Tuesday, June 18, 2013

Aria's Birth Story: A Bradley Cesarean

Adam: My wife and I have worked throughout the pregnancy for a natural non-medicated birth for our daughter. We took the Bradley Method classes, and spent a lot of time practicing and researching to be as prepared as possible. We chose a group of midwives at St. John's/St. Vincent Anderson Regional Hospital for delivery. All went well until week 37, which is when Aria decided to go from head-down to frank breach (bottom down). Lisa and I tried everything to flip her, from the chiropractic Webster Technique, to putting frozen vegetables on Aria's head, to lying upside down on an ironing board. After our 38 week midwife appointment, Lisa felt movement and hoped for the best that the baby had flipped back to vertex. I talked to our midwife, Charlotte, about delivering a frank breach vaginally - which can be done; they used to do it in the 70's even in the 80's - but due to liability issues the hospital would not allow it. She said the closest midwife she knew who could do it safely was in Tennessee. Anyone else would be risky because they wouldn't necessarily have the experience with enough breech births to do it safely. Delivering a breech baby is no longer taught in medical school.

We were running out of options and time before Aria's due date, so we scheduled an appointment for an external version on Friday, May 31, when Lisa was at 38.5 weeks' gestation. They would perform it after a quick ultrasound to determine Aria's position and eligibility for the procedure. The external version was our last option to attempt a vaginal birth; if it did not work, a c-section would be scheduled sometime early during Week 39 (June 3 – 7).

On Thursday, May 30, both Lisa and I felt like we were poised on the brink of something big; the calm before the storm. Lisa described it as that quiet moment of focused calm just before hearing the starting buzzer of a race, or that collective intake of breath before a band sounds the first note of a musical piece. We were ready, no matter what happened...c-section, or normal delivery.

Friday, May 31, 2:00 AM
Lisa: I got up in the middle of the night to pee (AGAIN), and noticed that my mucus plug had fallen out. I didn't think much of it; labor could be days, even weeks, away yet. I groggily went back to bed...but didn't get much in the way of rest. My contractions started in earnest. Somewhere in the back of my half-awake brain, I knew they were about 10 – 15 minutes apart. Then, at 3 AM, my water broke. Whatever I was before, I was awake now...this was labor. I elbowed Adam awake and asked for some towels.


Adam: I sat bolt upright, completely awake. I asked her if she was sure, which of course her response was a resounding yes. I got her some towels. She called the midwife, who told us to come in to the hospital around 5:00 am. Our favorite was on call: Charlotte. Charlotte was the most open to allowing what we wanted without pushing any interventions. I took the time to take a shower, walk the dog and make sure we had everything we needed, including putting a towel in the passenger side seat of the car. Lisa took the time to call her parents and to attempt to get some sleep. I was calm, excited and hoping that the baby had turned. As usual, I was practically pushing Lisa out the door to be at the hospital by 5:00 AM. I drove calmly, as I knew the route and had prepared for this moment. Lisa said the baby was moving fine, and there was no reason to hurry. We checked in and got settled into our room...which, unbeknownst to us, was going to be our home for the next 4 days.

Around 6 AM, Charlotte and the OB/GYN on-call came to do the ultrasound to check Aria's position. Our hearts sank. Still breech. And she had sunk so far into Lisa's pelvis that we couldn't see her legs anymore. Aria had made the choice for us: she had to be born c-section. The good news was, all her vital signs were good and she was handling each contraction like a champ. The OB/GYN agreed to schedule a non-emergency c-section, and to wait until there was an opening in the Operation Room schedule. We were all disappointed, because our midwife and all the delivery nurses had been rooting for us to go “all natural.” Our choice was a rare one, and they had been looking forward to experiencing it with us.

Lisa: I was overjoyed with the news that my c-section wouldn't happen until the early afternoon. More time for me to labor naturally and give Aria all the hormones she'd need to make a successful transition to our world. Despite the major distractions of nurses constantly coming in and out to check me, getting IV fluids and a badly placed hep-lock in my elbow (resulting in the loss of using my arm), continual fetal monitoring to make sure she didn't go into distress, and worst of all: no eating. I could handle the contractions; I had trained long and hard for them and was focused on keeping them from stalling out. The reduced movement was also hard because I couldn't move into the positions I wanted, and prevented me from being close to Adam. But the hunger-induced nausea was way worse, and unlike the contractions, never ended. With every contraction, I fought hard to keep from retching. The required anti-nausea meds they gave me prior to surgery just made it worse. Finally, just before the nurses took me down to the OR for surgery, I stopped fighting the nausea and threw up in the bathroom sink. The ultimate irony was, if they had allowed me to eat, I wouldn't have felt so sick.

