May 20, 2010

Working Towards a Better Birth

Mere hours after Charlie was born, I laid awake in my hospital bed thinking of his birth. I was shell-shocked, to say the least. I decided right then and there, in the wee hours of June 9, 2009, that I would never go through that again; I would rather just schedule C-sections for any future children. I just didn't want to deal with the pain of labor again.

A couple of months went by, and I had come to realize that the chemically enhanced labor I had experienced was vastly different from regular active labor. (Peeps, if you don't know, let me tell you now that Pitocin is a seriously awful drug that shouldn't be used as much as it is.) During this time, my mother-in-law, who delivered all three of her children by C-section, had discovered an umbilical hernia due to scar tissue in her abdominal area. (This developed less than a year after a fourth abdominal surgery for a complete hysterectomy.) One doctor advised her to have surgery to remove the hernia; another told her that the risks of another surgery outweighed the benefits and that she just needs to avoid lifting heavy things. For the rest of her life. She's 54 years old!

This scared (okay, scares) the bejesus out of me! For one, Roy and I would like to have three children, and chances are, since my mom had one, I will need a hysterectomy in the future. What's more, it's my mother-in-law we're talking about. She's got a time bomb in her tummy. This is scary business.

That is really when I began to think about VBAC seriously. I got involved in ICAN and began reading. Lots and lots of reading. About natural childbirth and medicalized childbirth and the 31% Cesarean rate in the US. About the risks of repeat ceseareans (and oh, there are many). I started to see quite clearly what had gone wrong with Charlie's birth. It wasn't that I had a bad doctor or was in a bad hospital or had a bad anesthesiologist or bad nurses. It was that I got lost in the system. A system where the mother's emotions and instincts are ignored in favor of what the doctor thinks is best. A system where birth and all of its transformative qualities are ignored in favor of one outcome: the medical definition of a healthy baby and a healthy mom.

It didn't take long for me to see, after spending hours reading birth stories on the web (now one of my favorite pastimes), that our maternal health care system is broken. While yes, it is wonderful that C-sections are possible for women who really need them, and yes, it is wonderful that obstetricians are available to oversee high-risk pregnancies, the vast majority of pregnant women in the US are treated as though they have a disease and thus are lawsuits waiting to happen. So they are induced before their bodies are ready to go into labor naturally; the induction meds cause the baby to go into distress; and as a result, one in three pregnant women ends up with a cesarean. Major surgery. Huge risks.

(That's just one scenario. But it's a common one. So common that, when people ask why I had a C-section, all I have to say is "I was induced..." and before I can get another word out, they are nodding knowingly.)

Many, many mothers end up like I did, scared and distrustful of their bodies, crushed and saddened by defeat. Their introduction to motherhood is underscored by a belief that they are broken, that they have failed. They are afraid to say anything about how they feel because they are all too quickly reminded that they should just be grateful that they had a healthy baby. In other words, "Shut up. You have no reason to complain. You are a bad mother for feeling this way."

I have news for the people who turn to the "you should just be grateful for a healthy baby" adage as a way of dealing with a mother looking for support:

I am grateful for my healthy baby. I am grateful to be alive. And I should be. Because Pitocin is not a drug that should be used as casually as it is. And neither is Cytotec. Because the medical community (and most of society) thinks that it is okay to administer these drugs to induce labor, I ended up being strapped down to an operating table so a doctor could cut my son out of me. I had a risky surgery that I didn't want and didn't even need because our maternal health care system is broken, because the vast majority of people think that chemical induction of labor is "normal", because we let doctors share the shit out of us to the point where we doubt our own instincts about what's right for us and our babies. I've spent almost a year now in the midst of a major depression, grieving a birth gone wrong. I get to be upset about what happened. I get to talk about it if I want to, over and over if need be. I get to have my feelings. I get to own my pain. Because to deny it would be telling the world that I am okay with what happened to me. And I am not okay with it. And if that makes you feel uncomfortable, then go somewhere else where there are puppies and unicorns prancing all over the place.

Anyway. Got off on a little (angry) tangent there.

Obviously, once I began thinking more seriously about having a VBAC, I started researching care providers. I learned that the hospitals in my area aren't VBAC-friendly. I learned that OBs have this tendency to see VBAC hopefuls as ticking clocks and thus these women are not allowed to go past 41 weeks. And I also learned that VBAC hopefuls all over are still being induced with drugs like Pitocin and Cytotec, despite their scarred uteruses. So it is nearly impossible to have a VBAC in a hospital here. There are too many conditions placed on women hoping for hospital VBACs.

That is how I came to the conclusion that we would pursue an out-of-hospital birth for our second baby, whenever we decided to have one.

