- By Jana Llewellyn
When I was pregnant with my son in 2007, I read articles, listened to radio broadcasts, and watched TV shows that all reported the alarming rate of C-sections. Since my pregnancy had been without complications up to that point, I assumed this wasn’t something I had to worry about. I was more interested in the increasing popularity of natural birth.
“Should I forego an epidural?” I asked my doctor.
He said, polite as always, that some women thought they’d decline an epidural, but once they hit active labor, “they realized why epidurals were invented.”
He tapped into one of my biggest fears: pain.
So after the obstetrician broke my water and told me I’d be in “excruciating pain,” I agreed to the epidural. She assured me that epidurals didn’t slow down labor as I had thought. Ten hours later, I was in the operating room. I had been given enough Pitocin to dilate, but the doctor suspected that my baby was positioned sideways and mandated a C-section.
When I got pregnant with my daughter almost two years later, I did not want another C-section. In fact, I was planning my VBAC (Vaginal Birth After Cesarean) only hours after my son was born. After all, my body was well-equipped to carry other human beings — both of my children wanted to stay well past 40 weeks — and I knew that I could labor successfully if given the chance. But, my doctor warned me, due to my first C-section, I was now considered a high-risk delivery case.
The biggest fear doctors and patients have with VBAC is a uterine rupture, where the scar tissue of the uterus opens, necessitating an immediate C-section to save the mother’s and/or baby’s life. This, of course, is to be taken quite seriously. But since the risk of uterine rupture is less than 1 percent, which means only 7 or 8 women in 1,000 will experience it, I thought I’d take my chances. After all, there are plenty of fatal complications that can occur in labor, like placental abruption, which affects women who have not had C-sections. Even women who have never had previous abdominal surgery are vulnerable to uterine ruptures. Furthermore, there are risks with C-sections, too — hemorrhaging, blood cots, bowel issues, and breathing problems for the baby — and I knew that having a second one could make those more likely should I get pregnant again. I also knew that a vaginal birth would come with a shorter recovery time and therefore allow me to be more attentive to my son during a transitional time.
For weeks I carried the weight of my decision in my chest, fretting about whether I was succumbing to unnecessary risks, whether I was being selfish in wanting to avoid surgery and somehow putting my life before my baby’s. The only way to face this labor, I decided, was to hire a doula, someone who would personally assist me before, during, and after delivery. I emailed one who was recommended by a friend and meanwhile continued to read more about the benefits of vaginal delivery as opposed to C-sections.
When I posed more questions to my doctors though, I became confused and overwhelmed. The male doctor who performed my C-section the first time around seemed eager to use this opportunity to convince me that a C-section was a better option, even though for my first two trimesters, I had told him I wanted a VBAC. He explained that many female obstetricians prefer to schedule Cesareans for their own births rather than endure the pain of vaginal labor. He also went into a story about women in third-world countries who labor for so many hours, their bladders collapse and urine shoots out of their vaginas. On my next visit, the female OB (the one who convinced me to have an early epidural) recounted how the doctors and nurses on call gulp down bottles of Pepto-Bismol when they have a VBAC patient in labor because they’re so afraid that something will go wrong. And when I told her I was considering avoiding the epidural, she told me that was not an option. It would be mandatory once I was three or four centimeters dilated.
Feeling discouraged, I wrote to my doula, Ellen, to tell her I didn’t think it would be worth it for her to be part of my labor. If I had to get an epidural that early, there wouldn’t be much pain management she could help me with. She called me before I even closed my laptop, angry for what she thought was my doctor’s dishonesty. I did not need an epidural, she said, and I had as much chance of succeeding at a VBAC as I did at a regular birth. In the more than 500 births she had attended, she had only seen a uterine rupture once, and it was for a first-time delivery. To my surprise, she told me I needed to leave my practice, or I’d end up in the same situation I did the first time around, with a stalled labor and a baby who hadn’t moved into position because of a premature epidural.
Who could I trust? And why did it seem that natural birthing advocates were on such opposing sides from the obstetricians I had entrusted to deliver my baby? This time I listened to my gut and took down the names of three practices that my doula felt would support my VBAC. But when I called, no one would schedule an initial consultation. Instead, they would only see me if I officially switched from my current practice. Not wanting my maternal health to be in limbo 10 weeks before my due date, I looked at the bottom of Ellen’s list, at the only name I hadn’t yet considered: the midwife who worked out of a hospital a half hour away.
