Showing posts with label VBAC. Show all posts
Showing posts with label VBAC. Show all posts

Tuesday, March 11, 2014

Khaleid's Birth Story (and my failed VBAC Attempt) - Part II

 "There could also be an initial attempt to do labor but after several nerve-wracking pushes, the baby's head turns out to be too large or the mommy's pelvis too small to allow the baby to pass through. In all of these, there would be a gut-wrenching pain, from labor or otherwise, followed by a relief that when everything else seemed to fail, the mother would be summoned to the operating room for incision for her own good. These mothers would end up with a scar from the CS operation, but they fought a battle, and they fought hard."
                                                             - An excerpt from my very first VBAC Post 

After a long, arduous, and exhausting trial labor, my efforts were all for naught because I wasn't able to deliver through a varginal birth. In medical jargon, the failed VBAC was because of "arrest in descent, secondary to cephalopelvic disproportion".  In ordinary parlance, the baby's head was too big and my pelvis was too narrow.

But for me, the real reason was the Universe working its way to save me from a looming danger. I was wide awake during the CS operation, that's why I was able to witness why God refused to listen to my plea for a normal delivery. 

Upon opening up the previous wound, Dra. Guinto immediately discovered that my first CS operation had not just one, but two incisions inside! That would have been okay, except that while the first stitch was low transverse (which is the primary requirement before a VBAC is allowed), the other stitch was VERTICAL - a contraindication of VBAC (the kind of incision with a higher risk of uterine rupture). 

The reason why Dra. Guinto allowed me to try VBAC was because I was a qualified candidate - or so we thought. The operative record of my previous CS operation indicated a low transverse incision, which led us to believe that I could pull off a VBAC without any unusual risk. (I wrote about the requirements for a VBAC candidate here.

But that was where the problem lied -the record indicated only the transverse incision; thus, neither Dra. Guinto nor I would know about the second incision. As to why the operative record did not accurately reflect what was done inside my body was something I refused to ruminate. It was water under the bridge.

At 10:16 AM, "baby out" was finally announced by Dra. Guinto. I heard my baby's cry and I let out a sigh of relief. 

When Khaleid was handed to me, there were no tears of joy or music playing in my head or thoughts of magical moment. Of course, I was glad that we were both safe, but I was so ready to close my eyes to sleep. I was that exhausted. But I couldn't sleep just yet. Khaleid was immediately placed in my breast for the "Unang Yakap". With just a few attempt, he latched properly and our breastfeeding journey began.

At this point, Dra. Guinto and her team was still at me, re-doing the stitches from my previous operation. She figured it would take her hours to "improve" the old stitches. When I heard her making calls to cancel all her appointments that morning, it dawned to me how fortunate I was to have found a very competent doctor. It was a good call she made to discontinue my VBAC attempt. With the vertical stitch inside my body, who knows, I might be just one push away from uterine rupture.

At around 2:00 PM, Khaleid and I were wheeled into our private room, where Kristan had been anxiously waiting. Kristan was alone in the room since my labor began and I could just imagine the worry and anxiety that he had to go through for hours. He kissed me on the forehead and whispered how much he loved me and how grateful he was to me for enduring everything. 

After two and a half days, I was cleared to go home. I stepped out of the hospital leaving my hopes of a vaginal birth behind. It was not only the end of my VBAC journey; it also meant that we could not try for more babies. But that's okay - I had always believed in the greater scheme of things. I knew the Universe knows better than me. 

The most important thing was how blessed we were to have been entrusted once again with another being - to raise, to nurture, and to love. It was a wonderful, wonderful journey which ended so beautifully with me endlessly taking a whiff of my baby's scent and planting kisses on his cheeks to my heart's content.

You can read PART I here.
You can read all my VBAC-related posts here.

Sunday, March 2, 2014

Khaleid's Birth Story (and my failed VBAC attempt) - Part I

I gave birth to our second son, Khaleid Immanuel, in the morning of February 3, 2014 via an emergency caesarian section. I was hoping for a Vaginal Birth After Caesarian (VBAC) so I was a little frustrated that I had to be cut open once more. But in hindsight, I'll dare say I'm still lucky things did not go my way, as there was an unforeseen risk that could have cost me my life had I insisted on vaginal birth.

