So the default childbirth 'attendant' in South Africa, even for a low-risk pregnancy and birth is a gynae (technically an obstetrician, since they are there in an obstetric role, but we all call them gynaes anyway). Why would we need a doctor when we are pregnant? We treat pregnancy as some kind of disease, as a medical problem to be fixed, and yet we are often healthier pregnant than at any other time in our lives, barring those with true medical conditions.
In a low-risk normal delivery, a gynae is called by the hospital midwives when you arrive to give birth, and is then periodically updated until they decide a C-section is 'required' or you are ready to begin pushing and they arrive to catch the baby. A hospital midwife is usually allocated to you while you are in labour, but will leave when her shift ends and another midwife comes on duty. Before you go into labour, you see your gynae every so often for 10 - 15 minutes at a time for a quick scan, and to get your urine and blood pressure tested.
In contrast, you see your midwife for an hour at a time before giving birth, she meets you at the hospital when you arrive (assuming you're having a hospital delivery - but at least you have the option of giving birth at home with a midwife), spends as long as necessary with you and you will only see her during your labour. By then you know her and trust her, as you have spent so much time with her, and she is able to encourage you in a way that is meaningful to YOU!
The contrast between the amount of time spent and the amount of money you pay for each boggles my mind! My entire hospital vbac birth (hospital stay, midwife, paediatrician and lab tests to check if C had jaundice) cost almost as much as the gynae bill alone of a friend who gave birth a couple of months before me.
But what if something goes wrong?
Firstly, something is a lot less likely to go wrong if you leave your body to birth naturally. No induction, no augmentation (to strengthen contractions or speed up labour), no pain medication. Yes an epidural is a wonderful invention - but its also likely to slow your labour down at best and can possibly stall it altogether, especially if you get it too early. Gynaes generally have much less experience in natural, normal birth than a midwife, and so tend to not trust the birth process quite as much. They get nervous when a birth isn't happening quite fast enough, or when fetal heartrate decelerates (totally normal during a contraction).
Unfortunately, one intervention tends to lead to another. You get induced because at 39-odd weeks you think you've been pregnant long enough (because, of course, pregnancy only lasts 40 weeks at most. If you are pregnant longer than your due date there must be something wrong with your body). The Pitocin you are given comes continuously, unlike the bursts of oxytocin that your body naturally produces, which causes extra-strong and extra-long contractions and your baby may struggle to recover in between contractions (usually a C-section will be recommended). Pitocin may cause placental abruption, uterine rupture, laceration of the cervix and hemorrage after giving birth, and also causes more painful contractions, so you ask for an epidural.
The epidural inhibits the production of a number of key labour hormones, increases the length of your labour (by up to 7.8 hours), increases your risk of a C-section by 2.5 times and increases the risk of pelvic floor problems (urinary, anal and sexual) after birth. Women who have been given an epidural are often confined to bed, instead of allowed to labour in the position most comfortable to them. Since they are lying on their back, their baby is 4 times more likely to turn posterior, decreasing the chance of a natural birth. Epidurals also cause immune suppression and decreased heart rate, blood and oxygen flow in babies, and can be present for up to 36 hours after birth (similar results are seen after a C-section, often leading to sleepy babies and breastfeeding problems). Babies who are exposed to anaesthesia may also be less alert and active for up to a month after birth.
All of this is much more likely if you are giving birth with a gynae.
Midwives have seen natural births so often - they know that you can do it! And because they know what a normal birth is supposed to look like, they also know what its not supposed to look like, and will be able to identify a (true) problem quicker and more accurately than a gynae. Gynaes spend much more time practicing their operating techniques than observing natural births, and are so adept at 'picking up problems' that they often anticipate them before they even occur, leading to the interventions that so often cause more problems than they solve.
And if something does go wrong, your midwife would call your back-up doctor (or the on-call doctor if its in the middle of the night). Just like the hospital midwives would call your gynae if something goes wrong during your gynae-assisted birth. My back-up doctor knew when I was in labour, and phoned my midwife every so often just to check on how things were going - if I had a problem, she would have been there just as fast as if I had been her own patient.
I understand that in higher-risk pregnancies, more specialised medical observation is required, but a normal run-of-the-mill pregnancy is best handled by the people who specialise in normal, natural births - a midwife! She's cheaper, spends more time with you and is more experienced - its a win-win situation all around!
Showing posts with label c-section. Show all posts
Showing posts with label c-section. Show all posts
Wednesday, 26 February 2014
Thursday, 30 January 2014
It's hard not to compare...
Its been a month today and its so hard to not compare...
Last time at a month in, I was still recovering. My scar twinged when I stood up, and hurt when Sophie kicked me. Obviously! My back was killing me. I had a colicky, miserable baby with a bad dairy allergy that hadn't yet been diagnosed. Because of that, she hardly slept, and only ever on me - so I was getting 2 or 3 hours of broken sleep a night. I was still hurting at the fact that my birth plan had gone so horribly wrong and struggling with the baby blues. I adored my baby, but didn't yet feel like she was MINE. I didn't know how I was ever going to go through that again, although I have always known that I wanted at least 2, preferably 3 children. I didn't want to see people and I was hiding out in my house for a while to come still. When I did see people, I felt disconnected from them and battled to make conversation.
