How I Had an Intact Birth after Cesarean
I was seven months into my second pregnancy, with many more discomforts than my first pregnancy, when my midwife asked me to get an ultrasound. Something just didn’t seem right, and she would be more comfortable if we checked it out.
We had the ultrasound and were joking together in the waiting room afterward, when the midwife came in and said soberly, “It looks like there are some malformations.”
“Oh my God,” I said, and looked at David. It was SO unexpected and such a shock that I didn’t really know if it was real. Once it sunk in, I started to imagine horrific malformations—a baby with two heads—and instead of feeling compassionately toward my baby, I found myself squeamish and grossed out that something malformed was growing inside of me. Suddenly instead of being a mother or a baby, I was a victim in Alien.
It did not help that the hospital could tell us nothing more. They sent us to another hospital where we were to get a level two ultrasound. We went the next day, and spent a good couple of hours trying to convince them to admit me. Apparently you can’t just waltz into a place and get an ultrasound. You have to have been sent by a medical professional. Well, we had been, but we hadn’t been given a piece of paper saying we had been.
At last we were in, and once they had administered the ultrasound they put on their serious faces and told me that I couldn’t leave. My baby had hydrops fetalis and the organs were not developing properly. I would have to stay in the hospital and the baby would be monitored constantly.
The next morning I was told that I would be getting a cesarean that day. The sooner the baby came out, the sooner the medical professionals could get to work fixing the baby’s body. It was our baby’s best chance at survival.
Being the last person in the world who would ever have a cesarean, I asked if there wasn’t some way I could birth vaginally. I was told that the baby was breech, and anyway wasn’t strong enough to survive being squeezed through the birth canal. I nodded numbly.
I almost told them how I didn’t want a hat put on the newborn baby because I had decided that being held skin to skin would provide enough warmth, and that I thought a baby’s body would learn to self-regulate temperature quicker without a hat; that babies were made to self-regulate when they needed to, and that their bodies are fast learners; that I didn’t want a hat to interfere with my smelling and nuzzling and bonding with my newborn. Then I remembered that they would be trying to save the baby’s life, to keep the heart beating, and that my crazy newborn hat ideas were pretty meaningless. I remembered that my baby might not live. And I kept my mouth shut on this most trivial of birth plan details—the only one that came to mind at the time. It hadn’t occurred to me to discuss whether my baby was bathed, or to request that she be kept with us, to mention my intentions to breastfeed exclusively or the fact that I didn’t want my baby circumcised. No, it was the hat thing that came to mind.
I treasure the few minutes we had to hold our baby girl, to name her and make sure she knew that we loved her. I really look back on this day fondly. It was the day I met my daughter and they only day I held and kissed her.
Those unmatched moments were preceded by a horrific operation. They kept increasing the anti-nausea influence pumped into my IV, and I kept vomiting anyway, so they gave up and handed my husband one of those little vacuums the dentist uses to suck the saliva out of your mouth. Thus were the mother and father engaged while the baby was being born. It was as if we were not at the birth. The birth happened on one side of the curtain, while my husband tried to comfort me through a terrible illness on the other.
They told me that I would feel as though I could not breathe, but not to worry because my body would be breathing just fine. I nodded at the time, but it turns out that when you feel like you can’t breathe, it’s very difficult to remain calm. I kept insisting that my collar was cutting into my neck and my husband and the anesthesiologist tried with futility to pull it away enough to make me comfortable.
I wondered if I would survive. I wondered how much longer I had to survive it. I forgot that a baby was being born.
Suddenly I realized that there were a group of doctors saying medical things on the other side of the room, and a second group of doctors murmuring over my body. I thought, the baby is out! Those doctors reading out heart rates aren’t talking about mine—I had a baby! I squeezed my husband’s hand and my eyes filled with tears. I don’t know when the baby had been born or how long until I noticed but I was a mommy and I no longer noticed whether I could breathe or remembered to vomit.
