Tiyama’s Story: Castiel’s unexpected VBAC (after a classical scar)
2012 was a very bittersweet year for our family. In the late spring of 2011, my husband ended up being diagnosed with unexplained secondary infertility. There were some decisions to make, and after a lot of thought and heart to heart chats, we felt the choice we made was right for us. We decided on sperm donation, and began trying that August. We were on cloud nine when I found out I was pregnant a few days before Christmas.18 months and then the help of a sperm donor, two pink lines and the word “pregnant” on a digi test!!! By late January, I found a midwife team that saw no reason why I couldn’t vbac with a classical scar and happy to have me as a client. I’ll never forget how elated I felt, me, under the care of home birth midwives. A water birth during the summer, what could be better? What we didn’t see coming was a cervix too weak to remain closed. My water broke at 20 weeks, I prayed for a miracle, to somehow see my little one through and keep him inside my womb. That miracle didn’t come, Azriel was born on 4/14/12 at 20.1 weeks and lived just long enough for us to say goodbye. When he left, so did my hopes and dreams for a home birth, a water birth and the midwife I had searched for, for so long and finally found…
I spent my time going between researching cerclages and planning Azriel’s memorial. By early August, I had my mind made up. Since no OB or MFM specialist I spoke with agreed to place a transabdominal cerclage for me in my state (California), I found one who would in New Jersey and at cost! The thought of having a cervix that would never take another child from me filled me with hope for trying again, I felt my prayers were answered and could just focus on my little guy’s memorial. I had the rest of the year to mourn and heal, or so I thought.. On August 10th, I had to go to the ER for severe lower abdominal pain. Despite being a Friday, I was brought in straight away, gave them a urine sample and placed in a bed. The doctor *thought* he saw something on the ultrasound screen and also told me they should have my results from the urine I gave very soon. I was told the pregnancy test was negative but he would order another ultrasound by an actual technician to get a more accurate picture. While I was waiting for the ultrasound department to call me in, a nurse came in to check on me. She was at the computer and causally mentioned my test was positive. “What test?” I was puzzled “The pregnancy test,” she replied. I stared at her just as the doctor came slowly through the curtain looking very sheepish. “I’m so sorry, ” he said, “it’s the nurses that usually read them, I figured I could help give you an answer a little quicker but I didn’t wait long enough. It’s my fault. There is a second line though.” “It’s still pretty faint but a line is a line.” The nurse piped up with a smile. ?????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!?????????? <—— in my head. How could this have happened?? DH and I had made love once and was told without ivf it wasn’t likely we’d get pregnant on our own, I even laughed when birth control was mentioned by one of the many high risk OBs I’d spoken to a couple of months before. Pregnant? Eventually, I got the ultrasound and a blood draw and by the time the results of both were back, I had a new ER doctor. He spoke to the OB on call who told him the cyst they found sounded like a corpus luteum cyst, although larger than usual, was normal and would most likely resolve itself. Beta was 165, was told that was a bit low and I had to go back to be checked for doubling numbers.
The numbers kept climbing and the journey of a new pregnancy began. Though shocked, DH was elated, his miracle baby was on the way! I was far from elated, I was scared and felt like a cruel joke was being played on me. It was then that the faith I had in God shattered, was he serious, putting a sweet little life in a womb that was attached to a piece of sh*t for a cervix? Why steer me toward support groups that helped me find my TAC surgeon, knowing I had to save up the $5000… I had the chance to have a ‘normal’ pregnancy. WTH?! I became a different person as the weeks went on, I grew more and more bitter. I snapped at anyone who tried to tell me things would be different this time around. How could they possibly know that? I felt trapped into getting the cerclage I had wanted to avoid. I went with the perinatologist in the practice who’s plan for me was a 12 week cerclage placement, 17P shots and bi-weekly monitoring. He was the least annoying care provider in the practice but it didn’t save him from me. (I’m sure my chart has really colorful code words describing me as a patient.) A lot of my rage was directed at him and he got an earful at every appointment. I had to leave the IC support group I had joined, I couldn’t take the posts full of hope, positivity and the faith they seemed to have in their care providers. Not that they shouldn’t, I was glad for them but I felt so out of place. I had none of those feelings. DH tried everything he could think of to help me feel more hopeful, but he couldn’t. I felt like a failure and was sure our journey wouldn’t end with this baby coming home either..
