c-section

Trea’s Birth story

| thedarwinsgirl

The delivery was a c-section.  My choice. Many people will silently judge me for making that decision.  Many people will envy the fact that I was able to make the decision, when so often women are forced/coerced into having c-sections when they aren’t medically necessary.  I chose this option.  The OB on-call tried her hardest to talk me out of it–reminding me of all of the benefits of a vaginal delivery and the possible complications of a c-section.  She was very positive, affirming and persuasive; and I love that she tried so hard to empower me.

Here is my story of why I chose an elective C-section for my final birth.

I was in tremendous pain for several days before the delivery-I’ve had pubic bone separation and hip pain for months that made walking, moving and standing painful. I have had this since early in pregnancy, however, the last week of my pregnancy was by far the worst.  On top of being in acute pain every time I moved, I was sick–headache, sore throat, fever and body aches.  I was exhausted and wasn’t sleeping–3 nights running with little to no sleep.

The day before Trea was born, I had my 40 week OB appointment.  Every time someone touched me for the simplest of procedures I cringed.  My nerves were shot–and I was edgy.  I begged (and actually cried in her office) my OB to induce me on Fri morn. She agreed, after giving me the lecture on risks of uterine rupture (up from  0.5% to 1.5%) and other complications. I went home feeling excited about the next day and optimistic that there was an end in sight.  Tomorrow I would be holding my little girl.

Jeff’s parents arrived that afternoon, and I spent the afternoon in bed, hiding under the blankets with a fever.  We got everyone settled for the night and I decided on a bath and then bed, as my indication appt was at 6am.  Best to get as much sleep as possible.  During my bath, I realized that I had not felt Trea move for a while…and she typically moved a lot!  I decided, for the first time in my pregnancy, to do a formal kick count.  I took 90 minutes and had only felt a few movements.  I freaked out.  I made Jeff take me back to L&D to be sure she was OK.

She was fine, but I wasn’t.  I was panicked, my heart rate was high, and I was on edge.  I was scared and exhausted.  We spent a good portion of the night in L&D waiting for tests and doctors.  They were very busy with many women in labor and delivering.

I decided then, just a few hours from my induction, and after considering my mental and physical state, the expected size of Trea (9 lbs or more), my hemorrhoids (out of control!), the recovery experience I had with Spencer and the risks, to opt for a c-section. We went home and rested for a few hours–the first chunk of sleep I had in days!  It felt great and I felt at peace.

L&D was busy when we arrived.  Our appt. was moved back several times for emergent C-sections.  Everything went fine during the procedure, though I was so very nervous!  I was most nervous about the epidural (I received a spinal block).  It went fine–though they did stick me twice!  And to make matters worse the nursing staff was counting their instruments while I was getting the spinal block.  The names of the instruments and the counting of them is a disconcerting experience.  I remember it vividly from Elliott’s birth.  I tried to go to my happy place, and hoped that I wouldn’t feel anything during the surgery (I didn’t).

Jeff was able to capture an amazing picture of Trea’s first moments of life outside the womb.

Welcome to the world!

After they removed her, Trea had some trouble breathing on her own.  They suctioned a ton of fluid from her tummy and gave her oxygen, but she was still struggling.  The doctors brought her over for a moment, and then they took her to the NICU-Jeff went with her.  I was left alone in the OR while they finished up my surgery and transferred me to the recovery room.

Jeff was moving back and forth from the NICU with Trea, to the recovery room with me.  He was giving updates and checking status–back and forth.  At one point, he was returning from seeing Trea and was about to walk into recovery only to be stopped by the nurses and me telling him to not look and stand back.  I had a slow postpartum hemorrhage, and while it was a lot of blood–it wasn’t enough to need a blood transfusion.  But it was enough to cause concern.  After both Trea and I were stable, I was allowed to be wheeled in to see her.  Finally after 4 plus hours–I was able to see my daughter.

