More news and thoughts about delivery options.

[rivka]

Wow, tammylc wasn't kidding when she said that there wasn't much out there on the web for women having Cesarean births.

Not much you'd want to read, anyway, if you think you're going to have one.

The first hit on Google for "cesarean section" is at childbirth.org, usually a good general information site. But their C-section page starts with a link to "Books on Labor, Birth, Cesarean and VBAC [vaginal birth after cesarean]" in which only one book about C-sections is recommended. It's called The Silent Knife: Cesarean Prevention and VBAC. The other books with "Cesarean" in the title are all about VBAC. The childbirth.org list of links continues: How to avoid an unnecessary section, risks of Cesarean section, Cesarean fact sheet (which contains not one piece of positive information about the procedure), VBAC checklist... halfway down the page there's a link to a short FAQ on planning your Cesarean, something about "family-centered Cesareans," and a link that doesn't work but claims to be about breastfeeding after C-section. But to get there, if you're reading down the list, you go through a poem about being DISEMBOWELLED ALIVE (emphasis theirs) and literally more than a dozen articles about C-sections being bad and unnecessary and dangerous.

Yes, I know that there are too many C-sections performed in the United States. But the World Health Organization estimates that the rate should be around 10-15%. That's still one in ten births. Shouldn't there be at least a little bit of positive information out there for those women?

My midwife recommended a twenty-year-old book called The Cesarean Birth Experience. The physical stuff is probably somewhat out of date - although from the other reading I've done, it doesn't seem that much has changed. The sections on emotional and family aspects, and the advice about making your Cesarean as birthlike as possible, are wonderfully helpful and reassuring. But the book's out of print. (I found it on Amazon - it wasn't at my library.)

The single most breathtakingly hurtful thing that I have seen: an offhand comment on a message board, one woman talking about another. "Both of her kids were C-sections, so she's never given birth."

Ow.

My midwife says: "This is still your birth." I'm trying to have that be my mantra.

Since I saw the midwife last week, there is new news.

I spoke to one anesthesiologist on the phone and brought my X-rays by the hospital to show a different anesthesiologist. Both of them seemed to think that there would be no problem performing spinal anesthesia. This completely contradicts what I was told by the asshole spine specialist last November, who told me that "no anesthesiologist will do an epidural for a woman with scoliosis." As you can probably imagine, I'm *very* angry with him now, all over again. He really has caused me needless suffering.

But at any rate: apparently, my spinal fusion is higher than most, and my lower vertebrae look just fine. That's where they'd want to do a spinal or epidural anyway. The anesthesiologist who saw my X-rays said that, if there is scar tissue in my spine, I might be more likely to get patchy or one-sided relief from an epidural - but that I also might be able to have one with no problems. She had no reservations about the spinal at all, although of course she said she couldn't promise me anything absolutely.

I asked her if she thought that different anesthesiologists might have different opinions about whether a spinal was possible. She didn't seem to think so, but she wrote a brief note about my case and told me she'd post it where the rest of the team could see it, so that everyone would be aware of my condition and it wouldn't take them by surprise. I was really pleased by that. In fact, the whole encounter with both anesthesiologists made me feel good about my choice of hospitals.

I feel much, much better about the prospect of a C-section knowing that, in all likelihood, I will be conscious for it. For me, the real goal hasn't been a vaginal birth (because I was always aware that my hip problems might make it impossible) but a conscious, aware birth. The intense stress about a C-section was mostly because I thought it would require general anesthesia. I don't *want* a C-section, but I think that now I'll be able to handle one.

Which is good, because we talked to the senior midwife again about percentages and she thinks the likelihood of C-section is "more than 50%." She didn't want to get more precise than that. We asked her how much it would reduce the risk of C-section to try an early induction, and she said "a little bit." She doesn't, at all, like the idea of trying a Pitocin induction. She unenthusiastically said we could think about trying Cervidil, which is a cervical ripening agent.

curiousangel and I talked it over and made the following decisions:

- We don't feel that an early induction would be worth the risk. When I posted about the situation to misc.kids.pregnancy, the women there gave me a lot of information about the poor success rates for early induction, especially in a woman who has never given birth. Plus we're concerned about potential problems if we birth the Li'l Critter before she's fully cooked, and we're concerned about the possibility of an intervention cascade (induction leading to epidural, leading to C-section). It doesn't seem worthwhile for a small increase in the likelihood of a vaginal birth. So we plan to wait for labor to begin spontaneously.

