CBAC refers to Cesarean Birth After Cesarean. I just discovered the term, which refers to mothers who undergo a ‘trial of labour’ ie attempted a VBAC, but had the birth end in a cesarean, and well I thought, that sounds like me.
Before I begin, I want to apologise that I do not have a successful VBAC story to tell. I even wondered if I should even bother publishing Hafsa’s birth story, or keep it in my personal journal for my own memories only. Cos I don’t think there will be anything in this story that will inspire. I would have liked to have a successful VBAC story to motivate the girlfriends I know who had a cesarean; to show you that it can be done, you can have a vaginal birth. And a natural birth too at that, without medical intervention. Unfortunately, a VBAC was not my rezeki, for reasons only He will know. But many others have done it, and you can too, inshaAllah, with adequate preparation, conviction, and of course supportive labour companions and medical care providers. So please, if you’re thinking about it, I hope my story will not make you change your mind. Every labour is different, every mother tolerates/copes with labour differently, and every mother makes decisions during her labour for her own unique reasons, depending on her unique circumstances. Like I mentioned in my last post, I’d do this all over again ie go through the trial of labour, even if hindsight showed me it would end in a cesarean in the end. Many mothers have done it, but it was just not meant for me, not for this birth at least. And I redha inshaAllah, I redha. So here goes..
Friday: I had been having Braxton Hicks contractions every day for the past week, so when I felt tightenings on Friday afternoon I didn’t pay them much attention. I thought it was just fatigue. I was 2 days past my EDD and had been out all day with Umar. We went to see my gynae Dr Joycelyn Wong, where I was told that baby is still active with plenty of amniotic fluid to keep her comfy for at least another week. Dr Wong agreed we can wait, and there was no talk of a repeat cesarean. To celebrate, I took Umar out for lunch and spent the rest of the afternoon watching him play with other children at Jacob Ballas. While Umar splashed about in the water play area, I felt mild surges (I prefer to use this word vs contractions) but ignored them. I even managed to enjoy a cup of chocolate ice cream, feeling really pleased and positive about “the wait”. “She needed a little more time. that’s all,” I assured myself.
Umar playing at Jacob Ballas, while I had my first surges, signalling Adik's coming...
That evening, I dragged myself to attend our fortnightly halaqah, leaving Umar at home. It was nice to spend some quiet time with my sisters, two of whom were pregnant too. We talked about motherhood and labour, among other things. In between our chat, my surges were unmistakable and I started to wonder if labour was beginning. Some of the sisters saw my discomfort but I just dismissed their concern, giving the excuse that I was tired. Hubby picked me up after the session, and once home, I realised that my surges were starting to get more regular, about one every 12mins. Though excited, experience taught us to rest in early stage labour, so we managed to get some sleep that night, but I held hubby’s hands all night and squeezed them whenever I was woken up by a surge.
Saturday: I notified my doula that morning, saying I *think* I am in early stage labour. By this time my surges were one every 10mins. We decided to call off whatever plans we had for the day, as my doula had advised to try to get some rest, to save energy for active labour later. We laboured at home all of Saturday, but the surges were erratic, and never got closer than one in 10 minutes, each lasting about 30 – 45secs. That night, we hardly slept, as the surges appeared to progress to one in every 8mins. I laboured on the ball and whenever I could, lying down, determined to “conserve energy”.
Sunday: Surges continued. Again, we had plans, to attend a cousin’s engagement, but we canceled. Stayed home and tried to time the surges but it was pointless as the surges were erratic and came once every 8 or 10 mins, with varying intensity. By evening, I was losing confidence, not sure I could last another night. It was getting tiring having to cope with the surges, seemingly with no end in sight. I started to doubt if I was really in labour, after 2 nights and 2 days of erratic surges. I confided my insecurities in my doula, who told me that what I was experiencing sounds very much like prodromal labour. We quickly googled it and found the description very much fit what I was experiencing. We read that prodromal labor contractions may begin hours or even days before active labor, and surprisingly, that didn’t make me feel nervous or defeated. I felt immediately calmed; it was reassuring to have a name, and an explanation, given to this long, slow labour. I read some prodromal labour birth stories and it was good to know that there are other mothers who have gone through this type of labour and had a successful natural birth in the end. So I just told myself to be patient, it could be days still. I’ve waited 10 months, and laboured 2 nights. So what’s a few more days. “She needed a little more time. that’s all,” I assured myself. That seemed to be my mantra for the entire labour.
