In the natural birth community, it is sometimes assumed that a woman who has a cesarean section will be dissatisfied with her birth experience. And in many cases, that would be correct. Or that a woman who has a natural birth with no complications will be thrilled about her experience. This is often correct as well.
But not always. In either case.
In my journey as a doula and childbirth educator, I have come to know that what TRULY makes the difference in a woman’s birth satisfaction is NOT the checklist of what did or didn’t happen during her labor and delivery. Rather, a woman’s sense of understanding and choice in the decision-making process bears more emotional weight than any medical procedure or natural comfort measure ever could on their own.
Read on to hear one woman’s story of her journey through two very different, yet ultimately similar birth experiences…
JESSICA’S STORY
Ever since I could remember I have been scared of childbirth. Not of pregnancy, but just of the birthing experience. I carried a tremendous amount of fear regarding my perception of the pain of childbirth and just the unknowns in general. Needless to say, when I learned that my husband and I were expecting our first child, I was all about the epidural.
I never took anytime or interest in educating myself. I mean really educating myself. Of course I read the generic materials that are out there, i.e. “What to Expect When Expecting” and read articles on various websites. Don’t misunderstand me, those resources are great; however, they are very “middle-of-the-road” …….for people just like me. I knew I didn’t want to feel any sort of uncomfortable sensation and would be getting the epi ASAP!!! So what was the point on learning anything further, right???
So here I am, four days past my due date (what seemed to be an eternity to me) and my water breaks at home. Contractions are about 10 minutes apart and are very mild. We head to hospital where I was examined and found to be 3 centimeters dilated. They ask me if I want an epidural and I immediately say, “Yes, the sooner the better,” as far as I was concerned. I received my epidural shortly after 7 am. I am now lying limp on the bed, what were already spaced out contractions are now slowing down even more due to the epidural. A pitocin drip is started to speed things back up. Most of day passes and after 5pm I am fully dilated. I push a few times for the nurse and maybe 4 or 5 times for my doctor. After a handful of pushes (literally a handful, I’m not lying) he says he doesn’t like the way the baby’s heart rate is looking and said that a c-section is necessary.
What do I say!?! I was completely unprepared for this. A cesarean section? Really? I didn’t want one but since I knew absolutely nothing I had no reason to disagree with him; I certainly had no educational knowledge to base any decision off of… 12 hours after being admitted into labor and delivery my daughter was born via cesarean section.
It wasn’t long after her birth that I began to find myself in a bit of emotional turmoil over the method by which my child was brought into this world. I was feeling as if one of nature’s most natural events had been stolen from me and that I had missed out on something amazing. I wanted to know more in depth what lead to this and what could’ve been done differently to have prevented this outcome, so I began my research. It was during this time that I really became enlightened on so many aspects of birthing, not just pertaining to my specific situation but also about the trend that our country was in regarding c-sections, the fact that my current doctor had an obnoxiously high c-section rate among his patients, and birthing knowledge in general. It was my goal to become as educated as I could regarding the subject of childbirth.
I knew that we would eventually have another child so I began to read everything that I could about VBACs, I even posted an online ad asking VBAC mothers for advice. I hounded nearly all of my friends (especially the ones who had delivered without any pain medications and another who had had a VBAC) with questions. Yeah, I was pretty obsessed with knowing all that I could. All of this new knowledge was wonderful, but it left me feeling and knowing that I had somewhat failed. I had failed to be more proactive during my pregnancy and perhaps, had I made different decisions, the entire outcome could’ve been different.
After the c-section my doctor had given me a list of very generic reasons why the surgery was necessary, one of which was that my pelvis was not shaped properly and, therefore, not conducive for a vaginal delivery. When I had discussed the possibility of a VBAC with him for the next delivery he was very negative and unsupportive. He said I could try but only if I were induced, which made no sense to me since induction increases the risk of uterine rupture. In so many words he basically said, “You can try but you will probably fail.”
I left his office in even more emotional turmoil. Not only did I have enough self-resentment over the complete absence of my involvement and my blind faith in the medical system in my first labor, but now I was questioning that maybe my body was not able to vaginally deliver a baby. Perhaps my body was broken.
Soon afterwards I consulted with a doula who gave me wise advice and who also helped me deal with and sort out some of the emotional issues that I was facing. She referred me to a few VBAC supportive doctors in the area and encouraged me to explore my options. I took her advice and did just that. I knew that I wanted a second opinion regarding my pelvis and that if I would attempt a VBAC then my best chance of success would be to be under the care of another physician.
I chose one of the referred physicians and requested that my previous physician send all of my medical records to my new OB. My new OB did a pelvic exam and found that, in her opinion, there was nothing wrong with my pelvis. We discussed what happened with my first birth and she reviewed my medical files that had been sent and concluded that I was a perfect candidate for attempting a VBAC.