- I'm going to continue to take Evening Primrose Oil capsules in an attempt to get things started a bit earlier. I am firmly resisting the urge to eat less so that the baby stays on the small side, because I know that the probable result would be an unhealthy baby.

- While it's nice to know that an epidural is a possibility if the midwife is right about me having severe pain from the baby's head hitting the bony prominence in my pelvis, we are continuing with our plan to labor without. I feel like my best chance of birthing vaginally is to be maneuverable and not tied down in bed. However, I am not ruling out an epidural if the bone-on-bone pain turns out to be truly intolerable.

- We are preparing for a C-section in addition to continuing to prepare for a natural birth. I'm revamping the C-section preferences in our birth plan to be more detailed and to reflect the updated news from the anesthesiologists. tammylc's birth plan has been very helpful here. I am also trying to prepare myself mentally and emotionally for a C-section, while continuing to practice my relaxation techniques and study up on labor.

- We don't intend to schedule a C-section. It seems worthwhile to give labor a try, even if the chances of a vaginal delivery are less than 50%. We might revisit this decision, however, if I go significantly past my due date and the baby seems large enough to reduce the likelihood of vaginal birth still further.

- We are focusing on the part of this where, at the end, we have a baby.

Thanks, everyone, for your help and support over the last week or so. It's been wonderful.

Comments

[ckd]

Still thinking good thoughts for all three of you, and appreciating your updates.

May all go well and give you good cheer.

[eeyorerin]

Plus we're concerned about potential problems if we birth the Li'l Critter before she's fully cooked

I just had the image of your belly button as one of those pop-up timers for poultry that indicate done-ness, and I can't stop giggling.

[rivka.livejournal.com]

Heh. You can currently see my belly button through some of my clothes, so, obviously she's done now. But am I going into labor? Nooooo.

[edschweppe.livejournal.com]

You can currently see my belly button through some of my clothes, so, obviously she's done now.
Errk. Every time I bake brownies, I end up having to put them back several times because I think they're done and they're not. Now I've got this image of the midwife saying "whoops, needs another couple of days" and trying to push Lil Critter back inside you...

In all seriousness, though, I'm glad that you're making sure that you've got accurate information. (Rassle-frassle idiot spine "specialist"!) And you're still in my thoughts (FWLTW). Last Sunday, after we finished our Our Whole Lives (http://www.uua.org/owl/) session and started planning the next one (on pregnancy, natch), the other facilitators and I were trying to think of who we might be able to get to come in and discuss their pregnancies with our youth. I thought of you, briefly, but somehow figured that you weren't likely to be available for a quick jaunt up to the Boston area...

[jonquil.livejournal.com]

I share your frustration with the insistence that since the need for intervention is rare, intervention is therefore never a good thing.

You can get a copy of the book for a buck from http://www.mxbf.com. http://www.bookfinder.com/search/?ac=sl&st=sl&qi=iL.sg68i5NdsD4A1AISPGFZu6wU_9657830157_2:4:9

Your reasoning in general about the birth strikes me as admirably pragmatic. Best of luck.

[rivka.livejournal.com]

Thanks for the good wishes. I actually found the book used at Amazon for a penny plus shipping, so I'm reading it now.

Books on C-Sections

[ailbhe]

It doesn't help you now, but my consultant obstetrician is going to write a book on c-sections and on traumatic birth as soon as she has spare time. I saw her specifically to discuss in detail what a c-section is like, because fear of that was one reason I wasn't getting better, and honestly, they sound fine.

Even my inner hippie thinks they sound fine. This is for my hospital in the UK, of course, but your hospital sounds similar in attitude to me:

An expected c-section tends to be lower-stress than a slightly complicated vaginal birth, because c-sections are more predictable. Everyone knows what to do and when, more or less, and the cleanup is a lot faster than for a complicated vaginal birth, so you get to be alone with your baby sooner. They are *more* conscious of a need to put the baby on your skin because they are aware of having already interrupted the natural order of things quite enough. And they are, apparently, "quite jolly, really."

