Caitlin's Journey to VBA3C

My husband and I found ourselves in a unique place during the spring of 2015. We were anticipating the birth of our 5th child who we expected to be delivered by cesarean sometime in June. But the Lord had different plans. And we are so glad He did. Let me rewind a bit….

We found out just after Katrina hit (Sept 2005) that we were expecting our first child. I began seeing the only OBGYN in our town (whom I’ll refer to as Dr B) who also delivered at the hospital where I worked. It was a kind of “go with the flow” pregnancy. I made very few preparations for the delivery other than faithfully attending prenatal appointments and reading the childbirth book that was provided by my doctor’s office. Looking back, I wish I would’ve taken a much more involved role in my first pregnancy and perhaps we wouldn’t have ended up in the situation we were in.

Somewhere around my 39th week Dr B let me know he would be going out of town and another doctor (whom I had never met) would be taking call. He offered an induction so that he could deliver me and I declined. A few days passed and I ended up calling the office and scheduling my induction. I was physically tired, not sleeping well. Just general “woes” of pregnancy.

I arrived on the morning of May 18, 2006. I changed into a gown and was put on a Pitocin drip. Sometime later (after experiencing some very intense back labor while still in the bed) I requested an epidural and then had a Foley catheter placed. After this, I had a relatively pain free few hours. At 39 weeks 6 days, about 12 hours after the Pitocin was started, I delivered a big baby girl! Kenslei (5/18/2006) weighed 9 lbs and measured 21 inches long. But it wasn’t quite so easy.

After seeing the size of her head as well as her OP presentation, my doctor (I believe fearing a shoulder dystocia) made a cut and used a vacuum to complete the delivery. I was left with a 4th degree laceration and began hemorrhaging. After some vomiting (Phenergan), more Pitocin and a shot (maybe 2?) of Methergine I was deemed stable enough to transfer to a postpartum room. I can vividly remember feeling so wiped out. I contribute it to basic exhaustion, the blood loss and a side effect from the Phenergan. I was told her glucose was low (I had no history of gestational diabetes but she was getting Accu-checks because of her weight) and although I wanted to breastfeed, I was too drained. They fed her formula (from a syringe-thank you to the nursery nurse that was trying to salvage a breastfeeding relationship that hadn’t even started!) and I was brought a breast pump. I continued to bleed heavily and had to be recatheterized due to swelling. Day 2 brought improvements and we were discharged home on day 3. I remained very tired for several weeks (normal recovery and excessive blood loss I supposed) and never established a good breastfeeding relationship.

Fast forward a few years. We experienced an early miscarriage and had a D&C in April 2008. By this time, we had a new OB/GYN in town (she joined the only other OB/GYN in practice). When I began experiencing the miscarriage it was the new doctor I saw, we’ll refer to her as Dr C. My original OB/GYN was out on medical leave.

After only a few short months I was pregnant again. With some early bloodwork I was found to have low progesterone and gave myself IM injections of PIO twice daily. Other than some bleeding around 11 weeks it was another uneventful pregnancy. At some point Dr C (knowing that I did not want a c-section) suggested a 38 week induction. It appeared that this baby was going to be at least as big as the first so the thought was that she would induce (proving that my cervix was favorable) and maybe he wouldn’t grow to the size of his sister and I would have an easier delivery Looking back now, I know this was foolish. Hindsight truly is 20/20. I would now call a lot of my birth decisions “foolish”.

I had originally planned for a foley bulb induction (I was trying to avoid Pitocin) but when I was checked at the hospital the morning of my induction I was already 4cm dilated. Since 4cm is the farthest the bulb induction can mechanically dilate the cervix the move was made to rupture my membranes to see if that would “kick things into gear”. At this hospital the policy was (and may still be) to keep you in bed once the membranes are ruptured. So I laid in bed for the next hour while nothing happened. It was after this time that the Piton was started. At the urging of Dr C (we know he is going to be big) I accepted an epidural at 7cm. I’m not sure of the exact time but I would guess it had been about 9 hours after the Piton was started and I was found to be “stuck” at 9cm. The labor nurse had me push for an hour (no position change, just pushing in the lithotomy position) while she tried to move a lip of my cervix back. I suppose this was unsuccessful. The labor nurse called and gave her report Dr C and then handed me the phone. I don’t remember the exact conversation but a c-section was her recommendation.

