Saturday, October 4, 2008

A Healthy Baby Isn’t All That Matters

A Healthy Baby Isn't All That Matters
By Christy Fiscer
Midwifery Today Issue 87

There are so many details of my cesarean that I have either left unwritten, or have written in fragments in various locations. A reply back to an online thread regarding the "safety" of a cesarean; or to a mom who is being told that her baby will be too big and she needs to have her baby surgically removed.

But you see, my story doesn't just end when we brought our son home from the hospital on Palm Sunday in 2004. My journey began when I found out I was pregnant in 2003, and it continues every day. Some days I wish it would all just be over with. Be done with the deeply seeded emotional pain, be done with the physical pain of ongoing adhesions and endometriosis from my cesarean - even 4 years later. The ongoing torture of the emotional pain could have been avoided, I suppose. However, in 2005 I made the decision to take the red pill. And for those of you who paid attention during the movie The Matrix, you'll get my analogy here. The red pill enables us to see truths that we otherwise would have never believed. The red pill takes us out of the "habit" beliefs - simply believing what we are told or what we were raised to believe. On the other hand, the blue pill enables us to live in the "ignorance is bliss" state. Never digging deeper, simply being happy with the things we believe and never questioning the origin or the author. So, in 2005 I made the choice to swallow the red pill. The reality that had been mine in childbirth, was shattered as I learned more. And as I gained more knowledge, my guilt and anger grew over what I had done to my son; and also pain for the vast number of women who do the same to their children unknowingly.

Just before my son turned one, I found the ICAN support list. To this day I don't remember exactly how I found it, but I did. I was still of the mindset and belief that some babies simply grow too big for mom to deliver safely, inductions are perfectly acceptable, and epidurals should be used by every woman. I joined the support list, totally oblivious to what I was walking into. Women who were totally angry over their cesareans, marriages compromised due to lack of support or differences in birth beliefs between a woman and her spouse. Women having their babies at home, after having undergone a cesarean with a prior pregnancy. Basically, a group of crazy women. Or so I thought at the time. I defiantly challenged their arguments that claimed it was intervention, not size, that caused my very difficult first birth and recovery. The harder I fought it, the more information and resources they flung my way. After a few days of this, I sent out a post calling them all crazy, and then unsubscribed. Six little words posted by a woman who is known for pulling out a wet fish when needed, haunted me and really made me think. "Damn. She took the blue pill." The nerve! Crazy, fanatic, rude women! Who were they to tell me that my cesarean was unnecessary and avoidable? But it planted a seed…

I began to research all of the things that they had challenged me with. Little by little, that seed began to sprout. Three months later I returned to the list, apologized for calling them all crazy , and asked for help.

So why am I telling you about ICAN and my beginnings with it if I am not writing this about my VBAC? Well, because without ICAN I would have continued to believe that my babies were just too big for my body. I would have continued to believe that there is nothing wrong with cesareans. The day that I re-subscribed to the ICAN list, is the day that I chose the red pill. I no longer wanted to live in ignorance, because after all…ignorance is what led to my son spending 9 days in the NICU.

Ironically, it was my son's 2nd birthday that hit me the hardest. On his 1st birthday, I was still learning, and not quite convinced yet that the cesarean wasn't necessary. But by that 2nd birthday, not only did I know from research that it had been unnecessary, just five months earlier I had pushed out my VBAC baby onto my bed. She was 10.10lbs and posterior. By body had never been broken - I was only told that it was. As I began to really process through this, I realized just how alone and misunderstood I was outside of the ICAN list.

"He's healthy now, that's all that matters."

From my friends, my mom, and even my husband. No one knew how damaging those words were, even though they were not meant to harm. I didn't understand. How is him being relatively healthy now, negate all of the harm that was done to him in his first seconds, minutes, hours, and days of his life? When a woman is trying to heal from a rape trauma, do people essentially tell her to get over it…at least she's safe now? But people are almost offended when the two are compared. Cesareans take place every single day and are accepted - even CHOSEN. So then, would it be different if many women didn't mind their rape experience? What would happen as a society if we as women told rape survivors, that their experience was acceptable, because women are raped all the time? How damaging and belittling would this be? Cesareans are major abdominal surgeries. And so many women are lied to, coerced, and convinced to have one. Many occur because of a cascade of intervention during labor that never belonged there to begin with. As a society, we have strayed so far from what birth is - a normal, physiological process. We've turned it into an ugly, scary, medical procedure. No wonder so many women are scared of it. All they hear is horror stories. You have to dig for the beautiful and unhindered birth stories that ARE out there. They are just not as common as the "You'll be begging for the epidural…" stories. I'm afraid that until women take a stand for their babies, that our daughters are going to have to figure this out for themselves.

So, back to my cesarean.

