Sunday, November 23, 2008

Cesarean Section Homebirth Style -- My Birth Story

By Rachel

The pediatrician described my labor and delivery as death by a thousand cuts. I’m not sure I would describe it that way, but it was intense. My water broke on Friday morning at 7:30. Contractions started by 8. My friend, Theanna, and Maria, the midwife, came over to the house. The morning and afternoon went as expected. Lots of rocking and swaying, humming, breathing, and counting. Cassie applied counter pressure to every contraction which also helped. I hung out in the shower, draped myself over an exercise ball, dropped into it instead of resisting, walked around outside in the sunshine, listened to the soothing music Theanna brought over, and did everything else we had learned to do to manage labor. I had an IV drip of antibiotics every 4 hours (to combat GBS which I tested positive for. GBS is a virus(?) that lives in the vagina of some women and can cause sepsis if it gets on the baby on the way out the birth canal). Cassie chased me around with water and OJ which I threw up on two occasions which was awful but usual apparently. Every few hours the contractions shifted to something more intense and we found a new rhythm, new pain management techniques, and kept moving through it.

This all went fine until late in the evening when we hit some new pain intensity that I could not believe. I had no idea it would hurt that much. None of the previous tricks were working and I was so tired. I had never lain down all day because it hurt too much. The midwife got me lying on the bed somehow so I could rest between contractions. That roller coaster was an amazing ride. Up with the excruciating pain, Maria talking me through the panic and sense of being trapped. Then down, still stiff and shaking, while Maria coaxed me to breathe, relax my shoulders, and rest. I would actually fall asleep during those 1 to 3 minute breaks and it was the most restful relief of my life.

We had one last secret weapon -- the warm birthing tub in the middle of the living which was set up with much hullabaloo in the morning. But I suppose we miscalculated when to use it. I threw up one last time during one of my rests on the bed which did it. My hold on control was so tenuous at that point that the trauma of coughing and spitting out vomit on the pillows sent me over the edge. I was done. I wanted it over. I was 5 centimeters.

I hung in there 20 more minutes for one last IV while bags were packed and we got ready to go to the hospital. I knew that complete relief was only moments away. I sort of remember having a contraction on the walkway on the way to the car, in the car, and again in the hallway of the hospital as I staggered towards to elevator. I'm sure I looked and sounded like someone dying a painful death. Finally the labor and delivery room, vital signs, blood drawn, fetal monitor attached, and news that they wouldn't even call the anesthesiologist until the blood work was back. I think we waited nearly two hours.

Maria said that she wanted me to do my best but that it wasn't supposed to be torture. It was torture. I continued to feel trapped and panicked every time. I remember staring at one spot on the ceiling to try to stay focused. My mind kept screaming to Cassie to "get me out of here!" Maria (I'm sure) did her best to guide me through. I refused some narcotic that was offered, knowing that the anesthesiologist would be there any minute. She finally arrived and I truly felt like she was the angel of mercy. Within a short period of time the needle was in. Someone looked at the monitor and said, "You're having a contraction." "I am?” I said. Cassie, Theanna and Maria looked at me in disbelief.

Then we slept. I am in tears of gratitude now thinking of the dedication of my birth team. Theanna slept in a chair, and Cassie and Maria slept on the cold, hard hospital floor. I could not believe it. Three or four hours later it was morning. I was 9 and more centimeters. Hooray! They said we would have a baby by noon.

There was only a little lip of cervix left which everyone thought wouldn't impede progress. I was absolutely done with pain and didn't want the epidural turned down so I could feel the contractions and know when to push. Maria and the hospital midwife coached me, and the pushing felt incredibly weird since I couldn't feel anything. After a few tries, the midwife checked and said I was pushing right but the baby wasn't coming down. Also, that little remaining bit of cervix wasn't moving. One problem with epidurals is that they can slow down contractions. So I agreed to a little bit of pitocin to get things moving again.

What happened after that gets blurry. There was much fiddling with epidural and pitocin levels. I could feel contractions again. I was exhausted from pain by then and shied away from every contraction. It hurt and I couldn't focus. I finally accepted the narcotic which didn't take the pain away but kept me fairly relaxed during contractions, and totally relaxed in between, without me having to do anything. I cried really hard. I couldn't see my way through. Everyone was helping me relax and get through it moment by moment. My dad appeared and held my hand.

Suddenly we changed gears. They wanted me to push. The nurse said something about if I wanted to avoid a c-section I had to work harder than I ever had in my life. I would not. I could not. I couldn't even get mad. I still felt trapped and powerless. Then I realized that, in fact, I was absolutely powerless over what was happening and what was to come. Theanna said a prayer with me, and then I let go of everything knowing I would be taken care of. I focused on a spot on the floor, blocked everything else out, and, following the cues from the contractions and the voices around me, put every ounce of myself into pushing.

This went on for some time. I could have gone on like that forever. We tried two positions. From time to time Maria or the hospital midwife checked. There was a swelling on the head that was moving down, but the bones of her skull were not passing under the pubic bone. They just bumped up against each other over and over. The hospital midwife said my pushing was stronger than any she had seen in a long time.

About two hours into it, the hospital midwife said it wasn't going to work and recommended a c-section. Maria agreed. I let down my guard and cried. That was it. It was over.