I cried as I was being prepped for the OR. This was not what I wanted but felt I was given no other choice. Once in the OR I still had sensation on one side of my body. I was dosed up with narcotics and antiemetics when the narcotics made me dry heave. I don’t remember much about the delivery except the comments once he was out. Everyone was amazed at his size. Maddox (3/30/2009) was 9lbs 10oz and 21.5 inches long.

Once again I was exhausted. Between the physical/emotional pain and the medications, I could barely keep my eyes open. I don’t remember much from the immediate postpartum period. After his weight, another noticeable thing about Maddox was his head. He had been asynclitic and had a very misshapen head.

I did try to nurse but couldn’t even stay awake to do that. He was either given dextrose water or formula for a real or imagined fear of his glucose level and I was given a breast pump. Despite having had to recover from a 4th degree laceration with my first delivery this recovery was much harder. I was so swollen from pushing and having the labor nurse try to manipulate my cervix that I felt as if I was recovering from a vaginal delivery as well as a cesarean. We were discharged home on day 3.

For some time I wasn’t sure how to process my delivery. I was “fine” and for all intents and purposes, so was my baby (he had weight gain issues d/t an undiagnosed tongue tie/breastfeeding issues and some musculoskeletal issues from his positioning). Despite all the “healthy mom/healthy baby” comments, I knew something was missing.

A short 9 months later we were expecting baby #3. I was seeing Dr C again and never questioned the fact that I would deliver this baby by cesarean as well. Some time around 32 weeks I was experiencing contractions which sent me to L&D. I was given fluids and sent home on Procardia to keep my contractions at bay. I took the Procardia until I was 36 weeks and at 38 weeks I went in for a scheduled RCS. Dr C was also pregnant and I was her last delivery before she took her maternity leave. I vividly remember Dr C commenting about how nicely I had healed after my previous c-section. She told me that had he not known that I’d had a c-section she wouldn’t have known by the look of my uterus. Asher (8/5/2010) weighed 9lbs and was 21 inches. Of my first 4 deliveries, this was by far my easiest recovery.

I experienced another miscarriage in May 2012 but was pregnant again shortly after. It was with this pregnancy that I was able to work through a lot of my feelings of failure from my first c-section. With these feelings of guilt, I began to research and with this research came my desire for a VBAC. I mentioned my desire to Dr C when I had my anatomy scan around 17 weeks (it’s a girl!). It was at this ultrasound that she diagnosed me with a complete placenta previa. I jokingly said “well, there goes my VBAC”. Her reply wasn’t encouraging and she would later tell me (once she rescanned and my placenta was in a normal position) that I was selfish (for wanting a VBAC) and putting my life and my baby’s life at risk. Needless to say, she was not supportive of my desire to VBAC. Once I was rescanned a few weeks later and my placenta was in a normal position, I began my search for supportive or even just sympathetic doctor.

I spent countless hours soul searching and researching. I knew that most of the reason that I was my current position was from poor decisions that I had made regarding my previous pregnancies and births. Had I done all this research with my first pregnancy perhaps I wouldn’t have been in the situation that I was. But since I couldn’t go back and change things and I was determined that this pregnancy/birth would be the change.

Needless to say, despite my efforts, that pregnancy also resulted in another RCS. I had either seen or tried to see (many times just hearing VBA2C, even to VBAC tolerant doctors, ended the phone call without even a consult appointment) at least 10 different doctors from Gulfport, Slidell, Hattiesburg and New Orleans. As I spouted off statistics and recited ACOG’s guidelines, I was obviously educated about my options (which I heard many times, “I can tell you’ve done your research and you really want this. I’m just not the doctor for you. You should try Dr fill in the blank”. But it wasn’t enough. In their eyes I was too big of a risk.

