Then what should we do about the C-section rate?

Inspired by a discussion on my last post with reader Amanda Anderson, I want to talk more about the rate of Cesarean sections in the U.S., and what, if anything, I think ought to be done about it.  Most definitely, the answer is not hanging creepy “awareness” ribbons.  I am not a medical professional—just a rather opinionated C-section mama.

Be realistic about the issueSo the C-section rate in the U.S. is “too high”?  What does that mean?  Let’s look at some numbers: In 2014, 32.2% of all deliveries were by C-section.  However, only 26.9% of low-risk deliveries were C-sections.  That’s still a pretty big percentage, and the U.S. Department of Health and Human Services agrees: they’d like to see the C-section rate for low-risk deliveries get down to 23.9% by 2020.

“Over the past three decades the WHO-proposed caesarean section rate of 10–15% was used as a threshold, despite the lack of concrete evidence to support this statement.”—Ye et al. (2015)

23.9% might be higher than some target numbers you’ve heard.  It’s very common for midwives and company to quote the old 10–15% C-section rate advocated by the World Health Organization (WHO), although the WHO no longer quotes a specific target rate and the original numbers were based on scant data.  It’s clear that 10% is a solid bare minimum, but recent studies show that maternal and neonatal mortality rates continue to drop until C-section rates are at least 20%.  (And bear in mind that death isn’t the only possible negative outcome; oxygen deprivation during birth can lead to severe brain damage, and even less severe effects like a broken collarbone are perhaps not desirable.)

So when I say “be realistic,” I mean this: don’t look at the U.S. C-section rate as being twice as high as it ought to be.  It’s more like a few percentage points higher than the optimum.

Recognize that it’s about risk.  It’s easy to say that if the C-section rate is too high, then some C-sections must be unnecessary, but which ones?  How can we tell in advance?

The reason for my C-section was a breech baby (meaning he was oriented head-up instead of the usual head-down).  Doctors like to avoid breech vaginal births because there’s a chance the baby’s head could get stuck after the rest of its body has already been born, a scary and potentially deadly situation.  But it doesn’t happen that often: for every 111 breech babies delivered the normal way, 1 baby dies.  Meaning, 99.1% of the time, that baby could’ve been born vaginally just fine, and so technically that C-section was “unnecessary.”  But we can’t tell in advance which babies will make it through—are you willing to take that 0.9% risk?

“Obstetricians are sued more frequently than physicians in most other specialties, awards against them can be very large, and they pay more for liability insurance coverage than any other specialty except neurosurgeons.”—Yang et al. (2009)

Risk is also at play when it comes to hospital rules, like how long you’re allowed to push during the second stage of labor, and whether or not you can attempt a VBAC (vaginal birth after cesarean).  For better or for worse, we have a very sue-happy culture in the U.S.  If your local hospital’s medical malpractice insurance doesn’t cover VBACs, they’re kind of stuck.

Don’t demonize doctors.  I’m sure there are obstetricians out there who are overly pushy when it comes to medical interventions in childbirth, and who make women feel out of control.  There are also midwives who are too pushy in the other direction and contribute to maternal and fetal deaths.  Every profession has bad apples, and humans in general are very susceptible to ideology.

But here’s my anecdote as a counterpoint: my OB very seriously warned me about the risks of a C-section and encouraged a version, which is when a doctor tries to turn the baby from the outside.  The specialist who did the version tried and tried, far beyond the expected three attempts, until his arms shook, because it seemed like my baby might turn.  The hospital was as nice of a place as hospitals can be, and the nurses were wonderful throughout.

Moving beyond anecdotes, I believe we shouldn’t put too much blame on doctors because we need them to work with us.  If there are medical practices that need changed, doctors are going to be the ones to do it.  Painting them as scary interventionists who just want to get to their golf games is not only largely untrue, it’s antagonizing to the very people who could be our greatest allies in improving obstetric care.

