Monday, June 1, 2009

when cesarean is necessary

Given what I post on this blog I'm sure that people believe I am a natural childbirth freak. That I oppose hospital intervention at all costs. However, this is highly inaccurate. I myself have had a cesarean, as well as a medicated vaginal birth. If all I cared about was NCB I would be the biggest hypocrite known to man - or wo-man.

I believe in physiological birth.

I believe that every birth and pregnancy is healthy and normal, until proven otherwise.

I believe in informed consent.

I believe that every woman needs to know the pros and cons of every decision she makes.

I believe that the laboring mother should be made the conductor of her birth.

I believe that the female body is an amazing gift from God.

I also believe that the human body was designed to only withstand so much, and at some point something has got to give.

I belong to a natural childbirth message board on Women from all over the world flock to this board for information and support. The ultimate end goal is a (of course) a healthy baby, but women on this board also desire a natural, unmedicated, physiological childbirth.

However, childbirth is unscripted. Sometimes, even the best laid plans are scrapped, and hospital intervention is needed in order to safely deliver our infants.

Recently, such a delivery was presented on the NCB support board on Below is the story. It's a bit long, but entirely worth the read:

Sorry for the hiatus. Obviously things went a little awry, and so here is my story:

After my last post to you DH and I finished eating dinner and my ctx really kicked in. For the next three hours I labored with DH all over the house. I decided to take a shower to ease the ctx pain and see if it would halt the labor. Ctx continued so I got some last minute things together and got dressed in some comfy clothes. I made sure to eat some light food and drink a lot of fluids the entire time. I spent a great deal of time on the toilet because that felt the best. I also spent some time on my hands and knees doing pelvic rocks and hip swaying. At about 10:30 pm we called my midwife practice and spoke to the midwife on call. She recommended that I wait out coming to the hospital until the ctx were 3 minutes apart and 1 minute long. When we called they were exactly 5 minutes and 45 sec long. So although this frustrated me we heeded her advice and waited it out. We decided to go to bed and try to get some sleep or at the very least relax until they paced at 3:1. I got into bed but couldn't get comfortable so I left DH in bed and went back downstairs to rest on the couch, the upright positioning felt much better. Around 11:45 I realized the ctx were spacing out, not coming closer together. I was so upset. Eventually they spaced to 12 minutes apart and I just fell asleep on the couch.This is where DH found me the next morning.

So Thursday morning the ctx were still coming, but they were irregular, more like 15 minutes or 20 minutes spaced for a minute each. And they were horribly debilitating. I just couldn't figure out what was going on. We ate some breakfast and I headed back upstairs to try to get some more sleep because I was exhausted from the day before. DH let me sleep until noon, and then got me in the shower because I had my midwife appointment at 1:45. We got to the office and by this time my ctx were picking up again, about 7-9 minutes apart but for 30 sec. I got my first internal exam. Let me say this, the value of NOT getting vaginal exams is highly under rated. I know we recommend it all the time on this board, and I hope that people realize how sage that wisdom is. I was only 2cm but 80% effaced. Neither DH or I could believe it. With the hell I had gone through the last 24 hours, that was the only progress I had made. So, we left the office with plans to just wait it out. At this point we didn't know if this would continue for another day, or a week. I was a little discouraged, but decided that a positive attitude was best. So we picked up some lunch and headed home.

Once I got home (3 pm-ish) I had a hard time eating because the ctx had picked up again and were really very bad, and centralized to my back. I had this creeping voice in my head telling me that back labor was not a good sign. But the midwife had reassured me that the baby was still anterior when we were at the office. I labored around the house and tried to keep my mind off it. My mom called around 6pm, and at this point things had really picked up. She even made a comment to DH about the pain in my back and rectum not being a good sign (but they never mentioned this to me until yesterday). I kept wanting to update on here but I was so debilitated that there was no way a coherent post would have come out.

By 9:30 I started to break down. I was crying and begging DH to just call the midwife. He kept trying to help me through it, rationalizing that we'd just be in the same situation as the night before. But I knew something felt different. The ctx were 3 min apart and longer than a minute each. And they felt different. I can't explain how. But maybe more real is the best way to put it. We spoke to one of the midwives, she suggested I take a shower just to see if things puttered out like the night before. I completely lost it then. I didn't want to shower. I felt like if I did I might have baby on the side of the road. Like real panic started to set in, so DH called our doula in an effort to talk me off the ledge. She really felt that i should go to the hospital, not only because of the sound of panic in my voice but because of the intensity and frequency of the ctx. So DH called back our midwife and told her we were leaving for the hospital and she haltingly agreed to meet us there. I think what convinced her was when she spoke to me and heard the panic and realized how hard it was for me to even get words out. So by 10:00 we were on the road.

