I had a meeting with a mama recently, a 6-week postpartum mama who was one of my monitrice clients. She hired me to help her have a VBAC and, in the end, she had a repeat cesarean. Controlled, empowered and with full consent and understanding; all the things she didn’t have the first time. She needed to talk; I needed to listen. We needed to spend some time together, our first without her in crisis, in pain and without others in the room (except for her lovely daughter, of course).
I chronicled her pregnancy and birth in FB as it was happening, her borderline pre-eclampsia, her several day powerful labor without progress, her choice to go into the hospital, the walk towards pitocin and an epidural, the continued lack of progress (where was that cervix anyway?) and, after 24 hours in the hospital, the being wheeled into the OR for a repeat cesarean.
With the last baby, mom, alone, tried to find peace with the birth that had many indications for a surgical birth, struggled through the pain and confusion, vowing to have a VBAC with the next birth. The initial healing was complicated by, what seems to have been, postpartum pre-eclampsia. Her doctor told her to lie on her left side even though her symptoms were a cracking headache, an ocean in her ears and an inability to see clearly. I told her it’s a miracle she didn’t have a stroke or a seizure with that flippant attitude of the OB.
When she got pregnant, she did everything she could to set herself up for success, including hiring me as her monitrice. We worked on mental blocks, working through fears and talked about all the physical ways to ensure a great “trial of labor” that could end in her triumphant VBAC.
Yet, repeating complications, blood pressure creeping up and up, edema getting deeper and higher, even a breech baby for a time, all slowly immobilized her. Eventually, she was on bedrest for three weeks, better than the six weeks last time, but complicated by a four-year old this time around. Both mom and dad are acupuncturists, well-versed in the alternative methods to balance the body, yet she continued having her body’s betrayal of all she wished for. When the blood pressure got high enough, she began serial Biophysical Profiles (BPPs), every three days, in for the ultrasound and if her BPs were too high, she schlepped off to be admitted to the hospital where they kept her on her left side, monitoring her (including blood tests) and the baby, for several hours at a time. By the time the baby was born, she’d had quite a number of scans and three admissions to the hospital – all before labor even began. Quite different from the easy-going birth plan she’d hoped for after the first traumatic birth.
Throughout, we discussed options, which dwindled as time passed and once she was having regular, strong contractions, it was hard for her to do much of anything without sending her BP to 140s over 100s. Having a really deep tub, she regularly soaked in it with Epsom Salt and that time in there was practically the only time she was upright.
Okay, moving on.
So, she labored hard for a couple of days. My vaginal exam found her to be 2cm, but that cervix so high I could barely reach it even with her hips on her fists. Trying to feel the position of the head was impossible; the head was at a -3/-4. Watching her labor, she looked to be 5-7cm, so we’d go to the hospital – something to help her sleep? That I might be totally wrong on my assessment? They’d check and send her home again. I was confused, but the reality of what was probably going on began to set in. All that lying on her left side settled the baby into a cock-eyed position. Way later, after the cesarean, that exact reason was validated, the baby having a bruise on the right side of the skull, she having tipped downward, trying to rotate, but getting caught by (the ischial spines? the pelvic brim?) bones that didn’t allow for continuing rotation.
The early postpartum period was infinitely easier than last time. She didn’t have any of the pp pre-eclampsia symptoms, the baby slept more than her first and, after she had the tight frenum snipped, she didn’t even have anymore nipple pain. Instead of having to focus on sheer survival, her mind was able to think about the birth and how it’d gone. She felt pretty good about it, knowing she really did everything she could under the odd circumstances.
She felt good about it until a woman at her son’s school, a recent homebirth convert, sent a shower of doubt on what she’d thought was a nice experience.
“Did your midwife try this? Did you stay out of bed? Did you change positions? Frequently? Did you do that? Why did you go in so early? Oh, you had an epidural. Oh, pitocin.” You could almost hear the clucking of her tongue and see the shake of her head in pity.
During my client’s pregnancy, this Natural Birth Prosthelytizer bragged about watching baby shows on tv and being able to pick which ones were going to end in a cesarean within minutes of the show beginning. She had an infinite number of “suggestions” for my client, many of which were contraindicated because of her circumstances.
So my mama, now filled with doubts, needed to talk about what happened. Did she try everything? Was there anything she could have done differently? Why did her body fail her twice? She’d been scouring the Internet looking for any clues she might have missed. She asked her husband, over and over, “why this, why that, how come…?” Her husband told her it was over, move on already. Why did she have to obsess about each birth like this? Couldn’t she be happy with the baby and that be good enough? I let her know that maaaaannnnnyyyy partners said those exact words to healing women, that she wasn’t alone. She said he finally told her to “Call Barbara!” and that’s when she called.
