The Birth Backstory
Birth #1: Planned Unmedicated Vaginal Birth turned Emergency C-Section
With my first child, I took Bradley childbirth classes and planned on an unmedicated vaginal birth. I found the knowledge empowering, and actually switched OB practices at 36 weeks after feeling pressure to induce early without medical cause. At 42 weeks, my water broke the night before my induction appointment. I had some prodromal labor, but did not move towards active labor. At noon the next day, I had 0cm dilation and only 50% effacement. I was induced, and after 12 hours of nonstop contractions and a swollen cervix actually decreasing dilation, the OB suggested an epidural. He gave me time to think and talk it over with my care team, and I decided it was the right decision. 30 hours after my water broke, I was 6cm, and he ordered pitocin. At 32 hours, my daughter had enough and she went into distress. An excellent team of nurses worked hard to help me change position to keep her safe and keep me from the OR, but it just wasn't working. I was 8cm dilated but she wasn't tolerating labor anymore. I had to head straight to the OR for a c-section. When she was finally out, I was so relieved that she was safe, and so happy to meet her that I wept with joy. I felt blissful, and that feeling lasted for weeks. Not a hint of baby blues. I felt acceptance of my birth, because I trusted my doctor. He was a top recommended OB for natural birth in the area, and if he said I needed to deliver, I believed him. With my third, I took another childbirth class series as a refresher, which took my knowledge even deeper. These two classes, taught by Amy Bookwalter of Rosebud Doula, helped me learn exactly what happened during that birth. It felt like cascading interventions, but I couldn't decide what I would have done differently with my knowledge of pros and cons. When she described conditions leading to posterior (sunny side up) presentation and how things go during labor, it described my daughter's birth perfectly. My daughter's chin had gotten stuck, keeping her from descending. I didn't know enough about what could be done during labor to change her position and help her. I was very excited about what I learned in Amy's classes. But I'm jumping ahead a little bit.
Birth #2: Planned VBAC turned Scheduled C-Section
With my son, I planned on attempting a vaginal birth after cesarean, or VBAC. The pregnancy went smoothly, with no indication that it wouldn't happen. But when I hit 42 weeks and showed no signs of impending labor, the same doctor said that it was time to deliver. My last prenatal visit was a Friday, and he told me we would schedule a CS for Tuesday. Sunday night, I broke down and cried. Time was running out to go into labor. After a good cry, I felt a little bit better although I was still sad, and a little scared, about another c-section. Monday morning I woke up, and we decided to make a nice breakfast and spend the day enjoying ourselves as a family of three for the last time. We were just pulling into the parking lot of Potbelly to have lunch when my husband’s phone rang. It was the OB's office. The receptionist informed me that my “procedure” was scheduled for 3pm that afternoon. It was now 11:30am.
“I’m supposed to come in tomorrow for an exam, and then go to the hospital for either an induction or a c-section based on the exam,” I told her.
“There’s no room at the hospital tomorrow or Wednesday, so you have to come today.” Her attitude was curt.
“Well, am I being scheduled for an induction or a cesarean?” I was almost shaking at this point. I was supposed to have one more day to go into labor. One more day to come to terms with a second surgery.
