Help me understand my c-section

[Jennifer1970]

Hi ladies, my beautiful 4 month old daughter was delivered via c-section. I'm starting to believe that my c-section was unnecessary. I would really appreciate some insight into what happened to me.

1) My water broke before going into labor. I think this is really the key to what happened to me. I had a few light contractions and my water broke. I was sent to the hospital where they immediately put me on pit. I know their fear was that I would get an infection. As I understand it the real risk of infection was the numerous internals they did while I was in labor. What should be done in a case like mine? Had I gone to a midwife instead of an OB, what would the standard protocol have been?

2) I wasn't allowed to eat or drink anything after admission. They told us during the tour that we could have juice but I wasn't allowed anything other than ice chips and popsicles. I suspect that I wasn't allowed to drink anything (not even water) because they knew there was a huge chance I would end up being sectioned because I was being induced and was a first time mom. How is it possible to do the hardest physical thing ever without eating or drinking anything? Would a midwife have let me eat? I remember being so thirsty and waiting until the ice chips had melted and drinking as much melted ice as possible while the nurse wasn't looking.

3) I had an epidural because the pain was so intense from the pit and then had to stay in bed. They told me that my DD was sunny side up and got stuck. If I had been able to move around could she have moved naturally?

4) I was told to push before I felt the need to push and had to push while lying on my back. While I was pushing I remember how ridiculous it was to push that like. It was so uncomfortable and felt totally unnatural. Because I was still on pit, the contractions were almost on top of each other and I had to push at every contraction so I couldn't get even a second of rest. Should you push before you feel like you need to push?

5) They told me that my "membranes" were very swollen. What did that mean exactly? Was that from pushing for 2 and 1/2 hours? They said because I was so swollen that I would have torn badly.

If I had done what I believe I should have done, gone to a midwife and delivered at a hospital that is friendly to alternative births, how could things have been different?

[lunita1]

Well, at the hospital where I had my three youngest, you would have been told to stay home until your labor started naturally, so you would have been eating and drinking normally. If you had been group B strep positive, you would have had antibiotics, but otherwise I think you'd just be told to keep everything out of your vagina and come in when you had regular contractions. So right there, your experience could have been very very different.

My water had meconium in it, so they kept me to monitor the baby once an hour. I ate meals, drank juice, and had the option of trying nipple stimulation, pitocin or cytotec to get labor going if I wanted. I did have contractions start regularly about 14 hours after my water broke (which was two hours after I checked into the hospital because I realized that I was leaking green amniotic fluid), but they kept stalling and not getting stronger. They were strong and regular enough to keep me from resting, so eventually I was tired and impatient about labor progressing so I tried nipple stimulation for two hours. It worked while I was doing it, but contractions seemed to just up and stop again as soon as I stopped the stimulation, so I ended up asking for pitocin. With the pit, I did have to have continuous monitoring, but it was by telemetry so I could move around, and the sensors were also waterproof so I could get into the birthing tub to labor (didn't get to do that for much time at all because I needed to push almost as soon as I got in, but it was nice that the option was there.) So even if you had gotten pitocin, you may have been able to cope with it better with more options for natural pain relief (or at least you could have delayed the epidural with more support and use of a birth tub.)

Posterior babies are tough. My second daughter was born sunny-side up. They're hard to push out in the best of circumstances. Positioning can play a huge role in helping the baby turn or in helping make room for her to be born face up if she doesn't turn. A midwife and/or doula would be able to help you find those positions for laboring and pushing. An ob usually isn't around enough during labor to help with that, but sometimes a good L&D nurse (with time to spend with you) can also help if you're mobile.

Pushing without the urge isn't ideal. There's no need to push until you're ready. I'm not sure what they meant by "swollen membranes." Perhaps they meant cervix?

