectant mothers and their families and provide objective labor/birth support for mom and her partner. Find out more by calling 455-6MOM.

Chris wrote the following account of the first water birth at Crouse Hospital, where Kristen Oganowski gave birth to her second child, Alec Oganowski Redding at 12:03 a.m. May 25:

Why would someone need a doula? Kristen knew why: for advocacy and support! As co owner of Doulas of Central New York, I want to share a birth story with you. Kristen phoned me at the office early in her pregnancy, explaining that she wanted to attempt a vaginal birth after her first Caesarean section delivery. We had an in-depth phone conversation regarding her previous history and arranged for a home meeting.

I met with Kristen and (her husband) Tim and went over their thoughts, wishes and dream for a vaginal birth. Kristen had done extensive research on VBACs -- vaginal birth after Caesarean. I referred her to VBAC books, appropriate Web site info and the local ICAN group for support.

We met about a month before she was due and went over a birth plan, basically discussing her labor plans, and how I could best support her and Tim. She was going to be doing hypnobirthing, and we talked about each of our "roles" in labor. We talked about some previous postpartum issues as well.

At 36 weeks, she met with her doctor for a pre-natal visit, and he voiced some concerns about her attempting a VBAC and basically told her that he would not support it due to her incision thickness/size.

Kristen was very knowledgeable on the statistics and was very upset. Tim phoned me right away. Doulas can offer support and resources in the community as well. I immediately encouraged them to seek a second opinion, which they did within the next few days.

They felt completely "at peace" with this new care provider and so grateful to have found one that would support her VBAC attempt and birth wishes.

Later, that week, I saw the initial care provider in the hospital, and we had a conversation about VBACs. He told me that he was very upset to have to tell Kristen that he could not safely support her VBAC attempt, so he went home and did some research on incision sizes/thickness on his own. He changed his mind and called Tim to let him know.

Now there is a doc that I respect; he is open to alternatives! Despite that, Kristen and Tim decided to stay with their new care provider.

Kristen called me on May 24 at 10 p.m. to let me know her water has broken, contractions were slight, and I let her know to call me when she either had a question or wanted support. Tim phoned me at 1 a.m. to let me know that her contractions were 5 to 7 minutes apart, and Kristen was hypnobirthing well. (They) just wanted me to come over for additional support.

When I arrived at their home, Kristen was listening to her hypnobirthing CD. At the beginning of each contraction she would indicate it to Tim, who would turn on the CD and she would immediate retreat into her laboring world.

Kristen's mom was present as well, timing contractions and offering her support. We reminded her to drink and change positions. Kristen's female cat was lying on the couch peacefully while her male cat was hissing at us in protection of her.

After an hour or so, Kristen indicated that she felt the baby moving down, and I suggested she do some stairs and rock a bit. She responded to all of this and found her peaceful laboring world again. Tim made us expressos. Kristen kept telling us that she felt that it was almost time to go, and Tim called the midwife on call.

A doula's role is to take the mom's lead. We were headed to the hospital about 45 minutes later. When we arrived, Kristen was laboring every 3 to 4 minutes and stopped to focus when she had a "surge." Arriving at the hospital calm was very important to Kristen; the transition needed to be uneventful.

The nurse began her admission questions, and I immediately let her know of the hypnobirthing procedure: "Kristen is hypnobirthing" (while showing her the birth plan). "She would like quiet while she is contracting. The contractions will seem to last longer because she is in her world of laboring, calming herself in her mind."

Because Kristen was so calm and resting, I let Kristen know to indicate when she had a surge by pointing a finger -- and then everyone would know to be quieter.

The on-call midwife came in to check Kristen. She was 1 to 2 centimeters dilated and 100 percent effaced. Kristen felt that she was further along and said to me, "I did not expect that." I waited until the nurse was done with her monitoring and left the room.

I sat by Kristen's side, Tim on her other, and let her know that "It is fine. You are 100 percent effaced. Most of the work is done, and now your body can dilate. Trust. Focus." She immediately closed her eyes and went in to her laboring world.

Outside at the nurse's station, I then went to talk with the midwife and found out Kristen's doctor would be in in about two hours. I wondered what she thought about Kristen going back home, even though her water broke. The midwife said it might be a possibility; I mentioned it to Kristen, but she quietly said she would rather stay and rest.