I had one last doctor to try (Dr L). I had decided if she told me “no” that I would give up. She and her delivering hospital had (and still does) and high VBAC success rate (even some with multiple c-sections). I called and was given an appointment. I faxed over records at their request and was called back by the “nurse” to be told that my appointment had been cancelled.

I didn’t ask too many questions. A decision I would question into my next pregnancy. I was defeated and conceded to another c-section.

I had numerous people (friends, family, fellow medical workers) suggest that I wait until I was “complete” to show up at the hospital and refuse a c-section. But this was not the kind of birth I wanted. Who is strong enough during that stage of labor to put up a fight? What I longed for was a supportive provider. Not someone who would “let” me have a VBAC. Not someone who would “allow” me to have a VBAC. Not someone walking around with a scalpel in his/her pocket “just in case”. I wanted someone who believed that I was capable.

Since I was going to have another c-section, I tried to make the best of it. While looking for a VBAC supportive doctor I had continued my prenatal care with Dr C and at 39 weeks 4 days (3/18/13) I had a “gentle cesarean” and delivered a 9lb 4oz, 21.5 inch baby girl (Eden). I refused the Duramorph that had made me itch insanely with my other sections and opted for a PCA pump after surgery instead. I told the CRNA that I did not want any narcotics (or Phenergan) unless I expressly requested. I got skin to skin in the OR and, out of all my other deliveries, I was most “awake” for this one.

Overall, this recovery was the hardest I have experienced yet. I had a lot of adhesions that were removed so I suppose this may have been the cause for that. We also had a very difficult breastfeeding experience.

In October 2014 I was expecting again. I called Dr C’s office to get orders to have my progesterone checked. I received a call back from Dr C. From my end of the phone she sounded very upset. She questioned why I was pregnant again, telling me “your body can’t handle another c-section but since you’re already pregnancy then we’ll deal with it”. I’m still not sure what she meant by this and I never gave her a chance to explain as I switched doctors. I had made it clear the previous pregnancy that I did not want another section. I felt that if she had been that concerned about my health she should’ve counseled me before I got pregnant (either while I was in the hospital or during a follow up office visit) as I had made it clear that I wanted to have more children.

I established care for this pregnancy in Slidell, LA (we live in Picayune, MS and all of my other children had been delivered there) with Dr B. I was prepared for c-section #4. I figured if noone would “allow” me to VBA2C then certainly noone would now that I’d had 3 c-sections. I was paying cash for my delivery and had paid Dr B by my sixth month. I just say that to show that I truly had no intention of doing anything but delivering via c-section with Dr B.

At some point (maybe around 28 weeks) a good friend, who was trying to establish care herself with a midwife, mentioned that this midwife had some recommendations of who I might could see for a VBAC. I’m really not sure why she was talking about me to the midwife but turns out that I’m glad she did. I told her I didn’t think I felt like “fighting” for a VBAC. I was tired and okay with my c-section.

Maybe a week or two went by and I began to consider contacting these doctors (I had been given 3 names. Two were in Jackson and one in the Gulfport/Biloxi area). What did I have to lose? I collected my records and began making phone calls. I faxed records to all 3 doctors. Those faxes netted me 1 no (from the doc @ UMMC “too risky, our insurance won’t cover us), 1 appointment (Gulfport/Biloxi) and the last (Dr. W) left me hanging. I decided I’d go ahead and attend the consult inBiloxi and not worry about Dr W (after all, the doctor at University had told me no). When I told my friend about this decision she encouraged me to call his office and find out what the delay was about. Maybe they had lost my number or misplaced the records.