During the time that I was in recovery–Trea received an IV, was on CPAP, and oxygen.  She had labs and a chest x-ray.  The initial thought was that she aspirated meconium, as there was some discoloration in my amniotic fluid.  So, they were treating her for possible sepsis.  They also were worried that during her struggle to breathe that she may have collapsed a lung.  Additionally, they worried that she might develop pneumonia, as she had fluid in her lungs.  The doctors didn’t know what would happen and all of these variables were floating around with no definitive answer.  It was a stressful time for Jeff and I both.

An emotional reunion.

Our reunion was cut short by me vomiting again (I also vomited right before I hemorrhaged)… and with all of the very sick babies in the NICU they quickly wheeled me back to recovery.  We made our way upstairs to the Maternity floor a few hours later, and then began our 3 hour rotation of visits to the NICU for the next several days.  I will detail that in a later post.

I don’t know if my decision to have a C-section caused the respiratory distress in Trea or if the way I was feeling was an external trigger that something was wrong and she needed to be delivered ASAP.  Respiratory distress can happen when babies are delivered via C-section or through a very quick vaginal delivery.  Contractions serve a greater purpose–they not only open the cervix to allow the baby to be born, but they push fluid from the lungs and stomach of babies on their journey out of a woman’s body.  I will never know the reason, and I am OK with that.  I do not regret my decision.  I do not mourn the loss of a vaginal delivery like I did after my first c-section.  And I am grateful that Trea was able to get the care she needed right away.  There is no way to know if she would have experienced the same distress during a vaginal delivery, or if she would’ve needed to be delivered emergently as a result.  All of these factors put my mind at ease.   I knew in my heart that I didn’t have the strength to endure labor.  Looking back, I needed to save all of my strength for handling my baby being in the NICU.

I am at peace with my decision.  My daughter is here, she is healthy and she is home.

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38 weeks

| thedarwinsgirl
I will be 38 weeks tomorrow.  I had my OB appt. today, and she didn’t do an exam but could feel the babes head deep in my pelvis.  I have been having a lot of pelvic pressure, my hips are killing me, and sometimes it feels as it the babies head is rubbing directly on my pelvic bone. 

I have also been having a fair amount of BH contractions, and the last couple of days cramping in the lower part of my tummy.  Today is by far the worst day.  I can barely walk.

The worst though are the hemorrhoids.  I have an RX for proctofoam, which I have been using since last night, and my doc gave me some Lidocaine today.  It is painful enough at times to make me wish for a c-section.  The thought of them worsening during delivery, is giving me a tremendous amount of anxiety about my upcoming labor and delivery.

I want this baby out! And soon. My only options though are to wait…since I have had a C-section-induction isn’t an option due to the risks of uterine rupture.  She can strip my membranes but not until next week.  And, if I opt for a C-section, it wouldn’t occur until at least 39 weeks.

So, I will just watch and wait.

C-section remorse

| thedarwinsgirl

In the old days, I used to subscribe to a whole slew of magazines. These days, I am more selective about my subscriptions and my time. With so little free time since Elliott’s birth, I had to make my parenting magazine selection carefully. I couldn’t fill my time with Parents, Family Circle and Better Homes and Gardens. So, I chose my favorite mag-called Mothering. It is published semi-monthly, and when it arrives I usually read it cover to cover.

The cover article for this issue was on Cesarean births, the articles title is Cesarean birth in a culture of fear. The opening paragraph went something like this-Cesarean births are on the rise and are increasingly being performed even when they are not medically necessary. When I (the articles author) ask women why they think this rise is occurring– they may give a variety of reasons, but they will always justify their own need for a c-section as medically necessary…

I read the entire article, and thought it was a well researched article, and I dont wholly disagree with the author. When I finished reading it, I felt bad about my Cesarean and it made me begin to question again our birth choices. I felt like the author and therefore the magazine put a black cloud over my birth because I had a C-section. The opening statements of the article insinuated that women who have C-sections think they are necessary, even when they are not medically needed. I think the author is missing the point.

If a woman has a C-section, and felt it was necessary, isn’t that a short coming on the medical establishments part for misinforming us about the actual need, versus the alternatives? The fear is on the part of the doctors, yes. They are trying to avoid liability and lawsuits. And if that is the point of her article, I felt the author should be standing up for our rights regarding informed consent, looking for ways to educate us on how to avoid feeling pressured into a C-Section, and teaching people how to make more educated decisions while under the pressure of labor, fatigue, and pain. She should not be pulling the rug out from under us that have had a Cesarean birth. She devalues those women who have had C-section births by making a generalized comment like her opening statements.