“I don’t know. I’ll call you back in ten minutes. Don’t eat or drink anything. When was the last time you had something to eat or drink?” I answered the question, suddenly very glad I’d had a big breakfast and realizing that I was currently very hungry and thirsty. We parked in front of the Potbelly, waiting for the phone to ring, AC running. Finally, at noon, the phone rang again. It was my OB. He told me the hospital couldn’t book me any other day before July 6. He was not comfortable letting me wait that long, and neither was I. He told me to come to his office at 1:30 for an exam, and then I would go straight to the hospital. Basically, sticking to the plan, but a day early. When we arrived at the doctor’s office, they were already closed for the day. When I knocked, they told me that the OB had been called to the hospital for another c-section and would meet me and examine me at the hospital. When we finally arrived, they seemed a bit unsure what to do with me. I had apparently already been scheduled for a c-section, but they sent me to the waiting room to wait until the OB was out of surgery and could examine me. Finally, they took me back to a little triage room to change into a hospital gown and wait. He came in, and I could tell by his face while he examined me what the outcome was going to be. Even though I thought I was ready to hear the news, as soon as he left the room, I cried. For some reason that I can't remember, I was alone in the triage room. I walked to the OR and got onto the operating table under my own power. I’m glad. It gave me back a little bit of feeling of control. I was so nervous when the spinal was placed, and hated being in the OR without a support person there. The spinal block went in, and I felt the warmth and then numbness flow down my legs. They helped me lay back. It felt strange to be so exposed as everyone went about their business, with my arms strapped down. Finally, they hung up the curtain and sent in my husband. By now, I was shaking from all the hormones rushing through me. It had happened with my daughter too, so I was more prepared for it. I started panicking, thinking that I could feel my legs. The anesthetist ran a cloth over part of my belly and I freaked out because I could feel it. Then she said, "do you feel this?" I said, "No," and she said, "Good, because they've started." When he was born, we had some back and forth conversation about his name, but all I really wanted to do was roll over and go to sleep. Finally, we were in recovery, and I could hold him and nurse him. The nurse in recovery let us know that I was the last patient of the day, and when I was released from recovery, she could go home. I was completely and utterly exhausted, despite not having gone through labor. (Of course I was tired! I'd just gone through major surgery!) I felt numb. I didn't feel that immediate elation or love. It took me a month to feel truly bonded to him, and I struggled with postpartum depression and anxiety for more than a year.
I also missed out on the excitement of sharing the news with family and friends. Only one person was allowed in recovery at a time, so it was up to my husband to go out and announce the birth. A friend video recorded the announcement, which I didn't see until much later. There was so much joy out in the hallway that I missed out on witnessing.
I also realized that I had not been the first or even the second non-medical professional to hold my daughter. Of course my husband was the first, but because they wouldn't let me hold her until they were done monitoring my blood pressure, other family members got to hold her first. I was also restricted from nursing both of my babies immediately.
I started seeing a therapist who specialized in birth trauma and postpartum depression, although I hesitated to describe my own experience as traumatic. After all, it was a completely medically routine c-section. We were both healthy. My therapist recommended a book called A Good Birth. It was tremendously helpful in analyzing why I felt fine after one c-section but not after the second. I learned about the importance of agency, mutual trust, and respect in birth.
I initially assumed that a third birth would automatically be another c-section. I knew women who had VBA2C (VBAC after 2 c-sections) and one who had successfully had VBA3C. I also knew that a lot of these women had to fight hard for their options, and I didn't feel that I had the emotional energy. In December 2015, I read a beautiful story about a local family centered cesarean. The doctor had allowed a doula in the OR and used a clear drape at the moment of birth. The doula shared a photo of the mom holding her baby's hand through the drape while the baby's cord pulsed. Then the mom was able to hold her baby skin to skin immediately after the birth. I knew right away that I wanted that experience. The hospital was within a reasonable amount of distance to my home, and I had met the doula before--she was the backup doula for my first birth and we had met professionally as well. I immediately made an appointment with one of the OB's in the practice for my next annual visit. I met him and loved him! He asked me if I wanted to attempt a VBA2C. I was surprised that he suggested it! I told him that I was just starting to try to get pregnant and would hopefully see him soon.
After eight months of trying, I found out I was pregnant! I'd been tracking my fertility, so I knew exactly when I conceived. I have PCOS, and I conceived in a 60 day cycle. I'd had some spotting late in my cycle, so I gave that as the date of my LMP to the doctor. It was pretty close to the predicted due date based on when I ovulated. They predicted a due date of April 21. They did a dating ultrasound as well, which gave me an EDD of April 15. In the end, they went with the April 21 date. The actual due date based on my ovulation was about halfway between those two dates.
The doctors in the practice had no problem with my desire to wait until 42 weeks to deliver. Many doctors push repeat cesareans at 40-41 weeks, but I really felt like my babies need the extra time in utero. Neither of my other two had been big babies. I also decided to try again for a VBAC, if I went into spontaneous labor, since I had a supportive doctor. I hired Amy (Rosebud Doula again) as my doula, and she encouraged me to take her class. Once again, I can't recommend her class enough to anyone in the area. Her Weekend Madness class is incredibly useful for those planning births in or out of the hospital, medicated or unmedicated. We couldn't stop talking about everything we'd learned in her class, despite our previous knowledge and experience.