The photos aren't as awful, either, because the mother tends not to be as exhausted, but does get the New Baby High, so she looks radiant. Most *new* new mother photos are scary.

And you can pee afterwards. I'm looking forward to that.

Baby baby baby baby BABY! SQUEE!

A.

[baratron.livejournal.com]

In googling for info about Caesarian sections (because I wondered if the spelling was an issue), I found the Birth Crisis Network. I presume you already know about it, but thought I'd pass it on anyway.

[akirlu.livejournal.com]

Gosh I wish I could remember the cite better, but I'm pretty sure the C-section positive article I read at my chiropractor's office a couple of years ago was in Parenting magazine. It was certainly one of that ilk. It was written by a woman who had had two children and had deliberately elected to have both of them by C-section based on concerns about the babies' safety and health. She was older when she started, and had a number of positives from the perspective of the health of the mother and baby. (And some trivial stuff, like the fact that the baby's head isn't pointed from the birth canal.) Dunno if it's worth your time from an informative point of view, but I wanted to let you know it was out there, somewhere.

[fairoriana.livejournal.com]

We're all pulling for you to have a positive birth experience, and best of all to have a happy, healthy baby at the end of it.

[puppytown.livejournal.com]

Did you see the C-Section Recovery website?

Hi to the baby, from me.

[elynne.livejournal.com]

Reading your updates with interest, concern, and hope. :) Soon there will be a Critter in your life...

[therealjae.livejournal.com]

Wow. That's a totally offensive way to approach information about C-sections. Yeesh.

Does it make you want to fill the information void with what you learn?

-J

[writingortyping.livejournal.com]

Ditto on the offensiveness. It's similar to those jackasses who perpetrate the whole adoption-isn't-really-parenting fruitbattery.

All the best to all of you. Glad you have sensible people giving you good advice in your life.

[baratron.livejournal.com]

I found this link, which seems to go into a lot of detail about what to expect in a Caesarian.

[minnaleigh.livejournal.com]

Such good news about the possibility of staying awake if a C-section ends up being necessary!

I'm glad you got the information about poor induction outcomes to aid you in your planning. It looks like you have a good plan here and it sounds as if you're comfortable with it and that's great.

My friend Deb had an emergency C-section with her first baby. She ran into some of that 'you've never given birth' attitude afterward and it pissed me off royally. Some people are just an utter waste of skin.

Talking about pain, possible squick warning.

[papersky.livejournal.com]

Of course she's given birth, sheesh, that's such a bizarre thing for the person saying that to have piled so much self-esteem on, the ability to push a baby out of a vagina.

My midwife said "There are the following situations in which a caesarian would be necessary..." one of them was placenta praevia, which is why I gave birth in hospital, because it might have been an issue.

The birth is huge and important and scary and significant, but it really doesn't take that long and isn't the difficult bit, the difficult bit is putting in all the years of work bringing the baby up to be a person. People who adopt are mothers, and men can be mothers, and goodness knows women who've had caesarians are certainly mothers, and whatever hole the baby comes out of, I know you'll be a good mother.

Oh, and on the pain/bony bit thing. Most of labour, you're not sitting with your legs apart pushing. It's actually a very short time, at least with me second stage was less than an hour. I also have pelvic issues, and I was afraid I wasn't going to be able to open my legs properly. But the bit that takes a long time and hurts a lot is first stage and transition, once your cervix is open you're pushing with the contractions and they feel appropriate. Now it seems to me that that's the point where the bony bit's going to be a problem, not before. I don't know how much it'll hurt, but it's not labour pain that you don't know about that'll hurt, it'll be familiar pelvic/hip pain that you do know how to deal with, plus the contractions you'll have had lots of time to get used to earlier on. But if it's only going to be a problem in second stage, I bet you could hack it, and I bet you could really hack it with some carefully timed drugs that help with pain without wiping out alertness. I could be totally wrong, and I have to admit I'm trying not to flash on the moment when the bad midwife pulled my bad leg away from my body in the middle of a transition contraction, which remains my benchmark for pain, but have you talked to anyone else with pelvic problems who has given birth?

