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Trying to Process my c-section. Could really use some input.

697 Views 17 Replies 12 Participants Last post by  doula mary
Hi, I'm new to MDC, but have been lurking since before I was even pregnant. I was hoping to get some perspective from other birth professionals on how my birth turned out. Here's the story:

I had 2 days of early labor before we went to the hospital around 1am on Saturday, July 30. I waited until the contractions were 3-5 minutes apart for 2 hours. I think I knew that I was going to the hospital too early, but I really wanted to know how much I was progressing. When we arrived, I was at 3cm with a bulging bag of waters. I was pretty disappointed because I had been at 3cm at my doctor's appointment on Thursday. They were going to send me home, but they didn't like how the baby's heart tones looked on the
monitor. Apparently, they were "flat," meaning her heartbeat wasn't reacting to contractions. It seemed like I was in triage forever because they wanted to keep me on the fetal heart monitor. I had been managing contractions pretty well up to that point mainly because of my Hypnobirthing CDs. However, they then wanted me to lie on my side to get a better reading and the contractions became unbearable in that position. I had also stopped listening to my CDs. I can't remember why. I think it was because I couldn't have the headphones on and lie on my side at the same time. I wish someone (my husband or doula) had made me listen to them.

At that point (around 3 or 4am), I asked for pain relief (an epidural) and they said the anesthesiologist was in surgery and wouldn't be available for two hours. The nurse then told me that they would have to break my waters in order to put an internal fetal monitor on my baby's scalp. I think they wanted to do this because they couldn't get a good or consistent reading with the EFM. Not sure, I'm a little fuzzy on some details. She then told me the contractions were going to get much more painful after they broke the water. Well, that was my psychological low point because I was already in agony and the thought of enduring two more hours of pain before getting the epidural was frightening.

They then moved me from triage into my own room. I was able to be on my back or sitting (which was the most comfortable for me) instead of being on my side. I was able to manage the contractions much better and continued listening to my Hypnobirthing CDs, which absolutely got me through the labor. Also, they told me that the anesthesiologist was out of surgery and would be available soon. Interestingly, they didn't break my water like they said they would. Instead, they let me wait until the epidural was in place.

I got the epidural around 6 or 7am I think. They didn't check me before placing it. It took about 20 minutes for it to take effect, but I was managing quite well without it. My doctor checked me about half an hour after the epidural was in, and I was at 10 cm. I really wish someone had checked me before they placed the epidural because I'm willing to bet I dilated pretty far on my own! My doctor then broke my water and placed the internal monitor. There was meconium in the water. I asked her how much, she said "moderate." She said that I could rest for 3 hours and we'd let the baby "labor down" before starting to push. Sounded good to me.

After getting a reading from the internal monitor for a while, the doctor wasn't happy with the heart tones. She also did "scalp stimulation" and the baby's heart rate did not react, which was not a good sign. Apparently, the combination of these factors: meconium, flat heart tones, and no response to scalp stimulation indicated fetal distress. She recommended a c-section. I was caught off guard and asked if I could try pushing for a while. I tried 2 sets of pushes and I guess the baby wasn't descending as fast as they hoped. The atmosphere got a little tenser, and they really wanted me to have the c-section at that point. I consented because I just wanted my baby to be born healthy. However, I was very disappointed and scared. During the surgery, I heard the doc say there was "thick" meconium, and she also mentioned that DD was posterior. I was shocked to hear that since I experienced no back labor. DD was born with Apgars of 8,9 and looked very pink and healthy.

If you've read this far, thank you. My questions are:
Do you think the c-section was warranted, based on the situation?
They seemed to be really concerned about the "flat" heart tones. Is that something you'd be as concerned about?
Would you have done anything differently if you were me, and presented with those "signs" of fetal distress: flat heart tones, meconium, and no response to scalp stim?
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I am so sorry you're having a hard time processing your birth. I'm sure there are a ton of "what if's" when you look back on it and it sounds like it's really important to know if this cesarean was "necessary".

I cannot really sit back and tell you whether or not your particular cesarean was necessary, nor do I think it's appropriate to do so. I can tell you that sometimes babies are a bit sleepy and go through long periods of sleep at the end of pregnancy. It sounds like they were concerned about a lack of variability in the heart rate, which is a common concern.

