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Vaginal Delivery after 2 C-sections

Vaginal Delivery after 2 C-sections

|by Mohamad Younes, RN, BSN, CPHON®

 

In this article, I will share with you the story of a fighter, a dreamer, and a mother. She refused to trust the judgments of her doctors and preferred to trust her intuition this time. After putting her faith and destiny in the hands of providers who failed to manage both her pregnancies in a skilled manner, she said “No More”. My wife decided to plan her delivery of our third child with her own scientific and well-designed algorithm. Amani was the producer, the director, and the leading star of her ingenious strategy for Vaginal Birth after 2 C-sections.

After we came back from our trip in Delhi, celebrating our 6th wedding anniversary on January 21, 2017. Amani decided to get pregnant. She timed it in a way her pregnancy will not delay our immigration process and would be undetected by the US embassy personnel. Her strategy was executed exactly as she planned. When she arrived to O’Hare International Airport – Chicago, she was 5 month pregnant.

I will take you back in time, and go over her pregnancy history. Amani had our first child at the age of 26. Her pregnancy was entirely healthy but she gained 90 pounds though. Fatima Asiri, MD OBGYN was following on her pregnancy at the Kingdom Hospital in Riyadh, KSA. At 39 weeks + 3 days, Amani was scheduled for induction. Her OBGYN justified her decision by stating, “your baby is too big, if we wait for your due date, I am afraid that you will fail to deliver normally”. Bare in mind, Jude was born weighing 8 pounds (normal sized baby).

10:00 on January 4, 2012 we were admitted to the Labor & Delivery unit at the Kingdom Hospital. Upon admission, Amani was 2 cm dilated. She was given 2 mg prostaglandin vaginal suppository. 5 hours later, she started contracting. By 17:00, contractions were 3 minutes apart.

Vaginal Delivery after 2 C-sections

The Bad News

 

Dr. Fatima examined my wife on hourly basis. Unfortunately, “she is not progressing”, Dr. Asiri stated every single time. By 20:00, Dr. Asiri stepped into Amani’s room and said: “your baby is huge, I will not be able to give you more Prostaglandin nor Pitocin because I am afraid your uterus might rapture”. We have to go to urgent C-section”.

Amani was in tears. We didn’t understand what’s the emergency situation that warrants a surgical intervention. Dr. Asiri mobbed her head asking me to step outside the room with her, I did. I followed her to the nurse’s station, she said: “ I can’t break her water because there is a risk the cord might get tied around the baby’s neck. Our best bet is to go ahead with the C-section”. She pulled the informed consent and asked me to sign it. In my heart, all I wanted is for my wife and son to be safe, so I signed the consent. I went back to the room, tried to calm Amani down and go through what the entire doctor explained.

We still didn’t get it, our minds were foggy and couldn’t tell what is the best decision to make. Amani went to the operating room, the anesthesiologist refused to let me in to support her. Yes, you are damn right, I made a scene. He agreed to let me in after he performs the spinal anesthesia.

I held her hand. Everything happened so fast. Jude was born at 23:05. I was in tears to see my baby boy arrive into this world. Amani was crying because she didn’t feel she delivered, she felt that they stole that feeling from her. Amani was hospitalized for 5 days. She was in a lot of pain due to incision and excessive gases. All her ADL’s were hindered. Amani went into a post-partum depression for 4 month. The delivery was the only topic we talked about for months. It felt as if every conversation we had eventually steered to the C-section situation.

Vaginal Delivery after 2 C-sections

* WARNING *

 

Stop! If you are skimming though the article or you have read this far but you feel you can’t relate, then my best advise is to skip to the next article. I know for a fact, it is hard for you to relate to our frustration if you haven’t experienced some kind of a C-section story in the past.

Thank you for sticking around, so now I know for sure that you interested in knowing Amani’s strategy that led her against all odds to have a Vaginal Birth After 2 Caesarian. But before jumping into that, let me walk you through Amani’s second pregnancy.

Amani spaced out her pregnancies and let her uterus recover for 20 month. She wanted her caesarian wound to heal as much as possible because she wants to try VBAC. We were living in Saudi Arabia at that time. Her OBGYN refused to give her a chance for VBAC. Amani refused to listen to her doctor, she decided to seek a second opinion, but she hit the same wall. Amani tried to get an exception to deliver at the hospital we work at (King Faisal Specialist Hospital & Research Center). Her supervisor Dr. Suwaylem (Head of IT department) refused her exception-to-policy proposal. It was clear that he denied her for religious reasons, because we come from a different sect of Islam. After asking about the name of her father, mother and me and where everyone is originally from in Lebanon. In a lame and desperate way of him to figure out our sect., he sarcastically said. “Why are you trying to get an exception to deliver here, you Lebanese people usually go and deliver your babies in Canada and America!”

 

Boom… A light bulb!

 

Amani walked out of his office with a smile. Excitably, she started texting a friend of her – Nadine. Nadine worked as a lab tech at Oakwood hospital in Detroit, Michigan. Amani emailed her all the reports of her previous C-section, and asked her to relay them to a OBGYN or a Nurse Practitioner to advise if VBAC is possible.

 

YES!

Nadine replied. VBAC is not only possible but they encourage it at Oakwood Hospital. Amani sparkled again. After two and a half years, she felt her dream of delivering normally is achievable for the first time.

We planned our annual leaves and flew to Beirut, Lebanon. We dropped Jude at my sister and we were ready to fly to Dearborn, Michigan. Airfare laws when it comes to pregnant women say, allowed onboard if you are 36 weeks and under. So, we scheduled an appointment with an OBGYN in Beirut and got a fake report that Amani is 30 weeks pregnant. She was 37 weeks at that time. We were willing to take the risk. We booked our flights and flew on an adventure to USA. I will skip the suspense of getting through the customs in Lebanon, Germany and USA.

 

Detroit – Michigan

 

I will fast forward to our appointment with our OBGYN at Henry Ford Hospital in Detroit, Michigan. The Doctor has Lebanese roots – Dr. Layla Najar– she was so nice and supportive, caring and compassionate. Our Nurse practitioner was also a remarkable healthcare professional, she gave us all the time we needed to work on our anxiety and fears.