The result, again, was me feeling judged by the author. And, at a time when I was almost emotionally healed…I am now questioning once again the necessity of my surgery, and therefore my proposed inability to deliver natural. I did all of the right things (and still failed). I was under the care of a Midwife. I took great care of myself during my pregnancy. I was low risk. I had a doula. I didnt take drugs during my labor (pain killers, an epidural, etc.), and labored naturally all the way to 10 centimeters. I pushed with all my might…for 3 hours! I followed the natural child birth prescription, and I still had a C-section. I had an abnormal labor condition-arrest of descent.

Was mine necessary? Was it medically the right thing to do? Could I have delivered my baby vaginally, without surgery? Was it safer for the hospital to suggest the surgery, versus risk an assisted delivery (which comes with a whole list of risks to the baby)? Did I make the right decision for both Elliott and myself? The tricky part about all of the questions and uncertainty is that I will never know for sure if the surgery was necessary. What the article doesnt tell you is when a C-Section is necessary. Or under what circumstances a Cesarean birth is suggested for the safety and health of the mother and child. I will always wonder if I could have pushed Elliott out, with a little help from pitocin and an epidural.

Everytime I use the restroom, I look at my incision. I feel my stomach, where it is still numb and sore to the touch and wonder if I could have avoided having a surgical delivery. I dont think a magazine that is supposed to support women, honor them as mothers, and hold them in high esteem would want their readerships take home message to be one of alienation and judgment. I am therefore very disappointed after reading this article that more thought was not rendered before delivering such a harsh blow to woman kind. I am also disappointed that an article that is calling our birth ritual ‘a culture of fear’, is using the same tactics to ‘educate’ its readership about the nuances of a Cesarean birth using a step by step diagram of the surgical procedures, with a header “so you want to have a cesarean?” Women and especially Moms already suffer from a tremendous amount of guilt. Should we be adding to their load by now questioning the way they birth?

While I cant change the course of events in my own life or their outcomes. I can say that I feel like in my case, a cesarean was the best option for us. If the author of the article wants to question that, I would encourage her to research and publish an article on how to avoid one, rather than one that instills fear in those first time Mom’s before they deliver.

Birth Story-Part II

| thedarwinsgirl

Up until the birth of my son, I had never been admitted to a hospital before. I had never had an IV, a catheter (or 2), I had never been hooked up to oxygen, or fetal heart monitors. I had certainly never had surgery (unless you count having a mole removed…). I was steadfast on minimizing the amount of medical intervention that was involved in the birth of my baby. I had adopted the mind set that women birth babies every day, every second without intervention, and often times unassisted. I didn’t want an epidural, or any drugs. I certainly didn’t want to be lead down the spiral path of intervention (bag of waters broken, pitocin, epidural, heart monitors, c-section).

I wanted to labor and birth naturally, the way my body intended. I also wanted to ensure that my son’s arrival into this world was not traumatic or medicalized. It was important to me that I wasn’t restrained while I was in labor. I was adamant about the need to be free to move around, and not be limited to a hospital bed. I didn’t want to be hooked up to an IV, or any monitors. I also didn’t want people to treat me like I was sick.

From 8:30am on Saturday to 2:30pm on Sunday things went exactly as I had planned. Then, the intervention happened. Beginning at around 3:00 pm on Sunday, it was clear that I wasn’t progressing, was suffering from exhaustion and my contractions had slowed to a grinding halt. The pitocin suggestion was offered, and we realized that something else needed to occur in order for us to move forward successfully.

Once we moved downstairs to labor and delivery, it was a whole new world. As soon as I was moved, I had an IV inserted. I was so out of it, I didn’t realize that she couldn’t find my vein, had made several attempts before finding it and I was bleeding all over the place (UCSD is a teaching hospital, and the nurse was obviously learning). I have a loose memory of seeing blood on my wedding ring.

