Our HOSPITAL’S First Planned VBAC
I say our hospital’s first planned VBAC (Vaginal Birth After Cesarean)….. however a prelude is necessary because the actual first VBAC I can remember…. totally freaked everyone out. Here are the stories:
Sometime in the mid 70’s -circa 1976, a mom came in to L/D for a labor check. She was near term with some regular contractions, a little bit of bloody show. The nurse calmly wrote her name down in the notebook…. [Yes– a notebook, that’s the only way we kept track of labor checks back in those days. No medical record, no registration, just a name in a book and the day they were here and checked]… She was getting ready to gather more information when the mom said she had a history of a prior C/S.
Suddenly all the nurses were scrambling—“Quick, call the doctor!” “Quick, shave her belly,” “Get the Fetal Hearts” “Call the OR and tell them we have a STAT C/S”…We were all busy quickly getting her ready for the OR.
This little baby, however, definitely had other ideas. The mom told them she had to go to the bathroom…
Someone said: “Not now honey, we’re going to get you to the operating room to have your baby.”
The Mom: “But—I have to go….. AUGHHHH” (loudly grunting)
One of the seasoned nurses threw the sheets back and low and behold, that little baby was crowning!! “Doctor W– No time for the OR– This baby is coming!”
She did deliver vaginally, quickly, and everyone was in a state of shock!
I was thinking– I didn’t think that was possible–they told me once a cesarean always a cesarean—they told me the uterus would rupture–that the mother would hemorrhage. She and her baby were just fine. I realized once again that I had a lot to learn!
Fast forward now to 1984.
I was sent a nicely written post on the VBAC Pendulum by Dr Shelley Binkley which discusses the rise and fall of VBAC’s in the US and makes for very interesting reading. There’s been tremendous controversy surrounding this topic.
VBAC’s were widely discussed in the literature at early to mid 80’s and many women were interested…the doctors???– not quite so sold on the idea. However, in the late 70’s early 80’s, we had one very progressive young doctor (Dr.B) in the main OB practice. He was responsible for many of the advances we had in a more natural approach to childbirth. He was willing and eager to give this a try.
I am not sure what he may have discussed in the office with his patients or how he may have selected his first patient who could try for a VBAC. Knowing him, he may have brought it up to mom’s instead of the mom bringing it up to him. Anyway– sometime in the summer of 1984 we heard we would be having our first VBAC! She was due in December with her second child. Her first baby had been delivered at our hospital by Dr. B via C/S because of some fetal distress. He knew her history and had full access to her records to know exactly what type or uterine incision she had. She was young, healthy and continued her pregnancy to term without any complications. She was very excited.
The hospital staff was a nervous wreck.
Where oh where were we going to labor her so that should ANY complication arise, we could do the fastest C/S possible??? We didn’t do C/S’s on our unit. The OR was down a floor and in another wing!!! Such a dilemma. They finally decided to use the tiny windowless isolation room of the Recovery Room right outside the OR. They decided to bring all the equipment from L/D down to that room to see how it all fit. We had a regular bed,overbed table, the fetal monitor, some other IV equipment/meds/ supplies etc.. a chair for dad, stool and sm desk for nurse…all crammed in the room. (OK- we scrapped the desk..that was rediculous) We were literally practicing like when they do separation surgery for conjoined twins!! Quite the production.
Ready or not, here she comes…….arriving in labor almost a week late at 40 5/7 weeks. She was in very early labor much to the relief of everyone involved. OF COURSE I was on duty! OF COURSE I was elected to be her nurse! I was after all, the most prepared (say all my co-workers). So while other’s got the room ready downstairs, I admitted her. There were no special consents at the time. My orders were continuous fetal monitoring, start an IV right away, AND insert a Foley catheter so we would keep the bladder drained, avoid any excess pressure on the uterine scar and keep her from needing to get up. I also had to do a big shave prep in case of an emergent C/S. We took her down to that tiny closet of a room when it was ready, around noon. She was still in early labor. The plan was to do a double set-up in the OR for delivery. That meant a whole set-up for a vaginal birth and a whole set-up open for a C/S complete with the entire OR team. They would call them in when she was in active labor. She had progressed to 7 or 8 cm with her first baby before needing a section so the thought was she’d go fast this time.
Early labor continued into the late afternoon. All the managers involved kept stopping in repeatedly with all the same questions:….. “Is everything alright??”….. “Any problems??” …..”Any sharp pain in the lower abdomen?”….. “Any blood in the urine?”…….. “How about any excess vaginal bleeding?” ……..They were making me crazy. We didn’t do any Pitocin augmentation. This poor mom was just in bed the whole time, in the closet with the single bright light, moving around when I suggested changing positions. Finally she headed into active labor and then did progress quickly to transition. The membranes ruptured spontaneosly and the fluid was clear. The baby was great on the monitor! The mom was a trooper, never complained, always smiling in between contractions, agreeable to whatever we said. They asked me to stay and I stayed…. long past my shift.
They called in the OR teams. I wasn’t nervous anymore. Get me alone with my patient– away from the nervous Nellies and we can connect and work together through labor. It helped that I had seen that unplanned VBAC so many years before and that I had tremendous trust in and respect for Dr. B.. He was there past his shift also. I had already helped her through so many contractions. She didn’t have the slightest symptom of problems. I had her pretty relaxed, she went thru transition and headed into the second stage in good shape. At this point, they wanted to move her to the OR for pushing. I think back and feel so bad for her… She was however, still excited and still very agreeable. She pushed on the hard delivery table in the OR in front of the assembled teams. Talk about performance anxiety. She sure had a lot of coaches!!
She delivered and 8lb 14oz boy named Michael later that evening!!! He was 20 1/2 inches long, his apgars were 8 and 8, just needing some blow-by oxygen in the OR.
There were no complications. This mom came back and had a few more VBAC’s ending up with 5 children overall. I don’t remeber how many VBAC’s we labored in that rediculous closet of a room before we would keep them in L&D.
I admire this mom for her strength and courage. I thank her for all she taught me…taught us..
Michael will be 25 years old this December!
If you like this story or have any interest in how any specific childbirth element was first seen or has evolved, Please comment or contact me! Thanks