Amani passed her Due date, her pregnancy continued till 41 weeks and 5 days when her physician scheduled her for induction. We were admitted to the Labor & Delivery Unit on April 30, 2014.

Amani was 2 cm upon admission; she was swiped two days before admission and the day she was admitted. Few hours later, Amani started contracting. The nurse practitioner started her on Pitocin. Amani’s cervical dilation was progressing slowly, around 1 cm every 2-3 hours. The contraction pain was excruciating. Amani tried all kind of positions to alleviate her pain during contractions. I massaged her lower back on every contraction. We tried everything possible for her to tolerate the pain for the longest period possible before seeking an epidural. She was at 5 cm when she couldn’t take the pain any more. She said: “Help! I need help, give me the epidural”. That was at 02:00 the next morning, May 1, 2014. It was Amani’s birthday. After the epidural, Amani was not allowed to get out of bed. She was tired and went to sleep.

Vaginal Delivery after 2 C-sections

The 2nd C-section

 

The nurse practitioner check her every couple of hours, but there was no progression, Amani was still at 5cm at 06:00. By seven o’clock, the nurses woke Amani up and the physician came in stating that over the past 4 hours, the fetal heart rate dropped 3 times (late decelerations). He said the pregnancy has not progressed for the past 5 hours. He said to Amani, “If you were my wife and your child was my child, I would go for a C-section right now”. He gave her a few minutes to think about it. Again, Amani was in tears. This can’t be happening again, we have travelled continents to make this happen and we failed. I said to Amani, “My love, you have shown courage and tolerated pain that no man can handle. You did your best to make this happen. I know how important this is to you, but believe me my gorgeous wife, having a Vaginal Birth doesn’t define you as a mother. Watching you raise Jude and care to every little detail made me appreciate motherhood. Honey, you have sacrificed and suffered a lot so far, let us go ahead and bring this boy to this world. He will be your greatest birthday gift ever”. I wiped Amani’s tears, kissed her on the forehead, held her hand and silently waited for her decision. She said: “I love you Moe, you are my true blessing and my genuine support. You, Jude, and Noah are my life, let’s bring this gift from GOD to this world”.

Amani signed the consent – 10 minutes later – Noah arrived. He brought tears into our eyes, but this time they were tears of joy. We appreciated GOD’s blessings and trusted his plan. The next day, we were discharged back to the hotel and a week later, we flew back home and reunited with Jude. Jude was amazed by his brother, we felt his joy. Amani and I finally felt that the mission was completed, and the outcomes were great.

Vaginal Delivery after 2 C-sections

Trip To India

 

Two years and eight-month fast-forward, Amani had just finished a 3-month photography class and she was so excited to start exploring life through her Sony lens. I was going through a depressive stage, waiting on immigration process to USA and all. So I decided to plan a trip to Delhi, India to celebrate our 6th wedding anniversary (January 21). I chose India because I wanted to expose Amani to a whole new country of culture and colors, so that she can apply her photography techniques into something unique and beautiful. Amani was so overwhelmed with the idea of going to Delhi. Our trip was so romantic and magical. We fell in love with the simplicity and humanity over there. That trip brought us back in touch with our life values and brought humbleness to our soul.

Vaginal Delivery after 2 C-sections

Alright, I don’t want to rattle, let me cut to the chase. Amani wanted to conceive on that trip and I was like, NO. I was saying no, because I didn’t want to have to add a dependent to our petition. That would delay our immigration process. Amani had everything written down, the date of her last period, the date of our US embassy interview, the date of our medical exams with the assigned Doctor from the US embassy. Then she had the estimated date to join the US employer and the preliminary dates of when she and the kids will follow me to the states.

We sat down and talked about it. We double-checked the dates, then triple checked them, and again quadruple checked them. I was almost 100% convinced that her plan would work. One night we came back to the hotel from a Magical Bollywood live dancing show called “Zangoora”. Romance and love were up in the air and it was the right moment. So, we just let the magic happen.

Vaginal Delivery after 2 C-sections

3rd Pregnancy | Immigrated To USA

Amani was pregnant. I arrived to USA on April 2017. Three month later Amani and the kids joined as planned. Now, she has all the time in the world to go through research studies to figure it out. What are the best practices to increase her success rate of having a natural birth after two C-sections?

A week before the delivery, we paid the ED 3 visits. The first visit was because of increased fetal heart rate. Apparently, Amani ate a dozen of Reese’s Peanut butter cups. The second trip was of potential amniotic fluid leak, which was negative. Third ED trip was because of severe contraction pain, and Amani wanted to be checked for cervical dilation (which was part of her master plan).

 

The Algorithm for a successful Normal Vaginal Delivery After Two C-sections is as follows.

 

Amani literally wrote it down on a paper and tweaked it every time she came across a legit research study.

Amani planned to get admitted to the hospital only when her cervical dilation is 2 cm or wider and her contractions are 5 minutes apart.

Amani decided to eat and drink whatever she heard could increase and speed up spontaneous contractions.

Amani decided that she will not take any Pitocin, she will just wait for spontaneous contractions, and let her uterus decide their rhythm, pattern, and intensity.

Since her contractions started at 38 weeks. Amani would sleep till the afternoon. Stay super active in the evening and at night. The intensity of contractions was fluctuating. High during activity and low during rest.

Rationale behind step 2 is, she wanted to adapt her uterus to contract during activity and slow down during rest.

Rationale behind step 3 is, she wanted to be admitted to the hospital late in the evenings. The reason being, she wants to labor all night and deliver in the morning when her Doctor arrives to work. Traditionally, patients get admitted to the Labor & Delivery unit in the morning. They labor all day and at night, the on-call provider delivers the baby.

Amani planned to go through the process of delivery without any pain killers.

Amani planned to only take the minimum dose of fentanyl when she is about to pass out.

Amani planned to only take the epidural when she is at 8 cm of cervical dilation.

Amani planned to stay on her feet through the whole night of contraction. She wanted to help the baby transition into her pelvis with the help of gravity.

Amani planned to exercise and perform all these weird positions in her labor room when she gets admitted.

Amani planned to utilize the bouncing ball during the night of labor when she is sitting down. She also planned to utilize the peanut ball when she is in a lying position.

Amani decided that if the fetus did its part and handled contractions without any decelerations, then she will eat pain for breakfast, launch, and dinner.

