Saturday, 2 November 2013

... And Breech Baby Makes 3: Our First Caesarean Birth

So how did I find myself in this position?  How is it that an otherwise normal, healthy woman ends up having two surgical births in spite of all her best intentions and wishes to the contrary?  When you are headed for a caesarean, it often begins with inadequate knowledge, lack of appropriate support for normal birth (by health care providers, family or whomever) and fear.

Prior to becoming pregnant with my first child, I had a rigid and fixed idea about the importance of having a natural, unmedicated childbirth.  Years ago, when I was just out of college, I was working for a small company and had an absolutely wonderful boss whom I admired quite a lot.  She was roughly ten years older than I was, successful, funny, intelligent, confident and hard-working; so many things I hoped to be when I was finally ready to become an "adult."  She had one child, a daughter, and had told me once or twice about her birth.  She had made a choice not to use epidural or other pharmaceutical pain-relief during her labour, and this was a completely radical idea to me.  At that point, I knew absolutely nothing about babies or having them, but I definitely believed that all women were medicated during childbirth.  I don't think it ever even occurred to me that a woman could do such a thing without drugs, and why would she want to, anyway?  My boss really made an impression on me when she raved about what an amazing experience it had been, how the rush of endorphins was such an overwhelming pleasure and how she was awed by her strength and felt she could accomplish anything.  There she was, just 20 minutes after the birth, high on natural birthing hormones and full of energy, asking others around her if she could make them a cup of tea.  This was the antithesis of everything I had ever seen or heard about birth.  It certainly doesn't look that way on tv or in Hollywood movies!  Birth is something to be feared, a life-threatening emergency.  After hearing her story, my outlook about what birth could be was forever changed.  I was worlds away from wanting to have children of my own at the time, but I determined that if I was ever going to have any, surely that was the way to do it.

Flash forward many years.  A different country, a different job and a different life as a newlywed, but I still had the same idea about the kind of childbirth I wanted for me and my baby.  However, two things happened after our wedding day that impacted on my ability to prepare myself appropriately for it, yet I wasn't even aware of the psychological effect these events had had on me. The first of these occurred just 5 months after we'd been married.  We were spending the Christmas holidays with my family in the USA, and I had just stopped taking the pill.  We were on top of the world.  Everything in our lives seemed to be going perfectly, and we were ready finally to start a family of our own after 7 1/2 years as a couple.  During the trip, however, my husband very suddenly developed a large lump just above his left collar bone.  We had both recently had a chest infection and a heavy cough, so we thought at first that it might be somehow related to that.  Yet I was feeling fine again, and he was still coughing, the painless lump slightly changing size and position day by day.  By the time we returned to Ireland, we were very concerned.  Our GP knew right away that it was some form of lymphoma.  He got us a hospital appointment for the very next day, and what was meant to be just a CAT scan ended up being a week-long hospital stay, full of invasive and painful tests and unbearable stress.

This was certainly not the way we had imagined spending our honeymoon period.  We were shocked, devastated, frightened of an uncertain future.  We were so young, and neither one of us really had any experience of hospitals and doctors.  To us, the uninitiated, the hospital seemed like a bizarre and backward world, almost Dickensian.  Some of the men on the ward were seniors and were clearly heading for their final days.  Others, though, came and went with various medical issues such as asthma and heart trouble.  We were struck by the way in which the new guys, whenever they arrived, waltzed in, and it wasn't immediately obvious that they were sick.  They seemed essentially bored during the early part of their stay.  They would pace the floors, try reading, anything to pass the time in this busy factory-like environment.  But eventually they would get sick, either because of the illness they had in the first place or because of the drugs, tests and treatments to which they had been exposed. Nothing about this place made it conducive to healing of any kind.  It was noisy.  Strict timetables were observed.  The food was appalling and clearly devoid of any nutritional value.  All of the "sick" people were crammed together in a holding pen, sharing dis-ease and getting sicker.  Possibly the most uncomfortable and scary thing of all was the withholding of information.  We knew that the doctors knew exactly what was wrong with my husband.  We could see it in their faces when they spoke to us and detect it in the way they avoided answering our questions directly.  They knew, but they couldn't tell us anything until they had satisfied themselves that they'd conducted an exhaustive battery of tests and had determined the appropriate course of treatment.  The hospital, it seemed, was not a place one should go to get well, but to get sick or sicker.

