Tuesday 19 May 2015

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.

17 comments:

  1. I am neither a fan of inductions nor c-sections (they tend to go hand in hand anyhow). My c-section was the single most unpleasant experience of my life. Granted it wasn't exactly a glorious moment for me like one should expect under the circumstances. I have an incredible tolerance for pain and I healed rather quickly, but I still would never encourage anyone to have an elective c. I won't delve too deeply in the topic because I doubt that you'll end up having a choice, but if you do, I would suggest you give yourself an expiration date; if I don't spontaneously go into labor by 40 weeks, then I will have a c-section. Because let's face it, inductions are such a fiasco.

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    1. Interestingly, when I worked in Connecticut, I noticed that many doctors gave postdates patients the option of a primary C/section in lieu of an attempted induction, and if the patient were unfavourable for an induction, there was more encouragement toward a C/section.

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  2. Yes I agree that there seems to be a lot of stigma around c-section births, I often read blogs where women feel incredible disappointment if their births ended up that way, which is sad.

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  3. Hurrah for the good news about your placenta moving! however you end up giving birth, I think that is something to be happy about. As for birth, I think it is so hard to make "choices" when you are not sure if you even have a choice. In your case you are aware that your choices may be limited as you are a specialist in the field and you have some complications. But even people who have uneventful pregnancies can't truly make the assumption that they will have "textbook" deliveries. I think it is interesting to look at why c-sections are done and consider whether they are medically justified or not. However I think it is not particularly advisable to view one's own body or delivery as an political statement, because, stuff happens. One of the most useful things we did in our birth classes was compare our expectations and intentions. It was very helpful to try to shift thinking from expectation to intention regarding the birth process. Although I had a somewhat challenging labour and came very close to a c-section I am at peace with how it went, and I think that is a big part of why. I am pretty sure I would have also have been OK with a c-section (although my intention was for vaginal unmedicated birth) because I understood what was going on and why decisions had to be made.

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  4. Yay for your placenta moving! As you know, I had to have a c-section due to my previous uterine surgery and while I was sad about it for a while during my pregnancy, I came to recognize the benefits of knowing when it would happen and to get ready for it. And it turns out it was easier to recover from than my fibroid/endo surgery! If people don't think that Izzy had a "normal" birth I simply don't care at this point. It was what was needed in order to ensure her safety and mine so that's all that matters.

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  5. I had a family member recently say to me, " I know a vaginal/unmedicated birth will happen for you, simply because you want it". This was after spending several hours (24) watching my long time friend try and reach this same goal - but only to end up with a c/section under general anesthesia. I like your stolen line - stop putting the pussy on a pedestal. Regardless of how a baby enters this world, it's a miracle. And those who (like my family member) think that it will go exactly as planned because that's what they want/desire - might feel that shame you explained for "failing" to deliver vaginally. I'm stoked about the placenta moving up - and I'll always advocate for women to try what their heart desires but be prepared for nothing to go as you originally planned. In your profession, I'm sure you already know this! :) XO Let's just get baby Jate here and safely. That's really all that matters!

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  6. My first thought upon hearing that my attempted "regular" birth was going to have to be a c-section was that I had let everyone down. Ridiculous! Does it matter now how Molly came into the world? Does anyone care now, 11 months later? Absolutely not. I mean, the kid was created in a petri dish and I was impregnanted while my husband was 100 miles away. Nothing about her path to birth has been natural or normal. But she's here and she's healthy and safe... and as my OB/GYN said, "If we wouldn't have done the c-section when we did, the baby would have died." So - ooookkkaaayyyy then. 100% worth it. Screw the haters.

    That being said, it's pretty cool that a vaginal delivery is possible for you. I've heard the recovery is much faster and easier, though for me the c-section recovery wasn't too awful. I guess I'll finally be able to compare if I realize my dream of a VBAC for this one.

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  7. "I had to become a medical professional to learn words such as 'hoo-ha'." HAHAHA... that was good.

