When a c-section is necessary…

Cesarean Section! Ack! It’s an evil word in the natural birth community, and it’s often passed around like it’s the worst thing on earth that could happen during a woman’s birth. C-sections are routinely overused and our national rate of 32.9% is reflective of that. WHO (World Health Organization) stated, “There is no justification for any region to have CS rates higher than 10-15%” (1). Doctors these days put excuses on the table to justify the c-section such as the baby is too big, or the woman’s pelvis is too small, or the woman has been in labor too long (after only 10-12 hours sometimes!) I feel this failure is completely on the Provider’s head, not on the Mother’s. I believe that the mother made the best decision she could while in that situation in order to protect her baby, unfortunately she wasn’t provided with sufficient information as providers don’t take the time to educate women on their options.

I think just more education on birth in our country would lower the cesarean rate. Now I don’t mean just the hospital birthing classes, I mean education on epidurals and the side effect, what pitocin can do to you, how important moving in labor is, and how the chance that your baby or baby’s head is too big isn’t true when the bone plates in their head fold over each other to come down the birth canal. Recently I read a birth story where the Mother was told with her first baby that her pelvis was too small and there is no way she could have possibly birthed her 8lb child and that the c-section was necessary. She later went on to have a home birth VBAC with a 10lb baby! Your body, unless in the case of true diabetes, will NOT create a baby that is too big for you to birth.

With all that said above, there ARE reasons for cesarean sections. Very valid reasons! I know of two examples that have both happened to two friends of mine.

The first case happened to a dear friend of mine. We had been discussing natural birth before she even got pregnant and she is very educated on her options. Around 30 weeks she started getting some swelling and was slightly concerned over it so she monitored it closely. She started getting chest pain as well, enough to keep her up for two nights in a row so she made an emergency appointment with her doctor at 31 weeks and 1 day. It was discovered that she had gained 35lbs in 3 weeks and had VERY high levels of protein in her urine and her blood pressure spiked to 201/140, enough for the doctors and nurses to worry about her having a stroke or seizures. The chest pain that she thought was being caused by the baby being too high was actually her organs swelling, which can lead to organ failure. She was sent to L&D immediately with severe preeclampsia, that eventually turned into HELLP, and was told she would be there until the baby was born. They were aiming to hold off the c-section for 48 hours in order to get the full dose of steroids to the baby but after 36 hours her numbers started to get worse and she had to go for an emergency c-section. Her baby was born 36 hours after being admitted weighing 4.5lbs and 17.5 inches long and was very healthy for his gestational age! He was so strong that he didn’t even need oxygen! Within the week he was moved to a lower level NICU where all he had to do was focus on his eating and growing before he got to go home! Her cesarean was of absolute necessity in order to save her and her baby’s life!

Baby Spencer holding onto his Mommy’s finger.

The second is one of my past Doula clients, I wasn’t her Doula this time around because we were due just days apart from each other both with our second children. During a routine ultrasound it was discovered that her baby had a heart defect (aortic valve stenosis) and would need heart surgery soon after birth. They wanted to keep that baby in her as long as possible to give him the best chance of survival so they did routine ultrasounds and monitored his heart rate and development. At 35 weeks it was determined that he wasn’t thriving anymore and he needed to come out soon. Mom had steroids to develop his lungs and then a c-section as they feared he would be too weak to survive a vaginal delivery. In the Mom’s own words, “When he was born, he let out a tiny weak cry and then silence. They whisked him away to the team of doctors waiting in the next room. There they bagged him (mask and ambu bag) pushing air into his lungs for several minutes, but he never did make any effort to breathe on his own after that first tiny cry. They had to put him on the breathing machine and the rest is another story. He likely would have died trying to be born via vaginal delivery.”

This woman also happens to be a Doctor and wrote the following to me, “I learned so many lessons as a doctor through this experience. While there are many things about pre-natal care that are probably unnecessary, the procedures and tests are there to prevent the few poor outcomes. So many more women and babies used to die in childbirth (and still do in other countries). I’ve always said that the only reason you need to have a baby in the hospital and the only reason you need a doctor on hand is for those few cases that aren’t the norm. Well, turns out we were one of those and now I have a beautiful baby boy. Praise God.”

