Thursday, January 22, 2009

A Prophet is Never Heard in Her Own Town

There is a lady in my church who just had an elective repeat C-section today.

This in itself is not shocking or notable. What gets me is that with her first baby, she took my natural childbirth classes, hired a doula and really wanted to have her baby vaginally without drugs. So she said. More on that in a minute.

With her first baby, she got the story from her OB that she had "low fluid" and needed to be induced right away. Conveniently, she was 41 and 3, just the gestation her doc wanted to induce her at. Prostaglandin gel did nothing. So, start pit in the AM. That didn't work either. So the doc broke her water against her request to leave it intact. Guess what? Lots of water came out. She got an epidural. Was NPO for about 30 hours. Got to 10, pushed for a bit, then was sectioned. Familiar story? Her husband had called me several times for info/advice throughout. I told him to FEED HER and that they would never get the baby out if she didn't get some nourishment. He promptly got her some food, which she refused because the doctor had told her not to eat.

Fast forward to this pregnancy. Right off the bat, she SAYS she wants a VBAC. I recommend her a different OB, one that I (used to) trust, who has done really well with VBACs in the past. I offer to doula for them for FREE.

Throughout her pregnancy I would ask her how it was going, trying to stand back and only offer tips/advice when asked. It was hard to do, I tell you. She told me she was waffling between actually doing the VBAC and being scared of uterine rupture. We had a discussion about the real relative risks (another post for another day folks) and she said she "knew" all that, but was still not sure.

At one point, I finally asked her if she was still interested in me being her doula, as she hadn't said anything and she was now 32 weeks. She replied that as of now, she was planning a cesarean. I was surprised and asked her why? She responded that first, her placenta was over the cervix at that time (okay, totally understandable) and that the doctor told her the baby was already 4 WHOLE POUNDS and that if the baby got over 8 pounds, he wouldn't want her to try and push. Um what? (By 34 weeks, her placenta was out of the danger zone)

I bit back the words that were tripping over themselves in a rush to get past my lips. "But...but..." I said. "C-section is major surgery. Lots of VBAC women have bigger babies than their first." She knows.

So then, on Sunday, Preacherman announces that her scheduled section is for Thursday. I hear her say behind me that she hopes to go into labor before then.

After the service, I turn around and tell her that if she really wants to go into labor before then that I have some tips. She asks if I have anything other than sex. I tell her, sure, there's lots of things. I mention a few things but offer for her to come over and I'll do a slow stretch of her cervix. She says, "But that hurts." I say, "Not when I do it." She tells me that it has "always" hurt when she's had it done before (only one other baby, remember) and I tell her she's never had it done by a midwife. She laments that she thought this doctor was "going to let her VBAC". I remind her she doesn't have to have the section. She says she knows, but her husband wants her to have it. He doesn't like that she was crabby with her last labor. Seriously!?

I ask her why Thursday for the section? She says, well the doc told her that either she had to be induced or have a section, and she knew the risks to induction, so she chose the section. I ask again why Thursday? Well, it's her due date of course. And "he" doesn't want the baby to get too big. I remind her that the last few weeks the baby is putting on fat, which squishes.

Every single solution I gave her only led to another roadblock.

If she just wanted a section, why couldn't she just say, "I'm having a section. This is what we've decided." Every time she SAID she wanted a natural birth, but it was someone else's fault why she couldn't, I tried to give her information to help her achieve what she said she wanted. I can only conclude that her "desire" for a natural birth was really just for show for me. But what is the point of that exactly? Why say one thing and do another thing altogether? Does she think that I will think the c-section is great if she can make me believe she was the victim? I'm glad she and her baby are okay. I'm glad she didn't have any complications.

Eventually, she walks out the door and I don't hear from her again.

PreacherMan went up to the hospital last night to visit her. She's really pleased with her birth and her baby. How big was this huge baby that she would never have been able to birth? Can you guess? 7 lb. 6 oz. Yep.

Makes me sad. I'm not going to apologize for having an opinion. Everyone has them. Barring medical complications, an unmedicated vaginal birth is optimal for mother and baby. If I believed that all births are equal, I wouldn't be a midwife.


Mrs. Spit said...

You know, we place such expectations on women. Birth is so politicized. I wouldn't have an elective section. I can't fathom how you could decide that a section is easier and hurts less than cutting open your abdomen.

I refused the section to give birth to a baby that was going to die, when that patently would have been easier, and very likely safer.

But, in the end, more than anything, I wish we could make birth a bit less political, a bit less of a performance issue, and say that a section wasn't right for me, but if it's what you want to do, and you are aware of the issues surrounding it, it's likely not going to kill you or the babe, and you will have a happy, healthy babe at the end, and that's what matters. Just because it isn't what I would do, it's not wrong. It might not be right either, but it's not going to be the end of the world.

I did learn after having Gabe, that no one hands out gold stars at the delivery room door because you had a natural birth, with no interventions and drugs.

Mandy said...