My saving grace was my Special Scars group. I hated being that way and thankfully, my SS sisters offered lots of love, support and listening ears. A package arrived in the mail from a dear SS sister that contained two very important books, one was a bible and the other was a book called ‘I Will Carry You’ by Angie Smith. I was instantly drawn to that book and started reading. Many, many, many tears later, I finished the book and felt sad but inspired. I was still frightened of losing the baby but for now, we were together. I was carrying him and already my pregnancy was more than half over. The baby deserved positive vibes and I looked at the positives that had gone ignored. A loving husband that made sure I was in a wheelchair to get around, a cervix that was holding up despite my earlier protests and fears, a pretty easy pregnancy that had only a week of morning sickness, friends and a few family members who cared and were very supportive, the couple of friends going through their own high risk pregnancies making sure they checked in with me. I started repairing my relationship with God as well, with the help of an e-book called Rainbows and Redemption and decided to rejoin the IC support group.
By 28 weeks, I smiled in the Perinatologist’s office for the first time and it surprised him so much he commented that it was really nice to see. My next thing to tackle, since it had been brought up by the Peri, was the birth. I had convinced myself that there was no hope for so long, I didn’t bother seriously thinking that far ahead. Since I took home birth off the table, I had to truly look at the possibility of a c-section, truly take it seriously for the first time. The idea of a vbac in the hospital wasn’t very appealing but I would try if I had no other option for a positive c-section. The most important thing to me became a positive environment, being so close to the one year mark of losing Azriel, I didn’t want to have to fight. I had heard of family centered c-sections before and I knew if I had to go that route, I wanted that kind of an experience. I searched online and found a wonderful e-book ‘Make the Most of Your C-Section’ by Mindy Brouse. I made an appointment with my regular OB to discuss it. I armed myself with info from the book, as well as an article regarding the use of clear surgical drapes and info about waiting until 39 weeks for delivery. By the time I saw my OB, I even had contact info from the OB and midwife mentioned in the book (thanks to Mindy) as well as the director of anesthesiology that implemented the clear drapes in his Boston hospital. He was impressed by the amount of research I put in and didn’t see any reason to disagree with a family centered c-section. The only disagreement was the week for delivery but we settled on a compromise of 38.6 weeks. He promised to work on getting the perinatal services director to look into the drapes and clear a couple of things with the anesthesia department, with a tentative date set for the 11th of April. He also asked if he could keep copies of the articles I brought in, so he could refer back to them for future patients and I told him absolutely yes!
At 35 weeks, I had my last 17P shot and it was time to remove the stitch. With the help of twilight sedation in the OR, it was a successful removal after a very painful attempt in his office the day before due to scar tissue. The Peri tried to convince me that I wouldn’t make it to April at all, let alone the 11th and to reconsider my c-section date because I was already 3-4cm dilated. I refused, 3-4 was typical for my cervix and with all the scar tissue, I wasn’t worried about sudden labor. Good news came in by week 36, everything was in order for a family centered c-section, including the drapes I wanted. Everything was all set for 4/11/13 at 9:30 in the morning. I felt at peace for the first time in a long time. On Easter Sunday, I caught a terrible cold. Thanks to a garlic lemonade recipe from a great friend of mine, I was feeling better by the following Sunday (4/7) just had a cough to deal with. It was still concerning so I called my midwife/doula, R to ask her opinion, she said if it was still very bothersome by 4/10, I should have the surgery rescheduled. It wasn’t my fault I got sick and coughs/colds don’t have cures, you just have to deal but not along with major surgery if at all possible. I completely agreed and continued the lemonade.
