A client writes in: A Special Cesarean Delivery

We knew Myles was going to be a big baby from 24 weeks forward.  I had been referred to Maternal Fetal Medicine because of his position at my anatomy scan.  He wasn’t showing off his spine too well, so my regular midwife wanted the expertise of the group upstairs in the same building.  My husband was home with our 2.5 year old daughter, so I asked special permission to Skype with him during the ultrasound.  I remember telling him, “Honey, did you hear that?  He’s already over 4 lbs!”  Luckily, though, both my doula and the midwives I continued to see throughout the pregnancy supported me with happy thoughts of still being able to birth this baby vaginally, and hopefully, medication-free.

I chose to use a doula and aimed for a medication-free birth because of my birth experience with our daughter.  Diagnosed with pre-eclampsia around 33 weeks, I ended up induced at 37w2d, and the induction lasted a grueling 56 hours before she finally arrived after 2 hours of pushing and a 3rd degree tear.  I remember being deliriously exhausted and so disconnected in those first moments after birth.  I did not want that feeling again; I wanted the immediate bonding, the overwhelming smiles, and the sweet satisfaction of knowing that I could do this on my own.

Toward the end of my pregnancy, I was very proud of the fact that I could continue to work (as an ER veterinarian), taking the steps from our doctor’s office to the treatment room just as well as I did at the beginning of my pregnancy.  My last day of work was February 20, which was just how the schedule worked out before having a week off.   At the end of my shift, I was 38w5d.  I was ready for Myles to arrive any time!  There were no signs of pre-eclampsia.  My weight gain was minimal.  And other than some mild pelvic pain, I just felt great!  I reminded myself daily that my body was made to do this, and there was nothing that could stop me from having the birth experience that I wanted.

At my 39 week visit, my midwife ordered an ultrasound because she wasn’t sure that baby was head down.  We had dealt with this earlier in the pregnancy.  He was laying transverse, and after several chiropractor visits, he did flip into the right position.  I felt defeated to think he might have flipped back to a transverse position.  I held my breath on the table as the ultrasound tech put the probe on my belly, and saw a nice big kick from our “little” guy.  Thankfully, he was indeed head down, but was weighing in at an estimated 9lbs 14 oz.  Nevertheless, I kept telling myself that I could do this; my body was made to do this.

My midwife must have thought differently, and she encouraged me to have an appointment with and OB in the group to discuss options.  I only later found out that in the midwife’s notes in my record, she wrote that she was concerned for dystocia.  Being an ER veterinarian, I’ve dealt with my share of dystocias in dogs and cats.  I know the risks and the complications.  But this was my baby, and my birth, and once again, I knew I could do this!  I blocked out comments from my mother who insisted that I should just stop trying to be a hero and have the surgery.  Big babies aren’t a reason for surgical intervention.

The following Tuesday, at 40w3d, I met with the OB.  Prior to my appointment, she had the ultrasonographer take another peek, and check my fluid levels.  The OB wasn’t concerned about size; she knew the baby was big, and told me that he wasn’t getting any smaller than the estimate from the previous week.  My fluid levels were above the 97th percentile.  My chart got the diagnosis of polyhydroaminos.  Myles was “way up high,” and floating in all that fluid, making no effort to descend and prime my cervix for labor.  “Big” babies aren’t a reason for surgical intervention solely, but that with high fluid levels made my candidacy for such much higher.

We discussed induction, but the OB knew my thoughts on induction after the (in my mind) traumatic induction with my daughter.  We discussed shoulder and body dystocia if I was induced.  And whether a scare tactic or not, she told me she has seen dystocias that can be resolved easily, and those that end of with the delivery of a baby that’s not breathing.  I couldn’t imagine taking that kind of risk.  At the top of my birth plan, above all else, I stated that I wanted to have a birth that kept my health and my baby’s health as a top priority.  The OB recommended a c-section, and after being reluctant, I gave in to the recommendation.  As I got dressed, I was in tears, and felt like I had given up on my body, and given up on my baby.  I reluctantly text messaged my doula, and thinking that she might chastise me for giving in to the surgical birth.  That never happened; she was actually excited for our birth too, as it was her first c-section as a doula.

Our area was set to have a potentially severe winter storm overnight and into the next morning.  The midwife in residence told me that we could come into the hospital before the storm arrived, but I knew I wouldn’t sleep there.  I stayed at home in my own bed, waking early the next morning to find only rain, yet another let-down!  We drove to the hospital, and met our doula in the lobby of the Women’s Place.  I hugged her and cried a little before my husband came into the hospital.  She knew my emotions were high and how I felt so down from not having the birth I had planned.  What I needed from her was unconditional support, even though my birth went from the plan of a vaginal, unmedicated birth to an “elective” c-section.  She did not disappoint, and gave me exactly what I needed in that moment.  I felt a reassuring calm, and didn’t have the nervousness that I expected.

The upside to our birth, though, was that the OB knew my reservations about a c-section.  She also knew that we had been working with a doula, and how important to me it was to have her with us for the birth.  When asked, the OB was more than happy to give permission to allow the doula to be in the operating room with us.  She even worked some behind the scenes magic to make the anesthesiology team okay with the idea of an extra person too.  Further, I requested to be able to nurse on the table.  And that was a “go” too!  I was the first patient in that hospital to be allowed both a doula in the operating room and to attempt breastfeeding on the table.  With that in mind, I focused on that, and tried to take back the empowerment that I felt earlier in the pregnancy.  I made the best choice for my baby, for myself, and I was going to at least have some of what I would have experienced in a different birth situation.

At my head that morning was the anesthesiology resident, Jackie (the doula), and my husband.  I remember briefly looking into the lights above me as the incision was made, seeing the reflection of my very pregnant abdomen, and then closing my eyes.  Minutes later, Myles was born, and after having some time for the cord to continue pulsing (a modified version of delayed cord clamping), he was taken to the table for his initial assessment.  His weight was announced.  “Eleven pounds!,” I heard the OB repeat from the nurse.  I asked if they were sure that was correct multiple times.  I couldn’t believe it!  We knew he was a big baby, but I never would have guessed that the ultrasound estimates were so close to being right!

I wanted him back right away for breastfeeding, and Jackie helped him try to latch while the OB sutured my incision.  The anesthesia resident loosened the restraints on my arms, and I could touch and feel my new baby.  I cried as my son latched onto my breast for the first time…until I felt nauseous at which point daddy got a turn to hold him!  Minutes later, when the anti-nausea drugs kicked in, I got to have him back in my arms, and held him until I was moved from one table to the other, and then again while I was wheeled out of surgery and back to my room.  He fell asleep in my arms as we went down the hall, hearing the lullaby over the PA system.

My birth experience wasn’t exactly what I had planned, but I so appreciated support that I received from everyone involved – the OB/Gyn office staff, the doula, and the hospital staff that were on board with a somewhat untraditional c-section.  Even with a c-section, you can take an active role in having the birth you want, and I’m proof of that.   Andrea Birth-1-2

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