One of the doctors came over and wondered whether we wanted to be told the sex. Until now, even with all the ultrasounds, we had requested to remain in the dark. Suddenly the baby had been born and I realized there was no moment of revelation to wait for. Sheepishly I said that they could tell us the sex. I mean, hell, everyone else knew!
She was a girl. She was alive—I could still hear reports of her heart rate. She was going to be rushed to the neonatal intensive care unit and the father had to go with her. I could see her go by if I turned my head just so and waited.
They were wrong—I couldn’t see her. I only saw doctors and a wheeled table rush past. Then I was left alone. I guess they were still repairing me. I lay there for a long time not knowing what was happening behind the curtain but thinking about what might be happening in the NICU.
Finally I was wheeled into a curtained room to recover. Recovery meant a deceptively friendly nurse pushing down on my abdomen to cause uterine contractions. This was more painful than birth ever was. After a while family members were admitted one at a time. My mother and sister, and my husbands parents had all come to the hospital to wait outside the operating room. They knew that their opportunity to meet their grandchild might be brief.
One at a time they smiled at me and held my hand, and said nice things about our little girl. They had all seen her already. I guess she had been ready for visitors before I had been. We talked about giving her a strong name because she would have to be strong. Tiamat, my sister suggested. I told each of them that I knew she would be all right because our family was a strong and happy family that had good things happen to us. By now I was convinced that she would overcome the difficulties she’d had in utero and quickly grow into a healthy and normal girl. I believed in and expected a miraculous recovery. How could it be otherwise.
They each agreed with me in turn, but they were reserved.
Finally David came in to see me. He told me that I needed to come see the baby. He asked the nurse how soon I could see her. He didn’t say that he was afraid she would die before I got there.
Eventually I was wheeled through the hospital to the NICU. There were several babies in plastic boxes with parents hovering nearby. There were lots of wires and machines and blinking lights and blinking noises. And there was my baby, lying still, eyes closed. She was dark brown and a little bit purple and very big—she did not look premature. Her body was puffy and swollen beyond normal. She didn’t move.
I could touch her, and I did, reaching across from my sickbed to hers.
Hi, baby. I’m your mommy and I love you. I’m so happy to see you. You’re going to get strong and come home. Soon I’ll hold you and things will be much better. You need to be strong and get better, sweet baby.
I said these things, with my hand on her head, because it was the part of her that wasn’t covered up. I knew she needed a mother’s touch and a mother’s voice. My own mother was with me while I talked to her because girls need mothers.
David had been talking to the doctors and now came to get me. They took me into a closed room where we could have privacy, and David told me that her lungs, which had stopped developing months ago, would never develop the way they were supposed to.
While in my womb she had been healthy–I had felt her kicking strongly every day. In utero my body had sustained her and she had not relied upon her own organs. Outside the womb she would not live without life support. I was her mother and if I could have been her life support as I had been for more than half a year, I would have. But I couldn’t even hold her. I nodded calmly and said, “So we should turn off the machines?”
He nodded.
“Then can I hold her?”
He thought so, and the doctor confirmed it, and the fact that I would get to hold my baby made the decision so easy. Yes, take her off the machines and bring her to me!
Our family gathered in this room, and a doctor brought my baby to me and put her into my happy arms. I immediately started to unwrap the blanket around her so that I could see her body, but found that wires and syringes were wrapped up in it. I quickly covered her up again, because it was the opposite of how I wanted to see her.
I studied her face and this time I told her a different story. I told her that she could leave this body and find a healthy body. I told her this one hadn’t grown properly but that she could find another body that would be perfect and that she would live a wonderful life in a healthy body. I told her that life was really nice and that it wasn’t usually like this—hospitals and plastic boxes and blinking lights. I told her I loved her, and I would always be her mommy and she would always be a part of our family. I told her how glad I was that she had come so I could meet her. I told her we had decided to name her Clementine Annabelle.
Then her daddy and each of our family members held her and spoke to her. I asked for a camera and someone found one to take some pictures of her. Then the doctor came in and listened to her chest and told us she was gone and we let him take her body away.