I had my last check up with Dra. Guinto on January 29 (Wednesday) and after an internal exam, she said I'd give birth within the next seven days. Thereafter, I had been having bloody show and contractions had been coming at irregular intervals. Despite the signs, I knew it wasn't time yet, so I went on with my routine as days went by.  

On Saturday, I was restless and anxious that I couldn't get myself a decent sleep. I was up until 4:00 AM, timing contractions that were still intermittent. On Sunday morning, contractions became a bit painful. That's when I knew I was nearing the D-day.

However, I was resolved to postpone going to the hospital until the pain becomes unbearable. I'd rather hurl invective in the comfort of my home than embarrass myself in the labor room. Besides, if I go to the hospital at the first sign of pain, and my dilation and effacement would progress slowly, I was afraid the doctors would become impatient and cut me up instead.

So with the thought of increasing my chances of VBAC, I went on to do the usual "palengke Sunday" with my husband instead of going to the hospital. I was wincing in pain in between haggling for the price of meat and weighing vegetables. After our errand, I stayed put and monitored the pain, which increased in intensity. And at the end of the long day, I managed to sleep through the pain.

I was awakened at around 1:00 AM because Zohan was coughing very badly. I got up to carry the poor kid and lull him back to sleep; when I realized my contractions were disturbingly painful. Although bearable, I knew it was time to hit the road. 

When we arrived at Manila Doctors, I was examined by the doctor and was told that I was already 6cm dilated. I was sent to the labor room where I would spend hours in labor pain. Dra. Guinto arrived soon enough and she patiently monitored my progress. Hours passed but I did not become fully dilated. At 8:00 AM, Dra. Guinto was already lecturing me on shifting to a caesarian operation. 

She gave me a final attempt and ordered me to try pushing. I gave out all my strength to do an epic push as if my life depended on it. To our surprise, I became 10cm dilated. At 9:00 am, Dra. Guinto said normal labor is a go. I was wheeled into the delivery room. Despite my exhaustion from seven hours of labor pain, I was grinning from ear to ear. This is it, I said to myself.

At the delivery room, the nurses and staff were in full force to help me push every time a contraction would come in. Since I had been waiting for that moment, I mustered all the remaining strength in my weary body to make strong pushes. Dra. Guinto said I was one of her powerful "pushers"; but it seemed that wasn't enough.

For an hour, I experienced strong contractions, to which I responded with even stronger pushes. But for reasons only my body could answer, my dilation would spring back and forth. Dra. Guinto could already feel the baby's head but since there was an arrest in descent, the baby just wouldn't come out. It also didn't help that baby's head was so big and my pelvic bone was too narrow.

At 10:00 AM, Dra. Guinto gave me last two chances to make a push before she would order an arrest CS. I began each push with a prayer. I took a deep breath and gave out the most powerful force I could give, but to no avail. The baby's head was already stuck inside with all the back and forth movements it underwent. The doctors were already concern with uterine rupture of my previous CS wound since I had been in labor for eight hours. The inevitable came and an emergency caesarian operation was ordered. I closed my eyes and accepted what I considered defeat...

(Part II here.)

Friday, February 14, 2014

Birth and Death

The past two weeks went by in a blur. Everything around me seemed to be spinning, and I was a mute follower who would automatically function to survive another day. 

On Monday, February 3, 2014, at exactly 10:16 in the morning, I gave birth to a beautiful baby boy. 

We named him Khaleid Immanuel. I delivered him via an emergency caesarian section. (Not through VBAC, as everyone had hoped. More on that when I regain my sanity and when I find the time.) Aside from the failed VBAC despite eight excruciating hours of labor, my delivery had been uneventful. Khaleid was born a healthy baby. I was up and about sooner. And my recovery was surprisingly fast and easy. Perhaps, it was to prepare me for the things to come.