Focus on maternal health.  Your average media article about the U.S. C-section rate treats it as the problem.  But what if it’s the symptom?  We know that the U.S population has high rates of obesity, heart disease, and diabetes, all conditions that make pregnancy and birth more risky.  We know that income inequality and access to affordable health care are huge issues in this country.  I believe that if we focused on those issues, mothers and babies would be healthier, and the C-section rate could naturally fall.

Speaking from my own experience, U.S. health care is a pain in the butt to navigate.  It’s a maze of insurance and referrals, waiting lists and three-letter acronyms.  And I’m an educated person, with financial and family resources—exactly the kind of person who ought to find it easiest to get good health care.  Imagine a mother who can’t easily take time off for OB visits every few weeks.  Who can’t rest up in late pregnancy because she has to save up all her sick days for after the birth.  Who can’t afford her co-pays.  Her prenatal health is going to be worse, and she’s going to be at greater risk of needing a C-section.

I often see the U.S.’s C-section stats compared to those of countries in northern and western Europe.  You know what those countries have?  Socialized medicine!  Social safety nets!

Support research.  And no, I don’t mean more research about the many possible ways in which C-sections could be scary.  I mean research about the facts of birth.  For instance, a 2014 study showed that with an epidural, it can be safe and normal for the pushing stage of labor to last up to nearly 6 hours, twice as long as the accepted norm.  That’s good, useful information, because it can inform hospital and obstetric policy.  Knowing that, doctors won’t feel like they’re taking as much of a risk letting women push for longer.

We need more data like that.  What is a “normal” labor for women in the U.S., given the current health and demographics of the country?  Can we find more markers of “low-risk”?  Can we develop better technology to measure pelvic widths (to rule out the problem of a too-big head), or to better augment labor when it’s slowing (to keep things going without a C-section)?  The better we can distinguish who’s going to need a C-section before birth, the more we can keep the rate of C-sections where it needs to be.

Make birth centers more available.  One story I hear over and over again is that women didn’t feel like they had any choice about the situation in which they gave birth.  Proper birth centers, that are staffed by proper nurse midwives (CNMs), and that have referring relationships with hospitals, would help with that.  They’re relatively rare, for reasons that I don’t completely know but suspect relate to insurance and perhaps to a general lack of CNMs.  (Midwifery qualifications in the U.S. have several tiers; only CNMs have qualifications on the level of midwives in Europe.)

Birth centers wouldn’t change the underlying health issues faced by many women, or reduce the number of high-risk births, but by offering a choice, they might bring the low-risk C-section rate down that last few percentage points.

And finally…

Stop scaring mothers.  I’ve said this before and I’ll say it again: we have to stop telling women that C-sections are bad.  If we set them up to believe that the surgery will be a bad experience, they’re much more likely to feel that it was.  Now, I know women who’ve had scary C-sections, because they were in an emergency situation and had to suddenly stop pushing and be rushed to the operating room.  I also know women who’ve had scary vaginal births, with stuck shoulders and painful tears.

The burden of changing the C-section rate does not lie on individual women, nor should it.  Women should be free to choose Cesarean if that’s what they want, or if it’s what they feel offers the safest route to a healthy birth.  No woman should be made to feel the need to defend her C-section, chosen or not.

Well, readers, I think that’s all I have to say on this, for now.  What do you have to add?

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What the heck is Cesarean Awareness Month?

I’ve seen on several blogs lately that April is Cesarean Awareness Month, which sounds pretty cool on the surface of it.  Let’s talk about our C-sections!  Let’s share our experiences (here’s mine).  Let’s talk about realities versus perceptions, the good (babies!) and the bad (weird numb incision sites).  Let’s commiserate about how those pneumatic anti-blood-clot things they make you wear on your legs in the recovery room are really loud and obnoxious.

There’s just one little problem.

Turns out that’s not what Cesarean Awareness Month is about.

