Saturday, December 24, 2011

My HBAC (home birth after Cesarean) story

This post is three years in the making.

Yep, three years!

And because it involves so much of my life and history of the past few years it's bound to be complicated (and long!), which is rather daunting, but I'm going to do my best.

A little background info to begin -- our first child, Oliver, was delivered by Cesarean one week after his due date, August 12, 2008. My water had been broken a full week by this time, though it was only a very slow leak so plenty of amniotic fluid was still available. Because we were planning a home birth, our midwife at the time allowed us to use the watchful waiting approach; she came to our home each day to listen to the baby's heart beat and make sure all was well. If we had been working with an OB and planning a regular hospital birth we would have been told to come in immediately and I would have been put on Pitocin to cause labor to start. Instead we tried every natural intervention possible during that stressful week spent waiting for labor to begin, including lots of acupuncture, enemas, castor oil (taken orally), walking, nipple stimulation, etc. It was not a fun week. When regular cramps finally started on day 7 I thought for sure labor was finally here -- but my midwife checked and told me I was only 2cm dilated. She could feel Oliver's head, which was nice and low, but she said it was tipped sideways. My time had run out. We all drove to St. Vincent's in her car while I tried hard not to cry.

After a few hours on Pitocin, with strong regular contractions (no epidural -- they didn't feel that painful to me) I still hadn't dilated past 3cm. An epidural to help me relax, with the view of encouraging dilation, didn't do the trick either, and as the OB on staff at the time was impatient for a resolution to my situation I was given a c-section about 7-8 hours after admission.

This was NOT the birth experience I had wanted. The hospital experience was one thing (I couldn't get any sleep, Hugo wasn't allowed to stay, I wasn't permitted to have Oliver in the bed with me, I was attached to IVs and monitors and could hardly move around, I passed a clot the size of my hand, I ate awful food, I could barely walk...the list goes on), but recovery at home was really tough. I had a hard time getting off my pain medication (Percocet), not so much because of pain from the incision but because I was probably very dehydrated and anemic which made me ache all over. I was extremely emotional and told Hugo I felt like Oliver was sucking the life out of me. Those were my exact words, said about a newborn baby I adored! I can barely remember the first few months of Oliver's life in this world; I remember being in a haze and feeling depressed.

Oliver was a very hard baby to soothe so the first few months were also difficult from a parenting standpoint; I have since realized that he probably had lots of tummy aches ("colic") because he liked pressure on his belly. Many factors would have contributed to this: c-section birth (which doesn't allow the mom to pass on microflora from the birth canal, which establishes the first colony of healthy bacteria in the gut); all the antibiotics and drugs I was on during the hospital "labor," operation, and recovery; and the Hep B vaccine he received in the hospital before we knew better than to vaccinate.

I knew I didn't want a repeat performance if we had a second child, though VBACs (vaginal birth after Cesarean) are not the norm. When working with an OB, it is very common for an initial c-section to more or less doom a woman to a second. I planned that we would try again for a home birth next time, but felt helpless about how I could bring about a better result down the road.

A clue to how I could improve my chances next time came in a chance conversation with a wellness coach who is a self-made thyroid "expert." She informed me that my inability to dilate during labor may have had something to do with the Synthroid I was on, which is a synthetic thyroid hormone medication given to people with low thyroid function. (I read recently that this is one of the top three medications on the market with record numbers of women taking it. Low thyroid function is a HUGE and rampant problem today, and many more people have thyroid issues that are not detected by medical tests.) I decided that if there was any chance at all that the medication had interfered with my body's ability to go into labor and deliver a baby naturally then I simply had to get off it, though the endocrinologist I was seeing laughed at that idea. In her opinion (and this is the standard medical view) people don't get off thyroid medications; they stay on them for life. I really have no idea if Oliver's head position was the problem, if the medication interfered, or if the hypothyroidism itself was the real issue -- maybe it was a combination of all three factors, or maybe it was something else entirely.

Three months after Oliver's birth the work of the Weston A. Price Foundation came into our lives. I had read the book Solved: the Riddle of Illness to try and understand my thyroid issues, which was the first source to tell me that soy foods are bad for the thyroid and so are birth control pills. I cut out soy (which I had been consuming heavily as a vegetarian) and resolved never to go back on the pill. But that meant finding another method of birth control. My midwife recommended I read The Garden of Fertility, which teaches the Fertility Awareness Method, and it was there -- in that marvelous book -- that I first read about the research of Weston Price, and learned that traditional animal foods are essential for fertility, healthy babies, and overall good health. I spent the following year gradually and completely changing my diet, and by the following summer (only 10 months after I began this regimen) I was unable to tolerate any thyroid medication and stopped taking it. My symptoms did not return. (I was tested twice during this pregnancy and showed no thyroid problems.)