Throughout my second pregnancy I continued my research, every day becoming more emboldened and positive that I could successfully do what my body was designed to do – deliver vaginally. I read numerous books and attended a Positive and Prepared Childbirth class, which was incredibly informative and useful. I created my birth plan and reviewed it with my husband and doctor. We were all on the same page. I had discussed with my doctor that I was hoping to go without any medical intervention and deliver naturally, but that I wasn’t ruling out pain medications either. If I were unable to cope or had no energy left, knowing that I would not have energy to push, I would consider other options. It was important to me to have resolved before the baby was even born that I would not feel bad or come down on myself if I needed pain medications or an epidural, or that if after giving it my all a c-section was needed then I would be okay with that. My doctor was very supportive; she really took her time with me. Each visit it became more apparent that she was truly interested and involved in my well being and that she recognized and supported what was important to me.
My contractions began at home on April 26th, three days before my due date, around 8:30 pm and were about 15 minutes apart and lasting for about 25 seconds or so. The contractions were not at all what I was anticipating. There was no build-up to their intensity and no let down either. Contractions hit with full force/intensity from the very beginning, remained at that level for the entire contraction and were very painful. I labored at home until the contractions were 5 minutes apart and lasting for about 45 seconds. At that point we left for the hospital and I was admitted around 2 am on April 27th. By the time 5 am rolled around I had been awake for nearly 22 hours, my contractions were coming every one and a half minutes and were one minute in duration. I was completely exhausted and was only getting a 30-second break between contractions. Because the contractions were so painful and the break between them was so miniscule, I could not even begin to relax. I was examined and was found to be dilated 7 centimeters.
At that point I asked for the epidural, I knew that I could give no more and that if I did not get some rest I would have no energy or will power to push. Considering that my first child was not “pushed out,” I knew that the pushing process was a crapshoot – could be fast or could be very long. I received the epidural and got some much needed rest. Later on I was examined and was fully dilated, but the baby was still relatively high at zero station so my doctor decided to let me rest a little more and allow the contractions to move the baby down a little further. Once the baby moved down enough, I began pushing. I pushed for about 45 minutes and delivered a beautiful, healthy baby boy. I was so ecstatic and proud – my body WASN’T broken. I delivered as I was designed to do!
Within seconds of delivering Judah, without even pushing, my placenta came flying out. That’s when my doctor knew something was wrong. I was bleeding heavily and there were no signs of it slowing down. Since I was a VBAC, my doctor’s first thought was to check to see if the site from my previous c-section incision had ruptured, but it had not. There was no rupture anywhere in my uterus.
At that point they realized that my uterus was unresponsive. It had stopped contracting, a condition known as uterine atony. Because of this condition the large blood vessels in my body that fed the placenta were continuing to bleed out. They were giving me pitocin and vigorously massaging my uterus in an attempt to help it begin contracting again. It wasn’t too much longer before I was being whisked away to the operating room. My doctor continued to work on me and they began a blood and plasma transfusion. I was knocked out at that point. I woke up in ICU, intubated. I was told that they got my uterus to contract but had done an ultrasound and saw pockets of fluid in my womb. Not knowing if it were blood (meaning I was still hemorrhaging internally) or just benign fluid they decided to measure the pockets, wait one hour and conduct a second ultrasound. If the second ultrasound’s measurements showed growth then they would need to do a c-section in order to fix the problem. Well, the measurements showed growth so a c-section was performed. Turned out that it was not blood, it was indeed just benign fluid. The surgery wasn’t needed after all, but I am so glad it happened.
While they were in there, two important things were discovered. The first was a uterine rupture, but not from my previous incision site. This rupture was in another location and was believed to be the result of all of the intense massaging that was administered. The second discovery was shoddy work performed during my first c-section. There are 7 layers of abdominal muscles that must be separated when performing a c-section. Apparently my previous doctor did not reattach those muscles when closing me up. Simply put, when my current doctor opened the site from my previous incision the first thing she saw was my womb! She did not have to go through all the muscles that one would normally have to go through. As a result of this “unnecessary” yet much needed surgery, a secondary uterine rupture was fixed and my muscles were reattached.
Please let me clarify that what happened to me that day was not due to the fact that I had a previous c-section. All indications point to the likelihood that I had developed preeclampsia during labor. Uterine atony and postpartum hemorrhaging could just as well have taken place during a c-section. Believe me when I say this was a very dramatic experience. In order to keep this story from being entirely too long, I’ve left out several other details of things that took place. But despite all of this, I feel more emotionally whole and restored than I did before, and not just because God said it wasn’t my time to die but because I successfully birthed my child into this world. I experienced that indescribable event.
It’s amazing the difference that mindsets and medical care providers can make (whether it be an OB/GYN or a midwife). Looking back at my first experience, my mindset at that time and my doctor at that time was a combination that lead to an unwanted outcome. Then there was my second experience, my redemption, where I decided to face my fears and arm myself with the necessary knowledge. I sought advice, found a caregiver who supported me on my journey and continued educating myself. I made informed decisions that I believed would lead to an outcome that I desired and it was a success!