However, if during the labor baby was doing pretty well (and it sounds like she was), I'm wondering if the end heart tones had more to do with what was normally going on for your baby, but no response to scalp stim is a bit concerning.

Having a posterior baby is something that results sometimes in longer earlier stages of labor, but it's also a good sign that your body dilated so quickly after labor became active. Whether or not you could have had her vaginally without any undue stress on her is another story. I wish I could tell you without a doubt one way or another, but I don't think anyone really can without being there throughout the entire process.

Babies have incredible reserves and some do really well holding on and others do not. I wish there was more I could offer you, perhaps another person can. All I can do is tell you to be gentle with yourself.
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I agree with what pamamidwife said. It's hard to sit an analyze a birth when you weren't there to notice all the small details. I know that being tied to a bed can be agony, especially during a posterior labor, and the tension it caused you couldn't have been good for the baby, either. But you have to remember, too, that midwifery isn't what is commonly practiced in the hospital...and doctors like their statistics, and want them on paper.

If the epidural was "on" while you were pushing, it was not likely that you'd make a ton of progress with the first two pushes, and this should not have surprised the docs or their staff.

Again, though, what pamamidwife said about variability is an important factor. Some babies with little variability are born pink and happy, some aren't...and the fact that your baby didn't react to scalp stimulation IS a flag that would be raised for me.

Please don't blame yourself for not remembering to use your CD's. Labor is HARD work. I used hypnobirthing myself for both my labors, and understand how it's used. It's really important to have the reminder there to relax when you're doing the hard work of labor, and if you were forced to labor in an uncomfortable position, and your support persons weren't remembering to give you the reminders to relax and weren't making sure that you were listening to your CD's, I'm sure that this situation was difficult to handle...both emotionally and physically. This is why you have support persons during labor, help you through these most difficult times.

I really don't think that there's much you could have done differently...except perhaps not worrying about a "number" to determine "progress"...but it's all relative. You were checked, and you were discouraged. The baby's heart rate was NOT variable, even with stimulation. This happens sometimes. And you did pay the doctor a lot of money to worry about the safety of your baby...and the baby was born healthy. There really are some c-sections that are necessary. You didn't go in begging for drugs right away, you went in with the expectation of a natural birth. You didn't schedule a convenience c-section. You didn't beg for a c-section because you were tired or discouraged. Your baby was showing concrete and valid signs of distress, and you and your care provider acted accordingly.

In the end, no two labors and births are the same. There is no reason that you couldn't go on to have successful and easy vaginal births with subsequent births. Check out "Birthing From Within",'s a good book to help you process "stuff" from previous births that you'd like to get past before you go at it again. Also, see your hypnobirthing teacher, if you had one. If you didn't have one, find one now. They can use what you learned for the birth to help you get over the outcome (reread the chapter in your hypnobirthing book about releasing fear).
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Thanks so much for your posts, pamamidwife and courtenay_e. You're right, it's impossible for anyone who wasn't there to tell me if the c-section was warranted. I'm just a little desperate in trying to figure things out. I felt pretty educated going into this birth, but I was caught off guard by what happened. I was unfamiliar with "flat" heart tones and scalp stim, so didn't know how to react when presented with that info. I remember thinking "Her heart's still beating, so what if it's not 'variable?'"

courtenay_e, I did not have a Hypnobirthing teacher. I just bought the CDs off the Hypbirth website. I was actually pretty skeptical about it, but it worked very well for me. I may try to find an actual teacher for next time, though. I'll definitely be reading "Birthing From Within" to process all of this. I absolutely want to VBAC next time.
The Hypbirth CD is great...I wish I would have had it when I had my kids. My husband's not real good at reading scripts, so I just used what was in my head the whole time. As for a hypnobirthing practitioner, you would do well to go to the Hypnobirthing website and contact them about finding a practitioner in your area. I believe it's The "Find a Practitioner" tab is all the way to the bottom of the list on the left side. They should be able to help you with the fear releasing part of the issue. Also, check out Marie Mongan's has a lot of great info!
There really are some c-sections that are necessary. You didn't go in begging for drugs right away, you went in with the expectation of a natural birth. You didn't schedule a convenience c-section. You didn't beg for a c-section because you were tired or discouraged. Your baby was showing concrete and valid signs of distress, and you and your care provider acted accordingly.
I'm no expert, but I do have enough experience to know that cesarean births are sometimes the best option and that is nothing to feel bad about. The situation you described sounds like a reasonable situation to have a c-section, so don't be hard on yourself, you did what had to be done for your baby.
(((hugs)))), Mama. You sound like processing is taking its toll.