The story is quite simple. I was young, I had delivered a larger-than-average baby vaginally 2 ½ years prior. The recovery from that birth was long and hard, and I had always been told that it was because she was 9.1lbs. Not the pitocin, AROM, stadol, or the forced pushing that ended up in a large episiotomy and vacuum extraction. I was terrified of another birth and recovery like this. I met with a new OB late in pregnancy, because my former OB refused to induce me even though my son was showing to be over 8 ½ lbs already, and I did NOT want to go through the hell that I went through with my first. Yes, I warned you…I was completely ignorant. This new OB agreed with me about size, and went on to tell my husband and I stories of large babies and shoulder dystocia, nerve damage, and broken collar bones. He said our best plan of action was a cesarean, and soon, since my son was only putting on weight at this point. We agreed, even though my husband and I both discussed later how we had a slight uneasy feeling about all of this, but shrugged it off as uneasiness over the unknown. The very next morning I went in for an ultrasound and NST. During the NST it was discovered that I was contracting quite regularly. Upon a vaginal exam, I was told that I was 4cm dilated, and would be having the cesarean that afternoon, instead of the next morning. I was nervous, but the thought of finally meeting my son was what I kept focusing on.

A lab technician came in and drew several viles of blood. Then a nurse came in to start my IV, administer Terbutaline to stop my contractions, and to insert a catheter. My mind was in a whirl as I was being prepped for surgery, and trying to get a hold of my husband to get back to the hospital. He had dropped me off, thinking that I was just going in for routine pre-surgery stuff. He arrived, as did my grandmother in law and my mom. My husband was told that he could not go into the OR with me, until my spinal block was in place, and they were ready for the surgery. I was terrified, and I had to leave the one person that I trusted most in this world, behind. The one thing I asked before walking in was that they cover the instruments. I didn't want to see what they were going to use on my body. They found this a bit strange, as they said that they have never had a patient request this before. Surely I couldn't have been the only one afraid of being cut open, could I?

The nurse walked me into the OR. I remember how cold it was. It was like walking into a sterile vortex. Bright lights, blue paper sheets everywhere, trays, oxygen devices, and nurses in full face masks and scrubs. It was surreal. I sat down on the operating table, trying to brace for the spinal. I was absolutely terrified beyond my wits that the spinal would not work, and I would feel them cutting into my body. I began to cry as the anesthesiologist prepped my back for the insertion of the catheter, and a nurse stood in front of me in efforts to console me. She made eye contact and told me that everything would be okay. I just cried. I don't remember a whole lot of the tiny details from here. I remember seeing my husband's face come into view above me when he entered the room, and felt him touch my hand. I remember my Obstetrician "joking" about how we'd better get the show on the road if he was going to make it to his office in time for furniture to be delivered that evening. I remember slowly falling asleep from the drug cocktail that was placed in my IV, and desperately trying to stay awake. Then, it hit me. The smell of my flesh burning as my OB cauterized at each step. I tried hard to tell myself that it was the oxygen mask on my face. I was smelling the oxygen. I am only smelling the oxygen.

My OB announced that the baby would be here in just a few moments, and that I would feel lots of pressure as the nurses pushed on my fundus to get baby out. I said that it felt like she was sitting on my chest, and they joked and said she was. I heard a suctioning sound as they announced that his head was out. I felt the tugging sensation release when his full body was pulled from mine. I waited to hear him cry. Waiting, waiting…and nothing. I kept asking what was going on, and received no answers. I turned to the side to see people in blue working vigorously on him. I was falling asleep. Then, I finally heard him cry, and let go a little bit. They bundled him up, and put him to my face to kiss quickly, and while he was in front of me, he once again stopped breathing. I have pictures of us in this moment, and he was so very grey. As soon as I had kissed his cheek, they pulled him from me, placing him into an Isolette and whisking him off to the NICU. I fell asleep as I was being sewn back up, and wheeled to recovery.

Then, a moment in time that I will never forget. The neonatologist visited my husband and myself in the recovery room, and stated that my son had experienced two seizures. They needed to find out why. I was asked to sign a consent form for a spinal tap. You're probably thinking that it's unforgettable because I learned that he had experienced two seizures, right? Well, it's unforgettable because I remember thinking that it was no big deal. I was so drugged up, so out of it, that it never even occurred to me to feel worry about my son. To even ask if he was okay. I signed the consent form, and fell back asleep. Later on that afternoon, as I was moved to my post partum room, I remember asking about him and not understanding that he needed to stay in the NICU. I was on the phone telling a friend that he had arrived, and then told her that he was in the NICU being checked out and would be in my room with me later that day. No one told me otherwise. No one told me much of anything, come to think of it. I continued falling asleep off and on throughout the day, sometimes even while my poor husband was mid-sentence. It wasn't until he went home that night and I sobered up a bit, that I asked about my son. They said he was having some breathing difficulties and that I could see him in the morning. I was again confused, but again didn't worry much because no one was seeming to make a big deal out of it. I requested a pump to help my milk come in, so that I would be ready the next day. I pumped every 3 hours that night.