[kalmn.livejournal.com]

My midwife says: "This is still your birth."

i admit, i haven't seen you in a while now, but last time i did, the critter was quite visibly inside of *you*. so, whose else would it be? *hug*

[rivka.livejournal.com]

I think "this is still your birth" is meant to be distinct from "this is your operation." But your point is also excellent. The Li'l Critter is, indeed, still inside, grinding her hard bony heavy head against my poor innocent cervix and bladder. Incessantly. With all her might.

Have I mentioned that pregnancy is not as much fun once the baby has dropped?

[mactavish.livejournal.com]

I think "this is still your birth" is meant to be distinct from "this is your operation."

And perhaps also, "This is not something the doctors are doing, it's what you're doing."

[kalmn.livejournal.com]

ah! see, i read it as "this is still your birth", which, well, duh.

maybe we could get a jack in there to scootch her up off your bladder and cervix. hmmm.

Re: More news and thoughts about delivery options

[pir-anha.livejournal.com]

you didn't mention if you checked using alternate spellings, so i did a quick googling on "caesarean section", and came across www.caesareanbirth.com (http://www.caesareanbirth.com/csection.html), which seems to have some useful information; at least their link to breastfeeding works.

[patgreene.livejournal.com]

The single most breathtakingly hurtful thing that I have seen: an offhand comment on a message board, one woman talking about another. "Both of her kids were C-sections, so she's never given birth."


Jesus H. Christ. Birth is a means to and end: a baby and mother that are as healthy as possible. Yes, it would be definitely preferable to have a natural birth, but fetishizing it is just ridiculous. Of course someone who has had a C-section has given birth.

Of course, I've had a C-section, so maybe I'm biased. But, in all honesty, I recovered more quickly -- sutures and everything -- than I did from that C-section than I did from the other births. (Maybe it was because I was allowed to stay in the hospital and rest rather than being rushed home.) And given the reasons why -- a baby that showed signs of distress, and showed signs that labor was causing more distress (not to mention he was face forward, looking out!) -- I'd do it all again in a heartbeat.

[geekymary.livejournal.com]

We are focusing on the part of this where, at the end, we have a baby.

In the end, that's all that really matters. Good luck, hugs and prayers to you.

Ack, people can be stupid

[(Anonymous)]

Oh Rivka, I'm sending my best wishes for you and the baby. I hope you get the kind of birth you want, but I hope more that you and the baby are well and recover quickly from whatever kind you get. Papersky is right to say that this isn't the hardest bit, however hard it is.

I had an elective Caesarean for my last baby, because she was very big (4.1 kg at 38 weeks) and my previous baby spent 3 days in neonatal intensive care after a VBAC where he got a bit stuck (he was 4.4 kg). It wasn't fun (I found the epidural insertion extremely stressful and frightening) but it was a safer option for both of us, and that got me through it. I'm glad you and curiousangel are keeping your eyes on the prize. Here, they give you the baby to hold, but then wheel you off to recovery until the anaesthesia wears off. My partner, older children and parents kept Lillian safe and loved until I got there about 2 hours later. She was fine, and raring to feed.

How am I going to function keeping all fingers and toes crossed for you for the next few weeks? Please make sure that the news is posted just as soon as one of you remembers to think of it ;-) Such joy is coming your way! It makes me smile to think of it.

Emma

[kcobweb.livejournal.com]

I'm so glad to hear that things are looking up somewhat. And I'll say, from my new-found experience of someone who has gone through childbirth *grin*, that I suspect few women get the perfect labor they are hoping for. I didn't *exactly* - and it was still okay. Fine, even - I have no regrets. And I have a fabulous little adorable baby in the next room to show for it.

People's attitude about C-sections pisses me off. As I see it, there is a baby inside, it has to come out somehow, and none of the options are easy or a walk in the park. You do what you need to do when the time comes.

Bottom line: yes, at the end you'll be sore and tired (promise! no matter what ends up happening!), and have a gorgeous little baby to take home.