So that was our plan on paper, but below is how it went down with all the challenges.

 

Am I Dreaming?

 

Jude my eldest woke me up and said: “Daddy, Daddy, help Mommy!”

I got off the couch to find Amani on the kitchen floor, down on her hands and knees grinding through the contractions. I was like, breath baby breath. “Is it coming”, I asked? She replied no, but soon… it will.

We already had everything ready in the truck, the kid’s toys and cloth, Amani’s bag of clothes, personal items, and the baby’s stuff. I stayed by her until we the contraction subsided. “How far apart are the contractions”, I asked. 5 minutes, with a scratchy voice as she was holding to the stove handle to stand back up. I made sure she is up and steady, then the countdown started.

I am still not aware of the time. I just woke up and it still felt like a dream. I turned off the TV, went down on my knees by Jude and Noah. I hugged them and said: “Are you guys ready?”. Angelina is telling mommy that she is ready to come now. Let us put on your shoe, wear your jackets, and I’ll drop you off at Hamoudi’s house (The 3-year-old son of our friends Ali & Lobna) for a sleepover.

Yey! They were so excited. One because it is their first sleepover, and most importantly because they have been wanting Angelina to come for so long now.

As we got out to the car… It was 08:00 p.m. by the way. The kids buckled up, I buckled up, and as Amani was turning around the car to the passenger’s seat. She leaned her head on the passenger’s door and was squatting down to the ground. I was like, Oh shit, oh shit. I unbuckled, went around the car and put my hands around and under her armpits so that she doesn’t go all the way down to the floor. Her contraction was 20 seconds long, but it felt like forever. I helped her to the passenger’s seat, buckled her up. I said: “Baby, we will make it, I will drop you at the ED first, then I will drop the kids”. Amani nodded her head that she was agreeable.

 

The Last Visit To The ED

 

Carle Foundation Hospital is 6 minutes away from our residence. I kept my composure and drove by the speed limit 30 miles per hour. I had mixed feeling and fear was dominating, but I wanted to show confidence as I didn’t want the boys to worry.

Amani had one more contraction just before we pulled to the ED, and then she said don’t worry I will make it to the front desk. Go drop the kids, and drive back safely.

Ali met me at the mosque parking lot, took the kids and said: “don’t worry about the boys, we will take good care of them. You go do your thing and take care of your wife”. He sent blessings my way, I kissed the kids and was on my way back. Amani texted me, I’m in room 1058. I parked in the fairgrounds, which is a 10-minute walk from the hospital. Walking to the hospital through the park, all I was thinking of was, Am I ready? Are we ready? By tomorrow we will have three kids. Will Amani have a natural birth or a third C-section? Oh GOD, that moment I wished I could read the future.

 

The Admission to The Triage Room in the L&D department

 

I entered the room 1058. Amani was in a patient’s gown lying in bed, chatting with the nurse. She already had the fetal heart monitor wrapped around her. I sat on the couch by the bed and listened to the nurse orienting Amani to the admission process.

Apparently, we were in a triage room and not fully admitted yet. The RN still was to examine Amani for cervical dilation and report back to the physician to decide on full admit status. Amani was 3cm in cervical dilation, at station -2, and contractions at 5 minutes apart and 30 seconds long. The nurse finished up with Amani and went out.

 

Dr. D.M

 

RN came back 10 minutes later with Dr. D.M.
Dr. D.M gave us the news that Amani is considered in active labor and will be admitted to the labor and delivery unit, which meant we will change rooms soon. Dr. D.M also wanted to discuss Amani’s decision for normal delivery after 2 C-sections.

Dr. D.M: “Why do you want to have a normal delivery after two C-section?”

Amani: “It is for emotional reasons, I had two bad experiences in the past, but I know I can give birth naturally.”

Dr. D.M: “I know you went through the risk of complications of your decision with Dr. Hennesy, but since I am on-call tonight I have to go over them again and ask you to sign another waiver/consent”

Amani: “Okay”

Dr. D.M: “There is a big risk of uterine rupture with a VBAC 2”

Amani: “Yes”

Dr. D.M: “You have to weigh what do you want more! A normal delivery or a discharge with a dead baby”

Amani turned pale when she heard that statement. We never thought that far in the process. We knew that we will switch to a C-section once RED Flags pop up where Amani or the fetus are in danger. But the way she put her statement was so mean, and left us with a lot of fear and anxiety.

A contraction started, Amani switched to her side and started grimacing. I could tell she was very upset. I took over the conversation and told Dr. D.M: “Thank you, but we already discussed the pros and cons with Dr. Michael Hennesy. We are aware of the complications, and we are willing to take the risk for now.

Dr. D.M left the room and Ramie Boyer our RN for the night looked stunned. When the RN left the room, Amani and I were shitless scared. We started doubting our decision. Are we being selfish! Are we jeopardizing our new baby’s life just to prove to ourselves that we can have a normal birth after 2 C-sections? Our anxiety was through the roof. Amani and I took 5 minutes between contractions to discuss our next step.

The risk is 1-3 percent for uterine rapture, which leaves us with 97% of it not happening. The success rate of normal delivery after 2 C-sections is 56%. My wife and I are RNs, and we are fully aware of when to switch gears before shit hits the fan. Based on all the above, we put our faith in GOD our savior, and stuck with our initial plan. We were in no way, shape, or form letting that doctor take over and deliver Amani. We will take it slow and steady, keep an eye on everything, handle the agony and the pain, and make it till the morning.

 

Full admit to the Labor & Delivery Room

 

We switched to room 1008. It was a way bigger room, which had plenty of space for a lot of staff to be present at the same time. A lot of space for emergency situations, where the bed can be dragged very easily outside of the room through the hallway and to the operating room. We were still in a panic from Dr. D.M’s way of handling things, but I automatically switched to RN mode and tried to work on Amani’s anxiety and fear.

Ramie Boyer our RN was fabulous. I believe she sensed that we were anxious and afraid. She didn’t want to oppose Dr. D.M’s opinion, I get it, but she acted in a very professional way. Ramie’s explanations and patient education were phenomenal. She knew every aspect of her job. She encouraged us to ask questions, and she was knowledgeable on every aspect of the process. Ramie gained our trust very quickly, in a matter of minutes. Amani was following Ramies instructions to the tee.