The surges continued that Sunday night. By this time I knew they were doing important work. See what childbirthsolutions.com says about prodromal labour (by the way, this page also provides a good overview of what happens during an intervention-free birth). Reading it told me that the surges were helping the cervix prepare for labour, and reassured me that it is normal to “feel let down and eventually become quite tired and discouraged… as time goes on and the contractions continue without any apparent progress”. It also reminded me to “keep your spirits up… use these contractions to get to know how your body feels as it begins the hard work of labor.. and prepare mentally for the challenges you will shortly be facing.” This reassurance helped me get through that Sunday night.
Monday: The morning came, and D and I had been up almost all night. By this morning the surges were getting more intense, and I had to focus and breathe each one down using the visualisation techniques that Hypnobirthing taught me. I had managed to stay calm and relaxed all these while but cos D had to go to the office for a couple of hours that Monday morning I got really upset, losing confidence, for how would I cope without him? I could call my doula, but it wouldn’t be the same. D was my rock, and having him around made me feel like I could get through anything. My surges were still once every 8 mins and although D offered to take me to the hospital (which would be a great excuse for him not to go to the office) I refused, knowing I would be dilated less than 4cm if I went to the hospital then. I knew that as a VBAC mother, they wouldn’t let me go home once they saw that I was in labour, so no, going to the hospital was not an option for me. It was too early. D went to work, and lo and behold my labour stalled, such was how closely my emotional state affected my labour. I had one surge every half hour, and then I had a nervous breakdown. I called my mom and bawled my heart out on the phone (at the same time refusing any suggestion to go to the hospital). I then calmed myself down, telling myself I need to focus on my birthing body and think positive thoughts, and that my baby would be affected if I was emotionally distressed. I also did some prayers, and read the Quran. These helped, and after a short nap, the surges returned, just as D came back from the office around noon, and we continued labouring. By afternoon I was done “waiting”. I wanted to “work” on the surges cos I was starting to get very impatient. My doula said to follow what my body tells me to do, so I told D I felt like walking, and we went out. I had to pause every now and them to breathe down a surge. After an hour, we went back home and by that evening I had more regular surges, once every 6 – 8 mins. I felt celebratory, and sms-ed my doula to be on “standby” mode, in case we needed her to come during the night. That whole night we laboured, with my surges coming once every 5 – 6 mins.
Tuesday: By 4am, we were both exhausted and since my surges were by then 3 – 4 mins apart, I called my doula to come over. When she arrived, she took over while D got some sleep. She was a God-sent angel, helping me cope with my surges by applying counter-pressure and massaging my lower back. She made me have a good breakfast, and then encouraged me to do lunges, squats, and hip rotations on the birth ball. These worked great in progressing my labour, and by 2pm my surges were very intense, lasting 60 – 90 secs, and one every 3 mins, like clockwork. I remember thinking about Maryam at this point, how she was active during her labour, walking about and shaking the tree from which dates fell and she ate them for energy. During one of our pre-birth meetings, my doula had reminded me that we can draw lesson from this. This image in my head calmed me and kept me going with the lunges and squats, in spite of being very sleep deprived. With the surges coming close together, D suggested going to the hospital but I was very hesitant. I felt really comfortable and secure in my birthing environment (my cosy bedroom had dim lights and was lemongrass scented, with my Macbook softly playing Ghamidi recitations of the Quran in the background, and all my other favourite things around me). I didn’t want to move, or go anywhere, fearing any change may stall my labour. Just the thought of the hospital made me hyperventilate during a surge, and so I knew I wasn’t ready. I told hubby lets wait an hour more, and in that hour I did zuhur and istikharah. I had surges during my sujud (which is an excellent position for labour IMO) and I used that moment to really du’a for guidance and help. Guidance in our decision-making during this labour process, and help should I face any difficulties later. Last of all, I prayed for protection, protection from any harm, to me, and my baby. At 3pm, my heart finally felt ease to leave for the hospital. I had one condition for my doula and D, and that is, if my labour stalled when I reach the hospital, we would turn back and go home, without seeing the doctor. D agreed and we took a long slow drive, even driving through McD at East Coast for some takeaway. My surges kept coming, and were in fact intensified by the car ride. I scolded my usually careful driver husband many times for driving too “bumpily”. I’m sure that wasn’t the case, cos my doula quickly reassured him that this was a common complaint by women in labour, bless his heart.
