This week is National Midwifery Week - an opportunity to recognize midwives and midwife-led care and raise awareness about the services that they provide.
Go Ask Mom will have a couple of posts spotlighting midwifery in the Triangle. Today, we have a Q&A with Cynthia Abell-Brown, a mom of two, who gave birth with the help of midwives at UNC's N.C. Women's Hospital, the only medical center in the area with midwives who work around the clock, seven days a week.
Abell-Brown had previously had a C-section and traumatic birth experience when she delivered her daughter more than two years ago. But, with the help of midwives at UNC, she was able to deliver her son vaginally, called a vaginal birth after a C-section (or VBAC), in March.
Abell-Brown lives on what she calls a "five acre slice of heaven" in Rougemont with her husband and children. She works in clinical research ... and in those moments when she has a little time to herself, she loves running, playing softball and target shooting.
Here's our email conversation. Stay tuned for more on midwifery care from Jenny Cox, a midwife at UNC, on Tuesday.
Go Ask Mom: Tell us about your previous birth experience. You had a C-section?
Cynthia Abell-Brown: The birth of my daughter was quite traumatic for me. I felt like I was never given the opportunity to birth as nature intended. My OB at the time, of whom I had been a patient for ten years, did not believe in the “just wait and see what happens” philosophy. His philosophy was that birth should be very regimented and timely. These are things I wasn’t aware of until I was a little more than a week from delivery. I held off agreeing to an induction as long as he possibly would let me. He eventually scared me into agreeing to the induction by telling me I was at risk of having placenta problems due to being a hypothyroid patient. I finally agreed to the induction one day shy of 41 weeks.
The induction did not go well; I was rushed and never allowed to labor. My body was just fighting against the induction from word go. After roughly 12 hours of being on the Pitocin, my OB informed me that he needed to break my water so that labor would speed up. I didn’t want to do this, but I also didn’t know enough to stand up for myself and my baby. He broke my water around 10 a.m. on Friday, May 2, 2014. I then labored with the Pitocin for an additional 10 hours. During this time, I wasn’t allowed to get up and move around, and in order to deal with not being able to move, I ended up getting an epidural too early, which slowed what little progress I had made. At about 6 p.m., my OB said I had not progressed far enough and that at 3cm after nearly 24 hours on Pitocin, I needed to agree to a C-section delivery. After a very emotional conversation between my husband and myself, I agreed to the C-section, but knew things shouldn’t have ever gotten that far. I never even made it into active labor, but yet I was deemed a “failure to progress” because my body was not progressing on the timeframe that my OB felt it should have.
The C-section was very difficult on me. Not only were my child and husband hurriedly escorted out of the OR, and I was left behind, but the anesthesiologist refused to listen when I told him my spinal block had worn off. Once in recovery, I was finally able to see my daughter and I just felt empty. She was beautiful of course, but I didn’t have a connection with her as I felt I was stripped of being able to bond with her in those first few hours in the OR. The following day, my OB said my pelvis was too small and that my daughter wasn’t positioned well, therefore, I wouldn’t have been able to have her vaginally anyway.
Then, 13 days postpartum, I was put back into the hospital because I had developed a seroma – a pocket of fluid that can build after surgery – that continued to grow, became infected and ruptured. I had to be put back into the hospital for a six-day stay away from my beautiful, newborn baby girl, which led to a second abdominal surgery, the placement of a wound vac and PICC line so that I could be discharged back home to my newborn daughter. So, finally after a full 16 weeks, my body healed completely, but my soul had not, and I struggled with both PPD and PTSD for a long while and still do to some degree.
GAM: When you got pregnant again, you wanted to delivery vaginally. What were you initially told?
CA-B: When I found out I was pregnant a second time when my daughter was 14 months old, I wanted nothing to be the same as my first delivery. I initially went back to the same OB as I did have a 10-plus year history with him. However, that was short-lived when he said there were only three reasons he’d allow me to VBAC - if I went into labor on my own prior to 38 weeks; if I was dilated prior to going into labor, as he couldn’t give me Pitocin; and if this was all assuming the child was not measuring larger than my first and if he felt my pelvis wouldn’t cause problems again. Then as early as my 12-week appointment he was encouraging me to go ahead and schedule a C-section. I knew this was not what I wanted and it became very clear he was not a pro-VBAC provider.
I started doing a TON of research on my own because I knew that I wasn’t a bad VBAC candidate. I discovered that it was unlikely the size of my pelvis would prevent a vaginal delivery – something like only 10 percent to 15 percent of women truly have cephalopelvic disproportion (CPD). I also discovered, since I never made it into active labor, that the “failure to progress” diagnosis was bogus and wasn’t possible as my body wasn’t given the chance to prove or disprove it could birth. I kept doing research and found a lot of great resources, like the local International Cesarean Awareness Network, Inc (ICAN) Triangle chapter. I also found by talking to other women who had been through similar situations that I would be a great candidate for a VBAC delivery. At the very least, if I did require another C-section delivery, I wanted a hospital that was less harsh and would honor me being able to do skin to skin, be able to see my child be born, and my husband and child allowed to stay with me so we left the operating room as a family. I connected with a wonderful local doula, Lesa Williams, and she is ultimately the one who encouraged me to find another provider. I started looking for local resources that were VBAC friendly and had good success rates. The UNC Midwives were the most highly recommended providers for someone in my situation. I decided to go for it, and I’m SO glad I did.
GAM: How did you come to learn that a VBAC might be possible?