No, some quick Googling taught me that CAM is put on by a group called ICAN (the “International Cesarean Awareness Network”), to whom I will not link.  ICAN’s mission is to reduce the number of C-sections performed.  Their “educational” material is all about how risky C-sections are*, how to avoid an “unnecessary” C-section**, and how to get over the disappointment that of course you’ll experience if you have one.***

They mean “Cesarean awareness” in the same way that other groups talk about “breast cancer awareness,” as though C-sections were a disease that needed to be eradicated.  They even have a ribbon for it!  (It’s burgundy, in case you’re curious.)

Ew.

Ugh.

No.

Don’t do that.

Don’t hang a ribbon for me because I was born by C-section.  Don’t hang a ribbon for me because I gave birth by C-section.  Don’t act like either of those is a terrible, terrible thing that makes me unhealthy and traumatized.  Don’t act like I didn’t make the safest choice for my baby, and that my mom didn’t make the safest choice for me.

Seriously.

 

*All things being equal, yes, surgery is riskier (to the mom).  All things are not always equal.  It’s not like vaginal birth is risk-free, either.

**Can we please stop with the false narrative that most Cesareans are unnecessary, and instead focus on actually improving maternal health?

***And can we please, please stop acting like C-sections are an inherently traumatizing experience?

How I came to hate attachment parenting

When Little Boy was an infant, I spent a lot of time online.  Trying to keep myself awake, mostly.  Somewhere amid the long dark nights, I found myself Googling “I hate attachment parenting.”  I needed affirmation for the black fire of anger that had arisen during pregnancy and spilled out everywhere during those newborn days.  I needed someone to tell me it was OK to parent in a way that really, truly worked for me and my baby.

This post is about where that black anger came from, and why I’ve had so much trouble letting it go.

Before I go any further, let me be very clear on one thing:  If you practice attachment parenting or any of its components because it is what works for your family, then this post is not about you.  All the core components of AP fall onto the spectrum of perfectly acceptable parenting behavior.  We did several of them ourselves: I breastfed Little Boy for 17 months; we frequently “wore” him around the house and neighborhood; we room-shared for the first few months.  Heck, most of those things are recommended by the American Academy of Pediatrics (AAP).

No, when I say I hate attachment parenting, I mean that I hate Attachment Parenting™, the worldview that believes that it is the only acceptable way to parent.  I hate the naturalistic fallacy that has infected the white, liberal, middle-class approach to parenting, and I hate the misinterpretations and misappropriations of science that are used to back it up.

It started when I was pregnant.  As those of you who’ve read Little Boy’s birth story know, I was interested in “natural” birth—that is, giving birth without pain medication—until Little Boy flipped breech in the third trimester and it became clear that a C-section was likely.  I am the kind of person who likes to learn as much as I can in advance, so I did a lot of reading about “natural” childbirth.  Only… it turns out that there aren’t a ton of resources for women like me, women who want to skip the epidural but stay in the hospital.  It was always sort of assumed that if I was going that route, then of course I didn’t trust doctors and of course I’d probably really want to give birth at home.

Here’s the thing: I’m a trained scientist.  I may not be a medical expert, but I have enough background to read medical papers, and my university affiliation gives me access to the full text of most major journals.  I can tell when people are spewing bullshit, and my bullshit meter was blaring like a siren.  It was so easy for me to check that all the woo about homebirth was wrong.  And all this scary stuff that people were telling me about hospitals?  It hasn’t been true since before I was born.

Unfortunately, while it was easy to dismiss the stuff that was obviously fringe, it was much harder to ignore that which had crept into the mainstream.  One of my friends, a smart, educated woman, was reading Ina May Gaskin and planning to deliver at a local birth center.  So that couldn’t be that weird, right?  The local hospital’s birth classes were taught by doulas and lactation consultants; the hospital itself boasted that babies were expected to room-in full-time after birth.  So that was good, right?

Except… My OB was a wonderful, caring woman, and the lactation consultant who visited our hospital room was a jerk.  Full-time rooming-in was terrifying and exhausting.  All of the naturalistic stuff I’d been hearing just didn’t jive with my experiences.

The second step came with the breastfeeding.  The funny thing is, breastfeeding went really well for us.  No problems with supply, no issues with weight gain, nothing to feel guilty about.  So why does the über-pro-breastfeeding culture make me so angry?

