Birth

Okay. You know the baby is coming. You know when he is coming. You know how he is coming.

NOW let me answer your questions...

"C-section? Why are you having a C-SECTION, Mimi? Are you a wuss? Why won't you act like a real woman and try a VBAC? Are you scared? Selfish? Don't you have what it takes? Do I need to come over there and beat some sense into you??!!"

All valid questions, and I don't blame you for thinking them. I haven't quite found the right way to answer these questions quickly. Like sometimes I'll see an acquaintance at the store or at church and I'll do the thing where I just keep walking while quickly saying "Hi, how are you? Great!" because I'm trying to get somewhere. Then they'll say something like "How long till you pop?" and I'll say "X days till the scheduled C"...and then they'll ask why. WHY? As if there's a ten second answer for that one. I always feel like I need to go overboard explaining myself.

Yes, I had a c-section with Joshua. I didn't have a jerky doctor who forced me into it, but I didn't elect to have surgery either. In fact, on my list of things NOT to do in life, "have a c-section" would've probably come somewhere between "give up chocolate forever" and "scratch out my eyeballs with a rusty nail". Definitely not a life goal. It was a last resort. The lesser of two evils.

I realize I never posted Joshua's birth story, and that was kind of on purpose. It was a terrible experience that I did not want to rehash every detail of. But I decided to give it to you here, if you're interested, so you can understand why I am downright frightened to try it again.

Joshua's Birth Story

In June of 2008, I was prepared for and committed to having the most natural birth possible in a hospital setting for my first little Snowbaby. I had taken childbirth classes with Matt to practice breathing and relaxation. I had just written a long research paper for school about the advantages of a natural, home birth and the dangers of hospitalization, medication during labor, unnecessary procedures, blah blah blah. I would NOT recommend doing that before giving birth, especially because you can never predict exactly what will happen. I think you need to be prepared to accept all the medical help that might be necessary and trust that the professionals sort of know what they're doing.

Thursday night before my due date around 11:00, I started leaking fluid and went into the hospital to be checked. It took them more than two hours in triage to conclude that I was, in fact, leaking amniotic fluid. My water had broken. Not completely, but enough of a "trickle" to be hospitalized and get the baby out before infection set in.

My body did not start contractions on its own, so they put me in a room and told me to try to sleep for a few hours before they'd start me on Pitocin around 6 a.m. Sleep? At that point? Right. Sleep didn't happen. Also at that point, I was only allowed to have a small snack and a juice box because a full tummy is supposedly not good during labor. For me, sleeping on an empty stomach is just not possible, pregnant or not.

Pitocin started in the morning through an IV -- the first step in a medicated direction I did not want to take. They increased the dosage every half hour or so because my body still was not getting started. After hours of sitting in bed being hooked to that machine and pumped full of fluid, they turned it up to the maximum dosage and basically said "This better work." They told me that once your water breaks, the baby needs to come out soon (ideally within 24 hours) because you're at risk of infection. Fortunately, that last big dose of pitocin started the contractions and we were on our way.

I progressed slowly. I was tired from not sleeping the night before and weak from not eating. By about 9:00 that night, I got an epidural, seeing no end in sight. And honestly, it was a little taste of heaven! I was able to sleep for a few minutes here and there over the next eight hours of labor, but I was stuck in my bed.

Around 5:00 the next morning, they checked my progress and said I was ready to push. The baby was right there, they could see his little head, and it "should only take about five minutes" to get him out. (Famous last words?)

Then my contractions slowed down, as if my body did not think it was a good idea to push. Still, I pushed. And pushed and pushed. Every few minutes for three hours. They usually don't let people push more than two hours because it's exhausting and because the baby could be in distress. By that point, I had a fever (unsure if it was from infection or from the epidural). The baby had a fever as well, and there was meconium in the amniotic fluid already, so he was in danger of inhaling his own feces.

After three hours of pushing, he had not moved one bit. A doctor came in and said she was going to try to pull him out with the vacuum, but if that didn't work, they would have to do a c-section. So she brought out a plunger-looking thing, secured it on the baby's head inside me, and started yanking with all the strength in her entire little body. I saw her face and heard her make a surprised comment when the baby didn't budge. She offered to either try it one more time or just take me into surgery.

I was so out of it. I was crying uncontrollably, my body and face so swollen from all the saline and pitocin and medicine that had been pumped through me that I could hardly keep my eyelids open. So exhausted that I could barely lift up my head. So hot and feverish that I couldn't think straight. I looked over at my mom, a wonderful registered nurse who had been standing next to the bed the whole time, and she said "Do NOT let her do that again!" referring to the doctor and the vacuum and my baby's delicate little head.