Next came the fetal heart monitors, and my heart monitor. Then the epidural. I was pretty scared to get an epidural, as I have needle phobia and all in all phobia about things being inserted into my spinal cord. But, this was probably the least painful thing about the whole process. It didn’t hurt at all, and the most uncomfortable part of the process what having to curl up and apply pressure to my very full bladder. It was done before I knew it, and my doula said it was the fastest epidural procedure she had witnessed. I was still having strong contractions at this point, and the need to push was still there. It was an odd sensation for the epidural to kick in, and be able to move my feet and legs, but to not feel pain. I still had the massive urge to push and bear down, but it was remarkably painless.

After that we needed to decide on the type of catheter I was going to receive. This is where the key decision needed to be made. If I opted for the pitocin then one type of catheter was required, but if we went straight for the c-section then a foley catheter was required. So, hubby and I consulted everyone, weighed all the options and decided for the c-section.

It was about 4:30pm by now, and the frenzy had begun. Since moving down to L&D, I had been surrounded by at least 5 people, and at any given time, at least 2 or 3 were doing some sort of procedure on me. The surgical nurses were now involved, and they took over for the birth center gals and the L&D gals. I had the foley inserted, I was partially shaved, and my husband was prepped for the OR.

It didn’t take long for them to wheel me in, swab me with betadine, lock my legs down, give me a stronger dose of the epidural, test me to be sure it was working, hook me up to oxygen, and prepare to cut me open. To say I was nervous is an understatement. I was shaking like crazy, even before the epidural kicked in from nerves. My husband finally was brought in. I think they almost forgot him, as the anesthesiologist had to say several times, “Are you going to bring the husband in?”. I was relived to see him. He stood by my head during the procedure.

It felt like it took forever! I could see Elliott being brought over to the table where he was examined and cleaned, Hubby cut his cord after it had finished pulsing. He was then brought over to me. He was placed on my chest for a moment (we got a photo), but the surgical team needed the space, so he was taken back over to the table, swaddled and his Dad got to hold him while they took some additional pictures.

They finished up the procedure, and placed Elliott on my chest while we were wheeled out to recovery. While we were in recovery we made our first skin to skin breastfeeding attempt. We weren’t very successful for several reasons, the first being my complete lack of coordination due to the drugs and anesthesia. And the second being my utter lack of experience. Elliott on the other hand was rooting around looking to latch on. He is a champ at that. My doula was there luckily to help me keep a hold of him, and comfort him and me in our first attempts.

We stayed in recovery for a couple of hours and then moved back up to the 4th floor. We stayed in the hospital for 3 more sleepless nights before we came home. Nothing but vital signs, liquid meals, and measured urine. Elliott did great on all his tests-apgars were 8 and 9, his weight was good and he didn’t lose too much over the first few days, he hearing test was fine. All pediatrician visits were positive. I was up and around after the first day, and have been pretty mobile since.

So in summary, I am still processing my feelings about the birth and the entire event. I feel deeply saddened that I wasn’t able to birth my son vaginally. I feel a little like I let him (and myself) down. Personally, I feel that I missed out on a rite of passage as a woman and a mother. I am still mourning the loss. But, in the same breath I feel that I did the very best I could, and could not have labored any longer without assistance. Not to mention the health risks that were at hand. What I need to remember is that Elliott is here, he is safe, he is perfect in every way possible. I wouldn’t change a thing about that.

I am head over heals in love with my boy. No amount of sadness about the way he came into this world will ever change that.

Birth Story-Part I

| thedarwinsgirl

My mucous plug was lost gradually over the morning, but I first noticed it at about 8:30 am on Saturday June 30th. I started to feel what I thought might be contractions beginning very shortly after that. I wasn’t sure they actually were ‘real labor’ contractions or if it was false labor, or if the contractions were going to start and then stop a while later.

The contractions felt like menstrual cramps (I only infrequently get cramps during my period, but imagine that this must be what they feel like when they are more pronounced) and they were in my lower belly. I continued cramping lightly throughout the morning, and with more intensity as the day wore on. The key for me was monitoring the time and continuous rhythm. Since I still wasn’t sure that real labor had actually begun, or for how long these contractions were going to last, I was intent on making the best of it.