When they finally decided to pronounce a diagnosis, a team of doctors, nurses and students took me, alone, into what seemed to be a large closet full of medical research journals and files.  My husband was undergoing a biopsy at the time.  They told me that he had Hodgkin's Disease, that the prognosis was excellent, but he would have to have several months of chemotherapy and possibly radiotherapy following that.  He would lose his hair and be quite ill.  As a result of the treatment, they informed me, there was a chance that he would be infertile.  They asked me if we had any children, and I said no, we had only been married five months.  They asked me if I had any family nearby, and I said no, all of my own family were in the States.  That was when I lost it.  Right there in a closet full of medical professionals, with my husband elsewhere lying on an operating table, I broke down in tears in front of them all.

My husband endured 6 months of chemotherapy.  Thankfully, he did not require follow-on radiotherapy, and we are eternally grateful that he has been "all-clear" ever since.  The care he received from the hospital staff was excellent, swift, confident and comprehensive.  Any reasonable person in similar circumstances would have to agree that his treatment was second to none.  However, taking the individual brilliant doctors and other medical staff out of the equation, the hospital as an institution left its mark on us as a world unto itself.  A frightening place where painful things are done to you for your own good, and where the very same people who hurt you re-emerge later as your heroes to cure you and make it all better.  A place where the sick go to get sicker.  A place in which vital information relevant to decision-making is withheld, where doctors have the knowledge and the facts and you as a patient do not.  A place similar to a prison.  We were told my husband couldn't leave, that it would be too dangerous, while he was being assessed during that week.  We had to beg to be "released" for a few hours to go out and have a relaxing dinner.  All of these paradigms would be reinforced time and again throughout our journey into parenthood through our interactions with the maternity hospital.

We decided to wait for 6 months after the end of the chemo before we would try for a baby for the first time, and we were unimaginably lucky when we conceived the very first month we tried. We were ecstatic.  We didn't tell anyone right away except for my parents.  I had heard that it was not a good idea to spread the word too quickly because alot of first-time pregnancies end in miscarriage.  (So from the outset, fear was a presence in my thoughts and feelings.)  We privately relished our news and busied ourselves with making plans for our baby, considering everything from baby names to which college s/he would attend.  Several weeks of sheer joy went by, and quietly, gradually my tummy didn't seem to be quite as swollen as before.  My breasts weren't sore as they had been.  Things seemed different, and I felt more like my normal self.  Although worry about a miscarriage was at the back of my mind, I wasn't consciously aware that something had gone wrong.  Maybe I just didn't want to be.  I reasoned that if I had a miscarriage, surely there would be bleeding and cramps and all sorts of drama.  It was my first pregnancy, so I had no way of knowing what to expect anyway.  We continued merrily along our way until one afternoon when I returned home from work.  I was exercising with a pre-natal yoga DVD, peacefully connecting with my unborn child and gently strengthening and stretching my pregnant body, filling both of us up with energy and vitality.  When I had finished, I went into the bathroom to shower.  There was a little bit of pink blood.  A few hours later, I met my husband at the door as he arrived home from work.  I simply said, "I'm bleeding."  His face fell.  Just like that, it was all over.

I am not going to talk too much about the miscarriage here, as I will devote a future post to my experiences with miscarriage.  It is such an important topic to address for me because I believe that our culture attaches stigma, shame and secrecy to a heartbreaking personal trauma that so many couples suffer.  For now, suffice it to say that the midwife we met during this, the first occasion when we visited the maternity hospital, was less than gently sympathetic, which clearly exacerbated the generally suspicious and negative feeling I had subconsciously developed towards hospitals in general during my husband's illness.  It also had the effect of calling my body's ability to create, carry and birth a healthy baby into serious question.  It didn't matter what I read or how many people told me that it wasn't my fault, there was nothing I could have done differently.  I was horrified with myself.  I hated my womb.  I was a failure.  I had never failed at anything in my life, but when it was something really important, something that really mattered, I was a failure.  Maybe I'd left it too late.  Maybe I was just too old to have children.  Whatever the problem was, it was my fault.  I never took the time to drill down into those feelings and heal myself, and again, although I wasn't consciously aware of them, they remained, and they were controlling my behaviour and my perspective unbeknownst to me.

All I wanted was to get pregnant again.  I can remember tearfully telling my husband, "I can't make this pain go away until I get pregnant again.  That's the only thing that will make this better."  I wanted to will it away and almost pretend it had never happened.  So we didn't wait for long.  We did get pregnant again during the very first month we tried.  (So much to be positive about!  But only the negatives were registering with my subconscious mind.)  At first, I was cautious about getting "too emotionally involved" with a baby who might not stick around, but it didn't take long before I was head over heels in love with a baby again.

