Today’s testimonial comes from a family member of mine, Beth.
Like most of you, I have had many family and friends who have given birth surgically by C-section. This is one of the main reasons why at Evidence Based Birth, I am committed to writing about evidence-based maternity care for all women—no matter how or where your birth takes place.
A few months ago, I wrote about the evidence for skin-to-skin care after a Cesarean. Medical evidence clearly shows that mothers and babies should stay together and have skin-to-skin care after uncomplicated births– no matter whether the birth is surgical or vaginal. Routine separation of healthy moms and healthy babies is not evidence-based care.
I believe that Beth is in a unique position to provide a testimonial about evidence-based practice after a C-section. Beth was separated from her baby after her first surgical birth and was not offered skin-to-skin care. A few years later, she had a repeat Cesarean at the same hospital. This time she had a radically different experience. Read her story to find out what made her two births so different.
Tell us a little bit about yourself.
I am a 33 year old mother of 4 year old and 1 year old boys. I am the shopkeeper for a letterpress shop in Columbus, Ohio, and I am married to a theatre professor who teaches at Ohio State University. I struggled for 2 years to get pregnant with Will, my older son. We ended up going through a few different treatments, and eventually injectable gonadotropins worked. Will was born in July of 2008. We had to go through the same treatments for Owen, and he was born in August of 2011.
Walk us through your first Cesarean with your son Will. What was it like? What was your physical and emotional recovery like?
Because I went through fertility treatments to get pregnant, I was assigned the high risk OB/GYN in our practice. Their reasons for doing so were because research has shown that, among women with fertility issues, there are a higher number of complicated pregnancies, stillbirths, and other problems. Despite this fact, my husband Nick and I were very clear from the beginning about our desire to have as natural a hospital birth as possible, with few interventions, monitoring, and drugs. I wasn’t against these things if they were medically necessary, but I have a very high pain tolerance, and I was confident about what my body could do. I have also been around hospitals, doctors and medical professionals my whole life (my parents are doctors and many family members are nurses or emergency medical technicians) so the medical aspect of being in the hospital did not make me anxious.
I actually enjoyed my pregnancy, and felt healthy most of the time. I had lots of energy through my second trimester. I have had carpal tunnel syndrome since 2004, and I am usually able to keep it under control with daily stretches and exercises. However, my carpal tunnel was getting progressively worse throughout my pregnancy. By my third trimester it was keeping me up at night and making it hard to perform routine tasks, like opening water bottles or driving. My OB didn’t, and couldn’t, do much during this time to alleviate my hand and arm pain.
Because I was considered “high risk,” my OB required me to do non-stress tests 3 times a week for the last 10 weeks. This involved monitoring the baby’s heart rate and having me push a button when I felt him move. Throughout my pregnancy and non-stress tests, there was nothing abnormal and nothing strange– everything was normal.
Three days after my due date, I went in for a routine non-stress test. At that test, Will’s heart rate had dropped, he wasn’t moving as much, and my blood pressure had spiked. Our OB offered us a few options – he could induce me, we could go for a C-section, or we could wait. At this point, the pain in my arms was about a 7 on the 10-scale and I was very uncomfortable. My OB was concerned that I had started retaining a lot of water in a very short amount of time and my blood pressure was up all of the sudden; I was diagnosed as preeclamptic. I had read lots of info about how inductions fail to prevent C-sections, and I am not one to mess around, so we went with a C-section.
They scheduled the C-section for about 3 hours later, and we headed home to gather things and head toward the hospital. I felt good about our decision, and I was excited to meet my son. However, I made the mistake of reading the few paragraphs that were devoted to C-sections in one of my pregnancy books, wanting to prepare myself for how to get the most “natural” experience out of this clinical surgery. Unfortunately, what I read was demeaning, condescending, and terrifying– and I started getting anxious.
When I got to the hospital, my blood pressure had risen and continued to rise, so we went ahead with the C-section. I had no idea what I could ask for, so things like skin-to-skin contact, nursing right away, and low “intervention” went out the window. I put myself and my son completely in the hospital’s hands. The one wonderful thing I remember during this time was our nurse, Nancy, and her mothering, caring spirit. She was able to put us at ease and help calm my nerves.
After the surgery, my husband brought Will to my side, but only for a few minutes. They said he had to go to the nursery, so Nick went with him while they sewed me up. After that, I remember feeling very alone. It took hours for them to let me go to my room and hold my baby. Once I got to my room and finally held Will, I started to feel better and more in control. The nurses informed me they fed him some formula already– just 1.5 hours after he was born. I was not pleased about that and let them know.
Will was a big baby—9lb 13oz, and he had high blood sugar, like lots of big babies. They had to prick his foot every few hours to test his blood sugar, and they monitored when I fed him. Nursing did not come naturally, and I was frustrated. The nurses, instead of helping (when I asked for help), said they could just take him into the nursery that night so I could get some sleep. I didn’t really know any better, so I agreed. I was in the hospital for that night (I didn’t get to my room until midnight) and the two following. The nights were like torture, being woken up every few hours from a fitful sleep in an uncomfortable bed– just horrible.
The next day, I kept trying to breastfeed Will, and it wasn’t going well, and at one point I forgot to tell our nurse that I had nursed him. She was angry with me and chided me in front of my entire family, saying that, if left unchecked, Will’s high blood sugar could cause brain damage or even death. I was furious; not only was I not being supported in my attempts at nursing, I was being shamed because I wasn’t following their clinical instructions. The next few days followed in the same manner: everything was very clinical, no permissions were asked of me or my husband– the whole environment was sterile. One bright spot was that my original high risk doctor was out of town, so another doctor from the practice did my post-op check and she was wonderful. She is now my current OB.