Well, there was the way the lactation consultants in my breastfeeding class spent the first 10 minutes telling us how inferior formula was.  We’re here at this class—we’ve already decided that we want to breastfeed!  Plus they seemed to be going way beyond what the science actually says, twisting and stretching the facts to suit a certain narrative about good motherhood.  Like I’ve said, I hate it when people get the science wrong.

Yet again, I found that there was no place for me in mothering culture, no place for a mother who wanted to breastfeed but didn’t want the answer to everything to be “more boob.”  It has always been extremely important to my husband that he be an active parent, and so it was very important to us that both parents be able to soothe Little Boy.  I didn’t want to nurse every five minutes.  I can’t nurse every five minutes and keep my sanity.  And you know what?  Little Boy didn’t need to nurse every five minutes.

It turns out, though, that when you search for the answer to breastfeeding questions, the answer is always “more boob, more often.”  Even when that doesn’t make sense.  Even when it’s clear that baby isn’t hungry.  The top-listed resources, Dr. Sears and KellyMom and La Leche League, they all assume that of course mom is going to be with baby constantly, probably co-sleeping, and dad’s just there to help out.

Attachment Parents like to tell you that their parenting beliefs are all about “following your instincts.”  They’re just doing what they feel they should do!  But here’s the thing: my instincts about parenting were always on the side of “he’s fine, give him a minute.”  I never had an “instinct” to run to the baby the second he started crying.  I love snuggling with him, but my “instinct” is always to put him down so that I can do things for myself once in a while.

I made the mistake, during pregnancy, of joining my “birth month group” on BabyCenter.com.  Oh hell no—do not do that.  BabyCenter purports to be a mainstream resource, but in its fora I saw women excoriated for letting their babies cry for THREE whole minutes.  Horrors!  Apparently my instinct—that is was OK to let Little Boy fidget a bit while I set up my environment to be comfortable for nursing—made me a terrible mother.

I’ve never felt the need to stare into Little Boy’s eyes constantly while I nurse, or to be down on the floor with him every second of his playtime.  Quite the opposite, in fact: I need time to myself in order to literally stay sane enough to function.

What do you do, when the culture is telling you your “instincts” are wrong?

I was already pretty viciously anti-attachment-parenting by the time we sleep trained Little Boy, but that was the last straw.  Our baby, at the age of three months, was not interested in being nursed to sleep, nor in being rocked gently off to dreamland.  We know.  We tried those things.  As long as something worked, we were willing to do it—but nothing worked.  Little Boy resisted sleep, and woke from his naps cranky and tired.

Sleep training (we used the Ferber method) was a miracle.  It took only a few nights and surprisingly little crying.  Little Boy, it seems, wanted the space to be left alone to sleep, without rocking or singing or nipples in his face.  He was happier, we were happier, and I have never had any doubt that we did the right thing.

Sleeping training, though—from an attachment parenting perspective, that is the worst thing we could do.  Some commenters have implied that we should have waited until six months.  One woman online told me that I was lazy and clearly didn’t know how to soothe my baby!  (I do know how to soothe my baby.  It involves giving him peace and quiet.)  I have seen mothers adopt severe martyr complexes about what they endured to avoid “crying it out,” even more than the martyr complexes they take on about breastfeeding.

My baby needed to learned to sleep on his own.  Anyone who thinks otherwise can fuck off.

Much later, I checked out Dr. Sears’ The Baby Book, that bible of attachment parenting, from the library and read it, wondering if perhaps my impression of him had been wrong.  Nope.  The Baby Book is every bit what I thought it was, filled with dire warning about the “bad start” of an un-“natural” birth and a general snide message of “don’t you want to know that you did the best for your baby?”  The “best,” of course, being Dr. Sears’ tenants of attachment parenting.

