Just Another C-Section Birth Story
Before I gave birth to my daughter earlier this year, I thought “birth stories” were kind of silly. Women all over the internet seemed to be routinely spilling their guts, explaining in laborious (ha ha) detail what had happened during the births of their children, the vast majority of which ended in a healthy separation between the two so who the heck cares?
Now, I know better. Birth stories, especially in an age of (1) older mothers (2) having fewer children (3) with more types of prenatal care and birth-related interventions available, have become a critical component of coming to terms with the rite of passage of contemporary motherhood.
Moreover, the more that childbearing and childrearing seems like a choice (instead of a moral, religious, and/or practical obligation), the more pressure we feel to fit its realities into our values and narratives instead of just withstanding it as one of life’s inherent trials.
In the past three months, I’ve had the opportunity to try out my birth story on a handful of various audiences, beginning with the postpartum woman sharing my hospital room on the very first night. It has by now taken on its mature character. So without further ado:
I woke up in labor the day I turned 41 weeks pregnant, on Superbowl Sunday. It started off mildly, but the every-5-minutes contractions wouldn’t let up and proceeded in exactly the same manner for hours and hours. This was a welcome development because my obstetrician and I had decided to induce labor the following day if I hadn’t given birth by then, but for various reasons I wasn’t a fantastic candidate for an induction.
I stuck it out at home in Brooklyn all day, cooking, eating, walking the dogs, and napping, until midnight when Byrne and I Ubered to the hospital in Manhattan. By this point, I had been in labor for about 17 hours, and intake took a couple hours more. The resident who checked me in the wee hours of Monday morning told me I had made only 2 centimeters of progress by that point, which was mildly discouraging. I asked for some pain killers to sleep for an hour and Byrne went home.
I woke up shortly thereafter, very early on Monday as the L&D ward came alive, in pain once more and wondering how things were going. I was checked by another resident — almost no progress. I requested an epidural before I was to be administered some oxytocin to strengthen the contractions and hopefully augment labor (I had heard those augmented contractions could be especially painful and wasn’t keen to feel them). I think by this point the nurses had noticed something abnormal with the fetal heart rate, because I had been outfitted with an oxygen mask, but I wasn’t yet very worried.
The epidural worked like magic and I watched as a nurse set up the oxytocin drip. Unfortunately, it had to be discontinued almost immediately — the baby wasn’t tolerating it well, the contractions must have been too strong for her. A resident came by and told me about the situation; he ended up breaking my water with a crochet hook-like tool. It flooded a tarp on the bed as my husband looked on. I couldn’t see or feel much. He screwed an additional monitor directly into the baby’s now-accessible scalp to keep a closer eye on how she was doing.
I spent the next couple of hours in limbo and semi-denial. The nurses left me in the oxygen mask and repeatedly flipped my limp body from side to side on the bed in a futile attempt to improve the baby’s condition (I guess sometimes a change in position alleviates pressure on the umbilical cord, improving its heartrate). This was an obviously uncomfortable and bewildering state, especially on close to no sleep. I was concerned about the baby, concerned about myself, and time was passing strangely.
I didn’t fully understand at this point that things were going fairly poorly, and didn’t ask questions either. Instead, I sent Byrne home to walk the dogs, thinking we had a long afternoon and evening of slow labor ahead of us. Of course, as soon as he got home, my obstetrician came to the hospital to check on me. The resident had told him that it looked like I’d need a c-section.
I began asking my OB about the risks and benefits of waiting a little while longer as he continued to review the paper record of the electronic fetal monitoring. But the more he saw, the more convinced he became that a caesarean was necessary — and quick. He told me he wanted to try to get me into the OR before another patient who was having a c-section soon. This new urgency was alarming, so I signed a consent form and frantically texted Byrne to come back ASAP.
Finally, I was transferred to the postpartum room, which I shared with one other mother each of my two additional nights. I could have stayed at the hospital one or two nights more, but I had trouble sleeping and wasn’t receiving or in need of any further care I couldn’t get at home. The obstetrician didn’t hesitate to let me hightail it out of there, but when it was time to actually leave, it felt like an insurmountable task. Somehow we filled out all the paperwork, gathered our baby into an ill-fitting snow suit, and packed her into an infant seat-bearing car service car. I hobbled down the hallway of our apartment building timidly with my tiny peanut girl in arms towards my recovery — blistered nipples, pinchy burning incision, bloated everything and all. About a week later, I began slowly to feel human again.
To the extent I had a “birth plan,” it was simply to have the hospital works. “Interventions?” I’ll take one of each, except a c-section, those are for sick mothers and sick babies and we’re fine thank you very much. Now I realize I should have known that my odds of needing a c-section by current, conventional obstetric best practices were rather high. But seemingly high rates of c-section are consistent, and probably required, for excellent mother/baby outcomes, I also now realize.
The alleged c-section epidemic, then, is sort of over and at the same time not an epidemic in the pernicious sense anyways. And that WHO statistic about the “optimal” percentage of caesarean births is apparently made up out of thin air. But conflicted feelings around caesareans remain, apparently even for women like me who do not have much of their identity tied up in their births. Was it necessary necessary? Are you a victim? What if what if what if?
