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Claudia: VBA2C

We sat in the office, meeting officially for the first time. Claudia sat across from me, telling me about her previous birth experiences and then her husband, Marco asked me a question: "What makes you more successful at getting people a VBAC?" as I answered his question, he smirked and then giggled at the end. "Claudia isn't going to do anything that she doesn't want to do. Basically, if you tell her to do something, that's when she won't."

At first I felt shocked by his reply and then I looked at her and she laughed. I understood the mindset that he was describing, I as well, might just be what they call stubborn. So then I asked, "Do you really want this? Because these are things you'll have to do to get it." Claudia began to well up, I felt the mood in the room shift from one of teasing laughter to something very heavy, and she replied, "I really want this." and her husband looking across the room at her said, "She really wants it."

The first thing to do was switch Claudia's provider. They were hesitant at first. They had birthed their other 3 children in this city. This was the city they lived in as well as the city they met when their love story began in high school. As I explained the statistics to them and they understood how different their chances could be, they decided to interview with a different practice. Claudia messaged me afterwards and said, "I like them very much. They seem very supportive of what I want. I'm going to make the switch."

Claudia continued to follow every piece of advice I gave her and was setting herself up for the greatest chance of having what she had always wanted, a vaginal birth.

Claudia's pregnancy would include risk factors. One on its own, wouldn't be a big deal, but as the pile of things began to grow, so did Claudia's anxiety. We were now at the end of the pregnancy and she asked me to go with her to an appointment at her obgyn office. Claudia decided she was going to ask about having an induction and the midwife her appointment was with that day, said, "We can't induce you because of a big baby. A big baby isn't a reason."

This is the reason I love and recommend this practice, but in this case, Claudia's gut was telling her something else. Claudia's gut was telling her it was time to get this baby out. I then pointed out all of the other risk factors she had and the midwife, then moved her head from side to side in contemplation, "Those are things we might induce for eventually, actually."

As we stood at the counter making her next appointment I suggested that she have it with a specific doctor, who might be more willing to go with Claudia's gut when she made the request.

She texted right after that next appointment: "Ok so he called the hospital, tomorrow morning but could be pushed off if they're swamped." I called her right away and she was shocked. She wanted this, but the fact that it was happening in less than 24 hours, was a lot to process and let sink in. "Melissa, I'm going to have a baby at some point soon!"

I met them at the hospital on Thursday morning at 9am. Claudia was on the monitors already and was contracting on her own, every 2-3 minutes. However, she was barely feeling them, which meant they weren't strong enough to be making any change.

The obgyn came in and checked her cervix so that we had a starting point. Claudia had a sweep the day prior and it was helping to change things. She was starting at 2cm dilated. This obgyn decided to start her on pitocin in hopes that it would help to strengthen the contractions that Claudia was already having.

At around 3pm Claudia was starting to feel her contractions. She admitted that while I had told her the only job to do the night before was to sleep, that her and Marco were so anxious that they didn't get much rest at all. I suggested that while her contractions were still mild she tried to close her eyes for a bit. However, they couldn't stop talking. They were both tired but buzzing around talking about all of the possibilities of the next few hours

The baby was still high in the pelvis so we worked on doing a few things to help the baby come down and apply pressure to the cervix to aid in dilation. Unfortunately though, her contractions had fizzled out.

At 8pm, Jen the midwife came in to check and see how Claudia had been doing. A cervical check would show that her cervix hadn't changed and was still very thick. Jen decided to place a balloon into the cervix to help with thinning. Marco was really interested in this process, so Jen gave him a tour of the vagina and a peek at what the cervix looked like. He was super excited for the bit of education she was willing to provide him and Claudia also thought that it was pretty neat that he was so engaged in the process.

At around 11pm contractions started to come back and this time they were more intense than before. They were coming in a more natural pattern too of every 3 to 4 minutes. I was hopeful that things were starting to change for Claudia. Marco asked lots of questions, more questions than anyone had ever asked me during this process.

The balloon came right out around 6am and Claudia was now 4cm dilated and 80% effaced which was a great change. They had turned down the pitocin overnight because her contractions were coming too close together. Now that the balloon was out, they decided to start the pitocin again in hopes to get a good pattern going one more time.