I’ve noticed that Attachment Parents like to present an aura of being rebels, of going against the mainstream.  It’s one of the things that seems to appeal to them.  But are you kidding me?  I’m sure there are places where it’s some of this stuff is still unusual, but on the whole?  In the media?  Give it up, you guys, you already won!  The AAP is staunchly pro-breastfeeding.  Babywearing has been common for a quarter-century.  Bed-sharing remains controversial, but the AAP itself recommends room-sharing.  The classic baby-care guide What to Expect the First Year won’t even answer the question of how to put a three-month-old on a regular schedule.  Among the white, liberal, educated middle-class, the attachment parenting approach is already the norm.

In fact, that’s why it’s so hard to reject: because there are bits and pieces of it that are smart and good and true, or at least reasonable under some circumstances.  If it didn’t pretend to be based on science, I would laugh it off just as I laugh at the anti-vaccine crowd.  But it pretends to be The Right Answer, and it drives the guilt that underlies my approach to motherhood.

So there it is: the anger.  Little Boy is one year old, going on two; you’d think I could let all this go by this point.  But I still remember the deep black darkness of his early days, and I remember how much the feeling that I was doing something wrong contributed to that pain.  I felt alone and judged and hopeless, and the attachment parenting ethos is one reason why.

And now, if you’ll excuse me, I’m off to be a DEtached parent.

Stop acting like C-sections are always terrible

The concept of “gentle” C-sections has been making the news lately.  (Well, actually, I think it was making the news rounds back in March, but a friend recently brought it to my attention again.  They’ve been available in some hospitals for several years.)  In a nutshell, a gentle cesarean means allowing the mom to watch her child’s emergence, then laying the baby immediately on the mother’s chest.  The newborn thus gets immediate skin-to-skin contact, just as is recommended after a vaginal birth.

I think this is a great idea.  It wasn’t offered to us as an option for Little Boy’s birth, but we didn’t ask, either.  As it turned out, I was in no condition during my C-section to appreciate such a thing.  All my energy was focused on surviving the pain (don’t worry, that’s not normal).  Instead, Little Boy received nearly an hour of skin-to-skin time with his father before being brought to me for his first attempt at nursing.  It was wonderful.

However, I am seriously annoyed with the conversation in the media.  Take this NPR article, for instance, titled “The Gentle Cesarean: More Like A Birth Than An Operation.”  Wait, what?  More like a birth?  Excuse me, but I think that when a baby is born, it is a birth, regardless of whether surgery is involved.

Or take this paragraph from the start of an NBC Today article on gentle C-sections:

Friends and family who had gone through it told her it was more like having surgery than giving birth. A C-section is just happening to you, it’s not an experience, they complained.

Yes, a C-section does involve a lot of laying on an operating table thinking wow, this is crazy.  But it is sure as heck an experience!

Both articles describe cesarean sections with words like cold and sterile, and feature stories of women describing “vague memories,” “failure,” and “feeling empty.”  Why is this the dominant story we tell about C-sections?

Birth, no matter the method, can be traumatic both physically and mentally, and it can be made better or worse by the environment and demeanor of the medical professionals involved.  Because C-sections come into the picture when there are complications with pregnancy or labor, it stands to reason that there are more terrifying and traumatic birth stories associated with C-section deliveries—they are, after all, the option that saves lives when things go very, very wrong.

But treating C-sections as inherently negative, traumatic situations is a self-fulfilling prophecy.  If women are made to fear cesareans, if they are told that the operation will hinder bonding and breastfeeding, if the resources they read imply that a C-section represents a failure of womanhood—then of course they will feel scared, awful, and disappointed if one becomes necessary.

One of the women interviewed in the NBC Today article, the one who described feeling empty after her C-section, explains her hopes for her next birth:

Now pregnant with her third child, [she] is hoping to be cleared for a vaginal birth, but is comforted by having access to a family-centered cesarean if not, she said.

That’s all well and good, but what if there’s an emergency?  Will she feel the same sense of mourning and failure for something completely out of her control?