The following day, my hunch had been confirmed. I always felt that something was terribly wrong with the health condition of my Nanang. I knew it was coming, her death.  In fact, while I was on the operating table, I was praying that her death wouldn't be too near my delivery date so that I would have time to recuperate and go home to her. I was hoping that she could wait for me, for us, a little longer. But she was probably too tired. On the morning of February 4, 2014, a day after I had given birth, I received the news that Nanang passed away.

I was trying to sleep after I had breastfed Khaleid when I heard my husband received a call from Nanay. It was the usual updating of what our day had been about, when I heard Kristan said that I was sleeping, then he stepped out of the room and continued with the conversation outside. I knew that was it. When he returned after what seemed like forever, I was sitting already. I just asked him to tell me when. He knew I was aware of what's happening. I could feel it from the deafening silence of my family. Ngayon lang, pagtawag ni Nanay, he said. 

I broke down in tears. I imagined the last time I was with Nanang. I looked at my son. I took a deep breath. She wasn't able to wait for us. She needed to rest. 

I was given clearance to go home the afternoon of my second day in the hospital. I could walk, I could carry my son, I was not feeling any pain - a far cry from my recovery when I gave birth to Zohan. I couldn't help but think that Nanang was also behind my speedy recovery - so that I could already be by her side soon.

On Wednesday, we sought clearance from Khaleid's pediatrician if he could travel to Batangas despite his very tender age. The doctor said as long as I am exclusively breastfeeding, Khaleid would have all the protection he would need. Fortunately, he was already nursing while the doctors were closing the stitch of my CS wound. We never had any problem with breastfeeding since then. 

Nanay came home from Rome on Thursday night.

We went home to Batangas for the wake of my Nanang on Friday. 

I would never forget the day that we arrived home. As I stepped closer to her coffin, I took a deep breath. I tried to imagine her face - the beautiful, the serene, the image of a gentle soul. I convinced myself that with all the years she spent with me, that day should be a day of acceptance and gratitude. I prayed to God to always remind me of that thought, because that was the only way I know to alleviate the pain.

Goodbye Nanang. As I mentioned when I kissed your forehead for the last time before your coffin was finally closed, Maraming Salamat po sa lahat.

I will always look at Khaleid with you in my thoughts.  


Friday, November 15, 2013

Finally found my (hopefully) VBAC doctor!

This is actually a late post because I already settled with an OB who's willing to do a VBAC at the onset of my pregnancy. But I'm quite hesitant to post specific details of my dream VBAC, baka mausog and all. 

Recently though, I realized that there could be other readers out there who may have significant experiences to share, and who, for some reason or another, stumbled upon this humble space of mine in the blogosphere. 

In addition, I was also inspired by my new-found philosophy that happiness is in the planning, so with the proper frame of mind how to manage in case all these preparations turned out to be nil, I had mustered enough courage to tell you about it.

I previously consulted two other OBs in my quest for a VBAC doctor. The first one was from UP-PGH whom I consulted for a preliminary determination of my chances. (At that time, I was not yet expecting. I wrote about it here.) Upon learning that I was pregnant, we went to the second doctor, who was from Makati Med. This doctor said she would only do a VBAC if she was the one who performed the prior caesarian. I never went back to her clinic.

Instead, I asked Zohan's pediatrician, Dra. Vienne Saulog, if she knew of a good VBAC doctor, and she recommended Dra. Valerie Tiempo-Guinto. I looked her up and learned that she is the Chief of the Section of Maternal and Fetal Medicine in UP-PGH and the Head of the Section of Maternal and Fetal Medicine in St. Luke's-BGC. How was that for a background?

So my husband and I decided to visit her clinic in Don Santiago Building in Manila, just right across PGH. At the onset, I already informed her of my preferred birth method and asked her of my chances. I took out all the medical records of my first pregnancy and she looked at my history. Through ultrasound, she examined the incision done inside my tummy to determine if its location would impede an attempt to do a vaginal birth. She also confirmed the findings of the first VBAC doctor whom we consulted.

After all the initial examinations, Dra. Guinto came up with the conclusion that I have a good chance to do a VBAC. I had been seeing her every month since, and each time, I would always ask about my chances. Thankfully, my pregnancy had been uneventful and her answer remained the same. 