At 9am, Claudia's contractions hadn't come back and they suggested breaking her water. Claudia was hesitant. With her first pregnancy, her provider had a time limit on broken water, which is what eventually led to her first cesarean. The doctor assured her that as long as everyone was ok, they wanted her to have a vaginal birth as much as she did, and that they wouldn't put a time limit on her because her water broke. After a bit of discussion with Marco and I, Claudia agreed.

At first the water being broken didn't seem to be helping, however at around 12:30pm, things began to kick into gear again. Claudia began to become very audible and needed our help to cope with contractions. Marco was making jokes in between and I finally started to understand their relationship.

Marco understood what she needed at every turn and all of his questions were in hopes to protect Claudia's heart from being broken one more time. They have been together for over 20 years and he wanted to be able to give her all of the answers and assure her that they made all the right decisions, in case this birth didn't go the way she wanted it to.

Claudia was now experiencing quite a bit of pain and she was struggling to let go. She had been awake for two nights, laboring on and off for 30 hours and she was exhausted. She was holding on for dear life and it was time that we had a talk. I'm going to keep what we spoke about between her and I. However, VBAC is especially VBA2C's are as big of a mental challenge as they are a physical one and she knew she needed to let go of the fear she was carrying in order to progress. We both cried a bit and then went back to work.

We called for nitrous in hopes that it could help her get a bit of rest. She was dozing on and off between contractions. Another cervical exam at 4:17pm would suggest that she had gained another two centimeters.

Eventually Claudia was so exhausted that we discussed an epidural. The midwife was in agreement that Claudia needed rest. I was also hopeful that this could help her to let go a little bit as well.

At 6:12pm the epidural was placed. It worked almost immediately. Claudia was still so anxious that she was talking to me the entire time. She couldn't sleep and that's what we needed her to do.

Another midwife came on at shift, Devon, and around 8pm she examined the cervix. She had suggested that Claudia was a centimeter less than the previous exam four hours earlier. Claudia and Marco felt defeated. I assured them that she hadn't gone backwards, but that cervical checks were really subjective and what one midwife my feel, another may not. We were 36 hours into the induction process and Marco pointed out, "we are only half way there!". I explained that things after 6cm started to usually move much faster and that this was the hardest part. I told him what we needed to look for to know that she was progressing.

At that point, I decided to head home and take a nap myself for a bit. Claudia was still struggling to get rest, I was hopeful that once I was gone, there would be no one to talk to as Marco had already fallen asleep and she would have no choice, but to close her eyes.

On Saturday morning at 12:20am I was woken up by the following text from Marco: "Showtime! She feels like she needs to go to the bathroom."

I headed back and told the nurse, Doris, that they had texted me "showtime!" when I saw her at the front desk. She seemed skeptical. Doris told me that they didn't think her contractions were adequate and had placed an IUCP around 10pm. They had turned up the pitocin to its max dose just an hour earlier after proving their theory about the contractions and while they were now at an adequate level, she believed that not that much could have changed in such a short time frame.

I sat in the room with Claudia and Marco chatting about what may happen next. They were both really excited, but I was setting them up to hear bad news even though they seemed really positive. And then it began to happen. Claudia had that look in her eye, she felt nauseous, she began to shake, and then she said to me, "this is exactly what you explained transition would feel like." Then I heard her start to grunt uncontrollably.

I went back out into the hall and asked Doris to grab the midwife. Doris and I have known each other for years and she's one of my favorite nurses. She looked at me over her glasses like I had lost my marbles, but she said, "I hope you're right for all of your sakes."

At 1:20am Devon and Doris stepped into the room and checked Claudia's cervix. Devon: "I don't feel anything. Doris, can you check as well." Doris: "Oh yeah? Of course."

I stood up in excitement and Devon turned to me and looked at me in disbelief. I looked at Claudia and then at Marco and they both looked so sad.

Me: "Ya'll did you hear what she just said?!"

Marco: "Yeah that she didn't feel any change."

Doris: "That is not what she said. She said she didn't feel anything. Is it ok if I check your cervix?"

Claudia in a very confused tone: "Yes."

Doris: "There is no cervix left."

Marco: "Hold on..."

Me: "Claudia you are fully dilated!!"

Claudia: "I am? I am? I am 10cm?"

Marco: "10cm means there's no more!?!?"

Devon giggling: "You did it! And your baby came way down too."