I saw a chiropractor throughout my pregnancy, for my own comfort and to work on the baby's position. I also worked with a prenatal masseuse. My husband described her as more of a prenatal physical therapist (although that's a different kind of certification) because she worked on specific ligaments to try to encourage a good position for the baby. It was less about a relaxing pampering session and more about aligning my body. However, it did relieve a lot of my late pregnancy aches and pains, especially in my pelvis. Totally worth it.
I continued to see my therapist and work on headspace so that I would accept any kind of outcome. I knew I was getting really excited about the idea of a VBAC, especially when I found out my hospital was getting a birth tub.
I had intense prodromal labor from about 36 weeks onward (I'm drafting a blog post about that experience too). There were so many times that I thought I was going into labor. I spent many nights in my bathtub, listening to music and swaying and moaning through contractions. I scheduled a CS date for 41 weeks and 6 days (by the doctor's count, 42 weeks 5 days by ultrasound). That gave me a date to count down to when the pains got intense. It also gave me time to prepare my mind for not going into labor, rather than playing a last minute wait and see game.
As I headed for 40 weeks pregnant, I was trying almost everything to get my body ready and go into spontaneous labor. I'd been drinking red raspberry leaf tea to tone my uterus (although I took a break to see if it was related to the prodromal labor. It wasn't). I ate a very large number of pineapples. I made the magical marinara sauce and the magical lemon cupcakes. I ate dates. I did Spinning Babies exercises. I used my breast pump and manual nipple stimulation. After 41 weeks, I went for three sessions of acupuncture. Frequently, after trying something, the prodromal labor increased, but it always stopped. At my weekly prenatal visits, my cervix remained as impenetrable as Fort Knox. Only a few things remained off limits: castor oil and evening primrose oil, both of which I'd tried the first time and had since researched and decided weren't worth the associated risks. Really, if you've heard of it as a natural or at home labor induction technique, I either tried it or decided it wasn't right for me. I can almost guarantee I've heard of it.
I was also working on my head space. I made a c-section playlist, carefully adding, deleting, and moving songs around until it was perfect. I listened to it while I was in the tub or trying to nap, and visualized the steps of a CS, trying to imagine what would happen during each song. I listened to the Earth Mama Angel Baby Labor Companion CD to help me through prodromal labor. I purchased a digital download of some beautifully lettered inclusive birth affirmations. I read them over and over again. And I continued to go to therapy throughout my pregnancy.
Finally, it was the last week of my pregnancy, with my c-section scheduled for Thursday. I was still a little nervous about how I would feel after a repeat CS, now that it seemed the most likely outcome. For the last seven days, I stopped trying to go into labor. I only worked on my head space and focused on my family. I'm very very glad I took that time.
At my last prenatal visit that Monday, my OB suggested I come into L&D on Wednesday to see if I could be induced with a foley bulb. If it didn't work out, we'd go ahead with the scheduled CS on Thursday. I agreed to the procedure. I wasn't hopeful that it would be a possibility, given that my cervix was still not favorable for induction, but I wanted to truly feel like I had exhausted all my options before heading to surgery.
Birth #3: Family Centered Cesarean
On Wednesday, we went to L&D as planned but my cervix was still high, closed, and tight, so it wasn’t possible to insert the necessary balloon. I’d been so prepared for that outcome that I hardly told anyone we were going in. While I was there, they monitored baby’s heart. It was within the range of normal, but on the lower end, lower than it had been at all of my prenatal visits. I drank a bunch of apple juice and ice water, while our doula, Amy, poked at my belly to try to get baby to wake up. The baby woke up enough to get some higher numbers, and they let me go home. But for a few minutes, I was sure they were going to admit me to have a baby right then. I also realized that I was completely at peace with that. I was ready for the prodromal labor to be done and to be able to see my baby and know he/she was ok.
That night, we went out to dinner with our families. The big kids went to spend the night at Nana’s house and my husband and I went home. On the way home, my prodromal labor was incredibly intense. It felt every bit like active labor, not just early labor. My back ached and I moaned through every contraction and could hardly wait to get out of the car and change position. Finally, we made it home. My husband ran a bath for me while I laid down. The contractions lessened in intensity once I was out of the car, and the rest of the pain went away once I was in the bath. I listened to my birth playlist and walked myself through the steps that would happen the next day. My husband shaved me in preparation for surgery, rather than having a nurse do it in a sterile and medical environment the next day.