((hugs)) It's hard to process these things. Give it time, journal or do other things to help work out how you feel, and maybe look into support through ICAN. http://www.ican-online.org/

[tammylsmith]

I delivered first dd with an OB. My water broke the evening before and contrax didn't start until the next morning. I had to get antibiotics anyways because of Strep B, so I went in and did that, though they didn't start the pit. Even though I expressed the desire to keep things natural, they "let me" progress on my own for a few hours and then the doc suggested pit. It is very hard to stand up for yourself in the face of an authority figure... especially when giving birth, when you are naturally vulnerable. I agreed to pit, which then tied me down to bed, which then led to my epidural. Thank goodness I had read up on natural birth and at least had the sense to insist on pushing in an upright position, leaning forward against the bed and a pillow. My OB commented that she "hadn't seen that in years." It did help dd move along, even though I had a loooong pushing phase and couldn't feel myself push. I still had 3rd degree tears, which I think were a result of me pushing too soon and not being able to feel it, so I couldn't adjust. When I became pregnant and she just said "oh, you'll tear again since you did last time" without any discussion or options for helping reduce my chances. I decided I deserved better care.

I haven't delivered yet, but my current midwife is open to my concerns and has said from the get go that I will push however I feel the need to. I will have at my disposal a jacuzzi tub, a birthing ball and my own to walking feet to get the babe into position (I could have had a birthing tub, but decided against it) I feel that she is better qualified to recognize a normal birth, and from our discussions, I know she has a whole arsenal of natural methods such as positioning, visualization, the tub, etc. to help things along without meds (though I am still delivering in a hospital, so meds are an option if I want them). Don't beat yourself up for it, because it is so easy to just get sucked into the typical OB procedures cascade... it is really hard not to imo!

I do think delivering with a midwife will increase your chances of a successful VBAC. Also, educate yourself and spend a lot of time reading up on things. I won't say whether your c section was unnecessary or not, because I wasn't there and you never know... but you do have more options than you were made aware of, and awareness makes all the difference!

[mamabutterfly]

Just wanted to send a hug after reading. I'm sorry it was a rough birth for you.

I think your instincts are right, mama. Several of the steps that you describe are correlated with decreasing your chance of a vaginal birth. They are also *very* standard practice in many US hospitals. I'm sorry you didn't have a provider or birthplace with a better understanding of the latest research on normal birth.

-Another provider might have had you wait 24 before any interventions if you had no fever or sign of infection. [This is not a radical idea, but it is not common in some hospitals.]
-Not eating/drinking in labor is no longer recommended by ACOG, a very conservative org in my book.
-Yes, pushing on your back with a posterior babe especially makes it really hard to help that baby out - as you found!
-Pitocin is hard to take without an epidural, and epidurals do increase your likelihood of a cesarean in a few ways, again as you discovered.
In other words, that set of hospital protocols didn't give you the best chance of a vaginal birth, let's put it that way.

Who knows. You could have had a home water birth and some complication could have arisen there necessitating a cesarean, I don't know. And it's hard that you can never get to replay that first birth again and try it another way. I hope that time helps you process it. Find a birth circle or some group of women to talk about it with if you can.
One thing I think that helps is to focus on all of the things that were within your control that you feel that you did well during the birth, ways that you did take care of yourself and your babe, despite whatever else was going on.

Best wishes to you. Enjoy that beautiful baby girl!

[BtotheG]

I don't think anyone can tell you if your c-section was necessary or not. I can tell you what my experience was (I had a homebirth with midwives) and what I learned from researching birth and common hospital interventions.

- Water Breaking: my midwives' policy was that labor had to start within 48 hours of rupture of membranes. Studies done on this show that as long as nothing is introduced into the vagina (eg, no internal exams) the risk of infection doesn't set in until about 4 days after the rupture. My labor started with my water breaking, and my midwife told me to make sure I didn't insert anything into my vagina.

- Eating and Drinking: my labor was only 7 hours, but my midwife told me to make sure I ate and stayed hydrated, which I did. I really can't imagine doing the hard work that I did without food and drink.

- My dd wasn't completely posterior, but she was facing to the side and a little to the front. Nothing happened in my labor for six hours (contractions didn't get any closer together or stronger, and I don't think I dilated, although I never had a cervical check so I can't be sure). It wasn't until I found the proper position to labor in that dd was able to turn. I felt her turn, and once she did, labor kicked into high gear and she was born an hour later. I am absolutely convinced that had I not been able to walk around and labor and push standing up, that dd wouldn't have gone anywhere. I am as sure as a person can be that had I been forced to labor and push on my back, I would have had a c-section. The few times I did lie down, contractions slowed WAYYY down, and though they weren't very strong, they were WAYYY more uncomfortable. Once contractions did really kick in, lying down was EXCRUCIATING. It was a night and day difference between lying down and standing up/moving around.