Though some women are strongly committed to seeing even the most justified of caesareans as evidence of misconduct, making a reasoned decision to trust a doctor in no way obviates a patient’s autonomy per se. Obstetricians are professionals whose practices contain inextricable elements of judgment. Most patients are unable and/or unwilling to do all the research that would be necessary to fully understand a doctor’s recommendations, and they cannot in any case get that kind of experience under their belts too.
I have spent a considerable amount of time trying to figure out whether my caesarean was “necessary,” but upon reflection the better way to think of them is simply as justified or not. This is a matter of degree, and involves all-things-considered probabilistic reasoning with many considerations as inputs. Understanding the justification helps you to understand why you gave consent at the time, making less of a victim of yourself too (except in rare cares when doctors really did misbehave ethically). It’s easy to be a Monday morning birth quarterback once baby is safe in your arms.
Perhaps my c-section wasn’t “necessary” in the sense that I would have lived, and the baby too, had we not had it. But just living isn’t good enough. What would those additional 5 or 10 hours of labor have been like, wondering every second whether her brain cells were dying for lack of oxygen? What would those remaining years of my life have been like, wondering still? What would the condition of my body have been, having passed a baby turned sort of the wrong way? My choice was not between an uncomplicated vaginal birth and a c-section, because things were already quite complicated. Surgery was a mercifully quick ending to this multifaceted ordeal. It was indeed justified if not literally necessary to complete the birth.
Above all, I wish to emphasize that it was unpleasant but not traumatic. It’s unpleasant to be handled by so many strangers, in such a strange environment as a hospital. But believers in conventional birth don’t do it because we’re masochists, we do it because it’s safe. I trusted more in my emotional resilience to handle the hospital experience and in the care providers who would provide sound treatment than in mother nature to serve up a smooth and easy birth for us. And that trust was well-placed.
Had I given birth to Claudia in a non-hospital setting, like a birthing center or at home, the birth may very well have been more pleasant at the time (apart from the lack of analgesics…). In part, that’s because without continuous electronic fetal monitoring we would have been blissfully unaware that she was significantly likely to be withstanding an extended labor poorly. Some peacefulness, eh?
More generally, the problem with non-hospital births is that the outcomes are far more polarized, and you can’t be certain which end of the spectrum you’re going to get. Basically either you peacefully guide your child into the world in a tub surrounded by candles or whatever, or you end up getting rushed to the hospital which you were desperate to avoid and treated by a stranger to interventions you hate on principle.
Many women play that lottery and win. A few lose, they and their babies suffer, and this suffering is often directly attributable to the mother’s desire to create a different kind of experience for herself. I would never want to live with that realization.
At a postpartum visit with my obstetrician, I had a few followup questions regarding how Claudia’s birth had gone. After discussing them, he mentioned to me that he likes to be conservative. This was striking, because those committed to seeing birth as a controllable, infallible process and caesareans as typically unnecessary, of course believe that conventional obstetricians are anything but “conservative”. Instead they are slicers and dicers extraordinaire.
What the OB meant, though, is that he has a bias towards safe action that reasonably balances the interest of mother and baby. Everyone is always careful to hedge: “c-sections are major abdominal surgery and shouldn’t be taken lightly…” This is true. Additionally, there is something intuitively worse-seeming about potentially withstanding injury from providers’ actions (e.g. c-section) instead of from their inaction (e.g. letting labor progress longer). But the fact of the matter is that c-sections (and the other suite of delivery interventions on offer) have good outcomes
To the extent that they present an increased risk of complications as compared to the complicated vaginal deliveries these women would otherwise have, c-sections transfer risk of permanent lifelong damage from baby to mother. That mothers who in other contexts would swear that they’d literally die for their children so aggressively avoid them when recommended by knowledgeable professionals should inspire some degree of cognitive dissonance.
Having a caesarean, as far as I can tell, is roughly on par with driving a car in terms of dangerousness. General C-section naysaying seems to come at least as much from stressors like feeling physically defective, adjusting to motherhood, struggling to bond, and clinging to an unrealized expectation as from health-related concerns regarding the actual procedure. Unfortunately, those particular difficulties cannot be addressed in a labor & delivery room.
To be clear, I don’t think I’m special because my c-section didn’t traumatize me. The claim that women feel generally, even universally, traumatized by caesarean and hospital-based birth is not borne out by actual evidence (including anecdotally, in my experience) though of course there is always room for improvement. Assuming widespread birth-related traumatization gives women too little credit for exercising autonomy regarding their medical care, responding to reasons offered by experts, and weathering rough turns of birth events that are nothing but bad luck.
There is no having it all. Sometimes what’s good for baby is less good for mom, and vice versa. Though I would have preferred not to have had a c-section, it was a satisfactory experience. This history of caesarean birth will complicate the prospect of subsequent births for me. But strongly prioritizing the well-being of an existing, viable, much-wanted fetus over theoretical future others makes fine moral sense. That’s my birth story, and I’m sticking to it.