Warning: This post may be triggering for those still recovering from a Cesarean.
A couple of weeks after Will came home after his lengthy NICU stay, I posted the story of his birth. Ever since then I have, in my head, been writing the story of how he was actually born in my head. Today’s the day it spills through.
When we realized Will’s pregnancy had taken a tenuous turn, all of the high risk OBs were very guardedly cautious about his birth. One in particular said that because the placenta was irregular, and because babies with IUGR tend to have placentas that age faster, I could expect to go into labor earlier than normal – around 34ish weeks (ha, if only!). If the baby were to come early, a cesarean section is recommended, because especially in babies with IUGR, there just isn’t a whole lot of fat on the baby to cushion them through the birth canal otherwise. That, plus his breech presentation in utero, plus the pre-e – all of this combined made it pretty much a foregone conclusion that a cesarean section was highly likely.
It was around this time that Josh and I hired Leslee to be our doula. Before all of this kerfuffle with Will’s limited growth in utero, I knew I wanted to hire her as our doula, but after we discovered what a difficult road lay ahead of us, I was positive. She helped me frame all of the questions and concerns I had about Will’s birth, however it was to come, in a way that empowered me. I had choices – I may not have liked all of my choices but I had choices. I could take control, somewhat, of a crappy situation.
I also attended my first ICAN meeting about a year ago, not too long after I went on bedrest. ICAN is the International Cesarean Awareness Network, and our local ICAN group in Tallahassee held my hand and talked to me frankly and supportively about the journey I was anticipating. The physical recovery from major abdominal surgery, the emotional recovery from the surgery – what to expect when you walk into TMH and how you get prepped.
I was ready, I thought. I knew what to expect and I could do this! I am woman, hear me roar! If the baby needed to exit other than the traditional route, then I’m up for the challenge!
Until, of course, it actually happened. Now, I understand completely that my cesarean experience was unique, and despite having something in common with about 30% of the women in the country giving birth, my build-up to Will’s arrival was different than anyone else’s. I had different baggage going in – but then, we all do. We all carry our own war stories of how we got to be flat on our back, numb from chest down, and feeling the tugs of the obstetrician’s hands working back and forth to cut through the layers of skin, muscle, and finally, into the womb.
On Friday May 10th of last year, we were scheduled to be wheeled into the OR at 5pm. At 3pm, Leslee arrived (with a nose ring made of glass – or was it plastic?) so I could replace my metal nosering with it (I was advised to remove all metal including jewelry). Around the same time, Josh’s parents arrived, and so the five of us waited. My dear friend Sylvia wrangled the older kiddos that night while we waited. And waited. And waited. Other more urgent c-sections needed to happen before my pre-eclamptic, IUGR, breech, and premature baby could be born, so in the meanwhile, we watched episodes of 30 Rock. We moved from the antenatal room I’d been staying in prior to birth day, to another room to prep for birth. I remember the nurse prepping me, all the while complaining about the computers that weren’t working properly -
- and all I could think at that moment was, “PLEASE DO NOT TELL ME RIGHT BEFORE YOU ARE GOING TO CUT ME OPEN THAT YOU ARE HAVING TROUBLE LAUNCHING WINDOWS.” Then I thought, “Fuck Windows.” And then I laughed to myself about how I teach students basic technology and here I am, held at the mercy of an inoperative operating system. -
There is no modesty in birth, no matter how it happens – and for this emergent c-section, the same applied. The nurse who prepped me was more brisk and nonchalant than I would have liked. I wish I had the nurse who was from Australia, who was on the night shift the night before, who sat with me for at least a half an hour while on rounds, while I quizzed her repeatedly about what I could anticipate – even though I already knew. My nerves were all balled up. The nurse prepping me, though, was curt and cold, and reminded me of the nurse Margaret Cho joked about in one of her standup routines. Then the time came and the nurse wheeled me in first, before Josh was told to come back. Leslee wasn’t allowed to come back, and neither were Kathy and Gary, so they all waited.
I was alone, in a room full of people. I recognized only two people, before Josh came in – Dr. G., who performed the surgery, and D., the brusque midwife from the practice – I’d seen her once before and didn’t care for her approach. She helped me up on the table, and when she had her arms around me, I melted and burst into tears. Out of nerves, fear, and a multitude of reasons, I burst into tears. “I’m scared,” I cried in D’s arms. She held on to me tight and smoothed my hair out and talked gently to me and pulled me through. “You’re strong,” she said. “You can do this. I know this isn’t what you wanted, but it’s what is needed. I’ll be here for you. You can do this.” I quieted down and held onto her as the anesthesiologist prepped my back for the spinal anesthesia, and slowly I felt my legs grow numb. The midwife and another nurse helped me lie down. The blue sterile drape went up, and the anesthesiologist clipped electrodes on my upper chest to check my heartrate. He affixed an oxygen monitor thing on my finger, and took a fresh, heavy, cotton knit blanket from their warmer and laid it across my arms. I stared up as my entire body went numb.
This numbness is surreal – for me, I recall feeling like I was leaning my feet against a log – of course, I wasn’t, but my legs were propped in a weird way, and then the anesthesia kicked in and that’s the last thing my muscles remembered. Dr. G. began her work and after an interminable amount of time, Josh came in, dressed in scrubs with my camera and lip balm in case I wanted it (I didn’t). I don’t really remember what we talked about. I cried occasionally, and waited, waited, waited, for Dr. G. to pull the baby out and tell us that everything was okay. Dr. G. pulled Will out and whisked him over to the heated isolette, where a bunch of nurses and the neonatologist swarmed. “What’s going on? What’s happening?” I kept asking Josh, since I was still helpless on the table and Dr. G. turned her attention back to me after the baby was removed.
