I don't have any pictures but here is my story.
Entries in induction (5)
“But the biggest surprise by far – on her stomach was a scar!”
(from the children’s classic, Madeline by Ludwig Bemelmans, referring to her appendectomy)
When you look at your Cesarean scar, what does it say?
My C-section was a surprise to me, so much so that I hadn’t packed enough clothes for a hospital stay of four days rather than two. Even though my obstetrician had been telling me for weeks that we would induce labor due to my gestational diabetes, and C-section was a possibility, I never thought I would come to that. I’m Marjorie’s daughter – Marjorie who had two easy, natural childbirths without complications.
I cried uncontrollably throughout the surgery. When they lifted my daughter, Cecily, from me and I heard her voice, I cried harder, but from relief and redemption. In the picture of me on the operating table, with my husband and Cecily, I look transfixed, in a state of grace, as though light were streaming from my face. I believe the grace and redemption I felt were genuine, not just my body reacting to the drugs.
We received a gift of three Madeline books in our first week home from the hospital. I had read and loved these books as a child, so I was happy to be reunited with them and to have them for my daughter. The page where Madeline proudly shows off her appendectomy scar to her hospital visitors did something to me. It was the first indication that I could think of my scar as something positive, something that others could look at and admire.
So even though I did not have a natural vaginal birth for my first child, it was still a spiritual experience. I still underwent the rite of passage from Maiden to Mother. And these days, as I am enjoying and getting to know my daughter, I tell myself the “C” of C-section stands for Cecily.
- Emily Richardson, April 18, 2010 (7 weeks post-op)
When you touch your Cesarean scar, what does it say?
“Macduff was from his mother’s womb / Untimely ripp’d.”
(Shakespeare, Macbeth, Act 5, Scene 8)
My scar is harder than the surrounding skin, and its red has not faded much yet. The hair that they shaved to make the incision has not yet fully grown back.
I didn’t want a C-section. I didn’t want labor to be induced before my due date, either, but I thought my obstetrician knew best, since she had medical training and I had gestational diabetes. Now when I look back and wish I had been allowed to go into labor on my body’s schedule, I think of Shakespeare’s description of Macduff’s birth as being “untimely ripped” from his mother. Vaginal birth, too, may be violent and bloody, but at least it is not untimely.
In Birthing from Within, Pam England notes that in some “primitive” cultures, women who have given birth are greeted in the same manner as warriors returning from battle. I like that this recognizes women as (at least) equally strong and enduring as men. If warriors returning from battle can point to their scars and remember their experiences, why can’t I? I am a “veteran” of the Cesarean operating table.
Right after the birth, I felt as if I hadn’t been as good or as strong as women who dilate to 10 cm and birth naturally. That my body was somehow lacking, and that was why I had a C-section. But now, I believe that my emotional as well as physical suffering during that night, when I had to accept, one after another, anesthesia, then epidural, then surgery – my emotional pain “qualifies” me and my strength as much as a vaginal birth would have. Women in normal childbirth, I’m told, reach a point of no return, where they have to go through the pain to the other side. I did that in my soul. And I have the scars to prove it.
- Emily Richardson, April 18, 2010 (7 weeks post-op)
I went in on a Friday to see my midwife. I was a little more than a week overdue at that point so they strapped me to the monitor to check things. Everything looked fine except the baby wasn't moving as much as they wanted. My midwife said just to be safe to go to the hospital for a NST. She told me that if I wanted to, just tell them I'm ready to have the baby and they'd induce me. That should have been my first clue that things might not go the way I was hoping.
So I went to the hospital and they decided that I was low on fluid. Fortunately the midwife on-call at the hospital was really understanding about me NOT WANTING an induction. Despite the doctor's recommendation (and my mother, and my aunt, and my grandmother) that I induce, the midwife suggested I go home over the weekend, drink tons of water and come back for another NST on Monday. I was very relieved to have another option.
I showed up at the hospital Monday afternoon and had another NST. While my fluid had not gone down, it hadn't come up either so the doctor, midwife, nurses, and my entire family told me to just get the induction. I still felt like it was the wrong thing to do, but everyone else was telling me to do what the doctor said and they kept insinuating that by NOT doing that I was endangering my baby's life. So I agreed.
