The Business of Being Born

I think my first exposure to the birth process was when I was 8 year old and saw the episode of Family Ties where Elyse Keaton gives birth at a radio station. If you're in my age group, you remember this episode too. It was during the WKS telethon, there was a major blizzard, pipes burst at their house causing flooding, you know, the usual chaos that accompanies TV births. Although the scene that made the most lasting impression was Alex dropping to his knees after hearing the words 'it's a boy!' I was curious enough to ask my mother just how the baby got out of her body. My mother indulged me with a detailed explanation, as she was probably hoping that I wouldn't ask the BIG question of how the baby started growing in her body in the first place. Her plan worked, I was overwhelmed with information and wouldn't ask the BIG question for a few more years, but I figured that this is how all babies were born. A few years later, while pushing the boundaries of my bedtime, I saw a Caesarean delivery on some medical drama (I think it was St Elsewhere) and I asked "why can't she push the baby out of her vagina?" Ah, back then I knew proper anatomic terms, I had to become a medical professional to learn words such as 'hoo-ha'. " So how was I born?" I asked, after my mother described the process of a Caesarean. She would confirm that I was a vaginal delivery, while she and her two sisters were delivered via Caesareans and my aunts also had Caesareans with my cousins. She was the only one in the immediate family to have a natural birth. I was only 10 or 11, but I could sense that she was proud of this distinction.

Many years later, I was a hospital volunteer in England and I was asked to accompany a nurse who had to go to the pysch ward to do a post partum assessment on a patient. The young patient became distraught after her Caesarean delivery which lead to a psychotic outburst. She was refusing to see the baby as she felt that she didn't deserve the baby. She had failed. As I overheard the pysch team discuss how she probably had an undiagnosed mental disorder and the birth was merely the trigger, I felt empathy for her. It was written on her chart "Indication for Caesarean: Failure to Progress." How could she not feel like a failure when that was her label? As I started my medical training, I became more aware of how the medical community viewed Caesarean births. I worked with a male paediatrician who routinely asked mothers, "Did you have a normal delivery or a C/section?" So, does that mean that a C/section is an abnormal delivery? That was my impression from his question and I think one mother interpreted it that way too, as she looked down at the ground and muttered that she did have a the big 'C'. I stayed behind after the doctor left the room and I told her, "I don't think he meant to imply that a C/section is abnormal, I just think he doesn't like saying the word 'vaginal'." A smile brightened her face and she giggled a bit.

When I started working in Labour and Delivery, all these prior perceptions were confirmed. A vaginal delivery was seen as a victory, while a C/section was an admission of defeat. Another statistic in the ever ballooning Caeserean rate. Is it any wonder that feelings of inadequacy are transferred to our patients? How can we stop treating Caesaran mothers as if they are second class citizens? My colleague recently described how she performed a C/section for a patient who ruptured her membranes before an external version of her breech baby could be attempted. "You are all ruining what is supposed to be the happiest day of my life." the patient told the OR staff. Despite the fact that a beautiful healthy baby came into her life that day, the experience was tainted because the baby wasn't expelled from her hoo-ha. We need to stop promoting one experience as being better than the other. To borrow a line from The 40 Year Old Virgin, we need to "stop putting the pussy on a pedestal."

The thing is... a vaginal birth is an impressive process. I am in awe of those who have that experience. I have been so privileged not only to witness, but to have had my hands welcome many babies into the world. It can be truly beautiful, but it can also be messy and complicated. I remember speaking with my mother after my first delivery, "How did it make you feel?" she inquired. Well, I really didn't have time to think about it. My mind was focused on, 'what can go wrong, and if X, Y or Z goes wrong, what do I need to do in those situations?'. That wasn't what she was really asking. "I meant, how did it make you feel as a woman?" Ah, my mother can be a big dork at times. I would eventually admit that it would often make me wonder what it would be like when I'm the one being commanded to 'p-u-s-h'. Although I've probably been wondering that ever since I saw Elyse Keaton's birth on Family Ties.

Infertility stopped my curiosity cold in its tracks. I knew I would be fortunate to have a baby any way I could, so the delivery mechanism was not important. After getting past the accreta scare and the potentially life threatening complications, the prospect of a routine C/section was actually appealing. I was digging the idea. Although I must admit I felt so validated as I had one of the ultimate indications for the big 'C'. I started looking a potential dates and began to plot my work leave. Yet, even when your birth plan is a C/section, situations change to challenge your plans.