Home birth has always sounded great to me, but to say that I don't have the confidence level to attempt it would be an understatement. A birth center with a midwife seemed like a good middle-of-the-road option for us, and lucky for me, I had already made contact with one and had gone on a tour of it before I found out I was pregnant. When the pregnancy test unexpectedly came up positive, we bypassed my OB entirely and just began my prenatal care with the birth center.

I feel good about our decision to pursue an avenue that's a little more nontraditional, because I want to have a birth that's empowering. Now that my reproductive health (and let's face it, my emotional health, too) is compromised by having a traumatic C-section, I need someone who will help me have a better birth. I don't have any illusions about being in control. Ultimately, there is very little in life that we're in control of, but I think trying for an unmedicated VBAC under the care of a midwife will at least put some of the power back in my hands. I am excited to see what my body is capable of, and even if I end up back in the OR for a second C-section, I think I will feel better about this birth because it will be something that I have an active role in, not something that will just happen to me as I lay flat on my back in an uncomfortable hospital bed.

This isn't about my needing to be a hero and suffering through the pain or even my need to prove my womanhood by having a vaginal birth. I want to have a birth on my terms. I want to be able to trust in myself - and in the world - again. I want to make up for what was lost when Charlie was born. Nothing will ever make up for it entirely - I know this. It's one of those things that will always hurt. But I do want the pain to lessen someday. I want to stop being angry and sad. At the same time, the anger and sadness have propelled me forward in a direction that I am so grateful for. The path I'm on is one I might never have explored if it hadn't been for Charlie's birth. I have learned so much from being cut open, enough to know that unless it's totally necessary, I never, ever want it to happen again.

(I am 16 weeks pregnant today and obviously still very long-winded - but very happy because I'm almost positive I felt the baby move today - twice. Insert ridiculously happy emoticon here.)


alyssa said...

Hire a doula. That way, no matter what happens, you know that a 3rd party is present to protect your desires. We had a doula...labored with us at home for 2 days and on the 3rd day I ended up with a c-section. I wasn't progressing, turns out my spine curves up so baby Elsie couldn't get through the birth canal. Our doula helped us make an educated decision that we feel wonderful about. I had an epidural and pitocin, both against my birthing wishes, but with our doula, my rights and wishes were protected through every decision.

inflammatory writ said...

No plans to have a baby anytime soon over here, but if I did, there's no way in hell I'd do a traditional hospital birth after the nightmare stories I've been reading. While I think things like freebirthing and unassisted homebirth are dangerous and irresponsible, I think homebirths with a doula and midwife are possible. I, however, would not feel comfortable doing it unless I was like next door to a hospital. Birthing centers are a wonderful middle ground in case something goes wrong, or in case you can't handle the pain, which DOES happen! Options are good. I am glad that you set a birth plan and I wish nothing but smooth sailing for you and baby #2!

Angie Eats Peace said...

Sounds like a good plan, and I am glad it is something you feel empowered by.

Nanette said...

It makes me sad and angry on your behalf that you didn't have the birth you really wanted. I have a few very, very minor things I'd do differently with our next one, but nothing as scarring as yours.

It really is amazing how different our bodies react to the process. My friend who just had her second son this week? Induced both times with Pitocin with no issues, and only pushed for a half hour with her second.

staciemarie said...

"I was induced". 31 hours later, I had a c-section.

Miranda said...

Our stories are so similar. So, so similar. I know that my c-section was a major contributor to my PPD. I'm glad you found ICAN. I've been in contact with my local chapter, too. I plan to attempt a VBAC for my next delivery (not currently in negotiations) because I feel like I have not given birth. I gave life but not birth. And I want that experience.

If you ever want to chat, feel free to email

amber said...

I think a birthing center sounds like a great option for you. I have an ex-boyfriend whose sister had a really tragic situation happen with a home-assisted birth that has forever soured that for me. But, with the birthing center, western medicine is right there if it is needed. I'm wishing you much love and good wishes for this time around. {{hugs}}

Delandra said...

Good for you for pursuing a gentler birth, not just being cycled through the system of repeat Cesarean.

I am so sorry you had the type of birth you did the first time around, although it did lead to your being an informed consumer in the world of maternity care. The world needs more women like you. If that birth had gone smoothly, you wouldn't have felt the need to do your research. You're right, had you decided against the induction and opted for natural childbirth your experience most likely would have been nothing like it was. Pitocin is evil stuff. These days, too many women have heard that contractions are god-awful (most likely because the ones they hear about were triggered by pitocin), how hard they are, and end up terrified of 'feeling' birth. You've done a great job of pointing out that pitocin makes labor NOT NATURAL. You can expect natural birth to be much gentler, not at all like before. This time, definitely hire a doula to help you and your husband through the birth (you'll be quite emotional and will benefit from the constant encouragement and reassurance) and good luck with your VBAC!