Wednesday, April 13, 2011

Unexpected Cesarean

I need to preface this story by admitting something. I never, ever thought a cesarean would ever happen to me. I'll admit that I even felt a little smug when I sometimes heard of other people planning natural births and then ended up having c-sections. I thought to myself, they must not have known how to fight for their bodies or they must not have known that they could have had a natural labor if they just tried x-y-z. I knew there were rare occurrences in which women needed c-sections and I knew those women had no choice (and I understood why c-sections had been invented to save those women and their children), but I didn't think that would be me! Well, I'm here to say that I thoroughly researched natural childbirth, thought I had taken just about every precaution . . . and I still ended up with a c-section! Here's my story:
We had no inkling that we were going to have our baby the least bit early. In fact, all along, I had almost planned on having the baby at 40 or 41 weeks. My mother had always had beautiful, swift, natural childbirths at 41 weeks, so I expected the same. It never even occurred to me that I would have a birth with any interventions. I had intentionally decided to use the practice that had the lowest rate of any interventions and to give birth at the hospital with one of the lowest intervention/c-section rates in the country.
So, when I stood up in that crowded movie theater on the night of July 25, 2009 and took a step down the stairs and felt my water break at 10:15 pm at barely 38 weeks, I was shocked beyond belief! We called the practitioner on call (a doctor that weekend; the practice has doctors and midwives working together) and told her what happened. She suggested we call again when the contractions had started and were five minutes apart lasting at least a minute each for about an hour. We then went home to check over our bags and to try to get as much rest as possible.
After the conversation with the doctor, I rechecked the bags we were bringing to the hospital and finished some odds and ends around the house. We went to bed around 11 and I tried to rest although it was pretty hard to do considering I was excited about meeting my baby soon and finding out once and for all if I was having a boy or a girl. Around midnight, the first contractions started. At first they were pretty sporadic and would wake me up briefly out of my light sleep, but somewhere between 2:30 and 3:30, I started noticing that I was getting them about every ten minutes and they were starting to intensify and last longer. Around 4:30, they started to come about every five minutes and because I could stand pretending to rest no more, I went downstairs and left my husband sleeping upstairs while I finished compiling another song list for the labor on the computer. I cooked myself an omelet because I wasn’t sure what food I would have access to at the hospital and it helped to give myself something to do. My husband came downstairs around 5 and asked if it was time to call yet. For some reason, I was reluctant to make the call, but at 5:30 (when it had been an hour), I finally did call and because I could no longer talk through the contractions, she asked me to come in.
What followed was the longest day of my life. It began well enough. We were put in the room with the nicest birthing tub and visions of waterbirth danced in my head as we settled in. (All the rooms in this hospital birth center were equipped with tubs, squat bars, birthing stools, birthing balls, etc. but this was, by far, the nicest of the tubs.) I knew from all of my labor books and my hypnobirthing class that my labor might slow a little as I got used to the new surroundings and, it did, but after some walking and bouncing on the ball, it picked back up.
As far as the contractions themselves went, I actually found that I could focus myself inward and make myself relax with each one pretty well. (Because I remained so calm throughout, I actually ended up having my nurse say that she had to check out hypnobirthing if it could help her be in labor like me.) Unfortunately, hour after hour passed with contraction after contraction, but no real progress was made as far as dilation and although the contractions became longer, they were not intensifying the way I expected and wanted them to. Still, I remained active and used probably every single laboring position I’d ever heard of in attempt to intensify my labor naturally. Seriously, every single one! Looking back, those first twelve hours or so were my favorite of the whole labor. My husband and I were a team with him writing down my contraction time and talking to me as I used my imagery to relax and work through each contraction one at a time. At about 10:30 am, the nurse asked if I wanted to order some food, so I ordered some fruit and a bagel, but I wasn’t even able to finish that. I wasn’t hungry for food. I wanted my baby instead.
At 12:30 pm, my doctor checked my dilation for the first time and discovered I was only at 3.5 cm. She also discovered that because it had been so long since my water had broken that a “pocket” had formed. With my permission, she broke the pocket and asked if she could re-assess in three hours, but shared her concern that if the labor had not progressed by then, she would like to introduce a very low level of pitocin because it had been so long since my water had initially broke. I was pretty heartbroken about the idea of not having a pristine completely "natural" birth and maybe not being able to have a water birth. (I was also a little scared about how much more painful the pit might make things and how stressful it would be on the baby.) I actually got so worried about it that my labor stalled for about a half an hour with the contractions getting further apart rather than closer. I took that time to lay down and rest for the first time since 4:30 that morning. But, after a quick cat nap, I soon redoubled my active efforts. I was convinced that my body would take over and would birth my baby, it just needed some time. I took a shower and tried nipple stimulation. I squatted and walked miles around my room. But when she checked in at 3:30 pm, I had not dilated any further. After discussing it further with my doctor, she promised to use the lowest levels of pitocin possible and to turn it off in time for me to push my baby in the water. (She shared that the hospital strongly encouraged the doctors to try to have women give birth within 12 hours of their water breaking . . . a milestone that we had already exceeded by five hours, but as far as her practice went, she would like to see us have the baby within 24-36 hours.) Not really knowing why the hospital and the doctor thought there should be a time limit on my delivery because my water broke, I felt really confused and scared that my body seemed to be so disappointing in its delivery preparation. However, we didn't know what else to do, so, we consented. (I'm still not sure if this was the right or the wrong thing to do.)