(1) World Health Organization. Appropriate technology for birth. Lancet 1985; 2
(8452): 436-7

Born in the fast lane…

37 weeks pregnant, 4 weeks before Rylan was born, with my daughter Aydia on a boat ride.

My birth story with Rylan starts several weeks before he was born. We were slightly nervous of making it to the hospital in time as we had been planning on birthing at a hospital about 30 minutes from us downtown St. Paul. Now granted, there is a hospital just 2 miles from us but there are not ANY midwives that have privileges there and no option of water birth; two things I really felt were necessary for my birth. I first had selected the midwife group I was with because they had a great reputation and a very low c-section rate. One of the hospital choices was St. Joseph’s and they have a stellar reputation for natural birth and I was kind of excited about being able to utilize that facility and have my water birth. With each appointment during my pregnancy I just felt more distanced from the group and never clicked with any of the midwives I saw. With Aydia I had a midwife that I loved and trusted wholeheartedly; this time I wasn’t finding that and I was getting discouraged but trusted that my birth experience would still be a great one.

Then I was diagnosed with gestational diabetes. As I continued testing my blood sugars for a few weeks I noticed that no matter what I ate it seemed like my numbers never went above the levels they wanted me at. I started thinking I had a false positive with my testing. At my appointments I was measuring small and I was right on track with any other normal healthy pregnancy. I grew more confident that I had a false positive. Then at my 34 week appointment the clinic I was with told me that I wouldn’t be allowed to go past my estimated due date of June 2nd; something I wasn’t comfortable with and I refused to be induced just based on a label. There had been no ultrasounds to check his growth at this point since 24 weeks and no medical indication that an induction would be necessary. I was devastated. Induction was NOT an option for me unless there was a medical reason and I didn’t feel like it was justified at all in even bringing it up yet. So I discussed my options with my husband. Option 1 was to do a homebirth, but money was tight so even though it would have been our first choice we chose not to. Unassisted birth, as tempting as it was is something that my husband Brandon wasn’t comfortable with and I respect those wishes, even though we did have a hospital 2 miles away should something go wrong. My 3rd option was to seek out my old midwife that I had with Aydia and discuss things with her to see if I could transfer care. I knew she had moved to Hudson Physicians and we knew we could have a very fast birth so we debated back and forth over this before I made the call. But the more we talked about it the more it settled in that it was our only option in order to have a birthing experience best for both me and Rylan.

So at almost 35 weeks I made the switch to my midwife Stephanie Johnson. I left my first appointment from her feeling empowered again in my birthing choices and knowing that I had made the right choice. I trusted her. I didn’t trust the other group. I felt confident now that my birthing experience was going to be wonderful. We did a growth ultrasound right away and discovered that he was well within the perfect growth for his gestation. Even the doctor who performed the ultrasound agreed based on my numbers and the measurements that I likely had a false positive. However since I did get that positive on the test, we all agreed that it would be best if I did non-stress tests twice weekly to monitor him, just to be safe. At each appointment he passed without issues. My body started to make progress towards birth and by 39 weeks I was 2 cm and 75% effaced and measuring only about 37 weeks along. I expected to go into labor between 39 and 40 weeks since Aydia came right at 40. We spent that entire week walking, going bowling, using evening primrose oil, having sex, eating spicy foods, you name it and we tried it but little Rylan stayed where he was. At 40 weeks I was 3 cm along and honestly kind of shocked that I was still pregnant. Another ultrasound showed a perfectly healthy baby boy just content and cozy inside his Mommy.