I am very much comfortable with Dra. Guinto. She isn't chirpy and comforting and sweet - in fact, she's the exact opposite. She looks and sounds tough, almost aloof - but I guess when one is an expert at high-risk pregnancies, being calm, composed and detached is a necessary requirement. And that's exactly how she appears to me. Despite her lack of knack for small talks, she is very thorough in explaining things without any sugarcoating. And with the premise that I want to do a VBAC, she is exactly what I need.

I am now at my third trimester, week 29 to be exact, and it seems I'm all geared up for the delivery room. After a thorough deliberation, my husband and I have decided that I will give birth at Manila Doctors, where Dra. Guinto is also an affiliate doctor. I am looking forward to the empowering experience and with Dra. Guinto's help, I have a really good feeling this "push project" will push through. So help me God.

Friday, September 13, 2013

All about my pregnancy

Pregnancy is a very beautiful thing - I will not argue with that. But I'm sure most mothers will agree that it isn't exactly a walk in the park either. Truly, it is a surreal feeling for a mother to finally see the little angel that she carried in her womb for what seems like eternity latched at her bossom. However, before a mother reaches that glorious end of the tunnel, she must undergo somewhat a series of "unfortunate events".

But, what's life without a little pain anyway?  After all, I believe that it is the concomitant sacrifice that makes the entire experience of pregnancy more meaningful.

Personally, I am thankful that the woes of my second pregnancy are lesser compared to when I had Zohan. (At least insofar as the first trimester is concerned.)There's no morning sickness, fewer food aversions, and lesser mood swings. However, the other familiar effects of pregnancy are here again. I'm having episodes of migraine-induced vomiting, I feel lethargic on most days, and my pimples did a MacArthur - they returned!!

My food cravings are not really unreasonable either. But last Monday, I woke up craving very badly for crunchy bacon. While I do not subscribe to the movie depiction of a pregnant woman's unreasonable cravings at the wee hours of the morning, I thought I deserved to eat what I wanted that day so I took the morning off to search for crunchy bacon. I headed to good 'ole Pancake House and had the entire morning to myself, slowly eating my food while tinkering with my phone.

This far in my pregnancy, that's the only episode of stubborn craving that I can think of. Of course, I eat citrus fruits like mangoes, pineapple, and santol, but these are fruits I'll take on any given day - pregnant or not. 

My weight gain is slow and steady compared to my first pregnancy. But that's partly because I am more conscious of what I eat. I have mentioned about my determination to do a VBAC (here and here); that's the reason why I have been watching what I eat. My OB says a big baby means we will not be trying a VBAC, so that's my inspiration to be obedient.

17 weeks pregnant

On the vanity side, I have not shopped for maternity clothes. I'm thinking of reusing my old maternity clothes, all of which I left intact at home. I also ditch the ugly but reliable crocs that I used during my first pregnancy. (Thank you crocs, you've been a big help!) This time, I consider style over functionality and settle for this Melissa shoes - flat, comfortable, and formal enough for attending hearings. I don't think it can accommodate my swollen feet until the ninth month though. Anyway, let's just cross the bridge when we get there. 
And of course, there are perks of being pregnant! I can take the "reverse ride" at the MRT. (When you ride at Trinoma to go southbound, you have to take the stairs to go to the opposite side. But if you're pregnant, the operators will allow you to enter the train after all the passengers have alighted, so you won't have to tire yourself. That means you're inside the train as it makes a reverse. Cool, right?) Until now, I take the public transportation so this reverse ride is making it more convenient for me. 

I can use the VIP lounge at the malls for free; I can take a cab without going through the long line; I get a nicer treatment from other people in general; and I have an excuse to grow big and add on pounds. And lest I forget, the baby in my tummy and I get a kiss each from Kuya Zohan every night before going to bed. Hands down, that's my favorite part!

That's it, pansit! I am now on my 18th week, and I hope it will continue to be uneventful from here until the end of the tunnel. (And pray with me for a safe VBAC, please?)