We had a bar mitzvah’s temple services to attend and a birthday party gift that needed to be dropped off. So, we dropped off the party gift and joked with our friends that our son might be born today, and headed up to the temple for Saturday Services. We arrived a few minutes late, but stayed the 2 hour service and for the kiddish, and then went back to our friend’s hotel to hang out for a bit. At around 3:00 pm, I suggested that we go home, and get changed for the party. It was again a joke that I was in labor, and everyone kept telling me to sit on a towel for fear that my water was going to break. I reminded them that often times a woman’s water doesn’t break, and that wasn’t always the next step in the labor progression. I didn’t want anyone to panic, or get all freaked out and start worrying.

I had expressed my desire for a particular bottle of pink champagne that I wanted to open after Elliott was born, in the hospital. Hubby hadn’t purchased it yet, so on our way home we stopped by BevMo and bought a bottle of pink champagne (although not the one I wanted…).

The whole day I vacillated on if this was it or not. I knew in the back of my mind that this was it, but I didn’t want to say it out loud for fear of freaking myself out. I was handling everything calmly, taking it one step at a time, and up to this point wasn’t making any assumptions. When we arrived at home I had decided that I was likely in early labor and should let my doula know so she can possibly begin planning, just in case something else happened. We agreed to keep one another posted if anything progressed, and hung up. I suggested to my hubby that he set his out of office assistant and tie up his loose work ends, and gather his things together so when I give the high sign, he is all ready. I also started to gather and pack up the last few things that I needed to take with me to the hospital. I was pretty much ready for whatever came next. Hubby was working on the computer, apparently putting the finishing touches on a few last things (though not with any sense of urgency).

I went to use the restroom. After emptying my bladder, I was just about ready to finish up, and a flow of liquid was released. I immediately knew what had happened, and there was no doubt in my mind that my water had indeed just broken!

I told my hubby what had happened, and in typical hubby style, I had to offer up all the reasons why I think that it happened, walk him through the details, and practically convince him that it was in fact true. (This is an ongoing conversation with hubby-ever since the positive pregnancy test-more on that later). I had to make a solitary decision, since it didn’t seem like I was going to get his buy in that my water had in fact broke. So, I called the Midwife hotline from our kitchen phone, which BTW is the only phone in the house. As soon as the answering service gal answers-my water really breaks. This was a main line fracture, just like every woman fears will happen while they are out in public. I start gushing amniotic fluid, and it is pouring out of me. I can’t stop laughing (I often laugh when I am nervous or don’t know exactly how to handle a situation), as I try to explain who I was and why I was calling the Midwife Hotline. I hang up the phone and turn around to a look on hubby’s face that I only wish I could have captured on camera. He looked totally freaked out-a combination of terror, shock and total disbelief (now maybe he will believe me is what I was thinking!).

In the meantime, he doesn’t know what to do, and is just standing there. What does he do first? No, not get me a towel or ask how he can help, or if I am OK. No, he gets the camera, and wants to start snapping photo’s to document the event. We are both hysterical and can’t stop laughing at the sheer amount of fluid that is freely flowing from my vagina. Once we got some sort of control over the flood gates, hubby realizes this if for real, and starts running around frantically to finish up what he needs to get ready. In the meantime, I am calmly waiting for him on the couch to leave for this hospital.

We pack up and go, and arrive at the hospital (5:30 pm). After we check in, we are notified that there isn’t a nurse available in the birth center, so they have to temporarily triage us in Labor and Delivery (bummer). We are laboring there (the 2nd floor of the hospital) for a while, and the midwife on call-Jasmine checks in on us periodically. But, we hadn’t officially checking in to the hospital yet.