I was also very happy now in my choice to switch providers as the other group would have wanted me induced by this time and it was obvious that Rylan wasn’t quite ready to come on his own yet. I wanted him to choose his own birthday as I really do think that babies know best as to when to be born, whether it’s at 37 weeks for some or 43 weeks for others! Going overdue however was a new experience for me and each day that passed after my due date grew more difficult. Physically I actually felt pretty good as Rylan hadn’t dropped yet and I was able to get around without any difficulties. However emotionally I was ready. By Wednesday at 40 weeks and 6 days I was hitting a wall. I was emotionally exhausted and felt like crying at everything. My daughter was trying my patience and so were the rest of my family. I spent some time that morning thinking about things and realizing how stressed out I was and how tense my body was. So I decided that whole day I needed to attempt to relax as much as possible. I drank some wine to relax my muscles and then took a one and a half hour bath while listening to my HypnoBirthing tracks. I went to get acupuncture done and that night before bed Brandon gave me a massage to help loosen my muscles. When I went to bed I felt some cramping but nothing that gave me indications of any sort of surges. I had a hard time falling asleep and finally drifted off a little before midnight.

I woke up to a strong surge and when it was over I looked at the clock and it said 2:02 AM. I turned back over and drifted back to sleep as I had been woken up by similar surges before. Then I woke up to another, stayed in the same position and quickly had a 3rd. I rolled back other and look at the clock which said 2:10 AM. I knew this was it as the 3 surges within about 9 minutes were pretty consistent with how Aydia’s labor started. I went to stand up and immediately felt amniotic fluid coming out. As soon as I was standing it really started coming out. I quickly woke up Brandon and he was out of bed and getting things ready to go right away. I noticed that there was light meconium in the amniotic fluid. I called my Doula and birth photographer immediately so they could get on the road and then called labor and delivery and let them know to page Stephanie that I was on my way as my water had broke. I hurried upstairs to throw a pad in my underwear to catch the amniotic fluid and woke up my Mom to let her know we were leaving. I wasn’t officially timing things yet but pretty sure the surges were consistent at about 2-3 minutes apart but not uncomfortable yet.

Stephanie called me as we were leaving the house and said she would meet us there and that they were getting the water birth tub filled up for me. We were out the door by 2:22 AM. Brandon did stick to only about 10 over the speed limit as while we obviously wanted to get there quickly we also wanted to be safe. I started timing my surges and they were about 30-45 seconds in length right at 2 minutes apart. With each surge I used a technique mentioned by Ina May Gaskin where I used a low mooing sound to get through each one called the Sphincter Law. By relaxing the jaw like this it also relaxed the muscles allowing things to not tense up. I rode each surge and didn’t fight them and they weren’t that bad, just a very strong tightening squeeze that rose up and fell each time. The surges quickly picked up to about a minute in length coming every 2 minutes. Between each one I was great, talking with Brandon, and focusing on what was happening to my body and getting excited that our son was on his way. When we had been in the car about 20 minutes I noticed that the surges were picking up in intensity and I was squeezing Brandon’s arm while using my sounds to get through each one. One particular surge lasted a full 2 minutes, and then I had a 15 second break and another one came on. I knew at this point that birth was very close.

Somehow I managed to keep hitting start on my contractions timer while I was in labor!

We made it to Interstate 94 from 694 and I suddenly felt the extreme pressure of the baby entering the birth canal. We had only been in the car about 25 minutes at this point and were about 8 minutes from the hospital. My surges had been right on top of each other and all I could get out to Brandon was, “FUCK BRANDON! FUCK!” He thought it was because I was experiencing pain but really I was trying to tell him that the baby was coming. I had a break as we were coming down the ramp and I quickly stripped off my underwear and moved my skirt aside. I reached up and could feel Rylan’s head about an inch up the birth canal. I told Brandon to call 911 because the baby was coming. I’m pretty sure he told me, “We’ll make it baby, don’t worry!” So I told him, “No, you don’t understand, the baby is coming NOW!” So he got on the phone with dispatch but kept driving…he was determined that we were going to make it to the hospital!

I had unbuckled by this point and had shifted up in the seat kind of balancing on my left hip with my right leg pushing up against the door to lift me off the seat some. At this point I stopped noticing the intensity of the surges and concentrated on Rylan. I stopped making any noises and actually was transcribing to Brandon what I was feeling. A surge came and Rylan’s head crowned. I kept my hand bracing his head ready for him to make the next move with my body. My body surged immediately and Rylan’s head came out and his body immediately followed. I already had my hand bracing his head and I quickly hooked my fingers under his arms and drew him up onto my chest. I don’t think Brandon even realized that he had been born!