Tuesday, June 5, 2012

What it takes to be a good candidate for VBAC (VBAC Post II)

Photo source

I shared in my previous post how I ended up gaving birth via C-section despite my strong conviction to do a vaginal birth. Months later, I showed up in the doorstep of a VBAC practitioner's clinic, asking my chances of having a VBAC for my second baby (which is in the works, by the way.) It was a good thing to finally talk to someone who could answer my queries and correct my misconception.

Case in point 1: I thought birth spacing was one of the considerations before one could do a VBAC, so I went to see the doctor prior to conception, just to be sure. Apparently, birth gaps did not really determine a VBAC's success. According to my OB, she had patients who successfully had a vaginal birth less than a year after their CS operation. 

Case in point 2: I thought there had to be a perfect proportion between the head of the baby and the pelvic bone of the one giving birth. Well, not entirely true. She mentioned that doctors usually order a pelvic x-ray to rule out cephalopelvic disproportion. But then again,  she had patients with wide pelvic bones but weren't able to push the baby out. In the same manner, she had patients with narrow pelvic bones who were able to do a vaginal birth. So, I guessed VBAC could still be possible, cephalopelvic disproportion notwithstanding. 

According to her, the more important considerations could be summed up into three. I tried to discussed them below, based on my own understanding. I also added other information based on my own personal research. If I happened to get anything wrong, please be kind enough to point it out by commenting. But if you are kinder, you could just discreetly correct me by sending me an e-mail and I will do my best to retract my mistake. 

1. Non-recurrent cause of the previous CS operation.

There could be several medical reasons for a CS operation which may include failure to progress during the first stage of labor, abruption of the placenta, fetal distress, pre-eclamptic toxaemia or commonly called as pregnancy-induced hypertension, to name a few. To be a candidate for VBAC, the cause for the CS operation must be non-recurrent -- meaning the reason for the previous Caesarian has a chance of not recurring during the second pregnancy. A previous CS due to, say, gestational diabetes, could possibly recur compared to a primary CS due to a heavy birth weight of the baby. 

In my case, if I would want the reason for my primary CS not to recur, I would have to observe what I eat and wage war against pan de sal.

2. Low-segment or low-vertical uterine incision

When I heard the type of incision mentioned by my OB, I swear I could hear the angels singing behind my head. I vividly recalled that in the Operative Medical Report which I submitted in support of my PhilHealth benefits, the incision indicated began with the word "Low". I thought to myself, well, the choices mentioned by my OB were both low, so mine had to be either of the two.

Upon arriving home after the check-up, I rummaged our cabinet to search for the darn medical record, which apparently had been submitted to the HR of our office without me making an extra copy. I couldn't sleep that night as I wracked my brains out to remember what kind of "low" I had, but to no avail. 

The following day, my superhero secretary pulled out my records from personnel and happily showed me an extra copy of the medical report, which stated that I had a primary low transverse incision. How many lows could there be, for crying out loud?!

Well, I could be really impatient at times, so I texted my OB-gyne that what I had was a different kind of low from her choices, and asked her if my low transverse was synonymous with low segment/low vertical. Guess what? Of course, she said “yes”, otherwise, this post would be pointless.

3. Presentation of the baby in the uterus

Before becoming a mother, I thought presentation of baby in the uterus was either cephalic, meaning head first, or breech, meaning buttocks first. I was wrong. In fact, there were different types of breech - there's complete breech, incomplete breech and Frank breech. (But we need not know the difference because once the baby's presentation is breech, the OB-gyne will more likely rule out a VBAC. ) To be a good candidate for VBAC, the baby must be in a cephalic position. While there were ways to effectively change a baby's presentation through certain types of massages, my OB said she would not recommend undergoing a massage if the pregnant woman previously had a CS operation. For this part, I could only hope that baby #2 will conspire with me and present herself properly. 


