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!!

Advocating Natural Childbirth

The more I learn about unmedicated childbirth, the more of an advocate I’m becoming for it.  Evidently, just calling it “natural childbirth” isn’t enough; too many women call a vaginal birth “natural” even though they’ve been prepped with Cervidil/Cytotec, induced with Pitocin, been given IV narcotics (Nubain) to “take the edge off,” and then are numbed with an opiate-cocaine anesthesia cocktail called a “walking” epidural.  Call me a purist...but that last scenario is probably the LAST thing that I envision when someone says “natural childbirth.”  Even if that woman delivered her child out the birth canal instead of having her baby pulled out via C-section, very little about that scene says “natural” to me.  But then again, everyone’s perspective, focus, and ability to handle pain is a little bit different.  I understand and respect that.

When I say “natural childbirth,” I mean an unmedicated vaginal birth.  That’s my goal for my daughter.  If medically necessary (and sometimes medications ARE warranted for very valid reasons), I will have an intervention...but only at the lowest possible dosage and as a last resort.  And even then, I won’t call my birth experience a “natural birth.”  I’ll call it what it is:  a vaginal birth.

The more I learn, the more amazed I become with the whole process.  It’s a beautiful, MIRACULOUS thing...and there’s so much going on that the medical profession is only just now beginning to scratch the surface of understanding it all.  We’ve come a long way from the “woman’s deliverance from the sin of childbirth” attitude of WWI and WWII.  Practices that doctors considered “safe” at that time have since proven to be detrimental - even deadly - for mother and baby.  With all the knowledge we have now with our past medical procedures/interventions, which modern ones will be proven to be detrimental in the future?  Some of them?  All of them?  It’s an exciting time to be giving birth, that’s for sure.  I truly believe that we’re at the cusp of an age of enlightenment and empowerment.  

Until I know for sure, I don’t want any of it.  No interventions, no augmentations, no drugs.  I’m even leery of “all-natural” options like tinctures, oils, teas, and supplements.  The only ones I truly trust to be completely safe are the tried-and-true:  patience, walking, more patience, baths and showers, rocking, relaxing, exercising, and finally a healthy dose of more patience.  Baby will come when she’s ready, and not a minute before. Yes, it's a personal choice. Yes, I know that every woman's birth experience is different. Yes, I know that unmedicated birth options are not the right choice for everyone. And yes, I know that not everything in birthing goes according to plan.

I only wish that more women were informed about the effects of what these drugs are doing to their babies and their bodies.  If you think that information won’t have any effect on the population of fertile women, I offer the growth of the organic industry as an example:  Organics existed on the fringe of the market until some very clever people in the 1990s thought to encourage pregnant and nursing women to make the switch from conventional to organic “for the health of their babies.”  Just a few years later, the industry was experiencing explosive growth in that sector, with the growth spilling outward into other demographics.  Today, not all women will eat organically during pregnancy and breastfeeding...but most will at least make the effort to buy a few organic items like produce, juice, or milk for their children.  It proves one powerful thing:  women will not change their behavior for their own health, but they will bend over backward for the chance (not even a guarantee!) that their children will be healthier than they are.  This is a powerful motivational tool that should be harnessed for the promotion of natural childbirth practices.

The thing that amazes me most about natural childbirth is its absolute perfection.  The design is flawless.  Baby (being head-down and hopefully in the Occiput Anterior position with her nose toward Mom’s tailbone) gets a signal that it’s time to be born, and the uterine muscles begin contracting.  Prior to the birth day, hormones in the cervix soften/ripen it to relax it from its normal closed state to one that can be stretched open.  Without the hormone Prostaglandin softening the cervix, birth cannot happen.  Uterine contractions can roll over each other all day, but if the cervix isn’t ripe, they’re not going to open it...come hell or high water.  

