Monday, April 7, 2014

A Birth Story Project: Sarah

Welcome to the inaugural post of A Birth Story Project. With it, I'm providing a public space for birth stories that want to be shared. Please contact me if you'd like to submit your own (anonymous or not, as you prefer). The spectrum of birth experiences is wide, and I'm hoping to be able to post an equally broad variety of stories.

This story is shared with permission. It was reformatted and edited for clarity, but no part of the story that was submitted has been removed. This is meant to be a safe space, so please read with compassion. Comments may be moderated.

Sarah's Second Birth

It was a regular Friday morning, my due date. I had donuts for breakfast with Grey. We went to the playground. I napped when G. napped. We went to the grocery store in the afternoon, and I felt fine.

Walking home around 4pm, I started getting Braxton-Hicks contractions. At 5pm, Kyle got home and I sent him to the playground with Grey so I could lie down.

I didn't want to get out of the shower at 6pm because the contractions were so painful.

By 7, I was calling my OB, bawling, because I was in so much pain and didn't want to get in a taxi.

Friends arrived to pick us up at 7:30. Somehow we got to the hospital by 8, even with tons of traffic.

When I got out of the car, a hospital worker saw me pause during a contraction and came running out with a wheel chair. "That baby is about to drop!" He ran us through the lobby and up a service elevator to L & D. I only remember gripping the wheel chair and looking down at the floor. The hospital was FREEZING and felt amazing.

L&D was hopping. My doctor checked me in triage and I was 4cm, so I could be admitted right away. I asked for an epidural immediately. My contractions were so close together I could hardly keep my breathing going. I kept saying "I just need a break to rest a minute" and another would come and then another.

I started screaming (bloody murder) and moving all over the bed, so she checked me again. This was maybe 10-15min later and I was 8cm. All the labor rooms were full so Kyle walks back over to me in scrubs and says "We are heading into the OR," and I freaked out. "Why do I have to get an operation?" And "Where are my DRUGS?!" I was seriously begging, but they were so backed up no one ever came.

I was in the OR for 5 minutes, tops, and I was at 10cm, but still at station -3 and my water hadn't broken. My doctor said "We can wait for him to move down or I can break your water." Wait for him to move down ?!?!? I wanted him out -- stat -- or I wanted the pain to go away... not to wait for him to move down!

She broke my water and just a little trickle came down. With the next contraction, his head came all the way down and the biggest gush of water came. I started screaming and laughing at the same time because it was just so surreal and painful. I could feel everything, and it was happening so fast I couldn't even catch my breath. It hurt so bad I really thought I was going to die for a second. I refused to push because I just couldn't.

Kyle helped me focus again and got me to breathe, drink some water and stop screaming. I felt for the first time, "OK. I can do this. I'm going to do this!" So I start pushing and OMG it's so hard, and it hurt to the point that I can't stop screaming. I move slightly to my left side and that really helped for some reason.

Suddenly an alarm starts going off. Heartbeat of baby completely drops, stops, and people start running in the room. Doctor says to take a huge, deep breath to get oxygen to him, and I did, and it picked back up again. She says, "We have to get him out now." A nurse basically puts her entire body weight on my stomach and pushes down. I'm pushing myself, my calf is clamped on Kyle's forearm for resistance, foot against his chest and the doctor is reaching in and like corkscrewing him out, and he comes out in that moment.

He doesn't cry at first and I'm very nervous. They whisk him over to a table next to me and he starts crying (thank God). The ped shouts out "10lbs 8oz." Kyle and I look at each other and I just say, "you are lying." Honestly, I'm still in shock. They bring him over and I see for myself that he is a man-baby !!!

They take me back to triage to hang out till our room is ready, and I finally ask what time it is. He was born at 10pm on the dot on his due date, only 2 hours after arriving at the hospital. Greyson's labor was 36 hours, so I was definitely in a state of shock. I did tear this time, but not even close to as bad as last time, and my tailbone was bruised but not broken (yay)! I had been for a growth scan 4 days prior and they guessed he was 8lbs 4oz. I'm so glad they were off because it would have definitely affected my labor and I would have most likely just opted for a section.

I still have no idea how I got him out. Maybe it was my crazy side position? Not sure but I'm definitely never doing it again :)

It was a very shocking but wonderful experience. I am so happy at the way it turned out.

Thanks for letting me share my story with you.

Wednesday, April 2, 2014

The Family-Centered Cesarean.

