Cesarean Awareness Month

Despite all of my hoping and planning and working toward natural childbirth, both my boys were born via cesarean section. With Alex, I regretably agreed to an induction at 40w5d — even though it is absolutely normal to be pregnant as long as 42 weeks. I knew intellectually that induction raised the risk of cesarean, but thought I would beat the odds. Instead, I fell into a cascade of interventions, and even though I got all the way to pushing and did indeed push for four hours, Alex was not in the optimal position and his head wouldn’t go past my pubic bone. I was told by the doctor at the time that it was “not yet an emergency, but it made sense to do the surgery now, before it became an emergency.” And so I did. In many birth circles, people would say my cesarean was for “failure to wait,” even though the official reason was “failure to progress secondary to occiput posterior presentation.” In some ways, it was an easy surgery, but it was still major surgery. I had shakes on the table so bad I could barely see, and severe shoulder pain as a side effect of the air they pumped into me during the surgery. And Alex even has a scar next to his eye where the surgeon cut him while he was cutting me.

I will never fathom why anyone would think that major abdominal surgery is “easier” than natural child birth.

When I was pregnant with Nate, I did much more research and was even more determined to have natural childbirth, only to learn that many doctors wouldn’t even consider “allowing” me to give birth naturally. The dirty word for what I was attempting to do, “VBAC” (vaginal birth after cesarean), followed me wherever I went (and I suspect the title of “attorney” didn’t help much either!). I went through three different practices and a lot of stress and tears before finding midwives an hour away who would give my body a chance. Then Nate decided not to cooperate — he was very stubbornly breech. In this day and age, something like 90% of breech babies are delivered by C-section, since breech does present a few more risks than head-down birth. But because breech scares care providers, the irony is that most don’t even know how to attend a natural breech birth, and so won’t do it. It’s a vicious cycle.

Still, I was adamant against scheduling a C-Section before I went into labor on my own unless it was truly medically indicated. The process of labor helps ripen the baby’s lungs, and helps signal mom’s body to produce milk. I felt that part of the reason I had intial troubles nursing Alex was that he wasn’t really quite ready to be born, and so I wanted Thumper to tell me when he was ready rather than scheduling him to come a week or more before 40 weeks. And I wanted to give myself and Thumper as much time as possible to turn around, and babies have been known to flip in the throes of labor.

The pressure was high. Lots of people told me to just schedule to avoid scarring Thumper for life with a possible Christmas or Christmas Eve birthday. Two days after my due date, in response to my very serious request to the doctor to explain to me why it was in mine and the baby’s best interest to schedule rather than wait for labor, the doctor told me that I should schedule so that I could ensure that the doctor was awake and alert when I needed surgery. Not good enough. She wouldn’t answer any of my other questions, and I left in tears.

While I was quite stressed about the possible surgery, I wasn’t really worried about going past my due date. I knew that Alex had gone past 40 weeks, and I expected Thumper to do the same. After a lot of tears, a lot of standing on my head, a lot of chiropractic adjustments, and a lot of moxibustion, I finally came to peace with the fact that Thumper might not turn and decided to just enjoy my Christmas and not worry about it. And I did. On the Wednesday after Christmas, at 41 weeks, I woke up to contractions and realized “today is the day!”

I labored from 5 am until the docs and nurses finished their shift change and were able to get me in for surgery at around 8 pm. Even by cesarean section, Nate came out butt-first. Not that I got to see it — in fact, I only saw him for a few seconds and didn’t get to hold him at all before he was whisked away from me. This time, I was spared the shakes and shoulder pain, but instead was over-anesthetized and the spinal that was supposed to make me numb from the chest down went all the way up my neck and made me feel like I couldn’t breath. In fact, I could only breath if I consciously thought about it (and spent extra time in recovery separated from Nate as a result, not being allowed to actually sleep and rest because when ever I slipped off to sleep I stopped breathing, leaving my support team to ensure that they didn’t feed my “huge” baby sugar water in the meantime). The anesthesia also made me vomit while on the operating table, and all I could do was turn my head and let the puke fall into my hair and try not to choke on it. The anasthesiolgist was not sympathetic. He just handed Mike an emisis basin.

I tell all of this not to complain. I never really talked about it here before, because I try to stay positive and keep the focus on the kids. They are the most important thing in the world to me, but that doesn’t mean I am not entitled to have pain, to mourn what I had hoped would happen, to be upset at the way I was treated, to be angered at the current medico-legal climate that makes VBAC so difficult and encourages doctors to be quick with the knife. But the thing is this: the media and most care providers tend to make c-sections sound easy. Even the easiest of sections are not easy. They are major surgery. And major surgery can have major complications, including death. It is NOT an easy option, and no one should ever think it is.

It is also very disheartening for many women, myself included, to lose out on the experience of childbirth. People often try to console with the words “the only thing that matters is a healthy baby.” Well, that is definitely extraordinarily important, but it is not the only thing that matters. A woman does not cease to exist as a separate entity when she becomes a Mom, even as she does make amazing sacrifices and put her children above her own needs in many ways. I dodged the post partum depression bullet, but women who have c-secs are much more likely to have trouble coping with the baby and her own emotions. It is physically harder to care for a newborn (muchless a newborn and a toddler at the same time!) when recovering from surgery.

April is Cesarean Awareness Month. Women who are pregnant or thinking of becoming pregnant really need to know that induction greatly increase the risk of surgery, and surgery is not fun. That babies born by c-section have a greater chance of having to spend time in the NICU (and away from their parents) in those first precious hours and days after birth. That it’s not a good idea to induce at 39 weeks just because you are a little (ok, a lot) uncomfortable and sick of being pregnant. Induction and cesearean section are both possibly life saving procedures, but they are overused to the detriment of women and babies.

I say all of this not to complain, but to get all of the dirty little secrets out into the open. Be aware.
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Since I first authored this post two years ago, I have become active in the local ICAN chapter. Our chapter is sponsoring a free showing of Ricki Lake’s The Business of Being Born this Sunday, April 27, 2008, at the Seven Oaks (Wesley Chapel, FL) Clubhouse. Details are here. Governor Christ has declared April to be Cesarean Awareness Month in Florida.