In terms of what could have been different, I can only speak to common homebirth policies, but here's a few:

- Not only would you have been allowed to eat and drink, you would have been encouraged to do so.
- The "clock" wouldn't have started on your labor until at least 48 hours after your water broke.
- You would not have been given pit to augment your labor. Your labor would have been allowed to progress naturally.
- You would have been given few, if any, cervical checks.
- You would have been encouraged to change positions to find what was the most comfortable to you. What is most comfortable is often what is needed to ensure optimum positioning and efficient contractions.
- No one would have coached you to push. Valsalva, or purple, pushing has been shown to be rather ineffective and sometimes harmful.


As a PP said, it's really hard to second guess after the fact though. I'm sorry that you're in the position now of wondering what happened and why.

[cathicog]

Wow, sorry you had to go thru all that...this is the classic "cascade of interventions" if ever i've seen it! In all honesty, you would have probably been better off birthing at home. For real...

Originally Posted by Jennifer1970

1) My water broke before going into labor.

this is a common way for labor to begin. Nothing wrong with it, just keep an eye on mom's temperature and keep anything out of the vagina

I think this is really the key to what happened to me. I had a few light contractions and my water broke. I was sent to the hospital where they immediately put me on pit.

Standard operating procedure(no pun intended)but you probably went too early. We tell the moms to wait til the ctx are 2-3 min apart, and 60-90 seconds long(with a first baby and also depends on how far away you lived from hospital)

I know their fear was that I would get an infection. As I understand it the real risk of infection was the numerous internals they did while I was in labor. What should be done in a case like mine? Had I gone to a midwife instead of an OB, what would the standard protocol have been?

You are correct. But you were in a place that doesn't work well with natural birth(most of the time) and they are on a timeframe. Get the baby out within 12-24 hrs of walking in the door. Many babies/moms just aren't ready yet, and shouldn't be MADE to be ready. A midwife would have probably had you stay at home way longer, til a good labor pattern was established. but not all midwives are alike- some are medically oriented and are more like docs, and some are very holistic, and more like homebirth midwives. It depends on the midwife.

I wasn't allowed to eat or drink anything after admission. They told us during the tour that we could have juice but I wasn't allowed anything other than ice chips and popsicles. I suspect that I wasn't allowed to drink anything (not even water) because they knew there was a huge chance I would end up being sectioned because I was being induced and was a first time mom. How is it possible to do the hardest physical thing ever without eating or drinking anything? Would a midwife have let me eat? I remember being so thirsty and waiting until the ice chips had melted and drinking as much melted ice as possible while the nurse wasn't looking.

This is one of the fastest ways i can think of to mess with a woman's metabolism and exhaust her. A hospital assumes all patients may require surgery and treats them accordingly. That's why most laboring women don't belong there!

I had an epidural because the pain was so intense from the pit and then had to stay in bed. They told me that my DD was sunny side up and got stuck. If I had been able to move around could she have moved naturally?

Pit contractions while laying in bed are some of the most tortorous pain imaginable. No wonder you had an epidural! Bless your heart! Yes, in all likelihood, being able to move around could well have turned the baby over, especially lunging and hands and knees, or leaning on a birth ball, or waterbirth, leaning on the side of the tub..I had two posterior babies that turned before each of them was born, but I was at home. I can almost guarantee the second one would have been a c/s if born in hospital

I was told to push before I felt the need to push and had to push while lying on my back. While I was pushing I remember how ridiculous it was to push that like. It was so uncomfortable and felt totally unnatural.

As well it should, because you were pushing the baby uphill. What I don't get is why they thought, as a first time mom, you would be able to push a posterior baby out...Many women who have had several children have difficulty with that. Read the book Optimal Fetal Positioning by Jean Sutton...it tells how to get baby in teh best position(for next time!)

Because I was still on pit, the contractions were almost on top of each other and I had to push at every contraction so I couldn't get even a second of rest. Should you push before you feel like you need to push?