During the first stage of labor, this large and powerful muscle group of uterine muscle begins pulling the cervix wider and farther back (called Dilation and Effacement), allowing Baby’s head to fall through.  As the baby’s head sinks lower into the pelvis, called “Stationing,” the head will eventually hit a point to trigger the pushing reflex.  Once the uterine muscles have finished contracting as far as they can, making the cervical opening 10 cm in diameter (~4 in), they Transition into a new role:  expulsion.  After the Transition stage, the uterine muscles still contract, but their force is concentrated at the top of the uterus and the force is directed downward toward Mom’s pelvis.  Mom then works with the contractions and the pushing reflex to move Baby past the pelvic bones and out through the vaginal opening.

The interesting thing in all of this is that BABY is the navigator during birth, NOT Mom.  The reflexes that all babies are born with are there to help them survive birth and the first few months in their new environment:

• Babinski & Step:  when the baby’s foot is touched, the foot will pigeon-toe and flex to become flat.  The baby will then kick back at whatever is pushing against its foot as if “walking.”  In the case of contractions, Baby will actually kick against the contracting uterine muscles to help push herself down the birth canal.
• Moro/Startle:  when a loud sound or large change in the environment causes baby to throw back her head, cry out, and quickly extend her arms/feet.  In birth, this reflex allows Baby to lift her chin up and over Mom’s perineum (preventing severe tearing) and acts as a bellows to inflate the lungs for her first breath.
• Rooting, Sucking, and Grasping:  these reflexes aid in establishing feeding habits immediately after birth.  It’s hard work being born, and everybody deserves a snack!

Mom can assist Baby during birth by changing positions and using gravity to help the contractions be more efficient, but in the end...Baby has to find her own way out.  This is a complicated thing; it involves using the tailbone as a slide, turning this way and that to fit through the pelvic bones and pelvic opening, and finally lifting her chin up and over the perineum after crowning.

These reflexes are awesome.  Who knew that Baby could do all that without being taught?!?  But the problem with medicated childbirth is that drugs used during delivery prevent those reflexes from working.  When Mom is numb, fuzzy-feeling, or can’t communicate with her body...Baby has the same problem.  More so, even, because Baby doesn’t have a blood-brain barrier yet, doesn’t have a liver developed enough to detoxify foreign substances, and has a much smaller mass than Mom.  So basically, when drugged Mom is trying to birth Baby, she’s doing all the work to power the ship without having an engine to propel it forward and no captain at the helm.  

And in the case of Pitocin being a synthetic hormone, Mom’s innate hormonal system is completely thrown off when it’s administered into the bloodstream.  Pitocin is a synthetic form of Oxytocin, the love-hormone and trigger for uterine contractions.  This hormone is the one responsible for causing a flurry of Braxton-Hicks contractions after orgasm, as well as for causing bonding between Mom and Baby after birth.  It’s also pretty handy for causing the uterus to shrink to half-size after birth and thus sloughing off the placenta in preparation for its own delivery.  In the case of any artificial hormone, once the synthetic is released into your bloodstream, your body stops producing the natural equivalent on its own.  And why should it?  The concentration of that hormone is already detected in the bloodstream; too much hormone is just as detrimental as not having enough.  So your body uses the synthetic hormone as a proxy for its own stores.  This very principle is how the Rhogam shot is protecting me from developing antibodies that fight Aria’s d-protein if she’s rH-positive while I’m rH-negative.  

Our bodies don’t do steady, continual release of hormones.  It’s more like a timed release system on a dam; hormone is released when it’s needed, and the concentration is backed off when it’s not.  Then, when the concentration of whichever hormone is needed gets too low, more hormone gets released.  It’s a wave...which is good during labor, because it means that you ALWAYS get a break between contractions.  It might not be much of one (as is the case in Transition), but there is always enough of a break in the hormone flood enough to catch your breath and get those uterine muscles to rest.  Pitocin doesn’t allow for that; it’s a continual release at a constant concentration...resulting in longer contractions and no breaks between them.  This of course, leads to fatigue, and doctors then need to administer an epidural or IV narcotic to slow down the contractions and counteract Pitocin’s effects on the body.  It also creates an increased perception of pain because of the duration and lack of break between contractions.  