David’s mother asked if I didn’t think she had perfect little ears and I worried because I hadn’t looked at her ears. Later I asked to see her body at the funeral home because I wanted to look at those ears. It was a mistake, as this empty body looked completely different, her mouth stretched downward at the edges in a frown that could only be made by uninhabited flesh. I quickly looked away.
We scattered Clementine’s ashes in the Gulf of Mexico. Ada misses the sister she never met. Recently, after the birth of our third daughter, Ada asked me why we didn’t bring her to the hospital to meet Clementine and I explained how unpleasant it had been and that we didn’t want her there unless we knew the baby was going to be okay. She named her doll Clementine and takes very good care of her. She waited patiently for us to get pregnant again so that she could finally meet a little sister, and she celebrated the birth of our next baby with a lot of joy.
Ada has been the most amazing sister and daughter. She takes good care of us and shows a lot of love every day throughout everything. She delights in her little sister, with no impatience, and is always there to hold her hand and say, “Don’t worry, little Apple,” when the baby is crying.
Our new baby shares a name with the one we lost. She is Annabelle Apple, perfect, and healthy, and surrounded by love.
Before we could get pregnant again, our family had to move out of mourning and come to a place where we could look to the future again with love, excitement, and a certainty that life is good. Babies need happy families, which is why they are blessed with the ability to make us so very happy. And now I think of each of my three birth-days with love and happiness.
I encourage anyone who has had a traumatic birth experience (regardless of the outcome) to address it fully and with all your heart before you next birth. Annabelle’s perfect birth in our home would not have been possible without our comfort with birth and our knowledge that this baby was healthy and this birth was not tied inexorably to the previous one.
We had to come to this knowingness in spite of the medical warnings and admonitions. We did a lot of research to determine why it was unsafe for me to birth vaginally and based on the studies, statistics, and our own experiences, we determined that a home vaginal birth was, in fact, the safest birth for me and our baby.
I did a purification rundown through my church which rid my body of the drugs that had been administered to me in the course of my hospital stay, and this program culminated with a miraculous few minutes in which all the mis-emotions of that birth experience spilled out of me and when they were gone I was left with peace. That same moment is when the tenderness on my abdomen vanished and the numbness left by the operation disappeared. I know from this experience that physical toxins, body somatics and emotions are tied together in a very real way that I believe contributes to physical problems that can occur in the future—such as uterine rupture or stalled labor leading to a cascade of interventions.
I also received counseling from my father, a minister, on the experience of Clementine’s birth and we continued until the experience left the realm of emotional trauma and came to be better described as a memory with loss about which I can be sad without being helpless to that sadness. I was myself again, only richer in knowledge and experience and love, instead of being a victim of what had happened to me.
In these ways I was prepared to conceive and birth again and I am so happy with the outcome. It allowed my daughter to have a healthy and safe birth free from fear or sadness, and allowed her to have a healthy, happy mother too.
I am deeply indebted to my husband who took such good care of me and makes me happy enough to withstand any devastation! He never faltered in holding my hand through this despite what he was going through personally as a father and husband.
Our family couldn’t have been more wonderful and we are very lucky to have so much support.
Without Jill Adams, who puts the “independence” back in “independent midwife,” we would not have had prenatal care and a trained birth professional. No one else here would entertain the idea of my birthing vaginally due to the “high risk” vertical incision on my uterus. Jill not only accepted me into her care without batting an eyelash, but after our initial discussion of emergency procedures should we need to go to a hospital, she did not bring up my scar, never referred to me as high risk, did not refer to a “trial of labor” and showed nothing but confidence that my homebirth was assured.
Dr Magloire, based out of Miami, drove the six hours to Orlando just to meet with several of us VBAC (vaginal birth after cesarean) hopefuls because there was no doctor closer than six hours away who would agree to discuss the risks and benefits of vaginal birth versus cesarean delivery and then sign a piece of paper saying we had been made aware of the risks.
In Florida this is a legal requirement for a midwife to deliver a baby vaginally to a woman with a scarred uterus. That’s right, I had to get permission to use my vagina. Why is it that “no means no” but when it comes to using my vagina for its intended purpose my right to assert that “yes means yes” is passed off to an OB?