Ramie explained every single step she was doing and why she was doing it. Ramie inserted two 18G Peripheral IV lines. She was taking Amani’s preference into consideration with the vein selection. Ramie put the wireless fetal heart rate probes to allow Amani to walk around in the room. Ramie also got us a bouncing ball so Amani could do the various bouncing positions that she planned to do. I was massaging Amani’s lower back every time a contraction started. Ramie suggested rubbing her lower back with a heat pack, which is more effective in reducing the contraction pain.

Amani was looking back and forth on the monitor to check the heart rate. Ramie picked up on Amani’s behavior and told her the most magical thing a nurse could say to a patient to ease her anxiety. She said: “Focus on your pain and contractions, and let me stress and worry about the fetal heart rate and your overall wellbeing. That is my JOB”.

We spent the night counting contraction time intervals and length. Contractions were ranging from 3-5 minutes apart and lasted 40-60 seconds. IV Fluids were running at 125ml/hour. We spent 4-5 hours walking around the room, going to the rest room, bouncing on the ball, and maintaining certain positions. Every couple of hours, Ramie would offer to check the cervical dilation. Amani was dilating around 1 cm every hour and the baby’s heart rate was holding beautifully through normal ranges.

 

00:45 a.m.

 

At 7cm cervical dilation, Amani was in excruciating pain and she was debating herself on taking the fentanyl. Ramie was able to convince Amani to take the fentanyl and reassured her that it will not slow the progression of your cervical dilation. Amani took fentanyl 50 mcg IV once, laid down in bed on her side and tried to rest. She slept for 5 minutes and then the pain was back. I couldn’t believe that fentanyl’s half-life is that short. I was planning to lie down and rest myself as well, it didn’t happen. I was back to massaging.

 

01:40 a.m.

 

8 cm / 100% effacement/ station 0.

Vaginal Delivery after 2 C-sections

03:00 a.m.

 

Amani was way out of control. She was pacing up and down the floor. Her pain was unbearable. Nothing was helping at this point. Amani hit the call bell, “Ramie, I want the epidural”. Ramie: “I will let the doctor know”.

Amani knew that she was at 9-10 cm of cervical dilation. But she was not going to allow them to check her dilation until she gets the epidural. Few minutes later, Ramie came back with Dr. D.M. We thought that Dr. D.M was finished with her earlier conversation, but apparently she was ready for round 2.

 

Round 2

 

Dr. D.M: “I am still recommending going to an elective C-section because the risk is high for uterine rapture and I don’t know if I am able to rush you to the OR in a timely manner”.

Amani: “what do you mean? Don’t you have a well staffed operating room standby for emergencies”!

Dr. D.M: “No, we have a standby operating room, but even if everything is ready. If you had a uterine rapture, by the time we recognize it and push you to the OR, things might be already late and might not be able to save the baby”.

A contraction started, and Amani was literally standing at the end of the bed, with her face dipped and knees bent right over the bouncing ball.

Dr. D.M didn’t wait till the intensity of the contraction pass. She was talking over Amani’s moaning and pain. She switched gears now and jumped to plan B in terrifying us.

Dr. D.M: “Even if she had a successful vaginal deliver, I am worried because of her history of multiple C-sections and adhesions. The placenta might be placed anteriorly on the uterus and that might result in severe bleeding and then possible hysterectomy”.

Amani (speaking in Arabic) while contracting: “Please tell her to get out of the room, tell her to get out, (shouting) tell her to stop talking”.

Me (interrupting Dr. D.M): “Listen… listen (took a deep breath), we understand the risks and we are still going with the natural delivery”.

Dr. D.M stopped her argument. YES ARGUMENT!

She was arguing with us. She wasn’t confident enough she can handle a case that deviated a bit from the norm. We felt that she lacked the professional experience both at the skills aspect and the communication aspect. We felt she is demoralized. She lacked compassion, and integrity.

 

Epidural Anesthesia

 

The anesthesia nurse arrived to the scene. Amani was sitting at the right side of the bed, dangling her legs, hugging a pillow, arching her back, and waiting for the anesthesia nurse to organize her equipment and her sterile field. The first epidural attempt was lengthy, and all of a sudden Amani felt a dezzzzzzet electrical current going down from her right hip to the ankle. The anesthesia nurse had to withdraw the spinal needle and reattempt. The second attempt was quick, successful, and pain free.

Ramie was extraordinary with her care and emotional support. She would rationalize by saying I am doing my job. Maybe that was her second nature to care, but to us, that was going far and beyond the average patient care. Ramie put Amani in a comfortable position. She adjusted the probes, and positioned the peanut ball between Amani’s legs. Ramie said: “Rest for few hours, you need to regain your energy and strength to be able to cross the finish line”.

Few minutes into the epidural, Amani was feeling relaxed and fell into deep sleep. I looked at that swing; from the awful pain to a pure silence in the room post the epidural. Ramie started the epidural at a rate of 10. I was freaking exhausted. I pulled up the recliner, Ramie offered me a pillow and a blanket, and I slept at a glance.

Two hours later, Ramie woke Amani up to position her to the other side. I woke up and helped her with the pillows. Ramie offered to check Amani’s progress by checking her cervical dilation. Amani declined the offer. Amani knew that she was fully dilated because she was feeling the baby pressing on her rectum and had the feeling that she wants to poop. But Amani didn’t want to give Dr. Morrison a reason to start the active delivery phase of the baby. Amani wasn’t confident with Dr. D.M’s skillset and didn’t trust her clinical judgment.

Amani declined Ramie’s offer to check her progress, she went back to sleep with the peanut pillow between her legs, and so did I.

 

07:05 a.m.

 

Amani built up some energy and was ready to be checked. She pushed the call bell. Ramie came in and introduced the Day shift RN Betsy. They started their bedside shift report. Ramie wished us the best of luck. We thanked her and she left. Betsy checked Amani’s progress and Amani was at 9-10 cm/ 100% effacement/ station +1.

 

Dr. Michael Hennesy

 

Betsy called Dr. Hennesy to inform him that Amani was admitted last night and she is at 9-10 centimeters. Dr. Hennesy was at our room in no time. He looked happy that Amani was able to work it out till this stage. I could tell that he was surprised she was able to pull it off. Dr. Hennesy stated: “There is no more worry about the uterine rapture, at this stage this is impossible to happen. I will break your water now, and give your uterus more time to contract and push the baby down. You did an amazing job so far, I am proud of you”.