Thursday morning, we woke up naturally around 7am. By this point, I felt nothing except excitement that I was finally going to meet my baby! We took care of our animals (dog, chickens, rabbits) and headed over to the Dunkin Donuts for the husband to get some breakfast. It was a little bit of tradition--we stopped at Dunkin Donuts on the way to the hospital to have our daughter. Then we popped into the Hallmark store to buy a little stuffed Yoda doll for our Star Wars Day baby. Finally, we were on our way to the hospital.
We arrived at the hospital a little before 10am and met Amy in the lobby. The three of us walked back to Labor & Delivery together, where we were greeted warmly at the nurses station. One of the nurses took us back to our triage room. They got an IV started and hooked me up to the monitors. The hospital has an essential oil diffuser, so Amy set that up with some lavender oil to help me relax. After a bit, my sister showed up too. One of the most gratifying parts of that part of the day was to watch my contractions on the monitor. For so long, I had felt crazy or wimpy, but now there was empirical data that I wasn’t just making it up or imagining things. You could see the strength of some of the contractions right there on the print out. And now I knew it was almost done. A nurse came and asked for a copy of my birth plan.
The anesthesiologist came in right at noon to talk me through the anesthesia. I asked if I could have one or both of my support people (Amy and Husband) come back with me during prep and insertion of the spinal. He told me both could be there during the surgery, but I had to pick one during prep because it’s such a busy time and he needed space to work. A little while later, my OB arrived. His excitement was contagious even though I was starting to feel nervous. Amy and Husband put on their surgery cover ups and walked to the OR with me. I said goodbye to Husband, who was going to wait back in the triage room until they were ready for him. Amy walked into the OR with me, and people started introducing themselves. By now, my heart was pounding and I was feeling really anxious. The nurse anesthetist was wonderful at explaining everything she was doing--I’d been through it all before but it’s practically impossible not to get nervous when you are about to undergo major surgery and remain fully conscious. I leaned on Amy while the anesthetist placed the spinal. Amy reminded me to release tension and kept me calm. She also pressed on pressure points on my palms while the needle went in. Then they laid me back on the table. When I was nervous, they calmly and respectfully talked me through. They checked and double checked to make sure I was numb. Amy stayed right by my head, talking to me and narrating.
The neonatologist came over and told me that she’d read my birth plan and saw that I wanted skin to skin. They unsnapped my gown and pulled it down so I was ready, then put a blanket over me to keep me warm during the surgery. All the leads had been placed on my back, out of the way. The IV was placed in the top of my forearm to be out of the way for the same reason.
Finally, they brought Husband in and he started my birth playlist. That morning, we’d jokingly added the Star Wars Throne Room music to the beginning of the playlist, and when he hit play, we all giggled a little bit. After about 30 seconds, I was ready for the relaxing music I’d picked out so we skipped to the first official track: Offering, by the Avett Brothers, which is our song. I started crying happy tears. By then they were beginning the surgery. Dr. G. was laughing and joking with me. He said “there’s a huge cyst in here! Oh wait, it’s your uterus.” The second song was “Let it Be,” and a few people started softly singing along. It gave me such a moment of connection with the people who were in the room. The third song was Blackbird, which we skipped when finally, Dr. G. very excitedly announced that it was time to lower the drape. I saw him pull out the baby’s head, and they quickly lifted the baby out and placed it on my abdomen. It was so fast that Husband didn’t see whether it was a boy or a girl, so they held up the baby and he shouted “it’s a girl!” We were both shocked! Then they put her back down, right up next to the clear drape, and I touched her through the plastic, holding her hand as best as I could. She was crying and I wanted to hold her, but we were waiting for the cord to stop pulsing. It stopped pulsing right at the two minute mark and they clamped it and brought her around to my side of the curtain. They placed her on my chest, and finally, I was holding her in my arms. She immediately started rooting around and trying to latch on, even though I hadn’t planned on nursing in the OR. Amy wiped her mouth a few times because she was draining amniotic fluid. All this happened during song #4, Israel K’s Somewhere Over the Rainbow/What a Wonderful World. I was crying happy tears and felt so much love and warmth. While Dr. G. was stitching me up, he kept looking down at me through the clear drape and smiling. Little Girl and I just stared at each other. Everyone was so joyful and centered on birth during the surgery. It never felt like just a routine day at work. Husband and Amy took pictures while I stared at my newborn daughter and tried to process that she was really here..and a girl! Dr. G. joked that he couldn’t take her back, all deliveries were final.
