Wednesday, October 13, 2010

The Perfect Birth Vs. the No-Regrets Birth

I recently read a blog about "The Myth of the Perfect Birth" and it prompted me to think about the concept of the perfect birth. I'm a dedicated birth junkie. I believe that how birth happens is important, and that "mother and baby are healthy" outcomes should not be the only goal (although they will always be the primary and most important goal). Between my two births, I have experienced just about everything possible in the birth world. I've had an induction, artificially ruptured membranes, epidural, and c-section (Nathan). I've had a home birth, labored in the water, no medication (not even a Tylenol), pushed the baby out in my own bed, episiotomy performed by my home birth midwife, stitched up by my hospital based doctor (Daniel). I think the only thing I haven't experienced is a short, uncomplicated labor (lucky me). So I well know that having the perfect birth can truly be an unattainable goal for some, particularly if your wishes for the birth involve more than getting the baby out any way possible. However, I do believe it is possible for any mom in any situation to have what I call a "no-regrets" birth.

I had a "no-regrets" birth with Daniel. I did not with Nathan. You might be sitting there thinking, "Well, duh. You finally got your natural, vaginal birth--and after a c-section, no less!" Actually, Daniel's birth would have been "no-regrets" even if I had ended up in the hospital having a repeat c-section (although I would NOT have been a happy camper). What made Daniel's birth "no-regrets" and Nathan's birth not was that, with Daniel, I made the best possible choices to promote the chances of having the birth I wanted. I advocated for myself. I stepped out (Stephen would say WAY out) of the box. I took risks, but they were the risks that I chose to take, eyes wide open. And if my birth had not turned out the way I had hoped, I would have known that I had done everything possible to make it what I wanted, and for reasons beyond my control, it was not meant to be.

I had to do a lot of emotional processing after Nathan's birth, especially since his birth was pretty much the exact opposite from what I intended. I wanted the complete natural package: make the big phone call ("I'm in labor, honey!"), labor in my home for much of the time, arrive at the hospital just in time to close the deal and push the baby out with lots of panting, sweating, and no meds. Snuggle baby for the prescribed hour before he was even removed from my arms. Nurse right away. Sometimes reality bites. Two weeks overdue, I checked into the hospital with an unfavorable cervix for an induction. Two Cervidils, lots of Pitocin, and one artificial rupture of the membranes later, I was in serious pain with no, and I mean NO progress. The doctor, trying to be positive, said, "I think you're about a fingertip now." Not what I was looking for, lady! When she said that sometimes having the epidural can relieve the pain and promote dilation, all my mental fortitude went out the window. After a horrible hour of waiting for the epidural man to arrive, I started to get some relief from the pain, but my blood pressure dropped and Nathan's heart rate dropped. The only way they could stabilize us was dropping the Pitocin levels. I remember them wheeling in the table with all the delivery instruments on it and thinking "But I'm not even dilated." I guess they had made up their mind that the baby needed to be delivered one way or the other, and the next cervical check would decide my fate. The news was not good. Still a centimeter. No way the baby was coming out that way. It was off to the O.R. The c-section could have been a poster birth for the doctors. Nathan came out pink and healthy. No complications with performing the surgery or the anesthesia. Stephen held Nathan minutes after he was born. I had to listen to his cry from my position, immobilized on the operating table. After a quick glimpse of him, Nathan was whisked off to the newborn nursery, and I dozed as they stitched me up, exhausted by the ordeal. It was hours before I saw him again. Finally, close to midnight, I sent Stephen to get Nathan, and told him, unequivocally, that he was not to come back until he brought the baby with him. I missed out on so many of the moments that were important to me. Being the first to hold the baby after he was born. Being there to watch the grandparents see the baby for the first time. Being there for those first precious hours of my baby's life. I was drugged, separated, and devastated. When my baby finally did arrived, wheeled in one of those little plastic carts, I clung to him. He was beautiful. Perfect. Everything I had longed for. Yet I couldn't let go of how everything had gone so horribly against my expectations.

To this day the "what-if's" swirl in my head. What if we had watched and waited for another day? Or two? Or three? How long would we have had to wait for my own body to initiate labor? What if we had done a slower induction? More ripener and more time before cranking the Pit? Or what if I hadn't let them break my waters? Would that have provided enough cushion to make the contractions gentler so Nathan wouldn't have been stressed by them? Or bearable so I wouldn't have had the epidural that initiated the decelerations? What if? What if, what if, what if?