When I sat down with her, I explained that if she hadn’t had the pre-pre-eclampsia, if her BP hadn’t been so high, if she hadn’t been on bedrest, then it was possible the baby wouldn’t have imbedded herself into her pelvis and there might have been a vaginal birth. Of course, I had to qualify that with the truth that some women who are upright throughout, who hula, wiggle, dance, walk up and down the stairs sideways, lift the baby out of the belly with a rebozo and are as evolved as Ghandi, also have acynclitic babies that need to be born via cesareans. I explained that because of her BP, I was limited in the suggestions for re-positioning the baby. She couldn’t tromp the stairs, she couldn’t tump upside down to start the baby’s descent all over again, I couldn’t use a rebozo because she was a VBAC, they were already doing acupuncture, soaking, meditating –and remaining calm on her left side. She wanted to know why I hadn’t said those other possibilities when she was in labor and I said, “What would be the point of saying, ‘Gee, if you didn’t have pre-eclampsia I could do A, B, C, D and E. Too bad you do, eh?’” Wouldn’t that have made her feel worse? She said it would have. It is important to remember, too, that she wasn’t my midwifery client, I was her monitrice. While I did discuss informed consent issues with her, knowing her, there were simply things that would have dragged her down instead of keeping her as positive as she could be. Not that she would have, but even if she said she wanted to put her head on the floor and her torso up on the bed, I would have had a serious issue with that. If she had a stroke because of something I suggested, it wouldn’t have gone over well… with the family or the doctor.
As we talked, she understood that her options were limited because of her individual circumstances and thought she had more information to tell the Natural Birth Prosthelytizer (NBP). I told her she owed that woman NO excuse/explanation at all. She’s an acquaintance who will learn humility one day, realizing her arrogant attitude towards others’ births and the belief she can predict all outcomes isn’t really true. I suggested that she could tell the woman, “I appreciate your interest in my birth, but I’m uncomfortable with your judgment of it without having all the information.” Or “Please don’t judge my birth. You don’t know all the information about my case.” I told my client I wanted to write the BP a nastygram, but she would blow it off that I was just one of those medwives who didn’t have a real appreciation for the perfection of birth – if left alone. I made my client laugh.
The conversation shifted to the Is My Body Broken part of the healing. It’s hard to say no when the same woman has had pre-eclampsia twice, had to live on bedrest for weeks at a time and who had a cesarean because the baby couldn’t find his/her way out. But, I shared that, from what I knew, the pre-eclampsia possibility is laid down when the placenta is born in the first few weeks of pregnancy. I said there seems to be a chain of events, a bumping of chemicals into each other, triggering one more step towards pre-eclampsia. That the dance is so intricate, no one really knows what causes it; if they did, she wouldn’t have had it. I told her there are some things we know for sure: high glucoses cause gestational diabetes, anemia causes fatigue. But, there are other illnesses or complications that have no easy answers. Preeclampsia is one of those. I told her it was very hard not being able to say, “If this, then that.” But, much of life is ambiguous; pregnancy is no different.
In a near whisper, she asked if being a sexual abuse survivor might have subconsciously influenced her body’s imperfection. She said she’d worked for so many years in therapy, but maybe there were still threads she didn’t know about that got in the way of the vaginal birth. I shook my head and said that was very unlikely. That there was a much better explanation – the increased BPs and the baby’s odd position were the obvious reasons. I reminded her that she was very easy-going with vaginal exams and that it isn’t uncommon for women with a sexual abuse history to struggle with them. She said again that she thought she’d worked through things and felt better that it probably wasn’t that.
“But, what about the surgery (colposcopy) I had on my cervix?” I told her I didn’t feel any adhesions when I did the exams and if I had, I would have asked permission to snap them. She seemed relieved to hear that, too.
As we addressed each concern, I reminded her that we were sitting on the couch with a newborn on her breast. That looking back, it was easy to say, “Well, maybe it would have been okay to tip upside down. I could have walked up and down the stairs” because you are healthy and alive. If we had done those things and you stroked out, it would be a totally different discussion. Birth is trial and error, risks and benefits and using the available information to map out the path ahead. It isn’t perfect, but it’s the best we have.
Feeling more at peace, I got ready to leave. Sweetly, she said, “I know you’re busy, but would it be okay to call you again?” I gave her and the baby a giant hug and told her, looking her in the eyes, that I am always her midwife. Forever. She could call anytime and I am there. If she wants to discuss things again, I am there. I told her it takes time to assimilate it all and to be patient with the process. She promised she would.
That women bring me into their worlds this way is an incredible honor. That women let me share their world with you all is an even greater gift.