Around 9 or 10pm, we are notified that a nurse has arrived and we can be moved to the birth center (4th floor of the hospital). While we are being transferred, they are filling up the tub with warm water for me to labor in. The birth center was nice, the room was big and private, and most important to me it was relatively uninterrupted. Things seemed to be moving along well, and looking back it was really all a blur to me now. We tried different positions on the ball, in the rocking chair, laying down, squatting, sitting in the bed, walking the halls, the tub, and anything else you can think of to ease the pain. I felt ultra focused and introspective. I felt very much inside of my head. I didn’t have much to say, and was really trying to concentrate on the contractions, not think about their length or time, or look at the clock. My Doula kept me hydrated and using the bathroom and she kept me active and calm.

My husband told me later that he and the Doula spoke around 3am, and consulted the midwife and guessed that based on my progress I would have the baby some time in the AM hours (9am was the estimate). Up until this point I had not had a vaginal exam (the midwives feel that exams are disruptive to labor, and are often counter productive to a laboring woman’s progress. I too was worried about having an exam, for fear that if I hadn’t progressed far enough that I would be disappointed by my own progress). Around 4:30am the Midwife comes in to check on me and see how I am feeling, and offers me an exam.

At 4:30 am I was dialed to between 5 and 6 centimeters. It was kind of disappointed that I wasn’t farther along, but I was still in good spirits and felt strong. By 9am, there was a shift change and a new midwife came on staff (the new midwife was my favorite one, so I was happy about that). Rebecca did another exam and I was dialed to 8.5 centimeters. She noted that my posterior cervix was still thick and wanted to help me loosen it. So, over the next hour or so, during a contraction she manually attempted and succeeded in bringing me to 10 centimeters. It was about 11:30 am and I was fully dilated. I didn’t feel the immediate urge to push, perhaps because she had manually manipulated my cervix, or perhaps because the babies head was only at a 0 station. During the exam she noted that the babies head was not facing the correct direction, but that it might shift during the next stage.

I began pushing to try to get the babies head to come down a few stations. So from 11:30 to 2:30pm I pushed, and pushed with each contraction trying to birth my son. However, in that time he only moved 1 station.

This is where my troubles began. I hadn’t be able to urinate for a few hours, and they had to insert a catheter to temporally assist with that. My bladder was FULL. By 2:30pm my contractions had slowed down dramatically, and I was exhausted. I hadn’t eaten since lunch time Saturday, and couldn’t eat while I was in labor as I was nauseous the entire time. The Midwife, then based on the length of time I had been pushing, the fact that I had only moved 1 station, the time that had lapsed since my water had broken, and the fact that my contractions were now 5 minutes apart–she suggested we move downstairs, and they administer pitocin (an epidural was implied as well, since I was already at 10 centimeters and pushing).

I broke down and cried for a long time, I realized then and there that my hopes of an unmedicated vaginal birth were not going to play out the way I had intended. I was grieving the loss. I thought for an even longer time about what that meant to me, what I was willing to do, and what I felt I was capable of. I had been in labor for more than 28 hours with no drugs and had gotten so far, but from the looks of it the babies head was not descending.

I agreed to go down stairs and be assessed. The labor and delivery doctor came in and performed an ultrasound, they did a blood draw and an exam. She spoke with the Midwife and then presented me with my options. They went like this:

Based on the ultrasound the babies head was crooked in the birth canal and that was why he wasn’t descending.
My white blood cell count was high, which meant that an infection could be brewing (it had been almost 24 hours since my water had broken).
I still couldn’t urinate, and my full bladder might be in the way of my progress.
They estimated the babies size at around 9 pounds. Because of his size and head position they didn’t feel that an assisted birth using forceps or a vacuum were recommended. They felt he was too high in the birth canal and assisting could cause him to get further loged as well as cause me vaginal and possibly cervical trauma (not to mention all the risks to my baby).
I would therefore have to push the baby out and they would only allow me to push for another 30 or so minutes, even with the epidural and pitocin.
If I couldnt push the baby out in that time frame, I would have to have a c-section anyway (and I increased the risk of the c-section depending on how far I was able to push him down the birth canal).

So, after I shed another 20 plus minutes of tears, and talked out every option and risk with the doctor, midwife, my doula and most importantly my husband…we opted to skip the pitocin and have a C-section. After more than 30 hours of natural, wonderful, unmedicated labor, pushing for 3 hours, and wanting more than anything to have a vaginal childbirth…I was going under the knife.