Those words of wisdom and encouragement coming from a provider to a patient showed experience and emotional intelligence. Unlike Dr. Morrison who was destructive and vicious with her words. Amani was so energized and she was confident that with Dr. Hennesy by her side, she will be able to realize her dream of delivering naturally.

 

Broke Her Water

 

Dr. Hennesy reached to the embryonic membrane and introduced a stylet in-between his fingers and raptured her water. Amani was so happy and I could feel that she is more alert and focused on what is going on. We waited 3 more hours. During that time, Betsy offered me coffee. Amani and I were chatting and killing time. Amani requested that Betsy lower her epidural by 2 mls every hour so that she will be able to feel the contractions to help push. Betsy consulted with the anesthesia nurse who approved Amani’s request.

 

10:30 a.m.

 

Betsy wanted to check Amani’s progress and as soon as Betsy lifted the gown, she was able to see the tip of the baby’s head. Betsy brought in a standing mirror so that Amani can see the progress and get excited. Betsy started coaching us on the right way to push and breath. Bear down as if you are defecating, hold your breath and push. When you feel there is nothing left in you, that is the time to keep pushing and then push some more.

Betsy was coaching while I was translating to Arabic. My wife is a very good English speaker, but coaching and cheering her in our native language brings more engagement. Amani was a fighter; we are at hour 18 of labor. Epidural is at 4 mls. Amani is fully dilated and the baby is at station +3.

Vaginal Delivery after 2 C-sections

Dr. Hennesy told us that the average transition phase of labor is 80 minutes. Betsy: “Let’s practice a couple of contractions”. Betsy’s hand is placed behind Amani’s right knee. The plan is to pull the knee upward to flex the hip to the maximum during contraction to assist the baby to transition and crown. I was standing on the left side with her left knee in my hand to do the same thing, up and flex.

I was looking at the monitor like a hawk. The wave started, so we pulled the knees up. Amani took a deep breath and started pushing. Amani’s face was so congested during pushing and her neck veins were distended. I was like push, push, c’mon honey push… push some more and when I feel she is about to give up, I tell her to relax. Take a deep breath and push, puuuuusssshhh, push some more. When I feel she can’t push anymore, I would say, “flex your neck and give me one extra push”. We were going at a rate of three pushes every single wave. A wave would last 60-90 seconds. We went through 3 waves and the baby was crowning.

 

Hurry… Call The Doctor!

 

Betsy paged Dr. Hannesy. We were passing the waves while waiting for him to arrive. 6 minutes later, he arrived. He entered the room and asked Betsy, “Do I have time to boot up”. Yes Dr. Hannesy”, Betsy replied. In less than a minute, Dr. hannesy looked like G.I.JOE. He was suit up from the head down. He started complimenting Amani of what a great fighter she is. He said: “I never thought you could pull it off, but you proved me wrong. If I can take back time, I would support you with your decision from the get go”. It is inspiring when you witness the humbleness of a Doctor admitting that he was wrong and the patient was right.

Two more waves and Angelina was born. Dr. Hennessy pulled her and placed her on Amani’s chest. I was in tears. The room was full of nurses and I didn’t want to cry, but I could not help it. I felt so proud of her. I felt that she has finally realized her dream. She has been talking about natural birth for more than half a decade and finally she was able walk that path.

Dr. Hannessy has 20 years of experience under his belt. He only had 5 patients succeed vaginal birth after 2 C-sections. Amani was number 6, he thanked her for choosing him to share her experience with. Three minutes on the clock were completed from the time of the birth. It was time to cut the cord.

It was my time to cut the cord, which was a very special moment for me. I handed my phone to the nurse to take a couple of pictures. This was a historical moment in our life. I don’t believe I will ever forget my emotions back then.

Vaginal Delivery after 2 C-sections

Sometimes when I get busy and overwhelmed, hustling between my full-time RN job at Carle, my RN weekend job at Gipson, my blog, my YouTube Channel, my other social media and my family. I sit back, reflect and go back to that day, that room, that moment. 11:30 a.m. when Angelina was born, that is my happy place I go to when things get overwhelming. That feeling of gratitude is a blessing.

Vaginal Delivery after 2 C-sections

Vaginal Delivery after 2 C-sections

I truly appreciate your support of hanging here this long and reliving our journeys through our pregnancies. A YouTube Video of me and Amani sharing our story will be out soon. Make sure you go and subscribe to my YouTube Channel at www.youtube.com/alphaslice and stay tuned for it.

Vaginal Delivery after 2 C-sections

If you liked this blog, I would love if you would leave a comment down below about your experience or about your thoughts to our story.

 

|by Mohamad Younes, RN, BSN, CPHON®

 

 

 

 

RN Had NO IDEA! - He Had FAMILY At The Cancer Center

     RN Had NO IDEA! – He Had FAMILY At The Cancer Center

|by Mohamad Younes, RN, BSN, CPHON®

 

 

Two of my RN colleagues (Ali & Alison) in the Oncology Triage Team, stepped to my cubicle. Surprise!
We are having a baby shower party for you down at the lounge area at noon for you and Dr. Mantha.
I was like WOW! What? … Say that again?

Let me give you a bit of a background story about our culture and me. So I come from Lebanon, and we don’t do baby showers over there. Our tradition – after the new baby is born – we decorate our home, we bring chocolate, juice, dessert to be served for the people who will visit. We also design and order little souvenirs for family and friends to take home after they come visit us and see the baby.

So going back to Ali & Alison, I was like! Can I call my wife and ask her to come; I mean she is the one who is going to have the baby… they were like, heck yeah!

Picked up the phone, ring … ring … ring … It was 11:15, C’mon Amani – Pick up!

Me: Hey honey, my team here at the Cancer Center are throwing me and Dr. Mantha a baby shower party in 45 minutes, do you think you can come!
Me thinking (she is going to kill me, bearing in mind that my eldest “Jude” was febrile that morning and didn’t send him to school, so she is supposed to come with both my boys)
Amani: What’s a baby shower!
Me: With my little knowledge of baby showers that I have from following up on my transition specialist’s (Dennis) baby shower pictures on Facebook. I tried to explain to her the purpose and the idea behind baby showers.
Amani: Okay babe that is great! I will be there by 12:00.
Me: Oh okay, text me when you get here.