4pm: We reached a very busy hospital. The labour wards were full and I ended up labouring standing up against the wall for almost an hour. By the time my gynae Dr Wong saw me at 5pm, VE indicated that I was 5cm dilated. Baby’s head was at station -1, partially effaced and my membranes were bulging. These were music to our ears, cos it meant that I am in active labour, no doubt about it (yes I still had doubts before that) yeay! There was no turning back now, and we hurried to get settled in the labour ward. Once we got our room and D had set up my lemongrass scent and got my Macbook playing Ghamidi, we got to “work” again. Squats, lunges, birthball. I was determined to help baby to descend and get into an optimal position, and I knew in my heart of hearts that though my progress had been encouraging, we still had a long way to go, and not much time. Most gynaes would grant VBAC cases only 6hrs of labour in the hospital but Dr Wong had earlier agreed to let me labour up till 10hrs as long as baby’s heart rate was good, as any fetal distress would be an indication of uterine scar rupture (rupture of the old c-sect wound). So, she needed me strapped on to the CTG for 20mins every hour to monitor this. I agreed, and in between, we continued with our lunges and squats.
6pm: By this time my surges were very intense, one every 2 mins, I had a minute of rest in between each surge and I used that time to do lunges holding D’s hands. As long as I stayed calm and confident, the surges didn’t hurt. It was a lot of pressure, but not pain. Breathing helped me relax, with counterpressure massages from my doula, and verbal prompts from D. I have to say now, that D was the most amazing birth partner. He was my rock and the only thing that got me through the surges at times. His whispered words of encouragement, kissed, hugged, and at times, held my entire body weight through an entire surge, God bless him.
8.30pm: It was time for our 3rd round of CTG monitoring. By this time I was starting to have trouble finding a position that suited me during a surge. I was feeling a lot of pressure and hence my most hated labour position was lying down. It totally went against what my body wanted to do during a surge, which was to half squat, or “waltz” with D ie standing and swaying hips during a surge. So I resented the need to lie down for the CTG. But it had to be done. During this session, the nurse detected fetal heart rate deceleration (in layman’s terms, baby’s heart rate dropped during a surge). Concerned, the nurse thought that it could be a sign that I was ready to push, and so she offered a VE. The crushing news; I was told that I was still only 5cm dilated.
9pm: I was given an oxygen mask, to help get more oxygen to the baby, and I caught the look of worry on D’s face as he held the mask on my face and looked at the fetal heart rate monitor. Dr Wong voiced concerned that baby may be in fetal distress due to a possibility of uterine scar rupture, that infamous reason for a repeat cesarean. Yes I was disappointed that I was still just 5cm, but as talks of cesarean started to surface, I felt angry. In between surges I reassured Dr Wong that no, I do not feel any pain on my c-sect wound and therefore I told her in no uncertain terms that I do not think my scar is rupturing. I argued that baby’s heart rate was probably dropping cos I have been strapped on for almost half an hour and I cannot cope with the surges well lying down. I told her if she lets me labour in a position I was comfortable in, baby would be fine again. Dr Wong relented, I got off the bed, and she continued to monitor baby’s heartbeat using a cordless doppler, every 15mins, in whatever position I was in during a surge. Alhamdulillah, baby’s heart rate improved and there was no more talk of c-sect. We continued working on the labour; I immediately got busy with my lunges and squats again. I was really annoyed for having “wasted time” being strapped on the CTG.
