VBAC with Doula

M. called me at approximately 11:00 AM on Friday.  She was 41 weeks pregnant and had just come from seeing her midwife.  She informed me that she was 2cm dilated, 50% effaced and contracting every 6 minutes according to the monitor.  She was not feeling these contractions, though.  The midwife told her to relax, continue to eat & drink and that she would probably have the baby over the weekend.  M. was scheduled for a repeat cesarean on Monday but was hoping for a VBAC (vaginal birth after cesarean.)  When the OB in M.'s practice heard that she was contracting he called and urged her to come to the hospital immediately.  But M. wanted to wait until the baby was ready and didn't want to be put "on the clock" so to speak so she stayed at home.  Her contractions continued off and on through the night.  I gave her a call Saturday morning to check in and she told me that she still wasn't contracting regularly nor was she in any pain.  I suggested some movement to get things going.  I picked her up at her house at 11:00 AM and we went to the YMCA.  We walked the track together and did stairs and lunges/squats.  Within an hour and a half she was having predictable contractions every 4-5 minutes.  We decided to go back to her house to labor.  M. felt best when she was moving during her contractions so she spent very little time sitting or laying down.  We worked with the ball, I did massage on her hands, feet and back and she walked around a lot.  Towards the end she needed a lot of counter pressure on her lower back which I was happy to do.  Her husband was emotionally supportive and also did a great job keeping their son busy during labor.  He also helped by applying counter pressure during contractions.  At 5:00 PM on Saturday M. requested that we go to the hospital.  Her contractions were coming every 2-3 minutes and she was feeling a lot of pressure.  When we got there the nurse did a vaginal exam and announced that M. was 9cm dilated and 90% effaced!   Her water broke on its own shortly after arriving at the hospital and then she was ready to push.  The midwife was on her way from another hospital and wasn't going to make it so a female resident came in to deliver her baby.  The hospital staff didn't have a chance to place her IV (hospital requirement for VBAC) or even finish her admitting paperwork before the baby was born at 6:23 PM.  I have never seen anyone as happy as M. was after the birth.  She was euphoric and extremely proud of her accomplishment.   It was truly amazing.

My roll at this birth was to keep M. active and encouraged throughout her labor.  To keep M. engaged in the process we had to change positions frequently and I constantly had to remind her of the natural process of birth.  She had a lot of fears about not being able to handle the pain or to be able to push her baby out (this was the point in her last birth where they did the c/s.)  I also provided many comfort measures such as TENS, massage, counter pressure, and healing touch.