Noon Sharp.

Amani texted me, she is at the South Clinic entrance. There she was, with the boys. We all went down to the lounge area and oh man – looking through the glass window of the lounge door – the room was stacked with people.

RN Had NO IDEA! - He Had FAMILY At The Cancer Center

We stepped in and my GOD, the welcoming was phenomenal. My little one “Noah” was so shy from the attention, he was behind me grabbing my legs and sticking his face in my butt. Jude and Noah had no idea what they are walking into. Nurses, Doctors, patient care representatives, I mean everyone was there.
My wife was like – speaking in Arabic – wow Moe that’s quite a gathering. I could sense that she was blown away, we sat on a couple of free chairs, I grabbed a couple of plates and put some fruits and dessert for the boys. I had some beef, Homos paste and beans, which were delicious. Amani got some chocolate cake, ice cream, and fruits. There was a wide variety of sugary stuff, which I made sure I tasted all of them.

Lol the IRONY, I was reading an email earlier that morning, it was a reminder to consider donating blood because it has been 8 weeks from my last donation. Part of the email was explaining the benefits of donating blood, it says: “You dump 650 calories with one donation and can skip the gym”. So I guess we evened out by the end of the party.

The people at our table were so nice; they were talking to us and getting to know us. Everyone was friendly and kind; my wife loved the engagement with the team.

RN Had NO IDEA! - He Had FAMILY At The Cancer Center

Half an hour into the party Sybil – my teammate in Triage – approached us and asked me: “Do you want to open the gifts here or at home? I was like nah, we will open it here. My thinking was that there is ONE gift. Sybil started handing me gift bags, bag after bag, six, seven, eight bags, and the bags are still coming, fifteen, sixteen, still coming. Twenty-one gift bags and boxes were given to us by an amazing team, the Carle Cancer Center Team.

My wife was out of words; she was even unable to express in Arabic. Honestly, that was unexpected. The hospitality, the kindness, and the thoughtfulness of the colleagues around us were unforeseen.

RN Had NO IDEA! - He Had FAMILY At The Cancer Center

Amani was telling me few weeks back, poor this new baby, she won’t be having any gifts because there is no family and friends to visit and celebrate her arrival to this world. I guess now she knows we have plenty of family and friends out here.

Yes, yesterday I felt my family around me. I guess I’m part of a family that I didn’t know exists – The Big Family of the Carle Cancer Center.

A huge Thank You to everyone who contributed to this party. A big Thank You to the Oncology Triage Team who managed to pull this off without me even noticing. A big thank you to Jane my Triage Teammate who coordinated the whole thing. A Big Thank You to my Nurse Manager, all the Doctors, all the Nurse Practitioners, all the Patient Care Reps, Clinical Educator, IT, Environmental Services, literally everyone… GOD blesses your heart.

Amani, the boys, and I left the lounge carrying all these gift bags and boxes. Walking down the hallway from the Cancer Center to the South Clinic, we were drawing attention, we were glowing. We felt special yesterday, we really did.

Ever since we arrived to the United States 5 month ago, I have not seen Amani any happier. On top of the baby shower, she also had her Ultrasound on that day, she saw the baby sucking on her hand for full 3 minutes and the boys were standing there looking and the black and white ultrasound monitor with their eyes glazing with joy.

RN Had NO IDEA! - He Had FAMILY At The Cancer Center

When I woke up that morning getting ready to work, 9/27 was another working day, but ended up to be the Best Day in a really long time. Amani spent the rest of that evening looking at the very nice creative gift cards, holding up the baby cloth which are the cutest ever, and taking pictures of every single item that we got.

Late that night Amani was like, Moe… (pause) … Moe… (pause) … Babe … (pause) … did you sleep already!
Of course, I was pretending to be dead because it was a long day and I had to wake up early for work the next day.
Moe… (pause) … Babe … (pause) … then she slapped me on the back of my head, I was like Emmmmmmm What! (moaning)
Amani: “I like your colleagues … (pause) … you have a great team in the Cancer Center”
Me: “I know, I’ve been telling you that for 3 months now”
She said: “I know, but hearing it is one thing, living it is another”

I smiled and slept on that thought…

 

 

 

 

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|by Mohamad Younes, RN, BSN, CPHON®

 

What's in it For You!

What’s in it for you!


|by Mohamad Younes, RN, BSN, CPHON®

 

 

I get approached with this negative mentality where nurses question me, why are you making those YouTube Videos, why do you ask people to share them. What do you benefit from having a blog, why do you ask nurses to share it. Why are you building your social media following, are you trying to be a celebrity.

LOL… These questions come from people who know me or know my wife Amani on the personal level. Usually those people are the ones who live in a nutshell, non-risk takers, non-motivators, non-helpers, and non- influencers.

Most of those people worry a lot about their image, they are selfish, and they are not willing to give or help unless there is something in return or revenue of some sort.

The IRONY is that those same people are the ones who ask me or my wife for advises to how to pass the IELTS, NCLEX, and CGFNS. They are the ones who ask, “how can I apply for immigration to USA, for a B1/B2 visa, for a sponsorship to a certain conference”. They are the ones who ask for advise to the application for nursing specialty certification like the CPHON. They are the ones who ask to send them free study material…. My GOD – what is wrong with you people!

They don’t get the BIG picture even though they are the ones who are getting most of the benefits from what I offer. If they cared enough to read my AlphaSlice Philosophy, or the About page on my YouTube Channel, or just read between the lines, they would have got the answer to their question.

Why do they ask for free help or advise, and they wonder why do I give it to others.

What’s in it for me!

I was in a dark place at one point in life. I lost all my savings and my wife’s savings trying to get answers, trying to get help, trying to find hope, safety, and wellbeing. We literally spent $80,000 trying to stay above water, trying to find shore. We were trying to find our way home, not our home, but to find a place that we can finally call it home.

We were trying to find a RN who has done it before and follow his or her footsteps. We failed, failed and failed to find that one RN who has immigrated to USA and is living the American Dream. I wanted to find a real RN not a staffing or recruitment agency, I wanted a RN currently living the Dream who would just answer my one and only question.