Tell us about your second pregnancy with your son Owen. What did you decide to do differently this time?
During my pregnancy with Owen, which was also pretty uneventful, we talked a lot about a repeat C-section versus a VBAC. Our OB informed us that we would have to sign a waiver if we wanted a VBAC, but that they would support either decision. We went back and forth quite a bit, but ultimately decided since I healed so well after the first C-section, and because we understood the process more, that we would go with a repeat C-section. Nick and I immediately started talking about making a pointed effort to make this C-section as “natural” as we could.
How did you approach your care provider with your requests for your second C-section? How did they respond?
I was healthy, active, and had no complications or risks during my pregnancy (no high blood pressure at all) and we talked with our OB about the possibility of skin-to-skin care, nursing right away, and staying with my baby after birth. Our OB was very positive about our wishes and said that she would support us. I told her up front that, even though I would be polite, I would push very hard with each of these issues with all of the hospital staff. I also told her I didn’t want to be in the hospital any longer than 36 hours, and although she said that was unusual, she did agree that if there was no reason for me to stay, and that if Owen and I were doing well, we could go home.
I informed each nurse and doctor that cared for me what our intentions were. I made sure to be kind but firm. I had the added advantage of having grown up surrounded by medical professionals, so I was not intimidated by hospitals, doctors, or nurses, or “doctor-speak.” I understood, and respected, that even though I was undergoing major abdominal surgery, I was also healthy and strong, and I still had my rights as a patient.
I chose to “be present” as much as possible during this C-section. I knew that this would take some serious focus and not be the most comfortable thing at times because of the epidural and various procedures needed during my surgery. This was one place that my background in theatre came in handy, and I was able to control my breathing. My thoughts stayed clear, and I meditated through the pain and procedures. I did not allow any decision my husband and I made to just “happen.” We were present throughout the whole process, and it felt like we were directing our time in the hospital.
Immediately after arriving at the hospital, I informed everyone that I would like skin-to-skin contact, I wanted to nurse Owen, and I wanted him to stay with me in my post-op room for as long as possible. I got a few sideways looks, but because my Cesarean was scheduled for a Sunday morning, the hospital was fairly quiet and they had extra nurses to help. They said that all of that would be possible, as long as there was a nurse able to stay with Owen in my room along with my own post-op nurse.
Right after Owen was born, they did Apgar scores and gave him to Nick right away. Owen stayed by my side, snuggling my arm and staying cheek to cheek with me while I was being sewed up. We all moved to my post-op room and they put Owen skin-to-skin on my chest for an hour, during which we breastfed for the first time. The nurses were pretty positive during this time, but my primary nurse got a bit salty and rude after the first few minutes, trying to hurry me along. I maintained my kind but firm attitude, and kept telling them how grateful I was for letting me stay together with my son.
All in all, the most important thing was for me to be present throughout the whole process. I think that this is the most difficult thing for a birthing mother to do– whether you are having a vaginal birth or a surgical birth. Staying in your mind and body, either through meditation or prayer, and going moment to moment focusing on breathing and clear decision making. I think medical professionals are very used to women who are completely out of it, out of their mind and not in control of their body.
My other main goal was to leave the hospital as soon as possible after my C-section. This might seem strange, but being in the hospital so long during my first one was the part I hated the most, and caused me the most anxiety and discomfort. I knew that, even if my other wishes weren’t carried out, that I would fight to leave as soon as possible. This fact I relayed to each and every nurse and doctor who cared for me. For the most part, they would smile and laugh. The pediatrician that checked on Owen the first day (not his normal doctor) said “there is no way you are going home after a day here.” But I just stayed firm.
We were in my room the whole first day and Owen did not leave my side. One nurse in particular was supportive of moving us through the “paces” with check-ups. After one horribly sleepless night (how does ANYONE sleep in hospital beds?) with Owen by my side, we “woke up” the next morning and started focusing on our discharge. It all went very smoothly, and I was able to get up and walk around most of the day and continue to nurse Owen. We were at my house by 3pm that day– 32 hours after I was admitted.
I healed very quickly, although I had issues with a recurring fever during my first 48 hours. My doctor attributed this to my milk not coming in yet. After my milk came in, the fevers stopped. It took about a week before I felt comfortable walking further than a block. Nursing went very well, and I felt more confident than I had with Will. I ended up being able to nurse Owen for 11 months, which was longer than I nursed Will.
What advice do you have for women who are going to give birth by Cesarean?
Ask questions, stay present, be respectful. Most importantly, I would encourage women to educate themselves about the process: Why are things done a certain way? What things are medically “necessary?” What things aren’t necessary? And what can be patient-directed rather than tradition-directed? Do you need that saline drip? Why does your baby have to go to the nursery?
I firmly believe that medical professionals helping laboring women want the best for them and the baby, so they are not to be villianized–don’t go into the hospital with a chip on your shoulder. You don’t know more than they do. However, you do know more about what you want and you can know a lot about the process. If you approach your C-section with a collaborative rather than combative attitude, you will get much farther with the doctors and nurses who you encounter.
Disclaimer: my “advice” is for C-sections that are given in non-life-threatening emergencies. I have no experience with the latter.
Have any of you successfully negotiated staying together with your baby after a C-section? What advice would YOU give to moms who want an evidence-based, family-centered Cesarean?