We got to the hospital at 10:25. The entire way I had ctx every three minutes for 1:25 minutes. I have to say this now, our hospital is awesome. I feel so comfortable here, and yes, I am still in the hospital. I was so concerned about interventions and being aggravated by protocol, but I was comfortable the moment I arrived, despite the first LD nurse we got. We were led to the delivery room and they started setting up a tub (which I never got to use). The first LD nurse did a vaginal exam, which I did allow. She tells us that I am only 1 cm 80% effaced! I nearly jumped through the ceiling. I know that you can regress but seriously! What was my body doing? So we just sat there wondering if we would be sent home. My midwife finally arrives along with my doula and they are told of my progress. My midwife looks at me with this look of shock, and said that she was going to check, and if I was at that stage she would send me home. She does the exam and completely loses it on the LD nurse, and orders her out of the room. Apparently I was really 5 cm and 90% effaced. LOL. That made me feel better, as did seeing my midwife get all momma bear on the hospital staff. SO LD nurse #1 is ejected and we get a new one, who was SO awesome and wonderful to work with.

I continue to labor all over the room and wing for the next 4 hours. I never got in the tub, and was forced to labor on my side for a little while because the baby was descending in a weird angle and my midwife wanted me to help him to position correctly. At the time I didn't really think about it, and laboring flat on your side sucks, but I trusted her. I was put on my back, my sides, all fours, got into the shower for about an hour and a half, the toilet, on a birthing ball, leaned against DH. At one point I was leaning on DH and I felt my hip adductor pop, which TOTALL SUCKED. So now I had horrible ctx and a shooting numb pain radtating down my right thigh, originating in my groin. Which eventually contributed toward my breakdown, because I could no longer find a comfortable way to labor properly.

My midwife comes back in and decides to check me again, I am still 5cm and 90% effaced. It's 3:30 am. But the worst part was the horrible ctx that were coming from my back. I started to freak out again, and dry heave with every ctx. We thought maybe I was nearing transition, which was encouraging, but I just felt like I couldn't take it. The ctx felt wrong. So at this point I was technically in labor for 48 hours. Although I had sworn against drugs I just couldn't do it. I was physically and emotionally drained, I could find a comfortable way to labor, nothing I was doing was helping me to open up. I was crying big snotty sobbing hiccup cries, expending good energy and probably closing back up to 1cm. So I caved and begged for the epidural. I used our secret "code word", and DH knew I meant business. Even as I asked for it I questioned myself, but I knew in my gut I was done. Even my midwife, who doesn't even like giving people aspirin, said that if I couldn't relax and get some rest I would not continue to progress. So I caved, and got the epidural. After it kicked in I was able to sleep for about 5 hours, during which time my midwife checked me to find that I was 10cm and 100% effaced. So at about 8 am everyone was woken from their cots and the epi turned off. By 8:30 I could feel a tremendous amount of downward pressure and felt the urge to push.

I started out pushing on my back, to try to train the baby into a good position, which was still questionable. Although it was never said outloud, I had this nagging suspicion that posterior would be used in a sentence at some point. I was taking oxygen between ctx/pushing in order to keep up my energy and prevent the baby from decelling. I pushed on my sides, and on all fours. All fours and the side positions were the most comfortable and productive, and I got the most encouraging responses from pushing in those positions. Unfortunately, it produced little effect.

Even though everyone could see my perineum bulging, and I pushed for 2.5 hours, they could not get the baby's head to pass under my pubic bone. I had hands in places you would never image, trying to help the baby over this point, to stretch my perineum and guide the head, to help me focus my pushing. Which strangely enough felt good and did help me to focus! The assistance gave me greater confidence to push. The pushing didn't hurt, but the pressure from the urge to push did.I wasn't scared of crowning, in a weird way I was looking forward to the ring of fire. If i didn't push during one of those ctx I went out of my mind, and I had been told to push every other ctx to build energy. Finally, at 11 am my midwife grabbed my face, only in the way a mother could do, and looked me in the eyes and said to me that she hated to tell me this, but she thought I was heading toward a section. I lost it. I just started to cry hysterically, even as I write this now I am getting all upset all over again. DH just held me while i sobbed and tried to keep me from wasting my energy.

My midwife decided to try one last thing. She made a call to her cooperating OB, someone that she works closely with, someone that respects her resistance to interventions and c-sections. She told me that when she spoke to him on the phone HE told her not to rush to judgement on the need for a section, that perhaps the baby just needed a version or he could use forceps to guide the head through while i pushed. Which I know some of you are gasping, but apparently he is so skilled with the forceps that the risk is negated, and he only uses them in extreme cases.

When the OB arrived he had me push a few times to see what exactly was happening. On his call it was decided that I had to be sectioned. The baby's heart was dipping to 86 and spiking to 140, too much for their comfort. And based on what the OB saw, there was no way the head could be forceped without risk and that there was no way it was passing the pubic bone. I was tired, emotionally wrecked, and in the worst pain ever. I agreed.

I felt/feel so defeated but I agreed. I just kept crying and apologizing to DH for failing, for not being able to do it. The OB, my midwife, my doula, DH all kept telling me that it wasn't my fault, there was nothing to apologize for and that there was no other option. The anesthesiologist came in, gave me a bolas (sp?) for the epi and I was prepped for surgery.