Kristen quietly labored and did not feel like moving around too much. I understood; she was tired! Awhile later, she did move to the bathroom, and Tim encouraged her with pictures of their son. She smiled lightly. She was so relaxed and peaceful. Her mom was giving her cool compresses.

Her doctor came in to check her and told her she was 4 centimeters dilated! She was progressing! I asked if she could get in the tub, and he immediately said, "Yes, she can float, relax, be buoyant." I went to start the tub, and there was no drain.

The nurse kindly went to find another, but that did not work and she suggested that we move to tub next door. She told me that we would not have to move all of Kristen's belongings if I could get her to the bed once she was ready to push, and I agreed. Nurses and doulas help each other.

I went to begin filling the tub. The doctor followed me, and we began to have a conversation about a recent movie event that we had been at together. "The Business of Being Born" (a movie about home birth) was shown earlier in the month, and he was a guest on our speaker panel following the movie. At the time, he mentioned doing a recent water birth, so I questioned him about it.

"You mentioned that you have done water births. I thought they did not allow them here?" He said what I know deep in my gut: "It is UP TO THE CARE PROVIDER."

"So if Kristen wants to stay in the tub and have this baby, you are fine with it?" I asked. He answered, "Sure," and excited for Kristen, I went to her and let her know. She sunk in the tub and immediately decided that it felt so relaxing. No mention of giving birth in the tub, but there was such a calming presence in that room. I gave Tim a stool to sit on beside her along with some cool compresses and Kristen's drink. He was the perfect coach, just giving her whatever she needed without her even saying so. Kristen's mom was taking pictures and passing cool clothes to Tim. What a team!

The nurse came in to monitor, and did a really nice job at adapting to the tub. I went down to the cafeteria to get a bagel and salad for Kristen's mom and myself. I was gone 15 minutes.

When I returned, Kristen's mom told me that Kristen felt like pushing, so I watched her myself through one of her contractions. Sure enough, there was a look of empowerment and determination on her face. I went to get the nurse and doctor. He checked her and she was fully dilated! Kristen grabbed his hand and shouted, "Doctor, do you know how long I have been waiting for someone to tell me that?!" She had dilated from 4 to 10 centimeters in one hour!

Her mom took a picture of her with her showing 10 fingers. It was so touching, we were all teary eyed. The nurse told us to get Kristen out of the tub to move in to the previous room. I told her that Kristen "wanted to now birth in the tub." The doctor also told her and helped her move some of the newborn equipment into the room.

I went down and kneeled near Kristen. I encouraged her to draw in to herself during her surges. To listen to her body, to feel it. The doc was standing behind me with the nurse, explaining how "normal" this was...the laboring down, the instinctive pushing that Kristen was doing. Kristen's mom was taking pictures and videotaping. We encouraged Kristen to wrap around her baby. The nurse reminded her of her birth plan and wanting to curl around her baby.

In the next two pushes the head was delivered. The doc came alongside my left side, Tim on my right, beside the tub. The doc calmly helped the baby come up through Kristen's legs while she sat back and grabbed her little boy! I took pictures. Kristen looked up at me in amazement. I could not stop my tears. I will never forget her face -- the empowerment, the strength. THIS WAS A VBAC WATER BIRTH!!

The first water birth at Crouse, not particularly planned from the beginning, but not an "oops." The doc was supportive; the doc was on board with normal.

Alec snuggled with mom for a while, and she carried him to the bed. The nurse and I cleaned up mom and wrapped warm blankets around her and Alec. Tim was teary-eyed and immediately got on the phone to call relatives.

Kristen delivered her placenta in its own timing, with the baby nursing and snuggling.

I would say, now looking back, that the best part was how the initial care provider went and researched VBAC incision safety, how the new doc was willing to do something "out of the normal" at this hospital that he just came to a few short months back. How he explained to the nurse that "this is normal" and later, "this is what women want."

Yes! To be empowered, to give birth back to who it belongs to. To TRUST birth and its process. It is so humbling to see moms empower themselves and to be just a little piece of their success.

I met with Kristen recently. It is like we are connected forever. I am GLAD I am a doula. I am glad I am comfortable asking questions at the right time. I am so thankful to the doctor for listening to my questions and being willing to guide the nurses into another birthing environment. THIS is what doulas do!