4/8/13: That afternoon, irregular contractions started and by evening, tapered off and stopped. On the 9th, the same irregular contractions started again, I paid them little attention. All day and into the evening, an hour here, 20 minutes there, 5 minutes, 15 minutes, 2 hours, ect, no real pattern and assured my husband that a trip to the hospital wasn’t necessary. By 8pm I was happily watching Hart of Dixie and didn’t notice any contractions, I figured once again they most likely tapered off. At 9pm, I started watching the new episode of New Girl, our Tuesday night routine when suddenly a contraction hit. This time however, the location was different, instead of just feeling it in my stomach, it seemed to start really low like near my cervix, moved to my bum, up my back and around my stomach. 5 minutes later, the same thing and every 5 minutes after that. At 9:30, I called R to see what she thought, I was pretty sure they weren’t a big deal but just in case… She answered on the second ring and I was in the middle of describing what was going on and if early labor could have a pattern, when another contraction hit, I had to breathe through it. She said early labor can have a pattern, and from the sound of things, something was definitely going on. “Do you have a plan in place for a vbac?” R asked and I said I didn’t, we both burst out laughing, as here I was most likely in labor. She offered to come and check my cervix, if I felt up to it, I decided to let her. I trusted her completely and felt it would help me make a more informed decision on what to do next, she was on her way. I hung up and no sooner had I done that, a much stronger contraction came over me. I moved into a modified downward facing dog position, that didn’t help. I made my way to sitting on the toilet for a little bit, that brought some relief so I stayed there. I told DH R was on her way, he then became superman suddenly. Before I knew it, the kids were being organized, I could hear him fishing my hospital bag out of the closet, and constantly checking on me in the bathroom. Eventually, the toilet wasn’t helping so I grabbed a towel and moved to the living room. I placed the towel on the floor (don’t ask why) and sank to the floor. WORST IDEA EVER!!! I was stuck there, howling like a wounded wolf engulfed in wave after wave of strong contractions. R arrived just before 10pm, DH let her in and she immediately went to my side after placing her midwife bag down. She spoke soothingly to me as DH went to check on the kids. Once a contraction came to an end, R said “I’m ready to check you whenever you’re ready.” I told her to go ahead and do it right then before another one came back. With a gloved hand, she checked as gently as she could. I fully expected to hear still at 3-4cm but instead she replied, “you are 8-9 sweetie”. “What? Are you sure?? The scar tissue… I can’t be.. I really am that far, my cervix isn’t broken?” I was shocked. “Our bodies can surprise us sometimes, can’t they?” she smiled and gave me a hug. I started to feel sick after another contraction and began to throw up, thankfully she had prepared for that possibility and had a bucket nearby. “That’s a good thing, your body is too busy laboring to digest,” she rubbed my back reassuringly as I kept vomiting . When my husband came back out to check on me, R told him that it was time to go to the hospital. I was progressing fast and we needed to get going. DH called my mom, since I was too sick to do it myself. R helped me get to my feet just as the boys came to wait in the front room. I wailed as another contraction came, my 6 year old kept asking what was wrong. R explained simply that his mommy’s body was working hard to bring his little baby brother or sister into the world. DH came out of the room, dressed, bags in hand and with some clothes for me. R and DH helped me get dressed and we started down the stairs, just as my mom pulled up. The boys got into her car and DH and I got into R’s, my mom called out to us that my sister would meet us at the hospital. We all hit the road just after 10:30pm.