Hope you are still with me. I know this is long, but it's why I couldn't get on here until today. I had to compose myself and be able to withstand judgement. Not that I think any of you would judge me, but I feel like a failure, so it's complicated. I'm still emotionally unstable right now.

So I get wheeled into surgery hysterically crying, totally defeated and demoralized. I put so much into having a natural childbirth. I caved on the epi and now i was headed to the one outcome I didn't want. The surgical team was really good. They tried to comfort me and help me to see that the health of my baby was the most important thing. The OB and his attending both attested that if there was a way I could deliver him vaginally they would never send me to the OR. And so the deed was done.

When the pulled Søren out and over the curtain for me to see I nearly passed out. On top of his head was a caput about the size of a mango. The entire room gasped and scrambled to attend to him. I won't even try to explain what this is, other than to tell you that had I kept trying to push him out I could have killed him. And that is the only consolation I get in the fact that I had a section. I will attach a link to images so you can see what I am referring to. His head was not conehead shaped because of the bones molding, he actually had a giant blood blister on top of his skull, from pushing so hard and he not being about to pass through my pubic bone. What I came to find out in recovery was that he was occiput posterior, and chin up. His forehead was hung up on the pubic bone and there was no way to turn him.

He's okay, there is no permanent damage. The swelling has subsided and he has a large bruise on his skull, it looks like a port wine birth mark and should fade in a few days. His APGAR was 8-9, and he was uncommonly alert and responsive despite the epi and section. Even the OR nurses were commenting about his strength. When he was being cleaned up in the OR he picked his head up off the table twice, which I thought babies couldn't do for several weeks. He continues to do this while resting on your chest, and the nursery nurses keep telling me how strong he is.

He's nursing really well, and fought off jaundice even though I am O+ and he is B+ and he is breaking down a lot of blood from the caput. He was with me as soon as I was closed up, about 45 minutes after birth. And I nursed him right as I got him.

I'm still struggling with the birth outcome. I go from being relieved that he is a beautiful healthy little boy, to being completely devastated that I could not have a NCB and had to have a section. I think the only thing that has kept me positive is Søren's healthy outcome, he responding like that of a vaginal NCB baby. Something that my midwife and the OB said to me after the surgery also helped. They both told me that every other factor related to my birth experience was perfect. I labored well and tolerated an unbelievable amount of pain, apparently all due to back labor because of the posterior positioning. They said my pain tolerance is unusually high. The fact that my body was able to efface and dilate completely, even with the intervention of an epi, rather than stall or regress, indicates that if I did not have back labor and bad positioning I would have had a less intense and arduous labor. I'm a FTM, so my body was learning what to do and trying to combat bad positioning. And had the baby been correctly positioned I would have had him out, without drugs, without tearing, in two or three pushes.

I know they are not "blowing smoke" you know where. Both of these people tell it like it is. And would not tell me lies to make me feel good about the experience. My midwife asked me if DH and I planned on having another baby. I told her that in two or three years we would like to. And I asked her is I could still attend her practice even though I would be a repeat section. And her response was the best. She told me not if I wanted another section and elected for one, only if I wanted to try for a VBAC. Because in her opinion, and the OB agreed with her, I was a perfect candidate for one. So of course my stupid hormonal self started crying again, and that was how I knew that I really didn't fail, it's just my little boy decided to throw a curve ball and flip himself around at the last minute.

So this is a big rambling mess. Partly because I am still emotional and trying to accept my non NCB experience, partly because I am trying to recover with staples and stitches with no pain meds, and partly because I am a new mommy and exhausted.

So I hope you were able to read through this whole thing. I still feel twinges of failure and disappointment, and I am sure it will be a while until I shake it completely. I think the idea of a VBAC one day is giving me some hope. I just have to hope that the little boy or girl I try to deliver next decides to stay in the right position.

My response to her:

I am not a big crier. Really. I never cry. But your story moved me. You are an amazing woman. You endured something that most women (including myself) can not. You labored for FORTY hours - a good portion of that FORTY hours was spent with back labor. Amazing.

I don't know you, and my opinion means nothing...but I am so PROUD of you.

Wow. What an amazing birth story. You are a fabulous story teller. I am surprised you remember so much Laughing This is definitely something you should print, and place in your little boy's memory book. When he mouths off at the age of 15, hand him this story and remind him of the ordeal he put you through Wink

Reading stories like this make me so happy. This is a perfect story of a mother doing everything she could to deliver her baby safely. She did not "cave" to an epidural. She used modern medicine to her advantage. She needed that epidural and that cesarean to make sure that her child entered into the world safely.

This is also a prime example of midwives and doctors ONLY stepping in when medical interventions were TRULY necessary. I wish all OB's around the country were like this doctor.

Amazing. Truly amazing.


"Women's bodies have near-perfect knowledge of childbirth; it's when their brains get involved that things can go wrong." -- Peggy Vincent

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