It is no surprise to anyone when I say there needs to be a change in they way healthcare is managed. It is no different in obstetrics. The rules, regulations set by the hospitals that are there to help "protect" moms and babies sometimes get in the way of providing humane care. I know that docs, nurses, hospitals really are out to provide safe competent care, but sometimes we forget how the patients feel and we are too quick to jump to a surgical delivery if things aren't running on schedule, or in our attempt to provide good care, we start that cascade of interventions that can lead to c-section. Induction - pitocin - AROM at only 2 cm and no change from the start of the pitocin - epidural - crank the pitocin - internal monitoring - temp - infection - antibiotics - failure to progress - c-section. Elizabeth wrote this about her two birth experiences. Her first birth experience was a c-section for breech. Her second, a VBAC. And while breech is a legitimate reason for a c-section, it doesn't change how a woman feels. We get involved in the process of prepping, draping, counting, etc., that we forget that here is a mother who wants her baby. Mom is taken alone to the OR, waiting for her partner to join her in a sea of strangers. The baby is born and she is frequently last to hold her, then the baby is taken away to the nursery while the surgery is finished and mom waits longer to see her baby. And she feels she isn't taking part in the birth, that she isn't doing what she should and sometimes feels her body failed her. She has not failed, it is the system. And some c-sections for "failed induction" or "large baby", are they really necessary? Some people might say "at least after a VBAC, she is healed". I'm not sure I agree with that. The mother doesn't forget her experience. Yes, while she was able to "prove" to herself, to others that her body does in fact work, that doesn't erase the feelings, the scars from a c-section.
Healthy Baby, Part I
C-Section. IV, cold arm. Surgery. Sign the waiver, "Potential fatality." Hairnet. Yellow Tummy and Razor. Crying. Alone. Where is my husband? Cold. Numb. Can you feel this? Helpless. Fear. Fear of pain. What if something goes wrong? Out of my hands. Nauseated. Relief he’s here. But he can’t help me. Sterile curtain. Waiting. Don’t cut yet. Cutting, pulling, pressure. Suction. Tugging. TUGGING. My bottom half is on a roller coaster. Throw up or pass out. Gurgle. Cry! Relief. Cry! I want to help. There he is, there he goes. Where is he going? I can’t go. Tubes, sucking, screaming, crying. Flashes of pictures. Anger. At least he’s there with him. They must be hurting him. He is scared. I am already not doing my job. I should be with him. He’s leaving. Why? Go with him, leave me. He needs someone. Waiting. Waiting. Terrible waiting. Counting. Why are they counting? Wish I could see something. Anything. Who is even down there? It’s all wrong. I feel wet, numb, and cold, but strangely hot. Surreal and bizarre. Finally, I get to go. In a stupor. They will bring him, I think. I don’t know anymore. Thirsty. So thirsty. I need something. Ice chips. High. Losing time. Looking at the clock. Waiting, sleeping? Clock again. How long? Nurse on the phone. She is there, but I’m not. I am unaware. I’m a pest. I need again. Husband here. Camera. There’s my baby on the camera. Everyone has met him but me. Rejection. Resentment. Finally rolling outta here. He’s beautiful, Liz! I wouldn’t know. He’s here somewhere, I guess. There he is, on the other side of the glass. He is lonely. He has surrendered to sleep. I have surrendered. Acceptance. Rationalization. Buzzed. Hot. Sweaty. Thirsty. Don’t let anyone else hold him before me, okay? Please? Are you ready to see him? Oh God, please let me have him now,
Healthy Baby, Part II
Pain wakes me. An owl outside the window. Sleep. Small pain. “I think I’m in labor.” Excitement. Anticipation. Try to rest. I’m up. Must eat. Must shower. Pause to breathe. Ah, shower. Eat and drink. Nightgown. Relax, there is no rush. I like to stand. He holds me and we breathe together. Goosebumps. Clock. They are getting closer. Time to go. Favorite blanket. Waiting outside in 50 degrees, exhilarating. Hugs. There is no rush! It will be a while, I know. Long car ride. Closed eyes, music on the radio. Good songs. We arrive. Welcome! No IV or EFM here. Sanctuary. Toast and morning TV. Joking around. Bathroom. My body is working. Stand and breathe, time. Serious. I need the shower. Come with me. I hold the wall. This is working. Need to get out. I must give in, not try to escape. Bed. Try to rest. Lying down hurts worse. O.J. Vomit. Heating pad. Wet rag. Nice. Is it slowing? Shower will help again. No, stay out this time. Holding friend the wall. Swaying. Moaning, who cares? Is this really working? There is a balloon in there. Wow. That is truly amazing! I get out and he comes. Dry me off. I felt it! I’m happy. Hot. Wall. Focus. Pain. Tense. Don’t get tense! Pain. PAIN. Don’t touch me. My thoughts are consumed by my body’s work. Concentration. Ow! Obscenities. Try different positions, but don’t want to move. Vomit again. They are close. It has taken over. Sit on the bed. Why am I pushing? POP! Warm and wet. It’s not clear. Oh, God! Panic. I knew it! Can’t go NOW! He dresses me. I cry. I feel stuck. Ambulance. Lay down. NO! I need drugs! No, I really do! I need help. I scream. I am pushing. Don’t push. I’m not! It just is. Complete. I already knew that, somehow. Gurney. No shame. Too much pain. Pushing. They will help. Sirens, honking. Eyes closed. Talking. Where is he? He’s there in the cab. He tells me he’s here. Love! Laying down is horrible. Familiar voice. I can push now. They help. A woman tells me, this is normal. Relief. I can do this. They will not cut me this time! Push through the pain. I’m working. Feel his head. Wrinkly. Amazing. Thrilled, but not done. It’s warm and numb, I’m tearing. He’s here. Don’t you dare take him! He is just over there. He is looking for me. They bring him. He is wet and messy. I’m not worried. I worked. I birthed. He is here and the pain is already forgotten. I’m a healthy woman alongside
Birth should be more like Part 2. I don't really need to say more. Elizabeth's writing is honest, and very emotional. Now, I know that not everyone who has a c-section is affected this way, my experiences were good as far as c-sections go, but how many women are traumatized by their c-section experience? Just one is unacceptable, and there are probably more women than we realize. Something needs to change. We need to remember that the patient on the table is a person, a new mother, and while it is important to make sure that the sterile field remains sterile and that all instruments and sponges are accounted for, we need to remember the person. The national c-section rate is unacceptably high, and we need to work to figure out how to bring that number down. VBAC's shouldn't be an unattainable goal, it should be encouraged. Too few people are given the opportunity to do what Elizabeth was able to do...to participate fully in her birth, to allow her body to do what it was meant to do. We need to remember that a due date is an estimated day of delivery, not an expiration date. We need fewer scheduled elective inductions, less interventions for moms with healthy babies, more patience, intermittent monitoring, freedom to move around in labor. And for those who do have/need a c-section, things need to change. I have been working with our processes to change how we manage c-sections. It's not much, but it's a start. The partners are now allowed to come back with mom while the spinal is placed. We are working on keeping baby in the OR...all assessments can be done there, baby can go with mom to recovery and that way mom doesn't feel quite as disconnected. We aren't using the arm straps (thank God) so mom's hands are free to touch and hold her baby. Like I said, it's a start. And to Elizabeth, thank you for being a voice for women out there who are affected negatively by their c-section, and for sharing your moving VBAC story.