There is a hesitation, it seems, to talk about positive cesarean experiences, as though to do so would encourage women to ask for them and doctors to perform them unnecessarily.  But the “ideal” C-section rate—the rate below which mothers and babies start to die in childbirth in increasing numbers—is 10–15%, according to the World Health Organization.  That means that 1 in every 7–10 moms should be having a cesarean.

We shouldn’t be telling those women to expect to feel like a failure.  We shouldn’t be making those women afraid.

Cesarean plus laughing gas: Little Boy’s birth story, part 2

Where I left off at the end of Part 1, my stubborn little breech baby had refused all efforts to turn him head-down.  I was already in a hospital bed, hooked up to the appropriate IVs and a low-dose epidural, and it was time to head to the operating room for a C-section.


Getting prepped for the C-section was rather surreal.  I’d never had surgery before, and it was a new experience to be so completely uninvolved in what was happening to my body.  The situation wasn’t an emergency – after all, I wasn’t in labor and my baby was perfectly healthy – so things proceeded fairly smoothly, except for some confusion about which anesthesiologist was supposed to stay with me and which one needed to go assist with some other operation in another building.

At some point, my epidural dosage was increased.  I still had enough control of my lower body when I entered the OR to help move myself from the bed to the operating table.  (I remember one of the nurses rushing over because the other nurse hadn’t properly stabilized the bed for the transfer.)

“This is the weirdest thing I’ve ever done,” I told someone when they asked how I was doing. By that point, I was lying flat on my back on the operating table, mostly naked, with my arms extended – all while processing that my baby was arriving very soon.  “Weird” doesn’t really do the feeling justice.

My husband, meanwhile, was getting suited up and waiting.  He was brought into the OR only when everything was ready and the surgery was about to begin.  We had already agreed that he would stay with me for the birth, then follow our son to the nursery while I was being stitched back together.  Before they wheeled me away to get ready, I’d firmly entrusted him with the responsibility of taking the first pictures of our child.  (He did a great job.)

He sat down at my left side and took my hand.  The anesthesiologist was at my right, giving me some kind of instruction on what to do if I felt queasy.

On the plus side, I definitely didn’t end up feeling queasy.

Here’s what some popular references have to say about what you’ll experience during a C-section:

What to Expect When You’re Expecting: “… you will probably feel some pulling and tugging sensations, as well as some pressure.”

The Mayo Clinic Guide to a Healthy Pregnancy: “If you’re awake, you’ll probably feel some tugging, pulling or pressure as your baby is pulled out. … You shouldn’t feel any pain.”

WebMD: “You will probably feel slight pressure at the incision site, but not any pain. … You may feel a slight tugging sensation as well as feelings of pressure …”

You get the idea.

The anesthesiologist said something very similar when I started moaning and calling out that it hurt.  “You’ll feel some tugging and pressure…”

I no longer remember the exact back-and-forth, but my husband and I had to state quite emphatically that what I was feeling was PAIN and it was NOT OK.

That’s why the anesthesiologist gave me laughing gas during my C-section.

It was excruciating.  The epidural must not have numbed my abdomen far enough up; the pain I felt was all the manipulation of my son that had to happen in order to remove him through a 5-inch incision.  (I didn’t feel the incision itself, thank goodness.  That part at least was numb.)

Even with laughing gas taking a little of the edge off, it was horribly painful.  The anesthesiologist told me that the last option was to put me to sleep completely for the rest of the surgery, but that if I thought I could make it, it wouldn’t be long now before the baby arrived.  I didn’t want to be put under and miss the birth, so I focused on each breath of gas and on my husband’s tightly-gripped hand, with his accompanying words of encouragement.

I’ve never loved my husband more than I did during that surgery.  Laughing gas gets some of the credit, but it was his strength that allowed me to stay awake for the birth of our son.  He told me I could do it, and I did.

What felt like an eternity later, someone said they could see the baby’s toes.  I know they meant it to be encouraging, but it wasn’t.  Toes?  You’ve all been telling me that the baby’s almost out when his toes are only just starting to poke out now?  (Remember, he was breech, so his bottom half would be first.)

Another eternity later, I heard a baby cry.