My story of raising Oliver from 3 months of age on traditional foods (first through breastmilk of course!) has been the subject of this blog, and if you've been reading along for any length of time you know about all the things that traditional foods and the GAPS diet have helped us with. [But just to recap: the health issues that were resolved by switching to a WAPF-style traditional foods diet included thyroid healing, improved immune function, better moods, blood sugar balancing (I had been severely hypoglycemic on a regular basis prior), relief of joint pain from past snowboarding injuries, and improved digestion; I also stopped ever having headaches. Later, after going on the GAPS diet, which is based on traditional foods but eliminates starches and sugars (with some exceptions), I effortlessly lost 8 lbs. of undesirable weight, the hair I had lost post-partum grew in with a vengeance, I stopped ever getting sick, my skin cleared entirely, my digestion improved even more, I saw my fertility cycles improve almost immediately, and I stopped having any premenstrual symptoms or cramps. I also found that I never felt even a hint of a "down" or depressed mood any longer.]

Now on to birth #2! (Interesting how I feel SO much happier as I commence writing this second part!)

Our midwife for Weston's birth was Joan Bryson, of Community Midwifery in Park Slope (Joan is pictured below, but this is an image I found online, not a picture of her with baby Weston). She works with Ellen Razgaitis, also a lovely and caring midwife who provided prenatal care along with Joan, but Joan was the one at the birth. Our doula, Jessi Bonilla (contact me for her info!), also provided amazing care, as well as placenta encapsulation services (read about the benefits here). Shara Frederick, birth assistant, doula, and childbirth educator was at the birth as well to assist Joan. I had never met her before, but was immediately comfortable with her and appreciated her help so much. [To learn about her services and fantastic array of childbirth preparation classes please visit Shara's website.]

My water broke early this time, too. Thursday night, December 1, I started a slow leak again, though there was more fluid initially than last time. I went to bed, confident that labor would begin during the night. I had been feeling Weston's head pressing down on my cervix for a few weeks, and some cramping as well. Instead, to my disappointment, I got a solid 9 hours of sleep.

The following morning I spoke with Ellen, Joan's partner. She recommended I see an acupuncturist to get labor going and gave me the name of a practitioner she often refers patients to. I went in for an appointment, but no dramatic changes occurred. I think Ellen and I spoke again that evening, because I remember feeling quite anxious and worried. She had mentioned that I should go in for an ultrasound to check the amniotic fluid level on Monday but I felt certain that simply setting foot inside a hospital would ruin my chances for a natural delivery. I remembered all too well the feeling of absolute disempowerment that overwhelmed me when I entered St. Vincent's on August 11, 2008.  I was anxious for labor to start naturally!

I decided to call my friend Rachel Koenig, of Aurora Healing Arts in Park Slope, and see if she had any Saturday openings. Rachel had been referring clients to me for traditional bone broth for about a year, as well as sharing my cooking class flyers with her patients. She has been an incredible blessing in our lives, ever-generous in word and deed, ready with uplifting words, smiles, and expressions of appreciation and comfort. I had intentionally not asked Rachel for treatment before because I had a feeling she would be too generous -- and I was right. She drove into Brooklyn on Saturday (12/3) to give me an acupuncture treatment in the comfort of my bedroom, well before her shift began at her office, and she offered to drive in on Sunday to treat me again if I needed it. When I asked how I could pay her, she said, "how about with a hug?" Best of all, she provided the reassurance I needed that all would go well with this delivery. I had never been treated by Rachel before, but by the end of our session I was convinced that she has a special gift. It turns out that she practices a classical form of acupuncture that she learned "underground," by studying from a master healer, before acupuncturists received licenses and formal schools of TCM and acupuncture were established in the U.S. A large part of what she does during an acupuncture session is feeling the patient's pulses, which tells her a great deal about their qi (chi) and overall health; it is because of what she observes in this way that she prescribes bone broths, which are healing and strengthening.

Rachel provided so much encouragement to me during our session -- she told me my pulses indicated that I was healthy and strong, without anemia or any other condition that would sap my strength. She said that the thyroid is a master gland and the fact that mine had recovered was a huge indicator that I had regained my health and was strong now, in a completely different place than I had been at Oliver's birth. She also told me how the acupuncture I had before Oliver's birth didn't work because my qi wasn't strong enough to pick up the signals it was sending to my body; as she described it, acupuncture provides a signal for what your body is supposed to do, but you have to be able to take the signal and carry on with it yourself. I have no way of knowing or measuring what either the first or the second session of acupuncture contributed to the birth outcome this time -- but I do know that her confidence and encouragement were exactly what I needed to relax and stop worrying. As Rachel told me, if you're worried and fearful your body can't produce oxytocin, which is needed for contractions!