This time, I have no pain (my tear took a couple of weeks to feel 100% again, but nothing compared to a C-section incision). I can cuddle my baby and toddler without any fear of being kicked anywhere. Charlotte is a peaceful, content baby with no allergies and wakes once or twice a night - I cannot say that is definitely from her birth, but babies born naturally are less likely to have allergies. Even with 2 kids under 2, I am still getting far more sleep this time around. I have had the odd day when I felt a bit down, but on the whole I am still on an absolute high from my amazing birth experience. Charlotte has felt like MINE since the moment she was born, and it has been such a joy to bond instantly with her. I was ready to go through pregnancy and labour again from when she was only a couple of days old (As my doula says, a good birth experience is addictive). And I've been out and about since the day after I had her, just a few hours after arriving home from hospital. I've really enjoyed spending time with friends.
I can't help but feel that her peaceful birth - in water with very dim lighting while I was surrounded by people that I knew and trusted, feeling emotionally and physically safe - has contributed to her peaceful nature. I don't know, but I can't help but compare.
Thursday, 2 January 2014
5 reasons why I've fought so hard for my vbac
**Disclaimer
(I started writing this post at about 38 weeks, when if I was having an RCS, I would have been going in really soon. It has taken a while to get all my thoughts typed out, so I am finishing it off 3 days after the birth of my little girl. Please excuse any continuity discrepancies as a result of this!)
The more I think about my decision to attempt a vbac, the more I am convinced that I am doing the right thing - the only thing - that makes sense for my family and I. I have had people tell me they think I am crazy, and others terribly concerned that I am doing something very dangerous. I respect these concerns, but my research has shown over and over that it is not nearly as dangerous as we are lead to believe (particularly in South Africa, with our scalpel-happy birth culture), and that far from being a crazy option, unmedicated natural birth is the best and safest option for mom and baby.
I realise that some women will take offense at what I have to say. Please understand that I make no judgement on anyone else's decision. I do however have serious issues with doctors who don't ever explain that there is another option - and that justify unnecessary caesareans (whether they may be a woman's first or a repeat) by scaring a woman with the terrible consequences that would have resulted if she had not had it ... and the label 'emergency caesar' that gets thrown at the c-sections that are done only too readily.
It is true that some c-sections are genuine emergencies. But the World Health Organisation recommends a maximum of 10 - 15% of births be done by c-section (to maximise mother and baby health), so you have to wonder why South Africa is so different that 70 - 95% of births in private hospital 'have' to be by caesar. The very label 'emergency' makes most women believe that their caesar was totally necessary, when in fact so many are merely as a result of an obstetrician's impatience, desire for his own convenience (rather than what is best for mom and baby), and his arrogance in assuming that his surgical skills are a better method of birthing than the way we were designed.
So many women just assume that their gynae (technically they are obstetricians when talking about pregnancy and birthing, but in South Africa we tend to refer to them as gynaes, and so I will stick with this practice out of habit) knows best, is up to date with research and only makes recommendations based on the best interest of her and her baby. Gynaes are only human! The greatest lesson I have learned in my vbac journey is that gynaes are not infallible. Sometimes those considered the 'best' in a city/hospital are actually those that are the most human, and make recommendations based more on their convenience (and human opinion) than on evidence-based medicine (and medical opinion). I long for the day when women make their OWN decisions about what is best for their child's birth, rather than simply accepting a gynae's opinions as fact.
Reason 1: My baby will come when she's ready *
All scheduled C-sections are too early. Simple as that. Some babies will have complications because of it, some won't. But the fact remains that if you haven't gone into labour, your baby was not yet ready to be born.
Some of the more common problems that babies have are respiratory distress and jaundice. Although babies are technically term from 37 weeks, they are only classified full-term from 39 weeks. Many countries will only schedule repeat c-sections from 39 weeks at the earliest (most from 39+3 or even 40 weeks) unless there are valid medical reasons for an earlier delivery, South African doctors are only too happy to schedule them from 38 weeks. By 36 or 37 weeks we generally feel huge and exhausted, and are only too ready to be un-pregnant again. Our doctors are only too happy to pander to this by suggesting we have our babies early to avoid the 'danger' of going into labour. No doctor ever tells us that it would be better for our babies to come on time rather than early, that there are still risks after 38 weeks (and in fact, no doctor would even admit that 38 weeks is actually early - despite the fact that only 50% of women go into labour by 40 weeks including premature babies, and the average first-time labouring mom will only go into labour at 41+3 weeks), and that our comfort is often at the expense of our baby's health.
Babies born between 38 and 38+6 weeks are twice as likely to have breathing problems than babies born after 39 weeks. (Babies born from 37 weeks are 4 times as likely to have breathing problems).