This was the bridge I was looking at once the car was stopped and Rylan was in my arms!

I exclaimed something to Brandon about him being here and then focused only on Rylan. He wasn’t crying immediately so I vigorously rubbed him while keeping him under a layer of my skirt to keep him warm. I did blow in his face a few times as well. I couldn’t tell if he was breathing or not but he still hadn’t cried after 30 or 45 seconds so I gently put my mouth over his mouth and nose and blew gently into him. He immediately started crying. Not once was I worried, I knew his umbilical cord was still attached so he was getting oxygen from that. Dispatch was trying to tell Brandon to find a safety pin or a lace to tie off the cord and I remember that I was very adamant to Brandon that we were not clamping the cord! He asked several times, I think he was in shock. I relaxed back into the seat and just kissed Rylan all over and kept him warm, amazed and feeling empowered over what had just happened. He wasn’t interested in breast feeding yet and after about 5 minutes he stopped crying and just relaxed and started to open his eyes up at me.

At this point a Sheriff’s deputy showed up and just kind of asked if I was doing okay and we were both excellent so he just stood outside the car chatting with Brandon…who was still basically in shock and hadn’t really even checked out his son yet! I called Nicole, our doula, to let her know what happened and then Labor and Delivery and spoke with Stephanie as she was standing right there. She was proud of me for not clamping the cord. Right when I hung up with her a first responder from fire rescue showed up and he also wanted to clamp and cut the cord and I had to defend it once again that I was leaving it intact. He even tried telling me that we needed to clamp it as Rylan was on my chest above the placenta. I just kind of looked at him and said, “It’s fine. We’re NOT clamping the cord. I already spoke with my midwife and she also said we shouldn’t do it so we’re leaving it alone.” He listened to Rylan’s lungs and then backed away as well, Rylan was still cuddled up on my chest, occasionally crying out but mostly just snuggling in, covered by my birth skirt and my robe had been placed on top of us at this point as well.

Nicole then showed up as she was coming up behind us on the freeway. As she did the deputy asked Brandon if he knew her and he said no, and I quickly jumped in with, “Yes you do! It’s Nicole!” Ha, poor Brandon still didn’t really know what had happened I think. I think I had my wits about me much more than he did the whole time. Nicole jumped in the car with us just amazed at everything and telling me how proud of me she was. I had also called our birth photographer Melissa and of course she had just passed us when I did so she decided to go onto the hospital and wait for us there. The ambulance showed up about 10 minutes after birth and checked out our vitals and then I was transferred out of the car into the ambulance to head onto Hudson hospital. I had guessed the time of birth at this point to be about 2:50 as I had looked at the clock several minutes after birth making the entire labor about 50 minutes long. It was probably about 3:15 or 3:20 by the time we arrived at the hospital. I went through ER first where basically all they did was check my blood pressure and his vitals again. Then Stephanie quickly pressured them into releasing me to the labor and delivery ward and into the water birth room. It was around 3:45 when Brandon cut the cord and I delivered the placenta thus officially completing the birth. Rylan stayed on my chest while Stephanie checked me out and gave me 2 small stitches…amazing considering that my perineum basically didn’t have any time to stretch considering how fast Rylan came!

Relaxing in the waterbirth tub once at the hospital.

After checking for any hemorrhaging Brandon was able to hold Rylan for a brief moment while I was able to get off the table and into the water birth tub. Rylan was handed to me as soon as I was in there and we spent a good 30 minutes relaxing in the tub. It was heaven! Rylan stretched out and relaxed and you could tell he loved it. He latched for the first time while in the tub as well and took to breastfeeding right away. The tub has lights in it that can be different colors and we choose blue. It was just perfect, everything about his birth was perfect and I wouldn’t have had it any other way. Sure, it was an unplanned, unassisted, freeway birth going about 80 miles per hour down the road, but it was simply put, AMAZING. I feel very empowered now and even more so do I trust birth, my babies, and my body.