To my surprise, I found I could focus just as much as I could before and found that while the pit made my contractions more rhythmic, they did not make them more painful. Pain medication didn't even enter my mind because I was so focused on taking each contraction one at a time and with each one I’d promise myself that whatever happened in the future, I would get through this contraction this time.
By 7:30, with the help of the pit, my labor was much harder, but still nothing I couldn’t handle. I felt strangely calm and single minded. I was going to birth my baby and that was it! The doctor checked and I had progressed to 6.5 cm. Although I had wanted to go into the birthing tub for hours, I had been afraid that to do so before 7 cm would delay my labor, so I had not gotten in beforehand, but with my legs shaking and my ankles weak from hours and hours of walking and bouncing and working to help my labor progress, I asked to go into the tub and what a relief it was! It was hot, but my husband kept me cool by placing washcloths soaked in ice water on my head and neck to cool me off.
By 11:30 pm I had progressed to 8.5 cm and then was in heavy transition for another two hours. (By that time, it was like time had ceased to exist for me because I was living contraction to contraction and usually had like 10 seconds or so between each one.) I was fairly quiet throughout this part of my labor, only thinking to myself as each contraction built “I can do this. I can do this.” Then at the top, I would say “Oooo” and would relax my body as much as I could and would ride the contraction back down. Again and again I did this. I started to feel the pressure of my baby and wanted to push, but the pressure was in the wrong place. It was too far forward. By this time, we were on our second 12 hour nurse shift and the veteran nurse assigned to us held one of my hands as I worked my way through each contraction. Once in awhile, I would let myself float outside of my body and I would start to panic because I was so exhausted I wasn’t sure how I would ever have the strength to push my baby out of me knowing that pushing could take hours on its own. When I voiced this concern to the nurse, she smiled and said not to worry. It was just the transition talking and I would have the strength when I needed it. Half an hour more, she told me and that baby will be in your arms. I would picture it then, the moment when my baby would slip out of me and I would be looking at him and he would be looking at me and I would know that I had done it. That WE had done it. And I would look at my husband and we would be a family. That image got me through the pain and the exhaustion. It had already been twenty four hours since my first contraction. Even as that “half hour” kept pushing further and further away, I kept telling myself it would happen. My body began to shake uncontrollably and I got out of the tub because I was anxious to see if getting back on the birthing ball would bring my baby to me more quickly.
It wasn't until 1:30 am when the doctor checked me again that I realized something was wrong. My dilation had regressed to 8 cm (I didn’t even know that was possible until that night) and the doctor told me that both my baby’s head and my cervix were swelling. Hot shame and fear washed over me as I sat shaking on that bed while contraction after contraction still pounded within me. How could this be happening? Why wasn’t I allowed to push? What had I done wrong? I had worked so hard! Was my baby going to be okay?
What followed was the most surreal situation I've ever experienced. The doctors surrounded me and tried to talk to me about my medical options and strongly recommended a c-section soon, but between the constant contractions and the exhaustion of being in labor almost 26 hours and trying every labor position ever remotely mentioned to me, I felt like I didn't even speak their language anymore. I felt like I was in another world miles from them or like I was looking at them from the distance of a long, long tunnel. I was incapable of making any medical decisions at all. I had thought I was moments away from pushing, not making important, informed decisions! That's when my husband stepped in. If not for him, I'm not sure what would have happened. He had to ask the questions and make the decisions because I was completely gone. Because he knew how important vaginal birth was for me and because he knew that I cannot take any strong pain medications (I have reactions to everything in the narcotics family) and thus would suffer more than usual if we had to have a c-section, we ended up making a last ditch effort to salvage the vaginal birth by administering an epidural in the hopes that perhaps after so many hours of labor, the epidural would help me relax more and get the last two centimeters I needed and get the swelling down in my cervix or the baby's head. The doctor gave us an hour to try it. It didn't work and we ended up with a c-section, anyway, but I will always be thankful to my husband for knowing and honoring my wishes and insisting that we try, anyway.
