I've been waiting for the right time to share my second birth story. My baby is 8 months old and I've been turning it around in my head for months, considering what angle to take with the story, how to approach it, how much of my first birth story to include. April is International Cesarean Awareness Month, so now seems like as good a time as any to share some of the glorious details.
High Cesarean Birth Rate
It feels hard to talk about birth, about cesarean birth, without talking about birth culture. Without going into the too-high c-section rate. Without trying to prove the necessity of your cesarean or lamenting that it was unnecessary or that you were pressured into it.
The c-section rate in most North American hospitals hovers around 30%. According to the World Health Organization (WHO): "Since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10-15%." Part of the problem with getting the c-section rate down has been that even among care providers, not everyone is in agreement over which cesareans are medically necessary and which ones are medically uncalled for.
Should the cesarean rate in North America be lower? Absolutely. It’s around twice as high as it needs to be. But here's the thing:
It is not our individual responsibility as birthing women to lower the cesarean rate by delivering our babies vaginally.
It is a public health issue and something that can only be remedied systematically, by doctors, policy makers and the birth community at large.
The personal is political, but it’s far more productive to focus on keeping your birth healthy, positive and in line with your own individual needs than to use your own birth as a political platform.
Believe me, I know.
A Tale of Two Births
My first birth was going to be a blissed out, low intervention homebirth and I was going to share about it widely. I planned to use this idealized experience that I was going to have to promote the idea that birth can be safe, beautiful, fearless and low intervention, if only you try hard and believe in yourself.
Instead I ended up with a postdates induction.
My first pregnancy lasted 42.2 weeks and ended in a hospital, with pitocin and an epidural. It was difficult, it was terrifying, it was the biggest shock of my life. It left me feeling traumatized and broken for months after.
My second birth was even more medically complicated.
The discovered low (almost no) fluid a "routine" 42 week scan and we decided to induce then and there, instead of waiting a few more days as planned. We started with cervical ripening, but had to stop, because it stressed baby out. We moved onto pitocin, which also stressed baby out. We stopped, I got an epidural, baby's heart rate stabilized, we went back to pitocin, baby still didn't love it. They had me try pushing at 5 cm in a last ditch effort to avoid surgery. It didn't work and I ended up with an unplanned, wholly unexpected and yet powerful, peaceful cesarean birth that brought me my gorgeous baby girl at 5:18am. I birthed her as the sun rose, just like my first. Because a cesarean may be major abdominal surgery, but it is unequivocally birth.
I left that experience feeling empowered, mighty, ready to take on the world.
Exactly as I’d expected to feel after the home birth that never happened. I’d done the unimaginable, survived an unplanned c-section, my worst fear. And came out feeling at peace, because in preparation for this birth, I’d worked hard to release expectations. My goal was a healthy baby, a physically and emotionally healthy mama and to escape the trauma that had consumed me for months afterward last time.
I'd still handed my midwife a typed list of birth preferences, so we'd be on the same page about what was important to me. Prioritizing a healthy baby doesn’t mean letting go of your own wants and needs. But the second time around, my number one priority became “Get the baby out.” And I did just that.
Lowering the cesarean rate and increasing our satisfaction with our birth experiences doesn’t mean we, as birthing parents, should all commit to low intervention, vaginal births. It doesn’t have to mean fighting to avoid unnecessary intervention.
I believe a good birth starts with choosing a care provider who makes you feel safe, who you trust, who respect your wants, needs and choices.
I used midwives both times, from a clinic with a low cesarean rate. There were many factors that led to my different feelings about my two births, but one was the midwife in attendance.
I never quite clicked with the midwife from my first birth. She was competent and lovely, but I never fully felt like we were on the same page. On some level, I didn’t completely trust her. It wasn’t her fault and it was probably more me than her, but this lack of connection certainly had an impact. I was also terrified to be in the hospital, after all the home birth propaganda I’d devoured through my pregnancy. The whole thing felt scary and unsafe, despite support from a good midwife, an incredible doula and my wonderful husband and mother.
With my second birth, I had a midwife who I really connected with and trusted entirely.
I felt seen by her. Heard. Respected. She was no-nonsense but compassionate and exactly the person I needed to guide me through this process. We were on the same page about avoiding interventions when possible but bringing them in as necessary.
Each step of the way, she explained what needed to happen, and because I trusted her judgement and I was more familiar with the process this time, I was prepared to readily consent and go with the flow.
With my first birth, my midwife (rightly) started suggesting an epidural as the evening wore on, since I was becoming exhausted and losing steam. I pushed it off longer than necessary, because I was unable to even entertain the possibility that sometimes an epidural may be beneficial. Finally consenting to it was one of the things that helped me avoid a cesarean last time.
This time, when my midwife recommended an epidural to help bring up my baby’s low heart rate, I was all for it.
“Yes!" I said between contractions. "Absolutely. Let’s do that!”
My doula laughed. “You know you could have asked for an epidural at any time!” she said.
This gave me a moment to think about whether I wanted an epidural and I turned to her and explained, “You know, if everything was fine, I really wouldn’t be ready to request an epidural. But since it's being medically recommended, I’m all for making this pain go away right now!”
It helped the pain, it helped stabilize my baby's heart rate (at least a bit) but this time it didn't help me avoid a c-section. Baby wasn’t tolerating labor, nothing we were doing was helping sufficiently and we eventually exhausted all our other options. It was time to get my baby out.
Having a care provider who I trusted allowed me to take her recommendations easily, it allowed me to feel safe.
I trusted her to focus on keeping my baby and me healthy, so that I could focus on laboring. I knew things were becoming complicated, but I wasn’t afraid, because I knew she had it under control. I knew things were heading south, but I also saw her going through the process, from lowest appropriate intervention to highest, without skipping ahead or panicking.
She frequently consulted with nurses and OBs throughout my labor, deferring to their judgment when necessary. It was clear that she respected their opinions and they respected hers. They were kind and respectful to me, introducing themselves and speaking quietly every time they entered my room.
By the time the OB called the c-section, it felt both necessary and inevitable. I saw that we’d tried and exhausted every other possibility and that everyone on my team had been working to get me the birth outcome I’d desired.
In the operating room, everyone was friendly and kind. One of the nurses told me that they’d all been rooting for me all night from the nursing station.
Having a good birth, a positive birth experience, isn’t about what interventions you accept or choose. It isn’t about your birth place or even about whether you're attended by an OB or a midwife.
It’s about feeling safe, supported, respected and informed.
It’s about being in control of the things you can control and letting go of the things you can’t and understating the difference between the two. It’s about knowing you did your best to bring your baby into the world, however he or she needs to arrive.
I don’t believe in absolutes, especially when it comes to birth. I don’t there is a single choice that will work for everybody, because every body is so different. No one can define what will make your birth good except for you.