11pm: By this time, I was losing gushes of fluids during each surge. Surges were coming fast, with barely a minute rest in between. There was so much pressure down there that I grunted and cried out His name with each surge. It felt surreal to me, cos with my first birth with Umar I never got to this stage. The pressure was so overwhelming that at some point, I asked my doula if she thinks I was ready to bear down. She gave me the option of just following my body, or request for a VE so that I know how far along I am, if really I was ready to push. A nurse poked her head in, and hearing my grunts she asked if I wanted a VE, and so I agreed, for some reason that till today I do not know. I remember turning to my doula asking “Am I making the right decision?” and her answer was if my heart feels so, yes. It turned out later that it was this VE that led to my decision for a cesarean.
11.30pm: The VE indicated that I was still 5cm dilated, and the nurse’s glove was covered in green meconium. I slowly felt my VBAC slipping away. I started hyperventilating, unable to breathe down the surges that were still coming fast and furious. My mind was racing with questions. How could I still be 5cm if my surges were already so close together? My surges were almost on top of each other; one starting before the first could end. So how could it be! What did green coloured meconium mean? Is my baby in danger? Dr Wong came in, did another VE (cos I did not believe the nurse) and confirmed I was still 5cm. Again talks of cesarean surfaced. She said she was comfortable with me labouring for as long as I wanted but there had been no progress for the past 6 hours and she’s concerned about waiting longer, especially with the meconium. D told her to give us time to think over the decision, and she left the room, giving us space. I was offered the gas, which I took, in an effort to calm myself down and give me room to think. The gas helped take the edge off the surges, and in between, I asked D what he thought. He did not answer, instead telling me to focus on my breathing.
I knew then, that it was up to me. My doula suggested visualisation exercises, and so I closed my eyes and silently prayed and talked to my baby through each surge. I asked my baby why she hasn’t descended further down my birth canal, why she is taking so long, and if she needed more time. I felt great unease as I had this silent conversation with her, and for some reason, my heart said no, she didn’t need more time, not anymore. The image of the nurse’s glove covered in meconium kept flashing throught my mind and when I next opened my eyes, I told D and my doula, please call Dr Wong, tell her we are doing the surgery, now. I was also losing focus, and could not cope with my surges anymore. Through my gas mask, I saw both their faces stare at me, and D continued asking me to breathe deeply, as another surge came on. I thought they didn’t hear me so I took the mask off (it wasn’t much use anyway) and repeated myself. They later told me that its not that they did not hear me, but they were not sure if I was serious, given how much I wanted a VBAC. I remember telling them “I know you guys think I can do this, I know you think that we should try a few more hours, but I don’t want to anymore. I’m still only 5cm after all these time. Now I’m worried about baby and can’t cope with the surges. We must do the cesarean now. I am not emotional about this decision because I think its the right thing to do.” I said the last sentence cos compared to my labour with Umar, I was then crying buckets when I agreed to the cesarean, completely upset, and even hyperventilating. This time, I was calm about my decision, even eager to get to the operating theatre. It just felt.. hmm.. like it has been decided for me. I don’t know how to explain it, but at that time I felt absolute certainty in my heart that He knows I have tried my best to bring my child into this world through natural means, but for some reason which only He will know, its not possible, and He has decided for me that my baby would be birthed by cesarean. I felt absolute certainty that He had something to teach me through this labour journey, and that the last 4 days of labour had not been in vain. My baby needed that 4 days, and that now, with the meconium, she needed help to come out.
Wednesday 12mn: So it was decided. Dr Wong came in, ready to launch into another persuading argument, but she did not have to, as we told her our decision. I was wheeled into the operating theatre, still breathing down surges every half a minute. Administrating the epidural was probably the most difficult part of my entire labour, cos of how close the surges were. Once I was prepped for the surgery, my husband joined me by my side, and held my hands. That was my last memory.