Like others have said, there is no way to tell you if this was a warranted cesarean. But Mama, you did try hard. I think sometimes, amidst all the confusion, we have to honor our body and our baby and believe they DO know what's best and the way birth needs to happen.

Second-guessing is hard, because you will never know. But to say, "Buck up, you have a healthy baby," is also a discredit to your feelings of loss. I hope you find peace and healing during this process.
Browning- You have nothing to regret... you have a healthy baby, and that's all that matters. I would have done the same thing as you. If they mentioned concern over the baby, I would have had the c-section too. I noticed you mentioned you thought you may have dilated to 10 cm. "on your own", and girl, you DID.
It was your body that did the work. You did it. You can feel good about your decision. Focus your energy now on taking care of you and baby.
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also it's important to note that research shows babies who went through some labor before a c-section do better than those who went straight to the section. so the pain you went through WAS worth it. you did your best, like others said, no one here knows all the tiny details that the dr based the decision on- others have expressed that no reaction to scalp stim is unsettling and perhaps this doctor was very concerned by that. "Monday morning quarterbacking" is definitely something we all do when birth doesn't go the way we'd hoped or planned. but from reading your story, nothing jumps out at me like you or the doctor made any irresponsible decisions. especially not you, if I were in your situation I would have done the same thing. ((hug))
Not an expert, but wanted to say -- I also thought that being educated and asking all the right questions and communicating my wishes very directly to all the MDs would protect me from a c-sect. Sometimes it just doesn't. I have mixed feelings, on the one hand I know I educated and prepared and empowered myself as much as could reasonably be expected, and dd is perfect and I am in good shape now, and in the moment, I don't think there was any other option. Still, I sometimes wonder, if I had done this differently or that differently . . . . there isn't any real answer, you just have to experience all your emotions, express them, and release them.

peace, R
I think it is wonderful you are thinking about and processing this birth, I suspect it will take some time to be Ok with it..but it is also "wonder too"

I agree with the ladies...always hard to comment when you are not actually there. It is concerning that baby would not react to her scalp stimualtion..hard call.

I suggest you get your hospital records, they might provide you with info. that will help you process and understand this birth.

Mama, I second and third what some of these ladies have said here... You made it to 10 cm with a posterior baby! That is some accomplishment! It sounds like you were quite brave in a hard situation, and hey, that's part of parenting. You also made decisions based upon the information you had at the time. Absolutely, meconium with non-fluctuating heartrate, no response to the scalp stim IS valid cause for concern, not overreaction IMO. Also if you had the epidural going you may not have pushed as effectively, esp where little babe was posterior. I do agree here that it was probably good to get that baby OUT sooner than later. We do our best out of love for our babies.
No matter what kind of birth we have, it is our NEED to go back over it, tell our stories. Process, heal, remember, and pat yourself on the back. Keep talking about it, it will help.
and congratulations!
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Some ideas to ponder for the future…


I think everyone has addressed so much about what happened so well that there is nothing more I could say to add to their excellent words. Well, except, do you have ICAN in your area? You can find them on-line. I have heard they are a good support source.

So the rest of this email may or may not apply to you depending upon your choice to have more children, or not. If you are planning on more you can print this up and save it for that time for ideas.

Here is some advice about birth that I say to anyone, it may or may not apply to you, but they are ideas.

If you have a practitioner with a low c/s rate then you know that if you are getting a c/s it probably is pretty necessary. (This statement is in no way meant to say that your c/s was not necessary, that is hard to say, it may very well have been.)

No matter who you are, and especially someone wanting to achieve a VBAC, this is one of the best pieces of advice one could ponder, I think.

Sometimes it is very hard to know who those folks are so asking a local homebirth midwife or LLL person is a great place to start. I think most of these ladies would be happy to give out this info to help you achieve a great birth experience if you wanted to call them. And I mean great birth experience no matter what happens, even in the event of a necessary c/s...because they are working in the birth arena, they tend to know who the really nice, compassionate and low c/s providers might be.