You have to be 4cm to start pitocin and I was nowhere close (about 1 cm) so they used a Foley bulb to dilate me further. It was painful, uncomfortable, and invasive. They basically insert a balloon inside your cervix, inflate it to 4 cm, and it puts pressure on your cervix. When your cervix dilates to 4cm it falls out. The thing is connected to a tube that runs down your leg, which is taped there to hold it in place. They did this later in the evening and told me to sleep with it in. Yeah. Right.
By this time everyone had gone home because it was clear I wouldn't be in labor any time soon. There was no bed for my husband to sleep in so he asked if he could go home too. I wanted to say no because I was so scared to be there by myself, but I knew that if I did go into labor the next day I'd need him to be well-rested so I said that if he wanted to go he could and he did. I've never been so lonely and scared in my entire life and I just lay there crying for a while. I felt abandoned and then guilty for begrudging him sleep. To my surprise, I actually fell asleep.
I woke up a couple of hours later and had to pee so I went to the bathroom. While I was there the bulb fell out of me. There was a lot of blood and it was sort of frightening. I called the nurse and she just told me over the intercom to leave it in the bathroom. I was disappointed she didn't come in because I was still feeling lonely and wanted to actually talk to someone. I fell back to sleep, much more comfortable now that I didn't have a contraption inside me.
The next day my family showed back up cheerful and well-rested. I was feeling a bit grumpy myself, but tried to be excited that I was going to have a baby today. I thought. I asked the midwife if I could go walk around outside for a while before they strapped me to all the IVs and monitors because at that point I'd been in that hospital room for almost 24 hours. So I got my last breath of fresh air for a while and walked around outside the hospital. It was a beautiful fall day.
I went back in feeling much better and settled in for a long wait. They started the pitocin and an IV antibiotic. The first anesthesiologist came in and offered me an epidural. That pissed me off because it specifically said in my birth plan NOT to offer me medications. I wasn't even in labor yet for crying out loud! It would have been waaaaay too soon for an epi even if I'd wanted one. I just said, "No. I'm not using medications." He laughed and said, "I bet I'll see you later" and walked out the door. I was pretty pissed off, but my mom and husband said "oh he was just kidding, you're making too big a deal out of it" so I tried to let it go.
After that it's a long, boring blur. Every few hours or so a new anesthesiologist would come in and ask if I was ready for an epi yet. I got irritated…then I thought it was funny, especially since I still showed no signs of labor. They kept cranking up the pitocin, but nothing was happening. I dilated to about 6cm by early evening, the monitor showed regular contractions, but I felt nothing. The baby was perfectly happy and showed zero signs of distress. I laid there on my back and got up from the bed only to go use the bathroom. I started lying about needing to pee just so I could get up.
Sometime in the evening a nurse offered me a rocking chair. I was surprised. I asked if it was ok for me to get out of the bed and she said of course. Geez, I wish someone had told me that earlier!! I'd have been up moving around, squatting, rocking, kneeling on all fours, all the things I knew would help the baby move down. At that point I don't think I sat down again. I stayed on my feet except when they checked me for dilation.
I don't know what time it was when the midwives changed shift, maybe 8ish, but the new MW came in and it seemed like right away she decided she needed to know how strong my contractions were since I hadn't dilated past 6. She put an internal monitor on my cervix, which meant the end of my standing. I had to lay on my back and try not to move at all. It wasn't long before I felt the water trickling out. I let her know my water had broken and she removed the monitor. I’ve since learned that the water always breaks when they use an internal monitor, but the midwife didn’t tell me that part when she said she was going to put it in.
At any rate I got excited once my water broke because suddenly I could actually feel the contractions. I thought what I'd been waiting for for two days was finally happening- I was in labor!! I was thrilled.
Then the midwife came back. She said the monitor showed that I was having really strong contractions and that because I wasn't dilating despite the contractions she thought it was time to do a c-section. I felt like someone punched me in the stomach and knocked the wind out of me. I started crying and said, "but I can feel the contractions now, I'm in labor." She told me I'd been in labor for a while and it wasn't progressing anything. I asked her if we could please just wait a little while to see if anything happened and she said she would give me one hour. If I hadn't dilated by then I had to have a c-section.