It was time for my 4 week growth check and placenta follow up. There was a major accident and traffic was a nightmare. We took the back roads and made it to our appointment on time, but learned that the perinatologist wouldn't be available as he was stuck on the motorway. Fortunately, we had one of the most experienced sonographers. She confirmed that my placenta accomplished what the perinatologist thought was unlikely. It moved and is no longer covering the cervix. The placenta itself looks healthy. Baby Jate is growing well. However, he or she is in a spine down transverse position. I shared with my swim coach that he or she is already starting to do the back stroke. I was disappointed not to be able to talk with the perinatologist, but I also know that he would most likely say 'we'll have to see how things are at your next scan in four weeks'.

So back we'll go, for yet another ultrasound. As of now my placenta is still being considered a marginal previa as the edge is 1 cm away from the cervical opening. A C/section would still be indicated if it persists, but may not need to be as early as 36-37 weeks. If it moves further and is more than 2 cm from the os, then a vaginal delivery can be attempted, other conditions permitting. At almost 32 weeks, there still is plenty of time for Jate to move into a cephalic position, but I laugh thinking that after all the ordeal with my placenta, I still could need a C/section for a malpresentation. The other variable that can influence the timing of delivery is my blood pressure. My readings have been normal thus far, but I know all change change within a day. So... I'm still in limbo... yet again... I know this is such good news about my placenta. There is less concern about the risk for bleeding. Jate can be delivered at full term. Yet, I don't like being in limbo... although I do need to get used to it. Apparently, this is only foreshadowing life after the baby arrives. I sent an email to my contact in Sacramento who manages our disability to inquire what I should do about submitting my 30 day notice for my leave, but I never heard back from her. Quelle surprise. So for now, I'm working another week. Yay.

I have to admit I feel conflicted to possibly have delivery options. When it wasn't my choice, I became attached to the conveniences and benefits offered through a Caesarean. Additionally, there is a huge difference in the experiences of a planned C/section versus an emergent one. I feel that I don't want to attempt an induction on an unfavourable cervix. My friend in LA had a successful version of her breech baby, only to have a postdates induction at 41 weeks and 2 days. She was in labour for 38 hours before the baby showed signs of distress and they went under the knife. Thirty-eight hours. A Venezuelan runner with muscular dystrophy finished the Boston Marathon in only twenty hours. Looking back, she shared that the induction and labour were worse than the surgery. In hindsight, she wishes that either the version had failed or she had just opted for a Caesarean. She could have had the same outcome two and a half weeks earlier. Yet some times inductions work well and deliveries go smoothly. I am so reluctant to do this, but to quote one of Myrtle's favourite expressions, 'you just never know...'

Just as I had resigned myself to the fact that I will probably always be jealous of Myrtle and her fucking textbook perfect vaginal delivery, my friend Amy provided some inspiration. We recently met up for lunch as she wanted to pick my brain about a repeat C/section versus an attempted Vaginal Birth After Caesarean (VBAC). A colleague of hers had a successful VBAC over twenty years ago and she shared how it felt so validating to her, especially as she viewed her first C/section as being unnecessary. "She seemed to presume that I had unresolved issues or resentment toward my Caesarean birth, but actually, I don't" Privately, I had to admit that I had similar thoughts about Amy. She really tried to have a natural non-medicated birth. She laboured at home for as long as she could and was admitted at 7 cm. They hired not one, but two doulas. She was on Kai.ser's midwife service, but interestingly it was the attending midwife who wanted to artificially rupture her membranes and start pitocin on her admission orders. A few months after the birth, she had requested a copy of her records, which she wanted me to review to see if her C/section was justified. Now, she was announcing that she was really leaning toward a repeat C/section. There was the practical convenience of having a scheduled date, so her mother could plan her trip from So Cal to stay with her daughter. She feared having another emergency delivery and felt that if she were to have another 'C', she wanted to be on her terms. Most sobering, she commented, "if I were to have a VBAC and the baby sustained an injury, I don't know how I'd live with that guilt" So, if a Berkeley hippie can get over not having a vaginal birth, I know I can too.

*I admit I haven't watched the Ricki Lake documentary. I just borrowed her title.