I always say it does not matter if your practitioner is like Robin Williams or Katie Couric, if they have a high c/s rate (above 15%) keep them as your friend but find a different practitioner. They are probably trained to fear birth more than appreciate it as a natural physiological process and to trust in a woman's body.

Hiring a midwife in a hospital setting or birth center does not necessarily mean a low c/s rate as some are either more medical oriented with higher c/s rates or are just more restricted in their practice because of their back-up doc protocols. Again, that does not mean they are not great just means one is taking that into consideration as part of the many things that one personally needs to achieve life/birth goals. But, some hospital midwives and docs have great rates. Here near where I live in MA we have a hospital midwife that is on-call 24/7 for her clients and has a 5% c/s rate. We are very lucky to have this kind of service...but, guess what, a couple of years ago, against what most OBs and CNMs would want, the hospital admin banned VBACs! SO, so sad. We had protests and letter writing w/ ob support in the media but still the same policy today. Anyway, another doc here has a 8% c/s rate, he works with 2 others and their rates are not as good, which means they share call and you do not know who you are going to get. I would have to go and talk to him about what rates his partners had when deciding to use them. But, guess what, he works at the same hospital that does not allow VBACs. Yikes!

Hiring a doula can also help tremendously. One that comes to a laboring mother's home is a good idea too, I think. Sometimes midwives will do Monitrice (sp?) work (like a doula… and go to hosp with you as a doula but can check your dilation and listen to heart tones at home). They do charge more than a doula.

Lot of things to think about and they may not apply to you but I thought I would mention them as ideas for the future, if applicable.

All the best, Paige
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Originally Posted by Nursin'Fool
Browning- You have nothing to regret... you have a healthy baby, and that's all that matters.

I just want to point out that having a healthy baby is not ALL that matters to some people. Yes, a babys health is of utmost importance, but to some women, its also important to feel like they've had choices, that they were able to make the decision with their caregiver, etc.
I think we do a disservice to women by invalidating their feelings and telling them a healthy baby is the ONLY thing that matters.
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"I just want to point out that having a healthy baby is not ALL that matters to some people. Yes, a babys health is of utmost importance, but to some women, its also important to feel like they've had choices, that they were able to make the decision with their caregiver, etc.
I think we do a disservice to women by invalidating their feelings and telling them a healthy baby is the ONLY thing that matters."

I agree, how you birth matters. If you feel you had power, control, peace and support, even with unexpected events, you can still come away feeling empowered. However, the flip side...if events went to "nightmare teritory" then is is quite possible to feel very tramuatized and to carry this pain inside. Some women deperately want a vaginal birth and the emtions after a c-birth go beyond disappointed.

I should have chosen my words more carefully.
I truly do think that having a healthy baby is the most important thing, but for sure, not the only thing that matters.
I think sometimes in our support and encouragement of women to birth "naturally" we create pressure and sometimes a sense of failure to women who may not be able to do so for various reasons.
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Thank you all for your responses! I didn't have a chance to check back with this thread over the weekend...

richella, I agree, it's the wondering "if I had done this or that differently, would the outcome have been different (better)?" that gets me.

I was just feeling a little down because I was recently re-reading Goer's "The Thinking Woman's Guide to a Better Birth" and it just hit home how much of a battle it will be to get the birth I want in the future. In Goer's words, my c-section has "cast a shadow" over the rest of my reproductive life, and I hate that. I guess I just felt like I needed to come to terms with my c/s. I just wish it had been more clear cut, so to speak. I still have questions about some of the decisions made. I'll be seeing my ob again soon, so I will ask for my medical records then.

Thanks again, everyone...
I had a terrible second birth with my son....had a really hard time coming to terms with how traumatic his birth was and how beautiful he was. It took a LONG time to accept that I could be upset abut his birth for ever if I wanted...does that make sense?? It's OK not to feel OK about something.

His birth was my motivation for becoming a doula, and now ten years later...I would not change a thing. I would have never become a doula if my birth had been different.

Definitely get your records, and journal your feelings. READ READ READ good birth books.

Do your homework on your care provider when the time comes again to have another baby..and maybe hire a doula!
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