She put me in the "Pretzel" position, which apparently is supposed to encourage dilation (again, no one could have suggested that earlier??) but unfortunately makes the fetal monitor hard to keep in place. I spent the entire hour crying to myself, listening to my mother and husband tell me it was for the best, and trying to ignore the nurse who would not leave me alone and kept messing with the stupid monitor. I wanted to scream at her that surely after 13 hours of lying there with the damned monitor strapped to me and the baby had never once shown any signs of distress, surely it would be ok for the next hour. But of course I didn't. I just kept trying to help her get the monitor situated. She didn't try to hide her frustration and impatience with me at all. She clearly thought I should just go do the surgery and get it over with.
Then the MW came and checked my cervix again. Still 6 cm, so she said. I have my doubts about whether she would have actually told me if I had dilated, but maybe I'm just paranoid.
So that obnoxious nurse came in, much more cheerful now, and shaved the top few inches of my pubic hair. Someone came in and gave me a shot of something "to calm me down." I requested they wait to give me a catheter until after I'd been numbed and they said yes. It was the best decision I made all day, I think, but the nurse seemed to think it was weird.
They rolled me to the OR, which looked like a supply closet. They said my husband would join me in a minute. The anesthesiologist just happened to be the same one who'd been there 12 hours earlier. He said, "I told you I'd see you later." All I can say is that it was a good thing that they gave me that shot to calm me down because I remember being angry but just not caring. That stupid nurse who'd been badgering me for the last hour was there as well. While they are getting things ready they were gossiping about some guy who was "totally looking at" one of the nurses. I didn't understand how they could not realize that I was laying there having one of the worst moments of my life. I wanted to scream at them that I knew they probably did this everyday, but I didn't and it was really scary and emotional for me, but I just didn’t have the energy. Probably because of the shot they’d given me.
My husband still hadn't shown up, but it was time for my spinal block. The thing I'd feared most throughout pregnancy- the reason I never wanted an epidural- a needle in my spine. I thanked the shot again. I leaned on the MW. Suddenly I thought someone had splattered boiling water down my left leg. I jumped and looked to see who'd dropped a cup but the MW just told me not to move. It was just the needle hitting a nerve. I laid back and they raised the curtain. I zoned out. The part of my brain not "calmed" by the shot wondered where my husband was.
Finally he came in. He seemed surprised they'd already started. Apparently he'd gone to get a cup of coffee and they couldn't find him.
It's all a blur from there until at 1 am I heard the doctor say, "Oh, what a beautiful baby." I remember wondering whether he said that about all the babies. I tried to look and see but the curtain was in the way. By the time they brought her to us she was clean and swaddled and had a little cap on, but she was the most beautiful thing I'd ever seen. Her face was so pink and her eyes were closed and she looked so peaceful. They handed her to my husband and I reached up and touched her cheek and said hello. I laid there with my hand on her cheek for god knows how long. It seemed like ages.
I started to realize that I felt a vague burning sensation in my abdomen. I told the anesthesiologist that I felt something. He asked me what it felt like and I thought for a second and said, "it feels like fingers in my belly." He said, "Let's get you a shot of morphine." They don't tell you this, but morphine makes you itch. It was terrible, it started in my nose, then my face...neck...chest. I was trying to focus on the baby but I was so itchy and I'd been laying there for so long.
Finally they finished and I was able to hold my baby for the first time as they rolled me back to my room. For a few moments all was right with the world. It wasn't so bad. My baby was healthy and I was OK. As soon as they parked my bed I put my daughter to my breast and she latched right on. I was so happy. I slept with her all night in my bed with me, nursing and snuggling.
The next day I was in the bathroom when I heard my usual midwife come in my room. It was the first time I'd seen her since that Friday she'd sent me for the NST. I sat there in the bathroom afraid to come out and started crying. I couldn't face her. The last time I'd seen her I was pregnant and happy and confident and now I'd failed. She was going to be disappointed in me and I was scared to look her in the eye. I tried to clean off my face and look like I wasn't crying and walked out to see her. That was the first time I pretended like it didn't matter but it wasn't the last.