When they were done stitching me back up and almost ready to move me to recovery, they took her for her measurements and newborn procedures. Husband went to the other side of the room with her, while Amy stayed with me. They wheeled us all to recovery where I saw my sister and got to see her reaction when she saw the baby and found out she was a girl. It was an incredible moment. More crying on all sides. The recovery nurse, who had also been my prep nurse, seemed really excited too. As soon as my bed was in place, they gave her to me again and I nursed her a little more easily now that I wasn’t completely flat on my back. Then they wheeled us down the hall to the mother baby unit. She spent most of her first hours on my chest, snuggled up skin to skin, where she belonged.
Why does having a "Good Birth" matter?
I was able to have every single thing I asked for in my c-section birth plan for four reasons:
1. Supportive OB. You have control over this part. Interview OBs, even before you are pregnant. Ask them about your options from the beginning. Even if you are planning a vaginal birth, have a c-section birth plan and discuss it with your OB ahead of time.
2. Supportive hospital. This hospital has made it a priority to offer these types of cesareans. It happened because of a lot of advocacy before I even got there.
3. Supportive anesthesiologist. In the OR, the anesthesiologist is actually the top boss. They get to decide who is allowed. They may limit support people because of space or worries that a support person will get in the way or even faint. There were two anesthesiologists at the hospital that day. The other one said he would not have allowed more than one person into the OR, and no one at all during prep. You probably don't have control over who you will have as an anesthesiologist.
4. Everything went smoothly. This is the area of least control. I had a scheduled c-section, but complications can always happen. Because it wasn't an emergency, we were able to take time.
That being said, I feel strongly that every birth should involve respect, informed consent, and an acknowledgment that birth is a big deal for the family. Delayed cord clamping or immediate skin to skin can't happen if mom or baby is in distress, but the medical team can still keep the attention in the room on the people who are central to the experience.
If you have a positive experience at a hospital, especially if they are breaking norms, write thank you notes. Write positive reviews. Write letters. Share your experience widely. Our anesthesiologist let our doula into the room because a previous anesthesiologist had allowed her in the OR. Precedent matters.
And now, for photos.
2. See the hand on my head? That's Amy's hand. She kept a hand on my head almost the entire time, which was incredibly reassuring. You can see it in the top three pictures.
3. That look on my face is absolute pure joy.
4. The only gap between her on my belly and her on my chest was the time it took them to walk around the table and get her safely situated on my chest. My hands are free because they were never strapped down.
5. That skin to skin time was amazing. Traditionally, c-section moms are deprived of the "golden hour" of skin to skin time that's recommended. I got a good portion of that hour.
6. You can see husband on the other side of the room, where he's standing with the baby (camera strap across his chest). By the time they took her, they were ready to take down the drape. Amy stood right by me so that I wasn't alone, telling me what was happening. She only stepped back from me to take this picture for me. Those moments without partner or baby are the loneliest part of a CS and I can't express enough what it meant to have someone by my head, telling me what a good job I did.
I also have photos of her emerging, which is amazing to me. I realize not everyone wants to see themselves being operated on, but I thought it was cool. (I couldn't see any part of my own body through the clear drape, by the way).
Childbirth Classes/Doula: Amy Bookwalter, Rosebud Doula
Prenatal Massage: Marilyn Alger
Chiropractic Care: Dr. Erica Statman, Maimonides Chiropractic
The OB practice for this birth was Capital Women's Care, with Dr. Gonzalez as the delivering OB. The hospital was Prince William Hospital. Not only did I have an excellent birth experience, the postpartum care was above and beyond. They promote skin to skin bonding and were very supportive of breastfeeding, although formula was available if I needed it. Every part of our stay was positive.
And finally, please reach out to me if you have any questions.