My pregnancy with my daughter can be summed up in one word:  blissful.  I felt I was queen of the world.  I indulged myself in rest and relaxation, believing in the old maxim, "Happy mom, happy baby."  Everything was about this baby.  I would come home from work and promptly do whatever I liked to relish and enjoy the special time I alone could share with this new and wondrous life force growing within me.  I attended pre-natal yoga classes regularly and read the books, magazines and websites, eager to learn as much as I could about everything that was happening in this secret garden in my womb.  However, I managed to skip over all of the chapters and articles about caesarean section, in an admittedly somewhat haughty fashion.  I wasn't going to need to know about that sort of thing.  I had seen the headlines before about women being "too posh to push."  Caesareans were perhaps for other women but clearly not for me.  I was bringing forth life.  I was going to be the incarnation of the goddess herself. 

My plans and desires were sincere, but the last six weeks or so leading up to the birth were quite stressful and worrisome as the pregnancy seemed to take a sudden turn for the worse.  First of all, my daughter had been in a breech position for a long time, and it did not seem likely that she was going to turn.  I tried everything from reflexology to acupuncture and moxibustion to practicing strange hips-up positions on the floor, all to no avail.  She simply was not budging.  We had an appointment on a Wednesday at the Fetal Assessment Unit.  Our consultant was going to attempt an External Cephalic Version, but after doing a scan she determined that there was not enough fluid around the baby and that the risks of the procedure probably outweighed the benefits in that it was unlikely to be successful.   She advised us that breech babies were normally delivered by caesarean, although she pointed out that this was based on what many critics say is a deeply flawed study and suggested that we could Google it to examine the evidence ourselves.  She told us that we could attempt a vaginal birth, but so many stipulations were attached to this option (induction at 39 weeks, epidural, and forceps to name a few) we felt that the benefits of a vaginal birth would be all but lost, and there was a good chance that we would end up with an emergency caesarean anyway when all was said and done.

I was distraught.  My daughter would not have the benefit of being born in her own time on the day she selected.  She would not have labour and the hormones of birth to prepare her for life outside the womb, and I would birth on my back, numb, rather than feeling my baby make her way down, through and out of my body with the tremendous surges of energy that herald the arrival of a strong, pulsating, new life force.  I was in a sheer panic thinking that my baby would be born premature, that her lungs would be too immature for her to breathe on her own and that the operation would damage her irreparably in some way.  There would be no labour pains in the middle of the night, no rushing to the hospital, no false alarms - none of the things that often make a birth story so singular.  It would be a very sterile, assembly line-style affair, exactly like every other major abdominal birth that ever has been and ever will be.  I was also quite simply terrified of having to undergo major surgery, and all of my fear and loathing of the hospital bubbled back up to the surface.

There was definitely also grief involved in coming to the end of the pregnancy, and this is a feeling that is not acknowledged in our culture.  Society focuses on how horrible the pregnancy is, how heavy and awkward a woman becomes and how she is so glad finally to have it over with.  That may be one aspect of pregnancy, but it certainly is not the only one and was never my experience.  As much as I longed to see, hold and cuddle my new baby in my arms, I knew I was going to miss my bump and all the unique sensations of sharing my body with another tiny soul.  From the barest flutters to the biggest kicks and wriggles, it had all been so strange and indescribably lovely.  I had had her all to myself for so long, and from now on I'd have to share my secret treasure with the rest of the world.

The caesarean was scheduled for a Monday morning.  In just a week and a half, our pregnancy would meet an abrupt end under the blade of a knife.  In the meantime, however, I had to return the Fetal Assessment Unit the following Wednesday for a check-up.  My consultant would be on holidays that week, but she wanted us to be monitored to make sure that all was still well.  A certain degree of doubt about the baby's health and well-being seemed to have crept into the picture of late, but there was a disturbing vagueness about it all.  The consultant had not been particularly happy with the fluid levels and with the baby's lack of continued growth on the last visit.  The day before had been my last day at work before taking maternity leave.  I was weary.  My husband was working, and I went up to the hospital alone.  We had no idea that things were going to happen so quickly.

In spite of my best efforts, I was never able to ascertain from any of the doctors or midwives involved exactly what was wrong.  Suffice it to say that a lot of very alarming language was being used.  I heard things like, "The environment in the womb is poor" and "Your baby is no longer growing" and "The levels of amniotic fluid are dropping, which indicates that the placenta may not be functioning optimally anymore."  They told me that the fluid levels had been 8 cm the week before, whereas now they were down to 4 cm. (I learned much later that the baby's bladder was full.)  From what I had read in my pregnancy books, I understood dropping fluid levels to be an indicator that the pregnancy was coming to a natural end and that labour might commence soon.  I asked if they were afraid that I might go into labour, which of course they wanted to avoid at all costs since the baby was breech.  The response was, "That's one of the things that could happen," but they were very cagey and would not elaborate.  Every time I asked a question they would give me some kind of evasive answer like that.  Without the calm and reassuring presence of our usual consultant who always communicated so well with us, I felt vulnerable and frightened.

