Monday, April 16, 2012

If I could do it over again...

...I would go with a midwife or a doula.

That's the conclusion. Here's the rest of the story.

It seems to me that to some extent every woman experiences psychological after effects of childbirth. For many women this results in the highly common "baby blues" or the slightly less common but very real experience of postpartum depression. For others who avoid these experiences their psychological after effects might come in the form of feeling overwhelmed by having to care for a baby or feeling isolated from friends and their former lives. Although I did not experience any of the above, my psychological after effects have come in the form of resentment regarding my birthing experience. In the weeks initially following Natalie's birth I was not dwelling on my resentment/hadn't come to terms with my resentment, but ever since then it has been very real.

Last week Natalie turned three months old, and the fact that this is still on my mind shows that clearly this topic matters to me. Every time I lean over Natalie's crib and feel a little pain from my c-section incision I feel a little resentment. I'm reminded of it every time I hear about someone else's "easy" labor, when I look in the mirror, and when I think about the future.

(Now a brief interruption for cute three-month photo shoot highlights...Natalie is quickly developing her trunk strength and can now sit up [supported] for longer periods of time.)

This is not something I've discussed much until now because people seem quick to brush this point aside, saying something along the lines of, "But in the end you got a healthy baby, so that's all that matters." Yes, it is true that once Natalie got out of the NICU we had a healthy baby and for that I am incredibly fortunate, but that does not change the fact that there could be some lasting implications for how this birth experience panned out, particularly in terms of future labor and deliveries.

I think resentment over the birthing process is something a lot of women experience but it falls into the category of events that if not experienced firsthand they're much more difficult to understand. In my limited experience it seems similar to how when a couple struggles with secondary infertility (the difficulty trying to conceive a child after having not experienced fertility problems with previous conceptions) people say, "Be thankful for the baby you have." No, that's not the point. The couple wants another baby. Or when a couple experiences a miscarriage and people say, "You can just try again." Yes, maybe they can try again, but that may not take away from the grief the couple experiences over the loss of life.

So this is my attempt to explain it from my perspective. It truly is one of the few major things in my life that if I had a chance to go back and do differently I would.

There are two reasons why I resent my birthing experience:

1) It landed Natalie in the NICU.

Every doctor and nurse we consulted with in the hospital agreed that the fluid that was in Natalie's lungs after her birth was a result of the c-section. We kept hearing that if she had been born vaginally the fluid would have been squeezed out of her during the birthing process and we almost certainly would not have dealt with a week in the NICU. While our NICU experience was remarkable (for what it was) and we got off easy compared to most NICU families for only being in there a week, it was still perhaps the most challenging week of our lives and something I would have preferred to avoid.

2) It significantly increases my chances of having a c-section in the future.

Who knows if there will be a baby #2, but if there is, he/she is likely going to be born by c-section. There is the VBAC movement (vaginal birth after c-section, in case you're new to this), but from the reading I've done it seems there's about a 50/50 chance for a successful VBAC. (I have found a number of conflicting reports, though, so I would like to know more and will keep reading!) There are lots of complications that can arise. Lots of women attempting a VBAC wind up with c-sections anyway. So, understandably, lots of women who had a prior c-setion opt for a c-section for future deliveries rather than putting themselves through the potential agony of the VBAC process. Trying again and still having a c-section might be worse than just going ahead with a c-section from the get-go.

So how does my experience with the birthing process relate to having a midwife or a doula? Frankly, in my gut I just believe that if I had been in this situation again with a professional female advocate by my side I would have avoided a c-section. My pregnancy was practically textbook, my labor and delivery was not high risk, and any complication I experienced toward the end (namely, cord around the baby's neck) was not highly unusual. I believe if I'd had someone with me pushing (ha!) more for a vaginal delivery that it would have happened. This is not to disparage my husband. He was great in the delivery room, but like me had never been in this situation before. You just can't really know what to expect until you're there, so I think a non-doctor (and let's face it, non-surgeon) presence would have helped me explore all possible options. Then if I'd still wound up with a c-section I'd have felt more confident that this was, in fact, a situation of last resort.

Two documentaries I've watched recently, Pregnant in America and The Business of Being Born, both available through Netflix streaming, confirm my point of view. While I happen to believe both documentaries are a little extreme in their anti-doctor, anti-hospital sentiment, I do believe there is something to be said for the rapid rise of c-section rates in America and the disheartening reasons that appear to be behind them. Here are a few kernels of note from the two movies (most statistics coming from Pregnant in America, which I watched more recently):

In 1975 the c-section rate in America was 7 percent. Today we have a 30 percent c-section rate. This is twice as much as the c-section rate of 15 percent the World Health Organization recommends nations not exceed.