A doula will give you a gold star! In fact, now that I'm a doula, I think I'm going to do just that. I'm going to bring gold stars to each of my client's births, and when they do the entire thing naturally, I'm going to hand out gold stars or medals to them as a reward. Maybe then people will stop making this statement "nobody gives out a medal for going natural" when refuting the idea of a natural childbirth. Of course that's not someone's JOB...unless you request it of your doula or midwife. I bet she would happily oblige! In fact, maybe all of us in the birth community should just start DOING THIS, then we can get rid of this silly statement!

But of course, as you said, it's not about a symbolic reward. It's about the pride you can have for protecting your birth experience, your baby, and your body. What better reward than that?

xiebob said...

I agree with Mrs. Spit. A lot of women have some pretty complicated emotions around childbirth. In particular, there is on the one hand the desire to do things in the ways that you as a midwife know are "better" - vaginal birth, natural, and on and on. On the other hand is the fear of the pain and the unknown-ness and the reliance on self that is implied in that. A doctor presents solutions that have the emotional appearance of the easy way out. The woman in your story seems very conflicted and scared, which I can really sympathize with!

Of course I can also sympathize with how confusing this must be to you, trying to help her.

Mama said...

I have had two c-sections. The first one definitely wasn't by choice. If I knew then what I know now, things would have gone very differently. My 2nd was planned due to pretty severe complications during my pregnancy. That c-section was done vertically, which was my choice for good reasons and it was definitely the best option for me at the time. They told me that if I ever got pregnant again, I would have to have a c-section due to having the vertical c-section. Have you had any experience with this? I'm very interested in hearing a pro-birth point of view.

One Hot Mama said...

To Mama:

I do know that a vertical UTERINE incision (are you sure that the vertical is on the uterus and not just the skin?)carries a risk of uterine rupture of up to 9%. This risk is too high for many women.

I do know that I have HEARD OF women having a VBAC even with a vertical incision, but I would not attempt it out of a Level III hospital.

TracyKM said...

Makes me sad too, and I'm not in the birth 'industry' in ANY way.
There was a show in Canada "Birth Stories" (Similiar to the one on TLC, except they showed several women on each episode, and followed them for several episodes). One woman was saying/doing all the "I want a natural birth" stuff, but in the shots with her doula, she was clearly detached. She kept saying she was afraid of it hurting and of tearing or needing an episotomy. During the labour, she seemed to be resisting the doula, and in the end, she made it to "9 3/4 cm" and wouldn't progress so she "needed" a c-section. As they wheel her out of recovery, she says "At least I didn't tear". It made me so sad, and I felt somewhat de-valued in a way, as someone who tried very hard to have natural births. I think that's part of the feels like a put-down for having done some pretty hard work. But as Mrs. Spit says, no one is handing out gold stars.

~Debbi~ said...

I agree with you that she sounds like she was just saying what she felt she was expected to say around you. I'm sure around others she chirped happily about her scheduled surgery, how nice it would be not to have 30 hours of labor, how she would know her baby's birthdate in advance, how she could have her hair and makeup done, camera-ready, and arrange for childcare for her first child.

I don't care that I look a mess in my post-birth pictures. I know I did absolutely everything to ensure that my children had a normal, natural start at life. Their health, their untainted bodies, letting my body do what it was supposed to do, those are my gold stars. My friend had a home VBAC, 11 lbs. 10 oz., in a birthing tub and I give her gold stars every time I see her and see her healthy child.

Jenny said...

I'm wondering if she didn't want to disappoint you because her mind was already made up, and she wasn't sure if you'd be 'pushy' about it. Not saying that you were, but being indecisive with you means that she wouldn't have to hear how what's she's doing is 'wrong' (even if you aren't the type to say it to her).

Other than that, she might be scared of birth. That's why I had a section. My stupid doctor scared me that my baby was big, and if I was "his wife, he'd recommend the section". My little guy was 9.5 pounds and 22 inches (so not really fat like he thought). I healed really well from my section, which makes me inclined to have another one. I wanted to go natural the first time around, too. And with my section, I had to have general anesthesia because the anesthesiologist couldn't get the spinal/epidural in me. That scares me that if I try to have a vaginal birth, I won't get pain meds if I need them. :(

Sorry to ramble... just my two cents.

Jana (Varley) Green said...

If someone would offer to doula for me for free. I would take it in a heart beat. Yes there is still fear of the unknown, of pain, of what will happen if I "just can't take it anymore", but with support and education, I think I could over come it.

Somethins' in the Kettle said...

Thank you!

Lee said...

Im not a midwife. I used to be a La Leche Leaque leader and after awhile I decided to only assist people who wanted assisting. I still feel no need to try to talk people out of their choices. (about anything) They can learn by my example and ask for help if they need it but Im not wasting my time trying to convert folks:) Best wishes:) I like your blog:)

Ms D said...

I have had twins by c-section 18 months ago. I am thinking about getting pregnant again, and my ob says that it is safer to have another c-section. With my first pregnancy I had a sudden onset of preeclampsia, my son was transverse, and my daughter was breech. Do you think having a repeat c-section would be better too?