Plus, due dates are at best an estimate. Even going by your last menstrual period (or LMP) can be out a few days, because we all ovulate at different times - and every day counts!
Certain antibodies are only transferred in the last weeks in the womb, so babies that are evicted before their time is up lose out on these antibodies and the protection they provide.
The church I go to starts at 9am on a Sunday morning. Some people are there by 8:50 or even 8:45 to park and get a good seat (or just because they like being on time). Most people arrive at or just before 9:00. My husband and I are usually late, and so we can arrive there anytime between 9:05 and 9:10 (and even later some days - the day I was in labour, we arrived at 9:20!). Taking babies out at a pre-specified time because they 'should' be ready by then, is like saying that everyone who attends that service should be there at 8:50. If we were somehow transported to church at 8:50am on a Sunday morning, we would probably still be in our pyjamas, eating breakfast. One time just doesn't work for everyone, even though we all aim for 9:00. Same thing for babies.
Reason 2: Labour hormones are GOOD for my baby *
Hormones released in labour help protect baby's brain, prepare her lungs and build her immune system, as well as helping baby to imprint on mom and assist with attachment and bonding.
Oxytocin is a feel-good, bonding hormone that is released during and after birth for an hour or more. It helps mom and baby learn to trust each other as well as feel calm and happy. It also acts in mom's brain to initiate affectionate maternal behaviours.
Pitocin is an artificial version of oxytocin and is used in inductions. However, it doesn't cross the blood-brain barrier. If no anaesthesia (eg by epidural - or in a C-section) is used then mom's body will still respond by releasing oxytocin during the birthing process - and so labouring before a C-section has some significant benefits, especially for baby. No oxytocin leads to an increased risk of postnatal depression as well as more difficulty in bonding. Oxytocin will still be secreted after a C-section while breastfeeding, but it remains low for at least 2 days after birth, which tends to increase mom's anxiety and decrease breastfeeding success.
Reason 3: C-section risks for baby
A lot of these risks are interlinked, and so some information will overlap between paragraphs.
Earlier I mentioned the increased risk of respiratory distress in babies born before 39 weeks. One of the hormonal and physical consequences of labour is that fluid from baby's lungs is absorbed. In babies born via C-section without the benefit of labour beforehand, there is a 4 times higher risk of breathing problems (assuming both babies are the same gestational age). This may be a contributing factor as to why C-section babies are twice as likely to suffer from allergies as vaginally-born babies.*
I also mentioned earlier that a number of antibodies are transferred from mom to baby in the last weeks of gestation - even more antibodies are transferred during labour, helping to protect baby by providing some initial immunity and a healthy gut system (a good reason to give your baby probiotics if you ever need a C-section). This may contribute to the fact that babies born via low-risk elective C-section (including RCS) have a tripled death rate in the first month of life compared with vaginal births.*
The risk of a c-section baby dying of SIDS is also significantly higher than that of a vaginally-born baby, which is probably connected to the increased risk of breathing problems as well as decreased immunity. A study carried out on rats showed that compression (i.e. from labour contractions) had a huge effect on breathing - rats were delivered via c-section and then either subjected to compressions (similar to those experienced during labour) or not. Those who underwent compressions were all still alive after an hour, whereas a number of those who were not compressed died fairly within the first hour. *
C-section babies are also at risk of being cut by the obstetrician's scalpel as s/he cuts open the uterus, although none of us like to think about it. 0.1 - 3.1% of babies born via c-section will suffer from lacerations due to surgery.
Anecdotally, I took my daughter to both a chiropractor and a kinaesiologist to help with her wind, colic and allergies. Both of them said that they see virtually only c-section babies. In particular, the chiro said that c-section babies are pulled instead of pushed out, and this regularly causes some spinal misalignment, which can result in general pain or cause gas bubbles to become trapped (because they cannot travel through the baby's system quite as easily) which can be very painful for a little baby. So next time your newborn is gassy or just plain miserable, it may be worth taking them to see a chiro - they can make a world of difference.
Reason 4: C-section risks for mom
First up, I am 3 - 11 times less likely to die from a natural birth than a c-section, depending in which study I use. That's a lot, no matter which way you look at it.
I'm also less likely to suffer a heart attack, need a hysterectomy, stay in hospital for longer (or be readmitted to hospital later as a result of a C-section), get a hematoma, struggle to recover (with the exception of haemorrhoids, which are more common after a vaginal delivery) or have long-lasting pelvic pain.
Plus, I'm also less likely to have painful sex after a natural delivery. Yes, that sounds like it makes no sense! But 40% of women who have had a caesarean delivery suffer from dyspareunia (pain during sex) after birth (which may last up to 6 or even 12 months after the birth), compared to only 26% of women who have given birth naturally.
Reason 5: I don't want major surgery unless really necessary!
This seems like a bit of a no-brainer to me! Just because C-sections have become routine here don't make them a simple procedure! They are still major surgery and so carry all of the general risks of any major surgical procedure, namely anaesthesia complications, bleeding problems, blood clots, risk of death, delayed healing, difficulty breathing and risk of infection.