Despite all my gentle attempts to naturally induce myself I had not gone into labor. I had to really fight with my midwives’ overseeing OB to get to 42 weeks, especially after I agreed to the US to check the baby's size and they estimated him at +9lbs. They scheduled a c-section for the day I hit 42 weeks. That was a Sunday. Here's the rest of the story...
Saturday morning at 6am I woke up and felt my first real contraction. It felt nothing like anything I'd felt before so I thought it was the real thing, but was afraid to get my hopes up again. They continued regularly every five minutes for over an hour so I knew something was really happening. I took a shower and they started coming one on top of the other so I called my doula. While she was on her way they evened back out a bit. My mom came and got my daughter and I settled in to what I thought would be a pretty quick labor- since they were already so close together and lasting about 45 seconds. Over the next few hours they got to every 2 minutes and stayed there. All. day. long. I should have tried to do other things to take my mind off of labor, but I was so afraid that if I stopped concentrating on the contractions they'd stop coming and I'd end up on that OR table the next day.
Around 6:30PM that night I called the on-call midwife because my doula was afraid I was going to get too worn out and she wanted me to try to speed things up. I'm so glad I called the midwife because she assured me that the surgery was definitely off since I was in labor. I didn't realize I'd been worrying about that all day- like I was trying to labor on a time clock. She told me to relax, make myself comfy, take a warm bath and let labor take its own course without trying to speed things up. I felt so much better. I sent my doula home- that was actually a big relief. She was starting to stress me with suggestions of how to speed things up and I was tired of being stared at.
So I took a hot bath, relaxed, laid down in bed, tried to watch SNL and dozed between contractions for a while. After a few more hours the contractions weren't getting closer together but they were getting harder to deal with and more intense so I decided to head to the hospital. I'd been in labor about 18 hours at that point, though I lied to the midwife when I got there and said the contractions had started early afternoon sometime. I really didn't want to be on their clock.
The drive to the hospital sucked, but we got there Sunday morning at 1am. We got lost trying to get in to the maternity ward but a friendly security guard helped us out and let us in the door that was locked after hours. The nurses recognized my name from the surgery roll for the next morning and were really excited for me that I was in labor. I was 5 cm when I checked in and incredibly happy to hear it. I had a heplock for antibiotics (I was GBS+) and was on continuous monitoring because I was VBAC, but generally comfortable and able to move around. I decided not to worry about whether they were getting good monitor readings and that made things easier. I used my yoga ball to sit on, lean on, drape myself over. I squatted into contractions, I laid on my side for a while. Basically I tried every position in the book and just generally stayed mobile.
By 4am I was 8 cm and 100% effaced. I heard that and cried with happiness. Then my body decided that it was done for a little while and I stopped progressing. It was probably good because I was able to sleep a little bit, but after a few hours they started talking about internal monitors and pitocin so my body kicked back into gear. In another hour or so I got to 10cm with a cervical lip that just wouldn't go away. I was getting frustrated at that point because I felt like no one was telling me what to do to make it progress. The doula was useless at this point (I’m sure she was worn out) and I was getting so tired and just frustrated. The pain really wasn't much of an issue for me, I was just exhausted from lack of sleep and a long labor and just READY FOR THE BABY TO COME OUT.
Then shifts changed and this angel of a nurse came in and started quietly making suggestions in my ear about how to stand, where to put my feet, how to curl my back forward instead of backward during contractions to get the baby around my pelvis. I got to the point where they said I could try pushing past the lip but the baby kept slipping back. The midwife (the same one I had talked to the night before on the phone) assured me that at this point I WAS going to have a vaginal birth, but they thought a "whiff of pit" would strengthen my contractions and make them consistent enough to actually push the baby out. I was still falling asleep between them at this point. I didn't even notice the pitocin, but once they gave it to me it took about 45 minutes of pushing before the head came out (at 11:13am after 29 hours of labor). I was laboring on my back at this point holding my feet and pushing against my own hands with some help from my aunt on one side and the nurse on the other with my mom holding my head and helping me curl into a shrimp position. My husband was waiting to catch the baby and my sister was watching over his shoulder. My eyes were mostly closed but I have a few mental images of seeing their faces as the baby was coming out. I thought it would be embarrassing but it was encouraging because they both looked so amazed and impressed. Then the head popped out and everyone cheered.
