Tuesday, April 1, 2008

Cesarean Awareness Month

April is Cesarean Awareness Month. In these days of rising cesareans, it is necessary to bring this information out in the open, to let people know that not every birth should be a surgical event.

How prevalent are cesareans? The CDC reports that the average rate in the US is over 30% of births are by cesarean. Some hospitals have rates of 50%... 60%... 80%. Are they saying that women cannot give birth? However did the species get as far as we've come?

When I had my first child, the rate was about 25%. That meant that 1 out of 4 women would birth by cesarean. We had 8 couples in our childbirth class, and yes, two of us had cesareans. I was one of them. While it was probably unnecessary, at least I could have a VBAC in those days without fighting for it. VBAC was a popular choice in the early 1990s. Now, women are not so lucky.

My mother had three children and no cesareans. Two girls and a boy. Both my sister and I have had cesareans for one of our births, and so has my sister-in-law. That makes 3 for 3. The reasons? My sister-in-law was past her due date with a large baby. My sister had a breech baby that did not turn after they attempted an external version. And my CNM was too tired and needed a nap, so they first gave me a cervical block, then after they effectively knocked out my endorphins with that, they talked us into an epidural, so we could not try different positions to get my daughter into an optimal position. All she need was to tuck her head, but I could do nothing to assist her since I was numb from my ribs down.

I do take some responsibility for receiving those drugs. While I had planned not to have them, I let them wear down my resolve. "You're too loud, you'll hurt your throat," they told me as I made deep moans with my contractions. "Your midwife needs a bit of a rest... and you look so tired. You could do with a rest yourself. Let us give you this epidural and you'll be able to take a nap." I had been in labor for only 6 hours at that point.

While I admit that I was a poster child for beached whale syndrome while in labor with my first, I think that with more support from the staff in being active I would have been fine. In fact, I was fine lying in bed dealing with the contractions. They hurt a lot, but I was sure I could handle it until they insisted that we do the cervical block. Once that wore off, I was doomed. This was my first baby, and the first time I had experienced any type of severe pain. All the books I had read and all that they talked about in my childbirth class went right out of my head.

I did try to put them off... but eventually we were worn down... after pushing ineffectively, I was wheeled to the operating room, where I swear no one was with me for quite awhile. I had made it to ten centimeters and had been doing purple pushes for 2 hours before they took me in for surgery. Seems they couldn't find an anesthesiologist, so I was left alone on the operating table, arms strapped out to each side and legs tied together. The epidural had worn off, and I had to push. If there was anyone in there with me, they were not within my field of vision and they certainly did nothing to either reassure me or help me deal with the strong pushing sensations I had to give in to.

When people finally came in, the anesthesiologist re-did my epidural. I asked the OB to please keep me informed on what was happening. They didn't... they talked about some vacation one of them was going to take. I tried to watch in the reflection on the overhead light... but it was too blurry. The only way I knew for sure that my daughter had been born was I heard her cry. They took her to the nursery and my husband followed. While they repaired the incision, it seemed an eternity went by before they finally brought her back in so I could see her. Every one else in the family met my daughter before I did. When my husband was able to bring her in, she was all swaddled in a tight blanket with a hat on her head. I couldn't hold her or touch her because my hands were still strapped down. The repair took forever!

At long last, they took me to recovery and I was able to hold my daughter at long last. I was finally able to unwrap her blankets and look at her, and was able to feed her. I was ready to have another baby right away, so I could get it right. I did not want another cesarean ever again, and now I can say that I have had 7 VBACs, four of which have been at home, and five of which have had no pain medications of any kind.

Let's do our part and spread the word. We don't all need to be cut open to have our babies. If it has happened to us, we don't need repeats of this surgery just because we're pregnant. We can give birth without a surgeon!


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