Or was it? Maria said there was one more position we could try. I said I could not do it. I couldn't regroup. The hospital midwife didn't come back. Maybe the hospital had given up. It was just me, Cassie, Theanna and Maria again. I regrouped enough to agree to try three more pushes in the new position just to say I had tried everything. We did more than three, and then Maria checked. She said she thought maybe a little something was happening, but she couldn't really tell. She said that she had a little bit of hope with this position, but that it could be two or three more hours of pushing, maybe two or three hours before we even knew anything. I freaked out. I couldn't go on this roller coaster ride anymore. What to do? "Little Bit of Hope" versus "Two or Three More Hours." I said no. I would not do it. At once, I was wheeled away for a cesarean.

That is the moment. The one I replay in my head over and over. "Little Bit of Hope" versus "Two or Three More Hours." Did I make the right call? I said I would do everything I could. I could have pushed for two or three more hours, couldn't I? Maybe, but I could not accept the idea that we might not know if it would work. My spirit and mind were totally exhausted and overwhelmed by then. Maybe I did the right thing. But I am sad. I cannot believe how terribly sad it makes me. I am starting to move through the feelings of utter failure, but the grief over being cut open is still strong, as is the loss of a vaginal birth, of finishing the experience, of being complete. Not to mention knowing that the possibility of ever having a home birth or even a vaginal delivery in the future is very compromised. I am surprised at the level of grief that I feel, but it is definitely there.
But, on to the good stuff. Within an hour of my decision, little Anna came to us. Her large head was turned the wrong way which explained the mystery of the ineffective pushing. They lowered the curtain at just the right moment so I could see her birth with my own eyes. Suddenly she was actually there, she was real! She cried just like in the movies. Cassie stayed with her at the table where they checked her out, and soon she was on my chest.
People said that any sadness or pain about your birth experience would disappear at the sight of your child. That is absolutely not true, but I do not ruminate on the grief and sadness. It immediately recedes to the corners of my mind at the sight of her. She is completely perfect and beautiful. I am in utter awe and deeply in love, on a cloud like never before. The bliss and joy is like they said it would be -- like nothing else.

As for the cesarean, I think of it as Cesarean Section Homebirth Style. My midwife says that homebirth is a state of mind, and I agree. I received excellent prenatal care which was compassionate and thorough. Every appointment lasted an hour, all of our questions were explored and concerns addressed thoroughly. Through those appointments and our excellent 6 week homebirth preparation class, we learned about every tool available to us at home and at the hospital. My fear of labor and delivery diminished over time and was replaced with confidence and respect. The folks in our class have kept in touch and encouraged each mama, holding her in love and light, as she brought her baby to the other side.

The memories of laboring at home bring me peace and joy. I hear the music and see the sky and sun and feel the soft breezes. I am very proud that I labored for 17 hours without intervention, mostly at home. Those were homebirth moments. My compassionate and dedicated partner was with me every single step of the way. She knew what to do thanks to her homebirth training. My beautiful and supportive friend, Theanna, got into the groove right away. My homebirth midwife was with us to the end guiding us in the ways of homebirth.

I don't see how I would have experienced all this if we had planned a hospital birth. We would have had perfunctory 15 minute prenatal appointments. I understand that many hospital oriented birth prep classes are cursory. We would probably have gone to the hospital early. I would have been given the epidural, pitocin and narcotics early. I may not have even known I had a choice. I would have missed the many hours of uninterrupted, quiet, natural labor at home. As it was, I was able to make informed choices at every turn with the help of my trusted birth team. I chose the epidural, I chose the narcotics, I chose pitocin and ultimately, I chose the cesarean, but only in the moments when I knew it was right for me and my baby. Those were also homebirth moments. I felt completely empowered through the entire process.

So that's my story. It's different than I expected it would be, but it's mine and it's perfect in its own way. And of course, most importantly, we got a beautiful baby girl out of the deal. Somehow we get to keep this little bundle of joy. She's ours! We're parents! The journey has just begun.

5 comments:

Habibi (Salamet) said...

Beautiful story Maria!!
::hugs::
Megan from CAM

Ilke said...

Hi Maria

Wow, what a roller coaster...well done on all your efforts you did great! Just some encouragement, I had a mis-managed birth with my first child which ended up in an unwanted c-section. I had deep regrets afterwards, and when I fell pregnant with our second child there wasn't a doubt in my mind that I wanted a natural birth. With a great midwife and my hubby and all my sisters my son was born in October this year after a swift, active natural labour. It has been very healing, and for you I want you to remember that you can absolutely have a vaginal birth round two! Congrats on little Anna, they are so worth the pain aren't they!

All the best
Ilke

CfM Molly said...

I love reading all the stories you share, Maria. Such amazing voices and diversity.

Molly

Anonymous said...

beautiful story-you made sure you and your baby were safe. adn it all worked out beautifully. you should never feel sad about that!

Rachael said...

wow. You're story is all too familiar. I've had two c-sections and both started out as planned homebirths. Both of my boys got stuck and I agreed to a c-section after 3 hours of pushing both times. I understand the intense feelings of failure and grief. I've been there. I'm still working through it and my first son is 2 1/2 and my second son is 1 1/2. I guess it just takes time.