“Am I chasing an illusion? Am I being stubborn? Am I dragging all my family down with me? Is there even an American Dream or that is just a Hollywood fantasy? Is it possible to get there?”

 

I just wanted confirmation, I wanted someone who has been in my shoes and is now in a better place to tell me,

“Yes keep going, it can be done. I have done it and now it is your turn to do it”.

I failed to find that one RN. But you know what! One night, I looked up to the guy upstairs and I prayed and I made a promise. If I make it, I will do whatever it takes to be that RN that I was looking for to give me hope, reassurance, and advise.

A lot of international RNs just need someone to talk to validate their goals and help them take decisions by sharing his experience. International RN’s want someone to connect to, who gives them inspiration, motivation to keep them going especially if they are in a place that sucks.

Most International RNs are underappreciated, underpaid, underrated, and undervalued. They want to bring life back to their nursing profession and to why they chose that profession in the first place. International RNs want safety, security, independence, financial stability, insurance, luxury, leverage, human rights, electricity, water, systems, and more. They want the western lifestyle. Is it possible to dream to have all that?

Most international RNs who are pursuing the American Dream have potential. They don’t know what they are capable of, because their situation, culture, country doesn’t not allow them to experiment and max out on their potential. They are like a Ferrari in an alley, there is no way you can test the full potential of a Ferrari in an alley. To test the full potential of a Ferrari is to put it on a racetrack. The same thing applies to international RNs, to test their full potential they need to immigrate to USA, and believe me “They Can Move Mountains”.

I love my profession because I can care and advocate to those who can’t care and advocate for themselves. Now, besides that, I found another passion in my profession, which is to motivate and inspire RNs who need the motivation and inspiration to improve their current status.

What’s in it for me!

 

To those who ask that question, I say.

Inspiring others to improve their life is not easy, and some, desperately need that idea of inspiration and motivation to keep them going especially if they are in a place that sucks, same place that you are currently in (instafuckenbility). Is this word hard for you to read, do you want me to break it down for you!

If you help other people get what they want, then you will get what you want. So stop asking silly questions and think outside of the box.

To the International RN I say. Listen, I know exactly what you are going through. I have been that guy 6 month ago. You see where I am now, you see what I was able to accomplish in this short period of time. Listen brothers and sisters, stand your grounds, surround yourself with positive people and it is shame to say but those positive people are not your family, your friends, or your country. Positive people can only be found ONLINE, yes you heard me, ONLINE! The people online don’t judge you or criticize you; they are online to help you. It doesn’t matter if they are helping you online for free or asking a price in return. The main thing is that they are there for you.

My fellow International RN, when I got here, there were no footprints to follow. I went through a lot of sacrifice and loses to get to where I wanted to be. Good News, Now you have footprints for you to follow. Stop looking, and make your first STEP!

I made it here through #perseverance. That is my only advise.

It takes 4-6 hours to make a 6-minute YouTube Video and another hour to market it on social media. It takes 2-3 hours to put a post like this one together. I am investing that time to help you by creating entertaining and educational material. All I ask for in return is to give me 3 seconds of your precious time, only 3 clicks.

Like, Subscribe, and Share, so that another RN, who is in the same shit hole I was in few years back, would find me, would find hope.

Submit a comment down below, share your thoughts

 

 

|by Mohamad Younes, RN, BSN, CPHON®

Do You Still Dream?

Do You Still Dream?

|by Mohamad Younes, RN, BSN, CPHON®

I got raised this way!

My parents raised me to do the right thing, to abide by the rules. My school teacher said: “focus on your studies, go to college, and get a JOB”. My employer asked me to follow policies, even if they didn’t make sense. My country expects me to graduate and start working. My Culture expects me to settle, get married, and have babies. BUT, I had a Dream!

The fact that you get absorbed by reality; exams, bills, taxes. Subconsciously, you feel compelled to put your dream aside, put it on hold and jump into pursuing standards preset by your culture.

Artists, Singers, and Young Entrepreneurs are looked down at in my culture because they are following a Passion, a Dream, and not a JOB that would pay the Bills!

LoL – That’s all it takes. One stare-down by your parents, your teacher, and/or your community to make you doubt what you are doing, and simply put your Dream on “coming soon” status.

A YouTube video came across my home page feeds the other day, a 14-year old boy in Texas had a revenue of $80,000 in 2 month. That little boy, oh I can’t call him little, that boy made $80,000 profit with $0 cash down. A 14-year old boy in my home country can’t even put that number together, $80,000 (Ironic right). The reason being, my 14-year old home town boy was raised on different standards “Do What You Are Told”, and the Texas kid was raised on “You Can Do/Be Whatever You Put Your Mind Into”.

I bet all you are eager to know how he made that kind of money.

The Texas kid states – { I came across an article on one of my favorite Entrepreneurs Journals, titled “Make $2000 in 1 week with a free Online Store”. I followed the steps, I got the free access to an e-course that taught me step-by-step of how to build and design my online store for free on Shopify. They showed me a strategy implemented by AliExpress website where they allow you to advertise items from their e-store into your e-store and earn 30% revenue on whatever you sell. No need for inventory, no need for shipping, and most importantly no need for down payments. I started marketing my store to my Facebook and Instagram, and then things got out of control. My bank account which is a sub-account of my mother’s bank account started blowing up, my mother started getting all these alert messages of foreign direct deposits to her account. Long story short, I was hosted by 2 TV shows, I was a keynote speaker at a University of Dallas Business Symposium where I talked about “Entrepreneurship & How To Market An Online Business“, and recently I gave a 30 minute talk at the Dallas Department of Juvenile Justice}.

 

Quite a Story right!

I posted a status a few days ago on my Facebook Group RN AlphaSlice, “Do You Still Dream! What is it?” I knew that some mentalities will be goal-focused and not dream-focused, and I was right.

One of the Dreams was “To pass the CGFNS & English😈“, a second Dream was “To pass the sea to Europe😂” meaning he wanted to illegally immigrate. A third Dream was “Marriage 😂😍 then moving to US”, another was “Speed up my immigration to Canada!!”, and another “American dream ✔💥A step at a time though IELTS, NCLEX, then boom 🔝🔝”, and the list goes on.