So surgery it was. 34 hours after I had checked into the hospital, they rolled my bed in to the operating room while Matt took a little break to cry his eyes out in the hallway before joining me. Then they strapped my arms down out to the sides and started cutting. Fortunately, I had already been given the epidural so they could get right to work. I felt the table shake under me as they tossed my lower body around trying to pull the baby out. He was stuck really well in the birth canal, so it took some work. My uterus tore a little in the process.

As they were doing the surgery, Matt and I were on the opposite side of a curtain so we couldn't watch. That's probably why nobody besides Matt noticed me crying out in pain. It was chaotic in there. But pretty soon, all I was aware of was the pressure I was feeling in my upper body. Like someone was shoving all my insides up toward my neck while a sumo wrestler was standing on my chest. And then my left arm, between the shoulder and elbow, felt like it was being cut off with a saw. Or compressed in a big metal vise that was being cranked tighter and tighter. All I could do was close my eyes and rock my head from side to side, trying to communicate to anybody that I was in serious pain. Finally Matt got the attention of a nurse, and after a few unsuccessful tries, she gave me something that knocked me out.

Turns out I was having referred pain, in which the brain confuses the actual site of the pain with where you perceive it to be. Basically I was feeling the surgery in my arm and my chest. (And oddly enough, often when I have cramps down in my lower abdomen, I feel pain and pressure in my left arm even to this day.)

I can't remember how long it was before I woke up -- sometime within the next two hours. I could barely open my eyes enough to see a picture Matt showed me on his cell phone. (Remember when Razor phones were the coolest?) It was our baby boy. And I remember it being so clear to me that that was him. Even though I had never seen him, he just looked like my baby. They made me wait in bed a while in some unfamiliar recovery room before they rolled me into the NICU and let me meet him and hold him for a few minutes. My dad snapped some photos and then they took me to my room to rest.

For the next 48 hours, the baby had to be in the NICU on antibiotics, due to his fever during delivery. They had me on antibiotics too, for the same reason. He also was a bit jaundiced and had a very low first APGAR score because of the difficult delivery, so they watched him closely. Every time I wanted to try nursing, I had to pull my post-surgery body out of bed and walk or wheelchair-it down the hall to the NICU. All this while I was hooked to an IV stand, which was my constant companion for almost four days.

My milk didn't come in for a while, even with almost constant pumping, so we had to try to feed the baby formula from a syringe and a tiny tube slid up next to Matt's finger, which the baby would suck on like a nipple. It was really, ridiculously difficult. And we were desperate to get him to eat more than he wanted, because the hospital staff had told us they couldn't release him from the NICU unless he stopped losing weight. (He was 7 lbs 3 oz at delivery and I think he had lost about six ounces those first two days, so they were worried.)

Finally, after a couple of days the IVs came off and Josh was able to spend a night in our hospital room. He still didn't nurse well, and wouldn't until I saw a lactation consultant a few days later who gave me a nipple shield, which I used for the next five months. (Life saver!) On Wednesday afternoon, Matt's 25th birthday, they finally discharged us and we got to go home.

Wow, that was a long summary. But trust me, there were plenty of details that I left out. We're talking about a period of almost six days in the hospital here. I said nothing about the incompetent hospital staff, Matt's sleeping arrangements, visitors, showers, catheters, blood, pain medication delays, hospital food, or post-surgery recovery. Consider yourself spared from all those lovely details and complaints.

Anyway, those are some reasons I'm scared to try it all again, but the most important reason is this:

THEY COULD NOT TELL ME WHY.

Why it all happened that way. Why my body wouldn't work. Why they had so much trouble getting Joshua out. The surgeon came in afterward for a few quick minutes and called it a "pelvic obstruction", which I understood as something being wrong with something in my pelvic area that makes it impossible to get a baby through there. Not to be confused with CPD (cephalo-pelvic disproportion, when the baby's head is too large in proportion to the mom's pelvis), which I asked about right then and there. It was very unclear and the specific problem was unknown.

The doctor then laid the smack-down and told me I would have to have c-sections for the rest of my children. This was in California, at an HMO hospital where they strongly encouraged natural births and midwifery, so I knew that everything was done that could have been done to get that baby out of me without surgery. Eventually I came to accept the fact that a vaginal, natural birth was not possible for me in the future.