CA-B: I learned a VBAC was a possibility at my very first appointment with the UNC Midwives. Jenny Cox spent such a long time with my husband and me at that first appointment, going through all of the risks, benefits and possible scenarios of how things could go. According to the VBAC success calculator at that time, I had anywhere from a 48 percent to 62 percent chance of having a successful VBAC. This range was based on the fact I never really made it into active labor so we didn’t know if my body knew what to do or not since it was never given the chance. She did also explain that a VBAC was very much attainable, but in the event something changed, then I should be open to scheduling a C-section as the risk of complications following C-sections drastically decreases if the mom has not labored prior to the procedure. She wanted nothing more than to help make this birth different from my first. I left that first appointment excited and not at all worried. Regardless of my delivery method, I knew that I had found the right place for me and my child.
I consulted with one of the high risk Maternal Fetal Medicine OB’s at UNC just to make sure they didn’t have any apprehensions. Dr. Elizabeth Stringer was very much on board with me proceeding with a VBAC delivery. She felt that I had a great chance of being successful, and even though I developed the severe infection with my first delivery, she felt that my scar tissue was more than strong enough. She did say there were some risks that could not be truly evaluated based on the fact that, until they happen, there isn’t much that can be done, but she explained those complications are very minimal and are quite infrequent. So again, I felt more and more confident that a VBAC delivery was within reach for me.
GAM: How did the midwives at UNC help?
CA-B: The midwives were PHENOMENAL! I met every single one of them in one capacity or another, and they are truly a remarkable group of strong women who want nothing more than to help moms achieve their goals! They were a source of unwavering support through my entire pregnancy and delivery. Honestly, I got to the end of my pregnancy, my due date came and went, and still nothing was happening. They offered to do an induction and I agreed to schedule one at 41+3. I agreed to this because the research currently shows, waiting up to 42 weeks to deliver is OK, but, between 42 to 43 weeks, the risk of stillbirth increases sharply. I remember being so distraught and feeling those same emotions of “failure” flood my mind at my last two appointments before delivery. Again, Jenny was the one who really helped push me past those fears and kept telling me I could do it and not to give up. Cherese Infinito was another one to really keep me motivated and to keep telling myself I could do this. I knew all of the midwives were on my team even if I felt like I wasn’t going to make it.
The day before my scheduled induction, I finally went into labor naturally! I was so excited that I couldn’t sleep despite being instructed to do so, but I was so elated this was it and I was going to be able to do this. Once contractions really started going, they came on hard and fast and got very close together in a matter of only a few hours. So I was advised to go into the hospital. Shannon Maaske was the one to triage me and decide I wasn’t going back home. I had made it to 3cm already. Since that’s as far as I got the first time, I knew things were going to be very different this time around. I was admitted and then started to walk trying to keep things moving. If I made one lap around the L&D floor, I made 1,000. Around 10 a.m. my lovely doula arrived and she really guided me through the contractions. I did hit a bit of a hiccup around the same time where the contractions spaced back out, but Kathy Higgins, the director of UNC Midwives, reassured me that starting a small amount of Pitocin would get me going in the right direction. I continued to labor and the midwives were very non-interventional. They let me labor as I needed to. I was able to move around, get in a tub, use a labor ball, etc., all of which made being in labor so much more enjoyable.
It was a grueling labor, and I hit a second hiccup at about 8 p.m. where I could not relax through the pain, so I opted for an epidural hoping that I had waited long enough this time, and it would work in my favor instead of against me, and it did! I went from 8 to 10cm in a couple of hours and was able to start pushing. I distinctly remember Jenny coming to the head of the bed and saying, “Don’t worry, your pelvis is more than adequate to deliver this baby, and you’re going to do this.”
That simple statement, despite having been in labor for a little over 33 hours by that point, made all of the difference. That statement really told me I was going to be successful, and I would know what it’s like to birth my child. Things did get a bit hairy at the very end when I spiked a fever and needed antibiotics, but again Jenny was very calm and told me this was just a bump in the road and nothing to be too concerned about, I was still going to make it.
As it turns out, my son was not in an optimal position at all, he was what is termed asynclitic and he was not making it easy on me coming down the birth canal. In fact, the student midwife, Amy D., was helping to guide his head down and turning him the correct way all the way out. After pushing for a little more than an hour, I was so exhausted and felt like I couldn’t keep going because I felt I wasn’t making any progress.
I nearly gave up on myself, but I’m so very glad I didn’t. Both Jenny and Amy cheered me on, my nurse Sarah cheered me on, and my doula, mother, father, mother-in-law and husband cheered me on. Their support combined is what helped get me over that hump and finally after 38 total hours of labor and 1.5 hours of pushing, I birthed my son earth side. It was the most magical yet healing moment I’ve experienced to date. That moment helped me to push out all of the negativity I remembered from my daughter’s birth and allowed me to be enveloped in a wealth of achievement. I will never forget this experience and the midwives definitely should be credited with helping me reach this lifelong goal!
GAM: What would you tell other expecting moms who are considering working with a midwife - or are on the fence about it?
CA-B: Do your research. Understand that you are the one in control and that you need to find a provider who has the same goals that you do. Midwives are very much about allowing the woman to birth as was intended with as little intervention as possible. For me, that is exactly what I wanted and that’s what helped me achieve my goals. If you’re wanting a provider or team of providers that support you and your wishes no matter what those are, then midwives are a great choice. I absolutely could not have achieved my VBAC without the UNC Midwives! I received excellent care, and many, if not all, of the midwives will always hold a very special place in my heart in one way or another. I will always hold dear to me the time, advice, encouragement, compassion, and love that the UNC Midwives showed me during my time as a patient.
Go Ask Mom features local moms every Monday.