Finally, a nurse brought Will over, and I cried. First, obviously, the happiness at seeing him out vs. in, but you know, in all of the prep for his birth, I don’t remember if they told us how tiny and puny he would look. His IUGR and premature arrival meant he didn’t have any fat on his tiny, little bones, and you could see through his thin flesh to his muscles. His face was so very tiny. He had a lot of growing to do. Josh left with Will and once again I was alone in a crowd. As she stitched me up, Dr. G. talked about trading her car in. Small talk, what we all do when we’re at work and are passing the time – except her job was to put back all of the organs she pulled out in order to get the baby. The wait was interminable.
Finally, they wheeled me to recovery and I got to see Kathy, Leslee, and Josh. I remember thinking the ice chips they gave me must have been laced with something amazing because they tasted so good! Of course, at that point, it had been well over 14 hours since I had had anything to eat or drink. The nurse administered some pain medication, and we waited there for awhile before getting to go see Will in the NICU – and of course, I couldn’t get up to hold him.
I didn’t hold him until he was a day old.
I didn’t unwrap him and hold his little body skin to skin until he was eleven days old.
I didn’t nurse him directly from me until he was 17 days old.
My brain knew what to expect from the c-section, but my body had no idea what onslaught I just bore. I might have been anesthetized, but the morning after, the spinal wore off and the dull and yet piercing ache of the wound in your lower belly throbs. Even with the heavy duty narcotic pain medication, you still feel it, an ever present burn.
Leslee came to see me later on that afternoon and I remember telling her that I still felt pregnant – every woman who gives birth knows that just because the baby is out, it doesn’t mean that your body instantly slims down again – there’s fluid retention to be dealt with, and a general shrinking of everything in your body, which happens slowly as your organs realize there is no longer a baby in your womb.
I still felt pregnant. Not only was he born too early, he was also in the NICU and I was housed in the post-partum wing, hearing every newborn infant cry in that distinct newborn shriek – and I sat there, with no baby in my arm but a physical ache in my abdomen where I was cut open and where the baby was removed. I sat there and pumped every three hours once the pump came up to the room. I asked for and received a belly binder, to hold my abdomen in place as I healed. I felt movement inside my body as things slowly started rearranging itself, and I still felt pregnant. I didn’t go into labor. For all my body knew, my baby was still inside. That first day was awful.
The pain slowly healed itself. I was discharged after three days, and after skipping my pain medication once in the hospital, vowed never to let that particular brand of craziness happen, so I set yet more alarms to remind me to take that heavy duty pill. Then I stepped down to ibuprofen, and probably a good two and a half months later, I could function without any kind of pain medication at all.
The first night home I cried a lot. I cried leaving Will there (because, seriously, fuck that noise), I cried because I missed being pregnant, I cried because I was in pain, and I cried because my body was so confused.
Slowly, through the help of some amazing people at ICAN and a therapeutic technique called EMDR, I was able to get my shit together. I still have moments now where I can think about Will’s birth as a real birth, and not simply a surgical extraction of a small baby.
I gave birth. I GAVE birth. I can say that now. Before, I would think of it as Will having been taken from me. But I gave birth, even though it didn’t happen the way it should have, the way I wanted it to.
Birth matters. Women matter. Last September, on Labor Day, I stood with fellow moms at Tallahassee’s Improving Birth rally. Improving Birth seeks to advocate for and promote evidence-based maternity care for all women. The World Health Organization has stated that the optimal recommendation for cesarean section is between 5-10% of all births, and yet, the average in the US is over 30%. You may hear the term unnecessary cesarean, and I might be in the minority here, but I don’t think any cesarean itself is unnecessary. By the time moms get to the point in birth where cesareans are on the table, for the vast majority, at that moment in time it’s necessary. By the time the clipboard of release forms is presented, it’s necessary. The kicker is, in my opinion, is that in birth, women are presented a lousy set of choices that don’t do anything to empower them, and because of a cascade of lousy choices, cesareans become necessary.
And in my opinion, it’s really amazingly hard to feel empowered by your birth experience when you are drugged up and cannot feel anything below your chest. You are vulnerable, and exposed. Not empowered.
I want to make it absolutely clear: I don’t regret having the cesarean. My body was already starting to fail me and my situation was untenable. It was time for him to exit, and I am glad we did it before I died or before Will did. I am supremely grateful for my OB, who did an amazing job and was the best person I could have asked for. Two nights before he was born, she sat on my bed next to me and made the recommendation for the baby to be born and when I cried, she hugged me and held me. I am supremely grateful for the technology (despite the cranky nurse’s complaints about her computer) that allowed Dr. G. to operate safely, cleanly, and without significant event. My cesarean was textbook perfect, done by an excellent surgeon, medically indicated due to pre-eclampsia, breech position, IUGR, fucked up placenta, and even through all that,
IT STILL SUCKED, especially compared to the alternative. The physical recovery, the mental recovery, the emotional recovery – just a bag of crap I wouldn’t wish on anyone.
I have friends who have had cesareans and the wide variety of experiences definitely indicate to me that it affects everyone differently – which is to be expected. We are all different. Birth affects all of us differently, no matter how the baby exits their mother’s body. I have to say, though, that if you know a mom who gave birth via cesarean section, know that they may still be processing their birth experience. New moms especially may still be in great physical recovery from this major abdominal surgery. New moms’ bodies might not realize it hasn’t given birth yet. New moms may be in mourning over an experience that is intense and may have left them feeling disempowered. New moms need to know that they matter, as much as the baby at the center of this experience. Birth matters.