I accept that giving birth involves pain of some sort. However, I'd rather deal with that pain before my baby arrives, rather than afterwards. I don't want to have to be in pain with a newborn and a toddler to take care of, unable to pick up my toddler because she's too heavy, unable to drive for 6 weeks, hobbling around, sore and yet still drowsy from the pain medication.
The honest aftermath - my feelings after my vbac
3 days ago, I got my vbac. It was hard work, far more intense than I had imagined. It took all day, from 3:40am until 2:10am the next day. That's a long time! It was seriously painful at times. I doubted whether I could do it a number of times. I got a second-degree tear and 9 stitches. That was really sore afterwards, and is still quite tender now. That's the bad side of it.
But the exhaustion gave way to elation and euphoria as soon as I gave birth. And that euphoria was also far more intense than I could have imagined. I went home the following day - I've been home for 2 nights already, whereas if I had a c-section, I would only have gone home today. I got up and showered as soon as I handed my baby over to be measured. I drove the day after I gave birth - without feeling like a rebel ;-) I pick up my toddler and cuddle her as much as I (or she) wants. And that tear hurts, but nothing like a c-section incision. I'm not drugged up on pain medication.
I felt and watched my baby come out from me - she felt like MINE from the instant I saw her. Then she was put on my chest and we just hung out together and gazed into eachother's eyes (and started breastfeeding as soon as she started rooting) for a couple of hours. No rush to bundle her up and take her off to be weighed and assessed. It was peaceful, at her pace (and mine), intimate (darkened lights, warm water) and most of all, it was just so real. My baby is alert, feeding well and is peaceful - can I say that all of this is from her birth? Of course not. But its hard to not compare this to my first, who was so sleepy from the anaesthetic that she struggled to stay awake long enough to feed for the first few days.
It was probably the hardest thing I have ever done, physically and emotionally, after fighting so hard for it and having so much invested in succeeding. But it was also the most rewarding, healing, triumphant, amazing experience. I could keep trying, but there are no words to describe what I felt then and still feel now at the memory of it. It goes so far beyond meeting your baby for the first time.
(I started writing this post at about 38 weeks, when if I was having an RCS, I would have been going in really soon. It has taken a while to get all my thoughts typed out, so I am finishing it off 3 days after the birth of my little girl. Please excuse any continuity discrepancies as a result of this!)
The more I think about my decision to attempt a vbac, the more I am convinced that I am doing the right thing - the only thing - that makes sense for my family and I. I have had people tell me they think I am crazy, and others terribly concerned that I am doing something very dangerous. I respect these concerns, but my research has shown over and over that it is not nearly as dangerous as we are lead to believe (particularly in South Africa, with our scalpel-happy birth culture), and that far from being a crazy option, unmedicated natural birth is the best and safest option for mom and baby.
I realise that some women will take offense at what I have to say. Please understand that I make no judgement on anyone else's decision. I do however have serious issues with doctors who don't ever explain that there is another option - and that justify unnecessary caesareans (whether they may be a woman's first or a repeat) by scaring a woman with the terrible consequences that would have resulted if she had not had it ... and the label 'emergency caesar' that gets thrown at the c-sections that are done only too readily.
It is true that some c-sections are genuine emergencies. But the World Health Organisation recommends a maximum of 10 - 15% of births be done by c-section (to maximise mother and baby health), so you have to wonder why South Africa is so different that 70 - 95% of births in private hospital 'have' to be by caesar. The very label 'emergency' makes most women believe that their caesar was totally necessary, when in fact so many are merely as a result of an obstetrician's impatience, desire for his own convenience (rather than what is best for mom and baby), and his arrogance in assuming that his surgical skills are a better method of birthing than the way we were designed.
So many women just assume that their gynae (technically they are obstetricians when talking about pregnancy and birthing, but in South Africa we tend to refer to them as gynaes, and so I will stick with this practice out of habit) knows best, is up to date with research and only makes recommendations based on the best interest of her and her baby. Gynaes are only human! The greatest lesson I have learned in my vbac journey is that gynaes are not infallible. Sometimes those considered the 'best' in a city/hospital are actually those that are the most human, and make recommendations based more on their convenience (and human opinion) than on evidence-based medicine (and medical opinion). I long for the day when women make their OWN decisions about what is best for their child's birth, rather than simply accepting a gynae's opinions as fact.
Reason 1: My baby will come when she's ready *
All scheduled C-sections are too early. Simple as that. Some babies will have complications because of it, some won't. But the fact remains that if you haven't gone into labour, your baby was not yet ready to be born.