VBAC vs. Cesarean

A couple years later, I moved to Chicago and became pregnant again. My first couple of doctors here looked at me like a crazy person when I said "pelvic obstruction" and told them that the only option for me was a cesarean delivery. They didn't believe me, and they didn't believe that a doctor would rule out a VBAC (vaginal birth after cesarean) because it's very rare to do so. Most importantly, these doctors made me feel like an idiot -- something that is far too common with medical professionals in my experience. I'm actually not a complete idiot when it comes to medical crap-ola. I took a lot of pre-med classes in college, so I understand quite a bit of doctor lingo. But if I ever try to throw out any medical jargon as the dumb-blonde-too-young-to-be-pregnant-on-purpose patient, it seems all I get back is sass.

The third opinion I got was from my current doctor, a very kind and personable man who actually listens to me and wants me to understand and feel good about my birth experiences. How refreshing! (Plus he has delicious free hot chocolate in his comfortable little office downtown, so you know I love him for that too.) He recommended I try a VBAC because I told him I want to have 4-5 children. He said that as a doctor, he can't advise anyone to attempt that many surgeries in the same part of their body. Obviously there are many women who have 5, 6, 7 c-sections and are just fine, but others have worse scar tissue or a thinner uterine wall and their body just can't handle multiple surgeries there.

So after a lot of thought and research about VBACs, I went back to my doctor and talked through things until I could make a decision. In VBAC deliveries, he said there is a 1% risk that the uterus will rupture at the scar tissue. This can lead to hemorrhage in the mother, hysterectomy, brain damage in the baby, or even death. Hmm...that risk sounds pretty bad. Still, he told me, about 70% of women who attempt a VBAC are successful, while the others will have an emergency c-section.

Then I told him how I read that emergency c-sections are much more common when your previous delivery was due to difficult or stalled labor (check), especially if you were fully dilated (check), and when the precise cause of the cesarean is unknown (check). Also your risk is increased if you have a narrow pelvis (check) or if your labor does not start on its own (check). I explained that all of these things applied to me. After that conversation, the doctor said, "Okay, let's say in your particular case you have a 50% chance of a successful vaginal delivery. How do you feel about it then?"

How do I feel? How do I FEEL?? How do you make this kind of decision?! It's not like either option is good. I wanted to know what the right decision was. Logically. Medically. Not subjectively. Here are my options:

Attempt a VBAC:
-- 49% risk of having the same terrible experience I had with Joshua, ending in emergency c-section, which is much more dangerous than a planned c-section.

-- 50% chance that everything will go well, meaning I could have vaginal births for the rest of my children and can have as many babies as I want. I will also feel fulfilled as a woman for being able to do what my body was made to do! (Remember, this part is a big deal for me.)
-- 1% risk of uterine rupture, possibly leading to hemmorhage (severe blood loss), hysterectomy (= no more babies), brain damage to baby, or death.

Planned cesarean:
-- Relatively safe delivery with the normal risks of any planned surgery -- much less stress for me and much much much easier recovery than last time.
-- Goodbye to options for future pregnancies because the rest would have to be c-sections, meaning goodbye to my hope of ever experiencing natural childbirth. I'll never know if a VBAC would've worked.

-- Risk of scar tissue getting worse and my uterus thinning, meaning my body may not be able to handle future pregnancies and my family size could be limited. (Doctors usually say three c-sections is doable).

So there you have it -- some of the thoughts and worries and doubts and possibilities that have been plaguing my mind since I was given this decision months ago. I've had dreams and nightmares about it. I've stared into space for countless hours deliberating. For some reason, it's a really big deal for me.

The Verdict:

Eventually I decided to schedule a c-section with my doctor for March 14th, one week before my due date so there's less risk of starting labor on my own and things progressing badly. Since that decision was made, I have felt peace about it. I feel like I'm choosing the safest option for my situation. We'll probably need to space our kids a little farther apart to allow for adequate internal healing, and we might have fewer children than planned. We'll have to reevaluate after every delivery. We may end up adopting someday. All of these things I've decided to be okay with, because I really believe we're making the right decision for us.

Anyway, that's the plan. Now you know why. Thanks for listening to me justify myself. And thanks for not judging me or trying to change my mind. I know VBACs can be awesome experiences for lots of people, but they are not for everyone.

This time around, I will get a full night's sleep and a good dinner the night before. I'll get to shower that morning. My parents can book plane tickets in advance and not worry about the wrong timing, so they can be here for the birth. Matt can take his finals and attend classes without worrying about when I'm going to go into labor and need him. I can check into the hospital not in a state of panic. And I can actually make a paper chain with the exact countdown to baby time!

Of course, this is all assuming the baby doesn't try to come more than a week early. And I've been having a lot of contractions lately, soooo....wish me luck!