January 19, 2009

Good labor and VBAC

Everyone likes to be right, and I'm no exception. Saturday night, I admitted a momma, pregnant with her 3rd baby. She had had some bloody discharge at home and was only having contractions about every 15 minutes, but she was worried about the blood so she came in to be checked out. She had been a good 4 cm in the office and she was still a good, soft, stretchy 4cm. She really was only contracting here and there, but when she'd have a contraction, she was pretty uncomfortable. I called her doc, who said she could stay overnight and we'd see if she change and that she may go ahead and induce her in the a.m. if she hadn't made any progress because she had some pregnancy complications and was scheduled to be induced the next night anyway. Or she could go home. I just really felt that even though she wasn't doing much yet, if she went home, she would get really active and by the time she returned to the hospital, she'd be complete and ready to push. Not that that would bother me, but she really didn't want to deliver without an epidural and they also had 2 other little kids to worry about. So I encouraged her to stay. I actually thought she was going to go home, but her husband and I did finally convince her to stay and see what happened. Husband took the other 2 kids home and about an hour later, she got up to the bathroom and there was a definite change in how uncomfortable she was. By the time I could get her back to bed, she had gone from barely contracting to cranking them out. She was 5cm, 100%. So IV started, and anesthesia was called. While we waited for anesthesia to get in to the hospital (no one was there and they have 30 minutes to get in from home in the night) she started making those deep primal grunty/pushy noises. All you labor nurses know what I'm talking about. Check her again, and she's 8cm. Called her doc back to tell her to head this way. The anesthesiologist arrived right after that, and he did place the epidural quickly and she did get some relief. Fifteen minutes after her epidural was placed she pushed with 3 contractions and delivered a beautiful baby, no tears or lacerations. The only thing that kept her from delivering before her epidural could be placed was that the baby was straight OP, or facing up. Her doc, a petite woman, I swear has fingers of steel, and she turned that baby so that he was facing her left leg while mom pushed with the first contraction. After that, the baby descended very quickly. If you saw this MD work, you'd never know that's what she's doing unless you really paid attention. It's really pretty amazing.
Last night, I actually had a VBAC patient. We don't see too many of those because most of the docs really discourage them from trying. This mom was having her 4th baby, delivered her first vaginally, but her last 2 were c-sections. She actually had no intention on a VBAC this time and was scheduled in 2 weeks. Well, she went into labor, and by the time she realized she was in fact in labor and got to the hospital, she was 9cm with a HUGE bulging bag of water. I called her doc, and thankfully, this doctor can get to the hospital in 4 minutes from the time you hang up the phone and he opens the door to the unit, I kid you not. In the short time it took me to call her doc in, her water broke and sprayed everywhere. Her doc got there and before I could even start an IV, she was crowning and she pushed that baby out like a pro. And, hmm, she had 2 prior c-sections and her uterus did not rupture. Hmm, and she delivered without an epidural. Imagine that. Love when that happens. Let mother nature rule the roost, and things go smoothly.


Unknown said...

I love a good VBAC story...(not that there's a bad one, lol)

Curdie said...

Yay for you for not sending that mama home!!

And yay for the VBAC!!! Woohoo!

Anonymous said...

An even catchier title for your post would be "Good labor abd VBA2C" (vbac afer 2 cesareans)which is what this mom really had! Was that mom proud of herself?

Laura Jane said...

Yay - Nature wins!!!!

I am working in a specialist clinic in our major tertiary level hospital for women planning their next birth after CS. It doesn't have to be VBAC, we plan the next CS if that's what required or desired by the woman. The CS is planned to be a positive experience, with attention paid to Mum's eyeline with bub, announcing of the sex by parents, early skin-skin contact and non-separation. Our current VBAC success rate is 66%, with some Vacuums and forceps.

my blog www.lovingthequestion.blogspot.com

Student Nurse Midwife said...

VBACs are actually safer than subsequent repeat C-Sections. I wish we could see more of them.