Claudia and Marco needed a chance to let it sink in that this was really happening. Devon and Doris stepped out. They hugged and kissed and both kept saying that they thought they would never get to this part.

After about 30 minutes everyone came back in and it was time to push. I was hoping that things would get easier for Claudia, but as time passed, it was proving to be another massive hurdle. We tried lots of positions as Claudia's epidural was allowing her to have very good movement, with very little pain, but she still knew when she was contracting.

Her epidural was so good that at one point we asked her to move toward the end of the bed and she stood up and we all started screaming. She was shocked by our reaction and we explained that she can not stand up even in the bed. It was crazy how much control she had. More than I had ever seen before.

We just kept moving her trying to find the best position. However, we were seeing signs that would prove this baby was as big as everyone had predicted. The baby would come way down and with each contraction it would slowly go way back up in position. While rocking in and out is a normal part of the process, Claudia was pushing her baby to +4 and the baby was sometimes retracting all the way back to +1 and even zero station. This can often be a predictor of a shoulder dystocia

After 3 hours of pushing, an obgyn popped in. She talked to Claudia about the possible need for a cesarean section. Claudia assured her that she still had enough strength to keep going and after the doctor watched her push a few times, she decided to give her more time.

At almost 6am the doctor popped in again and was trying to do everything she could to help. Claudia and I Iater laughed because the doctor probably put 4oz of gel on the babies head just in case it needed a little extra help sliding. The doctor decided to have Claudia stop pushing for a bit and turned down her epidural.

I heard the doctor whisper to the midwife at 6:25am that she would be willing to give her one more hour to try.

I grabbed a mirror for Claudia to see what she was doing. We needed for her to hold the baby's head in place in between contractions so that the baby didn't have a chance to scoot so far up in the pelvis. Eventually she got the hang of exactly what we needed her to do.

Dr. Martas came back in and talked to Claudia about the possibility of shoulder dystocia. This was a conversation that had come up all through out this labor, but this time she was getting specific instructions about listening and following directions in the event that happened.

Dr. Martas began cheering Claudia on in Spanish, and with the next few pushes made the exact progress that she needed to. I looked at Claudia and said, "You're going to do this. It's happening." Doris laughed and said, "All you needed was for us to yell at you in Spanish? I would have done that hours ago!"

I have never felt so proud of someone. She had been pushing for 5 hours without one complaint. She looked at me and said, "I want this and I'm taking it." I looked up at Marco and his eyes were completely welled up.

Dr. Martas stepped out of the way and put Devon in her place. Devon was going to be handling what we all knew was coming next. At 7:21am, almost 48 hours after their arrival, the biggest set of delicious baby cheeks came slowly earth side.

After a minute or so, everyone in the room began to change positions and Doris and I went over and each grabbed a leg. Dr. Martas stood up on a stool waiting for Devon's request for assistance. The room began to get noisy and I said to Claudia, "Push as hard as you can right now." Then Doris said, "PUSH!!!".

At 7:23am their big beautiful little boy’s body came earth side, he needed a bit of stimulation but was left on Claudia's chest. Claudia began to talk to her baby and then there it was; a big and beautiful cry. Everyone in the room was cheering.

"Muchas felicidades!"

"Here is your boy!"

"That was tremendous!"

Devon and Claudia both took a loud sigh and Devon said, "Well that whole process was long and slow." I looked at her and asked if she was ok and she nodded.

Doris, who had stayed past her shift, in hopes to meet this baby, and I hugged each other tightly. We both felt so much joy for Claudia.

I watched as Claudia had her first true skin to skin experience, Marco wiped the tears from his face as he tried to get out the words explaining how proud he was. He got to cut his first cord in a regular delivery room. They were both welcoming their son and telling him they loved him. Marco was in awe of Claudia. In absolute awe.

And then Marco said this thing to Claudia that has stuck with me ever since this birth, "You could have done it. If they would have given you time like they did here, you would have had the twins in the same way. I'm sorry if I doubted that."

This birth brought their last child earth side, but it did so much more than that. It allowed for Claudia to heal. It allowed for Marco to heal. It allowed for them to both see her as strong, powerful, and determined. It allowed for them to have the time they needed to process all of the past and it reminded this doula that anything is possible.

Claudia and Marco thank you so much for trusting me to guide you through this process and for allowing me to be part of something so absolutely momentous. You are the true definition of perseverance.

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