Jackie is a 32-year-old African American female in her third pregnancy. At 38.6 weeks pregnant, Jackie presented to the labor and delivery unit feeling regular contractions that had started early that morning. Although she had done this before, Jackie was nervous because this time, she was attempting labor after having had a cesarean section (C/S). Jackie was going to experience a trial of labor after cesarean section, aka TOLAC. You see, her last baby was breech, and her providers insisted that she have a due to the breech presentation. Unfortunately, she didn’t know of a provider willing to deliver her baby in this breach position, so she C/S despite her first delivery being vaginal.
Almost four years later, Jackie was pregnant again and ready to deliver another baby. She felt confident that she could have the vaginal delivery she desired despite the terrifying information the doctors provided regarding the risk of having a vaginal birth after cesarean section (VBAC).
Jackie came prepared, and the nurse quickly settled into a labor room. Her first sterile vaginal exam (SVE) revealed that she was 4cm dilated, 50% effaced, and at -3 station. Only six more to go, she thought. Around four hours later, the providers rechecked to find that Jackie was 6cm dilated, 75% effaced, and at -2 station. Her body was doing what she knew it could do. Since she was progressing on her own, the providers did not give her any medication to encourage the process. At the next SVE, just shy of three hours from her previous SVE, her cervix changed to be 7cm dilated, 90% effaced, and at -1 station. Jackie was excited. Her body was naturally progressing in labor, and she felt encouraged that a vaginal delivery was within reach.
Starting to feel her contractions, she did her best to hold off before getting her epidural. It was around 7 pm when she was rechecked, just 2 hours after her last SVE. At that time, her cervix was unchanged. Her cervix hadn’t made any change for 2 hours, and she was feeling the pain. The providers decided they wanted to start Pitocin to assist her labor progression. Due to the pain she was already experiencing, Jackie decided it was time for an epidural. Assisted by the day shift nurse, Jackie got her epidural just as the shifts were changing.
After her epidural, the shifts changed, and her body relaxed as she attempted to get some rest while she waited for those last 3cm. The nurse started Pitocin, and Jackie sat back anxiously, waiting to meet her baby boy.
Less than an hour or so after the nurse started the the Pitocin, Jackie needed to be repositioned because the baby was having dips in his heart rate. Jackie was turned from side to side to find a position the baby would tolerate. Shortly after that, the providers came in and decided it would be an excellent time to see if Jackie’s cervix had made some change. Quickly positioning her on the bed, the provider checked and discovered she was fully dilated and effaced, and her baby was at +1 station. Being fully dilated and effaced meant it was time to push. To her surprise, her water was still intact, and the providers thought it best to break the bag before allowing her to push.
The labor team quickly arranged the room for delivery, the provider broke her water, and she was holding a beautiful baby boy within twenty minutes.
Jackie had achieved the VBAC she desired.