Rachel and Steven welcomed their fourth child on October 9 in a 2VBA2C! (Second VBAC after 2 c-sections!) Rachel’s road to meet each of her babies had unique challenges so she was prepared for every possible outcome, even a c-section. I admired her willingness to be flexible but hoped very much for her sake that she wouldn’t have to. Well, as any experienced mother would tell you, Rachel’s body was gearing up in those final weeks. Her uterus was full of baby and her house was bustling with 3 busy kids. There was no rest for the weary! But she managed those last weeks well, resting in the fleeting moments she could, and stayed grateful for another baby on the way.

At her 38-week appointment she was curious for a cervical check and learned she was dilated 2 cm. It was encouraging to know things were starting to change but Rachel also knew that it could still be weeks before meeting her baby. In the meantime, though, and for the remaining couple of weeks, she had bouts of contractions that caught her attention and her imagination. She breathed through them and even did some positional things to help ease them. The contractions became a regular feature of each day and night and Rachel greeted them with patience. I was proud of her ability to face them and roll with them. In fact, Rachel thought it was the real deal at one point, but the contractions ended up petering off. With so much activity, I hoped when the time came, she would have the advantage of at least some sleep.

Steven sent me a text three days later on October 8 just past 10:00 am telling me Rachel’s water had broken. She was having contractions and thought to err on the safe side of getting to the hospital so she could get settled. It was also a relief to have her children taken care of and no longer under foot. She was dilated 3 cm, 80% effaced, and baby was at -2 station. It was a good start to her labor. Once settled, she labored with the peanut ball on her side. Cold cloths helped on Rachel’s face and Steven applied light strokes to help her relax. Counter pressure on her lower back also helped. She was in significant pain at this point which had me wondering about her baby’s position.

Sure enough, it was conveyed to us that baby was tilted a bit to the right. With all of her prodromal labor we weren’t surprised her baby was a little off kilter in there. We got busy trying some Spinning Babies things to help him find a more direct position. Fighting nausea, Rachel was willing to do it all – the jiggle, even the forward leaning inversion, and finally the side-lying release (on each side). She threw up soon after and around 2:00 pm got an epidural. It didn’t work perfectly at first, however. Rachel struggled with a window of pain on her left. It resolved after some time and adjusting the medication and I recall hearing her breathe deeply in slumber just past 3:35 pm.

The sleep was fleeting though because the window was not 100% gone. The nurse did a check and Rachel was dilated 4-5 cm but stretchable to 6. We worked on shifting Rachel into positions that would improve the pain management as well as help coax her baby boy more midline. Rachel was game for all of the positions we tried, even though the window remained. She used the PCA button when she could, and a heating pad and strategically placed pillow gave some comfort.

Rachel’s contractions were steady at 3 minutes apart and we were hopeful for cervical change. The biggest struggle was the pain management though, as the window remained a challenge. She labored in a variety of positions with the peanut ball under one leg and then the other, laying on one side and then the other, and even using the stirrup to hold her top leg in the runner’s position. By 6:30 pm she felt the pressure lower and more central which got us all hopeful that her baby had moved.

At 7:00 pm she was dilated 8 cm! Her cervix was 90% effaced and her baby was lower at -1 station. These were good changes, and we continued our repertoire of positions to help him find his way out. At 7:19 pm Rachel felt more pressure and her baby seemed lower. By 8:30 pm we positioned her bed in the throne position to make use of gravity to help.

Steven continued his gentle support in light touches and loving words. He told Rachel how proud he was of her and that he loved her. You could see the love reflected back from Rachel and it was a beautiful framework for them to welcome their fourth child. And by 9:27 pm, Rachel’s baby was at +1 station! She still had a bit of cervix, but we were very excited to know that her baby was on his way out of the pelvis!

She returned to an upright position, and we shifted her knees together to make more space in the lower part of her pelvis and rubbed her shoulders with Stress Away essential oil blend to help her release tension there. She lay back on her left side and the window of pain had returned. She received a second bolus from the CRNA, and it seemed to help some. And by 10:45 pm her cervix was gone! Her baby was still lingering around 0 station though and needed to come back down. So, we encouraged Rachel to rest as she labored her baby down.

Thankfully, the latest bolus of medicine really helped to manage the pain from the lingering window and Rachel was relaxed and comfortable enough to sing with the worship music that was playing. She remarked on how wonderful her team was and how well they listened to her. It was important that she feel heard and supported and every single person was very attentive to her needs.

By 12:25 am on October 9, her baby was very low, so she was encouraged to give a push and see what happened. Well, Rachel was a good pusher because one try had her nurse assembling the team. Her midwife was in the room by 12:35 am. Rachel wanted some oxygen to help give her extra stamina through pushing and it kept her mind clear. And she pushed for about 20 minutes or so and welcomed her not so little baby boy at 12:52 am! He weighed in at 8 lb. 11 oz.

Landric Steven didn’t cry out loudly at first, so he got some support at the warmer with some CPAP to open his lungs. There was meconium in the amniotic fluid as well and it was an added precaution to set him up for a good transition. He was back in his mom’s arms a little while later.

When the room was less crowded and quiet again, Rachel and Steven took in their son and reflected on the road to meet him. Rachel is so very patient and mild, and I admired her quiet hope for a positive birth. Rachel held her baby lovingly and enjoyed her first meal of pizza and a cranberry juice and ginger ale mocktail! It was a beautiful celebration of life and love as we welcomed this new person into the world. And it was also a healing birth for Rachel in many ways and reassured her that she could indeed have a VBAC…twice!