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.
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.
* 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.
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.
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.
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.
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.
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.
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.
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.
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.
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®