I never thought I’d choose a midwife. I didn’t know they existed beyond history books and the birth center a few miles from my home. But from the first minute I talked to Ronni, I knew I was in good hands. She was willing to meet with me for a consultation so she could answer all of my questions. She explained the slight differences of treating a VBAC patient and a regular patient. She was honest with me, and she fully supported my decision without ever skirting around the reality of the risks involved. (It also helped that in all her years as a midwife, she had never seen a uterine rupture.)
When I expressed concern over my obstetricians’ feelings about the switch, Ronni told me that they probably wouldn’t know I was gone. She was right. The office charged me an arm and a leg for select photocopies of my record, but I never received a phone call from a doctor asking me why I left. At my new prenatal appointments, in a cozy apartment with warm, green walls and a counter lined with tea, my two-year-old was welcomed with a box of toys and the title of “midwife’s helper” as he squeezed my blood pressure pump. In our half-hour appointments, Ronni did all the things my doctors did, but we also compared iPhones and talked about our lives and her recent deliveries.
Though my prenatal care was great, my labor was not as fun. Seven days past my due date, my daughter still hadn’t arrived, and it was the hospital’s procedure to induce before she got too big. I could receive only a small amount of Pitocin (large doses increase the chances of uterine rupture) through an IV to help things along, and as I sat on a hospital bed that morning, I lamented that the labor was already not going as I had hoped. Would I ever have this baby?
After seven hours, contractions were intense enough that I knew my baby was on her way. Surrounded by my midwife, doula, a hospital nurse, and my husband, I breathed, moaned, and visualized the clouds of Paris to get through particularly painful contractions. My husband stood by my side, rubbing my back as I rocked, sat, and walked, trying to get the baby to move into position. When I finally started pushing, I tried as much movement as possible. I squatted, I stood, I rocked. When the pain got so bad, I did what most women do: I asked for drugs. Ronni told me I was 9 centimeters dilated, and it was too late for drugs. Knowing I had come that far along gave me the boost I needed to get through the rest of my labor. A little after 9 p.m., I started feeling the urge to push, but after an hour and a half, the baby had barely moved. I got a thigh cramp that was worse than the contractions, and that’s when I started to curse at my midwife. I wanted her to DO something.
But within minutes I realized that no one could do anything. It was up to me, and solely me, to push this baby out. I closed my eyes and reached into the darkness, into reserves I never knew I had, in order to bring my daughter into the world. At 12:34 a.m., three hours after I started, I felt her body leave mine, and Madeleine, my nine-pound, one-ounce baby girl, was laid on my stomach. She and I locked eyes, and I can still remember the new warmth of her, those chubby hands.
That night, despite my exhaustion, I couldn’t sleep. I relived the whole surreal experience over and over in my head, still in disbelief that a baby with a head that big could come out a five-foot two-inch body. All the adrenaline convinced me I was the most amazing person alive, practically a superhero. The memory of my painful labor didn’t go away for a long time, but neither did my amazement at what I was actually capable of.
Related: The case for VBAC — what you should know before having a repeat C-section
If I had stayed with my obstetrics practice, there were a few things they would have done differently. First, I would have had an ultrasound in the last trimester to see whether my second baby was bigger than the first, and therefore not suitable for a vaginal delivery. Considering my first baby was 7.5 oz. and the second was 9.1, they would have probably forced me to have a C-section. Second, the practice would most likely not have induced me seven days after my due date. Instead, they would have wanted to perform a scheduled Cesarean if I didn’t go into labor soon enough. Lastly, most doctors are not willing to let a woman push for three hours. Even though the average pushing time for a first-time delivery is two hours, most doctors start mentioning the dreaded “C” word after much less time, which is not helpful for a woman’s mental and emotional state. Believe me, I wish I didn’t have to push for three hours, but I am glad I had a caregiver who let me finish what I started. In essence, I am convinced that my doctors would have looked for ways to encourage surgery, rather than allowing my body to perform its natural functions.
I look back on the birth of my daughter as the most difficult physical exercise I may ever undergo, as something that taught me the utmost limits of what a body — my body — can do. I was exhausted in the days and months after her birth, as all mothers are, but I was also triumphant, with a new inner confidence.
What better way to enter the next stage of motherhood?