Notice I said PERCEPTION of pain and not actual pain level.  Some people erroneously believe that Pitocin causes longer, stronger, more painful contractions.  This is not true; the drug cannot physically force a contraction stronger than any your body already produces on its own.  The drug is a trigger for movement, not the movement itself.  The difference is the duration of the trigger and lack of rest between releases.  Think about it this way:  running a mile all at once sounds a whole lot more exhausting and painful than “I’m running to that light pole, then walking for a minute, then running to the next pole down the street.”

Epidurals, of course, are specialized cocktails of opiates and cocaines (a central nervous system stimulant).  The exact concentration and mix of drugs is variable upon the hospital, level of anesthesia desired, and the anesthesiologist...so the epidural you get at Ball Memorial is different than one that you would get at Anderson Community or St. Vincent’s Anderson.  Of course, there’s always risk involved with epidurals:  allergic reactions, side effects like itching or severe headache, nerve damage, infection, and then the flat-out chance that it doesn’t take.  Worse, the epidural placement and pain relief does take...but only in certain places.  This is called a “hot spot.”  Not pleasant.

In the end, you’ve got a baby whose survival reflexes are impaired, a mother who physically cannot communicate with her body, a hormonal system that isn’t functioning properly, and for what?  A few hours’ worth of something akin to comfort, but isn’t really because you can still feel that something big is going on down there, and you can’t move around to go to the bathroom or get more comfortable?  The effects of epidurals and Pitocin and IV narcotics last for hours in Mom’s system; for days in the baby.  Is a few hours’ discomfort REALLY worth impairing Baby’s function for the first few days of her life?

Most interventions at birth (vacuum delivery, sucking mucus out of the nose & mouth, correcting respiratory distress and poor circulation issues) exist because Baby is drugged.  She doesn’t have the coordination or strength to do it on her own.  In addition to being tired, she can’t feel her body enough to even clear her own lungs.  

I can’t do that to Aria.  I just can’t.  Maybe if I were completely ignorant about the effects that drugs have on her system, I could.  But I’m not ignorant anymore.  I can’t knowingly subject her to the effects of narcotics, stimulants, opiates, steroids, and synthetic hormones.  Not when I’ve worked so hard to keep synthetics out of my system and fueled my body with organic food for so long; it would be hypocritical of me.  I haven’t even hit Aria’s system with overdoses of caffeine, sugar, or heavy metals during my pregnancy or in the many months (and years) before.  I feel bad enough about having taken hydrocortisone cream for a short time on my skin.  So why would all that change now, when I’m so close to the end?  I can’t just toss all my beliefs and past practices aside because “this is the way we do it here,” or “everyone does it this way, so you will too.”

The sad thing is that there are so few out there like me; that I’m the exception rather than the rule.  I don’t blame the nurses, the doctors, the insurance companies, the pharmaceutical representatives, the drug manufacturers, or the hospitals for making drugs and interventions so easily accessible.  I don’t blame the media for showing (and therefore promoting) intervention-heavy labor and delivery plot lines.  In all cases, they’re just doing what consumers expect and request.  Interventions sell movies, insurance policies, and erode women's self-confidence.  What needs to change is consumer attitudes toward pregnancy, birth, and delivery.  

Childbirth is not an illness from which we women must be “delivered.”  This is not a coercive guilt tactic we should lord over the male sex to incite their pity or bolster our superiority.  We are stronger and smarter than we think, and need to be encouraged to take advantage of that.  The more we demand natural childbirth practices and birth education, the more widespread they will become.  And the more we advocate for our own rights and desires in the nation’s birthing rooms, the more positive our attitudes toward our birth experiences will become.  Women with positive birth experiences must become louder voices than those women with “horror stories” spreading their fear and distaste for the experience with everyone they meet.  I have faith that we can do this.  Truly.  We shouldn’t be made to feel ashamed for our birth choices, unmedicated or otherwise.  But we should share the positive aspects of them with others.  Knowledge is power, and power is utilized best when it’s shared with others.