“Do you hear that?  Do you know what that is?” someone – I think it was my husband – asked me.

“It’s a baby,” I whispered in relief.

They brought my son, warmly swaddled and topped with a pink-and-blue-striped hat, over by my head for me to see.  His chubby cheeks and button nose matched the face we’d seen in a 3D ultrasound.  I reassured my husband that he could go with our child, that the worst part of the surgery was over and I could make it without him, and they left.

The rest of the surgery is kind of a blur.  It still hurt, but not with the same intensity.  Eventually, it was over and I was wheeled back to the room I’d started out in, where a nurse and her trainee monitored my progress and spent an extraordinary amount of time going over how to enter medications into the hospital’s new computer software.

I thought at first that I should try to avoid additional pain medication (an idea my nurse rightfully thought was a bad one), but the ache in my stomach grew worse and I began to shake.  Two doses of Demerol and a pile of warm blankets helped with the shaking.  The pain, however, remained, prompting the following exchange:

“On a scale of 1 to 10, how bad is the pain?”

“Uh… 6 or 7, I think.”

“Which one?  If it’s a 7, we can give you morphine.”

“It’s a 7.”

As I started to feel slightly better physically, I also started to get rather bored.  The nurses weren’t really that interested in talking to me, and listening in on their computer lesson was only entertaining for so long.  Plus I really wanted to see my baby again.  It therefore came as a great relief when they called over to the nursery that my husband and son could come back.

Little Boy had spent the first 45+ minutes of his life snuggled skin-to-skin on his father’s chest, listening to him sing.  Mostly Christmas music, because those were the only songs whose words he could remember.  I love thinking about this – I love that Little Boy had the comfort and love of his father from the very beginning.  When they were brought back to me, my husband pushed the little glass bassinet through the halls himself.

My husband tells me that the best part of that day was seeing the giant smile on my face when they walked in the door of my room.

He has his father’s sense of direction: Little Boy’s birth story, part 1

I came across this article about gentle C-sections on NPR yesterday and wanted to offer some commentary in the context of my own experience with giving birth, but then I figured I should share that experience in its entirety first.  And OK, I just couldn’t resist writing up Little Boy’s birth story.  In the interest of making it a little more readable, I’ve broken it up into two parts.


Early in my pregnancy, I decided that I wanted to try to give birth without pain medication.  Although most of the anti-epidural messages out there are nonsense, epidurals do lengthen the pushing stage of labor, which can indirectly increase your chances of a C-section.  But to be honest, I just really wanted to try “natural” childbirth.  I wanted to see what it felt like (experienced moms, feel free to laugh maniacally here).

So I read up on techniques and attended a natural childbirth class.  My husband and I practiced massage, counter-pressure, aromatherapy, and breathing; we discussed how he’d know when I really meant it if I changed my mind on medication mid-labor.  Our local hospital is extremely supportive of natural birth, so there were no problems there.

Meanwhile, I mentally prepared myself for the fact that anything can happen during labor.  I told myself that I wouldn’t be disappointed if our plans didn’t work out, if the pain proved to be too much for me, or if a medical emergency threw all our planning out the window.  All I could do was give labor my best shot.

The earth shook the day Little Boy turned.  Literally, not metaphorically.

It was late evening when the couch started to vibrate behind my back.  My first suspicion was that the cat was trying to climb up the back of the sofa and attack my ponytail again, but a glance around the room revealed that she was sleeping innocently by the bookshelf.  The weird feeling continued, so I got off the couch and knelt on the floor, at which point it seemed to stop.

Back on the couch some time later, I felt Little Boy vigorously kicking my lower back.  This was a new sensation, as he had previously been showing off his skill at kicking the top of my stomach.  There is a picture taken from the night before in which both his grandmothers have their hands on my belly, feeling his movements.  This new lower back kicking felt different, but not unlike the odd sense I’d had of the vibrating sofa.  Oh, that must have been what it was. 