Some of the more common problems that babies have are respiratory distress and jaundice. Although babies are technically term from 37 weeks, they are only classified full-term from 39 weeks. Many countries will only schedule repeat c-sections from 39 weeks at the earliest (most from 39+3 or even 40 weeks) unless there are valid medical reasons for an earlier delivery, South African doctors are only too happy to schedule them from 38 weeks. By 36 or 37 weeks we generally feel huge and exhausted, and are only too ready to be un-pregnant again. Our doctors are only too happy to pander to this by suggesting we have our babies early to avoid the 'danger' of going into labour. No doctor ever tells us that it would be better for our babies to come on time rather than early, that there are still risks after 38 weeks (and in fact, no doctor would even admit that 38 weeks is actually early - despite the fact that only 50% of women go into labour by 40 weeks including premature babies, and the average first-time labouring mom will only go into labour at 41+3 weeks), and that our comfort is often at the expense of our baby's health.
Babies born between 38 and 38+6 weeks are twice as likely to have breathing problems than babies born after 39 weeks. (Babies born from 37 weeks are 4 times as likely to have breathing problems).
Plus, due dates are at best an estimate. Even going by your last menstrual period (or LMP) can be out a few days, because we all ovulate at different times - and every day counts!
Certain antibodies are only transferred in the last weeks in the womb, so babies that are evicted before their time is up lose out on these antibodies and the protection they provide.
The church I go to starts at 9am on a Sunday morning. Some people are there by 8:50 or even 8:45 to park and get a good seat (or just because they like being on time). Most people arrive at or just before 9:00. My husband and I are usually late, and so we can arrive there anytime between 9:05 and 9:10 (and even later some days - the day I was in labour, we arrived at 9:20!). Taking babies out at a pre-specified time because they 'should' be ready by then, is like saying that everyone who attends that service should be there at 8:50. If we were somehow transported to church at 8:50am on a Sunday morning, we would probably still be in our pyjamas, eating breakfast. One time just doesn't work for everyone, even though we all aim for 9:00. Same thing for babies.
Reason 2: Labour hormones are GOOD for my baby *
Hormones released in labour help protect baby's brain, prepare her lungs and build her immune system, as well as helping baby to imprint on mom and assist with attachment and bonding.
Oxytocin is a feel-good, bonding hormone that is released during and after birth for an hour or more. It helps mom and baby learn to trust each other as well as feel calm and happy. It also acts in mom's brain to initiate affectionate maternal behaviours.
Pitocin is an artificial version of oxytocin and is used in inductions. However, it doesn't cross the blood-brain barrier. If no anaesthesia (eg by epidural - or in a C-section) is used then mom's body will still respond by releasing oxytocin during the birthing process - and so labouring before a C-section has some significant benefits, especially for baby. No oxytocin leads to an increased risk of postnatal depression as well as more difficulty in bonding. Oxytocin will still be secreted after a C-section while breastfeeding, but it remains low for at least 2 days after birth, which tends to increase mom's anxiety and decrease breastfeeding success.
Reason 3: C-section risks for baby
A lot of these risks are interlinked, and so some information will overlap between paragraphs.
Earlier I mentioned the increased risk of respiratory distress in babies born before 39 weeks. One of the hormonal and physical consequences of labour is that fluid from baby's lungs is absorbed. In babies born via C-section without the benefit of labour beforehand, there is a 4 times higher risk of breathing problems (assuming both babies are the same gestational age). This may be a contributing factor as to why C-section babies are twice as likely to suffer from allergies as vaginally-born babies.*
I also mentioned earlier that a number of antibodies are transferred from mom to baby in the last weeks of gestation - even more antibodies are transferred during labour, helping to protect baby by providing some initial immunity and a healthy gut system (a good reason to give your baby probiotics if you ever need a C-section). This may contribute to the fact that babies born via low-risk elective C-section (including RCS) have a tripled death rate in the first month of life compared with vaginal births.*
The risk of a c-section baby dying of SIDS is also significantly higher than that of a vaginally-born baby, which is probably connected to the increased risk of breathing problems as well as decreased immunity. A study carried out on rats showed that compression (i.e. from labour contractions) had a huge effect on breathing - rats were delivered via c-section and then either subjected to compressions (similar to those experienced during labour) or not. Those who underwent compressions were all still alive after an hour, whereas a number of those who were not compressed died fairly within the first hour. *
C-section babies are also at risk of being cut by the obstetrician's scalpel as s/he cuts open the uterus, although none of us like to think about it. 0.1 - 3.1% of babies born via c-section will suffer from lacerations due to surgery.
Anecdotally, I took my daughter to both a chiropractor and a kinaesiologist to help with her wind, colic and allergies. Both of them said that they see virtually only c-section babies. In particular, the chiro said that c-section babies are pulled instead of pushed out, and this regularly causes some spinal misalignment, which can result in general pain or cause gas bubbles to become trapped (because they cannot travel through the baby's system quite as easily) which can be very painful for a little baby. So next time your newborn is gassy or just plain miserable, it may be worth taking them to see a chiro - they can make a world of difference.
Reason 4: C-section risks for mom
First up, I am 3 - 11 times less likely to die from a natural birth than a c-section, depending in which study I use. That's a lot, no matter which way you look at it.
I'm also less likely to suffer a heart attack, need a hysterectomy, stay in hospital for longer (or be readmitted to hospital later as a result of a C-section), get a hematoma, struggle to recover (with the exception of haemorrhoids, which are more common after a vaginal delivery) or have long-lasting pelvic pain.