I am excited by a shift I am seeing (but very rarely, so far, in this country) in the way cesarean births may be supported. I am speaking of something often called the "family-centered cesarean" or "natural cesarean." Cesarean rates are high in many parts of the world (beginning to climb above 1 in 3 births here in the USA), and the family-centered cesarean is a response to problematic practices (dehumanization, non-individualized care, the all-too-routine separation of parent and child that makes for less-than optimal bonding and lactation, among other factors). It is still major abdominal surgery, of course, but with more thoughtful, evidence-based, and human-centered procedures woven into its medical protocols. These might include allowing a doula or midwife in the room with the surgical team, not strapping one or both the laboring parent's arms down, facilitating immediate skin-to-skin contact between birth parent and baby in the first minutes (and so-called "golden hour") after the birth, etc. 

The goal is not to make elective cesarean births more "desirable" than vaginal birth. It seems clear that work must be done to decrease the rate of unnecessary cesareans. The climbing cesarean rate is not making gestational parents and children healthier, ACOG just released a statement that cautions against many of the "traditional" non-emergency reasons for cesarean surgery, and the WHO suggests the rate should be well under 20% -- more like 10-15%. As this is a life-saving surgery, absolutely necessary in some situations, it will continue to be done, so it behooves us to improve the experience and its outcomes (both direct and related) if we can do so in ways that not only "do no harm," but may actually help families and babies. 

In one of my recent childbirth education training classes, there was a discussion about whether a particular video on this revolution in cesarean birth should be shown to local pregnant "consumers." (i. e. those taking a childbirth class we teach, or other prenatal clients).  

I've embedded the video here. It is not graphic, to my mind, but some of the surgery is shown. I understand if you would prefer not to watch for any reason. I also hope that anyone reading this who has had or supported a loved one in a previous cesarean birth will know I understand that, like any birth experience, feelings around it are very personal. I validate and value your thoughts and emotions, whatever they are. We do the best we can with the information and support we have. My thoughts continue below. 

Does this vision of a "kinder" surgery and explicitly compassionate caregivers set US (or other) pregnant people up for disappointment if/when their cesarean births are (likely) not done with this much care and respect? Or might it spur more people to reproductive rights activism -- on the world's behalf and/or on an individual level -- at the very least encouraging conversation with care providers (including surgeons and anesthesiologists) about how an all-too-often impersonal and medical cesarean experience can become more "family-centered" without compromising safety? Even if a caregiver says it can not, this may lead to an important discussion with that caregiver of why he/she disagrees.

I don't know if I would use this video in a class, but my gut says we should show this video to pregnant people -- and those who may become pregnant or who care about pregnant people (i. e. Just about everyone) -- because I think people should know it COULD be a different experience. I think it empowers "consumers" to know this kind of "customer service" (for it is a business, after all, at one level) is not fantasy. 

I was surprised by how many of my fellow teachers-in-training said they would absolutely not show this video to clients. I was surprised even though I know they made that decision out of compassionate consideration for people giving birth and the tender borders between hope/expectation/reality/disappointment. I can understand intellectually and emotionally that some (not all) pregnant people who watch this video and hope for a "natural cesarean" experience, if a cesarean becomes necessary -- but who go on to have an unwanted "traditional" medicalized cesarean birth experience -- could feel more traumatized by the birth because they know "there's another way." Once a person watches this video, that person is aware that there are practical choices (both a family's and a surgical team's) that can be made, and which are realistic and possible, but which a laboring person may still be denied. I can also imagine a pregnant person who feels empowered in a pregnancy after watching this video -- empowered to use this information to seek out a receptive caregiver, or even just to spread the word that these practices are possible, while choosing a support team and preparing for the birth experience.

I would love to know your thoughts. 

Disclaimer: of course, this video is a window (and a "produced" one, though not "faked") into an experience, not a complete picture. The risks that come with any c-section are real, and not discussed in this video. The nature of a surgery that may be done in a very immediate, emergency situation is that it will look different from birth to birth. As just one example, sometimes general anesthesia is necessary in an emergency cesarean, as opposed to an epidural/spinal, which would change the experience quite a bit. I still think the scenario of a family-centered cesarean -- whenever possible -- is one that is worth fighting for, especially when so many cesarean births in this country are planned and scheduled in advance. And even if we can't change it for every person who is pregnant now (though I am hearing encouraging stories of "natural" cesareans in the United States, as I seek them out), even if it takes a generation or two or three, it's still a worthy goal.

UPDATE! This story is an example of why I feel like pregnant people and partners SHOULD see this video. What an amazing birth -- and she advocated for herself! I'm so glad I came across her story.