So I called them back. Again, I explained my situation (the clerk remembered my story from my first phone call!). I really don’t remember what the confusion was with my records but she offered me an appointment. I was a little surprised. I asked her to stress to the doctor the fact that I had already had 3 c-sections (I thought maybe this tidbit had been missed). I was driving 2.5 hours for this appointment and didn’t want to get there and just be told “I’m sorry. we overlooked that. We can’t help you”. I thought it would be much easier to be told “no” over the phone vs a trip to Jackson just to be told no. I remember telling her something along the lines of “It’s okay if he says no. I’ve been told no alot. I’d rather him tell me no over the phone than to waste my time and yall’s” She assured me that he was aware.

On Monday, March 30 I saw the doctor in Biloxi. She politely told me “no” that she could not offer me the option of VBAC. Despite having my records, she had been told by her staff that had only had 2 sections. She explained that there were no studies supporting a VBA3C (which I knew) but had I come to her with my last pregnancy (VBA2C) she would have offered me a TOLAC. Wow, that was a dagger! She tried to tell me it would be “too risky” (maybe it would be but she had just admitted that we didn’t know risks because there are no studies!). I admitted that yes, it may be risky, but it was a risk I was willing to take. Each one of us takes many risks every day. Each time you get in a car, you take a risk. For me, the known benefits of a vaginal delivery outweighed the possible risks.

I left her office that day in tears. Once again I was told the same “I know you want this” line. In 3 days I had my appointment with Dr Wolfe. I was doubting whether or not we should even make the drive up there.

On April 2 we (my husband and our 4 children) set off for the appointment with Dr Wolfe. I don’t remember much of what we discussed during the ride. In my mind, we were going to Jackson, the doctor would tell me no and then we’d head back home. The same story I’d experienced so many times before.

Chris dropped me off and took the kids to “sightsee”. I’d warned him the appointment may take awhile so he was prepared to wait.

I will never forget my first encounter with Dr Wolfe. He walked in with his nurse, sat down across from me, flipped through my records, then peering over his glasses said “you’ve had 3 c-sections. What makes you want a vaginal delivery now?” Maybe I should’ve been offended. But I wasn’t. He was so raw, so real.

And so I told the same story that I’d told so many times before. After a few questions, he says “I’ll take you. You aren’t the best candidate but you aren’t the worst.” I began to cry. He looked at the nurse and said “why is she crying?” I was crying because I just received validation that I wasn’t crazy. Someone had heard me! Then I began to doubt. I asked if he ever told his VBAC consults “no”. Did he ever say “you are not a good candidate”? I mean, I wanted this but I also wanted a doctor that used discretion. We talked about the things that made me not-so-great a candidate (my travel time, history of 4th degree laceration). The risks associated with a VBAC for me as well as risks for my baby. The risks associated with a 4th c-section. Oddly enough, it wasn’t until I saw Dr W that I was counseled about the risks of multiple c-sections, including placenta accreta. I left the office that day with an appointment to return in a few weeks and transfer my care.

When Chris came and picked me up it was obvious that I had been crying (and I’m not a “crier”). He assumed that I”d been told no again and he didn’t even ask what went on. After I few minutes I told him “He said yes. He’ll take me”. I think he thought I was joking. It was hours before I text or called any friends or family. I was in disbelief. This was happening and I had so many preparations to make!

First up was transferring my care. I kept my next routine appointment with Dr B. He knew of my desire to VBAC and I told him that I was actively looking for another provider. I left his office on good terms and the office manager worked on processing my refund.

Next up was finding a doula. I called a doula in Hattiesburg not really expecting for her to have room on her calendar (I was already 32 weeks pregnant), but she did! And she had a natural childbirth class the following weekend which we took.

We thought it best to “move” to Jackson around my 38th week. We researched our housing options (renting an RV, borrowing a camper, extended stay) and ultimately ended up borrowing a camper from my grandparents and making reservations at Le Fleur’s bluff.