No, and Dr. Michel Odent (The Farmer and the Obstetrician" book along with several others) strongly advises against it. The unnatural frequency of ctx may have been compromising the baby's oxygen supply, and the staff was worried about getting her out soon enough. A very common side effect of pit/epidural..Normally, when the woman can feel, the baby's head moves down and presses on the nerves in the vagina near the vulva, and it produces what Dr. Odent calls the "fetal ejection reflex", where it feels like you hAVE to push, and even if you were unconscious, your body would push the baby out by itself...

They told me that my "membranes" were very swollen. What did that mean exactly? Was that from pushing for 2 and 1/2 hours? They said because I was so swollen that I would have torn badly.

Well, yeah, you were made to push for 2 1/2 hours with a baby head turned inconveniently backwards! I think the "membranes" they were referring to was your cervix. Usually the term membranes is used for the bag of water, i.e. amniotic sac, and that can't get swollen. And yes, you might have torn, but that is because they were making you push in a physiologically incorrect position. I have caught OP (Occiput posterior) babies before, and mom had a lot of back pain(back of the baby's head pressing on her spine) but it was her third, labor was quick and baby came out quickly...Otherwise I would have had her on her hands and knees, to get the baby turned round the other way...

If I had done what I believe I should have done, gone to a midwife and delivered at a hospital that is friendly to alternative births, how could things have been different?

Actually, I don't think birthing at a different hospital would have made THAT much difference(although it might have, you never know)...Most hospitals(there are exceptions, of course) would have done pretty much the same thing- You really should have been at home, and if you needed to transport, for whatever reason, then so be it, but the best chances for future vaginal birth, will be at home. Most docs/hospitals don't do VBACs,(and the ones that do sometimes STILL put the woman on a timeframe and give pitocin!-verboten for a previous uterine scar) and those that do are swimming upstream against thier peers. Home birth would probably be the best option for a truly normal birth(many birth centers won't take VBACs). Sorry this is so long, but you have been thru so much, and I wanted to see if I could help you sort it out...Enjoy your baby, and I really do believe you can have a better birth next time- at home!

[womenswisdom]

Originally Posted by Jennifer1970

Hi ladies, my beautiful 4 month old daughter was delivered via c-section. I'm starting to believe that my c-section was unnecessary. I would really appreciate some insight into what happened to me.

1) My water broke before going into labor. I think this is really the key to what happened to me. I had a few light contractions and my water broke. I was sent to the hospital where they immediately put me on pit. I know their fear was that I would get an infection. As I understand it the real risk of infection was the numerous internals they did while I was in labor. What should be done in a case like mine? Had I gone to a midwife instead of an OB, what would the standard protocol have been?

Depends on the midwife. The expectant management (as opposed to the active management) approach would be to wait for labor to begin while monitoring you for signs of infection and trying to minimize the risks of infection by doing no vaginal exams, maybe taking vitamin C, etc.

Originally Posted by Jennifer1970

2) I wasn't allowed to eat or drink anything after admission. They told us during the tour that we could have juice but I wasn't allowed anything other than ice chips and popsicles. I suspect that I wasn't allowed to drink anything (not even water) because they knew there was a huge chance I would end up being sectioned because I was being induced and was a first time mom. How is it possible to do the hardest physical thing ever without eating or drinking anything? Would a midwife have let me eat? I remember being so thirsty and waiting until the ice chips had melted and drinking as much melted ice as possible while the nurse wasn't looking.

Not an evidence-based practice, and ACNM (the professional organization for CNMs) recommends eating and drinking as desired during labor. Most CPMs or DEMs would abide by this as well.

Originally Posted by Jennifer1970

3) I had an epidural because the pain was so intense from the pit and then had to stay in bed. They told me that my DD was sunny side up and got stuck. If I had been able to move around could she have moved naturally?

Maybe, maybe not. I think not being able to move around probably increased the chances of a persistent posterior presentation, but I had one and did not have any pain meds until the OR for my c/s after 4 hours of pushing with no progress, so it isn't always the fault of an epidural.

Originally Posted by Jennifer1970

4) I was told to push before I felt the need to push and had to push while lying on my back. While I was pushing I remember how ridiculous it was to push that like. It was so uncomfortable and felt totally unnatural. Because I was still on pit, the contractions were almost on top of each other and I had to push at every contraction so I couldn't get even a second of rest. Should you push before you feel like you need to push?