Plus, I'm also less likely to have painful sex after a natural delivery. Yes, that sounds like it makes no sense! But 40% of women who have had a caesarean delivery suffer from dyspareunia (pain during sex) after birth (which may last up to 6 or even 12 months after the birth), compared to only 26% of women who have given birth naturally.
Reason 5: I don't want major surgery unless really necessary!
This seems like a bit of a no-brainer to me! Just because C-sections have become routine here don't make them a simple procedure! They are still major surgery and so carry all of the general risks of any major surgical procedure, namely anaesthesia complications, bleeding problems, blood clots, risk of death, delayed healing, difficulty breathing and risk of infection.
I accept that giving birth involves pain of some sort. However, I'd rather deal with that pain before my baby arrives, rather than afterwards. I don't want to have to be in pain with a newborn and a toddler to take care of, unable to pick up my toddler because she's too heavy, unable to drive for 6 weeks, hobbling around, sore and yet still drowsy from the pain medication.
The honest aftermath - my feelings after my vbac
3 days ago, I got my vbac. It was hard work, far more intense than I had imagined. It took all day, from 3:40am until 2:10am the next day. That's a long time! It was seriously painful at times. I doubted whether I could do it a number of times. I got a second-degree tear and 9 stitches. That was really sore afterwards, and is still quite tender now. That's the bad side of it.
But the exhaustion gave way to elation and euphoria as soon as I gave birth. And that euphoria was also far more intense than I could have imagined. I went home the following day - I've been home for 2 nights already, whereas if I had a c-section, I would only have gone home today. I got up and showered as soon as I handed my baby over to be measured. I drove the day after I gave birth - without feeling like a rebel ;-) I pick up my toddler and cuddle her as much as I (or she) wants. And that tear hurts, but nothing like a c-section incision. I'm not drugged up on pain medication.
I felt and watched my baby come out from me - she felt like MINE from the instant I saw her. Then she was put on my chest and we just hung out together and gazed into eachother's eyes (and started breastfeeding as soon as she started rooting) for a couple of hours. No rush to bundle her up and take her off to be weighed and assessed. It was peaceful, at her pace (and mine), intimate (darkened lights, warm water) and most of all, it was just so real. My baby is alert, feeding well and is peaceful - can I say that all of this is from her birth? Of course not. But its hard to not compare this to my first, who was so sleepy from the anaesthetic that she struggled to stay awake long enough to feed for the first few days.
It was probably the hardest thing I have ever done, physically and emotionally, after fighting so hard for it and having so much invested in succeeding. But it was also the most rewarding, healing, triumphant, amazing experience. I could keep trying, but there are no words to describe what I felt then and still feel now at the memory of it. It goes so far beyond meeting your baby for the first time.
Monday, 19 August 2013
A long overdue update!
So it's been a loooong time since I last posted!
I'm now 21 weeks, and all is looking good. Baby is 3 or 4 days ahead on all measurements and - so far - gaining with every ultrasound (which is so wonderful after Sophie, who was always 2 - 3 weeks behind!). I have an anterior placenta, which means that my placenta is in the front of my uterus, something that happens in about 30% of pregnancies. Sadly, this has buffered most of my precious Bean's kicks, so I only feel him/her move when lying breech because the kicks are then aimed lower than my placenta. I have noticed more and more movement over the last couple of days, and I think *just maybe* I'm starting to feel movement through the placenta. It will be a while before I can feel him/her regularly though. Also, we still don't know what gender baby Bean is - the angle wasn't great at my last scan (19 +1) so although the doctor guessed one gender, she admitted she honestly wasn't certain. My anatomy scan is next week Friday at 23 +2, so hopefully we'll be able to see nice and clearly then!
I have also sent off a motivational letter to the hospital ... all local private hospitals have a strictly no doula rule, and I really feel like a doula will be able to help me - especially since my midwife will not allow me an epidural since this is a vbac attempt (which I'm secretly grateful for, since epidurals seem to be associated with decreased vbac success, as well as increased uterine rupture risk).
This is the letter that I sent:
Dear XXX (Client service manager)
I had my first child at XXX Hospital on 10 February 2012, a failed induction turned caesarean section which I found bitterly disappointing. Since then I have been researching and hoping for a vbac. I am now 21 weeks pregnant with my second child, and hope to give birth at XXX Hospital again in December. I am seeing Sr XXX (midwife) and she has advised me that XXX Hospital does not usually allow doulas to be present during births.
Being a vbac mom, I have a number of added fears and anxieties to deal with, and I really believe that a doula would help make my birthing experience a more positive one than what I experienced last time (due to my failed induction and – I believe – rather unnecessary caesarean, not as a criticism of XXX Hospital).