C-section rates spike around the time of shift changes in the hospital. A few weeks before my delivery I asked my own doctor whether or not this is true and she admitted that while this is true nationwide it is not true through her practice. This is because each Kaiser doctor is on rotation at the hospital for a designated 12-hour shift once or twice a month, and as soon as that doctor's shift is up another one shows up to continue working with the laboring moms. Still, interestingly enough, after the doctor who performed my c-section completed the procedure she went home, as did the anesthesiologist and several other support staff in the operating room. So it's even more distressing to me now to consider that many women, perhaps myself included, are rushed into a c-section to accommodate the schedules of hospital staff. Also, virtually all scheduled c-sections and inductions occur Monday through Friday.

Pregnant in America also pointed out that in 1990 10 percent of pregnant women in America were induced, and in 2000 that rose to 20 percent. Every woman I've known who has given birth in the last year has been given an induction date. It's like when doctors notice that a woman is two or three weeks away from her due date -- the due date itself being a total estimate -- she is given an eviction notice that helps doctors plan their schedules. Additionally, getting induced increases the chances of having a c-section by 50 percent or more. Fortunately, I was not induced, but against my better judgement I agreed to allow the doctors to use Pitocin to move my labor along faster. Both documentaries dwell on the fact that one intervention leads to another, resulting in a series of interventions that complicate the birthing experience. My experience falls into this pattern.

And, though you've probably heard this before, it's worth reiterating that our nation's apparent obsession with medical intervention is not winning us awards. In 2011 we had an infant mortality rate of 5.98 per 1,000 live births, ranking us 49th in the world. We are not doing so hot when compared to most other developed nations. Maybe a lot of us could use a midwife or a doula.


  1. ((hugs)) I had a lot of those feelings after my first c-section. Lots of what-ifs. I had a midwife for baby #1 and still ended with a c-section because of my son's heart rate. With #2 I went for a VBAC. I hired a doula and my water broke at 39 weeks. After 24 hours, labor didn't even start, so I had a repeat c-section. I can tell you get a doula no matter WHAT your next birth choice is! Mine was worth her weight in gold. Although I didn't get my VBAC, the birth of my second child was very healing to me, partly due to her presence.

    Oh also, read the book Pushed by Jennifer Block. It gives you a lot more info on the c-section thing, and how we got where we are. You should also see if you have a local ICAN chapter, they are wonderful!

  2. I have heard these same feelings from several friends, and would be happy to share with you some of their experiences, if you're interested. Both have now had a second baby, one with a successful VBAC and one that ended with a second c-section. Both are now at peace, from my understanding.

    I firmly believe that the theme that keeps appearing, in my own experiences, and in those that people share with me, is that you have to be your own advocate. I agree that the statistics are frightening, and whatever the cause, each woman deserves to feel at peace with the outcome, not just because they have a healthy baby.

    Hang in there and best of luck on processing your thoughts and feelings.

  3. Hospitals schedule c-sections and inductions Monday through Friday, because that's when they have the most staff. I don't see anything wrong with this logic.

    I basically had the opposite experience during labor. I was extremely sick and couldn't get enough air. I was asking for a c-section and one of the RNs kept telling me it wouldn't be best for the baby and that I would regret it afterward. Thankfully, the doctor came in and honored my request. Less than a week later I was diagnosed with post-partum cardio myopathy. If I had listened to that RN instead of my gut, I would have most likely died during child birth, because my heart couldn't handle the stress.

    C-sections really aren't the devil.

  4. =0) This made me smile as you know how much I love midwives, but more because I understanding a birth story and more so the need to tell it. I have on more than one occasion had my patient email me a week or two later with their birth story because they just needed to tell it to someone who would not judge them. All women's stories are different and that is truly what makes birth so cool- I know I am a nerd.

    Love this blog post!

  5. I totally agree with you! Although I was lucky enough to give birth vaginally, my biggest fear was a csection. I wanted to experience a vaginal birth. I wanted to feel labor. I wanted to know what my body could handle. I was threatened with induction multiple(3)times the last 2 weeks of my pregnancy (I had low fluid levels). I think the only reason that I convinced them to wait was because it worked better for them (the labor and delivery unit was full). My water broke the day before my due date and I purposely waited to go in because I was not having contractions yet and knew they would push Pitocin and csection. My son was born on his due date, but not before I was threatened over and over that I would have a csection. I know that they have their place and save lives (mom and baby), but think that they are jumped to too quickly. I knew my son would come in his own time. I am sorry for your experience and totally understand your resentment toward your daughter's birth story. Great post!

  6. From your birth story it sounds like you had chorioamnionitis. A midwife would have recommended a c-section as well.