Up to that point, the pregnancy had been completely normal, and I couldn't understand what had suddenly gone wrong.  How could this be?  How could my own baby be struggling and suffering inside my body when I was feeling well and healthy?  How could I, her mother, possibly be the last to know?  I perceived this as another deep betrayal.  Just as my body had lost my first baby, it was now turning on this one.  My womb was a poor home for my baby.  Enough said, really.

They hooked me up to an electronic fetal monitor for a while because they were not sure if they wanted me to spend the night in hospital.  The beeping monitor kept track of my baby's heartbeat, and I had to press a button every time I felt her move.  I was texting and talking to my husband frequently, but I was incredibly nervous not really knowing what all the fuss was about, and I definitely did not want to stay in the hospital at that point.  I was not a big fan of the environment there as I always associated it with my miscarriage and the less-than-gentle treatment I felt I received at that time.

In the end, they took me off the monitor and reported everything to another OB, who was taking care of all of my consultant's patients for the week.  While they deliberated over the phone, another one of the doctors said to me happily, "I think you might be meeting your baby tomorrow!"  I felt a surge of terror.  I was still only 38 weeks pregnant and was so afraid that my baby was not ready.  Moreover, I suddenly felt so unprepared for parenthood.  Throughout the pregnancy, I had assumed that I was likely to go over my EDD by at least a week, and now I was going to be almost 2 weeks early.  The baby's room wasn't ready yet, the house was a mess and I had still been at work just the day before.  It was a big mistake not to have taken time off before the birth because I was mentally and physically exhausted before they ever wheeled me into theater.  Not the healthiest way to start off life with a newborn!

The medical staff decided they would *let me* go home for the night, but I had to be back at the hospital at 7:30 a.m. the following morning for the surgery.  I had to take a couple of tablets, one late that night and one at 6 a.m., which were meant to prevent me getting sick from the spinal block.  So I drove the hour's journey back home a nervous wreck and then promptly told all my family and friends via Facebook that Spud was coming a little early.  I spoke to my parents and a friend who had recently had a c-section with her first baby, also for frank breech presentation.  Talking to her and hearing her baby girl gurgling in the background got me super excited about meeting my brand new baby!  There was no way I could sleep knowing what was about to happen, so I spent most of the night trying to organise and tidy up the nursery.  I tried to rest as much as I could, but I think I only slept for about 4 hours.

In the morning, I was so tired and so filled with mixed emotions:  excited, anxious, scared, thrilled.  I was full of adrenaline.  We had had an unusually cold winter, and the roads that morning were treacherously frosty.  We practically had to crawl up to the hospital.  (If I can just digress with one thought for a moment, just in case others are dealing with a similar situation right now ... If I had known then what I know now... They wanted to section me because the baby was breech, pure and simple.  I will, in a later post, describe why I am certain that their other purported causes of concern were bogus.  I probably still would have chosen to have the caesarean because I wouldn't trust them to know how to attend a breech birth.  However, I would have demanded that they keep me in hospital for however long it took until I went into labour spontaneously.  Then, and only then, would I have given consent for the caesarean.)  We were a little late arriving at the hospital as a result of the frost, but it didn't seem to matter too much.  They took us up to a ward where we had to sign a bunch of consent forms.  A student midwife asked if I had shaved, and I was like, "Nobody told me to shave!"  I felt like a total idiot.  She shaved me with a little electric razor like the one I had when I was about 12 years old.  I had to put on my gown and get ready to go down to theater.  We met the substitute doctor, who had a completely different demeanor than the consultant with whom we were acquainted.  She was much more abrupt, cold and emotionless, and made it clear that she was calling the shots.  I made one final effort to find out what exactly was going on with my baby inside my womb.  I said that we were going to have an elective caesarean no matter what because the baby was breech, but I was wondering why we couldn't just wait until our originally scheduled Monday date and give the baby a little extra time.  She shook her head in a kind of half-exasperated way, her fringe wagging back and forth rapidly in front of her eyelashes, and replied, "Well, that would just be stupid.  There's no point in doing the scan if you're not going to do what the scan says."  That shut us up.  We laughed about it afterwards.  We still laugh about it because if we didn't laugh about it, we would cry.  There we were, trying to do our best by our baby, and with just a few barking, condescending insults we were taken down to the operating room without so much as a proper explanation.

