Thursday, March 5, 2009

Decision time

I thought I had healed, both physically and emotionally, from my experience of having a casesarian section when Norah was born. Over the past five or six weeks, I've come to realize that I was somewhat mistaken on both counts. I was out one evening with five other women from our parish, three of whom are young mothers as well. We were discussing our labour and delivery experiences, and one woman, even after hearing what I went through, and even though she'd had a rather easy experience said, "I'm scared of going through labour again! I wish I could just ask to have a c-section!" It was probably one of my greatest moments of self-control. I continued to sit in my seat and smile politely, when all I wanted to do was run crying from the coffee shop.

Why would anyone choose such an experience if it weren't necessary? Why would one want to be numbed from the ribs down, have her arms strapped down straight out by her sides, have a sheet draped in front of her face, and be totally cut off and disassociated from the birth of her child? Every time I watch "A Baby Story" and the woman ends up having a c-section, I end up in tears. I know I certainly never want to repeat that experience.

And yet, that is what I have chosen to do.

If you've read my older posts, you know that recently my OB offered me the option of attempting a VBAC (vaginal birth after caesarian). I was overjoyed at the prospect of being able to fulfill my dream of actually pushing out my baby. Actually, the way I explained it to Francis was "to actually give birth, not just have a baby taken out of me". So, like with just about everything else in my life, I sat down and started researching the pros and cons of each option.

There are risks involved with both c-sections and VBACs. And those risks are not insignificant. For example, with a c-section (which is major abdominal surgery):
- The maternal death rate is twice as high for elective c/s as for vaginal birth
- Babies delivered by c/s have an increased risk of respiratory problems.
- Serious complications for women undergoing c/s include infection (up to 30% of women acquire one postpartum), haemorrhage, blood transfusions, bladder and bowel injury, heart and lung complications, blood clots in the legs, anesthesia complications, possible scar tissue adhesions, the ability to establish breastfeeding is reduced, and possible hysterectomy (both in current and future pregnancies)
- In subsequent pregnancies, women with a prior c/s have higher rates of secondary infertility, miscarriage, ectopic pregnancy, and serious placental abnormalities.

See? Scary stuff. Believe me, I don't take any of that lightly. But here's the difference: with a VBAC, the biggest risks are to the baby, whereas the risks with the c-section are primarly to the mother's well-being.

The most significant risk in attempting a VBAC is uterine rupture. Sure, it's my uterus that would rupture, but it's my baby whose life would be on the line. Best case scenario - oxygen-deprivation related problems like cerebral palsy. Worst case scenario - baby would die. Because of the extreme pain I've been experiencing at the site of my internal stitches, I worry that this may be an indication that I'd be at higher risk for complications during labour and delivery, should I attempt a VBAC.

As a woman, I have strong preferences about the kind of birth I would like to experience, and nowhere in those preferences will you find "c-section". But as a mother, I know that it is my job to do what is best and safest for my baby regardless of my preferences. And isn't that, really, what so much of motherhood is about? Dying to ourselves, dying to our preferences, to do what our children need.

I'd prefer not to change poopy diapers. But I do, and I do it with love. I'd prefer not to let my dinner get cold while I try (often in vain) to find something that will suit Norah's tastes of the day. But I do, and I do it with love. By the time I was using my third kind of antibiotics and was bleeding nearly constantly, I would have prefered to stop breastfeeding. But I kept going, and I did it with love.

I'd prefer not to give up my hopes and dreams of being able to push my baby into the world. But it's safer for my child, so that's what I'll do.

And I hope I'll be able to do it with love.


Helen E.M. Wright said...

I was totally against having a c-section. Did not want it at all!!! Ended up having one. Things were not going well and at that point I just wanted to meet him. Luckily I didn't feel any grief over having the section. I know of others that do. Geordie was brought into this world with love and that was what was important to me...and then I never put him down! :)

On a different note...I was delivered by c-section. The boys were not! Do you see my point?!?! ;)

Elena said...

Oh, dear Jaclyn. Of course you will do it with love. I am glad for the c-section decision. It is for the best. rebecca has had both babies via c-section and has some great thoughts on the topic. My mother also has some wise words as she has moved way past the birth-experience-being-hyped-up and far more into the mothering-is-all-about-raising-the-child stage. All will be well. And, if it helps in the slightest, I pushed the twins out but I was all set up for c-section i.e. numbed, operation table, arms strapped down, millions of medical personnel present, Dave in cap and gown etc. The one thing I regret was my reaction when the nurse weighed Jacob. She placed him on the scale and he started to scream and all I could think was, "Oh God, am I going to have to hold him all the time?" Where was the love there?????

rebecca said...

dear Jaclyn,

Elena told me about this post, and i hope that you don't mind if i respond. as she mentioned, i had a similar experience -- emergency c-section, followed by a second pregnancy relatively soon afterward. (my boys are 17 months apart.) i was given the option of vbac and i really weighed this for a long time before making my decision, and the decision was to have a repeat c-section. it was not an easy choice to make. (although it was made somewhat easier by the fact that my husband had a strong preference for me to get the section.)

a dear friend of mine, whose first attempt at a homebirth resulted in an emergency forceps delivery, was one of my strongest supporters when i chose to go for a repeat c-section and a lot of people were very critical of that choice. she said to me "a good birth experience is good, but a healthy mom and baby is pure gold." she was right.

i desperately wanted a "natural" birth the first time around, i did not even want an epidural. needless to say, things did not turn out as i wanted. and you know what? it was okay. the whole birth experience, as you know, is such a small part of the entire thing, after having nurtured the baby for so long inside your body and before nurturing him (or her) for so long outside.

one thing that i noticed was a striking difference was how much more present i was for the scheduled c-section. the first time, it had been so long in labour and i was so out of it i barely noticed when they brought the baby to me. the second time, i was able to be completely aware and really THERE for his birth. it was really nice, and i hope that you have that experience too.

(by the way, you can always ask your ob to schedule the section with the caveat that if you go into labour early that you be allowed to continue with your labour, but very closely monitored. that is what we did, although i ended up getting the c-section anyway.)

i know it is a hard decision to make and i know (believe me, i know) you did not make it lightly. the most important thing is soon you will be holding your little baby in your arms and really, at that point, that is all that matters.

Jaclyn said...

Helen - I love that about you being a c-sec baby and the boys not! Too funny. :) Justin, Jenna and I were ALL c-sec babes, all for different reasons.

Elena - I can't imagine the heroic strength it must have taken to push out TWO babies while strapped down! Talk about working against gravity. I knew you had to deliver in the OR, but I had no idea they had you THAT prepped. Crazy. Thanks also for your support of my decision - it really helps.

Rebecca - Thank you so much for sharing your experience. I was very encouraged that you pointed out how much more present you were for the birth of your second son. That, for me, was the real downside of my c-section with Norah. I'd been through 37 hours of rough labour and hadn't slept in 2 nights. I was so exhausted that I don't really remember meeting Norah for the first time - mostly just from the photographs. I just remember thinking "Why don't they unstrap one arm so I can at least touch her?" You've given me hope that even with having another c-section, it can be a totally different experience.

Elena said...

I just wrote you a huge comment and lost it. I will tell you my thoughts in person when you visit on March Break. The end of the week is the best time for a visit as we have a pre-op appointment at CHEO on the 17th (Jacob's eye).