The amniotic sac was still intact and she had to burst it by poking her finger in his mouth. Then they told me to stop pushing because his shoulders were stuck. My husband was not able to deliver him because the midwife had to maneuver him a bit, which caused a tear, but when I felt his body slither out everyone in the room cheered. They put him up on my belly and I reached down and felt that he was a boy. He was just as beautiful all messy and blue as my daughter had been clean and pink. They had to take him away after a moment because he was in a little bit of shock from getting stuck, but they assured me that he was just fine and they kept him in the room while they checked him over. I delivered the placenta (that thing was huge!!!) and then they stitched me up. The stitching was the first time I said the word "epidural" the whole time I was in labor. That was the worst part of the whole experience. I tried to hold the baby to distract myself, but I was yelling so loud I had to give him to my husband until they were done. It took forever, but they finally finished and gave my baby back to me. I offered him my nipple and he immediately latched on and went to town like he'd been doing it forever. It was wonderful. It was the most healing, amazing experience of my life and I hope every woman can experience something like it.
If you'd asked me what my scar said to me when I looked at it or touched it a few years ago, I'd have said it was mocking me. It said, "Look what you let happen. Look what you let them do to you. Look how weak you are." It was a constant physical reminder that I failed at birth. I knew intellectually that I didn't fail, that it was the broken system that failed me, but emotionally I felt like a failure. I didn't mind the stretch marks or the varicose veins as visible proof of my motherhood, but that scar was a different story. I'd loved being pregnant, every second of it. And even though I went well past my due date I never felt "done" with being pregnant like so many moms do. But the medical professionals felt differently and even though looking back I can say that I did everything reasonable to avoid it, I still felt guilt for giving in to the fear and agreeing to an induction that I KNEW would not work. I KNEW my baby wasn't ready to come out yet.
As c-sections go, mine was actually not that bad. I was not separated from my daughter and I was able to nurse her within about an hour of her being delivered. She was perfectly healthy and my recovery, while difficult, was nothing out of the ordinary. But emotionally I had no idea the kind of fallout I would face. I couldn't acknowledge the shame and guilt. I hid in the bathroom of my hospital room and cried when my midwife came to visit and I didn't even know why until much later. It wasn't until I started talking to other moms who'd had similar experiences that I realized it was normal, or at least very common. Most of the people around me didn't understand and my inability to be happy with my experience made them noticeably uncomfortable. But once I was able to talk about it with people who didn't just reply, "your baby is healthy and that is what is really important" I started processing those mixed up feelings and even started to heal a little bit at a time.
The anger came first. Anger at the medical community, anger with myself, anger at all the people who had been present at the birth. Then came the acceptance of what happened along with a determination not to let it happen again. When I got pregnant with my second child the fear reared its head again, but I faced it head on this time and really examined what I was afraid of, how I could avoid it, and made lots of "what if" plans. I fought like a mama bear through most of my pregnancy to make sure the birth would go the way I wanted it to go and finally I had to just give up my false impression of control and trust my body to do what it was made to do. And it did. And it was the most healing experience of my life.
So now my scar says something different. It says, "Look what you can do! Look what you can overcome. Look how strong you can be." I may not be a the point yet where I can say I'm proud of my scar, but I don't avoid looking at it in the mirror anymore. I don't avoid washing it so I won't have to feel it, in fact I can barely feel it at all unless I really try. It's beginning to fade into my skin the way the memory of the birth is fading into the past, becoming a small part of my life experience. That doesn't mean I'll forget and it doesn't mean it's not important, but it doesn't have the rawness of a fresh wound anymore.
The article Delaying Childbirth Is Associated With Impaired Contraction of the Uterus and Rising Rates of Cesarean Section reminds me of a phrase I use when discussing post-term pregnancies:
Oftentimes, women who needed help getting pregnant need help getting un-pregnant.