    My baby obviously came into the world under complicated and hard circumstances, and then he found my arms under even harder and more complex circumstances. Not only did I not give birth (C-section, or otherwise) but I wasn't even THERE for the birth. This was some really heartwarming thoughts from a friend:

    "I just remember what my doc told me when I was pregnant and had a million questions about how the birth would go and if I should take medication or not and he said: keep in mind, the birth is over in a flash. the real serious part of parenting comes when you realize you are responsible for that little human and you take him/her home and realize you’ve got the next 18 year to take care of him and mold him and keep him safe. So you are getting to do the really important part. The birth and pregnancy part quickly fades under the importance of taking care of a tiny human."

    I'm not diminishing the desire for a natural birth or any of that. I know those are hard choices and many women have really issues with the way their baby entered the world months or even years later. I get that. Gosh, pre-infertility, I would have been one of them. Sign me up for therapy if the baby didn't enter this world after four hours of bouncing on the ball and an hour in a birthing pool because HOW WILL I LIVE? : ) I get all of that. Whatever you decide to try, and more importantly whatever actually happens, I hope you can say "that was the birth, and it was beautiful (or it sucked or whatever), but THIS, this is the good part." Because it is. : )

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    1. I LIVE the words from your friend Amanda! How true they are.

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  8. That's such great news about your placenta! Finally, something's going right for you...oh wait, I probably just ruined that by saying anything. ;) I was pretty disappointed when I was told I had to have a c-section, but primarily because it had been drummed into me over and over again how much harder the recovery would be than if I delivered vaginally. In hindsight (and with absolutely no reference for comparison) my recovery wasn't nearly as bad as I anticipated. And I'm with Amanda...nothing else about Q's conception was "normal", so why should I care what anyone thinks about his birth? It's awesome that you have options, though.

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  9. I'm sure you already know this more than most people, but I think the best way to give birth is whatever way you get to feel like you chose. I think women generally feel happy about their birth experiences when they believe they had agency.

    Don't watch it. My three-word review is "insultingly, infuriatingly paternalistic." If I'd been swayed by their arguments, I wouldn't have gotten the lovely births I had.

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    1. Oh, and I think you should choose whatever kind of birth you want, deep-down. Even though L&D is next-to-nothing like a spa day, I think there is a pampering side to choosing a birth. We get told a lot that it's silly to imbue things with more meaning and that we should just stick to the practical, but particularly since you're planning that this will be your only time doing this, your preferred option should be whatever you want to try. I gave birth unmedicated in a hospital while watching Lord of the Rings (no "Rainbow Connection" for us) because I felt like it. For me, it's like, if you're going to the moon once in your life, you should get to choose--within reason--what the trip is like. Same with this.

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  10. Good to hear your placenta is moving up. Less of a risk must be better.
    For some reason I was convinced SB would be delivered via C-section. As for the whole natural and possibly unmedicated part, honestly, there were so many drugs involved in creating this little embryo and keeping her inside long enough that I couldn't care less, as long as we both made it out ok. And I'm with Amanda about the rest of the parenting experience being so much more important, and long-lasting.

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  11. Hooray for your placenta moving! That's so great! I'm glad you at least have options for giving birth.

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  12. Great news about the placenta moving. As for a birth plan, I was terrified of either way and so relieved when Baby B made the decision for me by turning breech. And thank goodness, because it turned out that Baby A had the cord wrapped pretty good around her neck. It doesn't matter how Baby Jaye enters the world. The only thing that matters is that there is a Baby Jate in the first place!

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  13. The only reason I didn't want a c-section was because I was terrified of being sliced open while being awake. Then I had it and the surgery itself was no big deal. But, I find myself justifying and emphasizing that it was an EMERGENCY c-section because of the stigma. Recovery for me was not easy at all and seemed to take longer than I anticipated, but I think some of that had to do with my preeclampsia and my blood pressure being high for a full month after the delivery. I have thought about what I would do in the crazy chance I ever got pregnant again and I think I would do a scheduled c-section. I wouldn't want to try a VBAC and end up with an emergency surgery anyway.
    Bonus of my c-section? My ab muscles got all sewn back together. Yay for my belly not actually looking like I grew two humans in it.

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