Before we knew it, I was headed down to theater on a bed with my husband following along.  We had to wait in some kind of acute care ward for a while until they were ready for us, as they were squeezing us in among all the other scheduled caesareans.  We were alone for most of that time just chatting quietly.  When our number was finally up, my husband had to put on his scrubs, and they made him wait outside the operating room while I was having the spinal block inserted.  This was a disaster for me at the time.  I was really petrified of having a needle put into my spine, and before I realised I was going to have a section, I had been much more afraid of the prospect of having an epidural than I had been of labour pain.  I couldn't believe it when they said I had to do it alone.  When the anesthesiologist came in and started trying to insert the needle, there were so many instructions to follow.  Round your back, lean this way or that.  She was asking me if I could feel the needle in the middle of my spine, but I was shaking with fear and had no idea what I was feeling except that it was an incredibly odd, tickly sensation.  Then, my right leg started hopping up and down involuntarily, and I thought, "Oh God, I am going to be paralyzed if she keeps on playing with my spinal cord!"  At that point, I broke down in tears.  A really nice woman was beside me, holding me and wiping my nose and cheeks as I wept.  There were so many people in the room, and I felt like a small child.  The substitute OB was pacing around in her white clogs, phone in hand, checking in on the progress of her other patients I presume.  It was all business, very cold and with very bright lights.  I was so sad that my baby was going to be born in an operating room.

When the ordeal with the needle was finally over, the anesthesiologist was none too pleased with herself.  "I made her cry," she announced to someone or everyone.  Of course, it probably couldn't have been helped.  I was so nervous about the operation I probably would have cried no matter what, but I wanted to choke her and punch her in the face.  This is not about you, you awful bitch! I thought.  It's about my baby.  My heart was racing as I lay down on the table.  Another drug guy took over from the anesthesiologist, and he and another nurse started to paint my belly with brown disinfectant.  The man told me that the spinal block would soon take effect and I wouldn't be able to feel anything.  After a few minutes, I could hear clinking and clanking of metal instruments somewhere down towards my feet, but I couldn't see what was going on.  "You know I can still feel that, right?" I asked.  I was afraid they were going to start cutting me before I was fully numb.  I needn't have worried.  I got numb all right.  Even my arms and hands were all trembly and weak.  Everything from the neck down was pretty much dead weight.  Finally, they got the screen up, and my husband was *allowed* to join me.  I was trying to breathe deeply and slowly to calm my soaring pulse, but I don't think I was very successful.

Everything was happening so fast.  It's all a bit of a blur, but the operation felt like it was taking forever.  At long last, they told me that my baby was coming.  Earlier, I had requested that we get to see you all wet and sticky just after the birth, so I was anxiously anticipating the moment of holding her in my arms and cuddling her while she was still all gooey with vernix and amniotic fluid.  I couldn't wait to see her.  Then suddenly, the substitute OB lifted her over the screen for an instant, during which all I could see was a wet, bluish-red ball which disappeared again almost immediately.  For a few seconds, I felt relieved thinking that the operation was finally over and our baby had been born, but then I realised that she still wasn't making any noise.  I couldn't see what was going on, and my husband couldn't see, either, because our baby was surrounded by medical staff.  We were looking at each other, scared and helpless.  Finally, we started to hear some little cries.  Then, the OB said something I can't actually recall about the baby, but then she said, "...and we'll bring her over to you."  I kind of laughed and shouted out, "Her?!" because I had convinced myself that we were having a boy.  We were so relieved and thrilled.  One of the crowd brought our daughter over to us.  They had already dressed her and wrapped her up in blankets.  I couldn't hold her because my arms were too weak, but my husband held her and I started talking to her and touching her hand.  I was saying hello, and telling her that she had such a beautiful voice, and that she and the whole world was hearing her lovely voice for the first time.  As soon as she heard my voice, she stopped crying.  Her eyes were open, and she seemed alert, albeit shell-shocked perhaps.  Her tiny lips were rounded as if she were singing, "Ooooohh."  Her hands immediately drew my attention.  She was clasping her hands together and gracefully flexing her fingers.  They were such dainty, girly, expressive hands.  I was stroking her fingers and hands while Daddy cuddled her.  I wanted to hold her so badly, but my husband kept her right beside my head.  Her skin and hair were so dark, I could hardly believe she was ours!  She was the tiniest baby I have ever seen, our teeny, tiny Thumbelina.  My husband and I kissed and cried a little.  I couldn't wait to get out of there and have some privacy.  It felt like they were stitching me up for ages, but they finally took us to the recovery room.  My darling baby love had arrived . . .

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