I'm a person who wants to know. Even if the news is the worst, most horrifying news possible, just tell me so we can start dealing with it. Unfortunately, I'll never know if the cascade of intervention was responsible for the scar I now bear. I've worked through much of my emotional pain, although I still feel a pang when I hear a glowing new mom's story of how perfectly everything happened. I've come to a place of acceptance. I made the best decisions I could with the information I had at the time. I'm so thankful that my baby was born healthy. I'm so thankful that I healed well, and to this point, have experienced no complications from my Cesarean scar. I have so much to be thankful for, but it does not negate the way things happened or the toll it took on me. My birth experience was so far from the expectations that I had that I felt a little bit like I had planned a lovely trip to Paris but was shoved off with nothing but a parachute and landed in the middle of Nigeria. (I don't know anything about Nigeria. I really didn't want to go to Nigeria. But here I am in Nigeria. What do I do now?)

It took a work of God to accomplish my emotional healing. HE is able. Although I have questions, I no longer have regrets about Nathan's birth. But that is due to the greatness of my God, not the smallness of my problem (if you couldn't read between the lines, it was not a small problem to me). I am boasting in the Lord, because I am an overcomer. I have climbed this mountain, and He held my hand.

I knew pretty much as Nathan was being yanked from my abdomen that I would try for a VBAC with my second child. Although I did not know it at the time, I walked out of that hospital a very different person. While becoming a mother, I had found my voice, and I was ready to speak up for myself and my child, and all my future children. I did not know when I was having Nathan how much of an impact caregiver and location have on birth interventions and outcomes. After his birth, I became a research maniac. I read every book on birth I could get my hands on. I searched the internet. I joined ICAN's message board. I stared in (loving) disbelief when other mommies told me they were scheduling their elective repeat c-section. I obtained my records and pored over details of my scar placement and the relative risks of uterine rupture. I compared the risks of uterine rupture to the risks of catastrophic placental complications associated with multiple c-section scars. I found out the dirty little secret of obstetrics in the US: they smile and tell you you can have a VBAC while secretly sharpening their scalpel. You can have a VBAC, if you go into labor before 39 weeks, if the baby is perfectly positioned, if the baby is not too big, if you don't have any pregnancy complications. Perfect births happen rarely, but they almost never happen to a VBAC mom, probably because VBAC moms often have to overcome the issue that led to the initial Cesarean, whether that be a tendency to bake their babies longer (as I do), or a history of carrying their babies breech, stubborn cervixes, or a pelvic structure that does not lend itself to easy passage for babies looking for the exit. So to create conditions that only permit VBAC if birth is proceeding perfectly explains the abysmal VBAC rate in the United States.

That was when I started contemplating a home birth. Note that at this point, I was not even pregnant. I was crafting my master plan. I had discovered the secret. Having the birth you want is not a process of checking the appropriate boxes on your printed birth plan. Neither is it being in the right place in your own head, although that certainly helps. Are you ready? Here's the secret: you have to choose the right people to surround you during an extremely vulnerable time. I can be a bit of a control freak at times, so I was surprised to discover during Nathan's birth that although these people must obtain your consent before moving forward with anything, other people manage your birth. Particularly if you are planning a medication free birth, someone else has to be in charge while you breathe, scream, pant, and just try to survive while thinking that you'd rather be dead. And if you choose medication, it can dull your usually sharp faculties at the same moment you are forced to make life-altering decisions. What loving mom or dad can look at a doctor who is saying "Well, I'm a little concerned about this baby's well-being," and refuse any intervention to get that beloved baby in their arms safely? That's why it's important to know that your attending doctor or midwife knows your wishes, has your back, and that you can trust them not to recommend anything to you until it is definitely necessary.

I think if you're still reading, you might be a birth junkie too, but, believe it or not, I have more to say! I haven't even started on my journey with my little Daniel. But it's time to post and save Daniel's story, and the rest of my thoughts, for later. Until then, happy birthing!


  1. I love this. I kept waving [politely- ha!] at Davey to hush while I was completely engrossed in your story. Can I just say how proud I am of you? Not just for the fact that you had a VBAC and a natural one at that, but because you're an awesome mom and I admire you in so many ways. I too, loved spending time with you guys the other day. We should definitely do it again...soon!

  2. I really enjoyed reading this. I have a number of friends who are "birth junkies" - and I kind of am - I really enjoy learning about all of it just don't have a practical reason to get too into it yet. lol

  3. LOVE LOVE LOVE your honesty and candor. I shed a tear reading about your c-section, and then was grinning unstoppably as I read "the secret." It is such a relief to know that there ARE moms who GET IT!!! Who aren't just going to settle for what someone else decides is the best way to have their baby. Who aren't okay with the whole "At least you have a healthy baby" line. Mamas like you are the reason I'm putting it all on the line for midwifery!!!