I'm now 21 weeks, and all is looking good. Baby is 3 or 4 days ahead on all measurements and - so far - gaining with every ultrasound (which is so wonderful after Sophie, who was always 2 - 3 weeks behind!). I have an anterior placenta, which means that my placenta is in the front of my uterus, something that happens in about 30% of pregnancies. Sadly, this has buffered most of my precious Bean's kicks, so I only feel him/her move when lying breech because the kicks are then aimed lower than my placenta. I have noticed more and more movement over the last couple of days, and I think *just maybe* I'm starting to feel movement through the placenta. It will be a while before I can feel him/her regularly though. Also, we still don't know what gender baby Bean is - the angle wasn't great at my last scan (19 +1) so although the doctor guessed one gender, she admitted she honestly wasn't certain. My anatomy scan is next week Friday at 23 +2, so hopefully we'll be able to see nice and clearly then!
I have also sent off a motivational letter to the hospital ... all local private hospitals have a strictly no doula rule, and I really feel like a doula will be able to help me - especially since my midwife will not allow me an epidural since this is a vbac attempt (which I'm secretly grateful for, since epidurals seem to be associated with decreased vbac success, as well as increased uterine rupture risk).
This is the letter that I sent:
Dear XXX (Client service manager)
I had my first child at XXX Hospital on 10 February 2012, a failed induction turned caesarean section which I found bitterly disappointing. Since then I have been researching and hoping for a vbac. I am now 21 weeks pregnant with my second child, and hope to give birth at XXX Hospital again in December. I am seeing Sr XXX (midwife) and she has advised me that XXX Hospital does not usually allow doulas to be present during births.
I feel very
strongly that a doula would help in my case specifically and would like to request
that you allow me to have one assist at my birth.
Being a vbac mom, I have a number of added fears and anxieties to deal with, and I really believe that a doula would help make my birthing experience a more positive one than what I experienced last time (due to my failed induction and – I believe – rather unnecessary caesarean, not as a criticism of XXX Hospital).
Research
suggests that having a doula present can shorten labour and decrease the
likelihood of needing a caesarean section. I will not be using any pain
medication (Midwife's preference with vbacs), and doulas can help with managing
and alleviating pain in other ways. Also, I am concerned that my husband may
need more support during labour than I will be capable of giving him and I
would really appreciate the support that a doula can offer to him as well, so
that he might feel more comfortable with my labour process and have a better
idea of how to support me (rather than the other way around!).
I have
spoken with XXX (Doula), a WOMBS-certified doula and she is happy to come in
and meet with your staff to discuss how she can help me without hindering their
duties, as well as to go through any orientation process necessary.
I appreciate
your consideration of my request and look forward to your response.
Kind regards, etc
I copied the Maternity Unit manager in on the email, and have had a response from the Client Service manager so far, saying that the Maternity Unit manager will get back to me soon. I feel quite positive about my request though - if they refuse me I will appeal higher up, probably with the Hospital manager and even higher up in the XXX Hospital group. The group has an article on their website talking about different methods of pain relief/management, where they even mention a doula as an expert in alternative pain management techniques - plus one of their hospitals elsewhere is used as a doula-training facility.
I've also been doing a lot of research into vbacs and caesarean sections, including the various risks of both - hoping to link some on here in the next few days.
Wednesday, 19 June 2013
Beginnings ... Sophie's birth story
My vbac journey started just over 16 months ago when my daughter was born.
I was overwhelmed with paranoia throughout my pregnancy but especially as the time drew near to delivery, and Dr M (my obstetrician) suggested an induction at 38 weeks. I put it off for a week, too nervous to even tell my husband what she had suggested... I don't think I'd even mentioned how terrified I was that something would go wrong! I'd spent months googling every pregnancy ailment, genetic disease and anything else that could possibly go wrong and between my unfortunate new knowledge and the rush of pregnancy hormones, I couldn't control my imaginings. So when she said I could have my baby safe in my arms within a day, contractions possibly slightly stronger than if I went into labour naturally and my c-section risk only increasing to 35% (from 30%), it all seemed too good to be true.
In retrospect, it was. If I'd applied half the time to researching c-section rates (and their correlation to inductions) in South African private hospitals as I had to researching anencephaly and sickle cell anaemia, I would have realised that what she was telling me simply wasn't true. And that my greatest chance of having the natural delivery that I so desperately wanted was to simply ask her what other options there were. As in, could I simply schedule a 5 minute appointment with her twice a week until I went into labour, to ease my fears. Or even as simple as to ask her to check my Bishop score before scheduling the induction, to be confident that it had a chance of success (bearing in mind that I was still a couple of weeks short of the average first time gestation period of 40 weeks plus 8 days).
Induction - Day 1
So we went in at 9pm, just a day short of 39 weeks and after a lengthy admission process and numerous battles to get the fetal monitor to work correctly, I finally said goodbye to my husband at around 11pm. A while after that, they came in to administer my 'teabag', which was supposed to begin ripening my cervix.