Some members chose not to participate, reasons could be that they are afraid of sharing, they don’t want to be stared down at their dreams by others, or could be that they feel they are too old to dream and they prefer to dream through their kids or grandkids.

I shared my take on the status and shared my Dream with everyone, I will copy and paste below.

Thank you all for the participation and engagement 
The moral of the status: 
You are never too old to keep Dream. There is a difference between goals & dreams. Dreams have bigger value and depth, you need to have a dream to the extent where your friends and family would think you are crazy. Don’t be afraid of being a dreamer, dreams come true and if you believe, you can move mountains. 
I encourage everyone to start dreaming again, dream for yourself, not for your wife and kids.
I will share some of my dreams. I dream of financial freedom. I don’t want to worry about rent, bills, or gas. I dream of creating at least 10 successful businesses, I dream of owning 100 real estate properties, I dream of changing the lives of at least 1,000,000 individuals. I dream of creating something in my name…. I dream of creating a Legacy for my family… Yeah lol I dream a lot.  
Remember, no one can take your dream away from you.

My favorite Dream in the comments on my status was to this RN & Entrepreneur who understands the grind and is talking the talk and walking the walk. I would like to give her a shout out, her name is Sandra Ck she opened her little online Facebook page business called Idées à Crochet  Go check out her store guys. Her comment on my Status was:

I dream of being able to have my own crochet business , my own big name or crochet store ! I dream of being able to see my parents in Usa if not everyday every other day or weekend  I dream i can fly all by the rainbow so high ! I always have dreams ..

I will end this blog by saying, you are either contributing your time and energy to make your Dream come true, or working a JOB and helping other people’s Dream come true ~ Food for thought ~

 

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|by Mohamad Younes, RN, BSN, CPHON®

AlphaSlice Philosophy! How It Came To Be?

AlphaSlice Philosophy

|by Mohamad Younes, RN, BSN, CPHON®

 

Hey!

I’m Glad you asked. Now I’m sure I will impact at least one positive change in your life.

This Brand is supposed to be glamorous and drags you to stick around and watch my videos… Hope so!

Whether you are looking for motivation, inspiration, or a drive to be the hero of your life story – you are in the right place.
Since you are here now, something tells me that you are an #AlphaSlice. I feel your enthusiasm, your positive mindset, and your readiness to kick the world in the nuts.

Husshhh! maybe you…

• Want success but have no clue how to start your success story.
• Believe a bigger purpose was intended for you to influence others.
• Want to be creative, proactive, and functional.
• Are dabbling in the idea of improving yourself, and don’t know the real way to

do it.
• Want to live you life like you are the hero in your own movie.

Stop! Subscribe, Like the videos, share my videos, stay connected and let us take the first step into bringing your shit back together and accomplishing your life dreams.

My goals were around that, been there, done that. I believed…

• I had a built-in gene to passionately care for patients and their families and I found it morally rewarding, I wanted to advocate for nurses to set values to their professional practice model and raise their satisfaction while lowering their burnout.

• I am a freak of nature, top athlete of my class, captain of both the university’s basketball and soccer teams, had passion to the sport of bodybuilding after

College and the science behind muscle hypertrophy. I had a goal to preach a healthy lifestyle, fitness, and nutrition in the fitness community.

• I have the secrets for balanced relationships, love, and sex. I have the tools for troubleshooting couple’s struggles and conflicts. I wanted to write an e- book to explain my theories to ultimate happiness.

• One day I will start my YouTube channel, my blog, even create my website and put together online coaching programs, dieting plans, and oncology nursing courses for specialty certification.

The essence of your goals is: You have wisdom and talent – this is the secret recipe for success – you want to use this to improve your life and the world. I am here to help you reach your utmost potential and be the best version of yourself.

Hey! My name is Mohamad Younes and I am fascinated with transforming lives, setting realistic goals and achieving them by putting evidence and knowledge into practice.

How did my life come to this place?

Well, I got my Bachelor degree in Nursing Sciences in 2007… Yey!! I am an RN. I became a Certified Pediatric Hematology Oncology Nurse (CPHON®) in 2012; I’ve been a nurse for 10 years now, worked at elite hospitals in different cultures from Saudi Arabia to the United States.

I attended courses and conferences worldwide more that I can even remember. I’ve been speaker at conferences, hosted as the 2013 International Scholarship winner by the Association of Pediatric Hematology Oncology Nurses (APHON), advocate for oncology certification, and a member of the editorial board of the Oncology Nursing Certification Corporation (ONCC).

A year ago came back to Lebanon, after being away for eight years. I worked for a year and got shocked with the ethical dilemmas I encountered in the healthcare system, the underutilized, the under-paid, and the wasted talents and potential in the youth of the Lebanese community.

College graduates can’t find jobs, employed professional are pressured to serve corrupted companies or else lose their jobs. Professional working labor to live in dignity. Nurses failing to deal with moral distress. The unhealthy lifestyle and the flabbiness amongst men and women in their young adulthood, because of stress, burnout, depression and lack of motivation.

So I decided to put my longtime goal of starting a YouTube channel, e-book writing and online courses into action. I want to put my thoughts into practice, I want to recruit my knowledge and skills that I have learned through academic education and experience into a series of videos, e-books and online courses to help you freakin’ wake up and put some order into your life.

 

From now on, you are an #AlphaSlice in this world and you will act as one. This world has a lot of Alpha leaders and Alpha opportunities and you deserve a Slice from that #AlphaPie. Find your #AlphaSlice, whether it is a company, a creation, an investment, a passion, a business, a trade, a website, a brand, a profession… and the list goes on. Find your #AlphaSlice and shine like the brightest star in your constellation.

 

This is not for everyone but since you got this far reading then you’re damn right your going to reach your finish line and you will get your hand raised and walk away with the W.

I have successfully helped at least 100 individuals reach certain goals in their life, from fitness, to professional nursing, to building relationship intelligence and many others. Now it’s your turn!

Before I go… If you haven’t yet, please Subscribe to the YouTube channel, share, like my videos, and stay connected.

And Yo! Thanks for being here. I sincerely appreciate it… and you.

~ AlphsSlice ~

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|by Mohamad Younes, RN, BSN, CPHON®
© AlphaSlice 2024
Copyright. All Rights Reserved.