Getting the epidural was absolutely miserable. I hated that it was happening. I hated that it seemed to be my only chance to have my baby vaginally. I especially hated that the doctor said I would no longer be able to feel my baby move. The anesthesiologist came in and I’m sure he expected to be treated like a knight in shining armor, but I’m afraid I was a very mean patient. My tone with him was very harsh. I guess I needed someone to take my fear out on and it ended up being him. When he asked me how much I weighed (something I knew was already on my chart and I was loathe to say aloud), I actually even swore at him! “How much do I f***ing weigh? Aren’t I humiliated enough here?” To administer the epidural, he had me bend over and asked me to stay still (which was absolutely impossible with my contractions coming non-stop and my body shaking furiously). He accidentally put it in wrong initially and I lost feeling in the entire right side of my lower body with my left side left completely unchanged. He was forced to put the needle in again. This time it dulled the pain, but didn’t take it away. “You can use this button to up the medication until you can’t feel anything,” he said with a smile. I nodded and dropped it on the floor. This wasn’t about pain. This was about my last chance to birth my baby. I was relieved minutes later when I dimly felt my baby moving inside me. It was a little thrill of victory. Nothing could sever our tie completely! The doctor suggested that we try to rest for the hour before she would check again and turned out the lights. I did lose consciousness for about forty minutes from sheer exhaustion. I don’t remember what I dreamed about, but I do remember waking up and seeing that the doctor would be back in about fifteen minutes and crying when I realized that it still was not over. I still did not have my baby. I still did not even know whether I was having a boy or girl.
When the doctor checked again, she saw that I was still at 8 cm and the swelling of both the baby's head and my cervix had increased. She held my hand as I cried and agreed that a c-section was probably my best option. It helped to talk to my doctor. She tried to make me feel better by saying that if it were at all humanly possible, I would have had my baby naturally. She also pointed out that 100 years ago, a woman like me would have likely labored for days and if I had been successful in having my son, it was unlikely that both of us would have been okay, but she promised that 45 minutes from that moment, we would both be alive, well, and together. She told me not to feel I was a failure and, whenever the time came when I wanted to try again, she knew I could be successful with a VBAC. She also told me that she suspected that the baby might have tucked his head the wrong way and was now stuck. (It turned out that she was right about that. That's why he hadn't descended properly and why I didn't finish dilating as I thought I would.) Her words were kind, but I found them hard to believe for a long time. She did offer me more time to see if maybe I just needed to relax more, but I did not want my baby exposed to any more epidural than he had already been exposed to, so I told her just to do the c-section. (Moments later, his vital signs started dropping, so I was glad that the room was already being prepped.)
The anesthesiologist was paged once more to get me ready for the surgery. I apologized to him for my rudeness earlier and he shrugged and said he’d seen worse. (I’m pretty sure that this “worse” wasn’t directed toward him, though.) As we rolled toward the operating room, I warned him that I would soon be throwing up. He asked if I was nauseous or if I’d eaten recently and I told him the answer was “no” to both of those questions, but using the epidural for the surgery would result in me throwing up. He smiled and said that probably wouldn’t happen. Just in case, though, he gave me an antacid. It tasted like liquid cheap cherry tums. “This will taste pretty gross coming back up.” I told him. He just laughed. “It won’t be coming back up,” he said. He was wrong.
Laying on the operating table, waiting for my baby to be born, I felt like a strange parody of what I had hoped my birth would be. My upper body could not stop twitching and although the medications kept me from feeling the pain of what was going on, I could feel pressure throughout my lower abdomen. Then I felt her pushing on my stomach and before I knew it I was retching all over myself and I didn’t stop at once or even twice. All I know is that I was mid-retch when I heard a baby crying and I had to remind myself that it was mine. It was 3:25 am on Monday morning. My baby was finally here. I still hadn’t seen him and it seemed like an eternity before they brought him for us to see. (They were waiting for the cord to stop pulsing which is what I had requested them to do.) Finally, they brought him around rear end first so we could see his sex. “It’s a boy.” my husband said with wonder and tears in his voice. Then they took the baby over to a corner of the room to get him weighed and my husband followed him. As the anesthesiologist administered an anti-nausea medication and worked frantically with one of the nurses to help clean all the puke out of my hair and change the hospital gown that was draped across the top quarter of my body, I heard my husband exclaiming all the features he recognized. “He has my monkey toes! He just grabbed my finger with them! And “He has blue eyes and they are amazing!” Meanwhile, I was struggling to keep my eyes open. The anti-nausea medication contained a mild sedative that ordinarily would have just made me slightly calm, but, after 27 hours of labor, was making it a real struggle to keep my eyes open despite the brightness of the room and the knowledge that my baby was there. I had anticipated a lot of emotions when I had my baby, but apathy was not one of them. I was ashamed of myself and my struggle to stay awake and engaged.
However, there was one moment in the OR that I will treasure forever. When my husband was first handed our son to bond skin to skin with him, I heard my baby scared and crying. Instinctively, I started singing him the special song I had sung to him every day with his name in it and he instantly quieted and calmed. Suddenly, everything was okay because he knew that I was near. “He KNOWS you and he KNOWS that song!” The anesthesiologist cried. “Of course he does,” I said tiredly, “I’m his mama and we’ve spent nine months together.” That was our only connecting moment that first hour or so. I tried to reach out and touch him as he snuggled skin to skin in a chair behind me, but my hand was so cold that he pulled away from it to burrow into his much warmer father. Mother/son bonding would have to wait until we got out of the operating room.
As soon as we made it back into the birthing room, the nurse handed him to me and helped me to nurse him which helped me focus and wake up more. To my amazement, he was able to latch on his first try and we even heard him swallowing right away. I laid back with him on my chest and finally got to bond with him skin to skin. As he burped, he looked at me and I looked at him and although it wasn’t quite as I had imagined it, we had managed to successfully nurse together and that small victory was something!