12.48am: Hafsa was born. I do not have any memories of her birth, although I was awake. Maybe the epidural or some drug I was given had an amnesic effect on me, cos I have holes in my memory of this cesarean birth (unlike with Umar, I remembered every second of his birth). D told me I was conscious and talking, and even held Hafsa after her birth. I have a fuzzy memory of this, but there are photographs to prove it! But when D described the circumstances of her birth, I realised that my amnesia could also have been a psychological defense mechanism, or in other words, He had chosen for me not to be “awake” to hear Dr Wong give cry of alarm when Hafsa came out covered in thick green meconium, nor witness the tracheal suctioning that they did on Hafsa immediately after, to clear her airways. Since the minute I decided to have the cesarean, I had been worried sick about her being born with breathing difficulties due to meconium aspiration, as I have read about what they do with meconium babies at the hospital. So to me, it was a hikmah, or blessing, that I don’t remember her birth. And I don’t resent it. I’ve heard about how some cesarean mothers do not feel connected to their babies cos they did not feel nor see their babies leave their body, but alhamdulillah, I have no such issues, cos when I next held her in my arms in the ward, I was just so completely overwhelmed with emotion, because she’s mine, she’s mine. I know she’s mine. I remember feeling just so grateful she was safe and very healthy. And so absolutely perfect.
A teary Ayah saying the Adhzaan into baby Hafsa's ears after her birth
The birth did not turn out the way I planned it; I did not get the normal, natural birth that I wanted, but He is the best of Planners and He has chosen how and and when I would deliver my baby. I am so grateful to Him for the labour experience with Hafsa, which was so different, and went far beyond what I experienced with Umar. I had those extra days of labour, for Him to do whatever He needed to do to perfect His creation, and He allowed me to experience active labour without any pain relief. He blessed me with a wonderful labour companion, my doula Hanani, who gave me confidence, warmth and love during my labour and helped me to remain calm through everything that happened. He also blessed me with my amazing husband, who supported me in every decision, was patient with all my tantrums and mood swings and weird demands, and who assured me that it was okay to get the cesarean, that he trusted and loved me forever no matter what. I feel blessed that we had this experience together. I’m also grateful for my gynae Dr Joycelyn Wong, who was respectful of my wishes, and willing to work with me on all of my requests. Last of all I am grateful that Hafsa is so healthy, adorable, nursing well, gaining weight, sleeping well and that she didn’t have any breathing difficulties or need to spend any time in the hospital (we were discharged on her second day of life) despite having passed thick meconium in labour. I was told by my Dr Wong later that had she known that Hafsa had passed that much meconium, of that thick a consistency, she would have rushed me into the operating theatre no matter what I said. So alhamdulillah, my decision for a cesarean was a Guided one, alhamdulillah, alhamdulillah, alhamdulillah.
So I am now a mother who have had 2 cesareans. I don’t know if I will be able to try for a vaginal birth for my 3rd child, should He bless me with one, but immediately after Hafsa’s birth, my first priority was to recover quickly and be there for my children. I will write another day about how I recovered from this birth physically (I have had a quick recovery and have lots to share with other csect mothers) but emotionally I can say now that it was not easy. I loved labouring for Hafsa, and I feel strongly that her labour was Allah’s gift to me, for it was so very humbling and menginsafkan, in ways that words cannot describe. But I still mourned the loss of the dream of a natural birth. I mourned not being able to feel the joy of pushing out my baby, of grasping my warm, wet baby to my chest in ecstasy at the moment of birth, of bringing her to the breast shortly after. I mourned the fact that my body has been put through two major abdominal surgeries, and that no matter what, these surgeries have increased the health risk to me and my future pregnancies. I know I should be grateful for my two healthy children, and I AM. But still, this is a loss for me, and it is one that I needed to mourn.