After a night of very little sleep, I woke up with cramps in my legs rather than my uterus, and little change in my cervix beyond a slight softening. I started walking (marching!) the hospital corridors as soon as I woke up, to try and get my contractions going, and managed to get them to the point where I needed to pause for a moment as a new one started, but they never became regular. Later on they moved me to the delivery room, and a midwife gave me a medicine to drink (I asked what it was at the time, but the medicines are the one part of my story that I cannot remember) every hour for 4 hours. The monitor showed that my baby was still doing fine, and my contractions were peaking in the low 90s (apparently they should reach up to about 100). However, for every 'good' contraction, there was another one that was in the 30s or 40s - they never reached any semblance of regularity, and despite their intensity at times I was never in any kind of pain. The Braxton Hicks I had had for the past 4 or 5 weeks felt like they were doing more than these contractions!
As the day wore on, the previously upbeat midwives became a bit more somber as each cervical check revealed little to no change. A couple of them came in together around mid-afternoon, to check on me. I was still excitedly waiting for 'real' labour to begin, and quite happy to go run a marathon if thats what it took! However Dr M had said to me that TODAY I would have my baby, because I was now 'on the clock'. So we all knew that she would want to book a theatre slot by early evening at the latest. The midwives reassured me that my baby was strong and had a good heartrate, and encouraged me that if I still felt able, I could ask to continue with the induction tomorrow. So when Dr M came in to check on me, they came in with me and helped me to stand my ground, and she 'allowed' me to try again the following day. I was so desperate to have my normal delivery.
Looking back, I am horrified that I put such blind confidence in her! I felt as though I were a schoolgirl and she were allowing me to skip a class!!
Induction - Day 2
During the night, a midwife came in to insert my next 'teabag' - no good news, still just a fingertip dilated. So I slept as much as I could and as soon as it was light, I began walking the corridors again. I was determined that today was the day! At 8ish I realised I needed to get back to the maternity ward for breakfast and as I arrived I was met by a nurse, "Where have you been? The doctor's been trying to get hold of you. She's not happy, she's taking you into theatre soon so we need to get you prepped". My world dropped. I can still vividly feel that shock and disappointment, and horror at the thought of what was coming, and I have tears running down my cheek as I type this.
I phoned my husband in floods of tears. "They're taking me into theatre and I don't know when but I know its soon. Can you get here soon? I need you!". The poor man had been working late the night before and was woken by my phonecall - and I'm not sure how much sense I was making! But to his credit he arrived there within 20 minutes and my mom was shortly behind. The nurses prepped me and tried to lift my spirits, but I was already in the OR when I realised that, at the very least, my baby was coming today and I needed to cheer up. Despite my sadness, the most exciting event of our lives was about to take place.
... and Sophie is here!
The operation itself was unremarkable. The spinal went in fine and worked perfectly and the anaesthetist was a wonderful narrator, telling me what was happening and when Noel needed to get ready to take a photo. It was a little uncomfortable while they were tugging, but that was more the thought of what they were doing than the actual physical sensations. All of a sudden I heard a cry and realised that my baby was there. No big announcements; I had to ask to check whether it (she!) was a boy or girl. It was all quite routine and anticlimactic. Noel went with her as the paediatrician checked, suctioned and swaddled her, and then they brought her to me for a brief moment. I caught a glimpse of her out of the corner of my eye as they held her on my shoulder, all 2.926kg and 47cm of her.
It was all very surreal and she really didn't feel like she could possibly be the baby I had been talking and singing to and falling so hopelessly in love with for the last 9 months. She felt totally foreign, as if they had just handed me a stranger's baby. To make matters worse, they then rushed her to the nursery to get cleaned up while I was being stitched up and I was then forgotten in the recovery room for 20 minutes until a maternity ward nurse finally remembered to fetch me. By then it was almost visiting hour and so I was not allowed to see Sophie or begin breastfeeding her. Noel came through to my room to show me a couple of photos, and then went back so that at least one of us could be with her, while my mom sat next to my bed holding my hand, neither of us talking much and both ultra-aware that this momentous event had just happened but I was just so eager to hold and breastfeed my baby, and she was so disappointed that I had yet to hold her properly that we just couldn't find neutral topics to discuss.
Eventually visiting hour ended and my tiny newborn was brought to me. She latched with some help (just over 2 hours after birth) and after 5 or 6 difficult weeks (particularly in the first couple of days when she couldn't stay awake for more than a minute or 2) and numerous problems, we are still happily breastfeeding today.
Sophie is now a precious, bright, active, determined, independent, adventurous and very chatty toddler. She has opened my eyes to the true joy of being a mom and my heart now really does live outside my body. I wanted her from before she was conceived and loved her from long before she was born - but nothing could have prepared me for how much I treasure and adore this precious, funny little girl!
Postscript: a vbactivist is born
It was while being transferred onto the OR bed/gurney that I remembered reading about vbacs during all my wild pregnant researching, and decided that I would not - could not! - go through this again unless it was actually necessary for my (future) baby's health. I have researched it thoroughly in the past 16 months and my research has made me more convinced that the risks of a c-section are even greater than the risks of a vbac, and that it truly is the safest and best option for myself, my future child/ren and our family.
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