[pixel.livejournal.com]

Both of her kids were C-sections, so she's never given birth.

"Ok, that person is a complete loon. My sweetie has had two C-sections because she's too small to have given birth normally. And let Hellspawn Ver. 1 & 2[a] should be proof enough that she's given birth."

[a] yes I call them that, her comment when I said it was 'Yeah, we made all sorts of evil improvements for version 2.'

"Both of her kids were C-sections, so she's never given birth."

[ailbhe]

I've just begun to wonder - did this woman leave her kids out on the hillside, too? Because if "ability to survive The All-Natural Way" is her yardstick, she might have.

I'm too small to have given birth normally, too. So next times, I'll have a c-section. I do wish we'd found out before the first time, sort of.

A.

not nitpicking

[mhaille.livejournal.com]

The first was an emergency c-section because his heart rate plunged into the low 50s and didn't come back up for almost 10 minutes. The second, I suppose I could be peeved because the official reason was that the hospital's liability insurance wouldn't allow me to attempt vaginal delivery of a 10lb+ baby after having had a prior c-section, no matter the reason, but i'd been in labor for 4 days at that point and didn't particularly give a rat's ass if she came out through my nose as long as I could go to sleep when they were done.

At any rate, it is most assuredly a birth if somebody hands you a baby at the end of it, and that's the most important bit. You don't sound like the type to beat yourself up as a 'failure' if you wind up with a surgical delivery, but 'don't beat yourself up, do take the nice pain pills, and the side-lying position is great for nursing' are the distilled version of advice that I've got.

[jinian.livejournal.com]

On the theory that cuteness and tangential C-section things may help, I mention that cheesepuppet has recently had her second baby, this one by planned Cesarian. Her older child was born by emergency Cesarian. (And, obviously, anyone who says she hasn't given birth is being an ass.)

[sashajwolf.livejournal.com]

I've only just had a chacne to catch up with your journal. I'm sorry you're having a rough time. Your midwife sounds great, and I think you're making sensible decisions.

[johnpalmer.livejournal.com]

The single most breathtakingly hurtful thing that I have seen: an offhand comment on a message board, one woman talking about another. "Both of her kids were C-sections, so she's never given birth."

Ow.

My midwife says: "This is still your birth." I'm trying to have that be my mantra.



It sure as hell is. One way or another, you're bringing a child, conceived and carried through love, into this world. You're doing what you need to do to make that happen. You're bringing forth new life; that's birth.

[micheinnz.livejournal.com]

My midwife broke her leg in quite a catastrophic fashion when I was at 36 weeks, and I had to switch to her backup. That was all cool.

At 38 weeks we decided to schedule a Caesarean section (on the grounds that Weegirl was breech, transverse, and a version was likely to cause as many problems as it solved).

When my original midwife heard the news, she rang me and said "Remember, you are still going to give birth. You will still have a birth experience. It may not be the one you planned, but you will still give birth." I carried those words with me all the way through the process, and it was far less stressful than it could have been.

(I did have to endure a bit of snarking about "baby at ten, meeting at twelve" and "I didn't think you were allowed to do that" from people who didn't know our circumstances but feh, it's not like their opinions mattered.)

I wish you a healthy, happy last few weeks of pregnancy and a wonderful, fulfilling birth experience -- _however_ you end up giving birth.

[lisajulie.livejournal.com]

Of ghu's sake, it _is_ your birth!

/me rolls her eyes

And, then she's your baby/child/teenager(eek!)/offspring.

The best of thoughts to you both and Little Critter. And when she comes around, there's a modest pile of books to start her off on her life.

[lcohen]

behind, behind. i keep dropping further and further behind.

most of this sounds quite encouraging for getting more of what you want than what you don't want. and getting what you want most of all, especially.

re: idiot on message board--the scary thing is that she procreated.

*gentle hugs and many hair pets*

[bohemiancoast.livejournal.com]

Coming to this late cos I only just worked out you have a livejournal; and I guess you can't quite have had the baby yet as you're still blogging madly. Best of luck, and however the birth goes I hope it's a positive experience for you. And No Matter How Bad It Gets You Can Always Remind Yourself There's a Fanzine Article In It.