Today, two weeks later, looking at my two beautiful children nursing together, I am again reminded of the overwhelming rezeki that He has blessed me and my family with. So I decided, I have mourned and grieved enough. It still hurts, but alhamdulillah, He has eased for me to feel complete redha, or acceptance, in my heart, for what has happened. Today, I finally sat down and wrote this story, though unsure if it will teach anyone anything. For it didn’t end the way I wish it ended, not just for myself, but for you, Sis Liana, Zakiah, Alia, Zaheedah, and many other mothers, who I know were looking forward to a birth story that would motivate you to have vaginal birth for your next child inshaAllah. So please, I say again, please, don’t let my story make you change your mind. Birth is a funny thing, one of the mysteries of the human body that science have not, and probably will never completely figure out. No doctor could tell me when my baby would come, overdue as she was, and no doctor can tell me why I wasn’t dilated past 5cm (for both my births) even though all other signs indicated I was far along in labour with Hafsa. No one can tell me what if I had waited an hour, or a day more, would my labour progress? There are many unanswered questions, but inshaAllah, He has His reasons for everything, and the most important thing is to usaha, or try your best. Trust your body, trust Him, seek His knowledge, and be as prepared as you can, to usaha and fight for that vaginal birth, for if you don’t, you’ll never know, and will always wonder, what if, what if. For me, having a doula also stretched the “usaha” factor that bit more, cos I don’t think I would have lasted as long as I did without Hanani. I loved how I was empowered to make informed decisions, and that by His Grace, my labour was free of interventions all the way till I was on the operating table. In the end, although it wasn’t my rezeki to birth naturally, I was blessed with such a beautiful experience, that I’d do it all over again, maybe not tomorrow, but I will, I will inshaAllah. It may not be the perfect labor but it’s mine. And I am grateful for it.
Doula’s note: I have been asked by our dear N to contribute an account of her birth through my eyes. She has summarised her birth story well, and there is really nothing much to add other than the fact that I am still amazed to this day at her tenacity, strongwill and perseverance. Most importantly she wrote of how empowered she felt about the decisions she made. As a doula, I feel proud that she feels this way for that really is what labouring and birth is all about.
Was it a waste, labouring for days and not getting a natural birth? 100% not. Its not the outcome but really the process/journey that matters, and Im not saying this because I’m a doula. Imagine training for a marathon, you can have all the training and preparation in the world, but whether you complete the marathon is subjected to many other external variables on the day itself (eg: weather, health etc). But would you say the training has been nothing but a waste? No, because ‘training’ does long-term wonders to the physical, mental and spiritual state. And when applied to birth, it has exactly these same effects. I will not dwell on what they are because dear N has done this in her previous posts, and I’m sure you get the idea. 
Now on to the more technical aspects (knowledge within my capacity as a fairly new doula): N’s labour started on the slow side, and the three of us (N, hubby and me) got her into helpful labour positions to get them going. She understood that irregular contractions could be due to baby’s poor position, so she diligently did her lunges and other positions with regular rest breaks in between. At some point on the 4th day of labour, her surges picked up in intensity and duration, and became more regular. It was all good news. At the hospital, her surges continued to progress and reached a point where she started making ‘grunting’ noises that sometimes signified the point of pushing/bearing down. After 4 days of labour with good progress towards the end, all of us, including her gynae were convinced that she has finally reached the 2nd stage of labour (pushing). Now as to why she was still 5cm dilated after all the intense labouring remains something that only the Almighty knows. As a doula (or her gynae), we can make several guesses (pelvic shape for instance), but sometimes things can just happen without having a plausible explanation. And as Muslims, we know that when Allah wills for something to happen that is beyond our understanding, we have faith that there’s surely a blessing in disguise.
I am happy that N has put together this wonderful account of her birth story. I do feel that she has not given herself enough praise and commendation for her hard work; after all I’m sure not a lot us can stay strong when put through the same test. And simply because of this, I hope you, dear Sis, will continue to be a source of inspiration to many mothers who will be attempting a VBAC in the future, InsyaAllah.
I know they are well meaning but… oh well. 