Having said all these, it appears that I am a good VBAC candidate. But I do not want to get my hopes too high. I've been burned the first time by being too bent on having a vaginal birth, only to be disappointed in the end. As I see it now, a lot of my chances are left to the will of the Universe. I can religiously observe an OB-prescribed diet but still end up with a gestational diabetes. Nothing is certain, really. The only thing I'm sure of is that I will definitely try. If all else fails again, I'll be more than happy to just have a safe delivery and another baby! Besides, delivery is just a tiny spec on the tip of the motherhood iceberg. In the meantime, in order that all these blah-blah will make sense, I have to go and make a baby! :)

*It is always best to talk to a doctor. For those interested to get the contact details of my OB-gyne, you can send me an email here

Tuesday, May 15, 2012

The scar that fought no battle (VBAC Post I)

His first photo, right after the CS operation

I couldn't recall where I heard it, but I certainly caught somewhere that Caesarian scars were often referred to as battle scars. I'd imagine the battle to come in the form of several hours of labor pains in an attempt to go for vaginal delivery, only to be interrupted with a uterine rupture or a fetal distress. Another battle could be against the boredom of bed rest or anxiety of constant fetal monitoring after having been diagnosed with a placenta previa. There could also be an initial attempt to do labor but after several nerve-wracking pushes, the baby's head turns out to be too large or the mommy's pelvis too small to allow the baby to pass through. In all of these, there would be a gut-wrenching pain, from labor or otherwise, followed by a relief that when everything else seemed to fail, the mother would be summoned to the operating room for incision for her own good. These mothers would end up with a scar from the CS operation, but they fought a battle, and they fought hard.

As for me, I had a scar because I stuffed myself with too much pan de sal and gulped on too much iced tea and slept until it's time for bed again. How classy.

I had always wanted to give birth via normal delivery. In fact, I had prepared myself too much for it that it hurt so bad when I was operated on. For one, I did not take things slow when I was pregnant. In fact, I felt empowered when I was that big and could still do a lot of things. I never said no to attending hearings even until the very last day that I was at work. I was taking public transportation, to boot. And when I said public transportation, I meant taking that steeeeep stairs going up to MRT Magallanes station, walking on sunshine, taking the jeepney rides instead of cabs and repeating all of that several times a week. For another, I read up on everything I could lay my eyes on if it said "how to do vaginal birth". If the next chapter was about how to prepare for a caesarian delivery, I threw the material away. The power of the mind, you know. 

I guessed that arrogance caught up on me when weeks before I hit full term, my OB-gyne said  in a routine check-up that I was already at early labor stagewith 3-cm dilation! My OB-gyne was holding clinic at the province because I intended to give birth in my hometown, so after that findings, she advised against going back to Manila to continue with work. That was more than a month before my due date. Since I had nothing to do at the province but bask in the love of my relatives who thought pregnant women must not be put on a diet, you could already imagine what happened next, pan de sal wise.

Fast forward to one week before my due date and during my routine check-up, my OB-gyne noticed that the baby's weight had surged to 9 pounds! Yes people, this petite frame had carried a nine-pounder baby boy, so crossing out genes and family history, you could already identify the culprit here. Right there and then, I was directed to proceed to the emergency room for a CS operation because there was no way I could deliver that big a baby through the natural method. And since I wasn't prepped for that, I did not fast (I had a sandwich, what do you expect? I was stuffing myself crazy!) so they couldn't give me the sleep-inducing anesthesia. I was wide awake the entire surgical procedure, hearing their conversation and catching a glimpse of the knife and scissors and all. When Zohan was pulled out, he turned out to be 9.2 pounds.

There goes my battle - or the lack of it - for the scar on my abdomen. 

The dream of vaginal birth did not end there though because there was such a thing as Vaginal Birth after Caesarian (VBAC). In a tweet, Jenny Ong of Chronicles of a Nursing Mom mentioned that her OB-gyne was a VBAC practitioner. This news perked up the stubbornness in me and I lost no time in getting the doctor's contact details. After a few weeks, I found myself in her clinic and asking questions how I could prepare myself for VBAC. (Not that I am pregnant now, but in case there has to be a gap requirement from the first birth to VBAC, then I should probably get our calendar worked up.) She asked me a lot of questions, patient's history mostly, and gave me three basic points that would make a person a good candidate for VBAC.

Am I a good candidate? Watch out for the next post. (Oo, may ganon!)

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