Going Under the Knife

I bet you didn't know that April is in fact Cesarean Awareness Month, now did you?? Well, it is. So, I'm going to take this opportunity to shed a little more light on what - in my humble opinion - is a deplorable increase in cesarean births in the United States. Approximately 1/3 of all babies born today in this country are born via cesarean. And that number continues to grow.

I've had two cesareans, and to be quite frank, I'm rather pissed about it. Neither of my birth experiences came even remotely close to what I had wanted or dreamed of for so long.

I was a month shy of 24 when I gave birth to Carter. I was still rather young and meek and submissive, particularly to doctors, at that point. I thought, surely, if a doctor says you should do something, that means you really should, right? So, when my obstetrician told me she thought I should be induced two weeks before my due date because baby boy has a big noggin, and since a definitive end date was sounding pretty good at that point...I readily agreed to it. My doctor failed, however, to give me some pretty important details. Namely, that over 50% of first time mothers who are induced end up with a cesarean. And that induction in the vast majority of cases leads to other interventions that could otherwise be avoided. Nope, not a bit of that was mentioned.

So, I went to the hospital at 6 a.m. on March 11th, thinking they would just break my water (as we had agreed) and see what happened since I was already 2.5 cm dilated and almost completely effaced (meaning my body was on the brink of going into labor on its own anyway for those who don't know labor-speak). Rather than breaking my water, they hooked me up to a IV with pitocin - a.k.a the Devil's Spit. I should have protested, but I didn't. I was nervous and scared and really just wanted to have this baby already! The contractions came on hard and fast. An hour into it, my doctor showed up (how nice of her) and broke my water. HOLY MOLY OUCH. My pain level instantly tripled. Turns out, Master Carter was occiput posterior - facing up rather than down like he should be. And that my dear friends made the hardest part of his head press into my spine with every contraction - back labor. I had these delusions that I would have a med-free natural birth, but after 12 or 13 hours (who's counting at that point...) of laboring on pitocin with no pain meds, and without making much progress, my doctor gave me the option of an epidural or a cesarean. That was an easy choice. So I got the damn epi, and it worked for a whopping hour then wore off, but not before making me vomit and shake uncontrollably. Like you need MORE discomfort on top of discomfort. But I did in fact finish dilating. So, I started to push, and I got him down to the point where we could see his little head starting to come through, but every time I would push, his heartrate would drop. So, they had me wait and see if my body would bring him down naturally. Nope. I tried pushing again, and his heartrate kept plummeting to scary lows. So my doctor said (with sleep lines all over her face because it was after all 3 a.m.) I'm off to a c-section. NO!!!!!!!!!!!! This is not how it was supposed to happen!!! This was my nightmare!

So, Carter was born via cesarean. They cut me open, took out my baby, then took him to a warmer to clean him off, look him over and bundle him up. I got to lay eyes on my firstborn child for the first time as they were wheeling me out of the operating room and into the recovery room. I tried to hold him, but my arms couldn't support him from being numbed from the anesthesia. Within an hour after the delivery, I got very ill and they had to take him away because I was useless to him at the moment. I got to see him again 5 hours later. This is definitely NOT what I had envisioned giving birth to be like.

But my doctor assured me that I could try for a vbac (vaginal birth after cesarean) for my second child. So, I held onto that, made peace with my cesarean, and looked forward to giving birth the "right" way one day.

When I got pregnant with Bennett, I did all the right things to prepare for my vbac. I did all the research and was lining up interviews with doulas (special birth partners). Then, my water broke at 24 weeks. And of course, Bennett was breech. So there went my hope for a vaginal delivery. This time, my cesarean was even worse. I had uncontrolled bleeding during the surgery and it took them a good while and a lot of force to get the bleeding to stop. My recovery was extremely long and painful. Nearly a year later, I still have pain on one side of my incision where they nicked a muscle closing me up. Definitely not the birth I had envisioned.

So, I can hold on to hope for a vba2c, right??? Probably not. I will be lucky to find a doctor in Maryland who will attend a vbac after 2 cesareans. I'll save the argument for why THAT sucks for another day, as the risks of having something go wrong is still very slim. But the point remains, my dreams of giving birth to my child, of having them lay him on my chest while Ace and I stare down at him, of having those crucial bonding moments together - those dreams have been sliced to pieces with a very sharp scalpel.

Now, I realize that not all women feel so strongly againt cesareans. And not all women have bad experiences with them. But the facts are clear that cesareans generally are not a good thing, and should be avoided a much as possible.

* It is MAJOR abdominal surgery with huge risks to the mother of infection, blood loss and hemorrhage, hysterectomy, transfusions, bladder and bowel injury, incisional endometriosis, heart and lung complications, blood clots in the legs, anesthesia complications, and rehospitalization due to surgical complications, rate of establishment and ongoing breastfeeding is reduced, and psychological well-being compromised and increased rate emotional trauma. Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sex. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs and the risk of chronic problems from adhesions.

* Half of all women who have a cesarean encounter some complication from it. The death rate from cesarean is between 2 to 4 times greater than that from vaginal births. 180 women in the U.S. die from elective repeat cesareans every year.

* Each successive cesarean greatly increases the risk of developing placenta previa, placenta accreta and placental abruption in subsequent pregnancies. Both of these complications pose life-threatening risks to mother and baby. Cesareans also increase the odds of secondary infertility, miscarriage and ectopic pregnancy in subsequent pregnancies.

* There are risks to the baby too - respiratory distress syndrome (RDS), prematurity (when surgery is performed because of an error in determining the due date), persistent pulmonary hypertension (PPH), and surgery-related fetal injuries such as lacerations. Even with mature babies, the absence of labor increases the risk of breathing problems and other complications. Far from doing better, even premature and at risk babies born by cesarean fare worse than those born vaginally. Just today, I read a study that showed that being born via cesarean increases a child's odds of developing asthma by 80%!!!!!

* Cesareans can delay the opportunity for early mother-newborn interaction, breastfeeding, and the establishment of family bonds.

Unfortunately, it seems that the common-place occurrence of cesareans in this country has distracted us from the stark reality that it is a dangerous procedure for both mother and child. There are numerous reasons why the cesarean rate continues to rise, and I will definitely do a blog on that another day (in the meantime, you should try to watch Ricki Lake's documentary called "The Business of Being Born" - its fascinating!!). Suffice to say that something needs to be done. This is unacceptable and unnecessary. According to the World Health Organization, only approximately 10-15% of deliveries should be cesareans. As the nurses used to "joke" with me while I was on bedrest - it seems that the doctors all got a shiny new scalpel to try out.

(Disclaimer - I am fully aware that not all, and probably very few, doctors perform cesareans for any reason less than full belief that it is medically necessary, and yes, there are situations in which a cesarean is medically indicated).