I believe there is a misconception that any length of pregnancy is normal. Yet, if we left all pregnancies to find their natural end, some wouldn't ever be completed and the baby would also not survive.
Lots of caveats:
- Allowance needs to be made for women's cycles
- Some pregnancies do last longer than typical pregnancies (more on that in a moment)
- While I believe some women need to be induced in order to have healthy pregnancies, I do not agree with inducing earlier and earlier in the name of safety.
- I do not believe the definition of post-dates should be changed to 41 weeks or under. (Too many docs even consider over 40 weeks post-dates!)
But, in my experience, when women have hormonal or metabolic issues in their bodies, it isn't uncommon for the body to need a kick-start to get things moving. Maybe the kick-start is homeopathics, Evening Primrose Oil, herbs or even an enema/castor oil or stripping the membranes. Sometimes, the kick-start is prostaglandins or pitocin..
There will always be exceptions - I acknowledge that - but in my limited experience and in talking to loads of women, fat women, women with PCOS (Polycystic Ovary Syndrome), Syndrome X, Gestational Diabetes, older (over 35 or so) primips and women who used technology to get pregnant all seem to have disproportionately high numbers of post-term pregnancies.
Searching "PCOS post-dates pregnancy" comes up with story after story of women 2 weeks "late."
"Post-dates Gestational Diabetes" finds the same information.
(Post-dates is not the same as post-term in my mind. Post-dates is more arbitrary and post-term is a clinical description of the baby and placenta. But, one has to be post-dates in order to determine if the baby is post-term.)
I don't find much information talking about my theories, however, so I really could be way off the mark, missing something. But, I don't think so.
I define post-dates as moving beyond 41 weeks and 3 days with no cervical changes. (I've never written that down before. It feels... um... interesting? Good? Scary?)
It does seem an arbitrary number, doesn't it? What makes me pick that specific day? I admit it... lots of the thinking is "What's are we going to do when we hit 42 weeks?"
(And by 42 weeks, I mean the end of 41 weeks, the beginning of 42. Back in the day, a post-dates pregnancy was at the end of 42 weeks, the beginning of 43.)
Our law states we need to transfer care at 42 weeks. With informed consent, I can avoid what the law says to do, but informed consent is going to include fetal death if the pregnancy is left to go too long.
Starting at 41.3, I need clients to start Biophysical Profile (BPP) testing. I want to know how the baby and placenta are doing. I know it irks some women to hear it, but placentas do have a shelf life.
I have my clients do a BPP every two days while also becoming more aggressive in the "natural," yet active means of getting a cervix softer and hopefully, the uterus doing the work it needs to do.
I do get very antsy once we hit 42 weeks and nothing is happening. Enough research shows a sharp increase in fetal death after 42 weeks and higher and higher the longer the pregnancy goes.
The article mentioned in my opening validates some of what I am saying, although indirectly.
"...they hypothesized that the increased risk of caesarean section among older women is a result of a biological effect of aging on the ability of the muscle of the uterus to contract. They evaluated this hypothesis by examining biopsies from the uteruses of a separate group of 62 women (of mixed parity) undergoing routine elective cesarean delivery in Cambridge. They found that advancing age was associated with impaired uterine function as evidenced by a reduced degree of spontaneous contraction and the type of spontaneous contraction."
The article doesn't directly speak of post-dates or post-term pregnancies, but "impaired uterine function" could certainly be a cause of a post-term pregnancy.
So, I agree the cesarean rate is dramatically inflated for, what would seem to be, causes to do them, but what if women in today's world really were having labor issues and needed to have cesareans because of failed inductions? What if the number of older moms, fatter moms and women with metabolic disorders were some of the reason cesareans aren't in the 5%-10% range most of us think it should be? What if the rate of cesarean really should be higher in our country because of our over-nutrition? Because we are technologically able to conceive babies despite mechanical, hormonal or age issues?
What if we who do natural birth are overlooking information right in front of us? Would this be doing our clients a disservice?
I know it's sometimes hard to digest what the medicos churn out, but what if they're right on some things? How do we decipher the information? Whose spin do we assimilate into our practices?
I look forward to hearing others' thoughts on this topic.