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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.

woman laboring manchester memorial hospital

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.

coping with labor leaned over bed

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.

spinning babies inversion during labor

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.

miles circuit during labor

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.

falling asleep 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.

resting while in labor

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.