Alexa - Prodromal VBAC

I met Alexa when she was newly pregnant as part of a Birth Tribe consult. As we sat in that first interview she told me a traumatic story about her first sons birth. It was filled with provider bullying, lack of consent, disrespect, and the worst part was so many unanswered questions about why things happened the way that they did.

Based on everything that I could piece together, Alexa had been put under general anesthesia, for a non-emergent cesarean, and neither her or her partner were present for the first cry of their beautiful son Henry, who was not quite 2 years old.

She wanted to have a vaginal birth for this baby so badly, but there would be many road blocks along the way. Not ones put up by anyone else, not by her new provider, nor her physical body (we all knew she was capable), but Alexa would have to convince herself that she was making the right choice and that she could actually do this, over and over again.

Alexa was quiet during most of her pregnancy, but when she would reach out, she would be in a low state of confidence. She would start texts with, "I don't think I should do this," or "I think this is going to go badly and I don't think I could handle the disappointment again." or "I'm afraid to have her come out of me."

Each time we would talk it through, I could get her to a calmer place, but it never ended with "I CAN DO THIS!". It would end with, "I don't know, but ok."

Alexa also has an amazingly supportive spouse, Matthew. Matthew would call me concerned about Alexa's lack of confidence. He never doubted her not one time. I remember a phone call once where he said to me, "You and I know she's strong enough to do this and she really wants it. I just hope she gets to a point where she can believe that too."

Alexa would have periods at the end of her pregnancy where she thought she was in labor and then things would fizzle out.

However, on the evening of Saturday December 7th, Alexa started having contractions that woke her up. We would talk through out the night and early morning, but they were never getting close enough and her description didn't make them seem as the type that would be making cervical change.

Early on Sunday afternoon Alexa sent me a text that said, "I feel discouraged. I was fine and contracting regularly...and they're much less regular now, which is fine, but I feel like they (her family) stressed me into stalling."

Again that evening, it would look like early labor was beginning. I talked with Matthew and decided to come over and check on Alexa. She had told me her contractions were coming every 7 minutes or so. When I arrived we all sat on the couch talking. I could tell that she was having some regular discomfort, but that she wasn't in active labor as we were able to keep chatting.

We discussed prodromal labor and prioritizing rest. Alexa had been up now for two nights in a row and looked exhausted. A few hours later around 1am, she texted me again that she couldn't sleep. That the contractions were the most uncomfortable that they had been so far. My heart sank a bit. I had been called to another client, who was now in labor.

I let a backup know that I might need them and I kept in contact with her through the labor and birth of my other client. Alexa's contractions, while steady, never got closer.

At around 7am she texted me that they had once again become inconsistent. We discussed water and rest again. I could tell that she was frustrated with me, with Matthew, with Henry, and with this labor process. She was over it. She was seeing this lengthy on and off process as the start of a "failure".

She called the midwife office and they also suggested prodromal labor and rest. She texted me with, "they said the same thing as you..." What's hard about prodromal labor, is you struggle to feel connected to and trust your body, and Alexa was already starting off at a deficit because of her previous experience.

We spoke multiple times on Monday and at one point I said, "I know this is hard, but this isn't active labor yet." Alexa hung up the phone on me. Matthew called me a short while later. She had asked him to come home because she was going to head to the midwives office to get everything checked.

Alexa finally reached out to me and told me that she was 3cm dilated with a bulging bag of water and they were contemplating going home. Michelle, her midwife wanted her to go home and take a bath and try to rest. I knew that probably made Alexa feel a certain way.

However, things quickly changed. The baby was having some issues with its heart rate and after the exam Alexa started contracting more frequently. They would be heading to the hospital now for monitoring.

I met them at Manchester Memorial Hospital, where Maura the midwife came in to check on them and make a plan. After a few hours of contractions without much change, Alexa decided to get some help sleeping. It had been days without much rest and sometimes the body won't move forward in the process if it's too exhausted for the task. At 1am I tucked them in and headed home for a few hours of sleep.

Alexa texted me at 5:30am and asked me to come back. She rested on and off for the next few hours, then I encouraged her to take a shower and have some breakfast. Maura came in at 9:30am to see where we were starting today. Alexa's cervix had made some change and was now 4 to 5cm.

Alexa was having uncomfortable

contractions and Maura thought the baby might be in a bit of a wonky position. We did some spinning babies techniques, which I had taught Alexa and Matthew during a prenatal exam to see if we could help out a bit. We also did a round of the Miles Circuit to see if it could help things increase in intensity.