The next morning my husband arrived, and I had already had my catheter removed and had the nurses help me up to the bathroom. We prepared to go to the NICU to see our son…for the first time since the surgery. No one did or could have prepared me for what I was going to walk in on. I was under the impression that he had mild breathing issues, and just needed observation. What I walked into was a mother's worst fears. He was in his own little room, because he needed around the clock observation. When I entered the room, I couldn't believe what I saw. He was in an open isolette, sedated, horribly swollen, and hooked to many lines and machines. He wasn't moving. I began to cry as over and over in my head I kept repeating "This isn't my son. This can't be my son, they've made a mistake. This isn't my son." This fragile and broken baby couldn't possibly be the one who was too big and healthy for me to deliver vaginally. He was swollen…he didn't look like me or my husband! That couldn't possibly be our son. I could not hold him, so I touched him and cried quietly. I stayed for a while until I couldn't stand anymore. My belly was hurting, as was my back and the rest of my body. As my husband and I went back to my room alone, I just cried. He remained strong and just held me and told me that everything would be okay. I wasn't so sure. After all, they had told me that my son would be big and healthy.

One of the hardest parts of the hospital stay was being the only mom on the floor who was without their baby in their room. I listened as babies cried in the next room, and then were promptly consoled by their mother's touch. By nursing at the breast. By their mother's soothing voice. My baby was in another place. He was in darkness induced by drugs. He was listening to the sound of the machine's beeping, and by the sound of the nurse writing notes in his chart. My arms felt so empty, and I felt so helpless.

Two days after he was delivered, as my husband and I prepared to see him again, we were stopped by a NICU nurse. She explained that they were intubating Noah, and to please wait in the family waiting room for the neonatologist. I was confused, worried, frantic, and crushed. He had been doing just fine on the CPAP. I was so afraid that he wasn't going to make it. The neonatologist came in after 15 minutes or so of agony, and explained that Noah had taken a turn that morning, and the CPAP was no longer as efficient as it needed to be. We asked questions, mainly why was this happening. He was the biggest baby in the NICU, by far, and was full term. He explained that this is a common side effect of babies delivered by cesarean. Why hadn't our Obstetrician told us this while he was telling us all of the myriad risks of delivering a large baby vaginally? Why hadn't we been told? He couldn't answer those questions for us. We were allowed to go in and see our son a while later, and all I could do was cry. I couldn't even talk to him, because it made things worse for me. I just stood and stared as I held his tiny little limp hand. There was no reaction, no ability to grasp my finger. Emptiness.

The very next day, we had been told that they took the intubation tubing out overnight. The neonatologist said that he had never heard an intubated newborn scream so loudly, and that Noah had tried pulling at it. They sedated him once again and pulled the tubes out. He was now on a nasal cannula. I still was not allowed to hold him, and it was killing my heart because I was scheduled to be discharged that afternoon. I had continued to pump around the clock to leave colostrums for them to administer through his g-tube. It was heartbreaking having to leave him there under the care of strangers, and head home with empty arms. Beginning at four days post surgery, I was driving myself back and forth to the hospital to visit Noah. Finally, on day four I was allowed to hold him for the very first time. I remember the gut wrenching feeling of placing him back in the isolette because my guts and back were hurting from the surgery. I had waited so long to hold him in my arms, and I then failed to be able to do it for long. I was told that the next day his g-tube would be removed if all was well, and he could begin feeding by mouth. I left explicit instructions for them not to feed him by bottle, that I would be there to breastfeed him. Thankfully, they respected my wishes, and I was able to breastfeed him for his first feeding. The poor baby was choked by my rush of breastmilk, as my milk had already come in. It was awkward to try and breastfeed when my belly was so tender, and he had tubes everywhere. I returned 3 times a day to feed him. I would often call the NICU in the middle of the night during pumping, just to see how he was doing.

It was finally on day 9, Palm Sunday, that we were able to take our son home. During his NICU stay, they had not figured out what had caused his seizures. They did a CT Scan, an ultrasound of his brain, X-rays, blood tests, the spinal tap, and an EEG. They found nothing abnormal. Once he was through with his round of antibiotics and did well on room air, he was cleared to come home. I was nervous, excited, anxious, and scared all at the same time. I had never cared for a sick newborn before. Yes, he was fine when we took him home…but I had images flashing in my mind of the baby that I walked in on the day after the surgery. These images still haunt me.

I know that I will carry guilt with me for the rest of my life. I have taken responsibility for my role in his delivery and his NICU stay, even though it was all done out of ignorance. I firmly believe if my son had been perfectly healthy after the cesarean, that I never would have learned my lesson. Sometimes we have to learn things the hard way, and sometimes God has a reason and a purpose for what He allows us to endure. Had I not found the ICAN support list, I'm sure I wouldn't be who I am today, and be so passionate about birth today.

So you see, a healthy baby is not all that matters. A healthy mom matters too. A healthy birth matters. Just because a baby is healthy after a delivery, does not make everything that happened during the delivery any better or safer or healthier. And this doesn't just apply to cesareans.

Oh…for those of you who are wondering…my son only weighed 8.8lbs.

This is my story. My journey. Today is the 4th anniversary of when I was told that my body was incapable of safely delivering my son. And tomorrow is the 4th anniversary of my c-section. Happy Birthday precious Noah. Even though this was written with tears, in a whole host of bittersweet emotions.

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