It turned out that the shaking sofa had not actually been caused by my newly-breech baby, but by an earthquake!  We do not live in an earthquake-prone area; in fact, I’d never felt an earthquake before, which explains my inability to figure out what was happening.

Where I live, a breech baby means a C-section, especially for a first-time mother.  But my OB-GYN urged me not to worry: there was still plenty of time for him to flip head-down.  The doula who led the childbirth class suggested some exercises – crawling on hands and knees, bouncing on a fitness ball, laying with my hips propped up – and I tried them all, despite strong reservations about their scientific basis.  I even went so far as to try some decidedly-unscientific methods, like putting ice on the top of my stomach and playing music at the bottom.

In spite of my efforts, Little Boy decided he was awfully comfortable with his head up by my rib cage.  Four weeks from my due date, he still hadn’t re-oriented himself.   There was still some chance he might turn again on his own, but frankly, he was running out of space to do so.  Our last remaining hope was to schedule a procedure called an external cephalic version (ECV, or just “version”), in which a doctor would attempt to manually manipulate Little Boy into turning.

An extra ultrasound and maternal-fetal medicine consultation later, and I had an ECV scheduled for 39 weeks, 3 days pregnant (i.e., 4 days before my due date).  I knew going in that we had at best a 50-50 chance of success.  A compliant baby, and I’d likely be able to go home and wait for labor to start.  A stubborn baby, and I’d be headed straight to the OR for a C-section.

It took a while for me to deal with the idea that I might not even get to try labor.  I was disappointed; I hadn’t prepared myself for this.  I looked up a lot of statistics on breech babies and ECVs and what conditions maximized the chances of a successful ECV and why breech births are considered dangerous.  (One of the biggest risks, it turns out, is a lack of experience with breech delivery.  The American Congress of Obstetricians and Gynecologists flat-out mandated C-sections for breech babies from 2001 to 2006, although the “breech = C-section” equation has been around for decades before that.)

In the end, I mostly came to terms with the situation.  There were a few pluses; for instance, if the ECV failed, I’d get my own doctor for the C-section rather than whoever was on-call.  I was still really hoping it would work, though.

The registration process at the hospital was agonizingly long.  I had submitted the appropriate pre-registration forms, but the woman at the front desk seemed to drag … everything … out …  on … and … on … all in an extremely-Texan accent.  It was 5 a.m., I was exhausted and hungry (no breakfast allowed, of course), massively pregnant, and ready to get things going.

We finally made it back to a room, where we waited some more.  My husband and I danced a little, a slow, gentle rocking to pass the time.

A nurse came and hooked me up to the contraption that would monitor Little Boy’s heartbeat while I lay on the hospital bed and waited some more.

I played some FreeCell on my husband’s iPad, and we waited.

The placement of the epidural didn’t hurt.  My mom tells me that getting her epidurals started while having contractions every three minutes was rough, but I wasn’t in labor.  I was about as comfortable as you can be in a hospital gown while 9 months pregnant and desperately wanting to sleep.

Once the epidural took hold, however, I felt like crap.  My blood pressure crashed, making me terribly nauseated.  They gave me something to raise my blood pressure and tipped me slightly on my side, and the desire to throw up slowly went down.

Eventually, I was deemed sufficiently anesthetized for the ECV to begin.  A quick ultrasound to check that Little Boy was still head-up, and it was time.

It hurt.

The level of epidural medication that you get for an ECV is not the same as you get for a C-section.  You’re not supposed to be completely numb, just desensitized enough to relax while the doctor pushes at the baby in your stomach.

I focused on breathing through the pain while the maternal-fetal specialist tried to gently disengage Little Boy’s head from my rib cage and coax him into a somersault.  Two tries, then three, and it almost worked.  I felt the child get part of the way into a turn before slipping back.  The doctor tried again; fives tries, six – but Little Boy just kept turning back.

The doctor’s arms were shaking with effort, but my baby was stuck.  I was given the final say as to whether we were done trying, and I made the call.  Little Boy was going to be born by C-section.


Stay tuned for Part 2, in which I learn that laughing gas is available in the operating room.