You generally shouldn't push before you feel the overwhelming urge. But you had an epidural, and you likely would not have felt the urge at any point unless they allowed it to wear off, so directed pushing was maybe more necessary.

Originally Posted by Jennifer1970

5) They told me that my "membranes" were very swollen. What did that mean exactly? Was that from pushing for 2 and 1/2 hours? They said because I was so swollen that I would have torn badly.

They were probably referring to the mucous membranes in the vaginal canal. The swelling could have been from pushing a baby in an unfavorable presentation or from the amount of IV fluids you were likely receiving since you were on Pit and had an epidural.

Originally Posted by Jennifer1970

If I had done what I believe I should have done, gone to a midwife and delivered at a hospital that is friendly to alternative births, how could things have been different?

It all depends on the midwife, her backup OB and the hospital and your labor. I'm really sorry that all this happened to you. I've been in your shoes regarding an unnecessary c/s. Keep coming back and asking questions if you need to. You might also post in the VBAC forum, since those women have a lot of experience with c/s. Also the ladies at the ICAN forum (www.ican-online.org) might be helpful, and the website is a great resource.

[AustinMom]

I haven't read all the replies, but it seem like everyone has touched on the major points. Like infection, it goes up 24 after the 1st vaginal exam after your water has broke. The pit, IMO was probably not followed by the manufactures protocals, but the hospitals instead, which is usually much more intense.

A MW wouldn't have cared about water breaking until that 24 hr mark after the first exam, some don't even do but one vaginal exam, and that's when a mom feels pushy, they encourage you to pushy when you feel it, that is what probably caused your "membranes" (I think they were talking about your perineum) to swell.

Being on your back, pushing, holding breath for 10 seconds, etc, does swell your perineum, this is why most MW only use this when needed to get the baby out quickly.

Yes, they baby would have most likely turned on it's own from posterior (sunny side up), and a MW would have not only let this happen, but recognized it early and helped turn the baby with multiple position changes and techniques.

Yes, they encourage you to eat and drink. A woman in labor burns 800 calories an hour. You need to be putting those calories back in. The risk of eating and drinking is that if you have to have a c/s under general anesthesia, you "can" vomit and breath that vomit. This has been disproven, as the max amount of fluid in your stomach is enough to cause this damage. It's very rare, and that is why the benefit of eating and drinking is much more than the risk.


I would like to say this. You and your birth team did the best they knew how at the time. Our son was born by c/s after a birthing center planned birth that transferred to hospital. The MW there were very new and didn't really know how to help me and support me the way I needed. I was angry for so long at everyone, and that is okay to grieve the loss you have of the birth experience you wanted. The MW, me, my husband, the OB, and nurses all did the best they could with the knowledge they had. It wasn't good enough for our case though. This time, we are having an HBAC with a MW who HBACed her second baby, and a Doula how is chapter leader at ICAN locally. We are much more prepared. I read the book Rebounding from Childbirth and it really helped me heal from my experience. Also, go to an ICAN meeting and talk to some women who know and can relate to you. They can help a lot with healing.

Much Love your way!

[MiaMama]

I have 2 friends with almost the EXACT same birthing story. I actually think that the baby's positioning is a big factor. Some OP babies (sunny-side-up) have their chins tucked to their chest and can enter the pelvic opening. Others have their chins extended, and do not engage easily in the pelvis. From what I understand, this can lead to premature rupture of membranes, difficulty dilatiing, and extreme difficulty pushing.

FWIW, my two friends were both in hospitals, but both had desire for natural birth, and relatively supportive providers. They both had PROM, labored in the tubs, rex'd pit, ended up with epidurals (after hours and hours of little progress even w/the pit) and both ended up with c-sections. Your story sounds pretty similar to theirs.

Did anyone ever say the words "unfavorable brow presentation" to you? This was a major factor for both of my friends.

[Jennifer1970]

Thanks for listening to me Mamas and for helping me to understand. I don't recall anyone saying "unfavorable brow presentation" to me. I'm thinking about getting a copy of my medical records to see what's in there. I'm not sure I had difficulty dilating. The nurse told me I was dilating as much per hour as I should be.