Over the next several weeks we returned to Jackson a few more times for appointments. On May 29th a friend pulled the camper to Jackson and we made our humble abode there for the next almost 3 weeks.

On June 9 (40 weeks 6 days), I woke up @ 0430 with my first contraction. What a relief to know that for the first time in 5 pregnancies my body had gone into labor on it’s own. I wasn’t broken. This was really happening! I text our doula, called the answering service and Dr Wolfe advised us to head to Baptist. I must admit I was a little nervous about the judgement that would come from the nurses once they realized I’d had 3 c-sections but they were awesome! Anyhow, checked in around 0700 and at 1008 my 9lb 7oz baby boy (Silas Jackson) was born vaginally! Of course, I was exhilarated! I had done it. We had done it! I never want to forget how wonderfully painful each and every contraction was.

After a short recovery period in the LDR room (where I got up and walked to the bathroom within a few minutes of delivery!) I was wheeled to my postpartum room. Chris looked at me and commented how “normal” I looked. Silas was a vigorous nurser and we began a successful and stress free breastfeeding journey that lasted for 12 months. What a relief this was as well!

We stayed in Jackson a few more days before packing up and heading home. But the story doesn’t end there.

In October of 2016 we found out that I was once again expecting. I naively thought that finding a doctor closer to home to take me as a 2VBA3C would be a piece of cake. I have now “proven” myself. My body has “proven” itself. Wrong. After being shot down twice (faxing records and refused appointments in Hattiesburg and Covington, LA) we were back in Jackson for an appointment with Dr Wolfe. He welcomed me back but reminded me that he doesn’t encourage people to travel for healthcare. I assured him that I was diligently looking for a provider closer to home but had not yet been successful.

After another refusal (this time from a midwife group in New Orleans who couldn’t get their doctors to accept me) I did find a doctor who would take me on. She was one of the doctors (Dr L) that I had tried to consult when I was looking for a VBA2C. Back then, the nurse had called to cancel my appointment and I had never seen or spoken to Dr L. After reviewing my records and “reasons” for my previous c-section she asked why I hadn’t tried for a VBAC sooner. I explained that I had and that I had sought her out. After looking me up in her computer she apologized over and over again. Looking back (and telling me that was an unnecessary cesarean), she said that had she talked to me herself, she would’ve taken me with that pregnancy (VBA2C). Another dagger.

So Dr L says that she will take me but her (and delivering hospital) cash price is a bit higher than others I’ve seen quoted and I don’t particularly care for the location of her office (traffic in downtown New Orleans is horrendous!). I let her know that I’m not quite ready to commit and I have another appointment in several days with a midwife group in Baton Rouge, LA.

After jumping through a lot of red tape (partly because I am a cash customer), I was able to secure an appointment with the midwife group at Ochsner Baton Rouge. I first had to have my records brought before the doctors in the same group and they all had to agree to take me (in the event that any one of them could be on call when I went into labor) and then I was able to schedule a consult with one of those doctors before I could move on to seeing the midwife.

Ochsner Baton Rouge is where my next delivery took place. Although it would’ve been nicer to have been a little closer to home (Baton Rouge is roughly 1 hour and 45 minutes from “home”) we were grateful not to have to move for this delivery. My uneventful prenatal period was overseen by the midwife group here and at 42 weeks 1 day I had another natural vaginal delivery. Roman (7/5/2017) was an almost water birth and weighed 9lb 4oz. No tears, no cuts and another wonderful nurser!

I realize that the opportunities that I have had, many women won’t have. Access to supportive VBAC care is very limited here (and Louisiana as well). Most women either can’t or won’t be able to travel the distances that we did or endure the mental exhaustion. I count my self privileged to have taken this journey. Jackson will always hold a special place in our lives. There were a lot of sacrifices made on many peoples behalf. Had it not been for the support of others we know that our story wouldn’t read the same. We count it a blessing that in a state that leads the nation with it’s c-sections and has the lowest rate of VBACs that we were finally able to find a supportive provider.