Thursday, July 16, 2009

best laid plans

My Pumpkin arrived two months ago this week. I haven't had enough time or energy to fully process my experience, but this is a start.

I planned. I researched. I attended classes. I read books. I hired a doula. I switched from one clinic and midwife to a different clinic and midwife within a month or two of the due date in order to avoid having my child in a hospital machine with the highest cesarean section rate (36%*) in the metro area.

I wanted a safe and natural child birth. I wanted my son to come into the world free of any medicated haze. I wanted the satisfaction and empowerment that comes from going through the most intense and miraculous feat the human body can perform—one that it is built to do...meant to do. The exhilaration. The experience. I wanted the experience.

Also: the majority of women in my life (relatives and close friends) of my generation have had c-sections, planned and unplanned, and while I don't judge their choice or circumstances, I so wanted to avoid the same fate.

But if you go in for organized health care you can only dodge the hospital machine so much.

I had switched from a good midwife to an awesome midwife, but the switch in hospitals wasn't quite as impressive: the new one had a c-section rate of 27%. And then there are the rules. In particular, if you go more than two weeks past your due date you can no longer work with the midwife and are assigned an OB doctor.

So I found myself at week 42 . My pregnancy had been very healthy, so when my midwife suggested that I come in to get things started, I agreed. I really liked (and still do) my midwife and preferred to keep her over working with an MD. But she is one of three midwives at the clinic affiliated with the hospital we chose, and I went in on a day that she was off. The midwife scheduled was one who had rubbed me wrong on the two occasions I'd met with her. Not a good start.

I had a birth plan and a realistic enough expectation that not everything might go as I wanted, but I never expected the whole thing to be pretty much scrapped. The first interventions (ripening and induction) rolled into other interventions—just as I'd learned that they typically do.

One of my requests that did pan out for the most part—and the most positive part of the experience—was that I was not offered pain medication. I'm proud to say that with the support and encouragement of my husband and doula, I labored through about 18 hours of increasingly intense chemically induced contractions. I won't say it wasn't painful, but it was surmountable...I could rise above it and move through it because they both kept me focused, did what they could to provide comfort, and coached me through position after position to help my little one come out on his own. We tried all but an inversion position; all the positions that my doula (and others she called) knew. The effort did pay off. Pumpkin did respond and shimmied down, but ultimately he just wasn't ready. We stalled out at 6 cm.

I was exhausted and suggestions of an epidural and possible c-section were made. An anesthesiologist was called in. A nurse suggested laboring a while longer with an epidural and the midwife, on consulting with an OB doctor over the phone, pressed for the c-section. Even though Pumpkin's heartbeat never once wavered, she maintained that going longer would put stress on him.

I hated hated hated making the decision, but in the end, a c-section it was.

I'm full to the top with woulda-shoulda-couldas. YES, I have a healthy son and YES I'm so thankful for that, but what if I'd held out a little longer...ignored the 42 week deadline? Could I have avoided all of this or would a new set of rationales and warnings steered me toward the same end?

The deed is done, but it doesn't end there. I'm not broken, but I do now have this thin, seemingly innocuos scar. With it I'll encounter new rules and cautionary warnings should I get pregnant again because despite any scary, skewed warnings, I will not want another c-section. I can say that I'm pissed and that I won't let myself be steered away from the birth that I want. I thought I had girded myself for this first birth. How will the next one be different?

*"Countries with some of the lowest perinatal mortality rates in the world have cesarean rates of less than 10%. There is no justification for any region to have a rate higher than 10-15%."


Leila said...

I've had friends who've had VBACs (vaginal births after c-sections) so it's definately something you can aim for. Your attitude going into it was first rate. And it's true, once in the hospital machine it's hard to avoid being managed as such. A hammer only sees nails. But those are insane c-section rates. They're about half that up here. We've also got birthing clinics that are 100% managed by midwives. Doctors and hospitals are on call for emergencies only. Another reason to fly north.

The important thing, though, is that Abbott and you are healthy. Don't grieve over what might have been. Labouring for 18 hrs is no mean feat. Yay on you both!

Cool Ranch Luke said...

Congratulations! Wifey had a C-Section after thirteen hours of labor, and decided almost immediately that she would henceforth skip the labor part, and go directly to the surgery part.

None of that hippy midwife homeopathic nonsense for us! Of course it's not really my decision to make, but we're pretty firmly and unapologetically planted in the camp of "more drugs, more surgery, easier labor".

...We also (*gasp*) don't breastfeed. God it feels good to get that off my chest.

The bottom line is, you have a wonderful, frustrating, magical, painful, exasperating, thrilling experience ahead of you. You'll have plenty of things to celebrate and regret as you go along. No sense starting off with guilt.

Hope you're both recovering nicely!

erin said...

I'm glad that your wife found the birth that is right for her. If you have another child, she will have no trouble convincing a doctor to honor her wishes. That's how it should be.