Alexa was so exhausted. We discussed the benefits of an epidural and she decided that should would like one. While waiting for the anesthesiologist I sat in front of Alexa as she was sitting on the edge of the bed falling in and out of sleep. I occasionally had to hold her body up in between contractions.

Prior to the epidural there was another cervical check and all of this hard work, wasn't resulting in much change. I was hopeful that if Alexa could get comfortable and get her mind out of the way, that her body might make change.

After another few hours and a nap there still wasn't much change. Alexa was feeling the contractions through the epidural now too and could no longer rest. Maura suggested that it may be time to try pitocin to help strengthen the contractions. Alexa was hesitant as her previous induction, which included pitocin, led to her cesarean. However, we started talking about it, and she decided that it was the right choice.

As another evening rolled around, Alexa looked at me with the saddest eyes and I said, "You don't have to be afraid of this." While I try to process previous birth trauma during prenatals Alexa was extremely resistant and not intentionally. There was just so much damage and doubt.

I thought that maybe this is what was holding her back. I said, "Today is a huge day and has the potential to change the way you feel about yourself for the rest of your life and that is such a huge deal and deserves time to think about the celebration or the grief that may come." She nodded back and said, "exactly."

Alexa began sobbing and wailing. Matthew and I held her and tried to comfort her. Her blood pressure and heart rate were rising and the baby's heart rate did too. We talked everything through for 45 minutes or so, but I could tell everyone was beginning to get nervous that she was struggling to calm down and so was the baby.

Maura came in and told her that she had an OB watching the baby now as well. The nurse looked at me with concern and then also started to try to calm Alexa down. However, I could see a change in Alexa.

While I don't often talk about energy work in these stories, I often use reiki as a tool during labor. However, this would be the first time that I would ever put all of my focus onto a baby. I asked permission and placed my hands on Alexa's belly. When focused an intentional, I was able to keep them both calm and have a lowering effect on their heart rates. I heard the nurse whisper to another nurse at change of shift, "Melissa is doing something called reiki and it seems to be working, but I don't know."

I knew what she "didn't know". The midwife and the obgyn were considering having a discussion about a repeat cesarean section. The baby and Alexa had been elevated on and off for quite some time and this labor had been going on for days with very slow change and people were doubting that either could handle anymore. However, there was major shifts happening.

I switched Alexa to her hands and knees and everything changed. We were entering transition. Alexa was squishing and rubbing her face into my shoulder and would occasionally make eye contact, while I kept my hands placed on her belly. I would keep assuring her that they were both safe.

She eventually took this huge exhale. She was back in control. Matthew was on the other side of her and I could see the worry on his face. He didn't know what her and I knew, but I didn't want to say it out loud. I didn't want for Alexa to fear how quickly everything was changing now. I wanted her to continue to welcome her baby.

Alexa said, "I have a lot of pressure, should we tell someone?". I encouraged her to keep at it. I didn't want to call in anyone to early and effect the calmness and quiet of the space.

About 15 minutes later, Alexa looked at me straight in the eyes, completely calm, and with the most confidence I had ever seen her have and said, "You're going to have to get my baby."

I looked down and saw her tissues separating with each contraction. Her baby was right there. I pushed the call button and asked for the midwife to come down. The nurse on the other side said, "Can she bring you something?". This had been quite the process and many people were aware of the heart rate watching that was going on, however, I once again didn't want to create any chaos. I just asked if she could come right away.

Maura walked in about a minute later, with the OB right behind her. My heart sunk for a second and I hoped that I was right, because I feared them calling a cesarean section for her if I wasn't. Maura said, "hey what's going on?" I replied, "Alexa asked for me to get her baby and I think you should. check." Maura had a look of surprise and a bit of doubt.

Alexa looked up at me and asked, "We are going to do this, right?" and I replied, "You are doing it." Matthew's eyes widened as he connected what was happening. Maura put on a glove and squeeled, "Oh my!! Your baby is right there!!!!". Everyone in the room was shocked and also excited.

Alexa rolled over and with just two active pushes brought their beautiful baby girl earth side.

When placed upon her chest, Alexa said, "you're so beautiful, thank you" to her little one. Matt had tears rolling down his face and kept saying how proud he was.

The staff was exclaiming how amazing it was and Alexa looked up at me with such a look of glory and relief and said, "This will change me." And she was right. It would change her forever.

The staff was exclaiming how amazing it was and Alexa looked up at me with such a look of glory and relief and said, "This will change me." And she was right. It would change her forever.