I share this as my contribution to ICAN's Cesearean Awareness month. Next week, I will talk about the surprising things I learned about c-sections while recovering from mine.


SaraMG said... [Reply to comment]

Thanks for sharing this story Shawna, it made me cry, what a shame it didn't go as hoped but how wonderful that you were surrounded by understanding people (and what a great husband!) that respected your wishes until a C-sec was no longer avoidable.

Rachael said... [Reply to comment]

I was just thinking I wanted to read your birth story again, and viola, there it is!!! Thank you for sharing :o)

Annie said... [Reply to comment]

You told my story!! Oh my gosh!!

My first baby was c-section cause she was breach 10 days past my EDD. I tried a VBAC at a birth center with a midwife with my 2nd. Went 8 days past my EDD and my water broke. 36 hrs of painful ctxs, every position, even nursing my toddler constantly, I was only 3 cms! I did what you did. I yelled at my body. I concentrated so hard and told it to dialate, to open up and let my baby out. But it did not. In fact, labor quit entirely after 30 hours. The last 6 hrs were contraction free.

36 hrs later I asked for the c-section. My midwife was willing to let me go even longer, but I was exhausted and worried about the healthy of my baby. I am so glad you found out why you didn't dialate. I never had that. To this day I have no idea why my body did what it did.

This quote from your story meant the most to me: She also pointed out that 100 years ago, a woman like me would have likely labored for days and if I had been successful in having my son, it was unlikely that both of us would have been okay, but she promised that 45 minutes from that moment, we would both be alive, well, and together.

That made me smile so big. I held onto that thought when I had my son and chose the c-section. Thank you!!

Shawna said... [Reply to comment]

@SaraMG I know, I am very very grateful for my husband as well and I am also grateful that I had a doctor and a hospital that did their best to make my c-section as "humane" as possible and respected my birth plan. If you have to have a c-section, it definitely helps to have the spirit of what you want respected.

Shawna said... [Reply to comment]

@RachaelAnytime! Hopefully, next time I'll be telling you all about my happy VBAC in person!

Shawna said... [Reply to comment]

@Annie I'm always relieved to hear those who have similar stories. I, too, am planning a VBAC for the next time I am pregnant, but I also want to make a goal for myself to be a little more forgiving next time if the natural birth doesn't happen. I've had a lot of mixed feelings regarding my c-section and writing out the birth story definitely helped me to remember more of the good than I had originally! Birth is never easy, but it is especially frustrating when you believe in something so much and then it doesn't work the way you believed it would. Kudos to you for hanging in with the VBAC. I hope to be brave like you when the time comes!

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