The freeway ride was a smooth one and we made it to Kaiser. It gets a bit hazy as I was in a world of pain, a wheelchair was brought over, we got to L&D, I signed admission papers and brought to a room. Someone, mostly likely a nurse asked how far apart my contractions were and I had no idea, mostly groaned in response. R had left to park her car, there was a delay in DH coming to the room with me at first but once he came in, R was right behind him along with my mom, sister and our boys. R handled the staff beautifully as DH was focusing on me, making sure I was okay. I was given a quick check and was almost completely dilated, with water still intact. The nurses were pretty laid back, there seemed to be no real rush, no immediate IV, just an efm placed on my belly. The on call OB came and introduced herself, tried to ask me questions but I couldn’t really answer her. Between DH and R, she seemed satisfied with their responses and said she’s be back in a little bit. I was in agony and begged R for drugs. It surprised DH but R wasn’t at all, she just gave me a knowing smile and replied that the only thing that would make me feel better, was having the baby. I was doing great and didn’t need them. It wasn’t long before my chart was pulled up to reveal my history. Amazingly, no sudden panic or drama, just matter of fact “oh, a classical scar.” Dr. W came to my side to inform me of my “risks” but also stated that, everything looked fine with me and baby. Even though in her opinion a c-section would be best, I had already labored and was at 10cm at that point, I would most likely deliver before they could finish setting up the OR. What did I want to do? I told her I wanted to try to push. She mentioned if baby took too long to come, I would have to go through with the c-section, which R did not like how that was phrased but it didn’t bother me. If anything started to go wrong, I agreed to a section. “Well then, let’s have a baby!” She asked if I was comfortable in the position I was in or did I want to be a bit more vertical. I wanted to move so she said as soon as the nurse got the IV placed, I could. The nurse blew out 2 veins in my hands, which pissed off my husband, before calling another nurse to place it. The second nurse placed the IV on the side of my wrist, it worked perfectly and then I was free to move into position for pushing. My sister took my 6 year old outside since he started getting upset, my 10 year old followed, leaving our oldest to watch. The first nurse instructed me to grab both legs, my mom said no way, that I would tear for sure and I insisted I couldn’t, so no leg holding. The OB asked permission to break my water, I said okay and….. All the memories of how pushing felt came rushing back, I screamed and pushed. I stopped, crying that it hurt too much, I couldn’t do this!!!! “Yes you can, you are doing this!!” R encouraged me and the next push created a freight train, I couldn’t stop pushing even if I wanted to. I screamed the entire time and soon heard everyone calling my name over and over. I opened my eyes to everyone’s smiling faces, heard a small gurgled cry and felt a warm and wet baby on my stomach. Castiel Inias was born at 11:30pm on 4/9/13 at 38 weeks and 4 days, 6lbs 9oz and perfect. He had a short cord so he couldn’t go up to my chest immediately. The OB asked if I wanted DH to cut the cord, I asked if it had stopped pulsating, she said it had but I looked to R for confirmation, she smiled and nodded. DH cut the cord and I lifted him to my chest, he latched perfectly once he started looking to nurse. It felt so surreal, from questioning if I was even in labor to holding my sweet baby boy, all in 2.5 hours. I declined his bath during our stay and requested a form to keep my placenta. Both wishes were respected without issues. R promised to take my placenta with her so she could encapsulate it for me. R stayed with me for the rest of the night, as DH went home with the boys. I asked about going home the next day, and was told if all looked well for baby and I, we could. By the evening of the 10th, Cass and I went home and we all began to settle in as a family of 6.
I still can’t believe I had a vbac, even 2 months later. I could not have done any of this without the love, encouragement, wisdom, support and friendship of my SS sisters. I started this journey in a really dark place, this group lifted me in ways I can’t put into words. I love you all very much! My sweet little Azriel, thank you so much my love, for allowing us to have you in our lives, even if for just 20 weeks. Your sacrifice saved your little brother and I know you will continue to look over him and us, until we meet again. We love you and miss you. Castiel is doing very well and is so loved by his brothers. He’s a mama’s boy already and DH barely gets to cuddle him lol. I do believe, had I made it to my c-section date, it would have been a positive experience. In the end, I’m just grateful that Cass made it to us, decided to come when he was ready and chose a great day to be born.