I love hearing birth stories from our mothers and grandmothers. There is so much that can be learned by simply listening to them and what happened during their birth experiences. I was born via cesarean towards the end of the 70s and my birth story (breech baby, full term, allowed to labor, meconium, etc) is very different than many of the cesarean birth stories that women tell today.
From the bikini cut to the recent advent of the family-centered cesarean, from 4% to 30%+ cesarean rates, from fathers banned in the operating room to welcomed; the story of cesarean birth is about more than birth. It is history, science, and women’s issues being played out before our eyes.
In honor of Cesarean Awareness Month, I am excited to share this guest post from Jill. She tells two very different birth stories from two very different times.
Cesarean Birth: Then and Now
My mother was pregnant with me in 1978. Labor induction was unusual, and so the weeks ticked by past her due date until finally, at almost 44 weeks, she went to the hospital to be induced. About 18 hours later, she had developed a fever, my heart rate was high, and the doctor called for a c-section.
Shortly thereafter, all 10 pounds of me was born in the operating room, and I was whisked to the NICU (at that hospital at the time, a NICU stay was mandatory for all babies born via c-section). My mother remembers feeling bad visiting me there, looking at all the other babies who were so tiny and fragile, then getting to pull her wheelchair up to the bassinet with the biggest, fattest baby in the place. In the years to come, under the wisdom of “once a cesarean, always a cesarean,” she delivered my two younger sisters via c-section as well.
Fast forward to 2003: I was pregnant with my first baby, and my biggest fear was having a c-section. I had read some about birth (just enough to think I knew what I was talking about). And I had a birth plan: don’t get an epidural.
That was it.
As it turned out, a little more planning, preparation, and practice might have helped.
Even though I didn’t know what I didn’t know, I managed to do a few things right:
- I hired midwives: the team of Certified Nurse Midwives I chose treated my pregnancy as a normal life event rather than a potential medical emergency. When I had a question or concern, they were reassuring. I generally left my appointments feeling better than when I arrived.
- I “kept early labor a secret”: midwife Gloria Lemay recommends that when labor starts, especially if it’s at night, to keep the environment quiet and dark, and to rest as long and as much as possible. I felt my first contraction at 9pm, and felt a handful more before my husband and I went to bed at 10:30. I managed to lie down and sleep in between contractions until 1am, then sit on a birth ball next to the bed and at least lay my head on the bed in between. The lights remained off, I didn’t wake up my husband, and I didn’t keep track of each contraction.
- I stayed upright: at home, once contractions were too strong to keep lying down, I sat on the ball and rocked back and forth. When we arrived at the hospital around 5:30am, I stood next to the bed and rocked. Movement and gravity helped my baby to dilate my cervix and move down.
I also could have done a few things differently:
- I didn’t take a comprehensive childbirth class: I had taken the standard hospital class, which gave us a broad overview of birth and a few tips and tricks to cope with contractions (at least until we could get an epidural). However, the class did not cover things that might have been helpful during pregnancy (like chiropractic, nutrition, kegels, and exercise), or in-depth discussion and practice of labor-coping strategies (like guided relaxation, positioning, affirmations, and hands-on support for partners). It was also not a class whose mission was to maximize my chances of having the birth I wanted.
- I didn’t hire a doula: Even with the best birth class, it’s easy to forget your head in the throes of labor. My husband was generally helpful, but might have been more helpful with the guidance of someone who had actually witnessed a birth before. A doula also could have provided some hands-on comfort measures when things really got intense, and could have provided me with some perspective and encouragement when, at 7:00am, I asked for an epidural.
- I didn’t have a plan for what to do when contractions became too much to handle: when we arrived at the hospital, I was 5 cm dilated (which sounds pretty impressive until you know that I had been 4 cm dilated for the past two weeks). By 7:00am, when I asked for an epidural, I was 9 cm. I was shaky, and contractions were very close together. In addition to feeling them all the way around my midsection, the pain had started to radiate down my legs. I had no idea that could even happen, no idea what positions might alleviate that, and no frame of reference for how much longer I might have to endure these full-body contractions. It was clear to me and my irrational, in-transition brain that I was going to die.
And so, out of ideas, I carefully formulated my request to the nurse so that there would be no discussion and no ambiguity: “I have decided I would like an epidural NOW.” Even when she found I was already dilated to 9 cm, she said as a first-time mom I might be pushing for a couple of hours, so she called the anesthesiologist. At 8am, my epidural was in place. And then, all hell broke loose.
The epidural caused my blood pressure to immediately drop.
This, in turn, caused my baby’s heart rate to drop.
The nurse pulled the emergency cord and people started swarming into the room. I looked up at my husband, who looked terrified. I heard a nurse tell someone on the intercom to prep the OR. Suddenly, the midwife was there, looking me straight in the face, and telling me that I was going to push my baby out and he was going to help me. I nodded, and started pushing. The baby came down enough that the midwife was able to apply a vacuum to my son’s head, and between the two of us, our son Oliver was born at 8:12am, crying and pink. I had avoided a c-section by about 10 minutes.
Looking back, it’s not clear to me that my mother’s first c-section could have been avoided. The c-section rate in the US at the time was 15%, less than half of what it is today. Perhaps an earlier induction could have resulted in a smaller baby that could have been born vaginally. Or perhaps avoiding induction and continuing to wait for labor to start on its own would have had a different outcome. Maybe the hospital setting itself was an intervention that interrupted her birth. Or maybe I was one of the 10-15% of babies who are better off being born via surgery.
However, my almost-c-section certainly would have been unnecessary. My lack of knowledge combined with lack of support from a doula had nearly led me to become part of the ongoing c-section epidemic in the US.
It’s impossible to judge a birth or know what ‘could have’ or ‘should have’ happened had things been different. One thing we do know is that birth and the justification for cesarean has changed wildly in the last 100 years as technology has advanced and medicine has changed. Whatever the cesarean rate is, we must all hope and work to ensure that what happens to women and babies during childbirth is the best and healthiest option for them.
Jill Christianson, BBCI: Over the past nine years, Jill has had the opportunity to assist hundreds of couples with pregnancy, birth, and breastfeeding in her roles as birth doula, midwife’s assistant, breastfeeding counselor, and childbirth educator. She is currently a Certified Birth Boot Camp Instructor offering classes in the Twin Cities, MN. She and her husband live with their four children in Bloomington. Find her at www.naturalbirthmn.com.