Adam: The OR was running behind schedule, so we spent a lot of time in the recovery room waiting. Lisa moved into active labor, her contractions 5 minutes apart, then 4. I would rub her back and hold her up, especially for the really intense ones. I used everything I learned from the Bradley classes and it worked. Especially reminding her to breathe deep and slow. I'm extremely proud how my wife handled the contractions; she did a wonderful job. If you want to freak out a bunch of recovery nurses, start active labor in front of them. I did everything I had learned in class about creating a bubble around Lisa; I calmed the nurses to keep them from distracting her, telling them what was happening was fine and normal...just active labor. Apparently they'd never seen a woman in active labor awaiting surgery; most request drugs to stop the contractions. Finally, around 1:45 PM, the OR was ready. They took Lisa away to place the epidural, and I took the time to inform the recovery nurses that we wanted to get Lisa back up with the baby within the hour to start breastfeeding.

Lisa: Placing the epidural was by far the most painful and traumatic experience of the entire labor. When they took me into the OR, I had labored for 12 hours, and dilated to 6 cm and 90% effacement. I had given Aria the best I could, taken her as far as I could go. She would be exposed to the epidural drugs for only 15 minutes or less. I would be nursing her within the hour. She had come into this world on her terms; picked her birthday all by herself. I had succeeded in giving her those things. It took 2 tries and 6 different adjustments of the needle to place the epidural. Each movement of the needle triggered a contraction, and I felt fire race along my spinal nerves. I was panicking; I struggled to keep my breathing deep and even. Finally, the needle was placed, and my recollections became hazy and out-of-focus.

Adam: When I walked into the OR, it was not the best scene. Lisa was not doing well; there were tears in her eyes and she was very scared. I wished I could have been there earlier to help. I sat down in a chair they had and held Lisa's hand. I rubbed her head and told her everything going to be fine, you're going to be a wonderful mother, I love you, we're about to see our child. This helped calm her down. They put a small curtain up between us and the surgery area; of course I could peak over the curtain to watch. The next moments were some of the most amazing moments of my life. I watched them pull out Aria from Lisa. She looked good; with having less than 15 minutes of the epidural in her system, you could tell. Her coloring was great, and her muscle tone strong. She was alert and active. Her lungs inflated and she started crying immediately. Strong cries. They took her over to the nurse's table; did a few checks lasting a minute or two. Lisa kept asking if Aria was OK, and I told her everything was fine. She kept asking to see Aria every couple of seconds after that. I told her to wait just a minute, and I would be right there. I went over to the nurses and looked at Aria. They clamped the cord and let me trim it. The cord had to be cut immediately because Aria pooped as she was coming out, and they needed to check her for distress. It took three tries to cut through the umbilical cord; it is very strong! I couldn't get over how beautiful my daughter was, and how perfect she was to me...all 7 lbs, 3 oz and 19 inches of her. She was so small; tiny fingers and feet. And a full head of hair!

They gave her to me. Being drugged, Lisa couldn't hold her, but she told me to lay Aria down next to her. She wanted to kiss her and smell her hair. After a few minutes the nurses wanted her back, so I took Aria back over to the nurses and they wiped her off and did more checks. Aria was squinting with one eye, and struggled to open the other. They were worried, as there were some crud on it, but I shaded her eyes and Aria opened them both just fine. Those eyes were amazing, and melted my heart right there. Here was my daughter. I helped push the incubator box back to our room, never taking my eyes from hers.

We got back to our room and they did countless checks, leaving once for a minute to get stuff. I took that first moment to welcome Aria into the world. Aria was not happy about the checks, so I put my arm next to her while they were doing the check and would look in her eye and tell her everything was OK. I told the nurses we wanted the eye gel and vitamin K shot delayed until Lisa nursed her, as being a c-section birth, Aria would need all the help she could get in establishing a good latch. Lisa made it back to the room before the checks were done, and they put Aria skin-to-skin so she could nurse. The nurses left to finish the checks later, and Aria latched on right away. I've never seen a more proud mom.

Lisa: My memories of the operation and recovery room come in jumbled flashes. Flash: Adam above me, rubbing my face and hair. Flash: Aria crying, and me needing desperately to touch her, to smell her. Flash: me being back in my room. As soon as they put Aria on my chest and she began to nurse, the drug-induced fogginess disappeared. It was magic, that moment. I couldn't get enough of my daughter: her eyes, her cheeks, her tiny body, her perfectly formed fingers and toes.

The c-section was a more traumatic birth experience for me than I had anticipated, but breastfeeding my daughter has been the healing balm. It motivated me to focus on a mostly drug-free recovery (Ibuprofen only), and has helped me cast away the disappointment of not giving Aria the birth I felt she deserved. In the days immediately following Aria's birth, she sailed easily through the routine hospital checks as if she'd been a natural birth all along. She continued nursing like a pro, I was proud of that.


The most important thing I've learned from this experience is that the lessons and techniques we learned in the Bradley classes are applicable to any birth experience, natural or medically assisted. Adam and I both relied heavily on the information we learned in class, and took the time to ask questions and discuss our options...even in the height of the most intense moments. We worked as a team to support each other, and to choose the path of least medical intervention. For that, we are both very proud and grateful, and can't wait to grow together as a family!!