I originally thought I would have to birth in a hospital. It was only after searching in vain for a doctor who would “allow” me to have a VBAC in a hospital that I started to wonder whether I had a chance at a homebirth—my first choice.
But was it safe? I researched heavily and in the end the truth found in my heart was more important than truth found in statistics. I’m convinced that uterine rupture (the big risk of vaginal birth after cesarean) is more closely linked to spiritual and emotional than physical state, not because the integrity of the uterus is not important but because the physical follows the spiritual. Form follows function. I’m not proposing that it’s all about confidence, or being prepared. But I think fears are very important to the VBAC and that coming to peace with the past is probably the greatest contributor to success. Birth is such a sacred event and going into it with anything less than a full measure of strength and peace is dangerously irreverent.
I did have to come to terms with the statistics as part of the process of gaining peace. Other mothers with a classical incision may find it difficult, as I did, to understand “their chances” because of the amazing dearth of information on the VBAC with a classical incision. This incision type is very unusual now, so that all the literature reassures mothers that unless you have a classical incision, the risk of rupture is really very small. That left me saying, “But what if you do have a classical incision? What then? Is there no hope?” And the literature doesn’t give any clue.
The information here gave me hope: http://emedicine.medscape.com/article/275854-overview.
A 2% rupture rate was not so high. And I did not have any information about the health, weight, diet or spiritual state of any of the women in the study. I reasoned myself to be healthier than most Americans, physically and emotionally, and concluded that my risk of being in that 2% was itself small. Add to that my advantage of having had a prior vaginal birth, and the fact that it would be two years between births. Most compelling, I planned a large family, and all the studies show that the more vaginal births you have after cesarean, the lower your risk of rupture, while the more repeat Cesareans, the higher the risks of dangerous complications.
Furthermore, I reminded myself that a 2% rupture rate did not mean a 2% incident of fetal mortality. Outcomes were best when a woman with a rupture could be gotten into an operating room within about ten minutes. Our home is very close to a good hospital. Close enough that getting to the operating room might take no longer for me than for someone in the labor and delivery ward of the hospital itself! I called the hospital to verify that they are in fact ready to operate at all times with anesthesiologists, O.R.s, and surgeons on hand.
I had come to realize that for me, birthing in a hospital would mean major abdominal surgery. So I decided to birth at home, and plan on going to the hospital only in the event that I needed that surgery.
Another tangent to research is the laundry list of risks associated with cesareans in general and repeat cesareans in particular. The 2% risk of rupture was not after all weighed against a 100% guaranteed complication-free cesarean birth. To the contrary, I found benefit after benefit of birthing vaginally, for both the baby and the mother.
I told my husband how sure I was about having a homebirth, assured him I would not risk our baby’s life and that my choices were being made in order to secure the best outcome for our baby. My husband told me that after one homebirth and one hospital birth, the last place he wanted us to go was a hospital. He much preferred a homebirth, a safebirth.
So I was ready to hire a midwife. Unfortunately, the search for a midwife mirrored my search for an obstetrician—this one, too, seemed destined to failure. I was contemplating going out of state for my birth when someone on the local ICAN (International Cesarean Awareness Network) recommended Jill Adams. They didn’t know if she would accept a client with a classical incision, but she was known for accepting higher risk mammas. Lucky for me, Jill had just started her own business as an independent homebirth midwife after working at a birth center for a woman with more conservative views.
We met with Jill who explained that we would have to get our permission slip signed, but assured us that she would be happy to attend our birth with that legality out of the way. She wanted us to get one ultrasound to verify the position of the placenta, but she was willing to forgo use of the doppler during my prenatal care and resort to her old-fashioned fetoscope so as to minimize our baby’s exposure to ultrasound. She was experienced with vaginal birth after cesarean, and with home waterbirth. She was confident, comfortable, friendly and wonderful with our five year old daughter, whose presence was welcome at the birth along with whoever else we wanted there.
And she does this for families all the time.
The story of our perfect, peaceful homebirth on Christmas Day 2009 is here.
