The Back-Up Plan -- A Birth Story
It felt like we had been waiting forever.
Our fifth baby was going to be post-dates, like my first and fourth babies, and despite my impatience I was doing my best to enjoy the remaining days of this last pregnancy. It was hard, as my pelvis was causing discomfort and sleep was becoming impossible , so when my midwife suggested a post-dates ultrasound I jumped at the chance to see her little face one more time.
At the scan, our very animated technician loudly exclaimed, "Wow! She's going to be a big one!"
Having heard this before, and having had the estimates be wildly wrong, I laughed -- big heads run in our family and throw everything off. They'd never been right in the past and, until now, my largest baby had been 9lbs. The technician pegged her at between 11lbs-3oz and 11lb-10oz. I guessed 9.5lbs.
I chatted with my midwife later by phone about her size estimate, and confirmed I still intended to have a homebirth. A size estimate alone, especially one that was more than 2lbs out of the norm for the size of babies I birth, was not reason enough to change our birthing location. I had visions of a laid back birth, similar to our first homebirth, and welcoming our fifth child into the world in the room where her big sister and one of her brothers were born.
At our appointment the next day, we chatted more in depth about the risks associated with a larger baby. As I recall it, none of us felt the estimate was accurate. I'd gained no more weight than usual, there were no indications of gestational diabetes or other risk factors -- other than the usual aches and pains associated with having birthed four other babies, my pregnancy was uneventful. We were unconcerned. She was still a bit high but that isn't abnormal when you've had babies before -- sometimes babies wait until labour to fully engage.
The next morning, my water broke. That was a new experience for me. I don't birth during the day and my water doesn't break until well into labour. I laid in bed with a towel for a half hour waiting for my first contraction, mulling things over.
I called my midwife a little later, to let her know -- my labour, once it gets going, tends to be quite quick and I didn't want her to be stuck in rush hour traffic. By the time she arrived at my house -- 2hrs after my water broke, and 1.5hrs after my first contraction -- things were chugging along, but my contractions were starting to trip on top of each other.
And something felt off.
From the first contraction, something felt different than what I've experienced before. Having had 2 back labours, I knew that wasn't what I was feeling, but I had a lot of trouble articulating the sensation in the moment. Afterwards, I was able to put it into words: it felt as though someone was trying to snap my pelvis like a wish bone. All the pain and discomfort and pressure was at the very top of my hip bones and centered at the bottom on my pubis. I didn't feel pressure in my lower back, like I would expect if she were descending and I didn't feel the wrap-around sensation of the contractions across my lower belly.
After a couple hours of freight train contractions and still not a lot of descent by my baby, and with that "off" feeling niggling at my brain, I went with my gut instinct and requested a transfer for pain management so that we could reassess the situation and try to determine what was happening.
I requested a transfer...
I made that choice earlier than some, I suppose, but my back-up plan for transfer was intended to kick in the minute I felt that something was wrong because I didn't want things to escalate to a point where it was a true emergency.
Because I knew my limits (my last baby was a back labour homebirth), and when I would request a transfer, I also knew this would likely be an intervention heavy birth experience. That was okay. It was my decision and I was the one who requested it.
We arrived at the hospital, got settled, and I was hooked up to an epidural. We spent a bit of time trying different things, being assessed by the OB on call, and doing some practice pushing to see how far she would descend (not far enough). With the ultrasound estimate in the back of my mind, I had a frank discussion with my midwives and the OB about how they viewed what was happening to see if it jived with what I felt was happening. I asked specifically if labouring longer was likely to change anything and was told that was unlikely. I weighed the pros and cons of labouring longer, but with an arthritic back and four more kids at home, I didn't see any wisdom in labouring longer for what would likely be a surgical birth anyway.
I requested a c-section for as soon as an OR could be booked.
After a few photos to remember I really did feel upbeat about it all -- hindsight can colour our memories at times -- I was wheeled in. The OR was cheerful, everyone was bantering, and I didn't let the fact I was lying flat on a table about to have my baby surgically freed from my body prevent me from cracking jokes with the staff.
My *only* regret with the c-section is that, because I felt it such a remote possibility, I didn't fully think through what my options were in the minutes, hours, and days that followed.
It didn't occur to me to ask they not use a surgical screen, so I could see what was happening -- thankfully my husband took a wee bit of video for me. I didn't request they not wipe all the vernix off my baby. I didn't think to ask they lay her skin to skin against me immediately following her birth while they stitched me up. It didn't occur to me to ask if the lights could be dimmed. I forgot to tell them that I wanted to be the first to bathe her -- this was the hardest because she didn't smell like my baby, she smelled like hospital and antiseptic.
They felt like big things at the time, and still do in some ways, but that is a result of my poor planning and not at all boundary stomping by staff or care providers. My midwives were by my side every step of the way, and the OB on call was beautifully frank and direct when answering my questions. I was heard, validated, and never less than fully supported throughout my birth experience.
Turns out the ultrasound was right for once.
When she was freed, there was a fair bit of excitement about her size. She was a bit more than the 9.5lbs I had guessed. They delayed clamping her cord as long as possible, but it became apparent that there was an additional uterine tear somewhere that needed immediate attention (and, later, a blood transfusion). My midwives took my daughter, weighed and measured her, and declared her perfect before returning her to me.
Afterwards, the OB told me that there was no way she would have come out vaginally without significant intervention because her size combined with her posterior presentation would have caused a lot of trouble. It was likely why she hadn't dropped very low in my pelvis. I had enough difficulty with that presentation when birthing my 8lb-3oz fourth child. My 11lb-4oz fifth child wouldn't have made it through.
And I am fine with that. Birthing is not an extreme sport, where a vaginal birth must be achieved at all cost. I'd like to think I'm in a position to say that without being questioned, having four of them under my belt already.
Birthing is not an extreme sport...
It felt like the next week or so was spent trying to convince people that I actually was okay with having had a c-section.
Beyond griping about the longer recovery (it sucks!) and wistfully recalling how much easier it is to recover from a vaginal birth -- and I reserve the right to whinge about that from time to time because abdominal surgery changes the map of your body forever in a way that vaginal childbirth does not -- my experience was positive. The surgery itself was necessary. My daughter and I are mentally and physically healthy following our experience.
I made every single one of the decisions that led me to it by myself, informed, and without coercion -- listening to my gut instinct and following my established back-up plan.
My daughter was surgically freed from my uncooperative body and I have no regrets.
Being the person in the driver's seat, making the decisions that led me there, was one of the most personally empowering birth experiences I have had. I wouldn't change a thing.