Next was castor oil, which when taken internally is supposed to cause diarrhea after a few hours. This stimulates uterine contractions through the action of prostaglandins (I think -- not quite sure how exactly this works). At 3:15 that afternoon I took 2 oz. of castor oil in 2 oz. of fresh-squeezed orange juice and went back to organizing the bedroom and going through boxes of clothes to give away. By 5:30 I was having regular cramping, and at 7:30 the castor oil finally kicked in and started doing its work on my intestines. I was sitting on the toilet when I heard (or maybe felt) a "pop!" and saw a little bloody discharge. Suddenly the cramping was kicked up several notches; I called Joan and Jessi to give them a report. Just a few minutes later I was in the midst of painful contractions, which mixed with the intestinal cramping to make for a very fun early labor experience! Hugo began blowing up the birth pool and got Oliver packed up and sent off with our wonderful babysitter, but it wasn't long before I needed him with me full-time, so that I could grip his hands during contractions, which were now less than 2 minutes apart. He managed to call Joan and ask her to come over, but by the time she got there, around 8:40, I was fully dilated and still frozen on the toilet. It seemed the only position I could conceive of being in. The contractions were so intense and painful that I couldn't move or breathe -- in between I managed to tell Hugo how horrible the pain was and that I wasn't sure I would have done it this way if I had known! Labor came on so fast -- which can happen with castor oil -- that I didn't have time to build up endorphins which typically provide at least a little help with the pain of natural childbirth.

Joan managed to pry me off the toilet and get me set up on her brand new birth stool, right outside the bathroom door. I am so grateful that she had that birth stool with her, or I would have had to give birth to Weston on the toilet! It was really the only position I could manage. By now I was pushing, though it feels wrong to even say "I" was pushing since it was completely involuntary; I felt like I had no strength in my legs to brace myself with, and no ability to actively control anything that was happening. My body was entirely taken over by these incredible surging waves that made me feel like I was going to throw up, poop, and give birth all at once, while emitting awful involuntary groans. What an experience!! Joan propped up a hand-held mirror for me on the floor so I could see Weston's head emerge, and that was the only thing that offered some help to me in those 30 or so minutes of pushing.

Weston was born at 9:16pm, just an hour and 45 minutes after labor had really begun. The placenta wasn't delivered until an hour later, and the cord was allowed to continue pulsing that whole time, which is why he has such red skin -- all that extra blood! Jessi drained and prepared the placenta so she could take it home for encapsulation, which involves dehydrating it, grinding it, and putting the powder into capsules for me to take (to help balance hormones after birth, encourage milk production, promote healing, and boost mood). I was thrilled to hear Joan report that at most I could use 1 or maybe 2 stitches; the tearing was very minimal and since I wasn't in pain I opted out of the stitches.

I had just made a pot of oxtail broth and removed the meaty bones from the pot before labor kicked in, and after I got settled in bed I enjoyed delicious oxtail meat and a mug of broth while Hugo held Weston -- what a fabulous postpartum meal!

My milk seemed to come in immediately; I could hear Weston gulping it down! That had taken about 5 days to happen after Oliver's birth.

That night we slept with Weston between us, then spent the following day relaxing and enjoying time with our new little one. Oliver came home in time for dinner, a wonderful pastured chicken that Hugo roasted and served with mashed potatoes and salad. I was well enough to get up and make the dressing myself, and the next day I made fermented vegetable medley and chicken liver pate!

Weston has been a fairly easy baby, preferring to spend his days and nights alternating between nursing and sleeping. He is easy to soothe, and growing very well.

In a follow-up email Shara wrote, "It's not often that women just give birth to their babies (with no help, intervention, or intrusion) but that's what you did. Joan, Jessi, and I were just there in case you needed help."

All in all this has been an extraordinary experience. What a beautiful blessing our two boys are!


  1. I love Joan-- she was my midwife! (And Ellen, my good friend!) Thank you for sharing your wonderful story. I am so happy for you!

    Michelle Chiafulio

  2. So glad you wrote down your whole story, Hannah - feel like I could share the wonder of it all with you. In some small way I see my place, since I may have been the person who 'introduced' you to Rachel after I took the class you designed a year and a half ago to help me think about my daughter. Wonderful to have her appear with all her skill, wisdom and nurturing at just the right moment! Well done, all of you! sending so many good wishes
    Kathy McCullagh

  3. Beautiful story. Thank you so much for sharing it.

  4. congratulations hannah! blessings.

  5. Yay!!!! What a wonderful story, HANNAH!!! So very happy to hear about Weston and your HOME birth experience!!!! CONGRATULATIONS!!!!!!!!!

    Sending you and your family hugs!!